Werner Schaefer - Academia.edu (original) (raw)

Papers by Werner Schaefer

British journal of urology, Nov 1, 1993

Summary The anatomy of urinary incontinence and the underlying pathology is still under discussio... more Summary The anatomy of urinary incontinence and the underlying pathology is still under discussion.We examined 24 stress incontinent patients and 6 healthy volunteers. Magnetic resonance imaging (MRI) clearly shows that the urethra is not connected to the levator ani. The urethra is not fixed to deep perineal muscle layers. In stress incontinence the sharp angulation of the levator ani of healthy volunteers is lost in 65%. MRI shows degeneration of the levator ani muscle in 45% of stress incontinent patients. The extent of damage to the levator can clearly be identified with the aid of MRI.

The Journal of Urology, Apr 1, 2009

Aims: To report interpatient, intrapatient, and study site variability of urodynamic study (UDS) ... more Aims: To report interpatient, intrapatient, and study site variability of urodynamic study (UDS) parameters in patients with overactive bladder (OAB). Methods: Fifty-eight patients with OAB participated in a randomized, double-blind, placebo-controlled, urodynamic trial of an experimental OAB drug. Patients underwent 3 serial cystometries (CMGs) at three times: screening, pre-dose, and 4-hr postdose. This post hoc analysis describes intrapatient, interpatient, and site variability for the 6 CMGs prior to administration of study drug. Sites were given standard procedures for equipment calibration and UDS technique. Instilled volumes and pressures were recorded at first sensation of filling, first desire to void (FDV), strong desire to void (SDV), and maximum cystometric capacity (MCC). Results: The UDS volume endpoint with the smallest observed within-patient variability based on coefficient of variation (%CV) was MCC (%CV 24). Pressure measurements of all bladder sensations had larger within-patient variability than volume (MCC %CV 105). The between-patient variability was greater than within-patient variability for all bladder sensation volumes. Between-patient MCC variability for the 6 pre-treatment CMGs ranged from %CV of 50 to 58, whereas the within-patient %CV for MCC was 21-23. Excellent reproducibility was observed for bladder volume for MCC (intraclass correlation coefficients, range: 0.80-0.84). The between-site variability was large, as demonstrated by the mean volumes by site for MCC (132-397 ml). Conclusions: MCC was the most reproducible sensation. Pressure measurements were substantially more variable than volume. Between-patient variability was substantially greater than within-patient variability. The observed intersite variability suggests that despite detailed instructions, sensations may not have been measured in a consistent manner across sites.

CRC Press eBooks, Jul 15, 2010

Neurourology and Urodynamics, 2012

ics.org, Aug 23, 2010

After >50 years of investigation, the relationship between "non-neurogenic" urgency incontinence ... more After >50 years of investigation, the relationship between "non-neurogenic" urgency incontinence (UUI) and its assumed cause, detrusor overactivity (DO), remains unclear, and both etiology and the mechanisms underlying therapeutic response remain unknown. To gain further insight, we enrolled older adults with UUI in a prospective, clinical-urodynamic investigation. The goal was to identify the key physiological parameters that predict and/or likely mediate response to a widely recommended behavioral therapy (biofeedback-assisted pelvic floor muscle training, BFB). 2. Study design, materials and methods Subjects were cognitively and functionally intact, community-dwelling women aged > 60 years with at least 2 UUI episodes per week. All underwent detailed clinical evaluation, including history, physical exam, lab tests, and review of old records; 3-day bladder diary; 24-hour pad test; and comprehensive videourodynamics with simultaneous videocystosphincterometry, urethral testing, and pressure/flow study. A standard protocol was used to elicit DO if it did not appear spontaneously. Each evaluation was performed before and after therapy. EMG-based BFB followed a standard published protocol [1] and included 4 clinic visits and home practice. Therapeutic response was defined a priori and based on bladder diary and reassessed based on 24-hour pad test. Since pad test results were comparable with those based on the bladder diary, only the latter are presented. The study was funded by NIH.

