ABSTRACT
PURPOSE: We evaluated Valsalva and cough-induced leak point pressure measurements identically and compared their reliability in the patients with stress urinary incontinence (SUI). MATERIALS AND METHODS: Seventy-five patients complaining of SUI were assessed with medical history, uro-gynecological examination, any factors that could affect voiding symptoms, and videourodynamic study consisting of Valsalva leak point pressure (VLPP), cough-induced leak point pressure (CILPP) on supine and erect position, prospectively. We observed the location and descent of bladder neck on fluoroscopic images, and VLPP, CILPP synchronously. The bladder neck position, the degree of bladder neck descent, VLPP and CILPP were compared, then the correlation of each was analysed. RESULTS: The lower the position of initial bladder neck is, the more severe the descent of the bladder neck is in supine (Valsalva; r=0.305, p0.05). VLPP and CILPP in SUI type III are significantly lower than those in SUI type I and II (p<0.05), but VLPP and CILPP were not correlated to subjective symptoms of SUI. CONCLUSIONS: Both VLPP and CILPP are reliable in evaluation of SUI. However, ecause VLPP is reliable regardless of position and easier than CILPP in the measurement, it is expected as more useful method. If CILPP is used, it must be evaluated in the erect position.
Subject(s)
Humans , Cough , Neck , Prospective Studies , Supine Position , Urinary Bladder , Urinary IncontinenceABSTRACT
Numerous devices and techniques have been devised to facillitate the difficult endotracheal intubation. Percutaneous retrograde intubation was first described by Waters, who used a Tuohy needle to puncture the cricothyroid membrane and an epidural catheter as a guideline in 1963 and many variations on the technique have been described. Failure to intubate 2 male adult patients were planned retrograde tracheal intubation using the cricothyroid membrane. While the patients were awake, and after adequate local anesthesia was obtained, a 16G Medicut was punctured through cricothyroid membrane. After confirmation of the intratracheal position by aspiration of air into syringe, the opening of the Medicut was directed upward foward the larynx and the epidural catheter was inserted through it and advanced retrograde between the vocal cords and into mouth. The epidural catheter tip was passed through the Murphy's eye from outside to inside and out of the tracheal tube. By keeping the catheter taut and coincidently pulling back, the tube was advanced into trachea. Correct positioning of the tracheal tube inside the trachea was confirmed by end-tidal carbon dioxide monitoring and auscultation. Another 2 male adult patients were intubated by using cricotracheal retrograde approach method. We experienced successful retrograde tracheal intubation without significant complications using an epidural catheter through cricothyroid membrane and cricotracheal ligament in 4 male adult patients who were predicted impossibility of simple orotracheal intubation. (Korean J Anesthesiol 1995; 29: 304~309)
Subject(s)
Adult , Humans , Male , Anesthesia, Local , Auscultation , Carbon Dioxide , Catheters , Intubation , Intubation, Intratracheal , Larynx , Ligaments , Membranes , Mouth , Needles , Punctures , Syringes , Trachea , Vocal CordsABSTRACT
We retrospectively evaluated the 20 patients who underwent the Raz operation for stress urinary incontinence. In the degree of severity, 4 cases were in Stamey grade I, 14 cases in Stamey grade II and 2 cases in Stamey grade III. Posterior urethrovesical angle(PUVA) and Urethral inclination angle(ULA) on lateral cystourethrogram were measured preoperatively and postoperatively. Preoperative PUTA and ULA were increased as the grade was higher, but postoperative PUVA and ULA were returned to normal range. The overall success rate were 90% and complications were minima1. We think that Raz technique for stress urinary incontinence is safe, reliable and low morbidity procedure.