Air filled, including "air-charged," catheters in urodynamic studies: does the evidence justify their use?

Aims: Air filled catheters (AFCs) have been actively marketed for the past few years and in some geographic areas are widely used. However, as the scientific basis for introduction of this technology for pressure measurement in urodynamics was not clear, a study group examined the evidence.

Methods: A search of the peer reviewed literature was carried out.

Compound muscle action potential of the external anal sphincter.

Aim: Pudendal nerve terminal motor latency (PNTML) assesses distal innervation of the external anal sphincter (EAS) but it is insensitive to early nerve damage. We propose to extend the assessment of PNTML to the measurement of the compound muscle action potential (CMAP) of the EAS to understand its progressive denervation.

Method: Ninety women with faecal incontinence were prospectively examined and compared with 36 asymptomatic women who acted as controls.

Viscoelastic assessment of anal canal function using acoustic reflectometry: a clinically useful technique.

Background: Anal acoustic reflectometry is a new reproducible technique that allows a viscoelastic assessment of anal canal function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, opening and closing elastance, and hysteresis.

Objective: The aim of this study was to assess whether the parameters measured in anal acoustic reflectometry are clinically valid between continent and fecally incontinent subjects.

Fatigue rate of the external anal sphincter.

Aim: Studies of skeletal muscle show that fatigue rate corresponds to the proportion of fast-twitch and slow-twitch fibres that are present in the muscle. Limited work has been done on the fatigue rate of the external anal sphincter. We have prospectively studied fatigability of the external anal sphincter in women with faecal incontinence and women with normal bowel control.

Anal acoustic reflectometry: a new reproducible technique providing physiological assessment of anal sphincter function.

Background: Anal acoustic reflectometry is a new technique of assessing anal sphincter function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, the opening and closing elastance, and hysteresis.

Objective: This study aimed to compare the reproducibility of this new technique, in terms of test-retest and interrater reliability, with manometry, the current standard test of sphincter function.

Anal acoustic reflectometry: a new technique for assessing anal sphincter function.

Objective: Anal acoustic reflectometry (AAR) is a new technique that offers an assessment of anal sphincter function by the measurement of additional parameters not available with conventional manometry. The aim of this study is to describe the technique, methodology and initial pilot study results.

Method: Wideband sounds (100 Hz to 16 kHz) are transmitted into a thin polyurethane bag placed within the anal canal.

Executive summary: The International Consultation on Incontinence 2008--Committee on: "Dynamic Testing"; for urinary or fecal incontinence. Part 2: Urodynamic testing in male patients with symptoms of urinary incontinence, in patients with relevant neurological abnormalities, and in children and in frail elderly with symptoms of urinary incontinence.

Aims: The members of 'The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses (urodynamic) testing methods for patients with signs and or symptoms of urinary incontinence. Testing of patients with signs and or symptoms of fecal incontinence is also discussed.

Methods: Evidence based and consensus committee report.

Executive Summary: The International Consultation on Incontinence 2008--Committee on: "Dynamic Testing"; for urinary or fecal incontinence. Part 3: Anorectal physiology studies.

Aims: The members of 'The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses testing methods for patients with signs and or symptoms of incontinence. Testing of patients with signs and or symptoms of urinary as well as testing of patients with fecal incontinence is discussed.

Methods: Evidence based and consensus committee report.

Executive summary: The International Consultation on Incontinence 2008--Committee on: "Dynamic Testing"; for urinary incontinence and for fecal incontinence. Part 1: Innovations in urodynamic techniques and urodynamic testing for signs and symptoms of urinary incontinence in female patients.

Aims: The members of The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses (urodynamic) testing methods for patients with signs and or symptoms of urinary incontinence. Testing of patients with signs and or symptoms of faecal incontinence is also discussed.

Methods: Evidence based and consensus committee report.

Is it possible to diagnose intrinsic sphincter deficiency in women?

Purpose Of Review: The diagnosis of intrinsic sphincter deficiency became important about 20 years ago when it influenced the choice of operative procedure for women with stress urinary incontinence. However, it was ill-defined and diagnosed by a variety of techniques. The contemporary surgical treatment of urinary stress incontinence is by suburethral sling; so this review addresses three questions: is it still important to identify intrinsic sphincter deficiency prior to surgical intervention for stress incontinence? What techniques are available to do so? How robust are these measurements?

Recent Findings: There is some evidence that women with intrinsic sphincter deficiency have a poorer outcome if they are treated by a transobturator tape compared with a tension-free vaginal tape or a pubovaginal sling.

The effect of physical activity on pelvic organ prolapse.

Objective: The objective of this study was to determine whether pelvic organ prolapse increases after physical activity.

