Pentti Kiilholma

Clinical significance of abnormal nuclear DNA content in serous ovarian tumors

The nuclear DNA content of 160 serous ovarian neoplasms was determined by flow cytometry from paraffin‐embedded tissue. Three (11%) of the 27 histologically benign, seven (16%) of the 43 borderline malignant, and 59 (66%) of the 90 malignant neoplasms were aneuploid (P < 0.0001). None of the patients with an aneuploid benign or borderline malignant tumor died from cancer, but in carcinomas the DNA index (DI) was a more important prognostic factor in a multivariate analysis than age at diagnosis, stage, histologic grade or ploidy (diploid versus aneuploid). A DI of 1.3 was the most effective value hi predicting prognosis; patients with carcinoma with the DI more than 1.3 had inferior survival compared with those with the DI less than 1.3 (P = 0.002). Carcinomas with the DI more than 13 were more common in patients older than 60 years at diagnosis (P = 0.0002), and were associated with a low grade of differentiation (P = 0.008) but not with stage. It is concluded that DNA aneuploidy may occur in benign and borderline malignant serous ovarian tumors and that the DI is a highly valuable and objective prognostic parameter in serous ovarian carcinomas.

Comparison of a 10-mg controlled release oxybutynin tablet with a 5-mg oxybutynin tablet in urge incontinent patients.

Oxybutynin has long been used for the treatment of patients with detrusor overactivity and urinary urge incontinence. The short half‐life of oxybutynin administered as a conventional tablet formulation or syrup requires 2–3 times daily dosage to be effective. A new controlled release (CR) tablet for once‐daily administration has been developed. The efficacy and tolerability of this new controlled release tablet was compared to that of a 5‐mg conventional oxybutynin tablet administered twice daily. Seventeen female incontinent patients were studied in a double‐dummy crossover trial. Efficacy and tolerability were assessed by using a voiding diary, pad‐weighing test, visual‐analogue scale (VAS), and questionnaire. Adverse events were recorded spontaneously on a questionnaire by the patients themselves throughout the study. Serum concentrations of oxybutynin and its active metabolite N‐desethyloxybutynin were studied after both a single dose and multiple dosage.

Histological changes in the vaginal connective tissue of patients with and without uterine prolapse

SummaryThe histological structure of the vaginal fascia was studied in two groups of patients: 10 consecutive women having a vaginal repair for uterine prolapse or descent and 10 consecutive women having an abdominal hysterectomy for fibroids. Abnormal histological changes were found in 7 out of 10 patients with uterine descent as compared to 2 out of 10 controls (P < 0.05). This suggests a correlation between histological changes in vaginal connective tissue and pelvic laxity.

Incarcerated Richter's hernia after laparoscopy: a case report

An unusual case of Richters hernia on the 5th day after laparoscopy is presented. The complaints simulated a postoperative hematoma, but they became so intense that the expansion was surgically explored: a conservative procedure on the loop of small bowel was possible. To prevent this complication after laparoscopy careful shaking of the abdominal wall at removal of the instruments is necessary.

Absence of Bacterial DNA in the Bladder of Patients With Interstitial Cystitis

PURPOSE Although bacterial infection has been long considered a possible cause of interstitial cystitis (IC), no definitive proof for or against this hypothesis has been presented so far. We have used 16S rDNA bacterial polymerase chain reaction to study bladder biopsies and sterile urine samples from patients suffering from IC. This method is sensitive and detects all known eubacteria. MATERIALS AND METHODS Bladder biopsies and sterile urine samples obtained by transabdominal puncture were studied from 11 patients with IC. As controls we studied 4 patients with other urological problems leading to partly similar symptoms and 5 healthy individuals. RESULTS All samples from the IC patients were negative. One positive sample was obtained from a woman with a history of urinary tract infections who suffered from nonIC ulcerative cystitis. Her sterile urine sample yielded Lactobacillus acidophilus. CONCLUSION These results indicate that an ongoing bacterial infection is not the cause of interstitial cystitis.

Disappointing effect of endoscopic teflon injection for female stress incontinence

Twenty-two women were treated with endoscopic, transurethral, submucosal Teflon injection for moderate or severe urinary stress incontinence. The short-term effect was rather good, but he long-term results were disappointing. After 5 years, only 4 patients were completely or sufficiently continent and had not required any additional treatment for incontinence. Three major complications, paraurethral abscess, urethral diverticulum and Teflon granuloma with urethral wall prolapse occurred. Subsequent suprapubic urethropexy for the patients with inadequate response did not produce the usual good results.

