Fetal hydronephrosis: is there hope for consensus?

This review article aims at summarizing the data regarding fetal and neonatal hydronephrosis, at correlating controversial data with the differences in the practice of obstetrical sonography from one country to another, and finally, at presenting our own criteria for fetal renal collecting system dilatation along with our own guidelines of postnatal investigation.     

Urinary and faecal incontinence: a population-based study

AIM: To investigate the coexistence of urine and faecal incontinence in Swedish schoolchildren. METHODS: Cohort study of all schoolchildren in the first and fourth grades in the city of Eskilstuna. A questionnaire was used, in which parents reported the prevalence of urine and faecal incontinence for their children. with a response rate of 67%. Data were analysed with multiple logistic regression. RESULTS: Daytime urinary incontinence (at least once a month) was reported in 6.3% of the first graders and 4.3% of the fourth graders, while bedwetting (at least once a month) was reported in 7.1% and 2.7% and faecal incontinence in 9.8% and 5.6%, respectively. Daytime urinary incontinence was strongly associated with faecal incontinence; adjusted odds ratio (OR) 7.2 (p < 0.001) as well as with bedwetting; OR 4.1 (p < 0.001), whereas faecal incontinence and bedwetting lacked a significant association (OR 1.2). CONCLUSION: This study demonstrates that soiling and daytime urinary incontinence often coexist in Swedish schoolchildren. Collaborative treatment strategies with gastroenterological and urological content need to be developed for these children.     

A study of female urinary tract infection caused by urodynamic investigation

OBJECTIVE: The purpose of this study was to assess the prevalence of female urinary tract infection before and after urodynamic investigation and to identify the risk factors for urinary tract infection after urodynamic investigation. STUDY DESIGN: Eight hundred twenty-two consecutive incontinent women were recruited. All women were "double-screened" and treated for urinary tract infection before urodynamic investigation: first by mid stream urine culture 4 to 6 weeks before investigation and then by reagent strips for urine leukocytes and nitrites at the time of investigation. The investigation was postponed until the urinary tract infection had been treated. All women then received a standard urodynamic investigation. RESULTS: The prevalence of urinary tract infection before urodynamic investigation was 5.1% (95% CI, 3.6-6.6), and the prevalence after the investigation was 8.4% (95% CI, 6.5-10.3). Three independent risk factors were identified: age >or=70 years (odds ratio, 1.99; 95% CI, 1.14-3.48), previous continence surgery (odds ratio, 1.90; 95% CI, 1.05-3.43), and urinary tract infection before urodynamic investigation (odds ratio, 3.13; 95% CI, 1.43-6.83). The 3 most common uropathogens in the urinary tract infections after the urodynamic investigation were Escherichia coli (46.3%), Enterococcus spp (16.4%), and Enterococcus faecalis (11.9%). CONCLUSION: Despite a stringent screen-and-treat protocol before urodynamic investigation, patients still experienced urinary tract infection.     

Sexual activity predicts continued pessary use

OBJECTIVE: The purpose of this study was to determine which clinical variables predict continued pessary use. STUDY DESIGN: After IRB approval, charts of consecutive women at Loyola Women's Pelvic Medicine Center who bought a pessary from August 2000 to December 2002 were reviewed. Demographic information, length of pessary use, and reason for pessary discontinuation were recorded. Current pessary "users" were compared with "nonusers" (women who stopped wearing the pessary during the study period). RESULTS: Of the 136 study women, 82 (60%) were "users," and 54 (40%) were "nonusers." Women who were sexually active were more likely to continue pessary use (beta=2.204, P=.021). This was true regardless of indication for pessary placement. Women with prolapse were more likely than women with incontinence to continue with long-term pessary use (beta=2.031, P=.049). No other demographic characteristics predicted continued pessary use. CONCLUSION: Long-term pessary use is acceptable to sexually active women. Women being treated for pelvic organ prolapse are more likely to continue pessary use than women being treated for urinary incontinence. Additionally, the majority of women (60%) who accept a pessary for prolapse or urinary incontinence continue this treatment.     

A randomized, double-blind, placebo-controlled comparison of the effect of nitrofurantoin monohydrate macrocrystals on the development of urinary tract infections after surgery for pelvic organ prolapse and/or stress urinary incontinence with suprapubic catheterization

OBJECTIVE: The purpose of this study was to determine if antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals (study drug) after pelvic organ prolapse and/or urinary incontinence surgery with suprapubic catheterization (SPC) decreases urinary tract infection (uti) compared with placebo in a randomized, double-blind, multicenter trial. STUDY DESIGN: Six centers participated in this study. After a negative preoperative urine culture, history, surgical and postoperative course, urine culture and symptoms at SPC removal, and at 6 to 8 weeks postoperative, any other UTI and adherence were recorded. To demonstrate a 50% decrease in the bacteruria rate from 20%, with 80% power and alpha of 0.05, 438 patients were required. Data were evaluated with Student t test and Fisher exact test. RESULTS: Of 449 patients enrolled, 211 randomized to study drug, and 224 randomized to placebo. No pre- or perioperative differences existed between groups (all P>.05). Antibiotic prophylaxis decreased positive urine cultures compared with placebo (46% vs 61%, P=.002), symptomatic UTI at SPC removal (7.2% vs 19.8%, P=.001), and any other symptomatic UTI 6 to 8 weeks postoperatively (18.9% vs 32.6%, P=.002). Antibiotic prophylaxis did not decrease symptomatic UTI at the 6- to 8-week postoperative visit (1.8% vs 5.4%, P=.10). CONCLUSION: Antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals decreases UTI compared with placebo after pelvic organ prolapse and/or urinary incontinence surgery with suprapubic catheterization.     

