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Biomedical subjects

J A Fantl

Publications and source records attributed to J A Fantl.

At least 19 recordsLinked to original sources
PubMed1992

Obesity and lower urinary tract function in women: effect of surgically induced weight loss.

OBJECTIVE: The subjective and objective effects of massive weight loss on lower urinary tract function in morbidly obese women were examined. STUDY DESIGN: Thirteen subjects underwent a comprehensive evaluation of lower urinary tract function before and 1 year after surgically induced weight loss. RESULTS: We demonstrated significant improvements in lower urinary tract function after weight loss. Of 12 subjects who complained of incontinence before surgery only three complained of incontinence (p = 0.004) and only one requested treatment after weight loss. Objective and subjective resolution of both stress and urge incontinence was documented. Statistically significant changes were seen in measures of vesical pressure, the magnitude of bladder pressure increases with coughing, bladder-to-urethra pressure transmission with cough, urethral axial mobility, number of incontinence episodes, and the need to use absorptive pads. CONCLUSION: Weight reduction is desirable for obese women complaining of urinary incontinence and may obviate the need for further incontinence therapy.

Adult↗
PubMed1991

Efficacy of bladder training in older women with urinary incontinence.

The efficacy of bladder training was evaluated in a randomized clinical trial involving 123 noninstitutionalized women 55 years and older with urinary incontinence. Subjects were urodynamically categorized as those with urethral sphincteric incompetence (N = 88) and those with detrusor instability with or without concomitant sphincteric incompetence (N = 35). Bladder training reduced the number of incontinent episodes by 57%; the effect was similar for both urodynamic diagnostic groups. The quantity of fluid loss was reduced by 54%. This was greater for patients with detrusor instability than for those without it. Diurnal and nocturnal voluntary micturitions were also reduced. The effect on nocturnal micturition, however, was not observed in subjects with unstable detrusor function. It is recommended that bladder training be considered as an initial step in treatment of women with urinary incontinence. Provided prior comprehensive clinical evaluation is done, it can be prescribed without the need for urodynamic characterization.

Aged↗
PubMed1991

Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction.

Forty-seven women had urethral pressure profile determinations performed at rest and during a Kegel pelvic muscle contraction, after brief standardized verbal instruction. Twenty-three (49%) had an ideal Kegel effort--a significant increase in the force of urethral closure without an appreciable Valsalva effort. Twelve subjects (25%) displayed a Kegel technique that could potentially promote incontinence. Age, parity, weight, estrogen deprivation, prior continence surgery or hysterectomy, and passive urethral function did not predict a successful effort. We concluded that simple verbal or written instruction does not represent adequate preparation for a patient who is about to start a Kegel exercise program.

Adult↗
PubMed1991

Bladder training in older women with urinary incontinence: relationship between outcome and changes in urodynamic observations.

The purpose of this study was to clarify the mechanism by which bladder training affects urinary incontinence. Urodynamic data and specific urodynamic diagnoses of 108 women with urinary incontinence were compared before and 6 months after treatment with bladder training. Before treatment, 76 women had sphincteric incompetence, 11 had detrusor instability, and 16 had both. After treatment, 33 women no longer fulfilled the urodynamic diagnostic criteria for either sphincter or detrusor dysfunction. Controlling for severity before treatment, the number of incontinent episodes post-treatment was not associated with change in urodynamic diagnosis. Only the first sensation to void, voided volume, compliance, functional urethral length, and flow time showed any significant changes between pre- and post-treatment evaluations; however, none were correlated with change in the number of incontinent episodes. Bladder training does not appear to affect lower tract urodynamic variables or specific urodynamic diagnosis, and it is likely that its mechanism of action reflects adaptive behavioral changes. Physiologic changes not detected with techniques and/or criteria used in this study may still occur.

Aged↗
PubMed1991

Bladder training in ambulatory care management of urinary incontinence.

