Relationships between urethrovesical angles and urinary incontinence due to urethral sphincter mechanism incompetence in bitches

In women, the posterior urethrovesical angle is thought to be an important factor in the aetiology of stress urinary incontinence. This form of incontinence has many similarities to urethral sphincter mechanism incompetence (SMI) in the bitch. The role of the ventral and dorsal urethrovesical angles in the aetiology of SMI in the incontinent bitch has yet to be established. Positive-contrast retrograde vagino-urethrograms from 30 incontinent bitches with a diagnosis of SMI and 30 continent bitches were retrieved and the angles between the urethra and dorsal and ventral bladder walls were measured. No relationship was shown to exist between the dorsal urethrovesical angle (the equivalent of the posterior urethrovesical angle in women) and urinary incontinence due to SMI in bitches. Differences in ventral urethrovesical angles were considered to be associated with differences in bladder neck position between the two groups of bitches.     

Acquired urinary incontinence in bitches: its incidence and relationship to neutering practices

A five-year cohort study was conducted on bitches chosen by a sample of 233 randomly selected practising veterinary surgeons in the UK, to estimate the incidence of acquired urinary incontinence (AUI) in neutered and entire animals, and to investigate possible risk factors associated with neutering practices. Information was collected using questionnaires, and data on 809 bitches, of which 22 developed AUI, were obtained. The estimated incidence rates in neutered and entire animals were 0.0174 and 0.0022 per animal-year, respectively (95 per cent confidence intervals: 0.0110, 0.0275 and 0.0009, 0.0058, respectively). The relative risk, neutered vs entire, was 7.8 (95 per cent confidence interval: 2.6, 31.5). The attributable proportion(exposed) and population attributable proportion were 87.1 per cent and 63.1 per cent (95 per cent confidence intervals: 61.9 per cent, 95.6 per cent, and 28.3 percent, 88.5 per cent, respectively). An increased risk, significant at the conventional 5 per cent level, was not demonstrated in animals neutered before, vs after, first heat (relative risk: 3.9, 95 per cent confidence interval: 0.8, 10.4), although the result was significant at the 10 per cent level. Removal of the cervix was not shown to be a risk factor in neutered dogs.     

Dynamic activity of bladder neck and external sphincter in ejaculation

Macroamylasemia and acute pancreatitis are both associated with a high serum amylase. The former is an incidental laboratory finding and seems to have no apparent clinical significance or specificity. On the other hand, acute pancreatitis is a serious illness demanding recognition and treatment. Persistently normal pancreatic scans convincingly exclude acute pancreatitis and should alert one to the possible presence of macroamylasemia.     

Transrectal sonographic investigation of urethral and paraurethral structures in women with stress urinary incontinence

Transrectal sonography of the urethra was used in 14 asymptomatic volunteers, 37 women with frequency-urgency syndrome, 42 patients with mild stress urinary incontinence, and 18 with severe stress urinary incontinence. Transverse scanning over the midurethra was performed and cross-sectional images of the urethral and paraurethral structures were compared among the four groups, with P < 0.05 being considered statistically significant. The total cross-sectional area of the midurethra was significantly smaller in patients with stress urinary incontinence than in those without this disorder (86.7+/-29.9 versus 104+/-35.6 mm2, P = 0.005); this difference resulted from a significantly smaller peripheral striated muscle component in patients with stress urinary incontinence (42.8+/-20.7 versus 58.3+/-27.3 mm2, P = 0.001). The thickness of the urethropelvic ligaments was significantly thinner in patients with stress urinary incontinence than in those without (5.9+/-1.7 versus 8.9+/-2.1 mm, P < 0.001). The distribution of the peripheral striated muscle around the urethra was variable: complete surrounding the urethra was noted in 35.7% of the control women and in 48.6% of frequency-urgency patients, but only in 16.7% of patients with mild stress urinary incontinence and 5.3% of patients with severe disease. Bladder neck incompetence was seen in 42 patients with stress urinary incontinence but in none of the control women. The length of the pubourethral ligaments was similar in the four groups. Our finding showed that stress urinary patients had a smaller striated muscle component in the midurethra and thinner urethropelvic ligaments. These defects in the continence mechanisms might have great implications in the pathophysiology of stress urinary incontinence. Transrectal sonography of the urethra is a valuable investigative tool in assessing urethral and paraurethral conditions in patients with stress urinary incontinence before deciding treatment modality.     

