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Can Z, Şahin S. The prevalence of urinary incontinence in obese women and its effect on quality of life. Health Care Women Int 2021; 43:207-218. [PMID: 34748468 DOI: 10.1080/07399332.2021.1958329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This is an analytical cross-sectional study conducted to investigate the incidence of urinary incontinence in obese women and its effect on quality of life. The mean BMI of the obese women participating in the study was 37.34 ± 4.85 and 88.1% of them had urinary incontinence. The I-QOL score was 63 (min; max: 25; 108) in the women found to have urinary incontinence. According to the ICIQ-SF scores obtained, urinary incontinence was higher than the disturbing level.
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Affiliation(s)
- Zehra Can
- Yusuf Şerefoğlu Faculty of Health Sciences, Kilis 7 Aralık University, Kilis, Turkey
| | - Sevil Şahin
- Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
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Zenebe CB, Chanie WF, Aregawi AB, Andargie TM, Mihret MS. The effect of women's body mass index on pelvic organ prolapse: a systematic review and meta analysis. Reprod Health 2021; 18:45. [PMID: 33608022 PMCID: PMC7893921 DOI: 10.1186/s12978-021-01104-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/09/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Pelvic organ prolapse remains the public health challenge globally. Existing evidences report the effect of woman's weight on the pelvic organ prolapse inconsistently and this urges the need of pooled body weight effect on the pelvic organ prolapse. Although there was a previous work on this regard, it included papers reported before June 18/2015. Thus, updated and comprehensive evidence in this aspect is essential to devise strategies for interventions. OBJECTIVE This review aimed at synthesizing evidence regarding the pooled effect of body weight on the pelvic organ prolapsed. METHODS For this review, we searched all available articles through databases including PubMed, Web of Sciences, CINAHL, JBI library, Cochran library, PsycInfo and EMBASE as well as grey literature including Mednar, worldwide science, PschEXTRA and Google scholar. We included cohort, case-control, cross-sectional and experimental studies which had been reported between March 30, 2005 to March 30, 2020. In the effect analysis, we utilized random model. The heterogeneity of the studies was determined by I2 statistic and the publication bias was checked by Egger's regression test. Searching was limited to studies reported in the English language. RESULTS A total of 14 articles with 53,797 study participants were included in this systematic review (SR) and meta analysis (MA). The pooled result of this Meta analyses depict that body mass index (BMI) doesn't have statistical significant association with pelvic organ prolapse. CONCLUSION This review point out that women's body mass index has no significant effect on the development of pelvic organ prolapse. However, the readers should interpret the result with cautions due to the presence of considerable limitations in this work. Trial registration The protocol of this systematic review (SR) and meta analysis (MA) has been registered in PROSPERO databases with the Registration number of CRD42020186951.
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Affiliation(s)
- Chernet Baye Zenebe
- Gynecology and Obstetrics Department, University of Gondar, Gondar, Ethiopia
| | - Wagaye Fentahun Chanie
- United Nations Population Fund Supported Maternal Health Project, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | | | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Po. Box 196, Gondar, Ethiopia.
