Functional Profile Length Research Articles

Simultaneous recording of urethral pressure and cross sectional area profile.

A new technique for simultaneously recording urethral closure pressure and cross sectional area profile is described. The cross sectional area of the urethra could be measured using the field gradient principle. The procedure was performed readily in male patients and the recordings can be graphically presented during measurement. A high degree of reproducibility using this method was obtained. Typical recordings of control subjects was well as patients with pathology were obtained using this technique. The results of this study show that the maximum urethral closure pressure obtained was 60.8 + 3.4 mmHg and functional profile length, 4.8 + 0.4 cm. Internal meatus cross sectional area was 0.67 + 0.04 cm2 and the minimum urethral cross sectional area was 0.12 + 0.02 cm2. This method has been shown to be readily applicable in measuring urethral closure pressure in males and can potentially be used as a tool of comparing the functional parameters of pressure with the anatomical value of diameter.

Neobladder Construction using Completely Detubularized Sigmoid Colon after Radical Cystoprostatectomy

To improve the quality of life of the patient we used completely detubularized sigmoid colon for bladder reconstruction along with radical cystoprostatectomy in 6 men with invasive bladder cancer. Followup was 8 to 20 months. Postoperatively, all of the patients were continent during the day but only 4 (66.7%) were continent at night, although they had to awaken twice to remain dry. Neocystourethroscopy in 4 of the 6 patients revealed no tumor and no stricture at the urethrocolonic anastomosis. However, a stone in the neobladder was found in 1 patient. Urodynamic study of the neobladder showed a low pressure (mean 16.7cm. water) at the filling phase of water cystometry and an adequate maximal urethral closure pressure (mean 52.0cm. water) and functional profile length (mean 3.8cm.). The uroflow rate in all patients was good (1 patient even had a maximal uroflow rate of 31ml. per second). There was no reflux in any patient. One patient had intestinal obstruction 5 months postoperatively and died 5 months later of widespread metastasis. The remaining 5 patients are alive with a satisfactory quality of life. In conclusion, use of completely detubularized sigmoid colon may be an ideal operation for neobladder construction after radical cystoprostatectomy.

Use of fine-wire electrodes for electromyographic evaluation of the external urethral sphincter during urethral pressure profilometry in male cats

SUMMARY Evaluation of urethral pressure profilometry (upp) with simultaneous fine-wire electromyography of the external urethral sphincter (eus) was conducted in 11 healthy adult male cats sedated with xylazine and ketamine. A 3.5-F urethral catheter with a closed end and two 1-mm sideports was infused with sterile 0.9% NaCl solution at a rate of 2 to 3 ml/min. A fine-wire electromyographic (emg) electrode was placed percutaneously into or near the external urethral sphincter prior to the onset of the upp. The maximal urethral pressure achieved and functional profile length were recorded from upp. Setting both catheter withdrawal rate and paper speed at 5 mm/s enabled the measurement of actual urethral length directly from upp. Sphincter emg activity was rated as slight ( + ), moderate (+ +), or intense (+ + +). All recordings were replicated once during each trial for 8 cats and trials were replicated 5 to 7 days later in 4 cats. Before catheterization, emg activity of the external urethral sphincter was rated slight ( + ), whereas intense (+ + +) activity accompanied insertion. The activity evoked by movement of the catheter subsided, but intense emg activity of the external urethral sphincter was recorded from onset to completion of catheter withdrawal in all cats in both trials. The mean maximal urethral pressure was 93.1 ± 13.29 cm H20. The mean function urethral length was 8.1 ± 0.93 cm. Maximal urethral pressure or function profile length did not differ significantly between recordings within trials or between trials. Simultaneous recording of emg activity and upp of the external urethral sphincter was shown to be a simple, noninvasive technique for assessing neuromuscular and anatomic urethral function.

