Functional Urethral Length Research Articles

Urethral and bladder neck functional length related to urethral electrical conductivity (UEC) profile in female stress urinary incontinence

Urethral and bladder neck functional length related to urethral electrical conductivity (UEC) profile in female stress urinary incontinence

Relationship between urinary profile of the endogenous steroids and postmenopausal women with stress urinary incontinence.

The aims of this study were to investigate whether endogenous steroid hormones are (1) related to pathogenesis of stress urinary incontinence after menopause, (2) are related to severity of stress urinary incontinence, and (3) are related to prognostic parameters of stress urinary incontinence. Twenty post-partum women with clinically diagnosed stress urinary incontinence and 20 age-matched postmenopausal women without stress urinary incontinence (control group) were evaluated. We compared urinary profile of the endogenous steroid hormones patients with stress urinary incontinence and controls, and between grade I and grade II of stress urinary incontinence. We also investigated the relationship between urinary profile of the endogenous steroid hormones and prognostic parameters of stress urinary incontinence (maximal urethral closure pressure, functional urethral length, Valsalva leak point pressure, cough leak point pressure, posterior urethrovesical angle, bladder neck descent, and stress urethral axis). The ages of the patients and those in the control group were 64.3 +/- 5.6 and 57.5 +/- 3.8 years old and the body mass indexes were 24.96 +/- 3.14 and 22.11 +/- 2.73 kg/m2 in patients and in normal subjects, respectively. Nine patients were grade I and 11 were grade II. Estrone and 17beta-estradiol only were detected in all subjects, regardless of control or patient group. It is noteworthy that there were no significant differences (P > 0.05) in the levels of estrone and 17beta-estradiol in the urine of postmenopausal normal subjects compared with in the urine of postmenopausal patients with urinary incontinence. E2/E1 ratio was not different between the two groups (P > 0.05). Among the objective steroids, DHEA, Delta4-dione, Delta5-diol, Te, DHT, 16alpha-DHT, 11-keto An, THDOC, and THB were not detected either in the urine of normal subjects and nor in the urine of the patients. After comparing androgen levels between normal subjects and patients, no significant differences (P>0.05) were detected, except for 5alpha-THB and 5alpha-THF. Neither 5alpha-THB or 5alpha-THF were detected in the patients' urine. Et/An (11beta-OH Et/11beta-OH An) concentration ratios were not significantly different between the two groups, either (P > 0.05). There were not significant differences of concentrations (micromol/g creatinine) of urinary steroids between grade I and grade II of stress urinary incontinence. Pregnanediol was significantly related to bladder neck descent in supine and sitting positions (R = 0.79, P = 0.01, and R = 0.73, P = 0.03, respectively), and pregnanetriol was significantly related to maximal urethral closure pressure and functional urethral length (R = 0.68, P = 0.04, and R = -0.79, P = 0.01, respectively). Androsterone was significantly related to bladder neck descent in supine and sitting positions (R = 0.68, P = 0.04, and R = 0.78, P = 0.01, respectively). 5-AT was significantly related to bladder neck descent in sitting position and stress urethral axis (R = 0.72, P = 0.03, and R = -0.71, P = 0.03). 11-keto Et was significantly related to bladder neck descent in supine and sitting positions and related to stress urethral axis (R = 0.82, P = 0.01, and R = 0.81, P = 0.01, R = -0.67, P = 0.04, respectively). THS was significantly related to bladder neck descent in supine and sitting positions and related to stress urethral axis (R = 0.76, P = 0.02, and R = 0.74, P = 0.02, R = -0.68, P = 0.04, respectively). THE was significantly related to bladder neck descent in sitting position (R = 0.67, P = 0.04).beta-Tetrahydrocortisol/alpha-tetrahydrocortisol (beta-THF/alpha-THF) and alpha-cortol were significantly related to maximal urethral closure pressure and functional urethral length (R = 0.74, P = 0.02, and R = -0.92, P = 0.01; R = 0.71, P = 0.36, and R = -0.87, P = 0.000, respectively). 17beta-estradiol (E2) was significantly related to bladder neck descent in supine position (R = -0.62, P = 0.04) and 17beta-estradiol/estrone (E2/E1) was significantly related to cough leak point pressure (R = 0.79, P = 0.01). In conclusion, the urinary concentrations of endogenous steroid metabolites in postmenopausal patients with stress urinary incontinence were not significantly different from normal patients and were not significantly different between grade I and grade II patients with stress urinary incontinence. Some endogenous steroid metabolites were positively or negatively significantly related to prognostic parameters of stress urinary incontinence.

