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Trostorf R, Morales Orcajo E, Pötzke A, Siebert T, Böl M. A pilot study on active and passive ex vivo characterisation of the urinary bladder and its impact on three-dimensional modelling. J Mech Behav Biomed Mater 2022; 133:105347. [DOI: 10.1016/j.jmbbm.2022.105347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/05/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
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Trostorf R, Morales-Orcajo E, Siebert T, Böl M. Location- and layer-dependent biomechanical and microstructural characterisation of the porcine urinary bladder wall. J Mech Behav Biomed Mater 2020; 115:104275. [PMID: 33360487 DOI: 10.1016/j.jmbbm.2020.104275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/04/2020] [Accepted: 12/12/2020] [Indexed: 02/07/2023]
Abstract
The knowledge of the mechanical properties of the urinary bladder wall helps to explain its storage and micturition functions in health and disease studies; however, these properties largely remain unknown, especially with regard to its layer-specific characteristics and microstructure. Consequently, this study entails the assessment of the layer-specific differences in the mechanical properties and microstructure of the bladder wall, especially during loading. Accordingly, ninety-two (n=92) samples of porcine urinary bladder walls were mechanically and histologically analysed. Generally, the bladder wall and different tissue layers exhibit a non-linear stress-stretch relationship. In this study, the load transfer mechanisms were not only associated with the wavy structure of muscular and mucosal layers, but also with the entire bladder wall microstructure. Contextually, an interplay between the mucosal and muscular layers could be identified. Therefore, depending on the region and direction, the mucosal layer exhibited a stiffer mechanical response to equi-biaxial loading than that offered by the muscular layer when deformed to stretch levels higher than λ=1.6 to λ=2.2. For smaller stretches, the mucosal layer evinces no significant mechanical reaction, while the muscular layer bears the load. Owing to the orientation of its muscle fibres, the muscular layer shows an increased degree of anisotropy compared to the mucosal layer. Furthermore, the general incompressibility assumption is analysed for different layers by measuring the change in thickness during loading, which indicated a small volume loss.
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Affiliation(s)
- Robin Trostorf
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Enrique Morales-Orcajo
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Tobias Siebert
- Institute of Sport and Motion Science, University of Stuttgart, Stuttgart D-70569, Germany
| | - Markus Böl
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany.
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Holdø B, Verelst M, Svenningsen R, Milsom I, Skjeldestad FE. The retropubic tension-free vaginal tape procedure-Efficacy, risk factors for recurrence and long-term safety. Acta Obstet Gynecol Scand 2019; 98:722-728. [PMID: 30659576 DOI: 10.1111/aogs.13535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The retropubic tension-free vaginal tape has been the preferred method for primary surgical treatment of stress urinary incontinence and stress-dominated mixed urinary incontinence in women for more than 20 years. This study presents long-term safety and efficacy data and assesses risk factors for long-term recurrence. MATERIAL AND METHODS In a case-series design we assessed a historical cohort of primary surgeries performed with the tension-free vaginal tape procedure in 596 women from 1998 to 2012 with follow up through 2015. Information from the medical records was transferred to a case report form comprising data on early and late complications and recurrence of urinary incontinence defined as bothersome stress urinary incontinence symptoms. All analyses were performed with SPSS using Pearson chi-square, survival and Cox regression analyses. RESULTS After a 10-year follow up, mixed urinary incontinent women (hazard ratio 2.1, 95% confidence interval [CI] 1.4-3.0) had a significantly increased risk of recurrence of stress urinary incontinence symptoms compared with women with pure stress urinary incontinence as the indication for surgery. Overall cumulative cure rates after 1, 5 and 10 years were 92% (95% CI; 90%-94%), 79% (95% CI; 75%-83%) and 69% (95% CI; 63%-75%), respectively. Recurrent surgery (0.3%) and serious tape complications needing major surgical treatment (0.3%) were rare. Six patients (1.0%) had the tape cut due to urinary retention, and nine patients (1.5%) reported urinary retention more than 3 months after surgery. CONCLUSIONS The tension-free vaginal tape procedure has a high long-term durability. Mixed urinary incontinence as an indication for surgery predicted long-term recurrence. Long-term complications were rare.
