Linda Cardozo

The efficacy and tolerability of the β3-adrenoceptor agonist mirabegron for the treatment of symptoms of overactive bladder in older patients

INTRODUCTION mirabegron is a β3-adrenoceptor agonist developed for the treatment of symptoms of overactive bladder (OAB). As the prevalence of OAB increases with age, a prospective subanalysis of individual and pooled efficacy and tolerability data from three 12-week, randomised, Phase III trials, and of tolerability data from a 1-year safety trial were conducted in order to evaluate the efficacy and tolerability of mirabegron in subgroups of patients aged ≥65 and ≥75 years. METHODS primary efficacy outcomes were change from baseline to final visit in the mean number of incontinence episodes/24 h and the mean number of micturitions/24 h. Tolerability was assessed by the incidence of treatment-emergent adverse events (TEAEs). RESULTS over 12 weeks mirabegron 25 mg and 50 mg once-daily reduced the mean numbers of incontinence episodes and micturitions/24 h from baseline to final visit in patients aged ≥65 and ≥75 years. Mirabegron was well tolerated: in both age groups, hypertension and urinary tract infection were among the most common TEAEs over 12 weeks and 1 year. The incidence of dry mouth, a typical anticholinergic TEAE, was up to sixfold higher among the older patients randomised to tolterodine than any dose of mirabegron. CONCLUSIONS these analyses have demonstrated the efficacy of mirabegron over 12 weeks and the tolerability of mirabegron over 12 weeks and 1 year in OAB patients aged ≥65 and ≥75 years, supporting mirabegron as a therapeutic option in older patients with OAB.

Psychological characteristics and motivation of women seeking labiaplasty.

BACKGROUND Labiaplasty is an increasingly popular surgical intervention but little is known about the characteristics and motivation of women who seek the procedure or the psychosexual outcome. METHOD A total of 55 women seeking labiaplasty were compared with 70 women who did not desire labiaplasty. Various general measures of psychopathology as well as specific measures (Genital Appearance Satisfaction; Cosmetic Procedure Screening for labiaplasty) were used. Labia measurements of the women seeking labiaplasty were also obtained. RESULTS Women seeking labiaplasty did not differ from controls on measures of depression or anxiety. They did, however, express increased dissatisfaction towards the appearance of their genitalia, with lower overall sexual satisfaction and a poorer quality of life in terms of body image. Women seeking labiaplasty reported a significantly greater frequency of avoidance behaviours on all the domains assessed, and greater frequency of safety-seeking behaviours for most of the domains. Key motivations reported for labiaplasty were categorized as cosmetic, functional or sexual. Of the 55 women seeking labiaplasty, 10 met diagnostic criteria for body dysmorphic disorder. CONCLUSIONS This is the first controlled study to describe some of the characteristics and motivations of women seeking labiaplasty. We identified a wide range of avoidance and safety-seeking behaviours, which occurred more frequently in the labiaplasty group than the control group. These could be used clinically as part of a psychological intervention for women seeking labiaplasty.

Menopausal transition and the risk of urinary incontinence: results from a British prospective cohort

Study Type – Aetiology (inception cohort)
Level of Evidence 2b

Validation of genital appearance satisfaction scale and the cosmetic procedure screening scale for women seeking labiaplasty

Abstract Background: Existing outcome studies on women seeking labiaplasty have not used a validated scale that is specific for satisfaction with genital appearance. They have also not screened for the presence of body dysmorphic disorder (BDD). There are therefore two primary aims of this study (1) to validate the Genital Appearance Satisfaction (GAS) scale in women seeking labiaplasty and (2) to modify and validate a version of the Cosmetic Procedures Screening questionnaire (COPS-L), which has previously been used to screen for BDD. Method: Two groups of women were recruited: a group desiring labiaplasty and a control group. All participants completed the GAS, the COPS-L and other general measures of mood, disgust sensitivity, sexual satisfaction and body image quality of life. Results: Both the GAS and COPS-L demonstrated good internal consistency, concurrent and convergent validity with measures of related constructs, and discriminated between women seeking labiaplasty and controls. Three factors were identified in the GAS but were not robust enough to recommend their use clinically as subscales. The COPS-L discriminated between women seeking labiaplasty with and without BDD. Discussion: We recommend that both the GAS and the COPS-L be routinely used for audit and outcome monitoring of interventions for women distressed by the appearance or function of their genitalia. The GAS has an advantage in assessing additional functional symptoms in such women. The COPS-L may be helpful in identifying women with BDD.

A comparison of risk factors for women seeking labiaplasty compared to those not seeking labiaplasty

Little is known about the factors associated with the desire for labiaplasty. We compared 55 women seeking labiaplasty with 70 women in a comparison group who were not seeking labiaplasty. Measures administered included the Perception of Appearance and Competency Related Teasing Scale, Childhood Trauma Questionnaire, Disgust Scale Revised, and the Genital Appearance Satisfaction scale with open-ended questions about their genitalia. Approximately a third of the labiaplasty group recalled specific negative comments in the past towards their labia, a proportion significantly greater than the three per cent in the comparison group. Participants reporting genital teasing also showed higher Genital Appearance Satisfaction scores than those who were not teased. However, women seeking labiaplasty were, compared to the comparison group, no more likely to have a history of neglect or abuse during childhood. There was no difference between the groups on disgust sensitivity or the perception of being teased in the past about their competence or appearance in general.

A longitudinal investigation of the impact of typology of urinary incontinence on quality of life during midlife: results from a British prospective study.

Using prospective data from 983 British women born in 1946, the study aims to describe the profiles of symptoms of stress, urge, and severe incontinence, and to relate these to change in quality of life. Based on the longitudinal patterns of symptoms experienced, four groups of women were defined: ‘low symptom’, ‘onset’, ‘recovering’, and ‘chronic’. Childhood enuresis was associated with being in the ‘chronic’ group for urge and severe incontinence. Women in the ‘recovering’ group for stress incontinence experienced an improvement in the physical health domain (regression coefficient (95% CI): 0.1(0.02, 0.18)) compared with women without symptoms. This relationship existed beyond the effects of ageing, menopausal status, current life stress, and reproductive, lifestyle, and social factors. More research is needed to understand the mechanism that link childhood enuresis to being in the ‘chronic’ group for urge and severe incontinence.

Is transvaginal ultrasound a worthwhile investigation for women undergoing vaginal hysterectomy

Summary Vaginal hysterectomy (VH) is the definitive surgical management for uterine prolapse. It is also the preferred route for other pelvic pathology where a hysterectomy is warranted, as it is associated with lower complication rate and faster recovery time. The aim of this study was to determine the usefulness of transvaginal ultrasound scan (TVS) as an investigation prior to vaginal hysterectomy. A total of 103 patients were reviewed over 1 year. Associated gynaecological pathology was found in 46.6% of patients on TVS and this led to a change in planned management in 2.9% of cases. Consequently, preoperative TVS would appear to be a worthwhile investigation.