[Changes in the curvature of the urethra in women with complications after Burch's colpopexy].
Explore the source record for details and available documents.
Female↗
Biomedical subjects
M Halaska
Publications and source records attributed to M Halaska.
[Hormone therapy and urogynecology].
The female genital and urinary systems exists in close anatomical and functional proximity, disorders of one resulting in dysfunction of the other. The investigation and management of lower urinary tract disorders must take this important relationship into consideration, as neither can be viewed in isolation. The value of estrogen replacement therapy as a treatment of urinary incontinence is controversial and until today there is a little substantial evidence to conclude that estrogen therapy alone is of value in the treatment of this symptom. This conflicting evidence concerning the therapeutic benefit of estrogen therapy in stress urinary incontinence seems to be outweighed with other advantages of estrogen replacement therapy. Clear evidence exists to suggest that recurrent urinary tract infections can be prevented or even treated by the use of estrogen therapy. Systemic estrogen replacement appears to relieve the symptoms of urgency, urge incontinence, frequency, nycturia and dysuria, and low-dose topical estrogen is effective in the management of atrophic vaginitis. Even with postulating the HRT to be of enormous therapeutic value to postmenopausal women in urogynecology it may stay only a mean of support of other causal methods of treatment of dysfunction of lower urinary tract.
Estrogen Replacement Therapy↗
[Changes in the position of the ureterovesical junction during maximal voluntary contractions and during maximal vaginal electric stimulation of the pelvic floor muscles].
The objective of the study was to evaluate and compare the effect of the maximal voluntary muscle contraction of the pelvic floor (PFM) and contractions of the PFM evoked by maximal electric stimulation using an electrostimulation apparatus Conmax by monitoring the position of the urethrovesical junction by ultrasound. The trial comprised 20 women with confirmed stress incontinence of urine. With the patients in a supine position with abducted lower extremities an electrostimulation probe was inserted into the vagina. This was followed by perineal ultrasound (US) examination using an ACUSON 128 XP-10 apparatus and a convex tube 5 MHz. The ultrasound examination was made using the electrostimulation probe--at rest and during maximal voluntary contraction of the PFM. This was followed by maximal electric stimulation and after five minutes during stimulation the US examination was repeated. It was performed also during maximal electric stimulation (MES) concurrently with maximal voluntary contraction of the PFM. For electrostimulation a Conmax appartus was used. The applied frequency was 50 Hz, amplitude from 0 to 90 mA (grade 0-6), duration of pulse 0.75 ms. The maximum intensity of stimulation was determined by the patient, i.e. when stimulation was not yet painful. During US the authors investigated the gamma angle, i.e. the angle between the axis of the symphysis and the connecting line between the UV junction and the lower borderline of the symphysis. The mean difference of the gamma angle during voluntary contraction of the PFM and at rest was 13.6. During contraction caused by maximal electric stimulation of the PFM and at rest this difference was 21.3. The difference did not differ significantly during maximal electric stimulation of the PFM and during maximal electric stimulation and voluntary contraction of the PFM. From the trial ensues that contraction of the pelvic floor muscles during maximal electric stimulation is stronger as compared with the intensity of contraction caused by maximal voluntary contraction. The results confirm the favourable therapeutic effect of MES muscles of the pelvic floor in the treatment of urinary incontinence in women. These changes help to increase the muscular tonus and contractibility of pelvic floor muscles and thus promote also elevation of the neck of the urinary bladder. Elevation of the neck of the urinary bladder promotes normalization of intraabdominal transfer of pressure to the proximal urethra.
Electric Stimulation Therapy↗
[Ultrasonography of pelvic floor muscles in women with urinary stress incontinence].
Ultrasound examinations have become since beginning of the eighties one of the auxiliary examination methods in urogynaecology. Evaluation of the position and mobility of the neck of the urinary bladder practically replaced lateral chain urethrocystography. With the improving differentiating capacity of ultrasound equipment it is possible to visualize some periurethral and paravaginal structures which participate in the support of the urethra and urethrovesical junction by paravaginal and periurethral structures in women (fig. 1). In recent years many papers were published where for visualization nuclear magnetic resonance (NMR) is used [1, 12, 19]. The functional and physiological condition of these tissues is assessed by physical, urodynamic and ultrasonographic examinations and also by cystourethroscopy and manometry [7, 11, 10, 13, 14, 15, 16]. Despite this the greater part of anatomical knowledge of the supporting apparatus is derived from pathological studies and peroperative observations.
Female↗
[Ultrasonic imaging of the lower urinary tract in women with urinary stress incontinence and in women after the Burch colpopexy].
