Montserrat Espuña Pons

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.

Validación de la versión española del International Consultation on Incontinence Questionnaire-Short Form. Un cuestionario para evaluar la incontinencia urinaria

BACKGROUND AND OBJECTIVE A big proportion (40-70%) of patients with urinary incontinence (UI) do not ask for medical advice. Self-administered questionnaires may help in detecting UI. The objective of the present study was to validate the Spanish version of the questionnaire ICIQ-SF. PATIENTS AND METHOD 500 women who consulted at a UI-specialized unit responded to the questionnaire. A urodynamic study was carried out and sociodemographic and clinical data were collected. Feasibility, validity and reliability were assessed. Sensitivity (Se), specificity (Sp) and positive (PPV) and negative (NPV) predictive values of the clinical and urodynamic study were also calculated. RESULTS The mean time of administration was 3.5 (1.5) minutes. All patients answered all the items of the ICIQ-SF. According to the clinical diagnosis, patients with UI scored 11.6 (5.9) and patients without UI scored 4.5 (6.3) (p < 0.001). According to the urodynamic diagnosis, UI patients scored 11.1 (6.3) vs 6.2 (6.5) (p < 0.001). In patients with an urodynamic diagnosis of stress UI, a higher severity degree was associated with a higher score on the ICIQ-SF. The values of Se, Sp, PPV and NPV were 92.1%, 55.6%, 88.3% and 65.9%, respectively, regarding clinical diagnosis, and 87.7%, 40.8%, 85.1% and 46.2%, respectively, regarding the urodynamic study. CONCLUSIONS This is the first questionnaire designed for diagnosing UI validated in Spain. The psychometric properties of the ICIQ-SF are satisfactory and allow to recommend the use of the questionnaire in the clinical practice.Fundamento y objetivo Se estima que entre el 40 y el 70% de los sujetos con incontinencia urinaria (IU) no buscan atencion medica. Los cuestionarios autoadministrados pueden ayudar a detectar la IU. El objetivo del estudio fue realizar la validacion de la version espanola del International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Pacientes y metodo Contestaron el cuestionario 500 mujeres que acudieron consecutivamente a una unidad especializada en IU. A todas se les realizo un estudio urodinamico y se recogieron sus datos sociodemograficos y clinicos, a fin de disponer de diagnostico tanto clinico como urodinamico. Se evaluaron la factibilidad, validez, fiabilidad y el poder diagnostico respecto de ambos diagnosticos, y se calcularon la sensibilidad, la especificidad y los valores predictivos positivo y negativo. Resultados El tiempo medio (desviacion estandar) de administracion del cuestionario fue de 3,5 (1,5) min. Ninguna paciente dejo algun item sin contestar. De acuerdo con el diagnostico clinico, las pacientes con IU puntuaron 11,6 (5,9) y las pacientes sin IU, 4,5 (6,3) (p Conclusiones Las propiedades psicometricas del ICIQ-SF han demostrado ser satisfactorias y permiten recomendar su uso en la practica clinica para diagnosticar la IU.

Comparison of the LMA Supreme™ with the LMA Proseal™ for airway management in patients anaesthetized in prone position

BACKGROUND The laryngeal mask airway (LMA) has been successfully used in patients in the prone position either for rescue or elective airway management. The reusable Proseal™ LMA (PLMA) and the single use Supreme™ LMA (SLMA) have been reported to be suitable for this purpose but few comparative data are available. In this study, we compared the clinical use of both devices in adult patients anaesthetized in the prone position. METHODS One hundred and twenty patients undergoing surgery in the prone position were randomized to receive either the PLMA or the SLMA for airway management. Patients positioned themselves in the prone position and after pre-oxygenation, anaesthesia was induced using a target-controlled i.v. infusion of propofol and remifentanil. All PLMAs and SLMAs were inserted by experienced anaesthetists using a guided and a standard technique respectively. Ease of facemask ventilation, time and number of attempts needed for insertion, quality of ventilation, airway seal pressure, fibreoptic view, and complications were compared. RESULTS There were no differences between groups in insertion time or first attempt success (100% vs. 98%). The PLMA required fewer manipulations (3% vs. 15%; P=0.02) to achieve effective ventilation and provided a higher seal pressure (mean [sd] 31 [4] vs. 27 [4] cm H2O; P<0.01). The fibrescopic view of the vocal cords was similar, although easier to achieve with the PLMA. The complication rate was low and similar between the groups. Blood was present on masks in 7% vs. 8% and sore throat in 3% vs. 5% of patients with the PLMA and SLMA, respectively. CONCLUSIONS Airway management in patients anaesthetized in the prone position was efficient with both devices, although the PLMA required fewer manipulations and achieved a higher seal pressure.

