The role of ultrasonographic measurement of bladder and detrusor wall thickness in diagnosis of urinary incontinence

© 2021, Kuwait Medical Association. All rights reserved.Objective: To evaluate the diagnostic accuracy of bladder wall thickness (BWT) and detrusor wall thickness (DWT) measurements by transvaginal ultrasound in diagnosis and classification of urinary incontinence Design: Fifty-one women with pure stress urinary incontinence (SUI), 53 women with pure detrusor over activity incontinence (DOI), both of which were diagnosed by urodynamic studies, and 50 women without urinary incontinence (as controls) were enrolled in this prospective cross-sectional study. Settings: Using transvaginal probe, BWT was measured in three sites: at the thickest part of the dome of the bladder, the trigone and the anterior wall of the bladder. Measurements are taken first at 250-300 ml bladder volume and repeated after voiding at <50 ml bladder volume. Subjects: An average of the three measurements was considered as the mean BWT and DWT. Intervention: BWT and DWT at both empty and full bladder were significantly thicker in DOI group than in controls. DOI group measurements were also thicker than SUI group, except for DWT measurement in full bladder. Main outcome measure: There were no statistical differences in DWT and BWT measurements between SUI and control groups. Results: By using ROC curve analysis, the best cut off values for predicting the DOI were calculated as 4.35 mm for full BWT; 1.95 mm for full DWT; 5.95 mm for empty BWT and 2.25 mm for empty DWT. Conclusion: Transvaginal ultrasonographic measurement of BWT and DWT in full and empty bladder can be valuable in diagnosis of DOI with low sensitivity and relatively high specificity

Anatomical and symptomatic mid-term outcomes of patients with isolated anterior compartment defect repair or stress urinary incontinence

Abstract Background An evaluation of preoperative and postoperative 12th month Pelvic Organ Prolapse Quantification (POP-Q) and Lower Urinary Tract Symptoms (LUTS) changes in patients operated for the diagnosis of isolated anterior compartment defect (ACD) or Stress Urinary Incontinence (SUI). Method Patients who were diagnosed with isolated ACD or SUI were retrospectively analyzed at urogynecology unit of our tertiary referral center. All pelvic examinations were performed by the same experienced urogynecologist. Pre-operative and post-operative 12th month POP-Q scores and the responses to a detailed LUTS questionnaire in the unit were assessed. Results Of the 90 patients with isolated ACD or SUI, midurethral sling with mini-sling and retropubic transobturator tape methods was applied in 24, iliococcygeal fixation in 28, trapezoid repair in 9 patients, anterior bridge operation in 14, and plication of pubocervicovaginal fascia to the cervical ring in 15. We compared the POP-Q score and pre and post-operative 12th month LUTS. Between pre and post-operative 12th month, there was a statistically significant difference at Aa and Ba points (p < 0.00, 0.001). Comparative LUTS questionnaire showed statistically significant differences in stress urinary incontinence, frequency, urgency, abnormal emptying, nocturia, pelvic pain (p: <0.001, p < 0.001, p: <0.001, p:0.001, p:<0.001, p:0.003, respectively). Conclusion Anatomical and symptomatic recovery is achieved with appropriate surgical intervention in women with isolated ACD or SUI. When LUTS were evaluated in terms of symptomatic recovery, they were found to be related not only to symptoms involving the anterior compartment, but also to symptoms involving other compartments

The effects of different therapeutic modalities on cardiovascular risk factors in women with polycystıc ovary syndrome: A randomızed controlled study

Objective: This study was designed to evaluate the effects of 3 mg drospirenone/30 μg ethinyl estradiol (OC) alone or combined with 1700 mg metformin on metabolic risk factors. Materials and methods: In this randomized, prospective, controlled study, 87 non-obese (18–30 BMI) women of reproductive age (18–39) with polycystic ovary syndrome (PCOS) were assigned to control (n = 17), OC (n = 21), combination (n = 20) and metformin (n = 29) therapy groups. Results: Adiponectin levels changed −28.27%, −20.37% and 35.78% after OC, combination and metformin therapies, respectively. High sensitive C-reactive protein levels (hsCRP) changed with OC, combination and metformin therapies by 102.32%, 3.2% and −7.14%, respectively. Plasminogen activator inhibitor-1 levels decreased 41.34% in the metformin group. Apolipoprotein-B levels changed in a manner similar to changes in hsCRP levels. The homeostatic model insulin resistance index changed significantly between the groups following treatment (p = 0.001). Conclusion: Six cycles of treatments with OC alone may cause metabolic variables to deteriorate in non-obese women with PCOS. The addition of metformin to OC may ameliorate some aspects of this effect

Considerations on pathophysiology of primary dysmenorrhea under the light of alterations in complete blood count parameters

