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Nzinga Luzolo AM, Dilu Mabiala E, Bilo Mbaki I, Ngereza Kibimbi P, Bope Matshinga N, Kasonga RS. Epidemiological Profile and Attitudes of Pregnant Women Toward Urinary Incontinence: A Single-Center Cross-Sectional Study. Int Urogynecol J 2024; 35:521-526. [PMID: 38189851 DOI: 10.1007/s00192-023-05718-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The objective was to highlight the epidemiological and clinical profile of urinary incontinence in pregnant women during the first trimester and to determine their knowledge and attitudes toward this condition in Kinshasa. METHODS We carried out a descriptive cross-sectional study among 127 pregnant women who came for prenatal consultations in the first trimester from January to March 2022 at the LISANGA Medical Centre in Kinshasa. A questionnaire was developed containing the Urinary Symptom Profile (USP) scale. Kolmogorov-Smirnov normality tests were used to determine the normality of the distribution of the study variables. Inferential statistics were performed. The significance level was 0.05. RESULTS The mean age was 29.7±5.5 years. Thirty-eight women (29.9%) were primigravida. The median age of pregnancy was 6 weeks of amenorrhoea. The prevalence of urinary incontinence was 73.2%, with 31.2% of urge urinary incontinence and 16.1% of stress incontinence. In 61.4% of cases, overactive bladder was associated with urinary incontinence. Among the incontinent pregnant women, 3.2% had consulted a doctor while accepting that this condition is a health problem, 13.4% knew they had a pelvic floor muscle, 4.7% had knowledge of its rehabilitation, and 8.7% had benefited from gymnastics during pregnancy. CONCLUSIONS Urinary incontinence was frequent in the first trimester of pregnancy with a predominance of urgency. It was hardly discussed during prenatal consultations and pregnant women were not aware of the pelvic floor muscle, its rehabilitation, and of gymnastics during pregnancy.
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Affiliation(s)
- Andy-Müller Nzinga Luzolo
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium.
| | - Elie Dilu Mabiala
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Inès Bilo Mbaki
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Patient Ngereza Kibimbi
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nene Bope Matshinga
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Ra-Shin Kasonga
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Beyazıt A, Hakverdi AU, Gözükara KH. The Effect of Pregnancy on Urinary Symptoms. Cureus 2023; 15:e44232. [PMID: 37772213 PMCID: PMC10523107 DOI: 10.7759/cureus.44232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
Background Urinary incontinence is a condition that causes social, medical, or hygienic problems. The increase in the incidence of stress incontinence, particularly with increasing parity, emphasizes the role of pregnancy on the etiology of incontinence and other urinary symptoms. This study aimed to estimate the effect of pregnancy on urinary incontinence and other urinary symptoms with history and urodynamic data. Methodology This study was conducted at Mustafa Kemal University, Medical Faculty, Obstetrics and Gynecology Department. A total of 72 pregnant primigravid women without any urinary problems were included in the study. Patients with severe chronic disease, neurological disorders, antepartum hemorrhage, multiple pregnancies, younger than 18, and those with physical and mental disabilities were excluded. All patients were initially evaluated in the first trimester and finally in the sixth week of the postpartum period. Demographic and obstetric data, including urological complaints and urodynamic findings, were recorded. Results There were significant increases in nocturia, frequency, dysuria, urgency, and stress urinary incontinence complaints in pregnant women. Urge incontinence was not significantly different after pregnancy. In the postpartum urodynamic studies, nine (12.5%) patients with stress urinary incontinence and six (8.3%) patients with detrusor instability were detected. There was no significant difference between cesarean section and vaginal delivery regarding incontinence. Conclusions According to the study findings, pregnant women who were continent before pregnancy could become incontinent after birth according to urodynamic data. However, long-term studies are needed to determine whether this incontinence is temporary. Additionally, according to our results, cesarean section should not be recommended over vaginal delivery only to prevent incontinence.
