Othon Lalos

Efficacy of desmopressin (Minirin) in the treatment of nocturia: a double-blind placebo-controlled study in women

OBJECTIVE The purpose of this study was to investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in women. STUDY DESIGN Women aged 18 years or older with nocturia (>or=2 voids per night with a nocturia index score >1) received desmopressin (0.1 mg, 0.2 mg, or 0.4 mg) during a 3-week dose-titration period. After a 1-week washout period, patients who responded in this period received desmopressin or placebo in a double-blind fashion for 3 weeks. RESULTS In double-blind phase, 144 patients were randomly assigned to groups (desmopressin, n=72; placebo, n=72). For desmopressin, 33 (46%) patients had a 50% or greater reduction in nocturnal voids against baseline levels compared with 5 (7%) patients receiving placebo (P<.0001). The mean number of nocturnal voids, duration of sleep until the first nocturnal void, nocturnal diuresis, and ratios of nocturnal per 24 hours and nocturnal per daytime urine volumes changed significantly in favor of desmopressin versus placebo (P<.0001). In the dose-titration phase headache (22%), nausea (8%), and hyponatremia (6%) were reported. Two deaths occurred, although neither could be directly associated with the study drug. CONCLUSION Oral desmopressin is an effective and well-tolerated treatment for nocturia in women.

Effect of intraperitoneal instillation of 32% dextran 70 on postoperative adhesion formation after tubal surgery

Abstract. The intraperitoneal instillation of 32% dextran 70 (HyskonR, Pharmacia AB, Sweden) has previously been reported to prevent the formation of postoperative adhesions. Against this background, the present study was undertaken to evaluate the efficacy of HyskonR in counteracting peritoneal adhesions following tubal microsurgery. 105 infertile women were operated upon in a prospective, randomized, controlled, double‐blind, multicenter study. The intra‐ab‐dominal adhesions present from the beginning were classified by means of a standardized scoring scale and the extent of adhesions was again evaluated at follow‐up laparoscopy 4–10 weeks later. A reduction in the extent of the intra‐abdominal adhesions (statistically highly significant) was revealed in both the Hyskon group and the saline control group. The extent of adhesions in the Hyskon group was not lesser than in the saline group, however. The pregnancy rates in the two groups were also similar.

To tell or not to tell - what parents think about telling their children that they were born following donor insemination

Pioneering legislation regarding donor insemination was introduced in Sweden in 1985. The law gives the child, upon reaching sufficient maturity, the right to obtain information about the donor and his identity. One hundred and forty-eight Swedish couples with children conceived through donor insemination after the law was introduced have answered questions about disclosure and donation in a questionnaire. This article addresses the reasoning employed by individual couples in their decision whether or not to inform the children about their origin. Parental reflections on their decision and the childrens reactions to receiving this information are also presented. Five categories of parental arguments are reported. These included ‘reasons to tell’, ‘reasons not to tell’, ‘reasons why the question about telling or not would not be answered at all’, ‘inconclusive types of reasoning, that can still influence the fundamental decision’ and ‘context-dependent reasons associated with actual circumstances’. Through this meta-dassification of arguments it was possible to identify clues to how professionals could facilitate parental decision-making and promote disclosure. Parents who had informed their children did not regret their decision. All of the parents who responded to the question of whether it had been beneficial to the child to tell answered ‘yes’.

Psychological Reactions to the Medical Investigation and Surgical Treatment of Infertility

The psychological effects of the medical investigation and surgical treatment of infertility were investigated. For 2 years 30 women with a diagnosis of tubal damage and 29 men were followed with repeated interviews. Negative effects on sexual life were recorded in all individuals and were associated with the planning of intercourse. Semen analysis was psychologically difficult to half of the men and feelings of shame and degradation were common. Fear and anxiety were increased before reconstructive tubal surgery and postoperative depression was observed in 10 women. Most couples overestimated their chances of having a child and half of them expected pregnancy to occur within a few months. After 2 years the need for professional support and counseling had increased. The medical procedure has psychological side effects in the infertile couple and may provoke anxiety. The investigation should be comprehensive and short, and psychologically traumatic investigations like basal body temperature records should be used with caution. During the period of somatic investigation and treatment repeated discussions about the marital relationship and sexual life should be initiated and psychosocial counseling should be offered to all couples.

Depression, Guilt and Isolation among Infertile Women and their Partners

The crisis of infertility has been studied in 30 women with tubal damage and the manner in which it affected their partners over a period of 2 years. Altogether, 4 interviews were carried out with ...