Simplified colposuspension: a 15-year follow-up

AIM: Retrospective analysis of long-term results of a simplified 'Burch type' colposuspension. METHODS: A retrospective chart review, with follow-up through postal questionnaires sent in September 2000, of all 374 patients who had a simplified colposuspension between 1985 and 1998, with additional total abdominal hysterectomy in 103 patients. Outcome measures were patient satisfaction, complications and recovery. RESULTS: The mean period of follow-up was 9.2 years. Response rate to the questionnaire was 85% with 51.5% of patients very satisfied with the surgery, 17.4% moderately satisfied and 12.6% having some symptomatic relief. Complications developed in 31.3% but few were serious. Average hospitalisation was 5.8 days. The mean time to establishment of normal voiding was 58.5 h. The average length of catheterisation was 49.9 h, with only seven patients requiring prolonged catheterisation. Seventy-four patients required additional surgery for de novo, persistent or recurring symptoms. CONCLUSIONS: The present study provides evidence that a simplified Burch type colposuspension provides a satisfactory cure rate on long-term follow-up and is associated with earlier resumption of normal voiding. Transurethral drainage remains a simple and effective method of bladder management after colposuspension. The present study also confirms that many patients do need further pelvic floor surgery for later development of deficiencies in the pelvic floor.     

福州市社区女性尿失禁发病现状的分析

目的 调查福州市社区女性尿失禁的患病情况。方法按照整群随机抽样的方法,随机抽取生活在福州市鼓楼区的女性,进行问卷调查。结果 发出问卷5871份,回收5392份,回收率91．8％。调查结果显示,尿失禁的患病率为18．5％,65岁以上老年女性的患病率高达51．1％,其中压力性、急迫性和混合性尿失禁的患病率分别为9．1％、2．4％、7．0％,构成比为49％、13％、38％。各类尿失禁中以轻度尿失禁为主。在被调查者中,32．4％不知道去何处就诊,45．5％去泌尿科就诊,22．1％去妇产科就诊。结论尿失禁是妇女常见疾患,老年女性患病率高,就诊率低。     

压力性尿失禁患者阴道黏膜的神经表达

目的　探讨压力性尿失禁 (SUI)患者阴道黏膜神经组织学改变 ,分析神经表达与疾病发生的关系。方法　于手术中分别取SUI组患者 15例 (SUI组 )、盆腔器官脱垂患者 2 3例 (POP组 )、无SUI和POP的妇科良性疾病患者 15例 (对照组 )阴道前壁近尿道处黏膜。采用半定量免疫组化方法 ,观察阴道黏膜层的神经丝蛋白 (NF)表达。结果　阴道黏膜固有层中可见着色为棕色的神经纤维分布 ,依据表达阴性、弱阳性、阳性、强阳性的顺序 ,SUI组分别为 6、5、4、0例 ;POP组分别为 17、5、1、0例 ;对照组分别 3、2、4、6例。SUI组患者的阴道黏膜NF表达与对照组相比 ,差异有显著性(P <0 0 5 ) ,NF的表达与尿失禁的程度 (r =- 0 15 0 )和腹部漏尿点压力 (LPP) (r =- 0 198)无明显相关性 (P >0 0 5 )。POP组NF表达也低于对照组。结论　SUI患者的阴道黏膜层神经分布低于对照组 ,可能是SUI的发病机制之一。     

阴道无张力尿道中段悬吊术治疗女性尿失禁的临床观察

目的　探讨阴道无张力尿道中段悬吊术 (tension freevaginaltape ,TVT)治疗女性尿失禁的临床效果。方法　回顾性分析自 2 0 0 1年 5月至 2 0 0 3年 2月 ,应用TVT手术治疗的 2 3例 (其中18例为压力性尿失禁 ,5例为混合性尿失禁 )女性尿失禁患者的临床资料。结果　 2 3例TVT手术中 ,除 1例因术中可疑有损伤而改为尿道折叠 (Kelly)术外 ,其余TVT手术均成功 ,手术成功率为96 % (2 2 / 2 3)。 2 0例 (91% )术后排尿功能恢复良好 ,2例 (9% )分别因膀胱不稳定 (运动型急迫性尿失禁 )及感染而发生排尿困难 ,经持续导尿、膀胱训练及药物治疗后 ,均恢复正常排尿功能。平均手术时间为 4 9min。术后两年随访所有患者 ,排尿功能均恢复正常。结论　TVT手术简单、微创、恢复快、效果好。     

Hypermobility syndrome in 105 women with pure urinary stress incontinence and in 105 controls

We compared the frequency of Hypermobility Syndrome (HS) in 105 patients with urinary stress incontinence (USI) with the frequency of HS in 105 healthy controls that matched for age and parity. A Beighton score (BS) of more than 3 was used to make the clinical diagnosis of HS. Thirty-six patients (34.28%) from the USI group and 28 patients (26.66%) from the control group were diagnosed as HS. The mean BS values were 6.44±0.35 and 5.21±0.29 respectively. The difference between the two groups was statistically significant (P<0.05).