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Biomedical subjects

L D Cardozo

Publications and source records attributed to L D Cardozo.

At least 19 recordsLinked to original sources
PubMed2000

Biofeedback in overactive bladder.

Biofeedback is a form of learning or re-education in which the participant is retrained within a closed feedback loop. Information about one or more of the patient's normally unconscious physiologic processes is made available to the patient as a visual, auditory, or tactile signal. Objective responses are recorded on a polygraph trace so that they can be easily observed. Subjective responses are more difficult to monitor and it is often difficult to separate these effects of biofeedback from the placebo effect. Biofeedback has been successfully employed in cases of urinary incontinence due to detrusor instability. Indeed, a recent report has shown that biofeedback-assisted behavioral treatment is more effective than either oxybutynin or placebo in the treatment of urge and mixed urinary incontinence in older, community-dwelling women. Patients embarking on biofeedback need to be well motivated and intelligent enough to understand what is expected of them. The treatment is time consuming for both the patient and the operator, but the benefits of successful treatment include a reduction in morbidity and side effects associated with other therapies. Biofeedback can be employed as an adjunct to other forms of treatment, such as drug therapy, and is particularly useful in children.

Biofeedback, Psychology↗
PubMed1998

Reducing artefacts in ambulatory urodynamics.

OBJECTIVE: To compare the diagnoses derived from a retrospective analysis of 50 ambulatory urodynamic recordings, unaware of the final diagnosis, and to evaluate the importance of the symptom diary and the presence of two transducers in the bladder rather than one. PATIENTS AND METHODS: Fifty women underwent ambulatory urodynamics (duration 4 h) after video cysto-urethrography. A single solid-state microtip pressure catheter was inserted with both transducers inside the bladder, and another was inserted in the rectum. The women were asked to complete a symptom diary and the results were analysed with the active participation of the patient. Detrusor 'instability' was diagnosed on ambulatory urodynamics if there was a simultaneous increase in detrusor pressure and in the 'urethral' line in the presence of symptoms (urgency or leakage). All 50 recordings were analysed retrospectively in four combinations, i.e. with and without the additional 'urethral' line displayed on the screen and with and without the diary information. The total number of detrusor contractions was then calculated for each reading and 'abnormal detrusor activity' diagnosed when a contraction occurred with or without symptoms as recorded in the diary. The final diagnosis for each reading was then compared with that made at the time of the test with the patient present. RESULTS: Using the information from the diary reduced the number of pressure rises classified as 'abnormal detrusor activity' by 58%; using a second bladder pressure transducer further reduced the number of pressure rises classified as 'abnormal' by 19%. Overall, using both techniques together reduced the number of spurious pressure rises misclassified as 'abnormal detrusor activity' by 64%. CONCLUSIONS: Both the symptom diary and the placement of two transducers in the bladder can decrease, by almost two-thirds, the diagnosis of pathological detrusor activity on ambulatory urodynamics.

Ambulatory Care↗
PubMed1997

Urogenital ageing and its effect on sexual health in older British women.

OBJECTIVE: To provide information on the extent of problems of urogenital ageing in older British women. DESIGN: A MORI survey of a representative population sample of older British women. SETTING: Home interviews. PARTICIPANTS: Two thousand and forty-five women aged 55-85+. RESULTS: Urogenital symptoms had affected 48.8% of the women at some time, but no more than 11% were currently affected by individual symptoms; however, these were often of long duration. The majority (73%) were not sexually active, with lack of a partner being a factor for many. There was also a decreasing prevalence of sexual activity with increasing age. Those sexually active in the 65-74 year old age group (n = 148) tended to have a similar sexual frequency (at least once per month) compared with the younger women studied. Approximately 12% of those who reported dyspareunia and/or vaginal dryness claimed a severe problem; 33% did not seek professional advice and 36% resorted to an over the counter remedy. Use of hormone replacement therapy was generally of relatively short duration. There was a declining gradient of ever-use with age. CONCLUSIONS: The extent of significant urogenital symptoms is relatively low, but some women are seriously affected and use self-help as well as professional assistance. The extent of sexual activity in older women and factors affecting this have been defined, and the effect of urogenital symptoms on sexual activity demonstrated.

Aged↗
PubMed1997

GAX collagen in the treatment of urinary incontinence in elderly women: a two year follow up.

OBJECTIVE: To determine the efficacy of GAX collagen in the treatment of elderly women with genuine stress incontinence. DESIGN: A single centre prospective study. SETTING: A London teaching hospital. PARTICIPANTS: Thirty-four women older than 60 years of age with genuine stress incontinence diagnosed on videocystourethrography. INTERVENTIONS: Up to three paraurethral injections of GAX collagen. MAIN OUTCOME MEASURES: Subjective and pad test assessments performed pre-operatively, after one month, one year and two years after the first injection of collagen. Videocystourethrography and urethral pressure profilometry were carried out pre-operatively, after three months and one year. RESULTS: There was a reduction in urinary leakage as measured on pad testing. After two years 77% of the surviving 26 women were symptomatically cured. Objectively after two years 48% of the women were cured and 9% were improved over their initial pre-treatment level of incontinence. The cure rate was the same whether or not the women had undergone previous vaginal surgery. The maximum urethral closure pressure was not increased with treatment indicating that collagen injections do not act by producing obstruction, but this should be interpreted with caution due to the small sample size. CONCLUSION: GAX collagen is an effective method of treating urinary incontinence in the elderly and especially women who have undergone previous continence procedures. The technique is easy to perform and particularly suitable in those who are frail, but if failure occurs after two years consideration needs to be given to its cost effectiveness.