Bladder wall mechanics and micturition before and after subtotal and total hysterectomy

Twenty-two women were assigned at random to subtotal (n = 11) or total (n = 11) hysterectomy. The frequency of micturition was recorded and urodynamic investigation was performed before, and 6 weeks and 6 months after the operation. After hysterectomy the frequency of diurnal micturition decreased and the urethral conductance increased in all patients. After total hysterectomy an increased bladder volume was found. The two operative methods did not differ with respect to pre- and postoperative changes of urinary frequency or urodynamics. The bladder function was not altered by either operation.

How do urinary incontinence and urgency affect women's sexual life?

Objective. To investigate the impact of urinary incontinence and urgency on womens sexual life and the prevalence of urinary leakage during sexual activity. A further aim was to explore factors affecting sexual desire and satisfaction with sexual life. Design. A semi‐structured questionnaire study. Setting and Sample. Sexually active women (n=147) aged 18–74years with urinary incontinence and urgency were recruited from four outpatient clinics. Methods. The women completed questionnaires concerning medical history, psychosocial situation, partner relationship and sexual life, and answered the Bristol Female Lower Urinary Tract Symptoms questionnaire. All underwent clinical evaluation. Main Outcome Measures. Prevalence of urinary leakage during sexual activity, factors affecting sexual desire and sexual satisfaction. Results. The vast majority considered sexuality to be important in their lives. One‐third of the women had urinary leakage during sexual activity. Half reported that sexual life was more or less spoiled due to their urinary incontinence or urgency and they were worried about having urinary leakage during intercourse, and almost two‐thirds worried about odor and felt unattractive. The womens dissatisfaction with sexual life was strongly correlated to unsatisfying psychological health, orgasmic disability and worry about urinary leakage during intercourse. Insufficient vaginal lubrication, unsatisfying psychological health and their partners’ ill health were significantly correlated with decreased sexual desire. Conclusions. Urinary incontinence and urgency have a negative impact on womens sexual life. Thus, a dialogue about sexual function in women with urinary symptoms should become an integral component in clinical management.

Risk factors for tubal infertility among infertile and fertile women

Data regarding previous pelvic inflammation, abdominal surgery, endometriosis, obstetrical anamnesis, usage of IUD, occurrence of abdominal pain, vaginal discharge and metrorrhagia were obtained from 120 women with tubal infertility and compared to similar data from 126 pregnant women. Previous abdominal surgery, especially pelvic surgery was the most frequent risk factor present in 59% of the infertile women followed by pelvic inflammation (42%) and endometriosis (10%). In 23% of the infertile women there was no history of abdominal surgery, inflammation or endometriosis. Abdominal surgery, inflammation, ectopic pregnancy, salpingectomy and ovarian resection were significantly more frequent among the women with tubal infertility than among the pregnant women. Finally, there was no significant difference in the occurrence of appendectomy, IUD usage, induced or spontaneous abortion.

Social adjustment and spouse relationships among women with stress incontinence before and after surgical treatment

Forty-five women with stress urinary incontinence (SUI) and their partners have been interviewed three months before and one year after surgical treatment to investigate the social consequences of their impairment. One year after surgery 76% of the women reported that they were cured (group A, n = 34) and 24% that they were improved (group B, n = 11). The cured women were significantly younger than the improved women. The duration of urinary leakage before the operation was significantly shorter in group A than in group B. One year post surgery group A reported a significantly decrease in impediments to exert certain tasks due to urine leakage. As concerns leisure time, group A reported a higher level of overall activities before surgery than group B, whereas postsurgery both groups obtained about the same level of activities. Regarding social support, no differences between the groups occurred as concerns attachment. Furthermore, group A women showed a significantly higher degree of adequacy of social integration compared with group B. The majority of the couples could openly discuss sexual matters with their partners and were satisfied with their sexual life. More than half of the interviewed men reported an increase in sexual desire one year after their partners operation. Whereas about every third woman in both groups reported an increase in sexual desire. However, the frequency of intercourse did not change in any groups. In conclusion, this study underlines the importance of social factors in the assessment of the consequences of stress urinary incontinence and its treatment.

The wish to have a child : a pilot-study of infertile couples

ABSTRACT– All women (n= 30) who were to undergo microsurgical treatment for tubal infertility, and their partners (n= 29), were subject to individual interviews just before and 2 years after the tubal surgery. Initially, they answered an open question concerning their wish to have a child and then were asked to choose from a list of 36 alternatives, a maximum of five motives for having a child. The infertile couples’ motives were compared with those of three reference groups: one group of 30 who had decided to continue their pregnancy, another group of 101 women who also planned to continue pregnancy and a third group of 459 women applying for legal abortion. All motives on the list were categorized as “philosophical”, “social/cultural”, “interpersonal” and “intrapsychic” motives. The interpersonal and intrapsychic motives dominated both the infertile women and their partners. A central motive was that a child is an ultimate expression of love between a man and a woman. The motives of the infertile couples, generally, did not differ from those of the reference groups.