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Introduction and Hypothesis: The causal association between pelvic organ prolapse (POP) and overactive bladder (OAB) symptoms is supported by several theories. The aim of this study is to assess any changes in OAB symptoms among women with POP and OAB after successful pessary placement., Methods: During the study period, all women with symptomatic POP stage II or greater and OAB symptoms were offered the solution of either a ring or a Gellhorn pessary. All patients were asked to complete a 3-day micturition/incontinence diary. Objective evaluation endpoints at baseline and at 6 weeks included: change in the mean number of micturitions/24 h, change in the mean volume voided per micturition/24 h, and change in the number of urinary incontinence episodes. Subjective evaluation of the urgency, frequency, and nocturia symptoms was carried out using the score change of the questions 3, 5, and 2 of the International Consultation on Incontinence Questionnaire for Evaluating Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) respectively., Results: Seventy-four women were included in the study. A statistically significant decrease (-28.3%; p < 0.001) of the mean number of micturitions/24 h with a significant increase (37%; p < 0.001) in the mean voided volume per micturition/24 h was observed. The total urine volume/24 h remained unchanged. The number of urinary incontinence episodes was significantly increased 6 weeks after pessary placement (p < 0.001). De novo stress urinary incontinence (SUI) was reported by 16.7% of the initially stress continent women., Conclusions: Women with coexisting POP and OAB symptoms may experience a significant improvement in micturition frequency and in urgency and frequency symptoms after successful pessary fitting.

This retrospective case-control study aimed to compare 30 versus 40 W power of CO 2 laser for the therapy of genitourinary syndrome of menopause (GSM). Postmenopausal women with severe intensity of dyspareunia and dryness were eligible to be included in this study. Primary outcomes were dyspareunia and dryness. Secondary outcomes were itching/burning, dysuria, frequency and urgency, Female Sexual Function Index (FSFI), vaginal maturation value (VMV), and Vaginal Health Index Score (VHIS). One laser therapy was applied every month for 3 months. Outcomes were evaluated at baseline and 1 month following the 3rd therapy. Fifty (25 per group) women were included in this study. In the 30-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.0 ± 1.9, 5.9 ± 2.0, 16.6 ± 6.7, 29.9 ± 13.0, and 11.0 ± 2.9, respectively (within group comparisons all p < 0.001). In the 40-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.5 ± 2.0, 5.2 ± 2.5, 14.8 ± 7.1, 25.0 ± 13.4, and 10.5 ± 4.1, respectively (within-group comparisons, all p ≤ 0.001). Comparison between 30 and 40 W revealed that mean improvement or presence of all GSM symptoms and clinical signs was not statistically significant different. CO 2 laser therapy may improve GSM symptoms and clinical signs. This improvement did not seem to associate to power of 30 or 40 W.

Introduction and Hypothesis: The purpose of the study was to examine whether a test performed during urodynamics, the "1-3-5 cough test", could determine the severity of urodynamic stress incontinence (USI)., Methods: We included women referred for urodynamics who were diagnosed with USI. The "1-3-5 cough test" was performed to grade the severity of USI at the completion of filling cystometry. A diagnosis of "severe", "moderate" or "mild" USI was given if urine leakage was observed after one, three or five consecutive coughs respectively. We examined the associations between grades of USI severity and measures of subjective perception of stress urinary incontinence (SUI): International Consultation of Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptom (ICIQ-FLUTS), King's Health Questionnaire (KHQ), Urinary Distress Inventory-6 (UDI-6), Urinary Impact Questionnaire-7 (UIQ-7)., Results: A total of 1,181 patients completed the ICIQ-FLUTS and KHQ and 612 completed the UDI-6 and UIQ-7 questionnaires. There was a statistically significant association of higher grades of USI severity with higher scores of the incontinence domain of the ICIQ-FLUTS. The scores of the UDI-6, UIQ-7 and of all KHQ domains (with the exception of general health perception and personal relationships) had statistically significant larger mean values for higher USI severity grade. Groups of higher USI severity had statistically significant associations with higher scores of most of the subjective measures of SUI., Conclusions: Severity of USI, as defined by the "1-3-5 cough test", was associated with the severity of subjective measures of SUI. This test may be a useful tool for the objective interpretation of patients with SUI who undergo urodynamics.

Purpose of Review: This article reviews the literature regarding the safety and efficacy of the use of a pulsed CO2 laser for the treatment of vulvovaginal atrophy (VVA)., Recent Findings: Prospective observational studies have demonstrated histological changes after the use of pulsed CO2 laser vaginally in atrophic conditions. Increased collagen and extracellular matrix production has been reported together with an increase in the thickness of the vaginal epithelium with the formation of new papilla. Three different observational studies reported a significant improvement of VVA assessed subjectively (with a 10-point visual analogue scale) and objectively (using the Vaginal Health Index) after a cycle of three treatments of pulsed CO2 laser. Also sexual function (assessed with the Female Sexual Function Index) and quality of life (evaluated with the SF12 questionnaire) significantly improved. No complications or side-effects were reported during or after the laser procedure that was performed in an outpatient setting., Summary: Increasing evidence with histological and clinical data supports the use of pulsed CO2 lasers in the treatment of VVA; however, no randomized control trial (sham versus treatment) has yet been produced and no data on the duration of therapy are currently available.

Introduction and Hypothesis: Vaginal hysterectomy (VH) is a commonly performed procedure for the operative treatment of uterovaginal prolapse (UVP). The reported incidence of unexpected gynecological cancer in cases of VH for UVP ranges between 0.3 and 0.8 %. Aim of the study is to assess the incidence of malignant and premalignant gynecological histopathological findings among women who underwent a VH for UVP and had a normal preoperative workup., Methods: The histopathology reports of women who underwent VH for the treatment of UVP were retrospectively assessed. All women had a history of normal cervical smear tests and a normal preoperative transvaginal scan. Patients with a history of a premalignant or malignant gynecological pathological condition and women with abnormal uterine bleeding were excluded., Results: Overall, 14 out of 333 women who underwent VH (4.2 %) were found to have abnormal histopathological findings of the uterus. Among them, there were 9 cases of endometrial hyperplasia of any type (2.7 %), 1 case of cervical cancer (0.3 %), 1 case of cervical intraepithelial neoplasia (CIN) III (0.3 %), and 3 cases of CINI (0.9 %). No cases of endometrial cancer were detected. Among women who underwent salpingo-oophorectomy (n = 86) three simple serous cysts (3.5 %) were found, with no cases of ovarian cancer., Conclusions: The incidence of unexpected premalignant or malignant gynecological pathological conditions among asymptomatic women who underwent VH, with a history of normal cervical smear tests and normal preoperative TVS, was low but not negligible. This information should be included in the preoperative counseling of women planning to undergo surgery for UVP.

Introduction and Hypothesis: This study reports long-term outcomes of the transvaginal tension-free vaginal tape-obturator (TVT-O) procedure for treating stress urinary incontinence (SUI), including possible risk factors for failure., Methods: This was a retrospective study of women who underwent TVT-O with or without concomitant prolapse surgery. Procedures were performed at a tertiary referral urogynecology unit. Participants presented with SUI and had urodynamic stress incontinence (USI). Women with a history of previous anti-incontinence procedures, radical pelvic surgery, and detrusor overactivity (DO) were excluded. Objective cure was defined as absence of urine leakage during a cough stress test (CST). Subjective outcome was based on the International Consultation on Incontinence Questionnaire for Evaluating Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Quality of life was assessed using the King's Health Questionnaire (KHQ). Univariate and multivariate analyses were used to identify risk factors for subjective failure., Results: One hundred twenty-four consecutive women were assessed, with a median follow-up of 90.3 (range 80-103) months. Overall objective and subjective cure rates were 81.5 % (101/124) and 83.5 % (103/124), respectively. A significant improvement was observed in all KHQ domains. Concomitant vaginal hysterectomy [odds ratio (OR) = 2.98, 95 % confidence interval (CI) 1.10-8.05, p = 0.03] and increasing point C (OR = 1.17, 95 % CI 1.05-1.30, p = 0.006] were associated with a higher risk for subjective failure. De novo urgency rate was 7 %., Conclusions: The TVT-O procedure provides high objective and subjective long-term efficacy, a clinically meaningful improvement in patient quality of life, and an excellent safety profile. Concomitant vaginal hysterectomy and apical compartment prolapse were associated with a higher risk for objective and subjective failure.