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Affiliation(s)
- Bjørn Holdø
- Department of Obstetrics and Gynecology, Nordland Hospital, Bodø, Norway
| | - Margareta Verelst
- Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Tromsø, Norway
| | - Rune Svenningsen
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Ian Milsom
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Finn E Skjeldestad
- Institute of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Location-dependent correlation between tissue structure and the mechanical behaviour of the urinary bladder. Acta Biomater 2018; 75:263-278. [PMID: 29772347 DOI: 10.1016/j.actbio.2018.05.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 01/29/2023]
Abstract
The mechanical properties of the urinary bladder wall are important to understand its filling-voiding cycle in health and disease. However, much remains unknown about its mechanical properties, especially regarding regional heterogeneities and wall microstructure. The present study aimed to assess the regional differences in the mechanical properties and microstructure of the urinary bladder wall. Ninety (n=90) samples of porcine urinary bladder wall (ten samples from nine different locations) were mechanically and histologically analysed. Half of the samples (n=45) were equibiaxially tested within physiological conditions, and the other half, matching the sample location of the mechanical tests, was frozen, cryosectioned, and stained with Picro-Sirius red to differentiate smooth muscle cells, extracellular matrix, and fat. The bladder wall shows a non-linear stress-stretch relationship with hysteresis and softening effects. Regional differences were found in the mechanical response and in the microstructure. The trigone region presents higher peak stresses and thinner muscularis layer compared to the rest of the bladder. Furthermore, the ventral side of the bladder presents anisotropic characteristics, whereas the dorsal side features perfect isotropic behaviour. This response matches the smooth muscle fibre bundle orientation within the tunica muscularis. This layer, comprising approximately 78% of the wall thickness, is composed of two fibre bundle arrangements that are cross-oriented, one with respect to the other, varying the angle between them across the organ. That is, the ventral side presents a 60°/120° cross-orientation structure, while the muscle bundles were oriented perpendicular in the dorsal side. STATEMENT OF SIGNIFICANCE In the present study, we demonstrate that the mechanical properties and the microstructure of the urinary bladder wall are heterogeneous across the organ. The mechanical properties and the microstructure of the urinary bladder wall within nine specific locations matching explicitly the mechanical and structural variations have been examined. On the one hand, the results of this study contribute to the understanding of bladder mechanics and thus to their functional understanding of bladder filling and voiding. On the other hand, they are relevant to the fields of constitutive formulation of bladder tissue, whole bladder mechanics, and bladder-derived scaffolds i.e., tissue-engineering grafts.
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Guralnick ML, Fritel X, Tarcan T, Espuna-Pons M, Rosier PFWM. ICS Educational Module: Cough stress test in the evaluation of female urinary incontinence: Introducing the ICS-Uniform Cough Stress Test. Neurourol Urodyn 2018; 37:1849-1855. [DOI: 10.1002/nau.23519] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - Xavier Fritel
- Faculté de Médecine et Pharmacie; Université de Poitiers; Poitiers France
| | - Tufan Tarcan
- Marmara University School of Medicine; Istanbul Turkey
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A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence. J Urol 2018; 199:1557-1564. [DOI: 10.1016/j.juro.2017.11.073] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 11/23/2022]
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Diagnostic accuracy of single channel cystometry for neurogenic bladder diagnosis following spinal cord injury: a pilot study. Spinal Cord Ser Cases 2017; 3:16044. [PMID: 28503317 DOI: 10.1038/scsandc.2016.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 11/30/2016] [Accepted: 12/11/2016] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION This is a cross-sectional study of 1 year duration (August 2013 to August 2014). The objective of the study was to investigate the diagnostic accuracy of single channel cystometry (SCC) for confirmation of neurogenic bladder following spinal cord injury. MATERIALS AND METHODS The study was conducted in both out-patient and in-patient services of Department of Rehabilitation Medicine, Hospital Sungai Buloh, Malaysia. Subjects in the study include sixteen patients with a clinical diagnosis of neurogenic bladder following spinal cord injury aged between 15 and 62 years. Patients with a clinical diagnosis of neurogenic bladder were subjected to cystometric evaluation using SCC in our hospital. Confirmation of the diagnosis was made by urodynamic study (UDS) in another hospital. SCC procedure involved manual intra-vesical pressure assessment using a 12F Nelaton catheter. Cystometric parameter measurement taken in this study was detrusor pressure (cm H2O) done at regular intervals from baseline, throughout bladder filling phase and voiding/leaking phase. The relationship between detrusor pressure to bladder volume from initial bladder filling until voiding or leaking phase was recorded, analyzed and graph plotted. Maximum detrusor pressure (cm H2O) during bladder filling, voiding or leaking and the maximum cystometric capacity (mls) was recorded. RESULTS SCC was found to have 100% sensitivity, 50% specificity, 93.33% positive predictive value and 100% negative predictive value for neurogenic bladder diagnosis. Only 55.55% patients with SCC suspicion of detrusor sphincter dyssynergia (DSD) had comparable UDS findings. DISCUSSION The use of SCC may be considered for objective confirmation of neurogenic bladder diagnosis following spinal cord lesion in centers with limited access to UDS. However, we are not able to establish its clinical application for confirmation of DSD.
