Papers by Helen O'Connell
Autonomic Neuroscience, 2011
A number of methods to augment the resistance of the outlet of the urinary bladder and to improve... more A number of methods to augment the resistance of the outlet of the urinary bladder and to improve continence have been developed, including the artificial urinary sphincter and the placement of skeletal muscle around the urethra. It has been recently shown in a rabbit model that transplantation of smooth muscle around the proximal urethra reduces incontinence caused by internal sphincter deficiency. In the present work we have investigated the re-innervation of a peri-urethral smooth muscle transplant, and whether re-innervating axons have an appropriate effect when they are stimulated. Detrusor muscle from the dome of the bladder was transplanted to encircle the proximal urethras of rats. Rats tolerated the surgery and transplantation without any signs of compromised health. At 8 weeks the new sphincter was intact and easily recognised. The transplant contracted in response to transmural stimulation (1-5 Hz for up to 5 min) in a similar way to freshly removed detrusor strips. Contractions were graded with stimulus frequency, they peaked at about 10 s and faded to a lower tension that was maintained. The amplitudes of sustained contractions of the transplants were reduced to about 10% by hyoscine and were almost abolished by tetrodotoxin. Histological examination revealed healthy, vascularised smooth muscle in the transplants, similar in appearance to freshly dissected detrusor. Re-innervation was confirmed immunohistochemically for transplanted detrusor muscle and transplants of dartos muscle. We conclude that smooth muscle transplanted to form a new sphincter around the urethra becomes functionally re-innervated and has potential to be used for sphincter augmentation.
BJU international, Jan 12, 2015
Due to the myriad of treatment options available and the potential increase in the number of pati... more Due to the myriad of treatment options available and the potential increase in the number of patients afflicted with overactive bladder (OAB) who will require treatment, the Female Urology Special Advisory Group (FUSAG) of the Urological Society of Australia and New Zealand (USANZ), in conjunction with the Urogynaecological Society of Australasia (UGSA), see the need to move forward and set up management guidelines for physicians who may encounter or have a special interest in the treatment of this condition. These guidelines, by utilising and recommending evidence-based data, will hopefully assist in the diagnosis, clinical assessment, and optimisation of treatment efficacy. They are divided into three sections: Diagnosis and Clinical Assessment, Conservative Management, and Surgical Management. These guidelines will also bring Australia and New Zealand in line with other regions of the world where guidelines have been established, such as the American Urological Association, Europ...
Australian family physician
Significant advances in the management of some common urinary problems have occurred in recent ye... more Significant advances in the management of some common urinary problems have occurred in recent years. Problems that are likely to present to the general practitioner include urinary incontinence, voiding dysfunction, recurrent bacterial cystitis and interstitial cystitis. The aim of this article is to highlight the advances that have occurred in the management of these common problems and their management strategy in the primary care setting. The management of incontinence, particularly stress urinary incontinence includes an accurate diagnosis and treatment tailored to the condition identified. Urinary incontinence due to the overactive and/or underactive bladder is more difficult to cure but significant improvement can be achieved in the majority of people. While severe incontinence requires an accurate diagnosis, non-operative strategies without a urodynamic diagnosis can be used in the treatment of milder forms. It is important to obtain an accurate diagnosis when the patient is not improving with conservative strategies. The problem of recurrent bacterial infections is common in women of all ages but cure should be possible in the majority of affected women. While the enigmatic entity of interstitial cystitis is increasingly recognised in out patients the exact basis for this condition remains obscure. Symptomatic improvement is achievable to a variable degree in most patients.
Urologic Clinics of North America
The pressure based management of patients with neurogenic vesical dysfunction has led to greatly ... more The pressure based management of patients with neurogenic vesical dysfunction has led to greatly improved outcomes with respect to upper and lower urinary tract complications. At the heart of this management is detrusor leak-point pressure testing that verifies that a low intravesical pressure is achieved and subsequently maintained. The abdominal (or Valsalva) leak-point pressure that quantifies the degree and type of urethral sphincter dysfunction, is an essential test in selecting the appropriate treatment for stress urinary incontinence. The authors discuss the history, importance, and application of these two very different tests.
European Urology Supplements, 2005
Obstetrics & Gynecology, 2001
To estimate (1) the prevalence of urinary incontinence in a population-based sample of Australian... more To estimate (1) the prevalence of urinary incontinence in a population-based sample of Australian women aged 45-55 and to identify the factors associated with urinary incontinence; (2) the incidence of urinary incontinence over a 7-year follow-up period and to identify whether the transition from pre-to postmenopause is associated with the development of urinary incontinence.
