Urethral Pressure (urethral + pressure)

Distribution by Scientific Domains

Selected Abstracts

Non-neurogenic urinary retention (Fowler's syndrome) in two sisters

Simon Podnar
Abstract Aims To report for the first time occurrence of obstructed voiding due to excessive activity of the urethral sphincter (US) muscle in two sisters with polycystic ovaries (Fowler's syndrome). Methods In both patients precise micturition history was obtained. In addition, clinical neurological and gynecological examinations, cystometry, urethral pressure profile measurements, gynecological ultrasound, measurement of gonadotropic hormone levels, and concentric needle electromyography (EMG) of the US muscle were performed. Results Both sisters reported symptoms of severely obstructed voiding. Clinical examination, and filling cystometries were normal. Urethral pressures were increased (99,134 cm water). The first sister was not able to void, and the urinary flow was slow and intermittent in the second on voiding studies. Profuse complex repetitive discharges and decelerating burst activity were found on concentric needle EMG of the US in both of them. Both sisters had increased LH/FSH ratio (2.96 and 2.64), and ultrasonographic abnormalities compatible with polycystic ovaries. Conclusions Diagnosis of Fowler's syndrome was made in both sisters. Due to very low incidence rate of this syndrome (0.2/100.000 per year), we think that it is highly unlikely to find it in two sisters just by chance. We suggest that the probable explanation is a genetic predisposition to polycystic ovaries, with which this condition has been shown to be associated. Neurourol. Urodynam. 25:739,741, 2006. 2006 Wiley-Liss, Inc. [source]

Decrease in urethral pressure following repeated cough efforts: A new concept for pathophysiology of stress urinary incontinence

Xavier Deffieux
Aims: To describe the decrease in maximum urethral closure pressure (MUCP) following repeated coughs in women with stress urinary incontinence (SUI). Methods: MUCP was recorded at rest and after seven cough efforts in 70 women under age 40 referred for urodynamic investigation (47 women with SUI and 23 women without SUI). Results: The intraclass correlation coefficient for repeatability was very good at 400 mL filling volume: 0.94 (95%CI: 0.85,0.98), as compared to the mean and standard-deviations of the MUCP measurements. A decrease in MUCP >20% after seven cough efforts was observed in 18(38%) patients in the SUI group and in just 1(4%) woman in the non-SUI group (P = 0.0069). Conclusions: Many women with SUI exhibit a sharp decrease in MUCP after repeated coughs. Many hypotheses may explain this phenomenon, including increased fatigue of the periurethral muscles. [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]

Changes in bladder neck geometry and closure pressure after midurethral anchoring suggest a musculoelastic mechanism activates closure

Peter Petros
Abstract Aims The aim of this study was to investigate the anatomical origins and clinical significance of cough pressure transmission ratio (CTR) by using virtual-operation (VO) techniques. Methods Thirty-four patients underwent perineal ultrasound examination, standard urethral pressure cough testing both with and without unilateral midurethral anchoring (VO), all tests being performed without urethral elevation. In eight patients where there was no change in CTR, a one-sided fold of suburethral vagina (VO) was taken (pinch test) and the CTR repeated. Results After midurethral anchoring, maximal urethral pressure increased from a mean of 33.25 cm H2O to a mean of 58.06 cm H2O (P,<,0.0001) and restoration of anatomy was noted in all 11 patients who had obvious funneling on straining. Conversion of a <100% CTR to >100% CTR in the proximal urethra was observed in 14 of 22 patients (P,<,0.005), with no significant change noted in the distal urethra. Further conversion of CTR was noted in six of the remaining eight patients with unilateral plication of suburethral vagina (pinch test). Conclusions A musculoelastic closure mechanism most likely activates urethral closure. CTR is most likely an index of changed intraurethral area, not necessarily closure, and may be a more sensitive objective test than perineal ultrasound for diagnosing urethral narrowing, especially when used with virtual-operation techniques. Neurourol. Urodynam. 22:191,197, 2003. 2003 Wiley-Liss, Inc. [source]

Assessment of the intrinsic urethral sphincter component function in postprostatectomy urinary incontinence

Christian Pfister
Abstract Postprostatectomy incontinence remains a disabling condition. Sphincter injury, detrusor instability, and decreased bladder compliance have been previously reported as major factors. The aim of this study was to evaluate the urethral sphincter intrinsic component, which may provide passive continence. A urodynamic evaluation was performed in 20 patients undergoing a radical retropubic prostatectomy in the preoperative period and 3 months after surgery. Patients with disabled urinary incontinence underwent a new urodynamic evaluation 6 months later. The urethral pressure profile was measured just before, then 10, 20, and 30 minutes after the injection of 0.5 mg/kg moxisylyte chlorhydrate, an alpha adrenergic blocker. Three different pressure components were defined in urethral sphincter capacity: baseline, adrenergic, and voluntary. A postoperative intrinsic urethral sphincter pressure component was found in 17 patients and its value was under 6 cm H2O in five cases of severe incontinence. No significant difference was observed for these patients on urethral profile components 6 months later. In contrast, in cases of significant intrinsic component value, no incontinence was observed in most patients. Passive continence after radical prostatectomy should be a matter of concern and may also explain paradoxical incontinence, despite high voluntary urethral pressure obtained after reeducation. A follow-up evaluation of the intrinsic sphincter component is suggested, by using an alpha receptor blockage test during urodynamic studies in the management of patients with postprostatectomy incontinence. Neurourol. Urodynam. 21:194,197, 2002. 2002 Wiley-Liss, Inc. [source]