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At least 19 recordsLinked to original sources

PubMed1985

Relative urethral leakage pressure versus maximum urethral closure pressure. The reliability of the measurement of urethral competence with the new tube-foil sleeve catheter in patients.

In 78 female patients the urethral leakage pressure, defined as the intravesical pressure at which leakage starts from the urethral orifice, was estimated with the tube-foil sleeve catheter. In accordance with the definition of maximum urethral closure pressure, the relative urethral leakage pressure was defined as urethral leakage pressure minus intravesical resting pressure. In the same patients urethral closure pressure was also measured by urethral pressure profilometry with a flexible micro pressure-sensor catheter. On the average the ratio of relative urethral leakage pressure/urethral closure pressure was about 0.5. Relative urethral leakage pressure and urethral closure pressure were higher than the maximum detrusor pressure increases during detrusor instabilities in 21 continent patients with motor urge. The relative urethral leakage pressure correlated better with the detrusor pressure elevations at which fluid loss from the urethral orifice started in 24 motor urge incontinent patients than urethral closure pressure did.

Female↗

PubMed2004

Predictive value of maximum urethral closure pressure, urethral hypermobility and urethral incompetence in the diagnosis of clinically significant female genuine stress incontinence.

PURPOSE: We determined the value of urethral hypermobility, maximum urethral closure pressure (MUCP) and urethral incompetence in the diagnosis of stress urinary incontinence (SUI). MATERIALS AND METHODS: In this study 369 women with clinical symptoms suggestive of SUI without symptoms of bladder overactivity were evaluated in regard to urethral incompetence, urethral hypermobility and mean MUCP. The cohort was divided into 2 groups according to continence/incontinence status. ROC curves were used to test the performance of the various predicting factors. These factors were combined in forward stepwise logistic regression to find the cutoff point that simultaneously optimized sensitivity and specificity. RESULTS: Continent and incontinent patients differed with regards to urethral incompetence and hypermobility (each p <0.0001). Incontinent patients had a greater probability of a higher grade of each factor. Even after adjusting for the older age of incontinent patients by ANCOVA. MUCP was significantly lower in the incontinent group (p <0.001). The best univariate optimized cutoff point for discriminating continence from incontinence was obtained with urethral incompetence greater than grade I. CONCLUSIONS: The best single predictor of clinically significant SUI is urethral incompetence, followed by urethral hypermobility and MUCP. When combining several factors, namely grade II urethral incompetence with grade III hypermobility, grade III urethral incompetence with grades I to III hypermobility and grade IV urethral incompetence with or without urethral hypermobility, all indicated more than a 90% probability of clinically significant SUI.

Adult↗

PubMed1989

[Treatment of congenital urethral stenosis (urethral ring) in children. Optic internal urethrotomy in the congenital bulbar urethral stenosis in boys].

Congenital urethral stenosis in boys occurs at the junction of the entodermal primary urethra and ectodermal secondary urethra. Endoscopically this lesion is recognized as a ring-form stenosis just distal to the external urethral sphincter. It has been considered as rare congenital anomaly in American literature. But in our experience congenital urethral stenosis is an important cause of recurrent urinary tract infections, enuresis, pollakisuria or hematuria in pediatric urological practice. It also disturbs spontaneous healing of vesicoureteral reflux. The most effective treatment of this lesion is optic internal urethrotomy under direct vision. We would like to report our experience of optic internal urethrotomy for congenital urethral stenosis in boys. From 1974 to 1986, 226 boys with congenital bulbar urethral stenosis were treated in our clinic. Optic internal urethrotomy was performed using a Sachse urethrotome with a 10 or 13 Fr. sheath. Of the 176 ureters with vesicoureteral reflux, spontaneous disappearance of reflux after optic internal urethrotomy was noted in 62.5% of Grade I-II, 65.0% of Grade III, 28.9% of Grade IV and 16.7% of Grade V ureters. These spontaneous disappearance rates were significantly higher than those of primary vesicoureteral reflux in Grade III, IV and V ureters. Of the drug-resistant enuretic boys with a congenital bulbar urethral stenosis, enuresis disappeared or ameliorated in 69.4% after optic internal urethrotomy. Furthermore, urinary tract infections were mostly prevented by optic internal urethrotomy, irrespective of the presence or absence of vesicoureteral reflux. Our results support the view that congenital urethral stenosis (urethral ring) is an important clinical entity in pediatric urology.