Relationship between urinary endogenous steroid metabolites and lower urinary tract function in postmenopausal women.

To investigate the relationship between the endogenous steroid hormones and the lower urinary tract function in postmenopausal women. Thirty postmenopausal volunteer women who did not have lower urinary tract symptoms or hormone replacement therapy were enrolled in this study. Urodynamic studies included uroflowmetry, multi-channel cystometry, and urethral pressure profilometry were conducted. Gas Chromatography- Mass Spectroscopy(GC-MS) was used to measure the urinary endogenous steroid hormone metabolites. The relationship between the urinary profile of the endogenous steroids and the urodynamic parameters of these patients were investigated. The mean ages of the patients were 60.6 +/- 5.5 years, and the Body Mass Index (BMI) averaged 24.56 +/- 2.23 (kg/m2). Of the progesterone metabolites, pregnandiol was significantly related to the residual volume in the uroflowmetry and the functional urethral length parameters (R=0.98, p=0.000; R= -0.65, p=0.04). Pregnantriol was significantly related to the maximum flow rate, the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=-0.64, p=0.04; R=0.82, p=0.01; R=0.04, p=0.04; R=- 0.79, p=0.01). In the androgen metabolites, androstenedione, 5-AT, 11- keto Et, 11-betahydroxy Et, THS, and THE were significantly related to the residual volume in uroflowmetry (R=0.92, p=0.001; R=0.84, p=0.008; R=0.99, p=0.000; R=0.72, p=0.03; R=0.97, p=0.000; R=0.85, p=0.00). beta-THF/alpha-THF was significantly related to the maximum flow rate, the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=-0.76, p=0.02; R=0.67, p=0.04; R=0.74, p=0.02; R=-0.92, p=0.000). alpha-cortol was significantly related to the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=0.81, p=0.01; R=0.71, p=0.03; R=-0.87, p=0.000). Of the estrogen metabolites, estrone (E1) was significantly related to the normal desire to void (R=0.68, p=0.04) and 17beta-estradiol/estrone was also significantly related to the normal and strong desire to void (R=-0.70, p=0.03 and R=-0.74, p=0.02, respectively). The urinary progesterone and androgen metabolite concentrations were positively related to the residual volume in uroflowmetry and positively or negatively related to MUCP and FUL. However, the urinary estrone concentration was positively related to the normal desire to void and 17beta-estradiol/estrone was significantly related to the normal and strong desire to void.

Clinical and urodynamic features of intrinsic sphincter deficiency.

A prospective analysis of 92 patients with genuine stress incontinence was performed to identify the clinical and urodynamic features of intrinsic sphincter deficiency (ISD). We divided the patients into two categories: 50 patients affected by pure ISD as they had severe stress incontinence and no urethral mobility; 42 patients suffering from stress urinary incontinence without ISD as they had mild stress incontinence and marked urethral hypermobility. Cystometry was normal in all patients. The presence/absence of ISD was considered the dependent variable and was correlated against the following independent variables: age, vaginal deliveries, menopause, previous urogynecological surgery and/or hysterectomy, supine stress test, irritative and/or obstructive symptoms, Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), urethral functional length (UFL), and leakage during cystometry. The statistical analysis showed close correlations between ISD and age (P < 0.001), menopausal status (P < 0.001), previous surgery (P < 0.0001), supine stress test (P < 0.0001), leakage during cystometry (P < 0.001), and UFL (P < 0.01). The VLPP was below the cut-off value (</=60 cm H(2)O) in 70% of ISD patients (P < 0.0001), whereas the MUCP in 50% of ISD patients (P < 0.0001). Multiple logistic analysis showed that lower VLPP, lower MUCP, and previous surgery correlate more significantly with ISD. After backward conditional stepwise logistic regression, the odds ratio of having ISD were VLPP = 2.3, MUCP = 7.7, VLPP + MUCP = 62.8. ISD is related to the presence of a more severe clinical picture and case history, but the most significant independent variables are the VLPP and MUCP.