Neurourology and Urodynamics, 2011

Neurourology and Urodynamics, 2009

Neurourology and Urodynamics, 2012

The Journal of Urology, Apr 1, 2005

THE JOURNAL OF UROLOGY® many patients, these symptoms correspond to the urodynamic finding of inv... more THE JOURNAL OF UROLOGY® many patients, these symptoms correspond to the urodynamic finding of involuntary detrusor contractions during filling cystometry (i.e., detrusor overactivity). Animals with partial urethral obstruction also exhibit detrusor overactivity evidenced by spontaneous non-voiding contractions (NYC) during the filling phase. Type 4 phosphodiesterase (PDE4) is a high-affinity cAMP-selective isozyme. Elevation of cAMP levels by inhibition of PDE4 reportedly relaxes smooth muscles. We therefore investigated the effects of IC486051, a specific inhibitor of PDE4, on bladder activity in normal and bladder outlet obstructed (BOO) rats. METIIODS: Under halothane anesthesia, rats were induced BOO by partial urethral obstruction using a silk ligature placed around the urethra and tied in the presence of an intraluminal indwelling PE-90 polyethylene catheter (O.D. 1.27 mm). After 4 or 6 week of BOO, continuous cystometry under awake was performed with the urethral ligature intact. IC486051 (0.1-1.0 mglk:g) or vehicle was injected intravenously, and cystometric parameters, such as the number and amplitude of NVC, intercontraction intervals of voiding contractions, maximal voiding pressure, voided volume and post-void residual volume, were compared with the values in a control period. In normal rats, blood pressure was also measured during cystometry. RESULTS: In 4-or 6-week BOO rats, IC486051 significantly and dosedependently decreased the number and amplitude of NVC, producing a reduction of 67-80% and 72-73% from the control value, respectively, at 1.0 mg/kg (i.v.). In 6-week, but not 4-week, BOO rats, maximal voiding pressure after drug injection (1.0 mglk:g) was slightly and significantly reduced by 17%, without changing voiding efficiency. In normal rats, IC486051 at 0.5 mglk:g (i.v.) significantly reduced maximal voiding pressure by 34%, but other parameters, including voiding efficiency, were not altered at 0.1 or 0.5 mglk:g. In addition, IC486051 at 0.1-0.5 mglk:g did not significantly reduce blood pressure in normal rats. CONCLUSIONS: These results indicate that a cAMP-specific PDE4 isozyme inhibitor, IC486051, can effectively suppress detrusor overactivity with a minimal effect on voiding function in awake rats with BOO. Thus, selective PDE4 inhibitors might be clinically useful for the treatment of overactive bladder in patients with BOO.

The Journal of Urology, May 1, 2006

Purpose: We examined the relationship of DO and aging, and bladder function in female volunteers.... more Purpose: We examined the relationship of DO and aging, and bladder function in female volunteers. Materials and Methods: We recruited 85 cognitively competent, fully functional female volunteers who were 22 to 90 years old (median age 54) with and without symptoms suggestive of DO. Comprehensive assessment included a bladder diary, uroflowmetry and videourodynamics. We examined predefined urodynamic and diary variables for associations with DO and age, summarizing results in the 3 subgroups no DO, intermediate DO and clinically relevant DO. Results: Compared to women without DO those with DO showed a decrease in maximum cystometric capacity (558 vs 448 ml), mean daytime voided volume (260 vs 175 ml) and volume at strong desire to void (363 vs 283 ml) but an increase in maximum isovolumetric pressure (41 vs 64 cm H 2 O) and maximum detrusor pressure during involuntary contraction (intermediate and relevant DO 22 and 37 cm H 2 O, respectively). The positive association between increased detrusor contraction strength and DO was present at younger ages but absent in older subjects. Maximum urethral closure pressure and detrusor contraction strength decreased significantly with age. Conclusions: From young adulthood to old age DO appears to affect bladder function parameters. It is associated with decreased bladder capacity and increased bladder sensation. Moreover, in younger adults DO is also associated with increased detrusor contraction strength, which is an association not seen in older individuals. This age associated loss of muscle function may be related to sarcopenia, implying that different treatments may be appropriate in older adults.

