Terbutaline (Bricanyl) in the treatment of female urge incontinence

Fifteen women with idiopathic urge incontinence (8 motor and 7 sensory urge incontinence) were treated with a beta 2-adrenoceptor-stimulating agent, terbutaline (Bricanyl) for 3 months. A subjective effect on the symptoms urgency and frequency was found in 14 patients, and 12 patients (80%) became continent. In 6 of 8 cases the detrusor became stable. The drug was generally well tolerated; however, a high incidence of transient side effects were observed. Terbutaline seems to be valuable in the treatment of idiopathic female urge incontinence.     

Vaginal repair in female motor urge incontinence

Sixteen consecutive female patients with motor urge incontinence underwent vaginal repair operation. The patients were reevaluated after a mean follow-up of 37 months (range 8-72 months). Detrusor instability disappeared in only 31% of the patients after surgery which corresponds to the subjective and the objective cure rate. High pressure instability (contractions greater than or equal to 25 cm H2O) and/or a high instability index (greater than 1) were found to predict significantly a very poor prognosis. It is concluded that vaginal repair is an ineffective surgical procedure in patients with motor urge incontinence.     

Reliability of pudendal nerve terminal motor latency

Aim: To evaluate reliability of Pudendal Nerve Terminal Motor Latency (PNTML). Methods: Forty healthy subjects, 24 women and 16 men, and eight female patients were included. Four patients had idiopathic faecal incontinence and 4 an anal sphincter rupture after childbirth. PNTML measurement was performed by two observers with the patient in left lateral and supine position. Examinations were repeated on another day to evaluate intraindividual reproducibility. Results: Interobserver reproducibility was 92% – 116% for PNTML. Degree of agreement for PNTML between left lateral and supine position was 86% – 111%. Intra-individual reproducibility in the supine and left lateral positions was 89% – 109% and 88% – 113% respectively. Normal values for mean PNTML were higher in women compared with men, 1.91 msec (2 SD, 0.52 msec) and 1.74 msec (2 SD, 0.33 msec) respectively, t = 2.44, 37 DF, P<0.01. Conclusions: Reliability of PNTML in terms of interobserver and intraindividual reproducibility was high. Women had higher normal values for PNTML than men.

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Résumé. Le but du travail est d'étudier la fiabilité de la mesure du temps de latence du nerf honteux (PNTML). Méthode: Quarante sujets sains, 24 femmes et 16 hommes, ainsi que 8 patients de sexe féminin ont été inclus dans cette étude. Quatre patients souffrent d'incontinence fécale idiopathique et 4 présentent une rupture sphinctérienne aprés accouchement. La mesure du PNTML a été réalisée par deux observateurs avec le patient en décubitus latéral gauche et en décubitus dorsal. Les examens ont été refaits à 24 heures d'intervalle afin d'évaleur la reproductibilité de l'examen chez un même patient. Résultat: La reproductibilité entre observateurs est de 92 à 116% pour la mesure du PNTML. La corrélation pour la mesure du PNTML en position de décubitus latéral gauche ou en décubitus dorsal est de 86 à 111%. La reproductibilité chez un même individu en position dorsale ou en décubitus latéral est de respectivement de 89 à 109% et 86 à 113%. Les valeurs normales pour un PNTML moyen sont légèrement supérieures chez la femme que chez l'homme: 1,91 msec (2 SD, 0,52 msec) et 1,74 msec (2 SD, 0,33 msec), t = 2,44, 37 DF, P<0.01). Conclusion: La confidence de la mesure du PNTML est élevée en termes de reproductibilité inter-observateur et intra-individuelle. Les valeurs normales sont plus élévées chez la femme que l'homme.

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Accepted: 19 June 1997     

Urinary tract infections and diurnal incontinence in girls

To evaluate a possible relationship between urinary tract infections (UTI) and diurnal incontinence (DIC), we studied 251 girls aged 4 years or more who were referred with a history of recurrent UTI and/or DIC. During follow up (mean 35 months), 110 girls (44%) had both UTI and DIC, 50 (20%) only infections, and 41 (16%) only DIC whereas 50 (20%) had neither infection nor DIC. In 110 girls with infections occurring with intervals of at least 6 and 12 months, DIC was definitively initiated by infection on 32 (19%) occasions. Most girls were continent before the infection occurred. When the girls remained free of infection for 6 or 12 months respectively, the frequency of DIC remained unchanged. In conclusion, no support for the concept of DIC leading to UTI was obtained, whereas the reverse was found in some cases and suggested in others.Abbreviations UTI urinary tract infection(s) - DIC diurnal incontinence     

Three days cefoxitin in perforated appendicitis

This study was undertaken to assess the efficacy and safety of a 3-day course of treatment with Mefoxitin (cefoxitin sodium, MSD) in patients with perforated or ruptured appendicitis. A series of 235 patients undergoing surgery for perforated or ruptured appendicitis were treated with cefoxitin for 3 days. Twenty-four patients (10%) developed wound infection and 28 (12%) developed an intra-abdominal abscess postoperatively. No side effects were observed during the study. Compared with the results of our previous series, where a 5-day course of cefoxitin was used, the incidence of wound infection was similar. However the incidence of intra-abdominal abscesses in the present series was significantly higher (p less than 0.01). The results seem to indicate that a 3-day course of cefoxitin is as effective as a 5-day course in controlling the incidence of wound infection following surgery for perforated or ruptured appendicitis, whereas the 3-day course seems to be inferior to a 5-day course in controlling the incidence of intra-abdominal abscesses.     

How to measure urethral elastance in a simple way

Summary The elastance of a biological tube describes the resistance of the latter to dilatation. It is defined as dP/dV, where dP is the pressure increase caused by the volume increase dV. Elastance is the reciprocal of compliance. Elastance in the female urethra can be estimated from the slope of the regression line of related values of pressure and cross-sectional area. In the present study, urethral elastance was calculated by measurement of the related pressures and cross-sectional areas during stepwise dilatation by a balloon and by determination of the pressure at which inflow through side holes in catheters with increasing diameters began. There was no difference between the elastance values obtained by the two methods. Due to the linear correlation found between pressure and cross-sectional area we conclude that urethral elastance can be estimated from measurements of urethral pressure at two or more related cross-sectional areas by a simple technique using e.g., 8F, 14F, and 20F catheters.     

Pudendal nerve recovery after a non-instrumented vaginal delivery

The aim of the study was to investigate pudendal nerve function after a non-instrumented vaginal delivery. Seventeen primiparae women who had had a non-instrumented vaginal delivery were examined 3–5 days and 3 months after delivery. At both assessments pudendal nerve terminal motor latency (PNTML) was measured. The mean PNTML was found to decrease significantly from 2.64 ms in the first few days after delivery to 1.95 ms 3 months after delivery (P=0.00009). PNTML decreased in all but one of the 17 women during the observation period. Immediately after delivery 9 women (53%) had a pathological high PNTML value, which was normalized 3 months later in all but 1. It was concluded that pudendal nerve function is often impaired immediately after a non-instrumented vaginal delivery, but recovers in most women over a 3-month period.Editorial Comment: This study evaluates pudendal nerve function following a non-instrumented vaginal delivery and its relation to urinary and fecal incontinence. It has been established by other investigators that vaginal delivery leads to a prolongation of pudendal nerve terminal motor latency (PNTML) [1,2]. Beyond reconfirming this fact, Tetzschner et al. find that PNTML returns toward normal values approximately 3 months postpartum. Clinically, this translates into the need to question patients regarding urinary or fecal incontinence in the postpartum period, and to consider further evaluation and treatment if the patient remains symptomatic 3 months following delivery.     

The effect of bilateral pudendal blockade on the static urethral closure function in healthy females.

OBJECTIVE: To evaluate the effect of bilateral pudendal blockade on the urethral closure function in the resting state in healthy women. METHODS: Synchronous measurements of pressure and cross-sectional area were recorded at the bladder neck, in the high-pressure zone, and in the distal urethra before and after the pudendal blockade in ten women. RESULTS: The blockade reduced the resting pressure significantly (P < .01) all along the urethra. The viscoelastic indices of elastance (reciprocal of compliance) and hysteresis (difference in pressure at a given degree of urethral dilation when this is increased and decreased stepwise) were significantly (P < .05) reduced. CONCLUSIONS: The striated muscles innervated by the pudendal nerve are of paramount importance for the closure function in the resting state all along the urethra. Urethral elastance and hysteresis seem to depend on activity in the surrounding striated muscle fibers.     

Regenerative medicine provides alternative strategies for the treatment of anal incontinence

Introduction and hypothesis

Anal incontinence is a common disorder but current treatment modalities are not ideal and the development of new treatments is needed. The aim of this review was to identify the existing knowledge of regenerative medicine strategies in the form of cellular therapies or bioengineering as a treatment for anal incontinence caused by anal sphincter defects.

Methods

PubMed was searched for preclinical and clinical studies in English published from January 2005 to January 2016.

Results

Animal studies have demonstrated that cellular therapy in the form of local injections of culture-expanded skeletal myogenic cells stimulates repair of both acute and 2 – 4-week-old anal sphincter injuries. The results from a small clinical trial with ten patients and a case report support the preclinical findings. Animal studies have also demonstrated that local injections of mesenchymal stem cells stimulate repair of sphincter injuries, and a complex bioengineering strategy for creation and implantation of an intrinsically innervated internal anal sphincter construct has been successfully developed in a series of animal studies.

Conclusion

Cellular therapies with myogenic cells and mesenchymal stem cells and the use of bioengineering technology to create an anal sphincter are new potential strategies to treat anal incontinence caused by anal sphincter defects, but the clinical evidence is extremely limited. The use of culture-expanded autologous skeletal myogenic cells has been most intensively investigated and several clinical trials were ongoing at the time of this report. The cost-effectiveness of such a therapy is an issue and muscle fragmentation is suggested as a simple alternative.