Association of gene polymorphisms with women urinary incontinence.

Aim of study was set to investigate the association of women urinary incontinence (UI) with serotonin receptor HTR2A T102C and beta 3-adrenergic receptor ADRB3 Trp64Arg genes polymorphisms. The study included 110 women with Urge, Stress, and Mixed UI types and the control group - 105 continent women. Both groups have filled in the ICIQ-FLUTS questionnaire and their blood genotyping was performed. Urge UI subgroup was older and had higher body mass index (BMI) in comparison to other UI types and control group. More than half of all women had family history of UI in Stress UI and Mixed UI subgroups. The frequency of HTR2A T102C gene polymorphism's minor allele C and genotype CC was significantly more expressed in Urge UI subgroup, as compared with control group (C-77.3 vs 58.7%, p = 0.007 and CC-57.6 vs 31.1%, p = 0.015). The ADRB3 Trp64Arg gene polymorphism did not differ between groups. The regression analysis revealed CC genotype (OR = 3.06, 95% CI: 1.11-8.43; p = 0.030) and allele C (OR = 2.53, 95% CI: 1.16-5.53; p = 0.020) were risk factors for development of Urge UI. We conclude that HTR2A T102C gene polymorphism affected the development of Urge UI.

Affective Symptoms and Health-Related Quality of Life Among Women with Stress Urinary Incontinence: Cross-Sectional Study.

PURPOSE: To evaluate the relationship between affective symptoms, clinical variables of uro-gynaecological history and health-related quality of life (QoL) among women with stress urinary incontinence (SUI) in comparison to healthy controls. PATIENTS AND METHODS: In a cross-sectional study, 80 women 30 to 80 years of age diagnosed with SUI and 97 controls without symptoms of SUI provided sociodemographic data and answered the King's Health Questionnaire (KHQ) for assessing the QoL among individuals with urinary incontinence. Symptoms of anxiety and depression were assessed by Hospital Anxiety and Depression (HAD) scale with a threshold ≥7. A multiple regression was performed to reveal the cross-sectional predictors of affective symptoms and QoL among women with SUI. RESULTS: Women with SUI had a significantly higher prevalence of symptoms of anxiety and depression than the controls (50% vs 11% and 29% vs 3.1%, respectively; both p<0.001) and worse health-related QoL on all domains of the KHQ. In multiple logistic regression models adjusted for sociodemographic and clinical variables of uro-gynaecological history, perceived symptoms of mild-to-severe depression were associated with a higher amount of leakage (OR=3.59; 1.04-12.4), older age (≥55 years old vs <55 years old) (OR=5.82; 1.47-23.1) and higher BMI (OR=1.13; 1.01-1.27). In addition, when controlled for all domains of the KHQ, perceived depressive symptoms were associated with the "emotions" domain of the KHQ (OR=1.06; 1.02-1.09). Perceived anxiety symptoms (independent of age) were related to shorter duration of SUI, low parity, absence of comorbidities and to higher scores on the "personal relationships" and "emotions" domains of the KHQ. CONCLUSION: Women with SUI have a significantly poorer QoL than their counterparts without SUI. It was determined that one-half of women with SUI had anxiety symptoms, while one-third of women with SUI had depressive symptoms. In addition, this study indicated that QoL was associated with anxiety symptoms in middle-aged women and with depressive symptoms in older women, especially those with a shorter duration of SUI.

The Link between Thyroid Autoimmunity, Depression and Bipolar Disorder.

Depression and bipolar disorder are two major psychiatric illnesses whose pathophysiology remains elusive. Newly emerging data support the hypothesis that the dysfunction of the immune system might be a potential factor contributing to the development of these mental disorders. The most common organ affected by autoimmunity is the thyroid; therefore, the link between autoimmune thyroid disorders and mental illnesses has been studied since the 1930s. The aim of this review is to discuss the associations between thyroid autoimmunity, depression and bipolar disorder.

