Laser treatment for genitourinary syndrome of menopause Phillips, Christian; Hillard, Timothy; Salvatore, Stefano ...
BJOG : an international journal of obstetrics and gynaecology,
11/2022, Letnik:
129, Številka:
12
Journal Article
Recenzirano
Plain language summary
Genitourinary syndrome of menopause (GSM) is the term used to describe the group of symptoms including vaginal pain, vaginal dryness, itching, pain during sexual intercourse ...and fragile vaginal tissues as well as urinary symptoms including urinary frequency, urgency, incontinence, blood in the urine (haematuria) and recurrent urinary tract infections that occur due to a lack of the hormone estrogen.
These symptoms can have a significant negative impact on psychosexual issues, sexual function and quality of life in postmenopausal women. Traditionally women have been treated with vaginal lubricants, vaginal moisturisers or low‐dose vaginal estrogens.
Lasers have been used in the cosmetic industry for collagen remodelling and repair of the skin. Therefore, it has been suggested that laser therapy may be used on the vagina as an alternative treatment for GSM. A review of all the published studies assessing the safety and efficacy of laser therapy for GSM have shown promising beneficial results. The majority of studies to date have been small, short‐term, observational studies. However, there are randomised controlled trials underway. Laser treatment may be beneficial for the symptoms of GSM but until more robust evidence is available it should not be adopted into widespread practice, and should be used as part of a research study only.
A tribute to Professor Linda Cardozo Toozs‐Hobson, Philip
The obstetrician & gynaecologist,
January 2024, 2024-01-00, 20240101, Letnik:
26, Številka:
1
Journal Article
Aims
Obstetric anal sphincter injury (OASI) is associated with long‐term anal incontinence (AI). We aimed to address the following questions: (a) are women with major OASI (grade 3c and 4) at higher ...risk of developing AI when compared to women with minor OASI (grade 3a and 3b)? (b) is a fourth‐degree tear more likely to cause AI over a third‐degree tear?
Methods
A systematic literature search from inception until September 2022. We considered prospective and retrospective cohort studies, cross‐sectional and case‐control studies without language restrictions. The quality was assessed by the Newcastle‐Ottawa Scale and the Joanna Briggs Institute critical appraisal checklist. Risk ratios (RRs) were calculated to measure the effect of different grades of OASI.
Results
Out of 22 studies, 8 were prospective cohort, 8 were retrospective cohort, and 6 were cross‐sectional studies. Length of follow‐up ranged from 1 month to 23 years, with the majority of the reports (n = 16) analysing data within 12‐months postpartum. Third‐degree tears evaluated were 6454 versus 764 fourth‐degree tears. The risk of bias was low in 3, medium in 14 and high in 5 studies, respectively. Prospective studies showed that major tears are associated with a twofold risk of AI for major tears versus minor tears, while retrospective studies consistently showed a risk of fecal incontinence (FI) which was two‐ to fourfold higher. Prospective studies showed a trend toward worsening AI symptoms for fourth‐degree tears, but this failed to reach statistical significance. Cross‐sectional studies with long‐term (≥5 years) follow‐up showed that women with fourth‐degree tear were more likely to develop AI, with an RR ranging from 1.4 to 2.2. Out of 3, 2 retrospective studies showed similar findings, but the follow‐up was significantly shorter (≤1 year). Contrasting results were noted for FI rates, as only 5 out of 10 studies supported an association between fourth‐degree tear and FI.
Conclusions
Most studies investigate bowel symptoms within few months from delivery. Data heterogeneity hindered a meaningful synthesis. Prospective cohort studies with adequate power and long‐term follow‐up should be performed to evaluate the risk of AI for each OASI subtype.
Background
There is a risk that people who have invasive urodynamic studies (cystometry) will develop urinary tract infections or bacteria in the urine or blood. However, the use of prophylactic ...antibiotics before or immediately after invasive cystometry or urodynamic studies is not without risks of adverse effects and emergence of resistant microbes.
Objectives
To assess the effectiveness and safety of administering prophylactic antibiotics in reducing the risk of urinary tract infections after urodynamic studies. The hypothesis was that administering prophylactic antibiotics reduces urinary tract infections after urodynamic studies.
