Christine Sam

Prevalence of female sexual dysfunction in gynecologic and urogynecologic patients according to the international consensus classification

OBJECTIVES To evaluate the prevalence of female sexual dysfunction (FSD) in an outpatient gynecologic and urogynecologic clinic using the current International Consensus Classification. METHODS One hundred fifty-nine patients were asked to answer an anonymous survey about FSD. Patients in the gynecologic (group 1) and urogynecologic (group 2) clinics were compared. RESULTS The mean age in group 1 was 37.8 years (range 20 to 76) and in group 2 was 55.7 years (range 18 to 82). The prevalence of FSD was 50% in group 1 and 48% in group 2; 86% of group 1 and 66% of group 2 patients had been sexually active within the past 2 years. The differences found in FSD according to the consensus panel classification achieved no significance. Of the 159 patients, 96% were not embarrassed by filling out this questionnaire about their sexual function. CONCLUSIONS No statistically significant difference in FSD was found between the younger and older patients seeking help in a gynecologic or urogynecologic outpatient clinic. Because of the high incidence of FSD, we recommend integrating the inquiry about female sexual health concerns into routine gynecologic care. The simple survey based on the International Consensus Conference Classification of FSD gives reliable results, and this systematic framework facilitates methodologic examination.

Transurethral injection of silicone microimplants for intrinsic urethral sphincter deficiency.

Objective To assess the short-term efficacy of transurethral injection of silicone microimplants in women with intrinsic sphincter deficiency. Methods During January 1995 and December 1996, 32 women (mean age 64.3 years, range 39-85 years) with type III stress incontinence (intrinsic sphincter deficiency) underwent transurethral injection of silicone microimplants under general anesthesia. Twenty-eight had undergone previous continence surgery. Subjective and urodynamic assessments were made at 6 and 12 months after injection to evaluate success and short-term effects. Results Objective and subjective success rates were 75% and 59% at 6 and 12 months, respectively. Injections of silicone microimplants significantly increased maximum urethral closure pressure (maximum urethral pressure at rest: 34.40 ± 16.46 cm H2O, 95% confidence interval [CI] 28.55, 40.25 versus 25.35 ± 10.78 cm H2O, 95% CI 21.52, 29.18; P = .027). There were no complications after surgery up to 1 year. Conclusion Transurethral silicone injections were effective in 60% of cases of intrinsic sphincter deficiency, although there was a time-dependent decrease.

Port Site Metastases after Laparoscopic Lymph Node Staging of Cervical Carcinoma

The literature revealed only six cases of cervical carcinoma metastatic to a port site after laparoscopic lymphadenectomy. A woman with a poorly differentiated squamous cell carcinoma of the cervix had port site metastases after laparoscopic lymph node staging. The frequency of this event might be higher than expected. Therefore, surgeons should reduce mechanical irritation of port sites and spillage of tumor cells.

Differential diagnosis of detrusor instability and stress‐incontinence by patient history: The Gaudenz‐Incontinence‐Questionnaire revisited

Objective. To evaluate the validity of the Gaudenz‐Incontinence‐Questionnaire in the differential diagnosis of genuine stress‐incontinence and detrusor instability.

Value of urethral pressure profilometry in the female incontinent patient: a prospective trial with an 8-channel urethral catheter

OBJECTIVES To measure the pressure profiles at different positions of the urethral circumference simultaneously. METHODS Twenty-two women with symptoms of genuine stress incontinence underwent urogynecologic assessment and multichannel urethral pressure profilometry (UPP) at rest with a specially designed 8-channel urethral catheter with radial openings. RESULTS The distribution pattern of maximum urethral closure pressure (MUCP) and functional urethral length (FUL) values were significantly different (P=0.004 and P=0.0004, respectively). Most of the highest MUCP values per patient were found between channels 2 and 4 (P=0.015); most of the greatest FUL values per patient were found between channels 3 and 4 (P=0.15). CONCLUSIONS The data of our study substantiate asymmetric radial pressure distribution within the urethra and underline the necessity of cautious interpretation of results of conventional single-channel UPP, which might vary because of transducer orientation.

