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Biomedical subjects

J de Leval

Publications and source records attributed to J de Leval.

At least 73 records · Page 4Linked to original sources
PubMed1984

Enuresis and urethral instability.

31 patients with refractory enuresis underwent simultaneous urethrocystometry. Pure urethral instability was encountered in 14, urethral and bladder instability in 11 and isolated uninhibited bladder in 3. This allows us to discuss the functional relationship between the urethra and the bladder. We consider urethral instability as being a trigger mechanism for detrusor contraction, and the explanation for the paradox of stable bladder enuresis. Phenylpropanolamine (Ornade), 25-50 mg at bedtime, stabilizes the vesicosphincteric unit and stopped bedwetting in 11 of 16 patients.

Adolescent↗
PubMed1984

[Simultaneous urethrocystometry and hyperactive bladders: differential diagnosis and types of dyssynergia].

The authors reviewed the simultaneous urethrocystometry (SUCM) of 96 hyperactive bladders subclassified into 4 groups (pure detrusor instability, mixed instability, suprasacral spinal lesion, and CNS lesion) and compared the frequency of various urethral parameters. The absence of urethral relaxation before or during the augmentation of the detrusor pressure is the most specific sign of suprasacral spinal lesions. It constitutes what we call passive or tonic dyssynergia. When, in the beginning of SUCM, the maximal closure pressure is greater than or equal to 30 cm H20, or when a sphincteric contraction is associated with, either before ("kick") or during (active or clonic dyssynergia) the detrusor contraction, this urethral non relaxation is pathognomonic of such a spinal lesion. A "kick" is also specific of hyperreflexia but is less constant. On the contrary, in this series and with this technic, an active dyssynergia has no etiological significance; it' only reflects the degree of the vesicosphincteric imbalance.

Diagnosis, Differential↗
PubMed1984

[Urethral instability: diagnosis and clinical significance].

Simultaneous urethrocystometry, the advantages of which are outlined, enabled us to diagnose 27 cases of pure urethral instability (male and female) and 16 cases of mixed instability (urethral and bladder instability). We analysed the relationship between the main symptom, this urethral dysfunction and the competence of the bladder neck. Definition, characteristics and frequency of urethral instability are discussed. It is responsible of: frequency or urgency, in the absence of bladder instability, when the bladder neck is closed, intermittent sphincteric incontinence, in the presence of a normal closure pressure on the urethral pressure profile, when the bladder neck is incompetent, enuresis, particularly in case of stable bladder; a new treatment is proposed for this entity. The clinical interest of this diagnosis is stressed in these three situations.

Adolescent↗
PubMed1984

[The striated sphincter of the urethra. 1: Recall of knowledge on the striated sphincter of the urethra].

The first part of this report is devoted to the anatomy, nerve supply, and physiology of the striated sphincter, three subjects which greatly aroused a great deal of controversies. The conclusions of the authors are as follows. The striated sphincter of the urethra is a muscle of the perineum, arising from the cloacal sphincter. The deep transverse, bulbo-cavernous, anal sphincter, ischio-cavernous and superficial transverse muscles have the same embryological origin and together with the sphincter of the urethra form the accessory pelvic diaphragm. The embryological origin of the levator ani muscles is different. These arise from the caudal muscles and form the principal pelvic diaphragm. The striated sphincter of the urethra is unequally distributed in the male and female fetus. According to our anatomical concept, the urethral sphincter includes two structures: the para-urethral sphincter and the peri-urethral sphincter. The para-urethral sphincter form an integral part of the urethra and is distributed principally along the membranous part of urethra but extends approximately to the bladder neck and distally under the perineum aponeurosis. In the adult as in the fetus, the para-urethral striated sphincter is unequally distributed along the urethra, according to sex. In the male, it surrounds the membranous urethra and is absent from the posterior face of the prostatic urethra. By contrast, in the female, the sphincter surrounds the proximal third of the urethra and the rings are incomplete on the distal third. The peri-urethral striated sphincter includes the other muscles of the perineum and of the principal pelvic diaphragm. These two structures differ from a microscopic stand point; the para-urethral striated sphincter contains only narrow calibre slow fibers, with the absence of the neuro-muscular spindles. By contrast, the peri-urethral sphincter consists of slow and rapid fibers and contains neuro-muscular spindles. The nerve supply of the peri-urethral striated sphincter is insured by internal pudendal nerves. The para-urethral striated sphincter is supplied in great part of the same internal pudendal nerves arising from neurones situated in the nucleus of Onuf. However, the pelvic nerves may contain a group of accessory fibers from the same origin. There is no proof available as to the role played by the sympathetic nervous system. When micturition comes to an end, the para-urethral sphincter causes a constriction of the membranous urethra in the male, and single flattening of the middle part of the urethra in the female.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