International urogynecology journal and pelvic floor dysfunction最新文献

Introduction and hypothesis: To quantify the prevalence (previous month) of urinary incontinence (UI) and overactive bladder (OAB), to assess its relation with known risk factors and to characterize UI awareness and treatment.

Methods: Telephone interviews were conducted in 1,934 Portuguese subjects aged > or =40 years. UI was defined according to the International Continence Society definitions. OAB was assessed through the Overactive Bladder Assessment Tool.

Results: The prevalence of UI was 21.4% (95% CI 19.0-23.9) in women, 7.6% (95% CI 4.8-10.4) in men. Diagnosis (ever in life) was reported by 4.5% (95% CI 3.3-5.7) of the participants, from which 73.0% reported to have been treated for UI. OAB was reported by 29.4% (95% CI 26.6-32.2) of women and 35.1% (95% CI 29.6-40.6) of men. Obesity, hysterectomy and asthma in women, and age in men, were significantly associated with the symptoms.

Conclusions: UI and OAB prevalences were high, but the proportion of individuals aware of their condition was low, emphasizing the need for better information among physicians and general population.

Introduction and hypothesis: Pelvic floor muscle training (PFMT) is a treatment for stress urinary incontinence (SUI) that can be done individually or in a group. The aim of this study was to compare these two types of treatment.

Methods: Sixty women 30 to 75 years old with SUI were randomly assigned to participate in the two groups. They were evaluated before and after the treatment with the Oxford grading system, pad test, voiding diary, and the King's Health Questionnaire.

Results: Both groups experienced significant reductions in urinary leakage as measured by the pad test and bladder diary. A negative pad test was observed in about 50% of patients in both groups. There were statistically significant improvements in both muscle strength and quality of life. When the groups were compared, there were no differences in the results between them.

Conclusions: Individual treatment and group PFMT appear to be equally effective for improving SUI.

Introduction and hypothesis: To determine referral patterns to the gynecology directorate for symptomatic pelvic organ prolapse and urinary incontinence

Methods: A prospective multicenter survey of three district general hospitals in Northwest England. Referral letters sent by family physicians to consultants were studied over a three-month period. Main outcome measures were presenting complaints of prolapse and incontinence

Results: Two thousand seven hundred sixty-nine referral letters were surveyed. Urogynecological complaints (18.4%) were the second most common reason for referral. Menstrual irregularities (21.9%) were the commonest presenting complaint. Among these urogynecology referrals, 38.4% (196/510) were for urinary incontinence (UI), 36.2% (185/510) were for symptomatic prolapse (POP), and 25.3% (129/510) were referred with combined complaints of POP and UI. Of all urogynecological referrals, 56% were for women below 60 years of age. Twenty percent of those with urogynecological complaints had undergone prior hysterectomy.

Conclusions: Pelvic floor disorders were the second most common reason for referral to gynecologists.

Introduction and hypothesis: The aim of this study was to assess the relationship between ultrasound estimation of bladder weight (UEBW), symptoms and urodynamic diagnosis.

Methods: Women with lower urinary tract symptoms underwent urodynamics studies and measurement of UEBW at a fixed bladder volume.

Results: Women with overactive bladder symptoms had a median UEBW of 48.3 g (95% CI 44-52), with stress urinary incontinence a median UEBW of 35.1 g (95% CI 30-41) and with mixed urinary incontinence a median UEBW of 40.0 g (95% CI 37-43) (p<0.001). Women with detrusor overactivity had a median UEBW of 48.0 g (95% CI 46-51), with urodynamic stress incontinence a median UEBW of 30 g (95% CI 29-31) and detrusor overactivity and urodynamic stress incontinence a median UEBW of 37.3 g (95% CI 33-41) (p<0.001).

Conclusions: UEBW is higher in women with overactive bladder and detrusor overactivity. UEBW may be a useful tool in women with lower urinary tract symptoms.