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The impact of different intensities of exercise on body weight reduction and overactive bladder symptoms- randomised trial. Eur J Obstet Gynecol Reprod Biol 2019; 242:144-149. [PMID: 31590034 DOI: 10.1016/j.ejogrb.2019.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/23/2019] [Accepted: 09/26/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES to investigate the effect of a 3-month exercise programme with two different intensities on the reduction of body weight and body fat percentage in overweight women with overactive bladder symptoms (OAB). STUDY DESIGN randomised controlled study. The sample consisted of 77 overweight women with OAB symptoms, with an average age of 26.2 years. Body mass index (BMI) measurements confirmed if women were overweight. Participants were split into two groups, as follows: Group 1 (programme with high intensity) (n = 39) and group 2 (programme with low intensity) (n = 38). For evaluation of body composition, we used Bioelectric impedance analysis with assessment of body fat percentage (BFP) and visceral fat area (VFA). OAB symptoms were evaluated using a voiding diary, an overactive bladder questionnaire (OAB-q) and the Patient Perception of Intensity of Urgency Scale (PPIUS). The intervention was a Programme for Reduction of Abdominal Fat, aimed at reducing abdominal fat with elements of aerobic training, strengthening of the surface and deep abdominal muscles and stretching. RESULTS Group 1 lost body weight and showed a reduction in Body Fat Percentage (BFP) of more than 5%, whereas group 2 did not. Significant differences in OAB symptoms (p < 0.01) were recorded after training in favour of group 1 (number of voiding per 24 h changed from 8.92 ± 1.7 to 6.87 ± 0.40, OAB-q SS from 11.36 ± 8.57 to 1.46 ± 3.4). In the body composition assessment, significant differences (p < 0.001) were recorded after training in favour of group 1, in terms of BMI, BFP, WFA and body weight reduction. CONCLUSION The high intensity exercise programme for reducing abdominal fat (PRAF) significantly reduces overweight and mild symptoms of OAB after 12 weeks.
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Medium-term outcomes of laparoscopic sacropexy on symptoms and quality of life. Predictive factors for postoperative dissatisfaction. Int Urogynecol J 2019; 30:2085-2092. [PMID: 30888455 DOI: 10.1007/s00192-019-03923-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/05/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to evaluate the medium-term results of laparoscopic sacropexy (LSP) with validated self-administered questionnaires of symptoms and quality of life and to identify pre-, intra-, and postoperative predictors of postoperative dissatisfaction. METHODS The study included 152 women who had LSP for stage 2 or higher pelvic organ prolapse (POP). The study population comprised women who had completed the preoperative symptom questionnaire (including the PFDI-20 and ICIQ-SF). Postoperative questionnaires included those questionnaires as well as the PFIQ-7 and EQ-5D questionnaires, PISQ-12 sexual function questionnaire, and PGI-I questionnaire (to assess patient satisfaction). RESULTS In all, 92 women (60.5%) responded in the postoperative period; 75 (81.5%) had anterior and posterior mesh and 17 (18.5%) anterior mesh alone. Moreover, 14 women (15.2%) had a concomitant suburethral sling and 18 (19.6%) a concomitant subtotal hysterectomy. The mean follow-up time was 50.5 (± 20.3) months (4.2 years). PFDI-20 scores had improved significantly at 4 years (median: 47.4 before surgery vs. 34.4 afterwards, p = 0.002), and patient satisfaction was quite clear (PGI-I score = 1.8 ± 1.1). Nine women (9.8%) described recurring vaginal bulge symptoms, and 12 patients were reoperated during follow-up. Recurrence [odds ratio (OR) 8.11, 95% confidence interval (95% CI) 2.28-28.9] and postoperative constipation (OR = 3.47, 95% CI 1.02-11.8) were strongly associated with poorer postoperative satisfaction, as was concomitant UI surgery (OR = 12.5, 95% CI 2.32-67.0). CONCLUSIONS LSP improved women's symptoms and quality of life. Postoperative constipation, sensation of prolapse recurrence, and concomitant UI surgery were strongly associated with postoperative dissatisfaction.