Bladder training is an effective method of managing stress, urge, and mixed urinary incontinence in the outpatient setting that is relatively free of patient risks and burden. Provided a comprehensive clinical assessment is performed to rule our other contributing pathology, urodynamic evaluation does not seem a prerequisite to selection of this treatment approach. Bladder training is easy to implement in the clinical setting, does not require special equipment, and offers the opportunity for cure or significant improvement to many incontinent individuals. We are continuing in our research efforts to document the effectiveness of behavioral therapy in the management of urinary incontinence in noninstitutionalized populations. Our goal is to develop improved behavioral techniques with better targeting of patients who will be most likely to achieve the greatest benefit from them.

Algorithms↗
PubMed1990

Urinary incontinence in community-dwelling women: clinical, urodynamic, and severity characteristics.

Descriptive data on 145 community-dwelling older women with urinary incontinence are presented. Assessment included history, physical and functional examinations, and urodynamic and severity evaluations. Patients were 67 +/- 8 years old, mentally and functionally intact, predominantly white, and of middle-to-upper socioeconomic strata. Specific urodynamic criteria were used to establish the diagnosis of sphincteric incompetence and detrusor instability. Fifteen (10%) did not fulfill either criteria, 90 (62%) had sphincteric incompetence, 17 (12%) had detrusor instability, and 23 (16%) had both. Detrusor and urethral function variables showed some impairment in all patients. Impairment was least in subjects without demonstrable diagnosis and worst in those with both disorders (p less than 0.01). The findings suggest that detrusor and urethral functions are impaired in all incontinent women and that the degree of impairment varies. The impairment seems worse when both urodynamic diagnoses are demonstrable. The data support the pathophysiologic association of urethral and detrusor dysfunctions.

Aged↗
PubMed1989

Genuine stress incontinence: pathophysiology and rationale for its medical management.

Genuine stress incontinence is a condition in which increments of intra-abdominal pressure produce involuntary urine loss. The condition occurs as a result of urethral sphincteric failure in the absence of involuntary detrusor contractility. Several aspects of this dysfunction are amenable to nonsurgical treatment. These interventions are worth trying prior to proceeding for surgery.

Behavior Therapy↗
PubMed1988

Dynamic urethral pressure/profilometry pressure transmission ratio determinations in stress-incontinent and stress-continent subjects.

Bladder-to-urethra pressure transmission ratios were calculated in each quarter (designated Q1 through Q4) of the dynamic urethral pressure profile in 110 subjects. Thirty-seven subjects had genuine stress urinary incontinence, whereas 73 were stress continent. Subjects with genuine stress incontinence had significantly lower mean (+/- SD) pressure transmission ratios in all four urethral quarters compared with stress-continent subjects: 71% +/- 14% versus 94% +/- 38% for Q1 (p = 0.004), 69% +/- 16% versus 101% +/- 42% for Q2 (p = 0.00001), 79% +/- 19% versus 113% +/- 46% for Q3 (p = 0.0001), and 90% +/- 22% versus 117% +/- 36% for Q4 (p = 0.001). A pressure transmission ratio value less than 90% in the proximal half of the dynamic profile had a sensitivity of 97%, a specificity of 56%, an abnormal predictive value of 53%, and a normal predictive value of 97%. Calculation of pressure transmission ratios, as opposed to declaring the stress profile positive or negative based on whole urethra/bladder pressure equalization with stress, enhances the utility of the dynamic urethral pressure profile and allows quantification of one of the several variable in the equation of stress urinary incontinence.

Adult↗
PubMed1988

Dynamic urethral pressure profilometry pressure transmission ratio determinations after continence surgery: understanding the mechanism of success, failure, and complications.

