Biomedical subjects

N N Bhatia

Publications and source records attributed to N N Bhatia.

At least 19 recordsLinked to original sources

PubMed1992

Antibiotic prophylaxis following lower urinary tract instrumentation.

The value of routine antibiotic prophylaxis was assessed in 362 women undergoing lower urinary tract instrumentation. A three-day course of a once-a-day dose of 1 g of cefadroxil was compared with a three-day course of 100 mg of nitrofurantoin three times a day, in a randomized investigator blinded placebo controlled study. Both study drugs were significantly more effective in preventing postinstrumentation urinary tract infections than placebo (p less than 0.003). Differences in efficacy between the two test drugs were not significant; however, side effects in the nitrofurantoin group were more frequent and severe than those in the cefadroxil group. Cefadroxil also offered the advantage of a once-daily dosing schedule.

Adult↗

PubMed1992

Temporal separation of cough-induced urethral and bladder pressure spikes in women with urinary incontinence.

The time separation of cough-induced urethral and bladder pressure spikes were studied in 32 female patients: 16 with urinary incontinence due to sphincter incompetence, 9 with urinary incontinence and a competent urethral closure mechanism, and 7 after incontinence surgery. There were no significant differences in time separation between the three groups at different positions in the urethra. Age and menopausal status did not affect time separation of pressure spikes. It is concluded that time separation of pressure spikes during cough cannot be used as a discriminator of the etiology of urinary incontinence. Surgery does not restore the latency seen in normal continent women and may restore continence by a mechanism different from that of normal continent women.

Adult↗

PubMed1992

Urodynamic evaluation of voiding in women with cystocele.

To determine the effect of cystocele upon voiding, 30 women with various degrees of genitourinary prolapse were studied. The patients were divided into three groups depending on the severity of the cystocele and were evaluated with uroflowmetry, urethrocystoscopy, water cystometry, urethral pressure profilometry and voiding urethrocystometry. The three groups were similar in most parameters except maximum urethral closure pressure (P less than .05). The patients with cystocele did not demonstrate the abnormal voiding patterns characteristic of outflow obstruction.

Adult↗

PubMed1992

Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse.

Twenty-two clinically continent women with severe genitourinary prolapse were evaluated urodynamically to determine the prevalence of urodynamic abnormalities that could lead to potential urinary incontinence. Urodynamic testing found an occult incontinence disorder in 13 women (59%), of whom four had urine loss during cough pressure profiles after pessary placement, four had uninhibited detrusor contractions during retrograde medium-fill water cystometry, and five had both stress urinary incontinence and an unstable bladder. Therefore, nine of the 22 patients (41%) had uninhibited detrusor contractions during urodynamic testing. However, uroflowmetry did not reveal voiding dysfunction in this group, although peak flow rates appeared to be lower in the subgroup of women manifesting uninhibited detrusor contractions. Associated symptoms of frequency, nocturia, and urgency occurred in 41% of the women in this study; four of nine (44%) who had normal urodynamic test results, five of 13 (38%) who had abnormal test results, and five of nine (56%) who had an unstable bladder. Therefore, associated symptoms could not be used to determine which women would have abnormal urodynamic test results. These preliminary results suggest that women with genitourinary prolapse may be at risk for an occult incontinence disorder that is masked by the prolapse and that could manifest after corrective surgery for prolapse. Urodynamic testing is suggested for women with genitourinary prolapse who present with or without symptoms of incontinence, so that more data can be obtained to determine the importance of abnormal test results.

Female↗

PubMed1992

Modified suburethral sling procedure for treatment of recurrent or severe stress urinary incontinence.

