Effective and safe labour requires good cooperation of all the physiological systems. A proper synchronization of uterine and abdominal muscles is necessary for labour progression. Therefore, a new ...method for simultaneous monitoring of uterine activities and parturient’s pushing efforts is presented. A high sampled, rectified electrohysterographic signal is divided into a low, uterine passband (0.1-3.00Hz) and a high, muscular (40-100Hz) one. The time-dependent mean frequencies arse estimated for each passband separately. At the moments of uterine contraction the time-dependent LOW mean frequency was locally increased. During parturient’s pushing effort the HIGH mean frequency was increased in the manner typical for the skeletal muscles. It seems that the proposed method would be less sensitive to a measuring noise than the previously published RMS based estimators. Moreover, the proposed method enables to monitor fatigue of a uterus or abdominal muscles during the prolonged 2nd stage of a labour. It can be helpful to make a decision of Caesarean section.
To compare, in a multicenter, randomized clinical trial, collagen injections versus surgery with regard to efficacy, quality of life, satisfaction, and complications.
Of 133 women with stress urinary ...incontinence, 66 were randomized to collagen injection and 67 to surgery (6 needle bladder neck suspensions, 19 Burch, and 29 slings). After randomization, 15 women refused their allocated treatment. “Intent-to-treat” and “per protocol” analyses were applied. Women assigned to collagen injection could receive up to three injections before it was considered a failure. A “top-up” injection was allowed within 3 months after cure. Success as the primary outcome at 12 months was defined as a dry 24-hour pad test (2.5 g or less of urine) after having received only the allocated intervention.
The per protocol analysis showed that the success rate 12 months after collagen injections (53.1%) was much lower than that after surgery (72.2%). The difference was 19.1% (95% confidence interval −36.2% to −2%). The general and disease-specific quality-of-life scores measured by the Rand Medical Outcomes Study 36-item Health Survey and Incontinence Impact Questionnaire were similar in the two groups (
P = 0.306). Women treated by surgery were, on average, more satisfied (79.6%) than those treated by collagen injection (67.2%), but the difference was not significant (
P = 0.228). Finally, complications were less frequent and severe with collagen injection: 36 events in 23 subjects for collagen injection versus 84 events in 34 subjects for surgery (
P = 0.03).
One year after intervention, the success rate of collagen injection as a treatment for stress urinary incontinence was about 19% lower than that after surgery. This has to be tempered by the similar changes in quality of life and satisfaction in both groups and that the number and severity of complications were much greater after surgery than after collagen injection. The results of this study indicate that collagen injections might be a worthwhile alternative to surgery for the treatment of stress urinary incontinence.
We investigated the effects of didactic teaching and supervised hands-on practice on endourological skills using high fidelity genitourinary bench models at a surgical skills laboratory. We also ...validated a global rating scale and checklist designed specifically for endourological tasks.
We assessed 17 urology residents for the ability to remove a mid ureteral stone using a high fidelity genitourinary model on 3 occasions, including a pre-test at the beginning of the study to assess baseline skills, after a didactic teaching session and after a supervised practice session on high fidelity models. Performance was graded according to a global rating scale, checklist, pass rating and time needed to complete task.
Senior residents achieved significantly higher pre-test global rating scores than junior residents (p <0.01). One-way repeated measures analysis of variance revealed a significant effect of training on the endoscopic global rating score (p <0.001). Post-hoc tests demonstrated significant improvement in the global rating scores from the pre-test to the post-didactic session (p <0.05) and from the post-didactic to the post-practice session (p <0.01). Interrater reliability using the global rating scale was high (Pearson’s r = 0.82, p <0.01). Significant but less powerful results were observed in the checklist score, pass rating and time.
There was a positive effect of training at the surgical skills laboratory on endourological skills. The global rating scale showed good construct validity and reliability for assessing endourological tasks, more so than the checklist, pass rating or time.
Abstract Electrohysterography is a technique which measures a bioelectrical activity of a uterus. This paper presents an application of a nonlinear parameterization of multivariate ...electrohysterographical signals for a uterine activity assessment to improve unsatisfactory a labor prediction accuracy by methods published in the literature. A multivariate sample entropy used for differentiated 4-channel electrohysterographical signals, general Spearman׳s correlation and a combined index being the sum of them, were tested. These nonlinear measures use joint information contained in a multivariate signal. The results confirm that the combined index provides the best assessment of uterine contractions: 87% sensitivity and 50% specificity of labor prediction in the studied data. These results should be verified in a prospective study.
Abstract Electrohysterography is a technique which measures a bioelectrical activity of a uterus. This paper presents an application of a nonlinear parameterization of multivariate ...electrohysterographical signals for a uterine activity assessment to improve unsatisfactory a labor prediction accuracy by methods published in literature. A multivariate sample entropy used for differentiated 4-channel electrohysterographical signals, general Spearman’s correlation and a combined index being the sum of them, were tested. These nonlinear measures use joint information contained in a multivariate signal. The results confirm that the combined index provides the best assessment of uterine contractions: 87% sensitivity and 50% specificity of labor prediction in the studied data. These results should be verified in a prospective study.
Abstract
Objective:
Overactive bladder (OAB) is a common condition whose prevalence increases with age. Antimuscarinic agents are the pharmacologic treatment of choice, but adverse events such as dry ...mouth may lead to early discontinuation. The purpose of this analysis was to compare the incidence and severity of dry mouth and other adverse events with solifenacin 5 mg/day and oxybutynin immediate release (IR) 15 mg/day in patients 65 years and >65 years in the Canadian VECTOR study (VEsicare in Comparison To Oxybutynin for oveRactive bladder patients).
