An overview of treatment of overactive bladder syndrome in women.

Overactive bladder syndrome (OAB) is a common, often under-reported and under-treated condition that significantly affects the quality of life (QoL) of the sufferer and is associated with enormous related costs. Treatments options for OAB include lifestyle modifications, behavioural therapy, pharmacotherapy, neuromodulation, Botulinum toxin therapy and surgical interventions. For this paper, the Embase, Cochrane and Medline databases were searched for studies relating to the treatment options for OAB with (urge urinary incontinence) UUI from 1975 to 2010. Studies were also obtained from references of published reviews. Search terms used for retrieval were: overactive bladder syndrome, urge urinary incontinence, anticholinergics, Botulinum toxin A, sacral neuromodulation and clam bladder augmentation. The aim of this paper is to provide an overview of the treatment options currently available for women with OAB.

Stress urinary incontinence in continent primigravidas.

Stress urinary incontinence (SUI) is an often under-reported and under-treated condition. It can affect the psychological and social wellbeing of a woman; it can have long-term effects on their quality of life and is associated with enormous health-related costs. SUI is the most common type of urinary incontinence (UI) in pregnant women. SUI is a common aftermath of the first pregnancy and delivery. For the purpose of this review, we will be presenting data from studies of healthy primigravidae continent prior to pregnancy. For this review paper, the Embase, Cochrane and Medline databases were searched for studies relating SUI in pregnancy and the treatment options for SUI postnatally from 1969 to 2010. Studies were also obtained from references of published reviews. Understanding the causative factors and treatment options can health professionals deliver more informed counselling to their patients and encourage motivation and compliance for therapeutic options.

A randomised controlled trial evaluating the use of polyglactin (Vicryl) mesh, polydioxanone (PDS) or polyglactin (Vicryl) sutures for pelvic organ prolapse surgery: outcomes at 2 years.

The effects at 2 years of polyglactin (Vicryl) mesh inlay and polydioxanone (PDS) or polyglactin (Vicryl) suture material on prolapse symptoms, urinary, bowel, sexual function and prolapse related Quality-of-Life (QoL) in women undergoing pelvic organ prolapse surgery were evaluated in a randomised controlled trial with a 2 × 2 factorial design of Vicryl mesh (n = 32) or not (n = 34) and PDS (n = 33) or Vicryl suture (n = 33). The response rate at 2 years was 82%. There were no differences in the prolapse symptom scores between the randomised groups. Prolapse-related QoL score (mean difference: 2.05, 95% CI 0.19-3.91) and urinary incontinence score (mean difference: 2.56, 95% CI 0.02-5.11) were significantly lower (better) in women who had Vicryl compared with PDS sutures. The apparent superiority of the prolapse-related QoL and urinary incontinence scores in women using Vicryl suture material (vs PDS) needs to be confirmed in a larger trial.

Management of placenta praevia and accreta.

With the rising incidence of caesarean sections, the numbers of cases of placenta praevia accreta and its complications is continuing to increase. There is a paucity of information about the management of placenta praevia accreta. An Embase and MEDLINE search was performed using the keywords 'placenta praevia', 'placenta accreta', and 'placenta praevia and accreta', from 1978 to 2010. Further articles were identified by cross-referencing. In addition to the above information from the Royal College of Obstetricians and Gynaecologists Guideline on placenta praevia and placenta praevia accreta, RCOG Guideline No. 27 and the Confidential Enquiry into Maternal Deaths in the UK were searched. The review discusses the incidence, predisposing factors, pathogenesis, diagnosis, clinical implications and management options of this condition. It is concluded that a multidisciplinary team approach is essential to reduce neonatal and maternal morbidity and mortality. The mainstay of treatment is by caesarean hysterectomy, however in carefully selected cases, conservative options may be considered with caution.

A randomised controlled trial evaluating the use of polyglactin mesh, polydioxanone and polyglactin sutures for pelvic organ prolapse surgery.

To compare the effectiveness of polyglactin mesh, and polydioxanone or polyglactin sutures in women having pelvic organ prolapse surgery. Randomised controlled trial with a factorial 2(2 design of polyglactin mesh or not, and polydioxanone or polyglactin suture. Outcomes were assessed using questionnaires at baseline and on the third day and at 6 months after surgery. Women were also examined clinically 3 months after surgery. The primary outcome was the subjective improvement in prolapse symptoms and quality of life scores from baseline to 6 months. There was a subjective improvement in the prolapse symptom score from baseline to 6 months after surgery (mean difference of 9.2 (95% CI for difference 7.2-11.2, p < 0.001) and an improvement in the mean quality of life score over the same period with a reduction of 3.4 (95% CI for difference 2.4-4.3, p < 0.001). However, there were no significant differences in the mean difference in prolapse symptoms and quality of life (QoL) scores according to the randomised groups. The majority (86%) of women were satisfied with their surgery. Our study demonstrated that at short-term follow-up, there was no significant difference in the mean differences in prolapse symptoms and QoL scores after surgery using polyglactin mesh or not, polyglactin or polyglactin sutures, but the numbers were too small for a definitive conclusion. Longer-term follow-up and/or a larger trial are required.

