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Biomedical subjects

B Schuessler

Publications and source records attributed to B Schuessler.

At least 19 recordsLinked to original sources
PubMed2001

Pelvic muscle activity in nulliparous volunteers.

The aim of this study was to describe normal characteristics of spontaneous and voluntary pelvic muscle function in nulliparous healthy continent women and to assess the reaction of the pelvic floor to stress and fatigue. Ten nulliparous volunteers were recruited. Pelvic muscle strength was evaluated by palpation and perineal ultrasound. Kinesiological EMG and perineal ultrasound were performed to test for possible fatigue and to assess bladder neck mobility during coughing with a pre-contraction of the pelvic floor muscles. Bladder neck mobility did not increase after attempts to fatigue the pelvic floor muscles. Bladder neck descent was significantly less when the women were instructed to contract the pelvic floor muscles before coughing. The contraction of the pelvic floor muscles stabilizes the vesical neck in nulliparous women.

Adult↗
PubMed2001

Obstructed defecation caused by a cystourethrocele and mobile posterior vaginal wall: a case report.

Obstructed defecation may be caused by a rectocele and/or enterocele. Rectal wall procidentia may be due to an enterocele bulging into the rectum. Another cause of rectal procidentia resulting in obstructed defecation is presented. A 65-year-old woman complained of vaginal prolapse and incomplete bowel emptying. Pelvic examination revealed that a stage III anterior vaginal wall prolapse caused a mobile posterior vaginal wall to prolapse into the anal canal, resulting in rectal procidentia and subsequently in obstructed defecation. Careful assessment of all pelvic floor compartments is important to identify the cause of obstructed defecation, particularly in the absence of a rectocele.

Aged↗
PubMed2001

Abdominal sacrocolpopexy and anatomy and function of the posterior compartment.

OBJECTIVE: To assess the effect of abdominal sacrocolpopexy with obliteration of the pouch of Douglas on anatomy and function of the posterior compartment. METHODS: We prospectively studied 33 consecutive women with pelvic organ prolapse who had abdominal sacrocolpopexies [expanded polytetrafluoroethylene (Gore-Tex)] with pouch of Douglas obliterations and posterior extensions of mesh, using a standardized questionnaire, urodynamic studies, pelvic floor fluoroscopies, and vaginal-rectal examinations (Baden-Walker classification). Concomitant colpoperineorrhaphy was done if rectoceles remained at rectovaginal examination at the end of sacrocolpopexy. The goal was to correct rectoceles transabdominally. RESULTS: Thirty-one women returned for follow-up investigations after 12--48 months (mean 26 months). Mean age was 61 years (range 41--77 years). There was no recurrence of vaginal vault prolapse, enterocele, or anterior rectal wall prolapse. Among 28 preoperative rectoceles, 16 recurred (57%) and one occurred de novo. Defecation problems (outlet constipation) were present in 21 women (64%) preoperatively and persisted or were altered in 12 (57%) after sacrocolpopexy. Grade of rectocele was associated significantly with symptoms of outlet constipation preoperatively, but not postoperatively (P =.002). CONCLUSION: Abdominal sacrocolpopexy with obliteration of the pouch of Douglas and posterior extension of the mesh was effective for vaginal vault prolapse, enterocele, and anterior rectal wall procidentia, but not concomitant rectocele. Twenty-eight percent of women described altered defecation with stool stopping higher in the rectosigmoid colon ("high outlet constipation"), which might have been caused by denervation during rectal mobilization.

Adult↗
PubMed2001

Bladder neck mobility in continent nulliparous women.

OBJECTIVE: To evaluate the mobility of the vesical neck during coughing and valsalva in healthy nulliparous volunteers and to test the reliability of the technique applied. DESIGN: Clinical observational study. SETTING: Department of Obstetrics and Gynaecology, Cantonal Hospital Lucerne, Switzerland. POPULATION: Thirty-nine nulliparous volunteers. METHODS: Vesical neck motion was assessed with perineal ultrasound. Intra-abdominal pressure was controlled for with an intrarectal probe. Intra-rater reliability was evaluated. RESULTS: Vesical neck mobility was significantly lower during coughing (8 mm, SD 4 mm) than during valsalva (15 mm, SD 10 mm) (P < 0.005). Between individuals mobility varied from 4 mm to 32 mm during coughing and from 2 mm to 31 mm during valsalva. Test-retest-studies showed a maximum difference between to tests during coughing of 4 mm and during valsalva of 5 mm. CONCLUSION: The bladder neck is mobile in normal continent women and bladder neck mobility is lower during coughing than during Valsalva.

Adolescent↗
PubMed2000

The depth of the pouch of Douglas in nulliparous and parous women without genital prolapse and in patients with genital prolapse.

