Chinese validation of Urogenital Distress Inventory and Incontinence Impact Questionnaire short form.

INTRODUCTION AND HYPOTHESIS: UDI-6 and IIQ-7 are useful disease-specific questionnaires evaluating the impact of urinary incontinence on the QOL of women. We aim at validating them in Chinese language. METHODS: Both instruments were translated; 207 urinary incontinent women completed UDI-6 and IIQ-7, SF-36, bladder diary and urodynamic evaluation. The reliability and validity were assessed. RESULTS: There were high internal consistency (Cronbach's alpha for UDI-6 and IIQ-7 was 0.80 and 0.93) and test-retest reliability (Intraclass correlation coefficient was 0.72 and 0.75, P < 0.001). Scoring of UDI-6 and IIQ-7 was negatively correlated with SF-36 (P < 0.001); positively correlated with daytime urinary frequency and incontinent episodes (P < 0.001), and women's VAS (P < 0.001). Subscales of UDI-6 and IIQ-7 could discriminate women with different urodynamic diagnoses. CONCLUSIONS: The Chinese UDI-6 and IIQ-7 is reliable and valid. Study on the responsiveness to treatment is in progress. They are useful in assessing impact of the urinary incontinence in Chinese women.

Psychological morbidity and female urinary incontinence.

Female urinary incontinence is a common yet distressing condition. It affects women of all ages, but is especially common in the elderly. Its prevalence ranges from 15 to 55%, depending on age and population studied. Despite the ubiquity of female urinary incontinence, many incontinent women do not voice their suffering, and urinary incontinence has therefore been dubbed 'the silent epidemic'. The physical impact and social isolation associated with urinary incontinence lead to impairment of quality of life and psychological well-being. It is the aim of this review to discuss the epidemiology and psychological impact of urinary incontinence. The recognition and management of incontinence-related psychological morbidity are also explored.

Expression genomics of cervical cancer: molecular classification and prediction of radiotherapy response by DNA microarray.

PURPOSE: The incidence and mortality rates of cervical cancer are declining in the United States; however, worldwide, cervical cancer is still one of the leading causes of death in women, second only to breast cancer. This disparity is at least partially explained by the absence of or comparatively ineffective screening programs in the developing world. Recent advances in expression genomics have enabled the use of DNA microarray to profile gene expression of various cancers. These expression profiles may be suitable for molecular classification and prediction of disease outcome and treatment response. We envision that expression genomics applied in cervical cancer may provide a more rational approach to the classification and treatment of the disease. EXPERIMENTAL DESIGN: In this report, we examined the expression profiles of cervical cancer compared with normal cervical tissues in DNA microarrays that contained approximately 11,000 features that correspond to either human transcripts with known function or anonymous expressed sequence tags. RESULTS: Our results showed that normal cervical tissues were completely segregated from the cancer samples using about 40 genes whose expressions were significantly different between these specimens. In addition, clinical stage IB and stage IIB tumors could also be classified based on their signature expression patterns. Most importantly, some of the tumor samples were further stratified into two major groups based on their response to radiotherapy, and we were able to predict the response of these patients to radiotherapy from their expression profiles. CONCLUSIONS: Gene expression profiling by DNA microarray may be used for further molecular classification of disease stages and prediction of treatment response in cervical cancer.

Adjuvant low-dose aspirin therapy in poor responders undergoing in vitro fertilization: a prospective, randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the effect of adjuvant low-dose aspirin on utero-ovarian blood flow and ovarian responsiveness in poor responders undergoing IVF. DESIGN: Prospective randomized, double-blind, placebo-controlled study. SETTING: University-affiliated teaching hospital. PATIENT(S): Sixty patients classified as poor responders undergoing IVF. INTERVENTION(S): Supplementation with low-dose aspirin (80 mg daily) or placebo to a long down-regulation protocol. MAIN OUTCOME MEASURE(S): Doppler measurement of intraovarian and uterine pulsatility index was performed before (baseline) and after ovarian stimulation (day of hCG administration). Duration of use and dose of gonadotropins, cycle cancellation rate, number of mature follicles recruited, and oocytes retrieved were also measured. RESULT(S): High cancellation rates were found in both groups (33.3% vs. 26.7%, placebo vs. treatment). There were no significant differences in total dose of hMG used (66 vs. 57 hMG, 75 IU ampules), median number of mature follicles recruited (3.5 vs. 3.0), or median number of oocytes retrieved (4 vs. 3). No significant differences were found in either intraovarian or uterine artery pulsatility index measured at baseline or on the day of hCG administration. CONCLUSION(S): Supplementation with low-dose aspirin failed to improve either ovarian and uterine blood flow or ovarian responsiveness in poor responders undergoing IVF.

