Search PubMed⌕ Search

Biomedical subjects

H Madersbacher

Publications and source records attributed to H Madersbacher.

At least 55 records · Page 3Linked to original sources
PubMed1990

The various types of neurogenic bladder dysfunction: an update of current therapeutic concepts.

Increased experience with treatment strategies developed during the last 10 years in the field of neurourology justifies an update of current therapeutic concepts. Based on a rather simple, but clinically useful, classification of detrusor-sphincter dysfunction the therapeutic concepts now available for four prototypes of detrusor-sphincter dysfunction are discussed. (1) For the combination of a hyperreflexive detrusor with a hyperreflexive (spastic) sphincter, characteristic for the reflex- and the uninhibited neuropathic bladder, detrusor-sphincter dyssynergia (DSD) is still the greatest problem, and transurethral sphincterotomy is the method of choice if this situation cannot otherwise be managed. One concept is to convert detrusor hyperreflexia into hyporeflexia by adequate pharmacotherapy, which is nowadays available, and to assist or to accomplish bladder emptying by clean intermittent (self-) catheterisation (CIC) with the advantage of dry intervals in between. Japanese colleagues recommend bladder overdistension during the spinal shock phase to achieve detrusor hyporeflexia, but this procedure is rather decisive at an early stage of the disability, leaving the detrusor no chance for further rehabilitation. Another possibility is rhizotomy of the sacral posterior roots to eliminate detrusor hyperreflexia, and the simultaneous implantation of a sacral anterior root stimulator (Brindley) to achieve electrically induced micturition. From our personal experience with 12 patients this concept is ideal for female patients with unbalanced reflex bladder and otherwise uncontrollable reflex incontinence. (2) The combination of a weak detrusor with a spastic sphincter is a clear indication for CIC, as the bladder is emptied regularly, and due to the spastic sphincter, the patient stays continent as long as controlled fluid intake prohibits overflow incontinence. The implantation of an anterior sacral root stimulator is an alternative approach provided that at least weak reflex detrusor contractions are present. (3) With the combination of an areflexive or hyporeflexive detrusor and a flaccid pelvic floor, passive voiding by abdominal straining or by the Credé manoeuvre is usually recommended, but should be replaced by CIC if this mechanism of bladder emptying creates unphysiological high and dangerous intravesical pressures, or if vesico-uretero-renal reflux is present. Neurogenic urinary stress incontinence is usually associated with this type of lesion and can be successfully treated by the implantation of an artificial urinary sphincter (Scott). However in two thirds of the patients with neurogenic bladder dysfunction, additional, usually operative treatment is necessary to meet the criteria for implantation. Moreover, a 30% rate of repair operations must be accepted by patients, but is becoming less frequently required with an improved design of the device.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMed1990

Extradural implantation of sacral anterior root stimulators.

A technique for extradural deafferentation of the S2 to S5 segments and extradural implantation of stimulating electrodes is described, and its application to twelve patients with spinal cord lesions is reported. Nine patients use their implants for micturition, and seven are fully continent. The advantages and disadvantages of this technique compared with the more usual intrathecal procedure are discussed.

Adult↗
PubMed1990

[Neurogenic urinary incontinence: current treatment concepts].

Neurogenic urinary tract dysfunction is characterized by inadequate voiding and urinary incontinence. The aim of therapy nowadays is adequate bladder emptying and control of urinary incontinence. Neurogenic urinary incontinence can be caused by (a) detrusor hyperreflexia, (b) sphincter hypo- or areflexia, (c) a combination of both, or also (d) detrusor hyporeflexia with consequent overlow incontinence. Based on a simple urodynamic classification the current treatment strategies are presented. (a) Detrusor hyperreflexia can be transformed into hypo- or are-flexia pharmacologically with potent drugs now available. Bladder emptying then has to be assisted or can be achieved by intermittent catheterization. If conservative therapy fails, sacral posterior root rhizotomy together with implantation of a sacral anterior root stimulator (Brindley) is an alternative, especially for women. If the anatomical situation does not allow sacral deafferentation (e.g. in patients with myelomeningocele or sacral dysplasia) bladder augmentation is the method of choice: a detubularized segment of ileum will serve as an energy destroyer for the pressure resulting from uncontrollable detrusor contractions. In contrast to detrusor hyperreflexia (b) hypo- or areflexia of the sphincter cannot be influenced pharmacologically. Method of choice for restoration of urinary continence in these patients is the implantation of a hydraulic sphincter system (Scott); in this way urinary continence is achieved without creating outflow obstruction. The alternative is conventional colposuspension with maximal elevation of the bladder neck in order to create bladder neck outflow obstruction allowing the achievement of continence. In this situation intermittent catheterization is essential for bladder emptying (and can sometimes be difficult). If (c) detrusor hyperreflexia is combined with sphincter hypo- or areflexia, urinary incontinence is due to detrusor and sphincter dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Electric Stimulation Therapy↗
PubMed1987

