Kurt K. Nielsen

Long-term results of pelvic floor training and surgery for female genuine stress incontinence

Fifty-two women with genuine urinary stress incontinence were randomized to pelvic floor training or surgery. At 4 and 12 months follow-up patients not satisfied with the outcome were offered the alternative treatment. Ten patients (42%) were satisfied following the training program, 20 patients (71%) were satisfied following surgery, while 22 patients underwent both treatment modalities.The patients were re-evaluated 4–8 years later (median 6 years) by history (n=48), pad-weighing test (n=41), and urinary diary (n=37). The beneficial effect of pelvic floor training continues for years. The longterm results were practically the same as after 1 year for all treatments. Patients with significant incontinence may be well-adapted to the situation, and indication for treatment is very much dependent on the hazards involved. Objective measurement of the degree of incontinence is essential when different treatments are compared.

Urethral stricture following transurethral prostate prostatectomy

Abstract Urethral stricture is the most common late complication of transurethral prostatectomy. Uroflowmetry is recommended as the routine screening procedure for strictures postoperatively. If maximal urinary flow rate (Qmax) is below 10 mL/second the patients should be investigated further. The etiology of urethral stricture is still unclear. Further studies are necessary to evaluate the possible etiologic role of infected urine pre- and/or postoperatively, urethral catheterization pre- and postoperatively, catheter material, and the type and size of the resectoscope. A narrow urethra is probably a predisposing factor for stricture formation, but this is not definitively clarified. Only few randomized studies have been performed to evaluate the different prophylactic methods against development of strictures postresection. Resection via perineal urethrotomy perhaps preceded by urethral calibration, seems to be a way to avoid anterior urethral strictures The effects of internal urethrotomy preoperatively on stricture formation are conflicting. Further randomized studies are necessary.

Bladder dysfunction in advanced Parkinson's disease

Parkinsons disease (PD) patients often have lower urinary tract symptoms. Seventy‐four percent of patients with early‐to‐moderate disease report more than one bladder disturbance symptom. Severe bladder symptoms are reported in 27–39% of PD patients. The aim of this study was to evaluate the severity of bladder dysfunction in patients with advanced PD.

The Urethral Plug: A New Treatment Modality for Genuine Urinary Stress Incontinence in Women

A new modality, the urethral plug, was used to treat 22 women with genuine urinary stress incontinence. The plug is made of thermoplastic elastomer (Kraton G), and consists of a meatal plate, a soft stalk and 1 or 2 spheres along the stalk. The spheres were located according to the result of the urethral pressure profile. The midpoint of the proximal sphere was placed at the bladder neck and the distal sphere was placed just above the maximum urethral pressure point. At voiding the plug was removed and afterwards a new plug was inserted. The plug with 2 spheres was tested in week 1 (period 1) and the plug with only the distal sphere was tested in week 2 (period 2). A total of 22 patients completed period 1. Eight patients did not complete period 2, mostly due to either unchanged incontinence during period 1 or a repeated loss of the plug with 1 sphere. In periods 1 and 2, 73 and 79% of the patients were subjectively and objectively continent or improved. A total of 14 patients completed both periods. Eight patients preferred the plug with 2 spheres, 1 preferred the other plug and 5 had no preference. The side effects were few. This preliminary study shows that the urethral plug seems to be a promising alternative treatment for female genuine urinary stress incontinence.

Pad weighing tests with 50% or 75% bladder filling: Does it matter?

In order to evaluate the influence of bladder filling at the beginning of a 40 minutes pad test, 71 women completed this study. Thirty‐six patients were randomized to pretest filling of the bladder to 50% of the bladder capacity, and 35 patients to 75% pretest filling. In all patients, a retest was performed approximately fourteen days later. The leakage in the two groups was equal. Median leakage during the first test was 3 g in both groups (p = 0.97). The leakage was numerically larger during the second test, median 6.5 g and median 13 g, respectively (p = 0.69). The test‐retest variation was calculated in both groups. In patients with 50% bladder filling test‐retest variation (mean 2 S.D.) was −28.4%+ 206.8%. In patients with 75% bladder filling mean variation was −58.0% + 203.0%. The difference in test‐retest variation between groups was not statistically significant (p = 0A7). Only the subjective evaluation by the patients revealed a preference in favor of the test with 50% bladder filling. Significantly more patients in the 50% group reported that the results of the first test and the retest corresponded well with the daily urinary leakage (p=0.04). The most striking finding of this study was that, despite filling to either 50%. or 75% of the bladder capacity at the beginning of the test, the fluid load during the test, i.e. the initial volume instilled into the bladder plus the diuresis during the test, was equal in the two groups. The diuresis during the test in patients with 50% bladder filling was median 116 ml at the first test vs. median 64 ml in patients with 75% bladder filling (p = 0.01). These results were highly reproducible during the second test, where the diuresis in the two groups was median 115 ml and 63 ml, respectively (p = 0.01). The theoretical background for this phenomenon is discussed.

Spontaneous Rupture of a Diverticulum of the Female Urethra Presenting with a Fistula to the Vagina

A case is presented of a diverticulum of the female urethra presenting with sudden signs of a fistula to the vagina. The etiology, diagnosis, and treatment are discussed.

Xenon tissue/blood partition coefficient for pig urinary bladder.

In four landrace pigs the tissue/blood partition coefficient (lambda) for xenon (Xe) for the urinary bladder was calculated after chemical analysis for lipid, water and protein content and determination of the haematocrit. The coefficients varied from bladder to bladder owing to small differences in both the haematocrit and tissue composition. In Xe washout studies of the blood flow of the urinary bladder, we recommend calculating the lambda for Xe from the actual haematocrit and from the median value of tissue composition found in the present study.