Medical News...
Urinary Tract Infections
After each infection, it is more likely that you will have another.: 20% recur- of this group- 30% will have a third, and of this group- 80% will have additional recurrences
Increased use of antibiotics can lead to resistance. Voiding before and after intercourse, us of cotton underwear, avoiding feminine hygiene deodorants and scented toilet paper can all help reduce the risk. Best long term prevention:
- Cranberry-tablets (400 mg tid x 4 weeks )- or 300 ml/ D - limits bacteria adhering to bladder wall
- Cystex liquid cranberry complex-(Wallgreens, RiteAid, Wallmart)
- D-Mannose – prevents some bacteria adhering to uroepithelial cells of the bladder.
- Vitamin A, C
- Berberine- 400 mg x 1 or 200 mg/ kg x 1 (contraindicated in pregnancy-uterine contractions)
- Estriol cream, Vitamins A (200,000 IU) and C (100 mg/ D)
Surgery for Urinary Incontinence
Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence
The aim of this study was to evaluate the longterm effectiveness and safety of the tension-free vaginal tape (TVT) procedure. In a Nordic three-center prospective observational cohort study, 90 women with primary stress incontinence had a TVT operation performed in local anesthesia. Assessment included a 24-h pad test, a stress test, physical examination, and a visual analog scale for assessing the degree of bother. Patient’s global impression of cure was obtained, and condition specific quality of life questionnaires were used. Seventy-seven percent of the initial cohort of 90 women and 89% of those alive and capable of cooperating were assessed 11.5 years after the TVT operation. Ninety percent of the women had both a negative stress test and a negative pad test being objectively cured. Subjective cure by patients global impression was found in 77 %, 20% being improved and only 3 % regarded the operation as a failure. No late-onset adverse effects of the operation were found, and no case of tape erosion was seen. The TVT procedure is safe and effective for more than 10 years.
Moderate weight loss in obese women with urinary incontinence: a prospective longitudinal study
This study assessed the effect of moderate weight loss in obese women with urodynamically proven urinary incontinence using the International Consultation on Incontinence recommended outcome measures. Sixty-four incontinent women were offered a weight reduction programme with a target loss of 5–10%. This included a low-calorie diet and exercise. An anti-obesity drug (Orlistat) was offered to those who failed to achieve their target. Fortytwo (65%) achieved the target weight loss and had significant reduction in body mass index and girth. Weight loss was associated with significant reduction in pad test loss (median difference, 19 g; 95% confidence interval, 13–28 g; p<0.001). There was also a clinical and statistically significant improvement in quality of life measures. These results suggest that weight reduction of 5% of initial body weight can improve urinary incontinence severity and its effects on quality of life in obese women.
Pelvic Organ Prolapse
Family history as a risk factor for pelvic organ prolapse
The aim of this study was to determine whether a family history of prolapse and/or hernia is a risk factor for prolapse. A cohort of 458 women seeking gynecological care was classified as exposed (family history) or unexposed (without family history). We used x2 to assess confounding and logistic regression to determine risk. Nearly half (47.3%) of the 458 participants reported a positive family history. Of these, 52.5% had prolapse. This was significantly higher than the 28.9% rate of prolapse in women without a family history (p<0.001). The crude risk ratio for family history of prolapse and/or hernia and prolapse was 1.8 (95% CI 1.4–2.3). After adjusting for vaginal deliveries, incontinence, and hysterectomy, the risk of prolapse was 1.4 (95% CI 1.2–1.8) times higher in women with a family history of prolapse and/or hernia. Heredity is a risk factor for prolapse. History taking should include both male and female family members.
Abnormal Uterine bleeding
Limited Public Knowledge of Obesity and Endometrial Cancer Risk
The prevalence of overweight and obese Americans has continued to rise over the last 3 decades. In 2003 to 2004, 66% of adults in the United States were either overweight or obese (body mass index [BMI] 25 kg/m2 or higher), an increase from only 47% in 1960.1 This increase in the prevalence of obesity has been shown to be particularly important in women and in minority groups. Black and Hispanic women have been shown to have the highest weight accumulation when compared with either white women or men.2 In addition, black women are projected to have the highest increase in obesity based on current growth rates.3
Limited Public Knowledge of Obesity and Endometrial Cancer Risk
The prevalence of overweight and obese Americans has continued to rise over the last 3 decades. In 2003 to 2004, 66% of adults in the United States were either overweight or obese (body mass index [BMI] 25 kg/m2 or higher), an increase from only 47% in 1960.1 This increase in the prevalence of obesity has been shown to be particularly important in women and in minority groups. Black and Hispanic women have been shown to have the highest weight accumulation when compared with either white women or men.2 In addition, black women are projected to have the highest increase in obesity based on current growth rates.3
Can we rely on blind endometrial biopsy for detection of focal intrauterine pathology?
Focal lesions of the uterine cavity, including submucosal fibroids and endometrial polyps, are common pathologies associated with diverse clinical situations ranging from abnormal uterine bleeding to infertility.1 These conditions are usually diagnosed by office procedures, such as hysteroscopy, transvaginal sonography, and hydrosonography, which have replaced the classic dilatation and curettage by being more accurate and less invasive.2,3 Nevertheless, the blind and random endometrial biopsy (either the Pipelle sampler or the Novak curette) procedure is still widely used as the only diagnostic modality for evaluating women with abnormal bleeding. 4 The aim of the current study was to compare the accuracy of blind endometrial biopsy to that of hysteroscopy for detection of intrauterine lesions, using hysteroscopy as reference.
Interstitial Cystitis
Treatment Guidelines for Classic and Non-Ulcer Interstitial Cystitis
Interstitial cystitis (IC) is a chronic disease of as yet unknown etiology. It commonly affects females, presenting with symptoms of pain on bladder filling, and urinary frequency. Accumulated evidence indicates that IC is a heterogeneous syndrome. Compared to classic IC, the non-ulcer type appears different concerning symptomatic, endoscopic and histological findings, as well as the response to various forms of treatment. This review gives an introduction to the syndrome of IC, concerning epidemiology, clinical characteristics, diagnostic criteria and etiological considerations. A variety of treatment modalities have been suggested and are assessed and reviewed, such as hydrodistension of the bladder, intravesical instillation therapy, oral medication, transcutaneous electrical nerve stimulation, transurethral resection of diseased bladder tissue, and supratrigonal cystectomy followed by enterocystoplasty and urinary diversion. Our algorithm on non-surgical and surgical treatment for classic and non-ulcer IC is presented.