Comparison of the long-term effects of simple total abdominal hysterectomy with transcervical endometrial resection on urinary incontinence.

OBJECTIVE: To test the hypothesis that the hospital referral rate for urinary incontinence (UI) symptoms, within 10 years of a simple total abdominal hysterectomy (TAH) for dysfunctional uterine bleeding (DUB), would differ to that after a transcervical resection of the endometrium (TCRE). DESIGN: Retrospective case note review. SETTING: Teaching hospital in north east Scotland. POPULATION: All women who had a TAH (316) or a TCRE (229) for DUB, during the period from 1 January 1990 to 31 December 1994, who had never been referred for symptoms of UI prior to their operation. METHODS: Independent t tests, Mann-Whitney U tests and Chi-squared tests were used to compare the two study groups in terms of demographic details and outcome measures. Newcombe's method for the comparison of two unpaired proportions was used to calculate 95% CIs for the differences in outcome measures between the two operations. Logistic regression was conducted to investigate associations with hospital referral for UI. MAIN OUTCOME MEASURES: Hospital referral for UI at 10 years follow up. RESULTS: There were significantly more hospital referrals for UI in the TAH group compared with the TCRE group (46 [15%] versus 16 [7%]; OR 2.27, 95% CI 1.25-4.12). More women were referred for urological investigations after a TAH than after a TCRE (39 [12%] versus 13 [6%], 95% CI for the difference in proportions 2-11%). A higher, but statistically nonsignificant, proportion of women had objectively demonstrated UI after a TAH than after a TCRE (25 [8%] versus 10 [4%], 95% CI for the difference in proportions -1 to 8%). There were a greater number of hospital referrals for treatment of UI in the TAH group (36, 11%) than in the TCRE group (12, 5%), 95% CI for the difference in proportions (1-11%). After adjusting for age, weight, smoking status and mode of delivery, the increased rate of hospital referral for UI after TAH remained, with an odds ratio of 2.31, 95% CI 1.24-4.30. CONCLUSIONS: TAH is associated with a significantly increased incidence of hospital referral for UI, urological investigations and treatment for UI at 10 years of follow up compared with TCRE.

B-Lynch sutures for major primary postpartum haemorrhage at caesarean section.

This was a retrospective observational study of 11 consecutive patients of major primary postpartum haemorrhage (PPH) who had the B-Lynch suture at the time of caesarean section, performed between 1 March 2001 and 31 March 2004 at a teaching hospital in Scotland. Case-note review was performed in 123 patients, who had major primary PPH to identify patients who had B-Lynch sutures at the time of caesarean section. The patient's age, parity, gestation of pregnancy at which the B-Lynch suture was performed, the indication for caesarean section and the cause of primary major PPH were recorded. The operative details, intraoperative and immediate postoperative complications and the need for subsequent hysterectomy were noted. The patients were followed-up with clinic visits at 6 weeks and any further hospital referral for late postoperative complications and whether subsequent successful pregnancy was achieved, were documented. The incidence of major PPH in our centre was 0.5% of the total deliveries, of which 11 cases had the B-Lynch suture applied at the time of caesarean section. The patients were aged between 25 and 38 years old (mean 31 years). Parity ranged from 0 to 1 and the gestational age at which the procedure was performed ranged from 34 to 41 weeks (mean 38 weeks). Ten operations (91%) were performed by senior registrars supervised by the consultant on call and one (9%) case was performed by a consultant on call. All cases had the B-Lynch sutures performed for major primary PPH caused by uterine atony at the time of caesarean section. The weight of the babies delivered ranged between 2,110 - 4,820 g (mean 3,500 g). The total blood loss at surgery ranged from 2,000 - 10,000 ml (mean 3,500 ml). Only three patients (28%) required hysterectomy. All the patients made a good postoperative recovery. The hospital stay ranged from 4 - 24 days (mean 8 days). The patient who remained in hospital for 24 days did so because her baby was admitted into the neonatal unit. All the patients were reviewed 6 weeks postnatally. There was no significant morbidity. A subsequent successful pregnancy has been achieved in one patient.

Twenty-five sacrospinous ligament fixation procedures in a district general hospital: our experience.

The aim of this study was to assess the safety and medium term efficacy of sacrospinous ligament fixation procedure for grade 2 and grade 3-uterovaginal prolapse. This retrospective case study was performed between 1 July 2000 - 4 July 2003 at a District General Hospital in Scotland. For data collection, patient files, theatre records and the computer database were reviewed. The procedure was performed on 25 women. The subjective cure rate in our department was 23/25 (92%) and the recurrence rate was 2/25 (8%). These two patients underwent repeat surgery successfully. The mean follow-up time was 2 years (range 6 months to 3 years). The immediate postoperative complication rate was 2/25 (8%). The late postoperative complications rate was 7/25(28%). We concluded that the sacrospinous ligament fixation is safe and effective with good medium-term results and few postoperative complications. It should be regarded as a good primary procedure in a District General Hospital.