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Biomedical subjects

L Mouritsen

Publications and source records attributed to L Mouritsen.

At least 19 recordsLinked to original sources
PubMed1999

Follow-up after repair of vaginal vault prolapse with abdominal colposacropexy.

BACKGROUND: Vaginal vault prolapse after hysterectomy is a rare complication, with a prevalence of less than 1/2%. The vaginal depth an axis can be restored by colposacropexy with preservation of coital function. The aim of this follow-up study was to assess the results of colposacropexy with special attention to recurrence of prolapse and urogenital symptoms. METHODS: During a 4-year period 35 patients with vault prolapse were operated by colposacropexy. At follow-up the patients were interviewed about bladder, bowel and sexual symptoms. A pelvic examination and measurement of residual urine was done. Perioperative complications and any interim surgery was recorded. RESULTS: The patients were multioperated, because of prolapse or incontinence prior to colposacropexy. No serious perioperative complications were seen, except one case of severe bleeding from the presacral veins. Subjectively, 82% were cured of prolapse symptoms, one had recurrent vault prolapse and was reoperated, four had rectocele. Five patients developed urge incontinence, while urge incontinence, frequency, nocturia and voiding problems were cured in 75%, 80%, 50% and 100%, respectively. One patient developed fecal incontinence. No patients had coital problems due to the colposacropexy. Three patients were reoperated because of intestinal obstruction. CONCLUSION: Colposacropexy has a cure rate of vault prolapse of 97% (85 100%) and a positive effect on irritative bladder symptoms.

Abdomen↗
PubMed1997

Techniques for imaging bladder support.

BACKGROUND: Imaging techniques of bladder support can be of diagnostic value to differ causes of urinary incontinence like misbuilding of the lower urinary tract, hypermobility of the bladderneck and urethral wall pathology, which is valuable prior to surgery for incontinence. METHOD: Literature about imaging techniques, especially, voiding cystourethrography, ultrasonography and MRI were studied and their diagnostic value evaluated. CONCLUSION: Dynamic ultrasonography is the first line imaging method for studying bladder support. Bladderneck hypermobility, as a sign of defect in the adjunctive closure forces is better correlated to stress incontinence than bladder morfology, diagnosed during static cystography. Voiding cystography has its place in diagnosing misbuildings of the lower urinary tract. MRI is just at the beginning of its clinical era, and seems relevant for studies of urethral pathology.

Diagnostic Imaging↗
PubMed1996

[The open, interdisciplinary incontinence clinic at Hvidovre Hospital. Preliminary experiences from the first 16 months].

A "minimal care" program for examination and treatment of urinary incontinence in an open access incontinence clinic was assessed. The first 300 women and 27 men consecutively investigated in the clinic are described. A reference program based on minimal relevant work-up and non-operative treatment as first line with use of minimal resources was followed. Of 171 evaluated women, 100 received non-operative treatment besides general advice on voiding/toilet pattern and appropriate incontinence appliances. Subjectively 69% felt cured or very much improved, 25% experienced improvement while 6% did not report benefit of the treatment. Objectively, diminished leakage was demonstrated by pad-weighing test. Similar results were found in the treated men. Our preliminary results demonstrate, that an open access, interdisciplinary clinic is patient-accepted and effective for the evaluation and treatment of urinary incontinence.

Adolescent↗
PubMed1995

Comparison of three commercially available enzyme immunoassays for the screening of autoantibodies to extractable nuclear antigens.

The initial screening test used in the diagnosis of connective tissue diseases is based on the detection of antinuclear antibodies (ANA) by indirect immunofluorescence (IFA). When the ANA screen is positive, it is often useful to determine the specificity of the autoantibody to a series of extractable nuclear antigens (ENA), a procedure that has been classically performed by double immunodiffusion. Testing large numbers of clinical specimens for autoantibodies to ENA by double diffusion techniques can be time-consuming and expensive. ENA screening systems that employ enzyme immunoassay (EIA) technology have recently become commercially available. We compared three EIA ENA assays to classic Ouchterlony double diffusion techniques. Furthermore, the sensitivity of each antigen and methodology (including ANA immunofluorescence using HEp-2 cells) was tested using ENA positive sera possessing single autoantibodies. Two of the three EIAs that detected immunoglobulin G type autoantibodies to Smith (Sm), ribonucleoprotein (RNP), Sjögren's syndrome-associated antigens Ro (SSA) and La (SSB), were provided by INOVA and Sigma Diagnostics. A third EIA, which also included scleroderma-associated antigen 70 (SCL-70/DNA-topoisomerase I) and histidyl-tRNA synthetase (Jo-1) in addition to the four previously stated antigens, was provided by Clark Laboratories. This latter ENA screen detected IgG, IgA, and IgM type autoantibodies. Included in the study were sera covering a wide variety of anti-nuclear and other autoantibodies. Sensitivity was 100% for all EIA ENA screens when compared to Ouchterlony double diffusion and specificity exceeded 95% in each case. Sensitivity studies showed Ouchterlony to be less sensitive than EIA when detecting low levels of autoantibodies to ENA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Twenty-four hour pad weighing test: reproducibility and dependency of activity level and fluid intake.

