Biomedical subjects
Publications and source records attributed to R C Feneley.
Microtip catheters are being used increasingly for measurement of the urethral pressure profile. The orientation of the pressure sensor is critical and attention is drawn to variations of the measured parameters in different sensor positions. A standardization of transducer orientation is necessary and the lateral (9 o'clock) position is suggested.
The effect of opiate analgesics (omnopon, pethidine, pentazocine) on the urethral mucosal sensitivity threshold in 37 patients, and of the potent opiate/opioid antagonist naloxone on 10 volunteers is described. Omnopon and pentazocine caused a significant decrease in sensitivity (p less than 0.02) and naloxone caused a significant increase in sensitivity (p less than 0.02). The results confirm a role for the endogenous opioids in modulating urethral sensitivity, and the implications of this are discussed.
Thirty-two female patients with continued urinary incontinence, following a period of urethral catheterisation, have been treated by suprapubic catheterisation. A technique is described for closure of the female urethra and this has been effective in 20 out of 24 patients. The procedure has been undertaken in some patients with advanced neurological disease and in the presence of pressure sores.
The follow-up of 28 patients with urinary incontinence treated with periurethral Teflon injection revealed significant improvement in 53.6% and complete cure in 21.4%. Patients most likely to benefit were those with weak sphincters and stable detrusors. The method is quick and safe and requires only a brief hospital stay. It is suitable for patients in whom conventional operative techniques have failed or in whom surgery is best avoided on medical grounds.
Twenty-five patients who underwent nephrectomy for chronic pyonephrosis were studied retrospectively. Such patients may present with a wide range of symptoms. Marked haematological and biochemical abnormalities are found, the most striking being a gross elevation of plasma viscosity (or ESR) and a raised alkaline phosphatase. The resulting picture often suggests extrarenal disease, and diagnostic confusion occurred in a number of patients.
Much interest has been shown recently in the plight of the incontinent patient and how incontinence should be managed. Incontinence has a complex aetiology and may be part of many medical and social problems. Because there is a delay between completing investigations and making a diagnosis we have established a system of nursing care. Initially this was meant to provide the person protective garments and appliances, but it now covers management in both the community and the hospital. The preliminary results show that patient assessment is effective and that specialist nurses and a co-ordinated scheme to educate both doctors and nurses are needed.
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A single blind trial of the effect of opioid blockade on lower urinary tract function, assessed urodynamically, is reported. Twenty patients (10 male, 10 female) were studied by filling and voiding cystometry and urethral pressure profilometry before and after the administration of a potent opioid antagonist, naloxone. A significant rise in subtracted detrusor pressure was demonstrated throughout bladder filling. Cystometric bladder capacity was reduced at both first and urgent desire to micturate. Significant reduction of the urethral closure pressure was also seen. These effects represent evidence of an endogenous opioid dependent element in the control of lower urinary tract function.
Two hundred four male patients (aged twenty to forty-five years) with symptoms of lower urinary tract dysfunction have been investigated by urodynamic studies. Patients with symptoms of bladder overactivity (53 per cent) had a low incidence of bladder outflow obstruction but a high incidence of bladder hypersensitivity and bladder instability. Their symptomatic complaints accurately reflected their cystometric findings and, therefore, a urine flow rate estimation was the only necessary urodynamic investigation in most cases. Urine flow studies are an essential first investigation in all patients with possible bladder outflow obstruction (26 per cent), and full studies were necessary in many patients to discriminate the low flow rates produced both by outflow obstruction and by bladder underactivity which were diagnosed in a high proportion of patients. Similarly, in the neurologically abnormal patients (12 per cent), full urodynamic studies were necessary with the studies described in this article the minimum required.
One hundred and seven patients with symptoms of prostatic obstruction in whom prostatectomy was not clinically indicated were reviewed after an interval of 5 years. Ten had subsequently required surgery and 97 remained untreated. In the majority, symptoms did not worsen and only 2 developed acute retention. Urodynamic studies, where repeated, showed little change. Although there was no certain indicator or progression, a flow rate measurement could identify the patients at risk of clinical deterioration sufficient to require surgery.
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Clinical and urodynamic features of patients at risk from acute retention were investigated in 2 retrospective studies. It is suggested that detrusor decompensation may be a cause of acute retention in some individuals. This factor was investigated in a series of patients with outflow obstruction by a method of repeat cystometry.
The results of testing posterior urethral electrosensitivity in a variety of urological conditions are demonstrated and the relationship between urethral sensitivity and the standard urodynamic investigations discussed. The clinical features of a group of patients with urethral hyposensitivity are presented.