Biomedical subjects
Publications and source records attributed to L D Cardozo.
A clinical and urodynamic analysis of 100 women with geniune stress incontinence and 100 women with detrusor instability is presented to compare and contrast the conditions and the results of their treatment. Emphasis is placed on the need to distinguish accurately between these two conditions.
Careful selection of patients can lead to a modest cure rate in elderly women for incontinence due to urethral sphincter incompetence. This is worth while when considering the few complications encountered during and after the surgical procedure, the independence the patients have achieved and the alternative incomplete cure which would have been afforded by conservative therapy.
A new silicone rubber inflatable vaginal pessary has been evaluated in 33 patients with stress incontinence due to urethral sphincter dysfunction (genuine stress incontinence), confirmed by urodynamic assessment. Nine of 20 patients who used the device for one month showed subjective improvement and 2 patients have continued to use the device. Urodynamic changes include a marked increase in maximum urethral closure pressure and elevation of the bladder neck.
Cystometric changes produced by 3 parenterally administered drugs, flavoxate hydrochloride, emepronium bromide and imipramine hydrochloride, have been evaluated in 15 female patients with detrusor instability. Each patient was given 2 of the 3 drugs and cystometric recordings were done 10 and 30 minutes after the administration of each drug. Emepronium bromide was found to be the only drug to cause a significant improvement in bladder capacity and reduction in detrusor pressure.
Nnety-two female patients with genuine stress incontinence, and with otherwise normal bladder function, were treated by a colposuspension operation. Pre-operative and post-operative clinical and urodynamic assessments were performed on all patients. Following surgery 17 of them were found to have detrusor instability.
A preliminary comparison is presented, with pre-operative and post-operative objective assessment, of 25 women undergoing anterior repair and 25 women undergoing colposuspension for the correction of incontinence due to urethral sphincter incompetence. Colposuspension was found to be effective. The mechanism of successful cure was likely to be a combination of bladder neck and proximal urethral elevation and narrowing.
One hundred and eighty female patients complaining of stress incontinence were treated by a modified Burch colposuspension. Follow-up results were available at six months in 146 patients, at one year in 88 patients and at two years in 43 patients. The overall objective cure for stress incontinence was 87 per cent at six months, 87.5 per cent at one year and 86 per cent at two years. No relationship was found between the cure of incontinence and either the time taken to resume spontaneous voiding after surgery or concomitant hysterectomy. Cystourethrocele was effectively corrected by this procedure.
A preliminary study on 40 female patients who had undergone colposuspension surgery was carried out using four drugs in an attempt to reduce the time taken to void spontaneously following surgery and to define the cause of delay. Oral diazepam given as night sedation, was found to be the most effective drug.
Biofeedback training has been used to treat 27 female patients suffering from symptoms associated with detrusor instability Re-education to auditory and visual stimuli took place during 4 to 8 one-hour sessions at weekly intervals. Using subjective and objective methods of assessment 81% of the patients were improved following treatment.
Urinary urgency is a common unpleasant symptom which may result from a variety of different pathologies. Careful patient assessment and appropriate investigation allow the cause to be elucidated and treated effectively in most cases. However, further research is necessary to increase our understanding of these disorders and to improve the quality of life of the women affected by them.