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Biomedical subjects

A Groutz

Publications and source records attributed to A Groutz.

At least 37 records · Page 2Linked to original sources
PubMed2000

The significance of the American Urological Association symptom index score in the evaluation of women with bladder outlet obstruction.

PURPOSE: The American Urological Association (AUA) symptom index was originally designed to assess the severity of lower urinary tract symptoms in men with benign prostatic hyperplasia. Data concerning the clinical application of the AUA symptom index to women are sparse. We evaluated the significance of the AUA symptom index in women with urodynamically defined bladder outlet obstruction. MATERIALS AND METHODS: From a urodynamic database of 587 consecutive women 38 (6.5%) were identified with bladder outlet obstruction, defined as a maximum flow rate of less than 12 ml. per second on repeat noninvasive uroflowmetry studies with a detrusor pressure at a maximum flow of greater than 20 cm. water on pressure flow study. All patients underwent a complete clinical and urodynamic evaluation, and completed the AUA symptom index questionnaire. Results in women with urodynamic obstruction were compared with those in 2 control groups, including women without obstruction but with sphincteric incontinence and asymptomatic healthy women. RESULTS: Mean symptom score was significantly higher in women with obstruction than in those with sphincteric incontinence or no symptoms (15.8+/-8.4 versus 10.3+/-6.4 and 2.1+/-2.7, respectively). Likewise, scores were classified as severe in 34% of women with obstruction compared with only 7% of those with sphincteric incontinence. However, no correlation was noted between symptom index scores and objective urodynamic parameters, which is similar to data already reported in male populations. CONCLUSIONS: The AUA symptom index score may be useful as a bothersomeness index in women with bladder outlet obstruction. However, subjective symptoms associated with bladder outlet obstruction are nonspecific and a complete urodynamic evaluation is essential for making the diagnosis.

Female↗
PubMed2000

Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse.

PURPOSE: We determined the indications for anti-incontinence surgery in continent women undergoing surgical repair of severe urogenital prolapse. MATERIALS AND METHODS: We prospectively evaluated 24 continent women referred for evaluation of severe urogenital prolapse. All patients underwent a meticulous clinical evaluation, including a complete history and physical examination, urinary questionnaire, voiding diary, pad test, cotton swab test, video urodynamics and cystoscopy. The urodynamic evaluation was repeated with prolapse repositioning by a fitted vaginal pessary. Surgical intervention was tailored according to urodynamic findings. RESULTS: Reduction of prolpase with a pessary unmasked sphincteric incontinence in 14 women (58%). Ten women with no urodynamic evidence of sphincteric incontinence underwent anterior colporrhaphy and no additional anti-incontinence procedure was performed. Mean followup was 44 months (range 12 to 96). None had postoperative stress incontinence but 1 (10%) had a recurrent grade 2 cystocele. The 14 remaining women with sphincteric incontinence after prolapse reduction underwent anterior colporrhaphy with a pubovaginal sling procedure. Mean followup in these cases was 47 months (range 12 to 108). In 2 patients (14%) stress incontinence developed postoperatively and 1 (7%) had a recurrent grade 3 cystocele. The incidence of urge incontinence did not appear to be significantly influenced by either surgical intervention. Overall 12 patients had preoperative urge incontinence, of whom 9 (75%) had persistent urge incontinence postoperatively. In another woman new onset urge incontinence developed. CONCLUSIONS: Preoperative urodynamic evaluation with and without prolapse reduction is essential for making the correct diagnosis of masked stress incontinence in women with urogenital prolapse. The decision to perform a concomitant prophylactic anti-incontinence procedure should be tailored to individual urodynamic findings. Larger series and longer followup are needed to establish the most effective preventive procedure for this troublesome clinical problem.

Aged↗
PubMed2000

The pathophysiology of post-radical prostatectomy incontinence: a clinical and video urodynamic study.

