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USEFULNESS OF ANTIBIOTIC PROPHYLAXIS IN INVASIVE URODYNAMICS IN FERTILE AND IN POST MENOPAUSAL FEMALE SUBJECTS
829
830
USEFULNESS OF ANTIBIOTIC PROPHYLAXIS IN INVASIVE URODYNAMICS IN FERTILE AND IN POST MENOPAUSAL FEMALE SUBJECTS
DYNAMIC MR IMAGING OF THE PELVIC FLOOR: TECHNIQUE AND
Siracusano S.1, Tiberio A.1, Simonazzi M.2, Facchini F.2, Alfano V.3, Giannantoni A.3, Ciciliato S.1, Knez R.1, D’aloia G.1, Bernabei M.1 1
FEASIBILITY Karantanas A.H.1, Daskalopoulos G.2, Chondros N.2, Gourtsogiannis N.1, Sofras F.2
University of Trieste, Urology, Trieste, Italy, 2University of Brescia, Urology, Brescia, Italy, 3University of Perugia, Urology, Perugia, Italy
1
INTRODUCTION & OBJECTIVES: We conducted a prospective study to verify the incidence of UTI and to evaluate the usefulness of an oral AB to prevent UTI in fertile and in post menopausal females.
Heraklion, Greece
MATERIAL & METHODS: We studied 324 female subjects undergoing conventional IUD for SUI. 62 were fertile females (mean age 39 yrs) and 262 menopausal females (mean age 62 yrs). A mid voided urine specimen was sent for microscopy and sensitivity testing 7 days before and 3 days after IUD. Females with history of recurrent cystitis or with a culture of organism >105 colony forming units at the urine analysis performed 7 days before urodynamic evaluation where not enrolled. All subjects performed a pressure flow study (PFS) by a single-use. 6-Fr catheter. Standard aseptic methods were used. Females of the two groups were randomised in single blind to receive a dose of norfloxacin 400 mg orally as AB 12 hours before IUD. 7 days after all subjects were reassessed on the result of urine analysis performed on third day from IUD and on the possible reports of hyperpyrexia above 37°C and of hematuria if occurred in the first 72 hours after IUD. The subject was considered positive for UTI if at least one of the above pathological conditions was present. For statistical analysis Chi square test was adopted (p< .05 was considered significant). RESULTS: 71 (21.9%) of 324 females resulted affected by UTI. 17 (24%) of 71 subjects with UTI were fertile females and 54 (76%) of 71 with UTI were menopausal females. 159 (49%) of 324 females received AB while the remaining 165 (51%) of 324 females did not received AB. 126 (79%) of 159 who received AB did not develop UTI while 33 (21%) of 159 who received AB developed UTI. 127 (77%) of 165 who did not receive AB did not develop UTI while 38 (23%) of 165 who did not receive AB developed UTI. The results are reported in table I and table II. Statistical analysis revealed no difference about the incidence of UTI between females who underwent to AB and those who did not receive it.
AB
INTRODUCTION & OBJECTIVES: Dynamic MR imaging may be used as an alternative to dynamic cystoproctography for the evaluation of pelvic floor prolapse and configuration. MR criteria for normality are derived from conventional studies. Our study aimed to describe the MR technique of dynamic pelvic imaging and the feasibility of the study in a small group of symptomatic women. MATERIAL & METHODS: MR imaging was performed with a 1.5 T scanner, phased array abdominal coil and the following pulse sequences: T2-w high resolution in axial and coronal planes, T1-w SE in axial plane and dynamic True Fisp in saggital plane at rest and during Valsaval manoeuvre. Seven women aged 44-67, with urinary incontinence were examined. On saggital static images, the
with UTI
without UTI
Tot.
following were assess: pubococcygeal line (which represents the level of the pelvic
9 (31%)
20 (69%)
29
floor), the H and M lines (which are helpful for confirming pelvic floor laxity),
P>0.05
P>0.05
NoAB 8 (24%) Table I : incidence of UTI in 62 fertile females
AB
University of Creta, Radiology, Heraklion, Greece, 2University of Creta, Urology,
and the angle of the levator plate with the pubococcygeal line (which is helpful for
25 (76%)
33
with UTI
without UTI
Tot.
