Joseph Lee

Developmental risk factors for sexual offending

OBJECTIVEnThe aim of the study was to identify the general, common, and specific developmental risk factors for pedophilia, exhibitionism, rape, and multiple paraphilia, and to address five methodological issues observed in this area of research.nnnMETHODnThis study involved 64 sex offenders and 33 nonsex, nondrug-related, and nonviolent property offenders. The group of 64 sex offenders was further divided into eight subgroups, some of which overlapped in memberships because of multiple diagnoses. To overcome the methodological problem associated with overlapping group memberships, a special approach involving comparisons of sets of logistic regression analyses was adopted. Offenders were clinically assessed for evidence of paraphilias, and their adverse childhood experiences were measured by a battery of tests.nnnRESULTSnChildhood Emotional Abuse and Family Dysfunction, Childhood Behavior Problems, and Childhood Sexual Abuse were found to be general developmental risk factors for paraphilias. Furthermore, Childhood Emotional Abuse and Family Dysfunction was found to be a common developmental risk factor for pedophilia, exhibitionism, rape, or multiple paraphilia. Additional analyses revealed that childhood emotional abuse contributed significantly as a common developmental risk factor compared to family dysfunction. Besides, Childhood Sexual Abuse was found to be a specific developmental risk factor for pedophilia.nnnCONCLUSIONSnThe study has supported the value of conceptualizing certain childhood adversities as developmental risk factors for paraphilic behaviors. The role of childhood emotional abuse as an important developmental risk contributor, and the relationship between childhood sexual abuse and pedophilia are of theoretical significance. Furthermore, the results have significant implications for the prevention of childhood abuse and treatment of sex offenders.

International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related to native tissue female pelvic floor surgery

A terminology and standardized classification has yet to be developed for those complications related to native tissue female pelvic floor surgery.

Challenging the cognitive distortions of child molesters: An implicit theory approach

Abstract In this paper we present a novel way ofstructuring the cognitive distortions module of a comprehensive treatment programme for child molesters. The module is based upon using the notion of implicit theories to provfde a framework for conceptualising and challenging cognitive distortions. In this approach cognitive distortions a n viewed as deriving from a smaller number of more general, but maladaptive, set of underlying belief about the offender himself, his victims and the world in general, which then form the target of intervention. A description of how cognitive distortions can be collected and reframed in terms of their underlying implicit theories is provided. Then. an outline of a range of cognitive and dective techniques to undermine their validity and replace them with more appropriate cognitions is described. The possible advantages of using this approach in the treatment of sex offenders are discussed.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related to native tissue female pelvic floor surgery

Introduction and hypothesisA terminology and standardized classification has yet to be developed for those complications related to native tissue female pelvic floor surgery.MethodsThis report on the terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many external referees. A process of rounds of internal and external review took place with decision making by collective opinion (consensus).ResultsA terminology and classification of complications related to native tissue female pelvic floor surgery has been developed, with the classification based on category (C), time (T), and site (S) classes and divisions that should encompass all conceivable scenarios for describing operative complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids (www.icsoffice.org/ntcomplication).ConclusionsA consensus-based terminology and classification report for complications in native tissue female pelvic floor surgery has been produced. It is aimed at being a significant aid to clinical practice and particularly to research.

The general, common, and specific features of psychopathology for different types of paraphilias

A close examination of the literature on sexual offending suggests that offenders problems can be divided into two broad-based constructs: anger-hostility and social-sexual incompetence. In this study involving 64 sex offenders and 33 property offenders, the authors used these constructs in investigating the general, common, and specific features of psychopathology associated with pedophilia, exhibitionism, rape, and multiple paraphilia. A specific approach in design and analysis was also adopted to overcome the methodological problems related to overlapping paraphilic diagnoses. The results indicated that these two constructs were able to distinguish between sex offenders and nonsex offenders and largely between different types of sex offenders. The implications of these results and the specific design and analysis approach are discussed, and ideas for future research are outlined.

An Evaluation and 1‐Year Follow‐Up Study of a Community‐Based Treatment Program for Sex Offenders

Abstract The Psychosexual Treatment Program (PTP) is a 35-week community-based group treatment program for sex offenders, based on a cognitive-behavioural approach. An evaluation and follow-up study of this program indicates that the offenders have gained and maintained significant treatment effects for 12 months at the completion of the program: a reduction in the frequency and arousal of offenders deviant sexual fantasies, an increase in the acceptance and control of their sexual problems, an enhancement of their social and assertiveness skills, an improvement of their sex knowledge, and a decrease of their cognitive distortions associated with deviant sexual behaviours. The national recidivism rate for the 37 treated sex offenders who completed the program was 8.1%. (n = 3), which compares favourably with those for other similar programs. Treatment efficacy, assessment of treatment needs, recidivism rates, the value of short-term evaluation, and drop-out rates are discussed.

