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Biomedical subjects

R C Bump

Publications and source records attributed to R C Bump.

At least 19 recordsLinked to original sources
PubMed1992

Obesity and lower urinary tract function in women: effect of surgically induced weight loss.

OBJECTIVE: The subjective and objective effects of massive weight loss on lower urinary tract function in morbidly obese women were examined. STUDY DESIGN: Thirteen subjects underwent a comprehensive evaluation of lower urinary tract function before and 1 year after surgically induced weight loss. RESULTS: We demonstrated significant improvements in lower urinary tract function after weight loss. Of 12 subjects who complained of incontinence before surgery only three complained of incontinence (p = 0.004) and only one requested treatment after weight loss. Objective and subjective resolution of both stress and urge incontinence was documented. Statistically significant changes were seen in measures of vesical pressure, the magnitude of bladder pressure increases with coughing, bladder-to-urethra pressure transmission with cough, urethral axial mobility, number of incontinence episodes, and the need to use absorptive pads. CONCLUSION: Weight reduction is desirable for obese women complaining of urinary incontinence and may obviate the need for further incontinence therapy.

Adult↗
PubMed1992

Cigarette smoking and urinary incontinence in women.

OBJECTIVE: The goal of this case control study was to evaluate the relationship between smoking and female urinary incontinence. STUDY DESIGN: The study included 606 women whose smoking histories were known; 322 were incontinent and 284 were continent. The condition(s) causing each subject's incontinence was determined by urodynamic testing; 40% of the continent subjects had the same testing. RESULTS: There were highly significant overall differences (p = 0.000009) in the distribution of current, former, and never smokers between incontinent (35%, 16%, 49%) and continent (24%, 8%, 68%) groups. The odds ratio for genuine stress incontinence was 2.20 for former (95% confidence interval 1.18 to 4.11) and 2.48 for current smokers (95% confidence interval 1.60 to 3.84); for motor incontinence it was 2.92 for former (95% confidence interval 1.58 to 5.39) and 1.89 (95% confidence interval 1.19 to 3.02) for current smokers. Increasing daily and lifetime cigarette consumption was associated with an increasing odds ratio for genuine stress incontinence but not for motor incontinence. The increased risk for incontinence was not due to differences in age, parity, weight, or hypoestrogenic status. CONCLUSION: The data establish a strong statistical relationship between current and former cigarette smoking and both stress and motor urinary incontinence in women.

Adolescent↗
PubMed1991

Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction.

Forty-seven women had urethral pressure profile determinations performed at rest and during a Kegel pelvic muscle contraction, after brief standardized verbal instruction. Twenty-three (49%) had an ideal Kegel effort--a significant increase in the force of urethral closure without an appreciable Valsalva effort. Twelve subjects (25%) displayed a Kegel technique that could potentially promote incontinence. Age, parity, weight, estrogen deprivation, prior continence surgery or hysterectomy, and passive urethral function did not predict a successful effort. We concluded that simple verbal or written instruction does not represent adequate preparation for a patient who is about to start a Kegel exercise program.

Adult↗
PubMed1991

Bladder training in older women with urinary incontinence: relationship between outcome and changes in urodynamic observations.

The purpose of this study was to clarify the mechanism by which bladder training affects urinary incontinence. Urodynamic data and specific urodynamic diagnoses of 108 women with urinary incontinence were compared before and 6 months after treatment with bladder training. Before treatment, 76 women had sphincteric incompetence, 11 had detrusor instability, and 16 had both. After treatment, 33 women no longer fulfilled the urodynamic diagnostic criteria for either sphincter or detrusor dysfunction. Controlling for severity before treatment, the number of incontinent episodes post-treatment was not associated with change in urodynamic diagnosis. Only the first sensation to void, voided volume, compliance, functional urethral length, and flow time showed any significant changes between pre- and post-treatment evaluations; however, none were correlated with change in the number of incontinent episodes. Bladder training does not appear to affect lower tract urodynamic variables or specific urodynamic diagnosis, and it is likely that its mechanism of action reflects adaptive behavioral changes. Physiologic changes not detected with techniques and/or criteria used in this study may still occur.

Aged↗
PubMed1991

Ectopic pregnancy in an urban teaching hospital: can tubal rupture be predicted?

