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1.
BJOG ; 121(13): 1695-703, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25040835

ABSTRACT

OBJECTIVE: To investigate, among women who have had a third- or fourth-degree perineal tear, the mode of delivery in subsequent pregnancies as well as the recurrence rate of third- or fourth-degree tears. DESIGN: A retrospective cohort study of deliveries using a national administrative database. SETTING: The English National Health Service between 1 April 2004 and 31 March 2012. POPULATION: A total of 639,402 primiparous women who had a singleton, term, vaginal live birth between April 2004 and March 2011, and a second birth before April 2012. METHODS: Multivariable logistic regression models were used to estimate odds ratios, adjusted for other risk factors. MAIN OUTCOME MEASURES: Mode of delivery and recurrence of tears at second birth. RESULTS: The rate of elective caesarean at second birth was 24.2% for women with a third- or fourth-degree tear at first birth, and 1.5% for women without (adjusted odds ratio, aOR 18.3, 95% confidence interval, 95% CI 16.4-20.4). Among women who had a vaginal delivery at second birth, the rate of third- or fourth-degree tears was 7.2% for women with a third- or fourth-degree tear at first birth, compared with 1.3% for women without (aOR 5.5, 95% CI 5.2-5.9). CONCLUSIONS: The risk of a severe perineal tear is increased five-fold in women who had a third- or fourth-degree tear in their first delivery. This increased risk should be taken into account when decisions about mode of delivery are made.


Subject(s)
Cesarean Section/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Lacerations/epidemiology , Obstetric Labor Complications/epidemiology , Perineum/injuries , Pregnancy Outcome/epidemiology , Adult , Age Factors , Cohort Studies , England , Episiotomy/statistics & numerical data , Extraction, Obstetrical/statistics & numerical data , Female , Humans , Logistic Models , Multivariate Analysis , Pregnancy , Recurrence , Retrospective Studies , Risk Factors , Young Adult
2.
BJOG ; 121(2): 183-92, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24251861

ABSTRACT

OBJECTIVES: To investigate the demographic and obstetric factors associated with the uptake and success rate of vaginal birth after caesarean section (VBAC). DESIGN: Cohort study using data from Hospital Episode Statistics. SETTING: English National Health Service. POPULATION: Women whose first birth resulted in a live singleton delivery by caesarean section between 1 April 2004 and 31 March 2011, and who had a second birth before 31 March 2012. METHODS: Logistic regression to estimate adjusted odds ratios (OR). MAIN OUTCOME MEASURES: Attempted and successful VBAC. RESULTS: Among the 143,970 women in the cohort, 75,086 (52.2%) attempted a VBAC for their second birth. Younger women, those of non-white ethnicity and those living in a more deprived area had higher rates of attempted VBAC. Overall, 47,602 women (63.4%) who attempted a VBAC had a successful vaginal birth. Younger women and women of white ethnicity had higher success rates. Black women had a particularly low success rate (OR, 0.54; 95% confidence interval [CI], 0.50-0.57). Women who had an emergency caesarean section in their first birth also had a lower VBAC success rate, particularly those with a history of failed induction of labour (OR, 0.59; 95% CI, 0.53-0.67). CONCLUSION: In this national cohort, just over one-half of women with a primary caesarean section who were eligible for a trial of labour attempted a VBAC for their second birth. Of these, almost two-thirds successfully achieved a vaginal delivery.


Subject(s)
Vaginal Birth after Cesarean/statistics & numerical data , Adult , Age Factors , Birth Intervals , Birth Weight , Black People/statistics & numerical data , Cohort Studies , Diabetes, Gestational/epidemiology , Emergencies , Female , Fetal Membranes, Premature Rupture/epidemiology , Humans , Logistic Models , Pregnancy , Trial of Labor , United Kingdom , White People/statistics & numerical data , Young Adult
3.
BJOG ; 120(12): 1516-25, 2013 Nov.
Article in English | MEDLINE | ID: mdl-23834484

