Assessment of predictive value of pre- and postoperative urethral pressure profiles for long-term continence in female dogs with ectopic ureters: a preliminary study

To compare the urodynamic and hemodynamic effects of different dosages of phenylpropanolamine and ephedrine and determine effective dosages in increasing urethral resistance in female dogs. 20 sexually intact female Beagles. Dogs were allocated into 4 groups and received phenylpropanolamine once, twice, or 3 times daily, or ephedrine twice daily, for 14 days. On days 0, 7, and 14, urethral pressure profiles were performed while dogs were anesthetized with propofol. Variables recorded included maximum urethral pressure, maximum urethral closure pressure, integrated pressure, functional profile length, anatomic profile length, plateau distance, distance before maximum urethral pressure, and maximum meatus pressure. Arterial and central venous pressures were measured before anesthetic induction and 10 and 35 minutes after induction. Administration of phenylpropanolamine once daily or ephedrine twice daily significantly increased maximum urethral pressure and maximum urethral closure pressure. Values for integrated pressure were significantly increased after 14 days of once-daily administration of phenylpropanolamine. Variables did not change significantly from day 7 to day 14. Diastolic and mean arterial blood pressures increased significantly during the treatment periods, and arterial pressure decreased during propofol infusion. Oral administration of phenylpropanolamine once daily or ephedrine twice daily increased urethral resistance in clinically normal dogs and may be recommended for management of urethral sphincter mechanism incompetence. Treatment efficacy may be assessed after 1 week. Dogs with concurrent cardiovascular disease should be monitored for blood pressure while receiving alpha-adrenergic agents because of the effects on diastolic and mean arterial pressure.

Measurement of Urethral Closure Function in Women With Stress Urinary Incontinence

Summary Urethral pressures profiles (upp) obtained by use of microtransducer catheters were determined in 8 anestrous sexually intact female Beagles during general anesthesia. A upp study consisted of 3 consecutive recordings, and 4 upp studies were repeated at an interval of 5 days in each dog. Maximal urethral pressure (cm of H2O), bladder pressure (cm of H2O), and anatomic urethral length (cm) were recorded. Maximal urethral closure pressure (cm of H2O) was calculated. Mean ± sd (for all measurements) maximal urethral closure pressure was 12.8 ± 5.6 cm of H2O (range, 2.4 to 25.2 cm of H2O). Maximal urethral closure pressure was significantly (P < 0.05) decreased during the first recording period (11.4 ± 5.8 cm of H2O), compared with the second (13.0 ± 5.2 cm of H2O) or third (14.1 ± 5.7 cm of H2O) recording periods within a upp study (3 consecutive recordings). Mean maximal difference in urethral closure pressure during a single upp study was 4.8 ± 2.4 cm of H2O. Significant difference in maximal urethral closure pressure was not observed between studies. Mean (for all measurements) anatomic urethral length was 6.2 ± 0.9 cm (4.1 to 7.8 cm). Anatomic urethral length was significantly (P < 0.05) less during the first recording period (6.1 ± 0.9 cm), compared with values for the second and third periods (6.3 ± 0.9cm, 6.4 ± 0.9 cm respectively). Anatomic urethral length for time 3 was significantly (P < 0.05) less than the value for time 1 (5.8 ± 0.7 cm vs 6.6 ± 0.8 cm). We conclude that the microtransducer catheter technique for measurement of upp was reproducible during a single study and between successive studies. This method is useful in documenting maximal urethral pressure, maximal urethral closure pressure, and anatomic urethral length in clinically normal sexually intact female dogs.

