C-reactive protein serum levels are closely associated with lymph node status,but not with prognosis in patients with vulvar cancer

Objective

To evaluate whether C-reactive protein (CRP) serum levels can be used as prognostic parameter in patients with vulvar cancer.

Study design

CRP serum levels were measured at the time of first diagnosis of squamous cell vulvar cancer. Sixty-seven patients were enrolled; results were correlated to clinical data.

Results

Mean CRP serum levels in patients with vulvar cancer were 0.8 (0.80) mg/dL. CRP serum levels were significantly associated with lymph node involvement (p = 0.003), but not with tumor stage (p = 0.03), histological grade (p = 0.86) and patients’ age (p = 0.64). Univariate analysis showed lymph node involvement, tumor stage and histological grade, but not CRP serum levels and patients’ age to be associated with overall survival. A multivariable analysis determined only lymph node involvement as independent prognostic parameter for disease-free interval and overall survival.

Conclusion

CRP serum levels are closely associated with lymph node status but cannot be used as prognostic parameter in patients with vulvar cancer.     

Factors influencing outcome following the tension-free vaginal tape (TVT)

Objectives

To evaluate factors influencing the outcome with tension-free vaginal tape (TVT).

Study design

A prospective questionnaire survey of 100 women undergoing TVT between January 2006 and May 2007 for urodynamic stress incontinence. All women were assessed pre-operatively and 3 months post-operatively using a validated electronic pelvic floor symptoms assessment questionnaire (ePAQ). Using linear regression, the influence of age, severity of stress incontinence and pre-existing lower urinary tract symptoms (LUTS) were assessed on symptomatic improvement of stress urinary incontinence and on quality of life (QoL).

Results

Women with more severe symptoms preoperatively had a significantly greater improvement in stress incontinence symptoms (p < 0.001) and quality of life (p = 0.016). Age and pre-existing LUTS were not associated with adverse outcomes with surgery in terms of improvement in stress incontinence or quality of life.

Conclusions

Women with more severe stress urinary incontinence may expect greater improvement, both in their stress incontinence and their health-related quality of life (HRQoL) following a TVT. Age and coexisting lower urinary tract symptoms do not impact significantly on TVT outcomes in terms of the reduction in stress incontinence or improvement in HRQoL.     

Mannan-binding lectin in women with a history of recurrent vulvovaginal candidiasis

Objectives

To determine the serum concentration of mannan-binding lectin (MBL), a component of the innate immune system, in women with a history of recurrent vulvovaginal candidiasis (RVVC) and to correlate the result to candida-cultures, contraceptive use, if any, and to different antifungal therapies.

Study design

Twenty-nine women with a history of RVVC were investigated. Cultures of vulvar and vaginal samples were grown on chromogenic agar. Serum levels of MBL were determined by a sandwich time-resolved immunofluorometric assay, using anti-MBL coated microtiter wells containing samples, which were washed, incubated with biotinylated anti-MBL followed by europium-labeled streptavidin and measured by time-resolved flourometry.

Results

The median MBL level was higher in the RVVC cases than in 30 women with no history of genital candida infection who served as a comparison group (p = 0.006). It was also higher in the candida-positive than in the culture-negative RVVC (p = 0.02). The median concentration of MBL was also higher in hormonal contraceptive users as compared to condom-users and those using no contraceptive at all (p = 0.03).

Conclusion

The result indicates a role of MBL in RVVC and the production may correlate to vulvar/vaginal colonization by Candida, hormonal contraceptive use, and antifungal therapies.     

Regular exercise is the most significant lifestyle parameter associated with the severity of climacteric symptoms: a cross sectional study

Objective

To assess the association between demographic and lifestyle parameters and perceived severity of the climacteric syndrome in perimenopausal women.

Study design

A cross-sectional study of 151 healthy women aged 45–55 years who attended the University Medical Center affiliated menopause clinics. The analysis was based on self completion of the Greene climacteric score, consisting of psychological, somatic/physical, sexual and vasomotor subscores. The Greene total score and subscores were the main outcomes of the study.

