Correlation of bladder base elevation with pelvic floor hypertonicity in women with lower urinary tract symptoms.
ABSTRACT To determine whether the bladder base elevation as revealed by cystogram under fluoroscopy is associated with pelvic floor hypertonicity or bladder outlet obstruction (BOO) in women.
Sixty-two women who were referred to our videourodynamic laboratory for assessment of lower urinary tract symptoms (LUTS) were included in this retrospective analysis. Thirty-one of these women with bladder base elevation-revealed by cystogram under fluoroscopy during videourodynamic study-served as the experimental group, and another group of 31 women without bladder base elevation served as control. None of the patients had neuropathy, previous pelvic surgery or chronic urinary retention. The clinical symptoms, urodynamic diagnosis, and parameters were compared between the two groups.
The mean voiding pressure (Pdet.Qmax) and postvoid residual (PVR) were significantly greater, and maximum flow rate (Qmax) and voided volume were significantly lower in the bladder base elevation group. When a Pdet.Qmax of >or=35 cmH2O combined with a Qmax of <or=15 ml/sec in pressure flow study was used to diagnose BOO, significantly more patients in the bladder base elevation group had BOO than controls (51.6% vs. 9.7%, P=0.0003). Pelvic floor muscle electromyogram (EMG) was dyscoordinated during the voiding phase in 18 (58.1%) and 9 (29%) of the patients with and without bladder base elevation, respectively (P=0.0212).
Women with LUTS and bladder base elevation revealed in the filling phase of videourodynamic study had significantly higher voiding pressure and incidence of dyscoordinated pelvic floor EMG activities during voiding, suggesting a higher incidence of BOO and pelvic floor hypertonicity.
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ABSTRACT: The external sphincter spasticity syndrome is described with regard to diagnosis, etiology, pathophysiology and treatment. Use of urodynamic techniques (especially urethral pressure profile and diagnostic pudendal blocks) and adrenolytic agents and diazepam in the treatment of the dysfunction is discussed. We consider this clinical entity to be much more common than perviously reported.The Journal of Urology 05/1976; 115(4):443-6. · 3.70 Impact Factor
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ABSTRACT: Every child with day and night wetting is a suspect for vesicourethral dysfunction on a behavioral basis, which, when severe, appears as a syndrome that we have called the nonneurogenic neurogenic bladder. Futile attempts by the child at sphincteric urinary control in the face of uncontrollable bladder contractions not only produce the symptoms but also the anatomical and functional changes: vesical trabeculation, distortion of the ureterovesical orifices and dilatation of the upper tracts, along with residual urine and consequent bacteriuria. These changes are indistinguishable from obstructive or, particularly, neurogenic factors, although these causes must be ruled out. Urodynamic investigations in these children show incoordination between detrusor contraction and the expected but not forthcoming urethral sphincteric relaxation. Since these children usually are toilet trained initially, the incoordination appears to be a learned behavior or habit, perhaps as a response to under-appreciated detrusor contractions. Reversal of the syndrome is achieved by suitable medication and by some form of suggestion or retraining. Reparative operations will fail if done before the system is balanced.The Journal of Urology 11/1986; 136(4):769-77. · 3.70 Impact Factor
- The Journal of Urology 05/1973; 109(4):727-32. · 3.70 Impact Factor