Knud P. Olesen

Bladder Function in Urologically Normal Middle Aged Females: A Urodynamic and Radiological Investigation

The bladder function was studied in 15 urologically normal females over 40 years of age. They volunteered for this study which consisted of urodynamic studies and lateral micturition cystourethrography. The data are presented in tables. There are only small differences in the urodynamic parameters between this material and a material of women under 40 years of age. It is clearly demonstrated that a gynaecological cystocele tells little or nothing about the bladder function or bladder support. None of the cystometrograms showed uninhibited detrusor contractions. It is underlined to repeat the micturition studies several times in order to obtain a voiding event which the subject recognizes as normal.

Urinary incontinence and genital prolapse in the female: clinical, urodynamic and radiological examinations

Summary. Clinical examination, cystometry, combined pressure–flow studies and colpocysto‐urethrography were used to investigate 369 consecutive patients referred with symptoms of genital prolapse or urinary incontinence. The incidence of urinary incontinence in women seeking hospital investigation and therapy was 240/100000 women per year. Three hundred and three complained of urinary incontinence, 21% of these had urge incontinence, 36% both urge and stress incontinence and 43% stress incontinence. There was no correlation between previous obstetric history and present symptoms, the severity and objective signs of incontinence or the urodynamic findings. Correlation was found between urge incontinence and the cystometric finding of overactive detrusor function. Stress incontinence as a symptom was well correlated with low‐pressure micturition. Pelvic examination did not differentiate between patients with different types of urinary incontinence. Cystometry was essential for the investigation of vesical dysfunction. Urodynamic studies and colpocysto‐urethrography were useful in the diagnosis of outlet disorders and suspension defects.

CYSTO-URETHROGRAPHIC APPEARANCE OF THE BLADDER AND POSTERIOR URETHRA IN NEUROMUSCULAR DISORDERS OF THE LOWER URINARY TRACT

Cysto-urethrography in the straight lateral projection with simultaneous intravesical pressure recording was performed in 57 patients with localized neurological lesions at different levels. All patients were previously extensively evaluated urodynamically. Bladder trabeculation was not related to level of neurological lesion or reflex pattern of the detrusor. Serration of the bladder wall was a reliable sign of a contracting detrusor in bladders without severe trabeculation. Open bladder neck at rest was related to lesion of the peripheral parasympathetic nervous system, while supposed insufficient bladder neck opening during voiding could be related neither to pressure-flow parameters nor to site of neurological lesion. No specific configuration of bladder or urethra could be related to lesion of the sympathetic nervous system.

Dilatation of the resting posterior urethra in spinal cord injury patients.

In 26 patients with detrusor-sphincter dyssynergia after a spinal cord injury the resting posterior urethra at cystography was found either closed as in normal subjects or open to a varying degree. Highest intravesical pressure measured at cystometry during uninhibited detrusor contraction was statistically significantly related to the degree of dilatation of the resting posterior urethra. An even higher correlation coefficient was found between the dilatation of the resting posterior urethra and an arbitrary score calculated on the basis of highest cystometric pressure and duration of disease since spinal cord injury. The possible importance of this finding in relation to incontinence after urethral sphincterotomy is discussed.

The Effects of Vaginal Repair on Anterior Bladder Suspension Defects: A radiological and clinical evaluation

Abstract. In 22 patients with anterior bladder suspension defect as judged by colpocysto‐urethrography (CCU) a vaginal repair was undertaken. In 14 patients urinary stress or urge and stress incontinence was the indication for operation, and in 8, genital prolapse. At follow‐up more than 6 months postoperatively the CCU was repeated and a clinical evaluation undertaken. A normalization of the CCU was obtained in only 6 patients and 10 showed a less severe suspension defect. Nine of 14 patients were cured of incontinence. Only 3 of these had a normal follow‐up CCU. Improvement of bladder suspension defect was not the sole responsible factor for postoperative continence. Urinary incontinence developed postoperatively in 2 of 8 patients operated on solely because of symptomatic genital prolapse. Very high cure rates for urinary incontinence have been reported following a colposuspension operation. A vaginal repair is not recommended as first‐choice operation in incontinent females with anterior bladder suspension defects, if a CCU may be undertaken and the colposuspension technique is mastered.

Bladder Base Insufficiency: Radiological, Urodynamic, and Clinical Aspects

Abstract. Among 420 consecutive patients referred for voiding cystourethrography 26% presented the picture of bladder base insufficiency (b.b.i.). The examination was carried out as a colpo‐cysto‐urethrography. A urodynamic and gynecological examination was performed in each patient. The characteristic morphological features were: Anterior and inferior displacement of the bladder neck and a pointed bladder base. The position and form of the vagina was normal. Radiological signs of detrusor function were weak and opening of the bladder neck was characterized by funneling. Urodynamically the patients with b.b.i. showed low opening and low detrusor contraction pressures. The flows were highly varying. Very high flows were seen in a few patients but the more common pattern was slightly reduced maximum flow rates. Opening of the internal urethral orifice is known to be caused by detrusor contraction. Closing is passive, caused by elastic properties in the tissues. In b.b.i. intravesical pressures during micturition were low and radiological signs of detrusor contraction were weak, indicating that the bladder neck was easily opened. This, on the other hand, means that the bladder neck was insufficiently closed during bladder reservoir function, and may explain the main symptom, stress incontinence, which was present in 84% of the patients. The underlying pathology in anatomical support and suspension of the bladder base is discussed.

Urinary Stress Incontinence in Women

Primary female stress urinary incontinence has been evaluated with a full urodynamic, urostatic and uroradiological examination before and after vaginal repair or colposuspension operation. Vaginal repairs were generally performed in cases with a high or normal micturition pressure whereas colposuspensions were preferred in patients with a low pressure micturition pattern. The anatomy of bladder base and bladder support as depicted in the radiographs was taken into consideration in choosing operative techniques. The effect of the treatment was evaluated clinically and correlated to the observed changes in the urodynamic pattern. The operation does not result in any significant difference in urodynamic findings correlated to the subjective feelings: cure or failure.