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Affiliation(s)
- Ahmet Beyazıt
- Obstetrics and Gynecology, Mustafa Kemal University, Hatay, TUR
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Recognition and Management of Pelvic Floor Disorders in Pregnancy and the Postpartum Period. Obstet Gynecol Clin North Am 2021; 48:571-584. [PMID: 34416938 DOI: 10.1016/j.ogc.2021.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Often considered a condition of aging women, pelvic floor disorders may initially present in pregnancy and postpartum, having a negative impact on quality of life during this important time in a woman's life. This review outlines the clinical approach to implementing pelvic health into obstetric care through education and promotion of pelvic health in pregnancy, screening for pelvic floor disorders routinely, and providing support through resources, treatment, and referrals if pelvic floor disorders develop during pregnancy and postpartum.
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Erkal Aksoy Y, Akın B, Dereli Yılmaz S. Urinary incontinence experiences of pregnant women: A qualitative study. Urologia 2020; 88:140-147. [PMID: 33245027 DOI: 10.1177/0391560320974880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The research was carried out to determine the life experiences of pregnant women who have urinary incontinence problems. METHODS The type of the research is of qualitative type. Views of pregnant women were coded according to repeating frequencies; then thematic grouping was done. Both common views and individual repetitions of the pregnant women were coded. During the study, 52 pregnant women stated that they had urinary incontinence problems. However, five pregnant women did not want to participate in the study and six pregnant women wanted to leave during the interview. Interviews ended with 41 pregnant women. RESULTS In the study, the mean age of the pregnant women was determined as 29.75 ± 4.83, and the mean gestational week was 27.85 ± 5.60. The views of pregnant women are divided into five main themes and 16 sub-themes. The main themes for the urinary incontinence life experiences of pregnant women were determined as "strategies to take precautions, psychological effects, pregnancy and baby-specific effects, physical effects and changes in their relationship with the spouse." CONCLUSION As a result, it was determined that urinary incontinence problem negatively affected the life experience of pregnant women.
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Affiliation(s)
- Yasemin Erkal Aksoy
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey
| | - Bihter Akın
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey
| | - Sema Dereli Yılmaz
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey
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Sivarajah K, Relph S, Sabaratnam R, Bakalis S. Spina bifida in pregnancy: A review of the evidence for preconception, antenatal, intrapartum and postpartum care. Obstet Med 2019; 12:14-21. [PMID: 30891087 PMCID: PMC6416695 DOI: 10.1177/1753495x18769221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Women with spina bifida in pregnancy require complex multi-disciplinary management. Most women have uncomplicated pregnancies; however, complications are more frequent than in 'low risk' pregnancies. Careful antenatal planning and management of the complications can optimise outcome. There are currently no guidelines on the management of pregnant women with spina bifida, but there is a growing body of evidence from case reports and series examining the antenatal and postnatal course of these women. In this review, we examine the available literature and provide a framework on the prenatal counselling, antenatal, intrapartum and postnatal management of pregnant women with spina bifida.
