The Urethral Continence Zone and its Relation to Stress Incontinence

Research on the activity of the urinary tract has led to the creation of a theoretical mechanical model where elastic forces, affecting rigid segments represent the living tissue of the urethral walls whereby it is assumed that the tissue acts as an elastic material. Such a model provides a clearer picture of changes in the physical parameters of the elastic walls of the urethra and facilitates better analysis of measurement errors. Artefacts make it exceptionally difficult to accurately measure the urethral pressure profile. The known methods have a measurement error of at least 30%. We have been trying to eliminate the basic error caused by the size of the measuring sensor. The method involves measuring the urethral pressure profile in one patients using several sensors of varying diameters. The problem was defined mathematically. By extrapolation of measuring points, the value of elastic force under normal conditions can be obtained. Preliminary results of pressure profile measurements in our patients are much more accurate than those of other currently known measuring techniques. It is too early, however, to predict the extent of increased objectivity in the results of the new method for measuring urethral pressure profile, with and without functional electrical stimulation. The parameters of stimuli produced by our electrical stimulators will be based upon these findings.

Section: Resultsmentioning

confidence: 99%

Model of the Proximal Urethra: Measurement of the Urethral Stress Profile

Plevnik¹

1976

“…Area measurements on urethral closure pressure profiles in women have been re ported by Gleason et al [5], who found that the area of the proximal part of the profile from the point of pressure increase to the point where perfusion liquid escaped through the external meatus as well as the total area of the pressure profile were significantly lower in 18 stress-incontinent women than in 21 controls. The results obtained by Bright [6] compared stress-and urge-in continent women and found a significantly lower profile area in the former but gives no data regarding the age of the patients.…”

Section: Discussionmentioning

confidence: 99%

A Planimetric Study on the Female Urethral Closure Pressure Profile

Mortensen¹,

Kierulff²,

Frimodt-Møller³

et al. 1982

Integration of the pressures along the functional part of the female urethral profile performed by planimetry adds information to what can be obtained by measuring functional length alone. In 43 patients with urinary stress incontinence, a statistically significant lower area of the profile was found in patients with decreased urethral resistance (diagnosed by pressure-flow study and micturition cystourethrography), whereas patients with cystoure-throcele had larger areas than a control group. Patients with cystocele or bladder insufficiency did not differ from the controls.

“…The UPP with the perfusion technique as first de scribed by Brown and Wickham [1969] gives reproduc ible parameters [Ghonheimet al, 1975], Even with errors in measurement this method is commonly accepted for routine and scientific investigations [Brown, 1975;Plante and Susset, 1980;Susset and Plante, 1980], The conti nence area on the UPP and its relation to stress inconti nence was defined [Gleason et al, 1974;Awad et al, 1978;Mortensen et al, 1982] and seems to be more rele vant than the determination of the functional length and MUP. We took up this proposal and measured the conti nence area with a polar planimeter which is easy to do.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Urodynamic Assessment of Pharmacologic Therapy of Stress Incontinence

Kiesswetter¹,

F²,

Englisch³

1983

30 stress incontinent women with none or mild-degree suspension defects were selected for conservative therapy with an alpha-adrenergic stimulant (midodrine), a chohnesterase inhibitor (distigmine bromide), a tricyclic antidepressant (imipramine) and estriol (Triodurin®). The effect of these drugs on the urethral pressure profile parameters such as maximum urethral pressure and the planimetric index of the continence area were compared with parameters before and after pubovaginal sling operation, before and after single drugs and drug combinations. The medication period in each case was 4 weeks. While the profile area of the continence zone increased after successful suspension surgery by 45%, the increase was 9% after midodrine, 8.9% after imipramine, 7.3% after estriol and 0.48% after distigmine bromide. The maximum urethral pressure showed an increase of the mean values by 8.1% after surgery, 8.3% after midodrine, 7.9% after imipramine, 3.5% after estriol and 3.5% after distigmine bromide. Subjectively, adjuvant therapy, i.e. estriol plus midodrine and estriol plus imipramine, was highly favored by the patients; the urodynamic assessment, however, failed to show significant advantages versus single drug therapy.