Design: Prospective observational study.

Setting: St Mary's Hospital, Manchester, UK.

The long-term outcome of laparoscopic colposuspension: a 10-year cohort study.

Introduction And Hypothesis: The aim of this study is to provide long-term outcome data, at least 10 years, following laparoscopic colposuspension.

Methods: The study includes a control group who underwent open colposuspension. A consecutive series of 139 women who had undergone laparoscopic colposuspension were reviewed and compared to 52 women who had an open colposuspension in the same unit.

Liverpool Ultrasound Pictorial Chart: the development of a new method of documenting anal sphincter injury diagnosed by endoanal ultrasound.

Objective: To develop and validate a pictorial chart that documents ultrasound examination of the anal sphincter.

Design: A new pictorial chart (Liverpool Ultrasound Pictorial Chart [LUPIC]) depicting the normal anatomy of the anal sphincter was developed.

Methods: To validate LUPIC, two observers documented the findings of 296 endoanal scans.

Electrical stimulation for faecal incontinence in adults.

Background: Faecal incontinence is a particularly embarrassing and distressing condition with significant medical, social and economic implications. Electrical stimulation has been used with apparent success in the treatment of faecal incontinence. However, standards of treatment are still lacking and the magnitude of alleged benefits has yet to be established.

Investigation of stimulus position in the production of the strength duration curve of the external anal sphincter muscle in women with anorectal dysfunction.

Objective: The strength duration test (SDT) is a minimally invasive test of the innervation of a muscle and has been successfully adapted for use on the external anal sphincter (EAS). The SDT has previously been performed on the EAS placing a stimulating probe in the 3 o'clock position. The aim of this study was to determine whether there was any variation in the strength duration curves (SDC) produced at different positions around the EAS.

A valsalvometer can be effective in standardising the Valsalva manoeuvre.

A prospective randomised controlled study was performed in order to study the effectiveness of a device designed to reduce the variability in intra-abdominal pressures generated by individuals performing the Valsalva manoeuvre. One hundred women were recruited to take part in the project which compared a traditional Valsalva manoeuvre following standardised verbal instruction with forced expiration through a flow restriction device called a "valsalvometer". The abdominal pressure was measured using an air-filled rectal balloon catheter linked to a pressure transducer.

Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults.

Background: Faecal incontinence is a particularly embarrassing and distressing condition with significant medical, social and economic implications. Anal sphincter exercises and biofeedback therapy have been used to treat the symptoms of people with faecal incontinence. However, standards of treatment are still lacking and the magnitude of alleged benefits has yet to be established.

Routine symptom screening for postnatal urinary and anal incontinence in new mothers from a district.

Parous middle-aged women present with urinary and faecal incontinence and childbirth trauma is thought to be a causal factor. Both symptoms are common after childbirth but usually go under-reported. It has been suggested that new mothers are likely to benefit from routine symptom screening because by actively identifying symptomatic women they could then be helped to access continence services.

The strength duration test: a novel tool in the identification of occult neuropathy in women with pelvic floor dysfunction.

Objective: The Strength-duration test (SDT) is a simple minimally invasive measure of muscle innervation, recently adapted for the assessment of the external anal sphincter (EAS). This test can discriminate women with faecal incontinence from controls. The purpose of this study was to determine if the SDT could detect denervation of the EAS in women with weak but anatomically intact EAS and normal pudendal nerve terminal motor latency (PNTML).

Fatigability of the external anal sphincter in anal incontinence.

Introduction: Anal incontinence commonly results from external anal sphincter dysfunction. The muscle is routinely assessed by anorectal physiology studies. Fatigability is not routinely measured but should be an important factor in the maintenance of continence.

Opening detrusor pressure and the influence of age on success following colposuspension.

Objective: Women with urodynamic stress incontinence (USI) have lower opening and closing detrusor pressures than women without USI. This study was undertaken to determine whether a change occurs in opening and closing detrusor pressures after colposuspension, whether cure is associated with change, and whether age influences cure.

Design: Retrospective cohort study.

Stress incontinence and pelvic floor neurophysiology 15 years after the first delivery.

Unlabelled: HEADLINE: This is a longitudinal study of a cohort of primigravidae recruited between 1985 and 1987 and followed up 7 and 15 years later. Pelvic floor neurophysiology was performed and questionnaires were administered to determine the natural history of stress incontinence and to establish whether pelvic floor denervation after the first delivery is associated with symptoms of stress urinary incontinence in the future.

Objectives: To study the natural history of stress urinary incontinence arising during the first pregnancy, to determine whether postnatal pelvic floor denervation progresses with time and whether it predisposes to stress urinary incontinence in the future.