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Pelvic Diagnosis in Urology

Comparison of leak point pressure methods in an animal model of stress urinary incontinence.
Conway DA, Kamo I, Yoshimura N, Chancellor MB, Cannon TW
Int Urogynecol J Pelvic Floor Dysfunct. 2005 Sep-Oct;16(5):359-63. Epub 2005 Aug 19.

We compared three different methods of testing leak point pressure (LPP) in rats with or without the pudendal nerves and nerves to the iliococcygeus/pubococcygeus muscles transected: (1) sneeze induced with a whisker in the nostril (sneeze LPP), (2) manually increased abdominal pressure (Crede LPP), and (3) increased intravesical pressure using the vertical tilt table method (vertical tilt table LPP). In sham rats, passive intravesical pressure rises in Crede and vertical tilt table methods induced active urethral closure mechanisms that contributed to high LPPs (41.4 and 35.5 cm H2O, respectively), which were significantly reduced by nerve transection. During sneezing, leakage was observed in nerve-transected rats, but not in sham rats, indicating that sneezing can activate an additional urethral closure mechanism. Measuring LPP during sneezing or passive intravesical pressure rises in the vertical tilt table and Crede method seems to be useful for assessing the continence mechanisms under different stress conditions in rats.

Renal Multidector Row CT.
Kocakoc E, Bhatt S, Dogra VS
Radiol Clin North Am 2005 Nov;43(6):1021-47.

Multidetector row CT is the most recent advance in CT technology. An increased number of detector rows and more powerful x-ray tubes result in faster scanning time, increased volume coverage, and improved spatial and temporal resolution. MDCT technology allows superior image quality, decreased examination time, and the ability to perform complex multiphase vascular and three-dimensional examinations.

Prostate cancer in patients with an abnormal digital rectal examination and serum prostate-specific antigen less than 4.0 ng/mL.
Bozeman CB, Carver BS, Caldito G, Venable DD, Eastham JA
Urology 2005 Oct;66(4):803-7.

OBJECTIVES: To evaluate men with abnormal digital rectal examination (DRE) findings and a serum prostate-specific antigen (PSA) level less than 4.0 ng/mL who underwent prostate biopsy. METHODS: A total of 986 patients undergoing prostate biopsy were documented to have DRE findings suspicious for prostate cancer and a serum PSA level of less than 4.0 ng/mL. We examined the serum PSA level, age, and race to see which patient characteristics were statistically significant predictors of prostate cancer on biopsy. The pathologic findings of the biopsy and prostatectomy specimens were examined to determine which patients had serendipitously diagnosed prostate cancer. RESULTS: The positive predictive value of an abnormal DRE was 8.8%. The PSA level and increasing age were statistically significant predictors of a positive biopsy, but race was not. Well-differentiated cancer (Gleason score 6 or less) was diagnosed in 72.8% of the biopsies. Also, 87.5% of the patients undergoing radical prostatectomy had pathologic Stage T2 disease. Using specific pathologic criteria, prostate cancer was diagnosed serendipitously in 19% of the biopsies and in 43% of the radical prostatectomy specimens. CONCLUSIONS: Higher serum PSA levels even if less than 4.0 ng/mL were associated with dramatic increases in prostate cancer detection. Age was also a statistically significant predictor of cancer. Although the overall positive predictive value of the DRE was poor, most patients diagnosed with prostate cancer had an abnormality on the DRE that corresponded either to the location of cancer detected on biopsy or had cancer volumes on prostatectomy specimens large enough to be palpable.

Office urodynamics.
Cole EE, Dmochowski RR
Urol Clin North Am 2005 Aug;32(3):353-70.

Office urologic ultrasound.
McAchran SE, Dogra V, Resnick MI
Urol Clin North Am 2005 Aug;32(3):337-52.

Training on Bench Models Improves Dexterity in Ureteroscopy.
Brehmer M, Swartz R
Eur Urol 2005 Jun 15;.

