Determining normal values for intra-abdominal pressure

BACKGROUND: Intra-abdominal pressure (IAP) measurements can be used for the early detection and management of the abdominal compartment syndrome. IAP values are widely thought to be atmospheric or subatmospheric. However, there are no reports that describe normal IAP values using urinary bladder pressure measurements in patients not suspected of having a raised IAP level. This study sought to determine these normal values to aid our interpretation of IAP measurements in post-surgical patients or patients with suspected increased IAP. METHODS: Urinary bladder pressure measurements were carried out in 40 men and 18 women awake medical or non-abdominal surgery inpatients with existing indwelling catheters. Measurements were made in the supine, 30 degrees and 45 degrees sitting positions. Comparisons were carried out to determine the effects on urinary bladder pressure of body position, sex and a suspected diagnosis of benign prostatic hypertrophy. RESULTS: Median values for IAP were higher if measured in a more upright position (P < 0.0001). Median values were supine, 9.5 cmH2O (range, 1-18 cmH2O); 30 degrees upright, 11.5 cmH2O (range, 3-19 cmH2O); and at 45 degrees upright, 14.0 cmH2O (range, 4-22 cmH2O). Measurements recorded were neither atmospheric nor subatmospheric. IAP was higher in men compared with women in the supine and 30 degrees positions (P < 0.05) but not in the 45 degrees position (P = 0.083). There was no significant difference between patients with and without suspected benign prostatic hypertrophy. CONCLUSIONS: Normal IAP using urinary bladder pressure in awake patients are above atmospheric pressure. As a patient is moved from the supine into the upright position, IAP measurements increase.     

Terodiline, emepronium bromide or placebo for treatment of female detrusor overactivity? A randomised, double-blind, cross-over study

In a randomised, double-blind study, 20 women with idiopathic detrusor instability and associated symptoms were treated with terodiline 25 mg bd, placebo, and emepronium bromide 200 mg tds--each drug being given for 3 weeks with placebo as wash-out period before cross-over. The results were evaluated according to drug preference, frequency charts and elimination of detrusor instability on cystometry. Serum levels of both drugs were monitored as control of tablet intake. The preference for terodiline to placebo was statistically significant: 14/3 women (P less than 0.05), and the majority of women (12/4) preferred terodiline to emepronium. Terodiline also gave a small but significant reduction in 24 h micturition frequency and eliminated detrusor instability in almost 50% of the patients (P less than 0.05). Side effects were frequent but mild in all three treatment periods. It was concluded that terodiline offers an alternative in the treatment of female detrusor instability.     

Clinical experience with a dual switch valve (Miethke) for the management of adult hydrocephalus

The dual switch valve (DSV), which switches between two parallel valve chambers depending on the patient posture, was evaluated in 101 consecutive adult patients with hydrocephalus who required shunt surgery. The opening pressure was 5 or 10 cmH(2)O for the supine position and 30 or 40 cmH(2)O for the upright position depending on the sitting height. The results clearly showed that the DSV can regulate the intraventricular pressure (IVP) to 5 to 10 cmH(2)O in the supine and almost zero in the upright position, independently of posture. Ninety-four of the 101 patients received the DSV and 86 patients showed some clinical improvement. However, three patients required irrigation of subdural hematoma and six were thought to suffer underdrainage (4 probable and 2 possible). Such underdrainage probably resulted from the relatively high opening pressure in the supine position of 10 cmH(2)O and the bedridden state of these patients. This problem may be solved by the DSV with the 5 cmH(2)O setting in the supine position. The DSV can maintain physiological IVP in hydrocephalic patients independently of posture and provides generally satisfactory clinical outcome, but cannot prevent all inadequate drainage-related problems.     

