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Kotani Y, Murakami K, Kanto A, Takaya H, Nakai H, Matsumura N. Measures for Safe Laparoscopic Sacrocolpopexy: Preoperative Contrast-Enhanced Computed Tomography and Perioperative Ultrasonography. Gynecol Minim Invasive Ther 2021; 10:114-116. [PMID: 34040971 PMCID: PMC8140534 DOI: 10.4103/gmit.gmit_1_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 02/01/2021] [Accepted: 03/15/2021] [Indexed: 11/09/2022] Open
Abstract
Laparoscopic sacrocolpopexy is one of the most difficult laparoscopic surgical techniques. In this study, we report on our efforts to safely perform this procedure, which consists of suturing a piece of mesh onto the anterior longitudinal ligament using a nonabsorbent suture during mesh fixation onto the prepromontorium layer, which can lead to massive bleeding if a mistake is made, by performing preoperative and intraoperative image evaluation. Preoperative contrast-enhanced computed tomography was performed. Images in DICOM format were acquired, and three-dimensional vessel reconstruction was performed. After performing a peritoneal incision in the presacral area, ultrasonography was performed using a probe inserted through a 12-mm trocar into the abdominal cavity to re-confirm the absence of vessels near the planned suturing area. After ultrasonography, an Ethibond® suture was inserted through the anterior longitudinal ligament. In our hospital, 126 patients underwent the procedure, and none had a serious hemorrhage or required blood transfusion, indicating the safety of this modified procedure without separation of a wide presacral area. We believe that these techniques can be performed safely with minimal incision. However, we did not examine the efficacy of these techniques in this paper. Further studies are needed to determine whether this approach is suitable.
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Affiliation(s)
- Yasushi Kotani
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kosuke Murakami
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Akiko Kanto
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hisamitsu Takaya
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hidekatsu Nakai
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
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2
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Erin R, Ünsal MA, Güven S, Aran T, Bozkaya H. Comparison of Urodynamics Parameters with Intrafascial or Extrafascial Hysterectomy Techniques. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Recep Erin
- Department of Obstetrics and Gynecology, Trabzon Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
| | - Mesut Abdülkerim Ünsal
- Departments of Obstetrics and Gynecology, School of Medicine, Çanakkale On sekiz Mart Üniversitesi, Çanakkale, Turkey
| | - Süleyman Güven
- Departments of Obstetrics and Gynecology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Turhan Aran
- Departments of Obstetrics and Gynecology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Hasan Bozkaya
- Departments of Obstetrics and Gynecology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Saei Ghare Naz M, Ramezani Tehrani F, Behroozi-Lak T, Mohammadzadeh F, Kholosi Badr F, Ozgoli G. Polycystic Ovary Syndrome and Pelvic Floor Dysfunction: A Narrative Review. Res Rep Urol 2020; 12:179-185. [PMID: 32440514 PMCID: PMC7213900 DOI: 10.2147/rru.s249611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/14/2020] [Indexed: 01/06/2023] Open
Abstract
Pelvic floor dysfunction is one of the most common disorders in women that is associated with social and economic consequences. In general, this disorder imposes direct and indirect costs on the economy of various societies. This review aimed to investigate pelvic floor dysfunction in women with polycystic ovary syndrome (PCOS). In this narrative review, the published articles on pelvic floor dysfunction were examined in PubMed, Scopus, Web of Sciences and Google Scholar. We searched for terms related to polycystic ovary syndrome and pelvic floor dysfunction. Inclusion criteria of this research were observational, experimental, and review studies. In this investigation, the complications associated with polycystic ovary syndrome were examined as risk factors for pelvic floor dysfunction. In this narrative review, we discuss about changes in hormone levels, obesity and overweight, hormonal medications and complications such as diabetes and metabolic disorders and obstetric complications of PCOS can be involved in the pathophysiology of pelvic floor dysfunctions, including stress urinary incontinence and pelvic organ prolapse in women with PCOS. This review highlights knowledge gaps about protective effect of hyperandrogenism on pelvic floor dysfunction as well as destructive effect of metabolic changes on pelvic floor dysfunction in women with PCOS. Further cohort and prospective studies are recommended in women with PCOS to investigate the concept of pelvic organ dysfunction in these women.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Student Research Committee, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Behroozi-Lak
- Reproductive Health Research Center, Department of Infertility, Urmia University of Medical Sciences, Urmia, Iran
| | - Farnaz Mohammadzadeh
- Department of Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhnaz Kholosi Badr
- Department of Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giti Ozgoli
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Effect of bariatric surgery on urinary and fecal incontinence: prospective analysis with 1-year follow-up. Surg Obes Relat Dis 2017; 13:305-312. [DOI: 10.1016/j.soard.2016.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/31/2016] [Accepted: 07/31/2016] [Indexed: 11/21/2022]
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5
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Agarwal A, Rathi S, Patnaik P, Shaw D, Jain M, Trivedi S, Dwivedi US. Does preoperative urodynamic testing improve surgical outcomes in patients undergoing the transobturator tape procedure for stress urinary incontinence? A prospective randomized trial. Korean J Urol 2014; 55:821-7. [PMID: 25512817 PMCID: PMC4265717 DOI: 10.4111/kju.2014.55.12.821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/15/2014] [Indexed: 01/05/2023] Open
Abstract
Purpose Urodynamic studies are commonly performed as part of the preoperative work-up of patients undergoing surgery for stress urinary incontinence (SUI). We aimed to assess the extent to which these urodynamic parameters influence patient selection and postoperative outcomes. Materials and Methods Patients presenting with SUI were randomly assigned to two groups: one undergoing office evaluation only and the other with a preoperative urodynamic work-up. Patients with unfavorable urodynamic parameters (detrusor overactivity [DO] and/or Valsalva leak point pressure [VLPP]<60 cm H2O and/or maximum urethral closure pressure [MUCP]<20 cm H2O) were excluded from the urodynamic testing group. All patients in both groups underwent the transobturator midurethral sling procedure. Evaluation for treatment success (reductions in urogenital distress inventory and incontinence impact questionnaire scoring along with absent positive stress test) was done at 6 months and 1 year postoperatively. Results A total of 72 patients were evaluated. After 12 patients with any one or more of the abnormal urodynamic parameters were excluded, 30 patients were finally recruited in each of the "urodynamic testing" and "office evaluation only" groups. At both the 6- and the 12-month follow-ups, treatment outcomes (reduction in scores and positive provocative stress test) were significantly better in the urodynamic testing group than in the office evaluation only group (p-values significant for all outcomes). Conclusions Our findings showed statistically significantly better treatment outcomes in the urodynamic group (after excluding those with poor prognostic indicators such as DO, low VLPP, and MUCP) than in the office evaluation only group. We recommend exploiting the prognostic value of these urodynamic parameters for patient counseling and treatment decisions.
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Affiliation(s)
- Abhinav Agarwal
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sudheer Rathi
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Pranab Patnaik
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Dipak Shaw
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Madhu Jain
- Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sameer Trivedi
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Udai Shankar Dwivedi
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Vissers D, Neels H, Vermandel A, De Wachter S, Tjalma WAA, Wyndaele JJ, Taeymans J. The effect of non-surgical weight loss interventions on urinary incontinence in overweight women: a systematic review and meta-analysis. Obes Rev 2014; 15:610-7. [PMID: 24754672 DOI: 10.1111/obr.12170] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 01/24/2023]
Abstract
Although the aetiology of urinary incontinence can be multifactorial, in some cases weight loss could be considered as a part of the therapeutic approach for urinary incontinence in people who are overweight. The objective of this study was to review and meta-analyse the effect of non-surgical weight loss interventions on urinary incontinence in overweight women. Web of Science, PubMed, Pedro, SPORTDiscus and Cochrane were systematically searched for clinical trials that met the a priori set criteria. Data of women who participated in non-surgical weight loss interventions (diet, exercise, medication or a combination) were included in the meta-analysis. After removing duplicates, 62 articles remained for screening on title, abstract and full text. Six articles (totalling 2,352 subjects in the intervention groups) were included for meta-analysis. The mean change in urinary incontinence (reported as frequency or quantity, depending on the study) after a non-surgical weight loss intervention, expressed as standardized effect size and corrected for small sample sizes (Hedges' g), was -0.30 (95%CI = -0.47 to -0.12). This systematic review and meta-analysis shows evidence that a non-surgical weight loss intervention has the potential to improve urinary incontinence and should be considered part of standard practice in the management of urinary incontinence in overweight women.