The most suitable material used to perform suburethral sling procedures for recurrent or severe stress urinary incontinence remains controversial. A comparison was made between two commonly used materials, synthetic Gore-Tex (expanded reinforced polytetrafluoroethylene) and autologous fascia lata. Both groups showed improved urethral pressure profiles postoperatively, but there was no difference in the magnitude of change between groups. The objective cure rate at six months for the Gore-Tex group was 100.0 versus 87.5 percent for the fascia lata group (p = 0.155). While there was no statistical difference between the incidence of de novo detrusor instability or length of postoperative bladder drainage (p = 0.104 and p = 0.978, respectively), there was a trend toward more postoperative complications of urinary obstruction in the Gore-Tex group.

Fascia Lata↗

PubMed1991

Dynamic urethral pressure profilometry pressure transmission ratio: what do the numbers really mean?

Sixty-three women with genuine stress urinary incontinence were evaluated urodynamically both before and after modified Burch colposuspension to determine the association between pressure transmission ratio and leakage of urine during dynamic urethral pressure profile and the effect of surgery on pressure transmission ratio. Preoperatively, there was no difference in pressure transmission ratios between urethral pressure profiles associated with leakage of urine and those without urine leakage. Postoperatively, there were differences in pressure transmission ratios between leak and nonleak profiles in the sitting full and supine positions (P less than .001). We could not determine a threshold pressure transmission ratio that was more characteristically associated with leakage of urine. Finally, preoperative pressure transmission ratios were not associated with surgical success, but the higher the postoperative pressure transmission ratio, the more likely the surgery was to be successful (P = .023). In addition, the greater the difference between preoperative and postoperative pressure transmission ratios, the more likely was a cure (P = .011). The pressure transmission ratio may not be helpful in discriminating leak from nonleak dynamic urethral pressure profiles, and there may not be a threshold pressure transmission ratio below which patients characteristically leak urine. However, comparison of preoperative and postoperative pressure transmission ratios is helpful in determining the adequacy of surgical correction of the anatomical defect associated with genuine stress incontinence.

Adult↗

PubMed1991

Stress incontinence in women. Psychological status before and after treatment.

Sixty-three women with clinical and urodynamic evidence of stress incontinence were evaluated before and after incontinence surgery for symptoms of depression, nervousness, tension, sleep disturbances, decreased appetite, somatic weakness and headaches. Women treated successfully with surgery demonstrated a statistically significant improvement in their subjective psychologic status (P less than .05). Unsuccessful treatment, however, was not associated with a significant change in or deterioration of their symptoms. All the symptoms were evaluated individually to ascertain the specific effects of treatment. Sleep disturbances were significantly improved with successful treatment and worsened with unsuccessful treatment (P less than .05). Tension was significantly improved with successful therapy (P less than .05) but was unchanged if surgery was unsuccessful. Depression became worse with subjectively unsuccessful surgery. Headaches and appetite were not affected by the therapeutic outcome. Therapy can be instrumental in affecting the psychologic status of women with stress incontinence. If the psychologic disability continues after therapy and/or treatment is unsuccessful, a referral for psychologic evaluation should be considered.

Adult↗

PubMed1990

Changes in urethral cytology following estrogen administration.

Estrogen vaginal cream was given to 10 postmenopausal women with a diagnosis of genuine stress urinary incontinence. Clinical evaluation and urethral cytology from the midurethra were performed before and after 6 weeks of estrogen treatment. A favorable clinical response was obtained in 50% of the treated patients, in whom signs and symptoms of incontinence disappeared or significantly improved, by subjective and objective evaluation. Cytologic changes at the midurethra correlated well with clinical response to estrogens. Patients with a favorable response to treatment showed a positive 'maturation index' of squamous epithelium, changing towards more intermediate and superficial cells, and less transitional cells (p less than 0.05). Patients with a poor clinical response to estrogens had no significant change in urethral cytology after 6 weeks of therapy. Our results suggest that improvement or cure of stress incontinence after estrogen administration in postmenopausal women is achieved by affecting the 'urethral mucosal factor'.

Estrogens↗

PubMed1990

Importance of a neurologic evaluation in women with lower urinary tract dysfunction.