Urodynamic Evaluation of Changes in Urinary Control After Radical Retropubic Prostatectomy

To compare values of urodynamic measurements of cats with idiopathic cystitis (IC) with previously published data for healthy female cats. 11 female cats with IC. 2 sequential cystometrograms and 2 urethral pressure profiles were obtained for each cat. All tracings were evaluated for evidence of overactive urinary bladder (OAB). Maximum urethral pressure (MUP), maximum urethral closure pressure (MUCP), and functional profile length were recorded. Only 3 cats had obvious micturition events. None of the 11 cats had evidence of OAB. Although not significant, threshold pressure was lower in cats with IC than in healthy cats (mean ± SD, 89.0 ± 12.0 cm H(2)O vs 75.7 ± 16.3 cm H(2)O, respectively); however, the total volume infused was significantly lower in cats with IC (4.8 ± 2.1 mL/kg vs 8.3 ± 3.2 mL/kg). The MUCP was significantly higher in cats with IC than in healthy cats (158.0 ± 47.7 cm H(2)O vs 88.9 ± 23.9 cm H(2)O, respectively). The MUP was also significantly higher in all portions of the urethra in cats with IC. No evidence of OAB was identified in any cat evaluated; therefore, medications used to target this abnormality did not appear justified. The high MUCP in cats with IC suggested that α(1)-adrenoceptor antagonists or skeletal muscle relaxants may be useful in this disease, and if these data were applicable to male cats, then α(1)-adrenoceptor antagonism may help prevent recurrent obstructive IC. Further studies are indicated to determine the effects, if any, these drugs might have in cats with IC.

Objective To explore the clinical and urodynamic features of pelvic organ prolapse (POP) and its relationship with stress urinary incontinence (SUI). Methods From January 2003 to December 2006, 108 cases of perimenopausal and postmenopausal women, hospitalized in the Department of Obstetrics and Gynecology, GongLi Hospital, were admitted with stress urinary incontinence or pelvic organ prolapse surgeries, who had the urodynamic test aimed to evaluate prolapse based on the pelvic organ prolapse quantification (POP-Q) system, including the test of abdominal leak point pressure (ALPP), functional urethral length (FUL), maximal urethral closure pressure (MUCP), and maximal urethral pressure (MUP). Informed consent was obtained from all the participates. Results Among pelvic organ prolapse patients, stress urinary incontinence cases accounted for 68.5% (74/108). In terms of abdominal leak point pressure, the positive rate was 71.4% (70/98) in the pelvic organ prolapse patients who had participated in the urodynamic test. For functional urethral length, maximal urethral pressure, and maximal urethral closure pressure, significant decrease was identified in patients with pelvic organ prolapse. As to the abdominal leak point pressure among patients with and without stress urinary incontinence, the positive rates were 87.1% and 32.1%, respectively. In patients with uterine prolapse, the abdominal leak point pressure significantly increased over others. Taken of pressures at the abdominal leak point to evaluate, the incidence of occult stress urinary incontinence in pelvic organ prolapse patients would be 9.2% (9/98). There was no statistical difference in functional urethral length, maximal urethral pressure, and maximal urethral closure pressure between patients with stress urinary incontinence or not(P>0.05). Conclusion It is necessary to carry out preventive stress urinary incontinence correction operation for pelvic organ prolapse patients without clinical symptoms of stress urinary incontinence, in the condition of shorter functional urethral length, low maximal urethral closure pressure, and maximal urethral pressure value. Key words: pelvic organ prolapse (POP); stress urinary incontinence(SUI); abdominal leak point pressure(ALPP); functional urethral length (FUL); maximal urethral pressure(MUP); maximal urethral closure pressure(MUCP)