OBJECTIVES: This study was undertaken to assess the depth of the pouch of Douglas among nulliparous women and to compare it with those among parous women and patients with genital prolapse. STUDY DESIGN: The depth of the pouch of Douglas was measured in 22 nulliparous women and 28 parous women without genital prolapse and in 18 patients with prolapse of the posterior vaginal wall. RESULTS: The pouch of Douglas extended from 11% to 89% of the total vaginal length among nulliparous and parous women, without significant difference between these groups (mean, 49% and 45%, respectively). It was significantly deeper in patients with prolapse, ranging from 25% to 96% (mean, 72%). CONCLUSION: There is an extensive variation in the depth of the pouch of Douglas. A deep pouch of Douglas is frequently present in young nulliparous women and may increase the risk for development of a posterior vaginal wall prolapse.

Adult↗
PubMed1998

Myogenic changes of the levator ani muscle in premenopausal women: the impact of vaginal delivery and age.

The aim of this study was to evaluate the impact of parity and age on histomorphology of the pelvic floor muscles in female cadavers of reproductive age and to find out whether there is evidence of myogenic or neurogenic muscle injury. In a cross-sectional study 45 premenopausal unfixed and fresh female cadavers were studied. Four groups were defined: nulliparous and parous women under the age of 40 and over 40 years of age. The pelvic floor was biopsied at six standardized locations. For evaluation of the quantitative parameters and fiber type identification, actomyosin ATPase at pH 9.4 was used. For histomorphological evaluation, sections were stained with hematoxylin/eosin, van Gieson, and Gomori trichrome. The circumference of type I fibers is significantly larger in nulliparous women younger than 40 years compared to nulliparae older than 40 years. Comparing these groups, the form factor of type II fibers also increases significantly, presenting a more circular cell form. Compared to nulliparae, vaginal delivery led to a significant difference regarding the presence of centrally located nuclei, fibrosis, and variation in fiber diameter. In nulliparous women, these significant changes were also found with increasing age. In women with a history of vaginal delivery, no further increase in these characteristics could be detected with increasing age. Comparing the three different biopsy sites, all three changes were more pronounced in the ventral part. There was no evidence of grouped fiber atrophy, small angulated fibers, or type grouping in any of the biopsy specimens. Aging and vaginal childbirth lead to histomorphological changes of the pelvic floor muscle that are consistent with changes of myogenic origin. Evidence of neurogenic damage could not be demonstrated.

Adolescent↗
PubMed1997

Can simultaneous perineal sonography and urethrocystometry help explain urethral pressure variations?

OBJECTIVE: To correlate urodynamic with perineal sonographic findings in pressure variations. PATIENTS AND METHODS: In 15 women presenting with urethral pressure variations a urodynamic evaluation with water filling cystometry, urethral pressure at rest and during coughing and uroflowmetry were performed. During water filling cystometry, there were simultaneous perineal video-sonography and urethrocystometry. Video ultrasound images and urodynamic curves were simultaneously monitored on a computer screen. RESULTS: Simultaneous ultrasound and urodynamic evaluation in the 15 patients revealed movements in two areas leading to urethral pressure variations: activity of the pelvic floor muscles and of the urethral sphincter muscles. For the pelvic floor, we found either slow or fast contractions with, respectively, slow (15-30 cm H2O for 3-10 sec) or fast (30-130 cm H2O for 1-3 sec) urethral pressure changes. Urethral sphincter contractions were always fast, resulting in fast pressure changes of 30-170 cm H2O for 1-3 sec. CONCLUSION: Evaluation of simultaneous perineal sonography and urethrocystometry shows the association of urethral pressure variations and muscle activity. Urethral pressure variations are caused by the activity of urethral sphincter or pelvic floor muscles. With ultrasound the activity of the urethral sphincter muscle can directly be seen whereas pelvic floor muscle activity is indirectly visible. Pelvic floor muscle contractions are either fast or slow, whereas the urethral sphincter muscle contractions are always fast contractions.

Adolescent↗
PubMed1997

Exoanal ultrasound of the anal sphincter: normal anatomy and sphincter defects.