Pelvic Floor Muscle Training With Or Without Tibial Nerve Stimulation and Lifestyle Changes Have Comparable Effects on The Overactive Bladder. A Randomized Clinical Trial.

PURPOSE: To compare effects of transcutaneous posterior tibial nerve stimulation (TPTNS) and pelvic floor muscle training (PFMT) in women with overactive bladder syndrome (OAB). MATERIAL AND METHODS: We randomized 67 women ? 18 years with OAB to three parallel groups: group I (n = 22) received life-style recommendations (LSR) only; group II (n = 24) had LSR + PFMT and group III (n = 21) had LSR + PFMT + TPTNS. Urgency, evaluated by a 3-day voiding diary before treatment and six weeks later, was the main outcome measure. The King's College Health Questionnaire was also administered. RESULTS: Urgency was significantly reduced in all three groups from 5.1 ± 3.7 to 3.8 ± 3.2 episodes/day, P = .016 in group I, from 5.2 ± 3.6 to 3.2 ± 2.9, P = .006 in group II and from 6.8 ± 3.1 to 4.4 ± 3.5 in group III, P = .013. There were no intergroup differences. The questionnaire results improved significantly only in group III as regards general health perception, role limitation, physical and social limitations without intergroup differences. Womenimproved their micturition frequency in two groups from 8.9 ± 3.2 to 7.5 ± 2.3 episodes/per day, P = .025 in group II, and from 8.8 ± 2.3 to 7.4 ± 2.0, P = .001 in group III, but only in group II was a significant reduction of urinary incontinence seen from 3.8 ± 4.6 to 2.9 ± 4.8 episodes/day, P = .045. CONCLUSION: All three treatments lead to effective short-term reduction of urgency in women with OAB, but longterm efficacy evaluation is required.

Risk Factors and Types of Urinary Incontinence among Middle-Aged and Older Male and Female Primary Care Patients in Kaunas Region of Lithuania: Cross Sectional Study.

PURPOSE: The aims of the study were to evaluate the incidences, types of urinary incontinence (UI) and its risk factors among middle-aged and older (> 40 years) men and women visiting a general practitioner (GP). MATERIALS AND METHODS: This is a descriptive and cross-sectional comparative study using a questionnaire-based survey included 172 male and female patients who consecutively visited a primary care center in Kaunas region of Lithuania. RESULTS: All 86 women (100%) and 65 men (75.58%) had symptoms of UI (P < .001). About 55% of women were classified as having stress urinary incontinence (SUI) and 60% of men urge urinary incontinence (UUI) (P < .001). The risk factors for women with SUI were: age below 60 years (odds ratio [OR] = 2.89, 95% confidence interval [CI]: 1.89-4.43; P < .001), being married (OR = 6.31, 95% CI: 2.35-16.97; P < .001), sedentary-standing job (OR = 1.492, 95% CI: 1.01-2.20; P = 0.041), arterial hypertension (OR = 2.03, 95% CI: 1.39-2.96: P < .001), diabetes mellitus (OR = 3.01, 95% CI: 1.02-8.86; P = .032), menopause (OR = 1.48, 95% CI: 1.20-1.83; P < .001) and features of past pregnancies. The UUI was associated with age over 60 years (OR in men = 2.93, 95% CI: 1.15-7.51; P = .022, in women OR = 8.76, 95% CI: 2.37-32.33; P < .001. Low health-related quality of life was the most prevalent among men with UUI (50.8%) and among women with SUI (23.3%) (P = .023). CONCLUSION: UI was common among patients aged > 40 years visiting GP and affected more women of the same age range. SUI was more prevalent among women, while more men had UUI. Age below 60, being married, pregnancy and delivery history, concomitant illnesses were significant risk factors for women' SUI and older age and menopause for UUI. The only risk factor for men' UUI was age over 60 years.

TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study.

OBJECTIVES: The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). METHODS: A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). RESULTS: Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. CONCLUSION: the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.