The prone position is associated with a decrease in respiratory system compliance in healthy anaesthetized infants

Ten healthy (ASA I or II) anaesthetized infants undergoing clubfoot surgery were studied. General anaesthesia included rocuronium, nitrous oxide and isoflurane. Volume controlled ventilation (12 ml.kg-1) was delivered via a coaxial Mapleson-D (Bain) system and a Datex AS/3 ventilator. Pulmonary mechanics were measured sequentially in the supine and prone positions using a Bicore CP-100 pulmonary function monitor. Subjects had a mean age of 6 (+/- 2) months and a mean weight of 8.3 (+/- 1.4) kg. Dynamic compliance (CDYN) and static compliance (CSTAT) were both significantly lower in the prone position than in the supine position (P < 0.0005). Mean CDYN decreased from 14.9 +/- 4.9 ml.cmH2O-1 (supine) to 11.6 +/- 3.5 ml.cmH2O-1 (prone). Mean CSTAT decreased from 10.2 +/- 2.8 ml.cmH2O-1 (supine) to 8.9 +/- 2.3 ml.cmH2O-1 (prone). No clinically significant differences in gas exchange were noted, however, on repositioning.     

Experience with 100 cases treated with botulinum-A toxin injections in the detrusor muscle for idiopathic overactive bladder syndrome refractory to anticholinergics

PURPOSE: In this prospective, nonrandomized, ongoing study we evaluated the efficacy and safety of botulinum-A toxin injections in the detrusor muscle to treat patients with idiopathic overactive bladder resistant to conventional treatment, such as anticholinergic drugs. MATERIALS AND METHODS: A total of 23 men and 77 women with a mean age of 63 years (range 24 to 89) with nonneurogenic overactive bladder, including urgency-frequency syndrome, and incontinence despite the administration of maximal doses of anticholinergics were consecutively treated with injections of 100 U botulinum-A toxin in the detrusor muscle at 30 sites under cystoscopic guidance. Micturition diary, full urodynamics, neurological status and urine probes were performed in all participants before treatment. Bladder biopsies were done only in cases of suspected bladder fibrosis or unclear findings. Special attention was given to reflex volume, maximal bladder capacity, detrusor compliance, post-void residual urine, urgency and frequency/nocturia. Clinical, urodynamic and quality of life assessments were performed at baseline, and 4, 12 and 36 weeks after botulinum-A toxin treatment. RESULTS: Overall after 4 and 12 weeks 88% of our patients showed significant improvement in bladder function in regard to subjective symptoms, quality of life and urodynamic parameters (p <0.001). Urgency disappeared in 82% of the patients and incontinence resolved in 86% within 1 to 2 weeks after botulinum-A toxin injections. Mean frequency decreased from 14 to 7 micturitions daily (-50%) and nocturia decreased from 4 to 1.5 micturitions. Mean maximal bladder capacity increased 56% from 246 to 381 ml, mean detrusor compliance increased from 24 to 41 ml/cm H(2)O and pretreatment detrusor instability (mean reflex volume 169 ml) resolved in 74% of patients. Mean volume at first desire to void increased from 126 to 212 ml and mean urge volume increased from 214 to 309 ml. There were no severe side effects except temporary urine retention in 4 cases. Only in 8 patients was the clinical benefit poor and analysis revealed preoperative low detrusor compliance. Mean efficacy duration +/- SD was at least approximately 6 +/- 2 months and then symptoms began to increase. CONCLUSIONS: Our results show that intradetrusor botulinum-A toxin injections may be an efficient and safe treatment option in patients with severe overactive bladder resistant to all conventional treatments.     

