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Biomedical subjects

G Lose

Publications and source records attributed to G Lose.

At least 73 records · Page 4Linked to original sources
PubMed1997

Vaginal pudendal nerve stimulation: a new technique for assessment of pudendal nerve terminal motor latency.

BACKGROUND: To evaluate vaginal stimulation of the pudendal nerve, a new method for investigation of pudendal nerve terminal motor latency (PNTML) and to assess the reproducibility of the method. METHODS: Thirteen healthy women and 11 female patients, median age 31 years (range 21-53 years), participated in the study. Ten patients had sustained an anal sphincter rupture and one had idiopathic anal incontinence. Pudendal nerve terminal motor latency was measured after vaginal stimulation of the pudendal nerve with motor response from the pelvic floor and rectal stimulation with motor response from the anal sphincter using the St. Marks pudendal electrode. The women were stimulated by two observers both vaginally and by the rectum. RESULTS: Vaginal PNTML for observer 1 was 2.06 msec (0.50 msec, 2 s.d.) and 2.04 msec (0.55 msec, 2 s.d.) for observer 2, while rectal PNTML was 1.99 msec (0.56 msec, 2 s.d.) and 1.97 msec (0.54 msec, 2 s.d.) respectively. The difference between vaginal and rectal PNTML was 0.065 msec for observer 1 (p = 0.106) and 0.070 msec for observer 2 (p < 0.05). Degree of agreement between vaginal and rectal PNTML was 80%-116% for observer 1 and 84%-12% for observer 2 (100% represent total agreement between measurements). Interobserver reproducibility for vaginal PNTML was 90%-109% and 86%-113% for rectal PNTML. CONCLUSION: In clinical practice vaginal PNTML may replace rectal PNTML in women. Reproducibility is in the same range as for rectal PNTML.

Adult↗
PubMed1997

Delivery and pudendal nerve function.

OBJECTIVE: To assess the impact of mode of delivery and the occurrence of pelvic instability upon the pudendal nerve function and relate the pudendal nerve function to the occurrence of anal and urinary incontinence. METHODS: One hundred and forty-six pregnant women were examined during pregnancy and 12 weeks post partum with measurement of pudendal nerve terminal motor latency (PNTML), the difference between the two measurements was defined as delta PNTML. Anal and urinary continence status, details of delivery and the occurrence of pelvic instability were recorded prospectively. RESULTS: Pudendal nerve terminal motor latency increased from 1.7 msec in primiparae and 1.8 msec in multiparae during pregnancy to 2.0 msec (p < 0.001) and 2.1 (p < 0.001) respectively after delivery. The increase was significantly higher after the use of vacuum extraction (p < 0.04). Multivariate analysis showed that delta PNTML was associated with age, the presence of pelvic instability and the use of vacuum extraction. Whereas delta PNTML was not associated with factors such as infant's head circumference and weight, parity, cesarean section, pudendal block, epidural analgesia and second stage of labor. Only four women had anal incontinence after delivery. Twenty-five women with urinary incontinence had a significantly higher mean PNTML (2.20 msec) than 121 continent women (2.01 msec). CONCLUSION: Pudendal nerve terminal motor latency increases in both primiparous and multiparous women after delivery. In 10% of the women the increase resulted in a pathologic PNTML value > 2.4 msec. The delta PNTML was significantly associated with age, the occurrence of pelvic instability and the use of vacuum extraction. The group of women with urinary incontinence had a significant increased PNTML.

Adult↗
PubMed1997

Urethral pressure measurement.

BACKGROUND: Urethral pressure measurement is a procedure used for assessment of the urethral sphincter function during storage. METHODS: The techniques available are subject to significant pitfalls, interpretation problems and test-retest variation. CONCLUSION: Urethral pressure profile (UPP) parameters are of limited value in the assessment of the urethral sphincter function. The parameters do not 1) discriminate stress incontinence from other disorders, 2) provide a measure of the severity of the condition and 3) return to normal after successful incontinence surgery. Urethral pressure profile may be useful in disclosing local pathology, in assessment of changes with intervention in the individual patient and in selecting patients with 'low pressure urethra' which may have therapeutic implications. The quality of our techniques of measurement and our concepts of interpretation need to be improved.

Female↗
PubMed1997

Uroflowmetry and pressure/flow study of voiding in women.

BACKGROUND: Uroflowmetry and pressure-flow study are procedures used for the evaluation of micturition. METHODS: Uroflowmetry is mainly a screening test to pick up abnormal voiding patterns and an abnormal trace warrants further investigation. A certain test-retest variation exists in terms of flow-rates and pattern. CONCLUSION: Uroflowmetry is not helpful in diagnosing the types of incontinence found in women and its value as a routine test in the assessment of incontinent patients remains to be documented. Pressure-flow study of voiding enables the differentiation between true obstruction and of a hypoactive detrusor function. Test-retest variation of the obtained parameters, however, is significant. The role of pressure-flow study voiding in the preoperative assessment of patients with stress incontinence needs clarification.

Female↗
PubMed1997

Preventive vaginal and intra-urethral devices in the treatment of female urinary stress incontinence.

A number of vaginal and urethral devices have recently been introduced for the treatment of female urinary stress incontinence. Nine recent studies of these were scrutinized. The median corrected subjective cured/improved rate was 63% for the vaginal and 43% for the urethral devices. The latter group have a high percentage of side-effects with related drop-outs. Urinary tract infection and migration of the device into the bladder are particularly worrying. The vaginal devices currently available compete favourably with other non-surgical forms of therapy for stress incontinence in terms of efficacy and safety.

Female↗
PubMed1996

Influence of pudendal nerve blockade on stress relaxation in the female urethra.

The urethral pressure decay following a sudden and sustained dilatation corresponds to stress relaxation. Urethral stress relaxation can be described by the equation Pt = Pequ + P alpha e-t/tau alpha + P beta e-t/tau beta, where Pt is the pressure at time t, Pequ is the equilibrium pressure after dilatation, P alpha and P beta are pressure decay, and tau alpha and tau beta are time constants. The time constants have previously proved independent of the way the dilatation is performed. The urethral stress relaxation obtained in 10 healthy women before and after pudendal nerve blockade was analysed by the mathematical model and the pressure parameters and time constants determined. The fast time constant, tau beta, was reduced by the nerve blockade, whereas tau alpha was unaffected, however, both P alpha and P beta were reduced. No single stress relaxation parameter can therefore be related to the muscle or the connective tissue components. The method may prove useful in the further evaluation of the closure function of the urethra with special reference to the pathophysiology of stress urinary incontinence.

Adult↗
PubMed1996

Assessment of lower urinary tract symptoms in women by a self-administered questionnaire: test-retest reliability.

A self-administered questionnaire assessing female lower urinary tract symptoms and their impact on quality of life is described and validated, on 56 females in six participating departments. The patients answered two identical questionnaires on separate occasions before treatment. Test-retest reliability of the questionnaire, correlation between the symptoms and their troublesomeness, and the reproducibility of this correlation were assessed. The percentage of mistakes in answers to each of the questions varied from 1.8% to 49.1%, mainly owing to missing answers in the item groups: appliances, sexual function and social activities. Test-retest showed a repeat frequency of 50.0%-91.0% for symptoms and 44.6%-82.1% for trouble. A highly significant positive correlation was found between symptoms and trouble, which was most pronounced for questions concerning pain and incontinence. This correlation was consistent within time. The primary validation of this questionnaire is good. Its relevance as a basis for medical priority and clinical decision making remains to be investigated.

Adolescent↗
PubMed1996

Pudendal nerve recovery after a non-instrumented vaginal delivery.

The aim of the study was to investigate pudendal nerve function after a non-instrumented vaginal delivery. Seventeen primiparae women who had had a non-instrumented vaginal delivery were examined 3-5 days and 3 months after delivery. At both assessments pudendal nerve terminal motor latency (PNTML) was measured. The PNTML was found to decrease significantly from 2.64 ms in the first few days after delivery to 1.95 ms 3 months after delivery (P = 0.00009). PNTML decreased in all but one of the 17 women during the observation period. Immediately after delivery 9 women (53%) had a pathological high PNTML value, which was normalized 3 months later in all but 1. It was concluded that pudendal nerve function is often impaired immediately after a non-instrumented vaginal delivery, but recovers in most women over a 3-month period.

Adult↗
PubMed1996

Anal and urinary incontinence in women with obstetric anal sphincter rupture.

OBJECTIVE: To assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence and to identify factors to predict women at risk. DESIGN: An observational study. SETTINGS: Departments of Obstetrics and Gynaecology and of Surgery D, Glostrup County University Hospital, Denmark. PARTICIPANTS: Ninety-four consecutive women who had sustained an obstetric anal sphincter rupture. INTERVENTIONS: Assessment of history, anal manometry, anal sphincter electromyography and pudendal nerve terminal motor latency at three months postpartum A questionnaire regarding anal and urinary incontinence was sent two to four years postpartum. MAIN OUTCOME MEASURES: The frequency of anal and urinary incontinence and risk factors for the development of incontinence. RESULTS: Thirty of 72 women (42%) who responded had anal incontinence two to four years postpartum; 23 (32%) had urinary incontinence and 13 (18%) had both urinary and anal incontinence. Overall, 40 of 72 women (56%) had incontinence symptoms. The occurrence of anal incontinence was associated with pudendal nerve terminal motor latencies of more than 2.0 ms, and the occurrence of urinary incontinence was associated with the degree of rupture, the use of vacuum extraction and previous presence of urinary incontinence. Seventeen women had subsequently undergone a vaginal delivery in relation to which four (24%) had aggravation of anal incontinence, and three (18%) had aggravation of urinary incontinence. Of the women with incontinence, 38% wanted treatment but only a few had sought medical advice. CONCLUSIONS: Obstetric anal sphincter rupture is associated with a risk of approximately 50% for developing either anal or urinary incontinence or both. The prediction of women at risk is difficult. Information and routine follow up of all women with obstetric anal sphincter rupture is mandatory.

