Biomedical subjects
S L Stanton
Publications and source records attributed to S L Stanton.
Vaginal cones: a conservative method of treating genuine stress incontinence.
A set of weighted vaginal cones designed to exercise the pelvic floor muscles was used by a group of 39 premenopausal patients with genuine stress incontinence who were awaiting corrective surgery. The effectiveness of the exercises in reducing urinary loss was assessed with a standard urine pad test before and after 1 month of training. Of the 30 women who completed 1 month of the exercises 70% felt they were improved or cured and 90% found it an acceptable method of treatment. Of the 30 women only 11 (37%) opted for surgery after training. There was a highly significant correlation (P less than 0.001, rs = -0.21) between decreased urine loss and increase in retained cone weight.
The use of bladder neck electric conductance (BNEC) in the investigation and management of sensory urge incontinence in the female.
Measurement of urethral electric conductance can be used to detect the movement of urine along the urethra by registering a change in conductivity reading. This technique has been employed in patients complaining of urge incontinence and has shown movements at the bladder neck when urgency is appreciated. Patients with sensory urgency have been successfully managed by learning to control the movements at the bladder neck during a conductivity recording.
The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology.
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Micturition and the mind: psychological factors in the aetiology and treatment of urinary symptoms in women.
The mental state of 211 women attending a urodynamic clinic was assessed using questionnaires. Patients with genuine stress incontinence had scores comparable with other patients with longstanding physical complaints. Patients with sensory urgency were more anxious than those with genuine stress incontinence. Patients with detrusor instability were as anxious as patients with sensory urgency and in addition had higher scores on the hysteria scale. A subset of patients (roughly a quarter of the total) was identified, comprising members of all three diagnostic groups, for whom urinary symptoms rendered life intolerable. These patients were as anxious, depressed, and phobic as psychiatric inpatients, emphasising the serious psychological morbidity experienced by patients with urinary symptoms. Fifty patients with detrusor instability or sensory urgency entered a randomised trial comparing psychotherapy, bladder drill, and propantheline. The psychotherapy group significantly improved on measures of urgency, incontinence, and nocturia, though not on frequency. Bladder training was an effective treatment for frequency and patients became less anxious and depressed. There was a modest improvement in frequency of micturition in patients given propantheline. Frequency may be a learnt disorder which responds to the direct symptom oriented approach of bladder training. Patients with urgency and nocturia predominating might derive more benefit from psychotherapy.
Sixth Report on the Standardisation of Terminology of Lower Urinary Tract Function. Procedures related to neurophysiological investigations: electromyography, nerve conduction studies, reflex latencies, evoked potentials and sensory testing. The International Continence Society.
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Q-Tip test in female urinary incontinence.
The Q-Tip test, an inexpensive and widely used clinical investigative tool, was reevaluated as to diagnostic worth. One hundred patients were investigated with cystometergrams or videocystourethrography, and all patients underwent a standardized Q-Tip test. Thirty-two percent of patients with a positive Q-Tip test had either pure detrusor instability or pure sensory urgency as the diagnosis for urinary incontinence. Twenty-nine percent of patients who had a negative Q-Tip test had a diagnosis of pure genuine stress incontinence. The Q-Tip test was more likely to be positive in younger patients with a cystourethrocele who had undergone less bladder neck surgery. This study demonstrates the limitations of the Q-Tip test and reconfirms the need for more sensitive and specific urodynamic investigations of the incontinent woman.
Long-term follow-up of detrusor instability following the colposuspension operation.
Pre- and post-operative clinical and urodynamic data have been reviewed in 24 women with detrusor instability following colposuspension. Follow-up ranged from 3 to 5 years. Ten women remained asymptomatic throughout; of the remainder, four (28.6%) were improved by drug therapy. With one exception, patients who were symptomatic at the outset remained so at late follow-up.
