A retrospective review of tension-free vaginal tape/transobturator tape procedures done concomitantly with prolapse repair.

OBJECTIVE: Midurethral slings have become the standard of care for women with stress urinary incontinence; prolapse repair is often also required. The primary objective of our study was to compare voiding dysfunction rates and the need for reoperation between patients having midurethral sling procedures alone versus those having midurethral sling procedures with concomitant prolapse repair. METHODS: We performed a retrospective chart review over a two-year period in a tertiary urogynaecology clinic. Of 108 charts, 93 had complete data for analysis. RESULTS: Patients having concomitant prolapse repair had a longer operating time, a longer hospital stay, and a longer time to resume normal voiding in the immediate postoperative period. CONCLUSION: Although tension-free vaginal tape or transobturator tape procedures with concomitant prolapse repair have a higher incidence of voiding dysfunction in the immediate postoperative period, we found that this did not persist to the six-week follow-up visit. There appeared to be no greater risk of lasting voiding dysfunction or need for reoperation after concomitant procedures.

Objectif : Les interventions de fronde mi-urétrale sont devenues la norme pour les femmes qui présentent une incontinence urinaire à l'effort; une réparation du prolapsus est également souvent nécessaire. Notre étude avait pour objectif principal de comparer, chez les patientes ne subissant qu'une intervention de fronde mi-urétrale et chez celles qui subissaient une intervention de fronde mi-urétrale et une réparation concomitante du prolapsus, les taux de dysfonction mictionnelle et la nécessité de procéder à une deuxième opération. Méthodes : Nous avons mené une analyse rétrospective des dossiers sur une période de deux ans au sein d'une clinique tertiaire d'urogynécologie. Sur 108 dossiers, 93 comptaient des données complètes aux fins de l'analyse. Résultats : Les patientes subissant une réparation concomitante du prolapsus connaissaient une durée d'opération prolongée, une hospitalisation prolongée et un délai prolongé avant le retour de la miction normale au cours de la période postopératoire immédiate. Conclusion : Bien que les interventions par bandelette vaginale sans tension ou par bandelette transobturatrice s'accompagnant d'une réparation concomitante du prolapsus comptent une incidence accrue de dysfonction mictionnelle au cours de la période postopératoire immédiate, nous avons constaté que cette situation s'était résorbée au moment de la consultation de suivi à six semaines. À la suite de la tenue d'interventions concomitantes, il ne semblait pas y avoir de hausse du risque de dysfonction mictionnelle prolongée et nous n'avons également pas constaté une nécessité accrue de procéder à une deuxième opération.

The use of intraoperative cystoscopy by general gynaecologists in Canada.

BACKGROUND: The primary purpose of this study was to determine the intraoperative cystocopy practices of Canadian gynaecologists. The secondary aim was to identify barriers for the use of cystoscopy in this same population. METHODS: An 18-item questionnaire was sent to all active members of the Society of Obstetricians and Gynaecologists of Canada. The questionnaire included questions about basic demographic data and specific questions regarding cystoscopy use and barriers to use. RESULTS: The response rate was 23% (236/1006). Two hundred thirty-one respondents practised gynaecology, and, of these, 48% (111/230) used intraoperative cystoscopy routinely (16/111, 14%), selectively (84/111, 75%), or for other reasons (12/111, 11%), primarily during tension-free vaginal tape procedures. The respondents used cystoscopy with the following procedures: colposuspension (61%), vaginal hysterectomy (23%), vaginal vault suspension (21%), and culdoplasty (20%). Cystoscopy was most commonly performed transurethrally (73%) with a 30 degree cystoscope. Lack of training was the most common reason cystoscopy was not used (70/118, 59%). Increased physician age (RR 0.47; CI 0.38-0.59, P<0.01) and duration in practice of more than 10 years (RR 0.62; CI 0.46-0.83, P<0.01) was associated with significantly decreased cystoscopy use. CONCLUSION: Intraoperative cystoscopy is used by a significant number of Canadian gynaecologists for the detection of lower urinary tract injuries during gynaecologic surgery. Lack of training is the primary barrier to use of cystoscopy, and increasing physician age and duration of practice>10 years are associated with decreased use of cystoscopy.

Prevalence and risk factors for urinary and fecal incontinence four months after vaginal delivery.

