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Biomedical subjects

R C Bump

Publications and source records attributed to R C Bump.

66 records · Page 4Linked to original sources
PubMed1988

Dynamic urethral pressure/profilometry pressure transmission ratio determinations in stress-incontinent and stress-continent subjects.

Bladder-to-urethra pressure transmission ratios were calculated in each quarter (designated Q1 through Q4) of the dynamic urethral pressure profile in 110 subjects. Thirty-seven subjects had genuine stress urinary incontinence, whereas 73 were stress continent. Subjects with genuine stress incontinence had significantly lower mean (+/- SD) pressure transmission ratios in all four urethral quarters compared with stress-continent subjects: 71% +/- 14% versus 94% +/- 38% for Q1 (p = 0.004), 69% +/- 16% versus 101% +/- 42% for Q2 (p = 0.00001), 79% +/- 19% versus 113% +/- 46% for Q3 (p = 0.0001), and 90% +/- 22% versus 117% +/- 36% for Q4 (p = 0.001). A pressure transmission ratio value less than 90% in the proximal half of the dynamic profile had a sensitivity of 97%, a specificity of 56%, an abnormal predictive value of 53%, and a normal predictive value of 97%. Calculation of pressure transmission ratios, as opposed to declaring the stress profile positive or negative based on whole urethra/bladder pressure equalization with stress, enhances the utility of the dynamic urethral pressure profile and allows quantification of one of the several variable in the equation of stress urinary incontinence.

Adult↗
PubMed1988

Non-neuromuscular determinants of intraluminal urethral pressure in the female baboon: relative importance of vascular and nonvascular factors.

The female urethral sphincteric mechanism has both neuromuscular and non-neuromuscular components. The latter component has several determinants, including the urethral mucosa, the connective tissue of the urethra and periurethra, and the submucosal vascular bed. This study was designed to characterize the non-neuromuscular component of the urethral pressure profile (UPP) by quantitating the relative contributions of its vascular and non-vascular determinants in four female baboons. Following minimization of the smooth muscle and striated muscle determinants (the neuromuscular component) with halothane and pancuronium bromide, UPPs were performed before and after aortic occlusion. It is concluded that vascular and non-vascular factors contribute nearly equally to the non-neuromuscularly generated portion of intraluminal urethral pressure.

Animals↗
PubMed1988

Dynamic urethral pressure profilometry pressure transmission ratio determinations after continence surgery: understanding the mechanism of success, failure, and complications.

Twenty-two women who had previously undergone continence surgery for the correction of stress urinary incontinence were evaluated with dynamic urethral pressure profilometry and had bladder-to-urethra pressure transmission ratios calculated. Eight of the subjects had recurrent or persistent genuine stress incontinence (group 1), seven had detrusor instability (group 2), and seven had normal continence and detrusor function (group 3). In addition, we evaluated ten subjects with detrusor instability but no previous surgery (group 4). There were clear and significant differences in pressure transmission ratios between the four groups. These differences suggest that subjects in group 1 have the same basic mechanisms of incontinence (ie, inefficient pressure transmission to the urethra as reflected by pressure transmission ratios less than 90%) as do never-operated women with genuine stress incontinence. Subjects in group 2 had pressure transmission ratios that were significantly higher than those in either group 3 or 4. This supports the hypothesis that obstruction may play a role in post-continence surgery detrusor instability, but not in idiopathic detrusor instability. Group 2 subjects had pressure transmission ratios very close to the ideal of 100%. We postulate that continence procedures that consistently result in pressure transmission ratios close to 100% should have the greatest chance for success without inducing complications.

Adult↗
PubMed1988

Postmenopausal urinary incontinence: comparison between non-estrogen-supplemented and estrogen-supplemented women.

