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The first four reports of the Standardisation Committee of the International Continence Society dealt with the nomenclature relating to urinary incontinence, procedures related to the evaluation of urine storage (cystometry, urethral closure pressure profile), units of measurement (Bates et al., 1976), procedures related to the evaluation of micturition (flow rate, pressure measurement), symbols (Bates et al., 1977), procedures related to the evaluation of micturition: pressure flow relationship, residual urine (Bates et al., 1980) and neuromuscular dysfunction of the lower urinary tract (Bates et al., 1981). The fifth report has remained an internal document of the Society and deals with the quantification of urine leakage. This report deals with recommendations on terminology related to neurophysiological investigations of the lower urinary tract with particular reference to electromyography, nerve pathway studies and sensory testing. These standards are proposed to facilitate comparison of results by investigators who use these investigations. It is recommended that the acknowledgement of these standards in written publications be indicated by a footnote to the section 'Methods and Materials' or its equivalent: 'Methods, definitions and units conform to the standards proposed by the International Continence Society except where specifically noted.' [ABSTRACT FROM AUTHOR]

- Pre- and post-operative clinical and urodynamic data have been reviewed in 24 women with detrusor instability following colposuspension. Follow-up ranged from 3 to 5 years. Ten women remained asymptomatic throughout; of the remainder, four (28.6%) were improved by drug therapy. With one exception, patients who were symptomatic at the outset remained so at late follow-up. [ABSTRACT FROM AUTHOR]

- Twenty-five patients complaining of nocturia completed a double-blind cross-over trial using desmopressin (DDAVP) and placebo. All had failed to respond to treatment with antispasmodic agents and evening fluid restriction. The drugs were given as a single intranasal dose on retiring. Nocturnal urinary frequency was reduced from a mean of 3.2 episodes to 2.6 with placebo and 1.9 with DDAVP (0.01 > P<0.001). Diurnal urinary symptoms were not significantly affected and side effects were minimal. This drug seems to have a place in the treatment of nocturia, where more conventional therapies have failed. [ABSTRACT FROM AUTHOR]

- Ninety-two female patients with genuine stress incontinence, and with otherwise normal bladder function, were treated by a colposuspension operation. Pre-operative and post-operative clinical and urodynamic assessments were performed on all patients. Following surgery 17 of them were found to have detrusor instability. [ABSTRACT FROM AUTHOR]

- Detrusor instability has remained resistant to conventional forms of treatment. An attempt to use biofeedback methods in its management is described. Six female patients with symptoms of frequency, urgency and urge incontinence due to detrusor instability were conditioned to auditory and visual stimuli for 6 to 81 h sessions. They were assessed clinically and urodynamically. The results are presented as well as detailed case studies of 3 patients. Subjectively, 3 were cured, 2 improved and 1 remained the same; objectively, 3 were cured, 1 improved and 2 remained the same. No significant side effects were encountered. [ABSTRACT FROM AUTHOR]

The place of detrusor and sphincter electromyography in the investigation of patients with urodynamic problems is discussed. The low-frequency component of the detrusor E.M.G. and the urethral sphincter recordings are of diagnostic value, and the pressure and flow recordings provide further useful diagnostic information. [ABSTRACT FROM AUTHOR]

- A series of 28 female patients with urge incontinence refractory to other forms of treatment underwent a total of 40 transvesical injections of phenol into the pelvic nerve plexuses. Following primary phenol injection only 8 patients (29%) had a significant response to therapy and all relapsed during follow-up. Only 3 of 11 patients undergoing a second injection had a clinical response to this therapy and 1 developed a vesicovaginal fistula. This suggests that phenol injections have little place in the management of urge incontinence and it is unwise to proceed to 2 or more injections because of the risk of fistula. [ABSTRACT FROM AUTHOR]

A technique is described for investigating in conscious female patients both the low-frequency (wave) and high-frequency (spike) components of the detrusor E.M.G. The low-frequency component appears to be of value in assessing the chemotherapy by antispasmodic drugs in urgency of micturition. [ABSTRACT FROM AUTHOR]

