ABSTRACT
INTRODUCTION AND HYPOTHESIS: The objective was to find an alternative treatment to a low-dose antibiotic for the prevention of recurrent urinary tract infections (UTI) and to evaluate the difference in rates of reinfection within 1 year when treated with methenamine hippurate for prophylaxis compared with trimethoprim. METHODS: We present a non-blinded randomized trial comparing methenamine hippurate with trimethoprim for the prevention of recurrent UTI at 12 months after starting treatment. Women over 18 who had at least two culture-positive UTI in the prior 6 months or three in the prior year were included. Ninety-two patients met enrollment criteria and were randomized to receive daily prophylaxis with methenamine hippurate or trimethoprim for a minimum of 6 months. Both intent-to-treat and per-protocol analyses if patients received the alternative drug after randomization were analyzed using Student's t test, Mann-Whitney U test, Kaplan-Meier curves, log-rank test, and a logistic and multivariate regression model. The primary outcome of this study was culture-proven UTI recurrence by 12 months after initiating prophylaxis. RESULTS: In the intent-to-treat analysis, we found no difference between groups in recurrent UTI, with a 65% (28 out of 43) recurrence in the trimethoprim group versus 65% (28 out of 43) in the methenamine hippurate group (p = 1.00). In the per-protocol analysis, 65% (26 out of 40) versus 65% (30 out of 46) of patients had UTI recurrences in the trimethoprim group versus the methenamine hippurate group (p = 0.98). CONCLUSIONS: Methenamine hippurate may be an alternative for the prevention of recurrent UTI, with similar rates of recurrence and adverse effects to trimethoprim.
Subject(s)
Trimethoprim , Urinary Tract Infections , Female , Hippurates/therapeutic use , Humans , Methenamine/analogs & derivatives , Methenamine/therapeutic use , Trimethoprim/therapeutic use , Urinary Tract Infections/drug therapy , Urinary Tract Infections/prevention & controlABSTRACT
INTRODUCTION AND HYPOTHESIS: To assess cognitive changes in women 12 months after starting anticholinergic medications for overactive bladder syndrome (OAB). METHODS: We present a prospective cohort study assessing changes in cognition in women seen in a referral urogynecology practice. We compared women who started anticholinergic OAB medications with women not on anticholinergic OAB medications. The primary outcome was change over time on the Montreal Cognitive Assessment (MOCA) screening score. At enrollment, women completed a baseline MOCA screening, a Geriatric Depression Screen (GDS), and an assessment of medications to create an anticholinergic burden score (ACB). At 3, 6, 9, and 12 months after enrollment women were administered the MOCA, GDS, and a review of their medications and medical problems. Statistical analysis was performed using a linear mixed effects model taking into account correlated error terms given multiple MOCA assessments at various time points per patient. RESULTS: A total of 106 women were enrolled, 60 in the OAB medication group and 46 in the control (non-OAB medication) group. The mean age was 77 years, 93% of women were Caucasian, and 98% completed high school, with no difference between groups. Over time there was no difference in change of MOCA score between the OAB and control groups when controlling for age, GDS score, and ACB score (p = 0.78). This association did not change when women with a neurological diagnosis were excluded (n = 6). On average MOCA scores for the OAB group increased by 0.76 over 12 months and the control group increased 0.39, with no difference between the groups (p = 0.53). CONCLUSIONS: We found no changes in MOCA scores between OAB medication and control groups after controlling for age, depression, and polypharmacy after 12 months of follow-up.
Subject(s)
Urinary Bladder, Overactive , Aged , Cholinergic Antagonists/adverse effects , Cognition , Female , Humans , Infant , Prospective Studies , Urinary Bladder, Overactive/drug therapySubject(s)
Commerce/organization & administration , Nurse Practitioners/organization & administration , Office Management/organization & administration , Pelvic Organ Prolapse , Pessaries/adverse effects , Pessaries/supply & distribution , Prosthesis Fitting/nursing , Specialties, Nursing/methods , Specialties, Nursing/organization & administration , Vaginal Diseases , Female , HumansABSTRACT
Pelvic organ prolapse is a frequently overlooked condition occurring commonly among women of all ages. A brief overview of pelvic organ prolapse and a discussion of the Colpexin Sphere is provided. The Colpexin Sphere is a new intravaginal device that facilitates the performance of pelvic floor muscle exercises thereby enhancing the benefit provided by already established conservative therapy.
Subject(s)
Cystocele/therapy , Exercise Therapy/instrumentation , Pelvic Floor/physiopathology , Rectocele/therapy , Uterine Prolapse/therapy , Cystocele/physiopathology , Equipment Design , Equipment Safety , Female , Humans , Muscle Strength/physiology , Prolapse , Rectocele/physiopathology , Risk Factors , Uterine Prolapse/physiopathology , VaginaABSTRACT
Genital prolapse is the relaxation of the supporting structures of the pelvic floor. Significant morbidity can be associated if left untreated. Patients can elect to have surgical repair of their prolapse or use a pessary. The more significant the pelvic organ prolapse the more difficult it is to manage with pessary support. The case study in this article describes such a patient and the challenges we faced with managing her advanced genital prolapse.