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Affiliation(s)
- D Vissers
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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7
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Severity of Urinary Incontinence and Effect on Quality of Life in Women by Incontinence Type. Obstet Gynecol 2013; 121:1083-1090. [DOI: 10.1097/aog.0b013e31828ca761] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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8
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Sun H, Fu G, Xie H. A MEMS accelerometer-based real-time motion-sensing module for urological diagnosis and treatment. J Med Eng Technol 2013; 37:127-34. [DOI: 10.3109/03091902.2012.753127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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9
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Mohsin Rizvi R, Chughtai NG. Reliability of urodynamic interpretation in women presenting with urinary incontinence at a tertiary hospital. Urol Int 2011; 88:410-4. [PMID: 22156382 DOI: 10.1159/000334540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 10/19/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urodynamic testing is often regarded as essential to the proper diagnosis of bladder storage and emptying disorders but urodynamic testing is an invasive and expensive procedure. Pakistan is a developing country with limited provision of urogynecological services, and therefore few urodynamic studies. STUDY DESIGN This cross-sectional study was conducted from January 2009 to January 2010 at the Aga Khan University Hospital to assess the frequency of agreement between clinical findings and urodynamic studies in accurately diagnosing urinary incontinence. METHODS We included 157 women and their symptoms of urge urinary incontinence (UUI), stress urinary incontinence (SUI) or mixed urinary incontinence were matched with urodynamic study findings. RESULTS Out of 157 women 47 (29.9%) presented with SUI and 33 (21%) with UUI but urodynamic stress incontinence (USI) was found in 59 (37.6%) and detrusor overactivity in 38 (24.2%). This shows a reliability level of ĸ = 0.41 for SUI and ĸ = 0.7 for UUI. There was a weak agreement (ĸ = 0.33) between clinical findings of urinary incontinence and urodynamic studies; in 78 cases (49.7%) the urodynamic findings matched the clinical findings. CONCLUSIONS The poor level of agreement between clinical findings and urodynamic study interpretations re-emphasizes the fact that the bladder is not a reliable source of identifying urinary symptoms in women.
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Affiliation(s)
- Raheela Mohsin Rizvi
- Department of Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, Pakistan.
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10
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Urodynamic detrusor overactivity in patients with overactive bladder symptoms. Int Neurourol J 2011; 15:48-54. [PMID: 21468287 PMCID: PMC3070227 DOI: 10.5213/inj.2011.15.1.48] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 03/20/2011] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the relationship between urodynamic detrusor overactivity (DO) and overactive bladder (OAB) symptoms in men and women. Methods We reviewed the records of adult males and females who attended a tertiary referral center for urodynamic evaluation of OAB syndrome symptoms with the presence or absence of DO. DO was calculated for symptoms alone or in combination. Results The overall incidence of DO was 76.1% and 58.7% in male and female OAB patients, respectively. Of men 63% and 61% of women with urgency (OAB dry) had DO, while 93% of men and 69.8% of women with urgency and urgency urinary incontinence (OAB wet) had DO. Of women, 58% who were OAB wet had stress urinary incontinence symptoms with 26.4% having urodynamic stress incontinence. 6% of men and 6.5% of women with OAB symptoms had urodynamic diagnosis of voiding difficulties with postvoid residual greater than 100 mL. Combination of symptoms is more accurate in predicting DO in OAB patients. The multivariate disease model for males included urge urinary incontinence (UUI) and urgency while for females it included UUI and nocturia. Conclusions There was a better correlation in results between OAB symptoms and the urodynamic diagnosis of DO in men than in women, more so in OAB wet than in OAB dry. Combination of symptoms of the OAB syndrome seems to have a better correlation with objective parameters from the bladder diary, filling cystometry, and with the occurrence of DO.
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11
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van Leijsen SAL, Hoogstad-van Evert JS, Mol BWJ, Vierhout ME, Milani AL, Heesakkers JPFA, Kluivers KB. The correlation between clinical and urodynamic diagnosis in classifying the type of urinary incontinence in women. A systematic review of the literature. Neurourol Urodyn 2011; 30:495-502. [PMID: 21298721 DOI: 10.1002/nau.21047] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/10/2010] [Indexed: 01/25/2023]
Abstract
AIMS To determine the reclassification rate of clinically diagnosed stress, mixed, and urge urinary incontinence after urodynamic investigation. METHODS A systematic review of the published literature in MEDLINE and EMBASE of clinical trials among women with urinary incontinence. Studies were included in case the diagnosis based on symptoms and/or signs was compared with the diagnosis after urodynamic investigation. RESULTS Twenty-three articles involving 6,282 women with urinary incontinence met the inclusion criteria. A clinical diagnosis of stress urinary incontinence was reclassified into mixed urinary incontinence in 9% of women and into detrusor overactivity (DO) in 7% of cases. The pooled reclassification rate was highest among patients with symptoms of mixed urinary incontinence, where 46% of the patients had stress urinary incontinence and 21% had DO on urodynamic investigation. The available literature does not allow the identification of the additional value of non-invasive test, such as stress test and voiding diary, accessory to symptoms. None of the studies had therapeutic effects as an outcome measure. CONCLUSIONS This review of clinical studies shows that the level of agreement between classification based on clinical evaluation and based on urodynamic investigation is poor. Urodynamic observations are regarded as gold standard, but based on the poor correlation, this assumption should be questioned.
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Affiliation(s)
- Sanne A L van Leijsen
- Department of Obstetrics & Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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12
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Houwert RM, Roovers JPWR, Venema PL, Bruinse HW, Dijkgraaf MGW, Vervest HAM. When to perform urodynamics before mid-urethral sling surgery for female stress urinary incontinence? Int Urogynecol J 2010; 21:303-9. [PMID: 19921082 PMCID: PMC2815804 DOI: 10.1007/s00192-009-1035-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 10/14/2009] [Accepted: 10/19/2009] [Indexed: 12/21/2022]
Abstract
Introduction and hypothesis Development of a model that can predict in which group of women pre-operative urodynamics can be safely omitted. Methods Three hundred and eighty-one uncomplicated women who underwent pre-operative urodynamics were evaluated. A multivariate logistic regression model was developed based on medical history and physical examination predicting a high probability group of women with detrusor overactivity or a low (<20 cm H2O) mean urethral closure pressure and, therefore, are likely to benefit from urodynamics. Results Women are likely to benefit from pre-operative urodynamics if they (1) are 53 years of age or older or (2) have a history of prior incontinence surgery and are at least 29 years of age or (3) have nocturia complaints and are at least 36 years of age. Conclusion If urogynaecologists omitted pre-operative urodynamics in women in the low probability group, in our population, pre-operative urodynamics would be reduced by 29%.
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Affiliation(s)
- R Marijn Houwert
- Department of Obstetrics and Gynecology, St. Elisabeth Hospital Tilburg, Rooseveltlaan 35 III, 1079 AC Amsterdam, The Netherlands.