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Affiliation(s)
- Kenga Sivarajah
- Department of Obstetrics and Gynaecology,
The
Royal London Hospital, London, UK
| | - Sophie Relph
- Department of Obstetrics and Gynaecology,
The
Royal London Hospital, London, UK
| | - Radha Sabaratnam
- Department of Anaesthetics,
The
Royal London Hospital, London, UK
| | - Spyros Bakalis
- Department of Obstetrics, Maternal and Fetal Medicine, St
Thomas’ Hospital, London, UK
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Effect of pregnancy on the cholinergic responses of the bladder: role of acetylcholinesterase. Int Urol Nephrol 2018; 51:73-78. [PMID: 30478812 DOI: 10.1007/s11255-018-2032-5] [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: 09/13/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Pregnancy is associated with many functional changes of the urinary bladder. It was reported that most of healthy women complain from urinary symptoms during pregnancy. The parasympathetic system is mainly mediating bladder emptying. The aim of the study is to investigate the cholinergic effect and the role of acetylcholinesterase in the bladder during pregnancy. METHODS Sixteen rats were used in the present study as control group (non-pregnant) and pregnant group (18-20 days pregnant). Isolated urinary smooth muscle strips were suspended in organ baths filled with Krebs' solution for isometric tension recording. RESULTS Electric field stimulation (EFS), (0.1-40 Hz), of the control and pregnant bladder preparations produced frequency-dependent contractions. Atropine (1 µM) inhibited EFS-induced contractions in the two groups by 65% and 50% respectively indicating the response of cholinergic innervation. Neostigmine significantly enhanced EFS responses, confirming its selectivity for inhibiting acetylcholinesterase which is responsible for termination of acetylcholine. Concentration-response curves for acetylcholine were reduced in pregnant group than control. Concentration-response curves for ATP were increased in pregnant group than control. Neostigmine augmented concentration-response curves for acetylcholine in control and pregnant groups. The effect of neostigmine on acetylcholine contractile responses in pregnancy group was higher than in control. CONCLUSIONS Urinary bladder dysfunction during pregnancy might be due to augmentation of acetylcholinesterase effect. This will lead to the decrease in response to cholinergic stimuli. New pharmaceutical drugs specifically affecting the enzyme in the bladder can help in avoiding the unpleasant urinary symptoms during pregnancy.
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Bai Y, Wang X, Yang Y, Tang Y, Wang J, Han P. Parity and bladder cancer risk: a dose-response meta-analysis. BMC Cancer 2017; 17:31. [PMID: 28061845 PMCID: PMC5219774 DOI: 10.1186/s12885-016-3023-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 12/20/2016] [Indexed: 02/05/2023] Open
Abstract
Background Multiple studies have reported evidence of an inverse association between parity and bladder cancer risk. However, a comprehensive and quantitative assessment of this association has never been conducted. We conducted this study to clarify this issue. Methods Systematic search of PubMed and Embase was performed to identify all the studies. Studies were selected based on strict screening with inclusion and exclusion criteria. Summary relative risks (RR) with 95% confidence intervals (CI) were calculated by using a fixed-effect model, and the generalized least squares trend estimation was employed to compute study-specific RR and 95% CI per live birth increase. Heterogeneity and publication bias were also evaluated. Results Twelve studies (6,214 cases and 2,693,350 non-cases) were eligible in this meta-analysis. The pooled RR of bladder cancer for parous versus nulliparous women was 0.76 (95% CI: 0.70–0.82). Results were similar in the studies that adjusted for BMI(RR = 0.66; 95% CI: 0.53–0.81), cigarette smoking (RR = 0.67; 95% CI: 0.57–0.79), and age (RR = 0.77; 95% CI: 0.71–0.84). The dose-response meta-analysis showed a lower bladder cancer risk (RR = 0.95; 95% CI: 0.92–0.98) for each live birth increase in parous women. No evidence of publication bias or significant heterogeneity was detected in the above-mentioned analyses. Conclusions The finding from current meta-analysis suggest that parity may be related to decreased risk of bladder cancer. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-3023-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Xiaoming Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Yubo Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Yin Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China.
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Abstract
Overactive bladder (OAB) is a common form of urinary incontinence, resulting from spontaneous and random contractions of the urinary bladder. The affected individuals have an uncontrollable urge to urinate and experience incontinence and nocturia, which can greatly reduce the quality of daily life. There are several drugs for the treatment, and all of them have serious side effects. The following findings suggested that human chorionic gonadotropin (hCG) has a therapeutic potential that is worth investigating for the treatment of OAB. The finding are (1) human detrusor muscle contains hCG receptors, (2) detrusor muscle becomes quiescent during pregnancy, (3) hCG can inhibit detrusor muscle contractions induced by cholinergic stimulation in rats, and (4) hCG can mimic the anticholinergic drug on detrusor muscle contractions.