The effects of urethral dilatation have been investigated in girls with recurrent urinary infection. About 65 per cent of girls showed some improvement when this procedure was combined with long-term antibiotic therapy, provided that there was no serious vesico-ureteric reflux. However, the results were unpredictable, and in a controlled prospective trial the preliminary results of dilatation did not differ significantly from those obtained with cystoscopy alone. Nevertheless, improvement after dilatation did seem to be associated with a high urethral pressure profile, high bladder pressure, small bladder capacity and marked detrusor irritability; it is suggested that this 'dysfunctional bladder syndrome' may be the cause of recurrent infections in these cases, and that improvement may be anticipated after urethral dilatation, which should be combined with anti-cholinergic drug therapy if day wetting is a co-existing problem. [ABSTRACT FROM AUTHOR]

- A preliminary comparison is presented, with pre-operative and post-operative objective assessment, of 25 women undergoing anterior repair and 25 women undergoing colposuspension for the correction of incontinence due to urethral sphincter incompetence. Colposuspension was found to be more effective. The mechanism of successful cure was likely to be a combination of bladder neck and proximal urethral elevation and narrowing. [ABSTRACT FROM AUTHOR]

- Biofeedback training has been used to treat 27 female patients suffering from symptoms associated with detrusor instability Re-education to auditory and visual stimuli took place during 4 to 8 one-hour sessions at weekly intervals. Using subjective and objective methods of assessment 81% of the patients were improved following treatment. [ABSTRACT FROM AUTHOR]

Objective: To assess the short- and medium-term efficacy of periurethral collagen injection in women with urethral sphincter incompetence and to determine if urodynamic variables can elucidate the mechanism of action., Patients and Methods: Sixty women (mean age 64 years, range 20-90) with genuine stress incontinence received periurethral collagen injections under local anaesthesia; 55 had undergone previous continence surgery. A total of three injection sessions were allowed. Subjective and urodynamic assessments were obtained at 1, 3, 6, 12 and 24 months after injection to evaluate success and long-term effects of collagen., Results: Subjective success rates were 86% at 3 months, 77% at 12 months and 68% at 24 months. Objective cure rates were 61% at 3 months, 54% at 12 months and 48% at 24 months. Low urethral pressures and decreased bladder neck mobility did not affect the outcome. Collagen injections significantly increased stress maximum urethral closure pressures and functional urethral length; increase in the latter and clinical assessment of bulking at the time of injection appeared to predict medium-term success. There were some minor early complications and none in the medium-term., Conclusions: Periurethral collagen injections continued to be effective at the 2-year follow-up, although there was a time-dependent decline. In comparison with more complicated procedures used in patients with previous failed continence surgery, periurethral collagen injection is a simple, acceptable, day case procedure which improves the quality of life in physically fit or frail patients, with few complications.

This study reviews the 3- to 5-year follow-up of 35 elderly women treated by colposuspension for incontinence due to urethral sphincter incompetence (genuine stress incontinence). All patients had pre- and post-operative urodynamic studies and were followed up annually by clinical assessment and Urilos test. Thirty-two patients were subjectively cured and 31 objectively cured. Cystocele was corrected by the colposuspension. Rectocele and enterocele were frequently encountered at follow-up and prophylactic closure of the pouch of Douglas or posterior repair were recommended. Although the peak urine flow rate measurements at follow-up were reduced, no patient encountered difficulty in bladder emptying. The low operative and post-operative morbidity rate was due to careful pre-operative medical selection.

26 patients with frequency, urgency and urgency incontinence, without bladder or urethral abnormality, underwent psychiatric evaluation. They were divided into 2 groups according to the degree of neuroticism found. Treatment by group and individual psychotherapy showed that approximately one-third of the patients benefited considerably, one-third refused treatment or ceased prematurely and one-third improved slightly or not at all. The importance of excluding organic bladder or urethral disease prior to psychiatric assessment is stressed.