The study and control of impaired bladder-urethral function by electronic techniques
Başlık:
The study and control of impaired bladder-urethral function by electronic techniques
Yazar:
Rowan, David, author.
ISBN:
9780438052611
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (182 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 76-08C.
Advisors: O. F. Hutter.
Özet:
Urinary bladder dysfunction is a complex subject involving a combination of mechanical, pathological and neural factors. Broadly speaking, defects in bladder control fall into two categories: (a) impaired bladder muscle function (b) disorders of the urethral closure mechanism. Frequently, an accurate diagnosis requires more information than can be obtained from routine urological investigations. In this thesis, electronic recording techniques are described which complement these standard tests. The electronic methods include the continuous measurement of intravesical pressure during bladder filling (filling cystometry) and the measurement of the functioning length of the urethra together with the variation in pressure along it (urethral pressure profile measurement). The hydrodynamic behaviour of the bladder during micturition is studied by obtaining continuous and simultaneous recordings of the urinary flowrate and the associated variations in intravesical and intra-abdominal pressures. Detection of the intra-abdominal pressure is achieved by means of a tocodynamometer. Intravesical and intra-urethral pressures are measured by catheter-coupled strain gauge transducers. An isotope method is employed to measure urinary flowrate. The value of these techniques in providing a diagnosis in problem cases is discussed. There are still a considerable number of incontinent patients in whom the ordinary methods of treatment (e.g. surgery or drugs) have failed or have been contra-indicated. In some of these cases, incontinence can be alleviated by electrical stimulation of the voluntary muscles which control the outlet of the bladder. In those cases in whom long terra control is required, electrodes, imbedded in the target muscles, are connected to a receiver stimulator which is totally implanted in the abdomen. Stimulation is controlled by an external radio-frequency oscillator, the aerial of which is held close to the patient's skin overlying the implant. The external unit is battery-powered and is small enough to be worn by the patient. Rejection of the implant due to bacterial infection and pressure necrosis was obviated by improvements in the surgical technique of implantation and by avoiding the perineal location of electrodes. In the latest series of 30 patients treated by this method, 80% derived benefit. The possible modes of action of electrical stimulation are discussed. A method, which involves the use of skin surface electrodes, has been developed which enables faults in the implanted stimulator to be detected. Techniques are described for rectifying these faults with the minimum of surgical intervention. Disturbances of micturition commonly follow spinal injuries, the pattern of bladder emptying depending on the level of damage. These disorders usually take the form of an initial retention of urine. In these cases evacuation of the bladder can be secured by catheterisation. However, the presence of an indwelling catheter is associated with a high incidence of urinary tract infection and delay in the development of reflex or autonomous bladder control. In a previous communication, the author has shown that, in anaesthetised dogs, evacuation can be achieved by electrical stimulation of the motor nerves of the bladder musculature. A four-electrode implant was developed to apply this technique to the human bladder; it was energised in a similar fashion to the incontinence device. Eight patients were treated. Although bladder control was restored completely in two cases, the results were disappointing.
Notlar:
School code: 0547
Konu Başlığı:
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(684407.1) | 684407-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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