Journal of the American Geriatrics Society, Mar 1, 2006

OBJECTIVES: To identify age-associated changes in female lower urinary tract function across a wi... more OBJECTIVES: To identify age-associated changes in female lower urinary tract function across a wide age spectrum, controlling for detrusor overactivity (DO). DESIGN: Secondary analysis of a cross-sectional study of DO and aging. Eligible volunteers were stratified by age group and presence of DO. SETTING: Community-based volunteers, evaluated in research laboratory. PARTICIPANTS: Eighty-five ambulatory, nondemented, community-dwelling female volunteers, with and without bladder symptoms suggestive of DO, recruited by advertising, mean age 54 (range 22-90); 75% Caucasian, 21% African American. MEASUREMENTS: Comprehensive assessment included bladder diary, uroflowmetry, and detailed videourodynamics. Predefined urodynamic and diary variables were examined for association with age and DO. Mean values of these variables were calculated for subgroups aged 20 to 39, 40 to 59, and 60 and older (14 subjects !70). RESULTS: Maximum urethral closure pressure, detrusor contraction strength, and urine flow rate declined significantly with age (Po.001, Po.001, P 5.006, respectively), regardless of whether DO was present. Most elderly individuals continued to empty their bladder almost completely, with normal voiding frequency. Mean number of nocturnal voids was less than one in all age groups. Bladder capacity did not decrease with age (mean 522 mL in oldest group) but was smaller in subjects with DO. Bladder sensation diminished significantly with age (Po.001) but was stronger in subjects with DO. CONCLUSION: Female bladder and urethral function appear to deteriorate throughout adult life, whether DO is present or not. Specifically, detrusor contractility, bladder sensation, and urethral pressure decline. The common belief that bladder capacity shrinks with age may be related to DO rather than to aging itself.

Neurourology and Urodynamics, 2010

Neurourology and Urodynamics, 2007

Aims: To determine normative data for lower urinary tract function in asymptomatic continent wome... more 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 !20 years were recruited from the community. Comprehensive assessment included bladder diary, physical examination, uroflowmetry, and videourodynamics. 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.

The Journal of Urology, Apr 1, 2007

We report the primary outcomes analysis at 24 month followup of the Stress Incontinence Surgical ... more We report the primary outcomes analysis at 24 month followup of the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr), a prospective randomized controlled trial designed to compare the Burch colposuspension and autologous rectus fascia pubovaginal sling. METHODS: Women were eligible for the study if they had stress predominant urinary incontinence symptoms, a positive stress test, urethral hypermobility on Q-tip exam and desired surgical treatment for their incontinence. Patients were randomized in the OR and followed at regular intervals up until 24 months. Treatment success was defined in two ways: 1) Overall success was defined as no self-reported SUI symptoms on questionnaire; and a negative pad test(< 15 ml urine leakage over 24 hours); and no urinary incontinence on 3-day voiding diary; and a negative provocative stress test; and no re-treatment for SUI; 2) SUI-specific success was defined as no self-reported SUI symptoms; and a negative stress test; and no SUI re-treatment. Demographic characteristics, patient satisfaction, post-operative urge incontinence, voiding dysfunction and other adverse events were assessed. The study was designed to have 80% power to detect a 12% difference between the two procedures as statistically significant. RESULTS: 655 women were randomized (326 sling and 329 Burch} and 24 month follow-up was completed in 557 (85%). The two groups had similar pre-operative demographic, clinical and urodynamic variables. The sling demonstrated higher success rates than the Burch for both overall treatment success (41% vs 29%, p=0.005) and stressspecific success (60% vs 43%. p < 0.001). Women in the sling group reported higher rates of urinary tract infection (292 vs 195 UTI events}, post-operative urge incontinence (28% vs 22%) and voiding dysfunction (14% vs 2%) than women in the Burch group. Satisfaction rates at 24 months were similar between the sling (87%) and the Burch (81%) patients (p=0.12). CONCLUSIONS: The autologous rectus fascia sling provides 17% higher success rates than the Burch colposuspension in the resolution of stress-specific urinary incontinence but at a cost of higher morbidity including UTI, urinary retention and urge incontinence. In spite of these differences in efficacy and morbidity there was no significant difference in satisfaction.

