Kåre Molne

Long-Term Effectiveness Of The Burch Colposuspension In Female Urinary Stress Incontinence

Of 91 women who underwent Burch colposuspension, 86 were available for clinical, urodynamic and isotope renographic follow‐up examinations 5 years after surgery for evaluation of late complications and long‐term effectiveness in urinary stress incontinence. A repeat urodynamic examination was accepted by 76 patients. Stress incontinence was cured in 71 % of the patients with a stable bladder preoperatively, and in 57% with stress incontinence and detrusor instability (non‐significant difference). Cure rate was not significantly related to age, hormonal status or previous anterior vaginal repair. The urodynamic measurements at follow‐up showed a significant increase in the functional urethral length in the cured group, as compared with the improved group. The mean maximum urethral closure pressure was reduced in both groups. Symptomatic detrusor instability was found in 18% of the preoperative stable bladders, while 67% of the unstable bladders had become stable. Only 29% of the patients with a preoperative unstable bladder had a normal lower urinary tract function at follow‐up. Late voiding difficulties were observed in 3% of the study group; enterocele, requiring surgical repair, developed in 7%. One patient suffered a damaged kidney due to undetected ureteral obstruction after surgery. Irritative bladder symptoms such as urgency, frequency, stranguria and nocturia represent a long‐term problem after colposuspension. At the 5‐year follow‐up, only 52% of the study group were completely dry and free of complications, and about 30% needed further incontinence therapy. This may be due to some neurogenic factor which is not corrected by surgery.

Treatment of unexplained infertility: Fallopian tube sperm perfusion (FSP)

Patients and methods. Fifty‐one couples with unexplained infertility were enrolled in the fallopian tube sperm perfusion (FSP) program. FSP is in short a combination of ovarian hyperstimulation, ovulation induction and intrauterine and intrafallopian tube insemination using a sperm suspension of 4 ml volume.

Induced abortion: Chlamydia trachomatis and postabortal complications

The overall prevalence of Chlamydia trachomatis among 873 abortion‐seeking women was 9.3% during 1985. Significantly higher age‐specific prevalences of C. trachornatis occurred among younger women (p<0.000l). None of 17 women treated for C. trachomatis before the abortion was carried out, was readmitted to the hospital. Of 64 Chlamydia‐positive women, who commenced treatment within the first 2 weeks after the abortion was carried out, 14.1% were readmitted to the hospital, compared with 5.7% of Chlamydia‐negative women (p < 0.02). Postabortal salpingitis was verified at readmission among 10.9% of Chlamydia‐positive women and 3.2% of Chlamydia‐negative women (p < 0.01). An analysis of screening of all abortion‐seeking women is estimated to be worthwhile when the prevalence of C. trachomatis exceeds 4.3%. We recommend screening for Chlamdyia trachomatis of all abortion‐seeking women, 30 years or younger, at the preabortion visit, provided that treatment can be completed before the abortion is carried out.

The Concentrations of Ceftazidime and Thiopental in Maternal Plasma, Placental Tissue and Amniotic Fluid in Early Pregnancy

Studies on the transfer of drugs from mother to fetus in the first trimester of pregnancy are important because of the possible teratogenic effect on the fetus as well as possible therapeutic effect on both sides of the feto‐maternal barrier. The purpose of this study was to measure drug concentrations in maternal plasma, placental tissue and amniotic fluid in a group of first‐trimester abortion patients. Ceftazidime and thiopental were chosen as experimental drugs. The analyses were done with high pressure liquid chromatography. The penetration of ceftacidime into placental tissue and amniotic fluid was 20.6 and 2.2% from 1 to 4 h after drug administration. The corresponding values for thiopental were 54.3–71 and 1.5–7.4% from 5 to 15 min after drug administration, indicating a rapid transfer of both drugs across the feto‐maternal barrier during this period in pregnancy.

Menstrual dysfunction in Norwegian top athletes.

Abstract. Of 301 Norwegian female top athletes, all members of the national team in 27 different sports, who were approached with a questionnaire about menstrual function, 278 (92.4%) responded. Ninety‐nine of the respondents who used oral contraceptives were excluded. Of the remaining 179, 18 (10.1%) reported secondary amenorrhea (>4 months since the last period) and were chosen for further studies. Blood samples were drawn for hormonal analyses between 10 and 12 a.m. and at least 12 hours after the last training session. Their mean age was 20.8 years (range 18‐27), mean height 169.8 cm (160‐180), mean weight 58.5 kg (51‐67), and their mean age at menarche 14.6 years (13—16.5), significantly older than that of the other top athletes: 13.5 years (p <0.05). Their mean number of training hours per week was 16.1 (12—24). Hormonal changes were consistent with simple normoprolactinemic hypotha‐lamic suppression, characterized by low values of FSH, es‐tradiol—17β and prolactin. The androgen hormones demonstrated high levels of dihydrotestosterone. Testosterone levels were within normal limits, but in the upper part of the range, whereas sex hormone‐binding globulin was in the lower normal range.

A Spleen Pregnancy

Non‐tubal ectopic pregnancy is very rare. We report a case of spleen pregnancy, difficult to recognize clinically. The tests and investigations which led to the diagnosis and treatment are described briefly.

Long-Term Effectiveness of the Burch Colposuspension in Female Urinary Stress Incontinence

Of 91 women who underwent Burch colposuspension, 86 were available for clinical, urodynamic and isotope renographic follow-up examinations 5 years after surgery for evaluation of late complications and long-term effectiveness in urinary stress incontinence. A repeat urodynamic examination was accepted by 76 patients. Stress incontinence was cured in 71% of the patients with a stable bladder preoperatively, and in 57% with stress incontinence and detrusor instability (non-significant difference). Cure rate was not significantly related to age, hormonal status or previous anterior vaginal repair. The urodynamic measurements at follow-up showed a significant increase in the functional urethral length in the cured group, as compared with the improved group. The mean maximum urethral closure pressure was reduced in both groups. Symptomatic detrusor instability was found in 18% of the preoperative stable bladders, while 67% of the unstable bladders had become stable. Only 29% of the patients with a preoperative unstable bladder had a normal lower urinary tract function at follow-up. Late voiding difficulties were observed in 3% of the study group; enterocele, requiring surgical repair, developed in 7%. One patient suffered a damaged kidney due to undetected ureteral obstruction after surgery. Irritative bladder symptoms such as urgency, frequency, stranguria and nocturia represent a long-term problem after colposuspension. At the 5-year follow-up, only 52% of the study group were completely dry and free of complications, and about 30% needed further incontinence therapy. This may be due to some neurogenic factor which is not corrected by surgery.