• International Neurourology Journal
• /
• v.22 no.4
• /
• pp.268-274
• /
• 2018

Purpose: To describe a technique for urodynamic diagnosis of detrusor sphincter dyssynergia (DSD) using urethral pressure measurements and examine potential associations between urethral pressure and bladder physiology among patients with DSD. Methods: Multiple sclerosis (MS) and spinal cord injured (SCI) patients with known DSD diagnosed on videourodynamics (via electromyography or voiding cystourethrography) were retrospectively identified. Data from SCI and MS patients with detrusor overactivity (DO) without DSD were abstracted as control group. Urodynamics tracings were reviewed and urethral pressure DSD was defined based on comparison of DSD and control groups. Results: Seventy-two patients with DSD were identified. Sixty-two (86%) had >20 cm $H_2O$ urethral pressure amplitude during detrusor contraction. By comparison, 5 of 23 (22%) of control group had amplitude of >20 cm $H_2O$ during episode of DO. Mean duration of urethral pressure DSD episode was 66 seconds (range, 10-500 seconds) and mean urethral pressure amplitude was 73 cm $H_2O$ (range, 1-256 cm $H_2O$). Longer (>30 seconds) DSD episodes were significantly associated with male sex (81% vs. 50%, P=0.013) and higher bladder capacity (389 mL vs. 219 mL, P=0.0004). Urethral pressure amplitude measurements during DSD were not associated with significant urodynamic variables or neurologic pathology. Conclusions: Urethral pressure amplitude of >20 cm $H_2O$ during detrusor contraction occurred in 86% of patients with known DSD. Longer DSD episodes were associated with larger bladder capacity. Further studies exploring the relationship between urethral pressure measurements and bladder physiology could phenotype DSD as a measurable variable rather than a categorical observation.

• Journal of Korean Academy of Fundamentals of Nursing
• /
• v.5 no.2
• /
• pp.225-236
• /
• 1998

The literature review about bladder management method given to maintain and improve health of neurogenic bladder patients was done. Because the study of neurogenic bladder patients in nursing field is not enough, I tried to find report the study tendency through literature review, 1. There are five types of neurogenic bladder such as uninhibited neurogenic bladder, reflex neurogenic bladder, autonomous neurogenic bladder, sensory paralytic neurogenic bladder, and motor paralytic neurogenic bladder. 2. The accurate assessment of neurogenic bladder is done mainly through urodynamics and especially cystometrogram and urethrogram are used. 3. As the study of therapeutic management, the effect of Desmopressin, bladder auto-augmentation, incision of external urethral sphincter muscle, subarachnoid block and pudendal never block using phenol was studied. 4. For the study of general management, the effect of bladder training progam, intermittent catheterization and infection control has been studied but there has not been any obvious study in nursing field. Reviewed the study condition, it is necessary to develope bladder training program in order to increase life quality of neurogenic bladder patients.

• Journal of Sensor Science and Technology
• /
• v.15 no.6
• /
• pp.449-456
• /
• 2006

The purpose of urodynamic investigation is to obtain the information on the function of the urinary system. The aim of this study is to acquire the useful information of lower urinary tract symptom (LUTS) diagnosis through void force signal as noninvasive method. The system which could evaluate the function of compensatory hypertrophy with noninvasive and comfortable method was implemented to measure uroflow and void force during urination. The implemented system composes of the sensor parts, signal conditioning parts and PC monitoring program. For the evaluation of the implemented system, the simulation of control part of the system was performed and the model system for the lower urinary system was designed. The superiority of a measuring characteristic of the implemented system was verified using the model system. From the evaluation of the model system, we have found out that the void force was dependent on the occlusion degree and compensatory hypertrophy significantly.

