Continence nurse treatment of women's urinary symptoms.

The aim of this study was to establish how accurately a trained continence nurse could allocate appropriate second-line conservative treatment to women without urodynamic investigations. Depending on the number of patients coming taking up the service, there were between five and 12 nurses operating at any one time. Women aged 40 years and over, of which there were 2421 reporting lover urinary tract symptoms, were randomly allocated to a new nurse-led continence service. Of these women, 450 subsequently underwent urodynamic investigation, before which the nurses documented which second-line conservative treatment would be appropriate. The results showed that of all women with detrusor overactivity, 79.1% were correctly allocated anticholinergic treatment, and 64.8% were allocated pelvic floor exercises (PFE). Of all women with urodynamic stress incontinence, 88.8% were allocated only one treatment. This study showed that a trained continence nurse is able to allocate conservative treatment appropriately to the majority of women without the need for urodynamic investigation. This indicated that the management of urinary dysfunction by a team of trained, dedicated nurses has the potential to reduce waiting lists for urodynamic investigation, avoid unnecessary investigations and achieve greater patient satisfaction.

Factors affecting outcome of colposuspension.

A prospective follow-up study of 196 women who underwent a colposuspension operation for genuine stress incontinence (GSI) at the Leicester General Hospital between June 1991 and May 1996 (inclusive) was carried out to review the outcome of surgery. The outcome was based on clinical symptomatology, demonstration of stress incontinence in the clinic and limited postoperative urodynamic studies. The clinical cure rate was 91.33%. Continence rate was reduced by age above 70 years and post-operative urinary tract infections, and not affected by previous colposuspension, or anterior colporrhaphy. On the other hand, previous colposuspension, previous pelvic floor operations and urinary tract infections caused a significantly higher incidence of voiding problems. Older women and those who have had previous bladder neck surgery need special attention in assessment, counselling and in choice of surgery. Reducing postoperative urinary tract infections might help improve the overall outcome of the operation.

Androgen receptor exon 1 CAG repeat length and breast cancer in women before age forty years.

BACKGROUND: We conducted a population-based, case-control-family study to determine whether androgen receptor (AR) exon 1 polymorphic CAG repeat length (CAGn) was a risk factor for early-onset breast cancer in the Australian population. METHODS: Case subjects under 40 years of age at diagnosis of a first primary breast cancer and age-matched control subjects were interviewed to assess family history and other risk factors. AR CAGn length was determined for 368 case subjects and 284 control subjects. Distributions in the two groups were compared by linear and logistic regression, allowing adjustment for measured risk factors. All statistical tests were two-tailed. RESULTS: When analyzed as either a continuous or a dichotomous variable, there was no association between CAG, length and breast cancer risk, before or after adjustment for risk factors. Mean (95% confidence interval [CI]) CAGn lengths were 22.0 (21.8-22.2) for case subjects and 22.0 (21.7-22.3) for control subjects (P = .9). The frequency (95% CI) of alleles with 22 or more CAGn repeats was 0.531 (0.494-0.568) for case subjects and 0.507 (0.465-0.549) for control subjects (P = .4). After adjustment, the average effect on log OR (odds ratio) per allele was 0.16 (95% CI = -0.03 to 0.40; P = .2), and the effect of any allele was equivalent to an OR of 1.40 (95% CI = 0.94-2.09; P = .1). Stratification by family history also failed to reveal any association. Similar results were obtained when alleles were defined by other cutoff points. CONCLUSION: We found no evidence for an association between AR exon 1 CAGn length and breast cancer risk in women under the age of 40, despite having 80% power to detect modest effects.

Postoperative urinary tract infections (UTIs) following single-dose intraoperative antibiotic prophylaxis in colposuspension patients.

The records of 196 women who underwent colposuspension for genuine stress incontinence at the Leicester General Hospital, England, between June 1991 and May 1996 were reviewed for evidence of urinary tract infection (UTI). Variables analyzed include age, type of antibiotic, timing of a positive culture, organism(s) responsible and antibiotic sensitivity. Forty-six patients (23.47%) developed urinary infection; of these, 42 had received single-dose antibiotic prophylaxis with suprapubic catheterization. Thirty-two (76%) of those who developed UTI received augmentin (amoxycillin and clavulanic acid), whereas 10 (24%) were given cefuroxime and metronidazole. Positive cultures were obtained between postoperative days 3 and 28, with a mean of 9.6 days, and 81% occurred after the 7th day. Coliform organisms were responsible for nearly 70% of the infections. UTI is still common after colposuspension, despite single-dose antibiotic prophylaxis. Further studies looking at longer or alternative courses of antibiotics or clean intermittent self-catheterization are essential to establish the best way of curbing UTI in urogynecology patients.

Complete sequence and polymorphism study of the human TYRP1 gene encoding tyrosinase-related protein 1.

The complete 24,667 nucleotide sequence spanning the human TYRP1 gene has been determined from the inserts of two overlapping lambda clones. A LINE-1 repeat element is immediately adjacent to and may demarcate the immediate 5' promoter region of the gene. A search for polymorphism within the seven TYRP1 coding exons has been performed by an RNase mismatch detection procedure. Analysis of the TYRP1 gene in 100 Caucasian individuals of varying hair color has found no amino acid sequence variation nor revealed any hemizygous mutant allele in the hypopigmented phenotype of two 9p- syndrome patients.

The Stamey endoscopic bladder neck suspension: a clinical and urodynamic investigation, including actuarial follow-up over four years.

OBJECTIVE: To assess a modified Stamey endoscopic bladder neck suspension as a management for genuine stress incontinence in women unsuitable for colposuspension because of vaginal narrowing or inefficient voiding. DESIGN: Uncontrolled observational study. SETTING: Regional university gynaecological urology unit. SUBJECTS: A hundred women, median age 58 years, with genuine stress incontinence confirmed by urodynamic investigation; 65 had had previous surgery for the same problem. TREATMENT: A Stamey procedure with monofilament nylon and short buffers of silastic tubing at each anchor site. MAIN OUTCOME MEASURES: Urodynamic reassessment 3 months after surgery and clinical follow-up for up to 4 years, using life table methods. The median follow-up was 27 months. RESULTS: At 3 months the objective cure rate was 83%. Subjectively the cure rates at 4 years were 53% in patients under 65 years of age and 76% in those who were older. Overall mean bladder capacity decreased from 506 to 458 ml after surgery (P less than 0.05) and, in those who were cured, mean peak flow rate fell from 25.5 to 19.6 ml/s (P less than 0.05). The urethral functional length and the pressure transmission in the proximal three quarters were increased by successful surgery (P less than 0.01) but the resting urethral profile, voiding pressure and the frequency of detrusor instability were unchanged. CONCLUSIONS: This modification of the Stamey operation has an important role in the management of elderly patients those with previous unsuccessful operations, and those with inefficient voiding pre-operatively.