Subtrigonal Phenol Injection for Urge Incontinence Secondary to Detrusor Instability in Females

Ewing, R.; Bultitude, Matthew; Shuttleworth, K. E. D.

doi:10.1111/j.1464-410x.1982.tb13625.x

Cited by 50 publications

(21 citation statements)

References 11 publications

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“…A t 10 ml/min t h e median compliance was 11.0 ml/cmH20 ( r a n g e 2.6-183) 1 d i r e c t e d t o t h o s e known t o have a n i n t e r e s t i n urodynamics. I n a d d i t i o n , a q u e s t i o n n a i r e was s e n t t o a t least one c l i n i c i a n , ( u r o l o g i s t , g y n a e c o l o g i s t or g e n e r a l s u r g e o n ) , i n each of t h e 218 Health D i s t r i c t s i n t h e U.K.…”

Section: Resultsmentioning

confidence: 97%

“…. p < 0.05 <AS>...not s i g n i f i c a n t (1) 30 ( years. Twelve p a t i e n t s were being managed with condom drainage, 5 p a t i e n t s with i n i t i a l findings with respect intermittent catheterization, 3 with urethral catheters and 2 with suprapublc catheters.…”

Section: Methodsmentioning

confidence: 99%

“…The findings that the elastic component of $increases linearly with generated pressure, and that only the viscous component was affected by frequency, suggest a new physical model of detrusor muscle mechanics. In that model, the contractile element consists of a force source (1) in parallel with a Newton element, (dash-pot, 2 ) and in series with a non-linear Hook element (spring, (StaPey 1973) and stress leakage (Pereyra 1982, IIundy 1983) and endoscopic (Stamey 1980, Villiaps 1982 and sonographic (Richnund 1987) visualisation of the bladder neck. The difying effect of anaesthesia on urethral function is usually disregarded.…”

Section: Conclusi(3nmentioning

confidence: 99%

“…treatment. The mean number of treatments for the remainder was 2.5 (range [1][2][3][4][5] and included drugs, electronic and behavioural therapies, physiotherapy and phenolisation. None of these made any difference to outcome or to persistence or severity of symptoms, except that the severity and number of symptoms seemed proportional to the number of treatments.…”

Section: One Other Patient Had Developedmentioning

confidence: 99%

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Abstracts

1988

Neurourology and Urodynamics

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Ann A r b o r (IJ.S.A) ANATOMY AND MECHANICS OF STRUCTURES AROUND THE VESICAL NECK: HOW VESlCAL NECK POSITlON MIGHT AFFECT 1TS CLOSURE AIMS OF STUDY Initiation of micturition is associated with vesical neck descent, Simple displacement of the and arrest of urination, with its elevation. vesical neck could not influence its intraluminal pressure, unless some structure opposes this displacement. This study examines the morphology and mechanics of this region to see if some structural arrangement might allow vesical neck position to influence its opening or closure. METHODS Three types of observation were used to study the tissues around the vesical neck, minimizing distortion created by opening the retropubic space: 1) Dissection of an embalmed cadaver by removing the pubic bones. histologic slides of the pelvic viscera from 8 individuals, (0-37 years); fixed, in situ. 3 ) Dissection of 20 fresh cadavers (17-78 years) where tissues could be manipulated to recreate different vesical neck positions. RESULTS 2) Examination of 1500 serial Mallory and elastin stained An 8 cm fibrous band, composed primarily of collagen (arcus tendineus fasciae pelvis-ATFP), is suspended between the lower pubic bone and ischial spine bilaterally. A separate group of collagen, elastin, and smooth muscle fibers, (precervical arc=PCA) runs in a transverse orientation, between the two ATFP's in their anterior half and attachs to the anterior vesical neck (VN). In this region of the ATFP, the medial levator ani muscle (LAM) arises 3cm above the ATFP from its origin on the superior pubic ramus to run posteriorly, lying lateral to the ATFP. Posterior and lateral to the VN, the vaginal wall (Ilk') and VN's adventitia are attached to the LAM muscle, allowing it to control VN position through these connections. The configuration of the PCA changes with VN movement in a way which could influence VN closure. the VN to rotate posteriorly and inferiorly, by its attachment to the vaginal wall and VN adventitia, so it lies behind and below the origin of the PCA, in an orientation where the PCA pulls anteriorly on the VN, Relaxation of the LAM (Figl) allows 0 1988 Alan R. Liss, Inc. 162 Abstracts facilitating its opening. When the LAM contracts (Fig2) to resume its normal resting tone, it moves the urethra anteriorly. This compresses the VN against the PCA, favoring closure. \ \ \ \ \ \ \ Figure 1: Relaxation Figure 2: Contraction CONCLUSIONS These anatomical observations, suggest the following hypotheses Relaxation of the levator ani muscles favors vesical neck opening by placing it in a posterior-inferior position where the PCA pulls its anterior wall forward. Contraction, moves the VN anteriorly, compressing it against the PCA, favoring closure.2 The visco-elastic characteristics of the passive detrusor have been extensively studied in the past and several types of lumped parameter models have been proposed. The validity of such models, however, have not been tested in the actively contracting bladder. The aim of this study was, using the forced oscil...

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Section: Resultsmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Conclusi(3nmentioning

confidence: 99%

Section: One Other Patient Had Developedmentioning

confidence: 99%

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1988

Neurourology and Urodynamics

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“…Transvesical infiltration of the pelvic plexuses with phenol was described by Ewing et aI. [9] and popularized by Blackford et aI. [10] The method was to inject 10mL of 6% aqueous phenol at the mid-point between the bladder neck and the ureteric orifice on each side.…”

Section: Irreversible Procedures Closed Techniquesmentioning

confidence: 99%

Denervation techniques

Madersbacher¹

2000

BJU International

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The bladder can be denervated at several levels: centrally. at the level of the sacral nerves: peripherally, on the pelvic nerves; or in the bladder. by cutting the relevant structures. by injecting substances toxic to nerves. or by hyperbaric bladder distension. These procedures target the sensory or motor nerves to weaken or to interrupt the detrusor reflex arc. Most of the procedures introduced previously, e.g. bladder trans-section by open operation, endoscopic or transvesical phenolization, hyperbaric bladder distension. and peripheral denervation of the bladder, have now been abandoned. Although some of these techniques had a high initial success rate in abolishing detrusor overactivity and in controlling incontinence, the relapse rate within 18 months approached 100%. In the early 1950s, much of the denervation surgery was performed on sacral roots and

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The surgical treatment of detrusor instabiiity

Mundy

1985

Neurourology and Urodynamics

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The surgical treatment of detrusor instability is still in its infancy. At the present time there are two main types: operations designed to ablate the nerve supply and those designed to circumvent the problem by enlarging the bladder sufficiently such that the unstable contractions are either ineffectual or occur at such a large volume that they are clinically insignificant. The former approach is rarely successful, except possibly in patients over the age of 55 years; the latter seems to be effective in the majority of patients, but the data should still be considered to be preliminary. Hydrodistension of the bladder is ineffective.

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Subtrigonal Phenol Injection for Urge Incontinence Secondary to Detrusor Instability in Females

Cited by 50 publications

References 11 publications

Abstracts

Abstracts

Denervation techniques

The surgical treatment of detrusor instabiiity

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