Bladder Neck Mobility and Urethral Closure Pressure as Predictors of Genuine Stress Incontinence

Two hundred and seventy-five consecutive patients with symptoms of lower urinary tract dysfunction underwent urodynamic evaluation, including multichannel urodynamics, urethral pressure profilometry, X-ray and ultrasound imaging. After women with previous incontinence or prolapse surgery or pelvic radiotherapy and those with evidence of urethral kinking on ultrasound had been excluded, 179 datasets were analyzed. Both bladder neck descent (P<0.0001) and maximum urethral closure pressure (P<0.0001) were strongly associated with a fluoroscopic diagnosis of GSI. Only weak correlations between bladder neck mobility and urethral pressure parameters (highest r=−0.17) were observed. Regression analysis yielded a mathematical model that demonstrated a wide spread of odds ratios for GSI for the measured values (from <0.2 to >100). Bladder neck descent explained 29% and urethral closure pressure 12% of overall variability. Both bladder neck mobility and maximum urethral closure pressure are strong predictors of the diagnosis of GSI, provided major confounders are excluded. Bladder neck mobility appears to be the stronger predictor.     

Stress Incontinence in Women Under 50: Does Urodynamics Improve Surgical Outcome?

The aim of the study was to determine whether urodynamic testing improves the outcome of retropubic surgery in women aged 50 or younger. A retrospective study was undertaken of 212 women aged 50 or younger who underwent retropubic surgery at a medical school-affiliated hospital between February 1991 and July 1997. Excluded were patients with prior retropubic urethropexy and known low urethral closure pressures. The surgery was performed by one urogynecologist and two urologists. The minimal evaluation by the urogynecologist was a focused incontinence questionnaire, pelvic neurologic examination, pelvic floor grading, cough stress test, urinalysis, postvoid residual, cotton swab test and supine empty stress test. Full urodynamics consisted of uroflowmetry, subtracted cystometry, urethral closure pressure, cough leak-point pressure and cystourethroscopy. Subjective postoperative follow-up at 1–4 years was by annual questionnaire. The urogynecologist’s patients were in group I (95 women with full urodynamic studies) and group II (36 women with minimal testing). The urologists’ patients were in group III (81 women with a very minimal work-up and cystourethroscopy). A review of seven variables revealed no difference between the groups. In terms of cured, improved and failed, there was also no difference in outcome. There was a difference in postoperative voiding problems (though not stress incontinence) in group III compared to group I (P = 0.005) and group II (P = 0.002). Our conclusion was that all women with stress incontinence should undergo a careful minimal evaluation. In women aged 50 or younger urodynamic studies may be avoided unless there is significant stress incontinence, complex symptoms, a positive supine empty stress test, marked prolapse, or a history of prior retropubic urethropexy.     

Intrinsic Sphincter Deficiency: Do the Maximum Urethral Closure Pressure and the Valsalva Leak-Point Pressure Identify Different Pathogenic Mechanisms?

A prospective analysis of 166 women with genuine stress incontinence was performed comparing Valsalva leak-point pressure (VLPP) and maximum urethral closure pressure (MUCP) with age, previous urogynecologic surgery and/or hysterectomy, poor urethral mobility, weight, menopause and vaginal deliveries, to find correlations with intrinsic sphincter deficiency (ISD). Cut-off value for VLPP were 60 cmH₂O and for MUCP 30 cmH₂O. MUCP ≤30 cmH₂O identifies a group of patients with more severe incontinence, a shorter urethral functional length (UFL) (P= 0.02), more previous urogynecologic operations and the menopause (P= 0.004 and P= 0.000), and older age (P= 0.000). VLPP ≤60 cmH₂O identifies a group of patients with more severe incontinence, a shorter UFL (P = 0.005), more previous urogynecologic surgery (P = 0.006) and poorer urethral mobility (P= 0.004). As these two tests measure different components of urethral functions we can hypothesize that they detect different pathogenic processes contributing to ISD. When one or both tests is abnormal incontinence is more severe and the incidence of poor prognostic factors is increased.     