Results

Of all demographic, anthropometric and lifestyle parameters recorded, the correlates with reduced total Greene score were high-order maternity and regular physical exercise. Mothers of 3 or more children reported significantly lower total Greene score (18 ± 12.8 vs. 22.1 ± 8.1) (p = 0.01) as well as lower psychological subscore (8.7 ± 6.8 vs. 11.5 ± 5.4) (p = 0.01). Regular physical activity was also associated with significantly lower total Greene score (17.0 ± 11.0 vs. 22.6 ± 11.3) (p = 0.01) and specifically lower psychological subscore (9.5 ± 6.6 vs. 12.8 ± 7.7) (p = 0.03) and sexual subscore (1.1 ± 0.99 vs. 1.61 ± 1.05) (p = 0.03). Linear regression models showed that regular exercise was the lifestyle parameter most significantly correlated with a lower total Greene score (p = 0.006) independent of menopausal status. Of particular note, regular exercise was significantly correlated with lower psychological (p = 0.006) and physical subscores (p = 0.06). Moreover, the higher the frequency of exercise (both aerobic and non aerobic), the lower the severity of the climacteric symptoms reported, yet the vasomotor and sexual subscores remained unchanged.

Conclusions

Regular exercise of at least 3 times a week was the most significant lifestyle parameter to be associated with the severity of climacteric symptoms.     

Evaluation of confounding factors interfering with sexual function in women with minimal pelvic organ prolapse

Objective

To evaluate the effects of confounding factors on sexual function in women with minimal pelvic organ prolapse (POP).

Methods

A cross-sectional study was conducted at a cervical cancer screening center in Turkey between December 1, 2012, and March 31, 2013. Symptom-free women with stage I or II POP were enrolled to evaluate the association between sexual function and sociodemographic variables, POP, POP-related quality of life, stress incontinence, and overactive bladder.

Results

Of 243 volunteers (mean age 46.0 ± 9.1 years), 188 (77.4%) had a low Female Sexual Function Index score. Women with better sexual function tended to be younger, have a higher salary, not be in the menopause, and have no chronic illness (P < 0.05 for all). There was no difference between the groups in terms of POP Quantification measurements (P > 0.05), apart from transvaginal length (P = 0.011). Overactive bladder was more common (P = 0.005) and more severe (P = 0.002) in women with sexual dysfunction, and their POP-related quality of life was worse (P < 0.05). In a linear regression analysis, high salary had a positive effect and overactive bladder had a negative effect on sexual function.

Conclusion

Sexual dysfunction is highly prevalent in women with minimal POP. Overactive bladder and low income are the major factors adversely affecting sexual function.     

Non-cancer life stressors contribute to impaired quality of life in ovarian cancer patients

Objectives

Diagnosis and treatment for a life threatening illness such as cancer are known to be psychologically impactful. However, little is known about the influence that non-cancer life stressors have on the quality of life (QOL) of ovarian cancer patients. The goal of the present study was to examine associations between non-cancer life stressors and QOL in 123 women with invasive epithelial ovarian cancer who were followed prospectively and longitudinally for one year.

Methods

Mixed models for repeated measures were used to examine the relationship between life stressors and QOL pre-surgery and one year later, while adjusting for age, cancer stage, depressive symptoms, anxiety, and chemotherapy status (at one year). Prospective associations between QOL pre-surgery and one-year QOL were also examined.

Results

Number and severity of life stressors were unrelated to QOL of participants before surgery. At one year, however, participants experiencing a greater number of life stressors reported poorer concurrent physical well-being (PWB) (p = 0.015), functional well-being (FWB) (p < 0.0001), social well-being (SWB) (p = 0.0003), and total QOL (p < 0.0001). Similar effects were found for life event severity. Finally, experiencing a greater number of life stressors pre-surgery predicted poorer overall QOL one year post-diagnosis (p < 0.0001).