The prevalence of urinary incontinence varies from 5% in young to 50% in elderly women. The weak anatomical support of the urethrovesical junction, base of the urinary bladder and proximal urethra lead to its prolapse and hypermobility which is considered the main anatomical basis of stress incontinence. The majority of surgical procedures which resolve this problem describes elevation of the cervix of the urinary bladder. The final step of these operations, i.e. how much the urethrovesical junction should be pulled up, is described only rarely and superficially. The clinical consequence which may develop are complications associated with hypercorrection of the posterior urethrovesicular angle, i.e. problems with micturition-difficult micturition, or stage-wise micturition and symptoms of detrusor instability. The objective of the present investigation was: to analyze ultrasonic parameters of the lower urinary tract in women with stress incontinence (GSU), furthermore in women after colpopexy by Burch's method, and with regard to these results, possibly modify the surgical procedure. In the investigation in the first group 30 women were enlisted with confirmed stress incontinence. The second group was formed by 30 women three to nine months after colpopexy. The ultrasound examination was made by the perineal and introital route with the patient in a supine position, using a Acuson 128 XP 10 apparatus with a convex probe with a frequency of 5 MHz and by means of as vaginal probe with a frequency of 7.0 MHz. Assessment of the site and mobility of the urethrovesical junction was made by the transperineal route by means of a convex probe with a 300 ml filling of the urinary bladder; after micturition assessment of the areas of the urethral sphincter in a vertical and horizontal plane followed. In the vertical plane and anterior surface of the sphincter also the blood flow was measured and the pulsatile index (PI) and resistance index (RI) were assessed. The authors investigated also the thickness of the pelvic floor muscles and in the vertical plane the thickness of the urinary bladder wall on the anterior wall, in the vertex and in the area of the trigon. The authors found significant differences in ultrasound parameters in groups of women with GSI and women after colpopexy as regards the site and mobility of the urethrovesical junction and thickness of the urinary bladder wall (p < 0.01). In women with symptoms of urgency after colpopexy the authors found a mean thickness of the urinary bladder wall of more than 5 mm and mean values of the gamma angle smaller than 40 degrees and they recorded also a reduced mobility of the urethrovesical junction. These findings confirmed their expectations that in women with persisting symptoms of urgency frequently slight hypercorrection of the position of the urethrovesical junction is involved. These findings are important for the correction of the surgical approach and the evaluation of the above mentioned parameters is helpful in the diagnosis of urgency.
Female↗
[Treatment of cyclical mastodynia using an extract of Vitex agnus castus: results of a double-blind comparison with a placebo].
The aim of study presented here was to gather the data about the tolerability and efficacy of Vitex agnus castus (VACS) extract. The study was designed as double-blind, placebo controlled in two parallel groups (each 50 patients). Treatment phase lasted 3 consequent menstrual cycles (2 x 30 drops/day = 1.8 ml of VASC) or placebo. Mastalgia during at least 5 days of the cycle before the treatment was the strict inclusion condition. For assessment of the efficacy visual analogue scale was used. Altogether 97 patients were included into the statistical analysis (VACS: n = 48, placebo: n = 49). Intensity of breast pain diminished quicker with VACS group. The tolerability was satisfactory. We found VACS to be useful in the treatment of cyclical breast pain in women.
Adult↗
[Does maximum short-term electric stimulation cause contraction of the pelvic floor muscles?].
Electric stimulation is successfully used in the treatment of the stress and urgent type of incontinence. Electric stimulation of the muscles of the pelvic floor causes reflex contraction of the striated peri- and paraurethral muscles and is associated with concurrent reflex inhibition of the detrusor muscle. The therapeutic results depends greatly on the total or at least partially preserved innervation of the muscles of the pelvic floor by the pudendal nerve. One of the possible stimuli of the pelvic floor muscles is maximal electric stimulation (MES) and the objective of our study was to evaluate the effect of MES on the muscles of the pelvic floor or to detect possible changes by US and urodynamic examination. The study comprised women with the stress type of incontinence (GSI). The group was formed by 40 women with GSI, 20 were subjected to US examination and urodynamic examination (n = 20). The group of subjects subjected to urodynamic examination was extended to 40 (n = 40). For electrostimulation a Conmax apparatus was used. The applied frequency was 20 Hz, the amplitude from 0 to 90 mA (grades 0.6), pulse duration 0.75 ms. During the cystometric examination the authors recorded a significant increase of the maximal urethral closure pressure (MUCP), prolongation of the functional (FUL) and anatomical length (AUL) of the urethra during MES. During US examination the authors recorded a significant diminution of the gamma angle, a reduction of the mobility of the UV junction and prolongation of the anatomical length of the urethra during MES. From the investigation ensues that the pelvic floor muscles are contracted during MES and those changes contribute to an increase of the muscular tonus and contracting capacity of the muscles of the pelvic floor and thus cause among other things elevation of the neck of the urinary bladder. The elevation contributes to the normalization of the intraabdominal transmission of pressure to the proximal urethra and thus to treatment of the stress type of urinary incontinence.