Aged↗
PubMed1997

A new questionnaire to assess the quality of life of urinary incontinent women.

OBJECTIVES: To design and validate a condition-specific quality of life questionnaire for the assessment of women with urinary incontinence, and to use the questionnaire to assess the quality of life of women with specific urodynamic diagnoses. SETTING: A tertiary referral urogynaecology unit at King's College Hospital, London. DESIGN: The questionnaire was designed following six different pilot studies; in this study it was tested for validity and reliability using standard psychometric techniques. The questionnaire was used in 293 consecutive women referred for investigation of urinary incontinence. RESULTS: The questionnaire was shown to be reliable both by test-retest analysis and by measurement of its internal consistency. The construct of the questionnaire and the answers by respondents confirmed its face and content validity. Criterion validity was measured by correlation with scores obtained on a validated generic measure of quality of life, the Short Form 36. Women with detrusor instability had greater quality of life impairment than women with other urodynamic diagnoses. CONCLUSION: The questionnaire was easy for the women to use and was a valid and reliable instrument for the assessment of quality of life in women with urinary incontinence. It will be useful for the rapid appraisal and follow up of women with urinary incontinence in many different clinical settings, including the evaluation of new treatments of urinary incontinence in controlled clinical trials.

Adult↗
PubMed1997

A medium-term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compliance.

OBJECTIVE: The aims of this study were to determine the medium-term subjective outcome of treatment for women with a urodynamic diagnosis of detrusor instability and low bladder compliance. SETTING: A tertiary referral urogynaecology clinic. PARTICIPANTS AND METHODS: One thousand one hundred and five women referred for the investigation of their urinary symptoms were entered into a prospective, long term, quality of life study. Of these, 348 had a videourodynamic diagnosis of detrusor instability or low bladder compliance and form the basis of this paper. Women were contacted by post at least six months following their urodynamic assessment and asked to complete a questionnaire detailing their treatment, its efficacy and side effects, and any residual urinary symptoms. RESULTS: Two hundred and fifty-six women (73.6%) responded to follow up; only 5.5% were cured of their urinary symptoms. The majority (90.2%) had received anticholinergic medication, although only 18.2% continued with this treatment in excess of six months. Many women had residual urinary symptoms following their investigation and treatment. CONCLUSION: The medium term efficacy of the treatment of detrusor instability and low compliance is disappointing, and a large part of this failure may be attributable to poor treatment efficacy, side effects of medication, or inadequate follow up following the diagnosis and instigation of therapy.

Adult↗
PubMed1996

Ultrasound: a noninvasive screening test for detrusor instability.

OBJECTIVE: To determine whether transvaginal ultrasound measurement of bladder wall thickness can be used as a screening test for detrusor instability in women with urinary symptoms. DESIGN: A blinded prospective study. SETTING: A London teaching hospital. PARTICIPANTS: One hundred and eight-four symptomatic women presenting to a urodynamic clinic. MAIN OUTCOME MEASURE: The detection of detrusor instability by means of videocystourethrography (VCU) and ambulatory urodynamics in women with a mean bladder wall thickness of greater than 5 mm measured by transvaginal ultrasound. RESULTS: One hundred and eight women had a mean bladder wall thickness of greater than 5 mm. Ninety-four percent (102) of these women had detrusor instability either when undergoing VCU or ambulatory urodynamics. Seventeen women had a bladder wall thickness of less than 3.5 mm of whom three were found to have detrusor instability on VCU. CONCLUSION: The measurement of a mean bladder wall thickness greater than 5 mm with transvaginal ultrasound is a sensitive screening method for diagnosing detrusor instability in symptomatic women without outflow obstruction.

Adult↗
PubMed1995

Sex hormones, the menopause and urinary problems.

To date, there have been few appropriate placebo-controlled studies using both subjective and objective parameters to assess the efficacy of estrogen therapy for the treatment of urinary incontinence. Further confusion arises from the heterogeneity of different study protocols. Consequently, the best treatment in terms of type and dose of estrogen and route of administration is unknown. From these studies, however, there is clear evidence to suggest that recurrent urinary tract infection can be prevented or even treated by the use of estrogen therapy. Furthermore, systemic estrogen replacement appears to alleviate the symptoms of urgency, urge incontinence, frequency, nocturia and dysuria, and low-dose topical estrogen is effective in the management of atrophic vaginitis. Although the latter example appears to be free from side-effects, even following prolonged administration, it is unclear whether low-dose therapy has a sufficient effect on the lower urinary tract to treat urinary incontinence. There is no conclusive evidence that estrogen replacement alone is sufficient to cure stress incontinence, but in combination with an alpha-adrenergic agonist there may be a role for estrogen therapy in the conservative management of genuine stress incontinence. On the other hand, estrogen supplementation definitely improves the quality of life of many postmenopausal women and, therefore, makes them better able to cope with other disabilities. Perhaps the role of estrogen in the management of postmenopausal urinary disorders is as an adjunct to other methods of treatment such as surgery, physiotherapy and drugs. This is certainly a hypothesis which should be tested.

