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At least 19 recordsLinked to original sources
PubMed1978

[The diagnosis of urinary incontinence in gynaecology. Indications for urodynamic diagnosis and description of urodynamic diagnostic apparatus (author's transl)].

Our experience with comparative measurements using various methods of diagnosis of urinary incontinence resulted in the development of a urodynamic measurement station within the department. This station is equiped for urethrocystotonometry with microtransducers for urethrocystograms and for lateral urethrocystograms. The technological details of the apparatus are described. The greatest diagnostic value give measurements in the standing patient. The methods of measurement, the interpretation of the results and the pre-operative records of urethral pressure profiles are described. The urethrocystotonometry is especially valuable for functional diagnosis. For the morphologic evaluation and especially in view of the choice of the operative procedure a modified method of the lateral urethrocystogram is used.

Female↗
PubMed1979

Patient costs for urodynamic testing.

Urodynamic investigations are not completely standardized. However, the number of exhibits of urodynamic equipment at urologic meetings by commercial firms suggests that these studies have considerable applicability and relevance to everyday practice. Investment by a urologist in equipment for urodynamic testing should be cautious in the light of the costs for these investigations reported from centers in Canada, the United States, and Western Europe. The figures suggest that sophisticated urodynamic testing is not a screening test -- it is too expensive, but large urodynamic laboratories appear to charge only for a portion of the actual cost of such testing. Since urodynamic testing is much more expensive than actual patient charges, it is probably not yet cost effective in its present state of development.

Canada↗
PubMed1979

Urodynamic testing: alternatives to electronics.

Electronic urodynamic testing, including bladder pressure, urethral pressure profile, voiding rate and velocity, and electromyography, is expensive in terms of equipment, operator and time. Clinical urodynamic testing, including voiding habits and timing, bladder capacity, residual urine volume, voiding cystography, cystometrography and neurologic evaluation, is readily done in the office. Analysis of common syndromes requiring urodynamic assay shows that clinical urodynamic testing may be more useful than electronic urodynamic testing for appropriate treatment.

Child↗
PubMed1979

[Urodynamic assessment of enuretic children (author's transl)].

Urodynamic assessment was carried out in 33 children with persistent enuresis in spite of previous therapy. According to these investigations it was possible to divide our patients into several groups. One group of children displayed a normal urodynamic pattern. Another group showed neurogenic non-inhibited detrusor contractions on cystometry. Obstruction was noted in a third group of patients by means of urodynamic parameters. A small group of children was urodynamically normal, but suffered from recurrent urinary infections. The therapeutic results and the aetiology of enuresis is discussed.

Adolescent↗
PubMed1979

Pediatric urodynamics: a clinical comparison of surface versus needle pelvic floor/external sphincter electromyography.

Urodynamic evaluations were done on 37 children to diagnose voiding pattern abnormalities and/or recurrent urinary infections. Each of 25 children had 2 sets of testing to judge a practical method of urodynamic evaluation. Bipolar anal skin electrodes were compared to bipolar perianal muscle needle electrodes as a means of monitoring the urethral sphincter/pelvic floow electromyographic activity. In addition, the urethral catheter was compared to the suprapubic catheter as a means of monitoring intravesical pressure. The results were similar and statistically significant (p less than 0.001). The remaining 12 children were evaluated based only on the results of bipolar anal skin electrodes and uroflowmetry. The results of both groups clearly demonstrated that surface perianal electrodes are practical, accurate and reliable for the diagnosis and treatment of children with voiding pattern abnormalities. We recommend the use of surface electrodes and a urethral catheter as techniques for the urodynamic evaluation of voiding pattern abnormalities of children without overt neuropathology or extensive urethral operation. Preoperative surface electromyography of the urinary sphincters may prove to be a useful screening test to detect occult dyssynergia in patients who have had failed ureteral reimplants.

Adolescent↗
PubMed1979

Bladder function in children with meningomyelocele: comparison of cine-fluoroscopy and urodynamics.

We have assessed 60 children on an outpatient basis with cine-fluoroscopy combined with urodynamics. Bladder and rectal pressure together with sphincter electromyography were measured during bladder filling under fluoroscopy, which was followed by measurement of rectal pressure and sphincter electromyography during voiding under fluoroscopy. Comparison of the x-ray studies and urodynamics showed that the cystogram alone was not a reliable indicator of ray studies and urodynamics showed that the cystogram along was not a reliable indicator of detrusor function. The sphincter electromyogram during voiding must be interpreted in the face of intra-abdominal pressure changes owing to straining or Credé's maneuver. Residual urine estimations and the appearance of the bladder outflow on fluoroscopy were better parameters of outflow obstruction than sphincter electromyography.

