Tony Bazi

Spontaneous closure of vesicovaginal fistulas after bladder drainage alone: review of the evidence

A vesicovaginal fistula may occur as a surgical complication, the result of obstructed labor, or a late manifestation of radiotherapy. Surgical treatment includes many routes and techniques, with a success rate reaching 100%. The spontaneous closure of vesicovaginal fistulae after bladder drainage alone for varying periods has been reported by many. The factors favoring the success of this conservative method have not been well esamined. In this paper, all articles refering to this modality were reveiwed. The parameters studied included etiology, size, interval from the causative insult to drainage, and duration of drainage. The incidence of spontaneous closure of fistulate after bladder drainage alone ranged 0 and 100%. Among all assessed criteria, the interval to drainage seems to have the best correlation with success. This findi ng is most likely explained on the basis of the epithelialization of the fistulous tract with time, preventing spontaneous healing. In the view of the retrospective nature of the reviewed articles, the absence of a detailed classification system, and the heterogeneity of the treatment in question, no solid conclusion regarding management recommendations can be drawn.

Sarcoma of the uterine cervix: Clinicopathologic findings in three cases

The clinicopathologic findings in two patients with cervical stromal sarcoma and one with cervical leiomyosarcoma are presented. The patients were 35, 46, and 45 years, respectively. They presented with vaginal bleeding, vaginal discharge, and a cervical mass of less than 5 months duration. A hysterectomy with bilateral salpingo-oophorectomy was performed in each case. One patient received preoperative radiation therapy. Two patients with follow-up manifested hematogenous metastasis.

Clinical epidemiological insights into urinary incontinence

Introduction and hypothesisUrinary incontinence (UI) is very common and heterogeneous among women with limited knowledge of progression or prognosis. Evidence based on clinical epidemiology can help to better understand the natural history of UI.MethodsWe examine the challenges of UI definition and its subtypes, its impact on quality of life and health-seeking behavior. We review the proposed pathophysiology of UI subtypes and known risk factors as they relate to our current knowledge of the disease state. Finally, we emphasize the role of epidemiology in the process of acquiring new insight, improving knowledge, and translating this information into clinical practice.ResultsStress UI is most common overall, but mixed UI is most prevalent in older women. The three UI subtypes have some common risk factors, and others that are unique, but there remains a significant gap in our understanding of how they develop. Although the pathophysiology of stress UI is somewhat understood, urgency UI remains mostly idiopathic, whereas mixed UI is the least studied and most complex subtype. Moreover, there exists limited information on the progression of symptoms over time, and disproportionate UI health-seeking behavior. We identify areas of exploration (e.g., epigenetics, urinary microbiome), and offer new insights into a better understanding of the relationship among the UI subtypes and to develop an integrated construct of UI natural history.ConclusionFuture epidemiological strategies using longitudinal study designs could play a pivotal role in better elucidating the controversies in UI natural history and the pathophysiology of its subtypes leading to improved clinical care.

Prevention of pelvic floor disorders: international urogynecological association research and development committee opinion

Introduction and hypothesisPelvic floor disorders (PFD), including urinary incontinence, anal incontinence, and pelvic organ prolapse, are common and have a negative effect on the quality of life of women. Treatment is associated with morbidity and may not be totally satisfactory. Prevention of PFDs, when possible, should be a primary goal. The purpose of this paper is to summarise the current literature and give an evidence-based review of the prevention of PFDsMethodsA working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the prevention of PFDs was drafted, based on a review of the English-language literature. After evaluation by the entire IUGA R&D Committee, revisions were made. The final document represents the IUGA R&D Committee Opinion on the prevention of PFDs.ResultsThis R&D Committee Opinion reviews the literature on the prevention of PFDs and summarises the findings with evidence-based recommendations.ConclusionsPelvic floor disorders have a long latency, and may go through periods of remission, thus making causality difficult to confirm. Nevertheless, prevention strategies targeting modifiable risk factors should be incorporated into clinical practice before the absence of symptomatology.

A modulating effect of epigallocatechin gallate (EGCG), a tea catechin, on the bladder of rats exposed to water avoidance stress†‡

To examine the effect of epigallocatechin gallate (EGCG), a green tea catechin, on the bladder of rats exposed to water avoidance stress (WAS).

Intimate Partner Violence in a Lebanese Population Attending Gynecologic Care A Cultural Perspective

Occurrence of intimate partner violence (IPV) against women in the Lebanese society has been largely ignored by local legal and religious authorities. Our aim is to estimate the prevalence of IPV among married Lebanese women, and investigate perception of abuse, referral patterns, and measures taken to deal with abusive situations. In this cross-sectional study, married women aged 20 to 65 presenting to the American University of Beirut Medical Center for gynecological care were interviewed on various forms of IPV. Out of 100 women invited to participate, 91 consented to take part in the survey of whom 37 (40.67%) gave a history of physical abuse, 30 (33.0%) of sexual abuse, 59 (64.8%) of verbal abuse, and 17 (18.7%) of emotional abuse. Spouse-imposed social isolation was reported in 20 (22.0%) women, and economic abuse in 30 (33.0%). Reasons for deciding to stay in an abusive relationship were “lack of any family or social support” (40.5%), “lack of financial resources” (40.5%), and “fear that the partner may take away the children” (37.8%). Women expressed satisfaction with their spouse’s treatment irrespective of the existence of various forms of violence. A significant increase in the risk of weapon use against wife was correlated with decreased monthly income of the household, whereas a protective effect was conferred by an increased number of children. This study highlights the need for routine screening in health care settings for better identification of victims of violence. The selective conventional perception of abuse and the reactive normalization of violence observed indicate the necessity for culturally informed interventional strategies to complement screening.

Validation of an Arabic version of the global Pelvic Floor Bother Questionnaire.

To validate an Arabic version of the global Pelvic Floor Bother Questionnaire (PFBQ), a self‐administered 9‐item symptom assessment tool.

Female urethral dilation

Introduction and hypothesisThe aim of this manuscript is to review the subject of urethral dilation (UD) in female patients and to conduct a critical appraisal of the available evidence for its use.MethodsWe used an online search of electronic databases.ResultsUD has been cited as a treatment option for various conditions that do not share common etiologies and that affect the lower urinary tract in female patients. Outcome measurement was not consistent, even when performed for the same conditions. A total of six randomized controlled trials failed to prove any benefit for UD in repetitive urinary tract infections (UTI), urethral syndrome, and overactive bladder.ConclusionsConflicting results and diverse opinions have characterized the use of UD until present time. Professional societies are urged to attend to this issue, and to identify possible areas where UD could be potentially investigated.

Re: Intra-abdominal irrigation at cesarean delivery: a randomized controlled trial.

Schulz KF, 2010, OBSTET GYNECOL, V115, P1063, DOI 10.1097-AOG.0b013e3181d9d421; Viney R, 2012, OBSTET GYNECOL, V119, P1106, DOI 10.1097-AOG.0b013e3182460d09

Management of post-midurethral sling voiding dysfunction. International Urogynecological Association research and development committee opinion

Voiding dysfunction following midurethral sling procedures is not a rare event. There is no current consensus regarding management of this complication. Although it is often transient and self-limiting, chronic post-midurethral sling voiding dysfunction may lead to irreversible changes affecting detrusor function. Initial management includes intermittent catheterization, and addressing circumstantial factors interfering with normal voiding, such as pain. Early sling mobilization often resolves the dysfunction, and is associated with minimal morbidity. Sling incision or excision at a later stage, although fairly effective, could be associated with recurrence of stress urinary incontinence. There is insufficient evidence to justify urethral dilatation in this context.