Mark E. Vierhout

Risk factors for third degree perineal ruptures during delivery

Objective To determine risk factors for the occurrence of third degree perineal tears during vaginal delivery.

A review of adherence to drug therapy in patients with overactive bladder.

Drug therapy for overactive bladder (OAB) is associated with improvements in symptoms and quality of life, but the short‐ and long‐term adherence and persistence is suboptimal. In this review we outline methods of measuring, and factors affecting, adherence to pharmacotherapy in patients with OAB. Clinical practice suggests that adherence rates reported in clinical trials are much greater than in real practice. Factors affecting adherence include psychological and social variables that might alter patients’ perception of the benefits of taking medication, and the effect of comorbidity and polypharmacy. Whilst there is some evidence that lack of efficacy and side‐effects are contributory, these additional factors are also important.

Anal sphincter damage after vaginal delivery: Functional outcome and risk factors for fecal incontinence

Objective. To assess the role of anal sphincter damage following delivery in the development of anorectal complaints and urinary incontinence, and to identify obstetric factors associated with subsequent fecal incontinence.

Pelvic organ prolapse and overactive bladder

In this review we try to shed light on the following questions: How frequently are symptoms of overactive bladder (OAB) and is detrusor overactivity (DO) present in patients with pelvic organ prolapse (POP) and is there a difference from women without POP? Does the presence of OAB symptoms depend on the prolapsed compartment and/or stage of the prolapse? What is the possible pathophysiology of OAB in POP? Do OAB symptoms and DO change after conservative or surgical treatment of POP?

Symptomatic pelvic organ prolapse and possible risk factors in a general population.

OBJECTIVE We sought to examine the prevalence of pelvic organ prolapse (POP) symptoms and risk factors in a general white population. STUDY DESIGN This was a cross-sectional study. All female residents aged 45-85 years in a small Dutch city received validated questionnaires. Women were classified as symptomatic if they reported feeling and/or seeing vaginal bulge. RESULTS Response rate was 62.7% (1869/2979). Prevalence of POP was 11.4%. Multivariate analysis revealed POP symptoms during pregnancy, a maternal history of POP, and heavy physical work, with a total population-attributable risk of 46%. CONCLUSION There is high prevalence of symptomatic POP in a general white population of which independent risk factors are POP symptoms during pregnancy, a maternal history of POP, and heavy physical work. Clinicians should focus on risk factors in counseling of (pregnant) women to inform women to be aware of further exposures for themselves and their daughters.

Risk Factors for Exposure, Pain, and Dyspareunia After Tension-Free Vaginal Mesh Procedure

OBJECTIVE: To identify possible risk factors for exposure, dyspareunia, and pain after insertion of tension-free vaginal mesh in pelvic organ prolapse surgery. METHODS: This was a prospective observational cohort study. Consecutive women who underwent surgery with a trocar-guided tension-free vaginal mesh kit were included and evaluated at 6 weeks and at 6 and 12 months after surgery with respect to anatomy and complications. Logistic regression analysis was performed to identify risk factors for exposure, dyspareunia, and pain. RESULTS: Two hundred ninety-four patients were included. Exposure was found in 34 patients (12%). Smoking and total mesh were risk factors for exposure (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.1–8.7 and OR 3.0, 95% CI 1.2–7.0, respectively). Clinical and surgical experience were inversely related to the risk of exposure (OR 0.5, 95% CI 0.3–0.8 per decade). Pain (OR 3.2, 95% CI 1.2–8.4) and dyspareunia (OR 4.7, 95% CI 1.7–12.8) before surgery were predictive for pain and dyspareunia after surgery, respectively. Pain after surgery was found in 35 out of 275 (13%) patients and dyspareunia was found in 77 out of 171 (45%) patients. CONCLUSION: Smoking, total tension-free vaginal mesh, and experience were predictive factors for mesh exposure. LEVEL OF EVIDENCE: II

Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction.

