Cognitive changes in older women after urogynaecological surgery

Objectives: The need for pelvic floor surgery will increase with an aging population in the future. Aim of this prospectivestudy was to evaluate the evolution of cognitive function in elderly women after urogynaecological surgery.Material and methods: Between 2010 and 2014, 51 female patients 70 years and older who underwent urogynaecologicalsurgery participated in this study. Geriatric and urogynaecological assessment were performed before and six weeks after surgery, including the Mini-COG test, the clock-drawing test, a depression scale, an activities of daily living questionnaire, and the German pelvic floor questionnaire.Results: Mean age was 77 years (range 70–91). Overall, 15 women were operated for incontinence, 31 for prolapse, andfive for miscellaneous reasons. Only two (3.9%) of the 51 women developed postoperative delirium. Abnormal cognitivefindings increased from preoperatively 15.7% to 39.2% six weeks after surgery (odds ratio 3.4, 95% confidence interval1.3 to 8.7, p < 0.001). There were no statistically significant pre-post differences in activities of daily living and depression scores. Pelvic floor function indices improved significantlyConclusion: This study shows an overall decline of cognitive function in a vulnerable group of elderly women during theshort-term postoperative period. Postoperative cognitive dysfunction (POCD) after surgery has been described for othertypes of non-cardiac surgery but has been understudied in urogynaecological surgery. These patients need interdisciplinary management to prevent or minimize adverse effects of surgery on cognitive function

Does bladder wall thickness decrease when obstruction is resolved?

Introduction and hypothesis: The aim of the current study was to determine if sonographic bladder wall thickness diminishes after symptomatic obstruction is resolved in female patients after stress incontinence surgery. Methods: Between December 2008 and December 2010, 62 female patients with symptomatic bladder outlet obstruction, as defined by Blaivas, who had undergone prior surgery for urinary stress incontinence were included in the study. The patients' history was taken and symptoms were noted. Patients underwent gynaecological examination, and multichannel urodynamic assessment was performed. Vaginal sonographic assessment of the bladder wall thickness (BWT) was performed before and after urethrolysis. Results: 62 patients were included in this study, 55 of whom had undergone suburethral sling insertion and seven had Burch colposuspension. Postoperatively, BWT decreased significantly from 9.1mm ± 2.1 to 7.6mm ± 2.2 (p < 0.0001). In seven patients, obstruction was still unresolved postoperatively; of these, two had undergone a retropubic sling insertion and two had a Burch colposuspension. An ROC curve analysis showed a significant positive association between residual urine and persistent obstruction before surgery (AUC 0.76, 95%CI 0.58-0.94; p < 0.05). Conclusions: If obstruction is resolved, bladder wall thickness decreases. Preoperatively elevated residual urine may increase the risk of persistent obstruction after urethrolysi

Cognitive changes in older women after urogynaecological surgery.

OBJECTIVES The need for pelvic floor surgery will increase with an aging population in the future. Aim of this prospective study was to evaluate the evolution of cognitive function in elderly women after urogynaecological surgery. MATERIAL AND METHODS Between 2010 and 2014, 51 female patients 70 years and older who underwent urogynaecological surgery participated in this study. Geriatric and urogynaecological assessment were performed before and six weeks after surgery, including the Mini-COG test, the clock-drawing test, a depression scale, an activities of daily living questionnaire, and the German pelvic floor questionnaire. RESULTS Mean age was 77 years (range 70-91). Overall, 15 women were operated for incontinence, 31 for prolapse, and five for miscellaneous reasons. Only two (3.9%) of the 51 women developed postoperative delirium. Abnormal cognitive findings increased from preoperatively 15.7% to 39.2% six weeks after surgery (odds ratio 3.4, 95% confidence interval 1.3 to 8.7, p < 0.001). There were no statistically significant pre-post differences in activities of daily living and depression scores. Pelvic floor function indices improved significantly Conclusion: This study shows an overall decline of cognitive function in a vulnerable group of elderly women during the short-term postoperative period. Postoperative cognitive dysfunction (POCD) after surgery has been described for other types of non-cardiac surgery but has been understudied in urogynaecological surgery. These patients need interdisciplinary management to prevent or minimize adverse effects of surgery on cognitive function

Guideline of the Swiss Society of Gynaecology and Obstetrics (SSGO) on acute and recurrent urinary tract infections in women, including pregnancy.

