Use of free uroflowmetry vs pressure-flow studies in the diagnosis of overactive bladder syndrome in females.

OBJECTIVES: To determine if pressure-flow study (PFS) parameters, including flow index (FI) calculated by dividing average urethral flow by maximal urethral flow, increase the accuracy of urodynamic studies in the diagnosis of overactive bladder (OAB). STUDY DESIGN: Retrospective study to evaluate the medical history and urodynamic examination results of female patients diagnosed with lower urinary tract symptoms (LUTS) between January 2014 and December 2015. Patients were stratified into four groups depending on the type of LUTS: OAB; stress urinary incontinence (SUI); mixed urinary incontinence with predominant SUI symptoms (MUI-SUI); and mixed urinary incontinence with predominant OAB symptoms (MUI-OAB). RESULTS: OAB was diagnosed in 26 (15%) patients, SUI was diagnosed in 93 (52%) patients, MUI-OAB was diagnosed in 43 (24%) patients, and MUI-SUI was diagnosed in 17 (9%) patients. FI calculated using free uroflowmetry (FI-free) was significantly lower in the OAB group compared with the other groups (p<0.01). Analysis revealed no difference in FI-free between the SUI, MUI-SUI and MUI-OAB groups. Significant differences were found between the study groups for most free uroflowmetric parameters, including maximal urethral flow, average urethral flow and micturition volume (p<0.05). Similar differences were not found in PFS parameters. CONCLUSIONS: The decrease in the urethral lumen due to the presence of a transurethral catheter in patients with OAB, in contrast to women with SUI and MUI, was not found to influence FI calculated using free uroflowmetry or PFS. FI may serve as an important objective diagnostic tool for OAB, but only when calculated from free uroflowmetry parameters when assessing patients with LUTS.

3-D high-frequency endovaginal ultrasound of female urethral complex and assessment of inter-observer reliability.

OBJECTIVES: Assessment of the urethral complex and defining its morphological characteristics with 3-dimensional endovaginal ultrasonography with the use of high frequency rotational 360° transducer. Defining inter-observer reliability of the performed measurements. MATERIALS AND METHODS: Twenty-four asymptomatic, nulliparous females (aged 18-55, mean 32 years) underwent high-frequency (12MHz) endovaginal ultrasound with rotational 360° and automated 3D data acquisition (type 2050, B-K Medical, Herlev, Denmark). Measurements of the urethral thickness, width and length, bladder neck-symphysis distance, intramural part of the urethra as well as rhabdosphincter thickness, width and length were taken by three investigators. Descriptive statistics for continuous data was performed. The results were given as mean values with standard deviation. The relationships among different variables were assessed with ANOVA for repeated measures factors, as well as T-test for dependent samples. Intraclass correlation (ICC) was calculated for each parameter. Intra- and interobserver reliability was assessed. Statistical significance was assigned to a P value of <0.05 (two-tailed). RESULTS: Excellent reliability was observed for urethral measurements (length, width, thickness and volume) (ICC>0.8) and good reliability for rhabdosphincter measurements (ICC>0.6) between all three investigators. CONCLUSIONS: Advanced EVUS provides detailed information on anatomy and morphology of the female urethral complex. Our results show that 360° rotational transducer with automated 3D acquisition, currently routinely used for proctological scanning is suitable for the reliable assessment of the urethral complex and can be applied in a routine diagnostics of pelvic floor disturbances in females.

Pelvic floor disorders: role of new ultrasonographic techniques.

The paper presents the role of various ultrasound modalities in the diagnostics of female pelvic floor disorders (PFD). It describes the use of two/three/four-dimensional transperineal ultrasound and endocavitary transducers, which, up to now, have been used for proctological examinations and prostate cancer brachytherapy. Ultrasonography is the most widely available imaging modality. As a result of technical progress, novel transducers and more sophisticated software have recently been introduced to the market providing more information about the anatomy of pelvic organs. Some features of these transducers, such as higher frequency and multiplanar imaging, enable better visualisation of pelvic floor organs. In-depth knowledge of the technical and physical properties of modern ultrasonography, as well as its advantages and limitations, could provide an integrated approach to imaging of PFD. Technical modalities, the wide availability of ultrasonographic techniques, and an understanding of the imaging possible with modern ultrasonography could improve our understanding of PFD and allow better assessment in pre- and post-surgical management.

Height at menarche is influenced by estrogen receptor alpha gene polymorphisms.

BACKGROUND: It has been suggested that polymorphic variations in estrogen receptors (ERs) genes may have an impact on linear growth of girls during puberty. AIM: The aim of the study was to investigate whether height at menarche is influenced by PvuII and XbaI polymorphisms of the ERalpha gene. SUBJECTS AND METHODS: The study population consisted of 127 healthy girls, who were observed from premenarcheal period at six monthly intervals, until menarche occurred in all participants. Anthropometric measurements were taken at each visit and their values at menarche were calculated using centile curves drawn individually for each subject. PvuII and XbaI ERalpha gene polymorphisms were evaluated with RLFP-PCR. RESULTS: The age at menarche was not related to ERalpha gene polymorphisms. Girls with pp genotype were at menarche on average 3.2 cm shorter than PP homozygotes and in addition xx homozygotes were shorter than subjects with XX and Xx genotypes: 3.0 cm and 3.9 cm respectively. Subjects with px haplotype were, at the onset of the first menstrual period, from 2.3 cm to 3.1 cm shorter than carriers of other haplotypes. The leg length-to-height ratio at menarche was lower in xx homozygotes than in Xx heterozygotes and lower in px haplotype in comparison to Px and pX haplotypes carriers. Corresponding associations were observed at the final visit. CONCLUSIONS: Height at menarche is influenced by the ERalpha gene polymorphism.

