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Factors Predicting Intrinsic Sphincter Deficiency in Female Stress Urinary Incontinence.

Journal of the Korean Continence Society.2002;6(2):72-82.

PURPOSE: This study was conducted to investigate whether predictive factors are associated with stress urinary incontinence due to intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: We reviewed retrospectively the records of 254 women with the diagnosis of genuine stress incontinence. All women had undergone a detailed history by questionnaire and interview, physical examination and multi-channel urodynamic study, including the determination of VLPP. The patients were classified into three groups according to VLPP regardless of the presence of hypermobility; 1) ISD: VLPP<60cmH2O, 2) equivocal: VLPP 61-90cmH2O, 3) anatomical incontinence(AI) : VLPP>90cmH2O. The ISD group was compared with the AI group using 15 clinical factors. Univariate (t-test, chi-square test) and multivariate (logistic regression test) analyses were performed to determine which clinical factors were associated with ISD. RESULTS: The mean patient age was 51 years (range 25 to 77). Eighty-two women (32%) were in the ISD group and 98 (38%) in the AI group. The results of univariate and multivariate analyses found that women with ISD had a higher symptom grade than women with AI (p=0.001 and 0.0001, respectively). The number of patients in the ISD and AI group in accordance with the symptom grade were 11 (15%) and 61 (85%) in grade I, 53 (62%) and 33 (38%) in grade II, and 18 (82 %) and 4 (18%) in grade III respectively. There was no correlation between VLPP and other clinical factors. CONCLUSIONS: The only clinical factor that predicted the presence of ISD, as defined by VLPP of 60cmH2O or less, was the symptom grade. Higher grades of stress urinary incontinence have a higher possibility of ISD. One should consider this factor when evaluating patients, especially in the equivocal group.
Diagnosis ; Female ; Humans ; Multivariate Analysis ; Physical Examination ; Surveys and Questionnaires ; Retrospective Studies ; Urinary Incontinence* ; Urodynamics

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Pharmacological Effects of Berberine and Palmatine on the Prostatic and Urethral Smooth Muscle of the Rabbit.

Seung June OH ; Jeongyoon KANG ; Jeong Yun JEONG ; Kyung Hoon LEE ; Sung Joon KIM ; Young Shin CHUNG ; Eun Kyung HONG ; Kwang Myung KIM

Journal of the Korean Continence Society.2002;6(2):62-71.

PURPOSE: One of the major medical treatments for benign prostatic hyperplasia is targeted toward reducing bladder outlet obstruction by alpha-adrenoceptor blockade to relax the smooth muscle tone of the prostate. Berberine and palmatine, an isoquinoline alkaloids, have varied pharmacological actions and have been extensively used in folk medicine. A previous large scale screening test revealed that berberine derivatives have antagonistic effects at the alpha1-adrenoceptors, although they are less potent than prazosin. The aim of this study is to investigate the effect of the berberine and palmatine on the contractility of the isolated prostate, urethral and vascular smooth muscle tissues of the rabbit. MATERIALS AND METHODS: Muscle strips of the prostate, urethra and renal artery were obtained from 10-week-old male New Zealand White rabbits. In vitro isometric contraction was measured using organ bath study. Cumulative concentrations of phenylephrine as an agonist were added to produce concentration-response relationships. Breberin (1-500 microM) and palmatine (1-500 microM) were added to the bath before the repeated phenylephrine-induced concentration-response curve was made. Responses of developed tension to phenylephrine were plotted as percentage of the maximal increase for each concentration-response curve in the prostate, urethra and renal artery strips. RESULTS: Phenylephrine produced concentration-dependent contractions on the rabbit prostatic and urethral preparations. Berberine and palmatine induced a dose-dependent rightward shift of the dose-response curve of phenylephrine-induced contraction of both prostate and urethra with a reduction of maximal response, indicating the interactions of the two agents with phenylephrine in noncompetitive antagonism. The rank order of potency of the inhibitory effect was palmatine > berberine in the urethral tissue, while there was no significant difference between the two agents in the prostatic tissue. In the renal artery strips, both berberine and palmatine did not significantly inhibited the maximal contractile response to phenylephrine (1-50 microM). Higher concentration of berberine (500 microM) and palmatine (100-500 microM) decreased maximal contractile response induced by phenylephrine (0-10 microM), while they paradoxically increased maximal contraction induced by higher concentrations of phenylephrine (50-100 microM). CONCLUSIONS: Our results indicated that berberine or palmatine inhibited phenylephrine-induced contractions in urethral and prostatic smooth muscles, with no significant inhibition in the renal artery smooth muscle at lower concentration ranges of berberine and palmatine. A deeper understanding of the action mechanisms of berberine and palmatine would widen our therapeutic options for voiding disorders.
Alkaloids ; Baths ; Berberine* ; Humans ; Isometric Contraction ; Male ; Mass Screening ; Medicine, Traditional ; Muscle, Smooth* ; Muscle, Smooth, Vascular ; Phenylephrine ; Prazosin ; Prostate ; Prostatic Hyperplasia ; Rabbits ; Renal Artery ; Urethra ; Urinary Bladder Neck Obstruction

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Change of Intra-abdominal Pressure on Daily Activities in Patients with Spinal Cord Injury.