Adolescent↗

PubMed2004

Observations on the function of the female urethra: III: An overview with special reference to the relation between urethral hypermobility and urethral incompetence.

AIMS: To analyze the relation between urethral hypermobility and urethral incompetence, and to summarize the interdependence between maximum urethral closure pressure (MUCP), urethral hypermobility, and urethral incompetence. PATIENTS AND METHODS: A group of 255 patients was selected from a large bank of cases. Inclusion criteria were age 20 years or above, no neurological disease, stable bladder, and no previous incontinence surgery or hysterectomy. The degree of hypermobility (cysto-urethrocele) and the degree of urethral incompetence (abdominal leak point pressure (ALPP)) were determined. Statistical analyses between urethral hypermobility and incompetence were performed with Spearman's correlation and the Jonckherre-Terpstra test. RESULTS: The Spearman's rank correlation test showed a statistically significant relation between urethral hypermobility and the degree of urethral incompetence (P = 0.0049). CONCLUSIONS: The statistically significant relation between urethral incompetence and hypermobility suggests that urethral incompetence will increase as the degree of urethral hypermobility does. Optimal conditions for urinary continence include a high maximum urethral closure pressure, absence of hypermobility, and a low degree of urethral incompetence. This last factor is assured by a strong support underneath the urethra permitting compression of the latter during straining. Failure of the urethral closure mechanism is highly probable with a diminished maximum closure pressure accompanied by urethral hypermobility often associated with a high degree of urethral incompetence. Clinically significant urinary incontinence may appear in many intermediate circumstances between these two extreme states, but stress urinary incontinence is essentially an activity-related phenomenon.

Adult↗

PubMed2003

Observations on the function of the female urethra: I: relation between maximum urethral closure pressure at rest and urethral hypermobility.

AIMS: To study the relation between maximum urethral closure pressure at rest and urethral hypermobility in female patients. PATIENTS AND METHODS: We selected 255 patients aged 20 years and older, with a stable bladder on multichannel urodynamics, without known neurological pathology, and without a history of pelvic or anti-incontinence surgery. A resting urethral pressure profile and the degree of urethral hypermobility were registered. Two-tailed analyses of variance (ANOVA) with Fisher's post-hoc tests were used to detect any statistically significant difference (P < 0.05) in urethral closure pressure between groups with varying degrees of urethral hypermobility. RESULTS: Mean age was 45.6 +/- 12.7 (range 20-77) years. Mean maximum urethral closure pressure for the entire group was 62.7 +/- 29 (range 10-150) cm of water. A statistically significant inverse relationship was found between age and maximum urethral closure pressure (r = 0.489, P < 0.0001) when both analyzed as continuous variables, and with age categorized in 10-year increments (P < 0.0001). When comparing mean urethral closure pressure in each group examined for urethral hypermobility, a statistically significant difference was noted when grades I, II, and III were compared to grade 0 hypermobility. No significant difference was observed when grades I, II, and III were compared to each other. Even if statistically non-significant, there exists an inverse relationship between the degree of urethral hypermobility and the maximum urethral closure pressure: a higher hypermobility is associated with a lesser urethral closure pressure. CONCLUSIONS: Urethral closure pressure falls significantly when urethral hypermobility is present. This decrease is not related to patient's age or parity. Our observations demonstrate an inverse relation between urethral closure pressure and the degree of cysto-urethrocele. As hypermobility increases, closure pressure decreases, even if this decrease does not reach the level of statistical significance.

Adult↗

PubMed1992

[Diagnosis of gonococcal urethritis and chlamydial urethritis by polymerase chain reaction].

