Occurrence of vesicoureteral reflux in children.

AIM: The reported low occurrence of vesicoureteral reflux in the general population seems implausible. We wanted to test the hypothesis that reflux is more common and more independent of urinary-tract infection than has previously been thought. METHODS: We tested our hypothesis by analysing the characteristics of 406 consecutive children aged <5years who had been referred for consultation because of urinary-tract infection. Using data on their urine samples, we evaluated the reliability of the urinary-tract infection diagnosis and analysed the frequencies of vesicoureteral reflux and abnormal ultrasound findings in three reliability groups (A: certain urinary-tract infection, B: possible and C: improbable). RESULTS: The occurrence of reflux was the same irrespective of the diagnostic reliability of urinary-tract infection (A: 98/276 [36%] versus B: 13/46 [28%] versus C: 9/25 [36%]). Most of the abnormal ultrasound findings (58/71, 80%) were found among patients with a certain diagnosis (Group A). CONCLUSION: We suggest that vesicoureteral reflux is more common in children even without urinary-tract infection than has been thought previously. The guidelines recommending a search for reflux by means of voiding cystourethrography should be reconsidered.

The combined contraceptive vaginal ring (NuvaRing) and lipid metabolism: a comparative study.

This study compared the lipid profile after three and six cycles of treatment with NuvaRing delivering 15 microg ethinylestradiol and 120 microg etonogestrel daily with a combined oral contraceptive (COC) containing ethinylestradiol 30 microg and levonorgestrel 150 microg. In the NuvaRing group 40 women were treated and 43 in the COC group. Compared with baseline, total cholesterol did not change in either group. NuvaRing did not affect HDL, but HDL, HDL2 and HDL3 levels decreased with the COC. In contrast, HDL2 increased with NuvaRing at cycle 3. LDL increased after cycles 3 and 6 with COC, and decreased after three cycles of NuvaRing treatment. Apolipoprotein A-1 levels increased with NuvaRing, but decreased with COC; apolipoprotein B and triglycerides increased, and lipoprotein(a) decreased in both groups. Sex hormone-binding globulin increased markedly more with NuvaRing, whereas corticosteroid-binding globulin levels increased less. These changes reflect the lower androgenicity of etonogestrel versus levonorgestrel and show that NuvaRing has a minimal effect on lipid profile.

Selection and performance of the levonorgestrel-releasing intrauterine system.

BACKGROUND: The levonorgestrel-releasing intrauterine system (LNg IUS) is a hormonal contraceptive that is used in the uterine cavity. To determine whether the reasons for choosing LNg IUS vs. copperreleasing intrauterine devices (Cu IUDs) differ and whether their performances are comparable, we carried out a retrospective study in Finland during the first years of LNg IUS use. METHODS: Gynecological and contraceptive histories of 626 LNg IUS and 626 Cu IUD users and the performance of the device were reviewed from patient records. RESULTS: Women who accepted the LNg IUS were more likely than Cu IUD acceptors to have a history of menstrual bleeding of 6 days or more (44.4% vs. 28.4%), heavy bleeding (44.8% vs. 8.4%) and moderate or severe dysmenorrhea (15.9% vs. 7.5%). In both groups, 70% of the women had used Cu IUDs earlier. However, the LNg IUS acceptors had had more side effects during previous use of CU IUDs (58.2% vs. 28.8%). They also reported more side effects that resulted in discontinuation of a previous Cu IUD (39.4% vs. 10.1%). However, the 12-month life-table continuation rates of 80.6 (SE 1.9)% vs. 83.4 (SE 1.8)% were alike. Cu IUD users discontinued the current method more often because of problems of bleeding and unwanted pregnancy. Among those women who had previously discontinued a hormonal method because of hormonal side effects, there were no differences in the continuation rates of the two groups. CONCLUSIONS: LNg IUS can be successfully used by women who cannot use a CU IUD or who have experienced hormonal side effects with oral contraceptives.