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Göral Türkcü S, Kukulu K. Urinary incontinence and quality of life of women living in nursing homes in the Mediterranean region of Turkey. Psychogeriatrics 2017; 17:446-452. [PMID: 28589552 DOI: 10.1111/psyg.12271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was conducted to determine the effect of urinary incontinence (UI) on the quality of life of women living in nursing homes in the Mediterranean region of Turkey. METHODS The study was conducted on 95 women living in nursing homes in the Mediterranean region. Data were collected from a questionnaire on sociodemographic characteristics, the Urinary Incontinence Quality of Life Scale, the Index of Activities of Daily Living, and the International Consultation on Incontinence Questionnaire Short Form. RESULTS The quality of life of women who did not consider UI a health problem was significantly higher than that of those who considered otherwise. Mixed UI was the most common UI type among the women living in nursing homes, with a rate of 31.7%. According to the overall mean scores on the Urinary Incontinence Quality of Life Scale, quality of life was the most affected among women who had nocturnal incontinence. Quality of life was affected from most to least by the mixed type, stress type, and urge type of incontinence. CONCLUSION Early diagnosis and treatment of UI could be improved if health professionals, who have a unique role in changing the perception of society, offered training to women experiencing incontinence. Identifying this problem and determining and preventing the risk factors are important for enhancing women's quality of life.
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Affiliation(s)
- Sinem Göral Türkcü
- Pamukkale University, Faculty of Health Sciences, Department of Obstetrics and Gynecology Nursing, Denizli, Turkey
| | - Kamile Kukulu
- Akdeniz University, Nursing Faculty, Department of Obstetrics and Gynecology Nursing, Antalya, Turkey
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Brucker J, Wagner I, Rudofsky G, Rauch G, Sohn C, Brocker KA. In obesity even young women suffer from urogynecological symptoms. Arch Gynecol Obstet 2017; 296:947-956. [DOI: 10.1007/s00404-017-4514-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
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[Assessment before surgical treatment for pelvic organ prolapse: Clinical practice guidelines]. Prog Urol 2017; 26 Suppl 1:S8-S26. [PMID: 27595629 DOI: 10.1016/s1166-7087(16)30425-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The issue addressed in this chapter of recommendations is: What is the clinical and para-clinical assessment to achieve in women with genital prolapse and for whom surgical treatment has been decided. What are the clinical elements of the examination that must be taken into account as a risk factor of failure or relapse after surgery, in order to anticipate and evaluate possible surgical difficulties, and to move towards a preferred surgical technique? MATERIAL AND METHODS This work is based on a systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement [AP]). RESULTS It suits first of all to describe prolapse, by clinical examination, helped, if needed, by a supplement of imagery if clinical examination data are insufficient or in case of discrepancy between the functional signs and clinical anomalies found, or in case of doubt in associated pathology. It suits to look relapse risk factors (high grade prolapse) and postoperative complications risk factors (risk factors for prothetic exposure, surgical approach difficulties, pelvic pain syndrome with hypersensitivity) to inform the patient and guide the therapeutic choice. Urinary functional disorders associated with prolapse (urinary incontinence, overactive bladder, dysuria, urinary tract infection, upper urinary tract impact) will be search and evaluated by interview and clinical examination and by a flowmeter with measurement of the post voiding residue, a urinalysis, and renal-bladder ultrasound. In the presence of voiding disorders, it is appropriate to do their clinical and urodynamic evaluation. In the absence of any spontaneous or hidden urinary sign, there is so far no reason to recommend systematically urodynamic assessment. Anorectal symptoms associated with prolapse (irritable bowel syndrome, obstruction of defecation, fecal incontinence) should be search and evaluated. Before prolapse surgery, it is essential not to ignore gynecologic pathology. CONCLUSION Before proposing a surgical cure of genital prolapse of women, it suits to achieve a clinical and paraclinical assessment to describe prolapse (anatomical structures involved, grade), to look for recurrence, difficulties approach and postoperative complications risk factors, and to appreciate the impact or the symptoms associated with prolapse (urinary, anorectal, gynecological, pelvic-perineal pain) to guide their evaluation and their treatment. © 2016 Published by Elsevier Masson SAS.
