Pakistani preschoolers' number of older siblings and cognitive skills: Moderations by home stimulation and gender.

The present study examines the link between children's number of older siblings and their cognitive development, as measured by executive function (EFs) skills and verbal skills (VIQ) in a sample of 1,302 4-year-old children (54% boys) living in rural Pakistan. Specifically, we investigate whether the links between the number of older siblings and preschoolers' EFs and VIQ are moderated by preschoolers' quality of home stimulation and gender. Multivariate regressions revealed that the number of older siblings was positively associated with EFs for boys in homes with both higher and lower levels of stimulation, and for girls in homes with lower levels of stimulation (p < .05). However, the number of older siblings was negatively associated with EFs for girls from homes with higher levels of stimulation (p = .03). Further, the number of older siblings was positively associated with VIQ in homes with lower stimulation (p < .05), but not for higher stimulation homes. Gender was not a statistically significant moderator of the association between the number of older siblings and VIQ. Findings suggest that living with more older siblings may promote emerging EFs and VIQ among boys and girls with fewer opportunities for cognitive stimulation. However, more older siblings may hinder EF development for girls in the context of adequate home stimulation, perhaps due to inequitable allocation of resources among boys and girls in more affluent, larger families. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Outcomes associated with the use of midurethral slings for stress incontinence surgery according to the type of hospitalization.

OBJECTIVE: To evaluate the influence of type of hospitalization on outcomes of stress urinary incontinence (SUI) surgery using a midurethral sling procedure. METHODS: A retrospective secondary analysis was conducted using data from a prospective multicenter randomized trial of SUI surgery at several sites in France between January 1, 2003, and December 31, 2007. Type of hospitalization was chosen according to the surgeon's policy. RESULTS: Among 149 participants, 31 (20.8%) were treated as outpatients and 118 (79.2%) as inpatients. Perioperative complications were recorded for 1 (3.2%) outpatient and 12 (10.1%) inpatients (P=0.388). At 24months of follow-up, none of 25 outpatients and 6 (5.6%) of 107 inpatients had a positive stress test result (P=0.497). Dryness was reported at this time point by 22 (88.0%) outpatients and 89 (83.2%) inpatients (P=0.922). The median satisfaction score (measured by visual analog scale [scores of 0-100]) at 12months was 100.0 (interquartile range [IQR] 93.5-100.0) among outpatients versus 96.5 (IQR 80.0-100.0; P=0.003) among inpatients. Similar results were observed at 24months (P=0.003). CONCLUSION: Complication and failure rates were similar in both groups, but satisfaction was higher among outpatients.

Female urinary incontinence and intravaginal electrical stimulation: an observational prospective study.

OBJECTIVE: To assess the efficacy of intravaginal electrical stimulation in the management of female urinary incontinence. STUDY DESIGN: 359 Women with urinary incontinence (207 with stress incontinence [group A], 33 with urge incontinence [group B] and 119 with mixed urinary incontinence [group C]) were included in this multicenter prospective observational study. Patients were managed by home intravaginal electrical stimulation of the pelvic floor for 20-30 min per day, 5 days a week, for a period of 10 weeks. Identical clinical assessments were performed before and after pelvic floor rehabilitation, comprising a voiding diary and validated symptom and quality of life scores. RESULTS: Objective assessment demonstrated an overall cure rate of 63.5% (228/359): 65.7% (136/207) for group A, 57.6% (19/33) for group B, and 61.3% (73/119) for group C. The overall significant improvement rate was 15.6% (56/359): 14.6% (30/207) for group A, 24.2% (8/33) for group B and 15.1% (18/119) for group C. All domains of quality of life were significantly improved after pelvic floor muscle training (p<0.0001) with a patient satisfaction rate of 83.6%. Treatment was well tolerated with 1.4% (5/359) of patients describing pain at the highest stimulation intensities. No significant difference was observed between the various types of electrodes used (p<0.0001). CONCLUSION: The quantitative and qualitative efficacy in terms of social and psychological consequences and quality of life of home pelvic floor muscle training stimulators probably make this treatment modality one of the first-line treatments for female stress urinary incontinence.

Transobturator TVT-O versus retropubic TVT: results of a multicenter randomized controlled trial at 24 months follow-up.

INTRODUCTION AND HYPOTHESIS: The purpose of this study is to compare the retropubic tension-free vaginal tape (TVT) procedure with the inside-out transobturator approach (TVT-O). METHODS: Multicenter randomized controlled trial. One hundred forty-nine patients were randomly allocated to either TVT (n = 75) or TVT-O (n = 74). Interview, medical examination, pain scores, success rates, and quality of life assessment were recorded pre-operatively, and 2, 6, 12, and 24 months post-operatively. RESULTS: One hundred forty-nine patients underwent surgery, and 132 completed a 24-month follow-up. Bladder injury rate was 5% (4/75) in the TVT group and 2% (2/74) in the TVT-O group (p = 0.68). There was no significant difference between the two groups, concerning overall cure rate and the patients' satisfaction rate at 24 months follow-up. The range of mean pain scores was significantly higher after the TVT-O procedure post-operatively but not at 24 months follow-up. CONCLUSION: TVT and TVT-O procedures both have an outcome associated with an increase in quality of life with no significant differences in satisfaction rates at 2 years follow-up.

