Biomedical subjects
Publications and source records attributed to H Palmtag.
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As no simple test exists to verify objectively a neuromuscular lesion of the detrusor in the clinical practice, pharmacological stimulation of the detrusor with Carbachol was tested. In contrast to other pharmacological tests, the modified Carbachol test never led to false-positive results and is therefore recommended as a basic test in the clinical practice.
In the last years the symptom of unstable bladder behaviour has been interpreted with increasing clinical importance, sometimes being regarded as a diagnosis or as a causative factor for different complaints (1, 3-6, 16, 18, 20). The term 'unstable bladder' is still not precisely defined (17). Few investigations on this topic had been done in children, therefore, the urodynamic findings of 216 children were analysed to look for co-findings of bladder instability and, if possible, to demonstrate some causative factors. The investigations revealed that unstable bladder behaviour seems to be a secondary cystometric phenomenon (directly or indirectly induced). The treatment of unstable bladder should be concentrated on the causative disorder rather than on the cystometric symptom
Urodynamic studies were carried out in a 14-year-old boy with Prune Belly Syndrome and terminal renal failure prior and after successful renal transplantation. Increased bladder capacity, nonprovocative detrusor instability and a high compliance were the most characteristic findings during the filling phase of the bladder. During the voiding phase an increased detrusor pressure was demonstrated. Outflow resistance and maximum urinary flow rate were within normal range before and after transplantation. In contrast to the findings before renal transplantation, however, micturition was imbalanced after transplantation (residual urine 100 ml). Urodynamics revealed that the bulging of the posterior urethra, observed in the early voiding phase, was due to a congenital insufficiency of the posterior urethral musculature (megalourethra) and not caused by mechanical obstruction leading to urethral dilatation. It is suggested that detrusor-bladder-neck-dyssynergia is the primary cause of the imbalanced micturition and its consequences (bladder distention, reflux, urinary tract infection, hydronephrosis, pyelonephritis) in patients with Prune Belly Syndrome. The findings of a normal, respectively increased detrusor activity are in contrast to the observations of some authors, describing attenutation and absence of detrusor muscle fibres. The indications and effects of transurethral resection and internal urethrotomy, proposed by some authors, are discussed.
The urodynamic findings of 247 patients with a neurogenic bladder dysfunction were analyzed to evaluate factors which influence the X-ray picture of the bladder neck and urethra. Patients were classified according to the classification of Bors and Commarr, additionally different types of reflex detrusor activity could be differentiated in cases suffering from a supranuclear lesion. As the micturition cystourethrography of female patients with a supranuclear lesion looks similar to the X-ray picture of young girls with a WBNA a second analysis was made to compare the urodynamics of both groups. It is to note that in supranuclear lesions detrusor-sphincter dyssynergia and the type of reflex detrusor activity mainly form the shape of the posterior urethra, neither the duration of the lesion nor the level of spinal cord injury have any influence.
The bladder capacity of patients with a neurogenic bladder disorder was determined. Since the bladder capacity varies according to the type of neurogenic lesion (supranuclear, infranuclear), it was to be determined, whether reflex detrusor activity and duration of the lesion would influence bladder capacity. It was found that in supranuclear lesions s sufficient bladder capacity can be maintained with a balanced micturition, and that spincterotomy does not result in reduced bladder capacity. In infranuclear lesions intermittent catheterization is a good therapeutic method to preserve continence and an intact renal function as well.
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The second case of successful renal transplantation in a patient with "prune belly" syndrome is reported. In spite of early aggressive surgical approach in the management of this disease terminal renal failure frequently ensues. Hemodialysis and renal transplantation have offered new possibilities of prolonging life in these patients. The success of renal transplantation depends on the anatomic and functional state of the lower urinary tract. Pretransplant urologic examination is extremely important for the evaluation of urinary tract abnormalities.
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The successful treatment of urinary stress incontinence in females dependends on a careful study of urodynamics. Pre-operative measurements of urine flow rate and residual urine can be useful only in differentiating compensated from deconpensated micturition. However, some selected problems require a more detailed investigation. Therefore synchronous cine/pressure/flow/cystourethrographic studies were performed in 20 stress-incontinent women. In some of them, an increased outflow resistance was thus demonstrated. Any type of operation for stress incontinence which raises outflow resistance must be avoided in these cases. Long-distanced urethrocystopexy which permits to avoid an unwanted increase of outflow resistance with following retention of urine should be preferred.
Urodynamic investigations in 96 patients with carcinoma of rectum showed that the term "postoperative atony" does not describe the measurable alterations following excision of the rectum. Postoperative mechanical disorders of micturition and neurogenic lesions were analysed under the aspect of future therapy.
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For diagnosis of incontinence the exact analysis of the dynamics of micturition is of great importance, primarily in order to evaluate the urethral flow-resistance and detrusor activity. Extending already existing methods for the evaluation of urodynamics, we developed a complex method of cine/pressure/flow/cystourethrography. All data were recorded and simultaneously stored on videotape. Especially in cases of incontinence with a neurogenic component important information for a causative therapy was gained using this complex investigation. Thus in 20 patients with incontinence, studied for exclusion of a neurogenic component, we found two patients with a neurogenic bladder dysfunction that had been unknown prior to the examination. The neurogenic component in each case had remained unnoticed by usual routine diagnostic procedures.