Pulmonary effects of body position, PEEP, and surfactant depletion in dogs

The influence of position (sphinx, lateral, supine), surfactant depletion, and different positive end-expiratory pressure (PEEP) on functional residual capacity (FRC), series dead space (VdS) and compliance of the respiratory system (Crs) were evaluated in five dogs. Ventilation homogeneity as measured by an index (multiple breath alveolar mixing efficiency), oxygenation, and cardiovascular hemodynamics were additionally examined. The dogs were anesthetized with halothane, paralyzed, and mechanically ventilated. FRC and VdS were found to be notably large in dogs, 45 +/- 8 ml/kg and 6 +/- 1 ml/kg, respectively. FRC and ventilation homogeneity were improved in the sphinx position (prone position with upright head). Surfactant depletion by lung lavage with 37 degrees C saline caused an immediate and stable decrease in FRC, Crs, and oxygenation (P less than 0.05, respectively) for about 5 h without marked effects on the circulatory system. FRC and VdS increased with increasing PEEP. At the highest PEEP, 10 cmH2O (1 kPa), Crs decreased (P less than 0.05) and ventilation became more uneven, indicating alveolar overdistension.     

Decrease in functional residual capacity and ventilation homogeneity after neuromuscular blockade in anesthetized preschool children in the lateral position

BACKGROUND: While functional residual capacity (FRC) is reduced in children undergoing general anesthesia, the lateral position leads to an increase in FRC compared with the supine position. The impact of neuromuscular blockade remains unknown. We tested the hypothesis that neuromuscular blockade leads to a decrease in FRC and increase in lung clearance index (LCI) while the application of positive endexpiratory pressure (PEEP) of 6 cmH(2)O leads to a restoration in both parameters. METHODS: After approval of the local Ethics Committee, we studied 18 preschool children (2-6 years) without cardiopulmonary disease, who were scheduled for elective surgery. Anesthesia was standardized using propofol and fentanyl. FRC and LCI were calculated by a blinded observer using a SF6 multibreath washout technique with an ultrasonic transit-time airflow meter (Exhalyzer D). Measurements were taken in the left lateral position (PEEP 3 cmH2O) after 1. intubation with a cuffed tracheal tube, 2. neuromuscular blockade with rocuronium, and 3. the additional application of PEEP (6 cmH2O). RESULTS: Functional residual capacity mean (sd) decreased from 31.6 (4.4) ml.kg(-1) to 27.6 (4.2) ml.kg(-1) (P<0.001) following neuromuscular blockade while the LCI increased from 6.54 (0.6) to 7.0 (0.6) (P相似文献   

Funktionelle Ergebnisse nach temporärer Dauerableitung der hypokontraktilen Blase

BACKGROUND: Impaired bladder emptying is a common problem in older people and a challenging task in treatment. Conservative and medical treatment options have shown beneficial effects on micturition; however, in a substantial number of patients the effectiveness of these therapies is disappointing. In the end the decompensated bladder needs indwelling catheterisation. To study the effects on the detrusor function, we analysed the urodynamic data of 31 patients during long-term bladder drainage retrospectively. PATIENTS AND METHODS: All 17 female and 14 male patients showed impaired detrusor contractility, enlarged bladder capacity, decreased sensitivity and a high post-void residual urine volume (PVR). After exclusion of an acute pathology, the patients were treated continously with a suprapubic catheter for an average of 13.1 weeks. By urodynamic measurements before and after the drainage period, we analysed the filling parameters, pressure-flow patterns, PVR and detrusor contractility. RESULTS: At the end of the drainage period, significant changes in the detrusor function were obvious. Compared with the pre-treatment situation, the bladder volume at first desire to void decreased from 306.92 ml to 281.7 ml and the maximum bladder capacity from 691.8 ml to 496.8 ml, respectively. The compliance of the detrusor muscle diminished in the same period of time from 65.6 ml/cmH2O to 51.8 ml/cmH(2)O. The PVR dropped by 227.2 ml in average. The maximum flow rate was 9.4 ml/s, and the maximum detrusor pressure increased slightly up to 23.6 cmH(2)O. CONCLUSION: The continuous drainage of the bladder results in significant changes in the motoric as well as sensoric detrusor function. The reduced bladder capacity and the decreased PVR might be indications of a regenerating process of the detrusor. The long-term drainage of the bladder shows beneficial and therefore therapeutic effects. It still remains to be investigated on a functional as well as structural basis to what extent age, gender and pathogenesis influences the rehabilitation of the detrusor.     