INTRODUCTION: There is a need for alternative training in endourology. Computerised simulators have been introduced but have, so far, not been compared to real surgery. Bench models have proved to be comparable to real surgery when performing standard procedures in the upper urinary tract. OBJECTIVE: To validate training on bench models as a tool to improve dexterity in semi-rigid ureteroscopy. METHODS: Urology residents were tested when performing semi-rigid ureteroscopy on a bench model (Mediskills), before and after training. All standard equipment and instruments, including fluoroscopy, were available. For the test procedure we used a task-specific checklist and a global score (maximum score 10+9=19). After base line assessment, the participants practised under supervision. After training they were reassessed, using the same procedure as previously. RESULTS: The performance was significantly better after the training. Results before/after were: 5.1/9.2, 2.6/7.8 and 7.7/17.2 for task-specific checklist, global score and total score respectively. All residents felt more familiar with the instruments and the procedure after the training. CONCLUSION: Training on bench models for ureteroscopy enhanced the manual dexterity as well as familiarity with the method and is recommendable before operating on patients.

Re: Bryan NP, Chapple CR. Frequency volume charts in the assessment and evaluation of treatment: How should we use them?
Eur Urol 2004;46:636-40.
Govindaraju SK, Neilson D
Eur Urol 2005 Jul;48(1):171-2. Epub 2005 Feb 12.

Impact of patient position on filling phase of urodynamics in women.
Shukla A, Johnson D, Bibby J
Int Urogynecol J Pelvic Floor Dysfunct 2005 Jul 7;.

This is a randomised cross-over study designed to access the effect of position on urodynamic investigation of women with urinary incontinence. Women were investigated in the supine and sitting positions. There was small, not statistically significant difference in total bladder volume. Total bladder volume was nearer to women's actual bladder capacity in the sitting position. There was no difference in bladder volume at first sensation or normal desire in both positions. There was a small, not statistically significant difference in bladder volume at strong desire and urgency. Women felt strong desire and urgency at lower bladder volumes in the sitting position.There was no clear patient preference for one position over the other.

A comparison of urodynamic diagnoses and detrusor muscle function in white and South Indian Asian women.
Teo RE, Yisa S, Mayne C, Tincello D
J Urol 2005 Jul;174(1):184-6.

PURPOSE: We compared urodynamic data and the final diagnosis after testing between white and Asian women investigated for urinary incontinence. MATERIALS AND METHODS: Urodynamic traces of consecutive women investigated between January 2002 and December 2003 were reviewed. Urodynamic diagnoses were classified as normal, urodynamic stress incontinence, detrusor overactivity (DOA) or mixed incontinence. In DOA cases the amplitude and number of detrusor contractions, and the volume at which the first involuntary contraction occurred were recorded. Data were compared by ethnic group. RESULTS: The distribution of diagnoses was significantly different between Asian and white women (p <0.0001). In Asian and white women we noted urodynamic stress incontinence in 22% and 53% (OR 0.24, 95% CI 0.13 to 0.48), DOA in 28% and 17% (OR 1.88, 95% CI 0.98 to 3.60) and mixed incontinence in 22% and 7% (OR 3.74, 95% CI 1.70 to 8.22), respectively. Post-void residual volume (p = 0.02), volume at strong desire to void (p = 0.03) and cystometric capacity (p = 0.0002) were lower in Asian women. In those with DOA the first contraction occurred at a lower volume in Asian woman (57 vs 179 ml, p = 0.002). Asian women had more contractions (5 vs 3, p = 0.009) with higher maximum (50 vs 32 cm H2O, p = 0.004) and average (34.4 vs 25.3 cm H2O, p = 0.03) detrusor pressure. CONCLUSIONS: In women who undergo urodynamics a greater proportion of Asian women have DOA and mixed incontinence compared with white women. Functional differences in detrusor contraction pressures exist, which may suggest a fundamental difference in bladder function or disease etiology. Exploration of this theory requires further study.

