[Three tasks for the exploration of verbal fluency: evidence of test-retest reliability in Argentine adults]

INTRODUCTION

The phonological and semantic verbal fluency tasks are frequently used in neuropsychological assessment due to their easy application and good sensitivity to dementia. In Argentina, the psychometric evidence for these tasks is limited, with a special lack of knowledge of the temporal stability of its measurements. The psychometric production is even lower for the action fluency variant (emission of verbs in the infinitive in one minute). In effect, this research analyzes the test-retest reliability of three verbal fluency tasks in Argentine adults.

SUBJECTS AND METHODS

The sample was made up of 85 Argentine (average age, 63.7 years), 75,3% women and with a medium-high educational level. A prospective longitudinal design was carried out, administering phonological, semantic and action fluency tasks at two different times with an interval of up to four months. The intraclass correlation coefficient (ICC), a statistical method suggested for test-retest reliability studies, was analyzed. For the interpretation of the ICC, the Fleiss criteria were adopted.

RESULTS

The phonological and semantic fluency tasks showed good reliability, with ICCs of 0.77 and 0.79. The fluidity of action variant yielded ICC of 0.90, indicating excellent reliability.

CONCLUSIONS

All fluency tasks have appropriate temporal stability, and their use is recommended when prospective neuropsychological research is planned (with language evaluation at different times) or as a method of monitoring the evolution of aphasic patients undergoing neurorehabilitation. Based on its excellent reliability, it is recommended to use the action variant more frequently.

[Cognitive Reserve Questionnaire: psychometric analysis from the item response theory]

INTRODUCTION

Cognitive reserve is the ability to better tolerate brain damage through pre-existing and compensatory cognitive resources. One assessment method is the Rami CRQ-Cognitive Reserve Questionnaire. The objective was to carry out an analysis of the informative quality of the CRQ from the item response theory (IRT), in order to provide more precise data on the reliability of internal consistency. Convergent validity was also tested with measures of attention, working memory, and fluency.

SUBJECTS AND METHODS

210 Argentines from the general population (mean age, 66.8 years) participated. The CRQ was administered together with the digits test and three fluency tasks. A graded response model was fitted from IRT with estimation of discrimination parameters (a) and difficulty (b), and a CRQ information curve was created. Bivariate and partial correlations were made.

RESULTS

The IRT indicated high discrimination for the CRQ items 'Education' and 'Occupation level' (both for the 8-item version and the 6-item version). In the CRQ of 8 items, low discrimination was obtained for 'Musical training' and 'Intellectual games'. In both versions of the CRQ, the curve indicates greater informational value at a low level of the construct. There was a correlation with the digits test and with fluency tasks, even when controlling for age.

CONCLUSIONS

This study is the first analysis of CRQ from IRT, concluding that the instrument is more reliable when applied to subjects with less reserve. The CRQ has acceptable convergent validity.

[Cognitive reserve questionnaire: the psychometric properties in an Argentinian population]

INTRODUCTION

Cognitive reserve is the brain's capacity to actively overcome damage by means of pre-existing cognitive resources and compensatory processes. This capacity is enhanced by education, occupational attainment, learning languages and the habit of reading, among other important factors. This study aimed to investigate the psychometric properties of Rami et al's Cognitive Reserve Questionnaire in an Argentinian population.

MATERIALS AND METHODS

The sample that participated in the study comprised 203 Argentinian adult volunteers from the general population (mean age, 66.1; standard deviation, 8.1). The Cognitive Reserve Questionnaire was administered together with the Montreal Cognitive Assessment. Confirmatory factor analysis was carried out to test the unidimensionality of the questionnaire. In addition, reliability was estimated by the categorical omega coefficient and associative validity was analysed by means of bivariate correlations.

RESULTS

Factor analysis confirms the unidimensionality of the questionnaire with good fit indices. Items 5 (musical training) and 8 (intellectual games), however, show low factor loadings. The test has acceptable reliability, with a categorical omega coefficient = 0.72, although it should be noted that the average variance extracted (0.41) is below the recommended criterion of 0.5. Good associative validity is observed: r (200) = 0.4; p < 0.001.

CONCLUSIONS

The Cognitive Reserve Questionnaire is an instrument with acceptable psychometric properties for use in an Argentinian population. More research is required to further investigate the low factor loadings of items 5 and 8 and to strengthen the evidence of reliability.

Safety of vaginal erbium laser: A review of 113,000 patients treated in the past 8 years

Background: Energy-based devices are becoming a popular option for minimally invasive vaginal procedures. The aim of this study was to obtain information on the frequency of occurrence of adverse effects (AEs) related to vaginal erbium laser (VEL™) treatment.Materials and methods: The global survey was conducted among practitioners using the non-ablative VEL™ (Fotona, Ljubljana, Slovenia). Users were invited to provide the number of patients treated with VEL™ and the number of observed laser-related AEs.Results: The survey was conducted from August 2018 to April 2019. Responses from 535 practitioners were collected, with a total of 113,174 patients treated in the period from 2012 to 2019. Out of 535 respondents, 160 (30%) shared detailed information about the indications they treated in a population of 62,727 patients, whereas 188 (35%) respondents provided information on the frequency of AEs observed in their treated population of 43,095 patients. All observed AEs were mild to moderate, transient and appeared with low frequencies.Conclusions: Minimally invasive thermal-only laser treatment using the non-ablative VEL™ procedures appears to be safe and the incidence of AEs is low.

Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause

OBJECTIVES

To evaluate the long-term efficacy of a second generation of vaginal laser treatment, the vaginal erbium laser, as a non-ablative photothermal therapy for the management of genitourinary syndrome of menopause.

METHODS

The study was performed using an erbium laser crystal yttrium-aluminum-garnet (XS Fotona Smooth™, Fotona, Ljubljana, Slovenia) with a wavelength of 2940 nm. Postmenopausal women (n = 205) were treated with three laser applications at 30-day intervals. Symptoms were assessed before and after treatment throughout 24 months, using the subjective visual analog scale (VAS) and the objective vaginal health index score (VHIS). In addition, postmenopausal women suffering from stress urinary incontinence were evaluated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF).

RESULTS

Vaginal erbium laser treatment induced a significant (p < 0.01) decrease in VAS for both vaginal dryness and dyspareunia, as well an increase in VHIS (p < 0.01) up to the 12th month after the last laser treatment. The values returned to levels similar to the baseline after 18 and 24 months. In addition, vaginal erbium laser treatment improved mild-moderate stress urinary incontinence in 114 postmenopausal women. Less than 3% of patients discontinued treatment due to adverse events.

CONCLUSIONS

These results suggest that vaginal erbium laser may be effective and safe for the treatment of genitourinary syndrome of menopause.

Trocar-guided trans-vaginal mesh surgery for pelvic organ prolapse: effects on urinary continence and anatomical and functional outcomes. A prospective observational study

OBJECTIVE

Primary objective of this study was to assess the effects of trocar-guided transvaginal mesh surgery (TVM) on cure and prevention rates for incontinence, without concomitant surgery for Stress Urinary Incontinence (SUI). Our secondary objectives were anatomical outcomes, relief of symptoms and effect on quality of life (QoL).

STUDY DESIGN

This prospective observational study evaluated women who underwent TVM for symptomatic stage >2 Pelvic Organ Prolapse (POP). SUI was evaluated objectively using the cough stress test with prolapse reduced. SUI and urge urinary incontinence (UUI) were subjectively evaluated using ICIQ-SF. Anatomical cure was defined as stage <2 at POP-Q.

STATISTICAL ANALYSIS

McNemar chi-square test; paired t-test; Mann-Whitney test.

RESULTS

Seventy-two patients reached final evaluation (mean follow-up 72 months). In the 40 pre-op continent patients, 34 (85%) remained continent postoperatively and 6 (15%) showed de novo SUI. Only 1 patient chose to undergo subsequent TVT. The number needed to treat was 6 to prevent 1 women developing de novo objective SUI and 39 to prevent 1 woman having to undergo SUI surgery. In the 32 pre-op incontinent patients, 18 (56.3%) became continent postoperatively. Only 1 patient chose to undergo subsequent TVT. UUI was present in 44 patients pre-operatively and 15 (20.8%) post-operatively (1 de novo). Forty-four patients (61.1%) were continent post-operatively for SUI and UUI. We observed a significant improvement in storage, voiding, post-micturition and prolapse-related symptoms. The anatomical cure rate was 87.5% for the anterior compartment and 90.3%.for the apical segment. The apical recurrence was 8.3% in the patients previously hysterectomised, 18.8% in the patients with uterus preservation and 0% in the patients with concomitant hysterectomy. QoL scores improved in all domains except sleep and personal relationships. We observed mesh exposure in 10 patients (13.9%), in 5 of whom it was associated with a concomitant hysterectomy CONCLUSIONS: TVM showed excellent results in terms of continence and can be performed without contemporary anti-incontinence surgery, for both continent and incontinent women. Patients should have pre-operative counselling before POP surgery. For severe uterine prolapse the Perigee™ System should be employed with concomitant hysterectomy because uterus preservation is associated with significantly higher apical recurrence rates.

Rationale and design for the Vaginal Erbium Laser Academy Study (VELAS): an international multicenter observational study on genitourinary syndrome of menopause and stress urinary incontinence

The genitourinary syndrome of menopause (GSM) and stress urinary incontinence (SUI) are common clinical challenges for women's health and quality of life. The laser treatment and particularly the vaginal erbium laser (VEL) may provide a new non-invasive treatment for both GSM and SUI. However, the estimation of the ultimate results of different laser treatments may be altered by different issues, such as patient selection, concomitant treatments, and long-term effect of vaginal laser thermotherapy. In the present paper, we present the protocol for a large multicenter study on the evaluation of the efficacy and safety of VEL for the treatment of GSM and SUI, the Vaginal Erbium Laser Academy Study (VELAS). This study will evaluate the effects of three laser applications in 1500 postmenopausal women. Subjective and objective symptoms will be evaluated prior to the first laser treatment with follow-up visits after 4 weeks from the last laser application, and subsequently after every 3 months for 1 year. Findings from the VELAS have the potential to affect clinical care practice and health decisions for millions of women world-wide for a non-hormonal treatment for GSM and a non-invasive treatment of SUI.

Female urinary stress incontinence

Urinary incontinence (UI) is more common than any other chronic disease, such as hypertension, depression or diabetes, with the prevalence estimated between 9 and 74%. Among the various forms of urinary incontinence, stress incontinence (SUI) is the most prevalent (50%), with urgency incontinence (UUI) representing 11% and mixed type (MUI) 36% (3% not classified). Nowadays, the restoration of urinary continence is one of the greatest challenges for the well-being and quality of life of women. The introduction of minimally invasive surgical procedures changed the anti-incontinence surgery, leading to similar, or even better results as traditional, invasive techniques. The development of the mid-urethral slings offers a viable alternative to surgical correction of SUI. These further developments of mini-sling procedures are appropriate for local anesthesia, less traumatic, 'tension-free' (to ensure continence without obstruction), simple, rapid and repeatable. The latest minimally invasive approaches can be performed in day surgery, with clear advantages compared to traditional procedures. A novel approach through the use of vaginal laser techniques could represent an additional opportunity, as a non-invasive, outpatient method to treat SUI.

