Cross-cultural adaptation and validation of the Serbian version of the Australian pelvic floor questionnaire.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to cross-culturally adapt and validate the Serbian version of the Australian pelvic floor questionnaire. METHODS: The Australian pelvic floor questionnaire was translated according to the standard method of back-translation. Women who presented with pelvic floor disorders completed the Serbian version of the Australian pelvic floor questionnaire. Women were subjected to clinical and gynecological assessment including physical examination, cough stress test, pelvic prolapse anatomical assessment using the Pelvic Organ Prolapse Quantification system, and post-void residual volume. Reliability and divergent validity was performed on 76 patients with significant pelvic floor dysfunction and 23 women without pelvic floor dysfunction. Patients repeated the questionnaire after 4 weeks. RESULTS: High reliability was observed in all four dimensions (Cronbach's alpha coefficients were above 0.8 for each dimension: bladder 0.846, bowel 0.822, prolapse 0.842, and sexual function 0.823). Test-retest analyses revealed high reproducibility (intraclass correlation coefficients were above 0.9). Prolapse symptom score correlated significantly with pelvic organ quantification and bladder score correlated significantly with the results of the cough stress test (convergent validity). Scores distinguished between patients with pelvic floor disorders and controls (high discriminant validity). CONCLUSIONS: The Serbian version of the Australian pelvic floor questionnaire is a reliable and valid instrument for assessment of quality of life in women with pelvic floor disorders.

Cross-cultural adaptation and validation of the Serbian version of the ICS SF male questionnaire.

INTRODUCTION: The objective of this study was to cross-culturally adapt and validate ICS male SF questionnaire to Serbian language. MATERIALS AND METHODS: This study included 91 male patients with lower urinary tract symptoms and 24 men with similar age and with confirmed absence of LUTS. ICS male SF questionnaire was translated from English to Serbian language and then back-translated to English. RESULTS: Internal consistency was high in both dimensions, voiding (Cronbach's alpha = 0.916) and incontinence (Cronbach's alpha = 0.763). Comparison of the average scores between patients and controls revealed significant differences in both dimensions: voiding (med = 8 versus med = 0; P < 0.001) and incontinence (med = 3 versus med = 0; P < 0.001). Interclass correlation revealed high testretest validity in both dimensions, voiding ICC = 0.992 (P < 0.001) and incontinece ICC = 0.989 (P < 0.001). Correlation analysis revealed high agreement between ICS male SF voiding dimension and IPSS questionnaire (ρ = 0.943; P < 0.001). CONCLUSION: The Serbian version of male ICS SF questionnaire showed acceptable reliability and validity. The ICS male SF questionnaire could be used in routine practice as an easy and comprehensive tool for assessment of LUTS.

Comparative analysis of the current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology.

BACKGROUND/AIM: Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. METHODS: The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragisa Misovic"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. RESULTS: Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0.001) respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively). Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (ß = 0.843, p < 0.001) as well as under the projected DRG payment system (ß = 0.737, p < 0.001). The same predictor was crucial for the difference in the current payment method and the pro- jected DRG payment methods (ß = 0.501, p < 0.001). CONCLUSION: Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.

Impact of Voiding and Incontinence Symptoms on Health-Related Life Quality in Serbian Male Population.

PURPOSE: To investigate the impact of lower urinary tract symptoms on health-related quality of life (QoL) in Serbian population considering socio-demographic characteristics, habits, and health status. MATERIALS AND METHODS: The study was conducted in the Primary Healthcare Center "Novi Beograd", Serbia. The study included 1424 male participants, aged 40 years and above. QoL was assessed by using the -36Item Short Form Health Survey (SF36-) questionnaire, while voiding and incontinence symptoms were measured using the International Continence Society Male Short Form (ICS male SF) questionnaire. RESULTS: Voiding and incontinence symptoms significantly correlate with all domains of QoL. Voiding and incontinence symptoms have a high influence on general health, social functioning, physical functioning and body pain. After adjusting for age and education, voiding and incontinence symptoms had a similar influence on QoL. In the multivariate model the influence of cardiovascular diseases and income on QoL was lower than voiding and incontinence symptoms.. CONCLUSION: Voiding and incontinence symptoms affect QoL domains differently. Incontinence symptoms have a greater impact on QoL than voiding symptoms.

Surgical treatment of female stress urinary incontinence: retropubictransvaginal tape vs. transvaginal tape obturator.