Neurourology and Urodynamics, 2010
Aims: Intrinsic sphincter deficiency (ISD) causes significant disability and impairment of qualit... more Aims: Intrinsic sphincter deficiency (ISD) causes significant disability and impairment of quality of life despite a range of treatment options. We investigated a novel method to improve sphincter function that does not appear to have been previously attempted, that is, transplantation to create a smooth muscle cuff, that subsequently becomes innervated, around the urethra. Methods: Bladder pressure and passage of urine were measured in conscious, sedated rabbits of three groups: 6 control (unoperated) rabbits, 8 rabbits rendered incontinent by incision of their urethral wall, and 12 lesioned rabbits treated by transplantation of a circumferential strip of autologous dartos muscle whose innervation was later stimulated electrically. Effects of stimulation were tested up to 6 months after surgery. Results: Lesions of the proximal urethra caused the bladder to leak at filling volumes that previously caused no leak. The volume added to cause first leak was less than half the volume added to cause a voiding reflex in unoperated rabbits. Transplantation of dartos to the lesioned bladder neck did not affect urodynamic parameters. However, electrical stimulation of the innervation of the transplant increased the bladder volume necessary to cause voiding and restored voiding pressures and filling volumes towards normal. These effects were maintained for 6 months and were not related to spontaneous healing. Conclusions: Free transplants of smooth muscle that become innervated offer promise as a treatment for ISD that is unlikely to cause urethral erosion and will not require a pump to restore continence. Neurourol. Urodynam. 29:S24-S28,
Neurourology and Urodynamics, 1995
One hundred and twenty-two augmentation cystoplasties performed over an X-year period were review... more One hundred and twenty-two augmentation cystoplasties performed over an X-year period were reviewed. Mean age at surgery was 37 years (range 2-X2 years). There were X2 female patients. The primary urodynamic diagnosis was reduced compliance in 92 (77% ) patients and dctrusor hyperreflcxiaiinstahility in the remainder. The clinical diagnostic groups were: spinal cord injuryldiseaw in 32 (27% ), myclodysplasia in 27 (22% ). interstitial cystitis in 21 ( 17'4 ), idiopathic dctrusor instability in 13 ( I I % ). radiation cystitis in X (7% ). Hiniiian-Allcn syndrome in 5 (4% ), and miscellaneous in I I (9% ). A dctubulari d . ileal augmentation was used in X2 ( 6 7 % ) patients. In 36 (30%) a detuhularizcd ilcoccct~.ystoplasty was fashioned and in the remainder dctubularized sigiiioid was used. In 19 patients augmentation accoinpanicd undiversion. Sixteen patients had a siinultancous fascia1 sling for urethral incompetence. Mean follow-up was 37 months (range 6-96 months). There was n o postoperative mortality. During follow-up 4 patients died from unrelated causes, 1 I have h e n lost t o follow-up. and 5 patients await planned transplantation. Bladder capacity was increased from a preoperative iiiean o f I O X ml (range I S -S~X ) nil) to 43X nil ( Z O W l .?OO nil) postoperatively. Of the 106 assessable patients, XO ( 7 5 % ) had an excellent result, 2 I (20'2 ) were improved. and 5 ( 5 9 ) had major ongoing problems.
The Journal of Urology, 2005
Purpose: We present a comprehensive account of clitoral anatomy, including its component structur... more Purpose: We present a comprehensive account of clitoral anatomy, including its component structures, neurovascular supply, relationship to adjacent structures (the urethra, vagina and vestibular glands, and connective tissue supports), histology and immunohistochemistry. We related recent anatomical findings to the historical literature to determine when data on accurate anatomy became available.
The Journal of Urology, 2005
We determined the magnetic resonance imaging (MRI) characteristics of normal clitoral anatomy. A ... more We determined the magnetic resonance imaging (MRI) characteristics of normal clitoral anatomy. A series of MRI studies of 10 healthy, nulliparous volunteers with no prior surgery and normal pelvic examination was studied and the key characteristics of clitoral anatomy were determined. A range of different magnetic resonance sequences was used without any contrast agent. The axial plane best revealed the clitoral body and its proximal continuation as the paired crura. The glans was seen more caudal than the body of the clitoris. The bulbs of the clitoris had the same signal as the rest of the clitoris in the axial plane and they related consistently to the other erectile structures. The bulbs, body and crura formed an erectile tissue cluster, namely the clitoris. In turn, the clitoris partially surrounded the urethra and vagina, forming a consistently observed tissue complex. Midline sagittal section revealed the shape of the body, although in this plane the rest of the clitoris was poorly displayed. The coronal plane revealed the relationship between the clitoral body and labia. The axial section cephalad to the clitoral body best revealed the vascular component of the neurovascular bundle to the clitoris. The fat saturation sequence particularly highlighted clitoral anatomy in healthy, premenopausal, nulliparous women. Normal clitoral anatomy has been clearly demonstrated using noncontrast pelvic MRI.