To compare effects of isoflurane and propofol on the cystometrogram and urethral pressure profile (UPP) in healthy female cats. 6 healthy female cats. Cats were anesthetized, and a consistent plane of anesthesia was maintained with low and high doses of isoflurane and propofol. A 6-F double-lumen urinary catheter was placed aseptically in the urethra for cystometrogram and UPP measurements. Threshold pressure and volume were recorded for cystometrograms. Maximum urethral pressure for smooth and skeletal muscle portions of the urethra, maximum urethral closure pressure, and functional profile length were measured during each UPP measurement. Heart rate and respiratory rate were recorded. Cats anesthetized with the low dose of propofol had consistent detrusor reflexes, compared with results for the other anesthetics. Mean +/- SD threshold pressure, volume per unit of body weight, and compliance were 75.7 +/- 16.3 cm H2O, 8.3 +/- 3.2 mL/kg, and 0.5 +/- 0.4 mL/cm H2O, respectively, for low-dose propofol. Anesthesia with either dose of propofol caused a significantly higher percentage change in heart rate during the cystometrogram, compared with results for anesthesia with isoflurane. Maximal urethral pressure in the area corresponding to skeletal muscle and the maximum urethral closure pressure were significantly higher for the low dose of propofol, compared with results for the high dose of propofol. The low-dose propofol regimen was the easiest to titrate and maintain and yielded diagnostic-quality detrusor reflexes in all 6 cats. Anesthetic depth should be titrated appropriately when performing urodynamic procedures.

Radical cystectomy is the method of choice in management of muscle invasive, organ-confined tumors of the bladder (T2-T4, N0-Nx). The most frequent continent orthotopic urinary diversion after radical cystectomy is the ileal neobladder. A modified technique consists of using a shorter segment of the terminal ileum than the standard technique, around 30 cm. The aim of this study was to determine the urodynamic characteristics of the orthotopic ileal neobladder created by a modified technique. In this prospective clinical study we analyzed the urodynamic parameters of 24 patients who had underwent radical cystectomy with orthotopic urinary diversion by ileal neobladder created using a modified technique. In all the patients we performed invasive and noninvasive urodynamic investigations 12 months after the operation. The urethral pressure profile parameters analyzed were maximal urethral pressure, maximal urethral closure pressure and the functional urethral profile length. The average age of the patients was 63 (49-73) years, 90% were males and 10% were females. The median length of the shorter segment of the terminal ileum was 28 (range 22-35) cm. Prior to enterocystometry and uroflowmetry postvoid residual (PVR) urine was measured by a urethral catheter. The median PVR was 16.7 (0-140) mL. The median enterocystometric capacity was 396 (range 372-532) mL. The median end filling pouch pressure was 27.6 (range 20-70) cmH2O. The median maximal flow of urine was 22.1 (range 9.7-39.5) mL/s and the average flow of urine was 9.61 (range 3.6-17.6) mL/s. Flow time in the analyzed group was 47.5 (range 22-119) s. The median maximal urethral pressure was 54 (range 12-101) cmH2O, maximal urethral closure pressure 36.6 (range 6-91) cmH2O. Functional urethral profile length was 14.9 (range 4-37) mm. An ileal orthotopic pouch created by a modified technique using a shorter segment of the terminal ileum after 12 months presents with urodynamic characteristics similar to the native bladder.

To compare the effects of propofol and sevoflurane on the urethral pressure profile in female dogs. 10 healthy female dogs. Urethral pressure profilometry was performed in awake dogs, during anesthesia with sevoflurane at 1.5, 2.0, and 3.0% end-tidal concentration, and during infusion of propofol at rates of 0.4, 0.8, and 1.2 mg/kg/min. A consistent plane of anesthesia was maintained for each anesthetic protocol. Maximum urethral pressure, maximum urethral closure pressure, functional profile length, and functional area were measured. Mean maximum urethral closure pressure of awake dogs was not significantly different than that of dogs anesthetized with propofol at all infusion rates or with sevoflurane at 1.5 and 2.0% end-tidal concentration. Functional area in awake dogs was significantly higher than in anesthetized dogs. Functional area of dogs during anesthesia with sevoflurane at 3.0% end-tidal concentration was significantly lower than functional area for other anesthetic protocols. Individual differences in the magnitude of effects of propofol and sevoflurane on urethral pressures were observed. Sevoflurane is an alternative to propofol for anesthesia in female dogs undergoing urethral pressure profilometry. Use of these anesthetics at appropriate administration rates should reliably distinguish normal from abnormal maximum urethral closure pressures and functional areas. Titration of anesthetic depth is a critical component of urodynamic testing.