A polymerase chain reaction (PCR) method was compared to standard methods (cultures for Neisseria gonorrhoeae and Chlamydia trachomatis and an enzyme-immunoassay for C. trachomatis) in diagnosis of gonococcal and chlamydial urethritis in 40 male patients with urethritis. Gonococcal urethritis was diagnosed by detection of a 206 bp DNA fragment amplified by PCR with N. gonorrhoeae-specific primers. Chlamydial urethritis was diagnosed by detection of a 242 bp DNA fragment amplified by PCR with C. trachomatis-specific primers. Gonococcal and chlamydial urethritis, gonococcal and non-chlamydial urethritis, non-gonococcal and chlamydial urethritis, and non-gonococcal and non-chlamydial urethritis were diagnosed in 8, 10, 14 and 8 patients, respectively, by the PCR method. In 9 patients with gonococcal and chlamydial urethritis, 10 with gonococcal and non-chlamydial urethritis, 12 with non-gonococcal and chlamydial urethritis, and 9 with non-gonococcal and non-chlamydial urethritis, diagnosed by the standard methods, the coincidence rates of the PCR to the standard methods were 78% (7/9), 90% (9/10), 100% (12/12), and 89% (8/9), respectively. The overall coincidence rate between the PCR and the standard methods in diagnosis of urethritis were high (90%). In addition, N.gonorrhoeae and C.trachomatis could be simultaneously detected from one urethral sample in approximately 6 hours by means of the PCR. Thus, the PCR method could clinically be applied and would offer several advantages to diagnosis of urethritis, compared to the standard methods.

Chlamydia Infections↗

PubMed1991

Use of fine-wire electrodes for electromyographic evaluation of the external urethral sphincter during urethral pressure profilometry in male cats.

Evaluation of urethral pressure profilometry (UPP) with simultaneous fine-wire electromyography of the external urethral sphincter (EUS) was conducted in 11 healthy adult male cats sedated with xylazine and ketamine. A 3.5-F urethral catheter with a closed end and two 1-mm side-ports was infused with sterile 0.9% NaCl solution at a rate of 2 to 3 ml/min. A fine-wire electromyographic (EMG) electrode was placed percutaneously into or near the external urethral sphincter prior to the onset of the UPP. The maximal urethral pressure achieved and functional profile length were recorded from UPP. Setting both catheter withdrawal rate and paper speed at 5 mm/s enabled the measurement of actual urethral length directly from UPP. Sphincter EMG activity was rated as slight (+), moderate (+ +), or intense (+ + +). All recordings were replicated once during each trial for 8 cats and trials were replicated 5 to 7 days later in 4 cats. Before catheterization, EMG activity of the external urethral sphincter was rated slight (+), whereas intense (+ + +) activity accompanied insertion. The activity evoked by movement of the catheter subsided, but intense EMG activity of the external urethral sphincter was recorded from onset to completion of catheter withdrawal in all cats in both trials. The mean maximal urethral pressure was 93.1 +/- 13.29 cm H2O. The mean function urethral length was 8.1 +/- 0.93 cm. Maximal urethral pressure or function profile length did not differ significantly between recordings within trials or between trials. Simultaneous recording of EMG activity and UPP of the external urethral sphincter was shown to be a simple, noninvasive technique for assessing neuromuscular and anatomic urethral function.

Animals↗

PubMed1989

Urethral pressure variations diagnosed by multiple urethral pressure transducers. A common phenomenon in women suffering from urinary incontinence.

The prevalence of urethral pressure variations (variation of urethral pressure greater than 15 cm H2O) was investigated, with the use of a data-based multitransducer catheter, in female patients suffering from urinary incontinence. Urethral pressure variations were diagnosed in 45 (63%) of 71 patients. This prevalence was greater than in previous studies, possibly for methodological reasons; the urethral pressure was simultaneously measured by five urethral microtransducers, thereby registering all variations in maximal urethral pressure. The present method also showed that urethral pressure variations were simultaneously present in different urethral sites, but that the amplitude of variation differed between the different points of registration. In most cases, urethral pressure variations were already apparent at the start of urethrocystometry. Voluntary holding, in an effort to inhibit the desire to void, can cause these variations in urethral pressure. Hence urethral pressure variations may be a normal physiological phenomenon.

Female↗

PubMed1999

[Clinical trial of the effect of urethral catheter on the etiology of urethral stenosis following transurethral resection of the prostate].