High volume, low frequency continuous ambulatory peritoneal dialysis

Intra-abdominal pressure (IAP), forced vital capacity (FVC), and forced expiratory volume at 1 sec (FEV1) were measured in 18 stable continuous ambulatory peritoneal dialysis (CAPD) patients maintained on 2-liter exchanges, in the supine, sitting, and upright positions after infusing dialysis solutions in 0.5-liter increments up to 4 liters as tolerated. Thereafter, five patients did not increase to 3-liter volumes (RUT-0), four used 3-liter volumes occasionally (RUT-1), and nine chose 3-liter volumes for routine dialysis (RUT-2). IAP was similar in all groups and dependent on the intraperitoneal volume (IPV). The mean IAP increased 2.0, 2.7, and 2.8 cm H2O/liter of IPV in the supine, upright, and sitting positions, respectively. The patients of the RUT-0 group had dramatic deterioration (up to 42%) of FVC and FEV1 in the supine position with IPV above 2 liters. The patients with the greatest deterioration of pulmonary functions could not continue the measurements above 3 liters of IPV. Two of these patients were switched to 1-liter overnight exchanges. Even in patients who tolerated up to 4 liters, FVC and FEV1 decreased significantly in the supine and sitting positions, with IPV greater than 3 or 4 liters, respectively. In the upright position, the values did not decrease significantly below those with the empty abdomen up to 4.6 liters of IPV. Each liter of IPV increased the abdominal girth by 2.1 cm. Exchange volume and frequency should be individualized. In our studies, 50% of the patients could increase daily dialysate volume from 8 to 9 liters while decreasing daily exchanges from 4 to 3.     

Detrusor underactivity following laparoscopic radical prostatectomy

Strain voiding has been reported to be a frequent symptom following radical prostatectomy. However, pathophysiology of vesicourethral function underlying voiding difficulty has not been well studied. In the present study, we investigated detrusor underactivity following radical prostatectomy. The records on urodynamic study (pressure-flow study, urethral pressure profile) were retrospectively investigated in 80 patients undergoing laparoscopic radical prostatectomy and all urodynamic studies pre- and post-operatively. We extracted the cases with detrusor underactivity according to the criteria of overt strain voiding pattern on post-operative pressure flow study; detrusor pressure at the maximum flow rate (Pdet Q(max)) of less than 10 cmH2O in conjunction with an increase of abdominal pressure. Of the 80 patients, 6 (7.5%) were found to have detrusor underactivity. In all patients, good detrusor contraction was confirmed on the pre-operative urodynamic study performed before surgery. On the voiding phase of pressure-flow study in these patients, mean Pdet Q(max) showed a significant decrease postoperatively from 58.5 cmH2O to 3.0 cmH2O (p < 0.01), although mean abdominal pressure at Q(max) significantly increased from 24.2 cmH2O to 105.8 cmH2O (p < 0.05). Mean Q(max) on free uroflowmetry showed a significant increase from 12.8 ml/sec to 22.1 ml/sec (p < 0.05). No patient had significant post-void residual urine. On the storage phase of the study, however, maximum cystometric capacity, maximum urethral closing pressure showed no significant change between pre- and post-operative studies. Five patients acquired continence and one had mild urinary incontinence using one pad a day. The present study showed that detrusor contaractility could be impaired during radical prostatectomy, but, no apparent operative procedure related to detrusor dysfunction could be identified in the present patients.     

