Lone Mouritsen

Symptoms, bother and POPQ in women referred with pelvic organ prolapse

The aim of this study was to evaluate symptoms and bother in patients with pelvic organ prolapse (POP) and to compare symptoms with POP-Q grading and measurements. One hundred and ten women with POP filled in a symptom–bother questionnaire concerning frequency of mechanical, bladder, bowel and sexual problems, and a 4-point bother score. The POP was grouped grade 0–1 versus grade ≥2 in each compartment. Symptoms more than once per week were associated with a higher bother score. Mechanical symptoms, reported in 70%, were the most troublesome. Various bladder, bowel and sexual symptoms were reported in 5%–52%, 5%–39%, and 35%–57%, respectively. We concluded that symptoms from all domains were frequent and reported generally and with little relation to prolapse in a specific compartment or POP-Q value.

Follow-up after repair of vaginal vault prolapse with abdominal colposacropexy

BACKGROUND Vaginal vault prolapse after hysterectomy is a rare complication, with a prevalence of less than 1/2%. The vaginal depth an axis can be restored by colposacropexy with preservation of coital function. The aim of this follow-up study was to assess the results of colposacropexy with special attention to recurrence of prolapse and urogenital symptoms. METHODS During a 4-year period 35 patients with vault prolapse were operated by colposacropexy. At follow-up the patients were interviewed about bladder, bowel and sexual symptoms. A pelvic examination and measurement of residual urine was done. Perioperative complications and any interim surgery was recorded. RESULTS The patients were multioperated, because of prolapse or incontinence prior to colposacropexy. No serious perioperative complications were seen, except one case of severe bleeding from the presacral veins. Subjectively, 82% were cured of prolapse symptoms, one had recurrent vault prolapse and was reoperated, four had rectocele. Five patients developed urge incontinence, while urge incontinence, frequency, nocturia and voiding problems were cured in 75%, 80%, 50% and 100%, respectively. One patient developed fecal incontinence. No patients had coital problems due to the colposacropexy. Three patients were reoperated because of intestinal obstruction. CONCLUSION Colposacropexy has a cure rate of vault prolapse of 97% (85 100%) and a positive effect on irritative bladder symptoms.

A new bulking agent (polyacrylamide hydrogel) for treating stress urinary incontinence in women.

To evaluate the efficacy and safety of a transurethral injection with polyacrylamide hydrogel (PAHG) for treating stress urinary incontinence (SUI) in women.

Anal Incontinence After Obstetric Third- /Fourth-Degree Laceration. One-Year Follow-up After Pelvic Floor Exercises

Abstract: The study was a 1-year follow-up of 48 women with obstetric third- /fourth-degree perineal laceration. After primary surgical repair the symptomatic patients were treated with pelvic floor exercises with or without transanal electrical stimulation. Various methods for assessing anal sphincter function were also evaluated. One month postpartum 10 women (21%) complained of anal incontinence, 8 for flatus only; 1 patient was reoperated on. After 1 year none complained of fecal incontinence, and 3 (7%) complained of flatus incontinence. We found relatively few women with anal incontinence after third- /fourth-degree laceration. The pelvic floor training program was effective, but electrical stimulation was abandoned because of anal pain. Grade IIIb lesion, dilution of the sphincter at anal ultrasonography, and sphincter weakness at palpation were significantly related to symptoms of anal incontinence. For routine follow-up after third- /fourth-degree laceration, palpation of the anal sphincter and pelvic floor seems sufficient as first-line assessment.

