The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society.
TL;DR: The standardisation of terminology of lower urinary tract function: Report from the standardistation sub-committee of the International Continence Society.
Abstract: The standardisation of terminology of lower urinary tract function: Report from the standardistation sub-committee of the International Continence Society.
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TL;DR: The TVT procedure appears to be as effective as colposuspension for the treatment of urodynamic stress incontinence at 2 years, and when data were analyzed on an intention-to-treat basis, this study was undertaken to compare tension-free vaginal tape with colpos Suspension as the primary treatment for stressincontinence.
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TL;DR: Antimuscarinics are the main-stay of pharmacological treatment of the overactive bladder syndrome, which is characterized by urgency, frequency, and urge incontinence.
Abstract: The lower urinary tract constitutes a functional unit controlled by a complex interplay between the central and peripheral nervous systems and local regulatory factors. In the adult, micturition is controlled by a spinobulbospinal reflex, which is under suprapontine control. Several central nervous system transmitters can modulate voiding, as well as, potentially, drugs affecting voiding; for example, noradrenaline, GABA, or dopamine receptors and mechanisms may be therapeutically useful. Peripherally, lower urinary tract function is dependent on the concerted action of the smooth and striated muscles of the urinary bladder, urethra, and periurethral region. Various neurotransmitters, including acetylcholine, noradrenaline, adenosine triphosphate, nitric oxide, and neuropeptides, have been implicated in this neural regulation. Muscarinic receptors mediate normal bladder contraction as well as at least the main part of contraction in the overactive bladder. Disorders of micturition can roughly be classified as disturbances of storage or disturbances of emptying. Failure to store urine may lead to various forms of incontinence, the main forms of which are urge and stress incontinence. The etiology and pathophysiology of these disorders remain incompletely known, which is reflected in the fact that current drug treatment includes a relatively small number of more or less well-documented alternatives. Antimuscarinics are the main-stay of pharmacological treatment of the overactive bladder syndrome, which is characterized by urgency, frequency, and urge incontinence. Accepted drug treatments of stress incontinence are currently scarce, but new alternatives are emerging. New targets for control of micturition are being defined, but further research is needed to advance the pharmacological treatment of micturition disorders.
466 citations
Cites background or methods from "The standardisation of terminology ..."
...Disturbances of bladder function leading to symptoms of urgency, frequency, and eventually incontinence have been termed overactive bladder (OAB) syndrome (Abrams et al., 2002), defined as the symptoms of urgency, with or without urge incontinence, usually with frequency and nocturia....
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...Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, and Wein A (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society....
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...The terminology used to describe lower urinary tract function follows the recommendations of the International Continence Society (Abrams et al., 2002)....
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TL;DR: In this paper, the authors compared abdominal and vaginal sacral colpopexy in the treatment of V prolapse and found that the abdominal approach was associated with a longer operating time, a slower return to activities of daily living, and a greater cost than the sacrospinous colopexy.
452 citations
TL;DR: This report presents a standardization of terminology of pelvic $oor muscle function and dysfunction to facilitate comparison of results and enable eiective communication by investigators performing pelvic £oor muscle studies.
Abstract: STANDARDIZATION This report presents a standardization of terminology of pelvic £oor muscle function and dysfunction. No earlier documents contained de¢nitions on this terminology. These de¢nitions are descriptive and do not imply underlying assumptions that may later prove to be incorrect or incomplete. By following this principle, the International Continence Society aims to facilitate comparison of results and enable eiective communication by investigators performing pelvic £oor muscle studies.
442 citations
TL;DR: This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract.
Abstract: This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed.
417 citations
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TL;DR: A standard system of terminology recently approved by the International Continence Society, the American Urogynecologic Society, and the Society of Gynecologic Surgeons for the description of female pelvic organ prolapse and pelvic floor dysfunction is presented.
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TL;DR: This report contains a recommendation for a provisional standard method for defining obstruction on the basis of pressure-flow data and more detailed analyses of Pressure-flow relationships, described below, are advisable to aid diagnosis and to quantify data for research studies.
Abstract: textThe 1988 version of the collated reports on standardisation of terminology, which appeared in Neurourology and Urodynamics, vol. 7, pp. 403–427, contains material relevant to pressure flow studies in many different sections. This report is a revision and expansion of Sections 4.2 and 4.3 and parts of Sections 6.2 and 7 of the 1988 report. It contains a recommendation for a provisional standard method for defining obstruction on the basis of pressure-flow data.
2. Evaluation of Micturition
2.1. Pressure-Flow Studies
At present, the best method of analysing voiding function quantitatively is the pressure-flow study of micturition, with simultaneous recording of abdominal, intravesical and detrusor
pressures and flow rate (Fig. A.1.6.1).
Direct inspection of the raw pressure and flow data before, during and at the end of micturition is essential, because it allows artefacts and untrustworthy data to be recognised and eliminated. More detailed analyses of pressure-flow relationships, described below, are advisable to aid diagnosis and to quantify data for research studies.
The flow pattern in a pressure-flow study should be representative of free flow studies in the same patient. It is important to eliminate artefacts and unrepresentative studies before applying more detailed analyses.
Pressure-flow studies contain information about the behaviour of the urethra and the behaviour of the detrusor.
423 citations