PubMed Health⌕ Search

Biomedical subjects

G Lose

Publications and source records attributed to G Lose.

At least 19 recordsLinked to original sources
PubMed1996

Influence of pudendal nerve blockade on stress relaxation in the female urethra.

The urethral pressure decay following a sudden and sustained dilatation corresponds to stress relaxation. Urethral stress relaxation can be described by the equation Pt = Pequ + P alpha e-t/tau alpha + P beta e-t/tau beta, where Pt is the pressure at time t, Pequ is the equilibrium pressure after dilatation, P alpha and P beta are pressure decay, and tau alpha and tau beta are time constants. The time constants have previously proved independent of the way the dilatation is performed. The urethral stress relaxation obtained in 10 healthy women before and after pudendal nerve blockade was analysed by the mathematical model and the pressure parameters and time constants determined. The fast time constant, tau beta, was reduced by the nerve blockade, whereas tau alpha was unaffected, however, both P alpha and P beta were reduced. No single stress relaxation parameter can therefore be related to the muscle or the connective tissue components. The method may prove useful in the further evaluation of the closure function of the urethra with special reference to the pathophysiology of stress urinary incontinence.

Adult↗
PubMed1996

Assessment of lower urinary tract symptoms in women by a self-administered questionnaire: test-retest reliability.

A self-administered questionnaire assessing female lower urinary tract symptoms and their impact on quality of life is described and validated, on 56 females in six participating departments. The patients answered two identical questionnaires on separate occasions before treatment. Test-retest reliability of the questionnaire, correlation between the symptoms and their troublesomeness, and the reproducibility of this correlation were assessed. The percentage of mistakes in answers to each of the questions varied from 1.8% to 49.1%, mainly owing to missing answers in the item groups: appliances, sexual function and social activities. Test-retest showed a repeat frequency of 50.0%-91.0% for symptoms and 44.6%-82.1% for trouble. A highly significant positive correlation was found between symptoms and trouble, which was most pronounced for questions concerning pain and incontinence. This correlation was consistent within time. The primary validation of this questionnaire is good. Its relevance as a basis for medical priority and clinical decision making remains to be investigated.

Adolescent↗
PubMed1996

Pudendal nerve recovery after a non-instrumented vaginal delivery.

The aim of the study was to investigate pudendal nerve function after a non-instrumented vaginal delivery. Seventeen primiparae women who had had a non-instrumented vaginal delivery were examined 3-5 days and 3 months after delivery. At both assessments pudendal nerve terminal motor latency (PNTML) was measured. The PNTML was found to decrease significantly from 2.64 ms in the first few days after delivery to 1.95 ms 3 months after delivery (P = 0.00009). PNTML decreased in all but one of the 17 women during the observation period. Immediately after delivery 9 women (53%) had a pathological high PNTML value, which was normalized 3 months later in all but 1. It was concluded that pudendal nerve function is often impaired immediately after a non-instrumented vaginal delivery, but recovers in most women over a 3-month period.

Adult↗
PubMed1996

Anal and urinary incontinence in women with obstetric anal sphincter rupture.

OBJECTIVE: To assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence and to identify factors to predict women at risk. DESIGN: An observational study. SETTINGS: Departments of Obstetrics and Gynaecology and of Surgery D, Glostrup County University Hospital, Denmark. PARTICIPANTS: Ninety-four consecutive women who had sustained an obstetric anal sphincter rupture. INTERVENTIONS: Assessment of history, anal manometry, anal sphincter electromyography and pudendal nerve terminal motor latency at three months postpartum A questionnaire regarding anal and urinary incontinence was sent two to four years postpartum. MAIN OUTCOME MEASURES: The frequency of anal and urinary incontinence and risk factors for the development of incontinence. RESULTS: Thirty of 72 women (42%) who responded had anal incontinence two to four years postpartum; 23 (32%) had urinary incontinence and 13 (18%) had both urinary and anal incontinence. Overall, 40 of 72 women (56%) had incontinence symptoms. The occurrence of anal incontinence was associated with pudendal nerve terminal motor latencies of more than 2.0 ms, and the occurrence of urinary incontinence was associated with the degree of rupture, the use of vacuum extraction and previous presence of urinary incontinence. Seventeen women had subsequently undergone a vaginal delivery in relation to which four (24%) had aggravation of anal incontinence, and three (18%) had aggravation of urinary incontinence. Of the women with incontinence, 38% wanted treatment but only a few had sought medical advice. CONCLUSIONS: Obstetric anal sphincter rupture is associated with a risk of approximately 50% for developing either anal or urinary incontinence or both. The prediction of women at risk is difficult. Information and routine follow up of all women with obstetric anal sphincter rupture is mandatory.