Twenty-two women who had previously undergone continence surgery for the correction of stress urinary incontinence were evaluated with dynamic urethral pressure profilometry and had bladder-to-urethra pressure transmission ratios calculated. Eight of the subjects had recurrent or persistent genuine stress incontinence (group 1), seven had detrusor instability (group 2), and seven had normal continence and detrusor function (group 3). In addition, we evaluated ten subjects with detrusor instability but no previous surgery (group 4). There were clear and significant differences in pressure transmission ratios between the four groups. These differences suggest that subjects in group 1 have the same basic mechanisms of incontinence (ie, inefficient pressure transmission to the urethra as reflected by pressure transmission ratios less than 90%) as do never-operated women with genuine stress incontinence. Subjects in group 2 had pressure transmission ratios that were significantly higher than those in either group 3 or 4. This supports the hypothesis that obstruction may play a role in post-continence surgery detrusor instability, but not in idiopathic detrusor instability. Group 2 subjects had pressure transmission ratios very close to the ideal of 100%. We postulate that continence procedures that consistently result in pressure transmission ratios close to 100% should have the greatest chance for success without inducing complications.

Adult↗
PubMed1988

Lichen planus of the vulva.

Lichen planus is an uncommon cutaneous disease that can affect the vulva. Vulvar pruritus and pain are common symptoms in patients with genital involvement. Examination reveals an erythematous, friable vestibule with adherent exudate. Marked resorption of the labia minor and atrophy may occur in time. Diagnosis is based on associated clinical findings involving the oral mucosa and/or the skin and on vulvar biopsy.

Atrophy↗
PubMed1988

The urinary diary in evaluation of incontinent women: a test-retest analysis.

This study investigated the use of a one-week urinary diary in the evaluation of incontinent women. The sample consisted of 50 community-dwelling women, ages 55 years and older, ambulatory, and mentally intact, who were volunteers in a clinical trial on behavioral management for urinary incontinence. All subjects kept a urinary diary for two consecutive weeks. An analysis of the immediate (one-week) test-retest variability and correlations on weekly diurnal micturition frequency, nocturnal micturition frequency, and urinary incontinent episodes were performed in subjects with sphincteric incompetence alone (N = 34) and in those with detrusor instability with or without concomitant sphincteric incompetence (N = 16). In addition, information obtained on history was compared with that obtained from the diary. Diurnal micturition frequency, nocturnal micturition frequency, and number of incontinent episodes were highly reproducible and did not differ by urodynamic diagnosis. Test-retest correlations were highest with diurnal micturition frequency and incontinent episodes. Lower correlations were observed with nocturnal micturition frequency, with a significant difference observed between diagnostic groups. Although modest, significant relationships between data collected by history and diary were observed in the overall sample, but there were significant differences between diagnostic groups. The results indicate that a one-week diary is a reliable method for assessing the frequency of voluntary micturitions and involuntary episodes of urine loss.

Aged↗
PubMed1988

Postmenopausal urinary incontinence: comparison between non-estrogen-supplemented and estrogen-supplemented women.

Clinical and urodynamic variables of 49 non-estrogen-supplemented and 23 estrogen-supplemented postmenopausal women with urinary incontinence were compared. We ascertained their estrogenic status via plasma estradiol and estrone levels, as well as from parabasal and superficial cell counts from both the urethra and vagina. The effect of estrogen supplementation, in conjunction with the effect of age and urodynamic diagnosis, was studied in relation to filling-phase urodynamic data and incontinence severity and outcome variables. Analysis of covariance was used. No direct effect of estrogen supplementation was noted on parameters of urethral function. In patients with detrusor instability, a borderline direct positive effect (P = .06) was noted in the volume needed to reach maximal cystometric capacity from the first sensation to void. For these patients, the magnitude of fluid loss was greater without estrogen supplementation. However, this difference did not reach statistical significance. Nocturia was significantly less frequent in the estrogen-supplemented groups (P = .04). Estrogen-supplemented patients had a higher incidence of positive bulbocavernosus reflex (P = .01). These observations suggest that hypoestrogenism may affect the sensory threshold of the lower urinary tract of incontinent postmenopausal women.

Administration, Oral↗
PubMed1988

The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies.