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Affiliation(s)
- C V Rao
- Departments of Cellular Biology and Pharmacology, Molecular and Human Genetics, and Obstetrics and Gynecology, Reproduction and Development Program, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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A Giant Vesical Stone Causing Impending Rupture of Bladder During Labor. J Obstet Gynaecol India 2015; 65:267-70. [DOI: 10.1007/s13224-014-0543-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 04/22/2014] [Indexed: 11/26/2022] Open
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Urinary incontinence in pregnant women and its relation with socio-demographic variables and quality of life. Rev Assoc Med Bras (1992) 2013; 59:460-6. [DOI: 10.1016/j.ramb.2013.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 03/29/2013] [Accepted: 08/19/2013] [Indexed: 11/18/2022] Open
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Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J 2013; 24:901-12. [PMID: 23436035 PMCID: PMC3671107 DOI: 10.1007/s00192-013-2061-7] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/26/2013] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is the most common type of urinary incontinence (UI) in pregnant women and is known to have detrimental effects on the quality of life in approximately 54.3 %. Pregnancy is the main risk factor for the development of SUI. This review provides details of the pathophysiology leading to SUI in pregnant women and SUI prevalence and treatment during pregnancy. METHODS We conducted a PubMed search for English-language and human-study articles registered from January 1990 to September 2012. This search was performed for articles dealing with prevalence and treatment of SUI during pregnancy. In the intervention studies, we included studies that used a randomized controlled trial (RCT) design or studies comparing a treatment intervention to no treatment. RESULTS A total of 534 articles were identified; 174 full-text articles were reviewed, and 28 of them met eligibility criteria and are reported on here. The mean prevalence of SUI during pregnancy was 41 % (18.6-60 %) and increased with gestational age. The increasing pressure of the growing uterus and fetal weight on pelvic-floor muscles (PFM) throughout pregnancy, together with pregnancy-related hormonal changes, may lead to reduced PFM strength as well as their supportive and sphincteric function. These cause mobility of the bladder neck and urethra, leading to urethral sphincter incompetence. Pelvic floor muscle exercise (PFME) is a safe and effective treatment for SUI during pregnancy, without significant adverse effects. CONCLUSIONS Understanding these issues can be useful for health-care professionals when informing and counseling pregnant women to help prevent SUI during pregnancy and the postpartum period.
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Affiliation(s)
- Bussara Sangsawang
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Srinakharinwirot University, 215-216 Ammarinnivet III Saimai Soi 79, Saimai Rd., Bangkok, 10220, Thailand.
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Childbearing and the Risk of Bladder Cancer: A Nationwide Population-based Cohort Study. Eur Urol 2013; 63:733-8. [DOI: 10.1016/j.eururo.2013.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/06/2013] [Indexed: 11/23/2022]
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Abstract
The majority of urogynaecological problems can manifest during pregnancy or as a direct result of pregnancy and delivery. Those most commonly occurring during pregnancy are urinary tract infection, filling and voiding disorders, urinary incontinence, pelvic organ prolapse and faecal incontinence. The development of these may be as a result of physiological changes that occur in pregnancy or as a result of previous pregnancies. There may also be urogynaecological sequelae that occur as a result of trauma sustained during delivery. These include perineal and anal sphincter trauma, bladder or ureteric injuries during caesarean section or operative deliveries, and the development of vesico-vaginal or recto-vaginal fistulae.
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Affiliation(s)
- H Law
- Department of Obstetrics and Gynaecology, Mid-Essex Hospital NHS Trust, Chelmsford, UK.
