8,522 research outputs found
Validation of an Italian version of the prolapse quality of life questionnaire
No full textObjective: To validate the italian translated version of the prolapse quality of life questionnaire (P-QOL). Study design: The P-QOL questionnaire was translated into Italian and administered to women recruited from a gynaecology outpatient clinic. All women completed a P-QOL questionnaire at the time of the visit, and were examined in left lateral position using the ICS prolapse score. A second P-QOL questionnaire was posted and completed by women I week later. The validity was assessed by measuring levels of missing data, comparing symptom scores with objective prolapse stages and between affected and asymptomatic women. The reliability was assessed by testing internal consistency and stability using 1-week test retest analysis. Results: 132 symptomatic and 61 asymptomatic women were studied. The number of missing items was 2%. P-QOL domain scores were significantly different between symptomatic and asymptomatic women (P < 0.001). Severity according to P-QOL strongly correlated with the prolapse size (P < 0.01, rho > 0.5). All items achieved a Cronbach alpha greater than 0.8. The test retest reliability confirmed a highly significant correlation between the total scores for each domain. Conclusion: The Italian version of the P-QOL questionnaire has been validated, providing a reliable, easily comprehensible and valid instrument for the symptomatic assessment of Italian-speaking women with uterovaginal prolapse. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved
The open bladder neck: a significant finding?
No full textWomen with lower urinary tract symptoms were retrospectively studied. They were all investigated using a urinary symptoms questionnaire, a frequency-volume chart and videocystourethrography. An open bladder neck was recorded at maximum cystometric capacity with the patient standing in the left lateral position, if contrast medium entered the proximal urethra at rest in the absence of a detrusor contraction or an increase in intra-abdominal pressure. Women with neurological disorders were excluded. Of 4500 women, 2,593 (57.6%) had a single urodynamics diagnosis and were included in the study: 1207 (46.5%) had urodynamics diagnosis of urodynamic stress incontinence, 558 (21.5%) had detrusor overactivity, 118 (4.6%) had sensory urgency, and 710 (27.4%) had a normal urodynamic study. Out of the 2,593 women included, 776 women (29.9%) had an open bladder neck at rest while 1817 (70.1%) had a closed bladder neck at rest. Only 45% (542/1207) of women with urodynamic stress incontinence had an open bladder neck at rest. Seventy percent (542/776) of women with an open bladder neck had a diagnosis of urodynamic stress incontinence whilst 73% of women with detrusor overactivity and 93% of those with sensory urgency had a closed bladder neck. An open bladder neck at rest is not diagnostic of urethral sphincter incompetence but is associated with urodynamic stress incontinence. It is not associated with urgency as few women with sensory urgency and detrusor overactivity were found to have an open bladder neck. Imaging the bladder neck at rest has questionable value
The relationship of vaginal prolapse severity tosymptoms and quality of life
No full textObjective To assess the relationship and location of vaginal prolapse severity to symptoms and quality of life. Design A prospective observational study. Setting Urogynaecology Unit, Imperial College, St Mary's Hospital, London. Population Women with and without symptoms of vaginal prolapse. Methods All women completed a validated Prolapse Quality of Life (P-QOL) questionnaire. This included a urinary, bowel and sexual symptom questionnaire. All women were examined using the Pelvic Organ Prolapse Quantification system (POP-Q). POP-Q scores in those with and without prolapse symptoms were compared. Urinary and bowel symptoms and sexual function were compared and related to prolapse severity and location. Main outcome measures POP-Q scores, P-QOL scores, urinary and bowel symptoms and sexual function. Results Three hundred and fifty-five women were recruited-233 symptomatic and 122 asymptomatic of prolapse. The median P-QOL domain scores ranged between 42-100 in symptomatic women and 0-25 in those who were asymptomatic. The stage of prolapse was significantly higher in those symptomatic of prolapse (P < 0.001) except for perineal body (PB) measurement. Urinary symptoms were not correlated with uterovaginal prolapse severity whereas bowel symptoms were strongly associated with posterior vaginal wall prolapse. Cervical descent was found to have a relationship with sexual dysfunction symptoms. Conclusions Women who present with symptoms specific to pelvic organ prolapse demonstrate greater degrees of pelvic relaxation than women who present without symptoms. Prolapse severity and quality of life scores are significantly different in those women symptomatic of prolapse. There was a stronger relationship between posterior prolapse and bowel symptoms than anterior prolapse and urinary symptoms. Sexual dysfunction was related to cervical descent
Double incontinence in urogynecologic practice: A new insight
No full textOBJECTIVES: This study was undertaken to evaluate the prevalence of anal incontinence in an urogynecologic setting and to investigate the relationship between lower urinary tract dysfunction and anal incontinence. STUDY DESIGN: The study included 504 women referred to our urogynecologic outpatient clinic who were prospectively investigated and asked specific questions on anal incontinence. Clinical and instrumental data were compared between women with urinary incontinence and with double incontinence, with further analysis for subgroups in the anal incontinent group of women (passive/urge). For continuous variables, the Wilcoxon rank sum test was used, and the Fisher exact test was applied to dicotomic variables. Logistic regression was used for categorical data. A level of P<.005 was considered significant. RESULTS: Of the investigated women, 20.2% were also anally incontinent. Women with double incontinence showed higher scores for urinary urgency (P =.010), which reached the established level of significance only in the subgroup with urge anal incontinence (P =.003). In this group, a higher prevalence of detrusor overactivity was observed. CONCLUSION: Anal incontinence is highly prevalent among women with lower urinary tract disorders. The existence of subgroups of patients having different kinds of anal and urinary disorders should be taken into consideration both for research purposes and for new treatment perspectives
Do overactive bladder symptoms improve after repair of anterior vaginal wall prolapse?