Electric Stimulation Therapy↗
[Tolerance and effectiveness of propiverine hydrochloride in 752 patients with symptoms of detrusor hyperactivity and increased sensitivity and irritability of the urinary bladder: results of a study monitoring drug utilization].
In a post-marketing surveillance study of 752 patients suffering from urgent incontinence, mixed urgent-stress incontinence, reflex incontinence, urgency and enuresis were treated with propiverine hydrochloride. Clinical efficacy of propiverine hydrochloride was verified by the improvement of symptoms related to detrusor hyperactivity, hypersensitivity and hyperreflexia during a 12-week surveillance period: daytime and overnight urinary incontinence, as well as the frequency, nocturia, urgency in day time and at night decreased. These results are well demonstrated by decreased pad use and statistically significant decrease of Gaudenz urgency score during treatment, confirming the efficacy of propiverine hydrochloride already proved in clinical trials. The safety profile of propiverine hydrochloride displayed characteristic anticholinergic symptoms (dry mouth, accommodation disorders, constipation, tiredness, dizziness) with decreasing incidence during the 12-week treatment period. The residual urine volume decreased also. Serious adverse events were observed rarely and could be explained by the lack of consideration of contraindications, warnings and interactions with other drugs. The positive risk-benefit relationship of propiverine hydrochloride in the treatment of detrusor hyperactivity, hypersensitivity and hyperreflexia was reconfirmed in this post-marketing drug surveillance study.
Adolescent↗
[Fixation of the prolapsed vagina to the sacrospinous ligament after hysterectomy--the Amreich II-Richter vaginal fixation operation].
Preliminary experience with vaginal vault prolapse treatment with sacrospinous fixation (Amreich II-Richter) is described. Anatomical considerations having taking into account the method used by author are presented. From 1986 at the 1st Dept. of Obstetrics and Gynaecology 38 patients (20 of them after abdominal, 18 after vaginal hysterectomy) with this rare condition were treated by the discussed operation. Similar to other authors a high success rate, 97.4%, was achieved and no major bleeding or injury of adjacent nerves occurred. One injury of the bladder, one of the rectum was solved during the operation and an infection of supravaginal haematoma was treated. This operation provides excellent results and a good vaginal support.
Adult↗
[Ultrasound imaging of the urethral sphincter].
The integrity and functional capacity of the urethral sphincter is one of the important prerequisites of urinary incontinence in women. Urodynamic investigations revealed repeatedly that the maximum closure pressure in the median portion of the urethra corresponds to the maximal thickness of the external urethral sphinctor (rhabdosphincter urethrae). This striated muscle is adapted to maintain a relatively steady tonus which assists the closure mechanism of the urethra [4]. In the submitted study the authors focused attention on the ultrasonic visualization of the internal urethral sphincter in order to assess the relationship between the size of this sphincter and the stress type of incontinence (genuine stress incontinence-GSI). The investigation comprised thirty women with confirmed GSI and a control group of thirty asymptomatic volunteers. During perineal ultrasonic examination of women in a supine position by means of an ACUSON 128 XP 10 apparatus using a convex probe with a frequency of 5 MHz the authors recorded statistically significant differences in the areas and maximal thickness of the urethral sphincter in women with stress incontinence and symptom-free women. From the results ensues that the size of this muscle is much smaller in women suffering from GSI.
Adult↗
[Ultrasound examination of the lower urinary tract in women].
Explore the source record for details and available documents.
Female↗
[Changes in the position of the urethra and bladder neck during pregnancy and after delivery].
It is estimated that some 30-50% women suffer occasionally from urinary incontinence. At the end of pregnancy these complaints are more marked. In the author's group of 44 women 55% suffered from stress incontinence. The psychosocial impact of impaired function of the lower urinary pathways in women on different spheres of the patient's life is so serious that it calls for a qualified approach of a specialist. The increased mobility of the UV junction in incontinent women has been described by several authors [6, 12, 13]. It was also proved in the author's investigation closely before delivery and 3-5 days after delivery. Six weeks after delivery no differences were found in the mobility of the UV junction in continent and incontinent women. If the difference of the gamma angle (formed by the axis of the symphysis and the connecting line between the UV junction and the lower margin of the symphysis) during contraction of the muscles of the pelvic floor and Valsalva's manoeuvre (intraabdominal pressure raised by 30 cm H2O) is more than 30 degrees during the 40th week of gestation or 3-5 days after delivery (when this mobility is even greater), then the woman is liable to develop the stress type of incontinence and the authors recommend to use Kolpexin after the puerperium for exercise and strengthening of the muscles of the pelvic floor. Changes in the length of line p and angle beta are not statistically significant and cannot assess the disposition for development of urinary incontinence.
