Why do women have stress urinary incontinence?

This article reviews progress made in understanding the causes of stress urinary incontinence. Over the last century, several hypotheses have been proposed to explain stress urinary incontinence. These theories are based on clinical observations and focus primarily on the causative role of urethral support loss and an open vesical neck. Recently these hypotheses have been tested by comparing measurements of urethral support and function in women with primary stress urinary incontinence to asymptomatic volunteers who were recruited to be similar in age, race, and parity. Maximal urethral closure pressure is the parameter that differs the most between groups being 43% lower in women with stress incontinence than similar asymptomatic women having as effect size of 1.6. Measures of urethral support effect sizes range from 0.5 to 0.6. Because any one objective measure of support may not capture the full picture of urethrovesical mobility, review of blinded ultrasounds of movements during cough were reviewed by an expert panel. The panel was able to identify women with stress incontinence correctly 57% of the time; just 7% above the 50% that would be expected by chance alone, confirming that urethrovesical mobility is not strongly associated with stress incontinence. Although operations that provide differential support to the urethra are effective, urethral support is not the predominant cause of stress incontinence. Improving our understanding of factors affecting urethral closure may lead to novel treatments targeting the urethra and improved understanding of the small but persistent failure rate of current surgery. Neurourol. Urodynam. 29:S13–S17, 2010. © 2010 Wiley‐Liss, Inc.     

腹腔镜手术治疗妇科急性内出血273例临床分析

目的：探讨腹腔镜诊治妇科急性内出血的效果和可行性。方法：回顾分析2005年10月至2009年10月用腹腔镜诊治273例妇科急性内出血患者的临床资料。结果：273例妇科急性内出血患者均在腹腔镜下得到确诊,272例顺利完成腹腔镜手术,1例中转开腹,无一例发生并发症。结论：腹腔镜手术治疗妇科急性内出血性疾病,具有患者创伤小、术中出血少、术后康复快、疗效肯定等优点,有取代开腹手术的应用前景。     

Serum Total Adiponectin Is Associated with Impaired Glucose Tolerance in Asian Indian Females but Not in Males

Objective

Adiponectin may play a role in the development of type 2 diabetes and cardiovascular disease (CVD). However, little is known about the relationship between adiponectin and impaired glucose tolerance (IGT). We investigated the association between adiponectin and IGT and between adiponectin and cardiovascular risk factors among subjects with IGT.

Research Design and Methods

Subjects with normal glucose tolerance (NGT)(n = 571) and impaired glucose tolerance (n = 167) were recruited from the Chennai Urban Rural Epidemiology Study in south India. Serum total adiponectin levels were measured using a radioimmunoassay (Linco Research, St. Charles, MO). High sensitivity C-reactive protein (hsCRP) was estimated by nephelometry.

Results

In sex-stratified analyses, adiponectin was significantly associated with IGT in females [odds ratio (OR): 0.93, 95% confidence interval (CI): 0.872–0.991, p = 0.026] after controlling for age, waist circumference, blood pressure, alcohol consumption, smoking, lipid profile, and glycemic indices; in males there was no significant association (OR = 0.90, 95% CI: 0.798–1.012, p = 0.078). In prediabetic females, adiponectin was not associated with any CVD risk factors (age, waist circumference, blood pressure, cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, fasting glucose, fasting insulin, and insulin resistance level), but was associated negatively with 2-hour postplasma glucose levels (r = –0.243, p < 0.05) and hsCRP (r = –0.219, p < 0.05) after adjusting for demographic and biomedical indices. No associations with CVD risk factors were observed in males with IGT.

Conclusion

Serum total adiponectin levels are associated with IGT, 2-hour postplasma glucose, and hsCRP in Asian Indian females but not in males.     

A case‐control study on restless legs syndrome in nondialyzed patients with chronic renal failure

Restless legs syndrome (RLS) is a possible consequence of end‐stage renal disease. However, conclusive data on the association between RLS and chronic renal failure (CRF) in nondialyzed patients are still lacking. The aims of this study were: (1) to look for an association between RLS and CRF in nondialyzed patients; (2) to analyze the characteristics of RLS and its consequences on nocturnal rest in nondialyzed patients with CRF; (3) to identify possible predictors of RLS occurrence in nondialyzed patients with CRF. We recruited 138 nondialyzed patients with CRF (mean age: 69.8 ± 11.7 years; male: 61.6%) and 151 controls (mean age: 60.2 ± 18.6 years; male: 42.4%). An expert in sleep medicine investigated the presence of RLS by means of a face‐to‐face interview. Fifteen nondialyzed CRF patients and five controls were diagnosed as RLS affected. A multivariate analysis confirmed that RLS was independently associated with CRF in nondialyzed patients (P = 0.004). CRF patients RLS⁺ were more commonly women and showed the presence of an iron deficiency compared with the RLS^? ones. Independent predictors of RLS in nondialyzed CRF patients were: female sex (OR: 10.7, 95% CI: 2.2–31.3; P = 0.004) and percentage of transferrin saturation (OR: 0.6, 95% CI: 0.4–0.9; P = 0.04). This is the first case‐control study able to recognize an association between RLS and CRF in patients not yet on dialysis. Nephrologists should investigate and treat RLS in their nondialyzed patients with CRF. In particular, physicians should carefully investigate women and patients with iron deficiency in the presence of RLS symptoms. © 2010 Movement Disorder Society     

25‐year experience in the outcome of artificial urinary sphincter in the treatment of female urinary incontinence

Study Type – Therapy (outcomes research)
Level of Evidence 2c

OBJECTIVE

To report the outcome of artificial urinary sphincter (AUS) in female patients for the treatment of stress urinary incontinence (SUI).