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13
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Symptom-Based, Clinical, and Urodynamic Diagnoses of Urinary Incontinence. Female Pelvic Med Reconstr Surg 2010; 16:97-101. [DOI: 10.1097/spv.0b013e3181cc54b3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Panayi D, Tekkis P, Fernando R, Hendricken C, Khullar V. Ultrasound measurement of bladder wall thickness is associated with the overactive bladder syndrome. Neurourol Urodyn 2010; 29:1295-8. [DOI: 10.1002/nau.20871] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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de Tayrac R, Letouzey V, Triopon G, Wagner L, Costa P. Diagnostic et évaluation clinique de l’incontinence urinaire féminine. ACTA ACUST UNITED AC 2009; 38:S153-65. [DOI: 10.1016/s0368-2315(09)73575-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Dompeyre P, Pizzoferrato AC. Examen urodynamique et incontinence urinaire féminine non neurologique. ACTA ACUST UNITED AC 2009; 38:S166-73. [DOI: 10.1016/s0368-2315(09)73576-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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SEO JT, KIM KT, KIM TH. Efficacy of Synthetic Suburethral Slings in Female Urinary Stress Incontinence with Overactive Bladder. Low Urin Tract Symptoms 2009. [DOI: 10.1111/j.1757-5672.2009.00050.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Houwert RM, Venema PL, Aquarius AE, Bruinse HW, Roovers JPWR, Vervest HAM. Risk factors for failure of retropubic and transobturator midurethral slings. Am J Obstet Gynecol 2009; 201:202.e1-8. [PMID: 19560115 DOI: 10.1016/j.ajog.2009.04.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 01/31/2009] [Accepted: 04/10/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of our study was to identify and compare risk factors for failure of retropubic and transobturator procedures. STUDY DESIGN This was a retrospective cohort study. Women with predominant stress urinary incontinence who underwent a retropubic (n = 214) or transobturator tape procedure (n = 173) were included. Therapy was considered to have failed in women reporting any amount of urine leakage during stress after 2 and/or 12 months. RESULTS Risk factors for failure were mixed urinary incontinence (MUI; odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-9.1) and the observation of detrusor overactivity (DO) at urodynamics (OR, 8.6; 95% CI, 1.9-39.4) in the retropubic group. Reporting a history of previous incontinence surgery (OR, 3.9; 95% CI, 1.3-11.7) and a low mean urethral closure pressure (MUCP) at urodynamics (OR, 14.5; 95% CI, 1.5-139.0) were risk factors for failure in the transobturator group. CONCLUSION Women with previous incontinence surgery or a low MUCP might benefit more from a retropubic sling, whereas a transobturator procedure might be preferable in women with MUI or DO.
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Affiliation(s)
- R Marijn Houwert
- Department of Obstetrics and Gynecology, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands.
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Haessler AL, Nguyen JN, Bhatia NN. Impact of urodynamic based incontinence diagnosis on quality of life in women. Neurourol Urodyn 2009; 28:183-7. [PMID: 18973144 DOI: 10.1002/nau.20637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS To characterize the effect of urodynamic diagnosis on degree of incontinence related bother and health related quality of life in a large, multi-ethnic population of women. METHODS Effects of multichannel urodynamic diagnosis, urethral competency, and other patient characteristics on abbreviated Urogenital Distress Inventory (UDI6) and Incontinence Impact Questionnaire (IIQ7) composite scores were analyzed retrospectively. RESULTS Six hundred eleven patients were included. Mean UDI6 and IIQ7 scores were significantly higher among patients with mixed incontinence, detrusor overactivity, urinary stress incontinence with overactive bladder, and negative studies compared to those with stress incontinence without OAB. The relative composite UDI6 and IIQ7 mean scores did not significantly differ between the mixed incontinence, detrusor overactivity, stress incontinence with OAB and negative study groups. UDI6 and IIQ7 scores were significantly higher among stress incontinent patients with intrinsic sphincter deficiency, but similar among mixed incontinent patients with intrinsic sphincter deficiency. CONCLUSION Urodynamic diagnoses of detrusor overactivity, mixed incontinence, and stress incontinence with overactive bladder are associated with significantly worse incontinence related bother and health related quality of life when compared to those with stress incontinence without OAB. These conditions appear to have similar degree of impact on incontinence related bother and quality of life. Patients presenting with symptoms of incontinence can suffer a similar compromise in quality of life despite a negative MCUD study.
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Mamienski TD, Fischer JR, Gehrich A, Zahn CM. Symptomatic stress urinary incontinence not demonstrated clinically: survey of practice patterns. Int Urogynecol J 2008; 20:39-44. [PMID: 18797810 DOI: 10.1007/s00192-008-0725-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 08/29/2008] [Indexed: 11/25/2022]
Abstract
The aim of this study was to survey obstetrician/gynecologists and urologists regarding management of women undergoing hysterectomy with complaints of stress urinary incontinence (SUI) not demonstrated clinically. A survey was distributed electronically to military healthcare system OB/GYN and urologist physicians. Overall descriptive data and responses analyzed according to respondent demographics and the presence or absence of pelvic organ prolapse are reported. Two-hundred forty-two responses were obtained (44% response rate). Without prolapse, only 32% would perform an anti-incontinence procedure, more often by urologists than OB/GYN physicians. With prolapse, more respondents would perform an anti-incontinence procedure (32% increasing to 59%, p < 0.001). A mid-urethral sling was the most common procedure that was offered. Trainee versus attending status and teaching versus non-teaching responsibilities did not affect responses. There is no consensus among military obstetricians/gynecologists and urologists regarding management of women otherwise undergoing pelvic surgery with subjective SUI. The presence of prolapse influences this decision.
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Affiliation(s)
- Thaddeus D Mamienski
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC, USA
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Lemos A, de Souza AI, Ferreira ALCG, Figueiroa JN, Cabral-Filho JE. Do perineal exercises during pregnancy prevent the development of urinary incontinence? A systematic review. Int J Urol 2008; 15:875-80. [DOI: 10.1111/j.1442-2042.2008.02145.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ward RM, Hampton BS, Blume JD, Sung VW, Rardin CR, Myers DL. The impact of multichannel urodynamics upon treatment recommendations for female urinary incontinence. Int Urogynecol J 2008; 19:1235-41. [DOI: 10.1007/s00192-008-0610-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 03/08/2008] [Indexed: 10/22/2022]
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Ghoniem G, Stanford E, Kenton K, Achtari C, Goldberg R, Mascarenhas T, Parekh M, Tamussino K, Tosson S, Lose G, Petri E. Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J 2008; 19:5-33. [PMID: 18026681 PMCID: PMC2096636 DOI: 10.1007/s00192-007-0495-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 10/14/2007] [Indexed: 02/06/2023]
Affiliation(s)
- G Ghoniem
- Cleveland Clinic Florida, Weston, FL, USA.
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Lemack GE. Use of urodynamics prior to surgery for urinary incontinence: How helpful is preoperative testing? Indian J Urol 2007; 23:142-7. [PMID: 19675791 PMCID: PMC2721523 DOI: 10.4103/0970-1591.32065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence with urodynamic testing enhances presurgical counseling, more effectively models patients' expectations or improves postoperative outcome. Nonetheless, urodynamic testing is frequently utilized in the assessment of women with stress urinary incontinence and clearly accomplishes a number of goals when utilized for this purpose. For example, there are data to suggest that the risk of voiding dysfunction can be mitigated by utilizing data obtained from urodynamic testing to identify women more likely to void ineffectively after conventional stress incontinence procedures. Furthermore, it has been suggested though not proven, that patients with more severe forms of stress incontinence as identified by urodynamic testing, might be less likely to improve after surgery compared to others with more modest degrees of incontinence. Since urodynamic testing is invasive, costly and not always available, it is imperative that the usefulness of such testing be carefully explored and its utility appropriately defined. In this review, we discuss urodynamic techniques to assess stress urinary incontinence, particularly focusing on the ability of leak point pressure testing and urethral pressure profilometry to predict which patients would most likely benefit from surgery and which might be more likely to experience adverse events following surgery.
