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Biomedical subjects

Gunnar Lose

Publications and source records attributed to Gunnar Lose.

At least 19 recordsLinked to original sources
PubMed2007

Urethral pressure reflectometry; a novel technique for simultaneous recording of pressure and cross-sectional area in the female urethra.

AIMS: Urethral pressure reflectometry (UPR) is a new and easily applicable technique for simultaneous measurements of cross-sectional area (CA) and pressure in the urethra. CAs of 1-16 mm(2) and pressures of 0-200 cm H(2)O can be measured along the entire urethra in the same setting. The method is reliable in vitro. The aim was to present the method and some clinical results from the female urethra. METHODS: A very thin polyurethane-bag was placed in the urethra. A pump applied preselected pressures stepwise to the bag. For every step the CA was measured by acoustic reflectometry. Measurements were made both during inflation and deflation. The women were examined in different positions and with different provocations. RESULTS: UPR was easy to perform. The obtained parameters were opening pressure, closing pressure, elastance of the opening curve and closing curve, and hysteresis. CONCLUSIONS: UPR is feasible for measuring urethral pressure and corresponding CA. The technique is minimally invasive and with minimal impact on the urethra per se. The technique provides physiological sound parameters which add potentially important physiological/pathophysiological information about the urethra to what can be obtained on the basis of conventional urodynamic work-up. Further studies are needed to prove if this new method is useful for clinical and research purposes.

Aged↗
PubMed2006

Prevalence and bother of nocturia, and causes of sleep interruption in a Danish population of men and women aged 60-80 years.

OBJECTIVE: To study the prevalence and bother of nocturia, and sleep interruptions in an unselected population of Danish men and women aged 60-80 years. SUBJECTS AND METHODS: A postal questionnaire was sent to 2000 women and 2000 men aged 60, 65, 70, 75, and 80 years. The population was selected at random from The Danish Civil Registration System, in which every person living in Denmark is identified. The Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire (NNES-Q) was used to evaluate nocturia and bother, and sleep interruptions. Nocturia was defined as waking at night to void, according to the International Continence Society definition. RESULTS: In all, 92% (3664) subjects returned the questionnaire; 71% completed the questionnaire satisfactorily and were included in the study. The prevalence of nocturia increased with age. The overall prevalence of nocturia was 77% and there was no difference between men and women (P = 0.11), but men had slightly more severe nocturia than women. The bother caused by nocturia in men and women increased with the severity of nocturia, and women were slightly more bothered than men when the degree of nocturia was >2 voids/night. Nocturia was the most frequent self-reported reason for waking at night, followed by thirst. CONCLUSION: The prevalence of nocturia increased with age. There was no difference between the genders in the overall prevalence of nocturia, but nocturia of > or = 2 voids/night was more frequent in men. The degree of bother increased with the severity of nocturia, even after correcting for generic quality of life, and the younger groups were the most bothered. Nocturia was the major reason for waking at night, followed by thirst.

Aged↗
PubMed2006

Transvaginal repair of enterocele and vaginal vault prolapse using autologous fascia lata graft.

BACKGROUND: The aim was to describe the operative technique of transvaginal repair of enterocele and apical prolapse using autologous fascia lata and report intra- and postoperative complications and long-term outcome. METHODS: A retrospective chart review of 74 consecutive patients who had repair of a symptomatic enterocele and vaginal vault prolapse or uterine prolapse from January 1987 to August 1999. All patients were followed for a minimum of 3 months and 61 were available for long-term evaluation at 18-106 months (median 52 months). RESULTS: Intra- and postoperative complications were few. Pelvic examination at long-term follow-up disclosed a recurrence rate for enterocele of 1.7%, vaginal vault prolapse of 8.3%, and cystocele of 15%. Ninety-one per cent were subjectively satisfied with the relief of mechanical vaginal symptoms. Only 35% (6/17) were cured of constipation. Out of the 22 women who were sexually active after the procedure, 12 (54%) experienced improved quality. CONCLUSION: Repair of the posterior compartment defect and suspension of the vaginal vault using autologous fascia lata graft provides acceptable intra- and postoperative complication and long-term results.

Adult↗
PubMed2006

Risk of stress urinary incontinence twelve years after the first pregnancy and delivery.

OBJECTIVE: To estimate the impact of onset of stress urinary incontinence in first pregnancy or postpartum period, for the risk of symptoms 12 years after the first delivery. METHODS: In a longitudinal cohort study, 241 women answered validated questions about stress urinary incontinence after first delivery and 12 years later. RESULTS: Twelve years after first delivery the prevalence of stress urinary incontinence was 42% (102 of 241). The 12-year incidence was 30% (44 of 146). The prevalence of stress urinary incontinence 12 years after first pregnancy and delivery was significantly higher (P<.01) in women with onset during first pregnancy (56%, 37 of 66) and in women with onset shortly after delivery (78%, 14 of 18) compared with those without initial symptoms (30%, 44 of 146). In 70 women who had onset of symptoms during first pregnancy or shortly after the delivery but remission 3 months postpartum, a total of 40 (57%) had stress urinary incontinence 12 years later. In 11 women with onset of symptoms during the first pregnancy or shortly after delivery but no remission 3 months postpartum, a total of 10 (91%) had stress urinary incontinence 12 years later. Cesarean during first delivery was significantly associated with a lower risk of incontinence. Other obstetric factors were not significantly associated with the risk of incontinence 12 years later. Patients who were overweight before their first pregnancy were at increased risk. CONCLUSION: Onset of stress urinary incontinence during first pregnancy or puerperal period carries an increased risk of long-lasting symptoms.

Adolescent↗
PubMed2006

A new bulking agent (polyacrylamide hydrogel) for treating stress urinary incontinence in women.

OBJECTIVE: To evaluate the efficacy and safety of a transurethral injection with polyacrylamide hydrogel (PAHG) for treating stress urinary incontinence (SUI) in women. PATIENTS AND METHODS: The study comprised 17 women with pure SUI and eight with mixed incontinence (age range 35-84 years). Between November 2001 and November 2003, the women were injected into the urethral wall with a PAHG (Aquamid, Contura International A/S, Denmark), a homogenous, highly biocompatible, atoxic, nonresorbable sterile watery gel consisting of approximately 2.5% cross-linked polyacrylamide and 97.5% nonpyrogenic water. The women were followed prospectively (assessed at 1, 3 and 12 months after treatment) and their clinical outcome documented. RESULTS: Four women did not complete the study, and of the remainder, eight (38%) were subjectively dry and a further nine (43%) improved. Objectively, urine leakage/24 h was decreased by 93% and the number of incontinence episodes by 87%. Quality-of-life measures improved significantly in all domains other than general health perception. There were no significant changes of urodynamic variables. Treatment-related adverse events were recorded in 16 women. Urinary tract infection (10 cases) and urinary retention (five cases) were most common. There were no injection site reactions. CONCLUSION: PAGH seems to be a promising new bulking agent for the treatment of SUI.

Acrylic Resins↗
PubMed2005

Sexual activity and lower urinary tract symptoms.

Lower urinary tract symptoms (LUTS) have a profound impact on women's physical, social, and sexual well being. The LUTS are likely to affect sexual activity. Conversely, sexual activity may affect the occurrence of LUTS. The aims of the study were to elucidate to which extent LUTS affect sexual function and to which extent sexual function affect LUTS in an unselected population of middle-aged women in 1 year. A questionnaire was sent to 4,000 unselected women aged 40-60 years. All 2,284 women (57.1%) who completed a baseline questionnaire and a similar questionnaire 1-year later were included. Data comprised age, occurrence of LUTS, hormonal status, and sexual activity. A multiple conditional logistic regression model was used to analyze the relationship between sexual activity and LUTS adjusted for age and hormonal status. At baseline and 1-year later, 49 women (2.2%) had no sexual intercourse, and 298 women (13.0%) either ceased or resumed sexual relationship. Compared to women having sexual relationship, a statistically significant three to sixfold higher prevalence of LUTS was observed in women with no sexual relationship. In women who ceased sexual relationship an increase, although not statistically significant, in the de novo occurrence of most LUTS was observed. In women who resumed sexual relationship an insignificantly decrease in LUTS was observed. In women whose sexual activity was unchanged no change in the occurrence of LUTS was observed. Our study confirms a close association between sexual activity and the occurrence of LUTS. A hypothesis that sexual inactivity may lead to LUTS and vice versa cannot be rejected.

Adult↗
PubMed2005

Pressure reflectometry: in vitro recordings with a new technique for simultaneous measurement of cross-sectional area and pressure in a collapsible tube.

Pressure reflectometry is a new and easily applicable technique for simultaneous measurement of cross-sectional area and pressure in a collapsible biological tube. Related values of pressure and cross-sectional area are relevant for assessment of the mechanical properties of a biological tube. A very thin and highly flexible 6 cm long polyurethane bag with a diameter of 5 mm when expanded was introduced into test models. The cross-sectional area of the first 6 cm of the cavities up to 16 mm(2) (depending of the size of the bag) can be measured at the same time. The cross-sectional area was measured by acoustic reflectometry while pressures of 10-200 cmH(2)O were applied by a pump. The echoes from the cavity were analyzed and displayed by a computer technique. The aim of the study was to evaluate the technical capabilities and limitations of this new method. The accuracy and reproducibility were examined in eight different models with known cross-sectional areas in the interval of 4-16 mm(2). Two of the models had two successive constrictions reducing the cavity to 50% and 25% respectively. Measurements were reliable from about 1 to 5 cm within the cavity and at pressures from 10 to 200 cmH(2)O. The absolute error in models without constrictions did not exceed 0.9 mm(2) and at the first constriction the error did not exceed 1.2 mm(2). In cavities without constrictions, the coefficients of variation (CVs) were 0.2-11%. In models with constrictions the CVs were 6-25% at the first constriction when different pressures were applied to the plastic bag. The reproducibility was not influenced significantly by change in background noise, temperature, catheters, geometries of the cavities or new calibration. In conclusion, the accuracy of this new technique depends on the size of the measured cavity, on the pressure in the models and whether the model has constrictions or not. The measurements seem reliable for clinical use in the range of 4-16 mm(2) and at pressures from 10 to 200 cmH(2)O.

Acoustics↗
PubMed2004

A systematic review of the effects of estrogens for symptoms suggestive of overactive bladder.

OBJECTIVE: To perform a systematic review of the effects of estrogen therapy on symptoms suggestive of overactive bladder (OAB) in postmenopausal women. MATERIALS AND METHODS: This analysis involved a literature review of Medline, Excerpta Medica, and the Science Citation Index and a manual search of popular urology, gynecology, gerontology, and primary care medicine journals from January 1969 to December 1999. Articles had to include estrogen and placebo treatment groups, published or original data presented at a scientific meeting and report symptoms suggestive of OAB. This search identified 11 randomized trials and included a total of 430 subjects. Thirty-six subjects who participated in two crossover studies received both estrogen and placebo and thus are counted twice, therefore 236 received estrogen therapy and 230 were placebo controls. Estrogen was administered systemically or locally as estriol, estradiol, conjugated estrogen, or estradiol and estriol. A meta-analysis of these studies was performed for all estrogen therapies and then separately for systemic and local therapies. RESULTS: Overall, estrogen therapies were associated with statistically significant improvements in all outcome variables: diurnal frequency (P = 0.0011), nocturnal frequency (P = 0.0371), urgency (P = 0.0425), number of incontinence episodes (P = 0.0002), first sensation to void (P = 0.0001), and bladder capacity (P = 0.0018). Local therapies had statistically significant beneficial effects on all outcome variables. However, systemic therapies were only associated with significant improvements in incontinence episodes and first sensation to void while nocturnal frequency actually worsened. CONCLUSION: Estrogen therapy may be effective in alleviating the symptoms suggestive of OAB. Local administration may be the most beneficial route of administration.

Cross-Over Studies↗
PubMed2003

Motor evoked potentials from the striated urethral sphincter: a comparison of concentric needle and surface electrodes.

AIMS: The aim of this study is to compare two different surface electrodes (intravaginal and intraurethral) with the concentric needle as a criterion standard and concomitant testing of the levator ani as a potential contaminator. METHODS: Thirty healthy women with a mean age of 52 years. Bland-Altman plots were used to compare recorded latencies from the various electrodes and muscles. RESULTS: There was no significant difference between the latencies recorded with the various electrodes from either muscle, but the limits of agreement were wide. However, the concentric needle electrodes proved more reliable with a higher rate of reproducible responses. CONCLUSIONS: We did not encounter major difficulties in using the concentric needle electrode for recordings in the external urethral sphincter, and this electrode was also more reliable than either surface electrode. Therefore, we advocate the use of concentric needle electrodes in future studies.