Neurourology and Urodynamics, 2014

These guidelines provide benchmarks for the performance of urodynamic equipment, and have been de... more These guidelines provide benchmarks for the performance of urodynamic equipment, and have been developed by the International Continence Society to assist purchasing decisions, design requirements, and performance checks. The guidelines suggest ranges of specification for uroflowmetry, volume, pressure, and EMG measurement, along with recommendations for user interfaces and performance tests. Factors affecting measurement relating to the different technologies used are also described. Summary tables of essential and desirable features are included for ease of reference. It is emphasized that these guidelines can only contribute to good urodynamics if equipment is used properly, in accordance with good practice. Neurourol. Urodynam.

Neurourology and Urodynamics, 2010

Hypothesis / aims of study Prevalence of urgency and other lower urinary tract (LUTS) symptoms in... more Hypothesis / aims of study Prevalence of urgency and other lower urinary tract (LUTS) symptoms increases with age leading to incontinence which affects health and quality of life in otherwise functional elderly. Recent epidemiological studies in this group link subtle structural changes in their brain’s white matter, shown on magnetic resonance imaging (MRI) as white matter hyperintensities (WMH), with incontinence symptoms. The studies consistently show that the prevalence of urgency increases with the global extent of white mater damage (WMH ‘burden’) which reflects the damage in white matter pathways. Nevertheless, the mechanism how WMH might lead to incontinence remains elusive, since information about how these structural changes relate to functional brain activity and the neural circuits involved in continence control is lacking. Our group has adapted urodynamics to the fMRI environment to allow simultaneous monitoring of bladder pressure and brain activity in the scanner duri...

Neurourology and Urodynamics, 2018

This is another publication from the Bristol/Astellas group dealing with signs and symptoms relat... more This is another publication from the Bristol/Astellas group dealing with signs and symptoms related to the urodynamic observations or measurement of detrusor underactivity (DU) and this time with coexisting detrusor overactivity. However, again as in the previous publication, no signs are reported, and the symptoms need further discussion as well as the definition of DU. Obviously, the urodynamic definition of DU in males and females is very critical for all data in this publication. No wonder that the authors claim that very strict defining criteria for each group were applied, but that is based on unspecified expert opinion.

Neurourology and Urodynamics, 2000

British journal of urology, Nov 1, 1993

Summary The anatomy of urinary incontinence and the underlying pathology is still under discussio... more Summary The anatomy of urinary incontinence and the underlying pathology is still under discussion.We examined 24 stress incontinent patients and 6 healthy volunteers. Magnetic resonance imaging (MRI) clearly shows that the urethra is not connected to the levator ani. The urethra is not fixed to deep perineal muscle layers. In stress incontinence the sharp angulation of the levator ani of healthy volunteers is lost in 65%. MRI shows degeneration of the levator ani muscle in 45% of stress incontinent patients. The extent of damage to the levator can clearly be identified with the aid of MRI.

The Journal of Urology, Apr 1, 2009

Aims: To report interpatient, intrapatient, and study site variability of urodynamic study (UDS) ... more Aims: To report interpatient, intrapatient, and study site variability of urodynamic study (UDS) parameters in patients with overactive bladder (OAB). Methods: Fifty-eight patients with OAB participated in a randomized, double-blind, placebo-controlled, urodynamic trial of an experimental OAB drug. Patients underwent 3 serial cystometries (CMGs) at three times: screening, pre-dose, and 4-hr postdose. This post hoc analysis describes intrapatient, interpatient, and site variability for the 6 CMGs prior to administration of study drug. Sites were given standard procedures for equipment calibration and UDS technique. Instilled volumes and pressures were recorded at first sensation of filling, first desire to void (FDV), strong desire to void (SDV), and maximum cystometric capacity (MCC). Results: The UDS volume endpoint with the smallest observed within-patient variability based on coefficient of variation (%CV) was MCC (%CV 24). Pressure measurements of all bladder sensations had larger within-patient variability than volume (MCC %CV 105). The between-patient variability was greater than within-patient variability for all bladder sensation volumes. Between-patient MCC variability for the 6 pre-treatment CMGs ranged from %CV of 50 to 58, whereas the within-patient %CV for MCC was 21-23. Excellent reproducibility was observed for bladder volume for MCC (intraclass correlation coefficients, range: 0.80-0.84). The between-site variability was large, as demonstrated by the mean volumes by site for MCC (132-397 ml). Conclusions: MCC was the most reproducible sensation. Pressure measurements were substantially more variable than volume. Between-patient variability was substantially greater than within-patient variability. The observed intersite variability suggests that despite detailed instructions, sensations may not have been measured in a consistent manner across sites.