Search methods
We searched the Cochrane Incontinence Group Specialised Trial Register, MEDLINE (January 1966 to January 2009), CINAHL (January 1982 to January 2009), EMBASE (January 1966 to January 2009), PubMed (1 January 1980 to January 2009), LILACS (up to January 2009), TRIP database (up to January 2009), and the UK NHS Evidence Health Information Resources (searched 10 December 2009). We searched the reference lists of relevant articles, the primary trials and the proceedings of the International Urogynaecological Association International Continence Society and the American Urological Association for the years 1999 to 2009 to identify articles not captured by electronic searches. There were no language restrictions.
Selection criteria
All randomized controlled trials and quasi‐randomized trials comparing the use of prophylactic antibiotics versus a placebo or no treatment in patients having urodynamic studies were selected. Two authors (PL and RF) independently performed the selection of trials for inclusion and any disagreements were resolved by discussion.
Data collection and analysis
All assessments of the quality of trials and data extraction were performed independently by two authors of the review (PL and RF) using forms designed according to Cochrane guidelines. We attempted to contact authors of the included trials for any missing data. Data were extracted on characteristics of the study participants including details of previously administered treatments, interventions used, the methods used to measure infection and adverse events.
Statistical analyses were performed according to Cochrane Collaboration guidelines. Data from intention‐to‐treat analyses were used where available. For the dichotomous data, results for each study were expressed as a risk ratio (RR) with 95% confidence interval (CI) and combined for meta‐analysis using the Mantel‐Haenszel method.
The primary outcome was urinary tract infection. Heterogeneity was assessed by the P value and I2 statistic.
Main results
Nine randomized controlled trials involving the prophylactic use of antibiotics in patients having urodynamic studies were identified and these included 973 patients in total; one study was an . Two further trials were excluded from the review. The methods of the included trials were poorly described.
The primary outcome in all trials was the rate of developing significant bacteriuria, defined as the presence of more than 100,000 bacteria per millilitre of a mid‐stream urine sample on culture and sensitivity testing. The other outcomes included pyrexia, haematuria, dysuria and adverse reactions to antibiotics.
The administration of prophylactic antibiotics when compared to a placebo reduced the risk of significant bacteriuria (4% with antibiotics versus 12% without, risk ratio (RR) 0.35, 95% CI 0.22 to 0.56) in both men and women. The administration of prophylactic antibiotics also reduced the risk of haematuria (RR 0.46, 95% CI 0.23 to 0.91). However, there was no statistically significant difference in the primary outcome, risk of symptomatic urinary tract infection (40/201, 20% versus 59/214, 28%; RR 0.73, 95% CI 0.52 to 1.03); or in the risk of fever (RR 5.16, 95% CI 0.94 to 28.16) or dysuria (RR 0.83, 95% CI 0.5 to 1.36). Only two of 135 people had an adverse reaction to the antibiotics. The number of patients needed to treat with antibiotics to prevent bacteriuria was 12.3. Amongst women, the number needed to treat to prevent bacteriuria was 13.4; while amongst men it was 9.1 (number needed to treat = 1/ absolute risk reduction).
Authors' conclusions
Prophylactic antibiotics did reduce the risk of bacteriuria after urodynamic studies but there was not enough evidence to suggest that this effect reduced symptomatic urinary tract infections. There was no statistically significant difference in the risk of fever, dysuria or adverse reactions. Potential benefits have to be weighed against clinical and financial implications, and the risk of adverse effects.
Background
Bladder diaries represent a fundamental component in the assessment of patients presenting with lower urinary tract symptoms. Nevertheless, their importance often remains underappreciated ...and undervalued within clinical practice. This paper aims to conduct a comprehensive review of the existing literature concerning the utility of bladder diaries, underscore the criticality of their precision, elucidate the factors contributing to noncompliance with bladder diary completion, and investigate potential strategies for enhancing patient compliance.
Materials and Methods
A review of the English‐language scientific literature available in the domains of Medline, Embase, Emcare, Midirs, and Cinahl was conducted. This was supplemented by discussion at the International Consultation on Incontinence Research Society Proposal session to define knowledge and identify gaps in knowledge surrounding the utility of bladder diaries. The existing evidence and outcome of the relevant discussion held in the meeting are presented.
