Arieh Bergman

Effects of estrogen on urethral function in women with urinary incontinence

In a prospective study, 2 gm of conjugated estrogen vaginal cream was administered daily for a total of 6 weeks in a group of 11 postmenopausal women with urodynamically proved genuine stress incontinence. Midurethral cytologic studies and a complete clinical and urodynamic evaluation were performed twice at 6-week intervals. Clinically, six of the 11 patients (54.5%) were cured or improved significantly after estrogen treatment, whereas the other five patients (45.5%) were clinically unchanged. The favorable clinical response correlated with urodynamic findings of increased urethral closure pressure and improved abdominal pressure transmission to the proximal urethra (p less than 0.05); in the patients who had a poor clinical response to estrogens, no significant changes in urethral dynamics were noted. Changes in urethral cytologic findings also correlated well with clinical and urodynamic findings. Patients with a favorable response to estrogen showed a maturation change from transitional to intermediate squamous epithelium (p less than 0.02), whereas nonresponders showed no significant changes in urethral cells.

Urodynamic effects of a vaginal pessary in women with stress urinary incontinence

The manner in which a vaginal pessary restores urinary continence is poorly understood. This report provides an explanation. Following placement of the vaginal pessary, detailed urodynamic studies in a group of 12 women with stress urinary incontinence demonstrated consistent and significant (p less than 0.005) increase in urethral functional length and urethral closure pressure under varying stressful conditions, when compared with prepessary studies. Postpessary stress testing also became normal (p less than 0.005). Prepessary and postpessary simultaneous voiding urethrocystometry and instrumented uroflowmetry demonstrated absence of obstruction to free flow of urine. Clinically, 10 of 12 patients became continent. Characteristic postpessary urodynamic alterations and Q-tip test changes provided an objective explanation that the vaginal pessary restored continence by stabilizing the urethra and urethrovesical junction to allow proper pressure transmission and by actively increasing urethral resistance to escape of urine under resting and stressful conditions.

Uroflowmetry for predicting postoperative voiding difficulties in women with stress urinary incontinence

Summary. Pre‐operative knowledge of uroflowmetry and postvoiding residual urine volumes in a group of 45 women undergoing urinary incontinence surgery failed to predict risks of postoperative voiding difficulties. Only one out of nine patients needing prolonged post‐operative bladder drainage (7 days) gave a pre‐operative history of voiding difficulties. More than half the patients (5/9) who needed prolonged catheterization had normal flow rates pre‐operatively and five of the nine patients with reduced flow rates were able to resume spontaneous voiding within 7 days following incontinence surgery.

Acquired immunodeficiency syndrome manifested by chronic primary genital herpes

Herpes genitalis is commonly seen by the obstetrician-gynecologist. Prolonged persistence of herpes is unusual and may herald an underlying disorder. A case of chronic primary herpes is presented, in which the diagnosis of acquired immunodeficiency syndrome was delayed because of a low degree of suspicion.

Urodynamic appraisal of vaginal versus rectal pressure recordings as indication of intra-abdominal pressure changes.

To compare intravaginal versus intrarectal pressure recordings as an indication of intra-abdominal pressure changes, simultaneous recording of the vaginal, bladder, and rectal pressures were obtained in 20 women. The transmitted pressure changes recorded from the inner and middle thirds of the vagina strongly correlated with the transmitted pressure changes recorded from the bladder (r = 0.99) when compared with the observed correlation between bladder and rectal pressure recordings (r = 0.91). The vaginal pressure recording is an easier and accurate alternative to intrarectal pressure recordings for approximating abdominal pressure changes during urodynamic testing.

Urodynamic changes after successful operation for stress urinary incontinence

Urethral closure pressure profiles were evaluated in 18 patients who had surgical cure of stress urinary incontinence. Functional length and maximal closure pressures were compared before and after the operation to determine what effect, if any, successful surgical intervention had on these parameters. No apparent differences were identified. The reasons for successful surgical treatment of stress urinary incontinence are unrelated to any change in urethral functional length or closure pressure.

Changes in urethral resistance after surgery for stress urinary incontinence

Seventy women with stress urinary incontinence underwent simultaneous voiding-urethrocystometry using microtip transducers and an 8-channel recorder, before and three to twelve months after either the modified Burch (48/70) or the modified Pereyra (22/70) retropubic urethropexy. Increase in urethral resistance (p less than 0.005) was more marked following the Pereyra procedure (0.042 +/- 0.039 to 0.07 +/- 0.061) and 30 percent experienced postoperative voiding difficulties, compared with the Burch procedure (0.035 +/- 0.029 to 0.055 +/- 0.03) where 20 percent experienced postoperative voiding difficulties. Of those patients who voided without a detrusor contraction prior to surgery (35/70), in 50 percent a detrusor contraction component developed to their voiding mechanism postoperatively (p less than 0.05) and overcame the increased urethral resistance with no postoperative voiding difficulties. In the remaining 50 percent a detrusor contraction failed to develop during postoperative voiding and 90 percent of them demonstrated reduced flow rates and increased use of Valsalva maneuver, and needed prolonged postoperative bladder drainage prior to resumption of spontaneous voiding (p less than 0.005). Inability to develop a detrusor contraction during voiding in face of increased urethral resistance promoted by the incontinence surgery provided a suitable explanation for post surgery voiding difficulties in 20 to 30 percent of patients.

Pessary test: Simple prognostic test in women with stress urinary incontinence

To overcome urethral obstruction and other shortcomings associated with previously described tests such as the Bonney test and the Marshall test, the pessary test was employed during preoperative evaluation of women with stress urinary incontinence. The similarity of changes seen in the resting and stress urethral closure pressure profiles with the pessary test and post-incontinence surgery, provided an objective evaluation of the pessary test as a simple and reliable clinical tool to predict successful outcome of anticipated incontinence surgery.

Uroflowmetry: Spontaneous versus instrumented

Cette etude a ete entreprise pour voir si les heures dattente, lincertitude du volume vesical chez les patientes ayant une sensation de repletion vesicale et la necessite de repeter les mesures de debit urinaire lors de volumes vesicaux inferieurs a 150 ml a la mictiometrie initiale pourraient etre evites par la «mictiometrie instrumentee», a savoir un remplissage vesical superieur ou egal a 150 ml grâce a un catheter vesical et un bilan mictiometrique comparable a celui de la mictiometrie spontanee

Urodynamic appraisal of the marshall-marchetti test in women with stress urinary incontinence

To determine the reliability of the Marshall-Marchetti test as a diagnostic and prognostic preoperative screening test for stress urinary incontinence, the changes observed in urethral pressure profiles under resting and stressful situations were recorded and compared following varying degrees of elevation of the urethra and the urethrovesical junction. The characteristic similarity of changes was evident in the functional profile length, urethral closure pressure, and cough pressure profile of the urethra during performance of the Marshall-Marchetti test and intentional urethral occlusion. This study clearly invalidated the Marshall-Marchetti test by objectively demonstrating that the Marshall-Marchetti test restored continence under stress of coughing by occluding the urethra and the urethrovesical junction.