International urogynecology journal and pelvic floor dysfunction最新文献

Ureterouterine fistulas are rare surgical complications with fewer than 30 reported cases in the literature to date. Rarer yet is a fistula between an ectopic ureter and the uterus, with only one case described previously (Shibata et al. in J Urol 153: 1208-1210, 1995). Herein, we present the first case, to our knowledge, of a fistula between an ectopic ureteral stump (from a prior nephroureterectomy) and the uterus.

Introduction and hypothesis: The objective of the study was to determine urogynecology publication rates in obstetrics and gynecology literature.

Methods: Original scientific articles from American Journal of Obstetrics and Gynecology (AJOG) and Obstetrics and Gynecology (Obstet Gynecol) from 1996-2007 were reviewed.

Results: A total of 10,192 articles were evaluated. Two trends were noted in the AJOG: percentage of urogynecology articles increased (correlation with year r = 0.845; p < 0.05) and percentage of obstetric articles decreased (negative correlation r = -0.589; p < 0.05). Similarly for Obstet Gynecol, the number of urogynecology articles increased with time with a strong positive correlation of r = 0.743 and p < 0.05. There was a significant difference in the number of articles published in the AJOG in months with an annual scientific meeting compared to months without (t = -6.34; p < 0.001).

Conclusions: The numbers of urogynecology articles published in the general literature has increased and may be related to presentation at national meetings.

Introduction and hypothesis: We investigated whether the expression of alpha-1 antitrypsin (ATT), neutrophil elastase (NE), and lysyl oxidase-like protein 1 (LOXL-1) vary within the vagina in subjects with pelvic organ prolapse (POP).

Methods: Biopsies were obtained from the anterior and posterior vaginal wall of 22 women with POP (> or =stage 2 by POP-Q). The subjects were grouped by the most prominent defect: cystocele, cystocele plus uterine prolapse, and rectocele. Comparative real-time PCR, Western blotting, and NE enzyme activity assay were performed.

Results: The ratio of anterior and posterior vaginal wall ATT, NE, and LOXL-1 expression varied between individuals within the same defect group.

Conclusions: ATT, NE, and LOXl-1 expression was variable among different biopsy sites in the vagina. No consistent pattern was present when the subjects were grouped by the most prominent defect. We recommend careful consideration of biopsy sites in future studies on POP to enhance reproducibility of data.

Introduction and hypothesis: To confirm the efficacy and tolerability of extended release (ER) trospium chloride in women with overactive bladder syndrome (OAB), data from two identical phase III studies were analyzed.

Methods: Adults (aged > or = 18 years) who had OAB with urinary urgency, frequency, and urge urinary incontinence (UUI) were randomized to trospium ER 60 mg or placebo once daily for 12 weeks. The analysis included 989 women (trospium ER, n = 484; placebo, n = 505). Endpoints examined included changes from baseline in number of toilet voids and UUI episodes/day at week 12. Continuous data were analyzed using rank analysis of variance.

Results: At week 12, significantly greater mean reductions in numbers of toilet voids and UUI episodes/day occurred with trospium ER versus placebo (P < 0.0001). Adverse events considered at least possibly related to treatment with trospium ER included dry mouth (11.4%) and constipation (8.9%).

Conclusions: Trospium ER was effective and well tolerated in women with OAB.

Candida krusei is an uncommon cause of vaginitis and cystitis but is unique because of the management challenge it poses due to intrinsic resistance to fluconazole and flucytosine. We report a case of C. krusei vaginitis and cystitis successfully managed with topical vaginal and intravesical amphotericin B. The challenges in managing C. krusei cystitis and the role of amphotericin B bladder irrigation in the management of fungal urinary tract infections are discussed.

We report a case of vesicovaginal fistula associated to a vaginal foreign body. A 72-year-old woman consulted our clinic complaining of severe urinary incontinence. The leakage was continuous and significant and she was feeling a "vaginal mass". Pelvic examination was suspicious for an advanced vaginal cancer, but further investigations showed the presence of a retained vaginal foreign body complicated by perforation of the bladder.