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Affiliation(s)
- Gary E. Lemack
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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25
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Mixed incontinence: The misclassification of patients and limitations of clinical trials. CURRENT BLADDER DYSFUNCTION REPORTS 2006. [DOI: 10.1007/s11884-006-0005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tyagi R, Staskin DR. Mixed incontinence: the misclassification of patients and limitations of clinical trials. Curr Urol Rep 2006; 6:424-8. [PMID: 16238915 DOI: 10.1007/s11934-005-0036-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mixed urinary incontinence (MUI) has become a diagnosis of increased interest in the fields of urology and urogynecology, as drugs and treatments targeting urgency-related and stress-related symptoms are being developed and evaluated. We think the concept of "mixed incontinence" warrants revisiting because confounding clinical conditions exist, which result in a heterogeneous population of patients receiving the same diagnosis. The classification system for patients with signs and symptoms of MUI should undergo refinement. In addition, clinical trials for MUI should clearly delineate the lower urinary tract signs and symptoms found in the study population. Current study outcomes do not apply to the entire mix of patients included under the diagnosis of MUI, thus limiting their value. Investigation into the pathophysiologic basis of MUI and refinement of the definition of MUI are necessary if we are to evaluate the effect of future treatments on stress and urge components.
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Affiliation(s)
- Renuka Tyagi
- Department of Urology, New York Presbyterian Hospitals, Weill Medical College of Cornell University, 525 East 68th Street, Suite F-9 West, New York, NY 10021, USA.
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Martin JL, Williams KS, Sutton AJ, Abrams KR, Assassa RP. Systematic review and meta-analysis of methods of diagnostic assessment for urinary incontinence. Neurourol Urodyn 2006; 25:674-83; discussion 684. [PMID: 17016795 DOI: 10.1002/nau.20340] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS To evaluate the performance of all tests proposed for the diagnosis of urinary incontinence. METHODS A systematic review and meta-analyses of the published literature of methods for diagnostic assessment of urinary incontinence. RESULTS One hundred twenty-one papers were included in the full review [Martin et al., 2006]. The quality of reporting in the primary studies was poor which reduced the number of studies that could be included in the data analysis. The literature suggests that women with urodynamic stress incontinence (USI) can be correctly identified in primary care from clinical history alone with a sensitivity of 0.92 (95% C.I.: 0.91-0.93) and specificity of 0.56 (0.53-0.60). A clinical history for the diagnosis of detrusor overactivity (DO) was found to be 0.61 (0.57-0.65) sensitive and 0.87 (0.85-0.89) specific. Within secondary care imaging of leakage by ultrasound was found to be effective in the diagnosis of USI in women with a sensitivity of 0.89 (0.84-0.93) and specificity of 0.82 (0.73-0.89). CONCLUSIONS Clinical interpretation of the results of the review is difficult because few studies could be synthesized and conclusions made. The published evidence suggests that a large proportion of women with USI can be correctly identified in primary care from history alone. Ultrasound offers a useful diagnostic tool which could be used prior to, and possibly instead of, multi-channel urodynamics in some circumstances. If a patient is to undergo urodynamic testing, multi-channel urodynamics is likely to give the most accurate result. Further primary studies adhering to STARD guidelines are required on commonly used tests.
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Affiliation(s)
- J L Martin
- School of Electrical and Electronic Engineering, The University of Nottingham, Nottingham, United Kingdom.
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Buchsbaum GM, Duecy EE, Kerr LA, Huang LS, Guzick DS. Urinary Incontinence in Nulliparous Women and Their Parous Sisters. Obstet Gynecol 2005; 106:1253-8. [PMID: 16319249 DOI: 10.1097/01.aog.0000187309.46650.b2] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the role of vaginal delivery and familial factors in the development of urinary incontinence by comparing the prevalence of this condition in nulliparous women and their parous sisters. METHODS A sample of 143 pairs of nulliparous/parous postmenopausal sisters completed a comprehensive questionnaire regarding symptoms of pelvic floor disorders. Of these, 101 pairs underwent clinical evaluation of urinary incontinence and genital prolapse. RESULTS Among this sample of biological sisters, urinary incontinence was reported by 47.6% of nulliparous women and by 49.7% of parous women (P = .782). We found no difference in the severity or type of urinary incontinence between these 2 groups. There was a high concordance in continence status, however, within biological sisters. CONCLUSION Vaginal birth does not seem to be associated with urinary incontinence in postmenopausal women. Considering the high concordance in continence status between sister pairs, and considering that the majority of parous women are continent, an underlying familial predisposition toward the development of urinary incontinence may be present.
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Affiliation(s)
- Gunhilde M Buchsbaum
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA.
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Bradley CS, Rovner ES, Morgan MA, Berlin M, Novi JM, Shea JA, Arya LA. A new questionnaire for urinary incontinence diagnosis in women: development and testing. Am J Obstet Gynecol 2005; 192:66-73. [PMID: 15672005 DOI: 10.1016/j.ajog.2004.07.037] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a questionnaire for urinary incontinence diagnosis in women and to test its reliability and validity, with incontinence specialists' clinical evaluations as the gold standard. STUDY DESIGN One hundred seventeen urogynecology outpatients with urinary incontinence symptoms completed the Questionnaire for Urinary Incontinence Diagnosis at enrollment and 1 week and 9 months later. Baseline clinical diagnoses were compared with Questionnaire for Urinary Incontinence Diagnosis diagnoses (criterion validity). Nine-month Questionnaire for Urinary Incontinence Diagnosis change scores were compared across treatment groups (responsiveness). RESULTS Clinical diagnoses included stress (n = 15), urge (n = 26), and mixed urinary incontinence (n = 72). Internal consistency and test-retest reliability estimates were good. Sensitivity and specificity were 85% (95% CI, 75%, 91%) and 71% (95% CI, 51%, 87%), respectively, for stress urinary incontinence and 79% (95% CI, 69%, 86%) and 79% (95% CI, 54%, 94%), respectively, for urge urinary incontinence. The Questionnaire for Urinary Incontinence Diagnosis correctly diagnosed urinary incontinence type in 80% of subjects. Questionnaire for Urinary Incontinence Diagnosis Stress and Urge scores decreased significantly in treated subjects. CONCLUSION The Questionnaire for Urinary Incontinence Diagnosis, a new 6-item questionnaire for female urinary incontinence type diagnosis, is reliable and able to diagnose stress urinary incontinence and urge urinary incontinence in a referral urogynecology patient population with accuracy.
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Affiliation(s)
- Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
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Lemack GE. Urodynamic assessment of patients with stress incontinence: how effective are urethral pressure profilometry and abdominal leak point pressures at case selection and predicting outcome? Curr Opin Urol 2004; 14:307-11. [PMID: 15626870 DOI: 10.1097/00042307-200411000-00002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Disagreement exists as to the extent of evaluation required prior to offering surgical intervention for the treatment of stress urinary incontinence in women. While few would argue that additional information can be gleaned from a properly performed urodynamic investigation, it remains unclear exactly which women would most benefit from such preoperative study, and if urodynamic evaluation definitively improves treatment outcome. Since such invasive studies may not be widely available in certain areas, can be costly, and are associated with a low, but defined risk of bladder infection, it is imperative that the appropriate indication for preoperative urodynamic evaluation be carefully defined. This review highlights recent reports and controversies concerning the use of urodynamics (focusing on leak point pressure testing and urethral pressure profilometry) prior to surgical treatment for stress urinary incontinence. RECENT FINDINGS There remains no clear consensus as to whether urodynamic testing enhances surgical outcome of stress urinary incontinence treatments by improving case selection or altering the surgical approach based on study findings. As treatment strategies for stress urinary incontinence have developed over the last several years to a more uniform approach, it is less clear that the severity of stress urinary incontinence, based on either abdominal leak point pressure or urethral pressure profilometry will influence the choice of surgical technique. Furthermore, there is little evidence to suggest that patients with more severe forms of stress urinary incontinence by urodynamic testing fare more poorly after the most commonly offered surgical treatment than those with less severe forms. There are certain sub-populations of women who appear to be at higher risk of voiding dysfunction following incontinence surgery, and urodynamic testing may aid in identifying this group. SUMMARY It is not apparent that either abdominal leak point pressure measurement or urethral pressure profilometry can accurately predict which patients will achieve the best outcome of surgical treatment for stress urinary incontinence. Other parameters assessed during urodynamic evaluation might provide prognostic information regarding the risk of voiding dysfunction postoperatively and the possibility of persistent urge-related leakage following surgery, though not directly predict cure. A multi-institutional randomized study comparing the outcome between patients in whom treatment was determined with the urodynamic information known, compared with patients in whom this information was unknown would further enhance our understanding of the usefulness of urodynamics in the preoperative evaluation of women with stress urinary incontinence.