Vaginal erbium laser: the second-generation thermotherapy for the genitourinary syndrome of menopause

Aim To evaluate the effects of the vaginal erbium laser (VEL) in the treatment of postmenopausal women suffering from genitourinary syndrome of menopause (GSM). Method GSM was assessed in postmenopausal women before and after VEL (one treatment every 30 days, for 3 months; n = 45); the results were compared with the effects of a standard treatment for GSM (1 g of vaginal gel containing 50 μg of estriol, twice weekly for 3 months; n = 25). GSM was evaluated with subjective (visual analog scale, VAS) and objective (Vaginal Health Index Score, VHIS) measures. In addition, in 19 of these postmenopausal women suffering from stress urinary incontinence (SUI), the degree of incontinence was evaluated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after VEL treatments. Results VEL treatment induced a significant decrease of VAS of both vaginal dryness and dyspareunia (p < 0.01), with a significant (p < 0.01) increase of VHIS. In postmenopausal women suffering from mild to moderate SUI, VEL treatment was associated with a significant (p < 0.01) improvement of ICIQ-SF scores. The effects were rapid and long lasting, up to the 24th week of the observation period. VEL was well tolerated with less than 3% of patients discontinuing treatment due to adverse events. Conclusion This pilot study demonstrates that VEL induces a significant improvement of GSM, including vaginal dryness, dyspareunia and mild to moderate SUI. Further studies are needed to explore the role of laser treatments in the management of GSM.

Intravesical hyaluronic acid and chondroitin sulphate for bladder pain syndrome/interstitial cystitis: long-term treatment results

INTRODUCTION AND HYPOTHESIS

Reconstruction of the glycosaminoglycan layer plays a role in the successful treatment of bladder pain syndrome/interstitial cystitis (BPS/IC). Intravesical instillations of hyaluronic acid (HA) and chondroitin sulphate (CS) have given results in the short term. We hypothesise that these benefits continue in the longer term.

METHODS

With the aim of evaluating this therapy over a longer period we treated 12 BPS/IC patients refractory to other treatments with a combination of HA 1.6 % and CS 2.0 % over a period of 3 years assessing symptoms and quality of life using a visual analogue scale, 3-day voiding diaries and validated questionnaires.

RESULTS

Improvements in bladder function were sustained for 3 years (mean number of daily voids decreased from 17.8 at baseline to 15.5 at 9 months and 11.9 at 3 years, and mean volume per void from 136.8 ml at baseline to 143.9 ml at 9 months and 180.9 ml at 3 years). Quality of life assessments confirmed these improvements.

CONCLUSIONS

Intravesical instillations of HA and CS produced a sustained improvement of the symptomatology, up to 3 years, in patients with BPS/IC refractory to previous treatments. Further confirmation would be expected from larger controlled trials.

Voiding dysfunction after anti-incontinence surgery

Voiding dysfunction after incontinence surgery is a potential complication of all stress incontinence procedures. The term voiding dysfunction indicates from obstructive voiding symptoms up to complete urinary retention, requiring intermittent catheterization, and also includes irritative storage symptoms such as de novo urgency and detrusor overactivity. Of particular importance is the temporal relationship between symptoms and the previous surgical procedure, and although many different operations can result in voiding dysfunction, the most common cause remains attributable to hypersuspension of the urethra. The diagnosis of postoperative voiding dysfunction can be challenging. First of all surgeons must ask for an accurate history, in order to assess symptomatology and to carry out a physical examination. Further diagnosis could be done through urodynamics, but this is somewhat controversial: despite various proposed cut-off values, there are no absolute urodynamic criteria to define obstruction in women. Fortunately, most voiding dysfunction is transient and resolves spontaneously in a few days to weeks. Persistent voiding dysfunction (longer than 4 weeks) occurs in 5-20% after the Marshall-Marchetti-Krantz procedure, 4-22% after the Burch colposuspension, 5-7% after needle suspension, 4-10% after the pubovaginal sling procedure, and 2-4% after the trans-vaginal tape procedure. However, if symptoms persist, surgery is indicated. Several surgical approaches are described, including sling incision, sling lysis and formal urethrolysis, comprising vaginal and retropubic approach with or without graft interposition. In this article the procedures are described and the results of each type of urethrolysis are reported.

