Urinary Incontinence in the Female. The Value of Detrusor Reflex Activation Procedures

Nordling, Jørgen; Meyhoff, H. H.; Andersen, Jens T.; Walter, Steen

doi:10.1111/j.1464-410x.1979.tb02842.x

Cited by 18 publications

(6 citation statements)

References 5 publications

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“…No rectal pressure was recorded during cystometry. Detrusor instability was defined according to the definitions of the International Continence Society or was considered present if the patient did not have uninhibited detrusor contractions during filling cystometry but was unable to suppress a voluntarily induced detrusor contraction within 50 s once it had started (Nordling et al, 1979). Patients with detrusor sphincter dyssynergia were not included in the study.…”

Section: Patients and Methods*mentioning

confidence: 99%

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Placebo—the Drug of Choice in Female Motor Urge Incontinence?

Meyhoff

Gerstenberg

Nordling

1983

British Journal of Urology

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In a randomised double-blind cross-over trial of 19 females with motor urge incontinence but without bladder suspension defect, the effects of 14 days' treatment with emepronium bromide 200 mg qid, flavoxate chloride 200 mg qid or placebo qid were compared by means of micturition charts, the patients' drug preferences and evaluation of side effects. Placebo was the only drug giving rise to a statistically significant decrease in the frequency of voidings, incontinence and nocturia. Forty-seven per cent of the patients preferred placebo and side effects were less frequent during treatment with this medication. No differences could be demonstrated between the effects of emepronium bromide and flavoxate chloride. Perhaps detrusor instability is not always the main reason for the voiding dysfunction in these patients, in whom the effect of placebo was equal or superior to the effect of "active drugs" and superior to no treatment at all.

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Section: Patients and Methods*mentioning

confidence: 99%

“…In a consecutive series of incontinent female patients C 0 2 cystometry revealed detrusor instability in more than 50% (Nordling et al, 1979). The treatment of these patients with motor urge incontinence is usually pharmacological.…”

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confidence: 99%

Placebo—the Drug of Choice in Female Motor Urge Incontinence?

Meyhoff

Gerstenberg

Nordling

1983

British Journal of Urology

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“…anticholinergic therapy and surgery. The former has been associated with significant resolution of the urge component in only two‐thirds of these patients [22,23], but patients are not expected to be completely dry with this treatment alone, as treatment of the outlet defect was not targeted. In the present author's experience most of these patients are not satisfied with the anticholinergic therapy alone because of one or more of a poor response, side‐effects, the cost and/or the need for continuous treatment.…”

Section: Discussionmentioning

confidence: 99%

Stress incontinence surgery for patients presenting with mixed incontinence and a normal cystometrogram

Osman

2003

BJU International

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OBJECTIVE To evaluate the outcome of surgery for stress urinary incontinence (SUI) in patients presenting with a combination of stress and sensory urge UI. PATIENTS AND METHODS The study comprised 75 women presenting with mixed incontinence; the most important inclusion criterion was a negative cystometrogram for detrusor overactivity. Based on random selection, a third of the patients received a 6‐month course of anticholinergic treatment (group 1) and 50 (group 2) had surgery for SUI. The surgical procedure depended on the Valsalva leak‐point pressure (VLPP); those with a VLPP of ≥ 90 cmH2O underwent Burch retropubic bladder neck suspension (group 2a, 24 patients) while 26 (group 2b) with a VLPP of < 90 cmH2O had pubovaginal sling (PVS) surgery. A further group of 20 patients with pure SUI (no urge UI) underwent surgery (PVS in 12 and Burch in eight) as a control group (group 3). After at least 6 months of follow‐up (mean 9.3, sd 1.7), 68 patients were evaluable; they were assessed subjectively and objectively for dryness, and by a urodynamic evaluation and quantitative assessment using the SEAPI scoring system. RESULTS In group 1 none of the patients became completely dry; there was persistent stress with and without urge UI in nine (43%) and 12 (57%) of the available 21 patients, respectively. Only three of those who had persistent SUI with no urge in the whole study group were satisfied and chose to continue anticholinergic therapy despite SUI. In this group the mean (sd) improvement in the subjective and objective SEAPI score was 3.4 (1.0) and 2.3 (3.8), respectively. In group 2a, 20 of the available 23 patients (87%) became completely dry (both stress and urge continent). The mean improvement in the SEAPI scores was 7.8 (0.9) and 7.8 (1.3), respectively. In group 2b, 20 of the 24 patients (83%) became completely dry, with mean improvements in SEAPI scores of 8.2 (0.4) and 7.9 (0.3), respectively. The improvement was statistically significant after surgery, vs anticholinergic therapy, for all variables (P < 0.05). The incidence of persistent urge UI was highest in group 1 (43%), being 13% in group 2 (13% and 12% in 2a and b, respectively). In group 3 there was de novo urge UI in four of the 20 patients, and not significantly different from that in group 2. CONCLUSION Most patients with mixed stress and urge UI and a normal cystometrogram were cured of both symptoms by surgery. The incidence of residual urge in such patients was no higher than that of de novo urge after surgery in patients with genuine SUI.

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“…History taking alone seemed unreliable, and voiding diary or pad test could rather quantify the frequency of urgency episodes or the extent of urge incontinence. The 2-min test as described here was suggested by similar CMG tests of the literature [Nordling et al, 1979;Fall et al, 1995]. However, both the 2-min test of Fall et al (applied to water CMG) and the 50-sec test of Nordling et al (using CO 2 as a ¢lling medium) were devised to obtain a classi¢cation of DO, not to assess the severity of urge.…”

Section: Methodsmentioning

confidence: 99%