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Affiliation(s)
- Gary E Lemack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Al-Shahrani M, Lovatsis D. Do subjective symptoms of obstructive voiding correlate with post-void residual urine volume in women? Int Urogynecol J 2004; 16:12-4; discussion 14. [PMID: 15647960 DOI: 10.1007/s00192-004-1202-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2003] [Accepted: 05/15/2004] [Indexed: 10/26/2022]
Abstract
The objective was to determine if symptoms of obstructive voiding correlate with post-void residual urine volume measured by catheterization. A cross-sectional study of 134 consecutive women referred to a tertiary urogynecology clinic was performed. Subjects were interviewed regarding three types of obstructive voiding symptoms: a sensation of incomplete emptying, straining to void, and slow urine stream. Post-void residual urine volume was measured by catheterization as the gold standard. Data for each symptom were analyzed using Cohen's kappa test, sensitivity, specificity, likelihood ratios for a positive of negative test, and positive and negative predictive values. A total of 11 out of 134 patients (8%) had a post-void residual volume greater than 100 ml. Of these 11, 1 had symptoms of incomplete emptying (9%), 1 had symptoms of straining to void (9%), and 2 had symptoms of slow urine stream (18%). Sensitivity, specificity, likelihood ratio for a positive symptom, likelihood ratio for a negative symptom, positive predictive value, negative predictive value, and Cohen's kappa, respectively, were 9%, 80%, 0.47, 1.13, 4%, 91%, and 0.05 for the symptom of incomplete emptying, 9%, 91%, 1.12, 1.0, 8%, 92%, and 0.01 for straining to void, and 18%, 89%, 1.6, 0.92, 13%, 92%, and 0.07 for the symptom of slow urine stream. It was concluded that symptoms of obstructive voiding do not correlate with measured post-void urine volume. In clinically important situations, these symptoms cannot substitute for measurement of post-void residual urine volume.
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Affiliation(s)
- Mesfer Al-Shahrani
- Department of Obstetrics, Gynecology, and Reproductive Sciences, St. Boniface General Hospital and University of Manitoba, Winnipeg, Manitoba, Canada
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Mørkved S, Salvesen KA, Bø K, Eik-Nes S. Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women. Int Urogynecol J 2004; 15:384-9; discussion 390. [PMID: 15278255 DOI: 10.1007/s00192-004-1194-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2003] [Accepted: 05/21/2004] [Indexed: 10/26/2022]
Abstract
The aim of the study was to measure pelvic floor muscle function in continent and incontinent nulliparous pregnant women. The study group consisted of 103 nulliparous pregnant women at 20 weeks of pregnancy. Women reporting urinary incontinence once per week or more during the previous month were classified as incontinent. Function was measured by vaginal squeeze pressure (muscle strength) and increment in thickness of the superficial pelvic floor muscles (urogenital diaphragm) assessed by perineal ultrasound. Seventy-one women were classified as continent and 32 women as incontinent. Continent women had statistically significantly higher maximal vaginal squeeze pressure and increment in muscle thickness when compared with incontinent women. There was a strong correlation between measurements of vaginal squeeze pressure and perineal ultrasound measurements of increment in muscle thickness. This study demonstrates statistically significant differences in pelvic floor muscle function measured by strength and thickness in continent compared with incontinent nulliparous pregnant women.
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Affiliation(s)
- Siv Mørkved
- Department of Community Medicine and General Practice, Norwegian University of Science and Technology, 7489 Trondheim, Norway.
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Khan MS, Chaliha C, Leskova L, Khullar V. The relationship between urinary symptom questionnaires and urodynamic diagnoses: an analysis of two methods of questionnaire administration. BJOG 2004; 111:468-74. [PMID: 15104612 DOI: 10.1111/j.1471-0528.2004.00126.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether method of administration of a standard urinary symptom questionnaire alters the relationship of symptoms with urodynamic diagnoses. DESIGN Randomised crossover study. SETTING Tertiary Urogynaecology Unit, London, UK. PARTICIPANTS One hundred and fourteen women attending a tertiary urogynaecology clinic. METHODS Women were randomised to either an initial interview-assisted questionnaire in the clinic with a follow up postal questionnaire or an initial pre-outpatient questionnaire followed by an interview-assisted questionnaire at the clinic visit. Video cystourethrography or saline cystometry was performed at the clinic visit. MAIN OUTCOME MEASURES Question responses were compared with urodynamic diagnoses. RESULTS With an interview method, only severity of incontinence was significantly associated with detrusor overactivity (U= 593.5, P= 0.012). With self-completion, severity of nocturia (U= 477, P < 0.05), urgency (U= 395, P= 0.003), urge urinary incontinence (U= 392, P= 0.003), leakage without warning (U= 443, P= 0.035) and incomplete voiding (U= 413, P= 0.01) were significantly associated with detrusor activity. On interview the symptom of stress urinary incontinence (U= 523, P= 0.002) and use of pads (U= 564.5, P= 0.011) were significantly associated with a diagnosis of urodynamic stress incontinence. Severity of stress urinary incontinence (U= 276, P < 0.001), frequency of leakage (U= 348.5, P= 0.004), use of protection (U= 432.5, P < 0.018), nocturnal incontinence (U= 393.5, P= 0.002) and quantity of leakage (U= 441.5, P < 0.05) on self-completion were strongly associated with diagnosed urodynamic stress incontinence. There was no association between the symptoms of urgency or urge incontinence and the urodynamic stress incontinence. CONCLUSIONS Postal questionnaire responses have a better relationship with urodynamics, both for urodynamic stress incontinence and detrusor over activity, than interview-assisted questionnaire responses. However, no symptom has a high enough specificity and sensitivity to replace urodynamic testing.