Adolescent↗
PubMed1978

Modern urodynamic evaluations in the urologist's office.

Patients with voiding disturbances comprise 20 per cent of the yearly outpatient visits to urologists. Of this number 25 per cent have significant neurogenic bladder dysfunction. The theoretical basis and experimental demonstration of urodynamics have been established and reported by multiple investigators during the last 15 years. Recent advances in clinical applications of fast-flow gas cystometry have led to the development of complete, portable urodynamic units that can be used conveniently in the urologist's office and are capable of simultaneously recording parameters of detrusor, urethral and skeletal muscle phincter function. This equipment is simple, efficient, economical and can be operated by well trained paramedical personnel, with minimal immediate direction required by a physician. With recent recognition by many third party carriers this equipment may amortize itself rapidly but, more importantly, it may serve to identify neurological diseases of the bladder that are undetected by other conventional methods of investigation. During the last 9 months 213 patients have undergone urodynamic evaluation at our outpatient urology clinic. These patients were categorized according to type and incidence of voiding disturbance and the number of neurogenic bladders diagnosed within each group was compiled and discussed. Several of the more interesting and unusual clinical examples are presented to familiarize the urologist with the interpretative aspects of this study.

Ambulatory Care↗
PubMed1978

Urodynamics in benign prostatic hypertrophy.

Synchronous urinary flow and pressure studies were carried out on 51 male subjects of whom 12 were normal subjects and 39 had benign prostatic hypertrophy with varying degrees of bladder outlet obstruction. A urodynamic scoring system was evolved for accurate and objective diagnosis of bladder outlet obstruction. The minimum urethral resistance was found to be the most valuable single urodynamic parameter for the diagnosis of bladder outlet obstruction. Hitherto this urodynamic parameter was determined through tedious calculations. In the course of the present study a new instrument, the Urethroresistance, was devised for the direct recording of urethral resistance during micturition.

Aged↗
PubMed1978

Urodynamic studies in boys with disorders of the lower urinary tract. IV. Congenital bladder neck obstruction. A pre- and postoperative study.

Eighteen boys with diagnose of bladder neck obstruction, based on roentgenological criteria, underwent urodynamic investigations. In the majority of patients, urodynamics clearly deviated from the normal range, substantiating that bladder neck obstruction, although rare, really exists in male infants and children. A rather uniform radiographic appearance of the bladder neck was associated with different urodynamic patterns, suggesting that various pathophysiological mechanisms may be involved.

Child↗
PubMed1978

[Effective urodynamic evaluation in hospital and general practice (author's transl)].

Urodynamic diagnostic procedure have provided new concepts with consequent advantages for urological patients. The postoperative evaluation of renal pelvic surgery, the detection of functional stenosis of the ureter, stress incontinance, prostatic hypertrophy and postoperative incontinence are typical examples of conditions ideally suited to urodynamic assessment. Urodynamic investigation represents a very important contribution towards the prevention of postoperative failure and enables the achievement of higher diagnostic accuracy.

Humans↗
PubMed1977

Urodynamic study of 15 patients with postmicturition dribble.

Fifteen patients presenting with postmicturition dribbling as their only symptom were studied in the urodynamic laboratory. Seven of these patients had no urodynamic abnormality but left a significant bulbar residue after micturition. Five patients had normal detrusor function but failed to milk back contrast from the prostatic urethra during voluntary interruption of the steam. Two of these also had a small amount of bulbar residue. The remaining three had unstable detrusor function. One had classic bladder neck obstruction. One had a bulbar residue and the other failed to milk back properly. Despite the various mechanisms for postmicturition dribble, the management is the same in all cases. The patient is instructed to press the bulbar urethra manually in the perineum after micturition and evacuate the residue, and symptomatic relief is almost always obtained. Urodynamic studies in these patients are not justified unless this maneuver fails to alleviate the symptoms.

Adult↗
PubMed1977

Urodynamic evaluation of boy with myelodysplasia and incontinence.

