Urethral Function (urethral + function)

Distribution by Scientific Domains

Selected Abstracts

Urodynamics, the supine empty bladder stress test, and incontinence severity,,

Charles W. Nager
Abstract Aims Determine whether urodynamic measures of urethral function [(valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), functional urethral length (FUL)] and the results of the supine empty bladder stress test (SEBST) correlate with each other and with subjective and objective measures of urinary incontinence (UI). Methods Data were collected preoperatively from subjects enrolled in a multicenter surgical trial of mid-urethral slings. Subjective measures included questionnaire scores from the Medical Epidemiological and Social Aspects of Aging Questionnaire, Urogenital Distress Inventory, and Incontinence Impact Questionnaire. Objective measures included a 24-hr pad weight test, incontinence episode frequency on a 3-day voiding diary, and a SEBST. Results Five hundred ninety-seven women enrolled. Three hundred seventy-two women had valid VLPP values; 539 had valid MUCP/FUL values. Subjective measures of severity had weak to moderate correlation with each other (r,=,0.25,0.43) and with objective measures of severity (r,=,,0.06 to 0.45). VLPP and MUCP had moderate correlation with each other (r,=,0.36, ,<,0.001). Urodynamic measures of urethral function had little or no correlation with subjective or objective measures of severity. Subjects with a positive SEBST had more subjective and objective severity measures compared to the negative SEBST group, but they did not have significantly different VLPP and MUCP values. Conclusions VLPP and MUCP have moderate correlation with each other, but each had little or no correlation with subjective or objective measures of severity or with the results of the SEBST. This data suggests that the urodynamic measures of urethral function are not related to subjective or objective measures of UI severity. Neurourol. Urodynam. 29:1306,1311, 2010. 2010 Wiley-Liss, Inc. [source]

Static single channel and multichannel water perfusion pressure profilometry in a bench model of a urethra,,

G.R. Hirst
Abstract Aims To determine the catheter perfusion and withdrawal rate which generate the most repeatable single (SCPP) and multichannel pressure profilometry (MCPP) profiles in a bench model. Methods A bench model using a urethral substitute was developed in which SCPP and MCPP were performed using the Brown,Wickham method. One single channel and four multichannel catheters were tested using seven withdrawal rates and three perfusion rates. Repeatability was determined using spread of mean profile pressure, cross-correlation, Bland,Altman statistic, and a one-tailed Student's t -statistic. An artificial urinary sphincter (AUS) model was constructed to create a predictable intraluminal profile. MCPP data were used to generate three-dimensional (3D) images of the pressures exerted by the AUS model. Results A withdrawal rate of 0.5,mm/sec and perfusion rate 1,ml/min produced the most repeatable SCPP profiles with a spread of mean profile pressure ,7,cmH2O. For MCPP, a 10,F 6-channel catheter using a withdrawal rate of 1,mm/sec and perfusion rate of 1,ml/min produced the most similar profiles (cross-correlation,=,0.99). However, the spread of MCPP was large (spread ,44,cmH2O per channel). Nevertheless MCPP was able to consistently demonstrate areas of high pressure as predicted by the AUS model. Conclusions MCPP was not repeatable and is an unreliable measure of urethral pressure. MCPP and 3D images do demonstrate directional differences predicted from the AUS model. These may be of use for qualitative understanding and appreciation of relative relationships if not actual forces within the urethra and have application in understanding urethral function in vivo. Neurourol. Urodynam. 29:1312,1319, 2010. 2010 Wiley-Liss, Inc. [source]

A clinicoanatomical study of the novel nerve fibers linked to stress urinary incontinence: The first morphological description of a nerve descending properly along the anterior vaginal wall

Susumu Yoshida
Abstract When performing anterior colporrhaphy for cystocele, most pelvic surgeons have not considered the neuroanatomy that contributes to urethral function. The aim of the study was to anatomically identify nerve fibers located in the anterior vagina associated with the pathogenesis of incontinence and pelvic organ prolapse. Anterior vaginal specimens were obtained from 17 female cadavers and 33 cases of clinical cystocele by anterior vaginal resection. The specimens were step-sectioned and stained with hematoxylin-eosin, S100 antibody, and tyrosine hydroxylase antibody. As a result, descending nerves 50,200 ,m in thickness were identified between the urethra and vagina. They were located more than 10 mm medially from a cluster of nerves found almost along the lateral edge of the vagina and stained with S100 and tyrosine hydroxylase antibody, originated from the cranial part of the pelvic plexus, and appeared to terminate at the urethral smooth muscles. The authors classified the density of S100 positive nerve fibers in the anterior vaginal wall obtained from clinically operated cases of cystocele into three grades (Grade 1, nothing or a few thin nerves less than 20 ,m in diameter; Grade 2, thick nerves more than 50 ,m in diameter and thin nerves; Grade 3, more than 3 thick nerves in one field at an objective magnification of 40). Mean urethral mobility (Q-tip) values (28.1 19.6) observed in the Grade 3 cases was significantly lower than those (50.0 27.4 and 59.4 19.9) in Grade 2 and Grade 1, respectively. In addition, the presence of preoperative or postoperative stress urinary incontinence in the cases of Grade 1 was significantly higher than those of the cases with S100 positive stained nerves. In conclusion, the novel nerve fibers immunohistochemically identified in the anterior vaginal wall are different from those of the common nervous system or the pelvic floor and are associated with the pathogenesis of urethral hypermobility. Clin. Anat. 20:300,306, 2007. 2006 Wiley-Liss, Inc. [source]

Is the Male Dog Comparable to Human?

A Histological Study of the Muscle Systems of the Lower Urinary Tract
Because of their superficial anatomical resemblance, the male dog seems to be suitable for studying the physiologic and pathological alterations of the bladder neck of human males. The present study was carried out to compare and contrast the muscular anatomy of the male dog lower urinary tract with that of humans. The complete lower urinary tract, including the surrounding organs (bulb of penis, prostate, rectum and musculature of the pelvic floor) were removed from adult and newborn male dogs and histologically processed using serial section technique. Based on our own histological investigations, three-dimensional (3D)-models of the anatomy of the lower urinary tract were constructed to depict the corresponding structures and the differences between the species. The results of this study confirm that the lower urinary tract of the male dog bears some anatomical resemblance (musculus detrusor vesicae, prostate, prostatic and membranous urethra) to man. As with human males, the two parts of the musculus sphincter urethrae (glaber and transversostriatus) are evident in the canine bladder neck. Nevertheless, considerable differences in formation of individual muscles should be noted. In male dogs, no separate anatomic entity can be identified as vesical or internal sphincter. The individual course of the ventral and lateral longitudinal musculature and of the circularly arranged smooth musculature of the urethra is different to that of humans. Differences in the anatomy of individual muscles of the bladder neck in the male dog and man suggest that physiological interpretations of urethral functions obtained in one species cannot be attributed without qualification to the other. [source]