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Affiliation(s)
- Mohid S Khan
- Department of Obstetrics and Gynaecology, Mint Wing, St Mary's Hospital, Imperial College, London, UK
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Yalcin I, Versi E, Benson JT, Schäfer W, Bump RC. VALIDATION OF A CLINICAL ALGORITHM TO DIAGNOSE STRESS URINARY INCONTINENCE FOR LARGE STUDIES. J Urol 2004; 171:2321-5. [PMID: 15126813 DOI: 10.1097/01.ju.0000124909.31527.a9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We assessed the accuracy with which a clinical diagnostic algorithm for stress urinary incontinence (SUI) based on symptoms and signs without including urodynamics predicted the observation of urodynamic SUI and the condition of SUI. Such an algorithm would have applicability to ensure that the majority of women entering large SUI clinical trials would have urodynamic SUI and/or the condition of SUI without performing urodynamic testing in all subjects. MATERIALS AND METHODS A total of 1455 women with urinary incontinence at least 3 months in duration were enrolled in 3 randomized clinical trials (1 phase 2 and 2 phase 3 trials) of duloxetine vs placebo for the treatment of SUI in Europe and North America. Subjects were identified as having SUI based on a clinical algorithm that required a predominant symptom of SUI with a weekly incontinence episode frequency of 4 or greater (phase 2 study), or 7 or greater (phase 3 studies), absent predominant urge symptoms, normal diurnal and nocturnal frequency, a bladder capacity of 400 ml or greater, and a positive cough stress (sign of SUI) and stress pad test. Multichannel urodynamic studies were performed in a subset of 184 women at 23 study sites. Of these urodynamic tracings 173 (94%) were of adequate quality to make an assessment of the filling phase and assign a diagnosis of urodynamic SUI, detrusor overactivity or a normal filling phase. Two-sided 95% exact CIs for the proportions were calculated. RESULTS The clinical algorithm had a positive predictive value of 90.2% for urodynamic SUI with or without detrusor overactivity and 76.9% for urodynamic SUI only (pure urodynamic SUI). The positive predictive value for the condition of pure SUI was 85.0%, while for the condition of SUI in pure and mixed forms the positive predictive value was 98.3%. Patient age, previous continence surgery or the severity of incontinence did not influence algorithm accuracy. CONCLUSIONS The algorithm is suitably feasible and sufficiently predictive to be used in large clinical trials designed to evaluate conservative treatment for women with SUI. It ensures that the overwhelming majority of the study population would have urodynamic SUI and the condition of SUI.
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Affiliation(s)
- Ilker Yalcin
- Lilly Research Laboratories and Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Gomes CM, Arap S, Trigo-Rocha FE. Voiding dysfunction and urodynamic abnormalities in elderly patients. ACTA ACUST UNITED AC 2004; 59:206-15. [PMID: 15361987 DOI: 10.1590/s0041-87812004000400010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in elderly men and women. With the progressive aging of the population, it is important to understand common micturitional disorders that may occur in this population. Most urinary problems in the elderly are multifactorial in origin, demanding a comprehensive assessment of the lower urinary tract organs, functional impairments, and concurrent medical diseases. Urodynamics is a highly valuable tool in the investigation of elderly patients with lower urinary tract symptoms. Urodynamic tests are not always necessary, being indicated after excluding potentially reversible conditions outside the urinary tract that may be causing or contributing to the symptoms. Although urodynamic tests may reveal common diagnoses such as bladder outlet obstruction and stress urinary incontinence in the elderly population, findings such as detrusor overactivity and impaired detrusor contractility are common and have important prognostic and therapeutic implications. The purpose of this article is to describe common urologic problems in the elderly and review the indications for and clinical aspects of urodynamic studies in these conditions.
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Affiliation(s)
- Cristiano M Gomes
- Division of Urology, Department of Surgery, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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Digesu GA, Khullar V, Cardozo L, Salvatore S. Overactive bladder symptoms: do we need urodynamics? Neurourol Urodyn 2003; 22:105-8. [PMID: 12579626 DOI: 10.1002/nau.10099] [Citation(s) in RCA: 205] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS The aim of our study was to determine whether the urodynamic diagnosis is useful in the management of women with symptoms of an overactive bladder (OAB). METHODS Women with lower urinary tract symptoms, attending a tertiary referral urogynaecology clinic were studied. All women were fully evaluated, with history, urinary symptoms questionnaire, frequency-volume chart, vaginal examination, and videocystourethrography. Women with symptoms consistent with an overactive bladder (urinary frequency, urgency, and/or urge incontinence) were selected. Women with neurological disorders were excluded. Finally, urinary symptoms and urodynamic diagnosis were correlated. All terms and definitions are in accordance with the International Continence Society [Abrams et al., 1988, Scand J Urol Nephrol 114(Suppl):5-19.]. RESULTS A total of 4,500 women 22-73 years of age were studied. Only 843 women (18.7%) could be classified as having an OAB. Of these, 457 women (54.2%) had urodynamically proven detrusor instability, whereas 386 women (45.8%) had a stable urodynamic trace. Sixty-eight (8.1%) of the women studied had postvoid residual greater than 100 mL. Of the 4,500 women studied, 1,641 (36.5%) had detrusor instability on laboratory urodynamics. Only 27.5% of these women (457 of 1,641) had OAB symptoms. CONCLUSIONS Symptomatic diagnosis of OAB does not correlate with a urodynamic diagnosis of detrusor instability. The diagnosis of overactive bladder based on urinary symptoms underdiagnoses the condition of detrusor instability in a population of women suffering from lower urinary tract symptoms. Therefore, symptomatic diagnosis of OAB alone is not recommended. Our study suggested that urodynamic evaluation is mandatory in the management of the women with symptoms of an overactive bladder.
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Affiliation(s)
- G Alessandro Digesu
- Department of Urogynaecology, King's College Hospital, London, United Kingdom.
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Colli E, Artibani W, Goka J, Parazzini F, Wein AJ. Are urodynamic tests useful tools for the initial conservative management of non-neurogenic urinary incontinence? A review of the literature. Eur Urol 2003; 43:63-9. [PMID: 12507545 DOI: 10.1016/s0302-2838(02)00494-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To summarise the evidence for the role of urodynamic tests in the diagnosis and classification of urinary incontinence. METHODS Reference lists in relevant papers were reviewed and MEDLINE searches conducted. RESULTS The mean sensitivity (specificity) of clinical history versus urodynamic tests was 0.82 (0.57) for stress incontinence, 0.69 (0.60) for urge incontinence/overactive bladder, and 0.51 (0.66) for patients with mixed incontinence. The proportion of women with a clinical diagnosis of urinary incontinence but with normal findings from urodynamic tests ranged from 3 to 8%. Overall sensitivity of urodynamic tests was about 85-90% in the diagnosis of urodynamic stress incontinence, but generally lower following diagnosis of urge and mixed incontinence. No relationship emerged between urodynamic test results and response to medical treatment. CONCLUSIONS This literature review shows that the sensitivity of clinical history versus urodynamic tests was 0.82, 0.69 and 0.51 respectively for stress, urge and mixed urinary incontinence. It also suggests that urodynamic diagnosis does not predict response to treatment. These data add to the ongoing 'urodynamics or no urodynamics' debate in the evaluation of urinary incontinence and show that urodynamic testing may not be helpful for patients receiving initial non-invasive therapy. These data are in line with the conclusions of the 1st and 2nd International Consultations on incontinence.
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Affiliation(s)
- Enrico Colli
- Global Research and Development, Pfizer, Sandwich, Kent, UK
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Affiliation(s)
- Y Homma
- Department of Urology, Tokyo University Hospital, Japan
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41
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Abstract
Urinary incontinence in women has a multitude of presentations and can be a pure and simple entity or a complicated combination of overlying disorders. The diagnosis and work-up of the incontinent woman should proceed from the classic tools of medical treatment, as well as the history and physical exam, and should incorporate modern techniques of dynamic imaging. It is vital to remember that it is often not until a simple treatment has failed that we appreciate a patient's complex problem, and, for this reason, we advocate appropriate use of the available technologies in order to separate more carefully the straightforward disorder from the intricate and convoluted problems. A thorough investigation of the multiple dimensions of urinary incontinence in the female patient, using subjective and objective testing, is the key to diagnostic and clinical success.