Abnormal clinical and urodynamic findings in women with severe genitourinary prolapse.

In order to investigate the effects of urogenital prolapse on lower urinary tract function, we studied 61 women with stage III to IV pelvic organ prolapse (prolapse group) and 40 volunteers without prolapse (control group). Each woman underwent urinalysis, urinary questionnaire, pelvic examination, and urodynamic study. The incidence of urinary symptoms, including urinary frequency and urgency, stress/urge incontinence, incomplete emptying, difficult voiding and nocturia, were significantly higher in the prolapse group compared to the control group (p < 0.05). Urodynamic parameters, including residual urine, total bladder capacity, and bladder volume at strong desire to void, were not significantly different between the two groups (p > 0.05). Maximal flow rate, bladder compliance at urgency, functional urethral length, and maximal urethral closure pressure, however, were significantly higher in the control group compared to the prolapse group (p < 0.05). In addition, there was a higher incidence of poor pressure transmission ratio in the prolapse group (p < 0.01). The results indicated that severe urogenital prolapse could produce abnormal clinical and urodynamic results.

Computer-Assisted Virtual Urethral Pressure Profile in the Assessment of Female Genuine Stress Incontinence

In Brief OBJECTIVE To compare computer-assisted virtual urethral pressure profile changes between women with and without genuine stress incontinence. METHODS A full urogynecologic assessment including conventional urodynamic measurements and a clinical stress test were carried out. Computer-assisted virtual urethral pressure profile uses conventional urethral pressure profile measurements during stress, with the only change being that withdrawal of the catheter is stopped at distinct points along the whole urethra while the patient coughs. Cough-related changes of maximal urethral closure pressure, functional urethral length, and area under the urethral closure pressure curve were determined. RESULTS Sixty-one women were enrolled in our study: 30 symptom-free women (group A) were continent, and genuine stress incontinence was present in 31 patients (group B) complaining of urinary loss. Significant differences between group A and group B women were found for all parameters of computer-assisted virtual urethral pressure profile including maximal urethral closure pressure (91.59 ± 39.00 versus 20.70 ± 22.61 cm H2O; P < .001), functional urethral length (31.81 ± 9.02 versus 10.83 ± 10.76 mm; P < .001), and the area under the urethral closure pressure curve (2036 ± 1025.29 versus 253 ± 206.69 cm H2O × mm; P < .001). CONCLUSION Computer-assisted virtual urethral pressure profile is a new application of urethral pressure profile measurements during stress. Our data show significant differences between continent women and patients with genuine stress incontinence. Further studies are needed to assess the potential of computer-assisted virtual urethral pressure profile for diagnosing genuine stress incontinence. Computer-assisted virtual urethral pressure profile is a new method for analysis of the urethral pressure profile during stress to confirm genuine stress incontinence.

Existe-t-il une corrélation entre l’âge et les données du bilan urodynamique chez la femme présentant une incontinence urinaire d’effort (IUE) ?

PURPOSE: Our aim was to evaluate the impact of age on lower urinary tract function in women by means of urodynamics and modelized analysis of the recorded free uroflow curves. MATERIAL AND METHODS: One hundred and fifty three women (age range: 〚30-93 years〛 ; 6 decades A to F) with only SUI complaint underwent a urodynamic evaluation which included initial free uroflow, urethral pressure profile, cystometry and final free uroflow at bladder functional capacity. Modelized analysis was performed using the VBN mathematical micturition model; from comparison between recorded and computerized theoretical flow curves this model allows to determine two characteristic parameters: one of urethral obstruction and one of detrusor efficiency. RESULTS: No age-related changes were found in bladder capacity, peak flow rate in the first void and post residual volume. A significant increase of peak flow rate was noted in the second void for D and older. Bladder compliance decreased only from E. As usually described a decrease with age of the maximum urethral closure pressure occured while the functional urethral length decreased only from E. A flat distribution of the VBN parameters was observed. DISCUSSION–CONCLUSION: This study shows the absence of age-associated changes in both urodynamic data and VBN parameters in a population of women with SUI and without any other disease. These findings reinforce the idea that chronological age does not strongly correlate with the physiological status.