Objective: To investigate the changes of maximum urethral pressure (MUP) and maximum urethral closure pressure (MUCP) after artificial urethral sphincter (AUS) implantation and their prognostic value. Methods: The clinical data of patients who had undergone AUS implantation in multiple medical centers between March and July 2019 were retrospectively analyzed. Data of urethral pressure profilometry, pad usage, related scores and complications related to surgery were collected and compared. The primary endpoint was social continence (defined as 0-1 pad/d) 1 month after activation of the pump. Results: A total of five male patients were included in this study. Two underwent transurethral resection of the prostate for benign prostatic hyperplasia, two underwent radical prostatectomy for prostate cancer, and one underwent urethral reunion, urethral stricture dilatation and cystostomy due to trauma from traffic accident. All patients had different degrees of urinary incontinence. The results of preoperative urethral profilometry test showed that the MUP of five patients were 52, 53, 88, 32, and 66 cmH(2)O(1 cmH(2)O=0.098 kPa), respectively, and the MUCP were 17, 52, 62, 27, and 40 cmH(2)O, respectively. AUS implantation was performed. The intraoperative urethral pressure profilometry showed that the MUP were 53, 113, 50, 77, and 89 cmH(2)O in the inactivated state, and the MUCP were 50, 97, 31, 71, and 51 cmH(2)O, respectively. In the activated state, the MUP were 112, 174, 193, 121, and 120 cmH(2)O, and the MUCP were 109, 160, 175, 114, and 92 cmH(2)O, respectively. All patients met the social continence (0-1 pad/d) criterion. No complications were reported during the follow-up. Conclusions: The relationship between the range of intraoperative urethral pressure and the effect of urinary control can be gained by measuring the specific values of MUP and MUCP during AUS implantation and the post-operative effects, which provides as a data basis for standardizing AUS implantation.

SUMMARY Urethral pressure profiles were recorded in seven normal female and six normal male dogs. Each dog was immobilized with xylazine, and a catheter (continuously infused with saline solution) was placed into the bladder through the urethra and withdrawn at a fixed rate. Pressure changes were recorded, and the resulting graphs provided values for pressures within the urethra. Nomenclature used to describe the urethral pressure profile was standardized according to the International Continence Society's recommendations. The maximum urethral closure pressures in the female dogs were between 13.0 and 46.0 mm of Hg (mean of 23.9 ± sd 11.8 mm of Hg). There was a significant difference (P < 0.025) in the maximum urethral pressures of nulliparous female dogs less than 2 years of age when compared with those of older female dogs. The maximum urethral closure pressures in the male dogs were between 25.0 and 36.0 mm of Hg (mean of 28.3 ± sd 4.0 mm of Hg).

To evaluate lower urinary tract dysfunction of type 1 familial amyloidotic polyneuropathy (FAP) patients in Kumamoto, Japan. Lower urinary tract symptoms were evaluated in FAP patients. Urodynamic studies were evaluated in FAP patients as compared to those in control subjects. The location and distribution of amyloid deposits were evaluated in the urinary bladder in an autopsy case. In lower urinary symptoms, 86%, 19% and 38% patients showed difficulty in urination, urinary frequency and urinary incontinence. In detrusor function during filling cystometry, 14% patients showed detrusor overactivity. Moreover, 43% patients showed low compliance bladder, 62% and 38% patients showed normal and reduced bladder sensation, respectively. First desire to void (FDV), strong desire to void (SDV) and post-voided residual urine (PVR) were increased in FAP patients as compared to those in control subjects. In the urethral pressure profilometry, 71%, 10% and 19% patients showed incompetent, normal functional and overactive urethral closure mechanism, respectively. Maximum urethral pressure (MUP), maximum urethral closure pressure (MUCP) and functional profile length (FPL) were decreased in FAP patients compared to those in control subjects. Autonomic, somatic nerve systems and bladder detrusor musculature might be impaired in lower urinary tract of type 1 FAP patients in Kumamoto, Japan.

