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Biomedical subjects

P Hilton

Publications and source records attributed to P Hilton.

At least 19 recordsLinked to original sources
PubMed1996

Ambulatory monitoring and conventional cystometry in asymptomatic female volunteers.

OBJECTIVES: Ambulatory monitoring continues to gain acceptance and increasing clinical application. There remains, however, a sparsity of published data asymptomatic volunteers, particulary women. Our aim was, by study of such a group, to establish normal ranges for cystometric variables on ambulatory monitoring. PARTICIPANTS: We recruited 22 women from staff and gynaecological inpatients. A standard questionnaire of urinary complaints was administered and any woman with significant symptoms was excluded. Conventional cystometry and ambulatory monitoring were undertaken in all volunteers in random order. Volunteers were asked to go about everyday activities and to keep a detailed event diary whilst undergoing ambulatory monitoring. RESULTS: Using standard International Continence Society terminology, detrusor instability was found in 18% of volunteers on conventional cystometry and in 68% on ambulatory monitoring. Significant differences were found between ambulatory monitoring and conventional cystometry with respect to the detrusor pressure rise on filling (P < 0.001) and voided volumes (P < 0.001). A significant difference was also present with respect to voiding pressures (P < 0.001), although the absence of simultaneous flow rate measurement makes absolute separation of voiding pressure from post-voiding after contractions difficult. CONCLUSIONS: Ambulatory monitoring detects a greater number of abnormalities based on conventional cystometric criteria of normality. Before we can usefully apply the method to symptomatic patients we must first define normal ranges for filling and voiding cystometry for the technique. This study moves towards this goal. (The addition of flow rate data will permit accurate identification and measurement of voiding pressures.)

Adult↗
PubMed1993

Time-series analysis of urethral electrical conductance measurements in the assessment of unstable urethral pressure: results in normal patients and in those with genuine stress incontinence.

It is well established that urethral pressure variations occur in patients with or without urinary incontinence, but to what extent they contribute to a patient's symptoms remains unclear. Previous work has suggested that in stress incontinent patients, a rise in bladder neck electrical conductance (BNEC) occurs simultaneously with a fall in urethral pressure, and that this represents bladder neck opening. Six patients with genuine stress incontinence (gsi), and six normal controls underwent simultaneous urethral pressure and BNEC measurements, the results being subjected to time-series analysis, to determine whether the previous finding could be confirmed statistically, and to establish whether a similar association was present in normal women. All six patients with gsi and five of the normal patients had unstable urethral pressure. Estimated cross-correlation of differenced data for the two parameters showed a significant negative correlation at zero time lag in three patients with gsi and two of the control group. There was no significant correlation between the two parameters in the other seven patients. We conclude that the previous finding of a correlation between urethral pressure variation and BNEC, suggesting bladder neck opening occurs as urethral pressure falls in patients with gsi is confirmed, but appeared to be present in only 50% of patients; the finding is just as likely in normal patients, and therefore whilst it may be of relevance to the severity of symptoms, could not be held to have any aetiological significance.

Adult↗
PubMed1992

Subtrigonal phenol injections in the treatment of idiopathic detrusor instability in the female--a long-term urodynamic follow-up.

A total of 36 subtrigonal phenol injections were performed on 29 patients with detrusor instability. Long-term follow-up (mean 13.7 months) showed a subjective response rate of only 14%, and objectively there was no significant change in any urodynamic parameter in the group as a whole. There was, however, a significant improvement in cystometric capacity and volume at first contraction, in those under 55 years of age. One patient developed a vesicovaginal fistula following repeat injections. This suggests that subtrigonal phenol injections have little place in the treatment of detrusor instability, especially in the over 55s, and repeat injections should be abandoned because of the risk of major complications.

Adult↗
PubMed1991

The Stamey endoscopic bladder neck suspension: a clinical and urodynamic investigation, including actuarial follow-up over four years.

