Effects of ejaculation by penile vibratory stimulation on bladder reflex activity in a spinal cord injured man.
Explore the source record for details and available documents.
Ejaculation↗
Biomedical subjects
P Bagi
Publications and source records attributed to P Bagi.
Urinary tract infections in patients with spinal cord lesions: treatment and prevention.
Even though the mortality due to urinary tract complications has decreased dramatically during the last decades in individuals with spinal cord lesions (SCL), urinary tract infections (UTI) still cause significant morbidity in this population. Complicated UTI are caused by a much wider variety of organisms in individuals with SCL than in the general population and are often polymicrobial. Escherichia coli, Pseudomonas spp., Klebsiella spp., Proteus spp., Serratia spp., Providencia spp., enterococci, and staphylococci are the most frequently isolated bacteria in urine specimens taken from individuals with SCL. There is no doubt that the greatest risk for complicated UTI in these individuals is the use of an indwelling catheter. Intermittent catheterisation during the rehabilitation phase has been shown to lower the rate of UTI, and virtually eliminate many of the complications associated with indwelling catheters. Persons with SCL should only be treated for bacteriuria if they have symptoms. Generally, it is advisable to use antibacterial agents with little or no impact on the normal flora. Single agent therapy - in accordance with antimicrobial susceptibility test - is preferred. We advise extending treatment to at least 5 days, and in those with reinfection or relapsing UTI, at least 7 to 14 days, depending on the severity of the infection. The diagnosis of structural and/or functional risk factors is essential in order to plan an optimal treatment for UTI in individuals with SCL, which should include treatment of simultaneously occurring predisposing factors. The treatment of structural risk factors follows general urological principles, aiming for sufficient outlet from the bladder with minimal residual urine and low pressure voiding. For prevention of UTI, general cleanliness and local hygiene should be encouraged. If the patient has a reinfection or relapsing symptomatic UTI, it is important to check for inadequately treated infection and complications, which need special attention, in particular residual urine and urinary stones. No reliable evidence exists of the effectiveness of cranberry juice and other cranberry products. Prophylactic antibacterials should only be used in patients with recurrent UTI where no underlying cause can be found and managed, and in particular if the upper urinary tract is dilated. Antibacterials should not be used for the prevention of UTI in individuals with SCL and indwelling catheters. However, the use of prophylactic antibacterials for individuals with SCL using intermittent catheterisation or other methods of bladder emptying is controversial.
Anti-Bacterial Agents↗
Is bladder outlet obstruction normal in elderly men without lower urinary tract symptoms?
The aim of the present study was to correlate basic voiding parameters, including uroflowmetry, symptom score, and residual urine volume with the results of pressure-flow studies applying the Abrams/Griffith nomogram, in a series of urologically asymptomatic elderly men. Twenty-nine consecutive male volunteers (median age, 66 years) without past or present urological complaints participated. Fifteen (52%) of the 29 subjectively normal men proved to have bladder outlet obstruction (BOO). Qmax <10 mL/s had a positive predictive value of 100% in diagnosing obstruction, whereas the predictive information of higher flow rates proved very modest. No significant difference existed between obstructed and unobstructed persons at any cutoff value concerning symptom score. The sensitivity as well as the positive predictive value of a residual urine volume >50 mL was zero. It is concluded that a surprisingly high prevalence of BOO in asymptomatic elderly men was demonstrated and that the correlation between pressure flow investigations and alternative diagnostic tests, i.e., flow rate, symptom score, and residual volume was weak in this group of men. It is suggested that a possible explanation for the high frequency of BOO observed in the evaluated asymptomatic men could be that the values defining obstruction have been set too low. Neurourol. Urodynam. 18:545-552, 1999.
Age Factors↗
[Waiting lists for men with benign urinary disorders].
