N. Schmidt

University Hospital of Lausanne, Lausanne, Vaud, Switzerland

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Publications (6)9.18 Total impact

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    ABSTRACT: This study evaluates the usefulness of the urethral pressure profile (UPP) parameters in assessing the severity of genuine stress incontinence (GSI). Functional length (FL), maximum urethral closure pressure (MUCP), pressure transmission ratio (PTR), residual area at stress (RAS), number of patients with incontinent spikes (IS), and distribution of IS on UPP were determined in supine and standing position for 54 patients (group 1) with a 1-hour pad test < 2 g and compared with the values of 63 patients (group 2) with a 1-hour pad test > 2 g. The results were similar: FL (supine: 24 mm +/- 6/26 mm +/- 7 [P:0.2]; standing: 26 mm +/- 8/24 mm +/- 11 [P:0.5]); MUCP (supine: 51 cm H2O +/- 23/47 cm H2O +/- 20 [P:0.3]; standing: 45 cm H2O +/- 21/38 cm H2O +/- 18 [P:0.1]); and PTR (supine: 83% +/- 27/84% +/- 31 [P:0.9]; standing: 81% +/- 25 and 88% +/- 27 [P:0.3]). But the RAS was lower (supine: 502 mm2 +/- 497/246 mm2 +/- 268 [P < 0.009]; standing: 500 mm2 +/- 534/271 mm2 +/- 306 [P < 0.05]) in group 2. If the percentage of patients with IS was higher (supine: 57/93% [P < 0.001]; standing: 54/84% [P < 0.01]) in group 2, the distribution of IS over the entire FL demonstrated no differences between group 1 and 2. In conclusion, except for the RAS, standard UPP parameters cannot be considered determinant in assessing the severity of GSI.
    Neurourology and Urodynamics 01/1994; 13(1):21-8. · 2.67 Impact Factor
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    ABSTRACT: Birth trauma is the most important etiological factor in the genesis of stress urinary incontinence in women (SUI). There is a high incidence of SUI during pregnancy, and after delivery SUI persists in a small percentage of women (2-3%). Almost all studies on perineal muscle function reveal decreasing intravaginal pressures in the days after delivery which rarely return to predelivery levels. A few urodynamics studies have demonstrated reduced urethral closure pressures and functional length after vaginal delivery, but the importance of such findings in the genesis of SUI is controversial. Better consensus has been found when pelvic floor neurophysiology was carried out: there is electromyographic evidence of a denervation-reinnervation pattern in the striated urethral sphincter muscle and occasionally prolonged pudendal conduction times when the pudendal nerves are directly stimulated. Histomorphologic studies of the pelvic floor have demonstrated that, in some women, abnormal collagen types are responsible for vaginal prolapse and accompanying SUI. Finally, the great importance of perineal reeducation by electromyostimulation and biofeedback in patients with traumatic pelvic floor pathology may be emphasized, but the importance of its role in the prevention of late SUI development remains to be established by more prospective studies.
    Gynäkologisch-geburtshilfliche Rundschau 02/1993; 33(4):236-42.
  • S. Meyer, P. Grandi, N. Schmidt
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    ABSTRACT: The effect of babies >3500 g primimultiparity, previous forceps deliveries, obesity and stress urinary incontinence on urethrovesical junction mobility (UVJ) was determined by the Q-tip test in 440 women divided into four groups according to age. The urethral axis under stress (UAS) for these different categories of patient compared to corresponding nulliparous patients (4921) demonstrates an increasing statistically significant difference in UVJ mobility in primiparas (5621), multiparas (5819), patients with previous forceps delivery (5921) and with deliveries of babies >3500 g (6117). Surprisingly, obesity does not affect UVJ mobility. Except for postmenopausal women, assessment of UAS in patients with GSI by history demonstrates a 5 higher UVJ mobility compared to continent patients (a 10 higher UVJ mobility was found in a fifth group of clinically proven GSI patients). When considering UAS distribution in the four groups, only 6%–33% of nulliparas have a normal UAS of 60, demonstrating perhaps an increased risk of future GSI.
    International Urogynecology Journal 01/1993; 4(1):14-18. · 2.17 Impact Factor
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    ABSTRACT: In order to evaluate the obstructive effects of microtip transducer catheters on flowmetry parameters, 156 patients had a spontaneous uroflowmetry (SU) followed by an instrumented uroflowmetry (IU), with intravesical pressure recording for comparison of maximum flow rate (Qmax), corrected maximum flow rate for volume voided (Qmax.corr.), time to maximum flow rate (TQmax), and flow curve patterns. With SU and IU, Qmax values were 26±11 ml/s compared with 21±11 ml/s (Pmax.corr. as 29±10 m/s compared with 21±11 ml/s (Pmax values were 11±9 s compared with 30±52 s (Pmax (2O±20) than with a higher TQmax (17 cmH2O±16) (Pmax and Qmax.corr. and an increase in TQmax values, due to a lowered VOP in many patients, but little difference in curve pattern interpretation.
    International Urogynecology Journal 01/1993; 4(5):274-277. · 2.17 Impact Factor
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    ABSTRACT: A group of 36 patients (18 premenopausal and 18 postmenopausal), all suffering from genuine stress urinary incontinence, underwent conservative treatment with 6 sessions of intravaginal electromyostimulation followed by 6 sessions of biofeedback; 89% of patients reported an improvement, 5.5% considered themselves cured and 5.5% reported no change. Intravaginal pressure measured before and after therapy increased by an average of 11 cm H2O in premenopausal patients and 17 cm H2O in the postmenopausal group. Intravaginal pressure increased in all patients and, according to maximal urethral closure pressure, this increasing intravaginal pressure was observed even in patients with low pressure urethras. The urodynamic factors studied were functional length, maximum urethral closing pressure and pressure transmission, together with urethral surface at rest and during stress, and residual surface. No significant changes were noted before and after treatment. The excellent subjective results contrast with the absence of improvement in these values.
    British Journal of Urology 07/1992; 69(6):584-8.
  • S. Meyer, P. Grandi, N. Schmidt, O. Reymond
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    ABSTRACT: The importance of catheter diameter in causing inaccurate urethral pressure profile recordings was assessed with the aid of a special, dual diameter catheter. Cough pressure profiles obtained in premenopausal and postmenopausal incontinent patients were compared with control groups. The urethral functional length (FL) and pressure transmission ratio (PTR) did not change. The maximal urethral closing pressure (MUCP) decreased with the smaller catheter only in incontinent patients. Similarly, a decreased urethral surface at rest (USR) was observed for incontinent groups. Continent patients showed no modification of MUCP or USR with change in catheter diameter. The occlusive effect of the catheter was high (21 cmH2O) in incontinent patients and less in continent patients (5 cmH2O). The part played by the occlusive effect of the catheter may therefore be evaluated and considered an element explaining artificially high MUCP that do not reflect clinical reality in certain patients. This occurs most often in incontinent patients due to curvature of the catheter during coughing.
    International Urogynecology Journal 02/1992; 3(1):2-7. · 2.17 Impact Factor