The Journal of Urology, 1998
Purpose: We investigated the anatomical relationship between the urethra and the surrounding erec... more Purpose: We investigated the anatomical relationship between the urethra and the surrounding erectile tissue, and reviewed the appropriateness of the current nomenclature used to describe this anatomy.
Journal of Sexual Medicine, 2008
Factual presentations of sexual anatomy are required for educational purposes, for clinical and m... more Factual presentations of sexual anatomy are required for educational purposes, for clinical and more general communication about sexual matters. To date, unambiguous, accurate and objective images with appropriate labeling to enhance specificity in communication have been lacking. Aim. The aim of this presentation is to provide a comprehensive overview of anatomy of the distal vagina. We aim to simplify the anatomy to reduce the confusion of historical descriptions. In doing so, we aim to avoid sacrificing any of the specific detail. This would aid communication between clinicians, researchers, and the nonclinician regarding this anatomy. Outcome Measures and Methods. This article reviews the historical and current anatomical literature. Systematic dissection and photography, histological study, and magnetic resonance imaging have been used as the basis for this presentation. Digital technology has been used to label, color, and highlight photography to provide clarity and permit diagramatization of photography. No distortion has otherwise been used in presenting images from cadavers or anatomical research. Results. The anatomy of the distal vagina and surrounding structures is shown and described in detailed. The distal vagina, clitoris, and urethra form an integrated entity covered superficially by the vulval skin and its epithelial features. These parts have a shared vasculature and nerve supply and during sexual stimulation respond as a unit though the responses are not uniform. Conclusions. Significant progress has been made in the field of female sexual anatomy and its pictorial representation. This may facilitate further progress in the related fields of female sexual health and education. O'Connell HE, Eizenberg N, Rahman M, and Cleeve J. The anatomy of the distal vagina: Towards unity. J Sex Med 2008;5:1883-1891.
Clinical Anatomy, 2000
We aimed to define the gross anatomy of the supporting structures of the clitoris. We performed a... more We aimed to define the gross anatomy of the supporting structures of the clitoris. We performed a dissection of the perineum of a series of 22 female and four male cadavers. Specific dissection of the clitoral and penile suspensory ligament complex was performed in four female and two male cadavers. Serial written observations and photography were used to document the findings. Our findings were then compared with the anatomical description of these structures in the historical and current anatomical literature. The suspensory ligament of clitoris consistently displayed two components: a superficial fibro-fatty structure extending from a broad base within the mons pubis to converge on the body of the clitoris and extending into the labia majora; in addition there is a deep component with a narrow origin on the symphysis pubis extending to the body and the bulbs of the clitoris. The supporting structures of the clitoris are more substantial and complex than previously described. Their shape, extent, and orientation are different from analogous structures of the penis, the suspensory ligament of which was found as described in the literature.
BJU International, 2006
ABSTRACT
ANZ Journal of Surgery, 1993
Journal of Endourology, 1995
Transurethral Needle Ablation of the prostate (TUNA) is a new thermal ablation treatment for beni... more Transurethral Needle Ablation of the prostate (TUNA) is a new thermal ablation treatment for benign prostatic hyperplasia (BPH) utilizing radiofrequency electric current delivered by needles into the depth of the prostate to produce an area of coagulative necrosis. A pilot study of 10 patients in urinary retention was undertaken to assess the procedure. After treatment, nine patients voided at a median time of 3 days, although a further two required transurethral resection because of chronic infection in one and chronic urinary retention in the other. At 3 months' follow-up, the mean Qmax was 13.0 mL/sec, the mean AUA Symptom Score was 9.1, and the mean quality of life score was 1.6. The mean Pdet fell from 73.3 to 39.0 cm H2O. On transrectal ultrasound at 3 months, cystic lesions were seen in two patients, with a third having large cavities. A 10.2% reduction in mean prostatic volume, from 48.8 cc to 43.8 cc, was noted but considered to be not significant. On endoscopy at 3 months, mucosal retraction was seen in seven patients, with cavities in two patients. Histologic study in patients undergoing transurethral resection 4 to 6 months after TUNA showed necrosis and fibrosis. It is considered that an area of coagulative necrosis is produced by TUNA that resolves either by scar formation with retraction or by liquefaction with cyst formation. If the lesion communicates with the urethra, a cavity may form, which is undesirable. Our early experience is encouraging. The TUNA treatment is effective, can be given without anesthesia, and should be either a day case or an office procedure. It should prove to have a significant place in the treatment of BPH.
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Papers by Helen O'Connell