Transurethral balloon dilation of the external urinary sphincter: effectiveness in spinal cord-injured men with detrusor-external urethral sphincter dyssynergia

The authors investigated balloon dilation as a minimally invasive alternative to transurethral external sphincterotomy for the treatment of detrusor-external urethral sphincter dyssynergia (DESD). Seventeen spinal cord-injured men with voiding pressures greater than 60 cm H2O underwent balloon dilation of the external sphincter to 90 F at 4 atm of pressure for 10 minutes. The mean voiding pressures before and 12 months after dilation were 83 cm H2O +/- 35 and 37 cm H2O +/- 15, respectively (P = .008). There was a significant decrease in residual urine volume, from 163 mL +/- 162 to 68 mL +/- 59 (P = .05), whereas bladder capacity remained relatively unchanged at 253 mL +/- 181 and 230 mL +/- 97 (P = .30). Complications included one case of postoperative bleeding necessitating transfusion, two treatment failures, and one bulbous urethral stricture. Fourteen of the 17 patients (82%) now void without the aid of an indwelling catheter or alternative therapy. Balloon dilation has no detrimental effect on erectile function and may improve fertility.     

Quality of life following bladder training in older women with urinary incontinence

The elaboration of new mortality tables by the Swiss statistical office has allowed to estimate the impact of different pathology or risk factors on the average life duration of the resident population in Switzerland. Thus, attributable death of the smoking habits have for effect to decrease the life expectancy of swiss citizens of 2.9 years for men and 0.7 years for women, for the period 1988/1993. The calculation of mortality rates attributable to this factor of risk shows nevertheless that the risk of death has decreased since the end of years 1960 for all quinquennial age groups between 35 and 74 years. The smoking habits would be responsible of approximately 16% of deaths observed in the swiss population and 20% of premature deaths (between 25 and 64 years). The present analysis shows furthermore that different evolutions of the mortality associated with the smoking habits characterize men and women.     

Endoscopic treatment for urinary incontinence in children with a congenital neuropathic bladder

A new method for more timely monitoring of cancer patient survival was employed to assess progress in 5-year survival of breast cancer patients in Saarland, Germany, between 1980-84 and 1990-94. Five-year relative survival gradually increased from 68.8% to 73.5%. Improvements were most pronounced among age groups 50-59 and 60-69. The latter had the highest 5-year relative survival (77.1%) in 1990-94.     

The effect of bladder training on urinary incontinence in community-dwelling older women

Six patients presented with either entrapped fourth ventricles or noncommunicating cerebrospinal fluid collections of the posterior fossa requiring drainage. These collections were treated with shunt systems whose proximal catheter was placed into the fourth ventricle via a coronal burr hole using an endoscope guided by Eleckta's ISG Viewing Wand. The technique and its advantages are described as are the complications and early outcomes.     

The AMS 800 sphincter in urinary incontinence after prostatic surgery. Apropos of 16 patients

OBJECTIVE: To present the results of a series of artificial sphincters implanted for urinary incontinence after prostatic surgery. PATIENTS AND METHODS: From 1987 to 1996, artificial sphincters were implanted for urinary incontinence after prostatic surgery, consisting of one transvesical prostatectomy, 11 prostatic resections and 4 radical prostatectomies. All these patients were evaluate by urine culture, cystourethrography and urethrocystoscopy. Eleven patients underwent urodynamic assessment. The AMS 800 artificial sphincter was used. RESULTS: The mean interval between onset of incontinence and implantation was 18 months. The mean follow-up after implantation of the sphincter was 6 years. An operative wound of the bulbar urethra did not prevent implantation of the sphincter, but required repair and prolonged catheterization (12 days). The mean duration of catheterization was 6 days. The overall functional result was 81% (13 case), and 75% of sphincters were functional at 5 years. Five revisions were necessary to maintain functioning of the sphincter in 2 cases of rupture and 1 displacement of the balloon, 1 case of urethral atrophy and 1 rupture of the pump. Three explanations, 2 total and 1 partial, were performed. Two reimplantations were performed after 12 months and 26 months respectively. CONCLUSION: The AMS 800 artificial sphincter currently represents an effective treatment for urinary incontinence due to sphincter insufficiency after prostatic surgery. However, an old artificial sphincter may require revision to restore function.     