Eleven continent women with severe degrees of uterovaginal prolapse underwent a complete urodynamic evaluation that included passive and dynamic urethral pressure profilometry with and without careful barrier reduction of their prolapse. The aim of barrier placement was to reduce, but not overcorrect, the prolapse and to restrict stress-induced mobility of the viscera posterior and superior to the urethra. Each of the women had very high pressure transmission ratios in each quarter of the urethra (means of 257, 187, 170, and 166% from internal to external quarters) that were significantly reduced with barrier placement (means of 78, 84, 85, and 101%). Eight of 11 subjects had pressure transmission ratios less than 90% in the proximal three-quarters of the urethra with the barrier in place, a finding in nearly all subjects with genuine stress urinary incontinence. Maximum urethral closure pressure on passive urethral pressure profilometry also decreased significantly from a mean of 75 to 45 cm H2O with the barrier in place. We conclude that the stress continence mechanism in women with severe prolapse results from posterior-superior visceral descent with stress, causing mechanical obstruction of the less mobile urethra. The evaluation methods described may be useful in predicting which of these patients may require concurrent urethropexy at the time of prolapse reduction surgery to prevent postoperative stress urinary incontinence.

Adult↗
PubMed1987

Psychosocial impact of urinary incontinence in women.

This study explored the psychosocial impact of urinary incontinence and investigated its relationship to urodynamic diagnosis and degree of involuntary urine loss. The sample comprised 69 community-dwelling women, ages 55 years and older, who were ambulatory and mentally intact, and who had volunteered in a clinical trial on incontinence. Psychosocial impact was measured by an investigator-designed instrument, the Incontinence Impact Questionnaire. Urodynamic evaluation included detrusor and urethral sphincteric function tests. Subjects were grouped into two urodynamic diagnostic categories: sphincteric incompetence (N = 47) and detrusor instability with or without concomitant sphincteric incompetence (N = 22). Severity of incontinence was determined by a one-week urinary diary and a fluid loss quantitation test. Each of the items on the Incontinence Impact Questionnaire was affected by urinary incontinence, although to varying degrees. Activities involving unfamiliar places where the availability of restrooms was unknown were most affected. Subjects with detrusor instability with or without concomitant sphincteric incompetence reported significantly higher impact than subjects with sphincteric incompetence alone. There were modest correlations between psychosocial impact scores and both the number of weekly incontinent episodes and the quantitation of fluid loss. The results in this study population indicate that the relationships between the perceived impact of incontinence and objective measures of its severity are complex and not directly proportionate.

Aged↗
PubMed1987

Fluid loss quantitation test in women with urinary incontinence: a test-retest analysis.

A modified perineal pad-weighing method for objective quantitation of fluid loss is presented. The bladder was filled by retrograde flow, a sequence of provocative maneuvers was performed under direct supervision, and fluid loss was determined by pad weights. An analysis of immediate test-retest correlation and variability was done in patients with either sphincteric incompetence alone (N = 46) or detrusor instability with or without concomitant sphincteric incompetence (N = 21). Test-retest correlations were high in both groups, suggesting that the method could be applied as an index of severity of urinary incontinence in women. Test-retest within-patient variability was considerable, and limits its usefulness in the analysis of treatment outcome.

Adult↗
PubMed1986

Urethral axis and sphincteric function.

Position and mobility of the urethral axis are considered factors influencing urethral competence. Specific correlation between the urethral axis and its sphincteric function is lacking. Eighty-four patients with the symptom of stress urinary incontinence and 31 patients with sensory symptomatology but not urinary incontinence underwent clinical and urodynamic evaluation. This included objective assessment of urethral axial positions and mobility with use of a specially designed protractor. Comparative analysis of urethral axial data was done between 70 incontinent women with objective evidence of sphincteric incompetence and 24 continent women without it. The urethral axis at rest, during bearing down, and in its total excursion were found to be not significantly different and distributed similarly between both groups. Assessment of the urethral axis was found to be not predictive of urethral function.

Cough↗