Diagnostic Categories of Incontinence and the Role of Urodynamic Testing

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111148/1/j.1532-5415.1990.tb03509.x.pd

Bethanechol chloride in neurogenic bladder dysfunction

Representative case summaries of patients with different types of neurogenic bladder diagnosed by combined cystometric-perineal electromyography and treated with bethanechol (Urecholine) are presented. Determination of the activity of the periurethral striated muscle in relation to bladder dysfunction is extremely important in the selection of patients for bethanechol therapy. In the absence of structural obstruction, bethanechol can be used in patients with (1) the early phase of coordinated reflex neurogenic bladder and sphincter when there is incomplete bladder emptying due to feeble or unsustained detrusor contractions, (2) recovery phase of spinal shock when the periurethral striated muscle has recovered and is under voluntary control, (3) incomplete motor paralytic bladder with coordinated sphincter, and (4) sensory paralytic bladder with deeompensation. The bethanechol regimen will vary in accordance with the type of bladder being treated.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21646/1/0000030.pd

Urinary Incontinence in Elderly Women: Urodynamic Evaluation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111142/1/j.1532-5415.1987.tb02296.x.pd

Action of oral and parenteral bethanechol on decompensated bladder

A double blind balanced Latin-square study was conducted on 20 adult patients with decompensated bladders to determine the relative effectiveness of oral and parenteral bethanechol chloride (Urecholine) on the stretch response of bladder muscle. Detrusor reaction was measured by modified cystometry. Five mg. of subcutaneous bethanechol chloride produced a significant increase in intravesical pressure which was more rapid in onset, of larger magnitude, and of shorter duration than oral doses of 100 and 200 mg.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22876/1/0000439.pd

Success with penile prosthesis from patient's viewpoint

This study is designed to explore the patient's point of view on success with penile prosthesis. Detailed questionnaires were sent to 57 penile prosthesis recipients, 38 of whom responded. Overall, 89 per cent claimed improved sexual satisfaction, and 76 per cent noted improved self-image with their prostheses. Seventy-six per cent claimed their partners approved of the prosthetic device. Prosthetic appearance was satisfactory to 87 per cent. Five patients, knowing what they now know, would not have had the prosthetic implantation. A significant factor in 4 of the 5 patients was lack of partner approval. We conclude penile prosthesis implantation is successful in returning satisfactory sexual intercourse to impotent men and their partners. Partners of those desiring penile prosthesis should be included in the preoperative evaluation process.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24971/1/0000398.pd

Uninhibited neurogenic bladder in adults

The uninhibited neurogenic bladder is a common entity. It is characterized by urge incontinence, frequency, enuresis, and recurrent urinary tract infections. The diagnosis can only be made by a thorough urologic investigation, including cystometrography. A sound treatment program involves the use of anticholinergic medication to abolish uninhibited contractions, frequent voiding to keep intravesical pressure low, and antibiotic treatment when indicated for concurrent infection.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21800/1/0000199.pd

Review of neurogenic bladder in multiple sclerosis

Neurologic involvement of the urinary bladder and urethral sphincter in multiple sclerosis has been known for some time. Thirty-one patients with a proved diagnosis of multiple sclerosis were evaluated urologically for symptoms of urinary incontinence, retention, or urinary tract infection. On initial presentation, 27 (74 per cent) were found to have neurogenic bladders of which 23 (85 per cent) were of the uninhibited type. Electromyography of the periurethral striated muscle revealed vesicosphincter incoordination in 9 of the 19 patients studied. Approximately one-half of the patients with uninhibited bladders had uncoordinated sphincters. Modalities of treatment are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23659/1/0000627.pd

Cystometric and perineal electromyography in spinal cord-injured patients

The results of combined cystometry and perineal electromyography were reviewed retrospectively in 50 consecutive, traumatic spinal cord-injured patients. Early and frequent uro-dynamic evaluation was found necessary in order to tailor treatment to the changing cystometric and electromyography states in these patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23281/1/0000218.pd

Clean intermittent self-catheterization in the elderly

There has been some doubt as to whether or not the elderly patient can successfully master and comply with clean intermittent self-catheterization in the treatment of their bladder dysfunctions. We recently reviewed our experience with intermittent self-catheterization in patients sixty years of age and older to determine whether or not this was an acceptable alternative to other methods of urinary drainage. Our retrospective analysis of 65 patients between the ages of sixty and eighty years revealed that the elderly patient had little difficulty mastering the technique of intermittent self-catheterization. Complications were minimal and in general correctable. The catheterization program was successful in 94 per cent of the patients in our series.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24950/1/0000377.pd

Predicting lower urinary tract dysfunctions in patients with spinal cord injury

The results of combined cystometry and perineal electromyography were reviewed retrospectively in 75 consecutive, traumatic spinal cord-injured patients to predict lower urinary tract dysfunctions. In patients with vertebral spinal injuries at vertebral level T7 or above a reflex neurogenic bladder eventually developed. In those with vertebral level injuries T11 or below a lower motor neuron bladder dysfunction developed. Injuries at the vertebral levels T8, T9, and T10 represent a gray zone; and, depending on adjacent soft tissue injury, in these patients an upper or lower motor neuron bladder dysfunction developed. The transition from spinal shock (areflexia) to reflex neurogenic (hyperreflexia) bladder occurred at different times in different patients and could not be correlated to level of injury or its severity. The periurethral striated muscle was generally denervated if a lower motor neuron bladder dysfunction existed, however, rarely, dissociation may occur. When a reflex neurogenic bladder existed, sphincter dyssynergia was present 68 per cent of the time. This also could not be correlated with time after injury, level of injury, or severity of injury.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24218/1/0000477.pd