Search

BACKGROUND: Anterior compartment prolapse is the most common pelvic organ prolapse (POP) with a range of surgical treatment options available. // OBJECTIVES: To compare the clinical and cost effectiveness of surgical treatments for the repair of anterior POP. // METHODS: We conducted a systematic review of randomised controlled trials (RCTs) comparing surgical treatments for women with POP. Network meta-analysis (NMA) was possible for anterior POP, same site recurrence outcome. A Markov model was used to compare the cost-utility of surgical treatments for the primary repair of anterior POP from a UK National Health Service perspective. // MAIN RESULTS: We identified 27 eligible trials for the NMA involving eight surgical treatments tested on 3,194 women. Synthetic mesh was the most effective in preventing recurrence at the same site. There was no evidence to suggest a difference between synthetic non-absorbable mesh, synthetic partially absorbable mesh, and biological mesh. The cost-utility analysis which incorporated effectiveness, complications, and cost data found non-mesh repair to have the highest probability of being cost-effective. The conclusions were robust to model inputs including effectiveness, costs, and utility values. // CONCLUSIONS: Anterior colporrhaphy augmented with mesh appeared to be cost-ineffective in women requiring primary repair of anterior POP. There is a need for further research on long-term effectiveness and the safety of mesh products to establish their relative cost-effectiveness with a greater certainty. // FUNDING: The guideline referred to in this article was produced by the National Guideline Alliance (NGA) at the Royal College of Obstetricians and Gynaecologists (RCOG) for the National Institute for Health and Care Excellence (NICE). The views expressed in this article are those of the authors and not necessarily those of RCOG, NGA or NICE.

To compare levator ani muscle injury rates in primiparous women who had a forceps delivery owing to fetal distress with women delivered by forceps for second stage arrest; and to compare these injury rates with a historical control group of women who delivered spontaneously.Primiparous women who delivered by forceps were recruited retrospectively into 2 groups: forceps for fetal distress with short second stage (25±11 minutes; n=19); and forceps delivery for second stage arrest (137±26 minutes; n=19). MR images of the levator ani muscles were compared with a historical control group of women from a previous study who had delivered spontaneously (n=129).Major defect rates were: 42% for forceps and short second stage; 63% for forceps and second stage arrest; and 6% for spontaneous delivery. The odds ratios for major injury were: 11.0 for forceps and short second stage compared with spontaneous delivery; 25.9 for forceps and second stage arrest compared with spontaneous delivery; and 2.3 for forceps and second stage arrest compared with short second stage (P=0.07).Women delivered by forceps have a higher rate of levator ani injury compared with spontaneous delivery controls; the difference between the forceps groups did not reach significance.

• The postpartum bladder is vulnerable to urinary retention; if undetected, this can lead to bladder underactivity, recurrent urinary tract infection and incontinence. • The aim of intrapartum bladder care is to prevent bladder overdistension. • Following delivery or catheter removal, no woman should be allowed to go longer than 6 hours without voiding. • All units should have a guideline for bladder care and the management of postpartum voiding dysfunction. Learning objectives: • To be aware of the risk factors for the development of postpartum voiding dysfunction and the symptoms indicating voiding problems. • To learn about the management of postpartum voiding dysfunction. Ethical issues: • Is it acceptable to catheterise a woman to estimate the volume of residual urine when this can be estimated by ultrasound scanning of the bladder? Please cite this article as: Kearney R, Cutner A. Postpartum voiding dysfunction. The Obstetrician & Gynaecologist 2008;10:71–74.

Aims: Defects in the pubovisceral portion of the levator ani muscle are seen with MR imaging. This study aims to determine interrater reliability of physical examination in detecting these defects, and to validate ¢ndings from physical examination using comparisons with MR images. Methods: Two examiners palpated the pubovisceral muscles of 29 women to assess for defects in this muscle. Each examiner was blinded to the others ¢ndings. MR scans were acquired on a further 24 women after structured clinical examination by one examiner. These images were read to determine pubovisceral muscle defects, blinded to patient identi¢ers. Agreement between raters and between MR imaging and clinical examination were calculated. Results: The two examiners had positive agreement (presence of a defect) of 72.7% and negative agreement (absence of a defect) of 83.3%. The positive agreement between physical examination and MR imaging was 27.3% and the negative agreement 86.5%. Conclusion: The structured physical examination to detect defects in the pubovisceral portion of the levator ani muscle can be learned as shown by good interrater agreement. However, examination alone underestimates these defects compared with MR imaging. Neurourol. Urodynam. 25:50 ^54, 2006. 2005 Wiley-Liss, Inc.