No description available.

It has been said that a technique capable of recording a urinary bladder electromyogram could be useful in the clinical evaluation of the detrusor neuropathies and myopathies implicated in the generation of lower urinary tract symptoms. However, in contrast to electromyography of skeletal and cardiac muscle, detrusor smooth muscle electromyography has remained in its infancy despite fifty years of scientific effort. The principal problems appear to be isolation of the real signal from artifacts, and uncertainties surrounding the existence of electromyographic activity during parasympathetically mediated muscle contraction. The discovery of purinergic neuromuscular transmission in overactive human bladder samples has renewed interest in detrusor electromyography as, in contrast to cholinergic mechanisms, purinergically mediated contractions can generate extracellular electrical activity. This thesis describes the development and validation of a novel technique for recording electrical activity from neurologically intact guinea-pig bladders and human detrusor in vitro. We characterise a purinergic electromyographic signal and show that detrusor taken from overactive human bladders has a greater propensity to generate electromyographic activity than normal by virtue of an aberrant purinergic mechanism. We discuss the potential role of electromyography in the clinical evaluation of a putative purinergic detrusor myopathy.

No description available.

No description available.

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No description available.

There are many diagnostic tests available to help evaluate urethral sphincter and bladder dysfunction in patients with urinary incontinence. The most commonly used tests are multichannel cystometry, urethral pressure profilometry, leak point pressure, bladder diaries, pad tests and quality of life questionnaires. More recently, measurements of opening detrusor pressure obtained during pressure f1ow urodynamic studies have claimed to offer a suitable alternative to tests predicting urethral sphincter insufficiency. There have been very few studies evaluating the validity and reliability of these investigations in assessing lower urinary tract in women. The initial part of this thesis provides a review of the normal and abnormal bladder and urethral function. It also presents an overview of the investigation and management of women with lower urinary tract dysfunction. The remainder of this thesis aims to determine the reliability of the various tests currently available. This is done by assessing their reproducibility using test re-test analysis, on the same subject, in two different visits. The different tests are compared in a larger number of subjects, to establish any correlation that may be evident between them. Furthermore, I have compared different subgroups of patients with urodynamic stress incontinence, with or without detrusor overactivity, and assessed the effect they have on the reproducibility of urodynamic studies, urethral function tests and other commonly used bladder investigations. In the last section, the relevance of the study findings are discussed, final conclusions are made and suggestions for future research considered.

The aims of this study were to identify potential new therapeutic targets with which to treat the overactive bladder, by assessing the presence and importance of human bladder pacemaker cells and the effects of erythromycin lactobionate on detrusor muscle function.

Previous studies have indicated that pelvic floor muscle training supervised by a trained health care professional is beneficial, both as treatment and prevention of stress urinary incontinence. Currently there are few reports available in the literature that address pelvic floor muscle condition in the general population of women, and none which have investigated this group irrespective of continence status. However, it is known that verbal and written information are often insufficient for women to learn to contract their pelvic floor muscles correctly. The overall aims of this thesis were to ascertain by objective measurement what proportion of community dwelling women know how to and are able to voluntarily contract their pelvic floor muscles (PFM), and whether a nurse who had undertaken a short course training programme could effectively instruct women to increase strength, endurance and muscular co-ordination of the PFM. This might help to reduce one of the modifiable risk factors for incontinence and pelvic organ prolapse, namely pelvic floor muscle weakness. The first objective was to estimate the prevalence of pelvic floor muscle weakness in a community dwelling sample of women in both urban and rural areas of south west Devon and north east Cornwall, UK, who were attending their General Practice for routine health checks. The subjects were recruited from a general population and were not necessarily symptomatic of any incontinence or pelvic organ prolapse. The second objective was to investigate the relative importance of a number of specific factors (such as age, parity, body mass index etc.) that might be associated with pelvic floor muscle weakness in the sample of women. The key objective outcome measure was perineometry (vaginal squeeze pressure), focussing on pelvic floor muscle strength and endurance of contraction. In order to first assess a correct contraction, digital palpation (Modified Oxford Score) was used. Subjects with weak muscles, (scoring 2 or less) could be assigned to the second study. The final objective was to evaluate the effectiveness of an educational programme of PFMT delivered by Primary Care Nurses compared to a pelvic floor specialist nurse, or a control group with no training, over 3 months. The first study was a survey of pelvic floor muscle condition which investigated objectives 1 and 2. The second study, a randomised controlled trial of PFMT, addressed the final objective. In the survey, 762 women from a range of urban and rural General Practices, aged 19- 76 (mean age 46) were assessed. Forty four percent were found to have weak pelvic floor muscles (PFM). This declines further with age, increasing parity, body mass index, and obstetric factors such as having had a forceps delivery and/or episiotomy. The association of a weak pelvic floor with incontinence has also been confirmed. Although the majority of women knew of pelvic floor exercises (87%), few were practicing them at the time of the study .The greatest adverse effect on pelvic floor muscle strength was the transition from nulliparity to first childbirth. Generalized linear modelling was used to investigate the combined effects of multiple explanatory variables. Some women had strong muscles despite advancing age, obesity or grand multiparity. Those who were physically and sexually active had a significantly increased likelihood of strong PFM. Of the 337 women with weak PFM, 97 declined to take part in the second study. Two hundred and forty subjects were randomised to one of three groups (75 Control, 84 Practice nurse, 8\ Specialist nurse) for the RCT. Both treatment groups showed a significant increase in pelvic floor strength after 3 months' training, compared with Controls (p<O.O 1 both groups). The difference between the Practice Nurse and Specialist groups was not significant (p=O.32). The drop out rate was 33.75%. The drop- out rate suggests that many women might not be interested in adhering to the exercise programme. This was the first study to investigate the condition of the pelvic floor muscles in a large sample of community dwelling women in the UK. It confirms that pelvic floor weakness is common, but that women who take regular energetic exercise and are sexually active, despite their age, parity or body mass index, are more likely to have strong pelvic floor muscles, regardless of whether they were doing PFM exercises at the time of the survey. The results of the RCT confirm that a short course trained nurse is quite capable of providing supervised PFMT and can assist many women in the general population to achieve an objective improvement in pelvic floor strength (as assessed using the digital modified Oxford grading system and/or perineometry). This has implications for other health care professionals (e.g. midwives), to instruct and encourage women to effectively contract and train their pelvic floor muscles to increase strength, endurance and muscular co-ordination. If more healthcare professionals can be trained to effectively supervise women to improve their pelvic floor muscle condition, this might help to reduce one of the modifiable risk factors for incontinence and pelvic organ prolapse as part of a lifestyle health prevention programme.