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1.
Yvonne Hsu Markus Huebner Luyun Chen Dee E. Fenner John O. L. DeLancey 《International urogynecology journal》2007,18(11):1303-1308
The aim of the study was to compare the main body of the external anal sphincter (EAS) cross-sectional area (CSA) of women
with and without pelvic organ prolapse. Pelvic magnetic resonance imaging (MRI) scans of 40 women were selected for analysis.
Of these women, 20 had pelvic organ prolapse and 20 had normal support. Of the women with normal support, 10 had known major
levator ani (LA) muscle defects and 10 had normal LA muscles. The same was true for the women with pelvic prolapse: half had
major LA defects and half had no LA defects. All patients had previously completed pelvic MRI in the supine position. 3-D
models of the EAS were made and CSA of the EAS perpendicular to the fiber direction were measured circumferentially at 30°
intervals. Univariable and multivariable analyses were performed. The mean CSA did not significantly differ between women
with prolapse and normal support regardless of LA defect status (normal/−LA defect = 1.13 cm2, prolapse/−LA defect = 0.86 cm2, p = 0.065; normal/+LA defect = 1.08 cm2, prolapse/+LA defect = 1.28 cm2, p = 0.28). Women with prolapse and LA defects had a 49% larger mean muscle CSA compared to prolapse patients without LA defects
(p = 0.01). This difference associated with defect status in prolapse patients was not seen in women with normal support. Women
with prolapse alone had external anal sphincter CSAs that were comparable to women with normal support. However, women with
both prolapse and a major levator ani defect had larger external anal sphincter CSAs compared to prolapse patients without
levator ani defects. 相似文献
2.
Maíta Poli de Araujo Claudia Cristina Takano Manoel João Batista Castello Girão Marair Gracio Ferreira Sartori 《International urogynecology journal》2009,20(9):1079-1084
Introduction and hypothesis Current assessment for pelvic floor disorders (PFDs) allows comparison between different communities.
Methods A total of 377 indigenous women living in Xingu Indian Park were evaluated. The pelvic organ prolapse quantification (POP-Q)
was the system used to quantification the staging of pelvic support. The pelvic floor muscle strength was assessed by a perineometer.
Logistic regression analysis was used to determine risk factors that were associated with prolapse.
Results Only 5.8% of women reported urinary incontinence. The overall distribution of POP-Q stage system was the following: 15.6%
stage 0, 19.4% stage I, 63.9% stage II and 0.8% stage III. Parity and age were the risk factors for pelvic organ prolapse
(p < 0.0001).
Conclusions Urinary incontinence was uncommon in Xingu indigenous women. Like non-indigenous communities, age and parity were the most
important risk factors to the genital prolapse. 相似文献
3.
Victoria L. Handa Mark E. Lockhart Kimberly S. Kenton Catherine S. Bradley Julia R. Fielding Geoffrey W. Cundiff Caryl G. Salomon Christiane Hakim Wen Ye Holly E. Richter 《International urogynecology journal》2009,20(2):133-139
To compare pelvic anatomy, using magnetic resonance imaging, between postpartum women with or without pelvic floor disorders.
We measured postpartum bony and soft tissue pelvic dimensions in 246 primiparas, 6–12-months postpartum. Anatomy was compared
between women with and without urinary or fecal incontinence, or pelvic organ prolapse; P < 0.01 was considered statistically significant. A deeper sacral hollow was significantly associated with fecal incontinence
(P = 0.005). Urinary incontinence was marginally associated with a wider intertuberous diameter (P = 0.017) and pelvic arch (P = 0.017). There were no significant differences in pelvimetry measures between women with and without prolapse (e.g., vaginal
or cervical descent to or beyond the hymen). We did not detect meaningful differences in soft tissue dimensions for women
with and without these pelvic floor disorders. Dimensions of the bony pelvis do not differ substantially between primiparous
women with and without postpartum urinary incontinence, fecal incontinence and prolapse. 相似文献
4.
