International urogynecology journal and pelvic floor dysfunction最新文献

Introduction and hypothesis: To prospectively evaluate anorectal symptoms, quality of life (QoL), sphincter integrity and function after subsequent childbirth following previous obstetric anal sphincter injuries (OASIS).

Methods: A validated Manchester Health Questionnaire, endoanal sonography and manometry were performed during the third trimester and 13 weeks postpartum. Women without objective compromise of anal function were recommended a vaginal delivery and the others a caesarean section.

Results: Seventy-three consecutive women with previous OASIS were seen during a subsequent pregnancy of whom 59 were reviewed 13 weeks following delivery. Anal manometry findings did not change significantly following a subsequent vaginal delivery or caesarean section. Only one new defect (internal sphincter) occurred after a vaginal delivery. There was no significant change in symptoms or QoL. Three (6.8%) sustained repeat OASIS.

Conclusions: Women who have no antenatal evidence of objective compromise of anal sphincter function can be reassured that a vaginal delivery is not associated with any significant deterioration in function or QoL.

Guillain-Barré syndrome, an acute autoimmune polyneuropathy and demyelinating disease, is characterized by weakness, sensory loss, areflexia, pain, autonomic dysfunction, and occasionally, micturition disturbances including voiding difficulty, urinary retention, nocturnal urinary frequency, and urge incontinence. Typically, urinary dysfunction resolves simultaneously with other neurologic deficits. We report the case of a 20-year-old woman with Guillain-Barré syndrome and persistent urinary retention 18 months following initial diagnosis. This patient is the first described in the literature to undergo successful treatment with sacral neuromodulation. Immediately following neuromodulator placement, the patient voided spontaneously and has had no voiding dysfunction or postvoid residual after 5 months of follow-up.

Introduction and hypothesis: Women undergoing InterStim implantation for overactive bladder (OAB) or painful bladder syndrome (PBS) were prospectively evaluated to determine if neuromodulation has any effect on female sexual function (FSF).

Methods: Sexually active women in our InterStim database completed a female sexual function index (FSFI) preoperatively and at 6 months.

Results: Of 105 women, 54 have 6-month follow-up data. Of these, 27 were sexually active preoperatively and at follow-up. The mean (standard deviation (SD)) FSFI improved from 18.7 (6.8) preoperatively to 21.0 (6.0) postoperatively; however, this was not statistically significant (p = 0.220). Subgroup analysis of patients with OAB revealed that mean (SD) FSFI preoperatively was 18.6 (8.0) and 22.4 (6.4) at 6 months (p = 0.257). In the PBS group, mean (SD) FSFI was 18.8 (6.3) preoperatively and 18.7 (5.8) at 6 months (p = 0.98).

Conclusions: Neuromodulation does not significantly improve FSF in a heterogenous population. Additional studies are needed to confirm the findings in our study.

Introduction and hypothesis: The goal of our investigation was to find a neurological explanation for neuropathies reported following some uterosacral ligament suspension (USLS) [2-3].

Methods: We dissected the neural structures beneath the USL in seven female, adult, embalmed cadavers. We made a literature review to determine the spinal nerve sensory fiber composition of each exposed neural structure and the dermatome(s) that it innervates. We then compared anticipated sensory neuropathies for each neural structure with neuropathies following USLS to determine which neural structure entrapment could explain the reported symptoms.

Results: Several neural structures located beneath the uterosacral ligament (USL) are vulnerable to suture entrapment during USLS. Anticipated clinical outcomes of entrapments are discussed.

Conclusions: Entrapment of S2 sensory fibers in the second trunk of the sacral plexus or in the intrapelvic portion of the sciatic nerve is the most plausible etiology for reported neuropathies following USLS.

Understanding the occurrence and management of mesh kit complications has become increasingly important. A 54-year-old woman presented to our tertiary care center with complaints of constant perineal pain, and copious, foul-smelling vaginal discharge after anterior and posterior placement of a synthetic mesh and mid-urethral sling 3 months earlier. She was found to have two vaginocutaneous sinus tracts (to the left ischiorectal fossa and to the left labia majora), as well as bilateral abscess cavities within the ischiorectal fossae. The posterior mesh was completely excised, the tracts were opened, and the wound was packed and allowed to heal by secondary intention.

