Colpocystodefecography.

Purpose: To assess, in one single procedure, a complete study of the female pelvis, including the Douglas pouch.

Methods: Colpocystodefecography (CCD) combines vaginal opacification, voiding cystography, and defecography. Three hundred examinations are reviewed.

[Defecation disorders. Characteristics of manometric studies and rehabilitation].

The authors review the literature and their personal experience about the systematic exploration of defecation disorders by anorectal manometry and colpocystodefecography. They stress the importance of combining functional and morphological evaluation, in order to avoid inappropriate surgery. Concerning anorectal manometry, the determination of the smallest volume of rectal distention inducing a complete relaxation of the internal anal sphincter was found more useful than the maximal tolerable volume in the exploration of defecation disorders.

[Unstable bladder and kinesitherapy. The concept of deficient unstable bladder].

The authors present a series of 30 unstable bladders treated only by perineal muscular reeducation by contact. The best results are obtained in the group presenting with pelvic floor hypotonia and USI (efficiency 71.5%), especially when the closure pressure is normal (100%).

[2 classical contraindications for enteroplasty in spina bifida].

The authors report two cases of spina bifida which illustrate the two major contraindications of enteroplasty and stress the importance of a detubulated intestinal patch and an isometric ureterocystometry in the diagnosis and treatment of neurogenic bladder.

[Reinforced colposuspension (modified Cukier's operation). Immediate results, complications, indications].

In order to avoid mean term failures of colposuspension and short term obstructive complications of sling procedure, the author present a technique of urethropexy combining the two principles: reinforced colposuspension. A series of 67 consecutive procedures is subdivided in 45 stress incontinence and 22 incontinence with prolapse simultaneously treated by spinofixation. Continence is obtained in 97.

[Synopsis of neurological bladder sphincter dysfunctions].

The synopsis of neurogenic lower urinary tract dysfunctions aims to be practical and tries to give some simple algorithms to the physician to help his understanding of the pathophysiology and to guide him towards an easy, functional, preventive and chronological exploration and treatment.

[Bladder instability and kinesitherapy. The concept of deficient bladder instability].

The authors present a series of 30 unstable bladders treated only by perineal muscular reeducation by contact. The best results are obtained in the group presenting with pelvic floor hypotonia and USI (urinary stress incontinence) (efficiency 71.5%), especially when the closure pressure is normal (100%).

[Striated sphincter of the urethra. 4: Therapeutic possibilities].

Treatment of non-neurologic dyssynergia is aimed at diminishing urethral sensory impulses or the motor component of the dysreflexia. Although formal proof of efficacy is lacking, urethral dilatation or meatoplasty in young girls is still used when an obstacle exists to passage of a balloon catheter. Functional obstruction is treated by Valium for its muscle-relaxant properties, alpha-blocking agents or biofeedback.

[The striated sphincter of the urethra. 1: Recall of knowledge on the striated sphincter of the urethra].

The first part of this report is devoted to the anatomy, nerve supply, and physiology of the striated sphincter, three subjects which greatly aroused a great deal of controversies. The conclusions of the authors are as follows. The striated sphincter of the urethra is a muscle of the perineum, arising from the cloacal sphincter.

[Urethral instability: diagnosis and clinical significance].

Simultaneous urethrocystometry, the advantages of which are outlined, enabled us to diagnose 27 cases of pure urethral instability (male and female) and 16 cases of mixed instability (urethral and bladder instability). We analysed the relationship between the main symptom, this urethral dysfunction and the competence of the bladder neck. Definition, characteristics and frequency of urethral instability are discussed.

[Simultaneous urethrocystometry and hyperactive bladders: differential diagnosis and types of dyssynergia].

The authors reviewed the simultaneous urethrocystometry (SUCM) of 96 hyperactive bladders subclassified into 4 groups (pure detrusor instability, mixed instability, suprasacral spinal lesion, and CNS lesion) and compared the frequency of various urethral parameters. The absence of urethral relaxation before or during the augmentation of the detrusor pressure is the most specific sign of suprasacral spinal lesions. It constitutes what we call passive or tonic dyssynergia.

Enuresis and urethral instability.

31 patients with refractory enuresis underwent simultaneous urethrocystometry. Pure urethral instability was encountered in 14, urethral and bladder instability in 11 and isolated uninhibited bladder in 3. This allows us to discuss the functional relationship between the urethra and the bladder.