Interstitial cystitis or reflex sympathetic dystrophy of the bladder?
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Cystitis↗
Biomedical subjects
N T Galloway
Publications and source records attributed to N T Galloway.
Sacral reflex latency in acute retention in female patients.
Neurophysiological measurements of the innervation of the lower urinary tract were performed on 14 female patients presenting with unexplained acute urinary retention. The method consisted of (a) static electromyography (EMG) of the anal and urethral sphincter with the patient relaxed, coughing and gripping, (b) the study of sensory thresholds on the dorsal nerve of the clitoris and in the urethra, (c) the measurement of sacral reflex latencies (SRL) from the dorsal nerve of the clitoris to the anus and urethra and from the urethra to the anus. The results showed that all 14 patients had significant defects in the innervation of their lower urinary tract. These findings suggest that a neurological explanation for acute retention in women should always be sought before making any other diagnosis.
Acute Disease↗
An assessment of the complications of the Brantley Scott artificial sphincter.
A Brantley Scott artificial sphincter has been inserted into 95 patients since 1981; more than half of the patients had lower urinary tract neuropathy and most of the others post-TUR incontinence. The main problem with the device has been cuff failure (12), which should be resolved by the new "dipped" cuffs. The major surgical complication has been erosion (10), usually associated with infection. Twenty-four patients had variable degrees of incontinence but the artificial sphincter remains the cornerstone of continence control when other methods have failed or are inappropriate.
Female↗
The complications of colposuspension.
Fifty patients with stress incontinence treated by a colposuspension procedure were reviewed symptomatically and urodynamically before and after surgery and followed up for 1 to 6 years (mean 4.5). Although 84% were continent post-operatively, only 63% of those previously operated on for incontinence were dry, and only 44% were dry and complication-free in the long term.
Adult↗
The longer-term results of undiversion.
Thirty patients have been undiverted over the past 7 years. All but six were originally diverted for neuropathic problems of incontinence and/or upper tract compromise. Eighteen were undiverted because of deteriorating renal function. Only two were reconstructed for purely social reasons. Twenty-eight patients have stable renal function, though three are enuretic and two have persistent Pseudomonas infection. Ureteric "failure" remains the most difficult problem.
Colon, Sigmoid↗
Effect of a blood transfusion protocol and low dose steroid regime on renal transplant survival.
The effects of introduction of a low steroid regime and pre-transplant blood transfusion were evaluated. The kidney and patient survival rates for the period before such a policy was adopted were compared with the period after this policy. There has been a highly significant rise in patient survival rates to the present level of 95 per cent at three years. There was a similar rise in three year graft survival rates from less than 40 per cent to 66 per cent.
Actuarial Analysis↗
Patterns and significance of the sacral evoked response (the urologist's knee jerk).
Neurological examination may fail to demonstrate any abnormality in patients who have neurogenic bladder dysfunction. Standard clinical methods will include full examination of segmental nerves to the level of S1 but will not include the lower sacral segments which control sphincter function. We describe a simple method of measuring the integrity and function of these segments of the cord. The method and the common patterns of response are described. The stimulus is physiological (not supramaximal), the response is measured with surface mounted electrodes at the urethral and anal sphincters and each measurement is the average response after 100 stimuli.
Anal Canal↗
Minor defects of the sacrum and neurogenic bladder dysfunction.
Minor defects of the sacrum are common and often dismissed as normal. The radiographs of 100 patients with urinary incontinence revealed sacral abnormalities in 43. Sacral evoked responses were measured and compared independently with the radiological findings. Patients who had defective closure of the dorsal neural arches of S1 or S2 all had abnormal nerve studies. We suggest that incomplete development of the bones of the dorsal neural arches of the upper sacrum may be a marker of incomplete neurogenesis of the sacral nerves. The sacral neurological deficit is subtle and difficult to demonstrate, but it is real and may be important in the pathogenesis of incontinence.
Adolescent↗
Neurophysiological measurements in primary adult enuretics.
The nerve supply of the lower urinary tract was studied in 25 primary adult enuretics by full urodynamic assessment and neurophysiological measurements. The latter consisted of the measurement of static EMG, sensory thresholds and sacral reflex latencies (SRL). All patients were normal on clinical neurological examination. All neurophysiological measurements were within normal limits in only three patients and the remaining 22 had at least one abnormal response. The commonest abnormality was a high or even absent urethral sensory threshold. These defects in sensory and motor innervation correlated with the clinical dysfunction. It was concluded that this is a valuable method for the detection of nerve defects in the lower urinary tract, especially when the clinical neurological examination is normal.
Adolescent↗
Gas gangrene of the bladder complicating cyclophosphamide cystitis.
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Cyclophosphamide↗
Acute emphysematous cholecystitis.
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Acute Disease↗
Urethral sphincter abnormalities in Parkinsonism.
Urethral sphincter function was studied in 14 patients with Parkinsonism. All patients had urethral pressure profiles, sphincter electromyography and a voiding study with or without cystourethrography. Abnormalities were found in all patients, but profound abnormalities were present in four patients who had markedly increased sphincter tone and sphincter tremor and who failed to relax the sphincter when voiding. These abnormalities may be a significant cause of urinary symptoms in these patients.
Aged↗