Studies on the effect and mode of action of flavoxate in human urinary bladder and sphincter

Flavoxate, a smooth muscle relaxant, compared with propantheline showed no significant difference in clinical effect on voiding disturbances in hyperactive neurogenic bladders, but fewer side effects. Both drugs increased bladder capacity significantly, but flavoxate did not increase residual urine in contrast to propantheline.     

The endoscopic treatment of extensive urethral strictures and obliteration of the urethra and bladder neck

Extensive urethral strictures, obliteration of the urethra and bladder cervix are thought to be the most complicated urological diseases. They occur more frequently in young and middle-aged persons consequently to pelvic and perineal traumas or they are complications of surgical interventions. Open surgery often cause complications such as suppuration of the operative wound, emergence of urinary fistulas, enuresis, recurrence of the structure or obliteration. Negative results of these operations are also shortening of the penis, erectile dysfunction causing serious social dysadaptation. Current advances in endoscopic instruments and imaging provided design of endoscopic techniques able to represent an effective alternative to open surgical interventions in urethral strictures, obliteration of the urethra and bladder cervix. The experience gained in the Clinic of the Research Institute of Urology in the practice of updated and novel endoscopic interventions aimed at recovery of urethral patency (strictures longer than 1 cm--inner optic urethrotomy, obliteration of the urethra and bladder cervix--endoscopic recanalization) has proved the advantages of the endoscopic techniques over open operative interventions. They are most cost-effective, result in better outcomes, bring about no erectile dysfunction.     

Combining the strength-duration curve of the external anal sphincter with manometry for the assessment of faecal incontinence

BACKGROUND: The strength-duration curve of a muscle is thought to be a measure of its innervation. This study was designed to evaluate the ability of the strength-duration curve of the external anal sphincter to discriminate between controls and patients with faecal incontinence. METHODS: Forty-three women with faecal incontinence due to sphincter weakness were studied together with 45 age-matched women with no disorders of defaecation. Strength-duration curves of the external anal sphincter and anorectal manometry were recorded for all subjects with the additional measurement of pudendal nerve terminal motor latency in the incontinent group. RESULTS: Logistic regression was performed using resting and voluntary squeeze pressures and current strengths at 28 different pulse durations to develop a predictive equation for incontinence. Only currents at 1 and 6 ms were significant predictors. When anorectal manometry data were included, only the current required to elicit contraction at 1 ms was necessary. The following regression equation can be applied to predict continence in this population with a sensitivity of 95 per cent and a specificity of 100 per cent: logit(P)=4.1605-(0.0559 x squeeze pressure)-(0.1755 x resting pressure)+0.8622I(1 ms). A negative value indicates continence. CONCLUSION: The strength-duration curve, when used in conjunction with anorectal manometry, may have a role in the investigation of faecal incontinence.     

Clinical and laboratory assessment of the efficacy of baclofen (Lioresal) on urethral sphincter spasticity in patients with traumatic paraplegia

The nutritive value of sunflower seeds (Helianthus annus) was studied and compared to that of casein. Thirty-six male rats, Wistar strain, aged 23 days, were divided into two groups and fed (a) a sunflower cake meal diet, and (b) a casein diet. The results indicate that due to its high protein level (52.06%) and coefficient of digestibility (95 CD) sunflower can be used as a feeding formula although its PER does not recommend its use as a milk substitute.     

Stress urinary incontinence in women caused by severe sphincter hypotonia. Goebbel-Stoeckel intervention as alternative to artificial sphincter. Apropos of 26 cases treated between January 1985 and January 1994

Stress urinary incontinence with low urethral closure pressure and urethral mobility is often treated by artificial urinary sphincter. Our retrospective report in 19 patients evaluates the sling procedure as an alternative to the artificial urinary sphincter (7 patients). All patients had a preoperative clinical and urodynamic evaluation. 13 patients were continent (68.4%) in the sling procedure group and 5 in the sphincter group. Continence remained stable with a mean follow-up of 77 months (range: 39-110 months). 2 patients had urgency and none had dysuria. The sling procedure gave us the same results as sphincter with less morbidity.     

Ultrasonographic evaluation of urinary tract in children with chronic functional constipation

Urinary tract anomalies were prospectively investigated with ultrasound in 31 children with chronic functional constipation. These children were compared with 29 healthy controls without constipation both before and after treatment. Bladder residue and upper renal tract dilatation after micturition were significantly more common in the group with constipation than in the improved after-treatment and control groups.