Is the investigation of most stress incontinence really necessary?

The case histories of 494 women referred to a urodynamic clinic with the symptom of stress incontinence were studied. None had undergone previous incontinence surgery. In only 12 patients was stress incontinence the sole symptom. In the remainder, symptoms suggestive of detrusor instability were present in 417, of a voiding disorder in 261 and of an inflammatory disorder in 166. The sign of stress incontinence was present in only 168 patients and was not a reliable guide to the diagnosis of genuine stress incontinence. Urodynamic studies were necessary in 488 patients in order to obtain an accurate diagnosis.     

Transvaginal ultrasound in the assessment of bladder volumes in women. Preliminary report

Transvaginal linear array ultrasound is described as a method of measuring bladder volumes in the range 2 to 175 ml, overcoming the limitations of abdominal ultrasound at these smaller (though clinically important) volumes. The mean error over the range 10 to 175 ml was 23%. Statistical analysis of preliminary data obtained by this technique shows that bladder volume in ml can be calculated by the formula: Volume = 5.9 x (height x depth) - 14.6 ml (95% confidence limits = +/- 37 ml)     

Antibodies to liver cell membrane antigens in chronic active hepatitis (CAH). III. Partial characterization of the liver cell membrane antigens and comparison of reactivities in sera from patients with various liver diseases.

The reactivity of sera in liver diseases was investigated by an immunoradiometric assay for antibody to liver membrane antigens (LMAg). Serum reactivity was similar using glutaraldehyde treated hepatocytes from man and several animals, but the reactivity with human hepatocellular carcinoma cell lines was weak and irregular. F(ab)2 fragments from reactive sera were used in competitive inhibition experiments to ascertain whether anti-LMAg from different liver diseases reacted with the same or different antigenic determinants of the liver membrane. Sera from different patients with autoimmune CAH reacted predominantly with the same membrane components, as did sera from hepatitis B virus associated CAH (CAH-B); however sera from acute viral hepatitis A did not and, since such sera were reactive to LMAg in the assay, other membrane antigens are presumably involved. Enzymatic treatment of viable hepatocytes was performed to determine the nature of the reactive antigen(s): proteases or periodate resulted in reduced binding of reactive sera, but neuraminidase did not, suggesting that the LMAg recognized by CAH sera comprises species non-specific membrane glycoproteins. We conclude, on the basis of quantitative data from a immunoradiometric assay, that antibody to LMAg is more probably reactive than pathogenic, and that assessment of the antigenicity of specific membrane components is necessary.