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Une interposition prothétique synthétique inter-vésico-vaginale implantée par voie vaginale diminue-t-elle le risque de récidive de cystocèle ? Recommandations pour la pratique clinique. Prog Urol 2016; 26 Suppl 1:S38-46. [DOI: 10.1016/s1166-7087(16)30427-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sullivan SA, Davidson ERW, Bretschneider CE, Liberty AL, Geller EJ. Patient characteristics associated with treatment choice for pelvic organ prolapse and urinary incontinence. Int Urogynecol J 2015; 27:811-6. [PMID: 26642799 DOI: 10.1007/s00192-015-2907-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 11/20/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Women with pelvic organ prolapse (POP) and stress urinary incontinence (SUI) frequently undergo more than one treatment prior to settling on their final strategy. We hypothesize that women who are younger, with worse POP and SUI symptoms will desire and choose surgical treatment. METHODS A retrospective cohort study was performed over 1 year identifying new patients presenting with POP and/or SUI at a university hospital. Our aim was to determine patient desire for either surgical or conservative treatment, as well as the actual treatment chosen and received after the first visit and 1 year later. To identify predictors of choice, baseline demographic characteristics were obtained. RESULTS Of the 203 women who met the inclusion criteria, 44.3 % (90/203) desired surgery and 55.7 % (113/203) desired conservative treatment at their first visit. Women who desired surgery were more likely to be younger (p = 0.003), sexually active (p = 0.001), have more advanced prolapse (p = 0.006), and have more bothersome symptoms (p = 0.05). Of the women who desired surgery at their first visit, 12.2 % (11/90) actually chose conservative treatment. These women were less likely to be insured (p = 0.01). By 1 year, of the women who initially desired and subsequently chose conservative treatment, 26.5 % (30/113) had undergone surgery. The women who changed from conservative to surgical treatment were more likely to be younger (p = 0.01), non-White (p = 0.03), and sexually active (p = 0.04). CONCLUSIONS In this study, younger, sexually active women were more likely to either opt for surgery initially or to change their treatment plan from conservative to surgical.
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Affiliation(s)
- Stephanie A Sullivan
- Obstetrics and Gynecology, University of North Carolina, CB 7570 Old Clinic Building, Chapel Hill, NC, 27514, USA
| | - Emily R W Davidson
- Obstetrics and Gynecology, University of North Carolina, CB 7570 Old Clinic Building, Chapel Hill, NC, 27514, USA
| | - C Emi Bretschneider
- Obstetrics and Gynecology, University of North Carolina, CB 7570 Old Clinic Building, Chapel Hill, NC, 27514, USA
| | - Abigail L Liberty
- Obstetrics and Gynecology, University of North Carolina, CB 7570 Old Clinic Building, Chapel Hill, NC, 27514, USA
| | - Elizabeth J Geller
- Obstetrics and Gynecology, University of North Carolina, CB 7570 Old Clinic Building, Chapel Hill, NC, 27514, USA.
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Bayrak O, Seckiner I, Urgun G, Sen H, Ozcan C, Erturhan S. Transobturator Midurethral Slings versus Single-Incision Slings for Stress Incontinence in Overweight Patients. Int Braz J Urol 2015; 41:714-21. [PMID: 26401864 PMCID: PMC4757000 DOI: 10.1590/s1677-5538.ibju.2014.0209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose: To compare transobturator midurethral sling (TOS) and single-incision sling procedures in terms of their effects on urinary incontinence and the quality of life in overweight (BMI ≥25-29.9 kg/m2) female patients using the International Consultation on Incontinence Questionnaire scoring form (ICIQ-SF) and Quality of Life of Persons with Urinary Incontinence scoring form (I-QOL). Materials and Methods: In this prospective trial, the patients were divided into two groups consecutively; first 20 overweight female patients underwent the TOS (Unitape T®,Promedon, Cordoba, Argentina) procedure and the subsequent 20 consecutive overweight female patients underwent the single-incision sling [TVT-secur (Ethicon Inc., Sommerville, USA)] procedure. Age, urinary incontinence period, parity and daily pads usage were recorded. No usage of pads was defined as subjective cure rate postoperatively. Before the operation and 6. month after the surgery, the patients completed the ICIQ-SF and I-QOL. Results: There was no significant difference between the two groups in terms of mean age, duration of incontinence, parity, and BMI (p>0.05). ICIQ-SF and I-QOL revealed that the patients in the TOS group showed significantly better improvement (76.20% versus 64.10%, p=0.001, 81.31% versus 69.28%, p=0.001, respectively). In addition, subjective cure rates were found higher in TOS group (75% versus 55%, p=0.190). Conclusions: The existing data is showed that incontinence symptoms and the quality of life have higher improvement in overweight female patients who underwent the TOS procedure. It is likely that the TOS procedure may provide stronger urethral support and better contributes to continence in this group of patients.