Adult↗
PubMed2003

Motor evoked potentials from the striated urethral sphincter and puborectal muscle: normative values.

AIMS: Transcranial magnetic stimulation enables the study of corticospinal motor pathways through evoked potential testing. By separate stimulation of cortical centers and spinal roots, it is possible to test motor conduction times segmentally. This method enables the localization of central or peripheral demyelinating neuropathies. As lower urinary tract dysfunction often accompanies these diseases, we wanted to present normative data for the motor innervation of the external urethral sphincter (EUS) and the puborectal muscle (PR). METHODS: Thirty healthy women without evidence of neurologic or lower urinary diseases were studied. They had a mean age of 52 years. Transcutaneous magnetic stimulations were applied to the vertex, the upper lumbar spine, and the sacrum. Evoked potentials were recorded with concentric needle electrodes placed in the EUS and the PR by a transvaginal route. Stimulations were performed with relaxed pelvic floor and with tonic contraction (facilitated responses). At least three responses were recorded for each modality. Stepwise multiple regression analysis was performed to test for the effect of age, height, body mass index, vaginal parity, and menopause. RESULTS: In some subjects, it was only possible to record cortical latencies with facilitation. Technical difficulties were encountered with spinal stimulations. Reference values are presented as means with 95% confidence intervals. Regression analysis revealed height as a dependent factor for sacral latencies. CONCLUSIONS: Our data can serve as reference values for future studies of the fast conducting fibers in patients with sphincter dysfunction. The height of the patient should be taken into account. The clinical applicability of the method is questionable.

Adult↗
PubMed2003

Motor evoked potentials from the striated urethral sphincter and puborectal muscle: reproducibility of latencies.

OBJECTIVE: Transcranial magnetic stimulation can be used to test the motor efferents to the pelvic floor muscles. The aim of the present study was to assess the long-term test-retest reproducibility of pelvic floor MEPs. METHODS: Eighteen healthy women without evidence of neurological or lower urinary diseases had serial measurements of pelvic floor MEPs with a mean test-retest interval of 39 weeks. Cortical and spinal transcutaneous magnetic stimulations were applied. Evoked potentials were recorded with concentric needle electrodes placed in the striated urethral sphincter and the puborectal muscle by a transvaginal route. Responses from the abductor hallucis were also recorded for comparison. Stimulations were performed with relaxed pelvic floor and with tonic contraction (facilitated responses). Student's t test was applied and mean latencies were plotted against differences to analyze test-retest variability. RESULTS: There were no systematic effects of time or other variables that might differ between trials for all subjects. However, the means vs. differences plots revealed a large scatter of intra-individual test-retest values. The poor reproducibility was common for all tested pelvic floor muscles and modalities. CONCLUSIONS: The clinical use of pelvic floor MEPs is questionable.

Aged↗
PubMed2003

Efficacy of desmopressin (Minirin) in the treatment of nocturia: a double-blind placebo-controlled study in women.

OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in women. STUDY DESIGN: Women aged 18 years or older with nocturia (>or=2 voids per night with a nocturia index score >1) received desmopressin (0.1 mg, 0.2 mg, or 0.4 mg) during a 3-week dose-titration period. After a 1-week washout period, patients who responded in this period received desmopressin or placebo in a double-blind fashion for 3 weeks. RESULTS: In double-blind phase, 144 patients were randomly assigned to groups (desmopressin, n=72; placebo, n=72). For desmopressin, 33 (46%) patients had a 50% or greater reduction in nocturnal voids against baseline levels compared with 5 (7%) patients receiving placebo (P<.0001). The mean number of nocturnal voids, duration of sleep until the first nocturnal void, nocturnal diuresis, and ratios of nocturnal per 24 hours and nocturnal per daytime urine volumes changed significantly in favor of desmopressin versus placebo (P<.0001). In the dose-titration phase headache (22%), nausea (8%), and hyponatremia (6%) were reported. Two deaths occurred, although neither could be directly associated with the study drug. CONCLUSION: Oral desmopressin is an effective and well-tolerated treatment for nocturia in women.

Adult↗