Sequential assessment of urodynamic findings before and after transobturator tape procedure for female urodynamic stress incontinence

The objective of this study was to sequentially compare the urodynamic findings of patients with urodynamic stress incontinence before and after transobturator tape procedure. Between May 2004 and December 2005, 26 of 34 consecutive patients with urodynamic stress incontinence who underwent transobturator tape procedure were enrolled. The sequential urodynamic findings of each case were compared and analyzed. Based on pad test, the cure and improvement rates were 69.2 and 30.8%, respectively. A significant increase in pressure transmission ratio at maximal urethral pressure at 1 year postoperatively (p = 0.005) was observed after surgery. The improvement group (n = 8) had significantly lower preoperative maximal urethral closure pressure (45.4 vs 68.2 mmHg, p = 0.036) than did the cure group (n = 18). The postoperatively increased pressure transmission ratio at maximal urethral pressure appears to contribute to its cure for urodynamic stress incontinence.     

Correlation of Urethral Closure Pressure, Leak-Point Pressure and Incontinence Severity Measures

The aim of this study was to determine whether water perfusion maximum urethral closure pressure (MUCP) correlates with Valsalva leak-point pressure (LPP), and which of these best correlates with subjective and objective incontinence severity measures. Fifty-two women with previously diagnosed genuine stress incontinence (n= 46), or mixed incontinence with a minor and controlled urge component (n= 6), were assigned an incontinence status grade based on interview and diary review. These women then completed visually observed standing LPPs at 250 ml bladder capacity, supine water perfusion MUCP determinations, pad tests and quality of life questionnaires. The urodynamic and severity measures were compared with correlation analysis or analysis of variance. A modest correlation exists between LPP and MUCP (r= 0.50–0.62, P<0.001). Both MUCP and LPP demonstrated significant decreases (P<0.01) with increasing severity of assigned incontinence grade. A very low and insignificant correlation existed for these urodynamic parameters and pad loss or quality of life measures. MUCP and LPP correlate modestly with each other and both are comparable in predicting incontinence severity. Either can be used as the urodynamic measure to assess intrinsic sphincter deficiency.     

Determinants of Bone Mineral Density in Middle Aged Men: A Population-Based Study

Osteoporosis is a growing health problem not only in women but also in men. To assess determinants of bone mineral density (BMD) at the spine and proximal femur, a randomly selected sample of 140 Finnish men aged 54–63 years was measured using fan beam dual-energy X-ray absorptiometry. Isometric muscle strength was measured using a computerized measurement system and cardiorespiratory fitness was assessed with maximal oxygen uptake (VO₂max) using breath-by-breath respiratory gas analyses during an incremental bicycle ergometer exercise. Intakes of calcium and energy were estimated using 4-day food records. Smoking habits and alcohol consumption were assessed from an interview and a 4 week diary, respectively. Isometric muscle strength of triceps and biceps brachii, extensors and flexors of thigh and rectus abdominis correlated significantly with BMD (r= 0.18–0.35, p= 0.02–0.000). Calcium intake correlated positively with femoral (r= 0.19–0.28, p= 0.03–0.003), but not with lumbar BMD. In addition, calcium intake adjusted for dietary energy content (mg/MJ) correlated with femoral BMD (r= 0.25–0.36, p= 0.03–0.000). Smoking had no effect on BMD, whereas alcohol intake correlated positively with BMD at L2–L4 (r = 0.19, p= 0.031). In the multiple linear regression analysis adjusted calcium intake predicted BMD in every site measured, while strength of abdominal muscles predicted BMD at Ward’s triangle and femoral neck. Body weight was a predictor of trochanteric BMD. Body height was the best predictor of lumbar and femoral neck area. We conclude that low dietary calcium intake, weak muscle strength and low body weight are risk factors for low BMD in men. Received: 30 August 1999 / Accepted: 29 December 1999     

Effect of Intra-Abdominal Position of the Bladder Neck and Stability of its Supporting Structures on Pressure Transmission Ratio After Colposuspension