This paper reflects the problems in having a large non-specific waiting-list. One hundred and twenty-eight patients were on a waiting-list under the main diagnosis of prostatism. This diagnosis revealed seven patients with cancer in the urinary tract system. Only two-thirds of the patients on the waiting-list were interested in further examination and treatment. This paper emphasizes the need for a more specific referral, when dealing with symptoms from the lower urinary tract system.
Denmark↗
Recurrent bilateral renal calculi in a tetraplegic patient.
An 18-year-old male developed C-5 complete tetraplegia following a motor-cycle accident in May 1975. The neuropathic bladder was managed by an indwelling urethral catheter. He developed recurrent episodes of urinary infection with Proteus species. In September 1975, an X-ray of the abdomen revealed small calculi in both the kidneys. In July 1976, he underwent transurethral resection of the bladder neck and division of the external urethral sphincter; subsequently, he was put on a penile sheath drainage. He continued to suffer from repeated episodes of urinary tract infection with Proteus, Providencia, and Pseudomonas species, and he was treated with antibiotics. In 1980, intravenous urography (IVU) showed two large stones in the left kidney with marked caliectasis. The IVU performed in 1984 showed an increase in the size of the calculi in the left kidney which was grossly hydronephrotic. There were clusters of small calculi in the right kidney. The left renal calculi were treated by percutaneous lithotripsy in two sessions. In 1988, an X-ray of the abdomen revealed staghorn calculus in the right kidney and recurrence of stones in the left kidney. The staghorn calculus in the right kidney was treated by percutaneous nephrostolithotomy in two sessions. In 1991, he was admitted with acute urinary infection. IVU showed a stone in the pelviureteric junction with no excretion of contrast in the left kidney. Percutaneous nephrostomy drainage was established followed by left percutaneous nephrostolithotomy. In 1992, he was found to retain large amount of urine in the bladder; subsequently, his mother was taught to perform regular intermittent catheterisations. In 1995, he was admitted with acute urine infection. Abdominal X-ray revealed recurrence of large stones in both kidneys. With multiple sessions of Extracorporeal Shockwave Lithotripsy (ESWL), about 80% clearance was achieved on the left side. Right staghorn renal stone awaits treatment. This case shows that recurrent urinary infection in spinal cord injury patients is a predisposing factor for renal lithiasis. These patients require annual urological evaluation. Urinary tract calculi, if detected, should be dealt with promptly to prevent renal damage due to urinary obstruction and urosepsis. Renal calculi can be treated effectively and safely by ESWL in spinal cord injury patients, thus avoiding the need for an invasive procedure. It is essential to achieve low-pressure, adequate emptying of the urinary bladder in patients with spinal cord injury in order to prevent recurrent urinary infection and its sequelae. Social issues involved in the care of a tetraplegic patient play a vital role in the implementation of ideal medical treatment and need to be addressed promptly to avoid any compromise in the quality of medical care.
Adolescent↗
Home uroflowmetry by means of the Da Capo home uroflowmeter.
OBJECTIVE: The Da Capo home flowmeter was tested versus the Urodyn 1000 flowmeter. The two flowmeters are based on different principles. The Da Capo is a portable, battery powered flowmeter designed to record all voidings during a period of time (e.g. 24 h) for a single patient. METHODS: The flowmeters were tested with regard to accuracy of measurement of the voided volume and maximum flow (Qmax). Further, the Da Capo was tested by 10 healthy male volunteers, median age 47 years, range 21-57. RESULTS: Both flowmeters were very accurate measuring Qmax and voided volume. A few artifacts arose, i.e. extremely high Qmax values were recorded. All test persons found the flowmeter easy to handle. CONCLUSION: The weight transducer based Da Capo home flowmeter proved as accurate as the stationary flowmeters. It is easy to handle and it provides all-day monitoring of uroflow and voided volume.
Adult↗
Influence of pudendal nerve blockade on stress relaxation in the female urethra.