Adolescent↗
PubMed1996

New disposable vaginal device (continence guard) in the treatment of female stress incontinence. Design, efficacy and short term safety.

BACKGROUND: To develop a new disposable vaginal device for use during the daytime, and test its efficacy and short-term safety in the treatment of stress incontinence. METHODS: The intravaginal support device was designed from polyurethane, a foam product with documented high tissue compatibility. It was tested in 26 women with the symptom of stress incontinence. Before and after one month's use of the device, a 24-hour home pad weighing test, uroflowmetry, postvoid residual urine and a 3-days voiding diary were made. A questionnaire about the subjective effect and adverse events was filled in. In vitro and in vivo microbiology testing were performed. RESULTS: Four women discontinued the treatment because of discomfort or difficulties in using the device. Out of 22 women who completed the study nine (41%) were subjectively cured of incontinence, ten (45%) improved while three (14%) claimed unchanged incontinence. With the device in place all had decreased leakage at the 24-hour pad weighing test and unchanged urodynamic tests. The subjective complaints were few, and no vaginal or urinary infections were found. All women whose condition both subjectively and objectively improved, (19/22) wanted to continue treatment with the device. CONCLUSIONS: The new disposable vaginal device is effective in alleviating the symptoms of stress incontinence. It is well accepted and safe.

Adult↗
PubMed1995

Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth.

AIM: To evaluate anal function after childbirth in 94 women in whom sphincter rupture occurred and in 19 control women. The findings of anorectal physiological assessment and history of childbirth were related to the presence of fecal incontinence. METHODS: Anal manometry and electromyography were performed the first days after childbirth and repeated 3 months post partum together with measurement of pudendal nerve terminal motor latency. RESULTS: Eighteen patients (19%) presented with incontinence. None of the controls developed fecal incontinence after delivery. Anal manometry showed that both incontinent and continent patients had decreased resting and squeeze pressures compared to control subjects (p < 0.005). No difference in anal electromyography was found between the three groups. Both anal manometry and electromyography showed a significant increase in pressure and activity respectively 3 months after delivery in patients and controls. Patients with pudendal nerve terminal motor latencies > 2.0 milliseconds had an increased risk of having fecal incontinence compared to patients with pudendal nerve terminal motor latencies < or = 2.0 milliseconds (odds ratio 2.18, p < 0.05). Fecal incontinence could not be related to the weight or head circumference of the infant. The manometric and electromyographic findings, the use of pudendal nerve block, the length of the second stage of labor, the depth of rupture or the use of vacuum extraction could not be related to either fecal incontinence or pudendal nerve function. CONCLUSION: The manometric findings indicated damage to the anal sphincter apparatus in both continent and incontinent patients. Decreased pudendal nerve function characterized incontinent women. Accurate prediction of fecal incontinence in women with obstetric anal sphincter rupture is not possible.

Adolescent↗
PubMed1995

The urethral resistance to rapid dilation: an analysis of the effect of autonomic receptor stimulation and blockade and of pudendal nerve blockade in healthy females.

The urethral closure function is based upon permanently as well as adjunctively acting closure forces during rest and stress episodes, respectively. During urine ingression intra- and peri-urethral structures are suddenly stretched resulting in a pressure response which strengthens the closure function by sustaining the resistance to dilatation of the urethra. A method for measurement of the resistance to rapid urethral dilatation was used to evaluate the influence of noradrenaline, prazosin, terbutaline, propranolol, carbachol, and atropine, as well as bilateral pudendal nerve blockades in 40 healthy women. The drugs caused no significant change in the urethral resistance to dilatation, whereas the pudendal blockade produced a significant (p < 0.05) reduction at the bladder neck and in the high pressure zone. Although a quantitative assessment of their contribution cannot be obtained from this study, it may be concluded that the striated muscles innervated by the pudendal nerve are of major importance for the urethral resistance to dilatation.

Adult↗
PubMed1994

[Electrostimulation of the pelvic floor muscles in urinary incontinence].

External electrical stimulation is a simple, noninvasive and inexpensive treatment modality, which is useful in the treatment of stress- and/or idiopathic urge incontinence. The mode of action arises from excitation of the pudendal nerves leading to direct and reflex contraction of pelvic floor muscles and a reflex inhibition of the detrusor. Treatment can be applied either as a weak long-term stimulation at home, as a short-term maximal stimulation in clinic, hospital or home treatment. Approximately 50%-75% of incontinent patients are either cured or improved and the adverse effects are sparse. Electrostimulation seems to be valuable in the treatment of incontinence.

Contraindications↗