Adolescent↗
PubMed1996

New disposable vaginal device (continence guard) in the treatment of female stress incontinence. Design, efficacy and short term safety.

BACKGROUND: To develop a new disposable vaginal device for use during the daytime, and test its efficacy and short-term safety in the treatment of stress incontinence. METHODS: The intravaginal support device was designed from polyurethane, a foam product with documented high tissue compatibility. It was tested in 26 women with the symptom of stress incontinence. Before and after one month's use of the device, a 24-hour home pad weighing test, uroflowmetry, postvoid residual urine and a 3-days voiding diary were made. A questionnaire about the subjective effect and adverse events was filled in. In vitro and in vivo microbiology testing were performed. RESULTS: Four women discontinued the treatment because of discomfort or difficulties in using the device. Out of 22 women who completed the study nine (41%) were subjectively cured of incontinence, ten (45%) improved while three (14%) claimed unchanged incontinence. With the device in place all had decreased leakage at the 24-hour pad weighing test and unchanged urodynamic tests. The subjective complaints were few, and no vaginal or urinary infections were found. All women whose condition both subjectively and objectively improved, (19/22) wanted to continue treatment with the device. CONCLUSIONS: The new disposable vaginal device is effective in alleviating the symptoms of stress incontinence. It is well accepted and safe.

Adult↗
PubMed1995

Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth.

AIM: To evaluate anal function after childbirth in 94 women in whom sphincter rupture occurred and in 19 control women. The findings of anorectal physiological assessment and history of childbirth were related to the presence of fecal incontinence. METHODS: Anal manometry and electromyography were performed the first days after childbirth and repeated 3 months post partum together with measurement of pudendal nerve terminal motor latency. RESULTS: Eighteen patients (19%) presented with incontinence. None of the controls developed fecal incontinence after delivery. Anal manometry showed that both incontinent and continent patients had decreased resting and squeeze pressures compared to control subjects (p < 0.005). No difference in anal electromyography was found between the three groups. Both anal manometry and electromyography showed a significant increase in pressure and activity respectively 3 months after delivery in patients and controls. Patients with pudendal nerve terminal motor latencies > 2.0 milliseconds had an increased risk of having fecal incontinence compared to patients with pudendal nerve terminal motor latencies < or = 2.0 milliseconds (odds ratio 2.18, p < 0.05). Fecal incontinence could not be related to the weight or head circumference of the infant. The manometric and electromyographic findings, the use of pudendal nerve block, the length of the second stage of labor, the depth of rupture or the use of vacuum extraction could not be related to either fecal incontinence or pudendal nerve function. CONCLUSION: The manometric findings indicated damage to the anal sphincter apparatus in both continent and incontinent patients. Decreased pudendal nerve function characterized incontinent women. Accurate prediction of fecal incontinence in women with obstetric anal sphincter rupture is not possible.

Adolescent↗
PubMed1995

The urethral resistance to rapid dilation: an analysis of the effect of autonomic receptor stimulation and blockade and of pudendal nerve blockade in healthy females.

The urethral closure function is based upon permanently as well as adjunctively acting closure forces during rest and stress episodes, respectively. During urine ingression intra- and peri-urethral structures are suddenly stretched resulting in a pressure response which strengthens the closure function by sustaining the resistance to dilatation of the urethra. A method for measurement of the resistance to rapid urethral dilatation was used to evaluate the influence of noradrenaline, prazosin, terbutaline, propranolol, carbachol, and atropine, as well as bilateral pudendal nerve blockades in 40 healthy women. The drugs caused no significant change in the urethral resistance to dilatation, whereas the pudendal blockade produced a significant (p < 0.05) reduction at the bladder neck and in the high pressure zone. Although a quantitative assessment of their contribution cannot be obtained from this study, it may be concluded that the striated muscles innervated by the pudendal nerve are of major importance for the urethral resistance to dilatation.

Adult↗
PubMed1994

[Electrostimulation of the pelvic floor muscles in urinary incontinence].

External electrical stimulation is a simple, noninvasive and inexpensive treatment modality, which is useful in the treatment of stress- and/or idiopathic urge incontinence. The mode of action arises from excitation of the pudendal nerves leading to direct and reflex contraction of pelvic floor muscles and a reflex inhibition of the detrusor. Treatment can be applied either as a weak long-term stimulation at home, as a short-term maximal stimulation in clinic, hospital or home treatment. Approximately 50%-75% of incontinent patients are either cured or improved and the adverse effects are sparse. Electrostimulation seems to be valuable in the treatment of incontinence.