雌イヌの膀胱, 尿道に対するα<sub>1</sub>-アドレナリン刺激剤の尿水力学的作用

It has been known that alpha 1-adrenoceptors play an important role in urethral contraction. The incompetence of the urethral contraction is a cause of stress incontinence. We studied the urodynamic effects of a selective alpha 1-adrenoceptor agonist (midodrine hydrochloride) on the bladder and urethra of female dogs. Under anesthesia with intravenous chloralose, four doses (0.03, 0.1, 0.3 and 1.0 mg/kg) of midodrine were administered intravenously and urodynamic studies including cystometry, urethral pressure profilometry and electromyography (EMG) of the external urethral sphincter were performed. The administration of midodrine induced a significant increase of the maximum closing pressure in the proximal portion of the urethra (p less than 0.05 at 0.03 mg/kg and p less than 0.01 at 0.1, 0.3, 1.0 mg/kg). There were no significant changes in the functional profile length, the closing pressure at the external sphincters, the maximum bladder pressure, bladder capacity and bladder compliance. The administration of 0.3 mg/kg or more of midodrine produced a significant increase in the mean arterial blood pressure. After midodrine administration, transient increases in the external sphincter EMG activities were recognized. The activities showed the synergistic pattern during the bladder contractions. In conclusion, lower dose administration of a selective alpha 1-adrenoceptor agonist (midodrine) specifically produced an increase of the closing pressure in the proximal portion of the urethra without affecting blood pressure. These results suggest that midodrine is useful for the treatment of stress incontinence in humans.

Simultaneous urethral pressure profilometry using microtip transducer catheters in the bitch: A comparison of catheter material

AbstractSimultaneous urethral pressure profilometry using an 8FG polyurethane microtip transducer catheter in the bitch is subject to considerable variation, Marked differences occur in the parameters normally measured due to the orientation of the transducers and patient position. It has been suggested that a softer catheter may result in less variation. In this study, a comparison was made between 8FG polyurethane and silicone rubber microtip transducer catheters in 35 bitches. There were significant variations in both maximum urethral closure pressure and functional profile length due to catheter type (P < 0–001). Resting intravesical pressure varied with the recording transducer (P < 0–001) and there was a significant interaction between catheter type and recording transducer (P < 0–001). Radiographic measurements on 15 bitches suggested that variations in recorded intravesical pressure were probably related to the location of the transducers of the two catheters within the bladder. It is concluded that the use of a softer catheter material alone is insufficient to eliminate variations resulting from the orientation of the recording sensors within the urethra.

Pathophysiology of Urinary Incontinence After Radical Prost Prostatectomy

To define the origin of urinary incontinence after radical prostatectomy urodynamic studies in 24 incontinent patients were compared to those of 13 continent patients. A statistically significant difference between incontinent and continent patients was found for the mean functional profile length (2.1 versus 3.6cm., respectively, p less than 0.001), maximal urethral closure pressure (39 versus 74cm. water, respectively, p less than 0.001) and maximal urethral closure pressure during voluntary contraction of the external sphincter (107 versus 172cm. water, respectively, p less than 0.002). The differences among maximal detrusor pressure, initial bladder volume at which a detrusor contraction occurs, maximal cystometric capacity and residual urine were not statistically significant between the 2 groups. Urethral instability was present in 1 of the 24 incontinent patients (4.2%) and in none of the 13 continent patients, while detrusor instability was present in 6 (25%) and 3 (23.1%), respectively. Urethral and detrusor instability correlated poorly with incontinence (correlation coefficients 0.123 and 0.021, respectively).The appearance of the bladder outlet on voiding cystourethrography was correlated with urodynamic parameters and the presence or absence of continence. Tubularization above the level of the external sphincter was present in continent but absent in incontinent patients.Continence after radical prostatectomy is dependent upon sphincteric efficiency, which may be influenced by the anatomical configuration of the reconstructed bladder outlet and the integrity of the distal urethral sphincteric mechanism. (J. Urol, 143: 975–978, 1990)

Simultaneous urethral pressure profilometry using a microtip transducer catheter in the bitch: Effects of bitch position and transducer orientation

AbstractSimultaneous urethral pressure profilometry using a microtip transducer catheter was perfonned in 14 bitches to determnine the effects of the position of the animal and the transducer orientation.The technique was carried out in three positions of the bitch (right lateral, dorsal, and left lateral recumbency) and four orientations of the transducers (Diorsal, right, ventral, and left).Both functional profile length and maximum urethral closure pressure were significantly affected by the orientation of the transducer relative to the position of the bitch.The optimum position of the bitch and orientation of the transducers were detennined by evaluating the proportion of profiles from which measurements could not be made, the diagnostic value of profiles, and the Proportion of artefacts in functional profile length. It was concluded that the bitch should be positioned in right lateral recumbency with the transducers orientated dorsally as these positions result in the highest proportion of diagnostic and measurable profiles and the lowest proportion of artefacts in functional profile length.

Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises

AbstractFifty‐two women, mean age 45.9 years (24–64) with clinically and urodynamically proven stress urinary incontinence (SUI) were randomly assigned to one of two different pelvic floor muscle (PFM) exercise groups. Both groups performed 8–12 maximal PFM contractions 3 times a day for 6 months. In addition one group exercised with an instructor intensively 45 min once a week performing long‐lasting contractions with the supplement of 3–4 fast contractions at the end of each long‐lasting contraction.Initially and after 6 months an examination was performed comprising history, urinary leakage index, pad test, maximum urethral closure pressure, functional urethral profile length, and recording of vaginal pressure during PFM contractions. The latter was performed monthly.After the treatment 60% of the intensive exercise (IE) group and 17.3% of the home exercise (HE) group reported to be continent or almost continent (P < .01). Only the IE group demonstrated significant reduction in urine loss; from mean 27 g to 7.1 g (P < .01) and improvement in maximum resting urethral closure pressure (mean improvement 4.6 cm H2O. P = .02). PFM strength improved with mean 15.5 cm H2O (P < .01) in the IE group while the HE group improved with 7.4 cm H2O (P < .01).It is concluded that the results of PFM exercise for female SUI is highly dependent upon the degree and duration of treatment and frequent supervision by the therapist.

Effects of Prazosin HCl on the Urethral Pressure Profile in Patients with Benign Prostatic Hyperplasia

The effects of prazosin HCl on the urethral pressure profile (UPP) were studied in 14 patients with benign prostatic hyperplasia. Urethral pressure profilometry was performed 1 h after oral administration of 1 or 2 mg prazosin HCl. Functional profile and continence zone lengths were significantly reduced following administration of 1 or 2 mg prazosin HCl, as compared with the pretreatment lengths. The administration of 2 mg prazosin HCl resulted in a significant decrease in prostatic peak pressure, whereas the maximum urethral closure pressure exhibited an insignificant decrease. The results suggest that the effects of prazosin HCl on UPP were dose dependent within the range from 1 to 2 mg.

Urethral pressure profilometry in the anaesthetised bitch: a comparison between double and single sensor recording

A comparison was made between urethral pressure profiles obtained using a single sensor and 'subtracted' urethral pressure profiles resulting from double sensor recordings in 50 bitches. There were small but significant differences in the functional profile lengths and maximum urethral closure pressures between the two types of recording. The differences were partially explained by a significant fall in the intravesical pressure recorded during profilometry and variations due to respiration. The profiles from single and double sensor recording were of equal significance in the diagnosis of sphincter mechanism incompetence.

‘Simultaneous’ urethral pressure profilometry in the bitch: methodology and reproducibility of the technique

The technique of 'simultaneous' urethral pressure profilometry in the bitch is described. Four consecutive recordings were made from each of 100 bitches. From each recording, the maximum urethral closure pressure and functional profile length were measured and assessed for reproducibility. Analyses of variance revealed no significant differences (P greater than 0.2) between the measurements of functional profile length (means: 3.84, 3.84, 3.83, 3.80 cm; standard error of the differences: 0.037) but there were significant variations (P less than 0.001) in maximum urethral closure pressure (means of square roots: 2.26, 2.18, 2.12, 2.08 cm water; standard error of the differences: 0.042). Overall, there was a significant dependence of maximum urethral closure pressure on the measurement order (P less than 0.001). Thus, while functional profile length is a highly reproducible parameter, maximum urethral closure pressure is subject to significant variation.

Urethral pressure measurement: A comparison of profiles obtained by conventional and fibre‐optic microtransducers

AbstractResting urethral pressure profile measurements and continuous urethrocystometry traces were carried out in a group of 24 patients by using both conventional microtransducer catheter and fibre‐optic microtransducer techniques in an effort to assess the repeatability of the various profile parameters and to investigate rotational variations in the recordings.The microtransducer technique resulted in profiles with significantly higher values for total profile length (TPL), functional profile length (FPL), length to peak pressure (LtPP), and maximum urethral pressure (MUP), with significantly lower variation in urethral pressure than the fibre‐optic technique. These findings applied in all transducer orientations, even though the microtransducer method showed a greater degree of rotational variation.When a standard catheter orientation was employed (with the transducer facing laterally in the urethra) the microtransducer technique showed significantly greater consistency of profile parameters when an analysis of variance technique was used.