Computer-assisted virtual urethral pressure profile in the assessment of female genuine stress incontinence

OBJECTIVE: To compare computer-assisted virtual urethral pressure profile changes between women with and without genuine stress incontinence. METHODS: A full urogynecologic assessment including conventional urodynamic measurements and a clinical stress test were carried out. Computer-assisted virtual urethral pressure profile uses conventional urethral pressure profile measurements during stress, with the only change being that withdrawal of the catheter is stopped at distinct points along the whole urethra while the patient coughs. Cough-related changes of maximal urethral closure pressure, functional urethral length, and area under the urethral closure pressure curve were determined. RESULTS: Sixty-one women were enrolled in our study: 30 symptom-free women (group A) were continent, and genuine stress incontinence was present in 31 patients (group B) complaining of urinary loss. Significant differences between group A and group B women were found for all parameters of computer-assisted virtual urethral pressure profile including maximal urethral closure pressure (91.59 ± 39.00 versus 20.70 ± 22.61 cm H 2O; P < .001), functional urethral length (31.81 ± 9.02 versus 10.83 ± 10.76 mm; P < .001), and the area under the urethral closure pressure curve (2036 ± 1025.29 versus 253 ± 206.69 cm H 2O × mm; P < .001). CONCLUSION: Computer-assisted virtual urethral pressure profile is a new application of urethral pressure profile measurements during stress. Our data show significant differences between continent women and patients with genuine stress incontinence. Further studies are needed to assess the potential of computer-assisted virtual urethral pressure profile for diagnosing genuine stress incontinence.

Urethral pressure profiles in the female canine implanted with sacral anterior nerve root electrodes.

The purpose of this work was to study the pressure distribution along the urethra in female canines with and without electrical stimulation of the sacral anterior roots innervating the bladder and urethra. Urethral pressure profiles were recorded in two orientations, dorsal and ventral, with microtransducer catheters. Two pulse types were applied at 1 Hz, 500 micros quasitrapezoidal pulses to selectively activate the small axons and 100 micros rectangular pulses. Four parameters were measured from each profile; maximum urethral pressure (MUP), bladder pressure (Pv), functional urethral length (FUL), and the position of the maximum peak from the bladder neck (PMP). Two derived measures, the estimated maximum urethral closing pressure (UCP) and the position of the maximum as a percentage of the FUL (PM%) were calculated. There were highly significant differences (P<0.01) in the value and position of the estimated UCP in the two orientations of the transducers. The highest pressures were recorded in the ventral orientation near the terminal portions of the urethra. Principal sphincter activity during electrical stimulation of the ventral sacral roots was also confined to this part. Selective small fiber activation did not result in any significant increase in this peak pressure from passive values.

Pelvic floor education after vaginal delivery

Objective: To assess the effect of pelvic floor education after vaginal delivery on pelvic floor characteristics in nulliparous women. Methods: We examined 107 nulliparas during pregnancy and at 9 weeks and 10 months after vaginal delivery. Methods used included a questionnaire, clinical examination, perineosonography, urethral pressure profiles, and intravaginal and intra-anal pressure recordings during pelvic floor contraction. After the second examination, the women were assigned in alternating manner to either 12 sessions of pelvic floor exercises with biofeedback and electrostimulation ( n = 51) or no training ( n = 56). The two groups were compared at the third examination. Results: Stress urinary incontinence incidence decreased in 2% of control subjects compared with 19% of women who underwent pelvic floor education ( P = .002), whereas the incidence of fecal incontinence (5% versus 4%, P = 1) and the percentage of women who recovered predelivery pelvic floor contraction strength (33% versus 41%, P = .4) were no different. We observed no significant differences in bladder neck position and mobility, urethral functional length, maximal urethral closure pressure, pressure transmission ratio, residual area of continence at stress standing, or intravaginal or intra-anal pressures during pelvic floor contraction between groups at the third examination. Conclusion: Pelvic floor education, begun 2 months postpartum, significantly reduced the incidence of stress urinary incontinence, but not fecal incontinence or weak pelvic floor. Similarly, bladder neck behavior, urodynamic characteristics, intravaginal or intra-anal pressures during pelvic floor squeezing also were not modified.