The aim of this prospective study was to evaluate the influence of the higher intra-abdominal position of the bladder neck and the stability of its supporting structures after colposuspension, on pressure transmission to the urethra at the level of the bladder neck. Twenty-eight patients were included in the study. The pressure transmission ratio (PTR) was calculated at the level of the bladder neck, whereas the position and mobility of the bladder neck during coughing were evaluated with perineal ultrasound examination. The measurements were performed before and 3 months after colposuspension. After colposuspension we found a significant elevation of the PTR (P = 0.001), a significantly higher intra-abdominal position (P = 0.001) and decreased mobility (P = 0.001) of the bladder neck during coughing. Also, a negative correlation between the elevation of PTR and decreased mobility of the bladder neck during coughing (r=−0.5049; P = 0.006) and a weak correlation between the elevation of PTR and a higher intra-abdominal position of the bladder neck during coughing were found (r= 0.3828; P = 0.044). Reinforced tension resistance of the bladder neck supporting structures seems to be more important than intra-abdominal position of the bladder neck in achieving effective pressure transmission after colposuspension.     

The Prevalence of Urinary Tract Infections in Patients with Gestational Diabetes Mellitus

Microbiologic evidence of urinary tract infection was studied in 447 pregnant women with (n= 149) or without (control group, n= 298) gestational diabetes mellitus after mid-pregnancy. Laboratory investigations included chemical analysis, microscopic examination and culture of a clean midstream voided urine specimen. Nineteen women (4.2%) had asymptomatic bacteriuria (7 study, 12 contorl, P = 0.7). Of these, 7 (38%) developed symptomatic infection despite treatment with antibiotics (2 study, 5 control, P = 0.7) and 6 (31%) had recurrent bacteriuria later in pregnancy (3 study, 3 control, P = 0.3). Twelve more women (2.6%) had symptomatic infection (5 study, 7 control, P = 0.5), 7 had acute cystitis (3 study, 4 control, P = 0.5) and 5 had acute pyelonephritis (2 study, 3 control, P = 0.7). Escherichia coli was the commonest pathogen, accounting for 22 (71%) infection episodes. Gestational diabetes mellitus was not associated with increased risk of urinary tract infections nor of maternal and perinatal morbidity as a result of infection.     

Vitamin D and Bone Mineral Density in Ambulatory Women Living in Buenos Aires, Argentina

The aim of this study was to determine possible associations between bone mineral density (BMD), 25-hydroxyvitamin D (25(OH)D) and intact parathyroid hormone (PTH). In a retrospective study we examined the case notes of free-living postmenopausal women living in our city (34° S). We also report a low prevalence of vitamin D deficiency (25(OH)D <25 nmol/l, 5.6%) and of secondary hyperparathyroidism (intact PTH >65 pg/ml, 7.5%). Age was correlated with BMD at the lumbar spine (r=−0.25, p = 0.00038) and femoral neck (r=−0.252, p = 0.0003). Body mass index (BMI) was correlated with BMD at the femoral neck (r= 0.177, p = 0.021) but not at the lumbar spine. 25(OH)D was positively correlated with BMD at the femoral neck (r = 0.149, p=0.036) but not at the lumbar spine. PTH was positively correlated with age (r= 0.279, p = 0.012) and negatively correlated with 25(OH)D (r=−0.322, p = 0.0036). PTH was also negatively correlated with BMD at the lumbar spine (r=−0.258, p=0.02) and the femoral neck (r=−0.282, p = 0.011). Forward stepwise multiple regression showed that BMI, age and 25(OH)D made significant contributions to BMD at the femoral neck. PTH also showed a significant contribution to BMD at both sites. In conclusion, weak correlations found between PTH and 25(OH)D and BMD suggest these biochemical variables, among other factors, contribute to lumbar spine and femoral neck BMD. Received: 19 February 2000 / Accepted: 20 June 2000     

Vaginal Nylon Sling: Loop Length and Surgical Outcomes in those with Urethral Hypermobility and Intrinsic Sphincter Deficiency