• Journal of the Institute of Convergence Signal Processing
• /
• v.8 no.1
• /
• pp.6-14
• /
• 2007

The purpose of urodynamic investigation is to determine information on the function of the urinary system. One of the most frequently used measurement procedures in urodynamics is filling and voiding cystometry using invasive method. But in this method transurethral catheter is use and it makes patients uncomfortable. The aim of this study was to implement the system that could evaluate the function of urinary tract with noninvasive and comfortable method. Therefor in this study, a sensor and measuring system were implemented to measure uroflow, urophonography and noninvasive bladder pressure signal during urination for diagnosing the LUTS(lower urinary tract symptoms) using noninvasive method. The implemented system compose of the sensor parts, signal conditioning parts, system control parts using FPGA and PC monitoring program. For the evaluation of the implemented system, the simulation of system's control part was performed and the model system for the lower urinary system was designed. From the evaluation of the model system, the mean error rate of the uroflow measurement part was 1.08% and coefficient of variation was 1,48. And the mean error rate of the noninvasive bladder pressure measurement part was 2.41% and coefficient of variation was 2.81. urophongraphy signal analysis was accomplished in a time domain and frequency domain. Average RMS power was used in a time domain analysis, and MF was used in a frequency domain analysis. From the evaluation of the model system average RMS power and MF was dependent on the occlusion degree significantly and median frequency range of $60{\sim}160Hz$ was correlated with the occlusion.

• Journal of Sensor Science and Technology
• /
• v.14 no.1
• /
• pp.7-15
• /
• 2005

A sensor and measuring system were implemented to measure both uroflow and urophonography signal during urination for diagnose the lower urinary tract symptom. The implemented system was composed of the uroflow sensor using the load-cell, the urophonography measurement sensor so as stethoscope type, pre-processing part for sensors signal detection, amplifier and filter, system control parts and PC measurement program. A simulator of the lower urinary system that is experimental equipment implemented for evaluate the developed system. The two signals were measured using implemented system and analyzed these signal by means of time domain and frequency domain for extraction of the characteristic parameter which can most effectively reflected by the occlusion of the lower urinary system. Furthermore two signals were measured and analyzed with the subject of 5 healthy adult for clinical application possibility of the implemented system. As a result, the most influence bandwidth of effect according to occlusion of the lower urinary system is $253{\sim}282$ Hz of the urophonography signal.

• Journal of Medicine and Life Science
• /
• v.20 no.4
• /
• pp.166-171
• /
• 2023

Mixed urinary incontinence (UI) is common in women. This study aimed to assess the efficacy of anti-incontinence surgery in female patients with equally severe stress UI (SUI) and urge UI (UUI). All patients had equal severity of SUI and UUI. The postoperative cure rate was categorized into the cure group (CG) and failure group (FG). Postoperative satisfaction was categorized into the satisfaction group (SG) and the dissatisfaction group (DG). Statistical significance was set at P<0.05. Ninety patients (SG, 73.3%; DG, 26.7%; CG, 93.3%; FG, 6.7%) were included in the study. In the univariate analysis, body mass index (BMI), total bladder capacity, and overactive bladder symptom score (OABSS) were significantly different between the SG and DG groups. Peak urinary flow, Valsalva leak point pressure (VLPP), and OABSS were significantly different between the CG and FG groups. In the multivariate analysis, OABSS (P=0.001) and BMI (P=0.032) were independent predictors of postoperative satisfaction. VLPP (P=0.023) was the only independent factor associated with the postoperative cure rate. In equal severity of SUI and UUI, VLPP was found to be the only independent factor associated with postoperative cure rates. Higher VLPP values were associated with higher cure rates. BMI and OABSS were identified as independent predictors of postoperative satisfaction, with lower BMI and OABSS associated with higher postoperative satisfaction.

