Clinical significance of urethral instability.

Variations of urethral pressure were registered with microtransducers in 427 gynecologic patients with lower urinary tract symptoms during urethrocystometry. Urethral instability (variation of urethral pressure greater than 15 cm of water) was found in 16.4% of patients. The comparison of the urinary symptoms and the urodynamic data between patients with urethral instability (without previous surgery for incontinence, N = 57), and patients with stable urethra (variation of urethral pressure less than 5 cm of water, N = 269) showed that urethral instability was related to frequency, nycturia, urgency, and a history of urethral syndrome. In 27% of patients, the urethral instability was associated with a bladder instability. The comparison between patients with urethral instability and stable bladder (N = 51) and patients with bladder instability and stable urethra (N = 41) revealed that bladder instability seems to be more important than urethral instability as a factor associated with nycturia, urgency, and urge incontinence.

[Peridural anesthesia in obstetrics: impact on the lower urinary tract]. / Anesthésie péridurale en obstétrique: répercussions sur le bas appareil urinaire.

The results of non-invasive urodynamic examinations (urinary flow rates and ultrasound determination of residual urine in the bladder) and of urinary bacteriology were studied 4 or 5 days after delivery in 305 patients. The method of delivery and other clinical and obstetric parameters that could influence lower urinary tract function have been considered. The numbers of urines that contain bacteria in quantities of more than 10(5)/ml are significantly raised as compared with the control group after spontaneous delivery under continuous epidural analgesia (15% as compared with 4.5% - p less than 0.01). Continuous epidural anaesthesia increases the risk of urinary tract infection and is significantly associated with a prolongation of labour as well as an frequency of catheterisations as well as episodes of urinary retention. This compromises the likelihood of starting normal micturition after delivery.

Urodynamic and clinical assessment of the Lyodura sling operation for urinary stress incontinence.

A Lyodura sling operation for urinary stress incontinence was performed on 36 patients. The success rate was 89%, when success was defined as absence of objective urine loss at coughing or straining, with full bladder in the upright position and during a Urilos test, at least 6 months after surgery. Full urodynamic assessment, including urethral rest and stress profiles, were performed before, and 6 months after, surgery. Success of the operation depended mainly on enhancement of urethral pressure transmission. Functional length of the urethra and maximal urethral pressure did not influence the success rate. The procedure is especially suitable in patients with some degree of uterine or vaginal prolapse.

Angioplasty of a stenotic aorto-renal artery saphenous vein bypass graft to a single kidney.

A 69-year-old white woman who 18 months previously had undergone a right nephrectomy and an aorto-renal artery saphenous vein bypass to her left kidney because of accelerated hypertension underwent angioplasty repair of the saphenous vein bypass, which had become stenotic and was causing accelerated hypertension and renal failure. Angioplasty resulted in improvement in BP control and renal function. This is the first report of a successful angioplasty of an aorto-renal saphenous vein bypass. This case also demonstrates the previously described captopril-induced acute renal failure seen in patients with compromised renal perfusion pressure.

Modifications of the urethral rest and stress profiles after different types of surgery for urinary stress incontinence.

Full urodynamic assessment, including urethral profiles at rest and under stress, using microtransducers, was made before and at least 6 months after surgery for urinary stress incontinence in 86 patients. Cure was assessed objectively. Procedures compared were Burch colposuspension, Pereyra urethrovesical suspension and anterior colporrhaphy. The Burch colposuspension increased the pressure transmission ratio more efficiently than the vaginal operations and the cure rate was 91%. Only 50% of Pereyra operations were successful and success was related to an increase in the functional urethral length and in the pressure transmission ratio. The success rate for anterior colporrhaphy was 57% and was associated with a significant decrease in the maximal urethral closure pressure and the continence area. The prognostic value of the urethral profiles at rest and under stress and the therapeutic implications are discussed.

Effect of lumbar epidural analgesia on lower urinary tract function in the immediate postpartum period.

Urodynamic investigations including cystometry and electronic simultaneous urethro-cystometry were made in 27 primiparae between 2 and 5 days after delivery to assess possible effects of lumbar epidural analgesia on the function of the lower urinary tract. Three groups of patients were studied: 11 patients had vaginal delivery without epidural analgesia, 11 patients with similar obstetrical characteristics were delivered vaginally with epidural analgesia, and five others were delivered by caesarean section under epidural analgesia. The group of patients who were delivered vaginally under epidural analgesia had a significantly higher incidence (n = 4) of hypotonic bladders as determined by cystometry than the group without epidural analgesia (n = 0), (P less than 0.05). The maximum cystometric capacity was significantly greater (P less than 0.05) in the group who delivered vaginally with epidural analgesia than in the group without epidural analgesia, as well as the caesarean section group (with epidural analgesia), (P less than 0.01). Possible side effects of epidural analgesia implied by these results are discussed and a method for surveillance of urethrovesical function both during labour and after parturition is proposed.

Clinical relevance of urethral stress profile using microtransducers after surgery for stress incontinence in females.

The value of the urethral stress profile after surgery for urinary stress incontinence in females was prospectively analyzed using microtransducers. 95 patients were clinically and urodynamically assessed at least 6 months after surgery. The success of the operation was based on subjective (patient's history) and objective (no urine loss, erect, with full bladder, on coughing and during a Urilos nappy test) criteria. In 20% of the cases, the interpretation of the urethral profiles did not correlate with the clinical objective criteria. Possible explanations for this discrepancy are discussed.

Giant mediastinal lymph node hyperplasia (Castleman's disease): angiographic and clinical features.

The angiographic and clinical features of two cases of mediastinal angiofollicular lymph node hyperplasia (Castleman's disease) are presented. The masses were angiographically and microscopically extremely hypervascular. Both patients had profuse bleeding at initial surgery. In one patient, angiographic embolization after an initial attempt at resection made complete excision possible. These lesions behave in a benign fashion, and complete surgical excision is curative.

Angiographic diagnosis and treatment of bleeding by selective embolization following pelvic fracture in children.

Angiography has been used successfully in adults for evaluation following major trauma and to subsequently control hemorrhage associated with pelvic fracture by selective embolization. This report illustrates that the technique is applicable in the evaluation and treatment of children with similar injuries.