Results of endovesical hyaluronic acid/chondroitin sulfate in the treatment of Interstitial Cystitis/Painful Bladder Syndrome

OBJECTIVES

The aim of our study was to test the effect of a more viscous compound than existent hyaluronic acid formulation in helping to restore a defective glycosaminoglycan layer, and therefore in improving Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) symptoms when administered intravesically in IC/PBS patients.

METHODS

A total of 23 female patients completed the study. Patients received endovesical administration of hyaluronic acid and chondroitin sulfate in normal saline, 40 ml, weekly for 12 weeks and then bi-weekly for 6 months, if there was initial response.

RESULTS

After 12 weeks treatment both Interstitial Cystitis Symptom and Problem Index (ICSI/ICPI), pelvic pain and Urgency/Frequency Symptom Scale (PUF) showed a mean significant improvement, which was maintained thereafter. The average number of voidings and mean voiding volumes revealed significant improvement after the 12 weeks' treatment period, with a significant reduction and increase, respectively. Mean voiding volume increased from 143 ml to 191, which apparently was not reflected in a corresponding reduction of number of daily voids (from 15,5 to 14). VAS values decreased from 5,4 to 3,6 (pain) and from 6,0 to 3,5 (urgency) after the treatment cycle, showing a significant improvement.

CONCLUSIONS

In our preliminary experience, the administration of intravesical hyaluronic acid plus chondroitine sulphate appears to be a safe and efficacious method of treatment in IC/PBS.

The use of synthetics in the treatment of pelvic organ prolapse

Despite an improved understanding of pelvic anatomy and organ function and advances in surgical techniques, long-term success rates in pelvic surgery are still variable (3-59%), but can reach up to 92% in the case of associated procedures. The major causes of recurrent pelvic prolapse after corrective surgery are related to patient factors, such as poor tissues, impaired healing processes and chronic pathological increases in intra-abdominal pressure. Other causes of failure are, however, probably related to surgical techniques: the use of weak or insufficient sutures, or suboptimal performance of the surgery. In line with progress in the surgical correction of abdominal hernias, the use of synthetic mesh in pelvic reconstructive surgery also seems to guarantee its reliability, especially when autologous tissue is of poor quality or insufficient quantity. Moreover, the use of artificial mesh may simplify a surgical procedure, reducing operative time and the need for additional techniques. This review evaluates the main properties of synthetic biomaterials, their complications and the most common procedures involved in the use of synthetic mesh: the abdominal sacral colpopexy and transvaginal cystocele repair.

Surgical treatment of stress urinary incontinence

The treatment of stress urinary incontinence (SUI) is one of more controversial aspects of pelvic floor surgery. The indications for the surgical approach are related to the international classification as: Type 1 and Type 2 (Anatomical Incontinence), and Type 3 urinary incontinence (Intrinsic Sphincteric Dysfunction). The procedure of choice for Type 1 and Type 2 is Bladder Neck Suspension (BNS) that create a strong hammock against which the urethra can be compressed with sudden changes of abdominal pressure. Type 3 has to be treated by coaptation or compression of the deficient sphinteric unit (slings or injections). The mean cure rate after Marshall-Marchetti-Krantz is 77%, that of the Burch is 81%, and that of the Needle Suspension is 79%. Laparoscopy, Bone Anchors BNS and Tension-Free Vaginal Tape represent a promising option to the traditional techniques. The contribution of minimal invasive surgery consisting in: short recovery or possibility of day surgery, reduced trauma and pain, and success rate similar to the conventional techniques, is changing the SUI treatment.

