Urinary incontinence, faecal incontinence and pelvic organ prolapse symptoms 20-26 years after childbirth: A longitudinal cohort study.

OBJECTIVE: To investigate pelvic floor dysfunction (PFD; urinary incontinence (UI), faecal incontinence (FI) and prolapse) ≥20 years after childbirth and their association with delivery mode history and demographic characteristics. DESIGN: Cohort study with long-term follow-up. SETTING: Maternity units in Aberdeen and Birmingham (UK) and Dunedin (NZ). POPULATION: Women giving birth in 1993/1994. METHODS: Postal questionnaires at 20 (New Zealand) or 26 (United Kingdom) years after index birth (n = 6195). Regression analyses investigated associations between risk factors and UI, FI and prolapse symptoms. MAIN OUTCOME MEASURES: Prevalence of self-reported UI, FI, 'something coming down' from or in the vagina (SCD), and the Pelvic Organ Prolapse-Symptom Score, and relationships with delivery method. RESULTS: Thirty-seven per cent (n = 2270) responded at 20/26 years, of whom 61% reported UI (59% of whom reported more severe UI), 22% FI and 17% prolapse symptoms. Having only caesarean section (CS) was associated with a significantly lower risk of UI (OR 0.63, 95% CI 0.46-0.85), FI (OR 0.63, 95% CI 0.42-0.96) and SCD (OR 0.44, 95% CI 0.27-0.74) compared to only spontaneous vaginal deliveries (SVDs). Having any forceps delivery was associated with reporting FI compared to only SVDs (OR 1.29, 95% CI 1.00-1.66), but there was no association for UI (OR 0.95, 95% CI 0.76-1.19) or SCD (OR 1.05, 95% CI 0.80-1.38). Higher current BMI was associated with all PFD outcomes. CONCLUSIONS: Prevalence of PFD continues to increase up to 26 years following index birth, and differences were observed according to delivery mode history. Exclusive CS was associated with less risk of UI, FI and any prolapse symptoms.

Mesh inlay, mesh kit or native tissue repair for women having repeat anterior or posterior prolapse surgery: randomised controlled trial (PROSPECT).

OBJECTIVE: To compare standard (native tissue) repair with synthetic mesh inlays or mesh kits. DESIGN: Randomised controlled trial. SETTING: Thirty-three UK hospitals. POPULATION: Women having surgery for recurrent prolapse. METHODS: Women recruited using remote randomisation. MAIN OUTCOME MEASURES: Prolapse symptoms, condition-specific quality-of-life and serious adverse effects. RESULTS: A Mean Pelvic Organ Prolapse Symptom Score at 1 year was similar for each comparison (standard 6.6 versus mesh inlay 6.1, mean difference [MD] -0.41, 95% CI -2.92 to 2.11: standard 6.6 versus mesh kit 5.9, MD -1.21 , 95% CI -4.13 to 1.72) but the confidence intervals did not exclude a minimally important clinical difference. There was no evidence of difference in any other outcome measure at 1 or 2 years. Serious adverse events, excluding mesh exposure, were similar at 1 year (standard 7/55 [13%] versus mesh inlay 5/52 [10%], risk ratio [RR] 1.05 [0.66-1.68]: standard 3/25 [12%] versus mesh kit 3/46 [7%], RR 0.49 [0.11-2.16]). Cumulative mesh exposure rates over 2 years were 7/52 (13%) in the mesh inlay arm, of whom four women required surgical revision; and 4/46 in the mesh kit arm (9%), of whom two required surgical revision. CONCLUSIONS: We did not find evidence of a difference in terms of prolapse symptoms from the use of mesh inlays or mesh kits in women undergoing repeat prolapse surgery. Although the sample size was too small to be conclusive, the results provide a substantive contribution to future meta-analysis. TWEETABLE ABSTRACT: There is not enough evidence to support use of synthetic mesh inlay or mesh kits for repeat prolapse surgery.

Nanoscopic liquid bridges between chemically patterned atomistic walls.

A binary liquid mixture, containing the Lennard-Jones molecules A and B, in equilibrium with a bulk liquid reservoir near the point of phase separation, confined between atomistic chemically patterned walls, is studied by grand canonical Monte Carlo simulations. In the bulk, the B-rich phase is stable and the A-rich phase is metastable. The walls bear patches attractive to A; when the walls are close, A-rich liquid bridges condense between the patches. The normal and lateral forces on the walls are measured as a function of the wall separation and of the lateral displacement between the patches on opposite walls. When there are one or two molecular layers in the bridge and the wall lattice constant is close to that of crystalline A, the normal and lateral forces depend strongly on the registry of the wall lattices, varying in an oscillatory manner.

Resonantly forced inhomogeneous reaction-diffusion systems.

The dynamics of spatiotemporal patterns in oscillatory reaction-diffusion systems subject to periodic forcing with a spatially random forcing amplitude field are investigated. Quenched disorder is studied using the resonantly forced complex Ginzburg-Landau equation in the 3:1 resonance regime. Front roughening and spontaneous nucleation of target patterns are observed and characterized. Time dependent spatially varying forcing fields are studied in the 3:1 forced FitzHugh-Nagumo system. The periodic variation of the spatially random forcing amplitude breaks the symmetry among the three quasi-homogeneous states of the system, making the three types of fronts separating phases inequivalent. The resulting inequality in the front velocities leads to the formation of "compound fronts" with velocities lying between those of the individual component fronts, and "pulses" which are analogous structures arising from the combination of three fronts. Spiral wave dynamics is studied in systems with compound fronts. (c) 2000 American Institute of Physics.

Turbulent fronts in resonantly forced oscillatory systems.

Phase fronts in the forced complex Ginzburg-Landau equation, a model of a resonantly forced oscillatory reaction-diffusion system, are studied in the 3:1 resonance regime. The focus is on the turbulent (Benjamin-Feir-unstable) regime of the corresponding unforced system; in the forced system, phase fronts between spatially uniform phase-locked states exhibit complex dynamics. In one dimension, for strong forcing, phase fronts move with constant velocity. As the forcing intensity is lowered there is a bifurcation to oscillatory motion, followed by a bifurcation to a regime in which fronts multiply via the nucleation of domains of the third homogeneous phase in the front. In two dimensional systems, rough fronts with turbulent, complex internal structure may arise. For a critical value of the forcing intensity there is a nonequilibrium phase transition in which the turbulent interface grows to occupy the entire system. The phenomena we explore can be probed by experiments on periodically forced light sensitive reaction-diffusion systems.

Shearing of nanoscopic bridges in two-component thin liquid layers between chemically patterned walls.

Bridge phases associated with a phase transition between two liquid phases occur when a two-component liquid mixture is confined between chemically patterned walls. In the bulk the liquid mixture with components A, B undergoes phase separation into an A-rich phase and a B-rich phase. The walls bear stripes attractive to A. In the bridge phase A-rich and B-rich regions alternate. Grand canonical Monte Carlo studies are performed with the alignment between stripes on opposite walls varied. Misalignment of the stripes places the nanoscopic liquid bridges under shear strain. The bridges exert a Hookean restoring force on the walls for small displacements from equilibrium. As the strain increases there are deviations from Hooke's law. Eventually there is an abrupt yielding of the bridges. Molecular dynamics simulations show the bridges form or disintegrate on time scales which are fast compared to wall motion and transport of molecules into or from the confined space. Some interesting possible applications of the phenomena are discussed.