Tolerability and morbidity of urodynamic testing: A questionnaire-based study.
Yokoyama T, Nozaki K, Nose H, Inoue M, Nishiyama Y, Kumon H
Urology 2005 Jun 29;.

OBJECTIVES: To determine the tolerability and morbidity rate of multichannel urodynamics (UDS). METHODS: A total of 154 consecutive patients were included in the present study; 87 men and 67 women underwent UDS and completed a questionnaire. All patients undergoing UDS were given a two-part questionnaire. The first part, given immediately after UDS, contained four questions regarding pain, embarrassment, and physical burden (assessed with a visual analogue scale on which 0 = not at all, 10 = unbearable), as well as willingness to undergo UDS again. The second part, given within 2 weeks after UDS, contained five questions regarding micturition pain, gross hematuria, dysuria, cloudy urine, and fever episodes after UDS. Urine specimens were also analyzed. RESULTS: The mean (+/-SD) degrees of pain, embarrassment, and physical burden were 2.27 +/- 2.53, 2.59 +/- 2.69, and 1.76 +/- 2.43, respectively, and 73.6% of men and 80.6% of women were willing to repeat UDS. The most common complaint after UDS was micturition pain. Two men and 1 woman had fever after UDS; there was no relationship between fever and urinary tract infections. Urinalysis showed that 4.6% of men and 7.5% of women had leukocyturia after the investigation. CONCLUSIONS: The complication rates of UDS were relatively low. For most patients, UDS were tolerable and acceptable. Proper informed consent is necessary.

The effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. A randomized, double-blind, placebo-controlled study.
Madeiro AP, Rufino AC, Sartori MG, Baracat EC, Lima GR, Girao MJ
Int Urogynecol J Pelvic Floor Dysfunct 2005 Jun 14;.

To evaluate the effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. In this double-blind, placebo-controlled study, 79 patients with cervical cancer were randomized to receive bethanechol (30 mg/day), cisapride (30 mg/day), bethanechol combined with cisapride (same doses) and placebo. Urodynamic study was performed, including flowmetry, cystometry, pressure-flow study and urethral pressure profile before radical hysterectomy. Medication was administered postoperatively during 30 days. At the end of this period, urodynamic evaluation was repeated. There was an increase in both the maximum cystometric capacity and bladder capacity at first desire to void in the placebo group compared to the other groups. The rate of detrusor instability was higher in the group that used bethanechol combined with cisapride. Detrusor pressure at maximum flow was significantly higher when cisapride was used. There was a significant increase in postvoid residual volume in the placebo group. In patients undergoing radical hysterectomy, bethanechol and cisapride determined lower cystometric capacity and decreased bladder capacity at first desire to void, a higher maximum flow rate and higher detrusor pressure at maximum flow, with lower postvoid residual volumes. The early use of bethanechol and cisapride after radical hysterectomies positively modified urodynamic parameters, determining a more efficient detrusor function.

Can a baseline prostate specific antigen level identify men who will have lower urinary tract symptoms later in life?

Carter HB, Landis P, Wright EJ, Parsons JK, Metter EJ.
J Urol 2005 Jun;173(6):2040-3.

PURPOSE: We evaluated the relationship between baseline prostate specific antigen (PSA) and subsequent lower urinary tract symptom development during 3 decades in unselected men in the Baltimore Longitudinal Study of Aging. MATERIALS AND METHODS: Urinary questionnaires were used to evaluate lower urinary tract symptoms in 704 men during 3 decades. The number of repeat evaluations was 1 to 18. We divided subjects into age groups of younger than 50 and 50 to 69.9 years at the time of the first PSA evaluation. Subjects were divided into 3 PSA groups based on initial PSA below the 25th, 25th to 75th and above the 75th percentile. A mixed effects Poisson model was used to test whether there was a significant relationship between PSA grouping and symptom score with time. RESULTS: There was no statistically significant difference in symptom score distribution across PSA percentiles in men younger than 50 years (p = 0.87) or 50 to 69.9 years old (p = 0.59). When age was used as an independent variable in the model, there was no statistically significant relationship between baseline PSA and symptom score (p = 0.38). CONCLUSIONS: These data suggest that PSA is not a useful predictor of the development of lower urinary tract symptoms in unselected, asymptomatic men.

