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Effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state.

OBJECTIVE Our aim was to investigate the effects of urinary incontinence subtypes on womens quality of life (including sexual life) and psychosocial state. STUDY DESIGN The patients, who applied to our clinic from March 2011 to August 2011, were identified and stratified into three groups: those with stress incontinence proved urodynamically (USI), those with urge incontinence (UI), and those with mixed incontinence urge incontinence (UI) proved by urodynamic and clinic evaluation. Scores on the Beck anxiety inventory (BAI), pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), urogenital distress inventory (UDI-6), and incontinence impact questionnaire (IIQ-7) were compared between the urinary incontinence subtypes. RESULTS According to urodynamic and clinical examination of 111 women with urinary incontinence, 59 (53%) had USI, 35 (32%) had UI, and 17 (15%) had MI. BAI-scores significantly differed between the USI and UI groups (p=0.030) and between the USI and MI groups (p=0.011) not between the UI and MI groups (p=0.597). UDI-6 scores did not significantly differ between the three groups (p=0.845). IIQ-7 scores significantly differed between the USI and MI groups (p=0.003) and between the UI and MI groups (p=0.006) but not between the USI and UI groups. Patients with USI had significantly lower PISQ-12 scores than those with UI (p=0.015). CONCLUSIONS These differences in the effects of incontinence subtypes should be kept in mind in the evaluation of patients with urinary incontinence. Psychiatric assessment may improve the management of incontinence in women, especially UI and MI.

Comparison of saline infusion sonohysterography and hysteroscopy in diagnosis of premenopausal women with abnormal uterine bleeding

OBJECTIVE The aim of this study was to compare the diagnostic effectiveness of transvaginal sonography (TVS), saline infusion sonohysterography (SIS), and diagnostic hysteroscopy (HS), with the pathologic specimen as a gold standard diagnostic method, in detecting endometrial pathology in premenopausal women with abnormal uterine bleeding. STUDY DESIGN This prospective cohort study was conducted at Zeynep Kamil Education and Training Hospital, Istanbul, Turkey, and included 89 premenopausal women. All participants were examined first by TVS, further investigated with SIS and HS, and finally dilatation and curettage was performed when needed. The results obtained from these three methods were compared with the pathologic diagnoses. The positive and negative likelihood ratios (LR+ and LR-) of TVS, SIS and HS were calculated by comparison with the final pathological diagnosis. In addition, area under the curve (AUC) values were also calculated. RESULTS Polypoid lesion was the most common abnormal pathology. LR+ and LR- of TVS, SIS, and HS were 3.13 and 0.15, 9.83 and 0.07, 13.7 and 0.02 respectively in detection of any abnormal pathology, and the AUCs of TVS, SIS, and HS were 0.804, 0.920, and 0.954 respectively. When the three procedures were compared with each other separately, HS had the best diagnostic accuracy, and the diagnostic accuracy of HS and SIS was superior to TVS (p(1)=0.000, p(2)=0.000). For the detection of polypoid lesions, HS was the most accurate diagnostic procedure (AUC=0.947), followed by SIS (AUC=0.894) and TVS (AUC=0.778). CONCLUSION HS provides the most accurate diagnosis and allows treatment in the same session in premenopausal women with abnormal uterine bleeding.

Concomitant surgical correction of occult stress urinary incontinence by TOT in patients with pelvic organ prolapse.

OBJECTIVES To assess the post-operative urinary incontinence states of pelvic organ prolapse cases operated on with concomitant trans-obturator tape (TOT) procedure. STUDY DESIGN Urodynamic evaluation of 79 patients with pelvic organ prolapse, before and after operation, while reducing the prolapsed organs by ring forceps placed bilaterally on the anterolateral sulcuses avoiding urethral compression. According to urodynamic tests, 25 patients were diagnosed as having occult stress urinary incontinence. RESULTS Post-operative overactive bladder, stress urinary incontinence and mixed incontinence were found in three (12%), two (8%) and one (4%) patients of the occult stress urinary incontinence group, respectively. The corresponding numbers were six (11%), five (9%) and three (6%) in the continent group. No significant difference was found between the groups in terms of post-operative overactive bladder symptoms, stress urinary incontinence and mixed incontinence (Kruskal-Wallis test, X(2) = 0.52, p = 0.820). CONCLUSIONS This retrospective study suggests that a complete pre-operative urodynamic evaluation, including urodynamic tests at the time of POP reduction by placing ring forceps on the anterolateral sulcuses, is an efficient method for the diagnosis of occult symptomatic stress urinary incontinence (SUI). Prospective randomized studies are needed to establish the benefits and the risks of concomitant prophylactic surgery in patients with pelvic organ prolapse.

Is there a relationship between endometrial polyps and obesity, diabetes mellitus, hypertension?

