Urodynamic changes in women using diaphragms

Ramahi, Alfida; Richardson, Diane

doi:10.1002/nau.1930090602

Cited by 2 publications

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“…The possible change in urodynamic voiding parameters after vaginal pessary placement is still controversial. The usage of the standard contraceptive diaphragm was reported to compress the vesicourethral angle and caused an increase in maximal urethral closer pressures 15 and voiding detrusor pressure 16 . Ghoniem et al 13 .…”

Section: Discussionmentioning

confidence: 99%

“…The usage of the standard contraceptive diaphragm was reported to compress the vesicourethral angle and caused an increase in maximal urethral closer pressures 15 and voiding detrusor pressure. 16 Ghoniem et al 13 recommended gauze packing as it will not change other urodynamic parameters beside its simple usage. However, a more recent study by Chaikin et al 17 on continent women with severe urogenital prolapse reported that there was no increase in detrusor pressure and no patients without obstruction had bladder outlet obstruction after vaginal pessary placement.…”

Section: Discussionmentioning

confidence: 99%

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Voiding dynamics in women with stress urinary incontinence and high‐stage cystocele

et al. 2011

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Objectives:The aim of this study was to identify the urodynamic features of women with stress urinary incontinence (SUI) or with high-stage (stage 3 or greater) cystocele (HSC) as compared with symptom-free women. Methods: Fifty-six neurologically intact women with SUI and 47 women with HSC but without SUI were prospectively evaluated. All patients underwent full urodynamics, in addition to basic clinical evaluations. The urodynamic parameters of SUI and HSC were compared to the ones obtained from 78 urologically symptom-free normal women over the same period. Results: Patients with HSC, after correction of cystocele using a temporary vaginal pessary, had consistently lower maximum urinary flow rate with a lower detrusor pressure during micturition than the controls or those with SUI. On the other hand , patients with SUI had an equivalent to higher maximum urinary flow rate, normal detrusor contraction strength with a lower detrusor pressure during micturition than the controls. Both maximum Watts factor and bladder contractility index were significantly lower in the whole HSC cohort in comparison to the controls and patients with SUI. The urodynamic characteristics observed among the three groups were all maintained even after adjusting for age. Conclusions: Women with SUI demonstrate voiding with low-pressure, normal contraction strength with an equivalent to high urinary flow rate. Women with HSC demonstrate voiding with low pressures with weak contraction strengths and low urinary flow rates, suggesting a higher prevalence of detrusor underactivity. Chronically decreased or increased urethral resistance might alter voiding dynamics and performance.Key words: cystocele, lower urinary tract symptoms, urinary incontinence, urodynamics. IntroductionStress urinary incontinence (SUI) and cystocele are representative disorders associated with lower urinary tract dysfunction in women. 1,2 High-stage cystocele (HSC) or SUI may change voiding dynamics and cause voiding dysfunction. 3,4 However, there is a paucity of published data outlining the existing dysfunction, especially for HSC, with the quantified parameters obtained from the voiding phase for cohorts involving women with lower urinary tract disorders.In the present study, we attempted to identify the urodynamic characteristics of the lower urinary tract in adult women with SUI or with HSC, by comparing strictly with selected cohorts of symptom-free women who had urologically normal voiding. The urodynamic characteristics were focused on detrusor contractility, urethral resistance and pressure flow relationships. The information regarding these particular voiding dynamics of either SUI or HSC may give a beneficial contribution in a clinical setting, especially in predicting the outcome of surgery. Methods Control patientsAfter obtaining the patient's informed consent, which was approved by the ethics committee of our institution, 86 patients for whom simple or radical hysterectomy was scheduled from January 1999 to December 2006 were prospectively included in...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Voiding dynamics in women with stress urinary incontinence and high‐stage cystocele

et al. 2011

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The Value of the Vaginal Pack Test in Large Cystoceles

1994

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To detect possible stress urinary incontinence associated with but masked by large cystoceles protruding through the vaginal orifice, a vaginal pack test was done in conjunction with video fluoro-urodynamic studies. Sixteen female patients with large cystoceles did not demonstrate stress urinary incontinence on clinical examination and were included in this study. Additionally, 10 healthy female volunteers underwent the same test to study the effect of a vaginal pack on urethral dynamics. The vaginal pack revealed the presence of stress urinary incontinence in 11 patients (69%): 3 (19%) with type II (vesicourethral hypermobility) and 8 (50%) with type III (internal sphincteric deficiency). After insertion of the vaginal pack, urodynamic studies showed that the closing proximal urethral pressure in patients with stress urinary incontinence was significantly lower than in continent patients (p < 0.05). No significant change in urethral pressures was noted in volunteer subjects after vaginal pack insertion. Fluoroscopy showed kinking of the posterior urethra and enlargement of the most dependent portion of the cystocele, that is the lower half of the hourglass image. Our study suggests that the mechanisms of continence in these patients are multifactorial, including urethral kinking, urethral compression and pressure dissipation. The vaginal pack test is easy to perform, increases visualization of the vesicourethral unit when used with fluoroscopy, and can aid in the selection of patients who would benefit from anti-incontinence surgery and/or cystocele repair.

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Urodynamic changes in women using diaphragms

Cited by 2 publications

References 10 publications

Voiding dynamics in women with stress urinary incontinence and high‐stage cystocele

Voiding dynamics in women with stress urinary incontinence and high‐stage cystocele

The Value of the Vaginal Pack Test in Large Cystoceles

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