OBJECTIVE: To analyze the effect of the urethral catheter and urethral secretions in the development of urethral stricture post-transurethral resection of the prostate (TURP). METHODS: A clinical study was conduced on 109 patients treated by TURP. The patients were randomly assigned to one of the following groups: A (suprapubic catheter), B (urethral catheter), C (urethral cleansing). The incidence of urethral stricture in the different groups was compared using the chi-square test and survival was analyzed by the Kaplan Meier method. RESULTS: 5 patients were lost to follow-up (4.5%). The median number of days the catheter was indwelling was one day for group A, and 4 days for groups B and C. The overall incidence of urethral stricture was 4.3%; by groups the incidence was 3.8% for group A, 3% for B and 5.9% for group C. The differences were not statistically significant. CONCLUSION: The study showed no statistically significant differences in the incidence of post-TURP urethral stenosis in patients with a suprapubic or urethral catheter. Furthermore, urethral stenosis was not less frequent in patients in whom urethral cleansing was performed.

Aged↗

PubMed1997

Traumatic posterior urethral injury and early realignment using magnetic urethral catheters.

PURPOSE: We determined the success of early urethral realignment using magnetic urethral catheters. MATERIALS AND METHODS: We retrospectively reviewed the records of 13 patients with complete urethral disruption treated with endourological realignment 0 to 11 days after injury using coaxial magnetic urethral catheters. RESULTS: Urethral realignment was established in 11 of the 13 patients (85%) using magnetic urethral catheters. Of the 10 patients for whom followup was available urethral strictures developed in 5 (50%) a mean of 6.1 months after realignment, necessitating a mean of 1.4 corrective procedures per patient. Impotence was noted in 1 of 7 patients (14%) and no urinary incontinence developed after realignment. CONCLUSIONS: Urethral realignment within 2 weeks of injury using magnetic urethral catheters is a safe and simple technique with minimal morbidity. The stricture formation, impotence and incontinence rates of this technique are comparable to those reported for delayed urethroplasty. We advocate early realignment using magnetic urethral sounds as an alternative treatment for traumatic urethral disruption.

Adolescent↗

PubMed1999

Voiding and sexual dysfunctions after pelvic fracture urethral injuries treated with either initial cystostomy and delayed urethroplasty or immediate primary urethral realignment.

OBJECTIVE: The aim of this study is to evaluate the effects of the different immediate treatment modalities on the sexual and voiding functions in pelvic fracture urethral injuries. METHODS: The records of 38 male patients with traumatic posterior urethral injuries were reviewed, 18 of whom were treated by initial suprapubic cystostomy and delayed repair (Group 1), and 20 by primary urethral realignment (Group 2). Types of pelvic fractures and urethral injuries were classified according to surgical and radiological findings. Long-term voiding functions were determined by the patient questionnaire, residual urine and uroflow. Sexual functions were also determined by the patient questionnaire and a penile duplex ultrasound study. RESULTS: Mean follow-ups of Groups 1 and 2 were 37 and 39 months, respectively. Membranous urethral disruption extending to the urogenital diaphragm was the most frequent urethral injury (type 3), with incidences of 66.7% and 77.7%, respectively. There were no statistically significant differences in mean age, incidence of pelvic fracture types and urethral injury types between groups (p > 0.05). After the immediate treatments, 16.7% and 55% of the patients regained normal urination, and stricture developed in 83.3% and 45% of the patients, respectively. In 44.4% of the patients in Group 1 and 10% in Group 2, urethral strictures required open urethroplasty (p < 0.05). Erectile impotence before urethroplasty in 17.6% and 20%, anejaculation after urethroplasty in 17.6% and 15% and incontinence in 5.6% and 10% of the patients were found in Groups 1 and 2, respectively (p > 0.05). However, 88.8% and 90% of patients eventually achieved normal urination with complete continence. CONCLUSION: Sexual and voiding dysfunction after pelvic fracture posterior urethral injury seem to be the result of the injury itself, not of the immediate treatment modalities. In urethral disruption injuries, primary urethral realignment seems more favourable than suprapubic cystostomy and delayed repair.

Adolescent↗

PubMed1995

Human immunodeficiency virus DNA in urethral secretions in men: association with gonococcal urethritis and CD4 cell depletion.