Research design and methods:
VECTOR was a randomized, multicentre, prospective, double-blind, double-dummy study in 132 subjects with 1 urgency episode per 24 h, with or without urgency incontinence, and 8 micturitions per 24 h for 3 months. After a 2-week washout, patients received solifenacin 5 mg once daily or oxybutynin IR 5 mg tid for 8 weeks. For the current post-hoc analysis, adverse events were evaluated in subgroups of patients 65 years and >65 years, using a full logistic regression model, multinomial logit regression model and reduced model.
Clinical trial registration:
NCT00431041.
Results:
The incidence and severity of dry mouth and other adverse events with solifenacin were similar between younger and older patients. In both age subgroups, solifenacin 5 mg/day was associated with fewer episodes and lower severity of dry mouth, and a lower discontinuation rate, compared with oxybutynin IR 15 mg/day.
Conclusions:
Solifenacin 5 mg/day was better tolerated than oxybutynin IR 15 mg/day in younger ( 65 years) and older (>65 years) subgroups. Solifenacin was equally well tolerated in both age subgroups. Limitations of the analysis were that the study was not preplanned to perform post-hoc subgroup analysis, patients knew that dry mouth was a primary outcome, and the study used fixed doses of each drug.
This study compared the clinical efficacy (determined from micturition diaries) and safety of 12 weeks' treatment with either tolterodine 2 mg twice daily, oxybutynin 5 mg three times daily or ...placebo in patients with an overactive bladder. A total of 277 patients were randomized and treated at 25 centers. Both tolterodine and oxybutynin significantly increased volume voided/micturition compared to placebo. Both treatment groups evoked greater decreases in micturitions per 24 hours and incontinence episodes per 24 hours compared to placebo; however, only tolterodine was significantly better than placebo in reducing micturition frequency. Tolterodine and oxybutynin were equivalent in their effectiveness. Tolterodine was significantly better tolerated than oxybutynin when adverse events (particularly frequency and intensity of dry mouth), dose reduction and patient withdrawals were considered. Oxybutynin is an effective drug whose frequent adverse effects limit its clinical usefulness. Tolterodine has equivalent efficacy to oxybutynin, but with less severe adverse effects. This will allow patients to receive more effective treatment for their condition, with better compliance.PUBLICATION ABSTRACT
The Burch suspension is an effective treatment for stress urinary incontinence due to hypermobility. To decrease the associated morbidity and hospital stay, we attempted the procedure ...laparoscopically in 46 women.
All patients had stress incontinence with bladder neck hypermobility. Preoperative testing included cystoscopy, multichannel urodynamics with pressure-flow studies and measurement of Valsalva leak point pressure. Mean patient age was 49.5 years (range 26 to 70).
In 12 patients the laparoscopic approach could not be completed and an open operation was performed. Of the 34 laparoscopic Burch procedures 13 were performed transperitoneally and 21 extraperitoneally. Mean operative time was 196 minutes (range 130 to 300), mean blood loss 96.3 cc (range 50 to 400) and mean postoperative hospital stay 3.2 days (range 1 to 8). Five postoperative complications included hematoma/anemia in 2 patients, transient urinary retention in 1, enterocele in 1 and uterine prolapse in 1. Mean followup was 17.3 months (range 12 to 26). Of the 34 patients only 5 had persistent incontinence postoperatively (3 with stress and urge incontinence, 1 with stress incontinence only and 1 with urge incontinence only). Overall, 85 percent of the patients are totally dry. With experience the operative time and postoperative stay decreased. The extraperitoneal and transperitoneal approaches provide certain advantages.
The Burch suspension performed laparoscopically appears to have a favorable morbidity profile with a successful continence outcome. However, there is a steep learning curve to the procedure as manifested by the long operative time.
Objective: The aim of this study was to evaluate the efficacy and safety of a new PO controlled-release (CR) QD oxybutynin tablet relative to PO immediate-release (IR) TID oxybutynin in patients with ...urge urinary incontinence (UI).
Methods: In this multicenter, double-blind trial, patients with UI (⩾7 episode/wk) and frequency (⩾8 micturitions/d) were randomized to CR or IR oxybutynin for 6 weeks. Patients initiated treatment at 15 mg/d and the dose was adjusted (in 5-mg/d increments) over 2 weeks according to tolerability. Efficacy (UI episodes, voids, absorbent pads used, urgency, and volume voided per micturition) was assessed during the final 2 weeks of treatment. Tolerability was assessed by evaluating adverse events and treatment withdrawals.
Results: Of the 125 patients randomized, 94 (75%) were evaluable for efficacy; tolerability was assessed in all patients. In the CR group, 48 patients (91%) were women and 5 (9%) were men; the mean (SD) age was 58.0 (12.4) years (range, 26–78 years). In the IR group, 37 patients (90%) were women and 4 (10%) were men; the mean (SD) age was 60.6 (14.8) years (range, 26–83 years). Both CR and IR oxybutynin significantly reduced the mean number of total UI episodes per week (both P < 0.001 vs baseline). Both treatments produced equivalent reductions in mean voiding frequency and urinary urgency (all P < 0.001 vs. baseline). Significantly more patients rated CR oxybutynin tolerable on the initial dose of 15 mg/d (P = 0.020) and completed the study at a dose of ⩾15 mg/d (P = 0.018). Dry mouth was the most common adverse event, reported by 68% and 72% of patients in the CR and IR oxybutynin groups, respectively.
Conclusions: Among the patients with urge UI included in this study, CR oxybutynin was as effective as IR oxybutynin for improving primary symptoms, with the additional benefit of QD administration.