Sixth report on the standardisation of terminology of lower urinary tract function. Procedures related to neurophysiological investigations: electromyography, nerve conduction studies, reflex latencies, evoked potentials and sensory testing. The International Continence Society Committee on Standardisation of Terminology, New York, May 1985.
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Silastic sling for urethral sphincter incompetence in women.
Conventional sling materials have numerous disadvantages. A reinforced Silastic sling is described and its use reported in 30 patients. There was an 83% symptomatic and objective cure of stress incontinence. The advantages of this material include its consistent strength, adjustability and ease of removal.
Lateral bead-chain urethrocystography after successful and unsuccessful colposuspension.
Twenty-seven patients were studied after colposuspension with lateral bead-chain urethrocystography. Successful operation, compared with unsuccessful operation, repositioned the bladder neck significantly closer to the posterosuperior surface of the symphysis pubis, though not significantly higher. After successful colposuspension, the proximal urethra is exposed to compression against the symphysis pubis by the momentary descent of the pelvic viscera during physical effort. Failure of the colposuspension was usually due to an inadequate repositioning of the bladder neck.
Mechanism of urinary continence after colposuspension: barrier studies.
To test the postulate that colposuspension cures genuine stress incontinence by repositioning the proximal urethra against the posterosuperior surface of the symphysis pubis, 48 patients cured by colposuspension were studied to note the effects of a barrier placed in the vagina to interrupt the posterior route of force transmission. The barrier reduced peak transmission by 59% (P less than 0.0001). When the barrier was used to block compression by the high cystocoele, stress incontinence recurred transiently in 90% of patients. These results confirm Hilton's postulate (1981) that colposuspension constructs a novel, mechanical urinary sphincter rather than restoring normal sphincter function.
Stress incontinence. Why and how operations work.
We still remain uncertain of the precise mode of cure produced by many continence procedures. In achieving a cure, some operations produce unacceptable side effects of urge incontinence and voiding difficulty. True comparison of results of different procedures cannot be made until both subjective and objective results are presented, the criteria for patient entry are documented, and randomized studies using matched patients as far as possible (taking into account factors such as the patient's age, parity, and past history of bladder neck operations) are carried out. A follow-up for at least 2 years and preferably 5 years is necessary. As more than one factor may act to cause urethral sphincter incompetence, operations must be selective, and bearing that in mind, a schematic approach is needed to match the operation with the pathophysiology or anatomic lesion responsible for incontinence.
Stress incontinence: why and how operations work.
We still remain uncertain of the precise mode of cure produced by many continence procedures. In achieving a cure, some operations produce unacceptable side-effects of urge incontinence and voiding difficulty. True comparison of results of different procedures cannot be made until both subjective and objective results are presented, the criteria for patient entry are documented, and randomized studies, using matched patients as far as possible (taking into account factors such as the patient's age, parity and past history of bladder neck operations), are carried out. A follow up for at least two years and preferably five years is necessary. Because more than one factor may act to cause USI, operations need to be selective, bearing that in mind that a schematic approach is needed to match the operation with the pathophysiology or anatomical lesion responsible for incontinence.
Urinary diversion for incontinence--a beneficial procedure?
In the past 8 years at St George's Hospital, 13 women underwent urinary diversion for disabling incontinence. Seven patients had multiple sclerosis, 2 had suffered trauma to the lumbar spine and 4 had failed repeated surgery for urethral sphincter incompetence. One patient died several months postoperatively due to relapse of her multiple sclerosis. The remaining 12 were interviewed to determine the effect of the operation on their quality of life. Preoperatively, 9 patients (75%) were either housebound or only ventured out to do the shopping and none led a full social life. Postoperatively 8 patients (67%) managed a full social life and all were improved. Most managed their stomas proficiently and none regretted having the operation. The most common late complication was pyocystis. We conclude that patients with disabling incontinence can have their quality of life substantially improved by urinary diversion. The incidence of pyocystis is probably high enough to warrant vaginal vesicostomy to be performed routinely at the time of diversion, at least in those women with chronic urinary infection.