Lippes Loop intrauterine device left in the uterus for 50 years: case report.

BACKGROUND: The first Lippes Loop intrauterine device (IUD) was introduced in 1962. It was a plastic double "S" loop, a trapezoid shaped IUD that closely fit around the contours of the uterine cavity, reducing the incidence of expulsion. This IUD was commonly used from the 1960's to the 1980's. Some authors state that the IUD can be left in the uterine cavity for an indefinite amount of time. Prolonged use of this device was common, however, it was associated with some complications like uterine bleeding during post-menopausal period and inflammatory pelvic diseases. CASE PRESENTATION: The patient was a 74-years-old woman who was admitted to a university hospital due to urinary incontinence stress. The patient's history included 2 deliveries and 20 years of menopause. During ultrasonography a normally sized and shaped uterus was found. The uterine cavity was expanded by 14 mm with some fluid. A "Lippes" loop was also seen in the uterine cavity. Both ovaries were atrophic without any abnormalities. The patient had her IUD inserted 50 years ago. Patient underwent TOT (tension obturator tape ) surgery for urinary incontinence. Evacuation of IUD and uterine curettage was also done. CONCLUSIONS: Fifty years of prolonged usage of LIPPES IUD had no influence on the woman's health during our case.

Quality of obstetric services: perspectives of patients, obstetricians, and midwives.

OBJECTIVE. The aim of this study was to compare the perspectives of patients and health care staff on the quality of obstetric services in an obstetric department. Material and METHODS. This study was carried out at the Department of Obstetrics, Hospital of Lithuanian University of Health Sciences, where 68 obstetricians and midwives and 334 female patients completed anonymous questionnaires. Two different versions of the questionnaire for patients and health care staff were prepared with the aim to compare the results of both groups. RESULTS. Patients evaluated technical quality of services significantly better than health care staff. Other items were showed to have no significant differences with the exception of sterility of equipment and premises and appearance of physicians. Patients and health care staff had similar opinions about professional relationship between patients and physicians: patients can expect representation of their interests and evaluation of treatment progress. Evaluation of external efficiency revealed that respondents were satisfied with health care and would recommend the current health care institution to their friends and relatives or would use it again when needed. CONCLUSIONS. Patients evaluated technical quality of services significantly better than health care staff. The different perceptions of patients and health care staff about functional quality and external effectiveness of services in most aspects were insignificant.

Tension-free vaginal tape versus tension-free vaginal tape obturator (inside-outside) in the surgical treatment of female stress urinary incontinence.

UNLABELLED: The objective of this study was to compare TVT (tension-free vaginal tape) and TVT-O (tension-free vaginal tape obturator from inside to outside) procedures for the female surgical treatment of stress urinary incontinence: results, complications, and effectiveness after 1 year. MATERIAL AND METHODS: A prospective randomized study was carried out. The patients were followed up for 12 months. A total of 114 patients were operated on using TVT procedure and 150 patients - TVT-O procedure. There was no significant difference in age, body mass index, parity, menopausal status, and prolapse (no patients had cystocele greater than stage II) comparing both groups. RESULTS: The mean time in surgery was significantly shorter in the TVT-O group (19+/-5.6 min) as compared with the TVT group (27+/-7.1 min). No differences in the effectiveness of both procedures were found: TVT - 94.6% and TVT-O - 94.6% after one year, respectively. Hospital stay was significantly shorter in the TVT-O group (1.5+/-0.5 days) than in the TVT group (4.0+/-1.6 days). Significantly fewer complications were observed in the TVT-O group. CONCLUSION: TVT and TVT-O operations are equally effective for the surgical treatment of female stress urinary incontinence. TVT-O group had shorter time in surgery and showed a lower rate of complications.

[Surgical treatment of female pelvic organ prolapse at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine]. / Moteru dubens organu nusileidimo chirurginio gydymo metodai KMU Akuserijos ir ginekologijos klinikoje.