Oestrogens and overactive bladder

Estrogens are known to have a major role in the function of the lower urinary tract although the role of exogenous estrogen replacement therapy in the management of women with lower urinary tract dysfunction remains controversial. Whilst for many years systemic and vaginal estrogen therapy was felt to be beneficial in the treatment of lower urinary and genital tract symptoms this evidence has recently been challenged by large epidemiological studies investigating the use of systemic hormone replacement therapy. Consequently the role of estrogen in the management of postmenopausal women with Overactive Bladder (OAB) remains uncertain. In addition the evidence base regarding the use of exogenous estrogen therapy has changed significantly over the last decade and has led to a major changes in current clinical practice. The aim of this article is to review the evidence for the role of estrogen therapy in the management of OAB focusing on current knowledge with regard to both systemic and local estrogen therapy as well as investigating the emerging role of combination therapy with antimuscarinic agents. Neurourol. Urodynam. 33:1086–1091, 2014.

Sexual health in women with pelvic floor disorders: measuring the sexual activity and function with questionnaires—a summary

The integration of sexual health into the health care services is important. In women attending urogynecological clinics, the urinary function, anorectal function, and anatomical defects are more often evaluated than those related to sexual activity and function. A group of experts in urogynecology, sexuality, and patient reported outcome development, met in a roundtable with the final objective of reviewing what is currently available and what is needed to accurately evaluate sexual function in women with pelvic floor dysfunction. An article was prepared for each of the issued presented during the roundtable and combined into this supplement. This article is a summary of all articles included in this supplement. The pathophysiology of sexual dysfunction as related to pelvic floor disorders has not been well established. Sexuality questionnaires and scales play an integral role in the diagnosis and treatment of female sexual dysfunction. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) is the only validated female sexual function questionnaire specifically developed to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse; however, the PISQ does not screen for sexual activity. The effects of treatments for pelvic floor problems on sexual function have received little attention. There is a need for a validated sexual function measure that evaluates not only the impact of pelvic floor dysfunction on sexual function but also the impact on sexual activity.The integration of sexual health into the health care services is important. In women attending urogynecological clinics, the urinary function, anorectal function, and anatomical defects are more often evaluated than those related to sexual activity and function. A group of experts in urogynecology, sexuality, and patient reported outcome development, met in a roundtable with the final objective of reviewing what is currently available and what is needed to accurately evaluate sexual function in women with pelvic floor dysfunction. An article was prepared for each of the issued presented during the roundtable and combined into this supplement. This article is a summary of all articles included in this supplement. The pathophysiology of sexual dysfunction as related to pelvic floor disorders has not been well established. Sexuality questionnaires and scales play an integral role in the diagnosis and treatment of female sexual dysfunction. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) is the only validated female sexual function questionnaire specifically developed to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse; however, the PISQ does not screen for sexual activity. The effects of treatments for pelvic floor problems on sexual function have received little attention. There is a need for a validated sexual function measure that evaluates not only the impact of pelvic floor dysfunction on sexual function but also the impact on sexual activity.

