Linda D. Cardozo

Results of the colposuspension operation for incontinence and prolapse.

One hundred and eighty female patients complaining of Stress incontinence were treated by a modified Burch colposuspension. Follow‐up results were available at six months in 146 patients, at one year in 88 patients and at two years in 43 patients. The overall objective cure for stress incontinence was 87 per cent at six months, 87.5 per cent at one year and 86 per cent at two years. No relationship was found between the cure of incontinence and either the time taken to resume spontaneous voiding after surgery or concomitant hysterectomy. Cystourethrocele was effectively corrected by this procedure.

GENUINE STRESS INCONTINENCE AND DETRUSOR INSTABILITY—A REVIEW OF 200 PATIENTS

A clinical and urodynamic analysis of 100 women with geniune stress incontinence and 100 women with detrusor instability is presented to compare and contrast the conditions and the results of their treatment. Emphasis is placed on the need to distinguish accurately between these two conditions.

A Comparison Between Bromocriptine and Indomethacin in the Treatment of Detrusor Instability

Our 32 patients with urinary symptoms owing to detrusor instability (either primary or secondary to an upper motor neuron lesion) have completed a clinical trial of bromocriptine and indomethacin. Each drug was administered for 1 month, using a single blind crossover method. The symptoms and any side effects were assessed by means of a questionnaire before entry into the trial, after administration of the first drug and at the end of the trial. The improvement in diurnal and nocturnal frequency owing to indomethacin was shown by McNemars test to be statistically highly significant.

SPONTANEOUS VOIDING AFTER SURGERY FOR URINARY INCONTINENCE

Eighty patients with urinary incontinence were treated by colposuspension and bladder neck plication. Fourteen patients had difficulty in establishing normal micturition postoperatively. Of these, 10 patients took longer than 21 days to void and had reduced peak urine flow rates after surgery; the other four patients voided within ten days of surgery but had reduced peak urine flow rates before and after surgery and all had residual urines in excess of 100 ml following surgery. The value of the preoperative diagnosis of pre‐existent bladder dysfunction by symptomatology and the peak urine flow rate is discussed.

An Objective Comparison of the Effects of Parenterally Administered Drugs in Patients Suffering from Detrusor Instability

Cystometric changes produced by 3 parenterally administered drugs, flavoxate hydrochloride, emepronium bromide and imipramine hydrochloride, have been evaluated in 15 female patients with detrusor instability. Each patient was given 2 of the 3 drugs and cystometric recordings were done 10 and 30 minutes after the administration of each drug. Emepronium bromide was found to be the only drug to cause a significant improvement in bladder capacity and reduction in detrusor pressure.

Treatment of delayed onset of spontaneous voiding after surgery for incontinence

An apparatus for testing urine consists of a container and a float. The float, in combination with the container, makes it possible to measure the specific gravity of a urine sample. The container is designed for holding test strips impregnated with reagents. Sediment contained in the urine can be collected for microscopic examination.A preliminary study on 40 female patients who had undergone colposuspension surgery was carried out using four drugs in an attempt to reduce the time taken to void spontaneously following surgery and to define the cause of delay. Oral diazepam given as night sedation, was found to be the most effective drug.

Evaluation of female urinary incontinence device.

A new silicone rubber inflatable vaginal pessary has been evaluated in 33 patients with stress incontinence due to urethral sphincter dysfunction (genuine stress incontinence), confirmed by urodynamic assessment. Nine of 20 patients who used the device for one month showed subjective improvement and 2 patients have continued to use the device. Urodynamic changes include a marked increase in maximum urethral closure pressure and elevation of the bladder neck.