OBJECTIVE: To describe the sonographic appearance of normal anal sphincter anatomy and sphincter defects evaluated with a conventional 5 MHz convex transducer placed on the perineum. DESIGN: Prospective, single-blind study. SETTING: Department of Obstetrics and Gynecology, University of Michigan Medical Center, USA. POPULATION: Twenty-five women with symptoms of faecal incontinence, 11 asymptomatic nulliparous women, and 32 asymptomatic parous women. METHODS: A convex scanner was placed on the perineum with the woman in lithotomy position. Images were taken at three levels of the sphincter canal. Pictures were evaluated by two examiners who were blinded to the case history of the women and to the results of each other for the presence or absence of sphincter defects. MAIN OUTCOME MEASURES: Description of anal sphincter appearance on endoanal ultrasound. Reproducibility of the evaluation of sphincter defects. RESULTS: The internal anal sphincter is visible as a hypoechoic circle; the external anal sphincter shows a hyperechoic pattern. Proximally the sling of the puborectalis muscle is visible. Sphincter defects were detected in 20 women. In all five women who subsequently underwent surgery, the presence and location of the defect was confirmed at the time of surgery. Examiners were in agreement 100% of the time on the presence or absence of internal defects. They disagreed in one patient on the presence of an external defect. CONCLUSION: Exoanal ultrasound provides information on normal anatomy and on defects of the anal sphincter.

Adult↗
PubMed1997

Levator ani function before and after childbirth.

OBJECTIVE: To evaluate pelvic floor muscle strength before and after vaginal birth. DESIGN: Prospective repeated measures study. SETTING: Main district hospital. POPULATION: Fifty-five women: 25 primiparae and 20 multiparae following vaginal birth, and 10 women following elective caesarean delivery as a control group. METHODS: Pelvic muscle strength was evaluated by palpation, perineometry and perineal ultrasound before childbirth in the 36th to 42nd week of pregnancy, three to eight days postpartum and six to ten weeks postpartum. MAIN OUTCOME MEASURES: Pelvic floor muscle strength on palpation, intravaginal squeeze pressure and vesical neck elevation during squeeze. RESULTS: Pelvic floor muscle strength is significantly reduced three to eight days postpartum in women following vaginal birth but not in women after caesarean delivery. Six to ten weeks later palpation and vesical neck elevation on perineal ultrasound do not show any significant differences to antepartum values, while intravaginal pressure on perineometry remains significantly lower in primiparae, but not in multiparae. CONCLUSIONS: Pelvic floor muscle strength is impaired shortly after vaginal birth, but for most women returns within two months.

Adult↗
PubMed1996

Changes in vesical neck mobility following vaginal delivery.

OBJECTIVE: To assess changes in urethral movement during the Valsalva maneuver and pelvic floor muscle contraction following vaginal delivery. METHODS: In a prospective repeated-measures study, 25 primigravidas, 20 multiparas, and ten women who were to have elective cesarean delivery were examined sonographically at 36-42 weeks of pregnancy and 6-10 weeks after delivery. Vesical neck position at rest and excursion during Valsalva maneuver and maximum pelvic muscle contraction were measured with perineal ultrasound. Data about resting bladder neck position and bladder neck elevation at contraction were compared with findings in age-matched nulligravid volunteers. RESULTS: The bladder neck was significantly lower at rest in women after vaginal delivery than in those who had an elective cesarean delivery and in nulligravid controls. Bladder neck mobility had increased during the Valsalva maneuver in 16 of 25 primigravidas and 15 of 20 multiparas 6-10 weeks after vaginal delivery. The ability to elevate the vesical neck during pelvic muscle contraction was decreased in six of 25 primigravidas and in two of 20 multiparas 6-10 weeks after birth. Two women, one primigravid and one para 2 (with a previous elective cesarean delivery), both of whom had forceps delivery, completely lost the ability to contract voluntarily the pelvic floor muscles. CONCLUSION: Vaginal delivery alters vesical neck descent during the Valsalva maneuver, and the ability of the pelvic muscles to elevate the urethra in some women.

Adult↗
PubMed1996

Usefulness of ultrasound contrast medium in perineal sonography for visualization of bladder neck funneling--first observations.

OBJECTIVES: To assess the efficacy of ultrasound medium when imaging bladder neck anatomy with perineal ultrasound. METHODS: In 10 female patients with urinary stress or stress-urge incontinence, a new echogenic contrast medium (Echovist) was intravesically administered and perineal ultrasound performed. The examination was done with the women in the upright position both without and with ultrasound contrast medium at rest and during pressing, and the pictures of the bladder base, bladder neck, and urethra were compared. RESULTS: With the patient in the upright position, the ultrasound contrast medium enters the urethra during pressing and bladder neck funneling is identified more accurately than without contrast medium. With Echovist, bladder neck funneling was detected in 9 of the 10 cases but without it in only 4 cases. CONCLUSIONS: The use of ultrasound contrast medium results in a better visualization of the bladder neck anatomy. Bladder neck funneling and urinary leakage are seen more distinctly, and this improves the diagnostic reliability in female urinary stress incontinence. This pilot study supports the necessity for further investigations in the use of ultrasound contrast medium as a diagnostic improvement of perineal ultrasound.

