International urogynecology journal and pelvic floor dysfunction最新文献

Introduction and hypothesis: We hypothesized that self-reported pad use per day (PPD) after pubovaginal sling (PVS) correlated with postoperative quality of life (QOL) scores.

Methods: Two hundred fifteen women completed the incontinence impact questionnaire 7 (IIQ-7) and urogenital distress inventory 6 (UDI-6) before PVS and during follow-up. Starting 3 days before a visit, women recorded the number of protective urinary pad changes per day. Analysis of variance and Pearson correlation tests were used to determine if women reporting zero, one, or greater than or equal to two urinary pads per day after PVS had significantly different changes in baseline QOL scores.

Results: Over a mean 8.5 months follow-up after PVS, 131, 56, and 28 women reported zero, one, and greater than or equal to two pad changes/day. Each pad group showed progressively less improvement from baseline IIQ-7 and UDI-6 scores after PVS. Change in IIQ-7 and UDI-6 scores negatively correlated with PPD (p < 0.0001).

Conclusions: Self-reported PPD after PVS reflects patient perception of urinary-specific QOL.

Introduction and hypothesis: Urinary glycosaminoglycans (uGAG) have protective effects against urinary tract disorders. Here we investigated whether oral hormonal contraceptives (OC) affect uGAG excretion.

Methods: Urine specimens were from young women regularly taking: ethinyl estradiol + drospirenone, n = 9; ethinyl estradiol + cyproterone acetate, n = 9; and ethinyl estradiol + gestodene, n = 7. Controls were from ten women not taking OC. Total uGAG was assayed as hexuronic acid/urinary creatinine. Sulfated uGAG species was determined by electrophoresis.

Results: Unlike controls, total uGAG in the two halves of the menstrual cycle was similar in the OC groups. Whole cycle uGAG was higher in the OC groups (p < 0.01), especially for ethinyl estradiol + cyproterone acetate (p < 0.005). The three OC produced decreases of approximately 50% in heparan sulfate (p < 0.02) and dermatan sulfate (p < 0.02), and a approximately 100% increase in chondroitin sulfate (p < 0.004).

Conclusions: uGAG excretion is changed in women taking OC, and this might enhance the protective effects of these molecules against urinary tract disorders.

Introduction and hypothesis: The purpose of this study is to evaluate women with urge syndrome following pubovaginal sling procedure for stress urinary incontinence using a polypropylene mesh.

Methods: A total of 292 cases were available to compare preoperative and postoperative videourodynamic parameters.

Results: There were 142 women (48.6%) with urge syndrome before operation and 92 (31.5%) with urge syndrome after pubovaginal sling procedure. Urge syndrome was persistent in 79 women, resolved in 63, and de novo urge syndrome was noted in 13. Urodynamic detrusor overactivity (DO) was present in 67 (22.9%) women before operation and in 47 (16.1%) after operation. DO was persistent in 29, resolved in 38, and de novo DO in 18 after operation. Among the 18 women with de novo DO, 15 (83.3%) had preoperative urge syndrome.

Conclusions: Of patients with urge syndrome after pubovaginal sling procedure, 85.9% had a chronic condition, and 83.3% of patients with de novo DO had preoperative urge syndrome.

Introduction and hypothesis: Our objective was to translate and validate a Portuguese version of the Urinary Incontinence-Specific Quality-of-Life Instrument (I-QOL), a questionnaire that is widely used in clinical trials.

Methods: Fifty patients completed the same questionnaire twice at a 2-week interval. During the first visit, we conducted a face-to-face interview and collected demographic data. The King's Health Questionnaire was completed during the same visit for comparisons.

Results: The results showed that the Portuguese version of the I-QOL has very good psychometrics properties. Reliability was assessed by Cronbach's alpha (0.93), reproducibility was calculated through the intraclass correlation coefficient (0.88), construct validity was determined by comparing the I-QOL scores and King's Health scores, and discriminant validity was calculated by comparing the total I-QOL scores with measures of gravity.

Conclusions: We conclude that the Portuguese version of the I-QOL is a very good tool for the evaluation quality-of-life in women with urinary incontinence in Portuguese-speaking countries.

Introduction and hypothesis: This study investigated changes in participant knowledge, symptoms, and condition-specific quality of life after a 2.5-h nurse-ran workshop on pelvic floor health.

Methods: Data were collected prospectively on a convenience cohort of 51 women who completed questionnaires before, immediately after, and 3 months after the workshop.

Results: Participant response rate for questionnaire completion at 3 months was 83%. The median preworkshop knowledge score was 28/39 and median scores immediately postworkshop and at 3 months were 36/39 and 33/39. Knowledge scores were significantly higher immediately postworkshop (p < 0.01) and 3 months post (p < 0.01) when compared with knowledge scores preworkshop. Symptom and quality-of-life scores significantly improved from baseline to 3 months (Pelvic Floor Impact Questionnaire: mean difference = 14.2, p = 0.005, 95% confidence interval (CI) 4.7-23.8; Pelvic Floor Distress Inventory: mean difference = 17.4, p < 0.001, 95% CI 8.3-26.5).

Conclusion: Women's knowledge, symptoms, and quality-of-life scores significantly improved at 3 months compared to baseline preworkshop scores.

Introduction and hypothesis: This study seeks to assess the effects of forceps-assisted delivery on the levator hiatus.

Methods: Seventy-six women were investigated 12 months after forceps-assisted delivery. Introital three-/four-dimensional ultrasound measured volumes at rest and during the Valsalva maneuver. Morphological parameters analyzed were angle gamma, hiatal area, pubovisceral angle, and continuity between the muscle and pelvic sidewall. Avulsion was diagnosed by loss of continuity.

Results: Forty-eight women had avulsion injuries, 23 had bilateral, and 25 had unilateral. Bilateral avulsion increased hiatal area during straining and at rest and was associated with changes in bladder neck position at rest. Unilateral avulsion injury was associated with a higher pubovisceral angle on the side of the avulsion.

Conclusion: Forceps-assisted vaginal delivery is associated with levator ani injury. Avulsion of the pubovisceral muscle seems more common after forceps delivery than after spontaneous vaginal delivery. Avulsion alters hiatal shape and area and influences the position and mobility of the anterior compartment.

Introduction and hypothesis: The aim of this study is to compare acellular dermal matrix to standard colporrhaphy for cystocele repair.

Methods: One hundred two patients with greater than or equal to stage II anterior prolapse (Aa or Ba 0) who underwent anterior colporrhaphy with acellular dermal implant attached to the arcus between October 2003 and February 2007 were compared to 89 controls who received standard anterior colporrhaphy. Objective recurrence was defined as greater than or equal to stage II (Aa or Ba -1).

Results: The dermal graft and colporrhaphy groups were comparable in age, parity, body mass index, and concomitant surgeries except hysteropexy and hysterectomy. Regression was performed for possible confounders. Postoperatively, 14 (19%) recurrences were identified in the dermal graft group vs. 26 (43%) in the colporrhaphy group (p = 0.004). Two patients underwent reoperations for cystocele recurrence in the study group vs. four in the control group. Time to normal voiding, subjective stress urinary incontinence, estimated blood loss, and length of hospital stay did not differ between groups.

Conclusion: Dermal acellular matrix provides benefit over standard colporrhaphy.