Anne Rosamilia

Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis

Please cite this paper as: Lee J, Dwyer P, Rosamilia A, Lim Y, Polyakov A, Stav K. Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis. BJOG 2011;118:798–805.

Laparoscopic versus open Burch colposuspension : a randomised controlled trial

Objective  To compare perioperative characteristics, short‐term, and long‐term outcomes for laparoscopic Burch colposuspension (LBC) and open Burch colposuspension (OBC) for the treatment of urinary stress incontinence.

BLADDER MICROVASCULATURE IN WOMEN WITH INTERSTITIAL CYSTITIS

PURPOSE A cardinal cystoscopic finding in women with interstitial cystitis is mucosal small vessel hemorrhage or glomerulations after hydrodistention. We quantified and compared microvascular density and endothelial proliferation in the bladder biopsies of women with interstitial cystitis and a control group of women who were undergoing incontinence or prolapse surgery. MATERIALS AND METHODS We performed computer assisted image analysis and immunohistochemical studies to compare differences in the blood vessel count, and proportional area in the bladder suburothelium and deeper submucosa of bladder biopsies of 52 women, including 26 with interstitial cystitis. Routine light microscopy features were examined and correlated with microvascular density. RESULTS In the bladder biopsies of women with interstitial cystitis there was a lower blood vessel count (p = 0.01), and a lower proportion of the total image consisted of blood vessel wall (p = 0.03) in the suburothelium than in control biopsies. We noted no difference in the blood vessel count of the deeper submucosa or in the degree of endothelial cell proliferation. Suburothelial blood vessel differences correlated with the degree of histological change, such as edema, inflammatory infiltrate and vascular congestion. CONCLUSIONS We found decreased microvascular density in the suburothelium but not in the deeper submucosa in bladder biopsies of women with interstitial cystitis.

ACTIVATION OF THE KALLIKREIN KININ SYSTEM IN INTERSTITIAL CYSTITIS

PURPOSE We investigated whether the kallikrein kinin system is activated in interstitial cystitis by measuring urinary excretion rates of kinin peptides, active and total kallikrein, and the kininase neutral endopeptidase in women with interstitial cystitis. We compared these excretion rates to a control group of women with stress incontinence and normal bladder function. MATERIALS AND METHODS Catheter urine was collected from subjects during a water diuresis (approximately 10 ml. per minute) before and after distention of the bladder with 100 ml. water. The contribution of the bladder wall to urinary kinins was assessed by measuring the change in kinin levels after 2 minutes of bladder stasis before and after distention. RESULTS Absolute bradykinin and kallidin excretion rates were similar in women with interstitial cystitis and control subjects. Two minutes of bladder stasis after bladder distention increased urinary bradykinin (p = 0.02) but not kallidin excretion rates. Active and total kallikrein excretion rates were similar in patients with interstitial cystitis and control subjects. Neutral endopeptidase excretion rates were reduced in the initial urine collection from subjects with interstitial cystitis but were similar in both groups during later collection periods. CONCLUSIONS These data provide evidence for increased bradykinin levels in the bladder wall of subjects with interstitial cystitis, which may be due in part to reduced neutral endopeptidase levels. These increased bradykinin levels may participate in the pathogenesis and symptomatology of interstitial cystitis.

Urinary Symptoms Before and After Female Urethral Diverticulectomy-Can We Predict De Novo Stress Urinary Incontinence?

PURPOSE We assessed preoperative and postoperative urinary symptoms, and determined risk factors for de novo stress urinary incontinence after transvaginal urethral diverticulectomy. MATERIALS AND METHODS We reviewed the case records of 25 consecutive women who had transvaginal urethral diverticulectomy. Urinary symptoms were documented before and after surgery with a structured history and examination pro forma. Demographic, clinical and imaging parameters were reviewed to determine any association with preoperative and postoperative symptoms as well as possible risk factors for postoperative stress urinary incontinence. RESULTS The most common presenting symptoms were urinary urgency and frequency (60%), and dyspareunia (56%). On physical examination the most common findings were a tender anterior vaginal wall mass (88%) and urethral discharge (40%). At a mean followup of 15.1 +/- 14.9 months (median 12) the rate of urgency-frequency symptoms and dyspareunia decreased significantly from 60% to 16% and from 56% to 8%, respectively. All the patients who had urge incontinence were cured of this symptom after the operation. De novo stress urinary incontinence developed in 4 patients (16%) postoperatively, and it was mild and only necessitated surgical treatment in 1 patient. A diverticulum larger than 30 mm and proximal urethral location were significant factors (p <0.05) for the development of de novo stress urinary incontinence. CONCLUSIONS Irritative bladder symptoms are common in woman with urethral diverticulum and usually resolve after surgical excision. Stress urinary incontinence developed immediately after the operation, and had a significant association with a proximal urethral location and ultrasonically measured size greater than 30 mm.

Interstitial cystitis and the gynecologist.

Interstitial cystitis (IC) is a predominantly female condition with the presenting symptoms of frequency of micturition and pain. The diagnosis is confirmed by bladder visualization at cystoscopy during filling, emptying, and redistension. The epidemiology, proposed etiologies, and current therapies for interstitial cystitis are discussed. The condition of IC is poorly understood and has no specific histological characteristics. However, there is much that can be offered to the IC sufferer to relieve or cure her symptoms. It is hoped that the recent decade of increasing research activity will be fruitful in answering questions of etiology and pathogenesis, and offering hope for new therapies and ultimately cure.

The pain of Interstitial Cystitis

Interstitial cystitis (IC) is a poorly understood condition of the bladder which predominantly affects women (9:1) and causes chronic pain associated with urinary frequency and urgency. The pain may be localized to the bladder, vagina or rectum and is aggravated by coitus, diet or stress. It is temporarily relieved by voiding, with many women having extreme frequency: in one study [1] the average number of micturitions per 24 hours was 21. To alleviate this pain many sufferers drastically reduce their fluid intake to the extent that frequency may not be an obvious presenting symptom. As well as the inconvenience of chronic frequency the pain of IC is severe and unrelenting, resulting in a quality of life comparable to end-stage renal disease [2]. The pain of IC is not purely physical: many women are angry because of the considerable delay in diagnosis, usually following many medical consultations and unhelpful investigations and treatments. The average time from symptom onset to diagnosis in one study was 4.5 years [2]. The reasons for delayed diagnosis are many. The pain of IC is poorly localized; until recently there has been no consensus on criteria for diagnosis, and there is no simple diagnostic test or histological appearance of the bladder. During filling the bladder wall is frequently normal, with the characteristic petechial hemorrhages of IC only evident following distension while the bladder is being emptied. Women with IC are frequently referred to gynecologists for evaluation of their pelvic pain. The high incidence of hysterectomy [3] in women with IC may be indicative of the difficulties in diagnosis, and perhaps an ove> readiness to attribute this pain as uterine. The criteria for diagnosis of IC are: