Ash Monga

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.

Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female‐specific approach and clinically based consensus report.

An International Urogynecological Association (IUGA) International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction

Introduction and hypothesisNext to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report.MethodsThis report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus).ResultsA terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible.ConclusionsA consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

Primary repair of obstetric anal sphincter rupture using the overlap technique

Objective To evaluate the feasibility of a new technique of primary overlap anal sphincter repair instead Setting A teaching hospital and a district general hospital.

Urogynaecology: Collagen metabolism in the uterosacral ligaments and vaginal skin of women with uterine prolapse

Objective  To compare tissue markers of collagen metabolism in the uterosacral ligaments with those in vaginal tissue in women with uterine prolapse.

Pregnancy and delivery: a urodynamic viewpoint

Objective The aims of this study were to establish prospectively the prevalence of objective bladder dysfunction before and after delivery by means of urodynamic investigations and to assess the effect of obstetric variables on bladder function.

Correlation of Urethral Closure Pressure, Leak-Point Pressure and Incontinence Severity Measures

The aim of this study was to determine whether water perfusion maximum urethral closure pressure (MUCP) correlates with Valsalva leak-point pressure (LPP), and which of these best correlates with subjective and objective incontinence severity measures. Fifty-two women with previously diagnosed genuine stress incontinence (n= 46), or mixed incontinence with a minor and controlled urge component (n= 6), were assigned an incontinence status grade based on interview and diary review. These women then completed visually observed standing LPPs at 250 ml bladder capacity, supine water perfusion MUCP determinations, pad tests and quality of life questionnaires. The urodynamic and severity measures were compared with correlation analysis or analysis of variance. A modest correlation exists between LPP and MUCP (r= 0.50–0.62, P<0.001). Both MUCP and LPP demonstrated significant decreases (P<0.01) with increasing severity of assigned incontinence grade. A very low and insignificant correlation existed for these urodynamic parameters and pad loss or quality of life measures. MUCP and LPP correlate modestly with each other and both are comparable in predicting incontinence severity. Either can be used as the urodynamic measure to assess intrinsic sphincter deficiency.

A systematic review of clinical studies of electrical stimulation for treatment of lower urinary tract dysfunction

Introduction and hypothesisThe aim of this manuscript was to provide a systematic literature review of clinical trial evidence for a range of electrical stimulation therapies in the treatment of lower urinary tract symptoms (LUTS).MethodsThe databases MEDLINE, BIOSIS Previews, Inside Conferences, and EMBASE were searched. Original clinical studies with greater than 15 subjects were included.ResultsSeventy-three studies were included, representing implanted sacral nerve stimulation (SNS), percutaneous posterior tibial nerve stimulation (PTNS), and transcutaneous electrical stimulation (TENS) therapy modalities.ConclusionsMedian mean reductions in incontinence episodes and voiding frequency were similar for implanted SNS and PTNS. However, long-term follow-up data to validate the sustained benefit of PTNS are lacking. Despite a substantial body of research devoted to SNS validation, it is not possible to definitively define the appropriate role of this therapy owing largely to study design flaws that inhibited rigorous intention to treat analyses for the majority of these studies.

Obesity and pelvic floor dysfunction

Obesity is associated with a high prevalence of pelvic floor disorders. Patients with obesity present with a range of urinary, bowel and sexual dysfunction problems as well as uterovaginal prolapse. Urinary incontinence, faecal incontinence and sexual dysfunction are more prevalent in patients with obesity. Uterovaginal prolapse is also more common than in the non-obese population. Weight loss by surgical and non-surgical methods plays a major role in the improvement of these symptoms in such patients. The treatment of symptoms leads to an improvement in their quality of life. However, surgical treatment of these symptoms may be accompanied by an increased risk of complications in obese patients. A better understanding of the mechanism of obesity-associated pelvic floor dysfunction is essential.

Urinary symptoms in pregnancy: are they useful for diagnosis?

This is the second part of a study assessing 161 women 12 weeks after their first delivery. The urodynamic data have previously been published [Br J Obstet Gynaecol 2000; 107:1354]. The symptoms have been assessed using a (non‐validated) urinary symptom questionnaire. There was no correlation between symptoms and urodynamic findings and most importantly between the symptom of stress incontinence, a diagnosis of urodynamic stress incontinence (USI) and vaginal delivery. Symptoms of incontinence and abnormal urodynamic findings were also found in women who underwent caesarean section. These data explain why caesarean section does not appear to be wholly protective in preventing postpartum incontinence. This suggests that the aetiology of postpartum incontinence is multifactorial and urinary symptoms are misleading in determining the underlying causes.

Sexual Function after Rectocele Repair

INTRODUCTION Pelvic organ prolapse is a common condition among women with a prevalence of 11% and may affect the anterior, posterior, or apical compartment with a negative impact on sexual function. AIM Aim of the current study was to evaluate sexual function before and after surgical rectocele fascial repair in sexually active patients who suffer from symptomatic rectoceles. MAIN OUTCOME MEASURES   Female Sexual Function Index (FSFI) and anatomical outcome after rectocele repair. METHODS Between December 2000 and December 2009, we asked sexually active female patients who were to undergo rectocele fascial repair for symptomatic rectoceles to participate in this study. The patients were gynecologically examined before and after surgery and prolapse staging was performed using the ICS-Pelvic Organ Prolapse Staging. Patients were asked to fill in the FSFI before surgery and at 6 months follow-up. For statistical analysis, Graph Pad Prism version 5.0 for Windows was used (Graph Pad, La Jolla, CA, USA). Students t-test was used after normality tests to compare groups and α was set 0.05. RESULTS Sixty-eight patients were included in this study. Median age was 72 years (range 47-91), median parity of 2 (range 0-3) and median body mass index was 29 kg/m2 (range 23-31). Main complaints preoperatively were painful prolapse feeling (n=52), dyspareunia (n=59), and a feeling of vaginal heaviness (n=39). One patient who had suffered from postoperative infection that resulted in excessive scar tissue of the posterior wall suffered from de novo dyspareunia. Statistical analyses (paired t-test) showed significant improvement for desire (P<0.001), satisfaction (P<0.0001), and pain (P<0.0001) and no significant changes for arousal (P=0.0897), lubrication (P=1), and orgasm (P=0.0893). CONCLUSION Posterior fascial repair improves some domains of sexual function but not all in sexually active patients with symptomatic rectoceles, and local oestrogene treatment may contribute to this finding.