24 (18%)
106 (82%)
130
P>0.05
P>0.05
no AB 30 (23%) Table II : incidence of UTI in 262 menopausal females
102 (77%)
identifying small bowel prolapse. RESULTS: In all patients mild and moderate prolapse of the bladder was shown, in 3 hypermobility of urethra, in 4 associated uterine prolapses and in 2 rectal prolapses.
132
CONCLUSIONS: MR images provide relatively easy three-dimensional
CONCLUSIONS: The incidence of UTI in menopausal females is higher than in fertile females. The incidence of UTI between females who received AB and those who did not receive AB is not statistically different. There is a relative need of an AB in females underwent to invasive urodynamic study.
conceptualization of the pelvic floor and can significantly influence treatment planning by depicting involvement of one or more of the anatomic compartments.
831
832
URODYNAMIC CHARACTERISATION OF A FEMALE POPULATION WITH CLINICAL SUI AND CONCOMITANT SYMPTOMS SUGGESTIVE OF BLADDER OUTLET OBSTRUCTION
THE NATURAL HISTORY OF FEMALE URINARY INCONTINENCE OVER 5 YEARS
Costa A.M., Gravina G.L., Paradiso Galatioto G., Ronchi P., Gualà L., Vicentini C.
Madersbacher S., Wehrberger C., Temml C., Ponholzer A.
University of L’Aquila, Surgery, L’Aquila, Italy
Donauspital, Dept. of Urology, Vienna, Austria
INTRODUCTION & OBJECTIVES: End-point of the study was to assess urodynamic characteristics of a female population with clinical SUI and to investigate if they can also have an UDS proven bladder outlet obstruction (BOO). With this regard, we considered women urodynamically obstructed if the Qmax was 12 ml/s or less and the PdetQmax was 25 cmH2O or greater.
INTRODUCTION & OBJECTIVES: The natural history of urinary incontinence (UI) is poorly understood with less than 10 longitudinal studies reported to date. To investigate this issue we performed a longitudinal study over 5 years in a female population.
MATERIAL & METHODS: 190 neurologically intact women divided in: a BOO group (89 subjects) and a SUI group (101 subjects). The women in the BOO group presented obstructive and/or irritative LUTS. Patients with SUI were included only if a chief compliant of SUI and a positive 24-hour pad test were present. SUI group was then categorized based on presence or absence of adjunctive obstructive symptoms and named SUI without BOO (43 patients) and SUI with BOO (58 patients) subgroups. (P/FQmax, PdetQmax and BOOI were evaluated for each patient. Patients were excluded from the study if they had: episode of UUI during filling due to bladder overactivity, inability to void with urethral catheter in place. All subjects underwent a two fill and void UDS in a sitting position. All P values less than 0.01 were considered to indicate significance. All statistical tests were two-tailed. ANOVA test was used to compare the results of the different groups. When we performed a Post-Hoc analysis, pair wise multiple comparisons were made with Tukey HSD test. RESULTS: Our statistical analysis revealed that age, parity and menopause were not factors that affected PdetQmax, Qmax or BOOI (p>0,01). Qmax values in SUI with BOO group was less than in SUI group (20.8+/-8.1ml/s vs. 25.8+/-6.8ml/s; p=0.0075) but it was greater than in BOO group (20.8+/-8.1ml/s vs. 12.5+/-6.5ml/s; p<0.0001). Women in SUI with BOO group showed lower PdetQmax values than the obstructed subjects (21.2+/-10.1cmH2O vs. 33.8+/-14.2cmH2O; p<0.0001) and greater levels respect to the SUI group (21.2+/-10.1cmH2O vs. 15.2+/-8.9cmH2O; p=0.009). For BOOI, subjects affected to SUI with BOO presented lower outlet resistance than BOO patients (-20.1+/-19.6 vs. 8.9+/-21.9; p<0,0001) and greater resistance respect to SUI group (-20.1+/-19.6 vs. –35.6+/-16.9; p=0.0022). By applying cut-off values in order to detect urodynamic BOO in our female population, we observed that bladder outlet obstruction was present in 15.7% of patients in SUI group, in 26% of patients of SUI with BOO and only 2,1% of subjects in SIU without BOO. CONCLUSIONS: Our SUI with BOO population presented urodynamic values significantly different either from SUI without BOO or from BOO groups. In particular, by evaluating the outlet resistance, we noticed that SUI with BOO group, in spite of the chief complaint of stress urinary incontinence, did not present with chronically reduced outlet resistance as women with SUI. The identification of voiding dysfunctions in SUI subjects could represent not only a doctrinal speculation but a way to identify which patients could have unsatisfactory surgical outcomes.