Effect of urethral catheterisation on urethral sphincter emg and pressure profile

AbstractThe impact on urethral sphincter EMG and pressure profile of the introduction of a catheter per urethram was assessed in 48 women with various voiding dysfunctions. Urethral EMG activity was recorded with vaginal surface electrodes placed behind the midurethra. A 5F urethral profile catheter was used in 13 patients (group I), an 8F in 23 patients (group II), and a 10F in 12 patients (group III).In all three groups a statistically significantly increased EMG activity was observed following the introduction of the catheter. This increased activity ceased after a median time of 3–5 minutes. The increased EMG activity did not affect the maximum urethral closure pressure and functional profile length. No correlation could be established between changes in EMG activity and changes in urethral closure pressure. It is concluded that the increased sphincter EMG activity provoked by catheterisation does not affect the urethral pressure profile significantly.

Clinical study of a modified Stamey's endoscopic bladder neck suspension procedure for one hundred female patients with stress incontinence

One hundred female patients with stress incontinence have been operated on by means of modified stamey's endoscopic bladder neck suspension procedure, i.e. quantifying the thread tension for bladder neck suspension. Twelve patients had 1,000 grams in the nylon loop, 5,800 grams, 9,700 grams, 25,600 grams and 49,400 grams. A follow-up period varied from 10 to 32 months (mean: 20.5 months). A 60-min pad-weighing test revealed urinary loss of 1.0 to 196.0 grams/hour (mean: 36.0) prior to operation. 1. The modified Stamey's procedure was successful in 95 patients (95%). The appropriate thread tension for bladder neck suspension was 400 grams. 2. Various complications were encountered: removal of unilateral nylon suture was necessitated in 2 patients, bleeding from operative wound in 2, bladder tamponade in 2, and clean intermittent catheterization for more than one month in 4. 3. Micturition parameters, i.e. maximum and average flow rates, temporarily got worse post-operatively. Maximum urethral closure pressure decreased and functional profile length elongated which were significantly different from those of pre-operative values. 4. Questionnaire sent to the patients revealed that 89 percent of them were satisfied with the operative results but 11 percent were not. 5. The modified Stamey's procedure is simple to perform and prevents over-tightness of nylon loops. We conclude that this operative method is the treatment of choice for correction of stress incontinence.

Teflon injection in female stress incontinence. Effect on urethral pressure profile and flow rate.

Thirty-six females with genuine stress incontinence (GSI) were treated by bladder neck teflon injection. Urethral pressure profilometry (UPP) and uroflowmetry were performed both pre- and post-operatively on 18 patients. In 24 patients who were either completely cured or improved by this procedure, the mean urine flow rate was reduced by 23% and the mean functional profile length increased by 9% compared with pre-operative values. Although these findings appear to explain the mechanism by which teflon improves continence, these differences were not statistically significant. Fourteen of the 18 patients who had not responded to previous anti-incontinence procedures were successfully treated by teflon injection. The improved response rate in these patients was not statistically significant. It was not possible to predict with certainty those patients most likely to respond to teflon injection. However, in women with normal or near normal pelvic floor anatomy the procedure had an acceptable success rate. In view of the simplicity, lack of morbidity and the ease with which it can be performed and repeated, bladder neck teflon injection deserves consideration as an alternative, particularly where open surgery has failed.

Urodynamic Findings following Radiotherapy for Cervical Carcinoma

Forty patients were assessed urodynamically 5 to 11 years after radiotherapy for cervical carcinoma and compared with 27 patients prior to treatment. The mean volume of first bladder sensation after radiotherapy was significantly lower than the mean volume before treatment, as was the mean maximum cystometric capacity. The mean filling detrusor pressure was higher after radiotherapy than before treatment. Unstable detrusor contractions were found only in the 12 symptomatic patients. There was a significant reduction in maximal urethral closure pressure and functional profile length in the post-radiotherapy group. Detrusor instability was a common finding following radiotherapy. The reduction in bladder capacity alone was not sufficient to account for the symptoms of frequency, urgency and urge incontinence.