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Affiliation(s)
- Adam J Flisser
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
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Klingele CJ, Carley ME, Hill RFC. Patient characteristics that are associated with urodynamically diagnosed detrusor instability and genuine stress incontinence. Am J Obstet Gynecol 2002; 186:866-8. [PMID: 12015497 DOI: 10.1067/mob.2002.123405] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to compare characteristics of patients with urodynamically diagnosed detrusor instability or genuine stress incontinence. STUDY DESIGN A retrospective audit of 293 consecutive women who were referred to a urogynecologist for evaluation of urinary incontinence between June 1996 and April 2000. RESULTS Of the 293 patients, 289 women had a physical examination and urodynamic testing, which revealed genuine stress incontinence (35%), detrusor instability (32%), mixed incontinence (29%), or normal urodynamic function (4%). Compared with patients with detrusor instability, those women with genuine stress incontinence were more likely to be white than African American (P <.0001) and to have a cystocele(P =.027), rectocele (P <.0001), or paravaginal defect (P =.004). No differences in age, gravidity, parity, estrogen treatment, or previous anti-incontinence procedure were identified between women with detrusor instability and women with genuine stress incontinence. CONCLUSION In a tertiary referral center, the distribution of urinary incontinence is evenly divided among genuine stress incontinence, detrusor instability, and mixed incontinence. Patients with genuine stress incontinence are more likely to be white and to have pelvic floor prolapse and symptoms of pure stress incontinence.
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Lovatsis D, Drutz HP, Wilson D, Duggan P. Utilization of preoperative urodynamic studies by Canadian gynaecologists. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2002; 24:315-9. [PMID: 12196867 DOI: 10.1016/s1701-2163(16)30624-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES (1) To determine the proportion of Canadian gynaecologists who have urodynamic studies (UDS) readily available; (2) to assess the preoperative UDS utilization patterns of Canadian gynaecologists in various clinical scenarios of stress urinary incontinence (SUI). METHODS A mail survey was sent to all 1266 obstetrician/gynaecologist members of the Society of Obstetricians and Gynaecologists of Canada (SOGC), as part of an international survey with the U.K., U.S.A., New Zealand, and Australia. Survey questions included geographic availability of UDS and specific types of urodynamics testing available. Utilization of urodynamics prior to anti-incontinence surgery was assessed in four clinical scenarios: (A) a history of uncomplicated primary stress urinary incontinence, (B) a history of mixed stress and urgency incontinence, (C) stress incontinence with a history of straining to void, and (D) recurrent stress incontinence. RESULTS Of the 1266 surveys mailed, 230 (18%) were returned. Forty-four of the respondents did not manage incontinent women. Of the 186 respondents who did, 27% reported a special interest or additional postgraduate training in urogynaecology, and 73% were general gynaecologists. UDS were available in the same centre or city to 79% of respondents. For uncomplicated primary stress incontinence, 47% would always obtain preoperative UDS, 42% would not, and 11% would only if UDS were readily available. For the total group of respondents, in scenario A 47% would always obtain preoperative UDS, 42% would not, and 11% would only if UDS were readily available. Among general gynaecologists, in scenario A, if UDS were available in their city or centre of practice, 54% would always obtain preoperative UDS, as compared to 5% by general gynaecologists who did not have UDS available in their city or centre of practice. CONCLUSION The data collected in this survey are compromised because of the low response rate. However, most (79%) of the respondents who manage women with urinary incontinence had access to urodynamics in the same centre or city. The utilization of urodynamics prior to surgical treatment of uncomplicated primary pure stress incontinence varies depending on the availability of such testing. An uncomplicated history of primary SUI and decreased availability of testing were two factors seen to have an effect of decreasing utilization of preoperative UDS. Hospital management did not always comply with SOGC guidelines for preoperative testing for SUI. Updating and dissemination of these guidelines is necessary to ensure "best" practice and highest quality of care for all women with SUI in Canada.
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Weidner AC, Myers ER, Visco AG, Cundiff GW, Bump RC. Which women with stress incontinence require urodynamic evaluation? Am J Obstet Gynecol 2001; 184:20-7. [PMID: 11174474 DOI: 10.1067/mob.2001.108171] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to determine the predictive value of the symptom of stress urinary incontinence and to evaluate the ability of other factors suggested by a published Agency for Health Care Policy and Research guideline for the discrimination of patients unlikely to require urodynamic testing before surgical management. STUDY DESIGN We evaluated 950 consecutive women without advanced (stage III or IV) pelvic organ prolapse who were referred with symptoms of incontinence. Incontinence was recorded by means of standard forms and was characterized as "any stress loss" (76.4%), "primarily stress loss" (58.9%), "stress loss only" (29.8%), "stress and urge loss" (52.2%), "urge loss only" (13.8%), "constant and stress loss" (1.9%), or "constant loss" (2.3%). Other variables were assessed by means of a standardized history, physical examination (including urethral axis determination and stress test), 1-week urinary diary, and postvoid residual volume measurement. A urodynamic diagnosis of pure genuine stress incontinence was used as the criterion standard. Sensitivity, specificity, and positive and negative predictive values were calculated. Logistic regression models incorporating various combinations of stress loss only, previous prolapse or incontinence surgery, nocturia, voiding frequency, urethral hypermobility, and postvoid residual volume <100 mL (the factors recommended by the Agency for Health Care Policy and Research guidelines), along with age and race as predictors of genuine stress incontinence, were constructed to evaluate the predictive ability of the guideline in a subset of 447 patients for whom data on all variables were available. RESULTS Of the entire population 480 (50.5%) had pure genuine stress incontinence, 134 (14.1%) had both genuine stress incontinence and detrusor instability, 180 (18.9%) had pure detrusor instability, and 40 (4.2%) had intrinsic sphincter deficiency. Fifty-four (5.7%) had normal study results, and 62 (6.5%) had other nonincontinence diagnoses. Among the subjects with symptoms of stress loss only, 10.8% did not have genuine stress incontinence confirmed on urodynamic examination. Agency for Health Care Policy and Research guideline criteria had excellent discrimination (C statistic of 0.807) compared with the sole criterion of stress urinary incontinence only (C statistic of 0.574), with a positive predictive value of 85.7%. Only 7.8% of subjects met all the criteria, however, and 5.7% of these ultimately had a urodynamic diagnosis of either detrusor instability or normal study result. CONCLUSION The predictive value of stress symptoms alone was not high enough to serve as the basis for surgical management. Agency for Health Care Policy and Research guidelines improved the predictive value but were applicable to only a small subset of patients referred with urinary incontinence.
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Affiliation(s)
- A C Weidner
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Weidner AC, Barber MD, Visco AG, Bump RC, Sanders DB. Pelvic muscle electromyography of levator ani and external anal sphincter in nulliparous women and women with pelvic floor dysfunction. Am J Obstet Gynecol 2000; 183:1390-9; discussion 1399-401. [PMID: 11120502 DOI: 10.1067/mob.2000.111073] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare results of electromyographic assessment of muscular recruitment between nulliparous control subjects without pelvic floor dysfunction and parous subjects with genuine stress urinary incontinence and with pelvic organ prolapse. Interference pattern analysis is an electromyographic technique that reproducibly measures muscular recruitment by detecting both "turns" in the electromyographic signal produced by positive and negative peaks of the motor unit potentials and motor unit potential amplitude. Fewer turns can indicate loss of motor units or failure of central activation of contraction, whereas greater amplitude can indicate reinnervation after nerve damage. STUDY DESIGN We performed concentric needle electrode electromyographic examinations of the levator ani and external anal sphincter in 15 nulliparous control subjects and 20 parous subjects with abnormalities (n = 9 with genuine stress urinary incontinence, n = 11 with stage III or IV pelvic organ prolapse). We made digital recordings at multiple sites at rest and with moderate and maximal contraction. Interference pattern analysis yielded the number of turns per second and the mean signal amplitude (in microvolts) for each site at each contraction level. We compared individual patient data with data from the healthy population by means of cloud analysis. Mean values of number of turns per second and mean amplitude in each group were then compared with nonparametric methods and regression models. RESULTS Mean ages were 28.7 years (range, 20-49 years) for the control group, 54.3 years (range, 35-75 years) for subjects with genuine stress urinary incontinence, and 65 years (range, 41-77 years) for subjects with pelvic organ prolapse. Median clinical levator ani strengths were 9 (range, 5-9) in the control group, 5 (range, 2-7) in the genuine stress urinary incontinence group, and 5 (range, 2-8) in the pelvic organ prolapse group. Median external anal sphincter strengths were 9 (range, 7-9) in the control group, 5 (range, 3-9) in the genuine stress urinary incontinence group, and 8 (range, 4-9) in the pelvic organ prolapse group. The external anal sphincters of subjects with pelvic organ prolapse had the highest percentage of abnormal study results according to cloud analysis. Mean number of turns per second in levators was greater in control subjects than in subjects with abnormalities (P =.034). We found similar differences in number of turns per second for the external anal sphincter (P =.004). In contrast, we did not find differences between groups in mean amplitude in either the levator ani or the external anal sphincter. Comparison of patients with genuine stress urinary incontinence versus subjects with pelvic organ prolapse showed no significant difference in the number of turns per second in either muscle. Mean amplitude was greater in the pelvic organ prolapse group than in the genuine stress urinary incontinence group for both muscles (levator ani, P =.028; external anal sphincter, P =.048). Neither mean amplitude nor the number of turns per second could be predicted by clinically estimated levator ani strength, age, or fecal incontinence. CONCLUSION Compared with nulliparous control subjects, patients with genuine stress urinary incontinence and pelvic organ prolapse had changes in the levator ani and external anal sphincter consistent with either motor unit loss or failure of central activation, or both. Subjects with pelvic organ prolapse had findings consistent with greater recovery than was found in those with genuine stress urinary incontinence. Measures of recruitment by interference pattern analysis correlated better with clinical external anal sphincter strength than with levator ani strength and were independent of age.