Conclusions

Non-cancer life stressors can substantially impact long-term QOL of ovarian cancer patients, adjusting for medical variables such as chemotherapy and cancer stage, thus highlighting the importance of evaluating the stress burden of patients in ongoing cancer care.     

Idiopathic urinary findings and fetal growth restriction in low risk pregnancy

Objective

To determine whether maternal urinary findings in the first trimester of pregnancy are associated with fetal growth restriction.

Study design

The prevalence of urinary findings in singleton pregnancies complicated by fetal growth restriction were compared with a low-risk control group of pregnancies who gave birth to normal weight babies, in the same condition.

Results

There were significant statistical differences in the mean gestational age (p < 0.001), isolated asymptomatic bacteriuria (p < 0.001), hematuria (p = 0.002, OR = 6.6, CI = 1.8–24.2) and proteinuria (p = 0.016, OR = 4.1, CI = 1.2–13.3). There was no recognizable relation between ketonuria and fetal growth restriction.

Conclusion

Our data showed a relation between the increase of adverse pregnancy outcomes, including fetal growth restriction, and hematuria, proteinuria and asymptomatic bacteriuria. Appropriate monitoring of pregnant women using these findings may be helpful in the identification of more complications.     

Injury in adult female sexual assault complainants and related factors

Objective

This study was undertaken to document physical injuries and ascertain associated variables in female complainants of sexual assault.

Study design

164 cases of sexual assault between 2002 and 2006 in Belfast were included. 162 women consented to body examination and 153 to genital examination. Data for the study were obtained from the contemporaneous notes of a forensic doctor who examined the victims.

Results

Of 164 females, 44% were less than 20 years of age, mean age was 24.2, range 13–74 years; two-thirds reported alcohol consumption prior to assault. Non-genital (body) injury was observed in 61%, genital injury in 39%, both in 20% and 18% had no injury. Body injury was associated with time to examination (OR = 4.0, p < 0.01), alcohol intake prior to assault (OR = 3.33, p < 0.001), assault occurring outdoors (OR = 3.45, p < 0.01), previous sexual intercourse (OR = 3.19, p < 0.01) and genital injury (OR = 2.24, p < 0.05). Genital injury was related to acquaintance assault (OR = 2.33, p < 0.05), time to examination (OR = 3.70, p < 0.05), reported virgin status (OR = 3.03, p < 0.01) and absence of hormonal contraception (OR = 2.04, p < 0.10).

Conclusion

Almost half the victims of sexual assault were less than 20 years old and injury was detected in over 80%. Time to examination and prior sexual experience were related to genital and body injury. Assault occurring outdoors and alcohol intake were associated with body injury. Genital injury was more frequent in acquaintance assault and victims not using hormonal contraception. Young females drinking alcohol are at a very high risk for sexual assault.     

Can preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios be used as predictive markers for lymph node metastasis in squamous cell carcinoma of the vulva?

Objective

To determine whether the neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) before complete surgical staging provide information on lymph node metastasis in vulvar squamous cell carcinoma (SCC).

Study design

All patients with vulvar SCC who underwent complete surgical staging at two institutions between 1 January 2005 and 31 December 2011 were identified retrospectively from patient databases. Receiver operating characteristic (ROC) curve analysis was used to evaluate cut-off, sensitivity, and specificity values for preoperative NLR and PLR to predict lymph node metastasis.

Results

Data from 64 women with adequate information were analyzed. Lymph node involvement was detected in 19 (29.7%) patients. NLR and PLR were higher in the lymph node – positive group than in the – negative group (p < 0.001). The best cut-off values for predicting lymph node metastasis were 2.81 for the NLR, with 84.5% sensitivity and 89.5% specificity, and 139.5 for the PLR, with 68.9% sensitivity and 89.5% specificity. Forty of the 64 (62.5%) patients had NLRs ≤2.81 and 24 (37.5%) had NLRs >2.81. Lymph node involvement was more common in the NLR >2.81 group [60.7% vs. 5.6%; relative risk RR = 10.9, 95% confidence interval CI = 2.7–43.4; p < 0.001]. Mean tumor sizes were 4.2 ± 2.3 cm in the NLR >2.81 group and 2.1 ± 1.2 cm in the NLR ≤2.81 group (p = 0.001). The rate of lymph node involvement was higher in the PLR >139.5 group than in the PLR ≤ 139.5 group (54.8% vs. 6.1%; RR = 9.0, 95% CI = 2.2–35.9; p < 0.001).