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Long-term clinical outcomes with the retropubic tension-free vaginal tape (TVT) procedure compared to Burch colposuspension for correcting stress urinary incontinence (SUI). Int Urogynecol J 2017; 28:1739-1746. [DOI: 10.1007/s00192-017-3345-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 02/27/2017] [Indexed: 02/05/2023]
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Barski D, Gerullis H, Ecke T, Yang J, Varga G, Boros M, Pintelon I, Timmermans JP, Otto T. Bladder Reconstruction with Human Amniotic Membrane in a Xenograft Rat Model: A Preclinical Study. Int J Med Sci 2017; 14:310-318. [PMID: 28553162 PMCID: PMC5436472 DOI: 10.7150/ijms.18127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/30/2017] [Indexed: 12/23/2022] Open
Abstract
Background: Human amniotic membranes (HAMs) are assumed to have a number of unique characteristics including durability, hypoallergenic and anti-inflammatory properties. Materials and Methods: Multilayer HAMs from caesarian sections were applied to repair defined bladder defects in male Sprague-Dawley rats. The animals were sacrificed at 7, 21 and 42 days after implantation. Bladder volume capacity after grafting was measured. Histological analyses were performed to asses a number of parameters including HAM degradation, inflammatory reaction, graft rejection and smooth muscle ingrowth. Results: One rat died from sepsis in the treated group. No severe complications or signs of leakage were observed. Bladder capacity did not change over time. The initially increased inflammation in the HAM group diminished significantly over time (p<0.05). No signs of HAM degradation were observed and smooth muscle staining increased over time. Conclusions: HAMs appear to be durable and hypoallergenic grafts. The assumed suitability for the reconstruction of urinary tract justifies further research on detailed immunological process in larger grafts.
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Affiliation(s)
| | - Holger Gerullis
- University Hospital for Urology, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Thorsten Ecke
- Department of Urology, Helios Hospital, Bad Saarow, Germany
| | - Jin Yang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Gabriella Varga
- Institute of Experimental Surgery, University of Szeged, Hungary
| | - Mihaly Boros
- Institute of Experimental Surgery, University of Szeged, Hungary
| | - Isabel Pintelon
- University of Antwerp, Laboratory of Cell Biology and Histology, Antwerp, Belgium
| | | | - Thomas Otto
- Department of Urology, Lukas Hospital Neuss, Germany
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How often does detrusor overactivity cause urinary leakage during a stress test in women with mixed urinary incontinence? Int Urogynecol J 2013; 24:1537-41. [DOI: 10.1007/s00192-013-2049-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
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Reproducibility of a cough and jump stress test for the evaluation of urinary incontinence. Int Urogynecol J 2012; 23:1449-53. [DOI: 10.1007/s00192-012-1733-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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Rajendra M, Han HC, Lee LC, Tseng LAA, Wong HF. Retrospective study on tension-free vaginal tape obturator (TVT-O). Int Urogynecol J 2011; 23:327-34. [PMID: 21892684 DOI: 10.1007/s00192-011-1552-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aim to report the 3-year outcome and complications of the tension-free vaginal tape obturator (TVT-O) in treating female stress urinary incontinence (SUI). METHODS Retrospective analysis for complications and outcome of surgery was performed in 419 women undergoing the TVT-O from 2004 to 2006. RESULTS Three patients (0.8%) with an isolated TVT-O had a blood loss of more than 200 ml. Two patients (0.5%) had bladder perforation. Out of 11 readmitted patients (2.6%), 10 were due to voiding difficulty. Six patients (1.4%) required tape loosening or division. Persistent pain occurred in 3.6% and erosion in 2.4% of patients. One hundred eighty-five patients (44.2%) came for follow-up at 3 years. The actual subjective and objective success rates were 89.7% and 99.9% at 3 years follow-up, respectively. With imputation, the 3-year subjective and objective success rates were 86.9% and 97.4%, respectively. CONCLUSIONS The TVT-O is effective in treating female SUI with minimal complications.