[Urinary incontinence--conservative therapy].

About 5% of our population suffers from urinary incontinence. Basically urinary incontinence is caused by two mechanisms: (1) loss of voluntary control of the urinary bladder due to detrusor hyperactivity or detrusorhyperreflexia, resulting in urge or reflex incontinence and (2) sphincter weakness or sphincter paralysis resulting in urinary stress incontinence. Less frequent are overflow incontinence and loss of urine due to ectopic ureter or a fistula. Therapy of urge incontinence is basically conservative: Causes for secondary detrusor hyperactivity must be eliminated. With idiopathic hyperactivity "bladder drill" with or without support of parasympathicolytic agents is the method of choice. Also in patients with less severe degrees of genuine urinary stress incontinence conservative therapy is helpful: pelvic floor exercises, performed in an accurate ("feel and move"), regular and persistent way, reduction of body weight in obese persons, regular bladder emptying and the elimination of "stress situations", e.g. chronic bronchitis due to nicotine abuses may improve the situation considerably. The treatment of neurogenic incontinence is rather complex and must be based on the underlying pathophysiology of detrusor and sphincter dysfunction, but also in these patients therapy is mainly conservative. Elderly people have double the incidence of urinary incontinence found in younger age groups. About 20% of those in old persons homes have been found to be incontinent. 80% of these elderly people suffer from urge incontinence as a result of bladder hyperactivity, in about 30% bladder hyperactivity is combined with residual urine and consequent urinary tract infection which makes bladder instability worse. Moreover physical immobility increases the problem of urgency.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1986

[Recurrent urinary incontinence: cystomanometry--conditio sine qua non?].

The value of cystometry in the diagnosis of recurrent urinary incontinence is to differentiate between urge and stress incontinence. This is possible through determination of detrusor hyperactivity characterized by uninhibited detrusor contractions. Cystometry is necessary since neither history nor clinical examination can differentiate between urge and stress incontinence. Both types of incontinence are in many patients found together and factors causing stress incontinence, for instance coughing, may also cause spontaneous, uninhibited detrusor contractions. The diagnosis of detrusor hypoactivity is also important although lack of detrusor contractions is not identical to lack of contractility. In only 50% of patients are detrusor contractions present following correction of the urinary incontinence and increase of urethral resistance. In the other half of the patients, lack of detrusor contractility remains. There is evidence that a so-called micturition-stop-test may allow a prognosis in cases of lack of bladder contractility. Cystometry is, therefore, a conditio sine qua non although it only gives information concerning the function of the detrusor. Concerning the evaluation of the bladder outlet, additional radiological and urodynamic examinations are necessary.

Electromyography↗
PubMed1985

Permeability characteristics of the rat urinary bladder in experimental cystitis and after overdistension.

The permeability characteristics of the rat urinary bladder were investigated in experimental cystitis achieved by xylene/Escherichia coli, after dimethylsulfoxide (DMSO) exposure and 3 and/or 10 days after overdistension. The changes were found to be comparable between experimental cystitis and DMSO treatment, whereas those after overdistension were specifically different in nature. Passive increases in NaCl permeability were shown to be accompanied by functional, metabolic impairment of the urothelium. It has been suggested that the concept of an almost impermeable 'blood-urine barrier' is completely misleading under these circumstances. This should be taken into account in future clinical considerations.

