Uroflow measurements in healthy female volunteers.

OBJECTIVE: : There is not currently a standard definition of "normal" for uroflowmetry parameters, particularly with respect to spontaneous voids or multiple repeated measurements within an individual. Our study aimed to describe uroflow parameters for "normal" in a group of healthy women based on repeated measurements. METHODS: : Spontaneous voids of twelve healthy women were recorded over two weeks. Additionally, one prompted void per subject was recorded. Prompted voids were compared to the subjects' spontaneous voids. These voids were also compared to those of patients evaluated for urinary incontinence. Groups were compared using paired t tests. RESULTS: : The mean voided volume was 306 ml and the mean maximum flow rate was 49 ml/s. The prompted voids were lower in volume, maximum flow, and duration than spontaneous voids. When corrected for volume, these differences were not significant. Maximum flow rates in patients evaluated for urinary incontinence were lower than those of volunteers. CONCLUSIONS: : Uroflowmetry parameters vary widely between and within healthy volunteers. Prompted voids are representative of spontaneous voids. Maximum flow rates of patients evaluated for urinary incontinence were lower than those of volunteers. In a group of healthy volunteers voiding in a private, spontaneous setting, a maximum flow rate of lower than 17 ml/s (2 SDs below the mean) might be considered abnormally low.

Outcome of a randomized, double-blind, placebo controlled trial of botulinum A toxin for refractory overactive bladder.

PURPOSE: We determined the effectiveness of cystoscopic administration of botulinum-A toxin compared to placebo for the treatment of urinary incontinence in subjects with idiopathic overactive bladder. MATERIALS AND METHODS: Subjects were recruited from the Division of Urogynecology at the University of Rochester. Inclusion criteria were overactive bladder refractory to anticholinergic medications, multiple daily incontinence episodes and a 24-hour pad weight of 100 gm or greater. Subjects with low leak point pressures, increased post-void residual volume or neurological etiologies were excluded from study. Subjects were randomized to placebo or to 1 of 2 doses of botulinum-A toxin. The detrusor was injected at 8 to 10 sites above the trigone. Evaluations were performed at baseline, and at 3 and 6 weeks after injection, and included bladder diaries, pad weights, quality of life questionnaires and urodynamic studies. RESULTS: A total of 22 subjects participated in stage 1 of this 2-stage study. We report on the outcomes of stage 1 of this study. Because stage 2 is still ongoing and investigators remain blind to the doses of botulinum-A toxin, the 2 botulinum-A toxin groups were combined for this report. There were no differences in mean baseline measurements between the 2 groups. Statistically significant improvements in daily incontinence episodes, pads changed per day and quality of life questionnaires were seen in the botulinum-A toxin group with no changes in the placebo group. No change in nocturia, daily voiding frequency, peak flow or detrusor pressure was seen in either group. Of 15 subjects 4 (26%) receiving botulinum-A toxin had a post-void residual volume of 200 cc or greater and 1 subject required intermittent catheterization. Four subjects experienced a urinary tract infection, 2 (13%) in the botulinum-A toxin group and 2 (28%) in the placebo group (not significant). CONCLUSIONS: Botulinum-A toxin can significantly reduce urge urinary incontinence due to overactive bladder at 6 weeks. However, there is a risk of urinary retention requiring self-catheterization.

Pelvic organ prolapse in nulliparous women and their parous sisters.

OBJECTIVE: To investigate the role of vaginal delivery and familial factors in the development of pelvic organ prolapse by comparing the prevalence of this condition in nulliparous women and their parous sisters. METHODS: Pairs of nulliparous and parous postmenopausal sisters were recruited for assessment of pelvic organ prolapse. One hundred one sister pairs underwent clinical evaluation. Pelvic organ prolapse was recorded using the Pelvic Organ Prolapse Quantification System. RESULTS: The majority of women had no pelvic organ prolapse. By compartment there was a 74.3% to 91.1% concordance in prolapse stage within sister pairs. In discordant sister pairs, the parous sister was found to have the more advanced prolapse 88% of the time. CONCLUSION: High concordance of pelvic organ prolapse in nulliparous and parous sister pairs suggests a familial predisposition toward developing this condition. However, vaginal delivery does appear to confer a risk for more advanced pelvic organ prolapse. LEVEL OF EVIDENCE: II-2.