Contractile response of human anterior vaginal muscularis in women with and without pelvic organ prolapse

The aim of this study was to compare the contractility of the anterior vaginal muscularis (AVM) from women with and without pelvic organ prolapse (POP). In vitro experiments were performed to measure the peak force generated in response to potassium chloride (KCl; 125 mmol/L) and phenylephrine by AVM tissue from women with and without POP. Cross-sectional areas and co-localization of α(1A) adrenergic receptor protein with smooth muscle α-actin in AVM strips were determined by histology and immunofluorescence, respectively. There were no differences in the mean amplitude of force generated in response to KCl normalized to either wet weight or muscle cross-sectional area (mN/mm(2)) between women with and without POP (P > .30). However, AVM from women with prolapse produced a significantly higher mean force to KCl normalized to total cross-sectional area compared to controls (P = .007). While the control samples demonstrated a consistent response to phenylephrine, there was no response to this stimulant generated by AVM tissue from women with POP. The proportion of co-localized α(1A) adrenergic receptors with smooth muscle α actin in AVM tissue was significantly less in women with POP compared to normal controls (P < .0001). Although there was significantly greater tissue stress generated by AVM from women with prolapse compared to controls, there were no differences in muscle stress. Absent response to phenylephrine by AVM from women with prolapse may be related to a lower expression of α(1A) adrenergic receptors in vaginal smooth muscle.     

Myotonic dystrophy (DM1) and dysphagia: the need for dysphagia management guidelines and an assessment tool

Myotonic dystrophy (DM1) is the most prevalent muscular dystrophy occurring in adulthood. DM1 is a multi-systemic disorder resulting in early-onset cataracts, cardiac rhythm problems, muscle weakness, ptosis, and cognitive and psychiatric manifestations. Dysphagia is one of the most problematic symptoms of DM1 because it may cause weight loss, aspiration pneumonias or sudden death. The purpose of this review is to describe the characteristics of DM1 that make dysphagia management problematic, and to address the need for disease-specific guidelines and a clinical tool to aid in diagnosing and managing dysphagia in this population.     

The temporal relationship between anxiety disorders and urinary incontinence among community-dwelling adults

Objective

The purpose of this paper was to carefully examine the temporal relationships between anxiety disorders and urinary incontinence among community-dwelling adults.

Method

In all, 1071 persons aged 30 and over were the continuing participants in a population-based longitudinal study of community-dwelling adults. Participants were classified as incontinent if any uncontrolled urine loss within the 12 months prior to the interview was reported. Condition-specific functional loss secondary to urinary incontinence was further assessed based on a series of questions relating directly to participants’ inability to engage in certain activities due to their urinary incontinence. Anxiety disorders were assessed with standardized interviews keyed to the diagnostic criteria.

Results

In multivariate models that controlled for potentially influential characteristics the association between urinary incontinence with condition-specific functional loss and newly-incident anxiety disorders was statistically significant (adjusted relative odds (RO) = 2.55, 95% confidence interval (CI) [1.05, 6.20]).

Conclusions

Urinary incontinence with condition-specific functional loss predicted onset of newly-incident anxiety disorders among community-dwelling adults.     

Fibulin-5: two for the price of one maintaining pelvic support

Pelvic organ prolapse (POP) is a disabling disorder in women characterized by a loss of pelvic floor support leading to the herniation of the uterus into or through the vagina. POP is a complex problem that likely involves multiple mechanisms, and available therapies are limited. In this issue of the JCI, Budatha et al. explore the dual role carried out by fibulin-5 in facilitating the assembly of normal elastic fibers and inhibiting MMP-9 activity, revealing a new mechanism critical to the maintenance of pelvic organ support.     

Construct validity of a questionnaire to measure the type of fluid intake and type of urinary incontinence

Objective : to determine the reproducibility and construct validity of the Questionnaire Based Voiding Diary (QVD) for measuring the type and volume of fluid intake and the type of urinary incontinence. Methods : 250 women completed the QVD, a 48‐hour bladder diary and underwent complete urogynecologic evaluation to determine a final clinical diagnosis. The questionnaire was re‐administered after a 2‐week period with no change in treatment, and 2‐3 months later following treatment of urinary symptoms. Results : The reproducibility of the fluid intake, output, fluid intake behavior and urinary symptom subscales of the QVD was 0.68‐0.92. Correlation of the fluid intake scale of the QVD with the 48‐hour voiding diary for determining the type and volume of fluid intake was high (r = 0.65‐0.83, P < 0.01). High correlations were noted between the fluid intake behavior scale and urinary frequency (r = 0.82, P < .01), urgency (r = 0.77, P < .01) and urge incontinence (r = 0.71, P < .01). The median total fluid intake and mean urinary symptom score was significantly lower in responders (2074 mL, 10.2 ± 3.3) than non‐responders (2347 mL, 18.5 ± 4.6). As compared to the final clinical diagnosis, the sensitivity, specificity and positive likelihood ratio of the QVD for the diagnosis of predominant stress urinary incontinence are 86%, 66% and 2.6 and for predominant urge incontinence 82%, 79% and 4.0 respectively. Conclusion : The QVD provides clinically meaningful information on the type and volume of fluid intake and the type of urinary incontinence at the initial office visit. Neurourol. Urodynam. Neurourol. Urodynam. 30: 1597–1602, 2011. © 2011 Wiley Periodicals, Inc.