• Journal of Korean Neurosurgical Society
• /
• v.63 no.3
• /
• pp.358-365
• /
• 2020

To describe how to perform urological evaluation in children with tethered cord syndrome (TCS). Although a common manifestation of TCS is the development of neurogenic bladder in developing children, neurosurgeons often face difficulty in detecting urological problems in patients with TCS. From a urological perspective, diagnosis of TCS in developing children is further complicated due to the differentiation between neurogenic bladder dysfunctions and transient bladder dysfunctions owing to developmental problems. Due to the paucity of evidence regarding evaluation prior to and after untethering, I have shown the purpose and tools for evaluation in my own practice. This may be tailored to the types of neurogenic bladder, developmental status, and risks for deterioration. While the urodynamic study (UDS) is the gold standard test for understanding bladder function, it is not a panacea in revealing the nature of bladder dysfunction. In addition, clinicians should consider the influence of developmental processes on bladder function. Before untethering, UDS should reveal synergic urethral movement, which indicates an intact sacral reflex and lack of TCS. Postoperatively, the measurement of post-void residual urine volume is a key factor for the evaluation of spontaneous voiders. In case of elevation, fecal impaction, which is common in spinal dysraphism, should be addressed. In patients with clean intermittent catheterization, the frequency-volume chart should be monitored to assess the storage function of the bladder. Toilet training is an important sign of maturation, and its achievement should be monitored. Signs of bladder deterioration should be acknowledged, and follow-up schedule should be tailored to prevent upper urinary tract damage and also to determine an adequate timing for intervention. Neurosurgeons should be aware of urological problems related to TCS as well as urologists. Cooperation and regular discussion between the two disciplines could enhance the quality of patient care. Accumulation of experience will improve follow-up strategies.

• Proceedings of the Korean Institute of Information and Commucation Sciences Conference
• /
• 2006.05a
• /
• pp.697-700
• /
• 2006

A sensor and measuring system were implemented to measure two signals that uroflow and urophonography during urination for diagnose the lower urinary tract symptom. The implemented system was composed of the uroflow sensor using the load-cell, the urophonography measurement sensor so as stethoscope type, pre-processing part for sensors signal detection, amplifier and filter, system control parts and PC measurement program. A simulator of the lower urinary system that is experimental equipment implemented for evaluate the implemented system. The two signals were measured using implemented system and analyzed these signal by means of time domain and frequency domain for extraction of the characteristic parameter the most influence of effect according to occlusion of the lower urinary system. Furthermore two signals were measured and analyzed with the subject of 5 healthy adult for clinical application possibility of the implemented system. As a result, the most influence bandwidth of effect according to occlusion of the lower urinary system is $253\sim282Hz$ of the urophonography signal.

• International Neurourology Journal
• /
• v.22 no.4
• /
• pp.305-312
• /
• 2018

Purpose: The aim of this study was to analyze the efficacy and to estimate the complication rate of incontinence surgery according to the surgeon's specialty and whether a preoperative urodynamic study (UDS) was performed, using a nationally representative dataset. Methods: We enrolled 356,155 women over 20 years old who had undergone surgery for stress urinary incontinence between 2006 and 2015. Patients were followed for up to 3 years to analyze the reoperation and complication rates. Data were obtained from the National Health Claims Database of the National Health Insurance Service (NHIS) of Korea. Multiple Cox regression analysis was conducted to examine the efficacy and safety of incontinence surgery according to the surgeon's specialty and whether a preoperative UDS was performed. Results: The hazard ratio (HR) for reoperation was significantly higher for procedures performed by nonurologists than for procedures performed by urologists (HR, 1.174; 95% confidence interval [CI], 1.103-1.249). Acute urinary retention, postoperative infections, procedure-associated pain, and other complications were also more common in procedures performed by nonurologists than in those performed by urologists. When stratified by whether a preoperative UDS was performed, the HR for reoperation according to the surgeon's specialty varied by performance of a preoperative UDS. While the reoperation rate was significantly higher in procedures performed by non-urologists when a preoperative UDS was performed (HR, 1.208; 95% CI, 1.122-1.3), there was no significant difference in the HRs for reoperation according to specialty when a preoperative UDS was not performed. Conclusions: This population-based study showed that the postoperative outcomes of incontinence surgery were dependent upon the surgeon's specialty and that the reoperation rate according to the surgeon's specialty varied based on whether a preoperative UDS was performed.