PATIENTS AND METHODS

We retrospectively reviewed all female patients with AUS implanted over the last 25 years in one institution. Patient demographics, renal tract imaging and urodynamics assessment were documented. Outcomes measures included complications, duration and cause of AUS failure. Urinary continence was defined as no pad use after AUS insertion. AUS failure was defined as malfunction, infection or erosion. AUS malfunction included either mechanical (fluid leak) or non‐mechanical (infection or surgical damage to AUS). A Kaplan–Meier analysis was used to determine device failure over time.

RESULTS

In all, 47 consecutive women with a mean (range) age of 51 (17–78) years received an AUS for the treatment of UI. Of these, 35 women had failed anti‐incontinence surgery previously. There were two wound infections after AUS insertion but no mortality. Of the 47 AUS implanted, 39 (83%) AUS remained in situ. Eight (17%) AUS were removed due to AUS erosion or infection. There were 20 AUS revisions, 16 of which were primary AUS revisions. Most of the AUS revisions were related to mechanical malfunctions. Comparison of the proportion of AUS device survival over time using Kaplan–Meier analysis showed >80% of AUS remained functioning after 100 months. At the time of review, 83% of patients had a device in situ and the continence rate with no pads use was 59% with AUS only; this figure increased to 85% when concurrent clean intermittent self‐catheterization was performed.

CONCLUSIONS

AUS is an effective and durable treatment option for female SUI. In properly selected women, high continence rates can be achieved. Most patients maintained satisfactory long‐term continence rates despite revision surgery.     

20例亚洲地区貌美女明星脸型测量及分析

目的：获得明星脸型的美学指标,探讨运用这些指标作为方脸型患者的术前参考。方法：选取20例亚洲地区貌美女明星的正、侧位脸型的照片,利用photoshop软件进行测量,并行统计学分析。结果：获得明星脸型的相关美学指标。结论：利用建立的面部软组织比例定位坐标,可以获取明星脸型具体的美学指标,可将其作为方脸型患者的术前参考。     

尿流动力学在女性下尿路症候群诊治中的应用

目的评估尿流动力学在女性下尿路症候群（LUTS）分类和治疗中的作用。方法采用尿动力测定仪对127例女性下尿路症候群患者进行尿流动力学检查,并根据检查结果进行分类及相关治疗,治疗后观察临床症状变化并复查尿流动力学各项参数进行对照。结栗不稳定膀胱30例（26．8％）,低顺应性膀胱10例（8．9％）,逼尿肌无力12例（10．7％）,尿道压增高89例（79．5％）,尿动力学无明显异常15例（11．8％）。112例尿动力学异常患者经相应治疗后有效97例,有效率为86．6％。结论尿流动力学检查在女性LUTS的诊断分型及指导治疗上具有重要意义。     

342例女性假两性畸形的荟萃分析

 目的总结1994-2009年国内外公开发表的以及我院2000年至今诊治的女性假两性畸形(FPH)的病例,探讨其临床特点。方法以"女性假两性畸形"的中英文单词作为检索词,检索1994-2009年国内外公开发表的文献,并结合我院诊治的10例患者,进行荟萃分析。结果共检索到332例诊断明确的病例,加上我院的10例,共有342例入选病例。出生时即就诊的患者仅有27例,其他病例就诊年龄为1个月59岁不等,315例患者就诊时的中位年龄为29.54岁。病因以先天性肾上腺增生为主(70.47%)。临床表现主要为骨骼生长较快(95.52%)、阴蒂肥大(84.14%)以及不同程度的男性化(77.24%)。在治疗方式上以药物和手术的联合治疗为主。首次接受治疗的时间及治疗方法在预后方面起着至关重要的作用。结论女性假两性畸形并非罕见疾病,我们应提高对该病的认识,提早患者接受治疗的时间,坚持终身用药,以改善其预后。     

女性作息节律对其生殖机能影响探讨

在快节奏的现代生活中,越来越多的女性开始昼夜颠倒,起居无常,传统的作息节律被改变,直接导致物理、化学等一系列因素的综合改变。对女性气血、阴阳、五脏皆存在着影响,久而久之,阳气受损,阴阳之气被乱;心阳不足于上,肾阳亏虚余下,生殖功能受损。现代研究中光信号通过视网膜—松果体通路,调节褪黑素(MLT)的释放,进而影响垂体—下丘脑—性腺生殖轴,影响女性生殖机能。同时,作息节律的改变使人体不能得到正常的红外线照射,而不能接受温热效应,使得机体免疫力下降。     

深圳市暗娼、吸毒人群和货柜司机HIV及梅毒感染状况分析

目的了解暗娼、吸毒人群和货柜司机人类免疫缺陷病毒（HIV）及梅毒感染的情况,为制订预防措施提供依据。方法对深圳市2007年和2008年某妇教所收容的暗娼、戒毒所吸毒人员和货柜司机分别抽取静脉血,用酶联免疫吸附实验（ELISA）进行HIV1＋2抗体检测和梅毒甲苯胺红不加热血清试验（TRUST）初筛,梅毒阳性者用梅毒螺旋体明胶颗粒凝集确证试验（TP2PA）进一步确证,HIV-1确证实验用蛋白印迹法。结果 2007年和2008年暗娼人群均未发现HIV感染者,梅毒感染率分别为7.63%和5.14%;吸毒人群的HIV感染率分别为1.63%、2.67%,梅毒感染率分别为9.32%、2.94%;货柜司机的HIV感染率分别为0、0.31%,梅毒感染率分别为1.05%、0.92%。结论暗娼和吸毒人员的梅毒感染率明显高于货柜司机,是感染性病和艾滋病的高危人群,加强对暗娼和吸毒人群的行为干预和监测至关重要。