To evaluate the prevalence and correlates of human immunodeficiency virus (HIV)-infected cells in urethral secretions, samples were collected from 106 HIV-seropositive men with and without urethritis. HIV DNA was detected by polymerase chain reaction in 27% of 184 urethral specimens and was associated with CD4 cell depletion (P for trend, .03) and with urethritis (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.6) or gonorrhea (OR, 2.9; 95% CI, 1.5-5.8). Two multivariate models were constructed that included age, CD4 cell count < 200/mm3, and either urethritis or gonococcal infection. Detection of HIV-infected cells in urethral secretions was independently associated with < 200 CD4 cells/mm3 (OR, 2.2; 95% CI, 0.9-5.2; P = .05) and urethritis (OR, 2.7; 95% CI, 1.3-5.3; P = .003) in the first model and with gonococcal infection (OR, 3.2; 95% CI, 1.6-6.4; P < .001) in the second model. Successful treatment of gonococcal urethritis was associated with a 2-fold reduction in urethral HIV DNA (44% vs. 21%; P = .02). Thus, treatment of gonococcal urethritis may be an effective strategy for reducing HIV transmission.

Adult↗

PubMed1992

[Urodynamic studies before and after gradual urethral dilatation with metal sounds for female urethral stricture].

We evaluated the urodynamics in women with urethral stricture after urethral dilatation. A total of 16 patients underwent treatment with gradual urethral dilatation at increasing intervals (2 weeks, 1 month, 3 months and 6 months). Their urethra was dilated up to 30 F. with metal sounds. Urethral calibration with bougie à boule, uroflowmetry and urethral pressure profile were performed before urethral dilatation and 1 week after the last dilatation. The urethral caliber was increased from 18.1 +/- 0.6 F. to 23.5 +/- 1.0 F. (P less than 0.005), average flow rate from 9.4 +/- 0.8 ml/sec to 11.2 +/- 1.1 ml/sec (P less than 0.025) and maximum urethral pressure with a full bladder decreased from 105.4 +/- 9.4 cmH2O to 87.5 +/- 10.5 cmH2O (P less than 0.05). With gradual urethral dilatation with metal sounds, (1) the urethra was significantly dilated, (2) maximum urethral pressure was significantly decreased and (3) average flow rate was significantly increased.

Adult↗

PubMed1980

Studies of female urethral pressure profile. Part II. Urethral pressure profile in female incontinence.

Most pressure values, except U1 and areas under the curve, were significantly lower in the 456 curves obtained in 38 incontinent women than in normal subjects. Standard deviations of all parameters are important because of variations in the degree of patient relaxation, explaining a large overlapping zone in which curves from the incontinent and the normal groups are superimposed. There are 3 factors that cause a reduction in urethral pressure profile: 1) aging and menopause (which are attributed to reduction in urethral compliance), 2) multiparity and 3) previous significant urogynecological operations. Besides urethral compliance urethral pressure profile studies allow measurement of 5 other components of the urethral resistance: 1) the degree of patency of the vesical neck, 2) the maximum voluntary sphincter contraction, 3) the functional urethral length, 4) the facilitatory urethral relaxation reflex and 5) the degree of urethral displacement to some extent. Separate measurements of each urethral factor should allow a more accurate analysis of urethral resistance and, consequently, enhance the quality of therapeutic indications in the management of female incontinence.

Adult↗

PubMed2001

Urethritis associated with Chlamydia trachomatis: comparison of leukocyte esterase dipstick test of first-voided urine and methylene blue-stained urethral smear as predictors of chlamydial infection.

The use of nucleic acid amplification tests for the diagnosis of C. trachomatis has made it possible to send urine samples instead of urethral swab specimens to the laboratory. The sensitivity is very high, but not 100%, and we continue to perform a test for urethritis at our STD clinic. The aim of this study was to compare the performance of two alternative tests in the diagnosis of urethritis as predictors of C. trachomatis infection: the leukocyte esterase (LE) dipstick test of first-voided urine and polymorphonuclear leukocyte counts in a methylene blue-stained (MBS) urethral smear. Urine samples from 480 male patients attending an STD clinic were analysed using the LE test and LCR assay for C. trachomatis; urethral samples were analysed with MBS urethral smear and LCR. The majority (75.8%) of the 480 patients examined were asymptomatic. Chlamydial infection was detected in 50 patients. The sensitivity, specificity and positive predictive value of the LE test for predicting C. trachomatis infection were 46.0, 91.6 and 39.0%, respectively, among all patients examined and 25.9, 95.8 and 33.3%, respectively, among the asymptomatic patients. The corresponding values for the MBS urethral smear were 76.0, 82.1 and 33.0% among all patients and 63.0, 89.6 and 32.7% among the asymptomatic patients. At our STD clinic we chose to perform the examination of MBS urethral smears in the diagnosis of urethritis because of its higher sensitivity relative to the LE test for predicting C. trachomatis.

