Name: Urodynamics Third Edition By Paul Abrams
Author: Paul Abrams
Category: Medical Books
Size: 8.32 MB
Format: E-Book (PDF)
Total Pages: 347
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Summary : Urodynamics Third Edition By Paul Abrams
Lower urinary tract dysfunction produces a huge burden on sufferers inparticular and on society in general. Lower urinary tract symptoms have ahigh prevalence in the community: 5% of children aged 10 wet the bed, while 15% of women and 7% of men have troublesome incontinence; and in elderlymen of 75, benign prostatic hyperplasia occurs in more than 80% of individu-als, with benign prostatic enlargement coexisting in up to half this group andhalf of these having bladder outlet obstruction.
2 Summary : Urodynamics Third Edition By Paul Abrams
The confusion felt in many people’s minds as to the role of urodynamicshas receded for the most part. The need to support the clinical assessmentwith objective measurement has become accepted by most clinicians special-ising in the care of patients with lower urinary tract symptoms (LUTS). Sincethe first edition of this book in 1983, urodynamics has become more widelyaccepted. In the last 20 years the number of urodynamic units in Britain andEurope has increased rapidly and almost every hospital of any significanceembraces urodynamic investigations as an essential part of the diagnosticarmamentarium of the urology and gynaecology departments. Further,specialists in geriatrics, paediatrics and neurology recognise the importanceof urodynamics in the investigation of a significant minority of theirpatients.
3 Summary : Urodynamics Third Edition By Paul Abrams
Despite the technological innovations that have seen the introduction ofcomputerised urodynamics, the development of neuro-physiological testingand the introduction of new techniques such as ambulatory monitoring, theobjectives of this book remain unchanged. Urodynamics may appear compli-cated, and one of the objectives of this book is to put the subject over simplybut in enough detail to allow urodynamic investigation to be accepted, on itsown merit, as a fundamental contribution to the management of manypatients. To do this means not only describing the tests but also showing inwhich clinical areas they help management and in which they are pointless. Itmeans concentrating on the common clinical problems and on the presentingsymptom complexes, not the diagnosis; and it means pointing out any limita-tions and possible artifacts of investigation.
4 Summary: Urodynamics Third Edition By Paul Abrams
he statement “the bladder is an unreliable witness” was made by Bates in 1970 in one ofthe early papers on urodynamics (Bates et al., 1970). Two important papers appeared in1980. One by a gynaecologist, Gerry Jarvis (1980) found that of 100 patients diagnosed bytheir symptoms as having stress incontinence, only 68 were shown to have urodynamicstress incontinence. This was supported by the findings of Powell (working in the Bristolunit; Powell et al., 1980) that only 50% could be shown to have urodynamic stress inconti-nence. Both authors also looked at patients with apparent overactive bladder symptomspresumed to be the result of detrusor overactivity. Jarvis confirmed this diagnosis in only51% of cases, while Powell showed detrusor overactivity in only 33% of such patients.
5 Summary: Urodynamics Third Edition By Paul Abrams
Faced with the unpalatable fact that patients submitted for surgery without objectiveconfirmation of their condition did rather poorly, surgeons reacted in different ways. Somebecame ostrich-like, and dismissed those who published these results as poor surgeonsbereft of clinical acumen and operative skills, while making no effort to assess their ownresults. Others, who had always been uneasy about patient assessment by symptoms andnon-functional studies, such as intravenous pyelography, seized the opportunity to studythese large groups of patients by urodynamic means. Hence in the 1970s there was a rapidexpansion of clinical and research urodynamics. The wider acceptance of urodynamics hasallowed us to look at LUTS from a different perspective.
Even when knowledge does not appear likelyto improve the quality of life of that patient. There may still be an overall benefit to them ifknowledge in a difficult area. Effective treatment techniques can be increased. Anincrease in knowledge may, at a future date, result in the introduction of effective treatment. A good example would a young woman who cannot void adequately. When often normalvoiding cannot be re-established, intermittent self-catheterisation is a good treatment,although it is resented by many patients. However, routine investigations usually contributelittle to effective management, although neurophysiological testing may show abnormalsphincter activity. Hence investigations may show the cause, although the clinician does nothave the means to reverse these abnormalities.
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