Clinical and ultrasonographic correlations following three surgical anti-incontinence procedures (TOT, TVT and TVT-O).

The aim of this study was to compare ultrasonographic findings on tape position, angulation and mobility following three surgical anti-incontinence procedures (trans-obturator tape (TOT), tension-free vaginal tape (TVT), tension-free vaginal tape obturator (TVT-O)) and to correlate these data with clinical signs of cures and failures and de novo voiding disorders. In this prospective study, vesicourethral static and dynamic analysis of 81 patients (30 TOT, 28 TVT, 23 TVT-O) were evaluated using introital ultrasonography. Width, position and appearance of the tape were similar in all three groups, i.e. like a "V" at rest, round angulation on Valsalva and closed angulation at maximum retaining. Moreover, closer angulation on Valsalva was associated with voiding disorders. Closer angulation at retaining was associated with de novo urge incontinence. Larger angulation of the tape at rest appeared to be significantly associated with recurrent stress incontinence. Ultrasonography could a be useful tool assessing anti-incontinence procedures and investigating post-operative voiding disorders.

Anatomical and functional results of McCall culdoplasty in the prevention of enteroceles and vaginal vault prolapse after vaginal hysterectomy.

The objective of the study is to evaluate the anatomical and functional results of the McCall culdoplasty in the treatment of moderate hysterocele and the prevention of enterocele and vaginal vault prolapse after vaginal hysterectomy. Using a modified McCall procedure, 185 patients underwent vaginal hysterectomy for mild or moderate uterine prolapse. Pre- and post-operative assessments were carried out using the International Continence Society staging system. The 24-month follow-up showed stable 89.2% incidence of stage 0 vaginal vault prolapse (point C) and a 10% incidence of stage 1 vaginal vault prolapse that was well tolerated and did not require revision surgery. Functional analysis showed satisfactory sexual function at 24 months post-surgery for 81.2% of patients. The McCall culdoplasty did not lead to a disruption of the vaginal axis and gave excellent anatomical and functional results in maintaining support after vaginal hysterectomy, especially in sexually active patients.

[Pudendal nerve block: local anaesthesia for insertion of suburethral tape: preliminary study of 9 cases]. / Le bloc pudendal: une anesthésie loco-régionale pour la mise en place d'une bandelette sous-urétrale: étude préliminaire.

PURPOSE: The objective of this study is to evaluate the safety of local anaesthesia by pudendal nerve block (PNB) for insertion of TVT or TOT suburethral tape for the treatment of female urinary incontinence. MATERIAL AND METHOD: PNB is performed by bilateral injection between the anus and ischium. The pudendal nerve, detected by electrostimulation, is anaesthetised by a solution of Naropeine and Carbocaine. Anaesthesia is systematically completed by abdominogenital and genitofemoral nerve blocks and by deep infiltration in the vagina. Perioperative and postoperative pain was assessed by visual analogue scale (VAS). RESULTS: Nine patients were treated by suburethral tape under PNB between November 2002 and January 2003. The mean age was 65.5 years (range: 46 to 87 years). TVT was used in 6 cases and TOT was used in 3 cases. PNB was well tolerated by the patient in 66% of cases. Eight patients (88%) did not experience any pain during the operation. The majority of patients (88%) were very satisfied with the anaesthesia. One patient experienced residual pain for 3 weeks. The technique is easy to perform by the anaesthetist and did not modify the surgical technique. This technique is relatively inexpensive. CONCLUSION: This preliminary study on a limited number of cases shows that PNB appears to be a good alternative to the usual anaesthesia techniques for insertion of suburethral tape.

[Compression of the bulbar urethra by transobturator suburethral tape: anatomical study]. / Compression de l'urèthre bulbaire par bandelette sous uréthrale trans-obturatrice: étude anatomique.

INTRODUCTION: The management of female stress urinary incontinence has been markedly improved by the suprapubic tension-free vaginal tape (TVT) and transobturator tape techniques. The objective of our study was to assess the feasibility of this type of technique in males based on cadavre dissection. MATERIAL AND METHOD: A 300 mm x 15 mm polypropylene tape was inserted via a transobturator approach on a cadavre stored in the refrigerator at 4 degrees C and on three cadavres stored in formalin. The technique was almost identical to that used in females. It requires a midline perineal incision in the raphe and two small lateral incisions. The deep transverse muscle of the perineum was opened with scissors. The needle was introduced via the lateral incisions and its progression was guided by a finger introduced into the perineal orifice. The cadavre was then sectioned sagittally to verify the course of the tape and its relations to adjacent structures. RESULTS: The operative technique did not raise any particular problems. Dissection revealed that the tape crossed the deep transverse muscle of the perineum and the levator ani muscle, before travelling towards the obturator foramen. The tape avoided the bladder, prostate, corpora cavernosa, and pudendal pedicle. CONCLUSION: The transobturator tape technique therefore appears to be feasible in males. It does not appear to comprise any particular risks for adjacent organs. This anatomical study appeared to be essential before considering an in vivo application.