Search

Surgery to support the bladder neck appears to be an important part of reconstructive pelvic prolapse surgery. Urinary continence tests performed before reconstructive pelvic prolapse surgery do not seem to accurately predict continence problems after surgery or the need for later surgery to correct incontinence. Thirty-two women had either two stitches to support the vagina or three to five stitches to support the bladder neck as part of reconstructive prolapse surgery. All patients had urinary continence tests before surgery. The women who had the vaginal stitches had more post-surgical complications.

Kegel exercises are used to strengthen the muscles that support the vagina, bladder, and urethra, the tube extending from the bladder through which urine passes. These exercises are sometimes recommended to enhance the closing of the urethra to control incontinence; to improve function and tone of muscles following childbirth; and to enhance pleasure associated with sexual intercourse. However, despite verbal instruction, some women are unable to perform the Kegel exercises properly, possibly due to a lack of awareness of which muscles are being contracted. The correct performance of Kegel exercises can be checked by various methods. A bulb attached to a manometer, a device for measuring pressure, can be inserted into the vagina to measure changes in pressure accompanying muscle contraction and relaxation during the exercises. In addition, muscle contraction and relaxation are indicated by changes in the electrical activity of the muscle, or by the physical examination of muscle tone. Most patients are only given brief verbal or written instructions on how to perform Kegel exercises. The effect of brief verbal instruction on the performance of Kegel exercise was assessed in 47 women. The pressure within the urethra was measured at rest and during the exercises. A sufficient Kegel effort, indicated by a significant increase in the force with which the urethra closes, was observed in 23 women. However, 12 patients performed Kegel exercises in such a manner that would promote urinary incontinence. These findings suggest that simple verbal or written instructions to patients are insufficient for proper performance of Kegel pelvic muscle exercises. (Consumer Summary produced by Reliance Medical Information, Inc.)

This study evaluates fluid weight uroflowmetry as a screening technique for urogynecologic conditions. Sixty women with no known pathologic condition volunteered for the evaluation of normal uroflowmetric parameters and curve patterns. Forty were menstruating cyclically, and 20 were postmenopausal. The parameters studied included: (1) total voided volume, (2) flow time, (3) peak flow rate, and (4) time to peak flow rate. In addition, uroflowmetric tracings were classified according to their patterns of configuration into: (1) normal, (2) multiple peak, and (3) interrupted. The parameters studied showed no difference in the two normal groups. A wide range of values was observed. Neither age, parity, weight, height, nor menstrual cycle phase affected the data. Values obtained from patients with idiopathic instability of the detrusor muscle, sensory urgency, and stress urinary incontinence did not show differences or trends. Seventeen percent of the tracings of the normal population group showed either multiple peak or interrupted patterns. Patients with sensory urgency (p < 0.001) had a higher incidence of multiple peak and interrupted flow rate patterns.