Introduction and hypothesis: Transabdominal (TA) ultrasound and perineometry have been currently used to assess lifting aspect and squeezing action of pelvic floor muscles (PFM) function, respectively, in women with stress urinary incontinence (SUI). However, no study has directly compared these measurements. The purpose of this study was to investigate the reliability and correlation between perineometry and TA ultrasound as measurements of different aspect of PFM function.

Methods: A total of 28 women with SUI participated in the study. Vaginal squeeze pressure using a perineometer and bladder base movement on TA ultrasound was measured. Scattergram was depicted to determine the correlation between variables. Intraclass correlation coefficient and Bland-Altman plot were used to assess reliability.

Results: Scatter diagram depicted significant correlation of TA ultrasound with vaginal squeeze pressure (r = 0.72, R (2) = 0.52, p < 0.0001). High reliability was found for measurements.

Conclusion: TA ultrasound measurement may be an alternative measurement to perineometry when assessing PFM function.

Introduction and hypothesis: We assessed whether urinary excretion of glycosaminoglycans (GAGs) may be affected by a condition of detrusor overactivity (DO).

Materials and methods: We evaluated 24-h urinary excretion of GAGs in 25 patients (mean age 63.81 years) with DO and in 14 healthy controls (mean age 65.75 years). No patients or controls had urinary tract infection. The excretion of GAGs was measured on the basis of total urine volume and normalized to creatinine concentration. Student's test was employed to check between the urinary excretion of GAGs in the two groups.

Results: The urinary content of GAGs discovered in control group was significantly higher than that in pathological group for the ratio GAGs/creatinine concentration.

Conclusions: The low content of GAGs might be due to relative ischemia of the bladder wall epithelial layer following a chronically increased contractile activity of the detrusor even if further studies are needed to confirm this finding.

Introduction and hypothesis: Our aim was to review our experience with Fournier's gangrene in female patients.

Methods: A retrospective review of ten consecutive female patients with Fournier's gangrene was performed. Etiological and predisposing factors, causative microbiological organisms, and clinical outcome were investigated.

Results: Mean age of the patients was 52.7 years, and the mean duration of hospitalization was 17.6 days. The etiologic origin of the gangrene was anorectal, dermatological, and urogenital infection in 50%, 20%, and 10% of patients, respectively. All patients underwent aggressive surgical debridement and a diverting colostomy. Nine patients survived, and one patient died for an overall mortality rate of 10%.

Conclusions: Fournier's gangrene occurred in females with a pattern similar to that in males. We believe that a colostomy is an integral part of management for patients requiring extensive debridement, especially if the infection arises in the anorectal region.

Introduction and hypothesis: Many physicians in primary care and medical/surgical specialties will care for female patients with pelvic floor disorders (PFD).

Methods: A survey was mailed to 266 United States and Canadian clerkship directors that queried how medical students were being educated in PFD.

Results: Forty-four percent of clerkship directors responded. The mean clerkship size was 105 medical students. Over 97% of third year medical students received lectures on hypertension in pregnancy, normal labor, and abnormal uterine bleeding and at least 90% received lectures on obstetric hemorrhage, placenta previa, and menstruation. Forty percent to 85% of medical students received lectures in PFD depending on the topic. Eighty percent of medical students had no exposure to PFD during their first 2 years of medical school. During their third year, 95% of the students were exposed to PFD topics but only 60% had an opportunity to spend at least a day in an urogynecology practice. Clerkship directors indicate that PFD are relevant to medical student training, however, they have limited time in the clerkship to cover all of the required topics.

Conclusions: We are missing an important opportunity to educate future clinicians about PFD, which dramatically impact women's quality of life.

We report a rare case of vesical endometriosis in a 65-year-old postmenopausal woman. An abdominal hysterectomy had been performed 34 years previously, and exogenous estrogens had not been administered. The hormone levels were normal for a castrated female subject. The patient was treated surgically with transurethral resection and the following hormonal therapy. Endometriosis of the urinary tract can happen even in postmenopausal women.