Aged↗
PubMed1995

Quality of life and urinary incontinence.

Urinary incontinence affects some aspect of the lives of between 15 and 30% of women. The impact of incontinence, however, varies owing to many factors such as age and cultural beliefs. Quality of life assessments now offer both general and specific questionnaires that measure the impact of this debilitating condition. Although currently an important research tool, these assessments may ultimately become routine in clinical practice.

Female↗
PubMed1993

Prevalence and significance of urethral instability in women with detrusor instability.

The phenomenon of urethral instability has been poorly defined and its significance is disputed. The aim of this study was to investigate the prevalence and significance of urethral instability in a group of women with idiopathic detrusor instability. Urethral instability was defined as a spontaneous fall in maximum urethral pressure of one-third or more, in the absence of detrusor activity, over a 2-min period. Urethral instability occurred in 42% of patients with detrusor instability and was strongly associated with the sequence of relaxation of the urethra prior to unprovoked detrusor contraction. Women with detrusor instability and a stable urethra exhibited primary contraction of the detrusor. The symptom of stress incontinence was more common in women with urethral instability. Women with detrusor instability may be subdivided into 2 groups on the basis of urethral instability, the presence of which suggests a primary dysfunction of the urethra. Such patients may derive more benefit from treatment with an alpha adrenoceptor agonist in addition to (or instead of) standard anticholinergic therapy.

Female↗
PubMed1993

Denervation and re-innervation of the urethral sphincter in the aetiology of genuine stress incontinence: an electromyographic study.

OBJECTIVE: To investigate the role of altered innervation of the urethral sphincter in the genesis of genuine stress incontinence. DESIGN: Prospective observational study. SETTING: Tertiary referral centre urodynamics unit. SUBJECTS: Sixty-eight women, 33 with urodynamically proven pure genuine stress incontinence and 35 controls without urinary symptoms. INTERVENTIONS: Concentric needle electromyography of the urethral striated sphincter. MAIN OUTCOME MEASURES: The means of motor unit potential duration, number of changes in polarity and the amplitude of individual motor unit potentials were compared between the two groups. RESULTS: There was no statistically significant difference in motor unit potential duration (P = 0.87) or in the number of changes in polarity (P = 0.85). There was a trend towards a higher amplitude of motor unit potentials in the control group (P = 0.07). CONCLUSIONS: Our findings suggest that denervation and re-innervation of the striated urethral sphincter following trauma to the pelvic floor, such as that occurring during childbirth, is not a major aetiological factor in the development of genuine stress incontinence.

Action Potentials↗
PubMed1993

A comparison of bioelectrical and mechanical activity of the female urethra.

OBJECTIVE: To determine the relationship between mechanical function and innervation of the urethra in order to clarify the effect of denervation and reinnervation on urethral function. DESIGN: Prospective observational study. SETTING: Tertiary referral urodynamics unit. SUBJECTS: Thirty-six women, 21 with urinary symptoms and urodynamically proven genuine stress incontinence and 15 without urinary symptoms. INTERVENTIONS: All women underwent concentric needle electromyography of the urethral sphincter and urethral pressure profilometry at rest and during cough induced stress. RESULTS: Significant correlations were found between variables indicating denervation and reinnervation and improved resting urethral function. No correlation was found between these variables and urethral function under stress. CONCLUSIONS: Our findings contradict current opinion that denervation of the urethral sphincter is associated with a reduction in the sphincteric function of the urethra, at rest or during stress, and suggest that denervation cannot therefore be a major aetiological factor in the development of genuine stress incontinence.

Action Potentials↗
PubMed1992

Effect of vaginal ultrasound probe on lower urinary tract function.

Vaginal ultrasonography has been advocated as an alternative to videocystourethrography. Ultrasound avoids the potential risks of X-rays and reduces the cost of equipment. We have investigated the effect of the vaginal probe on the physiology of the bladder and urethra. A series of 24 women underwent urethral pressure profilometry, with and without a vaginal probe in situ. There was a significant increase in maximum urethral pressure, functional urethral length and area under the profile curve both at rest and during stress in the presence of the device. This was due to stretching and compression of the urethra by the probe. Transmission pressure ratios were significantly increased for the first 3 quartiles of the urethra. Twenty women underwent lateral bead chain urethrocystography with and without a vaginal probe. At rest, the probe resulted in elevation of the bladder neck and apposition to the symphysis pubis, and during a Valsalva manoeuvre the descent of the bladder neck was restricted by the presence of the probe. These results indicate that a vaginal probe alters the position and function of the lower urinary tract. We postulate that incontinence is reduced as a result of the probe. The use of vaginal ultrasonography in the assessment of women with urinary incontinence is therefore not recommended.

Female↗