Urodynamic appraisal of the marshall-marchetti test in women with stress urinary incontinence

To determine the reliability of the Marshall-Marchetti test as a diagnostic and prognostic preoperative screening test for stress urinary incontinence, the changes observed in urethral pressure profiles under resting and stressful situations were recorded and compared following varying degrees of elevation of the urethra and the urethrovesical junction. The characteristic similarity of changes was evident in the functional profile length, urethral closure pressure, and cough pressure profile of the urethra during performance of the Marshall-Marchetti test and intentional urethral occlusion. This study clearly invalidated the Marshall-Marchetti test by objectively demonstrating that the Marshall-Marchetti test restored continence under stress of coughing by occluding the urethra and the urethrovesical junction.

Simultaneous measurement of pressure profile and pull-through force in the urethra of 25 female patients.

Simultaneous registration of urethral pressure profile and pull-through force was performed to study the dynamics of sphincteric function in 25 female patients. Three separate types of catheters of six different sizes were used. A 6-French smooth catheter was used to measure maximal urethral closure pressure, functional profile length and length to maximal urethral pressure. The results were divided into three groups (A, B and C) with significantly different closure pressure values, only correlated to the age of the patient. In all three groups (A, B and C), the mean maximal urethral closure pressure increased in linear correlation to the catheter diameter and did not bear any relation to the shape of the catheter tip, either of the bulb or the ball type. A significant exponential correlation was demonstrated between pull-through force and catheter diameter. Also the correlation between force and length of the pull-through force curve was exponential, while only the mean values of closure pressure and force correlated exponentially. No further correlations were found, even after force values were ranked to form three other groups (I, II and III). In contrast to the groups A, B and C, no distinct differences in clinical diagnosis was noticed between groups I, II and III. The pressure and force curves can be explained on a physical basis, despite the variety in pathology. On the basis of this evidence it appears that a more accurate measurement of sphincter function in the female can be obtained by measuring pressure and force simultaneously with different sizes of catheters, especially with a diameter of 15 French or more.

Urethral pressure profile in sling operations for stress incontinence

Abdominovaginal sling procedures are one of the operative methods for treating urinary stress incontinence in women. They are used especially in incontinence associated with severe pelvic floor weakness. By suspending the vesicourethral junction to the anterior abdominal wall by help of a dural or fascial sling, the bladder neck and proximal urethra are restored to their original anatomical position. Changes in intraabdominal pressure are transmitted equally to both bladder and urethra. One of the difficulties during the course of the operation is to maintain proper tension to the sling while suturing it to the rectus sheath. If the sling is placed to loosely, therapeutic failure may result; on the other hand, overtightening of the sling can lead to delayed voiding and retention of urine. With this problem in mind, urethral pressure recordings were performed during the course of 14 abdominovaginal sling operations. Significant changes concerning the functional urethral profile length, the maximum urethral pressure, and especially the shape of the urethral closure pressure profile could be demonstrated following the main operative steps.

Possible Use of Indoramin in Patients With Chronic Neurogenic Bladder Dysfunction

AbstractIndoramin, which has great selectivity for alpha-1-receptors, was administered orally for 10 days to 21 patients with urinary retention or residual urine caused by neurogenic vesicourethral dysfunction. After Indoramin therapy 17 patients were able to empty the bladder with residual urine less than 50ml. There was a significant decrease in the maximum urethral pressure (23.87 plus or minus 4.13cm. water) and in the functional profile length (0.53 plus or minus 0.19cm.). A diminution in the sphincter electromyography activity was observed in 3 patients. Two paraplegics who were investigated during spinal shock could not achieve voiding after Indoramin therapy. However, involuntary urine leakage associated with a change of posture occurred in 2 patients but subsided after the dosage of Indoramin was decreased. No other side effect was observed. It may be desirable to use drugs with selective action upon alpha-1-receptors since blockade of noradrenergic autoreceptors (alpha-2) also by nonspecific alpha-adrenoceptor blocking agents, namely phentolamine, phenoxy-benzamine and so forth, causes the overflow of norepinephrine, which would produce symptoms such as tachycardia by stimulating beta-receptors.