Search PubMed⌕ Search

Biomedical subjects

A Wagg

Publications and source records attributed to A Wagg.

At least 19 recordsLinked to original sources
PubMed2006

Overactive bladder: The importance of new guidance.

Overactive bladder (OAB) affects an estimated 49 million people in Europe, but only a minority receive appropriate treatment. Others are bothered by unacceptable levels of symptoms that severely impair their quality of life and represent a significant financial burden to themselves and to their healthcare providers. Recently updated guidelines from the International Consultation on Incontinence (ICI) and the European Association of Urology (EAU) take account of important new developments in the management of bladder problems in both primary and secondary care. However, local implementation of previous guidance has been variable, with many patients with OAB and other bladder problems failing to gain full benefit from current clinical and scientific understanding of these conditions. The recent expansion of the range of treatments available for OAB and stress urinary incontinence makes it especially important that physicians become aware of the differential diagnosis of these conditions - the questions they need to ask, and the investigations which will help determine the most appropriate course of action.

Algorithms↗
PubMed2005

Nocturia: morbidity and management in adults.

Nocturia is an increasingly prevalent and bothersome urinary symptom associated with considerable impact and morbidity in later life. Nocturnal frequency is associated with a number of underlying pathologies, both related and unrelated to the lower urinary tract. Following careful assessment, diagnosis and management, the condition is amenable to amelioration, if not complete cure in the majority of cases. This paper outlines the epidemiology, underlying pathophysiology and diseases associated with nocturia and reviews current treatment strategies.

Adrenergic alpha-Antagonists↗
PubMed2003

Clinical pharmacology of old age syndromes.

Several syndromes occur in old age. They are often associated with increased mortality and in all there is a paucity of basic and clinical research. The recent developments in the clinical pharmacology of three common syndromes of old age (delirium, urinary incontinence, and falls) are discussed along with directions for future research.

Accidental Falls↗
PubMed2003

Pressure-flow variables in patients treated with tolterodine for detrusor overactivity.

OBJECTIVE: To test the hypothesis that drug treatment which modifies detrusor function (tolterodine) may influence the higher detrusor pressure at urethral opening and closure recorded in patients with detrusor overactivity than in those with stable bladders. PATIENTS AND METHODS: All patients treated with tolterodine in the treatment arm of a phase III, randomized, placebo-controlled trial of tolterodine were eligible for the study. Patients underwent urodynamics before and immediately after 4 weeks of therapy. The detrusor pressure at urethral opening, at maximum flow and at urethral closure, and the maximum bladder capacity and postvoid residual urine volume were recorded from matched urodynamic studies in the trial. Patients with a reduction in urinary frequency of more than two voids per 24 h were defined as responders to treatment and urodynamic data were dichotomised accordingly to allow comparison. RESULTS: There were no between-group differences in either the detrusor pressure at opening or closure when responders were compared with non-responders. Successful treatment was associated with a statistically significant change in bladder capacity and postvoid residual volume, although the change in residual volume was not clinically significant. Values of detrusor pressure at opening before treatment were greater in non-responders. CONCLUSION: The absence of changes in the pressure-flow plot variables is in keeping with previous studies reporting the search for a urodynamic variable which might be used to predict a favourable outcome after drug treatment.

Benzhydryl Compounds↗
PubMed1999

Visco-elastic properties of isolated detrusor smooth muscle.

The generation of force by the contractile apparatus and the modulation of that force by the intra- and extracellular matrix are the initial steps in the production of bladder wall tension. The biomechanical components contributing to the observed rise in bladder wall tension may be studied in isolated detrusor tissue and attempts can be made to isolate these. The problem is to determine whether clinically observed alterations in detrusor function are due to changes in the contractile apparatus or in the surrounding matrix. This review discusses the viscoelastic properties of detrusor muscle, concentrates upon the influence of bladder outflow obstruction on the mechanical properties of the detrusor in an attempt to understand changes in contractile function.

Animals↗
PubMed1998

Urodynamic variables cannot be used to classify the severity of detrusor instability.

OBJECTIVE: To explore the relationship between subjective severity of symptoms of detrusor instability (DI) on presentation, outcome after treatment for DI and initial diagnostic urodynamic variables, with the aim of identifying a urodynamic variable which might, by predicting a favourable outcome from treatment, classify the severity of DI. PATIENTS AND METHODS: Women with a urodynamically proven diagnosis of DI were recruited prospectively for the study. Data on disease symptoms and variables from their diagnostic cystometrogram were collected. All women were then treated and their outcome at 6 weeks after treatment compared with the initial urodynamic variables. Data on severity of symptoms were compared with initial urodynamic variables to explore any differences in these variables attributable to symptom severity. RESULTS: Of 300 women studied (mean age 54 years, SD 16), 290 were treated with oxybutynin and bladder retraining. At 6 weeks, 82 women had their treatment outcome classified as worse/no change; 218 women had improved. When good or poor outcome was compared with the urodynamic results, there was no significant difference between the groups. Likewise, the severity of symptoms did not relate to the values of urodynamic variables. CONCLUSIONS: There was no statistically significant relationship between reported severity of symptoms and urodynamic variables, and no relationship between the urodynamic variables used and response to treatment. Therefore, using these values it is not possible to predict a favourable outcome from treatment or to use them to classify disease severity.

Female↗
PubMed1997

Differences in detrusor contractile function in women with neuropathic and idiopathic detrusor instability.

OBJECTIVE: To compare urodynamic indices of isometric and isotonic detrusor contractile function between patients with idiopathic detrusor instability and patients with multiple sclerosis (MS) and detrusor hyper-reflexia and thus determine whether the different types of detrusor instability share a common pathophysiological pathway. PATIENTS AND METHODS: Two groups of women were studied; 1139 neurologically normal patients with detrusor instability (mean age 55 years, SD 17) and 141 with multiple sclerosis (MS) and detrusor hyper-reflexia (mean age 45 years, SD 11). Patients were assessed using static water cystometry, examining storage function, isometric and isotonic detrusor contractile function and voiding outflow function. RESULTS: Bladder capacities were lower in the MS group, with a median of 357 mL, 95% confidence interval (CI) 305-400 mL, compared with the neurologically normal patients (median 450 mL, 95% CI 425-450, P < 0.001, Mann-Whitney U-test). Voiding was incomplete in the MS group, with a median (95% CI) residual volume of 100 (100-125) mL, but complete in the normal group, at 10 (10-10) mL. Higher median (95% CI) detrusor pressures at urethral opening (P(det open)) and closing (P(det close)) were recorded in the MS group than in the neurologically normal group, at 35.5 (33.2-46.6) cmH2O and 30 (27.6-31.6) cmH2O for P(det open), respectively (P = 0.003), and 25.3 (20.9-31.6)cmH2O and 16.6 (15.0-18.1) for P(det close), respectively, (P = 0.001). In the MS group, the median (95% CI) isometric unstable contractions were less well maintained, but were more powerful, at 17.6 (15.6-18.9) N, compared to the neurologically intact group at 14.4 (14.0-14.9) N (P = 0.002). In the MS group, contractions frequently did not relax back to baseline, whereas in the group with detrusor instability, full relaxation after contraction was more usual. There was no significant difference in the maximum speed of detrusor shortening (isotonic activity), measured by the velocity constant Q*, between the groups (median for both groups 20 mL/s, 95% CI 17-23). CONCLUSION: These results show differences in storage function, isometric detrusor contractile function and voiding outflow function between detrusor instability and detrusor hyper-reflexia, indicating that the two conditions may not share a common pathophysiological pathway.

Adult↗