Dorothy Kammerer-Doak 《International urogynecology journal》2009,20(1):45-51
Forty-seven women participated in a pilot study for a multi-centre randomized controlled trial of the effectiveness of pelvic
floor muscle training (PFMT) for women with prolapse. Women with symptomatic stage I or II prolapse [measured by Pelvic Organ
Prolapse Quantification (POP-Q)] were randomized to a 16-week physiotherapy intervention (PFMT and lifestyle advice; n = 23) or a control group receiving a lifestyle advice sheet (n = 24). Symptom severity and quality of life were measured via postal questionnaires. Blinded POP-Q was performed at baseline
and follow-up. Intervention women had significantly greater improvement than controls in prolapse symptoms (mean score decrease
3.5 versus 0.1, p = 0.021), were significantly more likely to have an improved prolapse stage (45% versus 0%, p = 0.038) and were significantly more likely to say their prolapse was better (63% versus 24%, p = 0.012). The data support the feasibility of a substantive trial of PFMT for prolapse. A multi-centre trial is underway. 相似文献
5.
H. P. Dietz A. Kirby K. L. Shek P. J. Bedwell 《International urogynecology journal》2009,20(8):967-972
Introduction and hypothesis The levator ani muscle is generally thought to play a role in urinary continence, with incontinence assumed to be due to abnormal
muscle function or morphology. This study examined whether avulsion of the puborectalis muscle is associated with symptoms
or signs of bladder dysfunction.
Methods In a retrospective observational study, we reviewed the records of 425 women who had attended a urogynecological unit for
independent flowmetry, multichannel urodynamic testing, and 4D pelvic floor ultrasound.
Results Mean age was 55 years (range, 17–87 years). Of 420 women with complete datasets, 104 (25%) were diagnosed with a puborectalis
muscle avulsion. These women were less likely to suffer from stress urinary incontinence (SUI; P < 0.001) and urodynamic stress incontinence (USI; P = 0.065) and more likely to present with symptoms of prolapse (P < 0.001) and show signs of voiding dysfunction (P = 0.005). The negative association between avulsion and SUI persisted in multivariate models.
Conclusion Puborectalis muscle trauma is not associated with an increased risk of SUI or USI in a urogynecological population, even when
controlling for symptoms or signs of prolapse and previous surgery. 相似文献
6.
G. Alessandro Digesu Stefano Salvatore Charlotte Chaliha Stavros Athanasiou Rodolfo Milani Vik Khullar 《International urogynecology journal》2007,18(12):1439-1443
This 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. 相似文献
7.
Inka Scheer Vasanth Andrews Ranee Thakar Abdul H. Sultan 《International urogynecology journal》2008,19(2):179-183
This study aimed to compare urinary symptoms and its impact on women’s quality of life after obstetric anal sphincter injuries
(OASIS) with a matched control group in the short term. The study group consisted of 100 primiparous women with OASIS and
104 controls who sustained a second-degree tear or had a mediolateral episiotomy performed. All women completed a validated
International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire 10 weeks after delivery. Compared
to controls, significantly more women with OASIS reported overall urinary incontinence (21.2 vs 38%, p = 0.005) and had significantly worse quality of life score (incontinence score: 2.42 vs 1.2; p = 0.008). Significantly more women with OASIS suffered from stress urinary incontinence (33 vs 14%; p = 0.002; OR 3.06; CI = 1.54–6.07) than controls. Logistic regression analysis revealed that OASIS and a prolonged (>50 min)
second stage of labour were independent risk factors for the development of stress urinary incontinence. This study highlights
the importance of inquiring about urinary incontinence in women with OASIS.
Presented to the German Forum Urodynamicum 2006 by IS (11.03.2006) and received the Eugen-Rehfisch Award of the German Forum
Urodynamicum. 相似文献
8.
The objective of this study is to evaluate the effect of anatomic urethral length on the relationship between descent at point
Aa of the pelvic organ prolapse quantification (POP-Q) system and the Q-tip straining angle. The records of 323 patients who
were evaluated for urinary incontinence were reviewed. Prolapse staging was performed using the POP-Q system. Urethrovesical
junction hypermobility defined as a maximal straining angle ≥30° was assessed with the Q-tip test. Urethral length was measured
with a urethral profilometer. A substantial correlation was found between descent at point Aa and the straining Q-tip angle
(r = 0.65, p < 0.0001). There was no correlation between the anatomic urethral length and straining Q-tip angle (r = −0.01, p = 0.8). Urethral length does not affect the straining Q-tip angle. Point Aa is a strong predictor of an abnormal straining
Q-tip angle in women with stage I anterior vaginal wall prolapse or greater. 相似文献
9.
Shameem Abbasy Lior Lowenstein Thythy Pham Elizabeth R. Mueller Kimberly Kenton Linda Brubaker 《International urogynecology journal》2009,20(2):213-216
The purpose of this study was to evaluate the effect of colpocleisis and concomitant mid-urethral sling on voiding function.
This is an IRB-approved, retrospective case series of women who underwent a colpocleisis with concomitant synthetic mid-urethral
sling for treatment of stress urinary incontinence (SUI) between January 2005 and September 2007. Thirty-eight women with
pelvic organ prolapse and SUI symptoms were included. Thirty percent had a post-void residual (PVR) greater than 100 ml preoperatively.
PVRs were normal in all but two women after surgery. Median prolapse and urinary subscales of the pelvic floor distress inventory
improved significantly after surgery [75 (50–100) vs. 0 (0–38), p < 0.0001 and 44 (8–100) vs. 0 (0–50), p < .0001, respectively]. Colpocleisis with concomitant mid-urethral sling improves urinary symptoms without causing significant
urinary retention. This combination may be offered to elderly women with SUI who are undergoing colpocleisis regardless of
preoperative PVR. 相似文献
10.
Swati Jha Paul Moran Helen Greenham Caroline Ford 《International urogynecology journal》2007,18(8):845-850
The objective of this study was to compare sexual function in women before and after surgery for urodynamic stress incontinence
in the absence of pelvic organ prolapse. This was a prospective questionnaire survey. Fifty-four women undergoing surgery
(tension-free vaginal tape/tension-free vaginal tape-obturator) for urodynamic stress incontinence with no evidence of detrusor
overactivity or concomitant prolapse were assessed preoperatively and 6 months post operatively. Assessment was based on the
Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), the International Consultation on Incontinence Questionnaire
(ICIQ) and the Patient Global Impression of Improvement. Paired t-tests were used for comparing pre- and post-op scores and unpaired t-tests for comparing observations between groups. Spearman’s rank correlation was used for testing whether two numerically
scored items were related, and McNemar test was used to compare pre- and postoperative responses to individual questions.
ICIQ scores showed significant improvement after surgery (p < 0.001). Women completing PISQ were significantly younger (mean = 54) than those who did not (mean = 65; p < 0.001). The total PISQ score was better postoperatively (preoperative = 87.2, postoperative = 92.7; p < 0.001), with improvements in both the physical (preoperative = 31.0, postoperative = 35.2; p < 0.001) and partner-related domains (preoperative = 18.8, postoperative = 19.9; p = 0.002) but no improvement in behaviour emotive domains (preoperative = 37.3, postoperative = 37.6; p = 0.70). There was a reduction in episodes of coital incontinence postoperatively (preoperatively = 16/54, postoperatively = 39/54;
p < 0.002). Previous vaginal surgery, oestrogen status of respondents and hysterectomy status did not affect the PISQ. Surgical
correction of stress incontinence is associated with an improvement in sexual function. 相似文献
11.
Charles W. Nager Holly E. Richter Ingrid Nygaard Marie Fidela Paraiso Jennifer M. Wu Kimberly Kenton Shanna D. Atnip Cathie Spino 《International urogynecology journal》2009,20(9):1023-1028
Introduction and hypothesis The aim of the study was to determine whether successful incontinence pessary fitting or pessary size can be predicted by
specific POPQ measurements in women without advanced pelvic organ prolapse.
