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Predicting intrinsic urethral sphincter dysfunction in women with stress urinary incontinence
Citations from the literature/International
sterectomy and pelvic lymph node dissection in the treatment of stage IB and HA cervical cancer is controversial. Patients most likely to benefit from postoperative radiation include those with lesions that invade deeply into the cervical stroma, extend into the parametria, or have metastasized to regional lymph nodes. Between 1977and 1987,95 patients were treated with this combined regimen at the University of California Irvine Medical Center and Long Beach Memorial Medical Center, including 30 patients with deep cervical stromal invasion alone, 9 patients with parametrial extension alone, 37 patients with lymph node metastasis alone, and 19 patients with both positive nodes and parametrial extension. The estimated 5-year survival for this high-risk population was 67%. Pelvic recurrences alone occurred in 12 (13%) patients, and I4 additional patients (I 5%) recurred outside of the radiation field. In the node-positive group, the 5-year survival was 78% when the parametrium was not involved but decreasedto 39% when parametrial extension was documented (P < 0.05). Patients with grossly involved nodes or multiple nodal metastaseswere also more likely to recur. Finally, the estimated S-year survival for patients with deep cervical stromal invasion as the sole indication for radiotherapy was 73%. A retrospective analysis identified tumor grade and cell type also to be of prognostic importance. Severe complications attributable to radiation combined with radical surgery included two small bowel obstructions and one urinary tract listula. These data suggest that radical hysterectomy, pelvic lymphadenectomy, and adjuvant radiotherapy produce favorable survival results with limited morbidity in patients with high-risk cervical cancer independent of node status except in that subset of patients with both occult parametrial spread and nodal metastasis.
GYNECOLOGICAL
SURGERY
The value of cystoscopy in major vaginal surgery
Journal of Gynecology & Obstetrics 49 (1995) 87-97
93
Predicting intrinsic urethral sphincter dysfunction in women with stress urinary infontiaence
Horbach N.S.; Ostergard D.R. USA
OBSTET GYNECOL 1994 84/2 (188-192) Objective: To determine whether specific clinical characteristics can be used to identify women with stress urinary incontinence due to intrinsic urethral sphincter dysfunction without the aid of urodynamic testing. Methods: A retrospective analysis was performed of 263 consecutive patients who underwent complete urodynamic evaluation for complaints of urinary leakage. Intrinsic sphincter dysfunction was defined as a maximum urethral closure pressure of 20 cm Hz0 or less in the sitting position at maximum cystometric capacity. Women with sphincter dysfunction were then compared to the group with normal pressure (greater than 20 cm HzO) using t test, chi*, and logistic regression analyses for 13 clinical indices, endoscopic appearance of the proximal urethra, and eight urodynamic criteria. Results: The group with intrinsic sphincter dysfunction totaled 132 women (50.2%). Univariate analysis revealed that women in this group were older and were more likely to have undergone a hysterectomy and at least one anti-incontinence procedure compared to the women with normal urethral pressure. However, multivariate analysis revealed that age greater than 50 years was the only independent variable that could predict the presenceof intrinsic sphincter dysfunction in women with stressincontinence (odds ratio 1.6, 95% confidence interval 1.2-2.2). The two groups were similar in all other preoperative clinical characteristics. Conclusions: The only preoperative clinical index that predicted the presenceof intrinsic urethral sphincter dysfunction, as defined by low urethral closure pressure, was age over 50 years. In view of previous studies reporting a higher rate of surgical failure in women with low urethral pressure, urodynamic testing should be considered in surgical candidates over age 50 to allow adequate preoperative counseling.
Pettit P.D.; Petrou S.P. USA
OBSTET GYNECOL 199484/2 (318-320) This article reviews the case histories of 236 patients who had cystoscopy as part of their major vaginal operations. Sevenhad cystoscopically detected potential lower urinary tract injuries. Five of these injuries were ureteral obstructions, one occurring after anterior repair, three associatedwith a McCall culdoplasty, and one associated with a modified Pereyra bladder neck suspension.Two injuries were subtle cystotomies. These compromises of the lower urinary tract were detected during the main operative procedure and immediately rectified. We propose that routine intraoperative cystoscopy associatedwith intravenous administration of indigo carmine is an excellent method for detecting actual and potential lower urinary tract surgical injury. Cystoscopy cannot distinguish which surgical distortion or injury will spontaneously resolve. The identilication of non-blood-tinged urine from both ureteral orifices and the absenceof bladder trauma should eliminate the possibility of lower urinary tract surgical injury, except for ischemic necrosis. Cystoscopy, like laparoscopy, is a procedure that should benefit our patients and should not isolate a specialty.
