International urogynecology journal and pelvic floor dysfunction最新文献

The tension-free vaginal tape (TVT) is a well-established surgical procedure for the treatment of female urinary stress incontinence. Midurethral position was thought not to be necessary to achieve continence. But in our study, a patient with stress urinary incontinence was treated with a TVT suburethral sling. The symptoms of stress urinary incontinence still exist after the TVT procedure. With physical treatment and anti-inflammatory treatment, no relief was found. At the 50-day follow-up, the symptoms of stress incontinence worsened. Transperineal three-dimensional ultrasound revealed that the sling migrated from the midurethra to the bladder neck. With adjustment of the sling, the symptom of stress incontinence was improved and no complication was observed at the 6- and 12-month follow-up. Sling migration should be considered in a patient who presents with recurrent stress incontinence at the earlier postoperative period. We think that the midurethral position is necessary to achieve continence.

Introduction and hypothesis: The aim of this study was to determine the effectiveness of pelvic floor muscle exercises on urinary incontinence during pregnancy and the postpartum period.

Methods: The study was carried out on 80 pregnant women (study group, 40 subjects; control group, 40 subjects).The study group was trained by the researcher on how to do the pelvic floor muscle exercises. Both groups were evaluated for pelvic floor muscle strength and urinary complaints in their 36th to 38th week of pregnancy and postpartum sixth to eighth week.

Results: The study group had a significant decrease in urinary incontinence episodes during pregnancy and in the postpartum period, and their pelvic floor muscle strength increased to a larger extent. Control group had an increase in the postpartum muscle strength and decrease in the incontinence episodes in the postpartum period.

Conclusions: Pelvic floor muscle exercises are quite effective in the augmentation of the pelvic floor muscle strength and consequently in the treatment of urinary incontinence.

Introduction and hypothesis: The objective of this study was to report 1 year anatomical and functional outcomes of trocar-guided total tension-free vaginal mesh (Prolift) repair for post-hysterectomy vaginal vault prolapse with one continuous piece of polypropylene mesh.

Methods: We conducted a prospective observational cohort study of 46 patients. A minimum sample size of 35 patients was needed to detect a recurrence rate of less than 20% at 12 months. Instruments of measurement used were pelvic organ prolapse quantification and validated questionnaires.

Results: Overall anatomical success was 91% (95% confidence interval 83-99), with significant improvement in experienced bother and quality of life. Mesh exposure occurred in seven patients (15%). No adverse effects on sexual function could be detected.

Conclusions: Trocar-guided total tension-free vaginal mesh (Prolift) repair with one continuous piece of mesh for post-hysterectomy vaginal vault prolapse is well tolerated and anatomically and functionally highly effective. Results of controlled trials will determine its position in the operative armamentarium.

Introduction and hypothesis: The aim of the study was to investigate the incidence and severity of stress urinary incontinence (SUI) in primigravid women at term and its association with maternal body weight.

Methods: This was an observational study of 458 primigravid women who came to give birth at Donostia Hospital during 2007. Urinary symptoms were investigated (2002 ICS definitions), and a physical examination including height, weight, pelvic floor muscle strength, and fetal presentation was performed. We calculated the incontinence severity index (ISI) and the women answered the International Consultation on Incontinence short form questionnaire.

Results: SUI affected 139 (30.3%) primigravid women. The ISI distribution was 40.3% slight, 54.7% moderate, 4.3% severe, and 0.7% very severe. Pregnant women at term with body weight >or=75 kg appear to have more than doubled the risk of presenting SUI.

Conclusions: The incidence of SUI is high in pregnancy. Increased maternal body weight at term is an independent risk factor for incontinence.

Introduction and hypothesis: The purpose of this study is to assess the validity and reliability of a retrospective quality-of-life (QOL) assessment.

Methods: The Incontinence Impact Questionnaire (IIQ-30) and the Short-Form Health Survey (SF-12) were self-administered pre-operatively. At 3 months post-op, the IIQ-30 and SF-12 surveys were mailed to patients to reassess their pre-operative QOL status. Pearson's correlation coefficient (r) and the intraclass correlation coefficient (ICC) were used to test the validity and reliability of the recalled IIQ and SF-12 scores.

Results: Recall validity was excellent for the IIQ-30 (r = 0.64) and moderate for the SF-12 (r = 0.46 (physical component summary or PCS) and 0.42 (mental component summary or MCS)). Recall reliability was moderate with the IIQ-30 (ICC = 0.62) and poor with the SF-12 (ICC = 0.44 (PCS) and 0.49 (MCS)).

Conclusions: The IIQ-30 can be reliably used in a retrospective manner among women who have undergone surgery for SUI 3 months earlier.

Introduction and hypothesis: The aim of this study is to establish whether the presence of severe symptoms influences women's choice of pessaries or surgery for uterovaginal prolapse.

