Pia Teleman

Overactive bladder: prevalence, risk factors and relation to stress incontinence in middle‐aged women

Objective  To investigate the prevalence of and factors associated with overactive bladder in middle‐aged women.

Cost-analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension-free vaginal tape procedure

Background.  The aim of this study was to compare laparoscopic colposuspension with tension‐free vaginal tape (TVT) in terms of costs to the county.

Anterior colporrhaphy compared with collagen‐coated transvaginal mesh for anterior vaginal wall prolapse: a randomised controlled trial

To investigate the anatomical cure rate and complications related to collagen‐coated mesh for cystocele, compared with a conventional anterior colporrhaphy.

Validation of the Swedish short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic floor distress inventory (PFDI-20) and Pelvic organ prolapse/Urinary incontinence sexual questionnaire (PISQ-12).

Objective. To psychometrically evaluate the Swedish translations of the short forms of the Pelvic Floor Impact Questionnaire (PFIQ‐7), Pelvic Floor Distress Inventory (PFDI‐20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12). Design and Setting. Cross‐sectional design, University hospital. Sample. Forty‐four patients awaiting prolapse surgery. Methods. The dual‐panel translation method followed by an evaluation of validity and reliability in prolapse patients. Main Outcome Measures. Construct, convergent and discriminant validity, reliability via test–retest and internal consistency. Results. Item response rates were high (range 95.5–100%) for PFIQ‐7 and PFDI‐20. The corrected item–total correlations showed acceptable construct validity for PFIQ‐7 (r=0.338–0.826) but low for PFDI‐20 (r=0.116–0.581) and PISQ‐12 (r=0.024–0.735). Acceptable convergent validity was found in all three instruments, with a negative correlation with the SF‐12. There were no floor or ceiling effects in the three instruments. In the test–retest analysis, intraclass correlation coefficients were significant (r=0.888–0.943). Cronbachs α varied between 0.57 and 0.94. Conclusion. This is the first validated translation of the PFIQ‐7, PFDI‐20 and PISQ‐12 in Swedish. All three instruments indicated acceptable psychometric properties.

Lower urinary tract symptoms in middle-aged women - prevalence and attitude towards mild urinary incontinence. A community-based population study.

Objective.  To investigate the prevalence and perceived bother of lower urinary tract symptoms (LUTS) in middle‐aged women with and without self‐reported urinary incontinence.

The relation between urinary incontinence and steroid hormone levels in perimenopausal women. A report from the Women's Health in the Lund Area (WHILA) study

Objective. To outline possible associations between urinary incontinence (UI) and serum levels of steroid hormones in middle‐aged women. Design and setting. Community‐based observational study. Sample. All women aged 50–59 living in the Lund area by December 1995 were invited to a screening procedure. Sixty‐four percent (n = 6,917) attended the screening that included physical and laboratory examinations and questionnaires. Methods. Serum levels of cortisol, testosterone, androstendione, SHBG (sex hormone‐binding globulin), and estradiol were analyzed and the 2,221 (32%) women who reported urinary leakage causing a social or hygienic problem were compared to those who denied incontinence. Main outcome measure. Possible differences in serum levels of steroid hormones in continent and incontinent women. Results. There were no significant differences between continent and incontinent women regarding serum levels of cortisol, testosterone, androstendione, or testosterone + androstendione combined. Serum estradiol adjusted for body mass index, parity, smoking, and hysterectomy was significantly higher in incontinent women (87.1±138.4 pmol/l vs. 78.0±118.5 pmol/l, p = 0.005), whereas the ratio estradiol/SHBG was not. These differences persisted when the group of women not on hormonal treatment was analyzed. Conclusions. UI in middle‐aged women seems related to higher serum estradiol levels. This corroborates with studies showing a higher incidence and/or prevalence of UI in women on hormone therapy. No association between UI and serum levels of cortisol, testosterone, or androstendione wasfound.

A 3–year follow‐up after anterior colporrhaphy compared with collagen‐coated transvaginal mesh for anterior vaginal wall prolapse: a randomised controlled trial

To compare the 1–year (previously published) and 3–year objective and subjective cure rates, and complications, related to the use of a collagen‐coated transvaginal mesh for anterior vaginal wall prolapse against a conventional anterior repair.