Introduction and Hypothesis: The aim of this study was the cross-cultural adaptation, validation, and psychometric evaluation in the Greek language of two self-reported instruments used for patients with pelvic floor disorders (PFDs): the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7)., Methods: For the cross-cultural adaptation, a multistep forward-back translation protocol was utilized. Evaluation of the psychometric properties of the questionnaires involved the assessment of validity, stability, internal consistency, and responsiveness. Validity, stability, and internal consistency were evaluated in women presenting with PFDs (group A), whereas responsiveness was assessed in women undergoing pelvic floor surgery (group B)., Results: A total of 100 women presenting with PFDs were included in Group A. A near excellent content/face validity was confirmed as assessed by the missing values criterion (0-5 %). Stability, as assessed by the intraclass correlation coefficient, showed almost perfect agreement with a mean ICC of 0.850 (PFDI-20) and 0.840 (PFIQ-7). Internal consistency was found to be high for both questionnaires (Cronbach's alpha > 0.8). Finally, 85 women underwent pelvic floor repair surgery and were included for the assessment of responsiveness (group B). Good to excellent responsiveness was found for the prolapse and urinary subscales of the questionnaires. However, poor responsiveness was found for the colorectal-anal scale of the PFDI-20, whereas the colorectal-anal scale of the PFIQ-7 proved to be nonresponsive to change., Conclusions: The Greek versions of PFDI-20 and PFIQ-7 were found to be comprehensible, valid, reliable, and responsive to use with patients complaining of PFDs.

Introduction and Hypothesis: We assessed the efficacy and safety of an operative technique, the vaginally assisted laparoscopic sacrocolpopexy (VALS), for the treatment of women with severe uterovaginal prolapse (UVP)., Methods: A prospective pilot study of women with severe UVP, who underwent VALS, was carried out. Preoperatively, POP was assessed using the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) system and symptoms were evaluated using the International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms (ICIQ-VS). VALS is a combined minimally invasive surgical approach where a vaginal hysterectomy is initially performed, followed by a transvaginal placement of a synthetic mesh which is suspended laparoscopically on the sacral promontory. Postoperative assessment at 12 months was identical to the preoperative assessment with the addition of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Perioperative and postoperative complications were recorded., Results: Twenty-seven women with a mean age of 57.2 (range, 47-73) were included. Twenty women (74.1%) had stage 3 and 7 (25.9%) had stage 4 POP with a median point C = +5 (range, +2 to +8). VALS was successfully performed in all patients. All patients completed their follow-up assessment at 12 months. All POP-Q points showed statistically significant improvement apart from TVL, which remained unchanged. ICIQ-VS scores showed a statistically significant improvement of the vaginal symptoms and the total quality of life. The sexual matters score showed a tendency towards improvement, although it did not reach statistical significance., Conclusions: Vaginally assisted laparoscopic sacrocolpopexy appears to be a valid and safe minimally invasive option when treating women presenting with severe UVP, with encouraging short-term anatomical and functional outcomes.

Introduction and Hypothesis: We assessed the efficacy of midurethral slings (MUS) in women with urodynamically proven mixed incontinence (UMI)., Methods: A prospective study was carried out in women with UMI in whom conservative treatment failed and who underwent MUS. Pre- and postoperative assessment included: completion of the validated ICIQ-FLUTS questionnaire, POP-Q examination and urodynamics (UDS). The primary outcome was the assessment of symptoms at 12 months. Secondary outcomes included assessment of postoperative UDS findings and evaluation of differences in symptoms and UDS diagnosis between the TVT and TVT-O groups., Results: Eighty-five women were included; 44 (49.2%) underwent TVT and 41 (51.8%) underwent TVT-O. Concomitant prolapse surgery was performed in 65 out of 85 patients (76.5%). At 12 months' follow-up there was a statistically significant reduction in stress urinary incontinence (p < 0.001), urge urinary incontinence (p < 0.001), urgency (p = 0.021) and frequency (p = 0.014). Depending on the symptom 10.6% to 24.7% of women reported deterioration of symptoms. UDS at 12 months revealed the absence of urodynamic stress incontinence (USI) in 82.4% of patients and no evidence of detrusor overactivity (DO) in 35.3%. No differences in symptoms were found between the TVT and TVT-O group, but the absence of DO was more common in the TVT group (48.5% vs 22.7%, p = 0.014)., Conclusions: Placement of MUS alleviates incontinence and overactive bladder symptoms in patients with UMI. TVT causes similar subjective improvement to TVT-O, but resulted in higher resolution of DO. Our study provides data that could be helpful in informing patients preoperatively of the potential impact that the MUS may have on each individual symptom separately, including the likelihood of symptom deterioration.