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Affiliation(s)
- Malathi Rajendra
- Obstetrics and Gynaecology Department, Selayang Hospital, Lebuhraya Kepong-Selayang, Batu Caves, 68100 Selangor, Malaysia.
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Wieslander CK. Clinical approach and office evaluation of the patient with pelvic floor dysfunction. Obstet Gynecol Clin North Am 2009; 36:445-62. [PMID: 19932409 DOI: 10.1016/j.ogc.2009.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pelvic floor disorders are common health issues for women and have a great impact on quality of life. These disorders can present with a wide spectrum of symptoms and anatomic defects. This article reviews the clinical approach and office evaluation of patients with pelvic floor disorders, including pelvic organ prolapse, urinary dysfunction, anal incontinence, sexual dysfunction, and pelvic pain. The goal of treatment is to provide as much symptom relief as possible. After education and counseling, patients may be candidates for non-surgical or surgical treatment, and expectant management.
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Affiliation(s)
- Cecilia K Wieslander
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095-1740, USA.
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Wyndaele JJ, THi HV, Pham BC, Kovindha A, Huong VT, Weerts E. The use of one-channel water cystometry in patients with a spinal cord lesion: practicalities, clinical value and limitations for the diagnosis of neurogenic bladder dysfunction. Spinal Cord 2008; 47:526-30. [PMID: 19104508 DOI: 10.1038/sc.2008.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Investigational technique evaluation. OBJECTIVE To evaluate the clinical value and limitations of one-channel cystometry as a method for urodynamic testing in patients with spinal cord lesion (SCL). SETTING Spinal Cord Injury Centers Asia. METHODS Protocol, equipment and practical performance of the one-channel cystometry as used in Ho Chi Minh City and Chiang Mai were studied. RESULTS One-channel cystometry permits to accurately evaluate bladder pressure development at constant filling speed. It shows detrusor muscle behaviour as detrusor overactivity and allows evaluating sensation of bladder filling. It can strongly suggest detrusor external sphincter dyssynergia. The need of bladder-relaxant drugs and their effectiveness can be evaluated. The major limitation is that the one pressure line will show changes of intravesical pressure independent of their cause, which makes a continuous thorough observation mandatory throughout the test. Other limitations are a filling rate higher than physiological and a filling solution at room temperature. As in more elaborate urodynamic testing, the observations do therefore not necessarily reflect the function of the lower urinary tract in daily life. CONCLUSION One-channel cystometry is easy to perform, cheap and clinically valid. The results need to be integrated in the overall knowledge of the patient's neurological situation. The method permits one to gather a lot of information on bladder function in persons with SCL. With proper interpretation and a clear understanding of the shortcomings, it is a good guide for bladder management. It is applicable everywhere.
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Affiliation(s)
- J J Wyndaele
- Urology, Faculty of Medicine University Antwerp, University Hospital Antwerp, Antwerp, Belgium.
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Ghoniem G, Stanford E, Kenton K, Achtari C, Goldberg R, Mascarenhas T, Parekh M, Tamussino K, Tosson S, Lose G, Petri E. Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J 2008; 19:5-33. [PMID: 18026681 PMCID: PMC2096636 DOI: 10.1007/s00192-007-0495-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 10/14/2007] [Indexed: 02/06/2023]
Affiliation(s)
- G Ghoniem
- Cleveland Clinic Florida, Weston, FL, USA.
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Chapple CR, Wein AJ, Artibani W, Brubaker L, Haab F, Heesakkers JP, Lightner D. A critical review of diagnostic criteria for evaluating patients with symptomatic stress urinary incontinence. BJU Int 2005; 95:327-34. [PMID: 15679788 DOI: 10.1111/j.1464-410x.2005.05293.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The first paper in this section is a review by several highly respected authors of diagnostic criteria for evaluating patients with symptomatic stress urinary incontinence, and is followed by a review of the role of urgency and its measurement in the overactive bladder symptom syndrome, with emphasis on current concepts and future prospects. These are two important papers, which point the reader in the direction of a greater understanding of these conditions. The concept of alpha-blockade before a trial without catheter after acute urinary retention is revisited by authors from the UK, who used tamsulosin in a randomized controlled trial. They found that it is appropriate to recommend tamsulosin for such use in this condition.
