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Biomedical subjects

E Versi

Publications and source records attributed to E Versi.

At least 37 records · Page 2Linked to original sources
PubMed1991

Physiotherapy for stress urinary incontinence: a national survey.

OBJECTIVE: To study the physiotherapeutic treatment of urinary stress incontinence in England. DESIGN: Postal questionnaire survey. SETTING: All 192 English district health authorities. SUBJECTS: One physiotherapist from each district who was primarily concerned with urinary incontinence. A consensus view was requested. MAIN OUTCOME MEASURES: Responses to questionnaire and analysis of a visual analogue scale to indicate effectiveness. RESULTS: There was a 98% response rate. Treatment was often by senior physiotherapists (108 senior I grade or above) who, in 117 districts, claimed to have made a specialty of treating the condition. Gynaecologists and obstetricians were far more likely to refer patients than any other agency (147 respondents said that they were the commonest source of referral). One hundred and fifty four respondents stated that physiotherapy was usually used as the first line of treatment. Pelvic floor exercises and interferential treatment were most commonly used (by 178 and 144 respondents respectively) and thought to be the most effective, especially in combination, though various techniques were used in applying them. Positive motivation (108), recent onset of symptoms (55), and youth (40) were viewed optimistically, and obesity (60), previous surgery (59), prolapse (42), and a chronic cough (36) were considered to be bad prognostic features. The number of patients treated varied greatly (range 10-360) between districts and was poorly correlated with catchment size (correlation coefficient 0.3). CONCLUSIONS: As physiotherapists are treating considerable numbers of patients with stress incontinence research is urgently needed to produce efficacy data to enable rationalisation of resources to cater for the whole population.

Exercise Therapy↗
PubMed1991

The significance of an open bladder neck in women.

The significance of an open bladder neck at rest has been investigated in 147 women presenting to a urodynamic clinic. The prevalence of this condition was 21%; there was an association with urethral sphincter incompetence but an open bladder neck was not diagnostic of it. It is suggested that the finding of an open bladder neck at rest during urodynamic investigation is of little consequence.

Female↗
PubMed1991

Urethral pressures: analysis of transmission pressure ratios.

Transmission pressure ratio (TPR) analysis of urethral pressure profilometry data has been advocated for the diagnosis of genuine stress incontinence (GSI). However, the clinical usefulness of the technique has not been adequately evaluated. Using videourodynamics as the gold standard, the TPR results of 150 continent women and 153 with GSI have been compared. The mean TPR for each quartile of the functional urethral length was computed, as was the maximum TPR value (TPR-max) and the position on the urethra where it occurred (TPR-mode). There was a statistically significant difference between the 2 groups for TPR values in the distal 2 quartiles of the urethra and for TPR-max and TPR-mode. With the use of the Kappa statistic it was found that the TPR-mode was the most discriminatory of the TPR parameters. Even using this measure, the overlap between normal and GSI was so great as to make accurate diagnosis impossible. It was therefore concluded that TPR analysis is useless for the diagnosis of GSI. However, such an analysis is helpful for the understanding of the pathophysiology of GSI and its treatment.

Cough↗
PubMed1991

Symptoms analysis for the diagnosis of genuine stress incontinence.

OBJECTIVE: To determine the accuracy of an analysis of symptoms alone for the diagnosis of genuine stress incontinence. DESIGN: A comparison of results of symptoms analysis with urodynamic findings. SETTING: A gynaecological video-urodynamic unit. SUBJECTS: 252 consecutive patients referred for urodynamic investigations. INTERVENTIONS: A questionnaire of 20 symptoms of lower urinary tract dysfunction, midstream specimen of urine, pad testing, uroflowmetry, and video-cystourethrography. MAIN OUTCOME MEASURES: Using the urodynamic diagnosis as the 'gold standard', the accuracy of discriminant function analysis of symptoms was determined. RESULTS: Symptoms analysis achieved a correct classification of 81% with a false positive rate of 16%. Use of an accumulative probability curve defines patients who fall into the equivocal range. CONCLUSIONS: All women presenting with incontinence should undergo preoperative urodynamic studies.

Female↗
PubMed1990

Discriminant analysis of urethral pressure profilometry data for the diagnosis of genuine stress incontinence.

Urethral pressure profilometry (UPP) has been advocated for the diagnosis of genuine stress incontinence (GSI) but no published data exist to define clearly the criteria of measurement that should be used. The aim of this study was to examine the value of UPP in the diagnosis of GSI. Data from 102 urodynamically normal women and 70 women with GSI were compared. Thirty UPP variables from the resting and stress profiles were examined. The urodynamic diagnosis was made on the basis of a pad test, uroflowmetry and videocystourethrography. Each UPP variable was examined singly and thereafter all the measurements were examined by discriminate analysis. The single most discriminatory UPP variable was 'area under the stress profile' but the overlap between normal and GSI patients was too great to allow the test to be used diagnostically. Discriminate analysis resulted in correct classification in 78% of cases. On the basis of these results, UPP is not an accurate test for the diagnosis of GSI.

