[FPSUND: a pan-Canadian evaluation of a clinical classification of urinary incontinence]. / FPSUND: évaluation pan-canadienne d'une classification clinique de l'incontinence urinaire.

Historically, urinary incontinence is divided into 3 subtypes: stress, urge and mixed. This latter group, which according to many studies can account for up to 50% of the patients, is very heterogenous. For this same reason, the reports of treatments of urinary incontinence are very difficult to analyse using this simple classification. In a attempt to clarify this situation and to help the acquisition of useful clinical information relating to urinary incontinence, were have developed a clinical classification of urinary incontinence (FPSUND) in which 6 symptoms are graded in severity from 0 to 3. In this acronym, the F stands for frequency, the P for the use of protection, the S for stress-related complaints, the U for urge-related complaints, the N for nocturia and the D for the number of daily micturitions. Urologists across Canada were sent the French or English version of the classification and used it to evaluate 148 female patients aged from 18 to 70, suffering from urinary incontinence. A second, independent evaluation, was also performed on the same patients by registered nurses or urodynamic technicians. Reproducibility between observers, as assessed by the weighted Kappa score ranged from 0.47 and 0.74 (p < 0.05), was very good. Generally, the users of the classification found it very easy to use. In summary, we propose the FPSUND clinical classification of urinary incontinence as a useful and accurate tool to classify urinary incontinence and as a means to assess treatment outcome.

Radioimmunodetection of human bladder tumor xenografts in nude mice with radiolabeled monoclonal antibodies.

The tumor targeting potential of two monoclonal antibodies (mAbs) reacting with growth-regulated surface glycoproteins of human bladder cancer was investigated. The mAb T16 reacts more intensely with stationary cells while the mAb T43 is preferentially reactive with exponentially growing cells. The test target was T24 human bladder cancer cells grown subcutaneously in 30 nude mice. Controls for tumor specificity were human lung cancer cells grown on the contralateral side. Purified mAb's T16 and T43, and Om5, a non-reactive control, were radiolabeled with 131-Iodine and injected intravenously in doses ranging from 50 to 300 microCi in tumor-bearing animals. Consistent images of the bladder cancer xenografts were obtained at 48 and 72 hours with tumors as small as 0.1 gm. High resolution tumor images were obtained only with the reactive antibodies and according to their in vitro specificity. These results demonstrate that the two mAbs T16 and T43 can specifically and sensitively localize human bladder cancer cells in vivo.

[Perineal retraining in urinary stress incontinence]. / La rééducation périnéale dans l'incontinence urinaire d'effort.

Twenty patients suffering from urinary stress incontinence were treated by perineal reeducation. The assessment included a medical and urological questionnaire, a physical examination, a urine analysis and culture, a cystoscopy, urinary flow and cystometry, a urethral pressure profile and a subjective evaluation of the perineal musculature. The 20 patients selected had documented stress incontinence, had never been operated on for incontinence and had a stable bladder at urodynamic assessment. Treatment was identical for all patients and included 12 biofeedback and electrostimulation sessions over a 4 to 6 week period. The questionnaire, urodynamic and perineal assessment were repeated at the end of treatment. No complication occurred. Micturition frequency decreased in all patients. Clinical correction of incontinence was observed in ten patients, improvement in nine and no change in one for an overall cure or improvement rate of 95%. The urethrocystocele evaluation did not change. Perineal evaluation and urodynamic parameters were only slightly improved. At follow-up evaluation 6 to 9 months post treatment, a 75% cure or improvement rate was still present. Perineal reeducation is a non morbid and effective modality to correct urinary stress incontinence. Its long term efficacy and its use for other types of incontinence has to be demonstrated.

[Does perineal muscle testing provide information on the quality of the urethral sphincter in women?]. / Le testing des muscles périnéaux renseigne-t-il sur la qualité des sphincters urétraux de la femme?

A prospective study was carried out on 100 women presenting with urinary incontinence with the intent of determining whether a relationship could be found between the quality of the perineal musculature, as assessed by testing the levatores, and that of the urethral sphincters, as assessed by a study of the urethral pressure profile, thereby defining the respective importance of each of these tests. The mean maximum closing pressure values were compared for three groups whose testing was scored good, fair or nil. Evidence of a positive relationship existing between the levatores testing and the maximum closing pressure against rest (p less than 0.05) and stress (holding-back) (p less than 0.01) urethral pressure profiles was brought forth. However, this relationship does not allow to extrapolate the testing results to the sphinters. In practice, at the individual patient level, one may be satisfied by merely testing the pelvic musculature in case of reeducational treatment of incontinence. Nevertheless, whenever surgery is indicated, objective assessment of the urethral sphincters by ways of an urethral pressure profile study is mandatory.

The white blood cell differential. Evaluation of rapid impression scanning versus the routine manual count.

A quick, one and a half-minute qualitative microscopic scan was investigated as an alternative approach to the more labor-intensive 100-cell differential white blood cell count. The scanning results of 400 randomly selected hospital cases were compared with the on-line results of the 100-cell counts. Additionally, 50 cases selected to have a high percentage of abnormal results were each scanned and manually counted by four different readers. The results indicate that the scanning differential is equivalent to the 100-cell manual count in the detection of the presence of abnormal cell types such as immature granulocytes and blasts. Its ability to properly estimate the relative proportions of normal cells, especially lymphocytes, however, does not appear as reliable as the manual count. Most importantly, the analysis demonstrates that the scanning differential count exhibits a set of advantages and disadvantages that is complementary to those of the "three-part differential" technic provided by the newer generation automated hematologic analyzers. The authors therefore propose that these two procedures used in combination offer a suitable alternative to the manual 100-cell differential count.