Methods: This is a prospective study using the validated Sheffield Prolapse Symptoms Questionnaire.

Results: Women choosing surgery (n = 251) were younger (58 versus 66 years), more bothered by dragging lower abdominal pain (33% versus 25%, P = 0.04), need for vaginal digitation (8% versus 3%, P = 0.02), and incomplete bowel emptying (27% versus 19%, P = 0.01) than women choosing pessaries (n = 429). More women opting for surgery were sexually active (51% versus 29%, P < 0.0001), perceived avoidance of sex due to prolapse (28% versus 17%, P = 0.000), and perceived prolapse interfering with sexual satisfaction as a severe problem (26% versus 15%, P = 0.000).

Conclusions: Nearly two thirds of women with symptomatic prolapse initially opted for conservative management. Women choosing surgery over pessaries for treatment of prolapse describe more severe symptoms related to bowel emptying, sexual function, and quality of life and are bothered by them.

Introduction and hypothesis: The aim of the study was to determine whether patients' symptoms agree with findings on clinical examination and dynamic MR imaging of the pelvic floor.

Methods: Symptoms of pelvic organ dysfunction were measured with the use of three validated questionnaires. The domain scores were compared with POP-Q and dynamic MR imaging measurements. The Spearman's rank correlation coefficient (r(s)) was used to assess agreement.

Results: Only the domain score genital prolapse was significantly correlated in the positive direction with the degree of pelvic organ prolapse as assessed by POP-Q and dynamic MR imaging (r(s) = 0.64 and 0.27, respectively), whereas the domain score urinary incontinence was inversely correlated (r(s) = -0.32 and -0.35, respectively).

Conclusions: The sensation or visualization of a bulge in the vagina was the only symptom which correlated positively with the degree of pelvic organ prolapse, and clinical examination and dynamic MR imaging showed similar correlation in this respect.

Introduction and hypothesis: The aim of this study is to validate the Portuguese translated version of the Prolapse Quality-of-Life Questionnaire (P-QoL).

Methods: Ninety-eight women completed the P-QoL questionnaire translated into Portuguese at baseline and on the second visit, 2 weeks later. Clinical data and Pelvic Organ Prolapse Quantification Index (POP-Q) according to the International Continence Society were obtained. Psychometric properties of the questionnaire were assessed.

Results: Sixty-eight symptomatic and 30 asymptomatic women for POP symptoms were studied. Most patients presented POP-Q > 2. The P-QoL demonstrated good psychometric properties. The test-retest reliability confirmed a highly significant stability between the total scores for each domain (P < 0.0001). The construct validation distinguished differences in P-QoL questionnaire scores between symptomatic and asymptomatic women.

Conclusion: The Portuguese version of the P-QoL questionnaire is a valid and reliable instrument to assess quality of life in Brazilian women with pelvic organ prolapse.

Introduction and hypothesis: Our aim was to evaluate the morphological characteristics of the female pelvic floor that may be further elucidated with three-dimensional endovaginal ultrasonography (3D-EVUS).

Methods: A consecutive series of 20 nulliparous females underwent 3D-EVUS. Measurements were determined according to pre-established criteria. Descriptive statistics and Spearman's correlation test were performed.

Results: The levator hiatus (LH) was measured in the oblique plane parallel to the pubovisceral muscle. A positive correlation was found between LH area and age (p = 0.03). The anteroposterior diameter of the urogenital hiatus, measured in the axial plane tilted from the symphysis pubis to the ischiopubic rami, correlated with LH area (p = 0.008). No urethral rotations were observed in the coronal plane. Significant correlations were found among urethral parameters. Mean anal sphincter measurements were comparable to previously reported magnetic resonance imaging and ultrasound measurements.

Conclusions: 3D-EVUS allows measurements of key pelvic floor structures in planes that cannot be determined by conventional imaging modalities.

Introduction and hypothesis: We report our experience with a low-pressure colonic pouch for urinary diversion in women with irreparable vesicovaginal fistulas and bladder extrophy.

Methods: This is a case series of 35 women with irreparable vesicovaginal fistula who underwent urinary diversion and two cases performed for bladder extrophy.

Results: Partial or complete loss of the urethra was present in over 90% of fistula cases. Fifty-five percent had prior vaginal repairs. The median length of stay was 21 days. Median follow-up for 29 (78%) patients was 18 months. Nighttime urinary incontinence occurred in 31%. Twenty-one (91%) of 23 patients had a serum creatinine <1.5 although all patients had evidence of acidosis. Two patients died 4 years after surgery from sepsis and renal failure.

Conclusions: Urinary diversion using the Mainz pouch II can be performed in the developing world with low perioperative morbidity and mortality. Acidosis and nighttime incontinence are the most common complications.