Animals↗
PubMed1984

Urodynamic practice in neuro-urological patients: techniques and clinical value.

During the last decade a variety of urodynamic techniques have been developed. Despite this there is a tendency to be somewhat inflexible in the application of urodynamics; as soon as the investigator becomes familiar with one method he tends to use it for all his urodynamic evaluations. A short survey gives information about the most popular urodynamic methods with their combinations, as well as their clinical value for paraplegics. The type and number of urodynamic techniques used at the Rehabilitation Centre Bad Häring during the last 6 years demonstrate that extensive facilities are desirable. This gives the flexibility to choose the proper technique, giving maximal information for the individual patient with minimal costs. The combination of cystometry with X-ray videography (the simplest form of videourodynamics), is the most frequent method used, whereas the time consuming combined pressure-flow-EMG-X-ray-video-studies are only used for special indications (approximately 10 per cent of all our urodynamic studies). In order to obtain information of clinical value sometimes a compromise is necessary in order to find the method somewhere between what we would like to measure and the disturbance caused to the patient.

Electromyography↗
PubMed1982

Rehabilitation of micturition by transurethral electrostimulation of the bladder in patients with incomplete spinal cord lesions.

The effect of direct transurethral electrostimulation of the saline-filled bladder in 29 patients with bladder dysfunction after incomplete spinal cord injury is described. Following investigation by cystourethrography and cystomanometry, treatment was started from 14 days to 8 months after injury (average 3 months after injury). The method was considered to be very helpful in the rehabilitation of micturition. Twenty-six out of 29 patients gained normal bladder sensation, 25 achieved satisfactory detrusor contractions and 29 had low residual urines. Seventeen patients developed perfect bladder control and ten more were socially dry without the need for appliances.

Adolescent↗
PubMed1982

Rehabilitation of micturition in patients with incomplete spinal cord lesions by transurethral electrostimulation of the bladder.

Since the first description of the method of transurethral electrostimulation by Katona in 1956, controversial opinions have been published. In contrast to other types of electrical bladder stimulation the physiological basis for this method of treatment is the stimulation of receptors in the bladder wall. With the help of forceful stimuli damaged neurons may be activated leading to clinical success. This report presents our results over a 4-year period using stimulation parameters other than those published to date and studying the effects objectively by using urodynamic techniques. The results obtained in 30 adults with neurogenic bladder disturbance due to incomplete traumatic cord lesions will be presented under the following headings; development or alteration of bladder sensation or of detrusor contraction, the achievement of bladder control and the efficiency of micturition as shown by the decrease of residual urine. The method is helpful in the restoration of micturition in patients with incomplete traumatic spinal cord lesions: 26 out of 30 patients gained perfect bladder sensation, 25 of them achieved satisfactory bladder contractions, 28 ended the stimulation program with a residual below 50 cm3 and 17 out of 30 gained perfect bladder control, 10 others became at least socially dry without need for pads or urinals.

Adolescent↗
PubMed1980

Hydrodynamic aspects of bladder-outlet obstruction: consequences of functional micturition disorders.

Functional disturbances of micturition lead to secondary structural changes. Both factors may change the physical properties--shape, elasticity and consistency--of the posterior urethra and of the bladder neck. In order to demonstrate their influence on urodynamics experimental studies were undertaken, elastic models, straight tubes of equal diameter throughout their length, were used. One model was a straight elastic tube of PVC material, three other models had nonelastic segments of different shape but with the same square area as the undeformed elastic parts. Perfusion was performed under equal conditions. The experiments showed firstly that nonelastic segments in an elastic system reduce the flow rate and secondly, that flow depends on cross section versus circumference, which is expressed by the so-called hydraulic diameter. Elasticity, consistency and shape of the bladder-outlet, frequently altered in patients with neurogenic bladder disease, are therefore important factors regarding loss of friction. Our results support the clinical experience, that a functional obstruction has to be eliminated before secondary structural changes occur which alter the physical properties of the bladder outlet and therefore make flow conditions even worse.

