Charlotte Chaliha

The relationship of vaginal prolapse severity tosymptoms and quality of life

Objective  To assess the relationship and location of vaginal prolapse severity to symptoms and quality of life.

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.

Complications of surgery for genuine stress incontinence

For many women surgery for genuine stress incontinence (urethral sphincter incompetence) may be the only available treatment. Since the turn of the century over 150 operations have been described for the cure of stress incontinence. Of the variety of procedures proposed, none are entirely satisfactory, and the choice of operation therefore depends on the characteristics of each woman and the skill and experience of the operator. Evaluation of any operation for stress incontinence should include an analysis of short and long term success as well as immediate and delayed complications. A woman will not be satisfied with her treatment if she feels worse after the operation than before, despite being cured of her stress incontinence; for example, she may develop detrusor instability. When discussing treatment the choices of cure should be presented together with the risk of complications, but this is rarely possible because of the inadequacies of published information on the complications of continence surgery. Success is more likely to be reported than failure, especially when a new technique is being promoted, and the reporting of complications is a lesser priority. Even the reporting of ‘success’ is inadequate, for both objective and subjective measures should be used, and follow up prolonged. The purpose of this review is to highlight the importance of complications of surgery for stress incontinence, their frequency, duration and seventy and how they might limit the success of the operation.

Direct imaging of the pelvic floor muscles using two‐dimensional ultrasound: a comparison of women with urogenital prolapse versus controls

Objective  To evaluate the anatomy of the levator ani muscle in women with urogenital prolapse versus matched controls without prolapse using real‐time two‐dimensional (2‐D) ultrasound.

The ethnic cultural and social aspects of incontinence--a pilot study.

Abstract: This cross-sectional study aimed to study the religious and cultural practices of ethnic minorities that might affect the experience and ideas that sufferers of incontinence have. Subjects were multiparous women from the local community who suffered from incontinence. Structured and unstructured interviews were conducted to assess the effect of incontinence and menstruation on home life, sexual life, personal and communal prayer, rules and customs associated with menstruation, and the ability to discuss problems with their doctor and partners. Individual women differed in how they rated their daily activities, and this was not related to religious or ethnicity. Higher restrictions on activity were perceived for fecal than for urinary incontinence. Sexual relationships were restricted for Jewish and Muslim women during menses. Incontinence led to religious restriction, which was most marked for Jewish and Muslim women, and this was related to the need for cleanliness for prayer. Less then 50% of patients sought help, and this was not related to duration and severity of symptoms. Only Muslim women had a strong preference for female doctors, and this was for cultural reasons.

The relationship between urinary symptom questionnaires and urodynamic diagnoses: an analysis of two methods of questionnaire administration

Objective  To assess whether method of administration of a standard urinary symptom questionnaire alters the relationship of symptoms with urodynamic diagnoses.

Caesarean section is protective against stress urinary incontinence: an analysis of women with multiple deliveries

All women who had three elective caesarean sections were selected from a database of 40,000 women delivering between 1977 and 1998, and age‐matched with women having three vaginal births. They all completed a (validated) urinary and bowel symptom questionnaire. Women who had vaginal births had a significantly higher prevalence of stress incontinence but not other urinary or faecal symptoms compared with those delivered by caesarean section. The prevalence of faecal incontinence was lower than the prevalence of urinary incontinence. Although the prevalence of faecal incontinence was lower after caesarean delivery, this was not statistically different. These data have shown that caesarean section was associated with a lower risk of urinary incontinence, although a protective effect on development of faecal symptoms was not seen.

Urogynaecology: Urethral retro‐resistance pressure and urodynamic diagnoses in women with lower urinary tract symptoms

Objective  This study determines whether the retrograde urethral retro‐resistance pressure (URP) measurement discriminates between urodynamic diagnoses in a group of women.

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.

Changes in urethral resistance in the presence of detrusor activity

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.