Twenty-five women with stress incontinence of urine were given an alpha-adrenoceptor stimulating agent (norephedrine) and a placebo during respective 14-day periods according to a double-blind cross-over schedule. The results were classified as the patient's own assessment of therapeutic effect and as change in urethral closure pressure profile measured by a microtransducer catheter. Norephedrine had a significant therapeutic effect on the symptom stress incontinence and produced significant increase in maximum urethral pressure and maximum urethral closure pressure in the lithotomy and the erect position. Reduction of incontinence was associated with increase in maximum urethral closure pressure. The sum therapeutic effect was of moderate degree.

BACKGROUNDArtificial urethral sphincter (AUS) implantation is currently the gold standard for treating moderate and severe urinary incontinence. Currently, cuffs are chosen based on the surgeon’s experience, and adjusting cuff tightness is crucial. The T-DOC air-charged catheter has not been proven to be inferior to traditional catheters. We report how intraoperative urethral pressure profilometry is performed using a T-DOC air-charged catheter with ambulatory urodynamic equipment, to guide cuff selection and adjustment.CASE SUMMARYA 67-year-old man presented to our hospital with complete urinary incontinence following transurethral prostatectomy, using five pads/d to maintain local dryness. Preoperatively, the maximum urethral pressure (MUP) and maximum urethral closure pressure (MUCP) were 52 cmH2O and 17 cmH2O, respectively. An AUS was implanted. Intraoperatively, in the inactivated state, the MUP and MUCP were 53 cmH2O and 50 cmH2O, respectively; in the activated state, they were 112 cmH2O and 109 cmH2O, respectively. The pump was activated 6 wk postoperatively. Re-measurement of the urethral pressure on the same day showed that in the inactivated state, MUP and MUCP were 89 cmH2O and 51 cmH2O, respectively, and in the activated state, 120 cmH2O and 92 cmH2O, respectively. One month after device activation, telephonic follow-up revealed that pad use had decreased from five pads/d to one pad/d, which met the standard for social continence (0-1 pad per day). There were no complications.CONCLUSIONThe relationship between intraoperative urethral pressure and urinary continence post-surgery can provide data for standardizing AUS implantation and evaluating efficacy.

Rationale:Stress urinary incontinence (SUI) refers to the involuntary leakage of urine when abdominal pressure increases. Midurethral slings (MUS) have become the main surgical method for treating SUI, but no quantitative standard for the degree of sling tightness during operation exists. We achieved this quantitative measurement using ambulatory urodynamic equipment.Patient concerns:A 49-year-old woman presented to our hospital with intermittent urine leakage. Five pads were used daily to keep the vulva dry. The preoperative urethral pressure profilometry (UPP) showed that maximum urethral pressure (MUP) was 54 cmH2O and maximum urethral closure pressure (MUCP) was 53 cmH2O.Diagnosis:According to the medical history and examination findings, the patient was diagnosed as SUI.Interventions:The MUS and UPP were performed.Outcomes:The intraoperative UPP showed that MUP was 29 cmH2O and MUCP was 17 cmH2O. Three months after the operation, the patient was followed up by telephone. The amount of urine pad usage decreased from 5 pads/d to 0 pads/d, reaching the social control standard (0–1 pads/d). The patient's international consultation on incontinence questionnaire short form score decreased from 18 to 5, and their incontinence quality of life score increased from 12.5 to 78.4. The effect of urine control was satisfactory, and no complications occurred.Five months after operation, the patient was reexamined in the outpatient department. The UPP showed that the MUP was 98 cmH2O and the MUCP was 72 cmH2O. The patient still uses 1 pad/day. The international consultation on incontinence questionnaire short form score is 6 and incontinence quality of life score is 79.5. The curative effect is stable.Lessons:MUS has become an effective surgical method for SUI, and the tightness of the sling directly affects the surgical outcome. We have achieved the measurement of urethral pressure during MUS. However, although we found that there is no obvious clinical significance of urethral pressure measurement in MUS operation, future research will benefit from our findings by improving upon our study design to help standardize the clinical diagnosis and treatment of MUS.