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  • 1
    Electronic Resource
    Electronic Resource
    A medium term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compliance (1997)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 104 (1997), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective The aims of this study were to determine the medium term subjective outcome of treatment for women with a urodynamic diagnosis of detrusor instability and low bladder compliance.Setting A tertiary referral Urogynaecology clinic.Participants and methods One thousand one hundred and five women referred for the investigation of their urinary symptoms were entered into a prospective, long term, quality of life study. Of these, 348 had a videourodynamic diagnosis of detrusor instability or low bladder compliance and form the basis of this paper. Women were contacted by post at least six months following their urodynamic assessment and asked to complete a questionnaire detailing their treatment, its efficacy and side effects, and any residual urinary symptoms.Results Two hundred and fifty-six women (73.6%) responded to follow up; only 5.5% were cured of their urinary symptoms. The majority (90.2%) had received anticholinergic medication, although only 18.2% continued with this treatment in excess of six months. Many women had residual urinary symptoms following their investigation and treatment.Conclusion The medium term efficacy of the treatment of detrusor instability and low compliance is disappointing, and a large part of this failure may be attributable to poor treatment efficacy, side effects of medication, or inadequate follow up following the diagnosis and instigation of therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1997.tb12054.x
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  • 2
    Electronic Resource
    Electronic Resource
    A new questionnaire to assess the quality of life of urinary incontinent women (1997)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 104 (1997), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objectives To design and validate a condition-specific quality of life questionnaire for the assessment of women with urinary incontinence, and to use the questionnaire to assess the quality of life of women with specific urodynamic diagnoses.Setting A tertiary referral Urogynaecology unit at King's College Hospital, LondonDesign The questionnaire was designed following six different pilot studies; in this study it was tested for validity and reliability using standard psychometric techniques. The questionnaire was used in 293 consecutive women referred for investigation of urinary incontinence.Results The questionnaire was shown to be reliable both by test-retest analysis and by measurement of its internal consistency. The construct of the questionnaire and the answers by respondents confirmed its face and content validity. Criterion validity was measured by correlation with scores obtained on a validated generic measure of quality of life, the Short Form 36. Women with detrusor instability had greater quality of life impairment than women with other urodynamic diagnoses.Conclusion The questionnaire was easy for the women to use and was a valid and reliable instrument for the assessment of quality of life in women with urinary incontinence. It will be useful for the rapid appraisal and follow up of women with urinary incontinence in many different clinical settings, including the evaluation of new treatments of urinary incontinence in controlled clinical trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1997.tb11006.x
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  • 3
    Electronic Resource
    Electronic Resource
    Ultrasound: a noninvasive screening test for detrusor instability (1996)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 103 (1996), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine whether transvaginal ultrasound measurement of bladder wall thickness can be used as a screening test for detrusor instability in women with urinary symptoms.Design A blinded prospective study.Setting A London teaching hospital.Participants One hundred and eighty-four symptomatic women presenting to a urodynamic clinic.Main outcome measure The detection of detrusor instability by means of videocystourethrography (VCU) and ambulatory urodynamics in women with a mean bladder wall thickness of greater than 5 mm measured by transvaginal ultrasound.Results One hundred and eight women had a mean bladder wall thickness of greater than 5 mm. Ninety-four percent (102) of these women had detrusor instability either when undergoing VCU or ambulatory urodynamics. Seventeen women had a bladder wall thickness of less than 3.5 mm of whom three were found to have detrusor instability on VCU.Conclusion The measurement of a mean bladder wall thickness greater than 5 mm with transvaginal ultrasound is a sensitive screening method for diagnosing detrusor instability in symptomatic women without outflow obstruction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1996.tb09910.x
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  • 4
    Electronic Resource
    Electronic Resource
    A comparison of bioelectrical and mechanical activity of the female urethra (1993)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 100 (1993), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine the relationship between mechanical function and innervation of the urethra in order to clarify the effect of denervation and re-ennervation on urethral function.Design Prospective observational study.Setting Tertiary referral urodynamics unit.Subjects Thirty-six women, 21 with urinary symptoms and urodynamically proven genuine stress incontinence and 15 without urinary symptoms.Interventions All women underwent concentric needle electromyography of the urethral sphincter and urethral pressure profilometry at rest and during cough induced stress.Results Significant correlations were found between variables indicating denervation and reinnervation and improved resting urethral function. No correlation was found between these variables and urethral function under stress.Conclusions Our findings contradict current opinion that denervation of the urethral sphincter is associated with a reduction in the sphincteric function of the urethra, at rest or during stress, and suggest that denervation cannot therefore be a major aetiological factor in the development of genuine stress incontinence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1993.tb14268.x
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  • 5
    Electronic Resource
    Electronic Resource
    Denervation and re-innervation of the urethral sphincter in the aetiology of genuine stress incontinence: an electromyographic study (1993)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 100 (1993), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To investigate the role of altered innervation of the urethral sphincter in the genesis of genuine stress incontinence.Design Prospective observational study.Setting Tertiary referral centre urodynamics unit.Subjects Sixty-eight women, 33 with urodynamically proven pure genuine stress incontinence and 35 controls without urinary symptoms.Interventions Concentric needle electromyography of the urethral striated sphincter.Main outcome measures The means of motor unit potential duration, number of changes in polarity and the amplitude of individual motor unit potentials were compared between the two groups.Results There was no statistically significant difference in motor unit potential duration (P= 0.87) or in the number of changes in polarity (P= 0.85). There was a trend towards a higher amplitude of motor unit potentials in the control group (P= 0.07).Conclusions Our findings suggest that denervation and re-innervation of the striated urethral sphincter following trauma to the pelvic floor, such as that occurring during childbirth, is not a major aetiological factor in the development of genuine stress incontinence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1993.tb14267.x
