ABSTRACT
INTRODUCTION AND HYPOTHESIS: This study was performed to determine whether anatomical recurrence of cystocoele 1 year after anterior vaginal repair is related to biomechanical properties and/or the content of collagen in the vaginal wall and epithelial tissues. METHODS: In this prospective, observational study in a UK teaching hospital, we assessed women undergoing surgery for symptomatic anterior compartment prolapse. Outcome measures were anatomical recurrence, biomechanical strength and collagen content in vaginal tissues. In part one of the study, 42 women underwent biomechanical testing of full-thickness anterior vaginal wall tissue samples to determine the elastic moduli and yield stress. In part two, 59 women underwent immunohistochemical testing of anterior vaginal wall tissue samples to determine tissue content of procollagen I; collagen types I, III, V; and matrix metalloproteinases 1 and 2 (MMP-1 and 2). Results were then compared with anatomical outcome at 1 year postsurgery. RESULTS: Differences in yield strain in all outcome groups (optimal, satisfactory and unsatisfactory) were not statistically significant. Considerable variation was found in collagen type I in both satisfactory and unsatisfactory groups. There was no difference or correlation with procollagen, collagen types III and V, and MMP-1 and recurrence of pelvic organ prolapse (POP) between groups. There was a weak correlation between collagen type I and higher yield stress in both groups. CONCLUSIONS: Anatomical failure of anterior repair does not appear to be related to the biomechanical strength or collagen content of the anterior vaginal wall.
Subject(s)
Gynecologic Surgical Procedures , Uterine Prolapse/etiology , Uterine Prolapse/surgery , Vagina/metabolism , Vagina/physiopathology , Adult , Aged , Aged, 80 and over , Biomechanical Phenomena/physiology , Collagen/metabolism , Female , Follow-Up Studies , Humans , Immunohistochemistry , Matrix Metalloproteinase 1/metabolism , Matrix Metalloproteinase 2/metabolism , Middle Aged , Prospective Studies , Recurrence , Treatment Outcome , United Kingdom , Uterine Prolapse/epidemiology , Vagina/surgeryABSTRACT
The overactive bladder is a common condition, which has significant effects on quality of life. The aetiology in most cases is unknown, and treatment outcomes have until recently been unsatisfactory. Management includes excluding pathology and implementing behavioural changes such as caffeine reduction, bladder and pelvic floor training, as well as antimuscarinic drug therapy. Compliance is often problematic, and this can be improved with some of the newer antimuscarinics with fewer side-effects, and a good therapist/patient relationship. In the majority of cases this 'treatment package' is successful, but in those where it is not, intravesical therapies have been introduced, e.g. neuromodulation, alternative drug therapies (e.g. vanilloids, botox) and surgery. With a better understanding of the aetiology and identification of risk factors better outcomes from treatment are likely.
Subject(s)
Urinary Bladder Diseases/physiopathology , Behavior Therapy/methods , Cholinergic Antagonists/therapeutic use , Electric Stimulation Therapy/methods , Estrogens/therapeutic use , Female , Humans , Muscle Contraction , Patient Compliance , Pelvic Floor/physiopathology , Prevalence , Quality of Life , Risk Factors , Terminology as Topic , Urinary Bladder Diseases/etiology , Urinary Bladder Diseases/therapy , Urinary Incontinence/etiology , Urinary Incontinence/surgeryABSTRACT
The authors performed a self-administered postal questionnaire survey of 690 consultant gynecologists in the UK to determine the current surgical and perioperative practice in relation to colposuspension; 350 (51%) responded. One hundred and twelve (32%) identified themselves as having a specialist interest in urogynecology. The study shows the variation in the surgical technique of colposuspension and perioperative care among gynecologists, and it provides information that may help in the development of guidelines for those involved in the surgical treatment of female urinary incontinence.
Subject(s)
Urinary Incontinence, Stress/surgery , Urologic Surgical Procedures/methods , Female , Humans , Intraoperative Care , Postoperative Care , Practice Patterns, Physicians'/statistics & numerical data , Preoperative Care , Surveys and Questionnaires , Suture Techniques , United Kingdom , Urodynamics , Vagina/surgeryABSTRACT
This retrospective descriptive study was performed to assess the practice of using the distal urethral electrical conductance (DUEC) test to objectively demonstrate urinary incontinence in symptomatic women with a negative cough stress test on examination. One hundred women had stable bladders on cystometry (CMG). Genuine stress incontinence (GSI) was diagnosed during CMG in 45 (45%). DUEC performed prior to cystometry had revealed stress incontinence in an additional 13 with negative CMG, thereby improving the diagnosis of GSI by 13%. The test detected urge incontinence in one (1%). The DUEC test improves the detection of stress incontinence. However, it should not be considered as an alternative to cystometry, but as an additional test when stress incontinence cannot be demonstrated clinically.
Subject(s)
Electric Conductivity , Urethra/physiology , Urinary Incontinence, Stress/diagnosis , Cough , Female , Humans , Middle Aged , Retrospective Studies , Urinary Incontinence, Stress/physiopathology , Urodynamics/physiologyABSTRACT
The object of this study was to determine the variation in urodynamic practices in the United Kingdom. One hundred questionnaires were sent to units known to be performing urodynamic investigations. It was obvious that there was a significant variation in practices with only 51% of units having a protocol for what tests should be performed, under what circumstances and how. Standardisation of urodynamic variables may result in a greater consistency of diagnosis, allowing easier comparisons of treatment regimes and outcomes.
