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Biomedical subjects

J Kerdraon

Publications and source records attributed to J Kerdraon.

33 records · Page 2Linked to original sources
PubMed1993

[Bladder-sphincter complications after peridural anesthesia. 8 cases].

Eight cases of vesico-sphincteric disorders (dysuria and chronic retention of urine) observed after spinal anaesthesia are reported. These symptomatic disorders were caused by a peridural haematoma in 3 cases and by lack of bladder contraction due to an "exhausted detrusor muscle" in 5 cases. The mechanism of the disorders (predominant vesical hypoactivity with sensory disorders) is discussed. The usefulness of urodynamic investigation in determining the physiopathological mechanism(s) and that of electrophysiological exploration in the search for a neurogenic disease is emphasized, as is the need for a preventing treatment (intermittent catheterization) in case of forced bladder detected by systematic recording of postoperative micturitions.

Adult↗
PubMed1993

[Perineal electrophysiological studies in erectile dysfunctions. Study of 423 cases].

Perineal electrophysiological investigations allow an objective and quantitative approach to the different somatic (motor or sensitive) and vegetative nerve pathways involved in the control of erection. The level of neurogenic involvement (central or peripheral, encephalic, spinal, radicular, troncular) can be determined precisely and, sometimes, the prognosis also. A series of 423 patients underwent the following investigations: detection electromyography of the perineal floor muscles and recordings of the bulbo-cavernosus reflex latency, medial pudendal nerve somesthesic cortical evoked potentials, conduction rate of the dorsal nerve of the penis and sympathetic skin response. An alteration in at least one of the tests was observed in 49% of the patients. The most frequently observed disturbance involved reduced sensitive conduction of the dorsal nerve of the penis in neurologic patients (64.5%).

Electromyography↗
PubMed1993

[Active forces of urinary continence and urethral fatigability. Application to stress urinary incontinence in women].

Eighteen women who had urinary stress incontinence were studied to find the existence of urethral fatigue on effort by using a sphincterometric technique. Urethral pressure measurements at rest as compared with after six heavy coughs showed a mean lowering of the urethral pressure of 40% (range 24.5%-90%) in 10 women. Spectral analysis of the electromyographic trace of the striated urethral sphincter at rest and then after coughing confirms that the striated muscle and the periurethral tissues are involved with a marked quantitative lessening of electric sphincter activity. The clinical, physiopathological, prognostic and therapeutic consequences of this new concept are discussed, together with their relationship to other active forces involved in continence.

Adult↗
PubMed1993

[The active forces of continence. Illustration by quantified analysis of the electromyographic signal of the urethral striated sphincter combined with urethral pressure studies].

Continence in women, ensured by a constantly positive urethral closing pressure, is the result of two phenomena: purely passive factors (urethral pressure and compliance, transmission of bladder pressure to the urethra) and active factors mediated by a voluntary and reflex neuromuscular mechanism (contraction, reflexivity, sphincter endurance). In order to define these active forces of continence, we simultaneously studied the quantitative electromyographic activity of the striated sphincter and the bulbocavernosus muscle and variations in the urethral and vesical pressure under various conditions (rest, coughing, stimulation of the pudendal nerve). During coughing, the urethral pressure peak occurred earlier (100 milliseconds) than the vesical peak, associated with hypertransmission of 20%, the bulbocavernosus muscle contracted first, followed by contraction of the striated urethral sphincter (150 ms delay) and this electrical activity preceded the rise in vesical and urethral pressures. Stimulation of the pudendal nerve eliminated the possibility of an artefact related to coughing and induced the same sequence of events.

Adult↗
PubMed1993

[Decreased urethral pressure after coughing: the concept of urethral fatigability. Its relationship with active forces of continence].

The existence of urethral fatiguability was demonstrated by a sphinctometric study in 30 women. Comparison of the baseline urethral pressure values and after 6 maximal coughs demonstrated a mean reduction in urethral pressure of 40% (range: 24.5 to 90%) in 10 out of 18 women with stress incontinence. This decreased pressure lasted for several seconds. Spectral analysis of the electromyographic recording of the striated urethral sphincter under basal conditions and then after coughing confirmed the intervention of the striated and periurethral musculature with a marked quantitative decrease in the electrical activity of the sphincter. The clinical pathophysiological, prognostic and therapeutic implications of this new concept are discussed.

Adolescent↗
PubMed1992

[Comparative results of flowmeter studies before and after urodynamic exploration].

Results of flowmeter studies in 145 patients before and then immediately after urodynamic exploration were unchanged in 80% of women and 72% of men. Abnormal results on flowmetric examination, detected in 18% of cases prior to urodynamic studies, were assessed as normal during follow-up urodynamic tests. These findings raise the question of the validity of flowmeter parameters determined during urethrocystometric exploration.

Adolescent↗
PubMed1992

[Neuropathy due to stretching of the internal pudendal nerve and female urinary incontinence].