ObjectiveThe purpose of our study was to evaluate the relationship between endometrial polyps and obesity, diabetes mellitus (DM) and hypertension (HT).Materials and methods202 patients who applied to our gynecology clinic with complaints of infertility, recurrent pregnancy loss and abnormal uterine bleeding, diagnosed to have endometrial polyps by hysteroscopy, were compared with 79 patients without polyps, retrospectively. The relationships between risk factors and presence of a polyp and polyp size were analyzed.ResultsThe mean age of cases with endometrial polyps was significantly greater than the controls. The mean body mass index (BMI) of the cases with polyps was also significantly greater than the controls. There was no significant difference between groups with respect to prevalence of DM or HT.ConclusionThis study suggests that obesity is an independent risk factor in the development of endometrial polyps. Clinicians should be aware in terms of endometrial polyps in the assessment of patients with BMI ≥30. There was no relationship between HT or DM with presence of polyps.

Validation of the Wexner scale in women with fecal incontinence in a Turkish population

Introduction and hypothesisThe main aim of this study was to validate the Turkish translated version of the Wexner scale.MethodsAfter establishing the test–retest reliability and internal consistency of the Turkish version of Wexner scale on 31 patients, total and subscale scores and anal manometric measurements of 60 participants were performed. Correlation between Wexner scale scores and manometric measurement values were analyzed and those values of patients with or without anal incontinence symptoms were compared.ResultsOf the 60 participants, 47 (78%) showed no signs or symptoms of anal incontinence. Wexner scale showed a high internal consistency (Cronbach’s alpha = 0.816). Total and each subscale score of Wexner scale showed strong correlation with resting and maximal squeeze pressures and between each other (p < 0.005). The pressure values were significantly less in asymptomatic patients compared to patients with any degree of symptoms (p < 0.05).ConclusionThe Turkish translated version of the Wexner scale is a reliable, consistent, and valid instrument to evaluate anal functions in women with anal incontinence for Turkish speaking women. Total and subscale scores of the Wexner scale and anal manometric measurements showed significant correlation.

Effect of simple and radical hysterectomy on quality of life – analysis of all aspects of pelvic floor dysfunction

OBJECTIVE The impact of simple and radical hysterectomy on all aspects of pelvic floor dysfunctions was evaluated in current study. STUDY DESIGN This retrospective cohort study included 142 patients; 58 women (40.8%) who have undergone simple, 41 (28.8%) radical hysterectomy, and 43 (30.2%) women without any surgical intervention to serve as the control group. The validated versions of the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Pelvic Floor and Incontinence Sexual Impact Questionnaire (PISQ-12), Wexner Incontinence Scale score and pelvic organ prolapse quantification (POP-Q) system were used in detailed evaluation of pelvic floor dysfunction. One-way ANOVA and Pearsons chi square tests were performed in statistical analysis. RESULTS It was found that there were significant differences in irritative and obstructive scores of UDI-6 between Type III hysterectomy group and Type I hysterectomy group. In addition, patients of Type I hysterectomy had significant higher irritative and obstructive scores than the control group. Type III hysterectomy had the most significant deteriorating effect on sexual life, based on scores of PISQ-12 compared to both Type I hysterectomy group and control group. CONCLUSION Hysterectomy results in detrimental effects on the quality of life (QoL) regarding all aspects of pelvic floor functions especially in women of radical hysterectomy. Urinary dysfunctional symptoms like urgency, obstruction and especially sexual problems are more bothersome and difficult to overcome. The impact of hysterectomy on QoL should be investigated as a whole and may be more profound than previously thought.

β-human chorionic gonadotropin assay in vaginal washing fluid for the accurate diagnosis of premature rupture of membranes during late pregnancy.

OBJECTIVE To determine whether the measurement of beta-human chorionic gonadotropin (β-hCG) levels in vaginal fluid is useful for the diagnosis of premature rupture of membranes (PROM). MATERIAL AND METHODS A total of 92 pregnant women between 24 and 40 weeks gestation participated in this study. The patients with fluid leaking from the vagina were designated Group 1, the patients with no fluid leaking from the vagina were Group 2, and those with a suspicion of fluid leaking from the vagina were classified as Group 3. Irrigating the posterior vaginal fornix with 5 mL sterile saline was used to measure β-hCG levels of the patients. Receiver operator curve (ROC) analysis was used to determine the cut-off value for a positive diagnosis. RESULTS The β-hCG levels of vaginal fluid were measured as 20.5±25.0 mIU/mL, 254.6±346.8 mIU/mL, and 74.3±100.8 mIU/mL in Group 1, Group 2, and Group 3, respectively. Vaginal β-hCG level was higher statistically significantly in Group 2 than Group 1 and 3 (p<0.001). 100 mIU/mL was accepted as a cut-off value by using the receiver operating characteristic curve. According to 100 mIU/mL, sensitivity, specificity, positive predictive and negative predictive values were calculated as 71.2, 100, 100, and 65.1%, respectively. CONCLUSION The study showed that the measurement of β-hCG level in vaginal washing fluid is an efficient and easy diagnostic test for predicting the amount of fluid leaking from the vagina. However, due to the low negative predictive value of the test, it would not be convenient in daily practice.