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Davis-Dao CA, Henderson KD, Sullivan-Halley J, Ma H, West D, Xiang YB, Gago-Dominguez M, Stern MC, Castelao JE, Conti DV, Pike MC, Bernstein L, Cortessis VK. Lower risk in parous women suggests that hormonal factors are important in bladder cancer etiology. Cancer Epidemiol Biomarkers Prev 2011; 20:1156-70. [PMID: 21493870 DOI: 10.1158/1055-9965.epi-11-0017] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Urinary bladder cancer is two to four times more common among men than among women, a difference in risk not fully explained by established risk factors. Our objective was to determine whether hormonal and reproductive factors are involved in female bladder cancer. METHODS We analyzed data from two population-based studies: the Los Angeles-Shanghai Bladder Cancer Study, with 349 female case-control pairs enrolled in Los Angeles and 131 female cases and 138 frequency-matched controls enrolled in Shanghai, and the California Teachers Study (CTS), a cohort of 120,857 women with 196 incident cases of bladder urothelial carcinoma diagnosed between 1995 and 2005. We also conducted a meta-analysis summarizing associations from our primary analyses together with published results. RESULTS In primary data analyses, parous women experienced at least 30% reduced risk of developing bladder cancer compared with nulliparous women (Shanghai: OR = 0.38, 95% CI: 0.13-1.10; CTS: RR = 0.69, 95% CI: 0.50-0.95) consistent with results of a meta-analysis of nine studies (summary RR = 0.73, 95% CI: 0.63-0.85). The CTS, which queried formulation of menopausal hormone therapy (HT), revealed a protective effect for use of combined estrogen and progestin compared with no HT (RR = 0.60, 95% CI: 0.37-0.98). Meta-analysis of three studies provided a similar effect estimate (summary RR = 0.65, 95% CI: 0.48-0.88). CONCLUSIONS A consistent pattern of reduced bladder cancer risk was found among parous women and those who used estrogen and progestin for HT. IMPACT These results suggest that more research is warranted to investigate hormonal and reproductive factors as possible contributors to bladder cancer risk.
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Affiliation(s)
- Carol A Davis-Dao
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Huebner M, Antolic A, Tunn R. The impact of pregnancy and vaginal delivery on urinary incontinence. Int J Gynaecol Obstet 2010; 110:249-51. [PMID: 20570263 DOI: 10.1016/j.ijgo.2010.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 04/06/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify women who had urinary incontinence (UI) before, during, and after pregnancy, and to determine whether women with symptoms of UI during pregnancy were the same women who had urinary incontinence postpartum. METHODS All primigravid women who delivered within 1 year (1999) at the Charité Hospital in Berlin received a questionnaire about UI at 5 different time points during pregnancy and the postpartum period. RESULTS Of 610 eligible women, 411 (67.4%) completed the questionnaire. The prevalence of urinary incontinence increased significantly in the second half of pregnancy (26.3%, P<0.001). Although the overall number of women who reported UI within 6 weeks after delivery (28.5%) was almost the same as the number reporting UI in the second half of pregnancy, approximately every second women changed from being continent to incontinent and vice versa. CONCLUSION The group of women who experienced UI postpartum was different from the group that experienced UI before delivery and vice versa. Pregnancy itself may influence pelvic floor function in a different way compared with vaginal delivery.
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Affiliation(s)
- Markus Huebner
- Department of Obstetrics and Gynecology, University of Tuebingen, Germany.
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Fiadjoe P, Kannan K, Rane A. Maternal urological problems in pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 152:13-7. [PMID: 20483528 DOI: 10.1016/j.ejogrb.2010.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 04/05/2010] [Accepted: 04/26/2010] [Indexed: 11/29/2022]
Abstract
Urological conditions in pregnancy represent a major diagnostic and therapeutic challenge. During pregnancy the urinary tract undergoes some anatomical and physiological changes that may result in many symptoms and pathological conditions affecting both the mother and fetus. With prompt evaluation and expeditious treatment, the prognosis is good. Fear of causing harm is unfounded. This article describes urological problems in pregnancy, specifically infection, calculus, renal failure, renal tumour, lower urinary tract symptoms and trauma and their management.
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Affiliation(s)
- Paul Fiadjoe
- Department of Urogynaecology, The Townsville Hospital, Angus Smith Drive Douglas, Townsville, QLD 4814, Australia.
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Thomas AA, Thomas AZ, Campbell SC, Palmer JS. Urologic emergencies in pregnancy. Urology 2010; 76:453-60. [PMID: 20451969 DOI: 10.1016/j.urology.2010.01.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 01/17/2010] [Accepted: 01/19/2010] [Indexed: 11/26/2022]
Abstract
The management of urological emergencies during pregnancy presents unique clinical challenges for the treating physician. Clinical signs and symptoms are often subtle while diagnostic and therapeutic options are limited in treating patients to avoid fetal morbidity. A high index of suspicion with early diagnosis and treatment are essential for the management of genitourologic emergencies in pregnant women. It is essential for patients to be managed on an individual basis using a multidisciplinary approach.