We evaluated the medical history, physical examination, and laboratory tests done on 245 patients with laparoscopically proven ectopic pregnancies. The absence of abdominal pain was the only clinically useful negative predictive value (91%) regarding tubal rupture. Although mean levels of serum human chorionic gonadotropin (hCG-beta subunit) were significantly higher in patients with ruptured versus unruptured ectopic pregnancies (16,612 mIU/mL vs 6406 mIU/mL), no breakpoint excluded the possibility of tubal rupture. In fact, one third of ectopic pregnancies in patients with a serum beta-hCG level below 100 mIU/mL were ruptured. We conclude that clinical symptoms and signs are poor predictors of tubal rupture. In addition, absolute values of serum beta-hCG are not helpful in excluding the possibility of rupture.

Adult↗
PubMed1990

Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy.

To assess the relationship between either bacterial vaginosis or trichomoniasis vaginitis and posthysterectomy infection, preoperative evaluation of the vaginal secretions was performed in 161 women undergoing abdominal hysterectomy. Thirty-two patients (19.9%) and 27 patients (16.8%), respectively, met the diagnostic criteria for bacterial vaginosis and trichomoniasis vaginitis. Patients with either bacterial vaginosis or trichomoniasis vaginitis were more likely than control subjects to have cuff cellulitis, cuff abscess, or both (relative risk 3.2, 95% confidence interval 1.5 to 6.7 for bacterial vaginosis; relative risk 3.4, 95% confidence interval 1.6 to 7.1 for trichomoniasis vaginitis). Preoperative vaginitis had no effect with respect to the incidence of postoperative wound infection, urinary tract infection, or intravenous line phlebitis. Bacteroides sp., Peptostreptococcus sp., and/or Gardnerella vaginalis ("bacterial vaginosis organisms") were isolated from the vaginal cuff in the majority of patients with postoperative cuff cellulitis. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for the development of posthysterectomy cuff cellulitis.

Adult↗
PubMed1990

Urinary incontinence in community-dwelling women: clinical, urodynamic, and severity characteristics.

Descriptive data on 145 community-dwelling older women with urinary incontinence are presented. Assessment included history, physical and functional examinations, and urodynamic and severity evaluations. Patients were 67 +/- 8 years old, mentally and functionally intact, predominantly white, and of middle-to-upper socioeconomic strata. Specific urodynamic criteria were used to establish the diagnosis of sphincteric incompetence and detrusor instability. Fifteen (10%) did not fulfill either criteria, 90 (62%) had sphincteric incompetence, 17 (12%) had detrusor instability, and 23 (16%) had both. Detrusor and urethral function variables showed some impairment in all patients. Impairment was least in subjects without demonstrable diagnosis and worst in those with both disorders (p less than 0.01). The findings suggest that detrusor and urethral functions are impaired in all incontinent women and that the degree of impairment varies. The impairment seems worse when both urodynamic diagnoses are demonstrable. The data support the pathophysiologic association of urethral and detrusor dysfunctions.

Aged↗
PubMed1990

Urinary tract infection in women. Current role of single-dose therapy.

Administration of a single dose of an antimicrobial agent is acceptable therapy for women with uncomplicated lower urinary tract infections. There is adequate information in the literature to support the clinical use of single-dose therapy, although there is still a need for further, well-designed, sufficiently large studies that compare single-dose therapy to abbreviated-course (3-day) and traditional (7- to 14-day) therapy.

Anti-Bacterial Agents↗
PubMed1989

The urodynamic laboratory.

This article reviews some of the technical, philosophical, and procedural aspects of the workings of a clinical urodynamic laboratory. Specifically considered are four widely used tests (cystometry, urethral profilometry, uroflowmetry, and electromyography) and the measuring and recording systems used to generate them. The role of urodynamic testing in the overall evaluation of patients with lower urinary tract dysfunction is addressed.

Electromyography↗
PubMed1988

Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission.