Fifty-four women with stress incontinence underwent a vaginal nylon sling procedure. Of these, 15 were diagnosed as having type I, 27 as type II, and 12 as type III genuine stress incontinence. Follow-up averaged 25 months (range 6–42). The total suture length prior to ligation, which supports the bladder neck with no tension, varied from 200 to 313 mm and demonstrated weak correlation with body mass index (R²= 0.076, P = 0.043) and body weight (R²= 0.082, P = 0.036). The objective success rate was 89% (48 of 54 patients) 25 months later; the subjective rate was 93% (50 of 54 patients). Kaplan–Meier analysis demonstrated that the cumulative continence rate was 85.6% at 42 months for those with type I, 88.4% at 42 months for those with type II, and 91.7% at 40 months for those with type III incontinence (P>0.05). The main postoperative complication was retention or difficulty in urination. It was concluded that the total suture length cannot be determined in relation to patient’s physical parameters, but rather on surgical experience, and that this operation is recommended to those with not only intrinsic sphincter deficiency but also with urethral hypermobility, provided surgery is executed with safe precautions.     

The effects of duloxetine on urethral function and sphincter morphology

The aim of our study was to investigate the effect of duloxetine on urethral function and sphincter ultrasound morphology in 54 women, who were referred to a urogynecology unit, with urodynamic stress incontinence. All completed a King’s Health Questionnaire and a patient global assessment of improvement (PGI-I) question and underwent urethral pressure profilometry, measurement of urethral retro-resistance pressure (URP), and ultrasound of the striated urethral sphincter. The investigations were repeated after 8 weeks of duloxetine 40 mg twice daily in 36 women who continued the medication. After 8 weeks of duloxetine, the mean URP increased significantly compared to baseline (53.8 to 60.8 cm H₂O; p = 0.001), and sphincter thickness was significantly higher (1.8 to 2.0 mm; p < 0.001). There was a significant increase in the maximum urethral closure pressure (MUCP) (52.7 to 59.2 cm H₂O; p = 0.006) but not of functional urethral length. Subanalysis of responders (improved on duloxetine) showed a significant increase in URP (50.3 to 59.1 cm H₂O; p = 0.001), sphincter thickness (1.7 to 2.1 mm; p < 0.001), and MUCP (50.2 to 58.1 cm H₂O; p = 0.03). These changes were not seen in nonresponders. This study has demonstrated objective changes in urethral ultrasound morphology and function after duloxetine therapy, which relate to improved continence. A larger longer term study is required to assess if these changes persist over time. In summary, duloxetine therapy for urodynamic stress incontinence results in an increase in urethral closure pressure, URP measurement, and urethral striated sphincter thickness.     

Changes in Levels of Biochemical Markers and Ultrasound Indices of Os Calcis Across the Menopausal Transition

The aim of this longitudinal study was to investigate the changes in the levels of biochemical markers and ultrasound indices of os calcis across the menopausal transition. One hundred and ten healthy women (age 35–59 years at the 1992 baseline) participated in this 4-year population-based longitudinal study. Serum intact osteocalcin (IOC), urinary pyridinoline (Pyr), urinary deoxypyridinoline (Dpyr) and ultrasound indices were measured at baseline and after 4 years. The percentage changes in biochemical markers (%DIOC, %DPyr and %DDpyr) and the percentage decreases in the ultrasound indices (%DSOS, %DBUA and %DStiffness) were calculated. The values of %DIOC and %DDpyr in the perimenopausal subgroup (−4 to−3 years since menopause) and the values of %DSOS and %DStiffness in the perimenopausal subgroup (−2 to 0 years since menopause) were significantly higher than those in other groups. Pyr was significantly correlated with %DSOS (r=−0.467, p<0.01) and %DStiffness (r = −0.330, p<0.05) and Dpyr was significantly correlated with %DSOS (r=−0.390, p<0.05), %DBUA (r=−0.353, p<0.05) and %DStiffness (r = −0.454, p<0.05), while %DIOC was significantly correlated with %DSOS (r=−0.278, p<0.05), %DBUA (r=−0.369, p<0.01) and %DStiffness (r = −0.383, p<0.01) in the peri- and postmenopausal groups. These results indicate that the increase in bone turnover occurs 4 years before menopause. However, the correlations between biochemical markers and ultrasound indices were too low to allow prediction of bone change in the individual patient. Received: 12 October 1999 / Accepted: 30 June 1999     