[Endoscopic treatment of sphincter insufficiency with autologous fat injection]

A total of 11 women with stress urinary incontinence related to intrinsic sphinteric incontinence (type 3) underwent periurethral injection of autogolous fat. The fat was harvested from the abdominal wall by special liposuction unit including: a special syringe for plastic surgery provided with 6 straight needles 12-20 Gauge connected to a vaum extractor for the liposuction; a 14 Gauge straight needle for lipofilling periurethrally and then a cystoscope with a 0 degree and 70 degree lenses. The fat is injected at 3 and 9 o'clock position and the mean quantity was 15,5 ml. The exact localization of the injected area was endoscopically detected before, and afterwards with an ultrasound transrectal probe. Follow up results were assessed clinically and by urodinamic and ultrasound evaluation at 3, 6 and every six months following. A follow up was ranged from 9 to 36 months (mean 22.6). Of the 11 women, 6 (54.5%) were cured, 2 (18.2%) pats. Were improved and in 3 woman (27.3%) no change occurred. The Urodynamic parameters didn't show any statistical significant change except for Functional Urethral Length (p < 02) and Flow Time (p < 04) that increased in cured patient. The ultrasound evaluation showed an hyperecogenic aspect in all patients; and al the urethral wall was hyperecognic in 1 woman. The resorption average time was 8 months, and 8 pats (72.7%) showed a partial resorption after 22 months. 3 patients should have been reinjected, 2 of them were cured and in the last one an improvement was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Echographic diagnosis and treatment of urethral instability]

Unstable urethra as defined by the International Continence Society is the condition where loss of urine is caused solely by a fall in urethral pressure. But the condition is rare and therefore the term Urethral Pressure Variations (UPV) is better used. The UPV are caused by activity of smooth and striated muscles. Frequently is associated with Genuine Stress Incontinence or Detrsor Instability that can make worse urinary loss. An urogynecologic work-up can reveal the presence of UPV by Urodynamic and ultrasound evaluations. The Urethral Pressure monitoring reveals the fast or slow intraluminal pressure fall between 10 to 20 cm H2O or more. The ultrasound examination carried out by a linear vaginal probe (5 MHz) can observe the contraction of the "prepubic muscle" (anterior pubo-urethral ligament + bulbo-spongious muscle) as a preliminary phase of urethral pressure fall. The prepubic muscle located from clitoris to the external meatus exert a force on the anterior and distal part of the urethra during the intraluminal pressure falls. With the section of this structure (muscle + ligament) we treated 9 patients diagnosed as having UPV with concomitant irritative urologic symptoms. Out of 9 women with a follow-up ranged from 1 to 23 months (mean 9,5), 5 patients (56%) were cured, 2 (22%) of them were improved, in the last 2 (22%) patients no change was observed. The complications were minimal only a vestibulo-vaginal increased sensitivity, and one case of dyspareunia.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of human papillomavirus type 16 DNA sequences in paraffin-embedded tissues from the female urinary tract

We investigated the presence of human papillomavirus-related DNA sequences (HPV 6, 11, 16 and 18) in 33 formalin-fixed paraffin-embedded biopsies from the urinary tract of female patients with recurrent and persistent urethritis and cystitis, using the polymerase chain reaction (PCR). The samples for PCR reaction were selected among tissues examined for histological diagnosis on the basis of the presence of microscopic changes consistent with HPV infection. Sequences homologous to HPV 6, 11 and 18 genome were not found, while HPV 16-related DNA sequences were identified in 25/33 lesions with histopathological diagnosis of metaplasia (1 from the urethra, 23 from the trigone and 1 from the bladder). The results suggest that the spread of HPV in the female urinary tract may not be uncommon and point to the need for further research on the possible pathogenic role in recurrent female disturbances.

Acute urethral obstruction due to condylomata acuminata

Urethral obstruction is a rare disease in women, and even more uncommon is the occurrence of acute urethral obstruction due to condylomata. This case report describes the course of one such case, unique for its progressive clinical evolution, the primary involvement of the lower urinary tract in the absence of either an obvious primary site or a history of sexual intercourse for more than 15 years, and its successful treatment with cryotherapy.

Transvaginal bladder neck suspension: a safer method

A new modification of transvaginal technique of bladder neck suspension is described. Its main merit is its safety. The ligature-carrying needles are inserted from below rather than above. It virtually eliminates bladder injury. Our experience with 29 cases and a follow-up of six to thirty months shows that this technique is as successful as other similar procedures in controlling genuine stress incontinence.