Aims: The objective of this study was to validate four specific International Consultation on Incontinence Questionnaires (ICIQ) modules in the Greek language: (i) the ICIQ-FLUTS long form (ICIQ-FLUTS-LF), (ii) the ICIQ-FLUTS, (iii) the ICIQ-FLUTS-SEX, and (iv) the ICIQ-Vaginal Symptoms Questionnaire (ICIQ-VS), originally validated in English., Methods: The English questionnaires were initially translated into Greek, then back-translated into English and final modifications were made after testing the questionnaires on a sample of patients. To validate the translated questionnaires, the following tests were undertaken: Content/face validity, internal consistency (reliability) and stability (test-retest reliability)., Results: A total of 122 women participated in the study. Eighty-nine presented with pelvic organ prolapse (POP) and/or urinary incontinence (UI) symptoms and 33 attended an outpatient gynecological clinic without POP/UI symptoms. All modules showed excellent content/face validity (missing values 0-2.5%). Cronbach's alpha test for internal consistency showed satisfactory to excellent reliability (0.876 for ICIQ-FLUTS-LF, 0.85 for ICIQ-FLUTS, and 0.83 for ICIQ-VS), with the exception ICIQ-FLUTS-SEX which was 0.69. The test-retest reliability showed moderate to near-perfect agreement (weighted kappa value 0.52-0.99)., Conclusions: The Greek versions of the ICIQ-FLUTS-LF, ICIQ-FLUTS, and ICIQ-VS questionnaires were successfully validated. Our data showed that the ICIQ FLUTS-SEX questionnaire, as it stands in its current English version, cannot be reliably used to assess sex symptoms in the Greek female population., (Copyright © 2012 Wiley Periodicals, Inc.)

Acute cystitis is one of the most common health-related problems in the female population. Over the last few decades, a number of drugs labeled as 'urinary tract analgesics' were released; these are available over the counter and are gaining widespread resonance among the North American population. The main representatives of this class of drugs are phenazopyridine and methenamine hippurate. Methenamine's efficacy and side effects have been well studied in a recent systematic review. On the other hand, in contrast to its widespread use, the published clinical evidence regarding phenazopyridine's effectiveness and safety is scarce. In addition, consumers (potentially patients) appear to ignore the limitations of this kind of treatment. In this article, concerns regarding the use of over-the-counter uroanalgesics, with a focus on the relevant clinical evidence, are discussed.

Objective: To evaluate the effect of pelvic organ prolapse (POP) on female sexual dysfunction., Design: Cross-sectional, observational study., Setting: Gynecological outpatient and urogynecological university clinics in Greece., Population: One hundred and one women with POP seen in the urogynecology clinic (study group) and 70 women without POP seen in the gynecology outpatient department (control group)., Methods: Women with and without POP completed a condition-specific sexual dysfunction questionnaire (DYSQ) comprising four domains: sexual behavior; physical problems other than urinary incontinence; urinary incontinence problems; and satisfaction. Pelvic organ prolapse was assessed by the International Continence Society Pelvic Organ Prolapse Quantification System grading system. The primary outcome of the study was the assessment of sexual function by DYSQ in women with and without POP., Main Outcome Measures: We compared sexual function in women with and without POP and evaluated the extent of the effect of various grades of POP on sexual function., Results: One hundred and seventy-one women were recruited, 101 in the POP group and 70 in the control group. The total and factor-specific DYSQ scores in the POP group were worse than those in the control group (p < 0.001) but did not seem to worsen with an increasing grade of prolapse. Linear regression showed that the best model to describe the DYSQ score includes the presence of POP and years of menopause. These variables explain 15.6% of the total variability in DYSQ scores., Conclusions: The presence of prolapse only partly explains impaired sexual functioning in women with POP. Sexual dysfunction is related to the presence of POP and not the grade of POP., (© 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.)