Treatment of intractable hyperemesis gravidarum by ondansetron.

Hyperemesis gravidarum is a disabling condition. It is not uncommon that patients request termination of pregnancy because of intolerable symptoms and psychological stress. We report a case in which termination of pregnancy was avoided by the use of ondansetron to treat the hyperemesis gravidarum.

Large choledochal cyst present through 2 pregnancies. A case report.

BACKGROUND: Choledochal cyst is rarely diagnosed during pregnancy, and it is very difficult to make a diagnosis of it clinically or radiologically. CASE: A woman was diagnosed as having an ovarian cyst and gallbladder mucocele on ultrasonography in both her first and second pregnancies. She was asymptomatic, and conservative management was adopted. Three days after delivery of her second child, the patient had a sudden onset of right upper quadrant pain associated with deranged liver function. Emergency laparotomy revealed a type I choledochal cyst with evidence of infection. Excision of the cyst, cholecystectomy and bilateral hepatojejunostomy in the Roux-en-Y fashion were performed. CONCLUSION: A choledochal cyst in pregnancy is difficult to diagnose and poses a threat to mother and fetus.

Prevalence and associated risk factors of retention of urine after caesarean section.

Caesarean section poses higher risk of postpartum urinary retention (PUR) than vaginal delivery. The aim of this study was to identify the prevalence and the associated risk factors of PUR after caesarean section. Two hundred seven parturients (mean age = 31.26 years old, median parity = 0) who delivered by caesarean section were recruited from the postnatal unit of a tertiary hospital in Hong Kong. Voiding was encouraged 6 h after removal of Foley catheters. Transvaginal ultrasound scan was performed immediately after voiding to estimate the postvoid residual bladder volume (PVR). PUR after caesarean section was defined as PVR of more than 150 ml. The results indicated a prevalence of 3.38%. Logistic regression analysis indicating 'lack of progress of labor' was the only significant associated factor (p < 0.001). The findings of this study provide information for further exploration on how to reduce the morbidity caused by PUR in the postoperative period of caesarean section.

Measurement of tension-free vaginal tape trocar insertion and exit forces.

BACKGROUND/AIMS: This study aims to establish a model to measure the forces required for tension-free vaginal tape (TVT) trocar application using a pressure transducer. METHODS: A 3.5 x 3.5 cm pressure transducer was constructed from piezo-resistive material. The transducer digitally recorded the surface contact pressure (pressure = force/area) profile continuously during TVT trocar application. Recordings were successfully obtained from 24 subjects. RESULTS: The mean (standard error) peak contact pressures during application at the right and left side vaginal walls, and right and left side abdominal walls were 1.05 (0.12) pounds per square inch (psi), 1.08 (0.21) psi, 2.49 (0.3) psi and 2.49 (0.3) psi, respectively. On both the right and left side, pair-wise comparisons between trocar insertion and exit forces were significantly different (p < 0.001). CONCLUSION: A model has been developed by which TVT trocar application forces can be objectively measured. The TVT trocar exit force is substantially greater than the insertion force, regardless of side.

Changing prevalence and knowledge of urinary incontinence among Hong Kong Chinese women.

A territory-wide telephone survey was conducted in Hong Kong to assess the prevalence, knowledge, and treatment-seeking behaviour of Chinese women with urinary incontinence, using validated Chinese version of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Women, 540, aged between 17 to 77 years were interviewed. Of the respondents, 40.8% reported stress urinary incontinence, 20.4% had urge incontinence and 15.9% had mixed incontinence. Among these, 16.0% reported quality of life impairment; 9.3% felt frustrated with low morale, and 15.2% had nervous and anxiety problems. However, as many as 78.3% of the respondents did not know that stress urinary incontinence is a disease entity, and 60.6% thought that leakage of urine was a normal aging process. For those respondents having stress urinary incontinence, the first treatment of choice was physiotherapy. The second choice was medication, and surgical treatment was the last option. Respondents with stress urinary incontinence showed higher education level.

Screening test model using duration of labor for the detection of postpartum urinary retention.

