Jacques G. Susset

Evaluation of a new once-daily formulation of oxybutynin for the treatment of urinary urge incontinence

Abstract Objectives. To evaluate in a 16-center, single-treatment study once-daily controlled-release oxybutynin (Ditropan XL) for urinary urge incontinence. Methods. Two hundred fifty-six participants with urge incontinence or mixed incontinence with a significant urge component were treated. After baseline measurements, participants converting from conventional oxybutynin started Ditropan XL at their previous oxybutynin dose; others started at 5 mg/day. Doses were adjusted until participants reached a maintenance dose that produced continence or the best balance between continence and side effects. This dose was continued for 12 weeks. Effectiveness was assessed by urinary diaries. Results. Effectiveness was achieved across all doses studied (5 to 30 mg/day), with 70.8% of participants using maintenance doses of 5 to 15 mg/day. Mean urge incontinence episodes per week decreased from 18.8 at baseline to 3.9 in maintenance week 1, 2.7 in week 4, and 2.8 at the end of the study. For those participants who reported urge incontinence episodes at baseline but were free of urge incontinence at maintenance week 1, 31% remained free of urge incontinence at every subsequent assessment. Participants who converted from other medications showed symptomatic improvement after conversion. At some time during the study, 58.6% of participants reported dry mouth, with 23.0% of participants rating it moderate or severe. Only 1.6% of participants discontinued the medication because of dry mouth. Conclusions. Ditropan XL treatment reduced the number of incontinence episodes. Maximum benefit was demonstrated by maintenance week 4 and was sustained through 12 weeks of maintenance therapy.

Urethral pressure profile: Standardization of technique and study of reproducibility

The different methods utilized for measurement of urethral resistance were critically reviewed. Using dogs, experiments were done to standardize the pressure profile measurement. A catheter with eight side holes measureing 0.34 mm. each was found to give the best results. The various parameters which can influence the procedure were analyzed. Strict specifications are proposed to be utilized for such a procedure.

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.

Studies of Female Urethral Pressure Profile. Part I. The Normal Urethral Pressure Profile

The urethral pressure profile is influenced by the degree of patient relaxation, which explains marked variations in measured pressure values among normal subjects, as well as the frequent lack of reproducibility in a given subject. The quality of relaxation can be estimated by observing the difference between maximum resting and maximum holding pressures. The most reproducible parameters are 1) the total urethral length, 2) the length to the point of maximum pressure and 3) the ratio of area to the point of maximum pressure over total area. Changes in intravesical volume do not produce significant differences in peak pressure, total area or area to maximum pressure. When subjects were asked to strain the pressure in the proximal urethra increased by 60% of the intravesical pressure observed, even in the absence of a vesical neck opening.

The Influence of Vesical Distension on the Urethral Resistance to Flow: A Possible Role for Prostaglandins?

The possible role of prostaglandins in the mediation and/or modulation of the urethral response to vesical distension was investigated in female dogs. Three criteria for the possible involvement of these mediators have been investigated. Indomethacin could block the reduction of urethral resistance observed during vesical distension. Intra-arterial infusion of exogenous prostaglandin E2 resulted in a dose-dependent reduction in the urethral resistance to flow. Moreover, a significant release of prostaglandin E2 in the venous blood during the course of vesical distension could be demonstrated. The functional significance, mechanisms of release and mode of action of these highly active lipids are discussed.

Early detection of neurogenic bladder dysfunction caused by protruded lumbar disk

A case of cauda equina compression was suspected from urinary symptoms. The diagnosis was based on the presence of type A contraction on rapid cystometry and prolonged latency of the sacral evoked response. Such findings pointed to the need for myelography. Lumbar laminectomy, with removal of a ruptured intervertebral disk and cauda equina decompression, resulted in return of normal urination and normal cystometry and electromyogram of the perineal muscles.

Physical properties of the urinary detrusor muscle: A mechanical model based upon the analysis of stress relaxation curve

Abstract The viscoelastic properties of dog urinary bladder have been quantitatively studied in vivo and in vitro . The thickness of the bladder wall was taken into consideration when the stress in the detrusor muscle was calculated. Thirty ml of saline were rapidly injected three times successively with an interval of three minutes. The force-deformation diagram was found to be a non-linear relationship. The relaxation curve could be analyzed into three exponential components. Subsequently, a mechanical model was formed, and its mathematical formulae were composed based upon the correlation between the length change of the Hooke elements and the volume increment. Four elastic constants, three time constants, and three viscous coefficients were measured respectively. The urinary bladder does not obey Hookes law because of the specific configuration of collagen fibers. The quantitative evaluation of the physical properties of detrusor muscle can be utilized as a clinical diagnostic tool to supplement conventional cystometry.

Evolution of urinary flow rate with prostatectomy

Urinary flow rate was studied before and after transurethral prostatectomy in 53 patients. An average of 43.8 percent improvement in maximum flow rate after transurethral prostatectomy was observed in this series. Improvement of maximum flow rate occurred in 71 per cent of patients. Half of the cases in which flow rate did not improve were chronic prostatitis. Uroflowmetry cannot be utilized as a quality index of a transurethral prostatic resection as long as the degree of detrusor deterioration is not assessed. There is a relationship between the degree of preoperative symptoms and the degree of postoperative urinary flow improvement. The degree of preoperative symptoms and urinary flow deviation are not related which suggests that uroflowmetry adds to the assessment of symptoms in the determination of the degree of obstruction. Patients presenting difficulty of urination have a greater chance to demonstrate urinary flow improvement after surgery than patients complaining of urinary frequency.

Cavernous hemangioma of vesical neck

A thirty-six-year-old woman who had obstructive lower tract symptoms since childhood was found to have a contracted vesical neck. Transurethral resection of the vesicle neck showed a hidden cavernous hemangioma of the vesical neck. She was completely free of symptoms for six years. Indications for transurethral resection of vesical neck are discussed.

Dynamics of obstruction in acontractile bladder: Attempt at management

Five patients with acontractile bladders were observed during lateral voiding cystourethrography in the resting and straining states. Two abnormalities were noted: (1) posterior displacement of the bladder with closure of the posterior vesicourethral angle on straining, and (2) plication of the bladder over the symphysis pubis, resulting in the formation of an anterior pseudodiverticulum. Two other abnormalities are discussed: closure of the anterior vesicourethral angle, and descent of the bladder and prostate in flaccid paraplegia, causing plication at the prostatic apex. Surgical techniques for the correction of the abnormalities are described.