Urinary incontinence in elite
qulliparous
athletes
Nygaard I.E.; Thompson F.L.; Svengalis S.L.; Albright J.P. USA
OBSTET GYNECOL 199484/2 (183-187) Objective: To determine the prevalence of the symptom of urinary incontinence during athletic endeavors among a group of nulliparous, elite college varsity female athletes. Methods: All women currently participating in varsity athletics at a large state university were asked to fill out a questionnaire about the occurrence of urinary incontinence while participating in their sport and during activities of daily life. One hundred forty-four of 156eligible women (92%) responded. Results: The mean age was 19.9 years, and all women were nulliparous. Overall, 40 athletes (28%) reported urine loss while participating in their sport. The proportions in different sports were: gymnastics 67%, basketball 66%, tennis 50%, field hockey 42%, track 29%, swimming IO%, volleyball 9%, softball 6%, and golf 0%. Twothirds of the women who noted urine loss during athletics were incontinent more often than rarely. There were no statistically significant relations between incontinence and amenorrhea,
sterectomy and pelvic lymph node dissection in the treatment of stage IB and HA cervical cancer is controversial. Patients most likely to benefit from postoperative radiation include those with lesions that invade deeply into the cervical stroma, extend into the parametria, or have metastasized to regional lymph nodes. Between 1977and 1987,95 patients were treated with this combined regimen at the University of California Irvine Medical Center and Long Beach Memorial Medical Center, including 30 patients with deep cervical stromal invasion alone, 9 patients with parametrial extension alone, 37 patients with lymph node metastasis alone, and 19 patients with both positive nodes and parametrial extension. The estimated 5-year survival for this high-risk population was 67%. Pelvic recurrences alone occurred in 12 (13%) patients, and I4 additional patients (I 5%) recurred outside of the radiation field. In the node-positive group, the 5-year survival was 78% when the parametrium was not involved but decreasedto 39% when parametrial extension was documented (P < 0.05). Patients with grossly involved nodes or multiple nodal metastaseswere also more likely to recur. Finally, the estimated S-year survival for patients with deep cervical stromal invasion as the sole indication for radiotherapy was 73%. A retrospective analysis identified tumor grade and cell type also to be of prognostic importance. Severe complications attributable to radiation combined with radical surgery included two small bowel obstructions and one urinary tract listula. These data suggest that radical hysterectomy, pelvic lymphadenectomy, and adjuvant radiotherapy produce favorable survival results with limited morbidity in patients with high-risk cervical cancer independent of node status except in that subset of patients with both occult parametrial spread and nodal metastasis.
GYNECOLOGICAL
SURGERY
The value of cystoscopy in major vaginal surgery
Journal of Gynecology & Obstetrics 49 (1995) 87-97
93
Predicting intrinsic urethral sphincter dysfunction in women with stress urinary infontiaence
Horbach N.S.; Ostergard D.R. USA
OBSTET GYNECOL 1994 84/2 (188-192) Objective: To determine whether specific clinical characteristics can be used to identify women with stress urinary incontinence due to intrinsic urethral sphincter dysfunction without the aid of urodynamic testing. Methods: A retrospective analysis was performed of 263 consecutive patients who underwent complete urodynamic evaluation for complaints of urinary leakage. Intrinsic sphincter dysfunction was defined as a maximum urethral closure pressure of 20 cm Hz0 or less in the sitting position at maximum cystometric capacity. Women with sphincter dysfunction were then compared to the group with normal pressure (greater than 20 cm HzO) using t test, chi*, and logistic regression analyses for 13 clinical indices, endoscopic appearance of the proximal urethra, and eight urodynamic criteria. Results: The group with intrinsic sphincter dysfunction totaled 132 women (50.2%). Univariate analysis revealed that women in this group were older and were more likely to have undergone a hysterectomy and at least one anti-incontinence procedure compared to the women with normal urethral pressure. However, multivariate analysis revealed that age greater than 50 years was the only independent variable that could predict the presenceof intrinsic sphincter dysfunction in women with stressincontinence (odds ratio 1.6, 95% confidence interval 1.2-2.2). The two groups were similar in all other preoperative clinical characteristics. Conclusions: The only preoperative clinical index that predicted the presenceof intrinsic urethral sphincter dysfunction, as defined by low urethral closure pressure, was age over 50 years. In view of previous studies reporting a higher rate of surgical failure in women with low urethral pressure, urodynamic testing should be considered in surgical candidates over age 50 to allow adequate preoperative counseling.
Pettit P.D.; Petrou S.P. USA
OBSTET GYNECOL 199484/2 (318-320) This article reviews the case histories of 236 patients who had cystoscopy as part of their major vaginal operations. Sevenhad cystoscopically detected potential lower urinary tract injuries. Five of these injuries were ureteral obstructions, one occurring after anterior repair, three associatedwith a McCall culdoplasty, and one associated with a modified Pereyra bladder neck suspension.Two injuries were subtle cystotomies. These compromises of the lower urinary tract were detected during the main operative procedure and immediately rectified. We propose that routine intraoperative cystoscopy associatedwith intravenous administration of indigo carmine is an excellent method for detecting actual and potential lower urinary tract surgical injury. Cystoscopy cannot distinguish which surgical distortion or injury will spontaneously resolve. The identilication of non-blood-tinged urine from both ureteral orifices and the absenceof bladder trauma should eliminate the possibility of lower urinary tract surgical injury, except for ischemic necrosis. Cystoscopy, like laparoscopy, is a procedure that should benefit our patients and should not isolate a specialty.
Urinary incontinence in elite
qulliparous
athletes
Nygaard I.E.; Thompson F.L.; Svengalis S.L.; Albright J.P. USA
OBSTET GYNECOL 199484/2 (183-187) Objective: To determine the prevalence of the symptom of urinary incontinence during athletic endeavors among a group of nulliparous, elite college varsity female athletes. Methods: All women currently participating in varsity athletics at a large state university were asked to fill out a questionnaire about the occurrence of urinary incontinence while participating in their sport and during activities of daily life. One hundred forty-four of 156eligible women (92%) responded. Results: The mean age was 19.9 years, and all women were nulliparous. Overall, 40 athletes (28%) reported urine loss while participating in their sport. The proportions in different sports were: gymnastics 67%, basketball 66%, tennis 50%, field hockey 42%, track 29%, swimming IO%, volleyball 9%, softball 6%, and golf 0%. Twothirds of the women who noted urine loss during athletics were incontinent more often than rarely. There were no statistically significant relations between incontinence and amenorrhea,