[Stress urinary incontinence among women who underwent surgical treatment due to abdominal hernias]. / Ocena czestosci wysilkowego nietrzymania moczu u kobiet leczonych operacyjnie z powodu przepuklin brzusznych.

OBJECTIVES: Biochemical modification and resulting biomechanical disfunction of the connective tissue are believed to contribute to the pathogenesis of both stress urinary incontinence and abdominal hernias. Since the coincidence between this disorders may be anticipated, the goal of our study was to investigate the occurrence of stress urinary incontinence among women who underwent the surgical treatment of abdominal hernias. MATERIALS AND METHODS: Forty seven women who participated into the study were divided into two groups. The investigated group consisted of 23 women who underwent surgical treatment of femoral, inguinal or umbilical hernias, whereas the control group comprised 24 women after cholecystectomy due to cholelithiasis. Data concerning stress urinary incontinence and associated risk factors were obtained using Gaudenz's questionnaire. RESULTS: Stress urinary incontinence was reported by 34.8% of women after hernioplasty and 33.3% after cholecystectomy. The difference was not statistically significant. We found no association between known risk factors of stress urinary incontinence, as: age, weight, history regarding vaginal delivery and gynecological surgery, and occurrence of incontinence. CONCLUSION: The history of the surgical treatment of abdominal hernias is not a risk factor of stress urinary incontinence in women.

Evaluation of matrix metalloproteinases-1 and -3 concentrations in the tunica albuginea, the apical wall of atretic follicles and the corpus luteum of normal human ovaries.

Matrix metalloproteinases-1 (MMP-1) and -3 (MMP-3) are proteolytic enzymes involved in remodeling the ovarian extracellular matrix throughout the menstrual cycle. The aim of the present study was to evaluate the tissue concentrations of MMP-1 and MMP-3 in the apical wall of atretic follicles (androstenedione/estradiol ratio > 4), tunica albuginea dissected from the ovarian surface overlying areas devoid of follicles, corpus luteum, and tunica albuginea covering the corpus luteum. After extraction of MMPs from the tissue samples, their concentrations in the extracts were measured by enzyme-linked immunosorbent assays (ELISA). Significantly less MMP-1 was detected in the apical wall of atretic follicles compared to tunica albuginea taken from sites devoid of follicles. These data indicate that atresia is associated with relatively low concentrations of MMP-1 in the apical wall of the follicle. Moreover, there was a negative correlation between the amount of MMP-3 and the diameter of follicle. These data suggest that both MMPs play an important role in the final step of atresia. The amount of MMP-1 in the corpus luteum was several times lower than in the other tissues. This is likely due to stabilization of the extracellular matrix during the period of the corpus luteum maintenance. The concentration of MMP-3 did not differ significantly among the examined tissues.

Interstitial collagenase (MMP-1) activity in human ovarian tissue.

The collagen content and collagenase activity were estimated in human ovarian interstitial tissue devoid of all visible follicles in menstruating, fertile as well as climacteric women. The mean total collagenase activity in ovarian specimens taken during both follicular (n = 10, 3.97 +/- 0.58 U/g wet weight, ww) and luteal phase (n = 10, 3.39 +/- 1.24 U/g ww) of the normal menstrual cycle along with total collagen concentration (184.8 +/- 41.0 vs. 194.4 +/- 30.5 micrograms/mg ww, respectively) did not differ. Total collagenase activity of climacteric gonads (n = 5, 1.55 +/- 0.71 U/g ww) was lower than in specimens collected during both follicular and luteal phase (p = 0.0002 and p = 0.017, respectively). About 23% of the total collagenase activity in follicular phase ovarian extracts and only about 1% in luteal phase ovarian preparations was found in the latent form. The percentage of latent collagenase in ovarian tissue during the follicular phase was negatively correlated with the day of the menstrual cycle (r = -0.93, p = 0.007). Extracellular matrix remodelling in the human ovary can be correlated with the functional status of the follicular unit.

Local collagen turnover in human foetal membranes during full term vaginal delivery.

OBJECTIVES: To investigate if changes in local metabolism of collagens type I and type III may contribute to the term rupture of the foetal membranes. STUDY DESIGN: In extracts from membranes taken along the rupture line and near the site of the umbilical cord attachment to the placenta, we measured concentrations of specific markers of collagen synthesis, namely C-terminal propeptide of type I collagen (PICP) and N-terminal propeptide of type III collagen (PIIINP), as well as the concentration of the pyridinoline cross-linked C-terminal telopeptide of type I collagen (ICTP), which reflects the rate of collagen type I breakdown. RESULTS: The mean concentrations of PICP and PIIINP did not differ statistically between the two examined groups of samples. The mean ICTP concentration was threefold higher in extracts prepared from samples taken near the rupture site, than from membranes derived from the proximity of the umbilical cord attachment. CONCLUSIONS: Term rupture of foetal membranes is accompanied by increased local degradation of type I collagen fibrils at the rupture site, whereas the biosynthesis of collagen types I and III remains unchanged.

[Activity of tissue inhibitors of metal proteinases (TMI) in th fetal membrane during term vaginal delivery]. / Aktywnosc tkankowych inhibitorów metaloproteinaz (TIMPs) w blonach plodowych podczas porodu w ciazy donoszonej.

In the foetal membranes that ruptured spontaneously or by means of amniotomy during term vaginal deliveries the activity of tissue inhibitors of metalloproteinases was evaluated. Samples were taken from the proximity of the rupture line. Almost twofold lower TIMPs activity in the naturally ruptured membranes was observed. We conclude that during normally proceeding term vaginal delivery the activity of TIMPs in the lowermost pole of the amniotic sac is decreased, what may play very important role in the mechanism of the term rupture of the foetal membranes.