"Like a rabbit from a hat!"--a case of a sacrocolpopexy mesh being taken out by a patient.

Sacrocolpopexy, be it laparoscopic or abdominal, is associated with a risk of mesh extrusion. We report an interesting case of mesh extrusion with subsequent removal of the mesh from the vagina by the patient. We take this opportunity to review the literature regarding incidence, predisposing factors and complications of sacrocolpopexy mesh extrusion with specific reference to this case.

Urine production and bladder diary measurements in women with type 2 diabetes mellitus and their relation to lower urinary tract symptoms and voiding dysfunction.

AIMS: To establish bladder diary measurements in women with type 2 diabetes mellitus (DM) and their relation to bothersome LUTS and voiding dysfunction. METHODS: One hundred ten women with type 2 DM were assessed using the King's Health and ICIQ-FLUTS questionnaires. Patients were divided into bothersome and non-bothersome LUTS according to bother scale of the ICIQ-FLUTS. Voiding was assessed with free flow rate and residuals. Three day bladder diary measurements were obtained and 24 hr, daytime and nighttime urine production, daytime frequency, nighttime frequency, maximum bladder capacity, mean voided volume, mean daytime and nighttime voided volumes, and incontinence episodes were recorded. Differences in bladder diary measurements between bothersome and non-bothersome groups and between normal and abnormal voiding groups were established with multivariate analysis. Correlations between urine production and voided volumes and between diary measurements and domains of the ICIQ-FLUTS were established. RESULTS: There were no differences in urine production, between bothersome and non-bothersome LUTS groups. Women with bothersome LUTS had greater nighttime frequency (2.6 vs. 1.4) and number of incontinence episodes (3.3 vs. 0.4). Abnormal voiding group had higher nocturnal urine production (1,007 ml vs. 654 ml). There were significant correlations between nighttime frequency, number of incontinence episodes, and the storage and incontinence domains of the ICIQ-FLUTS. Bladder capacity significantly increased with increased total urine volumes. CONCLUSIONS: Bothersome LUTS in DM is not associated with increased urine production. Bladder capacity increased with total urine volume. Nocturia and incontinence episodes were significantly associated with bothersome LUTS.

Prevalence and risk factors for bothersome lower urinary tract symptoms in women with diabetes mellitus from hospital-based diabetes clinic.

INTRODUCTION AND HYPOTHESIS: There is limited data on prevalence and risk factors for bothersome lower urinary tract symptoms (LUTS) in women with diabetes mellitus (DM). This study assesses prevalence and risk factors for bothersome LUTS and voiding dysfunction in women with DM. METHODS: Two hundred twenty women participated in this study. Participants completed the King's health questionnaire and the international consultation on incontinence-female lower urinary tract symptom questionnaire. Symptoms prevalence and urinary flow rate were assessed. Logistic regression models for risk factors of bothersome LUTS and voiding dysfunction were constructed. RESULTS: One hundred forty-eight women completed the study. Sixty-one women (41%) had bothersome LUTS. Urgency incontinence, urgency, and nocturia were the most bothersome. Fifty-six (38%) had voiding dysfunction. Neuropathy and glycosylated haemoglobin were independent risk factors for voiding dysfunction. Voiding dysfunction did not affect quality of life in women with DM. CONCLUSIONS: Overactive bladder symptoms are the most bothersome in diabetic women. Neuropathy and glycosylated haemoglobin are risk factors for voiding dysfunction.

Diabetes mellitus and female lower urinary tract symptoms: a review.

Diabetes mellitus (DM) has reached epidemic proportions world wide. Many chronic complications of DM, including neuropathy, retinopathy and nephropathy, have been well studied and although urologic complications have been recognized since 1935, little is known about DM as a pathophysiological risk factor for development of lower urinary tract symptoms (LUTS) in women. Diabetic nephropathy, a life-threatening condition, has received considerable attention in the last few years. Diabetic cystopathy, on the other hand, has received far less attention despite having a significant impact on quality of life, and with significant individual health risks. Initial studies suggested that long standing DM causes paralysis of the detrusor muscle leading to voiding difficulties and this has been the received wisdom regarding diabetic cystopathy for many years. In this review, we discuss what is currently known about lower urinary tract function and urinary incontinence in diabetic females, with a critical analysis of the available evidence and suggest areas for future research.

Symptomatic and quality of life outcomes after site-specific fascial reattachment for pelvic organ prolapse repair.

The aim of this study was to assess symptomatic and quality of life outcome scores following site specific fascial reattachment surgery for pelvic organ prolapse using the validated Prolapse Quality of Life (P-QOL) questionnaires. One hundred and ninety two women underwent surgery for pelvic organ prolapse; ninety four underwent anterior repair (thirty four of them had vaginal hysterectomy), and ninety eight had posterior repair. Patients filled P-QOL questionnaires 24 hours prior to surgery and a postal P-QOL questionnaire six months post operatively. Pre and post operative questionnaires were paired. Quality of life and symptoms scores were calculated using Wilcoxon signed rank test. One hundred and one women returned their questionnaires and were suitable to include in the study. Forty nine underwent anterior repair (fifteen had vaginal hysterectomy) and 52 underwent posterior repair. Quality of life scores showed significant improvement in the anterior and posterior repair groups with the exception of general health in the anterior repair group and general health and prolapse impact in the posterior repair group. Anterior repair significantly improved urinary voiding and storage symptoms. Posterior repair group showed significant improvement in defecatory symptoms. Both groups showed improvement in sexual function and general prolapse symptoms. Prolapse repair with site specific fascial reattachment results in significant improvement in quality of life scores six months after surgery. Anterior repair improves urinary voiding and storage symptoms and posterior repair improves defecatory dysfunction and urinary voiding. Sexual function improves following prolapse repair with site specific fascial reattachment.