The repeatability of the 24-hour pad test.
Karantanis E, Allen W, Stevermuer TL, Simons AM, O'Sullivan R, Moore KH.
Int Urogynecol J Pelvic Floor Dysfunct 2005;16:63-8;

A prospective observational study was conducted in a tertiary urogynaecology unit in women with the primary symptom of urinary incontinence to assess the repeatability of the 24-hour pad test. One hundred and eight women undertook seven 24-hour pad tests over 7 consecutive days together with 7 simultaneous fluid and activity charts. The results were analysed collectively and according to urodynamic subsets. Repeatability was assessed by repeated measures analysis of variance and univariate analysis of variance for each urodynamic diagnosis group (USI, mixed and no USI). Variation between pad test weights over the 7 days was low, supporting good repeatability. The number of days of pad testing required to approximate the 7-day average was 3 days. However, a single 24-hour pad test correlated highly with the 7-day average (r=0.881) and was considered sufficient to gauge leakage severity.

Utility of urine reagent strip in screening women with incontinence for urinary tract infection.
Buchsbaum GM, Albushies DT, Guzick DS
Int Urogynecol J Pelvic Floor Dysfunct 2004 Nov-Dec;15(6):391-3; discussion 393. Epub 2004 Jul 1.

The aim of this study was to determine the utility of urine reagent strips in screening women with urinary incontinence for urinary tract infections. Subjects were all women presenting with urinary incontinence. A urine specimen was screened for urinary tract infection with a urine reagent strip and urine culture. Using the urine culture result as the gold standard, the sensitivity, specificity, and positive and negative predictive values of the urine reagent strips were calculated. A total of 265 pairs of reagent strips and urine cultures were evaluated. Thirty-one cultures grew out of a single organism; nine of these had a positive urine reagent strip, yielding a sensitivity of 29%. The specificity of the urine reagent strip was 99%, the positive predictive value was 82% and the negative predictive value was 92%. For women presenting with urinary incontinence, the sensitivity of a urine reagent test for diagnosing urinary tract infection was low.

Does posture affect cystometric parameters and diagnoses?
Arunkalaivanan AS, Mahomoud S, Howell M
Int Urogynecol J Pelvic Floor Dysfunct 2004 Nov-Dec;15(6):422-4; discussion 424. Epub 2004 Jul 1.

The objective of this study was to investigate the effect of lying and sitting positions on urodynamic parameters and diagnoses. This prospective study was carried out on 96 women with urinary incontinence who underwent urodynamic assessment. Cystometry was performed both in the lying and sitting positions. For filling cystometry, we infused normal saline at a rate of 50 ml/min. All the results were entered on the urodynamic database and were analysed using Minitab software release 13.30. Mean age was 49 (20-84) years. Sixty-four (67%) women complained of mixed incontinence, 16 (17%) of urgency alone, eight (8%) of stress incontinence and eight (8%) of urgency and urge incontinence. Two (2%) showed stress incontinence by lying cystometry, and 53 (55%) by sitting cystometry. During lying nine (9%) demonstrated detrusor overactivity, while 53 (55%) demonstrated detrusor overactivity in sitting position. No case of mixed incontinence was diagnosed by lying cystometry but 17 (18%) cases were detected by sitting cystometry. This study explains the higher detection rate of stress incontinence, detrusor overactivity and mixed incontinence by cystometry in sitting position. Therefore, we recommend that sitting posture is preferred over lying position for performing cystometry.

Urinalysis: a comprehensive review.
Simerville JA, Maxted WC, Pahira JJ
Am Fam Physician 2005 Mar 15;71(6):1153-62.