The urethral pressure decay following a sudden and sustained dilatation corresponds to stress relaxation. Urethral stress relaxation can be described by the equation Pt = Pequ + P alpha e-t/tau alpha + P beta e-t/tau beta, where Pt is the pressure at time t, Pequ is the equilibrium pressure after dilatation, P alpha and P beta are pressure decay, and tau alpha and tau beta are time constants. The time constants have previously proved independent of the way the dilatation is performed. The urethral stress relaxation obtained in 10 healthy women before and after pudendal nerve blockade was analysed by the mathematical model and the pressure parameters and time constants determined. The fast time constant, tau beta, was reduced by the nerve blockade, whereas tau alpha was unaffected, however, both P alpha and P beta were reduced. No single stress relaxation parameter can therefore be related to the muscle or the connective tissue components. The method may prove useful in the further evaluation of the closure function of the urethra with special reference to the pathophysiology of stress urinary incontinence.
Adult↗
Pressure-to-cross-sectional area relationships in the proximal urethra of men with bladder outlet obstruction.
PURPOSE: Related values of pressure and cross-sectional area in the proximal urethra were measured in patients with bladder outlet obstruction. Urethral opening pressure and elastance (the inverse of compliance) were estimated. MATERIALS AND METHODS: We studied 15 men with standard urodynamic examinations. The pressure-to-cross-sectional area relationship in the prostatic urethra was determined using a special probe. RESULTS: Elastance varied significantly along the studied portion of the urethra, with higher values found in the sphincter area. The estimated urethral opening pressure appeared high compared to that in unobstructed cases and without variation along the prostatic urethra. CONCLUSIONS: The most important effect of prostatic obstruction appears to be the increased urethral opening pressure.
Aged↗
Passive urethral resistance to dilation in healthy women: an experimental simulation of urine ingression in the resting urethra.
The dynamic urethral pressure response to a simulated urine ingression was studied at the bladder neck, in the high pressure zone, and in the distal urethra in 10 healthy female volunteers. The pressure response was characterised by a steep pressure increase simulataneous with the urethral dilation, followed by a decay during the next seconds until a new equilibrium pressure was reached. The pressure decay could be described by a double exponential function in the form Pt = Pequ + P alpha e-t/tau alpha + P beta e-t/tau beta, where Pt represents the pressure at the time t, Pequ represents the pressure at equilibrium, P alpha and P beta express the decline in pressure, and tau alpha and tau beta are time constants. The size of the pressure response proved highly dependent on velocity and size of dilation as well as urethral site of measurement, with the maximum values in the high pressure zone. The time constants, on the other hand, were uninfluenced by these factors. The pressure response represents an integrated stress response from the surrounding tissues which may reflect the visco-elastic properties of the structures involved. The findings indicate that striated muscle fibres are of dominating significance for the pressure response, and the varying size of the response along the urethra is in accordance with the localization of the horseshoe-shaped rhabdosphincter, which quantitatively is the dominating circularly arranged structure around the female urethra. Functionally, the stress response will oppose any dilation, and increasingly with rising size or velocity of dilation.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Pressure/cross-sectional area relations in the proximal urethra of healthy males. Part 1: Elastance and estimated pressure in the uninstrumented urethra.
The pressure/cross-sectional area relation in the resting urethra during the storage phase was studied in 31 healthy male volunteers aged 23-85 years. Measurements were performed at 5-mm intervals from the bladder neck and beyond the region of high pressure, and the elastance and estimated pressure in the uninstrumented urethra (Po) were calculated at each measurement location. All subjects were further evaluated by means of symptom score, prostatic volume determined by rectal ultrasound, urethral pressure profile, cystometry, and pressure flow. The elastance and Po both varied along the urethra, with significantly higher values of both parameters in the sphincteric region as compared to the prostatic area. A significant positive correlation was found between Po and age in the prostatic parts of the urethra, whereas no correlation could be demonstrated between elastance and age in any part of the urethra. These results indicate that the prostatic parts of the urethra are readily distensible at modest intraluminal pressures as compared to the sphincteric segment, and that the intraluminal pressure required to obtain a given distension of this segment of the urethra seems to increase with age. It is suggested that the technique may prove of value in the elucidation of pathophysiological mechanisms related to benign prostatic hyperplasia, and that the technique may bring new insight into the mode of action of various treatment modalities for this disease.
