Is the extent of obstetric anal sphincter injury correlated with the severity of fecal incontinence in the long term?
AbstractBackgroundObstetric anal sphincter injury is the most frequent cause of fecal incontinence (FI) in young women. However, the relationship between the extent of anal sphincter defects and the severity of long-term FI (at least 1 year after delivery) has been poorly studied. The aim of the present study was to determine if, in the long term, the extent of anal sphincter defects graded at anal endosonography was linked with the severity of FI.MethodsA retrospective study was conducted on women with a history of vaginal delivery, who presented with FI and had three-dimensional anorectal high-resolution manometry and endoanal ultrasound in our center from January 2015 to 2016. The detailed clinical history of each patient was obtained from the institutional database. The severity of FI was assessed with the Jorge and Wexner continence scale.ResultsThere were 250 women with a mean age of 60 ± 14 years. Seventy-six (30.4%) had an isolated defect of the internal anal sphincter, 21 (8.4%) had an isolated defect of the external anal sphincter, and 150 (60%) had both internal and external sphincter defects. The extent of IAS and EAS defects was proportionally correlated with the decr ease in mean resting anal pressure (p
AbstractPurpose of ReviewThe purpose of this review is to consolidate and present the most recent literature on colpocleisis in the treatment of pelvic organ prolapse.Recent FindingsSince its origin in the 1800s, the techniques for colpocleisis have remain largely unchanged. We will review the peri-operative considerations for a patient undergoing an obliterative procedure, specifically focusing on the potential concern for uterine pathology. There are no universally accepted guidelines for endometrial evaluation in the asymptomatic post-menopausal patient, yet the majority of providers prefer to perform some type of pre-o...
CONCLUSION: Evaluation of detrusor contractility in women is easily obtained using indices PIP-BCI and PIP1 or using the VBN nomogram giving indice-parameter k. PIP1 and parameter k produced comparable and consistent results with the urodynamic diagnosis while PIP-BCI leads to inconsistencies. LEVEL OF EVIDENCE: 4. PMID: 31866143 [PubMed - as supplied by publisher]
We performed a comprehensive clinical and morphological examination of 70 menopausal patients aged 42-62 years with dysuria and chronic pelvic pain. Assessment of the bladder and vaginal microcirculation by laser Doppler flowmetry in menopausal patients with genitourinary syndrome revealed reduced (by 12-65%) microcirculation parameters. Analysis of the quantitative and qualitative composition of the bacterial microflora of the urethra and vagina revealed abnormalities of microbiota of varying severity, which can be the cause of infectiousinflammatory processes in the pelvic organs leading to chronic pelvic pain syndrome a...
Urinary incontinence in mid-life women is common, stigmatizing, and treatable. Review its diagnosis and management options in this Practice Pearl.Menopause
Urinary incontinence is a common bladder health problem that disproportionately affects women, especially midlife women. In the absence of alarming signs or symptoms, a step-wise evaluation aligned with patient treatment preferences is appropriate. Initial interventions can include simple behavior therapies, lifestyle modifications, and toileting habits. Systemic medication, surgery, and specialty treatment also can be offered.
AbstractPurpose of ReviewThe purpose of this review article is to summarize the recent literature regarding the effect of hormone replacement therapy on pelvic floor disorders and its role as a preventative or treatment option.Recent FindingsThe recent evidence describing the effect of hormone replacement therapy on pelvic floor disorders is mainly limited to cohort studies, systematic reviews, and secondary analysis of randomized controlled trials such as the Women ’s Health Initiative and Nurses’ Health Study. There are few quality randomized controlled trials, especially within the last 5 years on this ...
This article is protected by copyright. All rights reserved.
ConclusionsIn summary, local estrogen seems to be safe and effective in the treatment of VVS and can also improve urinary symptoms in postmenopausal patients with UI, but most of these recommendations correspond to evidence level 2C. The evidence in POP is still scarce but not in favor of benefit. Finally, the duration of local estrogen treatment (LET), optimal dosage, long-term effects and cost-effectiveness compared with current practice are still unknown.
Conditions: Urinary Incontinence; Menopause Interventions: Drug: Testosterone Enanthate; Drug: Placebo Sponsor: Brigham and Women's Hospital Not yet recruiting
CONCLUSIONS: Menopause and UDI-6 scores could be prognostic factors for persistent SUI after TVT-O. Well-designed prospective studies with a suitable number of patients are needed to corroborate our findings. PMID: 29298467 [PubMed]