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  • 6
    Electronic Resource
    Electronic Resource
    GAX collagen in the treatment of urinary incontinence in elderly women: a two year follow up (1997)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 104 (1997), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine the efficacy of GAX collagen in the treatment of elderly women with genuine stress incontinence.Design A single centre prospective study.Setting A London teaching hospital.Participants Thirty-four women older than 60 years of age with genuine stress incontinence diagnosed on videocystourethrography.Interventions Up to three paraurethral injections of GAX collagen.Main outcome measures Subjective and pad test assessments performed pre-operatively, after one month, one year and two years after the first injection of collagen. Videocystourethrography and urethral pressure profilometry were carried out pre-operatively, after three months and one year.Results There was a reduction in urinary leakage as measured on pad testing. After two years 77% of the surviving 26 women were symptomatically cured. Objectively after two years 48% of the women were cured and 9% were improved over their initial pre-treatment level of incontinence. The cure rate was the same whether or not the women had undergone previous vaginal surgery. The maximum urethral closure pressure was not increased with treatment indicating that collagen injections do not act by producing obstruction, but this should be interpreted with caution due to the small sample size.Conclusion GAX collagen is an effective method of treating urinary incontinence in the elderly and especially women who have undergone previous continence procedures. The technique is easy to perform and particularly suitable in those who are frail, but if failure occurs after two years consideration needs to be given to its cost effectiveness.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1997.tb10657.x
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  • 7
    Electronic Resource
    Electronic Resource
    Predictive value of cervimetric labour patterns in primigravidae (1982)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 89 (1982), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary. From a study of 2000 consecutive labours the outcome of the 684 primigravid patients admitted in spontaneous labour has been examined according to their cervimetric progress during the first stage of labour. A partogram and labour stencil were used to identify dysfunctional labour which was treated with a standard protocol of augmentation by oxytocin. This policy achieved labours with a mean‘observed first stage’ of 6.3 h and a caesarean section rate of 8.7%. There was one stillbirth due to multiple congenital abnormalities and no increase in perinatal morbidity. Our data show that the type of first stage cervimetric pattern is helpful in predicting the outcome of labour. A normal cervimetric pattern resulted in a vaginal delivery rate of 98.4%; primary dysfunctional labour, which could be improved by oxytocin, had a 93.8% incidence of vaginal delivery, but if there was no improvement in the rate of cervical dilatation when this was administered the vaginal delivery rate was only 22.7%. A prolonged latent phase was associated with a caesarean section rate of 16.7% and the incidence of neonatal intubation was nearly as high as that found in uncorrected primary dysfunctional labour. The neonatal asphyxia in secondary arrest was minimal with an overall caesarean section rate of 28.4%; there was no increased incidence of neonatal morbidity with this cervimetric type.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1982.tb04631.x
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  • 8
    Electronic Resource
    Electronic Resource
    Social and obstetric features associated with smoking in pregnancy (1982)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 89 (1982), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary. The smoking habits of 2000 consecutive pregnant women have been analysed in relation to their race, social features and obstetric results. Only 60% of white patients were non-smokers compared with 80% of blacks and 90% of Asians, and whereas 20% of white patients smoked heavily only 3% of blacks or Asians did. Smokers booked later and were more frequently unsure of their dates, unemployed, unmarried and defaulters from the antenatal clinic. The incidence of antepartum haemorrhage was doubled amongst the heavy smoking multigravid patients in spite of a slightly decreased incidence of hypertensive disease. More non-smokers required induction of labour for raised blood pressure, and more smokers for fetal distress. The most significant differences between the smokers and non-smokers were the decrease in mean birth-weight associated with increased smoking (3.31 kg for non-smoking primi-gravidae compared with 3.14 kg for heavy smokers) and the threefold increased incidence of small-for-dates babies amongst the heavy smokers. There was no significant difference in the perinatal mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1982.tb04716.x
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  • 9
    Electronic Resource
    Electronic Resource
    Prolonged pregnancy: is induction of labour indicated? (1982)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 89 (1982), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary. A prospective controlled study of 2000 patients to determine the incidence of postmaturity and the effect of a policy of non-induction of labour in prolonged pregnancy is reported.‘Certain postmaturity’ was identified in 4% of the patients and was associated with an increased incidence of babies with Apgar scores of 〈5 at 1 min; induction of labour at 42 weeks gestation did not affect the neonatal outcome compared with that in patients allowed to go into spontaneous labour. Induction of labour in patients designated as‘certain postmature’ and‘uncertain postmature’ reduced the number of vaginal deliveries and increased the caesarean section rate from 9.6 to 26.7 and from 2.2 to 31.2% respectively. The failure to improve the perinatal outcome does not support or justify induction of labour for uncomplicated postmaturity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1982.tb04698.x
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  • 10
    Electronic Resource
    Electronic Resource
    Assessment of urinary symptoms in early pregnancy (1991)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 98 (1991), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objectives— To determine the correlation between lower urinary tract symptoms and urodynamic findings in early pregnancy.Setting— The termination clinic and gynaecology ward at King's College Hospital.Design— Observational study.Subjects— 47 women before termination of pregnancy at between 6 and 15 weeks.Interventions— Women filled in symptom questionnaires and then had urodynamic investigations, consisting of uroflowmetry and subtracted provoked cystometry.Main outcome measures— The occurrence of lower urinary tract symptoms and their association with urodynamic findings.Results— Lower urinary tract symptoms were fairly common but there was poor correlation with the urodynamic findings.Conclusions— The findings suggest that lower urinary tract symptomatology alone is insufficient to study lower urinary tract dysfunction in pregnancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1991.tb15403.x
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