Urodynamic characterisation of women with naive urinary incontinence: a population-based study in subjectively incontinent and healthy 53-63 years old women.

OBJECTIVES To compare the urodynamic characteristics in a group of middle-aged women with untreated urinary incontinence with the findings in a control group of healthy women. METHODS Sixty women with mild-to-moderate urinary incontinence and 28 symptom-free women, 53-63 years old, were randomly chosen out of a large health questionnaire study. All were investigated with a detailed history, gynaecological examination, urinalysis, frequency-volume chart, and urodynamics including cystometry and pressure-flow analysis. RESULTS The maximum urinary flow was significantly higher in the incontinent group of women, 22+/-1ml/s, than in the healthy controls, 16+/-2ml/s (p<0.01). The acceleration of flow, with a theoretical maximum of 0 degrees, was also significantly faster in the incontinent, 20 degrees, than in the healthy women, 32 degrees (p=0.01). In the five women with urge incontinence only, maximum urinary flow was 26+/-2.4ml/s and the flow acceleration 7 degrees. In incontinent women, both a lower opening pressure and detrusor pressure at maximum flow were seen compared with the healthy women, though the difference did not reach statistical significance. The incontinent and the healthy women did not differ regarding bladder volumes or pressures during filling. CONCLUSION The findings of this study indicate the presence of an increased efficiency of the urethral opening mechanism in incontinent women compared to normal, irrespective of the type(s) of symptoms present.

Urethral pressure changes in response to squeeze: A population-based study in healthy and incontinent 53- to 63-year-old women.

OBJECTIVE The purpose of this study was to investigate the urethral pressure pattern during short squeezes in incontinent and healthy women before and after pelvic floor exercise and to correlate the findings with vaginal measurements. STUDY DESIGN Sixty women with urinary incontinence and 28 healthy control subjects all aged 53 to 63 years were subject to urethral pressure measurements and vaginal palpation, pressure and surface electromyography measurements. Measurements were repeated after 4 months of pelvic floor exercise in the incontinent group. RESULTS The appearance of the urethral pressure curve during a squeeze on a semiquantitative scale from 0 to 4, in the healthy group, was 2.2+/-0.3 and, in the incontinent group, was 1.5+/-0.2 (P<.0 5), rising to 2.2+/-0.2 after pelvic floor exercise (P<.01). The semiquantitative grading correlated with vaginal measurements. CONCLUSION The increase of the urethral pressure in response to short squeeze is reduced significantly in incontinent women compared with healthy women of the same age and parity. A normalization was seen after pelvic floor exercise in the incontinent group.

Serum estradiol does not differentiate stress, mixed and urge incontinent women around menopause. A report from the Women's Health in the Lund Area (WHILA) study.

OBJECTIVE To outline serum estradiol levels in perimenopausal women with stress, mixed or urge incontinence. We believe the majority of urgency symptoms in perimenopausal women to be caused by a pelvic floor dysfunction and a hypermobility of the bladder neck. If this is the case, there would be no difference in estradiol levels between the groups. STUDY DESIGN SETTING University hospital. In the observational Womens Health in the Lund Area study, a subset of 400/2221 women reporting urinary incontinence completed a detailed questionnaire regarding lower urinary tract symptoms and had their serum steroid hormone levels measured. Statistical analyses were made by Chi-square test, nonparametrical tests, ANOVA, multi- and univariate logistic regression analysis. RESULTS Stress incontinence was reported by 196, mixed incontinence by 153 and urge incontinence by 43 women; in 369, serumestradiol values were available. Serum estradiol did not differ significantly between stress incontinent (median 49.5 pmo/l, range 2.63-875.4), urge incontinent (median 31.6 pmol/l, range 2.63-460.7) or mixed incontinent women (median 35.5 pmol/l, range 2.63-787.9, p=0.62). Logistic regression analysis correcting for age, parity, hormonal status, smoking, hysterectomy and BMI also failed to show any difference in estradiol levels between the groups (p=0.41-0.58). CONCLUSION No significant differences in serum estradiol levels between stress, mixed or urge incontinent perimenopausal women could be demonstrated.