C. Kelleher

Pelvic organ prolapse and overactive bladder

In this review we try to shed light on the following questions: How frequently are symptoms of overactive bladder (OAB) and is detrusor overactivity (DO) present in patients with pelvic organ prolapse (POP) and is there a difference from women without POP? Does the presence of OAB symptoms depend on the prolapsed compartment and/or stage of the prolapse? What is the possible pathophysiology of OAB in POP? Do OAB symptoms and DO change after conservative or surgical treatment of POP?

A comparison of the objective and subjective outcomes of colposuspension for stress incontinence in women

Objectives To investigate the impact of colposuspension for stress incontinence on the symptoms and quality of life of women undergoing both primary and repeat surgery for genuine stress incontinence and in addition to assess the use of a condition specific quality of life questionnaire as an outcome measure following surgery.

Overactive bladder: the importance of new guidance

Overactive bladder (OAB) affects an estimated 49 million people in Europe, but only a minority receive appropriate treatment. Others are bothered by unacceptable levels of symptoms that severely impair their quality of life and represent a significant financial burden to themselves and to their healthcare providers. Recently updated guidelines from the International Consultation on Incontinence (ICI) and the European Association of Urology (EAU) take account of important new developments in the management of bladder problems in both primary and secondary care. However, local implementation of previous guidance has been variable, with many patients with OAB and other bladder problems failing to gain full benefit from current clinical and scientific understanding of these conditions. The recent expansion of the range of treatments available for OAB and stress urinary incontinence makes it especially important that physicians become aware of the differential diagnosis of these conditions – the questions they need to ask, and the investigations which will help determine the most appropriate course of action.

Neurogenic Detrusor Overactivity in Patients With Spinal Cord Injury: Evaluation and Management

Lower urinary tract dysfunction can have a significant impact on patients with spinal cord injury. Over the years, many treatment options have become available. This article reviews the assessment and management of neurogenic detrusor overactivity, with a particular focus on articles from the recent literature. Recent guidelines on the subject will be discussed. Management options include antimuscarinics and bladder emptying measures, botulinum toxin A, and neuromodulation in refractory cases and surgery for intractable cases. Recent and relevant publications in these areas will be summarized and discussed.

Is there a link between overactive bladder and the metabolic syndrome in women? A systematic review of observational studies

To conduct a systematic review to determine whether there is an association between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) or overactive bladder (OAB) in women.

Persistence with mirabegron therapy for overactive bladder: A real life experience.

To evaluate persistence rates of patients receiving mirabegron therapy for overactive bladder (OAB) within our institution over a 6 month period, identify determinants of early discontinuation of therapy, and assess overall patient satisfaction with treatment.

A comparison study of two lower urinary tract symptoms screening tools in clinical practice: The B-SAQ and OAB-V8 questionnaires

Lower urinary tract symptoms (LUTS) have a detrimental effect on quality-of-life (QoL). However, sufferers are often reluctant to seek help. Screening for LUTS will identify patients with bothersome symptoms who may benefit from treatment and allow patients to self-assess their symptoms and the need for medical intervention, potentially saving costly medical time and reducing long-term morbidity. The aim of this study was to compare the value of two validated questionnaires: the Bladder Control Self Assessment Questionnaire (B-SAQ) and the Overactive Bladder Awareness Tool (OAB-V8) as screening questionnaires in clinical practice. A total of 223 women were recruited prospectively from three centres. Participants completed both questionnaires in the waiting area prior to assessment by a clinician, who completed a symptom evaluation sheet. Data were analysed using receiver operating characteristic curves. Both the B-SAQ and the OAB-V8 performed well in detecting symptoms of OAB and mixed urinary symptoms. The B-SAQ performed better in detecting symptoms of stress incontinence than the OAB-V8. The opportunity to screen for haematuria should never be missed and this is an important omission from the OAB-V8.

Overactive Bladder and Continence Guidelines: implementation, inaction or frustration?

Guidelines for the management of continence and overactive bladder are generally available across Europe. For a majority of countries, these have been adopted by professional societies in either urology or gynaecology for local use. There has, however, been little monitoring of formal implementation of these guidelines and seldom any attempt to audit their operation. The state of continence care therefore remains largely unknown. This article reviews current guidelines and their status across Europe and examines what might be relevant from other disease areas to promote successful implementation.

Validation of the bladder control self‐assessment questionnaire (B‐SAQ) in men

To validate the Bladder Control Self‐Assessment Questionnaire (B‐SAQ), a short screener to assess lower urinary tract symptoms (LUTS) and overactive bladder (OAB) in men.

A case of hyperreactio luteinalis with peripartum subacute ovarian accident

A 29-year-old black African woman in her first pregnancy presented for routine antenatal care and delivery. She booked at a gestational age of 13 weeks and 2 days. A dating ultrasound scan (USS) confirmed a single live intrauterine fetus consistent with her dates. She had two further scans at 20 weeks and 35 weeks for fetal anatomy and placental localisation, both of which were normal. She attended the antenatal clinic on 12 October 2007, at a gestational age of 38 weeks with complaints of abdominal pain and reduced fetal movements. Pain was generalised and constant but was relieved by paracetamol tablets. The symphysiofundal height measured 44 cm. There was no abdominal tenderness on palpation and the uterus was soft. The fetus was in a longitudinal lie with a cephalic presentation. Vaginal examination showed a cervical dilatation of 1 cm, intact membranes, and presenting part at station 0–2. An ultrasound scan showed an abdominal circumference of about the 97th centile with an amniotic fluid index of 20 that was clearly above the 95th centile. Umbilical artery Doppler was normal. Placenta was Granum 3. The cardiotocograph (CTG) showed suspicious trace, with a baseline rate of 150 beats per minute, no definite accelerations and the variability was reduced to less than 5 beats over a 40 minute period. There were no decelerations. Uterine activity was recordable at a frequency of about two over a 10 minute period. Because of concerns about the CTG, the patient was admitted to the hospital birth centre at 19:35 hours and had labour induced according to the unit’s standard protocol using dinoprostone gel, amniotomy and syntocinon infusion. She had an emergency caesarean section delivery of her baby after one hour of syntocinon because the CTG became pathological and cervical dilatation was unchanged at 1 cm. Operative findings were: 400 ml of blood stained peritoneal fluid, a live female infant, birth weight 3.58 kg, with cord pH of 7.193 (arterial), 7.22 (venous) and base excess of 5.5 and 5.8, respectively. There were no retroplacental clots. Examination of the uterine appendages following closure of the uterine incision showed normal tubes, but the ovaries were not visualised. A dark bluish mass extending from the left iliac fossa up to the left hypochondrium was identified. The mass was initially thought to be a splenic mass, but a careful abdominal exploration revealed the bluish mass to be bilateral, torted, very dark coloured multicystic ovarian masses, both friable and bleeding. Each mass measured approximately 25 cm630 cm. The findings were explained to the patient, as well as the need to remove all non-viable ovarian tissue. The patient gave verbal consent and had bilateral ovarian cystectomy. The residual ovarian tissue was reconstituted using 2/0 Vicryl. The omentum, liver and bowels were inspected and found to be normal. Overall, the estimated blood loss was 1300 ml. Postoperatively, she was fully debriefed as to the course of events. She made a satisfactory recovery and was discharged home on the third postoperative day, in a stable condition. She had a gynaecology outpatient appointment, scheduled for 3 months after cessation of breast-feeding for estimation of her oestradiol and FSH levels, but the patient was lost to follow-up. Surgical pathology report