Waterbirth and pelvic floor injury: a retrospective study and postal survey using ICIQ modular long form questionnaires.

OBJECTIVE: Benefits attributed to waterbirth (WB) include a shorter second stage of labour and reduction of perineal trauma. The aim of this study is to assess the incidence of perineal trauma and pelvic floor function following WB compared to land birth (LB). STUDY DESIGN: We conducted a retrospective analysis on the incidence of perineal trauma following a spontaneous WB (n=160) or a LB (n=623). Data were collected using the hospital's healthcare database, which codes information on pregnancy outcomes and related variables. ICIQ-VS for vaginal symptoms, and the ICIQ-KH Long Form (KHQ) were used to assess pelvic floor function a year after delivery. RESULTS: Length of 2nd stage was significantly shorter in the WB group. Although this did not translate into less perineal trauma, the incidence of 3rd degree tears appeared to be doubled in the WB group. 77 (38.5%) women from the WB group and 54 (22%) from the LB group answered the postal questionnaires. A significant number of women reported vaginal and urinary symptoms, however the difference between both groups was not statistically significant. CONCLUSION: Waterbirth results in a shorter 2nd stage of labour. This does not lead to less overall perineal trauma or better pelvic floor performance postpartum. Physical limitations in protecting the perineum during the expulsion phase may be associated with an increase in the incidence of 3rd degree tears in the WB population.

Bladder sensations during filling cystometry are different according to urodynamic diagnosis.

PURPOSE: To determine the position and character of bladder filling sensations in women undergoing urodynamic investigations. MATERIALS AND METHODS: Women with lower urinary tract symptoms referred to urodynamic clinics of two tertiary referral teaching hospitals were prospectively studied. During filling cystometry the women were asked to describe the bladder sensations at the first sensation of bladder filling, first desire to void, strong desire to void, maximum bladder capacity and if the woman felt urgency. Women were also asked to define the time that the voiding could be delayed and to indicate the position of each sensation on a body map. Women were classified into four groups according to urodynamic diagnosis: detrusor overactivity (DO), urodynamic stress incontinence (USI), co-existing DO and USI (mixed) and inconclusive urodynamics; the latter was excluded from the study. Bladder sensations were compared between these groups using Chi squared and Kruskall-Wallis tests. RESULTS: Eighty-two women were studied. Women with DO and mixed urodynamic diagnosis predominantly described the bladder sensations as being perineal or vaginal in origin, whereas those with USI felt the sensations suprapubically. The character of bladder sensation was not significantly different between the diagnostic groups and the intensity increased with larger bladder volume. The duration that women could delay voiding was significantly different between different urodynamic groups. CONCLUSIONS: Bladder sensations experienced during cystometry are different in position and duration in relation to urodynamic diagnoses. This indicates that uniform descriptions of sensations during filling cystometry might not be appropriate to different urodynamic diagnoses.

A review of solifenacin in the treatment of urinary incontinence.

Overactive bladder (OAB) is a prevalent condition which has an adverse effect on quality of life. The presence of urgency incontinence confers significant morbidity above and beyond that of OAB sufferers who are continent. The primary treatment for OAB and urgency incontinence is a combination of behavioral measures and antimuscarinic drug therapy. The ideal antimuscarinic agent should effectively relieve the symptoms of OAB, with the minimum of side effects; it should be available as a once-daily sustained release formulation and in dosage strength that allows easy dose titration for the majority of sufferers. Solifenacin succinate was launched in 2005, and has been shown in both short and long term clinical trials to fulfill these requirements. Solifenacin is a competitive M3 receptor antagonist with a long half-life (45-68 hours). It is available in two dosage strengths namely a 5 or 10 mg once-daily tablet. The efficacy and tolerability of solifenacin for the treatment of all symptoms of OAB has been evaluated in a number of large, placebo controlled, randomized trials. Long-term safety, efficacy, tolerability and persistence with treatment have been established in an open label 40 week continuation study.

A review of adherence to drug therapy in patients with overactive bladder.

Drug therapy for overactive bladder (OAB) is associated with improvements in symptoms and quality of life, but the short- and long-term adherence and persistence is suboptimal. In this review we outline methods of measuring, and factors affecting, adherence to pharmacotherapy in patients with OAB. Clinical practice suggests that adherence rates reported in clinical trials are much greater than in real practice. Factors affecting adherence include psychological and social variables that might alter patients' perception of the benefits of taking medication, and the effect of comorbidity and polypharmacy. Whilst there is some evidence that lack of efficacy and side-effects are contributory, these additional factors are also important.

Disease burden of overactive bladder: quality-of-life data assessed using ICI-recommended instruments.

Overactive bladder (OAB) is characterised by the storage symptoms of urgency, with or without urge incontinence, and usually with urinary frequency and nocturia. OAB is a common condition that affects people of all ages within society. It has an estimated prevalence of 16% and is known to adversely affect quality of life (QOL). Assessment of the QOL of patients is important to understanding both the burden of disease and improvement after treatment. In clinical practice, the physician's assessment of the disease burden of OAB has been shown to be inaccurate and non-reproducible. Psychometrically robust self-completion questionnaires provide a valid, reproducible and rapid assessment of patient-reported disease impact that can elicit the impact of symptoms, and they are also useful for the evaluation of the efficacy of an intervention. Many different questionnaires have been developed to assess the QOL impact of OAB. Generic instruments measure very broad aspects of health and are suitable for a wide range of patient groups and general population screening. They can be applied to patients with any medical condition and provide a measure of morbidity but are less sensitive to clinically relevant change in conditions such as OAB. Condition-specific questionnaires offer greater sensitivity and responsiveness to change in the assessment of QOL of specific patient groups. Single-item global assessment questionnaires are useful in conditions such as OAB that have multiple and varied symptoms, and reflect an individual's needs, concerns and values. Patient-derived outcome measures are used in real-world clinical practice, clinical trials, health economic research and healthcare planning.

Design and validation of a new screening instrument for lower urinary tract dysfunction: the bladder control self-assessment questionnaire (B-SAQ).

OBJECTIVES: To develop and validate a short patient self-assessment screening questionnaire: bladder control self-assessment questionnaire (B-SAQ) for the evaluation of lower urinary tract symptoms. This first validation study was undertaken amongst women. PATIENTS AND METHODS: Three hundred twenty-nine women attending general gynaecology and urogynaecology clinics completed both the B-SAQ and Kings Health questionnaire prior to medical consultation, and independent physician assessment of the presence of lower urinary tract symptoms (LUTS) and need for treatment. The psychometric properties of the B-SAQ were subsequently analysed. RESULTS: The B-SAQ was quick and easy to complete, with 89% of respondents completing all items correctly in less than 5 min. The internal consistency (Cronbach's alpha score 0.90-0.91), criterion validity (Pearson's correlation values of 0.79 and 0.81, p<0.0001 with the incontinence impact domain of the Kings Health questionnaire), and test-retest reliability of the questionnaire were good. The sensitivity and specificity of the questionnaire to identify patients with bothersome LUTS was 98% and 79%, respectively. CONCLUSIONS: LUTS are commonly underreported. Empowering patients to self-assess their bladder symptoms and the need for treatment will improve treatment-seeking behaviour. The B-SAQ is a psychometrically robust, short screening questionnaire that offers patients the ability to assess their bladder symptoms and the bother they cause, and the potential benefit of seeking medical help.