International urogynecology journal and pelvic floor dysfunction最新文献

A case of vesical calculus is being presented as a complication of TVT procedure done for severe stress incontinence in an elderly lady. The patient, who presented with obstructive and irritative lower urinary tract symptoms, needed an indwelling catheter. Non-enhanced CT scan of abdomen confirmed an intraluminal calcific density in the anterior wall of urinary bladder just left of midline. On cystoscopy, a blue-colored polypropylene mesh of the TVT was visible at the ends of this calculus, holding it to the anterior vesical wall. Holmium laser was used to disintegrate the ends of the mesh deep in the submucosa of the urinary bladder. To our knowledge, this is a unique case of calculus forming near the dome of bladder over a TVT mesh presenting 3 years post-operatively and treated with holmium laser.

Introduction and hypothesis: The levator ani muscle is generally thought to play a role in urinary continence, with incontinence assumed to be due to abnormal muscle function or morphology. This study examined whether avulsion of the puborectalis muscle is associated with symptoms or signs of bladder dysfunction.

Methods: In a retrospective observational study, we reviewed the records of 425 women who had attended a urogynecological unit for independent flowmetry, multichannel urodynamic testing, and 4D pelvic floor ultrasound.

Results: Mean age was 55 years (range, 17-87 years). Of 420 women with complete datasets, 104 (25%) were diagnosed with a puborectalis muscle avulsion. These women were less likely to suffer from stress urinary incontinence (SUI; P < 0.001) and urodynamic stress incontinence (USI; P = 0.065) and more likely to present with symptoms of prolapse (P < 0.001) and show signs of voiding dysfunction (P = 0.005). The negative association between avulsion and SUI persisted in multivariate models.

Conclusion: Puborectalis muscle trauma is not associated with an increased risk of SUI or USI in a urogynecological population, even when controlling for symptoms or signs of prolapse and previous surgery.

Introduction and hypothesis: The purpose of this study is to compare vaginal caldesmon expression in women with and without anterior vaginal wall prolapse.

Methods: Vaginal tissues were sampled in women with (n = 11) or without (n = 11) vaginal wall prolapse. Caldesmon messenger RNA (mRNA) expression was assessed by quantitative real-time polymerase chain reaction. Immunohistochemistry and digital image analysis were used to determine caldesmon protein expression in the histologic sections.

Results: There were no significant differences in demographic data between the two groups. Caldesmon mRNA expression was significantly decreased in the vaginal tissue from women with anterior vaginal wall prolapse compared to women without prolapse [(caldesmon mean +/- SD mRNA expression in relative units) 0.03 +/- 0.03 vs 0.17 +/- 0.17, P = 0.02]. The fractional area of nonvascular caldesmon staining in the vagina of women with anterior vaginal wall prolapse was significantly decreased compared to women without prolapse [mean +/- SD (0.09 +/- 0.04 vs 0.16 +/- 0.09, P = 0.03)].

Conclusions: Vaginal caldesmon expression is significantly decreased in women with anterior vaginal wall prolapse compared to normal subjects.

Introduction and hypothesis: This study aims to analyze comparatively the efficacy and safety of synthetic transobturatory and aponeurotic retropubic slings, in the treatment of stress urinary incontinence (SUI) in women.

Methods: Patients were separated in a randomized way. Twenty-one patients were submitted to the operatory correction by the transobturatory sling technique, whereas 20 patients were operated by the retropubic sling technique. All patients were submitted to complete physical exam and urodynamic test. The "T" test and the Mann-Whitney U test were applied to establish comparisons between the two groups. Patients were followed-up for 12 months.

Results: Healing rate was 90.5% (19/21) and 95% (19/20), respectively after 12 months. The transobturatory group presented lesser complications rate than the retropubic group.

Conclusions: The transobturatory and the aponeurotic slings techniques were equally effective for the treatment of SUI. The transobturatory sling has shown fewer complications and lesser surgical time than the aponeurotic sling technique.

Introduction and hypothesis: Pregnancy is a risk factor for urinary tract infection (UTI), and it has been shown that frequent urine voiding was a protecting factor against UTI for nonpregnant female cleanroom workers. We conducted a study to evaluate whether these findings also apply to pregnant women.

Methods: We recruited female workers in an industrial park who received an annual health examination between August 1 and September 31, 2003. From each participant, we collected a urine sample and obtained information through a questionnaire.

Results: A total of 2,062 workers, including 118 pregnant and 1,944 nonpregnant women, participated in the study. Pregnancy was a significant risk factor for both symptomatic (odds ratio [OR] = 6.33) and asymptomatic (OR = 2.13) UTIs. Urine voiding three or more times during a shift was a significant protective factor for asymptomatic UTI (OR = 0.40).

Conclusions: UTI is common among pregnant cleanroom workers, and frequent voiding appears to be a protecting factor.

Introduction and hypothesis: Multichannel urodynamic testing is considered to be the gold standard for evaluation of lower urinary tracts symptoms in women. The objective of this study was to assess the level of pain associated with this test.

Methods: We reviewed charts of women who underwent multichannel urodynamic testing for lower urinary tract symptoms and recorded pain levels using a validated visual analog pain scale of 0-10 before, during, and 1.5 h after the test.

Results: We identified 50 patients who underwent the test. Pain level increased mildly but significantly during the urodynamic test (1.24 +/- 0.9 vs 0.02 +/- 0.14 p < 0.001) and decreased thereafter (0.1 +/- 0.35, p < 0.001).

Conclusions: Multichannel urodynamic testing is associated with a low but significant level of pain, which generally abates shortly after the procedure. No correlation seems to exist between the degree of pain and various clinical and pelvic floor parameters.

Case report: We report a case of simultaneous injury of right external iliac artery and vein by a needle carrier that was inserted from the suprapubic area down to the vaginal lumen during anterior vaginal wall sling procedure.

Discussion: The risk factors and measures to be taken to avoid this life threatening complication are discussed.

Introduction and hypothesis: This study aimed to describe the self-perceived natural history of pelvic organ prolapse (POP) in women seeking care.

Methods: Women presenting to a university-based urogynecology clinic for POP (n = 107) completed a questionnaire including questions about how and when their prolapse was discovered. A urogynecologic examination including the pelvic organ prolapse quantification (POP-Q) was also performed.

Results: Forty-eight percent of these women sought medical attention "immediately" after discovering a bulge. The median time to seek care was 4 months (range from 1 month to 45 years). Twenty-six percent associated their prolapse with a specific event (e.g., moving furniture or pushing a car). POP was self-discovered by 76% (81/107) of women. Self-discovered prolapses were larger than those diagnosed by physicians (Ba +1.3 vs 0.1 cm, P = .03, respectively).

Conclusions: Women seek medical advice within months of discovering their prolapse. Self-discovery is associated with higher stage prolapse than prolapse diagnosed by health care providers.