Knowledge, attitude and practice towards pelvic floor muscle training among childbearing women.

OBJECTIVES: This study aims to identify knowledge, attitude, and practice of pelvic floor muscle training (PFMT) and to identify the prevalence of urinary incontinence. MATERIALS AND METHODS: The method used was a cross-sectional study. Self-administered knowledge, attitude, and practice questionnaires were distributed among childbearing women attending Maternal & Child Health Clinics in the East Coast region of Malaysia. RESULTS: The findings revealed that most respondents (N = 896) had good or moderate knowledge (80.1%) and attitudes (77.3%) regarding PFMT but most of them (87.2%) still lacked practice. However, there was no association between urinary incontinence and PFMT practice. On the contrary, married women showed a higher risk of urinary incontinence. CONCLUSIONS: The practice of pelvic floor muscle training should be recommended and emphasized to childbearing women by healthcare professionals.

Validation of the Malay version of the p-QOL questionnaire.

INTRODUCTION: This study aimed to translate and validate the P-QOL questionnaire in the Malay language. METHODS: The P-QOL questionnaire was translated into the Malay language and subsequently back-translated to English. Test-retest reliability and internal consistency were tested. All patients who visited the gynecology outpatient clinic of UKMMC, UMMC and IIUM between January 2016 and May 2017 completed the P-QOL questionnaires and were assessed for POP-Q staging. RESULTS: One hundred twenty patients with symptomatic pelvic organ prolapse and 180 asymptomatic patients were included. The Cronbach's alpha for each domain was > 0.70, which confirmed that there was a highly acceptable internal consistency. The value varied between 0.88 (role limitation) and 0.912 (sleep/energy). Test-retest reliability showed a significant correlation between the total scores for each domain (p < 0.001). There was a significant correlation between P-QOL domain scores and vaginal examination findings (POP-Q). With a higher POP-Q stage, a higher impact on the quality of life was detected in symptomatic patients. The total scores from all domains were significantly higher in symptomatic patients. CONCLUSION: The Malay translated version of the P-QOL questionnaire is a reliable, consistent, and valid instrument for assessing the severity of the symptoms and impact on the quality of life among women with uterovaginal prolapse. It is easily understood, administered, and self-completed by patients.

Translation and Validation of Bahasa Malaysia Version of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Quality of Life Questionnaires (IIQ-7), a Cross Sectional Study.

BACKGROUND: Urinary incontinence (UI) demonstrates major prevalence in women of different population groups. Reduced quality of life (QOL) is observed due to incontinence problems. Urogenital Distress Inventory (UDI-6) and Incontinence Impact Quality of Life (IIQ-7) are useful disease-specific questionnaires evaluating the impact of urinary incontinence on the QOL of women which is accepted internationally. OBJECTIVE: This study aims to translate and validate UDI-6 and IIQ-7 in Malay language. METHODS: A cross sectional study, which recruited 100 participants from two urogynecology clinics. Both questionnaires were initially translated from English to Bahasa Malaysia followed by back translation and final correction done by the professional translators. The participants were requested to maintain a urinary record of the upcoming week for three days that assisted in quantifying the severity of symptoms. None of the subjects were assigned any treatment during the study period. Validity and reliability of the translated questionnaires were determined by checking the internal consistency and also by doing test-retest. RESULTS: The internal consistency levels of the UDI-6 and IIQ-7 Bahasa Malaysia questionnaires were 0.73 and 0.90 respectively with good test-retest (0.86 and 0.95). Incontinence episodes were strongly associated with obstructive, irritative, and stress symptoms. The factor of day time voiding had strong correlation with obstructive and irritative symptoms. CONCLUSION: UDI-6 and IIQ-7 did not measure similar outcomes; however, both questionnaires have their strengths in clinical settings. Analysis has also revealed that the Malaysian versions of both questionnaires had appropriate test-retest validity and reliability. Thus, it can be said that both of the questionnaires had great importance for screening patients with urinary incontinence in Malaysia.

Predictors for de novo stress urinary incontinence following extensive pelvic reconstructive surgery.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to look for possible predictors preoperatively for the development of de novo stress urinary incontinence (SUI) in urodynamically continent women who underwent pelvic reconstructive surgery (PRS). MATERIALS AND METHODS: Medical records of 637 continent women who underwent PRS for severe prolapse from January 2005 to December 2013 in our institutions were included in this study. We excluded women who had urodynamic stress incontinence (UDI) either occult or overt, detrusor overactivity, neurogenic bladder-voiding dysfunction, and previous anti-incontinent surgery. Primary outcome measure was the development of de novo SUI at 6 months to 1 year post operation. RESULTS: Of women in this study, 11 % developed postoperative de novo SUI at 6 months to 1 year of follow-up. Women older than 66 years were 2.86 times [95 % confidence interval (CI) 1.01-2.53, p = 0.14], diabetes mellitus (DM) 2.18 times (95 % CI 1.63-4.21, p = 0.002), certain type of transvaginal mesh procedure 3.5 times (95 % CI, p < 0.001), maximum urethral closure pressure (MUCP) < 60 mmH20 4.65 times (95 % CI, 2.87-8.64, p < 0.001), and functional urethral length (FUL) < 2 cm 3.48 times (95 % CI, 2.13-5.83, p < 0.001) at greater risk of developing de novo SUI. CONCLUSIONS: Continent women with advanced pelvic organ prolapse (POP) > 66 years, with DM or low MUCP and FUL values during preoperative urodynamic evaluation have higher risk of developing de novo SUI; therefore, we suggest counselling such women for concomitant PRS and anti-incontinent surgery.