Methods In a multicenter study, women with stress urinary incontinence (SUI) and POPQ stage ≤2 were randomized to three treatment
arms: (1) incontinence pessary, (2) behavioral therapy, or (3) both. This study evaluates incontinence pessary size, POPQ
measures, and successful fitting in the 266 women assigned to treatment arms 1 and 3.
Results Two hundred thirty-five women (92%) were successfully fitted with an incontinence ring (n = 122) or dish (n = 113). Hysterectomy, genital hiatus (GH), and GH/total vaginal length (TVL) ratios did not predict unsuccessful fitting
(p > 0.05). However, mean TVL was greater in women successfully fitted (9.6 vs. 8.8 cm, p < 0.01). Final pessary diameter was not predicted by TVL, point D, or point C (p > 0.05).
Conclusions The vast majority of women with SUI can be successfully fitted with an incontinence pessary, but specific POPQ measures were
not helpful in determining incontinence pessary size.
Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH Office
of Research on Women's Health at National Institutes of Health (U10 HD54215, U10 HD41267, U10 HD41250, U10 HD41261, U10 HD54214,
U10 HD54241, U10 HD54136, and U01 HD41249). 相似文献
12.
Sexual Function in Women with and without Urinary Incontinence and/or Pelvic Organ Prolapse 总被引:8,自引:5,他引:3
G. R. Rogers A. Villarreal D. Kammerer-Doak C. Qualls 《International urogynecology journal》2001,12(6):361-365
The sexual function of women with and without urinary incontinence and/or pelvic organ prolapse (UI/POP) was compared using
a condition-specific validated questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ).
Eighty-three women with UI/POP and 56 without agreed to participate. PISQ scores were significantly lower among women with
UI/POP than in those without (P = 0.003). No differences in the stages of sexual excitement were noted between groups. The frequency of intercourse was less
with UI/POP than without (P = 0.04). Women with UI/POP restricted sexual activity for fear of losing urine more frequently than did those without (P= 0.005). No differences were reported in patients’ or partners’ sexual satisfaction. This study found that women with UI/POP
have poorer sexual functioning than those without, as measured by the PISQ, and report less frequent sexual activity. In
addition, women with UI/POP are more likely to restrict sexual activity for fear of incontinence, although they report similar
levels of satisfaction with their sexual relationships as do women without UI/POP. 相似文献
13.
H. P. Dietz 《International urogynecology journal》2007,18(6):665-669
It is assumed that pelvic organ descent and prolapse increase with age. Epidemiological studies support this assumption. We
aimed to define the relationship between age and bladder neck descent (BND) in a retrospective observational study on 790
women referred for evaluation of pelvic floor disorders. Bladder neck descent, cystocele descent and urethral rotation were
evaluated on maximal Valsalva manoeuvre, using trans-labial ultrasound.
There was a weak negative correlation between bladder neck descent on Valsalva and age (r = −0.154, p < 0.001), which was absent in nulliparous women (n = 107) and stronger (r = −0.213, p < 0.001) in parous women (n = 683). This relationship was evident from the age of 50 years onwards and may be explained by increased tissue stiffness
after menopause. The difference observed between parous and nulliparous women is intriguing and raises the issue of obstetric
confounders such as historical changes in the likelihood of significant pelvic floor trauma. 相似文献
14.
Daniel M. Morgan Rodney L. Dunn John T. Stoffel Dee E. Fenner John O. L. DeLancey Edward J. McGuire John T. Wei 《International urogynecology journal》2008,19(4):509-515
We sought to determine if postoperative urinary incontinence (UI) symptoms are associated with (1) sexual activity status
and (2) sexual function using validated health-related quality of life instruments. In this mailed cross-sectional survey
of 687 women who underwent stress incontinence surgery, 437 (63.6%) completed a questionnaire protocol. Clinical and sociodemographic
factors independently associated with sexual activity status were identified with logistic regression. Sexually active respondents completed the Pelvic Organ Prolapse and Urinary Incontinence
Sexual Function Questionnaire (PISQ-12) as a measure of sexual function. Factors independently associated with sexual function were identified with linear regression. Sexual activity was reported
by 57.6% (252/437). The likelihood that a respondent was sexually active was moderated by an interaction between age and UI
symptom severity (p = 0.059). Among the sexually active women, increasing UI symptom severity was associated with poorer sexual function (r = −0.42, p < 0.001). The severity of postoperative recurrent or persistent UI is associated with a lower probability of being sexually
active and an adverse effect on sexual function. 相似文献
15.
Susmita Sarma Graeme Hawthorne Kiran Thakkar Wendy Hayes Kate H. Moore 《International urogynecology journal》2009,20(9):1085-1093
Introduction and hypothesis The aim of this paper is to develop a motivation questionnaire regarding perseverance in pelvic floor muscle training (PFMT)
supervised by physiotherapists for stress urinary incontinence.
Methods Sixteen semi-structured interviews were conducted in women with stress urinary incontinence that revealed 15 common themes;
117 items were constructed and reviewed by continence advisors. Surviving items (n = 73) were administered to 210 women. Data were analysed for item properties, factor analysis was used to examine the questionnaire
structure and tests of convergence/divergence used to check for sensitivity.
Results The Incontinence Treatment Motivation Questionnaire (ITMQ) comprises 18-items in five scales, assessing attitudes towards
treatment (72.62% of explained variance; α = 0.87), reasons for not doing PFMT (55.73%; α = 0.74), living with incontinence (62.70% variance; α = 0.70), desire for treatment (65.37% variance; α = 0.74) and the effect of incontinence severity on PFMT (51.62% variance, α = 0.68). Scales were generally sensitive to known group differences.
Conclusions This study represents the first effort to develop a motivation scale for PFMT. This validated Motivation Questionnaire is
an instrument to test the impact of motivation upon cure, in PFMT.
The work was carried out at the Pelvic Floor Unit, St George Hospital, Kogarah, NSW, Australia 2217. 相似文献
16.
Janis M. Miller Carolyn Sampselle James Ashton-Miller Gwi-Ryung Son Hong John O. L. DeLancey 《International urogynecology journal》2008,19(6):773-782
The aim of the study was to determine the immediate effect of timing a pelvic muscle contraction with the moment of expected
leakage (the Knack maneuver) to preempt cough-related stress incontinence. Women performed a standing stress test using three
hard coughs without and then with the Knack maneuver. Volume of urine loss under both conditions was quantified with paper-towel
test. Two groups of women were tested: nonpregnant women (n = 64) and pregnant women (n = 29). In nonpregnant women, wetted area decreased from a median (range) of 43.2 (0.2–183.7) cm2 without the Knack maneuver to 6.9 (range of 0 to 183.7 cm2) with it (p < 0.0001); while in pregnant women it decreased from 14.8 (0–169.7) cm2 to 0 (0–96.5) cm2, respectively (p = 0.001). This study confirms the effect from the Knack maneuver as immediate and provides a partial explanation for early
response to widely applied pelvic muscle training regimens in women with stress incontinence. 相似文献
17.
The aim of this study was to examine the occurrence of urinary incontinence (UI) in mostly nulliparous women with a history
of regular organised trampoline training as adolescents and to identify possible predictors. Female trampolinists in Sweden
with licence for trampolining between 1995–1999 (n = 305), with a median age of 21 (range 18–44) years answered retrospectively a validated questionnaire. Competition with
double somersaults had been performed by 85 women, the “competition group” (CG), while 220 women comprised the “recreational
group” (RG). Of the trampolinists with UI during trampolining, 76% continued to leak. In CG, 57% and, in RG, 48% reported
current UI. Strong predictors for UI were inability to interrupt micturition (p < 0.001) and constipation (p = 0.007). Training factors such as frequency/week × years of trampolining (p < 0.001) and years of trampolining after menarche increased the risk of UI (p < 0.001). The prevalence of current UI was higher in ex-trampolinists than in normals (p < 0.001), and hence the negative effects of trampolining cannot be ruled out. 相似文献
18.