Quantitative Ultrasound of the Heel and Some Parameters of Bone Turnover in Patients with Acromegaly

Acromegaly caused by growth hormone (GH) hypersecretion is characterized by enhanced skeletal growth and soft tissue enlargement. Insulin-like growth factor-1 (IGF-1) is the main peripheral mediator of GH action and it has a crucial role in the maintenance of a normal bone mass. However, in some patients with acromegaly, secondary osteoporosis is observed, despite the strong anabolic effect of GH and IGF-1 in bones. It is thought to be due to hypogonadism. The bone changes are accompanied by increased turnover. The aim of this study was to assess bone properties by ultrasound and turnover in patients with acromegaly. The study was carried out in 26 patients (13 men, 13 women): 14 with active acromegaly and 12 cured by surgery who had non-active disease. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and their combination Stiffness Index (SI) by quantitative ultrasound (QUS) of the heel, hormonal status, serum osteocalcin (OC) concentration and the urinary excretion of pyridinoline collagen crosslinks (PYR) were all studied. Controls were 20 age- and sex-matched healthy persons. We observed statistically significantly lower QUS values in patients with active disease than in those whose disease was cured. The differences were more pronounced in men. QUS values were lower in the entire group of patients compared with the controls; however, the differences were not statistically significant. Serum OC concentrations and urinary PYR excretion were higher in active disease. Statistically significant inverse correlations between serum GH levels and SOS (r=–0.58, p = 0.002); BUA (r=–0.66; p= 0.0001); T-score (r = −0,65, p= 0.0001) and Z-score (r=–0.66, p = 0.0001) were found only in male patients. No correlations between IGF-1, duration of the disease, OC, PYR and other data studied were observed. In conclusion, we have shown decreased QUS parameters suggesting impaired bone properties and quality in terms of density and elasticity in men, but not in women, with active acromegaly. This finding suggests osteoporosis with increased bone turnover. The above-mentioned changes might be caused by the action of GH on trabecular bone and its metabolism, since no hypogonadism in male patients was shown. Moreover, the influence of acromegaly on heel geometry and soft tissue swelling should also be considered. Received: 20 February 2001 / Accepted: 23 October 2001     

In Vivo MRI Measurements of Bone Quality in the Calcaneus: A Comparison with DXA and Ultrasound

Magnetic resonance imaging (MRI) has shown promise in the assessment of bone architecture. The precision and feasibility of MRI measurements in osteoporosis in vivo have been assessed in this study. T2′ was calculated from measurements of T2 and T2* in the calcaneus of 32 postmenopausal women using a gradient-echo sequence PRIME (Partially Refocused Interleaved Multiple Echo). This sequence allows the measurement of T2 and T2* in one acquisition. In vivo measurements of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) were made in the calcaneus, spine and femoral neck. The ultrasound parameters broadband ultrasound attenuation (BUA) and speed of sound (SOS) were also measured in the calcaneus. These three techniques have not previously been compared in the same study population. The precision of the MRI technique was poor relative to the DXA and ultrasound techniques, with a CV of 6.9%± 4.4% for T2′ and 5.5%± 3.6% for T2*. Approximately 4% of this is due to system error as determined by phantom measurements. The postmenopausal women were classified as having low BMD if they had a lumbar spine (L2–4) BMD of less than 0.96 g/cm² (more than 2 standard deviations below normal peak bone mass). Calcaneal T2′ was significantly correlated with calcaneal BMD (r = –0.79, p <0.0001), BUA (r = –0.59, p = 0.0004) and SOS (r = –0.58, p = 0.0006). T2′ was significantly different in postmenopausal women with normal BMD and those with low BMD (p <0.01). However, the difference was of only borderline significance (p <0.06) after adjustment for age and years since menopause. Received: 8 July 1997 / Accepted: 29 April 1998     