Eur Urol Suppl 2006;5(2):230
MATERIAL & METHODS: Women who underwent a health investigation 1999/2000 in the area of Vienna completed the Bristol Female LUTS questionnaire. Five years later (2005) all women (n=925) aged >40yrs in 2000 were invited to repeat the questionnaire that was sent out by mail. RESULTS: A total of 441 women (47.7%) returned the questionnaire and entered the 5 years longitudinal study. Responders and non-responders were comparable regarding sociodemographic parameters, presence/severity of LUTS and urinary incontinence and laboratory data. In 2000, the prevalence of UI defined as any involuntary urine loss during the past 4 weeks was 32%. This percentage increased to 43% (+11%) 5 years later, hence the incidence of was 2.2%/year. of those with UI at baseline (n=114), a progression of UI was observed by 38%, a remission by 26% and in 36% the degree of UI did not change over 5 years. A full remission of UI was reported by 27 women (19%). Within 5 years 77 women (26%) developed a de novo UI, the majority were mild forms. More than half of the women with de novo UI have not consulted a doctor. About one third did not receive any form of therapy, one third had pelvic floor training, 13% medical therapy and only one woman (0.2%) underwent surgery. CONCLUSIONS: This 5 years longitudinal study design provides insights into progression and remission rates and the incidence of UI in a collective of apparently healthy women.
830
USEFULNESS OF ANTIBIOTIC PROPHYLAXIS IN INVASIVE URODYNAMICS IN FERTILE AND IN POST MENOPAUSAL FEMALE SUBJECTS
DYNAMIC MR IMAGING OF THE PELVIC FLOOR: TECHNIQUE AND
Siracusano S.1, Tiberio A.1, Simonazzi M.2, Facchini F.2, Alfano V.3, Giannantoni A.3, Ciciliato S.1, Knez R.1, D’aloia G.1, Bernabei M.1 1
FEASIBILITY Karantanas A.H.1, Daskalopoulos G.2, Chondros N.2, Gourtsogiannis N.1, Sofras F.2
University of Trieste, Urology, Trieste, Italy, 2University of Brescia, Urology, Brescia, Italy, 3University of Perugia, Urology, Perugia, Italy
1
INTRODUCTION & OBJECTIVES: We conducted a prospective study to verify the incidence of UTI and to evaluate the usefulness of an oral AB to prevent UTI in fertile and in post menopausal females.
Heraklion, Greece
MATERIAL & METHODS: We studied 324 female subjects undergoing conventional IUD for SUI. 62 were fertile females (mean age 39 yrs) and 262 menopausal females (mean age 62 yrs). A mid voided urine specimen was sent for microscopy and sensitivity testing 7 days before and 3 days after IUD. Females with history of recurrent cystitis or with a culture of organism >105 colony forming units at the urine analysis performed 7 days before urodynamic evaluation where not enrolled. All subjects performed a pressure flow study (PFS) by a single-use. 6-Fr catheter. Standard aseptic methods were used. Females of the two groups were randomised in single blind to receive a dose of norfloxacin 400 mg orally as AB 12 hours before IUD. 7 days after all subjects were reassessed on the result of urine analysis performed on third day from IUD and on the possible reports of hyperpyrexia above 37°C and of hematuria if occurred in the first 72 hours after IUD. The subject was considered positive for UTI if at least one of the above pathological conditions was present. For statistical analysis Chi square test was adopted (p< .05 was considered significant). RESULTS: 71 (21.9%) of 324 females resulted affected by UTI. 17 (24%) of 71 subjects with UTI were fertile females and 54 (76%) of 71 with UTI were menopausal females. 159 (49%) of 324 females received AB while the remaining 165 (51%) of 324 females did not received AB. 126 (79%) of 159 who received AB did not develop UTI while 33 (21%) of 159 who received AB developed UTI. 127 (77%) of 165 who did not receive AB did not develop UTI while 38 (23%) of 165 who did not receive AB developed UTI. The results are reported in table I and table II. Statistical analysis revealed no difference about the incidence of UTI between females who underwent to AB and those who did not receive it.