Introduction and Hypothesis: Standardized terminology has yet to be developed for reporting the outcomes for surgery for pelvic organ prolapse (POP)., Methods: This report combines the input of the Terminology and Standardization Committees of the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a joint Working Group on this topic, as well as expert external referees. The aim was to present a standardized terminology for the definitions of surgery and propose a structure for reporting the outcomes of surgical procedures for POP. An extensive drafting and review process was undertaken, as well as open review on both IUGA and ICS websites., Results: A terminology report was developed outlining the recommended structure for reporting outcomes of surgical trials involving POP. This document does not define success and failure. The report includes patient-reported, subjective and objective outcomes to enable researchers to report on their results and compare them with other studies., Conclusions: A consensus-based method for standardizing terminology for reporting outcome measures of POP surgery was developed to aid clinicians working in this area of research.

Mesh infection, although infrequent, is a devastating complication of mesh hernioplasties. The aim of this study was to systematically review and synthesize the available evidence on risk factors for synthetic mesh infection after hernioplasty. A systematic search was performed in PubMed and Scopus databases. The extracted data were synthesized with the methodology of meta-analysis. We identified six eligible studies that reported on 2,418 mesh hernioplasties. The crude mesh infection rate was 5%. Statistically significant risk factors were smoking (risk ratio [RR] = 1.36 [95% confidence interval (CI): 1.07, 1.73]; 1,171 hernioplasties), American Society of Anesthesiologists (ASA) score ≥3 (RR = 1.40 [1.15, 1.70]; 1,682 hernioplasties), and emergency operation (RR = 2.46 [1.56, 3.91]; 1,561 hernioplasties). Also, mesh infections were significantly correlated with patient age (weighted mean difference [WMD] = 2.63 [0.22, 5.04]; 2,364 hernioplasties), ASA score (WMD = 0.23 [0.08, 0.38]; 1,682 hernioplasties), and the duration of the hernioplasty (WMD = 44.92 [25.66, 64.18]; 833 hernioplasties). A trend toward higher mesh infection rates was observed in obese patients (RR = 1.41 [0.94, 2.11]; 2,243 hernioplasties) and in patients operated on by a resident (in contrast to a consultant; RR = 1.18 [0.99, 1.40]; 982 hernioplasties). Mesh infections usually resulted in mesh removal, and common pathogens included Staphylococcus spp., Enterococcus spp., and gram-negative bacteria. Patient age, ASA score, smoking, and the duration and emergency setting of the operation were found to be associated with the development of synthetic mesh infection. The heterogeneity of the available evidence should be taken under consideration. Prospective studies with a meticulous follow-up are warranted to further investigate mesh-related infections.

Introduction and Hypothesis: This pilot study compares protein expression patterns in the pubocervical fascia of women with pelvic organ prolapse (POP) and stress urinary incontinence (SUI) and asymptomatic women with normal pelvic support., Methods: Samples of pubocervical fascia were collected from four women with POP and SUI and from three asymptomatic (control) women. These were analyzed using two-dimensional electrophoresis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry., Results: The expression levels of transgelin, smooth muscle gamma-actin, myosin light polypeptide 6, and alpha-1 antitrypsin precursor were more than twofold higher in patients than in controls. An additional five proteins were overexpressed (more than twofold) in patients, while three proteins were detected only in the patients., Conclusion: This pilot study is the first study to estimate changes in protein expression in the pubocervical fascia of human patients with POP. These changes could be related to the pathophysiology of POP.

Introduction and Hypothesis: The purpose of this study is to examine the inter-observer reliability of the pelvic organ prolapse quantification (POP-Q) system in left lateral position., Methods: Women attending urogynaecology outpatient clinics were examined in the left lateral position using a digital examination and POP-Q. This was repeated separately by a second blinded clinician. The inter-observer agreement was calculated using the Cohen's kappa coefficient. The POP-Q examination was then performed with a woman lying in dorsal lithotomy position. The POP-Q findings in the two positions were compared., Results: Two hundred and eighteen women were recruited. The digital examination had a moderate inter-observer reliability with a kappa value of 0.54. The POP-Q showed a high degree of reliability (0.88). There was a high degree of correlation between the POP-Q findings in left lateral and lithotomy position (rho > 0.95, p < 0.001)., Conclusion: The POP-Q in the left lateral position is reliable, easy to perform, acceptable for patients, and is not a time-consuming examination.

