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Urinary incontinence following radical vulvectomy
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Citations from the Literature
ease, response was observed in 47% of patients. The therapeutic potential of this regimen should be tested in patients with small-volume disease after debulking surgery. Treatment of advanced gynecologic malignancies with intraarterial chemotherapy and accelera(ed fractionation radiation therapy: A preliminary report LaPolla JP; Roberts WS; Greenberg H; Kavanagh JJ; Quinn SF; Hoffman M; Fiorica J; Cavanagh D Department of Gynecologic Oncology, H Lee Moffitt Cancer Center and Research Institute, PO Box 280179, Tampa, FL 33682-0179, USA GYNJXOL ONCOL 1990,37/l (55-59) The results of a pilot study employing the administration of intraarterial chemotherapy and accelerated fractionation radiotherapy for advanced gynecologic malignancies are reported. The protocol consisted of three treatment sessions every 3 to 4 weeks. Each session consisted of bilateral or unilateral catheterization of the hypogastric artery with the infusion of cisplatin 100 mg/m* on Day 1 and 2-deoxy-5-fluorouridine (FUDR) 300 mg/m* on Day 2. An accelerated fractionation schedule of external-beam radiation was begun on Day 1 consisting of 200 rads twice daily for 4 days (1600 rads per session). Eight patients entered the protocol, and seven completed external-beam radiotherapy. Five completed three intraarterial sessions, and three, two sessions. Five of seven evaluable patients had a complete local response. Local control was sustained from 6 to 24 months in four patients. Complications included three sensorimotor neuropathies, one clinically insignificant catheter-related thrombosis, and three clinically significant radiation injuries. This multimodality treatment for locally advanced gynecologic tumors appears feasible with modification, and continued work exploring this approach is encouraged. Hypothesis: Does breast cancer originate in utero? Trichopoulos D Department of Epidemiology, School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115, USA LANCET 1990,335/8695 (939-940) Factors that increase the risk of cancer during adult life may also increase the risk of cancer when they act in utero (eg, ionising radiation and diethylstilboestrol in human beings and chemicals in animals). The existing empirical data seem to be compatible with the hypothesis that increased concentrations of oestrogens in pregnancy increase the probability of future occurrence of breast cancer in daughters.
GYNECOLOGICAL SURGERY Exercise and incontinence Nygaard I; DeLancey JOL; Arnsdorf L; Murphy E Department of Obstetrics and Gynecology, Box 0718, University of Michigan Medical Center, Ann Arbor, MI 48109-0718, USA OBSTET GYNECOL 1990,75/5 (848-851) Three hundred twenty-six women filled out questionnaires Int J Gynecol Obstet 33
to assess the relationship between exercise and incontinence. Two hundred ninety participants stated that they exercised regularly. Overall, 152 (47010)noted some degree of incontinence, which correlated positively with the number of vaginal deliveries (P < .OOOS).Eighty-seven exercisers (30%) noted incontinence during at least one type of exercise. Incontinence exclusively during exercise was seen in only one woman. Exercises involving repetitive bouncing were associated with the highest incidence of incontinence. Seventeen incontinent exercises (20%) stopped an exercise because of incontinence, whereas 16 (18%) changed the way a specific exercise was done and 48 (55Oro)wore a pad during exercise. Thirty-five percent had discussed their incontinence with a health care professional. These data suggest that incontinence during exercise is a common, although little known, problem. In addition to the behavioral adaptations which women initiate on their own, surgical and nonsurgical treatments may be of benefit.
Urinary incontinence following radical vulveetomy Reid CC; DeLancey JOL; Hopkins MP; Roberts JA; Morley GW Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, MI, USA OBSTET GYNECOL 1990,75/5 (852-858) Although incontinence has been reported after radical vulvectomy, its relationship to operative technique, anatomy, and treatment has not been defined. Twenty-one patients having vulvectomies for vulvar cancer were prospectively evaluated preoperatively and postoperatively with urodynamic function studies. A portion of the urethra was removed in four patients undergoing radical vulvectomy, and 14 had a vulvectomy excision that came within 1 cm of the distal urethra. Six patients (28%) developed a change of continence, with three developing total incontinence, two stress incontinence, and one urge incontinence. All four patients who had a portion of the urethra excised developed stress or total incontinence. The other two patients with incontinence (one total, one urge) had the vulvectomy excision that came close to the urethra. No patient had a change in continence when surgery did not involve or come close to the urethra. When the four patients with a distal urethral resection were compared with patients in whom the urethra was not excised, there was a significant decrease postoperatively in functional urethral length (P < .OOOl), anatomical urethral length (P < .OC01), and distal urethral pressure transmission ratios in Q, (P = .004), Q, (P = .02), and Q, (P = .005); but no difference in urethral support (Q-tip test), flow rates, residual urine, bladder capacity, maximal urethral pressure, resting closure pressure, or squeeze pressure. Histologic examination of urethral specimens demonstrated that a portion of the compressor urethrae muscle was often excised. Radical vulvectomy by itself does not cause incontinence, but it would appear that removal of a portion of the urethra increases the chance of incontinence. This observation has important implications for women who are to undergo vulvectomy and for our current concepts of continence.