AB
INTRODUCTION & OBJECTIVES: Dynamic MR imaging may be used as an alternative to dynamic cystoproctography for the evaluation of pelvic floor prolapse and configuration. MR criteria for normality are derived from conventional studies. Our study aimed to describe the MR technique of dynamic pelvic imaging and the feasibility of the study in a small group of symptomatic women. MATERIAL & METHODS: MR imaging was performed with a 1.5 T scanner, phased array abdominal coil and the following pulse sequences: T2-w high resolution in axial and coronal planes, T1-w SE in axial plane and dynamic True Fisp in saggital plane at rest and during Valsaval manoeuvre. Seven women aged 44-67, with urinary incontinence were examined. On saggital static images, the
with UTI
without UTI
Tot.
following were assess: pubococcygeal line (which represents the level of the pelvic
9 (31%)
20 (69%)
29
floor), the H and M lines (which are helpful for confirming pelvic floor laxity),
P>0.05
P>0.05
NoAB 8 (24%) Table I : incidence of UTI in 62 fertile females
AB
University of Creta, Radiology, Heraklion, Greece, 2University of Creta, Urology,
and the angle of the levator plate with the pubococcygeal line (which is helpful for
25 (76%)
33
with UTI
without UTI
Tot.
24 (18%)
106 (82%)
130
P>0.05
P>0.05
no AB 30 (23%) Table II : incidence of UTI in 262 menopausal females
102 (77%)
identifying small bowel prolapse. RESULTS: In all patients mild and moderate prolapse of the bladder was shown, in 3 hypermobility of urethra, in 4 associated uterine prolapses and in 2 rectal prolapses.
132
CONCLUSIONS: MR images provide relatively easy three-dimensional
CONCLUSIONS: The incidence of UTI in menopausal females is higher than in fertile females. The incidence of UTI between females who received AB and those who did not receive AB is not statistically different. There is a relative need of an AB in females underwent to invasive urodynamic study.
conceptualization of the pelvic floor and can significantly influence treatment planning by depicting involvement of one or more of the anatomic compartments.
831
832
URODYNAMIC CHARACTERISATION OF A FEMALE POPULATION WITH CLINICAL SUI AND CONCOMITANT SYMPTOMS SUGGESTIVE OF BLADDER OUTLET OBSTRUCTION
THE NATURAL HISTORY OF FEMALE URINARY INCONTINENCE OVER 5 YEARS
Costa A.M., Gravina G.L., Paradiso Galatioto G., Ronchi P., Gualà L., Vicentini C.
Madersbacher S., Wehrberger C., Temml C., Ponholzer A.
University of L’Aquila, Surgery, L’Aquila, Italy
Donauspital, Dept. of Urology, Vienna, Austria
INTRODUCTION & OBJECTIVES: End-point of the study was to assess urodynamic characteristics of a female population with clinical SUI and to investigate if they can also have an UDS proven bladder outlet obstruction (BOO). With this regard, we considered women urodynamically obstructed if the Qmax was 12 ml/s or less and the PdetQmax was 25 cmH2O or greater.
INTRODUCTION & OBJECTIVES: The natural history of urinary incontinence (UI) is poorly understood with less than 10 longitudinal studies reported to date. To investigate this issue we performed a longitudinal study over 5 years in a female population.