To assess the occurrence of pelvic floor dysfunction (PFD) in pregnancy- related low back and pelvic pain (PLBP) patients, a cross-sectional study was performed, comprising 77 subjects. Each subject underwent physical assessment, and filled in the Urogenital Distress Inventory completed with gynaecological questions. Differences in the presence of PFD between PLBP patients and healthy controls as well as differences in pelvic floor muscle activity were tested for significance. Interaction by age and vaginal delivery were tested. PFD occurred in 52% of all PLBP patients, significantly more than in the healthy control group. In PLBP patients a significantly increased activity of the pelvic floor muscles could be demonstrated with respect to healthy controls. The occurrence of PFD and PLBP was influenced by a confounding effect of age. Clinicians should be aware of the relation between PLBP and PFD and hence address both problems at the same time.

The operation room as a hostile environment for surgeons: physical complaints during and after laparoscopy.

Abstract Due to suboptimal ergonomic conditions during laparoscopic procedures, surgeons are exposed to physical strain on the upper extremity. The primary objective of this study was to assess the prevalence of physical complaints among laparoscopic surgeons and to assess the factors that influence these complaints. A questionnaire was distributed in a university hospital to all surgeons who perform laparoscopic procedures. Participants were asked to answer questions related to experience, physical complaints during or after laparoscopic procedures and the possible causes of their complaints. Fifty-five out of 92 (60%) surgeons completed the questionnaire. In this group, 40 surgeons (73%) reported physical complaints during or after laparoscopic procedures, mainly involving neck, lower back, shoulders and thumbs. Significantly more surgeons reported complaints in the dominant upper extremity compared to the non-dominant side. Poor table height adjustment, bad monitor positioning and suboptimal design of instrument handles were reported as important causes of complaints. Physical complaints of the dominant upper extremity are common among laparoscopic surgeons, especially less experienced surgeons. The dominant upper extremity appears to be more involved than the non-dominant side. More awareness and implementation of ergonomic guidelines is needed.

Systematic review on recovery specific quality-of-life instruments

BACKGROUND Postoperative recovery is a considerable issue in studies comparing operative techniques of similar effectiveness. In recent years, a shift has occurred toward patient-centered study outcomes such as quality-of-life questionnaires. The objective of this article is to provide a systematic review of the literature on general postoperative, recovery-specific quality-of-life instruments and their measurement properties. METHODS We searched the databases EMBASE.com, Cinahl, PsycINFO, and PubMed for articles reporting on postoperative, recovery-specific quality-of-life instruments. A checklist was used to assess the revealed studies and instruments. Existing quality criteria were applied to the measurement properties to compare the instruments. RESULTS The search strategy identified 620 studies, of which 18 studies reported on 12 different postoperative, recovery-specific quality-of-life instruments. None of the instruments had been validated completely in line with the 8 quality criteria, which were used to assess the measurement properties. Two instruments were clearly superior, which were the Postdischarge surgical recovery scale and the Quality of recovery-40. CONCLUSIONS No fully validated instrument is available for the assessment of general postoperative recovery. We advise to use the Postdischarge surgical recovery scale and the Quality of recovery-40 in future validation and application studies on short-term postoperative recovery.

Overactive bladder syndrome in older people

The overactive bladder symptom complex (OAB) is the commonest cause of urinary incontinence in older people, and is usually due to underlying detrusor overactivity, and as such is a treatable condition. Older people are a heterogeneous group, which includes fit community‐dwelling individuals and those with significant medical comorbidity; thus the requirements of care for this group are many and varied. The International Continence Society definition of the frail elderly, those aged >65 years with continence problems, who by virtue of comorbidity are house‐bound or living in an institution, is clearly not applicable to all. However, many conditions begin to appear in later life and practitioners need to be aware of the need to manage these, and their treatment, when dealing with older people. Studies of medication for OAB have included the elderly and there is evidence of an equivalent benefit in younger people. The impact of treatment on the cognitively impaired and those receiving acetylcholinesterase inhibitors is discussed.