URODYNAMIC STUDY IN DIAGNOSIS OF DIABETIC DYSURIA

Treatment of patients with diabetes-induced urinary disturbance requires consideration of many factors, due to wide variations. Attempts were made to classify the patients with diabetic urinary disturbance into subgroups, based on clinical point of views. In 57 patients with diabetic urinary disturbance, the cystourethral function was classified conventionally by using the following indicators: the cystometrographic curve in urodynamic studies, the maximum urethral closure pressure and the functional urethral length. Patients in individual groups were further divided into subgroups, based on the following factors the remaining urinary volume, the curve pattern of urinary flow volume, the degree of incontinentia, the length after appearance of diabetic conditions, and the degree of diabetic neuropathy. Each group of patients was compared, based on the ratio of these factors involved. There was no positive relationship between the cystometrogram curve, the maximum urethral closure pressure, and the functional urethral length. No positive relationship was also observed between the remaining urinary volume as an index for severity of diabetic urinary disturbance, the volume of urinary flow, and the incontinentia. Each index parameter presented in the urodynamic study is not causally related to the length of the appearance of diabetes mellitus. Although the diabetic urinary disturbance is generally considered peripheral due to neuropathy, this study suggests that it is not simply applicable to the classification of diabetic urinary disturbances. The results suggest the diagnosis and treatment of bladder disturbances require understandings of individual bladder and urethral functions based on accurate urodynamic studies.

Urethral instability: clinical and urodynamic characteristics.

Filling cystometry was performed on 397 patients with lower urinary tract complaints. The overall prevalence of urethral instability was 12.6% (50/397). Of these 187 patients had detrusor instability (DI). Within the DI group, clinical and urodynamic characteristics were compared. Patients with an unstable urethra had a shorter functional urethral length (P = 0.005). For those with DI, 28 of 187 (15%) had urethral instability. Forty (21%) women had a decrease in maximal urethral pressure that preceded the detrusor contraction (type II DI). When those with type II DI were excluded, the difference in functional urethral length was not observed. Patients with type II DI experienced an earlier sensation of fullness of 228 mL compared with 283 mL for the other patients with DI (P = 0.001). There was a positive association between urethral instability and type II DI. Four different patterns of urethral pressure changes were observed. Based on these findings, it appears that a urethral abnormality may be the primary disorder in patients with type II DI. The differentiation of the various subtypes of urethral instability and DI might be important for directing therapy.

The changes of electromyographic activity of the pelvic floor after the delivery

The urodynamics of the lower urinary tract, the clossure urethral mechanism and EMG activity of the pelvic floor, were studied in the group of patient (n = 14) in consequence with the vaginal delivery. Approximately 6-9 weeks after the delivery a slight decrease of the functional urethral length (P < 0.05) and the transmission factor (P < 0.05) were observed. On the contrary, EMG activity of the pelvic floor was significantly increased (P < 0.05) after the puerperium. - The authors suppose, that the decrease of pelvic floor contractility seems to be a physiological phenomenon given by mechanical, vascular and hormonal factors, that should facilitate the normal vaginal delivery. The relations between the changes of EMG activity and parity, birth weight or labour injury were not verified.

Laparoscopic colposuspension: a short term urodynamic follow-up and a three-year questionnaire-study

The purpose of the study was to evaluate outcome, urodynamic correlates and adverse effects of laparoscopic colposuspension using polytetrafluoroethylene sutures. Eighty-five consecutive women with primary stress urinary incontinence at one university hospital were included in this prospective non-controlled study. During videolaparoscopic surgery, two polytetrafluoroethylene sutures were placed on each side of the urethra and fixed to the Cooper ligaments. Pre- and postoperative clinical and urodynamic evaluations, including pad-test, were performed. A mailed questionnaire was used to evaluate cure-rate and complication-rate three years after surgery. At follow-up examination, we considered 62 of 76 women (82%) as being cured, ten (13%) improved, and four (5%) as being failures. The questionnaires were returned by 80 women; 41 (51%) considering themselves as cured and 31 (39%) improved, and eight women (10%) as unimproved or minimally improved. Clinical outcome was not associated with alterations in urethral functional length or in urethral closing pressure. Short preoperative urethral functional length was associated with failure (p=0.04).The incidence of new onset urge symptoms and of new onset recto/enterocele was 13% and 9% respectively. Laparoscopic colposuspension resulted in acceptable cure rate in short-, and medium long term evaluation. However, a decline in cure rate was observed. Cured women had significantly longer preoperative urethral functional length than women still leaking after surgery.