An experimental study of the influence of positive end-expiratory pressure for a bidirectional cavopulmonary shunt

In 8 mongrel dogs (weight 9-13 kg), we created a bidirectional cavopulmonary shunt through 4th intercostal thoracotomy. Positive end-expiratory pressure (PEEP) was added from 0cmH2O to 16cmH2O at the steps of 2cmH2O. The heart rate (HR), central venous pressure (CVP), pulmonary artery pressure (PAP), femoral artery pressure (FAP), pulmonary vascular resistance index (PVRI), and systemic vascular resistance index (SVRI) were measured as parameters of hemodynamics. Cardiac output (CO), pulmonary artery flow at proximal and distal site of this shunt (D-SF, P-SF) were measured using a magnetic flow meter. Blood gas analysis (PH, PaO2, PaCO2, HCO3-) were performed at the same time. HR had no significant change. CVP, PAP, PVRI, SVRI increased significantly (p less than 0.05, p less than 0.05, p less than 0.05, p less than 0.05) at 2cmH2O (9.2 +/- 2.5 mmHg), 10cmH2O), (29.3 +/- 5.5 mmHg), 4cmH2O (287 +2- 56 dyne.sec.cm-5.m2), and 8cmH2O (1298 +/- 156 dyne.sec.cm-5.m2) compared with 0cmH2O (87.3 +/- 2.6 mmHg, 26.8 +/- 3.4 mmHg, 240 +/- 29 dyne.sec.cm-5.m2, 1136 +/- 176 dyne.sec.cm-5.m2). FAP, CO, D-SF, P-SF decreased significantly (p less than 0.01, p less than 0.05, p less than 0.01, p less than 0.05) at 6cmH2O (129 +/- 7 mmHg), 2cmH2O(0.44 +/- 0.05 L/min), 2cmH2O(449 +/- 47 ml/min), and 8cmH2O(105 +/- 17 ml/min) compared with 0cmH2O(148 +/- 11 mmHg, 048 +/- 0.06 L/min, 471 +/- 44 ml/min, 132 +/- 19 ml/min). On blood gas analysis, PaO2 increased significantly (p less than 0.05) from 2cmH2O PEEP except PH, PaCO2, HCO3-. A mechanism for decline in D-SF was considered of being a secondary effect due to increase in CVP.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of posture on intraperitoneal pressure and peritoneal permeability in children

The posture of the patient influences both the intraperitoneal pressure (IPP) and the peritoneal permeability. We have studied the effects of the supine and the upright position in six children. Two peritoneal equilibration tests (PET) of 90-min dwell time each were performed consecutively, firstly in the supine position and then in the upright position. The same amount of dialysate was instilled (1,000 ml/m²; isotonic 1.36% dextrose) for each PET. Using the same filling volume, the IPP was significantly higher in the upright position (18.4±4.8 cm H₂O) than in the supine position (8±2.4 cm H₂O). The mean percentage IPP increase was 130%±35%. The decline in glucose resorption rate from the dialysate during the PET was significantly lower in the upright position. Despite this greater relative loss of osmotic gradient in the upright than the supine position, no significant difference in net ultrafiltration was noted after 90 min of dwell. The peritoneal equilibration ratio during the PET was lower in the upright than the supine position for urea, creatinine, and phosphate. These results favor performing peritoneal dialysis in a supine position, both to increase dialysis efficiency and to reduce patient discomfort. Received February 18, 1997; received in revised form September 15, 1997; accepted September 22, 1997     

