Priya Padmanabhan

Female stress urinary incontinence: how do patient and physician perspectives correlate in assessment of outcomes?

Purpose of review This article discusses outcome assessment following surgery for incontinence, by correlating patient perspectives with that of the physician. Recent findings A review of the literature demonstrates a large variance in the ‘success rates’ published for different stress urinary incontinence procedures. We review the elements essential in formation of a universal and valid incontinence questionnaire. Studies have attempted to correlate common clinical measures (voiding diaries, pad testing, urodynamics) with quality-of-life questionnaires. Sentinel articles in incontinence outcome assessment are discussed. Studies with critical measures of outcome are examined using the recommendations made by the Female Stress Urinary Incontinence Guidelines Panel summary report. Through presentation of our data on tension-free vaginal tape procedures, we give insight into the future of stress urinary incontinence research and outcomes. Summary Early ‘cure rates’ were severely limited by their retrospective nature and focus on chart review and physician assessment. Symptom and quality-of-life questionnaires provide subjective outcome assessments. No direct correlation exists between universally accepted objective and subjective measures of improvement. Recent studies are getting closer to the female stress urinary incontinence guidelines. Yet, the pursuit for a universal definition of success continues, in order to bridge patient and physician perspectives on cure.

Anatomy of Pelvic Support

Female pelvic anatomy can be a conceptual challenge. To understand the function of the pelvis, one must understand the basic anatomy and then the dynamic nature of the structures that allow for urinary and bowel continence in a variety of circumstances. An understanding of normal anatomy and function provides the clinician with a framework for understanding the pathophysiology of pelvic organ prolapse and female urinary incontinence. The evaluation of female urinary incontinence often involves the recognition and treatment of concurrent pelvic abnormalities, such as cystocele, uterine prolapse, enterocele, rectocele, or perineal laxity. The factors responsible for pelvic floor relaxation rarely affect isolated anatomic areas. This chapter provides a detailed description of normal female pelvic anatomy, and an emphasis is placed on key surgical landmarks for reestablishing normal anatomy.

Female bladder outlet obstruction: an update on diagnosis and management.

Purpose of review The diagnosis and evaluation of bladder outlet obstruction (BOO) in women remains a challenging topic. The goal of this study is to review recent literature and summarize the diagnosis and management of BOO with special focus on recent progress. Recent findings In recent years, numerous advances in the area of female BOO have taken place including a movement towards unified diagnostic criteria, summary of functional and anatomic causes, and exploration of potential diagnostic options. Summary This review discusses the known diagnosis and management of female bladder outlet obstruction, yet highlights specific functional causes, new criteria available for diagnosis, and long-term results of treatment options.