Objective: To assess current preferences regarding episiotomy and management of obstetric perineal injuries used by obstetricians in Greece, and to assess the impact of evidence-based information on everyday practices., Methods: A questionnaire survey of obstetricians regarding episiotomy use and the management of obstetric perineal injuries., Results: Fifty-one percent of obstetricians reported routinely performing an episiotomy during a normal vaginal delivery in primiparous women and 89% reported performing an episiotomy during vacuum-assisted deliveries. Forty-two percent of the respondents performed lateral, 44% mediolateral, and 14% midline episiotomies. Following an obstetric anal sphincter tear, half of the respondents recommended a vaginal delivery, regardless of bowel symptoms. There was significant heterogeneity of practices regarding the repair techniques of all obstetric perineal injuries., Conclusion: The majority of obstetricians prefer to perform routine mediolateral and lateral episiotomies, for both normal and operative vaginal deliveries. The adoption of evidence-based information should be implemented while considering working and cultural backgrounds.

We evaluated the prevalence of urinary tract infection (UTI) after pelvic floor operations for non-malignant etiology and the effectiveness of antibiotic prophylaxis. This was made possible by a review of the evidence from relevant randomized controlled trials (RCTs). Nineteen out of 879 initially identified studies met the criteria for inclusion in our review. Four RCTs compared an antibiotic prophylactic regimen with placebo, 11 two different prophylactic antibiotic regimens, and four had three different treatment arms. Among placebo recipients undergoing pelvic floor surgery, 10-64% developed UTI. In contrast, UTI after pelvic floor gynecological surgery occurred in 0-15% of the patients who received cephalosporins as antibiotic prophylaxis; the likelihood for postoperative UTI was higher for patients receiving cotrimoxazole (28%), ampicillin/sulbactam (13.6%), metronidazole plus ampicillin (20%), metronidazole (10-22.7%), or ciprofloxacin (27.2%). The use of a cephalosporin as perioperative antimicrobial prophylaxis is the optimal regimen in preventing UTIs after pelvic floor surgery.

We searched PubMed, Scopus, Web of Science, LILACS, EMBASE, and Cochrane Library databases to assess the effectiveness and safety of 5% imiquimod cream in the treatment of vulvar and vaginal intraepithelial neoplasia. From the results of the 17 relevant articles identified (1 reported on a randomized controlled trial, 10 reported on case series, and 6 were case reports), 26% to 100% of patients had complete regression, 0% to 60% had partial regression, and 0% to 37% experienced recurrence. The most common adverse events were local burning and soreness, but not severe enough for patients to discontinue treatment. From these reports imiquimod treatment leads to complete response in a considerable percentage of patients, and those who experience partial response will require less extensive excision. Treating vulvar and vaginal intraepithelial neoplasia with 5% imiquimod cream therefore appears to be promising.

The objective of this study is to investigate and compare the effects of different modes of delivery on urethral sphincter volume, bladder neck mobility, and changes to levator hiatus distensibility using ultrasound imaging. This study is a prospective observational cohort study. The setting of this study is at a London teaching hospital. The population is composed of 156 women recruited in their first ongoing pregnancy. Primigravid women were recruited between 32 weeks and term. Antenatal ultrasound measurements of levator hiatus and bladder neck mobility were assessed at rest, maximum strain, and maximum valsalva using transvaginal ultrasound imaging. Urethral sphincter volume was calculated using a three-dimensional transvaginal probe. The investigations were repeated at 6 weeks and at 6 months postpartum. Total urethral sphincter volume, rhabdosphincter volume, bladder neck position at rest, and rotational mobility from maximum contraction to maximum valsalva were measured in this study. Levator hiatus area at rest and levator hiatus on valsalva and squeeze were also measured. The 156 women underwent antenatal ultrasound pelvic floor assessment. One hundred ten (71%) completed the 6-month follow-up. There were no differences in the urethral sphincter volume between the different modes of delivery. Overall, the urethral sphincter was smaller after delivery compared to the third trimester. Vaginal delivery was associated with a significantly larger levator hiatus area on valsalva antenatally and at rest, squeeze, and valsalva postnatally compared to caesarean section. Antenatal and postpartum bladder neck mobility was also significantly greater in the women who delivered vaginally. Urethral sphincter changes postpartum are independent of mode of delivery. Vaginal delivery is strongly associated with a larger, more distensible levator hiatus and a greater degree of bladder neck mobility both antenatally and postpartum.

