Showing papers by "Stuart L. Stanton published in 2003"

Bulking agents for stress urinary incontinence: short-term results and complications in a randomized comparison of periurethral and transurethral injections

Abstract: The purpose of our study was to compare the two standard routes of urethral bulking injection in a prospective randomized trial. Forty women with genuine stress incontinence (n=36), or mixed incontinence with a minor and controlled urge component (n=4), participated in a urethral bulking agent trial. All patients had a standardized preoperative evaluation which included history, physical examination, assignment of incontinence status on a Stamey grading scale, postvoid residual (PVR) determination, Valsalva leak-point pressure, maximal urethral closure pressure, functional urethral length, Q-tip excursion angle, quantitative pad test, and completion of a quality of life questionnaire. On the day of injection they were randomly assigned to a periurethral or transurethral route of injection based on a computer-generated block randomization scheme. An ultrasound-determined PVR was obtained on all patients after injection. If self-catheterization was necessary, and the PVR was >200 ml, urinary retention was diagnosed. Postoperative assessment included a patient interview, subjective assessment of improvement, PVR, voiding diary, and assignment of incontinence grade. At the screening visit there were no significant differences between the groups for any variables except type of stress incontinence. With short-term follow-up both transurethral and periurethral routes of injection seem to be equally efficacious. In the periurethral injection group there was a higher rate of postoperative retention; this group had a significantly higher volume of injectable agent used. There was no significant difference in risk of urinary tract infections between the two groups. We conclude that both periurethral and transurethral methods of bulking agent injection for stress urinary incontinence are equally efficacious, with minimal morbidity.

Symptoms and anal sphincter morphology following primary repair of third-degree tears.

Abstract: Background: Approximately 0·6–9 per cent of vaginal deliveries are complicated by third-degree tears. The precise impact of such injuries on future pelvic floor function remains unknown. The aim of this study was to define the extent of structural and physiological damage to the anal sphincter and to investigate anorectal function in women who sustained third-degree tears during vaginal delivery. Methods: Fifty-six women who sustained a third-degree tear were investigated prospectively. All patients had a primary repair of the anal sphincter complex, and were assessed by anorectal physiology and endoanal ultrasonography at a mean of 3·6 months. Symptoms were assessed by direct personal interview and also by a self-completed questionnaire. Results: Forty-four patients had a persistent anal sphincter defect on ultrasonography. The mean resting and squeeze anal canal pressures were significantly lower in patients with a combined defect than in those in whom the repair was intact (P = 0·036 and P = 0·005 respectively). At direct interview three patients volunteered current symptoms of faecal and/or urinary incontinence whereas 32 reported bothersome symptoms on the questionnaire (P < 0·001). Conclusion: The anatomical and physiological damage sustained during third-degree tears appears to be much greater than is generally appreciated. Primary repair does not provide lasting integrity. A self-administered questionnaire appears to be more accurate in defining the symptomatology. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Vaginal wind - a new pelvic symptom.

Abstract: The aim of this study was to evaluate the risk factors, investigations and treatments for vaginal wind. A prospective longitudinal study was carried out at a tertiary care referral centre at St George's Hospital, London. Six consecutive women with symptomatic vaginal air were enrolled in the study, which used a comprehensive questionnaire for vaginal air, prolapse, urinary, bowel and sexual symptoms, vaginal examination following the Standardized ICS Scoring System for prolapse, physiotherapist evaluation, and analysis of the treatment. Main outcome measures were the effect of the patient's age, weight, parity, mode of delivery, fetal weight, and the treatment (conservative and surgical) on the frequency of vaginal wind. The mean age of the six women was 32.8+/-9.9 years (range 21-52), the mean BMI was 23.1+/-5.5 (range 15.2-32.2), all women were premenopausal and five were parous. The mean estimated frequency of the symptoms was 20.0+/-8.1 per day (range 10-40). All the patients completed a course of pelvic floor physiotherapy and one patient had a posterior repair and later a Fenton operation without improvement. A modified 'Bard' pessary was the main form of treatment and resolved the symptoms in two women. Vaginal wind causes significant distress and embarrassment to sufferers. Further information on risk factors, evaluation and treatment modalities should be obtained.

Pelvic Floor Dysfunction: The Need for a Multidisciplinary Team Approach

Abstract: Pelvic floor dysfunction (PFD) is a disorder predominantly affecting females It is common and undermines the quality of lives of at least one third of women There is little agreement on the reasons for such a high prevalence of pelvic floor disorders, the relative importance of specific risk facto

MRI visualization of the female pelvis in the plane of the tension-free vaginal tape (TVT) procedure

Abstract: We evaluated the distances and angles of the major blood vessels from various pelvic structures in the plane of the tension-free vaginal tape (TVT) procedure in 19 pelvic MR imagies. The major blood vessels were the iliofemoral vessels. The mean distance of the left iliofemoral vessels from the midline was 5.7±0.4 cm, and 5.7±0.3 cm for the right vessels. The mean distance of the left sacral tuberosities from the midline was 5.5±0.4 cm, and 5.6±0.3 cm for the right vessels. The angle between the midurethra and the left iliofemoral vessels was 50.6±4.4 cm, and 49.6±4.0 cm for the right. A significant correlation was found between the distance of the right and left iliofemoral vessels from the midline and the distance of right and left sacral tuberosities from the midline (P<0.01, P<0.007). We suggest that palpation of the sacral tuberosities might indicate the location of the iliofemoral blood vessels.