OBJECTIVE: To assess a modified Stamey endoscopic bladder neck suspension as a management for genuine stress incontinence in women unsuitable for colposuspension because of vaginal narrowing or inefficient voiding. DESIGN: Uncontrolled observational study. SETTING: Regional university gynaecological urology unit. SUBJECTS: A hundred women, median age 58 years, with genuine stress incontinence confirmed by urodynamic investigation; 65 had had previous surgery for the same problem. TREATMENT: A Stamey procedure with monofilament nylon and short buffers of silastic tubing at each anchor site. MAIN OUTCOME MEASURES: Urodynamic reassessment 3 months after surgery and clinical follow-up for up to 4 years, using life table methods. The median follow-up was 27 months. RESULTS: At 3 months the objective cure rate was 83%. Subjectively the cure rates at 4 years were 53% in patients under 65 years of age and 76% in those who were older. Overall mean bladder capacity decreased from 506 to 458 ml after surgery (P less than 0.05) and, in those who were cured, mean peak flow rate fell from 25.5 to 19.6 ml/s (P less than 0.05). The urethral functional length and the pressure transmission in the proximal three quarters were increased by successful surgery (P less than 0.01) but the resting urethral profile, voiding pressure and the frequency of detrusor instability were unchanged. CONCLUSIONS: This modification of the Stamey operation has an important role in the management of elderly patients those with previous unsuccessful operations, and those with inefficient voiding pre-operatively.

Adult↗
PubMed1989

A clinical and urodynamic study comparing the Stamey bladder neck suspension and suburethral sling procedures in the treatment of genuine stress incontinence.

Twenty women with urodynamically proven genuine stress incontinence were randomly allocated to treatment by suburethral sling or Stamey endoscopic bladder neck suspension. Urodynamic assessment was performed before and 3 months after surgery; clinical follow-up is reported up to 2 years. Blood loss was greater, and there were significantly more postoperative complications associated with the sling procedures. The subjective and objective cure rates at 3 months and 2 years were not significantly different between the two procedures. No significant changes in the resting urethral pressure profile were evident, although with both procedures, cure was associated with an enhancement in pressure transmission ratios in the proximal urethra. Detrusor instability occurring for the first time after operation was associated with both procedures; the sling, in addition, induced a significant degree of outflow obstruction, although this was not evident after the Stamey procedure.

Adult↗
PubMed1988

Surgical wound drainage: a survey of practices among gynaecologists in the British Isles.

All 2836 members and fellows of the Royal College of Obstetricians and Gynaecologists were circulated with a questionnaire concerning their practices with regard to wound drainage. The overall response rate was 43%, although that from practitioners of consultant and senior registrar status was 67%. The use of wound drainage was consistent between surgeons of differing levels of experience and different subspecialty interests within gynaecology. At routine 'clean' operations the use of drains is limited; only 0.4% of gynaecologists drain the peritoneal cavity, 1% the pelvis, 4% the subcutaneous tissues, and 20% the rectus sheath routinely. At more specialist 'clean' procedures, however, greater use of drains is made; at suprapubic incontinence operations 51% of surgeons drain the retropubic space; at radical hysterectomy 55% drain the pelvis; and at radical vulvectomy 63% use drains in the groins, routinely. In all the above operations much greater use is made of active (83%) than passive drains (17%). With potentially contaminated wounds, however, 46% of gynaecologists use a passive drain.

Appendectomy↗
PubMed1988

Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom.

A total of 400 women referred consecutively to a gynaecological urology clinic was questioned with regard to their sexual activity and were subsequently investigated by cystometry to establish the prevalence of urinary incontinence occurring during intercourse, and to define the urodynamic background of sufferers. Of the 400 women 324 were sexually active, and of these 79 (24%) experienced incontinence during intercourse; in two thirds of sufferers incontinence occurred on penetration, whereas in the remaining one third urine leakage was restricted to orgasm. Of the former group 70% were shown to have genuine stress incontinence and 4% detrusor instability; of the latter, 42% had genuine stress incontinence and 35% detrusor instability. A comparison of cystometric variables in these two index groups and matched controls failed to identify any specific abnormality of bladder function associated with these symptoms.

