Endometriosis and polycystic ovary syndrome: enhanced stimulatory effect of peritoneal fluid on progesterone release from human granulosa-lutein cells.

OBJECTIVE: To compare the activity of peritoneal fluid (PF) from women with and without endometriosis or polycystic ovary syndrome (PCOS) on P release from cultured human granulosa-lutein cells. DESIGN: Case-control study. SETTING: Medical school and hospital. PATIENTS: Women with mild to moderate endometriosis or PCOS and controls undergoing laparoscopic sterilizations. MAIN OUTCOME MEASURES: Human granulosa-lutein cells, obtained from the IVF clinic, were cultured with increasing volumes of steroid-extracted PF samples with and without hCG. Progesterone concentrations in the media after 72 hours culture were measured by RIA. RESULTS: Peritoneal fluid stimulated P release in a dose-dependent manner and, at the highest dose, the response was enhanced significantly by PF from women with endometriosis and PCOS compared with control samples. The effects of PF plus hCG were not simply additive. There was a large potentiation of the response, which was greater in women with endometriosis and PCOS. CONCLUSIONS: Peritoneal fluid contains factors that stimulate P release and potentiate the response to hCG. The increased activity of PF associated with endometriosis and PCOS in part may have some significance in abnormal ovarian function associated with these syndromes.

Bladder neck mobility and the outcome of surgery for genuine stress urinary incontinence. A logistic regression analysis of lateral bead-chain cystourethrograms.

Bladder neck position, as determined by preoperative and postoperative resting and straining lateral bead-chain cystourethrograms, was analyzed by logistic regression analysis in 94 women undergoing 98 operations for genuine stress incontinence. A total of 384 roentgenograms were analyzed in an attempt to build a model that would predict the likelihood of surgical success in a given patient based on the preoperative films and explain a successful surgical outcome based on the characteristics of the postoperative films. The most important predictors of success were the number of previous incontinence operations, a large distance between the bladder neck and the pubic symphysis at rest, and increased mobility of the bladder neck before surgery. Successful surgery appeared to be related most closely to decreasing mobility of a previously hypermobile bladder neck.

The Stamey operation for correction of genuine stress incontinence in the elderly woman.

Forty-four elderly women underwent the Stamey procedure for urethral sphincter incompetence; six had coincidental detrusor instability. All had pre- and postoperative urodynamic assessment. At follow-up, 15 patients continued to complain of stress incontinence and 11 of urge incontinence. Overall, 27 patients still had objective evidence of genuine stress incontinence, and 15 had evidence of detrusor instability. Although the operation has minimal operative and postoperative morbidity, we do not consider its success rate satisfactory for use in the elderly.

Vaginal cones: a conservative method of treating genuine stress incontinence.

A set of weighted vaginal cones designed to exercise the pelvic floor muscles was used by a group of 39 premenopausal patients with genuine stress incontinence who were awaiting corrective surgery. The effectiveness of the exercises in reducing urinary loss was assessed with a standard urine pad test before and after 1 month of training. Of the 30 women who completed 1 month of the exercises 70% felt they were improved or cured and 90% found it an acceptable method of treatment. Of the 30 women only 11 (37%) opted for surgery after training. There was a highly significant correlation (P less than 0.001, rs = -0.21) between decreased urine loss and increase in retained cone weight.

The use of bladder neck electric conductance (BNEC) in the investigation and management of sensory urge incontinence in the female.

Measurement of urethral electric conductance can be used to detect the movement of urine along the urethra by registering a change in conductivity reading. This technique has been employed in patients complaining of urge incontinence and has shown movements at the bladder neck when urgency is appreciated. Patients with sensory urgency have been successfully managed by learning to control the movements at the bladder neck during a conductivity recording.