International urogynecology journal and pelvic floor dysfunction最新文献

We report a rare postoperative complication of a mid-urethral tape. The patient presented with a chronic infection resistant to treatment with several weeks of antibiotics, with eventual surgical removal, and the resulting complications of an infected incisional hernia and vesico-cutaneous fistula required reconstruction of the abdominal wall with Permacol and excision of the vesico-cutaneous fistula. We also look briefly at the impact of health tourism on the National Health Service.

Introduction and hypothesis: The aim of this paper is to develop a motivation questionnaire regarding perseverance in pelvic floor muscle training (PFMT) supervised by physiotherapists for stress urinary incontinence.

Methods: Sixteen semi-structured interviews were conducted in women with stress urinary incontinence that revealed 15 common themes; 117 items were constructed and reviewed by continence advisors. Surviving items (n = 73) were administered to 210 women. Data were analysed for item properties, factor analysis was used to examine the questionnaire structure and tests of convergence/divergence used to check for sensitivity.

Results: The Incontinence Treatment Motivation Questionnaire (ITMQ) comprises 18-items in five scales, assessing attitudes towards treatment (72.62% of explained variance; alpha = 0.87), reasons for not doing PFMT (55.73%; alpha = 0.74), living with incontinence (62.70% variance; alpha = 0.70), desire for treatment (65.37% variance; alpha = 0.74) and the effect of incontinence severity on PFMT (51.62% variance, alpha = 0.68). Scales were generally sensitive to known group differences.

Conclusions: This study represents the first effort to develop a motivation scale for PFMT. This validated Motivation Questionnaire is an instrument to test the impact of motivation upon cure, in PFMT.

Introduction and hypothesis: Current assessment for pelvic floor disorders (PFDs) allows comparison between different communities.

Methods: A total of 377 indigenous women living in Xingu Indian Park were evaluated. The pelvic organ prolapse quantification (POP-Q) was the system used to quantification the staging of pelvic support. The pelvic floor muscle strength was assessed by a perineometer. Logistic regression analysis was used to determine risk factors that were associated with prolapse.

Results: Only 5.8% of women reported urinary incontinence. The overall distribution of POP-Q stage system was the following: 15.6% stage 0, 19.4% stage I, 63.9% stage II and 0.8% stage III. Parity and age were the risk factors for pelvic organ prolapse (p < 0.0001).

Conclusions: Urinary incontinence was uncommon in Xingu indigenous women. Like non-indigenous communities, age and parity were the most important risk factors to the genital prolapse.

Introduction and hypothesis: The aim of this study was to assess whether urethral dilatation (UD) leads to changes in pressure flow parameters in women with voiding dysfunction (VD) and whether this correlates with improvement in overactive bladder symptoms (OAB).

Methods: Forty three women with drug-resistant OAB and VD underwent cystoscopy and UD. Pressure flow studies were undertaken at 6 weeks with further follow-up at 6 months. Any significant changes in pressure flow parameters after UD were evaluated.

Results: Thirty three percent of the participants reported subjective improvement. This was maintained at 6 months in 19%. Improvement in OAB was associated with an increase in maximum flow rate centile (p = 0.02) and a decrease in detrusor pressure at maximum flow (p = 0.03). Thirteen percent developed urodynamic stress incontinence.

Conclusions: Thirty three percent of women with drug-resistant OAB have a short-term improvement following UD. Improvement is associated with an increased maximum flow rate centile and a decreased detrusor pressure at maximum flow. The long-term improvement rate is poor.

Introduction: The purpose of this study was to assess the impact of body mass index (BMI) on tension-free vaginal tape (TVT) success rates, patient satisfaction, and complications 1 year following surgery.

Methods: Baseline and 1-year postsurgery outcomes were abstracted, including Urogenital Distress Inventory (UDI-6) scores, Incontinence Impact Questionnaire (IIQ-7) scores, and patient satisfaction ratings. Multivariable logistic and linear regression analyses were performed to examine relationships between outcomes and BMI.

