The relationship between urethral mobility and parity.

OBJECTIVE: Urethral mobility is associated with stress urinary incontinence (SUI) and urodynamic stress incontinence, and this is particularly true for mid-urethral mobility. The purpose of this study was to determine whether there is a significant relationship between segmental urethral mobility and vaginal parity in women undergoing urodynamic testing for prolapse or lower urinary tract symptoms. DESIGN: Retrospective study. SETTING Tertiary referral service for multichannel urodynamic testing. POPULATION: Women undergoing urodynamic testing for lower urinary tract symptoms or pelvic organ prolapse. METHODS: The stored 3D translabial ultrasound volume data sets of 648 women were assessed. Measurements were performed using post-processing software in volumes obtained at rest and on maximal Valsalva manoeuvre. Analysis was based on a co-ordinate system using the dorsocaudal margin of the pubic symphysis. The urethral length was traced and divided into five equal segments. Mobility vectors are determined by the formula radical[(y(V) - y(R))(2) + (x(V) - x(R))(2)], where V indicates Valsalva and R indicates rest, with 'x' as the vertical distance and 'y' as the horizontal distance from the dorsocaudal margin of the pubic symphysis. MAIN OUTCOME MEASURES: Mobility vector lengths. RESULTS: The distal urethra is consistently the least mobile part of the organ, regardless of parity. Vaginal childbirth seems to increase urethral mobility by about 20% for all urethral segments (all P < or = 0.009). The first vaginal delivery showed the greatest effect, particularly on mid-urethral mobility. CONCLUSIONS: There is a significant association between urethral mobility and vaginal delivery in women seen for symptoms of pelvic floor dysfunction, affecting all segments of the urethra equally. Most of this effect seems to result from the first vaginal birth.

Pulmonary effects of acebutolol, a "cardioselective" beta adrenergic blocking agent.

The effect of chronic oral therapy with acebutolol, a cardioselective beta adrenergic blocking agent, was evaluated on resting pulmonary functions in a group of patients who were free of overt obstructive airways disease and who had chronic stable angina pectoris. The study design involved a 20-week, placebo-controlled, double-blind, randomized cross-over trial, using acebutolol, an agent with partial agonist activity that has been shown to be effective in the treatment of hypertension, cardiac arrhythmias, and angina pectoris. Utilizing spirometry, flow volume loops, and arterial blood gas analyses, this study demonstrated that acebutolol had no significant deleterious effect on resting pulmonary function when used in clinically effective dosages.