OBJECTIVE: To compare surgical methods, complications, and outcomes in the treatment of female pelvic organ prolapse at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine, and to disclose the risk factors that influence female pelvic organ prolapse. MATERIAL AND METHODS: A retrospective analysis of surgeries for pelvic organ prolapse performed during the period of 2003-2007 was carried out. A total 823 women were operated on for pelvic organ prolapse. RESULTS: During 2003-2007, 823 surgical procedures for the correction of female pelvic organ prolapse were performed at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine. Eighty (9.7%) patients underwent vaginal hysterectomy; 372 (45.3%), vaginal plastic operations (out of them, 23 were combined with TVT and 47 with TVT-O procedure); 360 (43.7%), vaginal hysterectomy with vaginal plastic surgeries; and 11 (1.3%), Prolift operations. The mean age of females was 62 years. Mean blood loss during operations was 162.1 mL. Patients undergoing vaginal plastic operations lost significantly less blood than those undergoing vaginal hysterectomy or combined operations (P<0.05). Mean time in surgery was 60.3 min. The duration of Prolift operations and vaginal plastic operations was significantly shorter than that of vaginal hysterectomy or combined procedures (vaginal hysterectomy + vaginal plastic surgery) (P<0.05). Mean hospital stay was 8.1 days. Hospital stay after vaginal plastic operations was significantly shorter than after vaginal hysterectomy or combined operations. The shortest hospital stay was after Prolift operation (P<0.05). Complications were related to the type of operation performed. CONCLUSIONS: The most common operations in the surgical treatment of female pelvic organ prolapse were vaginal plastic operations and combined operations. The shortest time in surgery and lowest blood loss was in case of vaginal plastic operations. The shortest hospital stay was after Prolift operations. The highest rate of complications was observed in patients who underwent vaginal hysterectomies, the lowest - after Prolift operations.

[Surgical treatment of urinary stress incontinence nowadays]. / Slapimo nelaikymo, kuri sukelia fizinis kruvis, chirurginio gydymo siuolaikines metodikos.

There are various surgical methods for the treatment of female urinary stress incontinence. According to the opinion of American Association of Urologists, anterior colpoplasty is supposed to be the least effective for the long-term treatment out of four surgical treatment categories (anterior colpoplasty, suburethral sling, colposuspension, and long-needle sling). Nowadays, the open retropubic colposuspension (Burch operation) is considered the most effective and long-term treatment of the female urinary stress incontinence. A first-year postsurgical effectiveness is 85-90% for this operation. Tension-free vaginal tape (suburethral sling) operations are considered as much effective as the above-mentioned surgeries and tend to be very perspective. However, these operations require to be evaluated for their long-term systematic results.

[A comparative analysis of hysterectomies]. / Lyginamoji histerektomiju analize

UNLABELLED: The objective of this study was to evaluate and compare operative and postoperative results and differences among laparoscopic, vaginal, and abdominal hysterectomies performed at the Department of Obstetrics and Gynecology of Kaunas University of Medicine Hospital. METHODS: A retrospective review of medical histories was performed for women who had undergone three different types of hysterectomies (laparoscopic, vaginal, and abdominal) at the Department of Obstetrics and Gynecology of Kaunas University of Medicine Hospital during 2004-2005. RESULTS: A total of 602 hysterectomies were performed: 51 (8.5%) laparoscopic, 203 (33.7%) vaginal, and 348 (57.8%) abdominal. The lowest complication rate occurred in patients who underwent laparoscopic hysterectomy (n=5, 9.8%) and the highest--abdominal hysterectomy (n=88, 25.2%) (P<0.05). More complication occurred after abdominal as compared to vaginal hysterectomy (n=88, 25.2% vs. n=20, 9.9%, respectively; P<0.05). There was no statistically significant difference in complication rate comparing laparoscopic and vaginal hysterectomies (P=0.26). The amount of blood loss depended on the type of hysterectomy--less blood was lost during laparoscopic and more during abdominal hysterectomy (123.4 vs. 308.5 mL, respectively; P<0.01). A significantly higher blood loss was observed during abdominal hysterectomy as compared to vaginal (195.3 mL) and vaginal as compared to laparoscopic hysterectomy (P<0.01). The mean length of hospital stay differed comparing all three types of hysterectomies: the shortest stay of 8.6 days was after laparoscopic, the longest of 13.7 days--after abdominal hysterectomy. The mean hospital stay was statistically significant shorter for vaginal hysterectomy compared to abdominal hysterectomy (9.1 vs. 13.7 days, P<0.01). The difference in mean length of hospital stay was insignificant comparing laparoscopic and vaginal hysterectomies (P>0.05). CONCLUSIONS: Abdominal hysterectomy was the most common procedure performed. The type of hysterectomy influenced the rate of complications--the lowest complication rate was after laparoscopic and vaginal hysterectomies. The amount of blood loss depended on the type of hysterectomy--the lowest was during laparoscopic hysterectomy. Abdominal hysterectomy required on average a longer hospital stay compared with laparoscopic and vaginal hysterectomies.