This study aims to evaluate the changes of overactive bladder symptoms to anterior vaginal wall prolapse repair. Ninety-three consecutive women with symptomatic anterior vaginal wall prolapse >or= stage II and coexistent overactive bladder symptoms were prospectively studied using a urinalysis, urodynamics, King's Health Questionnaire (KHQ), Prolapse Quality of Life (P-QOL) questionnaire and pelvic organ prolapse quantification (POP-Q) system before and 1 year after surgery. All women underwent a standard fascial anterior repair. Postoperatively, urinary frequency, urgency and urge incontinence disappeared in 60, 70 and 82% of women respectively (p value < 0.001). The vaginal examination findings as well as the quality of life of the women assessed using KHQ and P-QOL significantly improved after surgery (p value < 0.001). This study has demonstrated that anterior vaginal repair does produce significant improvement in overactive bladder symptoms. A larger longer-term study is required to assess if these changes persist over time.

The aim of our study was to investigate the effect of duloxetine on urethral function and sphincter ultrasound morphology in 54 women, who were referred to a urogynecology unit, with urodynamic stress incontinence. All completed a King's Health Questionnaire and a patient global assessment of improvement (PGI-I) question and underwent urethral pressure profilometry, measurement of urethral retro-resistance pressure (URP), and ultrasound of the striated urethral sphincter. The investigations were repeated after 8 weeks of duloxetine 40 mg twice daily in 36 women who continued the medication. After 8 weeks of duloxetine, the mean URP increased significantly compared to baseline (53.8 to 60.8 cm H2O; p=0.001), and sphincter thickness was significantly higher (1.8 to 2.0 mm; p<0.001). There was a significant increase in the maximum urethral closure pressure (MUCP) (52.7 to 59.2 cm H2O; p=0.006) but not of functional urethral length. Subanalysis of responders (improved on duloxetine) showed a significant increase in URP (50.3 to 59.1 cm H2O; p=0.001), sphincter thickness (1.7 to 2.1 mm; p<0.001), and MUCP (50.2 to 58.1 cm H2O; p=0.03). These changes were not seen in nonresponders. This study has demonstrated objective changes in urethral ultrasound morphology and function after duloxetine therapy, which relate to improved continence. A larger longer term study is required to assess if these changes persist over time. In summary, duloxetine therapy for urodynamic stress incontinence results in an increase in urethral closure pressure, URP measurement, and urethral striated sphincter thickness.

Objectives: Hyaluronic acid is a protective barrier of the urothelium. A damaged glycosaminoglycan layer may increase the possibility of bacterial adherence and infection. This damage is proposed to be a causative factor in the development of interstitial cystitis, common urinary tract infections, and hemorrhagic cystitis due to posthematopoietic stem cell transplantation. The aim of this article was to review the available data regarding the use of hyaluronic acid as an alternative treatment of the above-mentioned conditions., Methods: Articles relevant to our review that were archived by September 2006 were retrieved from PubMed., Results: Nine relevant studies were identified and evaluated. Hyaluronic acid was administered intravesically at a dose of 40 mg every week for 4-6 wk; patients with noted improvement received two additional monthly doses. Short-term responses of patients with interstitial cystitis, hemorrhagic cystitis, and recurrent urinary tract infections were 30-73% (7 studies), 71% (1 study), and 100% (1 study), respectively. The treatment was well tolerated except for occasional development of bacterial cystitis. The cost of each intravesical installation of hyaluronic acid is 120 UK pounds (excluding the cost of the urinary catheterization)., Conclusions: The available clinical data regarding the effectiveness of hyaluronic acid as a potential treatment of patients with interstitial cystitis, recurrent urinary tract infections, and hemorrhagic cystitis are limited. There is need for randomized controlled trials for further investigation of this important therapeutics question; these clinical trials should be disease-specific, blinded, and controlled, and of a sufficient number of patients. Until such studies are available, intravesical instillation of hyaluronic acid cannot be unquestionably endorsed for use for the aforementioned diseases.

