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Titolo:
Neurogenic failures of the external urethral sphincter closure and relaxation; a videourodynamic study
Autore:
Sakakibara, R; Hattori, T; Uchiyama, T; Yamanishi, T; Ito, H; Ito, K;
Indirizzi:
Chiba Univ, Dept Neurol, Chuo Ku, Chiba 2608670, Japan Chiba Univ Chiba Japan 2608670 ept Neurol, Chuo Ku, Chiba 2608670, Japan Chiba Univ, Dept Urol, Chuo Ku, Chiba 2608670, Japan Chiba Univ Chiba Japan 2608670 Dept Urol, Chuo Ku, Chiba 2608670, Japan Amco Co, Chioda Ku, Tokyo 1020072, Japan Amco Co Tokyo Japan 1020072Amco Co, Chioda Ku, Tokyo 1020072, Japan
Titolo Testata:
AUTONOMIC NEUROSCIENCE-BASIC & CLINICAL
fascicolo: 3, volume: 86, anno: 2001,
pagine: 208 - 215
SICI:
1566-0702(20010114)86:3<208:NFOTEU>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
BLADDER OUTLET OBSTRUCTION; URINARY-TRACT FUNCTION; SENSORY URGENCY; PRESSURE-FLOW; DYSSYNERGIA; WOMEN; STANDARDIZATION; INCONTINENCE; TERMINOLOGY; REFLEX;
Keywords:
urinary incontinence; uninhibited external sphincter relaxation; detrusor-external sphincter dyssynergia; videourodynamic study; pressure-flow study;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
32
Recensione:
Indirizzi per estratti:
Indirizzo: Sakakibara, R Chiba Univ, Dept Neurol, Chuo Ku, 1-8-1 Inohana, Chiba 2608670, Japan Chiba Univ 1-8-1 Inohana Chiba Japan 2608670 2608670, Japan
Citazione:
R. Sakakibara et al., "Neurogenic failures of the external urethral sphincter closure and relaxation; a videourodynamic study", AUTON NEURO, 86(3), 2001, pp. 208-215

Abstract

Urinary urgency and voiding difficulty are common features in neurologicaldiseases, which can be attributed to dysfunction of the urethral sphincterand the detrusor. However, little is known about dynamic sphincter behaviour in neurological diseases. The present study aimed at investigating neurogenic failures of the external urethral sphincter closure and relaxation byvideourodynamic study. We recruited 44 neurological patients with urinary urgency and frequency, 27 men and 17 women, mean age 61 years, and 28 of them had voiding difficulty as well. None had abnormal finding of digital examination or ultrasound echography of the pelvic organs: Using triple-lumen 7F catheter under X-ray fluoroscope, we measured detrusor pressure, external urethral sphincter pressure (Pura) and external sphincter EMG in all patients. We also performed pressure-flow study and obtained the Abram-Griffiths (AG) number, a numerical grade of obstruction During filling 30 had detrusor hyperreflexia. EMG-cystometry showed uninhibited external sphincter relaxation (UESR) in eight patients, seven of whom had detrusor hyperreflexia as well. Patients with UESR showed an abnormal reduction of Pura, mean reduction 64+/-27 cmH(2)O (mean+/-standard deviation). During UESR the Pura andEMG activity fluctuated, and fluoroscopic image showed bladder neck opening in four with extreme urge sensation, including one without detrusor hyperreflexia. During an attempt of voiding three patients with voiding difficulty had detrusor-external sphincter dyssynergia (DESD) with detrusor contraction and eight had unrelaxing external sphincter without detrusor contraction. Fluoroscopic image showed an incomplete or absent urethral opening at the external sphincter. Four of them had severe straining on voiding together with intermittent increment of EMG activity without a normal funneling ofthe bladder neck. The mean reduction of Pura during voiding was 6.4+/-6.7 cmH(2)O and 5.0+/-9.5 cmH(2)O (in women and men, respectively) with DESD orunrelaxing external sphincter which was less than 39+/-25 cmH(2)O and 53+/-47 cmH(2)O in those without (P<0.01). The mean AG number was 15+/-21 and 51+/-19 (for women and men, respectively) with DESD or unrelaxing external sphincter which was larger than 6.2+/-34 and 35+/-22 in those without (P<0.05). In conclusion, UESR and DESD/unrelaxing external sphincter could be a factor for urinary urgency and voiding difficulty in neurological patients, evidence of central dysregulation affecting the Onuf's nucleus and its fibres to the external urethral sphincter. (C) 2001 Published by Elsevier Science B.V.

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Documento generato il 28/03/20 alle ore 10:54:30