Modified Burch versus Pereyra retropubic urethropexy for stress urinary incontinence.

Sixty-four women underwent either the modified Burch retropubic urethropexy or the modified Pereyra procedure for surgical correction of stress urinary incontinence. All were evaluated clinically and urodynamically before and one year after surgery. The Burch procedure proved to be superior to the Pereyra procedure in terms of improving pressure transmission to the proximal two-thirds of the urethra (P less than .

Uroflowmetry for predicting postoperative voiding difficulties in women with stress urinary incontinence.

Pre-operative knowledge of uroflowmetry and postvoiding residual urine volumes in a group of 45 women undergoing urinary incontinence surgery failed to predict risks of postoperative voiding difficulties. Only one out of nine patients needing prolonged post-operative bladder drainage (greater than or equal to 7 days) gave a pre-operative history of voiding difficulties. More than half the patients (5/9) who needed prolonged catheterization had normal flow rates were able to resume spontaneous voiding within 7 days following incontinence surgery.

Aggravation of experimental atherosclerosis in vasectomized, cholesterol-fed rabbits.

Rabbits were fed a stock or atherogenic diet for a period of fourteen months. Half of each group of rabbits was bilaterally vasectomized while the other half underwent sham vasectomy. The level of plasma cholesterol was significantly elevated following vasectomy in stock diet-fed rabbits.

Pessary test in women with urinary incontinence.

Thirty women with urinary incontinence underwent detailed preoperative and postoperative clinical and urodynamic evaluation before and after the pessary test. The urodynamic changes observed with the pessary test (P less than .01) were very similar to those seen after corrective incontinence surgery.

Effect of thyroid releasing hormone on bladder and urethral pressures.

In order to explain the pathophysiology of urinary urgency frequency observed following the administration of thyroid releasing hormone (TRH) during thyroid function testing, simultaneous urethrocystometry was performed in six females before and after TRH administration, and in another five females before and after administration of normal saline (control group). Within a few minutes following TRH administration, a statistically significant and consistent drop in maximal urethral pressure and concomitant sensation of urinary urgency in the absence of significant changes in true detrusor pressure suggested the presence of a reflex neuronally mediated motor component to this sensory effect of urinary urgency. The absence of urethral and detrusor pressure changes in the control group reinforced the TRH-mediated origin of urinary urgency.

Pessary test: simple prognostic test in women with stress urinary incontinence.

To overcome urethral obstruction and other shortcomings associated with previously described tests such as the Bonney test and the Marshall test, the pessary test was employed during preoperative evaluation of women with stress urinary incontinence. The similarity of changes seen in the resting and stress urethral closure pressure profiles with the pessary test and post-incontinence surgery, provided an objective evaluation of the pessary test as a simple and reliable clinical tool to predict successful outcome of anticipated incontinence surgery.

Advanced hidradenitis suppurativa of the vulva. A report of three cases.

Advanced suppurative hidradenitis resulting from chronic, progressive, inflammatory involvement of apocrine sweat glands often fails to respond to conservative treatment. Extensive surgical excision of all the infected areas with aggressive postoperative wound care in two of three patients provided relief from this debilitating disease. Skin grafting promoted wound healing in addition to improving cosmetic results.

Cryotherapy for treatment of genital condylomata during pregnancy.

Cryotherapy for treatment of genital condylomata acuminata was safely and successfully employed on 34 pregnant women in the second (4 cases) and third (30 cases) trimesters of pregnancy. No fetal, maternal or neonatal complications occurred during or following cryosurgery. No recurrences were observed before or six weeks following delivery.

The conus demyelination syndrome in multiple sclerosis.

Bowel, bladder and sexual dysfunction are common in multiple sclerosis and are generally attributed to the widespread nature of the involvement of the neuroaxis by the demyelinating plaques. Recently we encountered a specific subset of patients within this group who had characteristic clinical complaints of hesitancy, straining and incomplete voiding, perineal hypesthesia on examination, areflexia by cystometry and colonometry and electrophysiological parameters suggesting involvement of the conus medullaris. This heretofore postulated but undocumented mechanism of neurovisceral dysfunction in multiple sclerosis is detailed and discussed in 2 patients in this report.

Urodynamic predictability of voiding following incontinence surgery.

To predict the duration of postoperative bladder drainage required after incontinence surgery, 30 patients were studied preoperatively using voiding-simultaneous urethrocystometry. Based on changes in bladder, urethral, and abdominal pressures, patients were divided into three groups. Patients who demonstrated adequate bladder contraction during voiding did not need prolonged catheterization (P less than .