Objective Cure Rates and Patient Satisfaction After the Transobturator Tape Procedure During 6.5-Year Follow-Up

STUDY OBJECTIVE To report the subjective and objective outcomes and patient satisfaction with the outside-in transobturator tape (TOT) procedure during long-term follow-up. DESIGN Clinical follow-up study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS One hundred ninety-one women who underwent the TOT procedure. Of these, 66% had stress urinary incontinence and 34% had mixed urinary incontinence, and 45% underwent concomitant surgery. INTERVENTIONS Patients underwent surgery between May 2003 and December 2004 using the TOT procedure. After a mean follow-up of 6.5 years, postal questionnaires and an invitation for a follow-up visit to the outpatient clinic were sent to the patients. Objective cure was defined as a negative result of a stress test and no repeat operation because of stress urinary incontinence during follow-up. Subjective outcome was evaluated using the following validated questionnaires: UISS (Urinary Incontinence Severity Score), DIS (Detrussor Instability Score), VAS (visual analog scale, 0-100), short versions of the IIQ-7 (Incontinence Impact Questionnaire-7) and UDI-6 (Urogenital Distress Inventory-6), and the EQ-5D and EQ-5D VAS. Patient satisfaction was evaluated using a self-tailored questionnaire. MEASUREMENTS AND MAIN RESULTS Of 191 patients, 139 (73%) were evaluated after a mean follow-up of 6.5 years. Objective and subjective cure rates were 89% and 83%, respectively. Of the patients with genuine stress urinary incontinence, 92% were completely or quite satisfied with the surgery, and 76% of the patients with mixed urinary incontinence were satisfied (p < .001). Patients with body mass index >30 had significantly higher scores on the IIQ-7, UDI-6 (p < .01 for both), VAS (p < .001), UISS (p < .01), and DIS (p < .001), thus indicating a less favorable outcome of the procedure. CONCLUSION A high objective cure rate persisted after a mean follow-up of 6.5 years. Caution is advised when the TOT procedure is planned in patients with mixed urinary incontinence or severe obesity.

Lower urinary tract symptoms in patients with Sjögren's syndrome and systemic lupus erythematosus.

Abstract: Sjögren’s syndrome (SS) and systemic lupus erythematosus (SLE) are autoimmune diseases which have many similarities with interstitial cystitis (IC), a urinary bladder disease with unknown etiology. This survey on the occurrence, severity and nature of lower urinary tract symptoms among patients suffering from SS or SLE showed that these patients have significantly more urinary complaints, especially irritative bladder symptoms, than age- and sex-matched controls. We studied 36 patients with SS, 85 patients with SLE and 121 controls. In these groups, 25%, 29% and 66%, respectively, were free of urinary symptoms. The prevalences of mild symptoms were 61%, 62% and 27%, and severe symptoms 14%, 9% and 7% in the respective groups. SS and SLE patients with urinary complaints reported mostly urinary frequency (27% and 62%) and suprapubic pain (36% and 34%). The most common symptom in the control group was stress urinary incontinence. The frequency of lower urinary tract problems in patients with SS and SLE supports the concept that autoimmune disorders also have bladder affections.

The prevalence of urinary incontinence in a randomized population of 5247 adult finnish women

A randomized study of the prevalence of urinary incontinence was performed among adult Finnish females. In 1986, 5247 women (aged 25–55 years) who participated voluntarily in a gynecological health study, anonymously completed a questionnaire concerning subjective symptoms and experiences with urinary incontinence. One-fifth of the studied population (20.1%) reported that they were handicapped by incontinence. The number of incontinent women increased significantly with increasing age up to 45 years. Stress urinary incontinence alone was reported by 73% of the women experiencing incontinence. Surprisingly, only one-third of the women stated that they needed treatment, and less than one-fifth of all had sought help for this disorder.

Outcome of Burch retropubic urethropexy and the effect of concomitant abdominal hysterectomy: a prospective long-term follow-up study.

Abstract: A prospective follow-up study was performed to evaluate the effect of a concomitant abdominal hysterectomy with Burch colposuspension. Sixty-five women underwent Burch colposuspension (the Burch group) and 78 women colposuspension with concomitant abdominal hysterectomy (the hysterectomy group) during a 1-year period in Turku University Hospital. Subjective outcome was assessed with three questionnaires: at 6 weeks, 1 year, and a mean of 4.9 years after the operation. Complications related to the operation occurred in 19 patients (29.2%) in the Burch group and in 36 (46.2%) in the hysterectomy group (P= 0.038). No statistically significant difference in the frequency of any subgroup of complications was found. Instead, complications cumulated to fewer patients in the Burch group. During postoperative care in the hospital intermittent catheterization to treat transient urinary retention was needed more frequently in the Burch group than in the hysterectomy group (10.8% vs. 1.3%, P= 0.046). No significant difference was found in subjective short- and long-term outcome. In the long-term follow-up 79% were subjectively cured or improved, 77% in the Burch group and 81% in the hysterectomy group.