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Biomedical subjects

G L Hosker

Publications and source records attributed to G L Hosker.

9 recordsLinked to original sources
PubMed1997

Urodynamic services, personnel and training in the United Kingdom.

OBJECTIVE: To audit the provision of urodynamic services in the UK, with particular emphasis on the personnel involved and the training they received. METHODS: A questionnaire was sent to 163 centres carrying out urodynamics in the UK asking for information on the department providing the service, the frequency of use, the number of patients investigated, professional training of the personnel and whether the personnel thought that the training was adequate. RESULTS: Most urodynamic facilities in the UK function on a part-time basis. Urodynamics are carried out by a variety of healthcare professionals but most are performed by doctors and nurses. Half the respondents considered the training to be inadequate. CONCLUSION: Consideration should be given to requiring a minimum standard of training for personnel carrying out urodynamics in the UK to ensure that a quality service is provided.

Delivery of Health Care↗
PubMed1993

Validation of a non-invasive radioisotope method of imaging ureteric urine transport.

Measurement of ureteric function has hitherto involved the use of invasive techniques. A non-invasive, radioisotope method of imaging and displaying individual ureteric boluses has been described, a refinement of which is used in this department. Each "spindle" displayed using this technique theoretically represents an individual ureteric bolus of urine, but the technique has never been validated in the normal ureter in either the experimental model or man. A porcine model was set up to allow simultaneous measurement of ureteric bolus transmission using the radioisotope (compressed image) method and by the accepted techniques of electromyography (EMG) and urine drop counting. The timing of each urinary bolus, as recorded by the different modalities was then compared. The results from 11 studies showed a significant correlation between the radioisotope and EMG methods (mean r = 1.00, P = 0.0003). There was a constant relationship between the part of the radioisotopic image representing the rear end of the bolus and the EMG complex (mean time difference = 5.32 +/- 1.067s), thus defining that part of the image representing the peristaltic contraction wave. There was a variable relationship between the EMG and the part of the image representing the leading edge of the bolus (mean time difference = 13.36 +/- 5.23s), emphasising that bolus length is variable, being dependent on bolus volume. The radioisotope "spindle" concurs with EMG activity in the porcine ureter. The compressed image technique is thus validated as a non-invasive method of demonstrating ureteric urine transport.

Animals↗
PubMed1990

Pelvic floor damage and childbirth: a neurophysiological study.

Ninety six nulliparous women were investigated to establish whether childbirth causes damage to the striated muscles and nerve supply of the pelvic floor. The techniques used were concentric needle electromyography (EMG), pudendal nerve conduction tests and assessment of pelvic floor contraction using a perineometer. There was EMG evidence of re-innervation in the pelvic floor muscles after vaginal delivery in 80% of those studied. Women who had a long active second stage of labour and heavier babies showed the most EMG evidence of nerve damage. Forceps delivery and perineal tears did not affect the degree of nerve damage seen. We conclude that vaginal delivery causes partial denervation of the pelvic floor (with consequent re-innervation) in most women having their first baby. In a few this is severe and is associated with urinary and faecal incontinence. For some it is likely to be the first step along a path leading to prolapse and/or stress incontinence.

Action Potentials↗
PubMed1989

The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study.

Single-fibre electromyography of the pubococcygeus muscle of the pelvic floor was performed in 69 asymptomatic women and 105 women with stress incontinence of urine or genitourinary prolapse or both. The results suggest that partial denervation of the pelvic floor with subsequent reinnervation is a normal accompaniment of ageing and is increased by childbirth. Women with stress incontinence of urine or genitourinary prolapse or both have a significant increase in denervation of the pelvic floor compared with asymptomatic women.

Adult↗
PubMed1989

The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women.

Conduction was studied in the terminal branches of the pudendal nerve in 42 women with normal urinary control and 87 women with stress incontinence of urine, genitourinary prolapse, or both. Women with stress incontinence of urine had delayed conduction to both the striated urethral muscle and the pelvic floor muscle, indicative of denervation injury. Women with normal urinary control and genitourinary prolapse had similar conduction times to the urethral sphincter striated muscle as normal women but clear evidence of denervation damage to the pelvic floor.

Female↗
PubMed1985

A uni-directional urethral force gauge.

Until now urethral transducers have had poor circumferential resolution and have been inadequate for assessing whether the forces closing the female urethra are equally distributed around its circumference or whether they are greater in some directions than others. This paper describes a urethral force gauge which is capable of measuring urethral occlusive forces in a uni-directional manner because it is sensitive to forces around only 20 degrees of the urethral circumference. The gauge comprises a sensor, utilising two semi-conductor strain gauges, mounted at the tip of a 14 F silicone rubber catheter. It has been used in the investigation of 232 female patients and has proved to be reliable and robust.

Biomechanical Phenomena↗
PubMed1985

The anisotropic nature of urethral occlusive forces.

A newly-developed unidirectional force gauge was used to demonstrate that the urethral occlusive forces are unequal around the circumference of the female urethra. In the proximal two-thirds of the urethra significantly greater forces are exerted in the anterior position compared with those exerted in the lateral and posterior positions. By contrast the occlusive forces in the distal third of the urethra are greater in the posterior and lateral positions than in the anterior position. These findings hold true for both women with normal and abnormal urinary control. Rotational variations have previously been reported but have been thought to be artefact due to catheter stiffness; this study shows that rotational variations are genuine and not due to artefact.

Female↗