PURPOSE: We examine various mechanisms of post-radical prostatectomy incontinence. MATERIALS AND METHODS: A total of 83 consecutive men (mean age 68 +/- 6.6 years) referred for evaluation of persistent post-radical prostatectomy incontinence were enrolled in the study. All patients underwent clinical and urodynamic evaluation. Final diagnosis was based on clinical judgment considering patient history, pad test, voiding diary, free (unintubated) uroflow measurements, video urodynamics and linear passive urethral resistance relation curves. We compared free uroflow and pressure flow obtained with a 7Fr urethral catheter in place, and empirically defined low urethral compliance as at least 10 ml. per second difference between these measurements. RESULTS: Sphincteric incontinence was the most common urodynamic finding, occurring in 73 patients (88%). Detrusor instability was identified in 28 patients (33.7%) and in 6 (7.2%) was the main cause of incontinence. In 2 other patients bladder outlet obstruction (1.2%) or impaired detrusor contractility (1.2%) was the only urodynamic finding. Impaired detrusor contractility was diagnosed by linear passive urethral resistance relation in 82% of cases but considered to be clinically relevant in only a third. In 25 cases (30.1%) low urethral compliance was noted, which we consider nearly synonymous with urethral scarring. CONCLUSIONS: Sphincteric incontinence is the most common urodynamic finding in patients with post-radical prostatectomy incontinence, although other findings may coexist. The most accurate diagnosis is attained when all objective measures are put in perspective with the clinical setting.

Aged↗
PubMed2000

Detrusor pressure uroflowmetry studies in women: effect of a 7Fr transurethral catheter.

PURPOSE: We evaluated whether a 7Fr transurethral catheter affects urinary flow in women undergoing pressure flow studies for voiding symptoms. MATERIALS AND METHODS: We reviewed a urodynamic database of 600 consecutive women referred for the evaluation of voiding symptoms. Before urodynamics all patients voided privately using a standard toilet and free flow was recorded. Urodynamics were performed using a 7Fr double lumen transurethral catheter. At functional bladder capacity patients were asked to void in the sitting position and pressure flow studies were performed. All uroflowmetry tracings were inspected and analyzed manually. Only patients who voided similar volumes varying by less than 20% on the free and pressure flow studies were assessed. Free and pressure flow parameters were compared according to voided volume category, main urodynamic diagnosis, uroflowmetry pattern and pre-void bladder volume. RESULTS: A similar volume was voided on the free and pressure flow studies of 100 women. In each voided volume category and urodynamic diagnosis pressure flow parameters were significantly different from the equivalent free flow parameters in all but 4 cases. Specifically the maximum flow rate was significantly less and flow time was significantly longer on pressure versus free flow studies (each p <0.01). An intermittent flow pattern was more common on pressure than in free flow measurements (43% versus 9%). CONCLUSIONS: A 7Fr transurethral catheter may adversely affect uroflowmetry parameters in women undergoing pressure flow studies for lower urinary tract symptoms. This finding may have further clinical implications regarding the interpretation of these parameters as well as establishment of an accurate diagnosis.

Aged↗
PubMed2000

Urethral diverticulum in women: diverse presentations resulting in diagnostic delay and mismanagement.

PURPOSE: We describe various clinical presentations of urethral diverticulum, which may mimic other pelvic floor disorders and result in diagnostic delay. Management and outcome results are reported. MATERIALS AND METHODS: We reviewed retrospectively 46 consecutive cases of urethral diverticulum. Patient characteristics, history, clinical evaluation, management and long-term followup are reported. RESULTS: Mean patient age plus or minus standard deviation was 36.3 +/- 11.7 years. Most (83%) cases were referred as diagnostic dilemmas with symptoms present for 3 months to 27 years. Mean interval between onset of symptoms to diagnosis was 5.2 years. The most common symptoms were pain (48% of cases), urinary incontinence (35%), dyspareunia (24%) and frequency/urgency (22%). The number of physicians previously consulted ranged from 3 to 20 and prior therapies included oral and/or vaginal medications, anti-incontinence surgery and psychotherapy. The diverticulum was palpable on examination in 24 patients (52%), in only 6 of whom was it possible to "milk" contents per meatus. Of these 24 palpable diverticula 2 contained malignancy, and 2 others contained endometriosis and stones, respectively. Diagnosis was made by voiding cystourethrography in 30 cases (65%), double balloon urethrography in 5 (11%) and transvaginal ultrasound or magnetic resonance imaging in 7 (15%). Diverticula were incidental findings during vaginal surgery in 4 cases (9%). Treatment consisted of diverticulectomy and/or Martius flap, pubovaginal sling and urethral reconstructive procedures when indicated in 35 cases (76%), and 2 other patients underwent radical surgery for diverticular malignancy. Subsequently all but 2 patients with pain were cured. In another patient de novo stress incontinence developed postoperatively. None of the patients who underwent concomitant pubovaginal sling had postoperative incontinence. CONCLUSIONS: The symptoms of urethral diverticulum may mimic other disorders. This condition should be considered in women with pelvic pain, urinary incontinence and irritative voiding symptoms not responding to therapy. Surgical treatment is usually effective in alleviating associated symptoms.