Twenty-two boys with myelodysplasia and incontinence were evaluated urodynamically. Three types of bladder function were noted, but each could not be correlated with any particular neuroligic level. The integrity of the external sphincter innervation was determined by electomyographic monitoring of periurethral striated muscle. Bladder sphincter dyssynergia was found in one of the boys with voluntary control, five with involuntary bladder contractions, and five with adynamic bladders who voided by Credé's method. A radiologically narrow external sphincter on voiding cystography could only be correlated with the bioelectric activity in children with dyssynergia. A narrow sphincter was also noted in three children with synergy and four with complete lower motor neuron lesions. Marked fibrosis was found to be the cause of narrowing of external sphincter area in these boys. Thus, urodynamic evaluation helped define the etiology of outlet obstruction when it was present in the boy with myelodysplasia. A classification of bladder sphincter function is proposed.

Adolescent↗
PubMed1979

Pitfalls of urodynamics.

Increased interest and use of urodynamic testing have led many clinicians to rely on the results for patient care. Numerous shortcomings and possible sources of error have been identified. Well trained personnel, properly structured examination rooms and understanding of the potential pitfalls in urodynamics are essential to proper medical management of patients with micturition problems.

Electromyography↗
PubMed1979

The bladder in boys with posterior urethral valves: a urodynamic assessment.

Urodynamic evaluation was performed on 8 of 62 boys (13 per cent) with persistent voiding difficulties after fulguration of posterior urethral valves. All had varying degrees of incontinence when evaluated. The striated muscle component of the external urethral sphincter was intact in each child. Five different types of bladder function were noted in the 8 children. Three boys had had a prior Y-V plasty of the bladder neck to improve upper and lower urinary tract emptying, which may have contributed to the subsequent incontinence. One additional boy had significant bladder neck obstruction requiring a unilateral bladder neck incision to improve voiding. Appropriate treatment plans were instituted based on the urodynamic findings of the bladder, bladder neck and external sphincter areas, and 6 of the 8 children are now completely continent.

Child↗
PubMed1978

Micturition urodynamic flow studies in children.

Voiding abnormalities are encountered frequently in pediatric patients. Symptoms of daytime incontinence, frequency and nocturnal enuresis in any combination may indicate underlying neurophysiologic detrusor imbalance. Incomplete evaluation of these symptoms can result in inappropriate medical therapy or even ineffective operations. Within the preceding 7 months 34 children with hard-core voiding abnormalities were evaluated with urodynamic techniques. Several categories of abnormal voiding patterns were identified, including the hyperactive external sphincter, uninhibited pediatric neurogenic bladder, detrusor hyperreflexia secondary to chronic cystitis, hyperactive external sphincter with hypotonic bladder and the hyperactive external sphincter with detrusor irritability. All patients received specific pharmacotherapy based on presenting signs and symptoms, and voiding pattern abnormality. Of the 24 patients who have been treated in this manner and were evaluated 83.5% have had complete remission of symptoms while on therapy, the remainder being improved but still having occasional symptoms. The technique and data demonstrate that children with hard-core voiding abnormalities can achieve rehabilitation with urodynamic assessment.

Adolescent↗
PubMed1978

Urodynamic evaluation of female stress urinary incontenence.

To understand further the urodynamics of female stress urinary incontinence 6 patients with this condition were studied before and after anterior vesicopexy. The evaluation included uroflowmetry, cystometry, urethral pressure profilometry, anatomical urethral length measurement with the subject in the supine and standing positions, demonstration fo stress incontinence and cystourethroscopy. These procedures, except cystometry and cystourethroscopy, were repeated 7 days and 4 to 6 weeks postoperatively in most patients. All patients had short preoperative functional urethral lengths and standing anatomical lengths and all were lengthened after the anterior vesicopexy. The urinary flow rate demonstrated decreased peak and average flow rates 1 week postoperatively but complete recovery 4 to 6 weeks later. We believe that this study reaffirms the importance of urethral length in the pathophysiology of female stress urinary incontinence and, by demonstrating decreased flow rates in the immediate postoperative period, draws attention to the need for careful observation of voiding after catheter removal to avoid bladder decompensation. The marked improvement observed in the 4 to 6-week postoperative period reveals that anterior vesicopexy does not obstruct the urethra since no tissue posterior to the urethra is used. These urodynamic studies have proved to be valuable adjuncts in the evaluation of female stress incontinence.

Adult↗