Pressure and flow limitations of anesthesia ventilators

The effect of increasing airway pressure on the mean inspiratory flow and maximum minute ventilation (VE) capabilities of five anesthesia ventilators (Ohio Anesthesia, Airshields Ventimeter, Ohmeda 7000, Draeger AV-E and Siemens 900D) was compared to identify mechanical factor(s) limiting intraoperative ventilation of the lungs of patients with acute respiratory failure. The effect of increasing airway pressure on mean inspiratory flow was determined by cycling each ventilator through increasing restrictors. Maximum VE was measured under three study conditions using a test lung: 1) low compliance (10-30 ml/cmH2O) and minimal airflow resistance; 2) positive end-expiratory pressure (PEEP) of 0, 10, and 20 cmH2O at a compliance of 20 ml/cmH2O with minimal airflow resistance; and 3) increased resistance (19 +/- 11 cmH2O.1(-1).s-1) and compliance of 30 ml/cmH2O. As airway pressure increased from 0 to 80 cmH2O, mean inspiratory flow decreased markedly for all ventilators except the Siemens. The Siemens ventilator delivered the greatest VE under all three conditions and maintained VE when airway pressure increased due to decreased compliance or the application of PEEP; all other ventilators markedly decreased VE under these conditions. The addition of airway resistance reduced maximal VE for all ventilators by limiting the maximal inspiratory duty cycle (T1/TTOT). Thus, mean inspiratory flow of conventional anesthesia ventilators decreases with increasing airway pressure. The decreased inspiratory flow limits maximum VE when airway pressure is elevated because of decreased lung-thorax compliance and/or increased airway resistance, such as that characterizing patients with acute respiratory failure. Significant airway resistance further limits maximum VE by limiting the maximal T1/TTOT that can be used without increasing end-expiratory lung pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Increasing fill volume reduces cardiac performance in peritoneal dialysis.

BACKGROUND: It is generally accepted that peritoneal dialysis (PD) affects systemic haemodynamics less than haemodialysis, but little is known about changes in haemodynamics during PD. It is unknown if increasing PD volume causes changes in cardiovascular haemodynamics possibly increasing the demand on the heart even during normal daily activities. METHODS: Fifteen stable PD patients were included in this randomized, controlled, open-label crossover study. After drainage, we measured blood pressure, pulse rate and cardiac output (CO) after 30 min in the supine position. The measurements were repeated 5 min later in an upright position. Subsequently, following fill, the measurements were repeated after 30 min in the supine and 5 min later in the upright position. The two procedures were repeated twice. The fill was either 2 l or 3 l of dialysate. CO was measured with a non-invasive device based on foreign gas rebreathing. Stroke volume (SV) and total peripheral systemic resistance were calculated. RESULTS: In the supine position, no difference was found between drained and 2 l fill. With 3 l fill both SV and CO decreased and total peripheral systemic resistance increased, while pulse rate and mean arterial blood pressure remained unchanged. In the upright position, SV and CO decreased and total peripheral systemic resistance increased. Pulse rate and mean arterial blood pressure were unchanged independent of fill volume when compared with the drained situation. During postural change, no significant differences were found between drained and 2 l and 3 l fill. CONCLUSION: The present study showed that cardiac performance decreased when increasing fill volume from 2 to 3 l in the supine position. The decreased cardiac performance was already present after 2 l fill in the upright position and did not change negatively by increasing fill. It was also shown that cardiovascular response from the supine to upright position was preserved.     

Comparison of supine and upright positions on autonomic nervous activity in late pregnancy: the role of aortocaval compression

In order to understand the effect of aortocaval compression on autonomic nervous activity, we compared the effects of supine and upright postures on measures of heart rate variability in late pregnancy. Thirty-two women in late pregnancy and 23 nonpregnant age-matched women were studied. Both time and frequency domain heart rate variability measures were compared between the supine and upright positions, and between pregnant women and controls. The pregnant women had smaller mean RR interval, standard deviation of RR intervals and normalised high-frequency power, and a larger low- to high-frequency power ratio than nonpregnant women in the supine position. When the position was changed from upright to supine in nonpregnant women, the percentage change in the mean RR interval and normalised high-frequency power were increased, whereas the percentage change in the coefficient of variation of RR interval and low- to high-frequency power ratio were decreased. In contrast, the percentage change in normalised high-frequency power was decreased and the percentage change in low- to high-frequency power ratio was increased in pregnant women when the position was changed from upright to supine. These results indicate that the vagal enhancing effect seen in normal subjects when changing position from upright to supine was reversed in women in late pregnancy. Aortocaval compression in the supine position in pregnant women might be responsible for this reversal in the autonomic response to lying down.     