ABSTRACT

OBJECTIVE: To describe the trends of severe perineal tears in England and to investigate to what extent the changes in related risk factors could explain the observed trends. DESIGN: A retrospective cohort study of singleton deliveries from a national administrative database. SETTING: The English National Health Service between 1 April 2000 and 31 March 2012. POPULATION: A cohort of 1 035 253 primiparous women who had a singleton, term, cephalic, vaginal birth. METHODS: Multivariable logistic regression was used to estimate the impact of financial year of birth (labelled by starting year), adjusting for major risk factors. MAIN OUTCOME MEASURE: The rate of third-degree (anal sphincter is torn) or fourth-degree (anal sphincter as well as rectal mucosa are torn) perineal tears. RESULTS: The rate of reported third- or fourth-degree perineal tears tripled from 1.8 to 5.9% during the study period. The rate of episiotomy varied between 30 and 36%. An increasing proportion of ventouse deliveries (from 67.8 to 78.6%) and non-instrumental deliveries (from 15.1 to 19.1%) were assisted by an episiotomy. A higher risk of third- or fourth-degree perineal tears was associated with a maternal age above 25 years, instrumental delivery (forceps and ventouse), especially without episiotomy, Asian ethnicity, a more affluent socio-economic status, higher birthweight, and shoulder dystocia. CONCLUSIONS: Changes in major risk factors are unlikely explanations for the observed increase in the rate of third- or fourth-degree tears. The improved recognition of tears following the implementation of a standardised classification of perineal tears is the most likely explanation.


Subject(s)
Anal Canal/injuries , Obstetric Labor Complications/epidemiology , Parity , Perineum/injuries , Adolescent , Adult , Age Distribution , Delivery, Obstetric/statistics & numerical data , England/epidemiology , Episiotomy/statistics & numerical data , Female , Humans , Middle Aged , Pregnancy , Regression Analysis , Retrospective Studies , Risk Factors , Rupture/epidemiology , Young Adult
4.
BJOG ; 115(6): 767-72, 2008 May.
Article in English | MEDLINE | ID: mdl-18355367

ABSTRACT

OBJECTIVE: To develop and validate a pictorial chart that documents ultrasound examination of the anal sphincter. DESIGN: A new pictorial chart (Liverpool Ultrasound Pictorial Chart [LUPIC]) depicting the normal anatomy of the anal sphincter was developed. METHODS: To validate LUPIC, two observers documented the findings of 296 endoanal scans. Reliability was assessed between observers using kappa agreement for presence and position of sphincter defects. To validate the use of LUPIC by different observers, a video of ten endoanal ultrasound scans was reviewed by our local expert (gold standard). Seven clinicians underwent test-retest analysis. Kappa agreement was calculated to assess intra-observer and gold standard versus observer agreement for the overall presence of sphincter defects and compared with the gold standard. Complete agreement for the position and level of sphincter defects was assessed for the five abnormal scans. MAIN OUTCOME MEASURES: Excellent agreement between the two observers was found for the presence (kappa 0.99), position and level of external anal sphincter defects documented using LUPIC. The intra-observer and gold standard versus observer kappa values of experienced clinicians (A-E) showed good agreement for the overall presence of sphincter defects. Complete agreement for the position and level of sphincter defects was found in 23 of 35 (66%) observations. CONCLUSIONS: LUPIC is designed and validated method of documenting anal sphincter injury diagnosed by endoanal ultrasound. Standardisation of endoanal ultrasound findings by using LUPIC may help correlate the degree of damage with patient symptoms.


Subject(s)
Anal Canal/injuries , Endosonography/methods , Obstetric Labor Complications/diagnostic imaging , Anal Canal/diagnostic imaging , Early Diagnosis , Endosonography/standards , Fecal Incontinence/diagnostic imaging , Fecal Incontinence/etiology , Fecal Incontinence/pathology , Female , Humans , Image Processing, Computer-Assisted/methods , Image Processing, Computer-Assisted/standards , Observer Variation , Obstetric Labor Complications/etiology , Obstetric Labor Complications/pathology , Pregnancy , Reference Standards
5.
BJU Int ; 91(3): 208-10, 2003 Feb.
Article in English | MEDLINE | ID: mdl-12581005

ABSTRACT

OBJECTIVE: To determine knowledge about bladder care among junior medical staff and allied health professionals, and to examine any difference in knowledge among the subgroups. SUBJECTS AND METHODS: Using a single-questionnaire survey in a large obstetrics and gynaecology Hospital Trust in an inner city setting, midwives, nurses and medical staff (not consultants) were asked eight questions about different aspects of female bladder physiology and care. The differences in responses among the professional groups were assessed. RESULTS: In all, 120 completed questionnaires were returned (32 doctors, 40 nurses, and 48 midwives). Knowledge was similar on urethral length, bladder capacity, daily fluid intake, ideal size of catheter, catheter balloon size, and the maximum time of use of a short-term catheter. Correct responses for normal daily fluid intake, duration of both short and long-term catheterization were given by fewer than half the respondents. There were significant differences among the professional groups in the correct response rate for long-term catheter duration (P = 0.031) and the normal time interval between voids (P = 0.038). CONCLUSION: There were significant differences in the knowledge of all subgroups about bladder care, and poor levels of knowledge in several areas. This is a potentially serious problem for women at risk of bladder complications after gynaecological surgery and childbirth. All staff involved in managing women after childbirth and gynaecological surgery should have formal training in bladder care, to optimize patient care.


Subject(s)
Clinical Competence , Personnel, Hospital , Urinary Bladder , Urology/standards , Education, Nursing , Female , Humans , Medical Staff, Hospital/education , Midwifery , Nurse Midwives/education , Surveys and Questionnaires , Urinary Bladder/physiology , Urinary Retention/therapy , Urination Disorders/therapy
6.
Fertil Steril ; 74(2): 251-6, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10927040

ABSTRACT

OBJECTIVE: To study the correlation between the incidence of sex chromosome aneuploidies in the somatic cells and spermatozoa in karyotypically normal infertile men and fertile donors. DESIGN: A prospective, phase two, controlled study. SETTING: A teaching Hospital Reproductive Medicine and Medical Genetics Units. PATIENT(S): Ten patients with idiopathic oligozoospermia and 10 sperm donors with proven fertility, all with a normal karyotype 46, XY. INTERVENTION(S): Multicolor fluorescence in situ hybridization (FISH) of peripheral blood lymphocytes and spermatozoa using a probe cocktail containing the alpha satellite DXZ1 for the X centromere, DYZ1 for the heterochromatic region of the long arm of the Y, and cosmids D21S259, D21S341, and D21S342 for Down syndrome critical region of chromosome 21. MAIN OUTCOME MEASURE(S): The incidence of chromosome X, Y, and 21 aneuploidies in peripheral lymphocytes and spermatozoa in both groups. RESULT(S): The incidence of aneuploidies related to chromosomes X, Y, and 21 were significantly higher in peripheral lymphocytes and spermatozoa of infertile men compared with donors. There was a positive correlation between the incidence of chromosome aneuploidies in the somatic cells and sperm in all men. CONCLUSION(S): These findings provide suggestive evidence for the importance of mitosis in spermatogenesis and the role of mitotic instability in unexplained oligozoospermia.


Subject(s)
Infertility, Male/genetics , Mitosis , Spermatogenesis/genetics , Adolescent , Adult , Aneuploidy , Chromosomes, Human, Pair 21 , Humans , Karyotyping , Lymphocytes/physiology , Male , Prospective Studies , Spermatozoa/physiology , X Chromosome , Y Chromosome
7.
Obstet Gynecol ; 95(3): 417-20, 2000 Mar.
Article in English | MEDLINE | ID: mdl-10711555

ABSTRACT

OBJECTIVE: To examine the performance of a silicon urinary control device for nonsurgical management of women with genuine stress incontinence. METHODS: A 3-month prospective study involved 41 women with genuine stress incontinence. They completed urinary diaries of voiding, incontinence, and severity of incontinence on a 4-point scale over a week. Subjects were taught how to apply the device and used it as required from the second week. Visual analogue scales were used to record aspects of use (such as acceptability, comfort, and ease of application), and 2-hour perineal pad tests were completed at recruitment, after 2 weeks, and after 3 months. Data were compared by Mann-Whitney U test, or Wilcoxon test. RESULTS: Ten women (24.4%) declined to participate and six (14.6%) withdrew before 2 weeks. Ten (24.4%) failed to attend for 2-week follow-up and 11 (26.8%) did not continue for 3 months. Two (4.9%) did not attend 3-month follow-up. Only two women (4.9%) completed the study. There was no difference in pad test results or in results from voiding diaries. CONCLUSION: The urinary incontinence device had low acceptability and was ineffective, and we cannot recommend it for nonsurgical management of genuine stress incontinence.


Subject(s)
Prostheses and Implants , Urinary Incontinence, Stress/therapy , Adult , Aged , Female , Humans , Middle Aged , Prospective Studies , Treatment Failure
8.
BJU Int ; 85(4): 416-20, 2000 Mar.
Article in English | MEDLINE | ID: mdl-10691817

ABSTRACT

OBJECTIVE: To test the hypothesis that compliance with oxybutynin would be improved if the severity of dry mouth could be reduced, thus leading to improved urinary symptom response and improved outcome, in a randomized, controlled trial of oxybutynin with or without salivary stimulant pastilles in patients with detrusor instability. PATIENTS AND METHODS: Sixty-seven women with detrusor instability were randomized to a variable dose regimen of oxybutynin with (37) or without (30) salivary stimulant pastilles for 8 weeks. Patients were asked to complete a baseline voiding diary. In weeks 1 and 2, patients were encouraged to adjust the dose of oxybutynin themselves to achieve optimum symptomatic control. A second diary was completed in the sixth week and patients were reviewed at 8 weeks. The outcome measures were the compliance rate, follow-up attendance rate, maximum dose of medication, changes in voiding and incontinence episodes, and changes in severity of urgency and of dry mouth symptoms between the first and sixth week. RESULTS: Of the 67 women, 32 (47%) completed the study; the proportion completing was the same in both groups. Four patients had stopped the medication and there was no difference in the distribution of maximum dosage achieved between the groups. Both groups reported a reduced severity of urgency symptoms and increased severity of dry mouth. There were no differences in reported symptom change between the groups during the study. CONCLUSIONS: The combination of oxybutynin and salivary stimulant pastilles does not improve compliance or symptom relief compared with oxybutynin alone; it does not allow a greater dose of oxybutynin to be tolerated.


Subject(s)
Cholinergic Antagonists/therapeutic use , Mandelic Acids/therapeutic use , Urinary Incontinence/drug therapy , Adult , Aged , Drug Combinations , Female , Humans , Middle Aged , Patient Compliance , Tablets
9.
Fertil Steril ; 73(1): 51-5, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10632411

ABSTRACT

OBJECTIVE: To estimate the incidence of sex chromosome aneuploidies in the somatic cells of karyotypically normal infertile men and fertile donors. DESIGN: A prospective, two-phase, controlled study. SETTING: Reproductive medicine and medical genetics units of a teaching hospital. PATIENT(S): Ten patients with oligozoospermia and 10 sperm donors with proved fertility, all with a normal karyotype 46 XY. INTERVENTION(S): Multicolor fluorescence in situ hybridization (FISH) of peripheral blood lymphocytes using a probe cocktail containing the alpha satellites DXZ1 for the X centromere and DYZ1 for the heterochromatic region of the long arm of the Y and the radiolabeled alpha satellite D18Z1 for chromosome 18. MAIN OUTCOME MEASURE(S): The incidence of sex chromosome aneuploidies in both groups. RESULT(S): A 13-fold increase in sex chromosome aneuploidies was observed in the somatic cells of infertile men with "unexplained" oligozoospermia compared to donors (P=.008). CONCLUSION(S): These findings provide suggestive evidence for the existence of an inherent mitotic instability in men with unexplained oligozoospermia.