Conclusion

Preoperative NLR and PLR are directly associated with nodal involvement status of vulvar SCC. These markers are simple, readily obtained and calculated, and easy to integrate into the surgical work-up of patients with vulvar SCC, at no extra cost.     

The inflammation-based modified Glasgow Prognostic Score in patients with vulvar cancer

Objectives

To evaluate the prognostic potential of the modified Glasgow Prognostic Score (mGPS), known to reflect the degree of tumor-associated inflammation and cachexia, in patients with vulvar cancer.

Study design

We included 93 consecutive patients with vulvar cancer into our study. As previously published, the pre-therapeutic mGPS was calculated as follows: patients with elevated C-reactive protein (CRP) serum levels (>10 mg/L) and hypoalbuminaemia (<35 g/L) were allocated a score of 2, patients with elevated CRP serum levels without hypoalbuminaemia were allocated a score of 1, patients with normal CRP serum levels with or without hypoalbuminaemia were allocated a score of 0. The mGPS was correlated with clinico-pathological parameters. The association between mGPS and prognosis was evaluated by univariate and multivariate survival analysis.

Results

Mean (SD) pretreatment CRP and albumin serum levels were 9.5 (9.6) mg/L and 41.4 (5.3) g/L, respectively. mGPS was associated with tumor stage (p = 0.01), but not with lymph node involvement (p = 0.4), histological grade (p = 0.8), and patients’ age (p = 0.7). In univariate analyses, mGPS (p = 0.006, p = 0.001), tumor stage (p < 0.001, p < 0.001), lymph node involvement (p < 0.001, p < 0.001), and patients’ age (p = 0.04, p = 0.007), but not histological grade (p = 0.1, p = 0.3) and year of surgery (1995–2001 vs. 2002–2008, p = 0.7, p = 0.3) were associated with disease-free and overall survival, respectively. In a multivariate analysis, tumor stage (p = 0.01, p = 0.02) and lymph node involvement (p < 0.001, p = 0.001), but not mGPS (p = 0.7, p = 0.8), patients’ age (p = 0.6, p = 0.4), histological grade (p = 0.2, p = 0.1), and year of surgery (p = 0.4, p = 0.8) were associated with disease-free and overall survival, respectively.

Conclusions

Despite being associated with prognosis in a univariate analysis, mGPS cannot be used as an independent inflammation-based predictor for survival in patients with vulvar cancer.     

The effect of tobacco exposure on maternal and fetal thyroid function

Objective

To determine the effect of smoking on maternal and fetal thyroid function.

Study design

This prospective cohort study involved healthy women undergoing elective cesarean section for term singleton infants. Maternal and fetal thyroid indices were compared between smokers (n = 21) and non-smokers (n = 83).

Results

Maternal thyrotropin (TSH) concentrations were significantly lower in smokers than non-smokers (1.75 mIU/L versus 2.15 mIU/L, respectively, p = 0.007), with similar free thyroxine (FT4) concentrations (9.59 pmol/L versus 9.56 pmol/L, p = 0.755). For women who smoked, the correlation between the average number of cigarettes smoked per day and maternal TSH concentrations was −0.427, p = 0.054. Infants of smokers and non-smokers had similar umbilical TSH (5.43 mIU/L versus 5.82 mIU/L, p = 0.124) and FT4 concentrations (13.06 pmol/L versus 13.57 pmol/L, p = 0.049).

Conclusion

We demonstrated for the first time that women who smoke during pregnancy have significantly lower TSH concentrations than non-smokers.     