A complete urinalysis includes physical, chemical, and microscopic examinations. Midstream clean collection is acceptable in most situations, but the specimen should be examined within two hours of collection. Cloudy urine often is a result of precipitated phosphate crystals in alkaline urine, but pyuria also can be the cause. A strong odor may be the result of a concentrated specimen rather than a urinary tract infection. Dipstick urinalysis is convenient, but false-positive and false-negative results can occur. Specific gravity provides a reliable assessment of the patient's hydration status. Microhematuria has a range of causes, from benign to life threatening. Glomerular, renal, and urologic causes of microhematuria often can be differentiated by other elements of the urinalysis. Although transient proteinuria typically is a benign condition, persistent proteinuria requires further work-up. Uncomplicated urinary tract infections diagnosed by positive leukocyte esterase and nitrite tests can be treated without culture.

Optimization of Multi-Detector Row CT Urography: Effect of Compression, Saline Administration, and Prolongation of Acquisition Delay.
Caoili EM, Inampudi P, Cohan RH, Ellis JH
Radiology 2005 Feb 16;.

PURPOSE: To retrospectively compare the effects of abdominal compression, intravenous saline hydration, and two imaging delays on both distention and opacification of the intrarenal collecting system and ureter during multi-detector row computed tomographic (CT) urography. MATERIALS AND METHODS: Institutional review board approval for reviewing images and medical records of the patients was obtained; informed patient consent was not required. Excretory phase images obtained from multi-detector row CT urography in 85 patients (57 men, 28 women) were reviewed. Examinations were performed by using one of four techniques: abdominal compression and intravenous hydration with 250 mL of normal saline, compression only, intravenous hydration with saline only, and neither compression nor saline hydration. Excretory phase imaging was performed at 300 and 450 seconds for each patient. Two reviewers measured urinary tract distention on transverse images and graded opacification and image quality on volume-rendered images. Effects were compared by using statistical mixed models with repeated-measures analysis of variance. RESULTS: Saline hydration significantly improved opacification (P = .02) and overall image quality (P < .001) of the intrarenal collecting system and proximal ureter. Delayed excretory phase image acquisition of 450 seconds significantly increased distention of the intrarenal collecting system and proximal ureter (P < .001). No significant effects involving the lower segment of the ureter were seen with any technique; however, there were fewer nonvisualized distal ureteral segments with the longer imaging delay. CONCLUSION: Compression does not significantly improve distention or opacification of the urinary tract. Saline hydration is effective in improving opacification of the proximal urinary tract. Longer imaging delays improve distention of the proximal urinary tract and may aid in visualization of the lower segment of the ureter. (c) RSNA, 2005.

Do cystometric findings predict the results of intravesical hyaluronic Acid in women with interstitial cystitis?
Daha LK, Riedl CR, Lazar D, Hohlbrugger G, Pfluger H
Eur Urol 2005 Mar;47(3):393-7. Epub 2004 Dec 18.

INTRODUCTION AND OBJECTIVES: According to National Institute of Health (NIH) criteria, a bladder capacity of less than 350cc is an automatic exclusion for a diagnosis of Interstitial Cystitis (IC). In the present study, patients, showing symptoms of IC and with bladder capacities of <350 and >/=350cc were tested as to their response to a intravesical hyaluronic acid therapy. METHODS: The study included 48 patients with clinical symptoms of IC and a positive 0.4M potassium sensitivity test. Maximum bladder capacity (C(max)) was assessed for the 0.9% NaCl solution first and then for the 0.2M KCl solution. After the NaCl cystometry, patients were separated into two groups: Group I with a C(max) of <350cc and Group II with a C(max) of >/=350cc. Both groups were again separated in two further groups as to the respective percentage reduction of C(max) with the 0.2M KCl solution: Group Ia/IIa (>/=30%) and Group Ib/IIb (<30%). Patients were treated with weekly instillations of 40mg hyaluronic acid for 10 consecutive weeks. Pre- and post-treatment bladder symptoms were evaluated through their visual analog scale (VAS) scores. RESULTS: With the saline solution, 32 patients had a C(max) of <350cc (Group I), while 16 patients had a C(max) of >/=350 cc (Group II). Evaluation of VAS scores confirmed a positive response, i.e. symptom relief, to hyaluronic acid therapy, irrespective of bladder capacity. The improvement was particularly evident in patients with a C(max) reduction of >/=30% versus those with a reduction of <30% with the 0.2M KCl solution (p=0.003). CONCLUSION: The present study demonstrates that patients with typical IC symptoms and a cystometric bladder capacity of >/=350cc, may have increased potassium sensitivity as a sign of IC and show symptom improvement after hyaluronic acid instillation therapy.