AIMS: To construct a screening test model for postpartum urinary retention (PUR), using the duration of labor, which was shown to be the risk factor for PUR. METHODS: A group of 691 consecutive patients were recruited at postpartum day 1. Of the 691 patients, 101 (14.6%) had PUR. The 691 patients were computer-randomized into two groups, 'A' and 'B.' A receiver operating characteristic (ROC) curve was constructed for Group A to determine the optimum cutoff value for screening PUR using the duration of labor. The cutoff value was then applied to Group B to determine the screening test characteristics of the duration of labor: sensitivity, specificity, predictive values, and likelihood ratios. RESULTS: An ROC curve with an area under curve (AUC) of 0.63 (95% CI 0.57-0.69, P < 0.0001) was constructed. A range of cutoff values (with specificity ranging from 0.60 to 0.99) for the duration of labor was determined and the test characteristics computed. According to the test characteristics the optimal cutoff value for the duration of labor was 700 min. This cutoff value for the duration of labor has a specificity of 0.95, negative predicative value of 0.86, and likelihood ratio for a positive test of 0.88. CONCLUSION: A screening test model using the duration of labor can be constructed to predict PUR.

Long-term reproductive outcome subsequent to medical versus surgical treatment for miscarriage.

BACKGROUND: When compared with the conventional surgical evacuation for the treatment of miscarriage, medical evacuation has been largely accepted as an effective and safe management. However, there is a lack of data on the long-term reproductive outcome of these two treatment modalities, which is crucial in patient counselling. The current study evaluates and compares the long-term fertility and pregnancy outcome following these two treatments. METHODS: A cohort of 604 women enrolled in a previous randomized controlled trial comparing medical and surgical evacuation for miscarriage were followed up prospectively by telephone interview at a median of 6 (range 4-9) years using a structured questionnaire. RESULTS: A total of 423 women were contacted and four declined to participate (response rate 69.4%). Of these, 261 women (131 medical and 130 surgical evacuations) had attempted to become pregnant since the miscarriage. There were no differences in their baseline characteristics including age, reproductive and contraceptive history. The natural conception rates were the same (97.7%, P = 0.99) and the cumulative pregnancy rates were similar between groups, being 60 and 80% at 12 and 24 months respectively. The median time-to-pregnancy was 8 months in both groups (P = 0.97) and the subsequent live birth rates (85.2 versus 88.2%, P = 0.72) resulting from the immediate pregnancy following previous treatment were similar. CONCLUSIONS: The long-term conception rate and pregnancy outcome are not different following medical or surgical evacuation for miscarriage. Women should be reassured that their long-term fertility potential will not be compromised after medical treatment.

Determining the reliability of ultrasound measurements and the validity of the formulae for ultrasound estimation of postvoid residual bladder volume in postpartum women.

AIMS: To determine the reliability and validity of ultrasonic assessment of the postvoid residual bladder volume (PVRBV) in postpartum women. METHODS: Ultrasound estimated PVRBVs were performed on 99 consecutive women with postpartum urinary retention, to validate 12 published bladder volume-estimation formulae. This ultrasound-predicted volume was compared with the immediately collected catheterized volume. Comparison of individual formula with the catheterized volumes was performed by using the Intraclass Correlation Coefficient (concordance), and difference plots (bias, linearity of the difference). All volumes were transformed logarithmically to ensure a normal distribution. RESULTS: The postpartum bladder maintained its ellipsoid appearance. One-way analysis of variance showed the variance of the individual formulae ranged from 83.42 to 3463.66 (SD 9.13 to 58.85). The four formulae with the least variance had an intraclass correlation coefficient ranging from 0.93 to 0.96, and a mean difference between volume estimated by the formula and catheterized volume ranging from -0.05 to -0.11 (SD 0.09 to 0.11). The error between the value predicted by the formulae and that of the catheterized volume was linear in only one formula: Volume = (pi x W x Dl x H) / 6. CONCLUSIONS: The results of this study have shown that ultrasonic assessment of the PVRBV in the postpartum period is accurate, and it can be used as a guide to whether transurethral catheterization is necessary.

Effect of one interval vaginal delivery on the prevalence of stress urinary incontinence: a prospective cohort study.