More than just bad sex: sexual dysfunction and distress in patients with endometriosis

Objectives

The aim of the current study was to evaluate the prevalence and the impact of sexual dysfunction, sexual distress and interpersonal relationships in patients with endometriosis.

Study design

A questionnaire-based multicentre cohort study was conducted in eight tertiary referral centres in Austria and Germany. One hundred and twenty-five patients with histologically proven endometriosis and dyspareunia were included. The Female Sexual Function Index and the Female Sexual Distress Scale were used to screen women's sexuality. Additionally, we evaluated psychological parameters and pain intensity during/after sexual intercourse via a self-administered questionnaire.

Results

Female sexual distress and sexual dysfunction were observed in 97/125 and 40/125 patients. Statistically significant correlations were found between sexual dysfunction and pain intensity during/after sexual intercourse (p < 0.01/p < 0.01), a lower number of episodes of sexual intercourse per month (p < 0.01), greater feelings of guilt towards the partner (p < 0.01) and fewer feelings of feminity (p < 0.01). Thirty-eight out of 125 women agreed that the primary motivation for sexual intercourse was to conceive and nearly half of women (46%) included stated that satisfying the partner acted as primary motivation for sexual contact.

Conclusion

Overall, our findings demonstrate that dyspareunia as a common complaint in patients with endometriosis causes a severe impairment of sexual function, relationship and psychological wellbeing.     

Endometrial cancer in morbidly obese women: Do racial disparities affect surgical or survival outcomes?

Objective

Endometrial cancer mortality disproportionately affects black women and whether greater prevalence of obesity plays a role in this disparity is unknown. We examine the effect of race on post-surgical complications, length of stay, and mortality specifically in a morbidly obese population.

Methods

Black and white women with endometrial cancer diagnosed from 1996 to 2012 were identified from the University Pathology Group database in Detroit, Michigan, and records were retrospectively reviewed to obtain clinicopathological, demographic, and surgical information. Analysis was limited to those with a body mass index of 40 kg/m² or greater. Differences in the distribution of variables by race were assessed by chi-squared tests and t-tests. Kaplan–Meier and Cox regression analyses were performed to examine factors associated with mortality.

Results

97 white and 89 black morbidly obese women were included in this analysis. Black women were more likely to have type II tumors (33.7% versus 15.5% of white women, p-value = 0.003). Hypertension was more prevalent in black women (76.4% versus 58.8%, p-value = 0.009), and they had longer hospital stays after surgery despite similar rates of open vs minimally invasive procedures and lymph node dissection (mean days = 5.4) compared to whites (mean days = 3.5, p-value = 0.036). Wound infection was the most common complication (16.5% in whites and 14.4% in blacks, p-value = 0.888). Blacks were more likely to suffer other complications, but overall the proportions did not differ by race. In univariate analyses, black women had higher risk of endometrial cancer-related death (p-value = 0.090). No racial differences were noted in adjusted survival analyses.

Conclusion

A more complete investigation, incorporating socio-demographic factors, is warranted to understand the effects of morbid obesity and race on endometrial cancer.     

Assessment of sexual dysfunction and determination of its risk factors in the Republic of Korea

Objective

To assess sexual function among women via self-evaluation of female sexual dysfunction (FSD) and to determine risk factors for FSD among Korean women.

Methods

A preliminary questionnaire-based study in Ansan, Korea, enrolled 935 women between January and December 2010. Participants completed the Female Sexual Function Index and a self-administered survey. Participants were divided into 2 groups: in the recognized group (RG), women were aware of their sexual problems; in the unrecognized group (URG), women were not.

Results

The prevalence of FSD was 46.1% (n = 431). The prevalence of recognized FSD was 21.5% (n = 201), whereas that of unrecognized FSD was 24.6% (n = 230) Younger women showed a significantly more positive attitude toward sex compared with older individuals (P < 0.001). Sexual desire, sexual arousal, dyspareunia, lubrication, and sexual satisfaction were factors of sexual dysfunction in the RG. In the URG, sexual arousal, sexual desire, orgasm, dyspareunia, and sexual satisfaction were identified as significant factors.