Is the leak point pressure alone an accurate indicator of intrinsic sphincteric deficiency?
Murphy M, Culligan PJ, Graham CA, Kubik KM, Heit MH
Int Urogynecol J Pelvic Floor Dysfunct 2004 Sep-Oct;15(5):294-7. Epub 2004 Jul 08.

The aim of this study was to determine the characteristics of women who meet the criteria for intrinsic sphincteric deficiency (ISD) on maximum urethral closure pressure (MUCP) but not on leak point pressure (LPP) measurement. We performed a cross-sectional chart review of every patient who underwent multichannel, microtransducer urodynamic testing in our center between 1994 and 1996 (n=423). From this population we culled a sub-population of women who fit into one of the following two groups: women with no evidence of ISD on MUCP or LPP and women with evidence of ISD on MUCP only. Logistic regression was used to identify independent predictors of group membership. Increasing age (>60.5 years) and a positive supine empty stress test were the only independent predictors of membership in the group of women with ISD on MUCP only. Knowledge of these risk factors may help clinicians in choosing appropriate pre-operative testing.

A new questionnaire for urinary incontinence diagnosis in women: Development and testing.
Bradley CS, Rovner ES, Morgan MA, Berlin M, Novi JM, Shea JA, Arya LA
Am J Obstet Gynecol 2005 Jan;192(1):66-73.

Objective The purpose of this study was to develop a questionnaire for urinary incontinence diagnosis in women and to test its reliability and validity, with incontinence specialists' clinical evaluations as the gold standard. Study design One hundred seventeen urogynecology outpatients with urinary incontinence symptoms completed the Questionnaire for Urinary Incontinence Diagnosis at enrollment and 1 week and 9 months later. Baseline clinical diagnoses were compared with Questionnaire for Urinary Incontinence Diagnosis diagnoses (criterion validity). Nine-month Questionnaire for Urinary Incontinence Diagnosis change scores were compared across treatment groups (responsiveness). Results Clinical diagnoses included stress (n = 15), urge (n = 26), and mixed urinary incontinence (n = 72). Internal consistency and test-retest reliability estimates were good. Sensitivity and specificity were 85% (95% CI, 75%, 91%) and 71% (95% CI, 51%, 87%), respectively, for stress urinary incontinence and 79% (95% CI, 69%, 86%) and 79% (95% CI, 54%, 94%), respectively, for urge urinary incontinence. The Questionnaire for Urinary Incontinence Diagnosis correctly diagnosed urinary incontinence type in 80% of subjects. Questionnaire for Urinary Incontinence Diagnosis Stress and Urge scores decreased significantly in treated subjects. Conclusion The Questionnaire for Urinary Incontinence Diagnosis, a new 6-item questionnaire for female urinary incontinence type diagnosis, is reliable and able to diagnose stress urinary incontinence and urge urinary incontinence in a referral urogynecology patient population with accuracy.

Changes in urethral function with bladder filling in the presence of urodynamic stress incontinence and detrusor overactivity.
Chaliha C, Digesu GA, Hutchings A, Khullar V
Am J Obstet Gynecol 2005 Jan;192(1):60-5.