Elasticity↗
PubMed1978

[Stauffer's syndrome. Reversible hepatic dysfunction in renal cell carcinoma (author's transl)].

Stauffer's syndrome represents a paraneoplastic liver disorder associated with renal cell carcinoma and is characterized by elevation of the serum alkaline phosphatase, increased bromsulphthalein retention, hypalbuminaemia, elevation of alpha-2-globulin and hypoprothrombinaemia, as well as hepatosplenomegaly. Two cases are reported in which this syndrome was the presenting feature and operation was undertaken on the basis of suspected primary biliary tract disease. The aetiology of the typical findings of Stauffer's syndrome are discussed. As they may be the only symptoms of an otherwise occult renal cell carcinoma, their presence should guide the diagnostic efforts in the right direction. Moreover, the possibility of predicting the postoperative course by follow-up control of the liver function tests is stressed.

Adult↗
PubMed1978

[The effect of transurethral electrical stimulation on the paralyzed and incontinent bladder: objective results (author's transl)].

Using objective parameters, improvement of the detrusor function and bladder sensitivity can be obtained in most children. A significant improvement in incontinence appears possible in 30--40% of the patients. The method according to Katona is the only one which creates bladder sensitivity. This method is not a cure all but has improved our therapeutic possibilities, especially when it is combined with pharmacotherapy, long term low dose antibiotic therapy and sphincterotomy.

Anti-Bacterial Agents↗
PubMed1977

[Neurogenic urethra. Urethrogram and pathophysiological aspects].

In the analysis of neurogenic urinary voiding disturbances, too much attention has been paid to the bladder, too little to the muscular tubing of the posterior urethra and to the pelvic floor. Contrast radiography of the urethra in injection and micturition, combined with urodynamic investigations, seemed suitable for comprehension of neurogenic functional disturbances of the posterior urethra and the pelvic floor. A cross section of 143 predominantly traumatic patients and 69 patients with myelomeningocele were investigated radiologically. In addition, in a number of patients urinary flow was determined by uroflowmetry and micturition studies with simultaneous recording of intravesical and intrarectal pressure, of the EMG-activity of the pelvic floor and urinary flow were performed by a special method. The radiologic section shows that the urinary picture of various neurogenic bladder types are characterized by specific changes in form of the posterior urethra. With the help of systematic investigations of a number of cases it was demonstrated that in automatic bladder the roentgen contour of the urethra changes with duration of illness and that primarily secondary, morphologic changes--recognizable at the same time from the increasing number of radiologically demonstrable changes of the prostate and the seminal vesicles--are responsible. Simultaneously a typical deformation of the posterior urethra in passive urinary voiding is described, and attention directed to the fact that the urinary pictures of children with neurogenic impaired urethra sometimes cannot be distinguished from those with urethral values. Urinary flow measurements show that the flow rates from a cross section of patients with lesions of the upper and lower neurons are significantly lower in comparison to normals. With the help of combined urodynamic investigations it was demonstrated that a functional obstruction was present in the neurogenic bladder at the level of spastic and of paretic pelvic floors. It was proved that the roentgenologically visible deformation of the posterior urethra plays a quite decisive role in neurogenically disturbed urinary voiding. It is the main reason why, despite sufficient bladder pressure values, urinary voiding remains unsatisfactory and urinary performance low. Hence the therapeutic consequence follows: an improvement in urinary performance in neurogenic bladder is generally only possible through a decrease in the expulsion resistance. Various operative procedures for the release of bladder outlet obstruction and their uses are discussed.

Female↗
PubMed1977

Combined pressure, flow, EMG and X-ray studies for the evaluation of neurogenic bladder disturbance: technique.

A set-up for combined pressure, flow, EMG and X-ray recording is presented. Some efforts are undertaken to keep artefacts by manipulation, instrumentation and by the investigation itself as low as possible. Using a specially designed, plastic made, radiolucent micturition chair this set-up is especially suitable for the urodynamic evaluation of the lower urinary tract in paraplegics, in myelomeningoceles and other handicapped persons. More than 90 urodynamic studies have been carried out in this way during the last 2 years without any complication whatsoever.

Adult↗