New surgical technique for the treatment of urinary incontinence in Clinic of Obstetrics and Gynecology of Kaunas University of Medicine.

UNLABELLED: There are various surgical methods for the treatment of female urinary stress incontinence. The aim of this study was to evaluate the effectiveness of tension-free vaginal tape (TVT) operation based on a three-year clinical experience and the possibility of its use in the outpatient settings. MATERIALS AND METHODS: The patients were examined according to a standardized protocol for urinary incontinence and were operated on according to the original "Gynecare TVT" protocol. A total of 57 women were operated on and followed up during the study period (02/25/2000-12/31/2002). The average age was 52 years. Out of them 31 (54.4%) women were after menopause and 56 (97.9%) gave birth. Nine women had operations in their medical histories: five had hysterectomies and the other four were operated on because of urinary incontinence. Besides, five women were operated due to mixed urinary incontinence. Among the operated women, 6 had local anesthesia, 13 had epidural, and 38 had lumbar anesthesia. The average time of the operation was 22.3 minutes. The mean hospital stay was 4.4 days. Five patients were hospitalized for one day. Besides TVT operation, eight patients had anterior colporrhaphy, two patients had posterior colporrhaphy, and two patients had "mesh" application for cystocele treatment. RESULTS: One woman had stress urinary incontinence symptoms after operation (the effectiveness of operation was 98.2%). The main complications were: perforation of the urinary bladder was present in 1 (1.8%) patient and infection of urinary tract - in 4 (7.0%) patients. CONCLUSION: TVT operation is a minimal invasive, fast, safe and very effective surgical procedure for the treatment of urinary stress incontinence, which has to be implemented in Lithuania as a routine outpatient procedure.

[Trauma in pregnancy: complications, outcomes, and treatment]. / Nesciuju trauma: komplikacijos, baigtys, gydymas.

UNLABELLED: The aim of this study was to analyze the effects of the various traumas on mother and fetus and to present the solutions of trauma management. METHODS: A review of data archive of Kaunas University of Medicine Hospital and articles published during the last 13 years (1990-2003) and selected by computerized Medline search. Trauma affects 7-8% of all pregnant women; motor vehicle accidents account for 42%, falls--for 34%, and violence--for 18% of the most frequently cited cases of injuries. Of the 27,715 pregnant females attending antenatal clinics, 372 (1.3%) experienced trauma: 84% of women had blunt injuries and 16% had penetrating injuries. There were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%). The success of pregnancy is associated with severity of maternal trauma. The survival of the fetus after trauma depends on the mother's condition in regard to respiratory passage, oxygenation, and hypovolemia. During 1990-2003, six pregnant patients with severe trauma were treated at Kaunas University of Medicine Hospital. Traumatic separation of placenta was observed in two cases. Three women and three fetuses died.