Transobturator slings for stress incontinence: using urodynamic parameters to predict outcomes

The purpose of this study is to evaluate the ability of preoperative urodynamic urethral function parameters to predict the success rate of transobturator slings (TOS). Seventy women urodynamically diagnosed with stress incontinence with urethral hypermobility underwent a Monarc™ TOS (American Medical Systems, Minnetonka, USA). Postoperative continence status was correlated with preoperative urodynamic urethral function parameters. Mathematical modeling was used to determine whether urodynamic parameters can be used to predict postoperative continence. Average follow-up was 8.1 (6–12) months; 56 (80%) patients were continent based on a standardized stress test and subjective report. The median Valsalva leak point pressure at 150 cc (VLPP₁₅₀) in the failures and successes was not different (p = 0.12). The median VLPP at cystometric capacity (VLPP_cap) in the failures was 32 cmH₂O compared to 71 cmH₂O in the successes (p < 0.001). The maximum urethral closure pressure (MUCP) had a median of 20 cmH₂O in the failures and 45 cmH₂O in the successful patients (p < 0.001). No correlation existed between the degree of urethral hypermobility, as measured by the cotton swab test, and surgical success (p = 0.17). There was no correlation between level of preoperative urethral function and persistent overactive bladder symptoms, post-void residual, voids/day, and nocturia. Using a combined model, the cutoff values of VLPP_cap > 60 cmH₂O and MUCP > 40 cmH₂O were the most predictive of surgical success, revealing a sensitivity of 83% (0.55, 0.95) and specificity of 79% (0.67, 0.88). A combination of urodynamic parameters can be used to predict continence rates after a TOS. A TOS should be used with caution in women with impaired urethral function. G. Willy Davila is a consultant to American Medical Systems.     

Low Valsalva Leak-Point Pressure and Success of Retropubic Urethropexy

The aim of this study was to determine whether an isolated low Valsalva leak-point pressure (VLPP) is predictive of intrinsic sphincter deficiency (ISD) and can be an independent risk factor for retropubic urethropexy failure in patients with a normal maximal urethral closure pressure (MUCP). Twenty-four women with urodynamically proven genuine stress incontinence with low VLPP (<60 cmH₂O) and normal MUCP (>20 cmH₂O) were evaluated subjectively and objectively by complex urodynamic testing before and after undergoing a modified Burch urethropexy. Success rates were then compared to historical success rates for subjects with ISD treated with retropubic urethropexy using an exact one-sample test for binomial proportions. Patients were followed postoperatively for a mean of 11.1 months, with a range of 5–16 months. Twenty-two of the 24 (91.7%) were continent on postoperative cystometry. This differs significantly from the published success rates of 50% (P<0.001), if a low VLPP alone were predictive of ISD. Retropubic urethropexy was successful in the majority of our patients with genuine stress incontinence with a low VLPP and normal MUCP.     

Effect of Soy Protein on Bone Metabolism in Postmenopausal Japanese Women

We conducted a cross-sectional study of the effects of soybean protein intake on bone mineral density and biochemical markers in 85 postmenopausal Japanese women. Nutrients in the diet of postmenopausal Japanese women visiting the osteoporosis unit, including subjects with normal lumbar spine bone mineral density (L2–4 BMD), were investigated by questionnaire, and the calculated daily energy, protein, soy protein and calcium intake were obtained. L2–4 BMD was measured with dual-energy X-ray absorptiometry, and assays done of serum alkaline phosphatase (ALP) and serum intact osteocalcin (IOC) as bone formation markers and urinary pyridinoline (UPYR) and urinary deoxypyridinoline (UDPYR) as bone resorption markers. Soy protein intake was significantly associated with the Z-score for L2–4 BMD (r= 0.23, p = 0.038) and UDPYR (r =−0.23, p = 0.034). Stepwise multiple regression analyses showed that soy protein intake is significantly associated with the Z-score for L2–4 BMD (β= 0.225, p = 0.04) and UDPYR (β=−0.08, p = 0.03) among four nutritional factors. These results suggest that high soy protein intake is associated with a higher bone mineral density and a lower level of bone resorption, but further studies are needed to confirm the causal dynamic mechanisms. Received: 17 September 1999 / Accepted: 29 February 2000     

Uterine Preservation or Hysterectomy at Sacrospinous Colpopexy for Uterovaginal Prolapse?