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Affiliation(s)
- A C Weidner
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, and the Division of Neurology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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Weidner AC, Sanders DB, Nandedkar SD, Bump RC. Quantitative electromyographic analysis of levator ani and external anal sphincter muscles of nulliparous women. Am J Obstet Gynecol 2000; 183:1249-56. [PMID: 11084574 DOI: 10.1067/mob.2000.107630] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Our aims were to introduce a method of digital quantitative electromyography of the levator ani and external anal sphincter muscles and to establish reference values. STUDY DESIGN Fifteen nulliparous, symptom-free women underwent concentric needle electromyographic examination of the levator ani and external anal sphincter. We sampled the levator ani transvaginally at 4 sites and the external anal sphincter at 2 sites. The signal was filtered and amplified, and digital recordings were made at 3 levels of voluntary activation at each site. Analyses of motor unit action potentials and interference patterns were performed with the use of these taped signals. Normal ranges were generated and compared with those established for other striated muscles. RESULTS The mean age of the subjects was 28.7+/-7.5 years. A median of 24 motor unit action potentials was recorded in each levator ani, and a median of 6 was recorded in each external anal sphincter. Parameters of the levator ani action potentials were significantly greater than those of the external anal sphincter in amplitude (0.48 vs. 0.37 mV; P =.001), duration (10.40 vs. 8.27 ms; P =.002), number of turns per second (2. 80 vs. 2.28; P<.001), and area (0.65 vs. 0.36; P<.001). Parameters of the interference patterns were significantly greater in the levator ani than in the external anal sphincter in number of turns per second (241.6 vs. 183.9; P =.015), amplitude (302.7 vs. 225.3 microV; P<.0001), activity (95.6 vs 61.2; P =.004), envelope size (861.1 vs 567.6 microV; P<.0001), and number of small segments (105. 8 vs 81.4; P =.047). There were no significant differences between levator ani, external anal sphincter, and published parameters from the biceps muscle with regard to amplitude and duration of motor unit action potentials. CONCLUSIONS Electromyography of the levator ani and external anal sphincter is feasible and well tolerated. Our findings confirm that the levator ani muscle has larger, more readily recruited motor units than does the external anal sphincter. Ranges for important quantitative electromyographic parameters for these muscles are similar to those published for the biceps.
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Affiliation(s)
- A C Weidner
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
Mixed symptomatology, i.e. both stress and urge incontinence, is reported by patients, either of their own accord or in response to a questionnaire. Our understanding of motor urge incontinence, detrusor instability, stress incontinence and sensory urge incontinence is changing. Detrusor instability is now known to be a urodynamic observation of uncertain clinical significance. Symptoms reported by patients are not equivalent to a urodynamic diagnosis but the problem seems to be more in the urodynamics than in the symptoms. Evidence shows that sensory urge incontinence and motor urge incontinence are probably gradations of the same condition. The relationship between stress incontinence and an overactive bladder is complex. For example, neither detrusor instability nor urge incontinence appear to adversely influence the outcome of surgical treatment for stress incontinence; however, this treatment does not have a good success rate. At present, it is not clear whether this poor outcome reflects a lack of efficacy of the operations used, or their application to inappropriate patients.
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Affiliation(s)
- E J McGuire
- Division of Urology, University of Texas Medical School at Houston, Texas, USA
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Carley ME, Schaffer J. Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers Danlos syndrome. Am J Obstet Gynecol 2000; 182:1021-3. [PMID: 10819815 DOI: 10.1067/mob.2000.105410] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to determine the prevalence of urinary incontinence and pelvic organ prolapse in a cohort of women with either Marfan syndrome or Ehlers-Danlos syndrome. STUDY DESIGN Female patients with either Marfan syndrome or Ehlers-Danlos syndrome were identified through a medical records search at two urban hospitals. Each patient's medical record was reviewed, and the history of pelvic organ prolapse and urinary incontinence was obtained through telephone interview. RESULTS Twelve women with Marfan syndrome were identified. Among these women 5 (42%) reported a history of urinary incontinence and 4 (33%) reported a history of pelvic organ prolapse. Eight women with Ehlers-Danlos syndrome were identified. Among these women 4 (50%) reported a history of urinary incontinence and 6 (75%) reported a history of pelvic organ prolapse. CONCLUSIONS Women with Marfan or Ehlers-Danlos syndrome have high rates of urinary incontinence and pelvic organ prolapse. This finding supports the hypothesized etiologic role of connective tissue disorders as a factor in the pathogenesis of these conditions.
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Affiliation(s)
- M E Carley
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, USA
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Leroi AM, Weber J, Menard JF, Touchais JY, Denis P. Prevalence of anal incontinence in 409 patients investigated for stress urinary incontinence. Neurourol Urodyn 1999; 18:579-90. [PMID: 10529706 DOI: 10.1002/(sici)1520-6777(1999)18:6<579::aid-nau8>3.0.co;2-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A clinical questionnaire concerning anorectal symptoms and urodynamic tests was used to investigate 409 women consulting for stress urinary incontinence. To compare urodynamic data, patients were divided into three groups of women who had either stress urinary incontinence associated with incontinence for formed and/or liquid stools or with gas incontinence, or isolated stress urinary incontinence. To take in account the patients'age for data interpretation, a Mantel-Haenszel test or covariate analysis was performed. Anal incontinence was reported in 114 (28%) of the 409 women investigated. The prevalence of incontinence for gas only, for liquid, or for solid stools was 18.3, 9.3, and 1%, respectively. The duration of gas incontinence was longer than that of fecal incontinence or stress urinary incontinence. Difficult defecation was more frequently observed in patients with double incontinence than in patients with only stress urinary incontinence, and the difference was significant between patients with gas incontinence and patients with stress urinary incontinence (53% versus 37%, P = 0. 03). There was no difference in the number of bowel movements per week among the three groups of patients. The number of vaginal deliveries was surprisingly lower in patients with fecal incontinence associated with urinary incontinence than in others. There was no urodynamic feature that could distinguish patients with urinary incontinence and patients with double incontinence. This study confirmed the close relationship between anal and stress urinary incontinence. Neurourol. Urodynam. 18:579-590, 1999.
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Affiliation(s)
- A M Leroi
- Groupe de Recherche sur l'Appareil Digestif, Centre Hospitalier Régional et Universitaire de Rouen, Rouen, France.
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