Adolescent↗
PubMed2000

Is amniotic fluid volume influenced by a 24-hour fast?

OBJECTIVE: To assess the influence of fasting for 24 hours on the amniotic fluid index (AFI). STUDY DESIGN: The AFI of 22 parturients in the second trimester of uncomplicated pregnancy was evaluated on the morning after a 24-hour fast. Patients were prospectively matched to another group of 25 patients who did not fast. Both groups were reevaluated after one week. Two different observers, blind to each other's results, performed the examinations. RESULTS: A statistically significant difference was found in the AFI between the two groups on the day after fasting (11.73 +/- 2.12 versus 15.4 +/- 1.2, respectively; P < .01). After one week there was no difference in AFI between the two groups (15.35 +/- 1.2 and 15.42 +/- 1.2, respectively; P > .01). CONCLUSION: Fasting may reduce the amniotic fluid volume as shown by the AFI, and fluid intake may restore the normal amount of amniotic fluid volume.

Amniotic Fluid↗
PubMed2000

Outcome results of transurethral collagen injection for female stress incontinence: assessment by urinary incontinence score.

PURPOSE: We assessed the results of collagen injection for female sphincteric incontinence using strict subjective and objective criteria. MATERIALS AND METHODS: We evaluated 63 consecutive women with sphincteric incontinence who underwent a total of 131 transurethral collagen injections. Sphincteric incontinence was confirmed by urodynamics. All patients were treated with 1 to 5 transurethral collagen injections and treatment outcome was classified according to a new outcome score. Cure was defined as no urinary loss due to urge or stress incontinence documented by a 24-hour diary and pad test, and patient assessment that cure was achieved. Failure was defined as poor objective results and patient assessment that treatment failed. Cases that did not fulfill these cure and failure criteria were considered improved and further classified as a good, fair or poor response. RESULTS: Mean patient age plus or minus standard deviation was 67.7 +/- 12.8 years. All women had a long history of severe stress urinary incontinence, 18 (29%) underwent previous anti-incontinence surgery, and 41% had combined stress and urge incontinence. Preoperatively diary and pad tests revealed a mean of 7.5 +/- 4.6 incontinence episodes and 152 +/- 172 gm. of urine lost per 24 hours. Overall 1 to 5 injections were given in 26, 17, 13, 3 and 4 patients, respectively. Mean interval between injections was 4.4 +/- 5.7 months, mean followup was 12 +/- 9.6 months, and mean interval between the final injection and outcome assessment was 6.4 +/- 4.9 months. There was a statistically significant decrease in the total number of incontinence episodes per 24-hour voiding diary after each injection session. Although there was a clear trend toward decreased urinary loss per 24-hour pad test, statistical significance was not established. Using the strict criteria of our outcome score overall 13% of procedures were classified as cure, 10%, 17% and 42% as good, fair and poor, respectively, and 18% as failure. CONCLUSIONS: As defined by strict subjective and objective criteria, we noted a low short-term cure rate after collagen injection in women with severe sphincteric incontinence. It remains to be determined how patients with less severe incontinence would fare using our outcome assessment instruments.

Aged↗
PubMed1999

[PVT--tension-free vaginal tape--a new minimally invasive surgical technique for female stress incontinence: preliminary results].

We evaluated the safety and efficacy of the tension-free vaginal tape procedure (TVT) in 20 consecutive women with urodynamically proven genuine stress incontinence. Mean operating time under spinal analgesia was 37.2 +/- 13 minutes and 80% were discharged within 24 hours. There were 5 uncomplicated, intraoperative bladder perforations, but no defects in healing nor tape rejection. The objective cure rate was 95%, while the subjective rate was 100%. Although follow-up was short (9-16 months), the TVT method seems to be safe and effective for stress urinary incontinence.

Female↗
PubMed1999

[Pelvic floor exercise and biofeedback in women with urinary stress incontinence].

Stress urinary incontinence is a medical and social problem. In the past decade there has been increased awareness of this condition and the number of those affected who seek help is increasing. Treatment is usually surgical-elevation of the bladder neck. Pelvic floor exercise is an accepted conservative treatment modality used for mild to moderate cases who have not yet completed their families. We present our results in 30 women, aged 28-71 years, av. 49% with genuine stress incontinence treated with pelvic floor exercise and biofeedback. 14 patients (46.7%) were completely cured and 15 (50%) were improved. In only 1 was there no improvement. Our results show significant improvement in the duration and intensity of pelvic floor contractions after treatment. Pelvic floor exercise with biofeedback is a very important treatment modality, requiring a highly motivated patient and a physiotherapist specialized in pelvic floor exercise.