Oral airway resistance during wakefulness in patients with obstructive sleep apnoea

BACKGROUND: Patients with obstructive sleep apnoea (OSA) have a number of upper airway structural abnormalities which may influence the resistance of the oral airway to airflow. There have been no systematic studies of the flow dynamics of the oral cavity in such patients. METHODS: Inspiratory oral airway resistance to airflow (RO) was measured in 13 awake patients with OSA in both the upright and supine positions (neck position constant). Each subject breathed via a mouthpiece while the nasal airway was occluded with a nasal mask. RESULTS: In the upright position the mean (SE) RO was 1.26 (0. 19) cm H2O/l/s (at 0.4 l/s) which increased to 2.01 (0.43) cm H2O/l/s when supine (p<0.05, paired t test). The magnitude of this change correlated negatively with the respiratory disturbance index (r = -0.60, p = 0.03). CONCLUSION: In awake patients with OSA RO is normal when upright but abnormally raised when in the supine position.     

Interstitial laser coagulation for benign prostatic hyperplasia: clinical results of the Indigo diode laser system

We report our experience with interstitial laser coagulation of the prostate (ILCP) using an Indigo 830j diode laser system for benign prostatic hyperplasia (BPH). From March 1998 to November 2000, we treated 45 patients between 51 and 95 years old (average 71.5) with symptomatic BPH. The mean prostatic volume before ILCP was 62.0 cm3. We experienced no serious complications. Three months after ILCP, the mean international prostate symptom score (I-PSS) quality of life (QOL) index and post-void residual volume (PVR) decreased significantly from 18.0 to 9.2, from 4.4 to 2.1 and from 103.6 ml to 44.5 ml, respectively. The mean maximum flow rate (MFR) increased from 7.6 ml/sec at baseline to 9.2 ml/sec 3 months after ILCP, but the difference was not statistically significant. Before and after ILCP, 8 patients were available to evaluate pressure-flow study data. The detrusor pressure at the maximum flow rate decreased significantly from 118.3 cmH2O at baseline to 78.6 cmH2O 3 months after ILCP. The improvement of the I-PSS, QOL index, MFR and PVR continued and at 24 months reached 5.7, 1.8, 11.6 ml/sec and 54.6 ml, respectively. In our assessment of the questionnaire addressing the patient's satisfaction after the treatment, the majority of the patients who answered the questionnaire were pleased with the results of ILCP. We assessed the relation of the overall treatment efficacy with the number of punctures and the total amount of the laser energy delivered, but we did not find any relation. Our clinical results suggest that the ILCP using Indigo 830j is an effective modality and the short-term treatment efficacy is favorable.     

Urodynamic findings in patients with a urethral Kock pouch after radical cystectomy]

Urodynamic evaluation was performed in 11 male patients, who underwent radical cystectomy with pelvic lymph node dissection for bladder cancer followed by bladder replacement with a urethral Kock pouch, 3 to 21 months after the operation. Frequency of micturition were 4.9 +/- 1.5 times (mean +/- S.D.) during the day-time and 1.5 +/- 1.2 times during the night-time. Tidal volume of micturition ranged from 300 to 550 ml and residual volume from 10 to 30 ml. Urinary continence was completely preserved in all patients (100%) during the day-time and 8 (72.7%) during the night-time. On pouchmetry, maximum capacity of the pouch was 429.2 +/- 82.4 ml, and intra-pouch pressure was 16.2 +/- 5.4 cmH2O at the capacity of 200 ml and 38.7 +/- 11.5 cmH2O at the maximum capacity. Maximum intra-pouch pressure on voiding was 80.0 +/- 19.4 cmH2O. Uroflowmetry demonstrated intermittent voiding curves in all the patients, with maximum flow rate of 15.2 +/- 6.5 ml/sec, voided volume of 405.9 +/- 80.7 ml and residual rate of 4.5 +/- 2.6%. Maximum intra-urethral pressure at the external urethral sphincter was 28.0 +/- 11.3 cmH2O when the pouch was empty and increased in response to pouch filling up to 64.7 +/- 27.0 cmH2O. Maximum urethral closing pressure and total profile length on the urethral pressure profile were 30.2 +/- 12.4 cmH2O and 20.9 +/- 9.0 mm, respectively, with the pouch empty, and 23.2 +/- 14.5 cmH2O and 20.0 +/- 7.6 mm, respectively, with the pouch full.(ABSTRACT TRUNCATED AT 250 WORDS)     

