Search

In this study, the rates of reoperation for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women who underwent a mid-urethral sling (MUS) with or without concurrent colporrhaphy were evaluated. An academic faculty practice consortium database was used to identify a cohort of patients treated surgically for SUI with or without concurrent POP repair (apical, anterior, posterior, or a combination of the three) with or without hysterectomy between 2009 and 2011. A total of 20,484 patients matched the criteria. Of patients who underwent a MUS, 7.2% underwent secondary surgery, with a higher rate of 8.6% associated with those who underwent concurrent prolapse repair (Apical repair HR 1.84, p  < .01; Anterior compartment repair HR 1.47, p  < .01). Concurrent hysterectomy was associated with a lower hazard of secondary prolapse surgery (HR 0.48; p < .01 ) if the initial surgery involved a complete POP repair. Prolapse mesh repair resulted in a higher hazard of additional surgery (HR 1.43, p  < .01). Medicaid insurance was also associated with an increased hazard ratio compared to commercial insurance for secondary surgery (HR 1.32, p  < .01). For women undergoing MUS with complete prolapse repair, concurrent hysterectomy is associated with lower secondary surgery rates. Concurrent prolapse repair with mesh is associated with higher secondary surgery rates. Synopsis: For women undergoing MUS (mid-urethral sling) with complete prolapse repair, concurrent hysterectomy is associated with lower secondary surgery rates. Concurrent prolapse repair with mesh is associated with higher secondary surgery rates.Impact Statement What is already known on this subject? Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can present at the same time and negatively impact patients' quality of life. There is little data regarding reoperation rates for patients who undergo both MUS and colporrhaphy in one setting. What do the results of this study add? This study found that patients who undergo concurrent MUS (mid-urethral sling) and complete POP repair with the addition of hysterectomy had a lower risk of secondary surgery. What are the implications of these findings for clinical practice and/or further research? Our data can be used by surgeons to counsel patients on the risks of re-operation for SUI for those who would like to undergo concurrent POP repair with or without hysterectomy.

Objective: The aim of this study was to determine whether sacrospinous ligament fixation independently increases the risk of anterior vaginal wall defect., Study Design: A retrospective cohort study was conducted on patients undergoing pelvic reconstructive surgical operations by a single surgeon from 1970 through 1997. Two groups were examined and divided into subgroups to evaluate the effects of exposure to sacrospinous ligament fixation: patients with anterior wall defects undergoing standard anterior colporrhaphy with (group 1A) or without (group 1B) concomitant sacrospinous ligament fixation, and patients without anterior wall defects undergoing other pelvic reconstructive procedures (but not anterior colporrhaphy) with (group 2A) or without (group 2B) sacrospinous ligament fixation. Recurrence rates were calculated for each group according to evidence of any degree of anatomic defect., Results: Among 322 patients in group 1, 9 of 77 in group 1A and 23 of 245 in group 1B (11.7% vs 9.4%, P >.05) had anterior wall recurrences. Among 73 patients in group 2, 8 of 45 in group 2A and 5 of 28 in group 2B (17.8% vs 17.9%, P >.05) had subsequent anterior wall defects., Conclusion: The occurrence of anterior vaginal wall defects was not found to be altered by the performance of sacrospinous ligament fixation. These findings may be attributable to surgical technique emphasizing maintenance of anterior vaginal wall length during sacrospinous ligament fixation.

Steady-state active stress in smooth muscle is maintained by cross bridges which undergo continuous cycling and myosin phosphorylation, and the two processes both consume ATP. In this study, we investigated whether energy utilization by cross-bridge cycling and myosin phosphorylation is compartmentalized and examined their relative affinities for ATP in airway smooth muscle. We measured active stress, myosin phosphorylation, O2 consumption, and tissue ATP content in bovine tracheal smooth muscle activated by K+ depolarization when glucose was replaced by pyruvate and when oxidative metabolism was inhibited by hypoxia or uncoupled by 2,4-dinitrophenol. The results indicate that ATP produced from both glycolysis and oxidative metabolism is available to both cross-bridge cycling and myosin phosphorylation. However, steady-state myosin phosphorylation was insensitive to the inhibition of oxidative metabolism by hypoxia and mitochondrial uncoupling when steady-state isometric stress and tissue ATP content were significantly reduced. These results suggest that, relative to actomyosin adenosine 5'-triphosphatase, myosin light chain kinase has a higher affinity for ATP in intact airway smooth muscle. However, peak myosin phosphorylation associated with the initial rapid stress development was sensitive to inhibition of oxidative metabolism, probably reflecting a lower content of intracellular calcium store as a result of metabolic inhibition.

