Biomedical subjects
Publications and source records attributed to B T Haylen.
The subjective assessment of urine loss in 84 incontinent women was quantified by using a 10-cm visual analogue scale. These results were compared with the results of a 2-h pad weighing test. We found no relationship between a patient's subjective impression of the severity of her incontinence and the corresponding objective assessment by a 2-h pad weighing test.
Transvaginal linear array ultrasound is described as a method of measuring bladder volumes in the range 2 to 175 ml, overcoming the limitations of abdominal ultrasound at these smaller (though clinically important) volumes. The mean error over the range 10 to 175 ml was 23%. Statistical analysis of preliminary data obtained by this technique shows that bladder volume in ml can be calculated by the formula: Volume = 5.9 x (height x depth) - 14.6 ml (95% confidence limits = +/- 37 ml)
Two potential sources of error in the measurement of residual urine volumes in women were quantified. These were (i) whether a diuresis is operating at the time of measurement, and (ii) the time between voiding and residual urine volume collection. A regime is suggested for the accurate measurement of residual urine in women by urethral catheterisation.
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Many women who present with symptoms of bladder dysfunction relate the onset to the operation of simple hysterectomy. A group of 42 women undergoing simple hysterectomy was studied prospectively. Urinary symptoms, urodynamic findings and sacral reflex latencies (SRLs) were assessed pre- and post-operatively. After hysterectomy the incidence of urinary symptoms increased from 58.3 to 75.0%. Vesicourethral dysfunction was altered in 30.6% of patients, 72.7% of whom had evidence of pelvic neuropathy as detected by SRLs. The results show that simple hysterectomy is associated with a significant incidence of post-operative vesicourethral dysfunction and that there is an identifiable neurological abnormality incurred at operation which is pertinent to the subsequent disordered voiding.
The study of voiding in men and women has been handicapped by the lack of a normal reference range covering urinary flow rates over a wide range of voided volumes. Normal volunteers (331 males and 249 females) were studied. Each voided once into a calibrated Dantec Urodyn 1000 mictiograph. On a second occasion 282 men and 46 women voided. The maximum and average urine flow rates of the first voids in both sexes were compared with the respective voided volumes. Nomogram charts, in centile form, for both the maximum and average urine flow rates were constructed using statistical transformations of the data. Males showed a significant decline in both urinary flow rates with age, although there was no statistically significant variation in either urine flow rate with respect to first versus repeated voiding. Females showed no statistically significant variation in either urine flow rate with respect to age, parity or first versus repeated voiding. The maximum and average urine flow rates in both sexes showed an equally strong relationship to voided volume. No artificial restriction of voided volume, e.g. minimum 200 ml, appeared appropriate. These nomograms offer reference ranges for both maximum and average urinary flow rates in both sexes covering a wide range of voided volumes (15-600 ml).
The case histories of 494 women referred to a urodynamic clinic with the symptom of stress incontinence were studied. None had undergone previous incontinence surgery. In only 12 patients was stress incontinence the sole symptom. In the remainder, symptoms suggestive of detrusor instability were present in 417, of a voiding disorder in 261 and of an inflammatory disorder in 166. The sign of stress incontinence was present in only 168 patients and was not a reliable guide to the diagnosis of genuine stress incontinence. Urodynamic studies were necessary in 488 patients in order to obtain an accurate diagnosis.
The volume of residual urine in a normal female population has not been studied and consequently no clear definition of its upper limit exists. Transvaginal ultrasound has been described as a method of identifying and measuring small bladder volumes in the range 2 to 175 ml. This allows the measurement of residual urine volumes without the need for catheterisation. Fifty-three women, who were attending for colposcopic examination agreed to take part in the study. They were deemed normal after denying specific urinary symptoms. Immediately following voiding, transvaginal sonocystography was used to measure residual urine. Forty-five women were found to empty their bladders completely (under 2 ml residual urine). The mean residual volume was 4.8 ml. The upper limit of normal for residual urine volume (taken at the 90th centile) was 10 ml.
Transvaginal ultrasound has been presented as a technique for measuring bladder volumes in women in the range 2 to 175 ml, thus overcoming the limitations of abdominal ultrasound at these smaller, though clinically important volumes. The mean error of the technique in a preliminary study using known volumes from 10 to 175 ml was 23%. The present study used the unknown bladder volumes of 41 women undergoing gynaecological surgery who required initial urethral catheterisation. The bladder volumes predicted by transvaginal ultrasound were compared with the volumes obtained when the bladder was emptied by urethral catheterisation. The mean accuracy rate was 24% and the optimum range was 50 to 200 ml. The applications of this technique to the measurement of residual urine in clinical practice include the management of women with voiding difficulties and monitoring women who are either self-catheterising or who have indwelling suprapubic catheters.
The effectiveness of different types of urinary catheters in completely draining the bladder has not been tested. Transvaginal ultrasound, which is able to measure bladder volumes in women from 2 to 175 ml, provides a means of measuring any fluid volume remaining in the bladder following catheter drainage. Using transvaginal ultrasound, the post-catheterisation bladder volumes were measured in 26 female patients; 14 underwent urethral catheterisation using either a 14F short plastic female catheter or a Foley catheter of the same size (balloon not inflated); 12 had an indwelling 12F suprapublic catheter following bladder neck surgery. The mean post-catheterisation bladder volumes after using the short plastic female and Foley catheters were less than 1 ml and 77 ml respectively. A short plastic catheter should be used in women to collect the residual urine volume by urethral catheterisation. A Foley catheter is relatively ineffective in this task. A 12F suprapubic catheter was found to drain the bladder relatively well. The mean post-catheterisation bladder volume was 35 ml. Prior to removing a suprapubic catheter post-operatively, it is recommended that the residual urine volume (measured using the suprapubic catheter) be checked by measuring the post-catheterisation bladder volume (using either a short plastic catheter or transvaginal ultrasound).
The pattern of bladder filling in response to a 1-litre fluid load was assessed in 20 women with urinary incontinence. The period between 60 and 120 min after the fluid load was identified as best for pad testing because of consistently high bladder volumes and filling rates. A 2-h pad test is recommended as achieving effective and reproducible test conditions for the quantification of urine loss.