Neil D Jackson

Dietary caffeine intake and the risk for detrusor instability: a case-control study

Objective To determine whether there is an association in women between caffeine intake and risk for detrusor instability. Methods Women were included if they had symptoms of urinary incontinence, completed a 48-hour voiding diary detailing fluid and caffeine intake, and had undergone standardized multichannel urodynamics. The study group had 131 women with detrusor instability on provocative cystometry and maximum urethral closure pressure greater than 20 cm of water. The control group had 128 women without detrusor instability on provocative cystometry and maximum urethral closure pressure greater than 20 cm of water. For statistical comparison, women were divided into the following three groups on the basis of caffeine intake: minimal (< 100 mg/day), moderate (100–400 mg/day), and high (> 400 mg/day). Results The mean caffeine intake of women with detrusor instability (484 ± 123 mg/day) was significantly higher than that of controls (194 ± 84 mg/day, P = .002). On univariate analysis, significant risk factors for detrusor instability were age, smoking status, and caffeine intake. On multivariate analysis, the statistically significant association between high caffeine intake and detrusor instability persisted after controlling for age and smoking (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.1, 6.5, P = .018). When women with moderate caffeine intake were compared with those with minimal caffeine intake, the risk for detrusor instability was lower and did not reach significant levels (OR 1.5, 95% CI 0.1, 7.2, P = .093). Conclusion An association between high caffeine intake and detrusor instability was seen in this population. Larger studies are required to determine whether the association is causal.

The effects of a course in cadaver dissection on resident knowledge of pelvic anatomy: An experimental study

Objective To determine whether a course in cadaver dissection can significantly increase resident knowledge of pelvic anatomy beyond that of current educational practices. Methods Thirteen first-and second-year residents were randomly assigned to a cadaver dissection course (seven) or a control group (six). The dissection group performed dissections with instruction, using a dissection guide designed specifically for the course. The control group received study references on pelvic anatomy and protected study time. Each participant took a practical and written examination at the beginning and end of the study. Results The two groups did not differ statistically in their scores on the pre-test. Both groups improved on the posttest, but the dissection group scored nearly 50% higher on the test than did the controls. The two groups differed significantly on the post-test, adjusted for pre-test performance (P < .01). In their evaluation of the course, participants from the dissection group emphasized its educational value and urged that it be offered to residents as a regular part of their training. Conclusion Dissection of a human cadaver provides a valuable experience, allowing participants to gain a greater understanding of surgical anatomy and surgical procedures in a no-risk, unhurried setting. Residents who participated in a cadaver dissection course designed specifically for their needs showed a statistically significant increase in knowledge compared with those without this experience. Both objectively and subjectively, a cadaver dissection course is an excellent tool for instructing gynecology residents.

Office screening test for intrinsic urethral sphincter deficiency: pediatric Foley catheter test

Objective To evaluate an office-based test as a screening method for intrinsic sphincter deficiency. Methods One hundred seventy-three women with urinary incontinence were evaluated prospectively by complete urodynamic studies. After catheterization, the pediatric Foley catheter test was performed on an empty bladder by withdrawing the inflated bulb of an 8-French Foley catheter through the urethra. The test was considered positive if the inflated catheter bulb could be withdrawn completely through the urethra. Women with grade 3 genital prolapse or higher were excluded. Intrinsic sphincter deficiency was defined as the presence of genuine stress incontinence and low maximum urethral closure pressure (at most 20 cm H2O). Results Seventy-six of 173 women (44%) had positive tests and 97 (56%) had negative tests. Seventy-six percent of those with positive tests were diagnosed with intrinsic sphincter deficiency, compared with 19% in women with negative tests (P < .001). All women with positive tests and negative cotton swab tests had intrinsic sphincter deficiency. The sensitivity, specificity, and positive and negative predictive values for diagnosing intrinsic sphincter deficiency were 76, 81, 76, and 81%, respectively. Conclusion A positive pediatric Foley catheter test in the absence of urethral mobility strongly suggests intrinsic sphincter deficiency. The pediatric Foley catheter test may be useful in screening for intrinsic sphincter deficiency.