This prospective study aims to evaluate the relationship between urethral resistance pressure (URP) and pressure flow parameters in women with lower urinary tract symptoms (LUTS). Consecutive women with LUTS attending three tertiary referral urodynamic clinics were asked to undergo urodynamic evaluation, pressure flow studies and URP measurement. The pressure flow parameters such as detrusor pressures at the start of flow (ODP), detrusor pressure at peak flow rate (PdetQmax), peak flow rate (Qmax) and detrusor pressure at the end of flow (CDP) were measured. The relationship between URP and pressure flow parameters was evaluated as well as differences between each urodynamic group. Two hundred seventy-nine women attended for urodynamic investigations. Two hundred twenty-three (79.9%) women had good quality pressure flow measurements and were included in the study. The mean age was 58 years (range 21-83). Women with urodynamic stress incontinence had significantly lower URP and ODP than those with detrusor over-activity [54.8 (+/-17.9) and 12.4 (+/-4.1) cmH(2)O, respectively, vs 85.6 (+/-21.4) and 33.7 (+/-13.3) cmH(2)O, respectively) (p<0.05, Bonferroni test). Furthermore, women with urodynamic stress incontinence have significantly lower PdetQmax values as well as higher Qmax than women with competent urethral sphincters (p<0.05, Bonferroni test). There was a significant correlation between ODP, PdetQmax, Qmax and URP measurements. In urodynamic stress incontinence, both URP and pressure flow parameters are reduced. Although the trend for values of both tests were similar and there was a significant correlation between these tests, we should consider that urethral function at rest differ from that during voiding due to activation of additional mechanisms. Therefore, further study is needed to confirm our results.

Antibiotics, heparin, and several surgical interventions have been used in various combinations for the treatment of septic thrombophlebitis, but the optimal management remains unclear. There are limited data from comparative trials studying this issue. Specifically, only one randomized controlled trial was conducted, while the rest of the evidence comes from case series and case reports. The results of this systematic review of septic thrombophlebitis suggest that the use of heparin in combination with antibiotics is associated with low mortality in patients with this serious type of infection. In addition, adverse effects related to heparin were limited in the reported literature. Although data from comparative trials are required to draw definitive conclusions, the available evidence suggests that the administration of heparin should be considered early in the management of patients with septic thrombophlebitis.

This was a prospective study performed at two tertiary referral teaching hospitals. The aim of our study was to investigate changes in urethral resistance with the bladder full compared to empty in women with different urodynamic diagnoses. Consecutive women attending the urodynamic clinics were asked to undergo urethral retro-resistance pressure (URP) measurement with the bladder empty and then full. 106 women were recruited - 25 had normal urodynamic studies, 17 had detrusor overactivity, 57 had urodynamic stress incontinence and 7 had mixed incontinence. Women with urodynamic stress incontinence have lower URP values than women with normal urodynamic studies or those with detrusor overactivity with the bladder empty (p = 0.01). Women with normal urodynamic studies and urodynamic stress incontinence showed a statistically significant rise in URP with the bladder full (p = 0.013 and p = 0.003, respectively). In women with detrusor overactivity, the converse was seen - URP was significantly lower with the bladder full compared to empty (p = 0.004). Our study has shown that bladder filling alters URP measurement and bladder volume should be standardised for reporting URP.

Recurrent urinary tract infections (UTIs) afflict a great number of women around the world. The use of probiotics, especially lactobacilli, has been considered for the prevention of UTIs. Since lactobacilli dominate the urogenital flora of healthy premenopausal women, it has been suggested that restoration of the urogenital flora, which is dominated by uropathogens, with lactobacilli may protect against UTIs. This review is based on a search of PubMed for relevant articles. Many in vitro studies, animal experiments, microbiological studies in healthy women, and clinical trials in women with UTIs have been carried out to assess the effectiveness and safety of probiotics for prophylaxis against uropathogens. Most of them had encouraging findings for some specific strains of lactobacilli. Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 (previously called L. fermentum RC-14) seemed to be the most effective among the studied lactobacilli for the prevention of UTIs. L. casei shirota and L. crispatus CTV-05 have also shown efficacy in some studies. L. rhamnosus GG did not appear to be quite as effective in the prevention of UTIs. The evidence from the available studies suggests that probiotics can be beneficial for preventing recurrent UTIs in women; they also have a good safety profile. However, further research is needed to confirm these results before the widespread use of probiotics for this indication can be recommended.