Results: Subjects (N = 195) with a mean age of 59.3 +/- 12.6 were included. There was significant improvement within each group (all p values <0.01) in total UDI-6 and IIQ-7 scores from baseline to 1 year postsurgery; all groups had high patient satisfaction. No differences in improvement or complications rates were observed among the BMI cohorts (all p values >0.05).

Conclusion: Differential counseling of overweight or obese women regarding outcomes of the TVT procedure is not supported by these results; longer follow-up is warranted.

Urolithiasis is the most common cause of urological-related abdominal pain in pregnant women after urinary tract infection. The disease is not uncommon during pregnancy occurring in 1/200 to 1/2,000 women, which is not different from the incidence reported in the nonpregnant female population of reproductive age. During pregnancy, the frequency of stone localization is twice as higher in the ureter than in the renal pelvis or calyx, but there is no difference between the left and right kidney or ureter. Urinary stones during pregnancy are composed mainly of calcium phosphate (hydroxyapatite) in 74% of cases and calcium oxalate in the remaining 26% (Ross et al., Urol Res 36:99-102, 2008). In conclusion, urolithiasis during pregnancy can be serious, causing preterm labor in up to 40% of affected women. The pathogenesis, diagnosis, and management are analyzed.

Introduction and hypothesis: This study aims to investigate whether body mass index (BMI) is a risk factor for cystotomy during sling placement via suprapubic approach for stress urinary incontinence.

Methods: Retrospective chart review was performed for suprapubic mid-urethral sling placement between June 2005 and October 2007. Data collected included demographics, BMI, and history of prior and concomitant procedures. Primary outcome was cystotomy during sling placement.

Results: Of 198 women identified, 129 had a BMI < 30 kg/m2 and 69 had a BMI > or = 30 kg/m2. There were 18 (14.0%) cystotomies in the BMI < 30 kg/m2 group and three (4.3%) in the BMI > or = 30 kg/m2 group (p = 0.04). BMI < 30 kg/m2 remained a risk factor for cystotomy after controlling for confounders (OR 4.63, 95% CI 1.20-17.86), as did prior anti-incontinence surgery (OR 3.55, 95% CI 1.01-12.50).

Conclusions: BMI < 30 kg/m2 may be a risk factor for cystotomy during sling placement utilizing the suprapubic approach.

Introduction and hypothesis: The aim of this study was to describe the learning curve of a single surgeon to achieve the ability to perform a complication-free and anatomically successful laparoscopic sacrocolpopexy (LSC).

Methods: All patients, from the first LSC onwards (1996) were included. Outcome measures were operation time, number of laparotomies, complications and anatomical failures within 3 months. Learning curves were generated using moving average method (MOA) and cumulative sum (CUSUM) analysis to assess changes in respectively operation time and failures (laparotomy, complication or anatomical failure).

Results: Of the 206 patients, 83% were completed by laparoscopy. The intra-operative and major respectively minor post-operative complication rates were 2.4% (n = 5), 4.4% (n = 9) and 12.6% (n = 26). CUSUM analysis showed adequate learning after 60 cases. MOA showed that operation time declined rapidly during the first 30 procedures reaching a steady state (175 min) after 90 cases. Complications remained unchanged throughout the series.

Conclusions: LSC was associated with a low complication rate but a long learning curve.

Introduction and hypothesis: A familial tendency has been demonstrated in the etiology of pelvic organ prolapse (POP), but the specific genetic defects have not been identified. Type III collagen is an important factor in the repair of connective tissue, and gene polymorphisms may impair the tensile strength. We hypothesized that polymorphisms in the alpha I chain of the type III collagen protein-encoding gene (COL3A1) pose women at risk for POP.

Methods: In this case-control study, the prevalence of type III collagen polymorphisms was compared in women with and without signs and symptoms of POP.

Results: Two hundred and two POP patients and 102 normal parous controls were included. A homozygous single-nucleotide substitution in the coding region of type III collagen (COL3A1 2209G>A, rs1800255) was identified in 27 (13%) POP patients and three (3%) controls (odds ratio, 5.0; 95% confidence interval, 1.4-17.1).

Conclusions: The probability of POP was higher in women with COL3A1 2209G>A. This polymorphism showed to be a relevant risk factor for POP.