The objective of this investigation was to determine the extent to which the sexual performance of adult bulls (18 to 24 mo of age) can be predicted by prepuberal sexual behaviors. Tests were administered to 121 polled Hereford bulls to determine whether adult sexual performance (especially serving capacity or ejaculation rate) was related to 1) whether or not the subjects mounted estrous females at 6 mo of age, 2) the age at which the bulls attained their first ejaculation, 3) the frequency of sexual behaviors exhibited in heterosexual interactions and 4) the frequency of male-male mounting exhibited in all-male groups. None of the above measures reliably predicted adult serving capacity. Prepuberal interest in mounting other males and estrous females and the age at which ejaculatory competence was attained bore little relationship to serving capacity at 18 to 24 mo. Individual differences in rate of ejaculation were consistent from one age to another only after the bulls had reached 18 mo. We concluded that the sexual behaviors of prepuberal beef bulls were of limited usefulness in predicting adult sexual performance.

The purpose of this investigation was to determine the interrelationships of the various sexual and aggressive behaviors exhibited by Hereford bulls in sexual performance (serving capacity) tests and to determine the extent to which these interrelationships change with age (maturity). Correlation matrices were constructed for the frequencies of sexual and aggressive behaviors exhibited by two groups of 13 and 14 bulls, respectively, during 120-min tests with females when the bulls were 12, 18, and 24 mo of age. The frequencies of selected sexual behaviors recorded during individual tests at 18, 21, and 24 mo were factor-analyzed using a principle components analysis. Also, a comparison was made of the length of the refractory periods following various sexual behaviors at 12 and 24 mo of age. Bulls varied greatly in the way they responded to sexual stimuli. Few sexual behaviors were intercorrelated and the factor analysis of selected sexual behaviors was inconclusive. Frequencies of aggressive behaviors were more highly correlated. Age (maturation) did not affect the interrelationship of the sexual behaviors recorded. Aggressive behavior variables were more highly correlated at 12 mo than at 18 or 24 mo of age. The average length of the refractory period following ejaculation was longer (112 s; P less than .05) than the refractory period following mounts without ejaculation (50 s), and the latter had a longer (P less than .05) refractory period than mount attempts, mount intentions and head throws (26 to 38 s).(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of the following study was to determine the effects of group size and the male-to-female ratio on the sexual and aggressive behaviors of bulls in the context of serving capacity tests. Tests were administered to two groups of 13 and 14 polled Hereford bulls, respectively, under four test conditions in which the number of bulls and the ratio of males to females was varied. The test conditions were as follows: 1) individual tests (single males were exposed to single females), 2) small-group tests (three or four bulls:three females), 3) large-group tests (13 or 14 bulls:3 females), and 4) male-only test (13 or 14 bulls were placed in the test area in the absence of females). In addition, the sexual performance of 44 Hereford and 12 Angus bulls was compared when competing (small-group tests) vs not competing (individual tests) for females. Ejaculation rate (serving capacity) was similar in individual and small-group tests in which a male-to-female ratio of approximately 1:1 was maintained. Increasing the male-to-female ratio to approximately 4.5:1 enhanced levels of aggression and reduced overall sexual performance. Angus bulls were more aggressive than their Hereford counterparts when competing for females and exhibited lower (P less than .05) ejaculation rates in small-group tests than when evaluated individually. We concluded that the sexual performance of polled Hereford bulls can be reliably evaluated when tested in small groups as long as a 1:1 male-to-female ratio is approximated.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to compare the sexual performance of rams that differed in age (maturation) and sexual experience. Twenty-four ram lambs (8 mo of age) and 21 rams (20 mo of age) were individually exposed to four females in hormonally induced estrus for 30 min on five occasions, 7 d apart. Half (12) the ram lambs and nine of the yearlings were sexually naive at the start of testing (had been denied access to females since weaning); the remaining males were sexually experienced. The sexual performance of the virgin rams was poorer during the initial exposure to females than in subsequent tests, whereas the sexual behavior of the sexually experienced males did not change over the days of testing. Sexually naive ram lambs and rams exhibited an improvement in sexual performance between Tests 1 and 2; during Test 3 to 5 the sexual performance (ejaculations per test) of sexually naive and experienced rams was similar. The only effects of age (maturation) on sexual performance during the last three test days were a higher frequency of mounts without ejaculation plus mount attempts (P less than .03) and a greater number of mount interactions per ejaculation (P less than .02) by ram lambs. In conclusion, one or two relatively brief exposures to estrous females can bring the sexual performance of virgin rams up to levels comparable to that of experienced males. Also, ram lambs in good condition exhibit acceptable levels of sexual performance.