To evaluate the reproducibility of the 24 hour pad weighing test and the possible influence of fluid intake and level of activity to the test result, 14 women, referred for operation because of urinary incontinence, performed six 24 hour pad tests each under the following conditions: 2 tests on normal daily activity level and on normal fluid intake, 2 tests on high vs. low activity level, and 2 tests on high vs. low fluid intake. The study concludes that the results of the 24 hour pad weighing test are reproducible with moderate variation in fluid intake and activity level. Artificially low fluid intake or extreme variations in activity level could, however, significantly alter the urinary leakage. Small variations in fluid intake and activity level have no effect on the test result.

Activities of Daily Living↗
PubMed1994

Ultrasonic evaluation of bladder neck position and mobility: the influence of urethral catheter, bladder volume, and body position.

The influence of urethral catheter, bladder volume, and body position on the ultrasonic assessment of bladder neck position and mobility was evaluated in 24 incontinent women. The bladder neck position was described by two independent parameters: BS-distance, from the bladder neck to the lower tip of the symphysis pubis, and the rotation angle between the BS-line and the symphyseal middline. Catheterisation resulted in apposition of the bladder neck towards the symphysis pubis, seen as a significant shortening of the BS-distance in postmenopausal women without estrogen replacement. The rotation angle was unaffected. Increasing the bladder volume to symptomatically full resulted in increased capacity to withhold, since the rotation angle decreased 6.6 degrees. Examination in the sitting position, compared to the supine resulted in bladder neck descent to a "lower level," and the rotation angle increased in average 16 degrees. Bladder neck mobility was unaffected by catheterisation and body position. Vaginal ultrasonic evaluation of bladder neck suspension is recommended to be performed without a catheter, with a comfortably full bladder in a convenient, but standardised examination position.

Adult↗
PubMed1994

Bladder neck anatomy and mobility: effect of vaginal ultrasound probe.

OBJECTIVE: To evaluate the effect of a vaginal ultrasound probe on bladder neck anatomy and mobility. PATIENTS AND METHODS: Twenty women, 15 with urinary incontinence and five with other urological complaints, were studied. Colpocysto-urethrography (CCU) during rest. Valsalva and withholding manoeuvres were compared with and without simultaneous vaginal endosonography. The CCU diagnoses and measurements of bladder neck position and mobility in relation to the symphysis pubis were compared with and without the probe inserted. A small, 7 MHz vaginal probe (Brüel and Kjaer, type 1846) was used with the scanning field 45 degrees to the long axis of the probe. RESULTS: The CCU diagnoses as well as the measurements of bladder neck position and mobility relative to the symphysis pubis were unaffected by the insertion of this probe. CONCLUSION: Vaginal ultrasonography is a minimally invasive technique; it is convenient for routine, firstline evaluation of bladder neck anatomy and mobility in incontinent women.

Adult↗
PubMed1994

Vaginal ultrasonography versus colpo-cysto-urethrography in the evaluation of female urinary incontinence.

To compare the information of bladder neck suspension given by colpo-cysto-urethrography (CCU) and vaginal ultra-sonography (US), 44 women with various grades of incontinence were examined by both methods. The criteria for evaluation of incontinence for each method were applied on both procedures. CCU-diagnoses of type of bladder neck descent were compared as well as US-measurements of bladder neck position and mobility in relation to the symphysis pubis during rest, Valsalva and withholding. The interobserver agreement of diagnosis was 58%, which is comparable to interobserver agreement for CCU. The measurements of bladder neck suspension by bladder to symphysis (BS)-distance and rotation-angle in relation to the symphysis pubis, revealed almost identical results for the two procedures. The US-measurements had a better accuracy than the CCU measurements. Furthermore, hypermobility of the bladder neck was related to grade of incontinence and to diagnoses including anterior suspension defects. Presence of a cysto- or rectocele affected the size of the rotation angles. Patients with a cystocele had a 16 degrees larger rotation angle by both procedures. Presence of a rectocele increased the rotation angle, measured by US, but decreased the angles, measured by CCU. Furthermore, the ability to withhold was decreased, when the patient had a rectocele. Since the same information of bladder neck suspension is provided by the two methods, and since the US-criteria revealed a better accuracy and a good clinical reliability, ultrasonography is recommended for evaluation of bladder neck anatomy--also for practical and economical reasons.

