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V Khullar

Publications and source records attributed to V Khullar.

25 records · Page 2Linked to original sources
PubMed1998

The urethra (UPP, MUPP, instability, LPP).

Urethral function can be assessed using many different techniques and this is very important when applied to women with neurological abnormalities. Urethral pressure profilometry, although not diagnostic for urethral sphincter incompetence, can be used to detect strictures and the ostia leading to urethral diverticula. Urethral instability may be recorded using urethral pressure catheters. The significance of this finding is uncertain but it has been suggested that women with urethral instability and detrusor instability are less responsive to therapy with anticholinergic drugs than those with a stable urethra. Micturition pressure profilometry is useful for determining obstruction during voiding and enables the site of obstruction to be determined. Leak point pressures (LPP) can be classified as detrusor or abdominal. Detrusor LPP are useful in patients with neurological disease. Abdominal LPP are subdivided according to the method used to increase intra-abdominal pressure either the Valsalva manoeuvre or coughing. The technique used to obtain an LPP can alter the measurement obtained and a standardized technique is essential for consistent results. LPP correlate with the urinary incontinence of women with genuine stress incontinence undergoing a pad test but is of no value if the woman does not leak! Tests of urethral function during bladder filling, stress and voiding phases help in assessing lower urinary tract dysfunction in neurourology.

Female↗
PubMed1997

GAX collagen in the treatment of urinary incontinence in elderly women: a two year follow up.

OBJECTIVE: To determine the efficacy of GAX collagen in the treatment of elderly women with genuine stress incontinence. DESIGN: A single centre prospective study. SETTING: A London teaching hospital. PARTICIPANTS: Thirty-four women older than 60 years of age with genuine stress incontinence diagnosed on videocystourethrography. INTERVENTIONS: Up to three paraurethral injections of GAX collagen. MAIN OUTCOME MEASURES: Subjective and pad test assessments performed pre-operatively, after one month, one year and two years after the first injection of collagen. Videocystourethrography and urethral pressure profilometry were carried out pre-operatively, after three months and one year. RESULTS: There was a reduction in urinary leakage as measured on pad testing. After two years 77% of the surviving 26 women were symptomatically cured. Objectively after two years 48% of the women were cured and 9% were improved over their initial pre-treatment level of incontinence. The cure rate was the same whether or not the women had undergone previous vaginal surgery. The maximum urethral closure pressure was not increased with treatment indicating that collagen injections do not act by producing obstruction, but this should be interpreted with caution due to the small sample size. CONCLUSION: GAX collagen is an effective method of treating urinary incontinence in the elderly and especially women who have undergone previous continence procedures. The technique is easy to perform and particularly suitable in those who are frail, but if failure occurs after two years consideration needs to be given to its cost effectiveness.

Aged↗
PubMed1997

A new questionnaire to assess the quality of life of urinary incontinent women.

OBJECTIVES: To design and validate a condition-specific quality of life questionnaire for the assessment of women with urinary incontinence, and to use the questionnaire to assess the quality of life of women with specific urodynamic diagnoses. SETTING: A tertiary referral urogynaecology unit at King's College Hospital, London. DESIGN: The questionnaire was designed following six different pilot studies; in this study it was tested for validity and reliability using standard psychometric techniques. The questionnaire was used in 293 consecutive women referred for investigation of urinary incontinence. RESULTS: The questionnaire was shown to be reliable both by test-retest analysis and by measurement of its internal consistency. The construct of the questionnaire and the answers by respondents confirmed its face and content validity. Criterion validity was measured by correlation with scores obtained on a validated generic measure of quality of life, the Short Form 36. Women with detrusor instability had greater quality of life impairment than women with other urodynamic diagnoses. CONCLUSION: The questionnaire was easy for the women to use and was a valid and reliable instrument for the assessment of quality of life in women with urinary incontinence. It will be useful for the rapid appraisal and follow up of women with urinary incontinence in many different clinical settings, including the evaluation of new treatments of urinary incontinence in controlled clinical trials.

Adult↗
PubMed1997

A medium-term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compliance.

OBJECTIVE: The aims of this study were to determine the medium-term subjective outcome of treatment for women with a urodynamic diagnosis of detrusor instability and low bladder compliance. SETTING: A tertiary referral urogynaecology clinic. PARTICIPANTS AND METHODS: One thousand one hundred and five women referred for the investigation of their urinary symptoms were entered into a prospective, long term, quality of life study. Of these, 348 had a videourodynamic diagnosis of detrusor instability or low bladder compliance and form the basis of this paper. Women were contacted by post at least six months following their urodynamic assessment and asked to complete a questionnaire detailing their treatment, its efficacy and side effects, and any residual urinary symptoms. RESULTS: Two hundred and fifty-six women (73.6%) responded to follow up; only 5.5% were cured of their urinary symptoms. The majority (90.2%) had received anticholinergic medication, although only 18.2% continued with this treatment in excess of six months. Many women had residual urinary symptoms following their investigation and treatment. CONCLUSION: The medium term efficacy of the treatment of detrusor instability and low compliance is disappointing, and a large part of this failure may be attributable to poor treatment efficacy, side effects of medication, or inadequate follow up following the diagnosis and instigation of therapy.

Adult↗
PubMed1996

Ultrasound: a noninvasive screening test for detrusor instability.

OBJECTIVE: To determine whether transvaginal ultrasound measurement of bladder wall thickness can be used as a screening test for detrusor instability in women with urinary symptoms. DESIGN: A blinded prospective study. SETTING: A London teaching hospital. PARTICIPANTS: One hundred and eight-four symptomatic women presenting to a urodynamic clinic. MAIN OUTCOME MEASURE: The detection of detrusor instability by means of videocystourethrography (VCU) and ambulatory urodynamics in women with a mean bladder wall thickness of greater than 5 mm measured by transvaginal ultrasound. RESULTS: One hundred and eight women had a mean bladder wall thickness of greater than 5 mm. Ninety-four percent (102) of these women had detrusor instability either when undergoing VCU or ambulatory urodynamics. Seventeen women had a bladder wall thickness of less than 3.5 mm of whom three were found to have detrusor instability on VCU. CONCLUSION: The measurement of a mean bladder wall thickness greater than 5 mm with transvaginal ultrasound is a sensitive screening method for diagnosing detrusor instability in symptomatic women without outflow obstruction.

Adult↗
PubMed1994

A novel technique for measuring bladder wall thickness in women using transvaginal ultrasound.

A new technique of measuring bladder wall thickness using transvaginal ultrasound is described. Measurement of the bladder wall using ultrasound was found to have a good intra- and interobserver reproducibility. Measurements of the bladder wall thickness were altered if more than 50 ml of fluid was within the bladder. Forty-five women with urinary symptoms were recruited from the urodynamic clinic; those with urodynamically diagnosed detrusor instability were found to have significantly thicker bladder walls than women with urodynamically diagnosed genuine stress incontinence. Application of this technique may be useful in the diagnosis of detrusor instability.

Journal Article↗