The purpose of this study was to describe maturation-related changes in the sexual and aggressive behaviors of Hereford bulls. Two groups of 13 and 14 bulls, respectively, were tested for sexual and aggressive behaviors every 3 mo from 3 to 24 mo of age. At 3 and 6 mo of age, the bulls were exposed, as groups, to two estrous females, whereas at 9, 12, 15, 18, 21, and 24 mo these bulls were tested under each of the following several treatment conditions: 1) individual tests (single males were exposed to single females), 2) small-group tests (three or four bulls:three females), 3) large-group tests (13 or 14 bulls:3 females), and 4) male-only tests (13 or 14 bulls were placed in the test arena in the absence of females). Most bulls consistently mounted females by 9 mo of age. Twenty-one of the 27 bulls (78%) attained their first ejaculation at either 12 or 15 mo of age. The frequency of mounting without ejaculation was greatest in large-group tests at 12 mo of age, and ejaculation frequency peaked at 18 mo. The incidence of male-male mounting in large-group tests (with females) did not appreciably change from 3 to 24 mo, whereas male-male mounting in male-only tests was greatest at 9 and 24 mo. We conclude that sexual performance data obtained in serving capacity tests administered to yearling bulls before 18 mo of age may underestimate the mating potential of certain individuals.(ABSTRACT TRUNCATED AT 250 WORDS)

Individual differences in the sexual reaction times and ejaculation rates (serving capacity) of 14 beef bulls were compared with their behavioral responses to a novel arena and to novel non-sexual visual and auditory stimuli. Correlation coefficients for ejaculation rates were consistently low and nonsignificant, but bulls that were most inhibited by the novel environment/stimuli exhibited the longest latencies for first mount and ejaculation. The emotional reactivity of bulls may be more closely related to their sexual inhibitions than to measures of reproductive success., (Copyright © 1990. Published by Elsevier B.V.)

Two recent court decisions clarified whether and under what circumstances a patient may refuse life-sustaining medical treatment, including food and water. The Nancy Cruzan case, decided by the U.S. Supreme Court on June 25, 1990, and the case of Shirley Crabtree, decided by Family Court Senior Judge Daniel G. Heely in Hawaii on April 26, 1990, had differing outcomes. Moreover, Hawaii has a living will statute which purports to place limits on when and whether a person may choose to die rather than live in a severely disabled condition. This article will summarize the current law, and will offer practical advice to physicians on how to deal with these sensitive issues that affect their patients.