This study retrospectively compared 34 women who had a sacrospinous hysteropexy and 36 who had a vaginal hysterectomy and sacrospinous fixation for symptomatic uterine prolapse. All women underwent independent review and examination, with a mean follow-up of 36 months in the hysterectomy group and 26 months in the hysteropexy group.  The subjective success rate was 86% in the hysterectomy group and 78% in the hysteropexy group (P = 0.70). The objective success rate was 72% and 74%, respectively (P = 1.00). The patient-determined satisfaction rate was 86% in the hysterectomy group and 85% in the hysteropexy group (P = 1.00). The operating time in the hysterectomy group was 91 minutes, compared to 59 minutes in the hysteropexy group (P<0.01). The mean intraoperative blood loss in the hysterectomy group was 402 ml, compared to 198 ml in the hysteropexy group (P<0.01). The sacrospinous hysteropexy is effective in the treatment of uterine prolapse. Vaginal hysterectomy may not be necessary in the surgical treatment of uterine prolapse.     

Correlation of maximum urethral closure pressure with Valsalva leak point pressure using air-charged urodynamic catheters

Introduction and hypothesis  The objective of this study was to measure the correlation of maximum urethral closure pressure (MUCP) with Valsalva leak point pressure (VLPP) in women with urodynamic stress incontinence using air-charged urodynamic catheters. Methods  Records of all women who underwent urodynamic testing for urinary incontinence using air-charged catheters over a 3-year period were reviewed. Data included scores on the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Results  One hundred ninety-three women met the criteria for urodynamic stress incontinence. There was a modest correlation of MUCP with VLPP at 200 mL (r = 0.46, p < 0.001) and a low correlation of MUCP with VLPP at maximum capacity (r = 0.35, p < 0.001). There was no correlation of UDI-6 or IIQ-7 scores with MUCP or VLPP. Conclusions  The low to modest correlation of VLPP with MUCP with air-charged catheters is similar to what has been reported with water-filled and microtransducer catheters.     

Time since Vertebral Fracture: An Important Variable Concerning Quality of Life in Patients with Postmenopausal Osteoporosis

The aim of the study was to identify factors affecting patients with postmenopausal osteoporosis who had experienced one or more vertebral fractures. The overall hypothesis was that time after fracture would influence patients’ perception of pain and well-being. The sample (50 patients) was split into two groups (group A, time after fracture ≤24 months; group B, time after fracture >24 months). A fracture was defined as a vertebral height reduction of more than 20% or at least 4 mm. The assessment was carried out using the Spine Deformity Index and was confirmed by an experienced radiologist. To assess quality of life (QoL) the following measures were used: ‘well-being scale’ including social extroversion as a subscale, pain scale, and limitations in everyday life. The Sense of Coherence questionnaire developed by Antonovsky measures the ability of a person to see life meaningful, manageable and explicable. This questionnaire may reflect patients’ coping abilities and was introduced to establish whether these influence the perception of pain and well-being after vertebral fracture. Variance and covariance analysis was carried out using SPSS (version 6.1). Differences between groups A and B were found for perception of average pain (p = 0.017), social extroversion (p = 0.003) and well-being (p = 0.024). No differences were found for limitations in everyday life (p = 0.607), Sense of Coherence (p = 0.638), the Spine Deformity Index (p = 0.171) and loss of height (p = 0.619). All analyses were corrected for age. Concurrent medication was not found to influence the results. Findings suggest that time after fracture is an important variable when considering QoL and well-being after vertebral fracture and should, therefore, be considered in future studies. Received: 25 June 1998 / Accepted: 10 November 1998