For many years, perineal neurogenic abnormalities associated with stress urinary incontinence have been described using electromyography examination, evoked potentials or neuromuscular biopsy. It has been suggested that the progressive denervation of the striated pelvic sphincter musculature that occurs in genuine stress incontinence is due to repeated stretch injury of the innervation of these muscles when the pelvic floor diaphragm is weak. New investigations such as perineal nerve motor latency confirmed this hypothesis. A real "perineal stretch neuropathy" may be described. It is very important to know about this neurogenic factor before considering rehabilitation therapy.

Female↗
PubMed1991

[Perineal neuralgia].

Ninety cases of chronic perineal pain of neurological origin are reported. Alcock's canal syndrome, consecutive to damage of the pudendal nerve in the ischiorectal fossa, is the most frequent of these neuralgias. It is characterized by burning pain or paraesthesia increased in sitting position and relieved by standing up. The specific treatment is CT-guided infiltrations of the pudendal nerve. Other neurological causes are spinal cord lesions (notably tumours of the conus medullaris), sacral meningoradiculitis (perineal herpes zoster), plexitis and pudendal nerve neuritis. In some cases the responsibility of perineal stretching neuropathy may be considered. In all patients, electrophysiological exploration of the perineum (detection of perineal floor muscles, sacral latency, somatosensory and motor evoked potentials of the pudendal nerve) are necessary to confirm the aetiological diagnosis and guide neurological investigations.

Adnexal Diseases↗
PubMed1991

[Perineal stretch neuropathy: its relationship to urinary stress incontinence in women].

For many years perineal neurogenic abnormalities in stress urinary incontinence have been described using electromyography examination, evoked potentials or neuromuscular biopsy. Swash suggested that progressive denervation of the stretched pelvic sphincter musculature that occurs in genuine stress incontinence is due to repeated stretch injury of the innervation of these muscles when the pelvic floor diaphragm is weak. New investigations such as perineal nerve motor latency confirmed this hypothesis. A real "perineal stretch neuropathy" can be described. It is probably very important to know about this neurogenic factor before considering surgery or rehabilitation therapy and in cases of recurrent stress incontinence. 40 cases are described.

Adult↗
PubMed1991

[Investigation of the vesical sphincter and genital-sexual autonomic pathways. Techniques, normal values, and application to pathology].

Parasympathetic and sympathetic pathways may be assessed by using different electrophysiologic tests. Sympathetic skin potentials (SSP) are elicited with peripheral electrical stimulation (e.g. median nerve or pudendal nerve). SSP are recorded from the skin of the hand and foot and from the genital skin. Skin responses were always obtained from normal volunteers. Absence of SSP is one of the earliest findings in neurogenic impotence. Electromyography of corpora cavernosa is described with a new method. A new corpora cavernosa response to pudendal nerve stimulation is described. This test appear to have application in the evaluation of neurogenic impotence.

Adult↗
PubMed1990

[Perineal neuropathy due to stretching and urinary incontinence. Physiopathology, diagnosis and therapeutic implications].

Perineal nerve injury due to stretching is caused by excessive traction on the distal motor branches of the pudendal nerve that innervate the perineum and anus. These injuries can occur in a number of morbid conditions (prolapsus, anorectal dyschezia, pelvic surgery) and induce denervation of the pelvic floor that very probably modifies the resistance of the sphincters. Stretch injuries should be considered when discussing physiotherapy or surgery for urinary incontinence. Diagnosis can be established by electrophysiologic studies of the perineum, particularly by measurements of distal pudendal nerve motor latencies. The authors report a series of sixty patients with stretch-induced neuropathy.

Adult↗
PubMed1989

[Vesico-sphincter disorders in neurosyphilis].

The authors report 8 cases of disorders of the bladder and sphincter in neurosyphylis. Urodynamic study suggested preponderant damage to the sensory pathways and in particularly the posterior roots. The most common clinical manifestation was dysuria or chronic retention, these occasionally being signs of neurological disease.

Adult↗
PubMedDate not supplied

[Value of intravesically instilled oxybutynin in refractory bladder hyperactivity. Study of 15 cases].

15 patients with neurogenic detrusor hyperactivity refractory to oral anticholinergics received a daily intravesical instillation of 5 mg of oxybutinin for 6 days. An improvement was observed clinically in 10 cases and on urodynamic parameters (60% increase in bladder capacity, doubling of the volume inducing an urge to void) in 12 cases. The mechanism of action is discussed.

Administration, Intravesical↗
PubMedDate not supplied

[Electrophysiologic perineal studies in the exploration of erectile dysfunction in diabetics].

Sexual disorders may be assessed in diabetic patients with neurophysiological investigations of the perineum including electromyographic detection of perineal floor muscles, sacral latency, somatosensory evoked potentials of the pudendal nerve, sympathetic skin response and nerve conduction velocity of the dorsal nerve of the penis. Alteration of sympathetic skin response and sensory dysfunction (reduction of the velocity or reduction in the amplitude of the distal sensory potential, alteration of the pudendal cortical evoked potentials) are the more frequent signs of perineal diabetic neuropathy.

Diabetes Mellitus↗