Adult↗
[Examination of urinary incontinence in women with perineal and introital sonography].
Explore the source record for details and available documents.
Female↗
[Urogynecologic examination in women after conservative treatment of urinary stress incontinence using the vaginal cone (Femcon)].
Explore the source record for details and available documents.
Exercise Therapy↗
[Manometric measurement of contraction capability of pelvic floor muscles].
The objective of our investigation was to introduce manometric assessment of the force of contraction of pelvic floor muscles as one of the examination methods for confirming the diagnosis of assessment of the degree of urinary incontinence in women; also to assess the relationship between MUCP (maximal urethral closure pressure), PWT (pad weight test) and results of manometric assessment. The trial comprised 10 healthy premenopausal and 10 postmenopausal women who did not suffer from incontinence. The authors investigated also 20 premenopausal women with the stress type of incontinence and 20 postmenopausal ones. In all manometric assessments with a WISAP apparatus were made. The maximal increase of pressure was recorded during contraction of the entire pelvic floor and when the pressure in the balloon was set at 50 and 75 mm Hg. During this assessment the authors recorded also a statistically significant difference between the group also a statistically significant difference between the group of continent and incontinent women before the menopause. No relationship between MUCP, PWT and the maximal contraction capacity of the pelvic floor muscles was found. The disadvantage of the manometric apparatus WISAP is the calibration of the apparatus in mm Hg (1 mm Hg = 13.5 cm water), i.e. the low sensitivity of the apparatus and the shape of the balloons which leads to irregular expression from the vagina during contraction of the pelvic floor muscles. From absolute values of the contraction force of the pelvic floor muscles we cannot draw any conclusions on urinary incontinence or its grade. The authors recommend this method only as a supplementary one, in particular to evaluate the results of exercise of the pelvic floor muscles.
Adult↗
[Urogynecologic follow-up after conservative therapy of stress incontinence with a vaginal cone (Femcon)].
The conservative treatment of women suffering from stress incontinence is very often highly successful. Vaginal cones (Femcon) are widely used for training the pelvic floor muscles. We investigated 60 women (mean age 50.7 years). After an exercise course with cones of 3 to 4 months, 75% of these patients reported good results with respect to pelvic floor function and stress incontinence. We found no differences between the parameters of cystometry and urethrocystometry at rest. The uroflow is also not affected. Objectively, we could only determine a statistically significant increase of the transmission ratio. This fact can be explained by the active contraction of the pelvic floor muscles, which are trained by means of the cones.
Exercise Therapy↗
[Ultrasound of the bladder neck-urethra transition before and after pelvic floor training with Kolpexin].
In this study we examined sonographically the position of the bladder neck in healthy control persons and patients suffering from stress incontinence before and after pelvic floor exercises supported by Kolpexin. 14 of the 20 patients are satisfied after performing the Kolpexin exercises. We found by using perineal sonography a significant decrease of the angle gamma after the pelvic floor training. The perineal sonography allows good informations about the position of the bladder neck after conservative treatment, too.
Exercise Therapy↗
[Ultrasound of the urinary bladder neck: changes before and after pelvic floor muscle exercise].
It was repeatedly reported that training of pelvic floor muscles in the treatment of the stress type of urinary incontinence produced favourable results [1, 4, 6, 7, 8, 10]. The objective of the present study was to examine by ultrasound, using the transperineal route, the influence of exercise of pelvic floor muscles in the treatment of the stress type of incontinence on the position of the internal reproductive organs and the vesicourethral system. For exercise and strengthening of the muscles of the pelvic floor the intravaginal aid Kolpexin [7] was used. The authors investigated two parameters--the angle formed by the median axis of the symphysis with the imaginary line connecting the apex of the lower margin of the symphysis with the urethrovesical junction (angle U). The second parameter is the distance of the apex of the lower margin of the symphysis from the urethrovesical junction (line P). The authors recorded statistically significant changes of angle U before and after exercise of the pelvic floor muscles which were confirmed by ultrasonic examination. Changes in the length of line P were not statistically significant. Strengthening of the pelvic floor muscles was confirmed also by manometric examination. From a group of 20 patients 14 (70%) improved markedly after two months' exercise of the pelvic floor muscles and thus are free from complaints. Ultrasonic urogynaecological examination provides information on a change in the position of internal reproductive organs and the vesicourethral system and is one of the many methods which can confirm the effect of conservative or surgical treatment.
Adult↗