Fallopian tissue sampling with a cytobrush during hysteroscopy: a new approach for detecting tubal infection*

OBJECTIVE To evaluate whether the transcervical approach for fallopian tissue sampling is a practicable and safe method to establish an etiologic diagnosis of salpingitis. DESIGN Controlled clinical study. SETTING Academic research environment. PATIENT(S) Twenty women with primary or secondary sterility undergoing hysteroscopy and laparoscopy. INTERVENTION(S) During hysteroscopy, fallopian tissue samples were obtained from the proximal parts of both tubes with a cytobrush inserted through the working channel of the hysteroscope. Diagnostic laparoscopy with assessment of tubal patency was performed in the same session. The specimens were split and used for chlamydial testing by both cell culture and polymerase chain reaction. Serum samples were evaluated for the presence of antichlamydial antibodies. MAIN OUTCOME MEASURE(S) Practicability and safety of the method. RESULT(S) The sampling procedure was performed in all patients without complications. Adequate samples were obtained from both tubes in all 20 patients. The fallopian specimens showed evidence of chlamydial infection in one patient. CONCLUSION(S) Those data indicate that transcervical fallopian tissue sampling with a cytobrush is a reliable and safe technique.

Effect of spinal anaesthesia on the lower urinary tract in continent women

Objective To evaluate the effect of spinal anaesthesia on the bladder neck position and the urethral closure function in the resting state and during clinical stress test in healthy, continent women.

Could we treat more unruptured ectopic pregnancies with intramuscular methotrexate

The main reason for the restricted use of methotrexate in the treatment of ectopic pregnancy (EP) obviously is the fear of tubal rupture in patients with lower abdominal pain after the administration of methotrexate. Therefore, we wanted to find out if patient characteristics at first presentation, such as age, pretreatment β-hCG level, adnexal mass as visualized by transvaginal ultrasonography, or history of prior EP, would identify patients at risk for tubal rupture if they were hemodynamically stable and showed no signs of peritoneal irritation. We examined whether more patients could have been treated medically with methotrexate, because tubal rupture was unforeseeable at first presentation and inclusion criteria for methotrexate treatment were fulfilled. From January 1996 to August 1998, 122 patients diagnosed as having EP were treated at the Gynecologic Department of the University Hospital of Vienna. Inclusion criteria for medical treatment with intramuscular methotrexate (50 mg/ m2 body surface area) were (1) hemodynamic stability, (2) an unruptured ectopic mass ≤5 cm at the greatest dimension demonstrated at transvaginal ultrasonography; (3) β-hCG level ≤5,000 mIU/ml; (4) no cardiac activity of the extrauterine embryo; (5) wish of future fertility, and (6) informed consent. Patients with hemodynamic instability, severe abdominal pain, an ectopic mass ≥5 cm at the greatest dimension, β-hCG levels ≥5,000 mIU/ml, cardiac activity of the extrauterine embryo, and no wish of future fertility, or disagreement with methotrexate treatment, primarily underwent surgery. Despite the fact that none of the above patient characteristics at first presentation identified patients at risk for tubal rupture, only 60/122 patients (49%) actually underwent medical treatment whereas our inclusion criteria would have granted medical treatment in 101/122 patients (83%). We determined the actual and maximal possible percentages of patients with unruptured EP eligible for medical treatment of EP with intramuscular single-dose methotrexate 50 mg/m2 body surface area. Our data show that tubal rupture in hemodynamically stable patients is not foreseeable and should not lead to a restricted use of medical treatment in patients preferring methotrexate.

Present state of diagnostics and therapy in female urinary incontinence

OBJECTIVE To determine the present state of urogynecological diagnostics, therapy and follow-up in the Departments of Gynecology and Obstetrics in Austria. DESIGN We sent questionnaires to all Departments of Gynecology and Obstetrics in Austria. The anonymous questionnaire consisted of 25 multiple choice questions. It was possible to choose one ore more answers by ticking applicable boxes with the casual option to give some additional information in form of free text. RESULTS Fifty-eight departments (58%) returned their questionnaires completely answered indicating interest in quality management in medicine. The most remarkable discrepancy was found between the interrogated peoples estimation of the expressiveness of examination techniques and the actual use of such techniques. CONCLUSION We regard the results of this survey as a basis for further quality management strategies in the field of urogynecology in Austria.

Urethrovesikale Morphologie bei kontinenten Frauen in Spinalanästhesie

Fragestellung: Wie wirkt sich eine neuromuskulare Blockade des Beckenbodens bei kontinenten Frauen auf klinische, urodynamische und morphologische Befunde des unteren Harntraktes aus? Methoden: In einer prospektiven Studie wurden 14 kontinente Frauen ohne Deszensus unmittelbar vor und wahrend Spinalanasthesie klinisch urodynamisch und sonographisch untersucht. Ergebnisse: Wahrend der Spinalanasthesie zeigte sich gegenuber der praoperativen Evaluierung eine signifikant tiefere Blasenhalsposition und bei 4 von 7 Para (0 von 7 Nullipara) ein positiver klinischer Stresstest (p = 0,003). Schlussfolgerungen: Diese Ergebnisse unterstreichen die Bedeutung neuromuskularer Faktoren fur die Atiologie von Beckenbodeninsuffizienz und Stressharninkontinenz.