Vaginal pessary: a culprit for intraperitoneal bladder perforation.

Vaginal pessaries are widely considered to be a safe and effective non-surgical management option for women with pelvic organ prolapse. Complications may occur, and are more frequent with improper care and certain device designs and materials. It is imperative to provide information to patients about potential complications. We present the case of a woman in her 70s who presented to the Emergency Department with increasing groin and abdominal pain following a vaginal pessary insertion 2 days prior for grade 3 vaginal vault prolapse. On presentation, her abdomen was markedly distended with guarding. Laboratory investigations showed a significant acute kidney injury with a metabolic acidosis. An initial non-contrast CT showed fluid and inflammatory changes surrounding the bladder, and bladder perforation was suspected. A subsequent CT cystogram showed extravasation of contrast from the bladder into the peritoneal cavity, in keeping with an intraperitoneal bladder rupture. The patient underwent an emergency bladder repair in theatre.

Urinary symptoms in pregnant women in their third trimester-a cross-sectional study.

INTRODUCTION AND HYPOTHESIS: Urinary symptoms are common in pregnancy. Our study aims to understand the extent of these symptoms in a cohort of pregnant women in the third trimester and their impact on quality of life (QOL) from the women's perspective. METHODS: A single-centre cross-sectional study of self-reported urinary symptoms of pregnant women in the third trimester conducted from August 2018 at the Diana Princess of Wales Hospital, Northern Lincolnshire, and Goole NHS Foundation Trust, Grimsby, UK. We used an international validated questionnaire (ICIQ-FLUTS questionnaire) (Brookes et al. Am J Obstet Gynecol. 191(1):73-82, 2004). RESULTS: A total of 302 women were included in this study. Nocturia was the most common symptom, reported by 97%, affecting QOL in 80%. Urgency of micturition was the second most common, present in 83%, adversely affecting QOL in 75%. Our study showed a startling finding of bladder pain in 47% (95% CI 41.1%, 52.3%) of these women. There was a high prevalence of nocturnal enuresis in 9.9% (95% CI 7.05%, 13.8%). Straining during micturition is not a well-known symptom in pregnancy, however reported by 18.2% (95% CI 14.2%, 23.0%). CONCLUSION: The high prevalences of bladder pain, nocturnal enuresis and straining in the third trimester of pregnancy are novel findings. Our study also confirms that the prevalence of all voiding, filling and incontinence symptoms in pregnancy is significantly higher than in the non-pregnant population, having a negative impact on QOL, and yet is not discussed as part of routine antenatal care.

Correlation Between Urodynamic and Clinical Diagnoses in Classifying the Type of Urinary Incontinence in Women.

Urodynamic tests are considered the gold standard for investigating and managing patients with urinary incontinence symptoms. The objective of this review is to determine the correlation between urodynamic and clinical diagnoses in identifying the type of urinary incontinence in pre and postmenopausal women. This is a retrospective review of 116 women with urinary incontinence symptoms that were evaluated clinically initially and then investigated further with urodynamic tests. The results of the urodynamic studies were compared with the diagnosis assigned based on the clinical evaluation. For 69 women, the clinical diagnosis was not confirmed by urodynamic tests. In addition to this, the clinical diagnosis was confirmed by urodynamic investigations in only 38% of the patients. This is in accordance with current literature, which is suggestive that the agreement between urodynamic studies and clinical evaluation in identifying the type of urinary incontinence is poor. Larger definite trials are needed to provide further evidence of the diagnostic value of urodynamic tests in the management of patients with urinary incontinence symptoms.

Prevalence of female urinary incontinence and its impact on quality of life in a cluster population in the United Kingdom (UK): a community survey.

AIM: To ascertain the prevalence of urinary incontinence and lower urinary tract symptoms, impact on quality of life and help-seeking behaviour. BACKGROUND: Urinary incontinence is common and will affect more individuals as the population ages. Estimates of the prevalence of urinary incontinence vary hugely. Additional information is required to inform resource allocation. METHODS: Population-based cross-sectional postal evaluation of all female patients over 21 years registered at a single medical practice in the United Kingdom. FINDINGS: A total of 40% of respondents suffered urinary incontinence, which caused significant problems in 8.5%. Stress urinary incontinence was the most common type of incontinence while 10% had symptoms of voiding dysfunction. A total of 17% of women had sought professional help. Patients perceived that urinary incontinence was part of the natural ageing process and that there was a low expectation of successful treatment.

Prevalence of genital prolapse symptoms in primary care: a cross-sectional survey.

INTRODUCTION AND HYPOTHESIS: The aim of our study was to determine the prevalence of pelvic organ prolapse (POP) symptoms in a community-dwelling population in the United Kingdom. METHODS: All women over the age of 18 from a community practice were sent the validated International Consultation on Incontinence Questionnaire for vaginal symptoms (ICIQ-VS), to determine their POP symptoms. Data were analysed as numbers (raw data) and percentages of responders. Statistical comparisons were made using Chi-squared and Kruskal-Wallis tests as appropriate. RESULTS: Questionnaires were mailed to 3,412 women, 1,832 completed questionnaires were received (response 53.7 %). Symptoms strongly associated with prolapse; vaginal bulge/lump and bulge or lump outside of the vagina had a prevalence of 8.4 % and 4.9 % respectively. Vaginal symptoms, previous pelvic floor surgery, and age were statistically increased in those who had had a previous vaginal delivery. There were statistically worse scores (more symptoms) for the group with any vaginal delivery with regard to "feeling a loose or lax vagina", "a vaginal lump or bulge coming down in the vagina". There was a high prevalence of worry regarding sexual function, regardless of delivery status, with no statistically significant differences found between those who had had a vaginal delivery and those who had not. The group with no vaginal deliveries described a statistically significant increase in the reported sensation of "do you feel your vagina is too tight". CONCLUSIONS: Symptoms of POP were increased in those women who had experienced a vaginal delivery, whilst the sensation of having a tight vagina was decreased in those who had had a previous vaginal birth.