Objective The purpose of this study was to assess the effect of detrusor overactivity and bladder filling on urethral function with the use of urethral profilometry. Study design Women with symptoms of urinary incontinence were recruited from our urodynamic clinic. All of the women underwent videocystourethrography and urethral pressure profilometry with the bladder empty and then full. The maximum urethral closure pressure, mean urethral pressure, functional urethral length, and pressure transmission ratios for each quartile were analyzed. Results Thirty-five women were recruited: 17 women had urodynamic stress incontinence, and 18 women had detrusor overactivity. In women with urodynamic stress incontinence, there was a significant increase in maximum urethral closure pressure and pressure transmission ratios over all quartiles when the bladder was full compared with empty. In women with detrusor overactivity, there was a significant decrease in functional urethral length and pressure transmission ratios in the second and third quartile of the urethral pressure profiles when the bladder was full compared with empty. Conclusion Decreases in functional urethral length and pressure transmission ratios with bladder filling in those women with detrusor overactivity are at variance with the normal physiologic response to bladder filling, which suggests that urethral function is affected by the presence of abnormal detrusor activity and that the valid assessment of urethral function may not be possible if the detrusor overactivity is not treated.

Striated urethral sphincter activity does not alter urethral pressure during filling cystometry.
Kenton K, Fitzgerald MP, Brubaker L
Am J Obstet Gynecol 2005 Jan;192(1):55-9.

Objective The purpose of this study was to determine the relationship between urethral pressure and the neuromuscular activity of the urethral sphincter with the use of quantitative electromyography during bladder filling. Study design Women who underwent multichannel urodynamic testing with concentric needle electromyography of the striated urethral sphincter between December 2000 and February 2002 were studied. Raw electromyography signals were processed by a electromyography instrument that was equipped with automated motor unit analysis software programs. Quantitative electromyography software was used to analyze the electrical activity of the urethral sphincter during filling cystometry. Results One hundred women (mean age, 60 years [range, 22-82 years]; median parity, 3 children [range, 0-8 children]) were studied. Most women (79%) were postmenopausal, and 68% of those women were receiving hormone replacement therapy. Quantitative electromyography values increased significantly at 300 mL and maximum cystometric capacity; however, there was no significant increase in urethral pressure. The median change in urethral pressure at 300 mL and maximum cystometric capacity were 4 cm water (interquartile range, 0-8 cm) and 0 cm water (interquartile range, -4-8 cm), respectively ( P = .229). The median change in quantitative electromyography at 300 mL and maximum cystometric capacity were 9 muV (range, 5-14 muV) and 10 muV (range, 7-19 muV), respectively ( P < .0005). There was no correlation between change in urethral pressure and motor unit activation on quantitative electromyography at 300 mL or maximum cystometric capacity. Fifty-six women had no change or a decreased urethral pressure at maximum cystometric capacity, yet all but 1 of these women had increased motor unit activation on quantitative electromyography. Conclusion Urethral pressure does not increase during filling cystometry, despite increased activity of the striated urethral sphincter, which suggests that urethral pressure change does not reflect the integrity of the striated urethral sphincter.

[Evaluation of residual urine volume by ultrasound for detection of urinary bladder dysfunction after surgical therapy of rectal cancer.]
Borschitz T, Kneist W, Junginger T
Chirurg 2005 Feb 3;.

INTRODUCTION: Despite total mesorectal excision and protection of the pelvic autonomous nerve system, dysfunctions of the urinary bladder are often observed after surgical therapy for rectal cancer. In this prospective study, the frequency of urinary bladder malfunctions was assessed by measuring residual urine volume using transcutaneous ultrasound before and after surgery.PATIENTS AND METHODS: Seventy-five patients with rectal cancer were analyzed for urine volume retained before and after surgical therapy. The tumors were localized in the lower third of the rectum for 31 patients, in the middle for 30, and in the upper third for 14.RESULTS: An increase in retained urine of more than 100 ml was found in 12 patients (15%), and neurogenic bladder was diagnosed in two (3%). In female patients, urinary bladder malfunctions were significantly less frequent and severe.CONCLUSIONS: The percutaneous assessment of urine volume retained in the bladder is suited for determining urinary bladder malfunctions after surgery. This method can serve to assess the quality of surgical treatment for rectal cancer. A standardized definition of relevant urinary bladder malfunctions is required.

