The tension free vaginal tape operation for women with mixed incontinence: Do preoperative variables predict the outcome?

AIMS: The aims of our study were (1) to investigate subjective and objective outcomes after tension free vaginal tape (TVT) operations in mixed incontinent women, (2) to detect if preoperative subjective and objective variables predict the outcome, and (3) to evaluate whether the surgical outcome is different for women who preoperatively find stress incontinence, urge incontinence, or urge and stress incontinence equally the predominant bother. METHODS: A prospective cohort study was performed on 450 mixed incontinent women. A short-form disease-specific validated questionnaire, 24-hr pad test, standardized stress test, residual urine, and maximum urinary flow were used before and after a TVT operation. "Cure" was defined as a condition where the women were very satisfied with the TVT operation and had negative stress- and 24 hr pad tests. RESULTS: Preoperatively 69% had stress incontinence, 7% urge incontinence, and 24% urge and stress incontinence equally as the predominant bother. Cure rates were 80%, 52%, and 60%, respectively, in these groups. Postoperatively 43% of the women had no urge incontinence, while 49% were less, and only 8% were more bothered by urge incontinence. A higher preoperative urge incontinence index was correlated with significantly higher postoperative bother for all indices and leakage during 24-hr pad test. CONCLUSIONS: Mixed incontinent women with predominant stress incontinence had a better cure rate than those with predominant urge incontinence and those who were equally bothered by urge and stress incontinence. This point needs to be addressed when informing mixed incontinent women before a TVT operation.     

Patients with coronary artery- or chronic obstructive pulmonary disease walk with mechanical inefficiency

OBJECTIVE: Patients with chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are associated with exercise intolerance. Whether exercise intolerance and reduced mechanical efficiency are due to inactivity alone or to disease related muscular abnormalities is not clear. The aim was to find out whether two patient groups with different limitations for exercise had the same mechanical inefficiency. DESIGN: CAD and COPD patients were compared to a healthy age matched reference group in walking and cycling mechanical efficiency. RESULTS: Both patient groups showed a similar mechanical inefficiency when walking (COPD 16.9 +/- 6.4%, CAD 19.2 +/- 4.1%) compared to healthy controls (24.7 +/- 6.4%). No differences were found when bicycling. VO2peak (mL x kg(-1) x min-1) was significantly reduced in both patient groups compared to the healthy controls (COPD = 23.1+/- 5.3, CAD = 27.9 +/- 3.6, Healthy controls = 36.2 +/- 7.1). CONCLUSION: Both COPD and CAD patients show mechanical inefficiencies when walking compared to healthy controls. Inactivity is a common feature between the two patient groups, whereas the exercise limitations are quite different. These findings indicate that the mechanical inefficiency might primarily be caused by inactivity.