Contrast Media↗
PubMed1996

Perineal ultrasound: determination of reliable examination procedures.

This is a report on the fundamentals of perineal ultrasound examination for female incontinence. The measurement method described here enabled us to determine the position of the bladder neck, the size of the retrovesical angle beta and the occurrence of funnelling. In four different investigations, each involving at least 30 patients, we investigated the influence of examination position, bladder filling volume and pressure of the ultrasound probe against the perineum on these measurements and analyzed the difference between coughing and the Valsalva maneuver. The results showed that when the patient is standing, the bladder neck is lower than when the patient is supine. We also observed that excessive pressure on the ultrasound probe displaces the bladder neck cranially and can squeeze the urethra. Increasing the bladder filling volume does not affect the measurement values, but funnelling can be seen better with higher bladder volumes. The best overall image quality was obtained at 300 ml. A comparison between coughing and the Valsalva maneuver showed that during coughing, the bladder neck descends less and remains closer to the symphysis than with the Valsalva maneuver.

Cough↗
PubMed1995

Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence.

OBJECTIVE: To assess the reproducibility of a new method for evaluation of the bladder neck with perineal ultrasound and to compare it with lateral chain urethrocystography. METHODS: In the first phase, two investigators examined 40 patients using perineal ultrasound to assess the reproducibility of a new measurement method for the determination of the bladder neck position. In the second phase, 60 patients were evaluated by perineal ultrasound and lateral chain urethrocystography. RESULTS: With perineal ultrasound, there was good interexaminer agreement for determining bladder neck position, funneling, and bladder neck descent at rest and during the Valsalva maneuver, but not for the posterior angle beta during straining. Comparison of sonographic and x-ray assessments showed good agreement for the bladder neck position at rest, but not during Valsalva, whereas the posterior angle, funneling, and bladder base descent differed between the two techniques at rest as well as during Valsalva. CONCLUSION: With our new method for determining the position of the bladder neck, perineal ultrasound is a reliable technique that allows reproducible static and dynamic evaluation. Lateral chain urethrocystography is superior to perineal ultrasound only if bladder neck funneling is the aim of the evaluation; it is inferior if bladder neck mobility during maximal Valsalva is being investigated.

Female↗
PubMed1995

Improvement of perineal sonographic bladder neck imaging with ultrasound contrast medium.

OBJECTIVE: To assess the efficacy of ultrasound contrast medium when imaging bladder neck anatomy in perineal ultrasound. METHODS: In 39 women with clinically and urodynamically proven urinary stress or stress-urge incontinence, a new echogenic contrast medium (Echovist) was administered transurethrally and perineal ultrasound was performed. Women were examined in the upright position both without and with ultrasound contrast medium at rest and during Valsalva maneuver, and the pictures of the bladder base, bladder neck, and urethra were compared. RESULTS: With the subject in the upright position, the contrast medium lay at the lowest point of the bladder and resulted in a reverse picture of the bladder base and bladder neck and clear visualization of these structures. In women with urinary stress incontinence, the ultrasound contrast medium entered the urethra during Valsalva, and bladder neck funneling was identified more accurately than without contrast medium. With Echovist, bladder neck funneling was detected in 38 of the 39 cases, compared with only 19 when it was not used. Furthermore, when the bladder neck, urethra, or bladder base were not visible with plain perineal ultrasound, they were seen when ultrasound contrast medium was used. The contrast agent was well tolerated, and there were no adverse side effects. CONCLUSION: The use of ultrasound contrast medium improves visualization of the bladder neck anatomy. Bladder neck funneling and urinary leakage are seen more distinctly, and this improves the diagnostic reliability in female urinary stress incontinence.

Adult↗
PubMed1981

Induction of abortion with sulprostone, a uteroselective prostaglandin E2 derivative: intramuscular route of application.

Sulprostone, a new prostaglandin E2-derivative, with high selectivity for the uterine muscle, was tested in 180 women (62 primigravidae) for induction of abortion in the first trimester of pregnancy by intramuscular administration. Total dosages from 500 to 1,500 mcg in single injections of 500 mcg were tested. The injections were given at intervals of 4 to 8 hours. Adequate cervical dilatation was achieved in nearly 94% of the patients with complete abortion in more than 50%. No sulprostone-related complications such as shock or cramps were registered. Side effects were at a tolerable level with concomitant medication being necessary for about one-third of the patients. Optimal effectiveness and acceptability were recorded, at an injection interval of 6 to 8 h and a total dose of 1,000 mcg sulprostone. The application of sulprostone as abortifacient in first trimester pregnancy is discussed.

Abortifacient Agents↗