Adolescent↗

PubMed1998

Applications of the KTP laser in the treatment of posterior urethral valves, ureteroceles, and urethral strictures in the pediatric patient.

PURPOSE: We describes our experience using the potassium titanyl phosphate (KTP)-532 laser in treating posterior urethral valves, ureteroceles, and urethral strictures in the pediatric patient. METHODS: A retrospective chart review was performed from 1987 to 1997 on a total of 33 pediatric patients who underwent retrograde endoscopic treatment for posterior urethral valves (PUV), ureteroceles (UC), and urethral strictures using a KTP-532 laser. RESULTS: Overall, our success rate was excellent in the treatment of valves and ureteroceles. With a mean follow-up of three years in the PUV group, no urethral strictures of micturation abnormalities were seen. The majority of ureteroceles were decompressed and only half of our patients required and additional procedure. Our experience with urethral strictures, however, was not as promising. All of these patients ultimately required open urethral reconstruction. CONCLUSION: The desirable thermal characteristics of the KTP laser, along with minimal complications and the availability of delicate pediatric endoscopic instruments have made this operation optimally suited for treating posterior urethral valves and ureteroceles in infants. However, the advantages for treating urethral strictures in children with the laser still remains to be established.

Adolescent↗

PubMedDate not supplied

Comparison of the Gram-stained urethral smear and first-voided urine sediment in the diagnosis of nongonococcal urethritis.

The diagnostic sensitivity of the numbers of leukocytes in the sediment of first-voided urine and in gram-stained smears of urethral secretions was evaluated by a study of 62 men with symptoms of nongonococcal urethritis. Fifty-one patients (82.3%) had pyuria (defined as ten or more leukocytes per high-power field) in the sediment of first-voided urine, whereas 8 (45.2%) had more than four leukocytes per oil-immersion held in gram-stained urethral smears. Frequencies of positive first-voided urine sediments and urethral smears were similar in Chlamydia trachomatis--positive and -negative cases. Results of cultures, urinalyses, and urethral smears were not affected by recent micturition. Pyuria in the first-voided urine but not a positive urethral smear is a sensitive sign of urethritis whether or not urethral discharge is evident. Specimens of urethral secretions were subjected to different storage conditions to determine the effect on subsequent isolation of C. trachomatis. Equal rates of isolation were demonstrated for specimens that had been held at 4 degrees C for either four or 20-24 hr or frozen to -70 degrees C for one week prior to culture.

Chlamydia Infections↗

PubMedDate not supplied

Long-term outcome of posterior urethral valves ablation using the Mohan's urethral valvotome.

CONTEXT: Posterior urethral valves are the most common cause of mechanical infravesical obstruction in children. The disorder has a broad spectrum of severity and the patients could develop complications on the long term, even after valves ablation. OBJECTIVE: To report the result of the follow-up study of 26 children who had posterior urethral valves ablated with the Mohan's urethral valvotome at the University college hospital, Ibadan over a period of five years. STUDY DESIGN SETTING AND SUBJECTS: Children who had posterior urethral valves ablated with the Mohan's urethral valvotome at the UCH, Ibadan between January 1996 and December 2000 were followed up in the out patient clinic on a regular basis. RESULTS: A total of 26 patients with posterior urethral valves had the valves ablated with the Mohan's urethral valvotome during the period of the study. The period of follow-up varied between 18 months and five years. Problems noticed on follow-up include recurrent urinary tract infections in 35% of the cases, acute and chronic renal failure in 5% and 15% respectively, rickets, anaemia, malnutrition and urethral stricture. CONCLUSION: Children who had posterior urethral valves ablated should be followed up much beyond the immediate post valve ablation period as complications could arise on the long term.

Child↗