The present study strives to evaluate how the components of complete blood count are altered in women with primary dysmenorrhea. This is a cross-sectional analysis of 155 women with primary dysmenorrhea and 155 women without dysmenorrhea. The primary dysmenorrhea and control groups were matched with respect to age and body mass index. When compared with the controls, the women with primary dysmenorrhea had a significantly younger menarche age, longer menstrual duration, higher leukocyte counts, higher neutrophil counts, and elevated MPV values (p=0.010, p=0.022, p=0.014, p=0.011 and p=0.04 respectively). The logistic regression analysis demonstrated that women with primary dysmenorrhea were more likely to have a younger menarche age (OR=2.14, 95% CI=0.971-3.346, p=0.018), longer menstrual duration (OR=1.91, 95% CI=0.988-2.308, p=0.044), higher leukocyte counts (OR= 2.90, 95% CI=1.040-3.788, p=0.007), and elevated MPV values (OR=3.17, 95% CI=2.056-9.128, p=0.001). The sensitivity and specificity of this model were 84.6% and 77.3%, respectively. Leukocytosis and increased MPV are might be associated with the inflammatory and vasoconstrictory pathogenesis of primary dysmenorrhea, but this result should be confirmed in the future researchesThe present study strives to evaluate how the components of complete blood count are altered in women with primary dysmenorrhea. This is a cross-sectional analysis of 155 women with primary dysmenorrhea and 155 women without dysmenorrhea. The primary dysmenorrhea and control groups were matched with respect to age and body mass index. When compared with the controls, the women with primary dysmenorrhea had a significantly younger menarche age, longer menstrual duration, higher leukocyte counts, higher neutrophil counts, and elevated MPV values (p=0.010, p=0.022, p=0.014, p=0.011 and p=0.04 respectively). The logistic regression analysis demonstrated that women with primary dysmenorrhea were more likely to have a younger menarche age (OR=2.14, 95% CI=0.971-3.346, p=0.018), longer menstrual duration (OR=1.91, 95% CI=0.988-2.308, p=0.044), higher leukocyte counts (OR= 2.90, 95% CI=1.040-3.788, p=0.007), and elevated MPV values (OR=3.17, 95% CI=2.056-9.128, p=0.001). The sensitivity and specificity of this model were 84.6% and 77.3%, respectively. Leukocytosis and increased MPV are might be associated with the inflammatory and vasoconstrictory pathogenesis of primary dysmenorrhea, but this result should be confirmed in the future researche

Considerations on pathophysiology of primary dysmenorrhea under the light of alterations in complete blood count parameters

The present study strives to evaluate how the components of complete blood count are altered in women with primary dysmenorrhea. This is a cross-sectional analysis of 155 women with primary dysmenorrhea and 155 women without dysmenorrhea. The primary dysmenorrhea and control groups were matched with respect to age and body mass index. When compared with the controls, the women with primary dysmenorrhea had a significantly younger menarche age, longer menstrual duration, higher leukocyte counts, higher neutrophil counts, and elevated MPV values (p=0.010, p=0.022, p=0.014, p=0.011 and p=0.04 respectively). The logistic regression analysis demonstrated that women with primary dysmenorrhea were more likely to have a younger menarche age (OR=2.14, 95% CI=0.971-3.346, p=0.018), longer menstrual duration (OR=1.91, 95% CI=0.988-2.308, p=0.044), higher leukocyte counts (OR= 2.90, 95% CI=1.040-3.788, p=0.007), and elevated MPV values (OR=3.17, 95% CI=2.056-9.128, p=0.001). The sensitivity and specificity of this model were 84.6% and 77.3%, respectively. Leukocytosis and increased MPV are might be associated with the inflammatory and vasoconstrictory pathogenesis of primary dysmenorrhea, but this result should be confirmed in the future researches. [Med-Science 2017; 6(4.000): 717-720

Safety, Efficiency, and Outcomes of Perineoplasty: Treatment of the Sensation of a Wide Vagina

Background. The sensation of a wide vagina is a common problem for women after childbirth. As its etiology is unknown, there is no uniform management strategy. We hypothesized that, rather than vaginal laxity, the cause was level 3 pelvic support deficiency. Methods. This retrospective study compared preoperative and postoperative genital hiatus length, perineal length, and total vaginal length in patients treated with perineoplasty for the sensation of a wide vagina. A telephone survey was used to determine postoperative patient and male partner satisfaction rates. Results. Mean age of patients was 48 (26–68) years; mean body mass index (BMI) was 25.3 (17.6–33.2); and mean parity was 2.5 (2–5). Preoperative and postoperative genital hiatus, perineal length, and total vaginal length were 4.62 and 3.18 (p<0.01), 3.06 and 4.04 (p<0.01), and 9.43 and 9.43 (p=0.882), respectively. At the 6-month follow-up, the success rate of the perineoplasty procedure was 87.9%; according to a visual analog scale, partner satisfaction rate was 92.6%. Ten percent (n=4) of patients said they experienced dyspareunia during sexual intercourse at the introitus of the vagina. Conclusion. With low dyspareunia rates, low complication rates, high patient satisfaction, and satisfactory anatomical success, perineoplasty can be considered successful for treatment of the sensation of a wide vagina