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Affiliation(s)
- Anil A Thomas
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Rizk DEE, Osman NA, Shafiullah MM, Nagelkerke NJD, Fahim MA. Effect of human chorionic gonadotrophin on in vitro contractions of stimulated detrusor muscle strips of female rats. J Obstet Gynaecol Res 2010; 35:835-41. [PMID: 20149029 DOI: 10.1111/j.1447-0756.2009.01052.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS We studied the effect of human chorionic gonadotrophin (hCG) on the in vitro detrusor muscle contractions in female rats. METHODS Two adjacent detrusor muscle strips from the bladder dome of 18 female Wistar rats (230-250 gm) were mounted in an organ bath for the recording of isometric tension. Carbachol (10(-9)-10(-3) M), alpha,beta methylene adenosine 5'-triphosphate (ATP) (10(-9)-10(-3) M) and potassium chloride (KCl) (10(-4)-10(-3) M) were applied (n = 6 x 3 groups). Concentration-response curves, before and after the addition of hCG (100 iu/mL) or oxybutynin (10(-5) M) to either muscle strip, were compared. RESULTS All curves were displaced to the right by hCG in a concentration-dependent manner with significant inhibition of contractions induced by carbachol (P < 0.001) and KCl (P = 0.016) but not those induced by alpha,beta-methylene ATP (P = 0.4). Estimated order of potency of inhibition was carbachol>KCl>alpha,beta-methylene ATP. The overall inhibitory effect of hCG was significantly less than oxybutynin (P < 0.001). CONCLUSIONS hCG significantly inhibited in vitro detrusor contractions induced by depolarization (KCl) and cholinergic (carbachol) but not purinergic (alpha,beta-methylene ATP) stimulation in a dose-dependent manner in female rats.
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Affiliation(s)
- Diaa E E Rizk
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
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Female Sexual Function and Pregnancy After Genitourinary Reconstruction. J Urol 2009; 182:2578-84. [DOI: 10.1016/j.juro.2009.08.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Indexed: 11/23/2022]
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Guichard G, Fromajoux C, Cellarier D, Loock PY, Chabannes E, Bernardini S, Maillet R, Bittard H, Kleinclauss F. Prise en charge de la colique néphrétique chez la femme enceinte : à propos de 48 cas. Prog Urol 2008; 18:29-34. [DOI: 10.1016/j.purol.2007.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2007] [Accepted: 11/22/2007] [Indexed: 10/22/2022]
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22
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Connolly SS, Mulvin DW, Quinlan DM, Lennon GM. Painful hydronephrosis of pregnancy. Eur J Obstet Gynecol Reprod Biol 2007; 140:145-7. [PMID: 18093721 DOI: 10.1016/j.ejogrb.2007.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 10/01/2007] [Accepted: 11/08/2007] [Indexed: 11/19/2022]
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23
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Hallamore SL, Grills RJ, Neerhut G, Lawrentschuk N. Submucosal vesical varicosities causing hematuria and retention of urine in pregnancy: cystovarix. Am J Obstet Gynecol 2007; 196:e29-30. [PMID: 17466671 DOI: 10.1016/j.ajog.2006.10.864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 09/23/2006] [Accepted: 10/11/2006] [Indexed: 02/06/2023]
Abstract
Pregnancy may be associated with urological complications but gross hematuria is rare. Mechanical obstruction of venous return with pregnancy-associated smooth muscle dilatation and vasodilatation causes venous congestion, predisposing to varicose veins. We present a case of bladder submucosal venous hemorrhage secondary to such varices and describe mechanisms underlying cystovarix formation.
