Jason Cooper

Prevalence of female urinary incontinence and its impact on quality of life in a cluster population in the United Kingdom (UK): a community survey

AIM To ascertain the prevalence of urinary incontinence and lower urinary tract symptoms, impact on quality of life and help-seeking behaviour. BACKGROUND Urinary incontinence is common and will affect more individuals as the population ages. Estimates of the prevalence of urinary incontinence vary hugely. Additional information is required to inform resource allocation. METHODS Population-based cross-sectional postal evaluation of all female patients over 21 years registered at a single medical practice in the United Kingdom. FINDINGS A total of 40% of respondents suffered urinary incontinence, which caused significant problems in 8.5%. Stress urinary incontinence was the most common type of incontinence while 10% had symptoms of voiding dysfunction. A total of 17% of women had sought professional help. Patients perceived that urinary incontinence was part of the natural ageing process and that there was a low expectation of successful treatment.

Female stress urinary incontinence

1 Scottish Government. Scottish health survey. 2008. www.scotland. gov.uk/Resource/Doc/286063/0087158.pdf. 2 Walker A. The cost of doing nothing: the economics of obesity in Scotland. National Obesity Forum, 2003. 3 Government Office for Science. Foresight. Tackling obesities: future choices. 2008. www.foresight.gov.uk/OurWork/ActiveProjects/ Obesity/Obesity.asp. 4 PeetersA, BarendregtJ.WillekensF, Mackenbach J, AlMamun A, Bonneux L Obesity in adulthood and its consequences for life expectancy: a life-table analysis./Ann/nfern/Wecf 2003;138:24-32. 5 Scottish Intercollegiate Guidelines Network (SIGN). Management of obesity. 2010.www.sign.ac.uk. 6 WHO. Obesity: preventing and managing the global epidemic: report on a WHO consultation (WHO technical report series 894). 2000. www.who. int/nutrition/publications/obesity/WHO_TRS_894/en/index.html. 7 Grundy SM, Cleeman Jl, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management ofthe metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement [corrections in Circulation 2005;112:e297, e298]. Circulation 2005;112:2735-52. 8 Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990. Arch Dis Child 1995;73:25-9. 9 Cleator J, Richman E, Leong KS, Mawdsley L, White S, Wilding J. Obesity: under-diagnosed and under-treated in hospital outpatient departments. IntJObes 2002;25:581-4. 10 Leslie WS, Hankey CR, McCombie L, Lean MEJ. Weight management: a survey of current practice in secondary care NHS settings in 2004./ EvalClin Pract 2005;11:462-7. 11 Hankey CR, Eley S, Leslie WS, Hunter CM, Lean MEJ. Eating habits, beliefs, attitudes and knowledge among health professionals regarding the links between obesity, nutrition and health. Public Health Nutr 2003;7:337-43. 12 Story MT, Neumark-Stzainer DR, Sherwood NE, Holt K, Sofka D, Trowbridge FL, et al. Management of child and adolescent obesity: attitudes, barriers, skills and training needs among health care professionals. Pediatrics 2002;110:210-4. 13 Schwartz MB, Chambliss HO, Brownell KD, BlairSN, Billington C. Weight bias among health professionals specializing in obesity. Obes Res 2003;11:1033-8.

Advanced glycation products’ levels and mechanical properties of vaginal tissue in pregnancy

OBJECTIVES Non-enzymatic glycation is closely associated with altered mechanical properties of connective tissue. Pregnancy, marked with high levels of female hormones, confers unique alteration to the mechanical properties of pelvic connective tissues in order to meet their physiological demands. However, there are few studies on glycation content and its influence on the mechanical properties of pelvic connective tissues during pregnancy. We hypothesise that the glycation content in pelvic tissues will change with a corresponding alteration in their mechanical properties, and that these changes are influenced by hormone levels. This study aims to investigate the correlation of vaginal tissue glycation content and mechanical property changes during pregnancy in association with the expression of a key pregnancy hormone (oestrogen) receptor, and an antioxidant enzyme, glyoxalase I. STUDY DESIGN A rat vaginal tissue model (tissues from non-pregnant and E15-E18 (last trimester) pregnant rats) was used in this study. Mechanical characteristics of vaginal tissues were analysed by a ball-indentation technique while modulus and morphology of the collagen fibrils within the tissues were measured with atomic force microscopy. A glycation marker, pentosidine, was quantified by a high performance liquid chromatography. The expression of oestrogen receptor and glyoxalase I in the tissue was qualified by immunochemical staining. The glycosaminoglycan (GAG) concentration difference in the tissues were quantified by a biochemical assay. RESULTS Pregnant rat vaginal tissue was characterised by significantly lower amounts of pentosidine, higher oestrogen receptor and glyoxalase I expression with larger creep, lower elastic modulus, larger fibril diameter and higher GAG content than their non-pregnant counterpart. There was a negative correlation between pentosidine and vaginal tissue creep. CONCLUSION There was a reduction in vaginal tissue pentosidine in pregnancy with an associated increase in oestrogen receptor and glyoxalase I immunoexpression. Reduced glycation was associated with increased creeping of vaginal tissue. Oestrogen may therefore play a role in the increase of the vaginal walls capacity to stretch through glyoxalase I up-regulation and subsequent glycation reduction. The new insight of the correlation of womens oestrogen level, glycation reaction and pelvic tissue mechanical property from this study may enhance our understanding of some pelvic organ diseases.

Why I use mesh: a personal perspective

The issue of using vaginally inserted polypropylene mesh is currently much debated. This personal view, stimulated by a live debate on the topic, sets out to look at some of the issues surrounding mesh, and aims to encourage discussion of this matter.