Variation in urinary flow according to voiding position in normal males.

Our objective was to study whether the urinary flow rate would vary according to voiding position. Twenty-one normal healthy male volunteers aged 24 to 40 years (mean, 29 years) were studied. The bed used was designed so that a hole could be opened at its center for voiding, and the bed could be bent at two points so that the subject could void in various positions. Urinary flow was measured with a portable uroflowmeter (P-Flow), which permits measuring urinary flow rate. Each subject assumed five voiding positions (standing, sitting, lateral, supine, and prone) in random order. Urinary flow was measured at least twice in each position to record a stable voiding. For voiding in the lateral position, subjects were instructed to void while bending the upper leg to keep an open angle between the legs. All subjects were also instructed to void without increasing abdominal pressure. Maximum flow rate was 20.7 +/- 6.59 mL/sec with voided volume of 262 +/- 77.8 mL in the lateral, 22.1 +/- 7.05 mLl/sec with voided volume of 309 +/- 130 mL in the supine, 25.0 +/- 8.25 mL/sec with voided volume of 287 +/- 122 mL in sitting, 27.1 +/- 8.89 mL/sec with voided volume of 263 +/- 102 mL in the standing, and 28.7 +/- 10.6 mL/sec with voided volume of 303 +/- 98 mL (mean +/- SD) in the prone positions. The maximum and mean urinary flow rates were greatest in the prone position. With regard to these parameters, significant differences were noted between the prone and lateral positions and between the prone and supine positions. In conclusions, the maximum urinary flow rate was highest in the prone position, followed by the standing, sitting, supine, and finally the lateral positions in normal males. Neurourol. Urodynam. 18:553-557, 1999.     

Parameters of bladder function in pre-, peri-, and postmenopausal continent women without detrusor overactivity

AIMS: To determine normative data for lower urinary tract function in asymptomatic continent women without detrusor overactivity (DO) across the age span. METHODS: Healthy female volunteers aged > or =20 years were recruited from the community. Comprehensive assessment included bladder diary, physical examination, uroflowmetry, and video-urodynamics. Continent women without history of frequent urgency and without DO were selected. Data on bladder storage, voiding and urethral sphincter function, urine output and frequency are presented for pre-, peri-, and postmenopausal women. RESULTS: Twenty-four asymptomatic women (mean age 50.2 years, range 22-80 years) met the inclusion criteria, including 7 pre- (29.2 years), 7 peri- (48.8 years), and 10 postmenopausal (66.0 years) women. For all subjects, maximum single voided volume in bladder diary was 500 ml and maximum cystometric capacity was 580 ml (median values). Strong desire to void (SDV) was reported at 287, 366, and 425 ml for pre-, peri-, and postmenopausal groups, respectively. The maximum flow rate was 25, 32, and 23 ml/sec in uroflowmetry and 23, 24, and 18 ml/sec in pressure-flow study, respectively. Median post-void residual volume (PVR) was below 20 ml in all groups. At maximum flow rate subjects voided with detrusor pressures of 29, 26, and 24 cm H(2)O, respectively. Maximum urethral closure pressure was 94, 74, and 42 cm H(2)O, respectively. CONCLUSIONS: We provide normative data on bladder function in asymptomatic, continent, pre-, peri-, and postmenopausal women without DO.