Sixty-eight sexually active and 52 virginal asymptomatic adolescent girls were evaluated for bacterial vaginosis and various laboratory indicators of bacterial vaginosis in a 3-month observational noninterventive study. Sixteen of 120 (13%) subjects had bacterial vaginosis during the study. There was no significant difference in the prevalence of bacterial vaginosis or in the prevalence of isolation of Gardnerella vaginalis between the sexually active and virginal groups. Only a few cases of bacterial vaginosis (one of eight), wet mount clue cells (four of 11), sniff tests (two of eight), and abnormal vaginal fluid succinate/lactate ratios (none of 6) persisted for 3 months in the absence of therapy. These results are discussed in light of several recent reports that suggest using the isolation of G. vaginalis or the diagnosis of bacterial vaginosis as evidence of sexual abuse in children. It is concluded that bacterial vaginosis should not be considered an exclusively sexually transmitted disease. The presence of the condition is neither proof of sexual activity nor warrants male sexual partner therapy. In addition, therapy seems unwarranted for the incidental finding of bacterial vaginosis in the patient without symptoms.

Adolescent↗
PubMed1988

Dynamic urethral pressure/profilometry pressure transmission ratio determinations in stress-incontinent and stress-continent subjects.

Bladder-to-urethra pressure transmission ratios were calculated in each quarter (designated Q1 through Q4) of the dynamic urethral pressure profile in 110 subjects. Thirty-seven subjects had genuine stress urinary incontinence, whereas 73 were stress continent. Subjects with genuine stress incontinence had significantly lower mean (+/- SD) pressure transmission ratios in all four urethral quarters compared with stress-continent subjects: 71% +/- 14% versus 94% +/- 38% for Q1 (p = 0.004), 69% +/- 16% versus 101% +/- 42% for Q2 (p = 0.00001), 79% +/- 19% versus 113% +/- 46% for Q3 (p = 0.0001), and 90% +/- 22% versus 117% +/- 36% for Q4 (p = 0.001). A pressure transmission ratio value less than 90% in the proximal half of the dynamic profile had a sensitivity of 97%, a specificity of 56%, an abnormal predictive value of 53%, and a normal predictive value of 97%. Calculation of pressure transmission ratios, as opposed to declaring the stress profile positive or negative based on whole urethra/bladder pressure equalization with stress, enhances the utility of the dynamic urethral pressure profile and allows quantification of one of the several variable in the equation of stress urinary incontinence.

Adult↗
PubMed1988

Non-neuromuscular determinants of intraluminal urethral pressure in the female baboon: relative importance of vascular and nonvascular factors.

The female urethral sphincteric mechanism has both neuromuscular and non-neuromuscular components. The latter component has several determinants, including the urethral mucosa, the connective tissue of the urethra and periurethra, and the submucosal vascular bed. This study was designed to characterize the non-neuromuscular component of the urethral pressure profile (UPP) by quantitating the relative contributions of its vascular and non-vascular determinants in four female baboons. Following minimization of the smooth muscle and striated muscle determinants (the neuromuscular component) with halothane and pancuronium bromide, UPPs were performed before and after aortic occlusion. It is concluded that vascular and non-vascular factors contribute nearly equally to the non-neuromuscularly generated portion of intraluminal urethral pressure.

Animals↗
PubMed1988

Dynamic urethral pressure profilometry pressure transmission ratio determinations after continence surgery: understanding the mechanism of success, failure, and complications.

Twenty-two women who had previously undergone continence surgery for the correction of stress urinary incontinence were evaluated with dynamic urethral pressure profilometry and had bladder-to-urethra pressure transmission ratios calculated. Eight of the subjects had recurrent or persistent genuine stress incontinence (group 1), seven had detrusor instability (group 2), and seven had normal continence and detrusor function (group 3). In addition, we evaluated ten subjects with detrusor instability but no previous surgery (group 4). There were clear and significant differences in pressure transmission ratios between the four groups. These differences suggest that subjects in group 1 have the same basic mechanisms of incontinence (ie, inefficient pressure transmission to the urethra as reflected by pressure transmission ratios less than 90%) as do never-operated women with genuine stress incontinence. Subjects in group 2 had pressure transmission ratios that were significantly higher than those in either group 3 or 4. This supports the hypothesis that obstruction may play a role in post-continence surgery detrusor instability, but not in idiopathic detrusor instability. Group 2 subjects had pressure transmission ratios very close to the ideal of 100%. We postulate that continence procedures that consistently result in pressure transmission ratios close to 100% should have the greatest chance for success without inducing complications.