Clinical and urodynamic variables of 49 non-estrogen-supplemented and 23 estrogen-supplemented postmenopausal women with urinary incontinence were compared. We ascertained their estrogenic status via plasma estradiol and estrone levels, as well as from parabasal and superficial cell counts from both the urethra and vagina. The effect of estrogen supplementation, in conjunction with the effect of age and urodynamic diagnosis, was studied in relation to filling-phase urodynamic data and incontinence severity and outcome variables. Analysis of covariance was used. No direct effect of estrogen supplementation was noted on parameters of urethral function. In patients with detrusor instability, a borderline direct positive effect (P = .06) was noted in the volume needed to reach maximal cystometric capacity from the first sensation to void. For these patients, the magnitude of fluid loss was greater without estrogen supplementation. However, this difference did not reach statistical significance. Nocturia was significantly less frequent in the estrogen-supplemented groups (P = .04). Estrogen-supplemented patients had a higher incidence of positive bulbocavernosus reflex (P = .01). These observations suggest that hypoestrogenism may affect the sensory threshold of the lower urinary tract of incontinent postmenopausal women.

Administration, Oral↗
PubMed1988

The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies.

Eleven continent women with severe degrees of uterovaginal prolapse underwent a complete urodynamic evaluation that included passive and dynamic urethral pressure profilometry with and without careful barrier reduction of their prolapse. The aim of barrier placement was to reduce, but not overcorrect, the prolapse and to restrict stress-induced mobility of the viscera posterior and superior to the urethra. Each of the women had very high pressure transmission ratios in each quarter of the urethra (means of 257, 187, 170, and 166% from internal to external quarters) that were significantly reduced with barrier placement (means of 78, 84, 85, and 101%). Eight of 11 subjects had pressure transmission ratios less than 90% in the proximal three-quarters of the urethra with the barrier in place, a finding in nearly all subjects with genuine stress urinary incontinence. Maximum urethral closure pressure on passive urethral pressure profilometry also decreased significantly from a mean of 75 to 45 cm H2O with the barrier in place. We conclude that the stress continence mechanism in women with severe prolapse results from posterior-superior visceral descent with stress, causing mechanical obstruction of the less mobile urethra. The evaluation methods described may be useful in predicting which of these patients may require concurrent urethropexy at the time of prolapse reduction surgery to prevent postoperative stress urinary incontinence.

Adult↗
PubMed1986

Urethral axis and sphincteric function.

Position and mobility of the urethral axis are considered factors influencing urethral competence. Specific correlation between the urethral axis and its sphincteric function is lacking. Eighty-four patients with the symptom of stress urinary incontinence and 31 patients with sensory symptomatology but not urinary incontinence underwent clinical and urodynamic evaluation. This included objective assessment of urethral axial positions and mobility with use of a specially designed protractor. Comparative analysis of urethral axial data was done between 70 incontinent women with objective evidence of sphincteric incompetence and 24 continent women without it. The urethral axis at rest, during bearing down, and in its total excursion were found to be not significantly different and distributed similarly between both groups. Assessment of the urethral axis was found to be not predictive of urethral function.

Cough↗
PubMed1986

Intraluminal urethral pressure measurements in the female baboon: effects of hormonal manipulation.

Four female baboons underwent cystometry and simultaneous urethral pressure profilometry (UPP) in a hypoestrogenic castrate state, after estrogen treatment, and after concurrent testosterone and estrogen treatment. Studies were performed under general anesthesia both before and after skeletal muscle paralysis. The results provide objective evidence that estrogen replacement enhances the urethral sphincter mechanism in the castrate female baboon by significantly increasing the paralyzed and nonparalyzed urethral length as well as the paralyzed total UPP area and the paralyzed UPP area to maximum urethral closure pressure (MUCP). The area increases reflected both the increase in functional urethral length as well as increases in mean urethral pressure. Muscle paralysis significantly reduced MUCP in all three hormonal states. The addition of testosterone had no significant effect on the UPP measurements. These findings are discussed in light of conflicting human studies regarding objective evidence for the role of hormonal modulation of urethral function and the role of estrogen therapy for stress urinary incontinence.

Animals↗
PubMed1986

Sexually transmissible infectious agents in sexually active and virginal asymptomatic adolescent girls.