MRI of female urethral and periurethral disorders.
Siegel C
J Urol 2005 Feb;173(2):417.

Patient perception of videourodynamic testing: a questionnaire based study.
Scarpero HM, Padmanabhan P, Xue X, Nitti VW
J Urol 2005 Feb;173(2):555-9.

PURPOSE: We determined the degree of anxiety, embarrassment and discomfort anticipated by patients before undergoing videourodynamics and compared the results to the actual degrees experienced by patients. In addition, we compared these variables between men and women, and younger and older patients. MATERIALS AND METHODS: All patients undergoing urodynamics for the first time were given a 2 part questionnaire. Patients with neurological disease or those requiring an indwelling or intermittent catheter were excluded. Part 1 given immediately prior to the test contained 5 questions regarding expected anxiety, pain, embarrassment, apprehension regarding x-ray exposure and preparedness. Part 2 given immediately after testing contained 5 questions comparing anticipated to actual overall experience, pain and embarrassment, preparation and whether the patient would undergo testing again. Each question had a 5 point scale. RESULTS: A total of 78 men and 88 women respondents completed the questionnaires. Most (greater than 95% per question) expected no to moderate anxiety, pain, embarrassment and apprehension. This did not vary with age, although more women anticipated greater embarrassment and more men expected little or no embarrassment (p <0.001). After testing most respondents (greater than 90% per question) thought that the test was the same or better than expected and it was associated with an expected or less than expected level of pain and embarrassment. This did not vary between the sexes but more younger individuals found that the test experience was worse than expected, while more older individuals found that it was better than expected. Of the patients 95% would undergo urodynamic testing again if medically indicated. CONCLUSIONS: Videourodynamics is well tolerated and is associated with only minimal to moderate degrees of anxiety, discomfort and embarrassment. A suspected lack of tolerance should not be a barrier to performing medically indicated urodynamic testing.

Further characterization of the supine empty stress test for predicting low valsalva leak point pressures.
Walter AJ, Thornton JA, Steele AC
Int Urogynecol J Pelvic Floor Dysfunct 2004 Sep-Oct;15(5):298-301. Epub 2004 Jun 04.

The aim of this study is to determine if the diagnostic accuracy of the supine empty stress test (SEST) differs depending on the volume of residual urine. We performed a review of all patients who were diagnosed with stress urinary incontinence (SUI) via multi-channel urodynamics including valsalva leak point determinations (VLPP). A SEST was performed and the residual urine recorded via catheterization. The test-specific indices of the SEST for the prediction of low VLPP (defined as <60 cm H(2)0) were determined for varying residual volumes. Ninety-nine patients were included. Regardless of residual volume, low sensitivities, specificities and positive predictive values were demonstrated. Sensitivity and positive predictive values were further reduced and negative predictive values were improved slightly with higher residual volume. The highest negative predictive value was 89% at a residual volume of greater than 10 mL. Residual urine volume has minimal impact on the utility of the SEST.

The repeatability of the 24-hour pad test.
Karantanis E, Allen W, Stevermuer TL, Simons AM, O'sullivan R, Moore KH
Int Urogynecol J Pelvic Floor Dysfunct 2005 Jan-Feb;16(1):63-8. Epub 2004 Jul 07.

A prospective observational study was conducted in a tertiary urogynaecology unit in women with the primary symptom of urinary incontinence to assess the repeatability of the 24-hour pad test. One hundred and eight women undertook seven 24-hour pad tests over 7 consecutive days together with 7 simultaneous fluid and activity charts. The results were analysed collectively and according to urodynamic subsets. Repeatability was assessed by repeated measures analysis of variance and univariate analysis of variance for each urodynamic diagnosis group (USI, mixed and no USI). Variation between pad test weights over the 7 days was low, supporting good repeatability. The number of days of pad testing required to approximate the 7-day average was 3 days. However, a single 24-hour pad test correlated highly with the 7-day average (r=0.881) and was considered sufficient to gauge leakage severity.