Does transition of urinary incontinence from one subtype to another represent progression of the disease?

INTRODUCTION AND HYPOTHESIS: Mixed urinary incontinence (UI) is, on average, more severe than urgency UI or stress UI. We tested the hypothesis that mixed UI is a more advanced stage of UI by comparing transition probabilities among women with stress, urgency, and mixed UI. METHODS: We used data from the General Longitudinal Overactive Bladder Evaluation Study-UI, which included community-dwelling women, aged 40+ years, with UI at baseline. Study participants completed two or more consecutive bladder health surveys every 6 months for up to 4 years. Using sequential 6-month surveys, transition probabilities among UI subtypes were estimated using the Cox-proportional hazards model, with the expectation that probabilities from stress or urgency UI to mixed UI would be substantially greater than probabilities in the reverse direction. RESULTS: Among 6,993 women 40+ years of age at baseline, the number (prevalence) of women with stress, urgency, and mixed UI was 481 (6.9%), 557 (8.0%), and 1488 (21.3%) respectively. Over a 4-year period, the transition probabilities from stress UI (34%) and urgency UI (27%) to mixed UI was significantly higher than probabilities from mixed to stress UI (6%) or to urgency UI (rate = 9%). The adjusted transition hazard ratio for stress UI and urgency UI was 2.06 (95% CI: 1.73-2.92) and 1.85 (95% CI: 1.63-2.57) respectively compared with mixed UI. CONCLUSION: The substantially higher transition from stress UI and urgency UI to mixed UI supports the hypothesis that mixed UI might represent a more advanced stage of UI that may have implications for understanding disease progression.

Unique complication of a Shirodkar cerclage: remote formation of a vesicocervical fistula in a patient with the history of cervical cerclage placement: a case report and literature review.

BACKGROUND: Cervical cerclage placement is an accepted treatment for cervical insufficiency and recurrent second-trimester pregnancy loss. The most commonly described complications of cerclage include rupture of fetal membranes, intra-amniotic infection, endometritis, and peripartum bleeding. We present a unique case of a vesicocervical fistula formation remote from cerclage placement. CASE: A vesicocervical fistula was diagnosed in a 51-year-old patient who presented with a chief complaint of vaginal bleeding. The fistula was found on cystoscopic examination after the extrusion, from the cervix, of Mersilene tape from a Shirodkar cerclage placed 13 years earlier for management of cervical insufficiency. CONCLUSION: Although the presented condition was managed conservatively, one should discuss remote formation of urogenital fistulae as a rare complication of cervical cerclage at the time of informed consent.

Cystoscopic removal of intravesical synthetic mesh extrusion with the aid of Endoloop sutures and endoscopic scissors.

Synthetic mesh is commonly used in urogynecologic surgical procedures for correction of stress urinary incontinence and pelvic organ prolapse. Bladder mesh extrusion is a recognized complication and frequently requires extensive mesh resection. We present a case of intravesical polypropylene mesh extrusion following a combined mesh kit and midurethral sling placement. A novel transurethral approach, employing Endoloop sutures with endoscopic scissors, was used to resect the protruding mesh located in close proximity to a ureteral orifice. Medline was searched for other minimally invasive treatment strategies for bladder mesh extrusion. Various techniques for minimally invasive resection of extruded intravesical mesh have been described in the literature. Our strictly transurethral approach avoids the use of an energy source and eliminates the need for open or extensive surgery. Advantages of this new transurethral operative technique include decreased risk of injury associated with the use of an energy source within the bladder and avoidance of open surgical complications.

Urethral prolapse formation after urodynamic testing: a case report.

Urodynamic testing is a widely used modality for evaluation of lower urinary tract symptoms with minimal morbidity to the patient. We report a case of strangulated urethral prolapse in a 74-year-old female that occurred right after urodynamic evaluation. The urethral prolapse was managed conservatively and the patient fully recovered without the need for surgical intervention.

Overactive bladder and hyperlipidemia: is there an association?

OBJECTIVES: : To determine the relationship between overactive bladder (OAB), with or without urinary incontinence (UI), and hyperlipidemia. METHODS: : A random sample of 8077 primary care patients were recruited for the General Longitudinal Overactive Bladder Evaluation. This was a prospective population-based survey to determine severity and occurrence of urgency, frequency, nocturia, and UI. A composite score of 5+ (range, 0-12) was considered to be a case status for OAB, and 2+ (range, 0-6) for UI. Data on hyperlipidemia were pulled out from the electronic medical records of all corresponding patients. Baseline covariates included age, education, body mass index, marital status, and other comorbidities. Logistic regression models were fit predicting OAB status (with or without UI) with prevalent hyperlipidemia as the main predictor. RESULTS: : A total of 3599 (45%) women older than 40 years completed the survey, with a mean (SD) age of 59 (13) years, median parity of 2 (range, 1-3), 66% being overweight or obese, 90% with at least high school education, and 66% married. The prevalence of OAB and UI was 33% and 35%, respectively. Prevalence of hyperlipidemia was 22%. The unadjusted odds ratio (OR) of OAB for those with versus without hyperlipidemia was significant: OR = 1.20 (95% confidence interval, 1.02-1.42; P = 0.029). After adjustment, this association was no longer significant: OR = 0.97 (95% confidence interval, 0.81-1.16; P = 0.726). Among women with OAB and UI, there was no association with hyperlipidemia before and after adjustment (P = 0.5). CONCLUSIONS: : Although on the surface there seems to be an association between OAB and hyperlipidemia, this association is primarily accounted for by other confounders.

Spontaneous bladder rupture following cystoscopy with hydrodistention and biopsy in a female patient with interstitial cystitis.

We report a case of remote spontaneous rupture of urinary bladder following cystourethroscopy with hydrodistention and a bladder biopsy in a patient with interstitial cystitis. This required abdominal exploration with cystorrhaphy. This case emphasizes a unique and dangerous complication of this procedure in a patient with interstitial cystitis.