Subject(s)
Colitis, Ulcerative/surgery , Hysterectomy, Vaginal/methods , Pelvic Organ Prolapse , Proctocolectomy, Restorative , Adult , Female , Humans , Pelvic Organ Prolapse/etiology , Pelvic Organ Prolapse/surgery , Proctocolectomy, Restorative/adverse effects , Proctocolectomy, Restorative/methods , Treatment OutcomeABSTRACT
BACKGROUND: Genital tract trauma is common with vaginal births and is associated with significant morbidity, particularly with obstetric anal sphincter injuries (OASIS). Debate continues regarding the effectiveness of perineal support during childbirth in reducing the risk of trauma. OBJECTIVES: This review aimed to assess the effect of routine 'hands on'/manual perineal support (MPS) during childbirth, versus ad hoc/no perineal support ('hands off/poised'), on the risk and degree of perineal trauma. SEARCH STRATEGY: This review is registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007058). We searched the CENTRAL, Embase, Medline, CINAHL, and OVIDs midwifery and infant care databases (from inception to December 2014). SELECTION CRITERIA: Published randomised controlled trials (RCTs) and non-randomised studies (NRSs) evaluating any 'hands on' perineal support technique during childbirth. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trials for inclusion, data extraction, and methodological quality. Discrepancies were resolved by discussion with a third reviewer. MAIN RESULTS: We included five RCTs and seven NRSs in the review. Meta-analysis of RCTs did not demonstrate a statistically significant protective effect of MPS on the risk of OASIS (three studies, 6647 women; relative risk, RR 1.03; 95% confidence interval, 95% CI 0.32-3.36; statistical test for heterogeneity I(2) = 71%). Meta-analysis of NRSs showed a significant reduction in the risk of OASIS with MPS (three studies, 74,744 women; RR 0.45; 95% CI 0.40-0.50; I(2) = 32%). CONCLUSION: Current evidence is insufficient to drive change in practice. An adequately powered randomised trial with an efficient design to evaluate the complex interventions adopted as part of MPS policies, ensuring controlled childbirth, is urgently needed.
Subject(s)
Anal Canal/injuries , Delivery, Obstetric/adverse effects , Lacerations/prevention & control , Obstetric Labor Complications/prevention & control , Perineum/injuries , Adult , Delivery, Obstetric/methods , Female , Humans , Labor Stage, Second , Lacerations/etiology , Massage , Practice Guidelines as Topic , Pregnancy , Randomized Controlled Trials as Topic , RiskABSTRACT
INTRODUCTION AND HYPOTHESIS: Evidence suggests that OAB (overactive bladder) can occur alongside disorders of the colon, such as irritable bowel syndrome (IBS). Moreover, patients with constipation are more likely to develop OAB symptoms than those without. Anticholinergic medications (AcH) are commonly used for treating OAB, and can result in the unwanted side effects of constipation. We aimed to study the relationship of AcH, and their effects on quality of life using the electronic Personal Assessment Questionnaire (ePAQ) by assessing changes in the bowel and bladder domains, pre- and post-AcH treatment. METHODS: Ninety patients completed the ePAQ pre- and post-AcH treatment from January 2011 to April 2014. Data were collected retrospectively and prospectively, and analysed using a paired t test. Effect size (ES) was calculated for OAB and bowel domains to quantify the effect on QoL. RESULTS: There was a significant improvement in the OAB (p = 0.0005) and bowel domains (p = 0.0005). In the bowel domains, the largest effect size was seen for IBS (0.5) followed by continence (0.4), evacuation (0.375) and a small ES was seen for constipation (0.2). There was a reduction in the "degree of bother" in OAB and bowel domains. CONCLUSIONS: Patients may benefit from the possible effects of AcH on their bowels, and assessment of all aspects of pelvic floor function is important before commencing AcH. This may help to counsel patients, with possibly improved compliance with therapy.
Subject(s)
Cholinergic Antagonists/therapeutic use , Quality of Life , Surveys and Questionnaires , Urinary Bladder, Overactive/drug therapy , Cholinergic Antagonists/adverse effects , Constipation/complications , Constipation/drug therapy , Fecal Incontinence/complications , Fecal Incontinence/drug therapy , Female , Humans , Irritable Bowel Syndrome/complications , Irritable Bowel Syndrome/drug therapy , Prospective Studies , Retrospective Studies , Severity of Illness Index , Urinary Bladder, Overactive/complicationsABSTRACT
INTRODUCTION AND HYPOTHESIS: Midurethral slings are an effective and minimally invasive treatment for stress urinary incontinence. One of the most common intraoperative complications is bladder perforation, complicating between 2 and 10% of all operations, and on average 4.7%. It is usually corrected during surgery, with repositioning of the trocars. The purpose of this video is to demonstrate a method of replacing the trocars under direct vision. METHODS: This video exhibits a bladder perforation during insertion of a retropubic midurethral sling (Advantage Fit; Boston Scientific) and gives a step-by step guide to the removal and repositioning of the sling under direct visualisation. CONCLUSION: Repositioning of the trocars under direct vision in cases of bladder perforation may have numerous advantages. It may prevent damage to the urethra, possibly reduce the risk of postoperative infection and may be beneficial for trainees.