The normal coordinated functions of the bladder and urethra are controlled by a set of central and peripheral reflex mechanisms. Disruptions of these neuronal reflexes may produce abnormalities in the storage and expulsion of urine. Electrophysiologic testing can be employed to complement other urodynamic tests used in the evaluation of these patients and also to document that abnormalities previously thought to be anatomic in origin in reality may be secondary to neurologic dysfunction.

Electroencephalography↗

PubMed1990

Patch procedure: modified transvaginal fascia lata sling for recurrent or severe stress urinary incontinence.

Ten patients with either recurrent or severe stress urinary incontinence were treated with a new procedure, using a patch of fascia lata to support the bladder base and the urethra. Nine of the ten patients are objectively continent of urine 1-2 years postoperatively. When pre- and postoperative urodynamics were compared, we noted significant increases in urethral closure pressure, functional urethral length, and abdominal pressure transmission to the proximal urethra. Intraoperative and postoperative morbidity was minimal. The procedure is easily performed and requires no more expertise than does a transvaginal needle bladder neck suspension.

Adult↗

PubMed1989

Effects of estrogen on urethral function in women with urinary incontinence.

In a prospective study, 2 gm of conjugated estrogen vaginal cream was administered daily for a total of 6 weeks in a group of 11 postmenopausal women with urodynamically proved genuine stress incontinence. Midurethral cytologic studies and a complete clinical and urodynamic evaluation were performed twice at 6-week intervals. Clinically, six of the 11 patients (54.5%) were cured or improved significantly after estrogen treatment, whereas the other five patients (45.5%) were clinically unchanged. The favorable clinical response correlated with urodynamic findings of increased urethral closure pressure and improved abdominal pressure transmission to the proximal urethra (p less than 0.05); in the patients who had a poor clinical response to estrogens, no significant changes in urethral dynamics were noted. Changes in urethral cytologic findings also correlated well with clinical and urodynamic findings. Patients with a favorable response to estrogen showed a maturation change from transitional to intermediate squamous epithelium (p less than 0.02), whereas nonresponders showed no significant changes in urethral cells.

Administration, Intravaginal↗

PubMed1989

Changes in urethral resistance after surgery for stress urinary incontinence.

Seventy women with stress urinary incontinence underwent simultaneous voiding-urethrocystometry using microtip transducers and an 8-channel recorder, before and three to twelve months after either the modified Burch (48/70) or the modified Pereyra (22/70) retropubic urethropexy. Increase in urethral resistance (p less than 0.005) was more marked following the Pereyra procedure (0.042 +/- 0.039 to 0.07 +/- 0.061) and 30 percent experienced postoperative voiding difficulties, compared with the Burch procedure (0.035 +/- 0.029 to 0.055 +/- 0.03) where 20 percent experienced postoperative voiding difficulties. Of those patients who voided without a detrusor contraction prior to surgery (35/70), in 50 percent a detrusor contraction component developed to their voiding mechanism postoperatively (p less than 0.05) and overcame the increased urethral resistance with no postoperative voiding difficulties. In the remaining 50 percent a detrusor contraction failed to develop during postoperative voiding and 90 percent of them demonstrated reduced flow rates and increased use of Valsalva maneuver, and needed prolonged postoperative bladder drainage prior to resumption of spontaneous voiding (p less than 0.005). Inability to develop a detrusor contraction during voiding in face of increased urethral resistance promoted by the incontinence surgery provided a suitable explanation for post surgery voiding difficulties in 20 to 30 percent of patients.

Adult↗

PubMed1989

Urodynamic changes following hormonal replacement therapy in women with premature ovarian failure.

The mechanism by which estrogen supplementation improves the symptom of stress incontinence in postmenopausal women is unclear. Six women with proved premature ovarian failure were studied urodynamically before and after administration of oral and vaginal estrogen to study estradiol's effects on lower urinary tract function. Regardless of the mode of administration, estrogen supplementation did not produce any significant change in urethral pressure, functional length, or cystometric parameters. However, a significant increase in pressure transmission ratio (P less than .05) to the proximal and mid-urethra was noted after the administration of vaginal estrogen cream. We conclude that estrogen alone, in the absence of aging and other known precipitating factors for stress incontinence, is of minimal significance in maintaining normal urinary tract physiology.