CRC Press eBooks, Jul 15, 2010

Neurourology and Urodynamics, 2012

ics.org, Aug 23, 2010

After >50 years of investigation, the relationship between "non-neurogenic" urgency incontinence ... more After >50 years of investigation, the relationship between "non-neurogenic" urgency incontinence (UUI) and its assumed cause, detrusor overactivity (DO), remains unclear, and both etiology and the mechanisms underlying therapeutic response remain unknown. To gain further insight, we enrolled older adults with UUI in a prospective, clinical-urodynamic investigation. The goal was to identify the key physiological parameters that predict and/or likely mediate response to a widely recommended behavioral therapy (biofeedback-assisted pelvic floor muscle training, BFB). 2. Study design, materials and methods Subjects were cognitively and functionally intact, community-dwelling women aged > 60 years with at least 2 UUI episodes per week. All underwent detailed clinical evaluation, including history, physical exam, lab tests, and review of old records; 3-day bladder diary; 24-hour pad test; and comprehensive videourodynamics with simultaneous videocystosphincterometry, urethral testing, and pressure/flow study. A standard protocol was used to elicit DO if it did not appear spontaneously. Each evaluation was performed before and after therapy. EMG-based BFB followed a standard published protocol [1] and included 4 clinic visits and home practice. Therapeutic response was defined a priori and based on bladder diary and reassessed based on 24-hour pad test. Since pad test results were comparable with those based on the bladder diary, only the latter are presented. The study was funded by NIH.

Neurourology and Urodynamics, 2011

Neurourology and Urodynamics, 2009

Neurourology and Urodynamics, 2012

The Journal of Urology, Apr 1, 2005

THE JOURNAL OF UROLOGY® many patients, these symptoms correspond to the urodynamic finding of inv... more THE JOURNAL OF UROLOGY® many patients, these symptoms correspond to the urodynamic finding of involuntary detrusor contractions during filling cystometry (i.e., detrusor overactivity). Animals with partial urethral obstruction also exhibit detrusor overactivity evidenced by spontaneous non-voiding contractions (NYC) during the filling phase. Type 4 phosphodiesterase (PDE4) is a high-affinity cAMP-selective isozyme. Elevation of cAMP levels by inhibition of PDE4 reportedly relaxes smooth muscles. We therefore investigated the effects of IC486051, a specific inhibitor of PDE4, on bladder activity in normal and bladder outlet obstructed (BOO) rats. METIIODS: Under halothane anesthesia, rats were induced BOO by partial urethral obstruction using a silk ligature placed around the urethra and tied in the presence of an intraluminal indwelling PE-90 polyethylene catheter (O.D. 1.27 mm). After 4 or 6 week of BOO, continuous cystometry under awake was performed with the urethral ligature intact. IC486051 (0.1-1.0 mglk:g) or vehicle was injected intravenously, and cystometric parameters, such as the number and amplitude of NVC, intercontraction intervals of voiding contractions, maximal voiding pressure, voided volume and post-void residual volume, were compared with the values in a control period. In normal rats, blood pressure was also measured during cystometry. RESULTS: In 4-or 6-week BOO rats, IC486051 significantly and dosedependently decreased the number and amplitude of NVC, producing a reduction of 67-80% and 72-73% from the control value, respectively, at 1.0 mg/kg (i.v.). In 6-week, but not 4-week, BOO rats, maximal voiding pressure after drug injection (1.0 mglk:g) was slightly and significantly reduced by 17%, without changing voiding efficiency. In normal rats, IC486051 at 0.5 mglk:g (i.v.) significantly reduced maximal voiding pressure by 34%, but other parameters, including voiding efficiency, were not altered at 0.1 or 0.5 mglk:g. In addition, IC486051 at 0.1-0.5 mglk:g did not significantly reduce blood pressure in normal rats. CONCLUSIONS: These results indicate that a cAMP-specific PDE4 isozyme inhibitor, IC486051, can effectively suppress detrusor overactivity with a minimal effect on voiding function in awake rats with BOO. Thus, selective PDE4 inhibitors might be clinically useful for the treatment of overactive bladder in patients with BOO.