AIM: To compare two different operative techniques for stress urinary incontinence in women, transvaginal tape obturator(TVT-O) and retropubictransvaginal tape(TVT). METHODS: The study included 63 women, of which 32 received TVT-O and 31 were treated with TVT. Follow-up for all patients was done after 1, 3, 6 and 12 months, and yearly thereafter. Each visit included objective evaluations (post-voig residual and stress test). RESULTS: The average operating time was 13.19±3.72 minutes in TVT-O group and 26.92±4.77 minutes for TVT. Average time of catheter removal was 1.19±0.4 and 1.26±0.44 for TVT-O and TVT, respectively. Average hospital stay was 2.38±0.75 days in TVT-O group and 2.03±0.91 for TVT. Appearance of complications such as trauma of urethra, bladder perforation, injury of vessels, hematoma and wound infection were not registered. Two (6.3%) of the patientswho underwent TVT-O had urinary infection. One (3.1%) of the patients who underwent TVT-O had pelvic pain. De novo urgency appeared in five(15.6%)patients for TVT-O and in four (12.9%) patients for TVT. The success rate in TVT-O group was 90.6% and 90.3% for TVT. CONCLUSION: Both procedures hada very high success rate, with a low rate of perioperative and late postoperative complications.

Does the addition of Serenoa repens to tamsulosin improve its therapeutical efficacy in benign prostatic hyperplasia?

BACKGROUND/AIM: It has been observed that a large number of patients with low urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH)) has been treated with a combination of tamsulosin (TAM) + Serenoa repens (SR) (TAM + SR). The aim of this study was to compare a combination TAM + SR with TAM and SR alone, to see if there was any difference in efficacy and tolerance of each in patients with LUTS/BPH. METHODS: In this prospective study patients had to have prostate volume (PV) < 50 mL, International Prostate Symptom Score (IPSS) of 7-18, Quality of Life score (QoLs) > 3, a maximal flow rate (Qmax) of 5-15 mL/s, with post voiding residual volume (PVR) < 150 mL and serum prostatic antigen (PSA) < 4 ng/mL. TAM (0.4 mg) was administered once a day, SR (320 mg) daily or SR (320 mg) + TAM (0.4 mg) daily for a median period of 6 months. RESULTS: A total of 297 patients were recruited, whereas 265 patients were fully available: 87 into the group TAM, 97 into the group SR and 81 into the group TAM + SR. There was no statistically significant difference between the treatment groups in the sense of demographic and other baseline parameters. No difference was found among the 3 treatment groups, neither in the major endpoint of the study in the sense of a change between baseline and final evaluation in total IPSS, obstructive and irritative subscores, improvement of QoLs, increase in Qmax, nor for the second endpoint including diminution of PV, PSA and PVR. During the treatment period 20 (23%) of the patients managed with TAM and 17 (21%) with TAM + SR had drug- treated with related adverse reactions. No adverse effect was detected in the group SR. CONCLUSION: Treatment of BPH by both SR and TAM seems to be efficacious alone. None of them had superiority over another and, additionally, a combined therapy (TAM + SR) does not provide extra benefits. Furthermore, SR is a well-tolerated agent that can be used alternatively in the treatment of LUTS/BPH.

[Peritonealization in gynecologyand obstetrics--review of literature].

INTRODUCTION: Our purpose was to review the literature on the subject of peritoneal closure and to evaluate the advantages and disadvantages of this procedure. EXPERIMENTAL STUDIES: Experimental studies have proved that peritoneal defects demonstrate mesothelial integrity (reperitonealization) 48-72 hours after injury and gross healing occurs within five days. A foreign body in the peritoneum causes tissue ischemia, necrosis, inflammation, and it stimulates numerous and dense adhesions. SURGERY (GENERAL AND GYNECOLOGICAL): The major advantage of peritoneal non-closure is a decreased adhesion formation, quicker return of bowel activity and reduced risk of bowel obstruction after surgery. Not only does peritoneal closure provide no immediate postoperative benefits, but it also prolongs surgical time, exposure to anesthesia and post-operative hospital stay unnecessarily, thus increasing surgery expenses. In summary, the existing data do not show advantages of this technique. Since many surgical tenets are based on limited data or opinion of the individual surgeons, they should be changed according to evidence-based medicine. CONCLUSION: Therefore, we suggest that the traditional practice of peritoneal closure be abolished in gynecology and obstetrics. It is our strong wish to encourage clinicians not to close both parietal and visceral peritoneum.