OBJECTIVE: To determine the prevalence of and risk factors for urinary and fecal incontinence four months after vaginal delivery. METHODS: All patients who had vaginal deliveries at a tertiary care hospital over a three-month period were approached during their postpartum hospital stay regarding participation in the study. Participants underwent a telephone interview at four months after their delivery to determine the presence and type of any incontinence. RESULTS: Of 632 patients, 145 (23%) had stress incontinence, 77 (12%) had urge incontinence, 181 (29%) had any urinary incontinence and 23 (4%) had fecal incontinence. In univariate analysis, stress incontinence was found to be increased in patients>or=30 years of age (26.2%) compared with patients<30 years of age (19.3%) (RR 1.4; 95% CI 1.0-1.8, P=0.05). Urge incontinence was increased in patients who had a forceps delivery (21%) compared with no forceps delivery (9%) (RR 2.2; 95% CI 1.4-3.6, P=0.005), an episiotomy (32.4%) compared with no episiotomy (18.7%) (RR 1.9; 95% CI 1.2-2.9, P<0.01) and a longer second stage of labour (108 min vs. 77 min, P=0.01). The prevalence of any urinary incontinence was increased with forceps delivery (15.5%) compared with no forceps delivery (8.7%) (RR 1.5; 95% CI 1.1-2.1, P=0.01) and maternal age of >or=30 years (34.1%) compared to <30 years (23.5%) (RR 1.5; 95% CI 1.1-1.9, P=0.003). In multivariate analysis, the two variables that remained significant for any urinary incontinence were maternal age>or=30 years (P<0.01) and forceps delivery (P<0.01). There were no identified risk factors for fecal incontinence. CONCLUSION: Urinary incontinence is common in women at four months post partum. Fecal incontinence is less common. Maternal age and forceps assisted delivery were risk factors for urinary incontinence.

Effectiveness of a new self-positioning pessary for the management of urinary incontinence in women.

OBJECTIVE: The objective of the study was to evaluate the effectiveness of a new self-positioning women's incontinence pessary. STUDY DESIGN: Thirty-two women were enrolled and followed up for 12 months. Evaluation included baseline questionnaires, physical examination including pelvic organ prolapse quantification (POP-Q) scores, cotton swab testing, and assessment of Kegel strength. A pad test and 7 day urolog were also performed before and after pessary fitting. RESULTS: Incontinence questionnaire scores were all significantly reduced as percent of baseline: stress incontinence, 7 of 15 (47%) (P = .000); urge incontinence, 5 of 14 (36%) (P = .002); the urogenital distress inventory (short form); 2 of 6 (33%) (P = .002); and incontinence impact questionnaire (short form), 4 of 8 (50%) (P = .002). Leaking episodes decreased by 4 (7 day urolog) (P = .028) and pad weights by 11 g (P = .006). Among women successfully fitted at 2 weeks, 16 of 21 or 76% continued using their pessary at 1 year. There were no complications with pessary use. CONCLUSION: The Uresta incontinence pessary significantly reduces urinary incontinence and is easy for women to use.

A survey of Canadian websites providing information about female urinary incontinence.

OBJECTIVE: Urinary incontinence (UI) is a prevalent health issue that has significant detrimental effects on quality of life. The Internet offers a unique vehicle for incontinent women to access information that could facilitate conservative self-help therapy. An evaluation of Canadian websites offering female UI information was conducted to determine their quality and readability. METHODS: We evaluated websites using published general quality criteria for health sites and a quality assessment tool compiled by the authors for specific UI information derived from published, peer-reviewed clinical practice guidelines. Three health care professionals reviewed sites for quality, Canadian content, and interactivity. The readability of health information was also evaluated. RESULTS: Fifty-six Canadian sites (18 professional, 22 organizational, 16 commercial) were evaluated. Significant agreement was found among the raters' evaluations on all measures. For all sites, the mean scores were general quality, 9/14; specific UI quality, 30/122; reading ease, 37/100; grade level, 10.9. The median score for Canadian content was high, but for interactivity it was low. The only significant difference between site types was for general quality (F [2,165]=3.38, P=0.036). Post hoc Tukey's tests showed a significant difference between organizational and commercial sites, with organizational sites having higher general quality. CONCLUSION: Canadian websites providing female UI information have moderately high general quality, low specific UI information quality, minimal interactivity, and more than minimal Canadian content. The reading level of most sites is too high for average consumers. A webliography of the best sites has been developed to guide patients.