Results
Bladder diaries (BD) serve to characterize the nature and severity of storage lower urinary tract symptoms (LUTS) and provide an objective record of an individual's urination patterns. They aid in the refinement and customization of treatment strategies based on the clinical responses documented in the diary, optimizing treatment outcomes. Notably, both BD and urodynamic studies (UDS) play complementary yet distinct roles in LUTS evaluation. BD offers a more comprehensive and accessible approach to assessing specific storage LUTS, particularly due to their affordability and widespread availability, especially in resource‐limited settings. Nevertheless, the absence of a standardized BD format across global healthcare systems presents a significant challenge. Despite being recognized as reliable, noninvasive, validated, and cost‐effective tools for evaluating patients with LUTS, the implementation and completion of BD have proven to be complex. The introduction of automated bladder diaries heralds an era of precise, real‐time data collection, potentially enhancing the patient–clinician relationship. Completion of bladder diaries depends on an array of individual, social, and healthcare‐specific factors. Compliance with bladder diary completion could be enhanced with clear instructions, patient education, regular follow‐ups and positive re‐enforcement. This study has identified four critical areas for future research: Addressing healthcare disparities between affluent and developing nations, enhancing the current functionality and effectiveness of bladder diaries, exploring the feasibility of incorporating bladder diaries into the treatment and education process and improving the quality and functionality of existing bladder diaries.
Conclusion
Bladder diaries play a pivotal role in the evaluation and management of patients with LUTS, providing a holistic perspective. When their complete potential is harnessed, they have the capacity to revolutionize the paradigm of LUTS management, ushering in a patient‐centered era of care.
Introduction and hypothesis
This qualitative interview study explores aspects women with urinary incontinence(UI) reflect upon when considering whether or not to have surgery. Conducted prior to the ...recent mesh pause in the UK, the article provides insights for current and future approaches to shared decision-making.
Methods
Qualitative in-depth interviews of 28 patients referred to secondary care for stress and mixed UI who were considering UI surgery. Participants were recruited from four urogynaecology clinics in the Midlands and South England, UK. Interviews were conducted in clinics, in patient homes, and by telephone. Data analysis was based on the constant comparative method.
Results
Participants’ accounts comprised three key concerns: their experience of symptoms, the extent to which these impacted a variety of social roles and demands, and overcoming embarrassment. Accounts drew on individual circumstances, values, and concerns rather than objective or measurable criteria. In combination, these dimensions constituted a personal assessment of the severity of their UI and hence framed the extent to which women prioritized addressing their condition.
Conclusions
Acknowledging women’s personal accounts of UI shifts the concept of ‘severity’ beyond a medical definition to include what is important to patients themselves. Decision-making around elective surgery must endeavour to link medical information with women’s own experiences and personal criteria, which often change in priority over time. We propose that this research provides insight into how the controversy around the use of mesh in the UK emerged. This study also suggests ways in which facilitating shared decision-making should be conducted in future.
Study Type – Therapy (meta‐analysis) Level of Evidence 1a
OBJECTIVES
To assess the effectiveness and complications of transobturator tape (inside‐out and outside‐in, TOT) by means of a systematic ...review of direct and indirect randomized controlled trials (RCTs).
METHOD
MEDLINE, EMBASE, CINAHL, LILIACS (up to December 2008), CENTRAL (The Cochrane Library, Issue 1, 2009), MetaRegister of Controlled Trials, The National Library for Health, the National Research Register and Google Scholar were searched using various relevant search terms. The citation lists of review articles and included trials were searched and contact with the Correspondence of each included trials was attempted. RCTs which compared the effectiveness of synthetic transobturator (inside‐out tape TVTO, or outside‐in TOT) with TVT by the retropubic route (Gynecare, Ethicon, Inc., or similar tape by a different company) or with each other for the treatment of stress urinary incontinence (SUI), and in all languages, were included. Two reviewers extracted data on participants’ characteristics, study quality, intervention, cure and adverse effects independently. The data were analysed using Review Manager 5 software.