Conclusion

Women in the RG had positive attitudes toward sex, whereas those in the URG had negative attitudes. Women who were unsatisfied with their sexual life did not express a need for treatment. The sociocultural background of Korean women should be considered in the diagnosis and treatment of FSD.     

The effect of prolapse repair on urinary flow rates and the relationship to changes in the ultrasound appearance of the bladder neck

Objective

To assess whether specific changes in bladder neck morphology, caused by an anterior repair operation, are associated with resolution of overactive bladder and improved urinary flow rates.

Study design

Sixty-four women with urgency documented on the urgency perception scale (UPS) underwent an anterior repair. Their preoperative flow studies were compared to those 8 weeks postoperatively. Flow rates were compared in those women who reported improved or cured urgency to those who reported no effect. Resolution of urgency was correlated with the change in bladder neck angulation (posterior urethrovesical angle-PUA).

Results

55% (35/64) women reported no urgency after the anterior repair. A further 19% (12/64) were improved and 26% (17/64) were no better. Patients who were cured or improved showed a significant increase in their flow rates after surgery (mean flow = 15 before and 17.6 ml/s after) (Mann–Whitney p = 0.04). There was a significant change (increase in the PUA angle/straightening of the angle between the bladder and urethra) from a mean value of 123 degrees (SD 49.3) preoperatively to a mean value of 146.8 (SD 29.2) post operatively (p < 0.001). Despite an increase in PUA, this was not correlated with an increase in the maximum flow rate centile (p = 0.45, r = 0.10).

Conclusions

An anterior repair results in increased maximum urinary flow rates but this does not correlate to changes in the appearance of the bladder neck.     

Bilirubin influences the clinical presentation of pre-eclampsia

Objectives

Pre-eclampsia is a placental, inflammatory disease modified by maternal anti-oxidant status to give a syndrome. In its most severe forms pre-eclampsia is followed by maternal and neonatal mortality and morbidity. Bilirubin is a known antioxidant and as such is associated with a reduced risk of cardiovascular and respiratory disease. Hence we aimed to find an association between maternal bilirubin levels and the clinical severity of the disease.

Study design

A retrospective observational study of 50,712 pregnancies, 925 of which had pre-eclampsia (1999–2010), to examine the association between bilirubin level and perinatal outcome.

Results

In women with pre-eclampsia, those with bilirubin levels in the lowest quintile were more likely to require caesarean section (p = 0.001, aOR 2.59 (1.52–5.72)). The lowest quintile of bilirubin levels is associated with an increased risk of poor maternal (p = 0.002, aOR 3.52 (95%CI 1.6–7.7)) and infant/fetal (p = 0.001, OR = 3.05 (95%CI = 1.63–5.72)) outcome.

Conclusions

Low levels of bilirubin were associated with poor maternal and infant outcomes in women diagnosed with pre-eclampsia. Bilirubin may act as an anti-oxidant in this condition and thus modify the disease.     

Predictors of fertility quality of life (FertiQoL) in infertile women: analysis of confounding factors

Objective

Infertility may adversely influence quality of life (QoL). The aim of this study was to compare QoL in women with primary and secondary infertility, and identify factors associated with poor and good QoL.

Study design

Quality of life was measured using the FertiQoL tool in 273 patients attending an infertility clinic, and demographic and clinical characteristics of the patients were recorded. Patients with primary and secondary infertility were compared for QoL subscales, and other confounding factors were investigated using multiple regression analysis.

Results

Women with secondary infertility obtained higher scores in emotional, mind/body, and social domains of the core subscale, tolerability domain of the treatment subscale, and total QoL (p < 0.05). Women desiring psychological support showed lower scores in all domains except environment. Prolonged duration of infertility was associated with lower scores of mind/body, social, tolerability domains and total QoL score (p < 0.05). Multiple regression analysis showed that the status of education and secondary infertility had a positive impact, whereas prolonged duration of infertility and desire for psychological support had a negative impact on total QoL scores.