MATERIAL & METHODS: 190 neurologically intact women divided in: a BOO group (89 subjects) and a SUI group (101 subjects). The women in the BOO group presented obstructive and/or irritative LUTS. Patients with SUI were included only if a chief compliant of SUI and a positive 24-hour pad test were present. SUI group was then categorized based on presence or absence of adjunctive obstructive symptoms and named SUI without BOO (43 patients) and SUI with BOO (58 patients) subgroups. (P/FQmax, PdetQmax and BOOI were evaluated for each patient. Patients were excluded from the study if they had: episode of UUI during filling due to bladder overactivity, inability to void with urethral catheter in place. All subjects underwent a two fill and void UDS in a sitting position. All P values less than 0.01 were considered to indicate significance. All statistical tests were two-tailed. ANOVA test was used to compare the results of the different groups. When we performed a Post-Hoc analysis, pair wise multiple comparisons were made with Tukey HSD test. RESULTS: Our statistical analysis revealed that age, parity and menopause were not factors that affected PdetQmax, Qmax or BOOI (p>0,01). Qmax values in SUI with BOO group was less than in SUI group (20.8+/-8.1ml/s vs. 25.8+/-6.8ml/s; p=0.0075) but it was greater than in BOO group (20.8+/-8.1ml/s vs. 12.5+/-6.5ml/s; p<0.0001). Women in SUI with BOO group showed lower PdetQmax values than the obstructed subjects (21.2+/-10.1cmH2O vs. 33.8+/-14.2cmH2O; p<0.0001) and greater levels respect to the SUI group (21.2+/-10.1cmH2O vs. 15.2+/-8.9cmH2O; p=0.009). For BOOI, subjects affected to SUI with BOO presented lower outlet resistance than BOO patients (-20.1+/-19.6 vs. 8.9+/-21.9; p<0,0001) and greater resistance respect to SUI group (-20.1+/-19.6 vs. –35.6+/-16.9; p=0.0022). By applying cut-off values in order to detect urodynamic BOO in our female population, we observed that bladder outlet obstruction was present in 15.7% of patients in SUI group, in 26% of patients of SUI with BOO and only 2,1% of subjects in SIU without BOO. CONCLUSIONS: Our SUI with BOO population presented urodynamic values significantly different either from SUI without BOO or from BOO groups. In particular, by evaluating the outlet resistance, we noticed that SUI with BOO group, in spite of the chief complaint of stress urinary incontinence, did not present with chronically reduced outlet resistance as women with SUI. The identification of voiding dysfunctions in SUI subjects could represent not only a doctrinal speculation but a way to identify which patients could have unsatisfactory surgical outcomes.
Eur Urol Suppl 2006;5(2):230
MATERIAL & METHODS: Women who underwent a health investigation 1999/2000 in the area of Vienna completed the Bristol Female LUTS questionnaire. Five years later (2005) all women (n=925) aged >40yrs in 2000 were invited to repeat the questionnaire that was sent out by mail. RESULTS: A total of 441 women (47.7%) returned the questionnaire and entered the 5 years longitudinal study. Responders and non-responders were comparable regarding sociodemographic parameters, presence/severity of LUTS and urinary incontinence and laboratory data. In 2000, the prevalence of UI defined as any involuntary urine loss during the past 4 weeks was 32%. This percentage increased to 43% (+11%) 5 years later, hence the incidence of was 2.2%/year. of those with UI at baseline (n=114), a progression of UI was observed by 38%, a remission by 26% and in 36% the degree of UI did not change over 5 years. A full remission of UI was reported by 27 women (19%). Within 5 years 77 women (26%) developed a de novo UI, the majority were mild forms. More than half of the women with de novo UI have not consulted a doctor. About one third did not receive any form of therapy, one third had pelvic floor training, 13% medical therapy and only one woman (0.2%) underwent surgery. CONCLUSIONS: This 5 years longitudinal study design provides insights into progression and remission rates and the incidence of UI in a collective of apparently healthy women.