Evaluation and treatment of the overactive bladder

The overactive bladder is characterized by symptoms of frequency, urgency, and urge incontinence, substantially affecting the quality of life of millions of people throughout the world. The symptoms are associated with significant social, psychological, occupational, domestic, physical, and sexual problems. Despite the considerable impact of this condition on quality of life, sufferers are often unwilling to discuss their problem with family members or health care professionals. This situation is unfortunate, for much can be done to alleviate the symptoms of this distressing condition. It is therefore of utmost importance that medical education about symptoms of the overactive bladder and other related problems be improved to help health care professionals identify and treat patients who will benefit from therapy. This article reviews current thinking regarding definition, epidemiology, quality of life effects, evaluation, and management of the overactive bladder

How to prevent complications in vaginal surgery

Vaginal surgery complications can at times be difficult to manage. Clearly the best management scheme entails steps to prevent complications. This requires judicious planning preoperatively with detailed knowledge of this patient's case, operative anatomy, surgical indications and expectations, as well as prudent use of preoperative diagnostic testing. Thus, being prepared facilitates better recognition of intraoperative complications and subsequent treatment in an expeditious fashion. The most frequent and important complications of vaginal surgery are listed in the following sentences and are extensively discussed: 1)- Bleeding: most cases of bleeding that one experiences during transvaginal surgery are self corrected; 2)- Infection: since bacteria potentially contaminate the vagina, it is a frequent site of infections in the postoperative period; osteomyelitis of the public bone is an infrequent occurrence, however, with the increasing use of bone anchors in vaginal sling surgery, one must be aware of this complication; 3)- Bladder Injuries/Perforation: injuries to the bladder may occur during dissection of the vaginal epithelium off of the underlying perivesical fascia and bladder or during suture passage in cystocele repairs or incontinence procedures; 4)- Urethral Injury: intraoperative injuries to the urethra should be an infrequent occurrence due to its easy identification with a foley catheter in place; 5)- Ureteric Injuries: occur in 0.3 to 3 percent of patients undergoing gynecologic surgery; 6)-Bowel/Rectal Injury: should be an uncommon complication, yet when injury does occur, one must approach it seriously; 7)- Neurologic Injury/Postoperative Pain: sacropinous fixation can be complicated by nerve injury as the pudendal nerve lies in proximity to the sacrospinous ligament...