Conclusion

QoL scores were better in patients with secondary infertility and higher educational status, whereas scores were negatively affected by prolonged duration of infertility and desire for psychological support.     

Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: a randomized controlled trial

Objective

To investigate the effects of a pelvic floor rehabilitation program (PFRP) on pelvic floor function and quality of life (QoL) in gynecological cancer survivors in a prospective, randomized, controlled trial.

Methods

Thirty-four patients with gynecological cancers recruited between July 2009 and December 2009 were randomly allocated into two groups: a PFRP group (n = 17), who participated in a 4-week PFRP exercise program, and a non-PFRP group (n = 17), who received the usual health care. The pelvic floor strength, the motor evoked potentials (MEPs) elicited by sacral and transcranial magnetic stimulation, the pelvic floor questionnaire, and the scores on two QoL questionnaires, (QLQ)-C30 and QLQ-CX 24, from the European Organization for Research and Treatment of Cancer (EORTC) were evaluated to assess changes in pelvic floor function and QoL before and after the exercise program.

Results

Twenty four patients (12 from each group) completed the exercise program. The PFRP group improved in pelvic floor strength (mean difference (MD) = 14.22, t₉ = 2.389, P = 0.036) and sexual functioning. The PFRP group also improved in physical and sexual function compared with the non-PFRP group.

Conclusions

The results suggest that the PFRP improved pelvic floor dysfunction and QoL of gynecological cancer patients. A larger randomized controlled trial is planned.     

Transobturator vaginal tape for the treatment of stress urinary incontinence in elderly women without concomitant pelvic organ prolapse: is it effective and safe?

Objective

To evaluate the efficacy and safety of the transobturator approach (TVT-O) for the surgical management of stress urinary incontinence (SUI) in older women.

Study design

Between 2007 and 2010, all consecutive women with SUI undergoing an isolated TVT-O procedure were prospectively enrolled in this study. Patients were divided into two groups by age: older women (≥70 years old) were included in group 1, while younger women (<70 years old) in group 2. Intra- and post-operative outcomes were compared between the groups.

Results

During the study period 181 women met the inclusion criteria and were included for final analysis. Among these women, 60 (33.1%) and 121 (66.9%) were included in groups 1 and 2 respectively. After a median follow-up of 26 (IQR 15–41) months for the younger and 25 (IQR 18–40) months for older patients (p > 0.99), no differences were observed between the two groups in terms of cure rate (92.5% vs. 88.3%; p = 0.40). No differences were observed in terms of voiding dysfunction, vaginal erosion and persistent groin pain, or in terms of onset of de novo overactive bladder (9.0% vs. 13.3%; p = 0.44).

Conclusions

TVT-O appears to be a safe and effective procedure for the management of stress urinary incontinence also in elderly population.     

Altered CD16 expression on vaginal neutrophils from women with vaginitis

Objective

Reduced CD16 expression is associated with neutrophil apoptosis. This study aimed to compare CD16 expression on neutrophils in the vagina from women with normal bacterial flora and with vaginitis.

Study design

Vaginal lavages were sampled from volunteers diagnosed with bacterial vaginosis (BV, n = 34), vulvovaginal candidiasis (VC, n = 43), BV plus VC (BV + VC, n = 14), and normal flora (NF, n = 51). Neutrophils were identified by expression of CD15, CD16 and CD24 surface markers as assessed by flow cytometry.

Results

CD16 expression was elevated in neutrophils from women with vaginitis (BV p < 0.0001; VC p = 0.01; BV + VC p = 0.0027) as compared to women with NF.

Conclusion

The reduction in CD16 down-regulation is consistent with prolonged neutrophil viability and activity in the vagina of women with vaginitis. This may contribute to greater microbial clearance and, conversely, with inflammation-associated pathology.