Adult↗
PubMed1993

Bladder neck mobility evaluated by vaginal ultrasonography.

Factors involved in monitoring bladder neck mobility were studied by means of vaginal ultrasonography. Thirty-three continent, 28 incontinent and 39 patients who had undergone surgery for incontinence were examined in the supine and sitting positions during rest, the Valsalva manoeuvre and withholding urine. Bladder neck mobility can be described as a semicircular movement with the tip of the symphysis pubis as the centre and a line from the tip to the bladder neck as the radius (BS). Movement can be measured by 2 independent factors: BS distance and size of the angle between the BS line and the midline of the symphysis, at rest, during the Valsalva manoeuvre and withholding urine. The continent controls were characterised by a 90 degrees angle at rest, a long BS (2.4 cm) and a fixed bladder neck. The incontinent patients had a shorter BS (2.1 cm), angles at rest of approximately 100 degrees--the angle increased with the grade of incontinence--and a mobile bladder neck. If 2 of the 3 criteria (angle at rest > or = 95 degrees, BS < or = 2.3 cm and mobility > or = 20 degrees) are regarded as diagnostic of incontinence, diagnostic sensitivity was 84% and specificity 82%. In the surgical group, patients who failed to respond to treatment had a shorter BS, larger angles and greater bladder neck mobility than their successfully treated counterparts.

Adult↗
PubMed1993

Inter- and intra-observer variation of colpo-cysto-urethrography diagnoses.

To evaluate the reliability of diagnosing type of bladder suspension defect in incontinent women by means of voiding colpo-cysto-urethrography (CCU), 93 CCU-series with exposures at rest, coughing, withholding and voiding were diagnosed. Three senior and one junior radiologists, a gynecologist and a urologist diagnosed the CCU-series twice with 3-6 months interval. The main diagnostic possibilities were anterior bladder suspension defects, posterior defects and normal, which were in accordance with general practice of choosing an abdominal suspension operation for the anterior suspension defects and a vaginal operation for the posterior defects. The intra-observer agreement varied between 99% and 72%, i.e. 1/5 to 1/4 of the patients changed from one main diagnostic group to another at the two examinations. The inter-observer agreement varied between 43% and 60%. Information of clinical patient data, given to the two clinicians, did not change their CCU-diagnoses significantly. We concluded, that CCU should not be recommended as a routine for evaluation of type of suspension defect since the intra-inter-observer variation was around 25% and 50% respectively. CCU might still be useful preoperatively in selected cases, since it gives an excellent visualisation of bladder base anatomy.

Female↗
PubMed1991

Long-term effect of pelvic floor exercises on female urinary incontinence.

In order to assess the permanent effect of pelvic floor exercises on female stress incontinence, 76 incontinent women, referred for incontinence surgery, underwent a 3-month exercise programme conducted by an experienced physiotherapist. The patients were followed up for 1 year. At the last assessment 30% were cured and 17% improved. Altogether 47% avoided surgery. No relapses were seen during the follow-up period. Patients with mild incontinence benefited from intensified training, since 72% could expect to be cured, while patients with severe incontinence and no immediate effect did not benefit from further exercises. Patients with a positive hormone status and those with normal weight had a significantly higher cure rate. The subjective results were confirmed by the 24-h pad test. Anal pressure profilometry was a valid method for instruction and objective control of pelvic floor function. It was concluded that pelvic floor exercises should precede surgery, since exercises had a permanent effect in half of the patients.

Adult↗
PubMed1988

The intracavernous injection of papaverine as a diagnostic procedure in patients with erectile dysfunction.

To evaluate the use of papaverine-induced erection as a diagnostic test in men with erectile dysfunction, 24 patients had papaverine injected into the corpus cavernosum. The results of the papaverine test in combination with the tentative diagnosis, based upon patient history, clinical examination and peno-brachial pressure index, gave in most cases sufficient information about the function of the penile vessels to decide in which patients a selective arteriography or a cavernosography was indicated. Two patients developed priapism after the papaverine injection.

Erectile Dysfunction↗
PubMed1987

Results of abdominal levator-muscle repair in urinary stress incontinence.

Results of the abdominal levator-muscle repair in 175 stress incontinent women are presented. Two years after the operation 83% were cured or improved regarding urinary incontinence. The urodynamic evaluation revealed a normalization of the maximum flow rate, residual urine and cystometry in nearly all cases. The abdominal levator-muscle repair carried a low morbidity, and is especially recommended in women with combined urinary and anal incontinence.

Abdominal Muscles↗