RESULTS
There were 12 RCTs that compared TOT with TVT, and 15 that compared TVTO vs TVT for treating SUI. There were four direct comparison RCTs of TVTO vs TOT. When compared at 1–44 months, the subjective (odds ratio 1.16; 95% confidence interval 0.83–1.6) and objective (0.94; 0.66–1.32) cure of TOT was similar to TVT. For TVTO, the subjective (1.06, 0.85–1.33) and objective cure (1.03, 0.77–1.39) was also similar to TVT. Adverse events such as bladder injuries (TOT, odds ratio 0.11, 0.05–0.25; TVTO, 0.15, 0.06–0.35) and haematomas (0.06, 0.01–0.30) were less in the TOT than TVT. Voiding difficulties (TOT, odds ratio 0.61, 0.35–1.07); TVTO, 0.81, 0.48–1.31) were slightly lower in TOT but this was not statistically significant. Groin/thigh pain (TVTO, odds ratio 8.05, 3.78–17.16) and vaginal injuries (TOT, 5.82, 1.85–18.3; TVTO, 1.69, 0.73–3.91) were more common in the transobturator tapes. Mesh erosion in TVTO (0.77, 0.22–2.72) and TOT (1.11, 0.54–2.28) was similar to TVT. The effectiveness data over 6 months available from four direct comparison studies of TVTO vs TOT suggested equivalent results for objective cure (1.06, 0.65–1.73) and subjective cure (1.37, 0.93–2.00). When compared indirectly, TVTO has similar subjective (1.23, 0.83–1.82) and objective cure (0.97, 0.62–1.52) to TOT. On indirect comparison, the de novo risk of urgency was similar in the two groups but voiding difficulties seemed to be less in the inside‐out group.
CONCLUSION
The evidence for the equivalent effectiveness of TOT and TVTO when compared with each other is established over the short‐term. Bladder injuries and voiding difficulties seem to be less with inside‐out tapes on indirect comparison. An adequate long‐term follow‐up of the RCTs is desirable to establish the long‐term continued effectiveness of transobturator tapes.
Defining nocturnal polyuria in women Baines, Georgina; Da Silva, Ana Sofia; Cardozo, Linda ...
Neurourology and urodynamics,
January 2021, 2021-01-00, 20210101, Letnik:
40, Številka:
1
Journal Article
Recenzirano
Aims
Nocturnal polyuria (NP) is defined by the International Continence Society (ICS) as “excessive production of urine during the main sleep period” and is one of the main causes of nocturia. The ...ICS recognized that “excessive” is not clearly defined and that this needs to be highlighted in both clinical and research settings. The aim of this study was to identify different definitions of NP and apply them to a population of women attending the Urogynaecology clinic.
Methods
This was a retrospective study of complete bladder diaries collected from women attending a tertiary Urogynaecology Unit. Six different definitions were identified and were divided into “absolute,” “relative,” and “functional definitions.” Prevalence data were calculated and values generated for sensitivity, specificity, positive and negative predictive values when related to women voiding ≥ 2 times per night.
Results
Complete bladder diaries were obtained from 1398 women, over 6 years, with a mean age of 57 years. Prevalence varied across the definitions from 21.5% (absolute definition) to 77% (relative definition). Sensitivity ranged from 43% (absolute) to 87% (relative). The definitions that showed the highest combined sensitivity and specificity were the functional definitions.
Conclusion
From this study it is clear that more work needs to be done to arrive at a consensus for defining NP to enable accurate diagnosis and development of treatment pathways. We propose that a relative definition may provide a more clinically relevant method of defining NP.
Abstract The growing scale and dimensionality of multiplexed imaging require reproducible and comprehensive yet user-friendly computational pipelines. TRACERx-PHLEX performs deep learning-based cell ...segmentation (deep-imcyto), automated cell-type annotation (TYPEx) and interpretable spatial analysis (Spatial-PHLEX) as three independent but interoperable modules. PHLEX generates single-cell identities, cell densities within tissue compartments, marker positivity calls and spatial metrics such as cellular barrier scores, along with summary graphs and spatial visualisations. PHLEX was developed using imaging mass cytometry (IMC) in the TRACERx study, validated using published Co-detection by indexing (CODEX), IMC and orthogonal data and benchmarked against state-of-the-art approaches. We evaluated its use on different tissue types, tissue fixation conditions, image sizes and antibody panels. As PHLEX is an automated and containerised Nextflow pipeline, manual assessment, programming skills or pathology expertise are not essential. PHLEX offers an end-to-end solution in a growing field of highly multiplexed data and provides clinically relevant insights.
PDF