Which women develop urgency or urgency urinary incontinence following midurethral slings

Introduction and hypothesisDe novo urgency has a negative impact on women after midurethral sling (MUS). We aimed to identify risk factors for de novo urgency (dU) and urgency urinary incontinence (dUUI) following MUS, using multivariate analysis.MethodsWe investigated 358 consecutive women with only stress urinary incontinence (SUI) [or urodynamic stress incontinence (USI)] and 598 women with both SUI (or USI) and urgency (but not UUI) who underwent MUS with a mean follow-up of 50xa0months. Women who developed dU or dUUI at long-term follow-up were compared to those who did not.ResultsdU occurred in 27.7xa0% (99/358) and dUUI occurred in 13.7xa0% (82/598) of women at long-term follow-up after midurethral sling. Intrinsic sphincter deficiency {odds ratio (OR) dU 3.94 [95xa0% confidence interval (CI) 1.50–10.38]; OR dUUI 2.5 (1.31–4.80)}, previous stress incontinence surgery [sling: OR dU 3.69 (1.45–9.37); colposuspension: OR dUUI 2.5 (1.23–5.07)], previous prolapse surgery [OR dU 2.45 (1.18–5.10)], preexisting detrusor overactivity [OR dU 1.99 (1.15–3.48); OR dUUI 1.85 (1.31–2.60)] increased the risk, whereas performing concomitant apical prolapse surgery [OR dU 0.5 (0.41–0.81); OR dUUI 0.29 (0.087–0.97)] significantly decreased the risk. Women are more likely to not recommend surgery when they experienced dU (18.2 vs 0.8xa0%, pu2009<u20090.0001) or dUUI (20.7 vs 2.1xa0%, pu2009<u20090.0001).ConclusionsUrodynamic parameters, history of prior incontinence or prolapse surgery and concomitant apical prolapse operation were important predictors of dU or dUUI following MUS.

Functional outcomes for surgical revision of synthetic slings performed for voiding dysfunction: a retrospective study

OBJECTIVEnTo determine the functional outcomes after synthetic sling revision surgery performed for voiding dysfunction.nnnSTUDY DESIGNnA retrospective review of 63 women who underwent surgical revision of a synthetic sling (SS) over an 11 year period between 2000 and 2010 inclusive, for the treatment of voiding dysfunction. Voiding dysfunction was defined as a persistently raised post-void residual of >150 ml. Patient review included demographics, a comprehensive medical history, all surgical reports and a detailed proforma with details of lower urinary tract symptoms, physical findings and bladder diaries. Variables were compared between methods of sling revision using the Fisher exact test (Freeman-Halton extension) with a 2 by 3 contingency table. Statistical significance is defined as P ≤ 0.05.nnnRESULTSnSixty-three women underwent SS revision for voiding dysfunction with an overall success rate of 87%. Three types of surgical revision were performed; simple SS division (46/63, 73%), partial excision of SS material (13/63, 21%) and either division or excision but with a concomitant procedure to prevent recurrent SUI (4/63, 6%). Persistent voiding dysfunction following revision in each of the three groups was 5/46 (10.9%), 1/13 (7.7%) and 2/4 (50%) respectively (P=0.09). Subsequent surgery for recurrent SUI in each of the groups was 1/46 (2.2%), 3/13 (23.1%) and 0/4 (0%) respectively (P=0.04).nnnCONCLUSIONSnSurgical revision of a SS is an effective treatment for postoperative voiding dysfunction. Both simple division and partial excision of the SS are successful, but simple division carries a lower risk of recurrent SUI. A concomitant SUI procedure at the time of revision may prevent recurrence but may increase the risk of persistent voiding dysfunction.

The effect of vaginal pelvic organ prolapse surgery on sexual function

Data on female sexual function after prolapse surgery are conflicting. The aim of the study was to evaluate the change in sexual function and vaginal symptoms using patient reported outcomes following prolapse surgery in addition to the anatomical stage.

Functional outcomes following surgical management of pain, exposure or extrusion following a suburethral tape insertion for urinary stress incontinence

Introduction and hypothesisSurgical revision of a tape inserted for urinary stress incontinence may be indicated for pain, or tape exposure or extrusion. This study assesses the clinical outcomes of revision surgery.MethodsA retrospective review of 47 consecutive women who underwent surgical revision for the indications of pain, tape exposure or tape extrusion.ResultsForty-seven women underwent revision. 29 women (62xa0%) had initial tape placement at another institution. Mean interval between placement and revision was 30xa0months. 39 women (83xa0%) had an identifiable tape exposure or extrusion with or without pain, while 8 women (17xa0%) presented with pain alone. 11 (23xa0%) of the tapes were infected clinically and histologically at revision, 10 of the 11 (90xa0%) being of a multifilament type. In 23 (49xa0%) cases, the revision aimed to completely remove the tape. Partial excision 24 (51xa0%) was reserved for localised exposures or extrusions where infection was not suspected. A concomitant continence procedure was performed in 9(19xa0%) at the time of tape revision. None of these 9 women has experienced recurrent stress urinary incontinence (SUI) compared with 11 out of 38 women (29xa0%) requiring further stress incontinence surgery when no continence procedure was performed (Fisher’s exact pu2009=u20090.092). Eight out of 47 underwent revision surgery for pain with no identifiable exposure or extrusion; pain subsequently resolved in all 8 women.ConclusionsExcision is an effective treatment for tape exposure and pain whether infection is present or not. Tapes of a multifilament type are strongly associated with infection. When infection is present, complete sling removal is necessary. A concomitant procedure to prevent recurrent SUI should be considered if tape excision is planned and infection is not suspected.