Adult↗
PubMed1988

Bladder drainage: a survey of practices among gynaecologists in the British Isles.

All 2836 members and fellows of the Royal College of Obstetricians and Gynaecologists were circulated with a questionnaire concerning catheterization practices; 1229 replies were received, an overall response rate of 43%; the response rate from practitioners of consultant and senior registrar status was 67%. Practices varied considerably, some aspects of management apparently relating to the age or experience of the surgeon, some to their level of interest or surgical commitment in gynaecological urology, and some showing regional variation. Of the 960 respondents in active gynaecological practice, 84-93% (depending on the operation) drained the bladder before routine abdominal procedures, 52-54% (depending on the route) drained the bladder before incontinence surgery, and 62-70% routinely used continuous bladder drainage for periods between 1 and 12 days following these procedures. Overall, 51% of respondents preferred urethral, and 39% suprapubic catheters for postoperative bladder drainage; this showed a marked regional- and experience-related variation. Prophylactic antibiotics were used by 32% of gynaecologists overall, and a wide variety of other measures were employed in the management of catheter-associated infection, and other problems of catheter management.

Abdomen↗
PubMed1986

Intravenous anaesthesia with propofol and alfentanil. The influence of age and weight.

Sixty healthy patients undergoing body surface surgery were anaesthetised with continuous infusions of propofol (200 micrograms/kg/minute) and alfentanil (0.25 microgram/kg/minute). Additional bolus doses of propofol (20 mg) were given if movement occurred. The incidence of patient movement in response to skin incision was significantly less in patients over 45 years of age than in those below 45 years (p less than 0.05). Maintenance dosage of propofol sufficient to abolish movement decreased with increasing age (p less than 0.001). Systolic blood pressure decreased in most patients over the first 10 minutes of anaesthesia and the magnitude of this decrease increased with age (p less than 0.0001). These parameters did not correlate strongly with body weight. Dose requirements of propofol are not the same for patients of all ages and strongly suggest that young and old patients should not be treated as a homogeneous group, either for investigative or clinical purposes.

Adult↗
PubMed1983

Urethral pressure measurement by microtransducer: the results in symptom-free women and in those with genuine stress incontinence.

Urethral pressure measurements were recorded at rest and during stress by a microtransducer technique in 20 women without urinary symptoms and 120 women with urodynamically proven genuine stress incontinence. In the symptom-free women the resting profile values were largely maintained during stress, as a consequence of 100% transmission of intra-abdominal pressure rises to the proximal three-quarters of the functional urethral length. Whilst the majority maintained continence at the bladder neck level, 25% of these controls showed evidence of bladder neck opening during stress. The stress-incontinent patients showed a deficiency of pressure transmission ratios which appeared to have an 'all or none' character in the determination of symptoms. The amplitude and stability of the maximum urethral closure pressure at rest, the extent of urethral closure pressure lost in response to stress, and the extent of intrabdominal pressure rises interact to determine the severity of symptoms or 'margin to continence'.

Adult↗
PubMed1983

A clinical and urodynamic assessment of the Burch colposuspension for genuine stress incontinence.

Twenty-five women having a Burch colposuspension operation were assessed before and after the operation by urodynamic investigations including urethral pressure measurements at rest and on stress. After 3 months, the objective cure rate was 88%. An increase in voiding difficulty and urodynamic evidence of outflow obstruction was seen after the operation. The operation does not induce any significant change in resting urethral profile variables. The stress profile showed accentuation in pressure transmission ratios, most marked in the proximal urethra. These changes are likely to be mechanical in origin and may be responsible for voiding difficulties in those women who initiate voiding by straining.

Adult↗