Subject(s)
Aneuploidy , Karyotyping , Mitosis , Oligospermia/genetics , Sex Chromosomes , Adult , Chromosomes, Human, Pair 18 , Humans , In Situ Hybridization, Fluorescence , Male , Prospective Studies , Tissue Donors
11.
BMJ ; 316(7129): 435-7, 1998 Feb 07.
Article in English | MEDLINE | ID: mdl-9492667

ABSTRACT

OBJECTIVE: To evaluate the performance of reagent test strips in screening pregnant women for asymptomatic bacteriuria at their first visit to an antenatal clinic. DESIGN: Prospective case series. SETTING: Antenatal clinic of a large inner city maternity hospital. SUBJECTS: All women attending for their first antenatal clinic. Patients taking antibiotics for any reason and those with urinary tract symptoms were excluded. INTERVENTION: A midstream urine specimen was divided; half was sent for microscopy and formal bacteriological culture and the other half was tested with a commercial reagent strip test for the presence of blood, protein, nitrite, and leucocyte esterase. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of the reagent strips in diagnosing asymptomatic bacteriuria (defined as 10(5) colony forming units/ml urine). RESULTS: Sensitivity was low, with a maximum of 33% when all four tests were used in combination. Specificity was high, with typical values of 99% or more. Positive predictive value reached a maximum of 69% and negative predictive value was typically 95% or more. CONCLUSION: Urine reagent strips are not sufficiently sensitive to be of use in the screening for asymptomatic bacteriuria and therefore many patients would be missed. In view of the potentially serious sequelae of this condition in pregnant women we recommend that formal bacteriological investigation remain the investigation of choice in this group of patients.


Subject(s)
Bacteriuria/diagnosis , Pregnancy Complications, Infectious/diagnosis , Reagent Strips , Female , Humans , Predictive Value of Tests , Pregnancy , Prenatal Diagnosis/methods , Prenatal Diagnosis/standards , Prospective Studies , Reagent Strips/standards , Sensitivity and Specificity
12.
Article in English | MEDLINE | ID: mdl-9891961

ABSTRACT

The aim of the study was to assess the ability of the Larsson chart nomogram to predict the presence of detrusor instability or genuine stress incontinence without recourse to cystometry. The Larsson chart provides a probability of detrusor instability by plotting 24-hour urinary frequency against the range of void volumes. Frequency/volume chart data were obtained from the records of 216 patients who had undergone subtraction cystometry. The Larsson chart was assessed by comparing the probability of detrusor instability or of genuine stress incontinence obtained with the cystometric diagnosis. The maximum sensitivity of the Larsson chart was 52%, with a specificity of 70% for detrusor instability. For genuine stress incontinence these figures were 66% and 65% respectively. The Larsson chart provides no diagnostic information and does not remove the need for formal cystometric evaluation of patients with urinary incontinence.


Subject(s)
Urinary Bladder/physiopathology , Urinary Incontinence, Stress/diagnosis , Urodynamics/physiology , Female , Humans , Sensitivity and Specificity , Urination , Urine
13.
Br J Urol ; 80(5): 752-6, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9393297

ABSTRACT

OBJECTIVE: To evaluate the efficacy and acceptability of the FemAssist urinary control device (Insight Medical UK Ltd). PATIENTS AND METHODS: Twenty-seven women with cystometrically confirmed genuine stress incontinence performed a perineal 1 h pad-test; the pad test was then repeated with the FemAssist device in place and the difference in pad weights compared with and without the device in place. Patients were given 100 mm visual analogue scales (VAS) to measure discomfort, acceptability and embarrassment associated with using the device. RESULTS: The median (range) loss with and without the FemAssist device was 4.9 (0-65) mL and 21 (1-94), respectively (P < 0.01); 20 patients were less wet when using the device. The median (range) VAS scores were; discomfort 35 (4-93), embarrassment 11 (0-75), and acceptability 65 (3-100). Discomfort was greater among the women with a greater loss. The acceptability correlated negatively with discomfort (r = -0.53) and negatively with embarrassment (r = -0.39); 15 patients (56%) reported that they would use the device in the long-term. CONCLUSION: The FemAssist device produced a significant reduction in urine loss. The magnitude of benefit could not be predicted for an individual and the device was ineffective in some women. The use of the device was influenced by discomfort and associated embarrassment. The device has a role in the management of stress incontinence but patients must be assessed individually for suitability.


Subject(s)
Prostheses and Implants , Urinary Incontinence, Stress/rehabilitation , Adult , Age Factors , Aged , Exercise Therapy , Female , Humans , Middle Aged , Patient Satisfaction , Silicone Elastomers/therapeutic use , Treatment Outcome
14.
Br J Urol ; 80(3): 414-6, 1997 Sep.
Article in English | MEDLINE | ID: mdl-9313659

ABSTRACT

OBJECTIVE: To assess the efficacy of salivary stimulant pastilles in improving tolerance of and compliance with oxybutynin chloride for detrusor instability. PATIENTS AND METHODS: Thirty women with detrusor instability were treated with oxybutynin in either a fixed or variable dose. After 3 weeks, patients were given salivary stimulant pastilles (Salivix, Thames Laboratories, Clwyd, UK) to chew as often as required. Symptom diaries were used to record episodes of dry mouth (xerostomia) together with a 100 mm visual analogue scale (VAS) score of the severity of xerostomia. RESULTS: The frequency of xerostomia was unchanged but there was a significant decrease in median severity from 71 to 39 on the VAS (P < 0.05, Mann-Whitney U-test). Nine patients on the variable-dose regimen tolerated a higher dose of oxybutynin when taking the pastilles (P < 0.01, Wilcoxon's matched-pairs test). CONCLUSION: Salivary stimulant pastilles appear to be a useful adjuvant therapy for patients receiving oxybutynin chloride for detrusor instability, allowing higher doses of oxybutynin to be tolerated.


Subject(s)
Mandelic Acids/therapeutic use , Parasympatholytics/therapeutic use , Patient Compliance , Urinary Incontinence/drug therapy , Xerostomia/chemically induced , Administration, Oral , Female , Humans , Mandelic Acids/adverse effects , Parasympatholytics/adverse effects , Pilot Projects , Tablets , Xerostomia/drug therapy
16.
Br J Urol ; 70(4): 370-2, 1992 Oct.
Article in English | MEDLINE | ID: mdl-1450843

ABSTRACT

The density of subepithelial, presumptive sensory nerves in the bladder wall was assessed in 21 women with idiopathic detrusor instability and compared with the density of these nerves in 21 asymptomatic women, using a point-counting technique on sections of bladder biopsies stained for acetylcholinesterase activity. The mean value (+/- S.E.) for the amount of such nerves in patients with detrusor instability (91 +/- 13/mm2) was significantly greater than that from the control group (61 +/- 7/mm2). This suggests that a relative abundance of subepithelial sensory nerves may serve to increase the appreciation of bladder filling, giving rise to the frequency and urgency of micturition which are characteristic of patients with detrusor instability.


Subject(s)
Urinary Bladder Diseases/pathology , Urinary Bladder/innervation , Adult , Aged , Female , Humans , Middle Aged , Neurons, Afferent/pathology , Urinary Incontinence/pathology
17.
Fertil Steril ; 58(1): 153-8, 1992 Jul.
Article in English | MEDLINE | ID: mdl-1623997

ABSTRACT

OBJECTIVE: To provide an inexpensive and extensive in vitro fertilization (IVF) service for the Mersey Region, United Kingdom. DESIGN: Twenty-four transport IVF patients treated in two district general hospitals using the central university laboratory as co-ordination point for treatment schedule and embryology. Outcomes were compared with 26 control patients treated in the central unit. SETTING: Royal Liverpool University Hospital, a central IVF unit, and two district general hospitals in the Mersey Region. PATIENTS: Fifty patients under 35 years of age with irreversible tubal damage selected and treated by IVF, half in the central unit and the other half in two district general hospitals. MAIN OUTCOME MEASURES: Pregnancy rate (PR) in the different centers. RESULTS: A PR of 42.3% per cycle in the peripheral hospitals compared with 30.7% per cycle in the central unit. CONCLUSION: Transport IVF is an inexpensive and feasible alternative to standard IVF in a central unit for patients without access to central units.


Subject(s)
Community Health Services/trends , Fertilization in Vitro/methods , Adult , Cells, Cultured , Embryo Transfer , Female , Gamete Intrafallopian Transfer , Humans , Oocytes/physiology
18.
Br J Urol ; 70(1): 17-21, 1992 Jul.
Article in English | MEDLINE | ID: mdl-1638368

ABSTRACT

The diagnosis of interstitial cystitis (IC) is not usually considered in patients with idiopathic instability. Because histamine provokes detrusor contractions in vitro, we assessed detrusor mast cell counts in 29 females with refractory instability. Raised mast cell counts (greater than 28/mm2 of detrusor muscle, consistent with a histological diagnosis of IC) were found in 29% of such cases. Thus cystoscopy and bladder biopsy should be considered in patients with idiopathic instability which fails to respond to anticholinergic drugs, as alternative therapy may be useful. Patients with refractory instability and normal detrusor mast cell counts often gave a history of prolonged childhood nocturnal enuresis (55% of cases); in contrast, patients with intractable instability and abnormally high mast cell counts seldom gave such a history (12%). These trends may give some insight into the aetiology of idiopathic instability--"congenital" or acquired?


Subject(s)
Cystitis/pathology , Mast Cells/pathology , Urinary Bladder/pathology , Urination Disorders/pathology , Adult , Aged , Biopsy , Cell Count , Cystitis/complications , Cystoscopy , Female , Humans , Male , Middle Aged , Muscles/pathology , Urinary Bladder/physiopathology , Urination Disorders/etiology , Urination Disorders/physiopathology
19.
Br J Urol ; 68(5): 479-82, 1991 Nov.
Article in English | MEDLINE | ID: mdl-1747721

ABSTRACT

The urodynamic case records of 1000 consecutive men and women were reviewed to study the link between idiopathic detrusor instability (DI) and childhood nocturnal enuresis and to determine whether a sex difference in this relationship may exist. Idiopathic DI was found in 10% of the men, 63% of whom had suffered from childhood bedwetting; 29% of the women had idiopathic instability, of whom 38% had been nocturnal enuretics. Thus the link between adult idiopathic DI and childhood bedwetting appeared to be stronger for men than for women. The sex distribution of subjects is not always reported in urodynamic studies of bedwetters and adults with an unstable bladder. We suggest that this should become routine practice as it may help to shed light on the aetiology of idiopathic detrusor instability.


Subject(s)
Enuresis/epidemiology , Urinary Incontinence/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Enuresis/physiopathology , Female , Humans , Incidence , Male , Middle Aged , Sex Factors , Urinary Bladder/physiopathology , Urinary Incontinence/physiopathology , Urodynamics/physiology
20.
Br J Obstet Gynaecol ; 98(6): 569-72, 1991 Jun.
Article in English | MEDLINE | ID: mdl-1873247

ABSTRACT

This study investigated whether British women prefer to crouch over public toilet seats, and measured the effect of such a voiding position on urine flow rate and residual urine volume. Of 528 consecutive women who attended a general gynaecological clinic and completed an anonymous questionnaire, 85% usually crouched over the toilet when using a public convenience, 12% applied paper to the seat and 2% sat directly on public toilet seats. When using a friend's bathroom 38% of the women voided by crouching. Results were similar for 155 patients attending a urodynamic clinic, 80 of whom were studied while voiding in both positions. There was a 21% reduction in average urine flow rate and a 149% increase in residual urine volume in the crouching position. Women undergoing urodynamic tests should be asked which voiding position they used before abnormal results are interpreted. Patients with a reduced functional bladder capacity may benefit from being encouraged to sit comfortably on the toilet whenever possible.


Subject(s)
Posture , Urination/physiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Habits , Humans , Middle Aged , Toilet Training
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