SIGMOID NEOBLADDER IN WOMEN AFTER RADICAL CYSTECTOMY

Neobladder reconstruction using an intestinal segment is the common procedure of choice in men after cystectomy. Recently this procedure has been extended to women. We present our surgical and functional experience with the sigmoid neobladder in women. A total of 11 women 49 to 74 years old (mean age plus or minus standard deviation 60 +/- 8.5) with transitional cell carcinoma of the bladder underwent lower urinary tract reconstruction with a modified sigmoid neobladder after nerve and urethral support sparing cystectomy. After at least 3 months voiding pattern and continence status were evaluated. Pressure flow studies and uroflowmetry were performed, the urethral pressure profile and neocystourethral angle were measured, and blood chemistry was analyzed. After at least 3 months complete daytime continence was achieved in 2 patients, while 8 had mild stress incontinence. At night 8 of the 11 women (72.7%) were continent with or without voiding at regular intervals. All except 1 patient voided to completion. Of the 2 patients with complete continence 1 needed clean intermittent catheterization 4 months postoperatively. Mean maximal urinary flow was 19.9 +/- 10.5 ml. per second. Excluding the woman who required catheterization mean residual urine volume was 15 +/- 13.7 ml. Postoperatively maximal urethral pressure was slightly lower and functional urethral length was about 10 mm. shorter than preoperatively. The mean neocystourethral angle was 131.9 +/- 21.7 degrees. Mean pH, bicarbonate and base excess were 7.38 +/- 0.03, 23. 48 +/- 2.34 mmol./l. and -0.92 +/- 2.50, respectively. After nerve and urethral support sparing cystectomy a modified sigmoid neobladder may be constructed in women to obtain satisfactory continence and voiding results.

Comparison of preoperative and postoperative pressure transmission ratio and urethral pressure profilometry in patients with successful outcome following vaginal patch sling for genuine stress incontinence

Introduction: Pressure transmission ratio (PTR) determination allows for the quantitative measurement of the relative efficiency with which intraabdominal pressure increases are transmitted to the bladder and urethra. We studied preoperative and postoperative PTR in patients undergoing vaginal patch sling for the primary treatment of genuine stress incontinence (GSI).Methods: Forty-four patients with a clinical and urodynamic diagnosis of GSI were studied. The PTR for each cough was calculated by dividing the amplitude of the urethral pressure spike by the amplitude of the corresponding bladder pressure spike and multiplying the quotient by 100. Cough spikes were assigned locations in the first, second, third, or fourth quartile of the functional urethral length designated Q1 through Q4, respectively.Conclusion: PTR in the two proximal quartiles of the urethra were significantly improved postoperatively, which suggests that the vaginal patch sling technique restores continence by repositioning the proximal urethra into the intraabdominal pressure zone, thus enhancing pressure transmission to the proximal urethra. PreoperativePostoperativeP valuePTR (%)Q170 SD ± 13104 SD ± 12<0.01Q272 SD ± 16102 SD ± 20<0.001Q376 SD ± 1880 SD ± 16NSQ468 SD ± 2272 SD ± 14NS

Urodynamic Investigation of Women Operated on for Genuine Stress Incontinence

Anterior colporrhaphy (Kelly-Stoeckel suture) was performed on 22 women suffering from grade-I or grade-II genuine stress incontinence. Urodynamic investigation was performed on every patient before surgery and 6 months postoperatively. 21 patients were cured and 1 patient improved. After operation the functional urethral length was increased by 28.8%, and urethrovesical pressure transmission was improved by 22.9%. Maximum urethral closure pressure decreased postoperatively by 21.1%. Pressure transmission was clearly improved by the surgical intervention and urinary continence was restored in spite of the fact that maximal urethral closure pressure decreased. Based on these results it is suggested to consider performing anterior colporrhaphy in cases of weak urethral closure pressure, because of the increased risk of worsening the complaints of these patients.

Comparison of treatment outcomes for imipramine for female genuine stress incontinence.

