Management of bladder dysfunction in multiple sclerosis.

Sixty-seven consecutive patients participated in a prospective urodynamic study of the diagnosis and treatment of urinary bladder symptoms in multiple sclerosis. The etiology of symptoms was classified as either failure to store urine (30%), failure to empty the bladder (18%), or a combination of the two (50%). Treatment was individualized on the basis of the underlying pathophysiology and consisted of intermittent self-catheterization (21%), none (20%), surgical (12%), drugs (9%), voiding maneuvers (6%), and external condom drainage (6%).

Failure of bethanechol denervation supersensitivity as a diagnostic aid.

A total of 33 patients who demonstrated detrusor areflexia during cystometry underwent the bethanechol denervation supersensitivity test. In each instance the presence or absence of a neurologic lesion was documented carefully by complete neurologic evaluation. Of the 21 patients with a neurogenic bladder there was a falsely negative rate of 24 per cent.

Vesicourethral dysfunction in multiple sclerosis.

Urodynamic evaluation was done 45 times on 41 consecutive patients with multiple sclerosis. Bladder symptoms correlated poorly with any single urodynamic finding and, accordingly, a comprehensive evaluation was necessary to define the underlying pathophysiology. Only 63 per cent of the patients with symptoms of urgency, frequency and urge incontinence actually were found to have uninhibited bladder contractions, while 73 per cent of the patients with obstructive symptoms had detrusor areflexia.

Urodynamic evaluation as neurologic test of sacral cord function.

The use of urodynamic evaluation as a diagnostic tool for evaluating subtle neurologic lesions involving the second, third, and fourth segments of the sacral spinal cord is redefined. Six illustrative cases are presented.

Primary renal artery dissecting aneurysm: a review.

Primary dissecting aneurysms of the renal artery are exceedingly rare. Our recent encounter with a patient with this condition prompted a review of the literature. The diagnostic and therapeutic problems in 30 patients were analyzed and guide lines for proper management were discussed.

Acute urinary retention in women: complete urodynamic evaluation.

Sixteen women underwent complete urodynamic investigation of acute urinary retention. Simultaneous recordings of intravesical and rectal pressures allowed an easy distinction to be made between bladder contractions and abdominal straining. Needle electromyograms, viewed on an oscilloscope by an experienced electromyographer, permitted an exacting neurologic diagnosis.

Changing concepts in the urodynamic evaluation of children.

Urodynamic evaluation was performed in 46 children with myelodysplasia, spinal cord injury, enuresis, postoperative incontinece, sacral agenesis and recurrent urinary tract infection. The basic study consisted of voiding cystourethrography followed by the simultaneous recording of intra-abdominal and intravesical pressure with external urethral sphincter electromyography. Urethral pressure profile, urinary flow rate and anal sphincter electromyography were performed selectively.

A new approach to electromyography of the external urethral sphincter.

Detailed electromyographic investigation of the external urethral sphincter was done as part of a urodynamic evaluation of 119 patients. The sphincter was located by inserting electrodes alongside the urethra. The electromyogram was viewed on an oscilloscope and recorded on paper.

Idiopathic pelviureteric varices.

Pelviureteric varices are well-documented sequelae of renal vein thrombosis, but there have been only 10 prior reports of idiopathic renal vein varicosities. Herein we report 3 more cases and review the literature. Two thirds of the patients presented with hematuria; one-fourth had flank pain, and one-third had saphenous vein varicosities.

Paraurethral cysts in female neonate.

Paraurethral cysts in the female neonate are uncommon lesions. All reported cases have either ruptured spontaneously or responded to simple marsupialization. However, complete urologic evaluation is mandatory because they simulate ectopic ureteroceles in appearance.

Chemolysis of residual stone fragments after extensive surgery for staghorn calculi.

Chemical dissolution of residual stone fragments was attempted in twelve instances via nephrostomy tube irrigation. Appropriate solutions containing either hemiacidrin or sodium bicarbonate were used for struvite and uric acid stones, respectively. Precautions were taken to prevent and recognize outflow obstruction and urinary infection.