Adult↗
Pressure/cross-sectional area relations in the proximal urethra of healthy males. Part 2: Power generation during voluntary contraction.
The power generation in the proximal urethra during voluntary squeezing was studied in 30 healthy male volunteers aged 23-85 years. Measurements were performed at 5-mm intervals from the bladder neck and beyond the region of high pressure, and the maximum power generation during contraction was calculated at each measurement location. All subjects were further evaluated by means of symptom score, prostatic volume determined by rectal ultrasound, urethral pressure profile, cystometry, and pressure flow. There was a significant variation in power generation along the urethra, with minimum values in the prostatic segments and an approximately 5-fold increase in the high pressure zone. Power generation remained high in the urethral segment distal to the high pressure zone. No correlation between age and power generation could be demonstrated in any part of the urethra. The technique employed does not allow for a differentiation of the individual muscles involved, however, it is suggested that the pelvic floor dominates above the level of the perineal membrane, whereas the striated muscles of the penis may influence the proximal part of the spongious urethra. Physiologically, the contractile capability of the male urethra is probably important for the continence function, as well as it may be of significance for the normal ejaculatory function.
Adult↗
Characterization of pressure changes in the lower urinary tract during coughing with special reference to the demands on the pressure recording equipment.
The exact demands on urodynamic equipment for measurement of coughs and cough associated pressure changes in the lower urinary tract have been analyzed from high-speed pressure recordings using a double microtip transducer and a storage oscilloscope. The equipment was tested in vitro by the step-test method. The natural frequency response was 175.6 Hz and the rise-time 2.5 ms, resulting in accurate measurements of frequencies up to about 60 Hz, which is way above the clinically measured frequencies. Four men and 2 women, all of whom were healthy volunteers, were examined in the supine position with an empty bladder. Pressures were measured in the bladder and in the external sphincter zone of the urethra. The spectral power density of the bladder and urethral pressures were calculated by Fourier analysis. The pressure changes in the urethra were in all volunteers equal to or slower than in the bladder. The analysis of the spectral power density showed that 99% of the pressure changes could be recorded with an instrument capable of recording 9 Hz frequencies, i.e., with a sampling rate of 18 Hz or more.
Adult↗
[Early complications of enterostomy. Importance of the type of suture].
The frequency and character of early complications following creation of enterostomies, and their relation to the type of suture material used were studied in 50 consecutive patients. The stomas were matured by muco-cutaneous eversion, and were fixated with Maxon 4-0 and Vicryl 3-0 sutures. Half the stoma circumference was sutured with the one suture type, and the other half with the other. No statistically significant correlation was found between enterostomy type or surgical procedure and complications. The incidence of muco-cutaneous complications was significantly higher following fixation with Vicryl as compared to Maxon sutures. The cause of this difference is uncertain, however, the physical configuration of the sutures seems important, Maxin being monofile versus Vicryl being braided. Whether the chemical structure is significant as well remains undetermined at present.
Adult↗
The dynamic pressure response to rapid dilatation of the resting urethra in healthy women: an in vivo evaluation of visco-elastic properties.
The urethral pressure response to a sudden forced dilatation was studied at the bladder neck, in the high-pressure zone and in the distal urethra in ten healthy female volunteers. The pressure response was fitted with a double exponential function of the form Pt = Pequ + P alpha e-t/tau alpha + P beta e-t/tau beta, where Pequ, P alpha and P beta are constants, and tau alpha and tau beta are time constants; this equation has previously been demonstrated to describe the pressure decay following dilatation. On the basis of a theoretical model the elastic and viscous constants for the urethral tissues were computed. The results showed significant differences along the urethra, with the high-pressure zone showing the highest maximum and equilibrium pressures, fastest pressure decay and highest elastic coefficient. The pressure response represents an integrated stress response from the surrounding structures, which reflects the visco-elastic properties of the tissues involved. The findings seem therefore to correlate well with the anatomical findings, which have shown a high fibre density of the horseshoe-shaped rhabdosphincter in the mid-portion of the urethra. The method permits a detailed assessment of static and dynamic urethral responses to dilatation which can be applied as an experimental simulation of urine ingression, and is therefore presumed to be of value in the evaluation of normal and pathological urethral sphincter function.
