Norman R. Zinner

Efficacy, safety, and tolerability of extended-release once-daily tolterodine treatment for overactive bladder in older versus younger patients

OBJECTIVES: To evaluate the efficacy, safety, and tolerability of a new, once‐daily extended‐release (ER) formulation of tolterodine in treating overactive bladder in older (≥65) and younger (<65) patients.

Role of inner urethral softness in urinary continence.

Given adequate external squeeze upon suitable urethral geometry, continence depends on the mechanical properties of the outflow tract wall. Evidence indicates that these mechanical properties include an ability to deform and behave in a fluid-like manner.

Clinical Aspects of Detrusor Instability and the Value of Urodynamics

According to the International Continence Society, detrusor instability (DI) is not a disease, it is a condition found only by urodynamic examination. Thus, the word instability is misleading. It implies that the bladder is abnormal. We do not think of unstable situations as being normal. It is inappropriate to use the term because it makes it too easy for clinicians to feel they have made a diagnosis when they have not. It curtails further thinking and does not promote the scientific pursuit of fact. What is the evidence that DI is abnormal? As described by the ICS in 1981, the patient must have no neurological bladder abnormality. Studies show it can be provoked in asymptomatic individuals and can be found ‘naturally’ with ambulatory urodynamic testing. A person may be clinically asymptomatic and totally unaware that the contraction is occurring. The findings are simply phasic pressure increases reflecting typical rhythmic contractions of visceral structures such as bowel and urinary bladder. This paper proposes the term ‘phasic detrusor contractions’ (PDCs). It has no connotation, describes the finding, and frees the clinician and scientist to explore the matter without prejudice.

Analysis of drop intervals in jets modelling obstruction of the urinary tract.

The external human urine stream breaks into drops, the sequence and properties of which contain information about the condition of the urinary outlet tract. These are studied wih an optical instrument, the Urinary Drop Spectrometer. One particular analysis, the distribution of time intervals between the drops, is made with data taken with a simplified brass model of the adult male urethra. A quantitative measure of the sensitivity of this analysis to the size and location of annular obstructions is presented. Similarities to results for several common types of obstruction in humans are exhibited and discussed.

Evaluation of inner urethral softness Part II. Clinical study using new grooved probe device

This study, in incontinent women, evaluates the effectiveness of a new device to measure properties of urethral softness. The device is a straight sound with a longitudinal groove cut along its surface. It is inserted through the urethra and into the bladder. A soft, deformable urethra is expected to fill itself into the groove and prevent the loss of urine from the bladder along the groove to the outside. Using this instrument it is learned that (1) postmenopausal women are less able to seal the urethra than younger ones; (2) as the urethra is stretched it is less able to form a seal; and (3) the anterior urethra is the weakest link in sustaining continence when tested by methods used in this program.

The Urinary Drop Spectrometer - An Electrooptical Instrument for Urological Analysis Based on the External Urine Stream

This communication presents the design and an outline of clinical experience with two models of the urinary drop spectrometer (UDS), a noncontact optical instrument used for assessing urological abnormalities based on observation of the external urinary stream.

Measuring softness of inner female urethra. Part I. Simple new device.

A new device is described to measure clinically the softness of the female urethra. It is a rod-shaped urethral sound with a longitudinal groove along its surface. The sound is constructed in sizes 12 to 24 French. Each has one groove which is 2 mm wide and either 2, 2.5, or 3 mm deep. The groove is 11 cm long. When inserted into the filled female bladder per urethram, the groove will span the urethra from the bladder to the outside. If the urethral inner lining is soft and deformable, it will fill itself into the groove and prevent leakage of urine from the bladder along the groove to the outside. If the urethra is relatively rigid, urine will leak from the bladder. This instrument permits testing of women to determine urethral properties in preventing leakage when studied with a range of probe sizes.