Urodynamics: the appropriate modality for the investigation of frequency, urgency, incontinence, and voiding difficulties

Article Abstract:

The bladder stores urine until it becomes full, at which time it empties itself. It signals the need to expel with increasing intensity as urine accumulates and causes the bladder to expand. The signals are controlled by the interaction of a number of bodily systems. Abnormalities in any of these systems can interfere with the signal and cause symptoms such as frequent or urgent need to urinate, incontinence, and difficulty in urinating. Videourodynamics (VUD) is the established diagnostic technique for examining these problems. This technique measures pressure, filling volume, and flow rate during urination, and is able to image the bladder during urination. In normal adults, the bladder can hold about half a quart of fluid with awareness of bladder filling beginning at about 25 percent of capacity. Standard changes in pressure during the process have been established for adults. Abnormalities appear on VUD as pressure changes that do not fit within the standard range or when signal intensity is not appropriate for the level of bladder filling. There are a number of causes of these abnormalities. Stress incontinence is mainly found in middle-aged women. This problem is characterized by bladder leakage, resulting from weakness in the bladder neck. Detrusor instability, or an unstable bladder, is a common problem. It is caused when the bladder contracts independently from the amount of urine in the bladder. VUD can detect the contractions and inappropriately high pressures. The sensitive bladder is characterized by a heightened awareness of bladder filling. Urination is sensed to be necessary even though the bladder is not highly filled. Often a psychological problem, it can also be caused by cystitis (inflammation of the bladder), which can be detected by VUD. Obstructions can also cause urination problems. These commonly occur in the prostate (in men) and in the bladder neck. VUD can detect these obstructions. Urination problems may occur after surgical removal of the prostate gland (prostatectomy), either because the prostate was not the cause of the problem or because the surgery was inadequate. VUD provides a well-rounded examination of the anatomy of the bladder and its functioning and is useful in assessing bladder problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Urinary organs, Bladder, Urinary tract, editorial

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Distal urethral electrical conductance (DUEC) -a preliminary assessment of its role as a quick screening test for incontinent women

Article Abstract:

To diagnose urinary problems in women complaining of incontinence (inability to retain urine in the bladder), 100 female patients were evaluated with the distal urethral electrical conductance (DUEC) catheter. While the patient stands this device is inserted into the urethra (the tube through which urine leaves the bladder), and measures changes in electrical conductance as the patient coughs (an action likely to result in involuntarily expelled urine in an incontinent patient). The patient then washes her hands under running water. The conductance changes reflect the presence of urine in the urethra, which causes a conductance increase. Three patterns of conductivity were identified that correlate well with variables identified by other methods of rating urine storage and flow (urodynamics). Prior to assessment, patients were asked to maintain a comfortably full bladder; afterwards, they voided, and peak urine flow rate and volume were recorded. They then underwent a full range of conventional urodynamic tests. Results from DUEC measurements correlated with results from cystometry (measurement of bladder capacity and pressure changes during voiding) for only 55 patients, but led to an incorrect diagnosis in 45. However, results for the 33 women who voided more than 250 milliliters of urine were more encouraging: in this case, 94 percent were correctly diagnosed by DUEC, and there were no incorrect diagnoses. It seems that a full bladder is essential for accuracy of diagnosis by the DUEC catheter; when this requirement is met, the approach offers important advantages over urodynamic studies. The latter are more costly, may require long waits before they can be performed, and can be performed if results from DUEC catheter screening are uncertain or indicate abnormality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Diagnosis, Women, Women's health, Urinary stress incontinence

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Disappearing breast calcifications

Article Abstract:

It is important to differentiate among calcifications that occur in the breast because certain patterns and types of calcification are associated with cancer. As the number of calcification increases there is an increasing probability that neoplasia (abnormal tissue growth) is occurring. Most calcifications occur within the ducts or lobules of the glandular tissue rather than in the fat and loose connective tissue of the stroma (supporting tissue of the breast). Fine calcification, generally associated with cancer of the breast, are thought to be formed as a secretory product of increased cellular activity of the mammary lobules (small subdivisions of lobes). Little attention has been paid to the fact that calcification may spontaneously disappear. This group of researchers describes 17 patients with ages between 47 and 67 years who had 20 foci of disappearing breast calcification. The disappearing calcifications tend to be large (greater than one millimeter), solitary and round. They seemed to develop deep within glandular tissue, and only one of the 20 foci was slightly suspicious of malignancy. It is not known whether these disappearing calcifications are reabsorbed or extruded. The authors conclude that disappearing breast calcifications are probably an uncommon but not a rare occurrence.

Case studies, Calcification, Breast

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