Administration, Intravaginal↗

PubMed1989

Leiomyoma of the female urethra. A case report.

A huge vaginal mass arose from the urethra, causing obstruction and urinary retention. Preoperative biopsy revealed a benign leiomyoma. Vaginal excision of the mass was performed without complications.

Adult↗

PubMed1989

Transvaginal needle bladder neck suspension procedures for stress urinary incontinence: a comprehensive review.

Transvaginal needle bladder neck suspension procedures for surgical correction of stress incontinence are increasing in popularity among genitourinary surgeons. Since 1959, three main modifications of the originally described procedure have emerged as representing various needle suspension procedures, ie, the modified Pereyra procedure among gynecologic surgeons and the Stamey and the Raz procedures among urologic surgeons. The overall success rate of 85% (range 40-100%) among a total of 1967 surgical procedures reported in the published literature may be misleading; the majority of reported studies relied upon subjective clinical cures rather than objectively demonstrable cures of urinary incontinence. The majority of studies lacked long-term follow-up of successfully treated patients. Few studies reported urodynamic changes after needle suspension procedures in terms of increased functional urethral length and improved pressure transmission to the proximal urethra. A 20-50% incidence of postoperative voiding difficulties has been reported in various studies. This publication reviews the controversies in the nomenclature of various needle suspension procedures, indication, suture materials, procedural details, and results of previously published needle suspension procedures and their modifications. Differences among commonly performed procedures are pointed out and analyzed for their role in the correction of stress urinary incontinence.

Evaluation Studies as Topic↗

PubMed1989

New approaches in the treatment of urinary tract infections.

Our increased understanding of the pathophysiology of urinary tract infections (UTIs) have not only challenged our past approaches to the management of UTIs but also have enhanced our skills to diagnose and control the great majority of UTIs simply, quickly, and cost-effectively. Single-dose treatment is increasingly replacing traditional 10 to 14 days treatment for UTIs. Recurrent UTIs are better understood and becoming more manageable. Newer antibiotics are proving to be very promising and effective with minimal risk of development of resistant strains.

Anti-Bacterial Agents↗

PubMed1989

Role of antibiotic prophylaxis in retropubic surgery for stress urinary incontinence.

The effectiveness of prophylactic antibiotics was studied prospectively in 26 women undergoing retropubic urethropexy for genuine stress incontinence. Each of the 14 patients in the antibiotic prophylaxis group received three 1-g doses of intravenous cefazolin administered before, during, and 6-8 hours after surgery. Twelve women served as a control group and did not receive prophylactic antibiotics. Postoperative febrile morbidity and hospital stay were significantly less (P less than .01 and P less than .05, respectively) in patients who received prophylactic antibiotics.

Adult↗

PubMed1989

Management of coexistent stress and urge urinary incontinence.

Fifty-two patients with objective evidence of pressure equalization incontinence and detrusor instability were evaluated retrospectively to compare nonsurgical modes of therapy with retropubic surgery. Based on the patient's desire for surgery and her overall medical condition, 27 women were treated primarily with retropubic urethropexy (modified Burch procedure) and 25 with various combinations of oxybutynin, imipramine, and estrogen. Thirty-two percent of the patients treated medically were cured and 28% were markedly improved, whereas 59% of patients treated surgically were cured and 22% improved. There was no statistically significant difference in the results between medical and surgical therapy. All failures in the surgically treated group were due to persistent detrusor instability after surgery. We identified no preoperative urodynamic criteria that consistently and accurately predicted surgical outcome in patients with combined stress and urge incontinence. Patients with combined stress incontinence and detrusor instability should initially be managed medically, as this will reduce the incidence of surgical intervention.

Adult↗