Urodynamic effects of a vaginal pessary in women with stress urinary incontinence.

The manner in which a vaginal pessary restores urinary continence is poorly understood. This report provides an explanation. Following placement of the vaginal pessary, detailed urodynamic studies in a group of 12 women with stress urinary incontinence demonstrated consistent and significant (p less than 0.

Urodynamic appraisal of the Bonney test in women with stress urinary incontinence.

To determine the validity of the Bonney test as a prognostic screening test for urinary incontinence, the urethral and urethrovesical functions were studied under resting and stressful conditions. The characteristic similarity of changes was evident in the functional profile length, closure pressure, and cough pressure profile of the urethra during performance of the Bonney test and intentional urethral occlusion. This study clearly invalidated the Bonney test by objectively demonstrating that the Bonney test restored continence under stress of coughing by obstructing the urethra and urethrovesical junction.

Cortical evoked potentials on stimulation of pudendal nerve in women.

Somatosensory evoked potentials were recorded in five normal women on percutaneous stimulation of the pudendal nerve. A consistent response was obtained over the scalp 2 cm behind the Cz electroencephalographic recording site. The latency of onset of this response had a mean value of 33 msec, and the mean latency of the first positive peak was 39.

Urodynamics: continuous monitoring.

Continuous ambulatory monitoring of intravesical and intraurethral pressures was done in 26 patients using a portable tape recorder, a specially designed urethral catheter and pressure sensitive catheter tip transducers. With this technique we overcame some of the difficulties encountered with previously described recording systems for monitoring intravesical and intraurethral pressures on a continuous basis. Pressure changes in the urethra and bladder were recorded in response to various resting and stressful situations, with the patient in a natural environment and with freedom of activities of daily living.

Colonometry, cystometry, and evoked potentials in multiple sclerosis.

The conditions of three patients with advanced-stage multiple sclerosis and symptoms related to bowel and bladder function were evaluated using colonometry, cystometry, and somatosensory evoked responses from the posterior tibial nerve. The colonometrograms and cystometrograms showed notable hyperreflexia and reduced filling capacity when compared with neurologically intact patients. The neurological lesions were localized to above the conus medullaris by recording normal somatosensory responses at L-1 and abnormal responses over the scalp.

Urodynamics in women with stress urinary incontinence.

Characteristic alterations of urethral pressure and length occur in patients with stress urinary incontinence. Urodynamics in this group of 50 patients revealed a significant decrease in urethral functional length under the stress of bladder filling and change of position from supine to sitting. A decrease in urethral closure pressure was present in individual patients and was significant.

Colonic dysfunction in multiple sclerosis.

Multiple sclerosis is a central nervous system disease frequently accompanied by urinary symptoms and severe constipation. In order to investigate the pathophysiology of these symptoms, we studied colonic motor and myoelectrical activity, as well as colonic volume-pressure relationships (colonometrograms) and have correlated these data with cystometry and electrophysiologic studies of the central and peripheral somatosensory nervous system. The study group consisted of 7 patients with advanced multiple sclerosis marked by symptoms and signs of somatic and visceral nervous system dysfunction including severe constipation.

Uterine osseous metaplasia.

A rare case of osseous metaplasia of the endocervix and endometrium is discussed with both macroscopic and microscopic evidence of new bone formation in the uterus. History of menstrual irregularities, repeated abortions, infertility with histopathologic evidence of chronic inflammation, and bone formation may be evident in these cases. Various theories of the pathogenesis of benign uterine bone formation are discussed.

Pudendal evoked responses.

The dorsal nerve of the penis or clitoris, a branch of the pudendal nerve, was stimulated while averaged evoked responses over the spinal cord, sensory cortex, and bulbocavernosus muscle were recorded in a series of normal subjects. The morphologic features, peak latencies, and peripheral and central conduction times were compared with spinal and cortical evoked responses from the posterior tibial nerve. These tests are of potential clinical importance in the evaluation of sacral nerve root or plexus injuries and bowel, bladder, or sexual dysfunction.

Altered lipid profile, postheparin lipolytic activity, and xanthoma of choroid plexus in vasectomized rabbits fed an atherogenic diet.

Plasma and erthrocyte lipid profile and lipoprotein lipase activity in postheparin plasma on vasectomized rabbits were studied and also the incidence of atherosclerosis in different arterial beds. Four groups of animals were studied, sham-vasectomized and vasectomized animals fed stock diet (groups A1, A2) and sham-vasectomized and vasectomized animals fed atherogenic diet (groups B1, B2). Elevated levels of neutral lipids and phospholipids in plasma and in erythrocytes of the vasectomized rabbits were observed.