Pre-operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre-operative mixed urinary incontinence.

AIMS: To determine if specific pre-operative urodynamic parameters could predict detrusor overactivity following TVT in patients with urodynamic mixed incontinence. METHODS: Notes of women with detrusor overactivity (DO) and urodynamic stress incontinence (USI) before undergoing tension-free vaginal tape (TVT) surgery were retrospectively reviewed. Patients underwent clinical evaluation pre-operatively including history, examination, and conventional urodynamic studies and were treated with pelvic floor exercises and anti-cholinergic medication. Those with persistent stress urinary incontinence (SUI) underwent TVT. Patients were re-assessed after at least 6 months post-operatively. Pre- and post-operative opening and closing detrusor pressure, and detrusor pressure at maximum flow were recorded retrospectively from pre-operative urodynamics traces by two clinicians independently and compared to the patients' post-operative symptoms and urodynamic diagnosis. RESULTS: Fifty-one women were reviewed. Forty-six of the 51 attended follow-up and 35/51 agreed to conventional urodynamic studies. Seventeen of the 35 reported OAB symptoms, and 18/35 were asymptomatic. Nineteen of the 35 women had DO and 16/35 had normal urodynamic studies (NUDS). The median pre-operative opening detrusor pressure was higher in women with overactive bladder symptoms post-operatively. The median pre-operative opening detrusor pressure in women with DO post-operatively was 33.0 cmH(2)O and the median pre-operative opening detrusor pressure in those with NUDS post-operatively was 16 cmH(2)O (15.0-23.0 cmH(2)O) (P < 0.05 Mann-Whitney U-test). CONCLUSIONS: Higher numbers of patients are required to demonstrate the value of opening detrusor pressure in predicting post-operative overactive bladder symptoms. Opening detrusor pressure is predictive of post-operative DO after TVT.

Effects of imitative and conversational recasting treatment on the acquisition of grammar in children with specific language impairment and younger language-normal children.

The purpose of the study was to compare the relative effectiveness of imitative treatment and conversational recast treatment in children with language impairment and in a group of children with normal language skills. Language treatment outcomes were compared between a group of older (4.7 to 6.7) specifically-language-impaired (SLI) children and a group of younger (2.2 to 4.2) language-normal (LN) children matched on language levels and on intervention targets. The results indicated: (a) Target acquisition was more rapid under conversational recast treatment for both groups: (b) This outcome held for targets absent initially (in pretreatment sampling and probing) as well as for initially partially mastered targets. (c) SLI children sometimes can learn grammatical structures as efficiently as language-normal children if similar language input is tailored to their specific developmental language levels. Implications of these findings for language treatment strategies with SLI children are discussed. Theoretical models compatible with the data also are considered.

Comparison of conversational-recasting and imitative procedures for training grammatical structures in children with specific language impairment.

The recent literature on language intervention has become increasingly focused upon developing treatments that more closely parallel normal language acquisition. However, there have been relatively few reports that directly compare imitative procedures to conversational-interactive interventions. The purpose of the present study was to compare the relative effectiveness of imitative intervention and conversational recast language intervention applied to a wide range of grammatical morpheme and complex sentence targets in 21 children with specific language impairment. The results indicated that although both kinds of treatments were effective in triggering acquisition of most targets, consistently fewer presentations to first spontaneous use were required in the conversational procedure. In addition, the transition from elicited production to generalized spontaneous production was more rapid under conversation-interactive treatment. Finally, although imitation treatment was more effective in generating elicited production, a significantly greater number of spontaneous productions occurred under the conversational training procedures. The theoretical and applied ramifications of these findings are discussed.