The prevalence of detrusor overactivity amongst patients with symptoms of overactive bladder: a retrospective cohort study.

INTRODUCTION AND HYPOTHESIS: Overactive bladder (OAB) is a symptom-based condition consisting of urgency, with or without incontinence, usually with frequency and nocturia. There are many potential causes of OAB, yet many patients are prescribed anticholinergic medications empirically. This study aimed to determine what proportion of patients presenting for urogynecologic assessment with symptoms of OAB had urodynamic detrusor overactivity (DO). METHODS: Retrospective chart review was performed for 220 consecutive patient referrals. Demographic data, physical exam information, and urodynamic results were collected. The t test and Fisher's exact test were used for statistical analyses. RESULTS: The prevalence of DO was 11.8 % in this population. Urogenital atrophy and incomplete emptying were more common. Patients with DO were older and more often menopausal than those without DO. Significant prolapse was a common finding amongst patients with OAB symptoms. CONCLUSIONS: Patients with symptoms of OAB should undergo pelvic examination and assessment of post-void residuals before being initiated on anticholinergic medication.

Vaginal delivery and pelvic floor dysfunction: current evidence and implications for future research.

Vaginal delivery is the major risk factor for the development of pelvic organ prolapse and urinary and fecal incontinence, resulting from damage to the pelvic floor muscles, nerves and connective tissue. This article reviews the perineal trauma mechanism during vaginal delivery and discusses implications of current and future research projects.

Safety and efficacy of sacrospinous vault suspension.

The objective of the study was to determine the success rate and complications of sacrospinous vault suspension when performed by an experienced surgeon. Retrospective data collection was performed for 293 women who had undergone sacrospinous vault suspension at Mount Sinai Hospital, Toronto, between November 1993 and 19 December 1998. Primary outcome measures were complication rates (acute and long term) and success rate, with failure defined as any degree of vault prolapse requiring repeat operation, any degree of symptomatic isolated vault prolapse, or any vault prolapse at or beyond the introitus. Statistical analysis was performed using simple descriptive techniques. During the study period, 305 sacrospinous vault suspensions were performed; however, 12 cases were excluded because of inaccessible records. This study therefore comprised the remaining 293 cases: 129 at the time of vaginal hysterectomy, 5 with transvaginal cervical stump excision, 155 for post-hysterectomy vault prolapse, and 4 without hysterectomy. Two hundred had follow-up of 1 year or more, with maximum follow-up 5 years. Of these 200, there were 6 failures (3%). There were no acute hemorrhages and no deaths. There was a complaint of postoperative right buttock pain in 18 of the 293 procedures (6.1%), with this persisting on a chronic basis in 3 patients. Eight patients complained of new-onset postoperative dyspareunia. Nine patients had postoperative stress urinary incontinence, and 14 patients had de novo anal incontinence. Postoperatively, there were 17 patients with a cystocele and 7 with a rectocele. There were three other complications: one pelvic hematoma at the sacrospinous suspension site, one right foot drop which spontaneously resolved, and one case of pain in the right sciatic nerve distribution which spontaneously resolved. Forty-three patients complained of anal incontinence preoperatively, and 38 (88.4%) had the symptoms resolved postoperatively. It was concluded that, when performed by a surgeon experienced in the procedure, sacrospinous vault suspension is safe and effective, with a successful result at 1 year in more than 90% of cases, and rare major complications.

Is transabdominal repair of mild to moderate cystocele necessary for correction of prolapse during a modified Burch procedure?

A nonconcurrent cohort study by chart review of cases was carried out at the Urogynecology Unit of Mount Sinai Hospital in Toronto, Canada, in 380 patients with stress urinary incontinence (SUI) undergoing Burch retropubic urethropexy (RPU) with or without transabdominal internal anterior repair (TIAR). There were 191 subjects (group A) who had both RPU and TIAR, and 189 (group B) who had RPU alone. The main outcome measures were postoperative recurrence of cystocele and SUI. Statistical analysis was performed using multiple regression analysis; P<0.05 was considered statistically significant. Of patients with preoperative cystocele grade 1 and 2 (mild to moderate) followed-up at 1 year, recurrence in groups A and B, respectively, was found in 13/114 (11.4%) vs. 4/99 (4.0%) (P<0.05). Regression analysis showed this trend of greater recurrence with TIAR to persist at 5 years, although a significant number of patients were lost to follow-up. There was no statistically significant difference in the cure of SUI between the groups. There was a 2.1% incidence of inadvertent cystotomy during TIAR (with no bladder injuries in group B), although this complication was always recognized and repaired without sequelae. In patients with both SUI and mild to moderate cystocele, TIAR may not be a necessary addition to RPU for treatment of the cystocele, although a randomized clinical trial is needed to determine the optimal transabdominal treatment in such cases. There is no detrimental effect of TIAR on the Burch procedure's success in curing SUI.

The role of estrogen in female urinary incontinence and urogenital aging: a review.

Urogenital aging is a complex of urogenital symptoms involving the lower urinary tract, the genital tract and the pelvic floor. These symptoms involve hypoestrogenism in the menopausal woman. This review concludes that irritative urinary and local vaginal symptoms are quite amenable to estrogen therapy. Urinary incontinence is thought to be benefited by treatment with estrogen, although controversy exists. There is a limited role for estrogen in problems of urogenital prolapse, rectal symptoms, and sexuality in menopause.