The Journal of Urology, May 1, 2006

Purpose: We examined the relationship of DO and aging, and bladder function in female volunteers.... more Purpose: We examined the relationship of DO and aging, and bladder function in female volunteers. Materials and Methods: We recruited 85 cognitively competent, fully functional female volunteers who were 22 to 90 years old (median age 54) with and without symptoms suggestive of DO. Comprehensive assessment included a bladder diary, uroflowmetry and videourodynamics. We examined predefined urodynamic and diary variables for associations with DO and age, summarizing results in the 3 subgroups no DO, intermediate DO and clinically relevant DO. Results: Compared to women without DO those with DO showed a decrease in maximum cystometric capacity (558 vs 448 ml), mean daytime voided volume (260 vs 175 ml) and volume at strong desire to void (363 vs 283 ml) but an increase in maximum isovolumetric pressure (41 vs 64 cm H 2 O) and maximum detrusor pressure during involuntary contraction (intermediate and relevant DO 22 and 37 cm H 2 O, respectively). The positive association between increased detrusor contraction strength and DO was present at younger ages but absent in older subjects. Maximum urethral closure pressure and detrusor contraction strength decreased significantly with age. Conclusions: From young adulthood to old age DO appears to affect bladder function parameters. It is associated with decreased bladder capacity and increased bladder sensation. Moreover, in younger adults DO is also associated with increased detrusor contraction strength, which is an association not seen in older individuals. This age associated loss of muscle function may be related to sarcopenia, implying that different treatments may be appropriate in older adults.

Journal of the American Geriatrics Society, Mar 1, 2006

OBJECTIVES: To identify age-associated changes in female lower urinary tract function across a wi... more OBJECTIVES: To identify age-associated changes in female lower urinary tract function across a wide age spectrum, controlling for detrusor overactivity (DO). DESIGN: Secondary analysis of a cross-sectional study of DO and aging. Eligible volunteers were stratified by age group and presence of DO. SETTING: Community-based volunteers, evaluated in research laboratory. PARTICIPANTS: Eighty-five ambulatory, nondemented, community-dwelling female volunteers, with and without bladder symptoms suggestive of DO, recruited by advertising, mean age 54 (range 22-90); 75% Caucasian, 21% African American. MEASUREMENTS: Comprehensive assessment included bladder diary, uroflowmetry, and detailed videourodynamics. Predefined urodynamic and diary variables were examined for association with age and DO. Mean values of these variables were calculated for subgroups aged 20 to 39, 40 to 59, and 60 and older (14 subjects !70). RESULTS: Maximum urethral closure pressure, detrusor contraction strength, and urine flow rate declined significantly with age (Po.001, Po.001, P 5.006, respectively), regardless of whether DO was present. Most elderly individuals continued to empty their bladder almost completely, with normal voiding frequency. Mean number of nocturnal voids was less than one in all age groups. Bladder capacity did not decrease with age (mean 522 mL in oldest group) but was smaller in subjects with DO. Bladder sensation diminished significantly with age (Po.001) but was stronger in subjects with DO. CONCLUSION: Female bladder and urethral function appear to deteriorate throughout adult life, whether DO is present or not. Specifically, detrusor contractility, bladder sensation, and urethral pressure decline. The common belief that bladder capacity shrinks with age may be related to DO rather than to aging itself.

Neurourology and Urodynamics, 2010

Neurourology and Urodynamics, 2007

Aims: To determine normative data for lower urinary tract function in asymptomatic continent wome... more 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 !20 years were recruited from the community. Comprehensive assessment included bladder diary, physical examination, uroflowmetry, and videourodynamics. 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.