Christina Lewicky-Gaupp Rebecca U. Margulies Kindra Larson Dee E. Fenner Daniel M. Morgan John O. L. DeLancey 《International urogynecology journal》2009,20(8):927-931
Introduction and hypothesis This study aimed to describe the self-perceived natural history of pelvic organ prolapse (POP) in women seeking care.
Methods Women presenting to a university-based urogynecology clinic for POP (n = 107) completed a questionnaire including questions about how and when their prolapse was discovered. A urogynecologic examination
including the pelvic organ prolapse quantification (POP-Q) was also performed.
Results Forty-eight percent of these women sought medical attention “immediately” after discovering a bulge. The median time to seek
care was 4 months (range from 1 month to 45 years). Twenty-six percent associated their prolapse with a specific event (e.g.,
moving furniture or pushing a car). POP was self-discovered by 76% (81/107) of women. Self-discovered prolapses were larger
than those diagnosed by physicians (Ba +1.3 vs 0.1 cm, P = .03, respectively).
Conclusions Women seek medical advice within months of discovering their prolapse. Self-discovery is associated with higher stage prolapse
than prolapse diagnosed by health care providers. 相似文献
19.
E. H. M. Sze N. Kohli J. R. T. Roat M. M. Karram 《International urogynecology journal》1999,10(6):390-393
The objective of this study was to compare the surgical outcome of abdominal sacrocolpopexy and Burch colposuspension with
sacrospinous fixation and transvaginal needle suspension in the management of vaginal vault prolapse and coexisting stress
incontinence. One hundred and seventeen women with vaginal vault prolapse and coexisting stress incontinence were surgically
managed over a 7-year period. The first 61 consecutive women who underwent sacrospinous fixation and transvaginal needle suspension
comprised the vaginal group, and the following 56 consecutive women who underwent abdominal sacrocolpopexy and Burch colposuspension
comprised the abdominal group. Office records were reviewed to assess the presence of recurrent prolapse and urinary incontinence
during postoperative follow-up. Objective follow-up was available for 101 women. Mean duration of follow-up was 24.0 ± 15
months for the vaginal group, and 23.1 ± 12.6 months for the abdominal group. The incidence of recurrent prolapse to or beyond
the hymen (33% vs. 19%, P = 0.0505) and lower urinary tract symptoms (26% vs. 13%, P = 0.0506) were significantly higher in the vaginal group than in the abdominal group. Our data suggest that the combined
abdominal approach has a lower incidence of recurrent prolapse and lower urinary tract symptoms than the combined vaginal
approach in managing vaginal vault prolapse and coexisting stress incontinence. 相似文献
20.
Haleh Sangi-Haphpeykar Pantea Mozayeni Amy Young Paul M. Fine 《International urogynecology journal》2008,19(3):361-365
The purpose of the study was to provide estimates of stress urinary incontinence (SUI) and practice of pelvic floor muscle
training (PFMT) postpartum as well as counseling during and after pregnancy among Hispanic women. Two hundred Hispanic women
were surveyed 6 months postpartum. Twenty-three percent had SUI with onset primarily during pregnancy (70%). Only 20% had
received information regarding SUI and PFMT during pregnancy or postpartum. Most women not counseled wished they were (81%).
Less counseling occurred among Hispanic women with lower levels of education (odds ratio [OR] = .39; 95% confidence interval
[CI] = 0.19–0.82; p = 0.02) and those whose primary language was Spanish (OR = .36; 95% CI = 0.15–0.87; p = 0.02), while higher rates occurred among women with a forceps delivery (OR = 2.94; 95% CI = 1.06–7.78; p = 0.03). Fifty-seven percent of women counseled practiced the exercises. Primary reasons for noncompliance were belief that
PFMT would not help (47%), and not understanding the instructions (39%). SUI and PFMT counseling is low among Hispanic women.
Most women desire such information, and improvement in performance of PFMT among this group is possible.
An erratum to this article can be found at 相似文献