The objective of the present study was to determine the effects of short-term (6 wk) individual housing on the sexual interest (libido) of sexually experienced bulls. Twenty-two Hereford bulls reared with both males and females (BMF) or in all-male groups (BM) and approximately 21 mo of age were given free access for 40 min to five restrained females in hormonally-induced estrus and restricted access for 30 min to a single enclosed estrous female on two separate occasions. Free-access tests were administered to bulls in groups of five or six individuals, whereas bulls were tested individually in restricted-access tests. After testing, half the animals were housed individually (physically isolated from conspecifics) and half remained in group housing for a 6-wk period. Libido tests were administered again at the end of the treatment period and 2 wk after reinstatement of group housing for the experimental subjects. Individually housed bulls exhibited fewer mounts (P less than .001) and spent less time with females (P less than .01) in tests administered during physical isolation than before or after treatment. Individual housing did not affect BMF and BM bulls differentially. In conclusion, short-term individual housing temporarily reduced libido of beef bulls.

The display of penile reflexes and copulatory behavior appears to reflect the activity of two different underlying neuronal system, both of which are modulated by systemic testosterone (T) concentration. To indirectly compare the two systems, the responsiveness to T of penile reflexes and copulatory behavior was examined. In the first experiment castrated spinal male rats were given penile reflex tests while receiving replacement T through Silastic capsule implants filled with T (50 mm T). After capsule removal the number of penile erections and flips declined within 24 hr and gradually decreased for 12 days. Subjects were then reimplanted with new 50-mm T capsules. The number of penile flips and erections increased within 6 and 12 hr. respectively. This is a much more rapid response rate to T than has been established for copulatory behavior. In the second experiment castrated spinal male rats were tested for penile reflexes with a 50-mm T capsule, which was then replaced with a 10-, 5-, or 2-mm T or an empty capsule. The number of penile reflexes declined in a dose-response fashion. In the third experiment, castrated sexually experienced male rats were tested for copulatory behavior with two 25-mm T capsules which were then replaced with a 10 or 2-mm T or an empty capsule. Only males with empty capsules had decrements in copulatory behavior, revealing that a low level of T can maintain virtually normal sexual behavior despite a marked decline in penile reflex activity. The neuronal system underlying penile reflexes (spinal neurons) is apparently much more responsive to changes in T concentrations than the neuronal system underlying motivational and appetitive aspects of copulatory behavior (brain neurons).

Seminal plugs, which must be tightly adhered to the vaginal walls for optimal fertilization, are disturbed or loosened by copulatory intromissions. In multi-male mating encounters, a male may reduce the sperm delivered by a previous male by dislodging the former male's plug and depositing his own sperm and plug. Recent work has documented that the striated penile muscles are involved in the production of penile erectile cups and flips. This study focused on the effects of penile muscle excision on the ability of male rats to dislodge and deposit tight plugs. Using a radiopaque contrast medium to visualize if a seminal plug was tightly adhered to the vaginal wall, displaced caudally or dislodged, Experiment 1 examined the manner in which plugs were removed during a series of intromissions. The dislodgement process was envisioned as a gradual one beginning with caudal displacement which occurs during the first or second intromission. Following excision of either the bulbocavernosus (BCX) or ischiocavernosus (ICX) muscles in Experiment 2, plug disturbance ability was impaired in 54 percent and 40 percent of BCX and ICX subjects respectively. Ability to deposit tight plugs was impaired in 45 and 20 percent of BCX and ICX subjects respectively.

Lamb-specific odor is used by ewes to discriminate between their own and alien offspring. Recent studies have demonstrated that fostering can be facilitated by transferring own-lamb odor to alien lambs via cloth stockinettes. The objective of the present study was to investigate the effectiveness of the odor-transfer technique in enticing ewes with a single lamb to adopt an additional lamb ("add-on" procedure). Shortly after birth, nylon stockinettes were placed on the single offspring of 49 ewes and 49 additional alien lambs designated for fostering. Approximately 20 h following parturition, stockinettes were removed from 41 natural lambs and placed on alien lambs (experimental treatment). In the control treatment (eight ewes) own and alien lambs retained their own stockinettes. Four acceptance tests were conducted, 24 h apart, starting at the onset of fostering. Successful adoptions were attained for 21 of 31 experimental ewes (68%) exposed to add-on lambs similar in facial coloration to their own lambs. Only 2 of 10 experimental ewes (20%) with whiteface natural lambs adopted blackface add-on lambs. One of eight control ewes (12.5%) adopted an add-on lamb. Of the 24 ewes that adopted alien lambs 10 (41.7%) demonstrated immediate acceptance and 20 (83.3%) had adopted lambs by the second test day. A higher proportion of primiparous than multiparous ewes adopted alien lambs. The presence of own-lamb odor on stockinettes worn by add-on lambs appears to facilitate fostering. However, the presence of own-lamb odor may not be a significant-enough cue to override obvious differences in facial coloration between own and add-on lambs.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationships between sexual and aggressive behaviors and levels of plasma testosterone and luteinizing hormone (LH) were examined in Hereford bulls at 18 and 24 mo of age. Concentrations of hormones in bulls during periods of sexual rest (13 blood samples collected from each animal during a 24-h period) were compared with individual differences in sexual and aggressive behaviors when exposed to restrained females, either individually or in groups. Nearly all correlation coefficients were low and nonsignificant. It was concluded that individual differences in sexual performance and aggressive behavior cannot be predicted based on circulating levels of testosterone and LH in bulls during periods of sexual rest.