The Journal of Urology, Apr 1, 2007

We report the primary outcomes analysis at 24 month followup of the Stress Incontinence Surgical ... more We report the primary outcomes analysis at 24 month followup of the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr), a prospective randomized controlled trial designed to compare the Burch colposuspension and autologous rectus fascia pubovaginal sling. METHODS: Women were eligible for the study if they had stress predominant urinary incontinence symptoms, a positive stress test, urethral hypermobility on Q-tip exam and desired surgical treatment for their incontinence. Patients were randomized in the OR and followed at regular intervals up until 24 months. Treatment success was defined in two ways: 1) Overall success was defined as no self-reported SUI symptoms on questionnaire; and a negative pad test(< 15 ml urine leakage over 24 hours); and no urinary incontinence on 3-day voiding diary; and a negative provocative stress test; and no re-treatment for SUI; 2) SUI-specific success was defined as no self-reported SUI symptoms; and a negative stress test; and no SUI re-treatment. Demographic characteristics, patient satisfaction, post-operative urge incontinence, voiding dysfunction and other adverse events were assessed. The study was designed to have 80% power to detect a 12% difference between the two procedures as statistically significant. RESULTS: 655 women were randomized (326 sling and 329 Burch} and 24 month follow-up was completed in 557 (85%). The two groups had similar pre-operative demographic, clinical and urodynamic variables. The sling demonstrated higher success rates than the Burch for both overall treatment success (41% vs 29%, p=0.005) and stressspecific success (60% vs 43%. p < 0.001). Women in the sling group reported higher rates of urinary tract infection (292 vs 195 UTI events}, post-operative urge incontinence (28% vs 22%) and voiding dysfunction (14% vs 2%) than women in the Burch group. Satisfaction rates at 24 months were similar between the sling (87%) and the Burch (81%) patients (p=0.12). CONCLUSIONS: The autologous rectus fascia sling provides 17% higher success rates than the Burch colposuspension in the resolution of stress-specific urinary incontinence but at a cost of higher morbidity including UTI, urinary retention and urge incontinence. In spite of these differences in efficacy and morbidity there was no significant difference in satisfaction.

Neurourology and Urodynamics, 2014

These guidelines provide benchmarks for the performance of urodynamic equipment, and have been de... more These guidelines provide benchmarks for the performance of urodynamic equipment, and have been developed by the International Continence Society to assist purchasing decisions, design requirements, and performance checks. The guidelines suggest ranges of specification for uroflowmetry, volume, pressure, and EMG measurement, along with recommendations for user interfaces and performance tests. Factors affecting measurement relating to the different technologies used are also described. Summary tables of essential and desirable features are included for ease of reference. It is emphasized that these guidelines can only contribute to good urodynamics if equipment is used properly, in accordance with good practice. Neurourol. Urodynam.

Neurourology and Urodynamics, 2010

Hypothesis / aims of study Prevalence of urgency and other lower urinary tract (LUTS) symptoms in... more Hypothesis / aims of study Prevalence of urgency and other lower urinary tract (LUTS) symptoms increases with age leading to incontinence which affects health and quality of life in otherwise functional elderly. Recent epidemiological studies in this group link subtle structural changes in their brain’s white matter, shown on magnetic resonance imaging (MRI) as white matter hyperintensities (WMH), with incontinence symptoms. The studies consistently show that the prevalence of urgency increases with the global extent of white mater damage (WMH ‘burden’) which reflects the damage in white matter pathways. Nevertheless, the mechanism how WMH might lead to incontinence remains elusive, since information about how these structural changes relate to functional brain activity and the neural circuits involved in continence control is lacking. Our group has adapted urodynamics to the fMRI environment to allow simultaneous monitoring of bladder pressure and brain activity in the scanner duri...

Neurourology and Urodynamics, 2018

This is another publication from the Bristol/Astellas group dealing with signs and symptoms relat... more This is another publication from the Bristol/Astellas group dealing with signs and symptoms related to the urodynamic observations or measurement of detrusor underactivity (DU) and this time with coexisting detrusor overactivity. However, again as in the previous publication, no signs are reported, and the symptoms need further discussion as well as the definition of DU. Obviously, the urodynamic definition of DU in males and females is very critical for all data in this publication. No wonder that the authors claim that very strict defining criteria for each group were applied, but that is based on unspecified expert opinion.

Neurourology and Urodynamics, 2000