A clinical evaluation of four disposable laryngeal masks in adult patients

STUDY OBJECTIVE To compare the clinical use of four disposable laryngeal masks (DLMs): the Ambu laryngeal mask [Ambu LM], Solus, Laryngeal Mask Airway (LMA) Unique, and Soft Seal. DESIGN Prospective, randomized study. SETTING Operating room and recovery area of a university-affiliated ambulatory surgery unit. PATIENTS 200 adult ASA physical status I, II, and III patients, scheduled for ambulatory procedures. INTERVENTIONS Patients underwent insertion of the DLM by nonexperienced residents. MEASUREMENTS The time and number of attempts needed for insertion, quality of ventilation, airway sealing pressure at 60 cmH(2)O of intracuff pressure, and complications were all evaluated. MAIN RESULTS Ease of insertion was greater (P = 0.03) and first attempt success rate was higher with the Ambu LM (78%) and LMA Unique (80%). The Solus most often needed three attempts to be placed (12 cases); the Ambu LM needed three similar attempts in two cases; the LMA Unique in 4 cases; and the Soft Seal in 5 cases (P = 0.018). The LMA Unique achieved the highest rate of optimal ventilation (46/49 cases) of the 4 groups. Airway sealing pressure was significantly higher with the Soft Seal (27.3 +/- 5 mmHg), compared to the Ambu LM (23.7 +/- 5 mmHg), the Solus (20.9 +/- 4 mmHg), and the LMA Unique (22.1 +/- 6 mmHg) (P < 0.001). Blood staining of the DLM on removal was most frequent with the Soft Seal (38%). CONCLUSIONS The Ambu LM and LMA Unique DLMs appear to be easier to insert by inexperienced residents and are less traumatic for the patient. The Soft Seal achieves a higher airway seal than other devices, but it causes more mucosal trauma. The Solus had the highest insertion failure rate of the 4 groups.

Evaluación del resultado del tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en la mujer mediante el cuestionario ICIQ-UI SF

Fundamento y objetivo El objetivo de este trabajo fue evaluar la sensibilidad para detector cambios tras el tratamiento quirurgico en mujeres con incontinencia urinaria tras la aplicacion de la version espanola del International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI) SF. Pacientes y metodo Estudio prospectivo de 71 mujeres con incontinencia urinaria de esfuerzo (IUE) tratadas con banda vaginal libre de tension. Se recogio en todos los casos el diagnostico urodinamico de IUE y la puntuacion del ICIQ-UI SF al entrar en el estadio y despues del tratamiento quirurgico para evaluarlo. Resultados Despues del tratamiento, el 86% no tenia IUE segun la urodinamica; esta solo fue normal en 45 (63,4%). Segun el ICIQ-UI SF, resultaron curadas 37 (52,9%). Las puntuaciones postratamiento fueron inferiors a las previas, las puntuaciones de las curadas fueron inferiores a las de las no curadas (p Conclusiones El ICIQ-UI SF es sensible para detectar cambios tras tratamiento quirurgico en mujeres con IUE.

Sexual health of women with pelvic floor disorders

Sexual health is a right for the healthy or sick individual human being. The effects of the illness on sexual function may be mediated directly by physiological mechanisms or by psychological factors related to the illness. Treatment of the illness itself can affect sexual function. Comorbidity in women with sexual dysfunction is common. When we evaluate sexual dysfunction, it is important to determine the role of the illness as a factor that predisposes, precipitates, and maintains the sexual problem. In the context of urogynecological clinical practice we have patients sexually active or inactive, with a self perceived “normal sexual life”, or with sexual problems that may be related or not with their pelvic floor dysfunction (PFD). Most physicians admit that this is important to detect sexual dysfunction, but only half of them regularly screen for it. Considering pelvic floor dysfunction as a comorbidity of women’s sexual dysfunction and in spite of the inherent complexity of women’s sexuality, future research would merit focusing on this comorbidity as well as a bio-psychosocial approach. In the twenty-first century, in general, we still have a great deal to learn about female sexuality.Sexual health is a right for the healthy or sick individual human being. The effects of the illness on sexual function may be mediated directly by physiological mechanisms or by psychological factors related to the illness. Treatment of the illness itself can affect sexual function. Comorbidity in women with sexual dysfunction is common. When we evaluate sexual dysfunction, it is important to determine the role of the illness as a factor that predisposes, precipitates, and maintains the sexual problem. In the context of urogynecological clinical practice we have patients sexually active or inactive, with a self perceived “normal sexual life”, or with sexual problems that may be related or not with their pelvic floor dysfunction (PFD). Most physicians admit that this is important to detect sexual dysfunction, but only half of them regularly screen for it. Considering pelvic floor dysfunction as a comorbidity of women’s sexual dysfunction and in spite of the inherent complexity of women’s sexuality, future research would merit focusing on this comorbidity as well as a bio-psychosocial approach. In the twenty-first century, in general, we still have a great deal to learn about female sexuality.