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Affiliation(s)
- Christopher R Chapple
- Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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Walter AJ, Thornton JA, Steele AC. Further characterization of the supine empty stress test for predicting low valsalva leak point pressures. Int Urogynecol J 2004; 15:298-301. [PMID: 15580414 DOI: 10.1007/s00192-004-1172-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2003] [Accepted: 04/25/2004] [Indexed: 12/01/2022]
Abstract
The aim of this study is to determine if the diagnostic accuracy of the supine empty stress test (SEST) differs depending on the volume of residual urine. We performed a review of all patients who were diagnosed with stress urinary incontinence (SUI) via multi-channel urodynamics including valsalva leak point determinations (VLPP). A SEST was performed and the residual urine recorded via catheterization. The test-specific indices of the SEST for the prediction of low VLPP (defined as <60 cm H(2)0) were determined for varying residual volumes. Ninety-nine patients were included. Regardless of residual volume, low sensitivities, specificities and positive predictive values were demonstrated. Sensitivity and positive predictive values were further reduced and negative predictive values were improved slightly with higher residual volume. The highest negative predictive value was 89% at a residual volume of greater than 10 mL. Residual urine volume has minimal impact on the utility of the SEST.
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Affiliation(s)
- Andrew J Walter
- Division of Urogynecology at Kaiser Permanente, Sacramento, CA, USA.
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Choe JM. Pubovaginal sling surgery without using abdominal leak point pressure: an outcomes analysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 539:467-80. [PMID: 15088923 DOI: 10.1007/978-1-4419-8889-8_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Jong M Choe
- Urodynamics and Continence Center, Division of Urology, University of Cincinnati Medical Center, OH 45267, USA
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Defreitas G, Zimmern P. The Role of Urodynamics in Women with Stress Urinary Incontinence. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1570-9124(03)00036-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Williams KS, Assassa RP, Smith N, Rippin C, Shaw C, Mayne C. Good practice in continence care: development of nurse-led service. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2002; 11:548-59. [PMID: 11979208 DOI: 10.12968/bjon.2002.11.8.10164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2002] [Indexed: 11/11/2022]
Abstract
The implementation of evidence-based interventions in clinical practice is often alluded to in the literature; however, the development of these interventions is rarely documented. Within continence care, there is a larger body of relevant literature on which primary clinical interventions can be based. The Leicestershire Medical Research Council (MRC) Incontinence Study is a series of inter-related studies exploring the epidemiology of urinary symptoms, including incontinence, and evaluating service provision and treatment options for these symptoms. This article describes one aspect of the Leicestershire study, namely the development of evidence-based intervention protocols for use in a new nurse-led continence service. This service is currently being evaluated in a randomised controlled trial.
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Hsu TH, Rackley RR, Appell RA. The supine stress test: a simple method to detect intrinsic urethral sphincter dysfunction. J Urol 1999; 162:460-3. [PMID: 10411057 DOI: 10.1016/s0022-5347(05)68589-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE A new clinical test for intrinsic urethral sphincter dysfunction is proposed and compared to abdominal leak point pressure determination by video urodynamics. MATERIALS AND METHODS Patients were prospectively included in the study if they had stress urinary incontinence symptoms and were to undergo video urodynamic testing. Patients with urinary tract infection, cystocele, rectocele and vaginal vault prolapse were excluded from study. A supine stress test using cough and Valsalva's maneuvers was performed after bladder filling to 200 ml. with sterile normal saline solution by gravity. Efflux of the bladder solution from the meatus coinciding with the cough or Valsalva maneuver indicated a positive clinical test. A video urodynamic study, including abdominal leak point pressure, was performed. Intrinsic urethral sphincter dysfunction was diagnosed if abdominal leak point pressure was less than 100 cm. water. Test indexes were calculated based on the results of the supine stress test and the abdominal leak point pressure measurements. RESULTS Results were positive in 30 of 41 consecutive patients and negative in 11. Using abdominal leak point pressure measurement, the supine stress test had 93.5% sensitivity, 90.0% specificity, 96.7% positive predictive value and 81.8% negative predictive value for detecting intrinsic urethral sphincter dysfunction. CONCLUSIONS The supine stress test is easy, quick and inexpensive, and a positive test is a reliable predictor of intrinsic urethral sphincter dysfunction. A negative test is highly correlated with the absence of intrinsic urethral sphincter dysfunction during video urodynamic testing. This test is more reliable in diagnosing intrinsic urethral sphincter dysfunction than other nonurodynamic tests reported in the literature. The supine stress test can be a useful supplement to cotton swab testing for urethral hypermobility in determining the appropriate management for stress urinary incontinence.
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Affiliation(s)
- T H Hsu
- Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA
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