Introduction and hypothesis: An anatomical study on fresh cadavers was done to determine the vulnerability of the dorsal nerve of the clitoris to injury during "outside-in" transobturator sling procedures.

Methods: The dorsal nerve of the clitoris was identified bilaterally in ten fresh cadavers. Transfixing needles marked the inferomedial border of the obturator foramen. The distance between the foramen border and the nerve was measured.

Results: The nerve ran medially in close approximation to the ischiopubic ramus and inferior to the obturator foramen in all specimens. In no instance did the nerve follow an aberrant course traversing the obturator foramen. The mean distance between the inferomedial border of the obturator foramen and the nerve was 9.3 mm, range 3-14 mm.

Conclusions: When the "outside-in" technique is used, the introducer cannot come into contact with the dorsal nerve of the clitoris because the introducer would have to pass through the ischio-pubic ramus. This is not anatomically possible.

Single system ectopic ureter is a rare congenital malformation of the urinary tract, frequently associated with genital tract malformations. We report the first case of an adenocarcinoma arising in an ectopic ureter in a woman and mimicking uterine cervical adenocarcinoma. A 34-year-old woman, previously diagnosed as having bicornuate uterus, presented with post-coital bleeding. On gynecological exam, there were two cervixes with a small nodule on the left cervix. After nodule biopsy, the initial diagnosis was adenocarcinoma of the uterine cervix. Pelvic ultrasound and magnetic resonance imaging demonstrated an ectopic tumoral ureter draining a dysplastic pelvic kidney and inserted in the cervix of a bicornuate uterus. The patient was treated by radical hysterectomy and left nephroureterectomy. Pathological exam demonstrated an adenocarcinoma arising in the ectopic ureter. We suggest that this case could be an argument for recommending regular follow-up for women with ectopic ureter for detecting malignant transformation.

Introduction and hypothesis: There is limited data on prevalence and risk factors for bothersome lower urinary tract symptoms (LUTS) in women with diabetes mellitus (DM). This study assesses prevalence and risk factors for bothersome LUTS and voiding dysfunction in women with DM.

Methods: Two hundred twenty women participated in this study. Participants completed the King's health questionnaire and the international consultation on incontinence-female lower urinary tract symptom questionnaire. Symptoms prevalence and urinary flow rate were assessed. Logistic regression models for risk factors of bothersome LUTS and voiding dysfunction were constructed.

Results: One hundred forty-eight women completed the study. Sixty-one women (41%) had bothersome LUTS. Urgency incontinence, urgency, and nocturia were the most bothersome. Fifty-six (38%) had voiding dysfunction. Neuropathy and glycosylated haemoglobin were independent risk factors for voiding dysfunction. Voiding dysfunction did not affect quality of life in women with DM.

Conclusions: Overactive bladder symptoms are the most bothersome in diabetic women. Neuropathy and glycosylated haemoglobin are risk factors for voiding dysfunction.

Introduction and hypothesis: This study reports 1-year outcomes in women who underwent transvaginal pelvic organ prolapse (POP) surgery with Prolift transvaginal mesh.

Methods: Pre- and postoperative objective vaginal Pelvic Organ Prolapse Quantification (POP-Q) and subjective symptom and impact assessments (Pelvic Floor Distress Inventory (PFDI)-20 and Pelvic Floor Impact Questionnaire (PFIQ)-7, respectively) were performed. Postoperative vaginal tenderness, stricture, and patient satisfaction were also obtained. Paired t tests were utilized for analysis.

Results: Mean age was 61.8 +/- 9.8 years; mean follow-up interval was 425.0 +/- 80.0 days (range, 237-717). POP-Q measurements of Ba, Bp, and C were significantly improved (all p values

Conclusions: Women undergoing transvaginal repair of POP with the Prolift mesh system showed significant improvement in 1-year anatomic and subjective measures.