Efficacy of FemiScan Pelvic Floor Therapy for the Treatment of Anal Incontinence.

OBJECTIVES: Pelvic floor muscle training can be effective in alleviating anal incontinence; however, women need instruction, motivation, and feedback to gain optimal benefit. The FemiScan Pelvic Floor Therapy System is approved in the United States and European Union for the treatment of urinary incontinence. It uses office electromyography and an in-home programmable device. This study was undertaken to document the effect of FemiScan on anal incontinence symptoms of women who completed a physician-supervised program. METHODS: Women referred for treatment of urinary symptoms who also reported anal incontinence symptoms were included in the analysis. We collected patient demographics, electromyographic measurements, and responses to subjective questions about the status of their anal incontinence. RESULTS: Forty eight (55%) of 88 patients who started treatment completed the 8-visit protocol. No adverse events were reported. Mean age was 54.8 ± 12.0 years. There was a statistically significant increase in the mean maximal response comparing the first and final electromyographic measurements obtained during the first and last office visits: left side, 13.7 ± 9.3 µV versus 23.2 ± 13.5 µV, P < 0.001 and right side, 14.6 ± 2.4 µV versus 22.7 ± 10.6 µV, P < 0.001 were analyzed separately. Fifty six percent reported that they were 100% free of symptoms, and 77% considered their symptoms at least 80% improved. Colorectal Anal Distress Inventory results demonstrated a statistically significant improvement when comparing the first and last visit (28.9 ± 17.9 vs 2.1 ± 7.8, P < 0.001). CONCLUSIONS: FemiScan appears to be a safe and effective treatment for anal incontinence with concomitant increased pelvic floor electromyographic activity.

Efficacy of FemiScan Pelvic Floor Therapy for the Treatment of Urinary Incontinence.

OBJECTIVES: Pelvic floor muscle training can be effective in alleviating urinary incontinence; however, women need instruction, motivation, and feedback to gain optimal benefit from pelvic rehabilitation. The Food and Drug Administration-approved FemiScan Pelvic Floor Therapy System uses office electromyography and an in-home programmable device to provide training, motivation, and feedback between office visits. This study was undertaken to document the outcomes of women who completed an MD-supervised program using the FemiScan Pelvic Floor Therapy System. METHODS: In this chart review, women with urinary incontinence, who completed the 8-visit protocol, were included in the analysis. We collected patient demographics, electromyographic measurements, and responses to subjective questions about the status of their urinary incontinence symptoms. RESULTS: Two hundred fifteen (60%) of 361 patients who started treatment with FemiScan completed the 8-visit protocol. No adverse events were reported. The mean age was 54.4 ± 12.7 years. There was a statistically significant increase in the mean maximal response comparing the first and final electromyographic measurements obtained during the first and last electromyography office visits. The left side (15.9 ± 10.2 µV vs 28.0± 15.2 µV, P < 001) and the right side (16.6 µV vs 28.2 µV, P < 0.001) were analyzed separately in peak electromyographic measurements between the first and final visits. Seventy-five percent considered their symptoms at least 80% improved with 45% reporting complete subjective cure. Urinary Distress Inventory 6 results confirmed the subjective report with a statistical significant improvement comparing the first and last visit (9.47 ± 3.66 vs 2.71 ± 3.58, P < 001). CONCLUSIONS: FemiScan appears to be a safe and effective treatment for urinary incontinence with concomitant increased pelvic floor electromyographic activity.

Serum inhibin A concentration in women with polycystic ovarian syndrome and the correlation to ethnicity, androgens and insulin resistance.

A prospective case-series in an academic hospital clinic was performed to determine whether there is a relationship between polycystic ovarian syndrome (PCOS) and ethnicity. Also, serum inhibin A concentrations were compared between PCOS and normal-ovulatory women. The possibility of a correlation between inhibin A, androgens and insulin resistance in PCOS women was evaluated. Serum inhibin A concentrations were measured in anovulatory PCOS patients (n=32) and in control women of reproductive age (n=16). Statistical analysis was performed using the Mann-Whitney U-test. Serum concentrations of inhibin A, follicle-stimulating hormone, LH, prolactin, thyroid-stimulating hormone, fasting glucose, insulin, testosterone, 17-hydroxyprogesterone (17-OHP) and dehydroepiandrosterone sulphate (DHEAS) were measured. Inhibin A concentrations were significantly lower (4.5+/-4.8 pg/ml) when compared with the control group (13.2+/-14.4 pg/ml; P=0.003) and were not significantly different between Hispanic and Caucasian women diagnosed with PCOS. There was no correlation between inhibin A concentrations and insulin, testosterone, free testosterone, 17-OHP, or DHEAS concentrations. In PCOS women, inhibin A concentrations are similar between Hispanic and Caucasian women; however, women with PCOS, regardless of ethnicity, have a lower inhibin A concentration compared with normal-ovulatory women. No correlation was observed between inhibin A androgens and insulin resistance in women diagnosed with PCOS.

Premature luteinization and in vitro fertilization outcome in gonadotropin/gonadotropin-releasing hormone antagonist cycles in women with polycystic ovary syndrome.

OBJECTIVE: To determine the incidence of premature luteinization in patients with polycystic ovary syndrome (PCOS) undergoing controlled ovarian hyperstimulation (COH) with exogenous gonadotropin/GnRH antagonist (GnRH-a); to compare clinical outcomes in patients with and without premature luteinization. DESIGN: Retrospective case series. SETTING: IVF clinic. PATIENT(S): Thirty-five treatment cycles in 30 patients with PCOS. INTERVENTION(S): Controlled ovarian hyperstimulation with gonadotropin/GnRH-a protocol. MAIN OUTCOME MEASURE(S): Premature luteinization defined as a P concentration of >/=1.3 ng/mL on the day of hCG administration; number of oocytes and two pronuclei (2PN) embryos; implantation and clinical pregnancy rates (PR). RESULT(S): The incidence of premature luteinization was 28%. Compared with those without premature luteinization, patients with premature luteinization had a higher number of oocytes retrieved (24.1 +/- 13.3 vs. 12.0 +/- 5.9) and greater number of mature oocytes (19.7 +/- 11.7 vs. 9.5 +/- 4.5), respectively. The number of good quality embryos and embryos transferred was not significantly different between groups. Although implantation rates (56% vs. 40%) and clinical PRs (36% vs. 30%) were higher in patients without premature luteinization, the differences were not statistically significant. CONCLUSION(S): The patients with PCOS with premature luteinization had a higher number of oocytes retrieved and mature oocytes, and similar clinical PRs as patients with PCOS without premature luteinization.

Inhibin A: marker for diagnosis of ectopic and early abnormal pregnancies.

A prospective case-control study was performed to determine whether inhibin A concentration is a clinically useful marker of ectopic pregnancy (EP). Inhibin A concentration in patients diagnosed with EP by laparoscopic and pathological findings (n = 17) was compared with that in missed miscarriage (n = 35), incomplete miscarriage (n = 14), spontaneous miscarriage (n = 5), threatened miscarriage (n = 6), normal pregnancy (n = 24) and non-pregnant controls (n = 20). The data were analysed using the Mann-Whitney U-test. EP yielded significantly lower inhibin A concentrations compared with normal pregnancy, 12.7 +/- 11.7 versus 237.3 +/- 125.9 pg/ml (P < 0.0002), and similar concentrations to non-pregnant controls (13.3 +/- 14.3 pg/ml). Inhibin A concentrations in abnormal pregnancies were significantly lower than in the normal pregnancy group: missed miscarriage 42.4 +/- 54.9 pg/ml (P < 0.0002); spontaneous miscarriage 47.5 +/- 55.6 pg/ml (P < 0.0002); and incomplete miscarriage 12.2 +/- 10.5 pg/ml (P < 0.0002). Threatened miscarriage was not statistically different to normal pregnancy (183.1 +/- 119.4 pg/ml). Human chorionic gonadotrophin concentrations in EP were not statistically significantly different compared with missed miscarriage and incomplete miscarriage. In conclusion, serum inhibin A concentration may be a reliable marker of EP.