To assess the efficacy of imipramine as a treatment of genuine stress incontinence and to explore the possible determining factors for treatment success and failure. A prospective study. University department of obstetrics and gynaecology. Forty women with genuine stress incontinence were enrolled. Each woman was treated with 25 mg imipramine three times a day for three months. Each woman had a 20-minute pad test and urodynamic study including uroflowmetry, both filling and voiding cystometry, and stress urethral pressure profile before and after treatment. After treatment, 35% (n = 14) were cured, 25% (n = 10) improved by > or = 50% and in the remaining 40% (n = 16) treatment failed. The efficacy of successful treatment was 60% (95% CI 44.8-75.2). The median age and parity, as well as menopausal status, showed no statistical differences between the two groups. The pre-treatment data including pad weight, functional urethral length, maximal urethral pressure, bladder compliance at urgency, bladder capacity, and average and maximal flow rates showed no statistical differences between the two groups except urethral closure pressure (P = 0.001). Besides, the functional urethral length and urethral closure pressure were significantly improved in the treatment success group. After medication, the median functional urethral length was 3 cm (intraquantile range [IQR] 2.3-3) in the treatment success group vs 2.3 cm (IQR 2-3) in the treatment failure group (P = 0.028). The urethral closure pressure was 77 cmH2O (IQR 61-105) for the treatment success group vs 40 cmH2O (IQR 34-53) in the treatment failure group (P < 0.0001). The efficacy of imipramine for genuine stress incontinence was 60% (95% CI 44.8-75.2). The pre-treatment high urethral closure pressure may serve as a predictor for treatment success.

Urodynamic Evaluation after Endoscopic Modified Bladder Neck Suspension

A total of 45 simplified double-needle bladder neck suspensions for genuine stress incontinence were clinically and urodynamically evaluated pre- and postoperatively. After a mean follow-up of 26 months, the subjective cure rate was 82.2% and the objective cure rate was 86.6%. Comparison of the pre- and postoperative urodynamic parameters showed a significant change in the maximum urethral closure pressure, functional urethral length, bladder capacity and maximum urine flow rate but no significant alteration in maximum detrusor pressure and first sensation during bladder filling. In summary, the modified bladder neck suspension effectively restores normal urethral function urodynamically.

NEUROUROLOGICAL INSIGHTS INTO THE ETIOLOGY OF GENITOURINARY PAIN IN MEN

Purpose Pelvic pain remains a challenging urological problem. Because antimicrobial therapy is often unsuccessful for relieving symptoms, it is reasonable to question whether pelvic pain is the result of microbiological versus functional pelvic disease. We analyzed clinical and urodynamic findings to evaluate the role of pelvic floor dysfunction in patients with pelvic pain. Materials and Methods We retrospectively evaluated history, physical examination and urodynamic studies in 103 men with an average age of 47 years who presented with pelvic pain between August 1994 and August 1997. In all patients microbiological tests were negative before study entry. Results The reported locations of pain were the prostate and/or perineal region in 45.6% of cases, scrotum and/or testis in 38.8%, penis in 5.8%, bladder in 5.8%, and lower abdomen and lower back in 1.9% each. Previous treatment consisted of 1 to 12 courses of antibiotics in the preceding 6 to 36 months. In 88.3% of the patients there was pathological tenderness of the striated muscle with poor to absent pelvic floor function. Urodynamics were performed in 84 cases. Cystometry was normal except for decreased compliance in 5 patients. Abnormal findings were mostly evident in the coordination of voiding and in dynamic sphincter-pelvic floor activity. Average sphincter pressure was increased to 104.9 cm. water in 72.6% of the patients, average peak urine flow was decreased to 9.9 ml. per second in 61.9% and functional urethral length was increased to greater than 35 mm. in 79.8%. Urethral profile pattern was dysfunctional, obstructed, and combined dysfunctional and obstructed in 52.4, 11.9 and 21.4% of the cases, respectively, while in 88.1% urethral sensitivity was minimally or markedly increased. Conclusions Since activity is a reflection of neural control, the apparent association of pelvic floor dysfunction with pelvic pain raises the probability of a primary or secondary central nervous system breakdown in the regulation of pelvic floor function. This hypothesis is supported by the improvement in symptoms caused by therapy aimed at modulating the pelvic floor, such as biofeedback, medication and sacral anterior root stimulation.