Multilevel musculo-fascial defect magnetic resonance study of female pelvic floor: retrospective case control study in women with pelvic floor dysfunction after the first vaginal delivery.

INTRODUCTION: Magnetic resonance imaging (MRI) provides a detailed display of the pelvic floor structures responsible for normal pelvic floor anatomy. The aim of the study is to assess the appearance of musculo-fascial defects in women with pelvic floor dysfunction following first vaginal delivery. MATERIAL AND METHODS: Analysis of axial T3 (Tesla 3) MRI scans from a case control study of symptomatic (n = 149) and asymptomatic (n = 60) women after first vaginal delivery. Presence and severity of pelvic organ support and attachment system defects in three axial pelvic planes were assessed. RESULTS: In the symptomatic group, major muscular defects were found in 67.1% (for pubovisceral muscle complex) and 87.9% (for iliococcygeal muscle). Only 6.7% of major pubovisceral and 35.0% of major iliococcygeal defects were identified in the controls (p = 0.000). Prolapse patients had an odds ratio (OR) of 22.1 (95% CI 8.94-54.67) to have major pubovisceral muscle complex defect and OR of 4.9 (95% CI 1.51-15.71) to have major iliococcygeal muscle defect. Fascial defects were found in 60.4% and 83.2% the symptomatic group, respectively. Those with prolapse had an OR of 29.1 (95% CI 9.77-86.31) to have facial defect at the level of pubovisceral muscle complex and an OR of 16.9 (95% CI 7.62-37.69) to have fascial defect at the level of iliococcygeal muscle. Uterosacral ligaments detachment was associated with prolapse with an OR of 10.1 (95% CI 4.01-25.29). For the model based on combination on all MRI markers, the area under the receiver operating characteristic curve is 0.921. CONCLUSIONS: This study provides comprehensive data about first vaginal delivery-induced changes in the levator ani muscle and endopelvic fascial attachment system. These changes are seen also in asymptomatic controls, but they are significantly less expressed.

Effect of severity of urinary incontinence on quality of life in women.

AIMS: While the effect of different types of incontinence on the quality of life (QoL) has been clearly documented, the information about the impact of incontinence severity on QoL in women is lacking. Therefore, we investigated whether increasingly severe degrees of incontinence were linearly correlated with poorer QoL. METHODS: We included 391 incontinent women and 81 continent volunteers in the study and assessed them in accordance with routine clinical practice. A 24 h pad-weight test was used to objectively quantify the incontinence severity. We then stratified participants according to incontinence type and severity and assessed correlations between incontinence severity and Patient Perception of Bladder Condition (PPBC), International Consultation on Incontinence short-form questionnaire (ICIQ-SF), and King's Health Questionnaire (KHQ) quality of life scores in the entire study population and in individual groups according to incontinence type. RESULTS: Minimal incontinence was associated with significant negative impact on QoL, as measured by all quality of life assement tools. There were nonlinear correlations between scores on individual questionnaires and daily leakage volumes. Stress urinary incontinence had a weaker impact on quality of life than urge or mixed incontinence, as measured by PPBC (P < 0.0001), KHQ part 1 (P < 0.0001), and KHQ part 2 (P < 0.001). Stress urinary incontinence also had a weaker impact on QoL than mixed incontinence as measured by ICI-Q (P = 0.007). CONCLUSIONS: This study demonstrated that even mild urinary leakage significantly reduces the QoL, while subsequent increase in the degree of incontinence has only minimal additional effect. There was no linear correlation between incontinence severity and QoL.

Is it possible to cure the symptoms of the overactive bladder in women?

PURPOSE: To evaluate the feasibility of discontinuing treatment with mirabegron once symptoms have subsided in patients with overactive bladder (OAB). METHODS: The present study evaluated a total of 159 female OAB patients (age 62.9 ± 12.36), each of which were prescribed 50 mg/day mirabegron (Time point 1-T1). Data obtained from voiding diaries and patient-reported outcome variables were assessed during follow-up visits at months 1, 3, 6, 12, 18 (T2), and 21 (T4). At the 18-month visit, patients with an Urgency Bother-Visual Analog Scale score of ≤ 50% were advised to stop treatment with mirabegron. Upon re-emergence or worsening of OAB symptoms, patients were allowed to start taking medication again at their discretion (T3). Statistical analysis was performed using a Chi-square test. An ANOVA analysis and a two-sample t test were used to evaluate differences between groups. RESULTS: A total of 56 out of 159 (35.3%) patients took 50 mg of mirabegron daily between T1 and T2. A total of 17 out of 56 patients (30.4%) did not meet the criteria for mirabegron discontinuation (Group A). A total of 24 out of 56 patients (42.9%) stopped taking the medication temporarily, but later returned to treatment (Group B). The average time span between T2 and T3 was 53.9 days. Fifteen of 56 patients (26.8%) ceased treatment with mirabegron without starting it again before T4 (Group C). The average time span between T2 and T4, in Group C, was 124.7 days. CONCLUSION: A small percentage of OAB patients were able to discontinue mirabegron due to symptom cessation.

Overactive urinary bladder in elderly female patients: treatment specificities and drug interactions.

Aging is an inevitable process in the life of each organism and it is no different in the human world. According to the world statistics and demographic data, an ever increasing group in our population live to a ripe old age. The paper deals with pharmacological therapy for overactive bladder (OAB) in older women while also considering frequent comorbidities in older age. The prevalence of OAB at this life stage is greater as compared to other, more serious diseases. There are less clinical studies on geriatric patients than those focusing on younger age categories. The effect of pharmacotherapy with antimuscarinics against placebo is demonstrable within all age groups including people aged over 75. With regard to polypharmacotherapy in older adults, antimuscarinics may intervene in drug interactions. Therefore the authors draw attention to these risk factors and the ways to prevent them. Key words: drug interactions - geriatry - overactive bladder - urinary incontinence.

Prospective Randomized Study of MiniArc and Ajust Single Incision Sling Procedures.

OBJECTIVES: The aim of this study was to evaluate the efficacy of the Ajust and MiniArc system mini-sling anti-incontinence procedures for female stress urinary incontinence, at a minimum of 24 months after surgery. METHODS: This prospective, randomized, multicenter study included 66 women with previously untreated stress urinary incontinence, and 63 patients completed the study. These women were randomly divided into two groups; the first group of patients underwent operations using the Ajust (n = 33) technique, while the second group were treated with the MiniArc (n = 33) technique. The efficacy of the Ajust and MiniArc procedures (n = 31/32) was evaluated at an average of 28/29 months (minimum24 months) after the procedures. Subjective assessment of the cure rate and the leakage of urine was based on the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF) and five-point Likert scale. Objective assessment of leakage of urine was assessed by the cough test. RESULTS: Subjective assessment by the ICIQ-UI SF questionnaire showed that 93.5-96.9% of patients were dry or improved 28/29 months after the Ajust/MiniArc operations. Based on evaluation by means of the Likert scale, 83.9/81.3% of patients in the Ajust/MiniArc group were dry or improved. Objective assessment by cough test showed that 93.5/81.3% of patients had negative results for this test 28/29 months after the Ajust/MiniArc procedures. CONCLUSIONS: The cure rates of the Ajust and MiniArc procedures are very good with the follow-up of 24 months.