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Affiliation(s)
- Omer Bayrak
- Department of Urology , University of Gaziantep, Gaziantep, Turkey
| | - Ilker Seckiner
- Department of Urology , University of Gaziantep, Gaziantep, Turkey
| | - Gokhan Urgun
- Department of Urology , University of Gaziantep, Gaziantep, Turkey
| | - Haluk Sen
- Department of Urology , University of Gaziantep, Gaziantep, Turkey
| | - Caglayan Ozcan
- Department of Obstetrics and Gynecology, University of Gaziantep, Gaziantep, Turkey
| | - Sakip Erturhan
- Department of Urology , University of Gaziantep, Gaziantep, Turkey
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Haddad JM, Fiorelli LR, de Lima Takami T, Peterson TV, Soares JM, Baracat EC. Relationship between BMI and three different devices used in urinary incontinence procedures and anatomical structures in fresh cadavers. A pilot study. Eur J Obstet Gynecol Reprod Biol 2015; 194:49-53. [PMID: 26322590 DOI: 10.1016/j.ejogrb.2015.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/20/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To demonstrate the needle positioning during three types of slings in relation to anatomical structures in fresh cadavers and to evaluate if this positioning is influenced by body mass index (BMI). METHODS TVTr sling (retropubic), TVT-O sling (transobturator) and mini-sling (TVT-Secur™) were performed in ten fresh cadavers, followed by dissection of the pudendal (genital) area (external evaluation) and abdominal cavity (internal evaluation). The distance between the devices used in each technique and specific anatomical structures (vessels and bowel) was measured. RESULTS The mean distance between TVTr needles and the closest segment of the bowel was 5.0±1.1cm. The mean distance between the TVTr needles and iliac vessels was 8.55±1.59cm, and this distance was inversely proportional to BMI. However, the both correlations were not significantly (p<0.05). The mean distance from TVT-O needle to obturator vessels and nerve was 2.25±0.34cm. This distance was inversely proportional to BMI, but it was not statistically significant. CONCLUSION Our data suggested that BMI may be not an important factor for influencing the relationship between the devices and anatomical structures in three different slings in fresh cadavers.
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Affiliation(s)
- Jorge Milhem Haddad
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lilian Renata Fiorelli
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tatiane de Lima Takami
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Villela Peterson
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Maria Soares
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Edmund C Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Palleschi G, Pastore AL, Rizzello M, Cavallaro G, Silecchia G, Carbone A. Laparoscopic sleeve gastrectomy effects on overactive bladder symptoms. J Surg Res 2015; 196:307-12. [DOI: 10.1016/j.jss.2015.03.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/07/2015] [Accepted: 03/13/2015] [Indexed: 11/26/2022]
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Menzella D, Thubert T, Joubert M, Lauratet B, Kouchner P, Lefranc JP. Impact de l’indice de masse corporelle sur les résultats de la promontofixation robot-assistée : étude comparative rétrospective. Prog Urol 2013; 23:1482-8. [PMID: 24286549 DOI: 10.1016/j.purol.2013.08.327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
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İlgün S, Ovayolu N, Ovayolu Ö, Özcanlı D, Yağcı F. Does biofeedback affect incontinence and quality of life in Turkish women? INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2013. [DOI: 10.1111/ijun.12013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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