Demetri Panayi

Rectal distension: The effect on bladder function

To assess how rectal distension affects urodynamics parameters and diagnosis.

Reliability and normal ranges for the Patient's Perception of Intensity of Urgency Scale in asymptomatic women

Study Type – Symptom prevalence (prospective cohort)
Level of Evidence 1b

Pre-operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre-operative mixed urinary incontinence†

To determine if specific pre‐operative urodynamic parameters could predict detrusor overactivity following TVT in patients with urodynamic mixed incontinence.

Ultrasound measurement of bladder wall thickness is associated with the overactive bladder syndrome.

To assess the relationship between mean bladder wall thickness and components of the overactive bladder (OAB syndrome).

Urogynaecological problems in pregnancy and postpartum sequelae.

Purpose of review Women in pregnancy can experience lower urinary tract symptoms which are related to the pregnancy and delivery and iatrogenic, and related to use of epidural anaesthesia and urethral catheters. This article assesses the controversial relationship between pregnancy and delivery and the development of urinary incontinence and pelvic organ prolapse. Recent findings Lower urinary tract symptoms are common in pregnancy and they peak in the third trimester. If women have lower urinary tract symptoms prior to pregnancy, they are more likely to persist after delivery. Vaginal delivery is the factor most strongly associated with stress urinary incontinence after delivery and elective caesarean section may be protective. Vaginal childbirth causes levator ani injury and increase in levator hiatus size, and these persist following vaginal delivery. Women with levator ani injuries may be twice as likely to develop uterovaginal prolapse. Voiding difficulties are more likely to occur after a traditional epidural than a low dose or combined spinal epidural. Summary There is radiological evidence supporting pelvic floor injury following vaginal childbirth and epidemiological evidence for the relationship between vaginal delivery and urinary incontinence and pelvic organ prolapse. Rigorous long-term studies are needed to identify the direct relationship between these two phenomena.

Ultrasound measurement of vaginal wall thickness: a novel and reliable technique

Introduction and hypothesisThe aim of this study was to validate a technique to measure the vaginal wall thickness (VWT) using two-dimensional ultrasound.MethodsWomen were scanned by two independent operators and by the same operator at two separate visits at the level of the bladder neck, the apex of the bladder, the anterior fornix, the anorectal junction, rectum and posterior fornix. Fresh female cadavers were scanned and ultrasound thickness of the vagina was compared to histological thickness.ResultsBland Altman analysis revealed a low mean difference between operators and between visits by the same operator. The 95% confidence intervals as a percentage of the mean vaginal wall thickness ranged between 2.8% and 7.4%. There was a low percentage difference between ultrasound and histological vaginal wall thickness.ConclusionUltrasound vaginal wall thickness demonstrated good intra- and interoperator reliability, as well as consistency with histological measurement. It is a valid technique.

Validity of the Rome III Criteria in assessing constipation in women

Introduction and hypothesisA study was conducted to validate a constipation questionnaire based on the Rome III criteria.MethodsWomen attending outpatient clinics completed a constipation questionnaire based on the Rome III Criteria. The internal reliability, the test–retest as well as the content and construct validity of the questionnaire were evaluated.ResultsTwo hundred one women were studied. Of the women, 28% (56/201) reported constipation but only 14% of these (8/56) could be defined as constipated accordingly to the Rome III Criteria. Nine percent of women (13/145) who did not report constipation were classified as constipated accordingly to the Rome III Criteria. The questionnaire had good reliability (Cronbach’s alpha of 0.85 and ICC of 0.85). However, the questionnaire did not have significant construct validity with patients’ self-report of constipation, stool frequency and stool form (Pearson chi-square P > 0.05).ConclusionsThe Rome III Criteria questionnaire is a reliable and reproducible tool but does not appear to be a valid instrument in diagnosing constipation.

Transvaginal ultrasound measurement of bladder wall thickness: a more reliable approach than transperineal and transabdominal approaches

Study Type – Diagnosis (exploratory cohort)
Level of Evidence 2b

Changes in detrusor muscle oxygenation during detrusor overactivity contractions

OBJECTIVE To investigate changes in the oxygenated and deoxygenated haemoglobin (Hb) of the bladder wall during voluntary and involuntary detrusor contractions. STUDY DESIGN Women with lower urinary tract symptoms were recruited from a urodynamics clinic. Near infra-red spectroscopy, a non-invasive optical technique which monitors changes in tissue oxygenation, was used to measure oxygenated and deoxygenated haemoglobin simultaneously while the women underwent urodynamics. All data were compared using paired sample t-test. RESULTS Fifty-five women with a mean age of 52 years were enrolled into the study. In the 23 women with detrusor overactivity (15 with isolated detrusor overactivity and 8 with mixed urinary incontinence) there was a statistically significant rise in deoxygenated Hb during involuntary detrusor contractions at maximum detrusor pressure compared to the start of filling (p=0.02). There was no statistically significant change between Hb parameters measured at the start of the filling phase and those measured during voluntary detrusor contraction at pdetQmax (detrusor pressure at maximum flow rate). The mean detrusor pressure measured during voiding, however, was significantly higher than the maximum pressure during involuntary detrusor contractions (p=0.03). CONCLUSION There is a significant rise in the deoxygenated Hb in the detrusor muscle during detrusor overactivity, which is not seen during voiding even when the pdetQmax was higher than the peak detrusor pressure during involuntary contractions. These interesting changes in detrusor muscle oxygenation during involuntary detrusor contraction need to be explored further to assess if deoxygenation plays a role in the pathogenesis of detrusor overactivity.

Women’s perspective of botulinum toxin treatment for overactive bladder symptoms

Introduction and hypothesisThis study aimed to evaluate the women’s’ views and expectations about outcomes and complications of botulinum toxin treatment for overactive bladder (OAB) symptoms.MethodsConsecutive women with OAB symptoms and detrusor overactivity were requested to fill out a multiple choice questionnaire to assess whether they would consider botulinum and what outcomes as well as complications they would find acceptable to undergo this treatment.ResultsTwo hundred sixty-one women, mean age of 58 (range, 38–78) years, were studied. Two hundred twenty-four were treatment-naive women (group A), while 37 were no responders to anticholinergics (group B). Only 49.6% of women in group A and 54% in group B would accept botulinum toxin. No significant differences were found between treatment-naive women and non-responders to anticholinergics (p > 0.05).ConclusionsAcceptance of botulinum toxin treatment involves a complex interaction of efficacy and possible complications. The balance of these factors changes the acceptability of the treatment.