Contraindications↗
PubMed1994

[Laparoscopic vaginal hysterectomy].

Laparoscopic assisted vaginal hysterectomy (LAVH) is a rather new operative procedure in Denmark. During the period 1.12.1992-28.02.1993 we performed ten LAVH. The procedure is described. The operations were performed with bipolar coagulation and subsequent cutting with scissors. The average operating time was two hours. The average uterine weight was 130 g and total average hospital stay was two 2.8 days. In one patient laparotomy had to be performed due to arterial bleeding close to the right ureter. One patient developed a postoperative haematoma with temporary stasis of the right ureter. Both patients recovered. Adequate laparoscopic training in humans and animals is mandatory before LAVH is performed. In the learning phase it is advisable that the uterine size does not exceed 200 g.

Adult↗
PubMed1994

Characterization of pressure changes in the lower urinary tract during coughing with special reference to the demands on the pressure recording equipment.

The exact demands on urodynamic equipment for measurement of coughs and cough associated pressure changes in the lower urinary tract have been analyzed from high-speed pressure recordings using a double microtip transducer and a storage oscilloscope. The equipment was tested in vitro by the step-test method. The natural frequency response was 175.6 Hz and the rise-time 2.5 ms, resulting in accurate measurements of frequencies up to about 60 Hz, which is way above the clinically measured frequencies. Four men and 2 women, all of whom were healthy volunteers, were examined in the supine position with an empty bladder. Pressures were measured in the bladder and in the external sphincter zone of the urethra. The spectral power density of the bladder and urethral pressures were calculated by Fourier analysis. The pressure changes in the urethra were in all volunteers equal to or slower than in the bladder. The analysis of the spectral power density showed that 99% of the pressure changes could be recorded with an instrument capable of recording 9 Hz frequencies, i.e., with a sampling rate of 18 Hz or more.

Adult↗
PubMed1994

The effect of pharmacological stimulation and blockade of autonomic receptors and of pudendal blockade on urethral stress relaxation in healthy women.

OBJECTIVE: To examine the influence of autonomic receptor stimulation and blockade (noradrenaline, prazosin, terbutaline, propranolol, carbachol and atropine), and of pudendal nerve blockade on urethral stress relaxation. SUBJECTS AND METHODS: Forty healthy women were evaluated. The stress relaxation parameter was defined as the relative rate of pressure decrease during a fixed period of time following a rapid dilatation of the urethra. The dilatation was performed by water-infusion into a small rubber cylinder placed in the urethra. RESULTS: The drugs did not affect stress relaxation significantly, whereas the pudendal blockade produced a significant change along the length of the urethra characterized by a faster pressure decay following dilatation. CONCLUSION: In women, stress relaxation in the urethra relies significantly on the pudendal nerve-innervated striated muscles.

Adult↗
PubMed1994

The effect of bilateral pudendal blockade on the adjunctive urethral closure forces in healthy females.

The effect of bilateral pudendal blockade on the urethral pressure and power generation during coughing and pelvic floor squeezing was evaluated in 10 healthy women. The measurements were carried out at the bladder neck, in the high pressure zone, and distally in the urethra before and after blockade. Strong adjunctive closure forces were demonstrated all along the urethra. They were significantly reduced by pudendal blockade except at the bladder neck during coughing. The results indicate that the pudendal innervated striated muscles contribute significantly to the adjunctively acting closure forces all along the female urethra, including the bladder neck. Some passive pressure transmission to the bladder neck seems to take place during stress episodes following pudendal blockade, but whether it occurs in healthy females remain uncertain. The findings following pudendal blockade, corroborate with those in stress incontinent women, and thereby support the concept that striated muscle weakness is of pathophysiological significance in stress urinary incontinence.

Adult↗
PubMed1994

Vesicovaginal fistulas: the transperitoneal repair revisited.

The experience in surgical repair of 18 complex vesicovaginal fistulas following abdominal hysterectomy is reviewed. The technique consisted in a transperitoneal approach and bivalving of the bladder. The fistulous tract was excised widely and the vagina closed transversely and the bladder longitudinally. In 10 patients, however, the bladder was closed in a Y-shaped fashion to avoid tension on the suture line. In 4 patients 5 ureters had to be reimplanted. There was one recurrence which was closed in a second attempt. For simple fistulas a simple vaginal approach is recommended. In complex fistulas including recurrences after vaginal repair a transperitoneal approach following the principles outlined will provide a high rate of success.

Adult↗