Twelve stallions that had been given 0, 50 or 200 micrograms testosterone propionate (TP)/kg body weight every other day for 88 days were examined for the effects of androgen withdrawal on spermatozoal production, seminal quality and libido. Although the lower dosage did not affect most of the traits studied, the higher dosage severely reduced scrotal width, spermatozoal production, the number of sperm per ejaculate, the percentage of progressively motile spermatozoa and the percentage of normal spermatozoa. These adverse effects were found to be largely reversible. By 90 days after the cessation of treatment, scrotal width, testicular weight and spermatozoal production were similar for treated and control stallions. Although the number of sperm per ejaculate remained lower for stallions given 200 micrograms TP than for controls during the recovery period, the number of sperm in the extragonadal ducts was similar for all groups after 90 days of recovery. Spermatozoal motility and morphological characteristics were normal for all three groups by the end of the recovery period. Libido was not affected by TP treatment or withdrawal.

Eighteen sexually experienced Hereford bulls were exposed individually to a pair of restrained hormone-induced estrous and nonestrous females to determine mating preferences in the context of serving capacity testing. No evidence was obtained to support the hypothesis that restrained estrous females are more attractive to bulls than restrained nonestrous females. Estrous and nonestrous females received similar numbers of mount intentions, mount attempts, mounts without ejaculations and ejaculations during the 20-min tests. Time spent with estrous and nonestrous females and latencies to leave initially chosen estrous and nonestrous females to investigate the alternative female also were similar. Bulls interacted more with the females that they contacted first, regardless of estrous condition. A female position effect was noted. We conclude that restrained nonestrous females are as effective as restrained estrous females in assessing the serving capacity of Hereford bulls.

The objective of this study was to determine the effect of postweaning exposure to females on the subsequent sexual performance of young rams. Twenty-five crossbred rams were reared in a group with ovariectomized females from 4.5 to 9 mo of age. Ewes were brought into estrus every 2 wk during this period. A companion group of 23 crossbred rams was not exposed to females following weaning. Four 30-min sexual performance tests were administered at 10 mo of age. Rams reared with males and females (RMF) exhibited more mounts (P less than .001) and more ejaculations (P less than .002) than rams reared only with males (RM). The frequency of successful matings by the latter group did not increase with experience. Nine rams were sexually inactive in the sexual performance tests. Follow-up tests revealed that two of the RMF rams and one RM ram developed and maintained a sexual preference for males. The six remaining rams eventually mated with females when tested in familiar pens and subsequently exhibited normal levels of sexual performance even when tested in an unfamiliar enclosure. Exposure to ewes during the postweaning prepubertal period enhanced sexual performance. However, early exposure to females did not ensure that all males developed sexual preferences for females. The environmental context in which sexual performance tests are administered may inhibit the expression of heterosexual behavior in a small percentage of animals. After heterosexual behavior was expressed, the rams continued to show normal levels of sexual performance.(ABSTRACT TRUNCATED AT 250 WORDS)

There are many serious medical problems that are associated with the use of cocaine and "crack" cocaine.