Tissue Integration of Polyacrylamide Hydrogel: An Experimental Study of Periurethral, Perivesical, and Mammary Gland Tissue in the Pig

BACKGROUND Polyacrylamide hydrogel (PAAG) is a nondegradable water-based polymer with high viscoelasticity. The gel is used as a tissue filler, the only risk being prolonged infection with anaerobic, contaminating microorganisms if not treated early with broad-spectrum antibiotics. OBJECTIVE With silicone gel as reference, PAAG tissue integration and migration was studied in a longitudinal study of the pig. MATERIALS AND METHODS Forty-one pigs were used. PAAG and silicone gel were injected into mammary tissue, and PAAG was injected into urethral or bladder wall or the anal canal. Tissues and regional lymph nodes were examined at 1, 1 1/2, 3, 3 1/2, 6, 12, and 14 months, and other lymph nodes and organs were examined at 1, 6, 12, and 14 months. RESULTS PAAG was invaded by macrophages and giant cells that were gradually replaced by a network of fibrous tissue. Silicone gel was seen inside these cells or as large vacuoles, surrounded by a fibrous capsule. Regional lymph nodes contained PAAG only at 1 1/2 months and silicone gel at 12 months. CONCLUSION PAAG is a stable, viscoelastic bulking agent, which unlike silicone gel is slowly integrated within its host tissue via a thin fibrous network. Long-term risk of fibrosis and migration is minimal.

Vaginal ultrasonography: a diagnostic tool for urethral diverticulum

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Pathophysiology of sexual dysfunction as related to pelvic floor disorders

Female sexual dysfunction must be evaluated in the context of age, marital status, and general health status of the woman. Questionnaires evaluating the four domains of female sexual dysfunction can be used as a screening tool to evaluate the effect of pelvic floor disorders and coital leakage, as well as the effect of surgical methods and medical treatment on sexual function. Sexual problems are seldom volunteered symptoms, and only recording whether the woman has dyspareunia and frequency of sexual activity must be considered end-point parameters of a complex function. These parameters cannot explain the pathophysiological causes of the problem. There is a paucity of validated, easily accessible methods and parameters to objectively assess female sexual function.

Evaluation of a simple, non‐surgical concept for management of urinary incontinence (minimal care) in an open‐access, interdisciplinary incontinence clinic

Our objective was to evaluate a new concept for assessment and treatment of urinary incontinence in an open‐access, interdisciplinary incontinence clinic. A standardized program for investigation and treatment of incontinence was based on minimal relevant investigations, primarily non‐surgical treatment with a limited consumption of resources (“minimal care”). This was a prospective observational study of 408 consecutive women examined and treated in the clinic. The main characteristics of the women were a high median age and a high prevalence of severe concomitant diseases with possible influence on lower urinary tract function. More than half of the patients had urge or mixed incontinence. Most of the patients were managed with conservative treatment. Fifteen percent were referred to in‐hospital treatment, with 5% to incontinence surgery. In total 44% felt cured or very much improved. Before and after treatment one third of the women completed quality‐of‐life questions and voiding charts, while 43% completed the pad tests. Quality of life improved significantly. Objectively leakage on pad test and voiding charts was significantly improved. The patients were in general very satisfied with clinics program. Almost one fourth of the women were followed up for 6 months after discharge. No significant deterioration in the subjective results were found compared to status at discharge. In conclusion, the results highlight the need for advice and treatment of patients with incontinence. The minimal care program and interdisciplinary structure in the incontinence clinic offer effective and low cost treatment for urinary incontinence. The open‐access, interdisciplinary incontinence clinic model is recommended. Neurourol. Urodynam. 18:9–17, 2000.

Pro et contra pelvic floor exercises for female stress urinary incontinence.

Pelvic floor exercises are now established as a first line treatment for female urinary stress incontinence. This treatment modality can give substantial improvement in many patients. However, the incontinence is often not completely cured and the treatment requires a long term effort by the patient, which many are unable or unwilling to make. This paper discusses the pros and cons of pelvic floor exercises for stress incontinence and offers some guidelines for the selection of patients while emphasizing the importance of guided, intensive exercises and motivation to achieve the treatment goal.

Effect of vaginal devices on bladder neck mobility in stress incontinent women

Objective. To evaluate how vaginal continence products affect the bladder neck mobility and ability to contract the pelvic floor muscles.