No full textThis study aims to evaluate the changes of overactive bladder symptoms to anterior vaginal wall prolapse repair. Ninety-three consecutive women with symptomatic anterior vaginal wall prolapse >= stage II and coexistent overactive bladder symptoms were prospectively studied using a urinalysis, urodynamics, King's Health Questionnaire (KHQ), Prolapse Quality of Life (P-QOL) questionnaire and pelvic organ prolapse quantification (POP-Q) system before and 1 year after surgery. All women underwent a standard fascial anterior repair. Postoperatively, urinary frequency, urgency and urge incontinence disappeared in 60, 70 and 82% of women respectively (p value < 0.001). The vaginal examination findings as well as the quality of life of the women assessed using KHQ and P-QOL significantly improved after surgery (p value < 0.001). This study has demonstrated that anterior vaginal repair does produce significant improvement in overactive bladder symptoms. A larger longer-term study is required to assess if these changes persist over time
Urethral retro-resistance pressure and urodynamic diagnoses in women with lower urinary tract symptoms
No full textObjective This study determines whether the retrograde urethral retro-resistance pressure (URP) measurement discriminates between urodynamic diagnoses in a group of women. Design A prospective observational study. Setting Urogynaecology units of three tertiary referral teaching hospitals. Population Women with lower urinary tract symptoms. Methods Consecutive women attending the urodynamic clinics of three tertiary referral teaching hospitals were studied using a validated urinary symptom questionnaire, URP measurement and urodynamic evaluation between February and July 2004. The URP mean values were compared with urinary symptoms and urodynamic diagnoses, using the independent t test correction for multiple measurements. Main outcome measures Retrograde URP, urodynamic diagnoses and urinary symptoms. Results One hundred and eighty-five women were recruited. Women with urodynamic stress incontinence (USI) have significantly lower URP than women with competent urethral sphincters (P 0.05, independent t test). There was no significant difference between mean URP values and different urinary symptoms (P > 0.05, independent t test). Conclusions There are significantly different URP measurements between women with DOA and those with USI. However, the URP is not a diagnostic tool
Efficacy of tolterodine in relation to different urodynamic findings of detrusor overactivity
No full textEfficacy of tolterodine in relation to different urodynamic findings of detrusor overactivity
No full textAim of the study was to evaluate the efficacy of tolterodine in relation to different urodynamic findings of detrusor overactivity (DO). Women with urodynamic diagnosis of DO were prospectively included into two groups: with involuntary detrusor contractions during the cystometric filling phase (group 1) or after provocative manoeuvres (group 2). Tolterodine 4 mg ER was prescribed to all women. Drug efficacy was assessed using a 3-point scale. Women were defined responders if they were improved/cured after 3 months of therapy, and non-responders if symptoms did not change. The outcome of therapy was compared between groups. A total of 111 women were included. The groups did not differ for demographic characteristics. After 12 weeks, we found a significant difference (P = 0.0008) between groups in terms of tolterodine efficacy with a better response rate in group 1. Our study shows that tolterodine efficacy may be related to different urodynamic findings of DO
Pressure flow study: A useful diagnostic test of female lower urinary tract symptoms
No full textAims: To compare pressure flow parameters in the different urodynamic diagnoses in women with lower urinary tract symptoms (LUTS). Materials and Methods: Urodynamic traces of women with LUTS were prospectively studied. Detrusor pressures at the start of flow (ODP), detrusor pressure at peak flow rate (PdetQmax), peak flow rate (Qmax) and detrusor pressure at the end of flow (CDP) were measured and compared with different urodynamic diagnoses. Results: Six hundred and twenty one women were prospectively investigated between September 2000 and February 2002. Only 85% (529/621) of women had good quality pressure flow studies and was included in the study. Women with detrusor overactivity have higher ODP, CDP and PdetQmax than women with urethral sphincter incompetence. All these pressure flow parameters are significantly lower in women with urethral sphincter incompetence than continent women (P < 0.05, Bonferroni test). Qmax was significantly greater in women with urodynamic stress incontinence compared to women who had detrusor overactivity (P < 0.05, Bonferroni test). Women with mixed incontinence had pressure flow parameters intermediate between women with detrusor overactivity and those with urodynamic stress incontinence. Conclusions: Pressure flow parameters appear to be useful urodynamic tools in the evaluation of women with LUTS as they help the clinician in assessing the urethral and detrusor function. (C) 2004 Wiley-Liss, Inc
Identification of risk factors for genital prolapse recurrence
No full textAims: To assess the relationship between prolapse recurrence and some risk factors in a group of women submitted to reconstructive pelvic surgery. Methods: Women referred to our Urogynaecological Units complaining of prolapse symptoms were prospectively included. We excluded women who were affected by apical vaginal prolapse >stage I after a previous hysterectomy. All women had pelvic surgery with traditional techniques without using grafts. Each woman was reassessed at 1, 6, and 12 months and then yearly postoperatively. We defined as prolapse recurrence a vaginal descent >= II stage involving the operated compartments. Results: A total of 360 consecutive women were recruited and submitted to vaginal reconstructive pelvic surgery. At a mean follow-up of 26 months, 36 women (10%) had a recurrent prolapse. A preoperative vaginal descent >= III stage was the only significant risk factor for recurrence (P = 0.02, OR 2.4, 1.1-5.1 95% CI). Conclusions: Women with prolapse >= III stage had a significant higher risk of developing prolapse recurrence after surgical repair without grafts. Neurourol. Urodynam. 28:301304, 2009. (C) 2009 Wiley-Liss, Inc
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