Adult↗
PubMed1988

Postmenopausal urinary incontinence: comparison between non-estrogen-supplemented and estrogen-supplemented women.

Clinical and urodynamic variables of 49 non-estrogen-supplemented and 23 estrogen-supplemented postmenopausal women with urinary incontinence were compared. We ascertained their estrogenic status via plasma estradiol and estrone levels, as well as from parabasal and superficial cell counts from both the urethra and vagina. The effect of estrogen supplementation, in conjunction with the effect of age and urodynamic diagnosis, was studied in relation to filling-phase urodynamic data and incontinence severity and outcome variables. Analysis of covariance was used. No direct effect of estrogen supplementation was noted on parameters of urethral function. In patients with detrusor instability, a borderline direct positive effect (P = .06) was noted in the volume needed to reach maximal cystometric capacity from the first sensation to void. For these patients, the magnitude of fluid loss was greater without estrogen supplementation. However, this difference did not reach statistical significance. Nocturia was significantly less frequent in the estrogen-supplemented groups (P = .04). Estrogen-supplemented patients had a higher incidence of positive bulbocavernosus reflex (P = .01). These observations suggest that hypoestrogenism may affect the sensory threshold of the lower urinary tract of incontinent postmenopausal women.

Administration, Oral↗
PubMed1988

The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies.

Eleven continent women with severe degrees of uterovaginal prolapse underwent a complete urodynamic evaluation that included passive and dynamic urethral pressure profilometry with and without careful barrier reduction of their prolapse. The aim of barrier placement was to reduce, but not overcorrect, the prolapse and to restrict stress-induced mobility of the viscera posterior and superior to the urethra. Each of the women had very high pressure transmission ratios in each quarter of the urethra (means of 257, 187, 170, and 166% from internal to external quarters) that were significantly reduced with barrier placement (means of 78, 84, 85, and 101%). Eight of 11 subjects had pressure transmission ratios less than 90% in the proximal three-quarters of the urethra with the barrier in place, a finding in nearly all subjects with genuine stress urinary incontinence. Maximum urethral closure pressure on passive urethral pressure profilometry also decreased significantly from a mean of 75 to 45 cm H2O with the barrier in place. We conclude that the stress continence mechanism in women with severe prolapse results from posterior-superior visceral descent with stress, causing mechanical obstruction of the less mobile urethra. The evaluation methods described may be useful in predicting which of these patients may require concurrent urethropexy at the time of prolapse reduction surgery to prevent postoperative stress urinary incontinence.

Adult↗
PubMed1986

Urethral axis and sphincteric function.

Position and mobility of the urethral axis are considered factors influencing urethral competence. Specific correlation between the urethral axis and its sphincteric function is lacking. Eighty-four patients with the symptom of stress urinary incontinence and 31 patients with sensory symptomatology but not urinary incontinence underwent clinical and urodynamic evaluation. This included objective assessment of urethral axial positions and mobility with use of a specially designed protractor. Comparative analysis of urethral axial data was done between 70 incontinent women with objective evidence of sphincteric incompetence and 24 continent women without it. The urethral axis at rest, during bearing down, and in its total excursion were found to be not significantly different and distributed similarly between both groups. Assessment of the urethral axis was found to be not predictive of urethral function.

Cough↗
PubMed1986

Intraluminal urethral pressure measurements in the female baboon: effects of hormonal manipulation.

Four female baboons underwent cystometry and simultaneous urethral pressure profilometry (UPP) in a hypoestrogenic castrate state, after estrogen treatment, and after concurrent testosterone and estrogen treatment. Studies were performed under general anesthesia both before and after skeletal muscle paralysis. The results provide objective evidence that estrogen replacement enhances the urethral sphincter mechanism in the castrate female baboon by significantly increasing the paralyzed and nonparalyzed urethral length as well as the paralyzed total UPP area and the paralyzed UPP area to maximum urethral closure pressure (MUCP). The area increases reflected both the increase in functional urethral length as well as increases in mean urethral pressure. Muscle paralysis significantly reduced MUCP in all three hormonal states. The addition of testosterone had no significant effect on the UPP measurements. These findings are discussed in light of conflicting human studies regarding objective evidence for the role of hormonal modulation of urethral function and the role of estrogen therapy for stress urinary incontinence.

Animals↗