Sixty-eight sexually active and 52 virginal adolescent girls were evaluated for six sexually transmissible infectious agents: Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis, Trichomonas vaginalis, and Neisseria gonorrhoeae. There were significant differences between sexually active and virginal girls with respect to the prevalence of isolation of U urealyticum (75% v 33%, P less than .005), M hominis (27% v 10%, P less than .05), and C trachomatis (19% v 2%, P less than .025) but not for G vaginalis (34% v 17%, P = .09). N gonorrhoeae and T vaginalis were isolated exclusively from sexually active girls, but their low prevalence (6% and 9%, respectively) made the difference statistically insignificant (P = .2 and .06, respectively). Race, current v previous sexual activity, multiple sexual partners, oral contraceptive use, and concurrent isolation of another organism did not identify those at increased risk for chlamydial isolation. Such girls were significantly more likely to have inflammatory Papanicolaou smears (36% v 10%, P less than .05) and excessive WBC in their vaginal secretions (50% v 19%, P = .05). The data support the contention that C trachomatis, N gonorrhoeae, and T vaginalis are organisms that are predominantly acquired via sexual routes. Significant nonsexual modes of transmission are supported by the data for the genital mycoplasmas and G vaginalis. Finally, a history of sexual activity in an adolescent female warrants specific diagnostic testing for Chlamydia.

Adolescent↗
PubMed1985

Urethral isolation of the genital mycoplasmas and Chlamydia trachomatis in women with chronic urologic complaints.

Eighty-six abacteriuric women with chronic urologic complaints were studied to determine the relationship of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum to their symptoms or diagnoses. All patients had urethral scrape specimens for isolation of the three organisms as well as a detailed urologic history and urodynamic evaluation. Thirty-three of 86 patients (38%) had positive urethral ureaplasma cultures; seven had concurrent M. hominis isolation. No patient had M. hominis as the only urethral isolate and none had a positive C. trachomatis culture. There were no significant differences in urologic symptoms or in urodynamic diagnoses between Ureaplasma culture-positive and culture-negative subjects. It was also found that colonization of the urethra with Ureaplasma decreased with increasing age and with hypoestrogenism.

Chlamydia Infections↗
PubMed1985

Chlamydia trachomatis as a cause of prepubertal vaginitis.

Chlamydia trachomatis was encountered in four cases during the evaluation of 29 premenarchal girls with gynecologic complaints during 1983. Only one of the patients had antecedent infection with Neisseria gonorrhoeae. The importance of using specific tests to actively establish a definite diagnosis of chlamydia is stressed. The susceptibility of the thin premenarchal vaginal mucosa to chlamydial infection is discussed as is the role of chlamydia as a marker for sexual abuse. Once a diagnosis of chlamydial rectogenital infection is established in a child, it is mandatory to investigate for child abuse and sexual molestation as the source of the infection.

Adolescent↗
PubMed1984

The prevalence, six-month persistence, and predictive values of laboratory indicators of bacterial vaginosis (nonspecific vaginitis) in asymptomatic women.

The natural course of signs and laboratory test findings indicative of bacterial vaginosis was followed in an observational noninterventive 6-month longitudinal study of 270 asymptomatic women. Only the minority of positive Gardnerella vaginalis cultures (5 of 33), wet mount clue cells (5 of 14), sniff tests (3 of 11), Papanicolaou smear clue cells (0 of 5), and discharge consistent with bacterial vaginosis (11 of 49) persisted in the absence of therapy. While these four laboratory parameters as well as chromatographic succinate/lactate ratios (performed only on the final visit) were abnormal significantly more often in patients with abnormal discharge than in those with normal discharge (p = 0.006, p less than 0.0001, p less than 0.0001, p = 0.0003, and p = 0.002, respectively), all were insensitive predictors of abnormal discharge with sensitivities ranging between 10.6% and 20.2% and abnormal test predictive values between 30.6% and 65.2%. We conclude that G. vaginalis represents indigenous flora in some normal women and that therapy is unwarranted for the incidental finding of a positive laboratory indicator of bacterial vaginosis in the patient without symptoms.

Adolescent↗