Acute and recurrent urinary tract infections (UTIs) are common auto-infectious diseases transmitted from the intestinal tract. They affect the urinary tract either through recurrence or through persistence. The incidence of UTIs increases with age and comorbidities. In this guideline from the Swiss Society of Gynaecology and Obstetrics (SSGO), diagnosis and treatment of UTIs are grouped into uncomplicated and complicated cases. This is to our knowledge the first guideline that specifically considers UTIs in pregnancy and breastfeeding, and the prevention of UTIs in the context of urogynaecological diagnosis and surgery. Recommendations are based on observational, retrospective or randomised controlled studies. The level of evidence was rated according to recommendations made by the Oxford Centre of Evidence-based Medicine. In non-pregnant women and women &lt;65 years with dysuria, pollakiuria and suprapubic pain, no urine diagnostic testing is needed. If the clinical presentation is unclear, urinary tests such as midstream urine stix or urine analysis should be used, and in cases of unclear or recurrent infections, a urine culture. Routine screening for asymptomatic bacteriuria (ASB) should not be carried out, and antibiotic treatment should be avoided in cases of incidentally detected ASB. As an exception, screening for bacteriuria should be carried out in patients prior to urogynaecological surgery where urinary drainage by catheter is necessary or probable. In pregnancy, systematic screening for ASB is not recommended, because most women with ASB do not develop complications during follow-up, and contamination of urine samples collected in pregnancy is common. Patients should be advised that most UTIs are self-limiting, that the symptoms can be relieved with non-steroidal anti-inflammatory drugs (NSAIDs) and that the same time is required to eradicate the bacteria using antibiotics or NSAIDs. For non-pregnant women with uncomplicated UTIs, a 48-hour-delayed antibiotic prescription is recommended, supplemented by NSAIDs for pain relief. If antibiotics are needed after 48 hours, or in case of direct antibiotic administration in pregnant women, the shortest possible course of treatment should be carried out. There is increasing interest in alternatives or complementary treatments to antibiotic therapy, especially for recurrent UTIs. Different recommendations and alternative medications are summarised. This short and comprehensive guideline provides quick answers for every day clinical questions concerning UTIs, especially for obstetricians and gynaecologists

Out of Eastern Africa: defibulation and sexual function in woman with female genital mutilation

Female genital mutilation (FGM) is defined by the World Health Organization (WHO) as all procedures that involve partial or total removal of the female external genitalia and/or injury to the female genital organs for cultural or any other non-therapeutic reasons

Does bladder wall thickness decrease when obstruction is resolved?

The aim of the current study was to determine if sonographic bladder wall thickness diminishes after symptomatic obstruction is resolved in female patients after stress incontinence surgery

Sexual function after vaginal and abdominal fistula repair

OBJECTIVE The purpose of this study was to compare clinical outcomes and sexual function between transvaginal and transabdominal repairs of vesicovaginal fistulae (VVF). STUDY DESIGN Participants (99 women with VVF at a tertiary referral center) were treated with urinary catheterization for 12 weeks and, if the procedure was unsuccessful, underwent repair either the transvaginal (Latzko) or transabdominal technique. Objective clinical parameters were analyzed; subjective outcomes were recorded prospectively at the 6-month follow-up examination with the use of the female sexual function index to evaluate sexual function and the visual analogue scale to measure general disturbance by the fistula. RESULTS After bladder drainage for 12 weeks, 8 patients had spontaneous fistula closure. Demographic variables were similar in the transvaginal (n = 60) and transabdominal (n = 31) repair groups. The transvaginal procedure showed significantly shorter operation times, less blood loss, and shorter hospital stay. Continence rates 6 months after surgery were 82% (transvaginal) and 90% (transabdominal). Sexual function in the 64 sexually active patients was significantly improved, and overall disturbance by the fistula was reduced with both operative techniques. Neither surgical intervention was superior to the other regarding any domain of sexual function or visual analog scale. CONCLUSION Fistula repair improves sexual function and quality of life with no difference attributable to surgical route. Given this and that operating time, blood loss and length of stay are less with the transvaginal approach, the transvaginal approach is preferred in VVF repair if fistula and patient characteristics are suitable

Sexual function after rectocele repair

Pelvic organ prolapse is a common condition among women with a prevalence of 11% and may affect the anterior, posterior, or apical compartment with a negative impact on sexual function

Sexual function after sacrocolpopexy

Pelvic organ prolapse affects approximately 50% of parous women over 50 years of age and has a lifetime risk of 30-50%. Vault descent or prolapse occurs in about 20% after hysterectomy and can have a negative effect on sexual function. Sacrocolpopexy is the gold standard of surgical treatment for apical prolapse in fit, sexually active patients. Few data exist which determine sexual function after sacrocolpopexy

Sonographic transvaginal bladder wall thickness: Does the measurement discriminate between urodynamic diagnoses?

Measurement of bladder wall thickness (BWT) using transvaginal ultrasound has previously been shown to discriminate between women with confirmed detrusor overactivity and those with urodynamic stress incontinence. Aim of the current study was to determine if vaginally measured BWT correlates with urodynamic diagnoses in a female population