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Affiliation(s)
- Sandra L Hallamore
- Department of Surgery, Division of Urology, The Geelong Hospital, University of Melbourne, Geelong, Victoria, Australia
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Genadry R. A urogynecologist's view ofthe pelvic floor effects of vaginal delivery/cesarean section for the urologist. Curr Urol Rep 2006; 7:376-83. [PMID: 16959177 DOI: 10.1007/s11934-006-0007-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pregnancy and parturition have been implicated in the development of pelvic floor dysfunction. These disorders include urinary incontinence, fecal incontinence, pelvic organ prolapse, and other pelvic and sexual dysfunctions. The urologist caring for women with urinary dysfunction needs to be familiar with the causes of pelvic floor dysfunction and their implications. Defects of the pelvic floor have clearly resulted from the traumatic effect of vaginal delivery. The likely mechanisms of injuries during vaginal delivery involve stretching and compression of the pudendal nerve and peripheral branches, as well as an additional tearing of muscles and connective tissue. Optimal management of labor and optimal techniques of repair of unavoidable sphincteric lacerations, ante- and postpartum pelvic floor muscle conditioning, and timely and proper indications for cesarean delivery will minimize the effect of incidental traumatic delivery.
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Affiliation(s)
- René Genadry
- Johns Hopkins at Greenspring, 10755 Falls Road,Suite 330, Lutherville, MD 21093, USA.
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Le Roc'h A, Debodinance P. Grossesse après soutènement sous-urétral par voie trans-obturatrice (Monarc®). ACTA ACUST UNITED AC 2006; 35:191-3. [PMID: 16575367 DOI: 10.1016/s0368-2315(06)76395-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rare cases of pregnancy occur after surgical treatment of an urinary incontinence. We report the case of a 37-year-old patient became pregnant 5 months after trans-obturator insertion of a suburethral sling (Monarc). The pregnancy was monitored regularly and no sign of urinary incontinence was observed. Caesarean delivery was decided at 40 weeks gestation. The patient has remained quite continent, one year after delivery. The appropriate mode of delivery is discussed.
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Affiliation(s)
- A Le Roc'h
- Service de Gynécologie-Obstétrique, CH de Dunkerque, 43, rue des Pinsons, 59430 Saint-Pol-sur-Mer
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Damaser MS, Whitbeck C, Chichester P, Levin RM. Effect of vaginal distension on blood flow and hypoxia of urogenital organs of the female rat. J Appl Physiol (1985) 2004; 98:1884-90. [PMID: 15591288 DOI: 10.1152/japplphysiol.01071.2004] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vaginal delivery of children causes traumatic injury to tissues of the pelvic floor and is correlated with stress urinary incontinence; however, the exact mechanism of organ and tissue injury leading to incontinence development is unknown. The purpose of this project was to test the hypothesis that vaginal distension results in decreased blood flow to, and hypoxia of, the urogenital organs responsible for continence, which would suggest an ischemic and/or reperfusion mechanism of injury. Thirteen female rats underwent vaginal distension for 1 h. Thirteen age-matched rats were sham-distended controls. Blood flow to the bladder, urethra, and vagina were determined using a microsphere technique. Hypoxia of these organs was determined by immunohistochemistry. Blood flow to all three organs was significantly decreased just before release of vaginal distension. Bladder blood flow decreased further immediately after release of vaginal distension and continued to be significantly decreased 15 min after the release. Blood flow to both the urethra and vagina tripled immediately after release, inducing a rapid return to normal values. Vaginal distension resulted in extensive smooth muscle hypoxia of the bladder, as well as extensive hypoxia of the vaginal epithelium and urethral hypoxia. Bladders from sham-distended rats demonstrated urothelial hypoxia as well as focal hypoxic areas of the detrusor muscle. We have clearly demonstrated that vaginal distension results in decreased blood flow to, and hypoxia of, the bladder, urethra, and vagina, supportive of hypoxic injury as a possible mechanism of injury leading to stress urinary incontinence.
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Affiliation(s)
- M S Damaser
- Research Service, Hines Veterans Affairs Hospital, Hines, New York, USA
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