Showing papers by "Stuart L. Stanton published in 1990"

Caffeine: Does it Affect your Bladder?

Abstract: Summary— Patients with symptoms of frequency and urgency often complain that their symptoms are exacerbated by tea or coffee. A series of 20 women with confirmed detrusor instability and 10 asymptomatic women were given 200 mg of caffeine citrate and urodynamic studies were performed. In the group with detrusor instability there was a statistically significant increase in detrusor pressure on bladder filling following administration of caffeine, but no difference in volume at first contraction, height of contraction or bladder capacity. Normal women had no abnormality on cystometry.

Stress urinary incontinence.

Abstract: Stress urinary incontinence due to urethral sphincter incompetence (genuine stress incontinence) afflicts some 5-15% of women. The mechanism of continence is imperfectly understood, as is the precise mode of its cure, whether conservative or surgical. The pathophysiology is a reduction in urethral resistance in the absence of detrusor activity. Aetiological factors include congenital malformation of the bladder neck, denervation of the pelvic floor and sphincter mechanism following childbirth, trauma causing disruption of the urethral sphincter mechanism, fibrosis associated with bladder neck surgery for prolapse, oestrogen deprivation at the menopause, and urethral relaxation or instability. Conventional investigations include urethral pressure measurement, urethral electric conductance, electrophysiological tests, and cystometry or videocystourethrography (the latter procedures diagnose by exclusion). A more precise evaluation of the role of urethral resistance is hampered by lack of suitable techniques for measuring urethral and sphincteric function. Treatments include pelvic floor exercise, drugs to increase urethral resistance, and surgery, either to evaluate the bladder neck or to increase urethral resistance.

Suprapubic approaches for stress incontinence in women.

Abstract: he suprapubic approach to the control of stress incontinence due to urethral sphincter incompetence (genuine stress incontinence) is one of T several routes that include the pure vaginal route and the combined suprapubic and vaginal routes. The primary goal of most continence operations is to elevate the bladder neck to within the abdominal zone of pressure. The artificial urinary sphincter works by raising the intraurethral pressure so that it exceeds the intravesical pressure. This is an additional mode of action of both the sling and colposuspension. A critical and objective review of the literature is difficult for several reasons. First, most studies report only subjective data derived from responses to a yearly questionnaire; objective data from urodynamic testing is often omitted. Second, apart from stress incontinence, symptoms such as urgency, urge incontinence, frequency, and voiding difficulty are frequently not reported. These should be included because they are often made worse or may occur for the fmt time after continence procedures. Third, the follow-up time is often unspecified or too short (ie, less than one year). Fourth, details such as suture material and sling tension are often not specified. Finally, two procedures (ie, the Marshall Marchetti Krantz urethropexy and the anterior colporrhaphy) may be combined, precluding proper evaluation of either. With these limitations, I shall review the following procedures: the Marshall Marchetti Krantz urethropexy, colposuspension, sling, and artificial urinary sphincter. MARSHALL MARCHETTI KRANTZ PROCEDURE

The Pyridium pad test for diagnosing urinary incontinence. A comparative study of asymptomatic and incontinent women.

Abstract: Eighteen women with urodynamically proven genuine stress incontinence awaiting surgery and 23 normal, asymptomatic, continent female volunteers took part in a study to compare the accuracy of a qualitative pad test with a quantitative pad-weighing test in detecting urine loss. Each woman took 600 mg of phenazopyridine hydrochloride (Pyridium, Parke-Davis) in three equally divided doses over 18-24 hours and then underwent a standardized, one-hour pad test as described by the International Continence Society. The Pyridium pad test was regarded as positive if there was any orange staining on the pad. The quantitative pad-weighing test was considered positive if there was a weight gain of 1.0 g or more at the end of the one-hour test period. All 18 patients with genuine stress incontinence had positive Pyridium pad tests, and all had pad weight gains of greater than or equal to 1.0 g (mean, 16.5). The maximum pad weight gain in the asymptomatic, continent volunteers was 0.7 g (mean, 0.1), and none was aware of any urinary leakage during the test; however, 12 (52%) had positive Pyridium pad tests. The Pyridium pad test appears 100% sensitive in detecting urine loss in symptomatic women with genuine stress incontinence, but it has a high false-positive rate in healthy, asymptomatic, continent women. If pad-weighing tests are done, the addition of Pyridium generally will not be useful, and if Pyridium is used by itself, the results may be misleading.