Translation and validation of the Endometriosis Health Profile (EHP-5) in patients with laparoscopically diagnosed endometriosis

OBJECTIVES To validate the Turkish-translated versions of the Endometriosis Health Profile 5 (EHP-5) for use in patients with laparoscopically proven endometriosis. STUDY DESIGN This case control study was conducted in a tertiary referral teaching institution between April and June 2014. Fifty-eight patients with surgically proven endometriosis were enrolled. The EHP-5 questionnaire was evaluated for patients with laparoscopically diagnosed endometriosis. Test-retest reliability, descriptive statistics, reliability analysis (internal consistency and item-total correlation), data completeness, and known-group comparison were all assessed in the validation of the EHP-5 form as translated into the Turkish language. RESULTS Two weeks test-retest reliability showed statistically significant correlation; Spearmans rho was 0.885 (p<0.001) for the EHP-5 core questionnaire and 0.896 (p<0.001) for the EHP-5 modular questionnaire. Cronbachs alpha values for the translated form of the EHP-5 core and modular questionnaires were 0.829 and 0.804, respectively, with a high level of internal consistency. In known group comparison, there were statistically significant differences in all subgroups except in the infertility group on the core questionnaire. Pain scales on the core questionnaire and infertility scales on the modular questionnaire showed the highest mean scores (1.14±1.16 and 1.78±1.77). CONCLUSION Like the original English questionnaire, the Turkish-translated version of the EHP-5 is a reliable and valid instrument for assessing symptom severity and the impact of endometriosis on health-related quality of life in Turkish-speaking women.

Maternal and fetal risk factors affecting perinatal mortality in early and late fetal growth restriction

OBJECTIVE To determine the factors which affect the perinatal deaths in early and late fetal growth restriction (FGR) fetuses using threshold of estimated fetal weight (EFW) < 5(th) percentile. MATERIALS AND METHODS This retrospective study included singleton 271 FGR fetuses, defined as an EFW < 5(th) percentile. All fetuses considered as growth restrictions were confirmed by birth weight. Fetuses with multiple pregnancy, congenital malformation, chromosomal abnormality, and premature rupture of membrane were excluded. Samples were grouped in early and late FGR. Early FGR fetuses was classified as gestational age at birth ≤ 34 weeks and late FGR was classified as gestational age at birth > 34 weeks. Factors which affect the perinatal deaths were analyzed descriptively in early and late FGR. The perinatal mortality was calculated by adding the number of stillbirths and neonatal deaths. RESULTS The study included 86 early and 185 late FGR fetuses, 31 resulted in perinatal deaths, 28 perinatal deaths were in early FGR, and three perinatal deaths were in late FGR. Perinatal deaths occurred more commonly in early FGR fetuses with an EFW < 3(rd) percentile. Prior stillbirth, preeclampsia, the degree of increasing vascular impedance of umbilical artery(UA) and uterine artery (UtA) showed significant correlation with perinatal death in early FGR. All three perinatal deaths in late FGR occurred in fetuses with EFW < 3(rd) percentile and severe oligohydramnios. Also, placental abruption and perinatal death was found significantly higher in increased vascular impedance of UtAs whatever the umbilical artery Doppler. CONCLUSION Only EFW < 3(rd) percentile and severe olgohydramnios seem to be contributing factors affecting perinatal death in late FGR in comparison with early FGR.

Effects of Single Vaginal Incision Technique on Quality of Life in Women with Stress Urinary Incontinence

STUDY OBJECTIVE To estimate the short-term effects of a minimally invasive single vaginal incision technique without passing through the abdomen or groin (ContaSure Needleless System) on the quality of life in women with incontinence. DESIGN Prospective cohort study (Canadian Task Force classification II-2). SETTING Tertiary referral urogynecology clinic. PATIENTS 50 consecutive patients with urodynamically proved stress urinary incontinence from October 2008 to March 2009. INTERVENTIONS Preoperative and postoperative scores on the short forms of the IIQ-7 (Incontinence Impact Questionnaire, UDI-6 (Urinary Distress Inventory) PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function), and long form of the P-QOL (Prolapse Quality of Life) were evaluated in 50 patients with urodynamically proved stress urinary incontinence. Scores were compared with postoperative urodynamic findings. MEASUREMENTS AND MAIN RESULTS Mean (SD) follow-up was 433.5 (44.1) days (95% CI, 420.1-445.1). Patients showed statistically significant improvement insofar as preoperative and postoperative scores on the IIQ-7, P-QOL, and PISQ-12 and the irritative and stress subgroups of UDI-6. Obstructive score of UDI-6 worsened, consistent with the findings of pressure-flow studies. Postoperatively, 40 patients (80%) were urodynamically continent. Eight patients (16%) were still incontinent; however, their quality of life scores (IIQ-7 and UDI-6 stress) improved. Two patients (4%) continued to experience leakage, with equal or worsened quality-of-life scores. CONCLUSION Early clinical results of the present trial demonstrate that the ContaSure Needleless System seems to be capable of improving significantly all aspects of quality of life in women with incontinence. To improve the willingness for treatment of women with stress incontinence, this minimally invasive technique should be encouraged after confirming its efficacy in larger prospective, randomized, comparative trials.