Citations from the Literature
ease, response was observed in 47% of patients. The therapeutic potential of this regimen should be tested in patients with small-volume disease after debulking surgery. Treatment of advanced gynecologic malignancies with intraarterial chemotherapy and accelera(ed fractionation radiation therapy: A preliminary report LaPolla JP; Roberts WS; Greenberg H; Kavanagh JJ; Quinn SF; Hoffman M; Fiorica J; Cavanagh D Department of Gynecologic Oncology, H Lee Moffitt Cancer Center and Research Institute, PO Box 280179, Tampa, FL 33682-0179, USA GYNJXOL ONCOL 1990,37/l (55-59) The results of a pilot study employing the administration of intraarterial chemotherapy and accelerated fractionation radiotherapy for advanced gynecologic malignancies are reported. The protocol consisted of three treatment sessions every 3 to 4 weeks. Each session consisted of bilateral or unilateral catheterization of the hypogastric artery with the infusion of cisplatin 100 mg/m* on Day 1 and 2-deoxy-5-fluorouridine (FUDR) 300 mg/m* on Day 2. An accelerated fractionation schedule of external-beam radiation was begun on Day 1 consisting of 200 rads twice daily for 4 days (1600 rads per session). Eight patients entered the protocol, and seven completed external-beam radiotherapy. Five completed three intraarterial sessions, and three, two sessions. Five of seven evaluable patients had a complete local response. Local control was sustained from 6 to 24 months in four patients. Complications included three sensorimotor neuropathies, one clinically insignificant catheter-related thrombosis, and three clinically significant radiation injuries. This multimodality treatment for locally advanced gynecologic tumors appears feasible with modification, and continued work exploring this approach is encouraged. Hypothesis: Does breast cancer originate in utero? Trichopoulos D Department of Epidemiology, School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115, USA LANCET 1990,335/8695 (939-940) Factors that increase the risk of cancer during adult life may also increase the risk of cancer when they act in utero (eg, ionising radiation and diethylstilboestrol in human beings and chemicals in animals). The existing empirical data seem to be compatible with the hypothesis that increased concentrations of oestrogens in pregnancy increase the probability of future occurrence of breast cancer in daughters.
GYNECOLOGICAL SURGERY Exercise and incontinence Nygaard I; DeLancey JOL; Arnsdorf L; Murphy E Department of Obstetrics and Gynecology, Box 0718, University of Michigan Medical Center, Ann Arbor, MI 48109-0718, USA OBSTET GYNECOL 1990,75/5 (848-851) Three hundred twenty-six women filled out questionnaires Int J Gynecol Obstet 33
to assess the relationship between exercise and incontinence. Two hundred ninety participants stated that they exercised regularly. Overall, 152 (47010)noted some degree of incontinence, which correlated positively with the number of vaginal deliveries (P < .OOOS).Eighty-seven exercisers (30%) noted incontinence during at least one type of exercise. Incontinence exclusively during exercise was seen in only one woman. Exercises involving repetitive bouncing were associated with the highest incidence of incontinence. Seventeen incontinent exercises (20%) stopped an exercise because of incontinence, whereas 16 (18%) changed the way a specific exercise was done and 48 (55Oro)wore a pad during exercise. Thirty-five percent had discussed their incontinence with a health care professional. These data suggest that incontinence during exercise is a common, although little known, problem. In addition to the behavioral adaptations which women initiate on their own, surgical and nonsurgical treatments may be of benefit.
Urinary incontinence following radical vulveetomy Reid CC; DeLancey JOL; Hopkins MP; Roberts JA; Morley GW Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, MI, USA OBSTET GYNECOL 1990,75/5 (852-858) Although incontinence has been reported after radical vulvectomy, its relationship to operative technique, anatomy, and treatment has not been defined. Twenty-one patients having vulvectomies for vulvar cancer were prospectively evaluated preoperatively and postoperatively with urodynamic function studies. A portion of the urethra was removed in four patients undergoing radical vulvectomy, and 14 had a vulvectomy excision that came within 1 cm of the distal urethra. Six patients (28%) developed a change of continence, with three developing total incontinence, two stress incontinence, and one urge incontinence. All four patients who had a portion of the urethra excised developed stress or total incontinence. The other two patients with incontinence (one total, one urge) had the vulvectomy excision that came close to the urethra. No patient had a change in continence when surgery did not involve or come close to the urethra. When the four patients with a distal urethral resection were compared with patients in whom the urethra was not excised, there was a significant decrease postoperatively in functional urethral length (P < .OOOl), anatomical urethral length (P < .OC01), and distal urethral pressure transmission ratios in Q, (P = .004), Q, (P = .02), and Q, (P = .005); but no difference in urethral support (Q-tip test), flow rates, residual urine, bladder capacity, maximal urethral pressure, resting closure pressure, or squeeze pressure. Histologic examination of urethral specimens demonstrated that a portion of the compressor urethrae muscle was often excised. Radical vulvectomy by itself does not cause incontinence, but it would appear that removal of a portion of the urethra increases the chance of incontinence. This observation has important implications for women who are to undergo vulvectomy and for our current concepts of continence.