Urethral pressure variations

URETHRAL

STANISLAV JANEZ

PRESSURE

PLEVNIK.

JANEg.

I?.!%:.

;1I.D.

From the Institute Center. Universit!.

J. Stefan. and Urological Clinic. Clinical of Karclelj. Ljubljana. Y~~gosla\-ia

Urethr,ll pressure is a parameter frequentl! used in urod\.namic studies. In routine urod>rnamics the values of urethral pressures are obtained mostly by measuring urethral pressure profiles (UPP). UPP sho\vs the pressure distribution along the urethra during a rather short time determined b>. the \vithdra\val speed of the measuring catheter. Thus. it does not contain milch information about the possible rlrethral pressure-time (UPT) variations, even if reproducible UPP curves, measured several times. are obtained. UPP lrariations as \vell as CPT \.ariations \vere observed in our studies v’ere obpre\.iorlsly. ’ \vhile UPP xrariations scw.ed in other studies.” ‘) The purpose of this study was to objectif! l’PT variations on a greater number of patients. to e\,aluate the reliabilit!. of UPP tvith respect to UI’T variations, and to investigate the spatial organization of UPT variations. jlatcrial

VARIATIONS *

and Methods

To determine the possible UPP lwiations. UPPs \~~erv measllred three to four times by us-

ing the Rro\l,n and Wickham” met hod (one-side opening Lvith 1 mm diameter. infusion rate 2 mlimin. \\.ithdrawal speed 1 I~I~/SW) or the hlillar 5-F catheter-tip pressure transducer. Values of UPP variations at the point of maximal pressure \vere further verified b!. measurenlents of UPT variations with the same catheter, i.e.. by static monitoring of maximal urethral pressure in the region of distal urethral sphincter. Measurements were done hvith patients in the supine position and \+.ith ernpt!‘ l)ladder. Studies Lvere undertaken on 30 females (lwt\vet~n 21 and ‘79 years old): \fith stress incontinence. 10 \vith urge incontinence and/or fretluenc*>. of micturition. and 13 \vith mixed stress and urge incontinence. In 5 subjects in Lvhom UPT \,ariations lvere observed. and in 1 additional patient \vith atonic neurogenic bladder (lesion L [ I. the spatial organization of UPT variations v.as studied. ,4 speciall!. designed perfusion catheter. similar to the one described b\. Constantinou and Govan in l!178,‘1 was used for that purpose (Fig. 1). UPT \.ariations \vere studied b\. simultaneous measurement of the pressure in the bladder and the pressures in the urethra at t\vo measuring points lvhich were S mm apart.

20;

Results and Comment

variations in the stress incontinent group were of considerabl!. lowrer \.alues, i.e., from 10 to 15 cm of water, compared to the other t\vo groups of patients. Among the 20 patients in whom the measurements revealed UPT variations, UPP variations were observed only in 10 cases and were in the range of 10 to 35 cm of water. Both small and high UPP variations with high UPT variations

Of the 30 patients. UPT variations were observed in 20. Variations of the maximal urethral pressure (peak to peak values) were in the range of 10 to 40 cm of wrater. Pressure variations exceeding 10 cm of Lvater were considered to be significant. UPT \.ariations were not related to the t!ye of urinary incontinence. However, the

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13- b FI(:cw. 2.

In putimt UPP curiations (I+) cariatians (right).

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with nlictrrritio~l frcyucnc~y. bladder mhibitcd WI rtninhibitcd rwntractiom: und high UPT variatiom (right); and (B) high UPP variatiom (left) a&

3 (A) small high UPT

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