Is portable three-dimensional ultrasound a valid technique for measurement of postpartum urinary bladder volume?

OBJECTIVE: To determine the accuracy of bladder volume (BV) measurement and to identify factors that influenced the ultrasound bladder scanner (UBS) measurement of BV in postpartum women compared with transurethral catheterization. MATERIALS, METHODS AND RESULTS: A total of 190 paired measurements were performed on 190 women aged between 16 and 47 years. Majority of the women (36.9%) were in their first parity (range: 1-9). The mean BV was 159.46 mL [standard deviation (SD) = 99.78; range: 17-593 mL] on three-dimensional (3D) UBS and 143.76 mL (SD = 104.89; range: 2-588 mL) on catheterization. The mean difference between the two values was 15.70 mL (SD = 69.31, p < 0.001). The Foley's catheter was clamped for a minimum of 30 minutes and a maximum of 260 minutes. The UBS measurements were highly correlated with the BV obtained by catheterization (r = 0.819; p < 0.001). There was no significant difference between UBS and catheterized volume in a different volume subgroup. There were 35 cases (18.2%) with the difference in measurement of more than 25%. Twenty-five cases were associated with a catheterized volume less than 50 mL. There were a total of 33 cases with true BV of less than 50 mL, and only eight cases (24.24%) had an accurate measurement. The UBS tends to overestimate BV between 2 and 270 mL in this group. There was a significant linear relationship between the difference in measurement and body weight and duration of clamping. CONCLUSION: Measurement of BV in immediate postpartum period using UBS is comparable with urethral catheterization. The accuracy of measurement is affected by body weight and increasing amount of BV.

Second-trimester uterine rupture: lessons learnt.

UNLABELLED: Uterine rupture is a rare life-threatening complication. It mainly occurs in the third trimester of pregnancy and is rarely seen during the first or second trimesters. Our centre experienced three important cases of uterine rupture. FIRST CASE: spontaneous uterine rupture at 14 weeks of pregnancy, which was diagnosed at autopsy. It was misled by the ultrasound finding of an intrauterine pregnancy, and searching for other non-gynaecological causes delayed the urgent obstetric surgical management. SECOND CASE: ruptured uterus at 24 weeks following medical termination due to foetal anomaly. It was diagnosed only at laparotomy indicated for failed medical termination and chorioamnionitis. Third case: uterine rupture at 21 weeks of pregnancy in a patient with gastroenterology symptoms. In these reports, we have discussed the various risk factors, presentations, course of events and difficulties in diagnosing uterine rupture. The study concludes that the clinical presentation of uterine ruptures varies. It occurs regardless of gestational age. Ultrasound findings of intrauterine pregnancy with free fluid do not exclude uterine rupture or ectopic pregnancy. Searching for non-gynaecological causes in such clinical presentations might delay crucial surgical intervention, which leads to unnecessary morbidity, mortality or loss of obstetrics function.

Fetal Intra-Abdominal Umbilical Vein Varix in Monochorionic Twins: Is it Significant?

A 30-years-old Taiwanese female in her second pregnancy spontaneously conceived a monochorionic twin pregnancy. A routine ultrasound at 27 weeks of gestation revealed a selective intrauterine growth restriction (sIUGR) fetus and an appropriate gestational age (AGA) fetus. The AGA fetus was found to have a fetal intra-abdominal umbilical vein (FIUV) varix. Serial ultrasounds showed no changes in the FIUV varix. 2 weeks later, the pregnancy progressed to twin-twin transfusion syndrome (TTTS). Repeated amnioreductions were required at 29 and 30 weeks gestation. The babies were delivered by caesarean section at 31 weeks due to fetal distress in the sIUGR fetus. Both fetuses survived the neonatal period with problems of prematurity. The FIUV varix disappeared a few days after delivery.

Uterine inversion with massive uterovaginal prolapse and multiple bladder stones.

A non-puerperal uterine inversion in advanced uterovaginal prolapse is a rare occurrence. Even more unusual is the presence of bladder calculi in these two conditions, which has not been documented before. We report a case of acute urinary retention secondary to severe uterovaginal prolapse associated with uterine inversion and multiple bladder calculi.

Repeated endoscopic excision of an eroding calcified mesh sling-continued follow-up is required.

The tension-free vaginal tape (TVT) procedure is the most popular worldwide for treating stress urinary incontinence. Intravesical mesh erosion related to the use of the TVT sling is rare. We report a rare case of mesh erosion over the bladder dome, with stone formation developing 11 years after TVT surgery. The diagnosis was made by cystoscopic examination after a 5-month history of lower urinary tract symptoms. Cystoscopic cystolithotomy was performed. No obvious mesh material was seen except for a small filament that was excised cystoscopically. Repeat cystoscopic follow-up was performed a year later. A recurrent stone formation resulted from a nonvisible mesh filament. Repeat cystoscopic cystolithotomy was performed, and the patient refused further surgical intervention. In women with a history of undergoing the TVT procedure and who have persistent lower urinary tract symptoms, a cystoscopic examination is mandatory to avoid delay in diagnosis and underreporting of sling-related complications. Despite satisfactory cystoscopic management, long-term regular follow-up is still required.