Validación de la versión en español del cuestionario¿Epidemiology of Prolapse and Incontinence Questionnaire-EPIQ¿

Introduction: One out of three women suffers from pelvic floor disorders. Thus, an instrument to evaluate this pathology in common clinical practice would be very useful. In this study the psychometric characteristics of the Spanish version of the US questionnaire “Epidemiology of Prolapse and Incontinence Questionnaire-EPIQ” have been evaluated, in order to test its equivalence to the original and allow for its use in Spain. Material and Methods : 60 women with pelvic floor pathology and 60 control women filled in the Spanish version of the EPIQ. The questionnaire was validated following the statistical procedure used in the validation of the original form. Results: Factibility: 113 women filled in all questionnaire items and 7 leaved some of them blank. Validity: 7 dimensions were indentified: quality of life (QoL), overactive bladder (OAB), anal incontinence (AI), micturition difficulty/pain (MD/P), functional defecation disorders (FDD), stress urinary incontinence (SUI), and pelvic organ prolapse (POP). The validity of contents was proved comparing the mean scores for each dimension in patients and control (T-student test). Positive and negative predictive values were POP=92,3% and 82,52%; SUI= 54,34% and 84,93%; OAB=60,6% and 84,52% and

Determinación de las preferencias de las mujeres sobre el tratamiento de la incontinencia urinaria de esfuerzo mediante el método de la comparación de parejas

OBJETIVOS Conocer las preferencias de las pacientes con incontinencia urinaria de esfuerzo, para facilitar la toma de decisiones en la asignacion de recursos y ayudar en la eleccion del tratamiento mas adecuado. METODOS Estudio transversal de 150 mujeres diagnosticadas de IU de Esfuerzo (IUE) en una Unidad especializada en IU. Todas fueron sometidas al protocolo diagnostico de la Unidad. Se realizo una entrevista personal que incluia informacion sobre tres tratamientos para la IU (Reeducacion Muscular del Suelo Pelviano-RMSP, farmaco y cirugia) y el ?Cuestionario sobre preferencias? desarrollado por el metodo de la ?comparacion de parejas?. Se construyo una escala ?ranking? con las alternativas y se cuantifico la distancia entre ellas aplicando la ?ley de los juicios comparativos?. RESULTADOS Las pacientes en conjunto prefieren el tratamiento con RMSP a las otras dos opciones, preferencia que se mantiene en el grupo de edad menor o igual a 46 anos y en el de 56-62 anos. Las pacientes entre 47 y 55 anos parecen inclinarse por el tratamiento farmacologico. Las pacientes de edad mayor o igual a 63 anos prefieren la cirugia. De acuerdo al nivel de gravedad, parece que en todos los niveles las pacientes prefieren el tratamiento conservador con RMSP, ocupando el segundo lugar el farmaco en las de gravedad moderada y severa. CONCLUSIONES Las mujeres con IUE y que no han recibido tratamiento previamente, prefieren el tratamiento conservador con RMSP seguido del farmacologico y la cirugia.