Introduction and hypothesis: Traditionally, vaginal hysterectomy (VH) has been limited to cases of uterine prolapse, despite the fact that vast worldwide literature has demonstrated its applicability in other common benign diseases, such as uterine fibromatosis and abnormal uterine bleeding, with excellent outcomes.

Methods: Such outstanding results have made this procedure one of the most useful and advantageous alternatives when compared to the abdominal and laparoscopic routes.

Results: Currently, VH (an ancient procedure) does not represent a first-line alternative.

Conclusion: Therefore, the main goal of this paper is to describe some of the advantages of the vaginal route in order to help vaginal surgery schools to re-establish the leading role of this approach as a part of the minimally invasive gynecological surgery trend.

A case of primary malignant melanoma of the urethra in a 67-year-old female is presented. Cystourethroscopy performed during a workup for pelvic organ prolapse revealed a bladder and urethral mass. Initial histologic examination was interpreted as undifferentiated sarcoma; however, after immunohistochemical staining by two separate institutions, malignant melanoma was diagnosed. Being rare, urethral melanoma is often misdiagnosed, and treatment can be delayed. Given its poor prognosis, early diagnosis is essential, and clinicians need to include it in their differential when working up a patient with genitourinary complaint.

Introduction and hypothesis: COLIA1 polymorphism is associated with increased risk for stress urinary incontinence. We hypothesize that a similar association exists with pelvic organ prolapse (POP).

Methods: Patients with advanced prolapse and healthy controls were evaluated by interview, validated questionnaires, and pelvic examination. DNA was extracted from peripheral blood, and polymerase chain reaction was performed to determine the presence or absence of the polymorphism. Power calculation indicated the need for 36 patients in each arm.

Results: The prevalence of the polymorphic heterozygous genotype (GT) in the study and control groups was 33.3% and 19.4%, respectively, leading to an odds ratio of 1.75. This difference, however, did not reach statistical significance (p = 0.27).

Conclusions: The COLIA1 polymorphism was not significantly associated with increased risk for POP.

Introduction and hypothesis: The objective of this study was to measure the correlation of maximum urethral closure pressure (MUCP) with Valsalva leak point pressure (VLPP) in women with urodynamic stress incontinence using air-charged urodynamic catheters.

Methods: Records of all women who underwent urodynamic testing for urinary incontinence using air-charged catheters over a 3-year period were reviewed. Data included scores on the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7).

Results: One hundred ninety-three women met the criteria for urodynamic stress incontinence. There was a modest correlation of MUCP with VLPP at 200 mL (r = 0.46, p < 0.001) and a low correlation of MUCP with VLPP at maximum capacity (r = 0.35, p < 0.001). There was no correlation of UDI-6 or IIQ-7 scores with MUCP or VLPP.

Conclusions: The low to modest correlation of VLPP with MUCP with air-charged catheters is similar to what has been reported with water-filled and microtransducer catheters.

Introduction/methods: A cohort of 408 patients with bladder pain syndrome/interstitial cystitis (BPS/IC) was evaluated, and findings were discussed in this retrospective chart review.

Results: Based on the chief complaints, they were divided into four subgroups: BPS/IC (n = 157), CPP (n = 98), vulvodynia/dyspareunia (n = 40), and "other" (n = 113). Similar findings were found in all four subgroups: complaints of voiding dysfunction (70%), dyspareunia (54%), mean PUF score of 15.9 +/- 6.4, and a positive potassium sensitivity test in 83%. Urodynamics revealed a maximal urethral pressure of 131 cm of water and an abnormal uroflow in 80%. Urothelial therapy in the form of intravesical therapeutic anesthetic cocktails provided benefit in all groups (50%, 67%, 73%, and 77% for vulvodynia, CPP, BPS/IC, "other").

Conclusions: All subgroups had similar findings and response to therapy. Five to 10% of patients with chief complaints of stress or urge incontinence or prolapse were also found to have BPS/IC.