Adult↗
A technique for measurement of related values of pressure and cross-sectional area in the male urethra.
A probe for measurement of related values of cross-sectional area and pressure in the male urethra was constructed. The probe allows induction of variable pressures or fluid volumes in a distensible balloon located in the urethra and simultaneous recording of related values of cross-sectional area and pressure. Cross-sectional area is measured in the range of 11-102 mm2 using the field-gradient principle. Pressure is measured in the range of 0-250 cmH2O using tip transducers. The time constant for cross-sectional area measurement is 0.02 s and that for pressure measurement, 0.007 s. The pressures required to reach the maximal and minimal cross-sectional areas of the balloon are 2.8 and -2.4 cmH2O, respectively. The shape of the probe after its placement in the urethra was studied by transrectal ultrasound in five volunteers. The results showed that the measurement error caused by the slope of the balloon walls or the forced bending of the catheter did not exceed 5%. The method enables a description of the biomechanical properties of the male urethra at rest in terms of estimated pressure at zero cross-sectional area, elastance, and stress-relaxation and at voluntary contraction in terms of work and power as evaluated at well-defined anatomical locations.
Adult↗
In vivo evaluation of visco-elasticity in a biological tube. Part 1. Stress relaxation in the female urethra studied by cross-sectional area and pressure measurements.
The urethral response to a sudden forced dilatation was studied by a mathematical analysis of the pressure response in ten healthy women. A total of 60 dilatations, using various sizes and velocities of deformation, were performed in the high-pressure zone. The decay in pressure during relaxation proved to follow an exponential equation of the following form: Y = Z + C alpha e-t/tau alpha + C beta e-t/tau beta, where Z is the equilibrium pressure, C alpha and C beta are pressure decay, and T alpha and T beta are time constants. The time constants were unaffected by the circumstances of dilatation, whereas all the other parameters were correlated to size or velocity of dilatation, or both. The time constants showed a fairly high reproducibility when repeated after one weak. The method is presumed to characterise the tissue composition of the periluminal tissue layers and may prove useful in the evaluation of the normal urethral sphincter function. Furthermore, it may prove of value in the elucidation of the pathophysiology of stress urinary incontinence.
Adult↗
In vivo evaluation of visco-elasticity in a biological tube. Part 2. Application of a mechanical model.
Based on a theoretical model, the urethral stress-relaxation response following a sudden forced dilatation was studied in ten healthy female volunteers. The energy dissipation following a sudden urethral dilatation proved to follow the function Y = Z + C alpha e-t/tau alpha + C beta e-t/tau beta. Hence, a mechanical model was chosen, consisting of two Maxwell elements and one Hooke element coupled in parallel. The decay in force following deformation may be described as F = F(o) exp (-t.E/eta) for each Maxwell element. Thus, it was possible to determine the elastic E and viscous eta coefficients for the participating mechanical equivalents in the model, and thereby quantitatively describe the visco-elastic properties in the urethra. The reproducibility of the elastic and the viscous coefficients proved to be fairly high, and they seemed to be unaffected by the size of dilatation. On the other hand, the rate of dilatation clearly influenced the computed parameters. However, this phenomenon was easily explained by the duration of the deformation, which allowed the viscous elements to move before any measurements were performed. The present method permits in vivo evaluation of the elastic and viscous properties of the urethra, as well as other accessible biological tubes, and may be of value in the description of normal physiological and pathophysiological behaviour of the structures studied.
Adult↗