AIMS: To analyze the effect of one interval vaginal delivery on the prevalence of stress urinary incontinence amongst a cohort of nulliparous women. METHODS: A cohort of 276 nulliparous women without incontinence was recruited consecutively in 1996, after they had vaginal delivery, and were followed-up for urinary incontinence in 2000. The age, obstetric variables of the 1996 delivery (mode of delivery, genital tract trauma, birth weight, epidural analgesia, episiotomy, durations of labor, postpartum urinary retention), and the presence of interval vaginal delivery during the follow-up period were recorded. The obstetric factors and the prevalence of urinary stress incontinence at follow-up were then compared between women with and without interval vaginal delivery. Logistic regression analysis was performed to test the independence of the obstetric variables in the index pregnancy and the presence of one interval vaginal delivery, with urinary stress incontinence being the dependent variable. RESULTS: A total of 148 (53.6%) women were followed-up. The prevalence of urinary incontinence was 28.6% in women without interval delivery and 21.1% in women with one interval delivery. There was no significant difference in the prevalence of urinary incontinence between the two groups (chi(2) test, P = 0.31). Logistic regression showed that none of the obstetric variables or the presence of one interval vaginal delivery was significantly associated with urinary incontinence. CONCLUSIONS: One interval vaginal delivery does not increase risk of urinary stress incontinence 4 years after the index vaginal delivery.

Arcus tendineus levator ani tear causing pelvic hematoma after tension-free vaginal tape insertion.

Although vaginal tamponade is usually sufficient for hemostasis, it is not useful if a pelvic hematoma occurs. Here, we report the unusual case of a large pelvic hematoma necessitating laparotomy for hemostasis due to a tear of the arcus tendineus levator ani after insertion of a tension-free vaginal tape.

A study of female urinary tract infection caused by urodynamic investigation.

OBJECTIVE: The purpose of this study was to assess the prevalence of female urinary tract infection before and after urodynamic investigation and to identify the risk factors for urinary tract infection after urodynamic investigation. STUDY DESIGN: Eight hundred twenty-two consecutive incontinent women were recruited. All women were "double-screened" and treated for urinary tract infection before urodynamic investigation: first by mid stream urine culture 4 to 6 weeks before investigation and then by reagent strips for urine leukocytes and nitrites at the time of investigation. The investigation was postponed until the urinary tract infection had been treated. All women then received a standard urodynamic investigation. RESULTS: The prevalence of urinary tract infection before urodynamic investigation was 5.1% (95% CI, 3.6-6.6), and the prevalence after the investigation was 8.4% (95% CI, 6.5-10.3). Three independent risk factors were identified: age >or=70 years (odds ratio, 1.99; 95% CI, 1.14-3.48), previous continence surgery (odds ratio, 1.90; 95% CI, 1.05-3.43), and urinary tract infection before urodynamic investigation (odds ratio, 3.13; 95% CI, 1.43-6.83). The 3 most common uropathogens in the urinary tract infections after the urodynamic investigation were Escherichia coli (46.3%), Enterococcus spp (16.4%), and Enterococcus faecalis (11.9%). CONCLUSION: Despite a stringent screen-and-treat protocol before urodynamic investigation, patients still experienced urinary tract infection.

A probability model for ultrasound estimation of bladder volume in the diagnosis of female urinary retention.

OBJECTIVE: The aim of this study was to evaluate a probability model for ultrasound estimation of bladder volume in the diagnosis of female urinary retention, which is a common condition in the postpartum period. METHODS: A total of 53 women with vaginal delivery were recruited on postpartum day 1, and their bladder volumes were first estimated by ultrasound. Immediately after the ultrasound scans the bladders were catheterized for the true bladder volumes. The ultrasound-estimated bladder volumes were then compared with the catheterized bladder volumes. The data were first tested for non-normality, and then logarithmic transformed in order to conform to normality. A probability model was built using the logarithmic-transformed data, based on the following: an arbitrary cut-off value of 150 ml for urinary retention, linear regression analysis, and paired difference analysis. RESULTS: There was a linear relationship between the ultrasound-estimated and catheterized bladder volumes, which can be represented by the equation: log(10) (Vc) = 0.2959 + 0.8853 log(10) (Vu), where Vc = catheterized bladder volume, and Vu = ultrasound-estimated bladder volume. A normogram was constructed, and the probability of urinary retention presented. CONCLUSIONS: The results of this study showed that our method and statistics are logical by which the probability model of urinary retention is precise enough to support clinical decision-making.