Discriminant Analysis↗
PubMed1990

The treatment of detrusor instability in post-menopausal women with oxybutynin chloride: a double blind placebo controlled study.

Idiopathic detrusor instability is a common cause of incontinence in the elderly for which anticholinergic agents are regularly prescribed. Oxybutynin chloride combines anticholinergic action with direct muscle relaxant properties. We performed a double blind placebo controlled fixed dose cross over study of oxybutynin chloride in post-menopausal women suffering from detrusor instability. We found oxybutynin chloride significantly more effective than placebo at reducing the symptoms of urgency and urge incontinence and more effective at reducing the height of the highest unstable detrusor contraction. This was at the expense of an increased residual urine and considerable side effects.

Aged↗
PubMed1988

The prevalence of variation of resting urethral pressure in women and its association with lower urinary tract function.

Variation of resting urethral pressure has been reported and it has been postulated that this is important in the genesis of lower urinary tract symptomatology in women. In order to differentiate between normal and abnormal urethral pressure variations several arbitrary values have been chosen and the prevalence of abnormality in symptomatic women reported. However, large variations in urethral pressure may be seen in healthy, asymptomatic volunteers. We have identified the prevalence of urethral pressure variation in a large group of female volunteers and have shown that "abnormal" urethral pressure variation is not associated with lower urinary tract symptomatology.

Female↗
PubMed1988

The effect of vaginal delivery on the urethral sphincter.

To investigate the aetiological role of vaginal delivery in genuine stress incontinence we compared two groups of women who underwent full urodynamic assessment in our department. The women in the first group had competent urethral sphincter mechanisms and those in the second group had genuine stress incontinence. There were no differences between the two groups in respect of parity, number of vaginal deliveries or birthweight of the heaviest baby. The group with competent urethral sphincter mechanisms did show some evidence to implicate an increased number of vaginal deliveries in poor function of the distal part of the urethral sphincter mechanism.

Birth Weight↗
PubMed1988

Correlation of urethral physiology and skin collagen in postmenopausal women.

Connective tissue collagen is thought to contribute to the generation of urethral pressure. It has been previously shown that skin collagen and urethral pressure are oestrogen dependent. This study demonstrates a correlation between urethral pressure measurements and skin collagen content. It is suggested that the beneficial effect of oestrogens on urethral function may be mediated by collagen.

Collagen↗
PubMed1987

Effect of oestrogen and testosterone implants on psychological disorders in the climacteric.

In a double-blind trial oestradiol, oestradiol/testosterone, or placebo implants were assessed for their effects on psychological symptoms in women attending a menopause clinic. After two months, women receiving active treatment scored better than the placebo group on a self-rating scale of distress, on anxiety, and on depression (p less than 0.05). Postmenopausal but not perimenopausal women improved after placebo, and at 4 months the scores in the three groups no longer differed significantly.

Adult↗
PubMed1987

Skin collagen changes in post-menopausal women receiving oestradiol gel.

Sixteen post-menopausal women who had never previously received any hormonal treatment applied Oestrogel cream 1.5 mg/day percutaneously for 1 yr. Skin biopsies were taken from the abdomen and from the lateral aspect of the thigh at 0, 3, 6 and 12 mth, and the changes in skin collagen content were noted. The abdominal skin collagen content increased significantly (P less than 0.001) over the 1-yr treatment period. The thigh skin collagen content also increased, but did not reach significant levels. There was a strong correlation between the change in skin collagen content (in both the abdomen and the thigh) and the original skin collagen content, indicating that the change in collagen content in response to oestrogen therapy is dependent on the original level. There is no further increase once an 'optimum' skin collagen level has been reached.

Administration, Topical↗
PubMed1987

Decline in skin collagen content and metacarpal index after the menopause and its prevention with sex hormone replacement.

The thigh skin collagen content and the metacarpal index were measured in 69 untreated postmenopausal women and in 37 postmenopausal women who had been receiving oestradiol and testosterone implants for 2-10 years. There was a significant positive correlation between the skin collagen content and the metacarpal index in both groups of patients. In the untreated group, there was a statistically significant decrease both in the thigh skin collagen content and in the metacarpal index with the years since the menopause. This decrease was preventable in women who were on sex hormone replacement therapy.

Collagen↗
PubMed1987

Skin collagen changes in postmenopausal women receiving different regimens of estrogen therapy.

Collagen is a widespread body constituent that is affected by estrogen status in women. Its decrease after menopause can be prevented and/or restored by estrogen treatment. We explored the effect of four different hormonal replacement regimens on total skin collagen content by measuring hydroxyproline in skin biopsy specimens taken from postmenopausal women. All regimens showed increases in skin collagen levels proportionate to the levels at the start of the treatment. Estrogen replacement therapy is shown to be prophylactic in women who have higher skin collagen levels and both prophylactic and therapeutic in women with lower skin collagen levels.

Administration, Cutaneous↗