What is the success of drug treatment in urge urinary incontinence? What should be measured?

PURPOSE: The aim of this study is to evaluate the efficacy and the tolerability of three classic antimuscarinic drugs used in the treatment of over active bladder syndrome using clinical data and quality of life tests, and to evaluate the parameters affecting the success of these drugs. METHODS: A total of 90 patients with urge urinary incontinence were randomly allocated into three groups either to receive tolterodine (group A), trospium chloride (group B) or oxybutynin (group C). Urogenital distress inventory short form (UDI-6) and Incontinence impact questionnaire short form (IIQ-7) of the Turkish Urogynecology and Pelvic Reconstructive Surgery Association were performed to each patient before and after treatment to evaluate the effectiveness and tolerability of the antimuscarinic drugs. Adverse events were also recorded during treatment. RESULTS: Improved urodynamic test values were recorded after 6 weeks of treatment in each group. Similarly, statistically significant differences were observed in UDI-6 and IIQ-7 test scores before and after treatment. Complete cure was achieved in 86 % of patients in group A; however, complete cure rates were 67 and 80 % in group B and C, respectively. Although, patients reported comparable tolerability against trospium chloride (77 %) and tolterodine (80 %), only 23 % of patients using oxybutynin considered the drug as tolerable. The most common side effect was dry mouth, followed by insomnia. Both dry mouth and insomnia was highest in group C (50 %). One patient (0.3 %) in group B and two patients (0.7 %) in group C reported that they did not want to continue to use the drug. CONCLUSION: Antimuscarinic medications are very successful in the treatment of urge urinary incontinence; however, the success of treatment is not only limited to clinical improvement. Patients do not regard a drug as successful unless it is tolerable, easy to adapt to the daily life and improve the quality of life even it has very successful clinical outcomes.

An unusual growth of ovarian cystic teratoma with multiple floating balls during pregnancy: a case report.

We report a case of ovarian cystic teratoma with an important growth during pregnancy and the sonographic appearance of intracystic multiple, mobile, polygonal structures called intracystic "fat balls." Due to the rapid growth of the lesion, which exceeded 15 cm in diameter, a right oophorectomy was performed. Histopathologic diagnosis confirmed the mature cystic teratoma. The presence of floating balls composed of keratin and fat is rarely seen but is pathognomonic of mature cystic teratomas. Growth of a teratoma during pregnancy is a rare condition.

Early post-partum diabetes mellitus screening rates in patients with history of gestational diabetes.

INTRODUCTION: Patients with history of gestational diabetes (GDM) are at high risk for developing diabetes mellitus (DM) after pregnancy. This study investigates the rate of GDM patients who received screening and the prevalence of DM in the early post-partum period. MATERIALS AND METHODS: This study included 78 patients diagnosed and treated for GDM between January 2005 and December 2007. They were evaluated whether or not they were screened with 75 g oral glucose tolerance test (OGTT) or fasting blood glucose measurement at post-partum 6-12-week period. The rates of DM and impaired glucose tolerance (IGT) were determined. RESULTS: Of 78 GDM patients only 10 (12.8%) patients were screened with OGTT and 27 (34.6%) patients were screened with fasting blood glucose (FBG) measurement. 41 (52.6%) patients did not receive any post-partum screening. Insulin treated patients during pregnancy underwent OGTT more frequently (p = 0.008). We found that 61% of the patients who did not receive any screening test were seen by a doctor for any reason during this period. DM was diagnosed in 50% of patients who underwent OGTT and 7.4% of patients who underwent FBG measurement during early post-partum period (p = 0.013). CONCLUSION: Despite the fact that GDM is generally strictly and carefully monitored during pregnancy, it is usually neglected in the post-partum period. Insulin treated patients during pregnancy should be informed better for post-partum screening with OGTT. OGTT appears to be a better way of screening to diagnose DM.

Posterior sling (infracoccygeal sacropexy): an alternative procedure for vaginal vault prolapse.

This study of 30 patients evaluated the effectiveness and safety of the posterior sling (infracoccygeal sacropexy) in the surgical treatment of vaginal vault prolapse. The patients were reevaluated 3 months, 6 months and yearly postoperatively. Coexisting preoperative symptoms of pelvic pain, urgency, nocturia and 'obstructed' micturition feeling were followed-up. There was remarkable improvement in vault prolapse and in coexisting symptoms.

Recurrent pelvic hydatid cyst obstructing labor, with a concomitant hepatic primary. A case report.

BACKGROUND: Hydatid disease in pregnancy is a rare condition, with an incidence of 1/20,000 pregnancies. Although the female reproductive system is a rare site for hydatid disease, various obstetric and gynecologic presentations have been reported. CASE: A 31-year-old multipara was evaluated due to obstructed labor. Sonographic evaluation revealed an 18-cm hepatic and 15-cm pelvic hydatid cyst at 38 weeks of gestation. A healthy, 3,200-g infant was delivered by cesarean section. The cyst, originating in the right ovary and occupying the pouch of Douglas, was removed surgically. The hepatic cyst was decompressed via the percutaneous approach. The follow-up was uneventful. CONCLUSION: Hydatid disease should be considered in the differential diagnosis of adnexal masses in pregnancy. The percutaneous technique is a promising treatment option for hepatic cysts. Not only the diagnosis but also the treatment of hydatid disease is facilitated with currently available magnetic resonance imaging, computed tomography and ultrasonography.