Comparison of microtransducer and fiberoptic catheters for urodynamic studies.

OBJECTIVE: To assess the validity and reproducibility of a fiberoptic transducer urodynamic catheter for urethral closure pressure profiles and leak point pressure determination, using a microtransducer catheter as the standard. METHODS: Ninety women without significant pelvic organ prolapse underwent urodynamic evaluations with both fiberoptic and microtransducer catheters. Maximal urethral closure pressures and "leak point pressures" were repeatedly measured by the two catheters and statistically compared. The order of catheter use was randomized. RESULTS: Significantly lower mean maximal urethral closure pressures were recorded by the fiberoptic system than by the microtransducer system (28.9 cmH(2)O +/- 17.3 versus 43.2 cmH(2)O +/- 24.9, P <.001). The fiberoptic catheter predicted microtransducer values for maximum urethral closure pressure only within a range of 27 cmH(2)O. Mean "leak point pressure" recorded by the fiberoptic catheters (66.9 cmH(2)O +/- 2.9) was not significantly different than that recorded by the microtransducer catheters (66.4 cmH(2)O +/- 2.9, P =.97). CONCLUSION: There is a significant difference between maximum urethral closure pressure values recorded by the microtransducer and fiberoptic catheter systems. No significant difference was found between the two systems in measurement of Valsalva "leak point pressure."

Patient selection criteria for treatment of urinary incontinence with pelvic floor stimulation.

This article describes a comprehensive assessment used at the authors' institutions for women with urinary incontinence who want to try pelvic floor stimulation. Physiologic, cognitive, psychosocial, and affective parameters are included. There are factors in each of these areas that contribute to the success or failure of pelvic floor stimulation as a treatment. Voiding diaries and visual analog scales are used to measure baseline and treatment progress. The authors recommend a 7-day diary before treatment and continuance of a diary for 3 to 4 months. A Patient Response Chart is presented that helps patients to report severity of symptoms. Patients would objectively show a decrease in incontinence episodes. Subjective improvement should also occur because patient satisfaction and quality of life are the ultimate goals of treatment.

Key components of patient education for pelvic floor stimulation in the treatment of urinary incontinence.

A thorough patient education plan promotes motivation and compliance and is essential to insuring successful outcomes with pelvic floor stimulation therapy. A pyramid forms the conceptual framework for an education program and for nurse-patient interactions. The introduction, goal-setting, education, achievement, and outcome stages are parts of this pyramid. Clinical discussion of the process as applied to pelvic-floor stimulation is detailed. Use of the pyramid approach contributes to three nurse-patient goals; facilitating home management of pelvic floor stimulation equipment, increasing patient knowledge about causes and treatments for urinary incontinence, and establishing mutual goals and outcome measurements for pelvic floor stimulation home therapy.