Stuart L. Stanton

The standardisation of terminology of lower urinary tract function

We updated the terminology in the field of paediatric lower urinary tract function. Discussions were held of the board of the International Children’s Continence Society and an extensive reviewing process was done, involving all members of the International Children’s Continence Society as well as other experts in the field. New definitions and a standardised terminology are provided, taking into account changes in the adult sphere and new research results. Reprinted with permission of the Journal of Urology and Elsevier. First published 2006: The Journal of Urology. July 2006; 176(1): 314-324. NOTE: The article will be reproduced in two parts. Part II is to be published in the next edition of the Australian and New Zealand Continence Journal.

Posterior colporrhaphy : its effects on bowel and sexual function

Objective To determine the anatomical cure rate of posterior colporrhaphy and its effect on bowel and sexual function one to six years later.

Burch colposuspension: a 10–20 year follow up

Objective To review the outcome of women who underwent Burch colposuspension 10 to 20 years ago and to assess factors which affect long term success.

Urethral pressure measurement by microtransducer: the results in symptom-free women and in those with genuine stress incontinence

Summary. Urethral pressure measurements were recorded at rest and during stress by a microtransducer technique in 20 women without urinary symptoms and 120 women with urodynamically proven genuine stress in‐continence. In the symptom‐free women the resting profile values were largely maintained during stress, as a consequence of 100% transmission of intra‐abdominal pressure rises to the proximal three‐quarters of the functional urethral length. Whilst the majority maintained continence at the bladder neck level, 25% of these controls showed evidence of bladder neck opening during stress. The stress‐incontinent patients showed a deficiency of pressure transmission ratios which appeared to have an ‘all or none’ character in the determination of symptoms. The amplitude and stability of the maximum urethral closure pressure at rest, the extent of urethral closure pressure lost in response to stress, and the extent of intra‐abdominal pressure rises interact to determine the severity of symptoms or ‘margin to continence’.

Regular review: management of urinary incontinence in women.

Urinary incontinence is defined by the International Continence Society as an involuntary loss of urine that is objectively shown and a social and hygiene problem.1 Urinary incontinence not only causes considerable personal discomfort but is also of economic importance to the NHS, costing around £424m per annum.2 In a survey of 10 226 adults aged over 40, the prevalence of incontinence in women was reported as 20.2%.3 Table ​Table11 summarises the prevalence of urinary incontinence from a variety of studies.4 It is likely that about 3 million people are regularly incontinent in the United Kingdom, a prevalence of around 40 per 1000 adults.5 Table 1 Prevalence of urinary incontinence Incontinence can be broadly divided into genuine stress incontinence and an overactive bladder (detrusor instability) (fig ​(fig1).1). Bladder symptoms often do not correlate with the underlying diagnosis. Thus urge incontinence often but not always results from an overactive bladder. Emphasis must be placed on the management of urinary incontinence in primary care, as this is effective in both the short term and the long term and benefits secondary care by ensuring that only patients who cannot be managed in primary care are referred.6,7 Urodynamic studies can be reserved for when conservative treatment has failed, surgery is intended, there are voiding difficulties, or a neuropathy is present. Summary points Urinary incontinence affects 20% of women over the age of 40 It affects the quality of life and causes a financial burden to the NHS Emphasis must be placed on primary health care as many patients can be managed at this level, thus ensuring appropriate referral to hospital The main causes of urinary incontinence are urethral sphincter incompetence and an overactive bladder Urodynamic studies are reserved for when conservative treatment has failed, surgery is intended, or voiding difficulties or neuropathy is present Figure 1 Classification of incontinence

The incidence of genital prolapse after the Burch colposuspension

OBJECTIVE Our objective was to determine the incidence of postoperative genital prolapse after the Burch colposuspension and to identify risk factors for the development of subsequent prolapse. STUDY DESIGN The charts of 131 patients who had a Burch colposuspension performed by the senior author (S.L.S.) between 1977 and 1986 were reviewed at the Urodynamic Unit of St. Georges Hospital, London. Emphasis was placed on the degree of genital prolapse on clinical examination and whether further surgery was required to correct the prolapse. RESULTS Thirty-five patients (26.7%) required a total of 40 operations to correct genital prolapse after colposuspension. At 20 operations, more than one procedure was required to correct combined prolapse. The patients age, weight, parity, menopausal status, and prior pelvic surgery did not affect the incidence of postoperative prolapse. The only preoperative risk factor identified was the presence of a large cystocele. CONCLUSION Postoperative genital prolapse is a significant complication of the Burch colposuspension. It is unclear whether this is due to a disruption of the vaginal axis or to an intrinsic weakness of the pelvic floor in these women.

THE INCIDENCE OF UROLOGICAL SYMPTOMS IN NORMAL PREGNANCY

We questioned 181 healthy pregnant women about their urological symptoms during pregnancy; frequency and stress incontinence were commonest. The incidences of stress incontinence and urge incontinence were increased and that of hesitancy was decreased by pregnancy. Descent of the presenting part did not affect any of these symptoms.

Primary repair of obstetric anal sphincter rupture using the overlap technique

Objective To evaluate the feasibility of a new technique of primary overlap anal sphincter repair instead Setting A teaching hospital and a district general hospital.

Efficacy, safety, and tolerability of extended-release once-daily tolterodine treatment for overactive bladder in older versus younger patients

OBJECTIVES: To evaluate the efficacy, safety, and tolerability of a new, once‐daily extended‐release (ER) formulation of tolterodine in treating overactive bladder in older (≥65) and younger (<65) patients.

Preserving the pelvic floor and perineum during childbirth–elective caesarean section?

13 Lindgren CL, Smyth CN. Measurement and interpretation of the pressures upon the cervix during normal and abnormal labour. J Obsstet Gynaecol Br Comnwlrh 1961; 68: 901-914. 14 Gee H. Uterine activity and cervical resistance determining cervical change in labour [MD thesis] University of Liverpool, England, 1981. 15 Gough GW, Randall NJ, Genevier ES, Sutherland IA, Steer PJ. Head-to-cervix forces and their relationship to the outcome of labor. Obstet Gynecol 1990; 75: 613-618. 16 Olhh KS, Gee H, Brown JS. Measurement of the cervical response to uterine activity in labour and observations on the mechanism of cervical effacement. J Perinat Med 1991; 19 Suppl 2: 245.