Jeong Hwan SEO ; Young Chang JEONG ; Chul Gyu SONG ; Myoung Hwan KO ; Sung Hee PARK

Journal of the Korean Continence Society.2002;6(2):54-61.

PURPOSE: To evaluate the change of intra-abdominal pressure related with intravesical and intrarectal pressure in patients with spinal cord injury according to daily activities and postural changes which make the abdominal pressure elevated. MATERIALS AND METHODS: Ten subjects with lower thoracic and lumbar spinal cord injury were enrolled. Their mean age was 38 years. The urodynamic study was performed and the intravesical and the intrarectal pressures were measured with a double lumen catheter and a intrarectal probe. The intravesical and the intrarectal pressure were obtained during patient's speech, sneeze, cough, valsalva and various postural changes with supine to decuitus, decubitus to supine, supine to sit, and sit to supine according to empty and full bladders, respectively. RESULTS: The order of higher intravesical and intrarectal pressure rise during various maneuvers were valsalva, sneeze, supine to sit and cough, respectively. Higher correlation coefficient between the intravesical and intrarectal pressures were noted during cough, sneeze, valsalva and supine to sit in empty bladder than full one. CONCLUSION: These results demonstrated that the intravesical and intrarectal pressures were influenced by daily activities and postural changes of increasing the intra-abdominal pressure. The intrarectal pressures according to daily activities such as cough, sneeze, valsalva and postural change were significantly related with intravesical pressures.
Catheters ; Cough ; Humans ; Spinal Cord Injuries* ; Urinary Bladder ; Urodynamics

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A Study of Overactive Bladder for the Women Aged over 30 years.

Hyo Jeong SONG ; Myung Ja KIM ; Nam Young YANG ; Mi Sook LEE ; In Ok LEE ; Ju Sun NAM ; Hae Hyang SONG ; Eun Joo LEE ; Joon Chul KIM ; Ji Youl LEE ; Donghwan LEE

Journal of the Korean Continence Society.2002;6(2):44-53.

PURPOSE: This study was designed to provide the basic data for the development of the management program for overactive bladder by ascertaining its prevalence among Korean women aged over 30 years, and the factors related to its occurrence. MATERIALS AND METHODS: The study was performed by using self-questionnaires through the community-based cross sectional study from May to July, 2000. The subjects consisted of 2869 women, aged over 30 up to 89 years, among those who understood and responded to the questionnaires, and was residing in Seoul, Kyongki Kangwon, Chungchong, YongNam, HoNam, Cheju proinces. They also did not have known neurological problem and diabetes mellitus. The data were analyzed by Student t-test, chi2-test, and multiple logistic regression with using SAS program. RESULTS: The results were as follows ; 1. They all experienced at least one of frequency, urgency, nocturia, urge incontinence for the past one year and 52.3% of the subjects had experienced symptom at least once in 5 voidings. The highest prevalence of overactive bladder was 86.2% in the category for 70 to 89 years, 74.3% for the sixties, 45.3% for the forties, 42.5% for the thirties. In the symptoms of 1499 women among subject, 19.4% of them had nocturia, 18.2% frequency, 10.5% urgency, 9.6% urge incontinence, 9.5% frequency and urgency, 5.9% frequency and nocturia. 2. The age(OR = 1.041, 95% Cl = 1.027, 1.055) and the menopause(OR = 0.696, 95% Cl = 0.527, 0.919) were related to overactive bladder occurrence. CONCLUSIONS: The above findings indicated that about the half of the women aged over 30 years had symptoms for overactive bladder, and the prevalence was higher in old women and the women with menopause. So, the prevention and management programs for overactive bladder are required to be developed, and the primary screening programs based on community shall be developed.
Diabetes Mellitus ; Female ; Gangwon-do ; Gyeonggi-do ; Humans ; Jeju-do ; Logistic Models ; Mass Screening ; Menopause ; Nocturia ; Prevalence ; Surveys and Questionnaires ; Seoul ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge