Biomedical subjects
Publications and source records attributed to M Perrigot.
Based on the results of the clinical and urodynamic investigation of 15 patients, presenting with functional genitourinary symptoms, the authors report the efficacy of treatment with alpha-blockers. They stress the importance of the clinical history and of static sphincterometry in this type of patient.
Fifteen cases of perineal neuralgia are reviewed, the lesion arising from a canal syndrome due to compression of the pudendal nerve in the ischiorectal fossa (Alcock's canal syndrome). The clinical characteristic of the pain syndrome was its postural nature with the existence of a true Tinel sign (increased pain on sitting). Diagnosis was confirmed in all cases by a perineal electrophysiological which showed peripheral neurogenic signs on examination of perineal muscles and an increase in sacral evoked potentials latencies (latency of bulbocavernous or clitorido-anal reflexes, cortical somesthetic evoked potential from pudendal nerve). Treatment was infiltration of cortisone derivatives into the pudendal nerve canal, under CT guidance because of the difficulty of infiltrating the pudendal nerve by an external perineal approach. Results were satisfactory in 9 of the 15 patients.
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The restoration of the continuity of the urinary tract after renal transplantation in anuric patients, an increasingly frequent situation, raises a number of theoretical problems: is it possible to use a bladder which has been non-functioning, sometimes for many years (20 years)? What should be performed during pre-operative assessment? Which surgical technique should be used? The authors try to answer these questions on the basis of their experience of 116 transplanted anuric patients. Anuria, even of long duration, does not prevent the use of the bladder, provided that the bladder was originally normal and is not infected. The pre-operative assessment is the same as for other patients and urodynamic investigations are not required. The optimal reimplantation technique is the Leadbetter-Politano open bladder technique and every effort should be made to obtain abundant diuresis immediately. Under these conditions, reimplantation into these non-functioning bladders is not associated with more complications than in the case of normal bladders.
The authors propose a new pathophysiological and diagnostic approach to detrusor hyperactivity by the study of the isometric pressure obtained during the stop-test. This test consists of the sudden interruption of micturition by voluntary contraction of the striated urethral sphincter, resulting in sudden contraction of the bladder against the closed sphincter. This isometric contraction is equal to 20 to 30 cm of water. The increase in the pressure (delta P) between the basal micturition pressure and the absolute value of the isometric pressure (P iso) reflects the contractile force of the detrusor. The progressive return to the basal micturition pressure reflects the relaxation of the detrusor, which is the sum of visco-elastic properties and the mechanisms of cortico-sub-cortical neurological inhibition. Calculation of the isometric area (delta P X T/2), where T represents the time taken to return to the initial pressure, allows cases of central neurological hyperactivity (isometric area always greater than 100) to be distinguished from cases of detrusor hyperactivity of mechanical origin (isometric area less than 80). These data have been confirmed in a series of 30 patients.
Fifteen men were treated for postoperative urinary incontinence by implantation of an AS 800 artificial sphincter between May 1984 and May 1986. Follow up for at least 6 months and in some cases for more than 2 years has shown perfect day and night continence in 11 of the 15 patients and almost perfect continence in the remaining 4 who consider nevertheless that their quality of life has been transformed. These findings plead in favor of the implantation of this type of material.
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The authors present a series of 73 cases of intraspinal lipomas in the lumbosacral region. Sixty-four patients were operated on, 43 of these under intraoperative monitoring of neural function. The results of this series and of major series published in the past 10 years demonstrate both the potential severity of these lesions (which are responsible for progressive neurological deficits in 56% of affected cases) and the benignity of their surgical treatment. The authors emphasize the usefulness of systematic early surgical treatment of these lesions.
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A hundred patients with multiple sclerosis and urinary disorders were examined clinically and by gas or water cystometry. Particular attention was paid to abnormalities in the voiding need sensation. These abnormalities can best be studied by cystometry combined with urethral striated sphincter electromyography. When the sequence of the three degrees of need (usual need, pressing need and urgent need) is respected, there is a good correlation between the progression of the voiding need during the filling phase of the cystometry and during the detrusor action. When there is interference with the sequence of these three degrees of the voiding need, especially the absence of the sensation normally contemporaneous with the detrusor action or immediately preceding it, there is exaggeration of either the hyperactivity or the hypoactivity of the bladder, and this aggravates vesical sensitivity: premature contraction of the detrusor muscle eliminates the first two degrees (usual need and pressing need), while progressive distension of the detrusor muscle eliminates all three stages. As the multiple sclerosis evolves a stage is reached at which there are functional mictional disorders exclusively connected with the interference with the degrees of voiding need pollakiuria and urgency.
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Clinical and urodynamic examinations were carried out in 63 patients with Parkinson's disease presenting with disorders of the urinary bladder sphincters with no detectable other neurological or urological cause. The incidence of these disorders varies greatly according to different authors this being likely due to a lack of their recognition in routine examinations. In many cases of the present series they were the initial symptom of the disease. The most frequent complaint was urgency of micturition, alone or associated with dysuria, the latter alone being much rarer. Urinary incontinence as a result of one or the other of these disturbances was a frequent feature. Overall clinical characteristics confirm the central neurologic origin of these disorders. Cystometry demonstrated detrusor hyperactivity in 60 p. cent of cases and hypoactivity in 35 p. cent. An electromyogram of the striated sphincter muscle and/or a urethral pressure graph were recorded in some patients. On the whole urodynamic data indicated detrusor muscle dysfunction as being the cause of the micturition disorders. L-Dopa could modify these disorders by increasing detrusor hypoactivity, probably through a central action. Anticholinergic agents provided good therapeutic results when detrusor hypoactivity was involved but it was much more difficult to improve hypoactivity. Data suggesting the role of basal ganglia lesions in detrusor dysfunction in Parkinson's disease are discussed.