Adult↗
PubMed1999

Development of postoperative urinary stress incontinence in clinically continent patients undergoing prophylactic Kelly plication during genitourinary prolapse repair.

The present study was undertaken to evaluate the efficacy of Kelly plication in preventing postoperative urinary stress incontinence in clinically continent patients undergoing surgery for genitourinary prolapse. Thirty clinically continent patients with grade-3 genitourinary prolapse were found to have a positive stress test with repositioning of the prolapse during preoperative urodynamic evaluation. In addition to the genitourinary prolapse repair, these patients underwent a Kelly plication as a preventive measure against possible development of postoperative urinary stress incontinence. Postoperative follow-up included a detailed urogynecologic questionnaire, pelvic examination, urine culture, Q-tip cotton swab test, and a full urodynamic evaluation. The mean duration of follow-up was 25.5 +/- 14.1 months. Fifteen (50%) patients developed subjective and objective postoperative stress incontinence. Eleven (37%) patients developed objective postoperative stress incontinence (proven by urodynamic evaluation) with no subjective complaints of stress incontinence. Prophylactic Kelly plication as performed by the method described does not appear to be effective in preventing postoperative urinary stress incontinence in clinically continent patients who undergo surgery for genitourinary prolapse.

Evaluation Studies as Topic↗
PubMed1999

Anal incontinence: prevalence among female patients attending a urogynecologic clinic.

The present study prospectively surveyed the prevalence of anal incontinence among 283 consecutive female patients attending a urogynecologic outpatient clinic in a maternity hospital. Data concerning bowel habits, laxative use, previous anorectal surgery, and the presence, severity, and frequency of anal incontinence were collected by interviewing the patients. Anal incontinence was reported by 83 women, representing 29% of the study population. Of those reporting anal incontinence, 30% (9% of the study population) were incontinent to solid feces, 22% (6%) to liquid feces, and 48% (14%) to gas. Age distribution demonstrates progressive rise and a high prevalence of anal incontinence in patients older than 60 years. A significant higher rate of vacuum deliveries was found among patients with anal incontinence, compared with continent patients (9.6% vs. 2.5%; P = 0.01). Increased prevalence of anal incontinence was also found among patients with past history of hemorrhoidectomy and those with urodynamic diagnosis of combined genuine stress incontinence and detrusor instability/sensory urgency. In conclusion, in patients attending a urogynecologic clinic, anal incontinence is a frequent, although rarely volunteered, symptom.

Adult↗
PubMed1999

Stress urinary incontinence: prevalence among nulliparous compared with primiparous and grand multiparous premenopausal women.

The study was conducted to assess the prevalence of stress urinary incontinence in premenopausal nulliparae, primiparae, and grand multiparae, and to examine possible obstetric risk factors. Three hundred consecutive nulliparae, primiparae, and grand multiparae, 20 to 43 years of age, were interviewed during the third postpartum day of their consequent delivery about the symptom of stress urinary incontinence. Women were asked whether they had experienced stress urinary incontinence before, during, or after previous pregnancies and how troubled they were by their incontinence. Details of general and gynecologic history, parity, mode of previous deliveries, and birth weights were sought. Main outcome measures included prevalence of pregnancy-related and (persistent) nonpregnancy-related stress urinary incontinence. Prevalence of persistent stress urinary incontinence was significantly higher in grand multiparae compared with nulliparae (21% vs. 5%, respectively; P = 0.0008). Prevalence of persistent stress urinary incontinence among grand multiparae who had been delivered of at least one baby weighing more than 4,000 g was significantly higher than in those who did not (29.4% vs. 16.7%, respectively). The birth weight of the first newborn and operative vaginal delivery were not found to be associated with increased risk of stress urinary incontinence. Grand multiparity was found to be associated with an increased risk of developing persistent stress urinary incontinence during reproductive ages. The delivery of at least one baby weighing more than 4,000 g seems to be a predominant factor. Neurourol. Urodynam. 18:419-425, 1999.

Adult↗
PubMed1999

Sexual function in women attending a urogynecology clinic.

The study prospectively evaluated the relationship between sexual dysfunction and urodynamic diagnoses in 100 consecutive female patients referred for urogynecologic evaluation. Sexual function was evaluated by a detailed questionnaire that addressed four phases of the sexual cycle: desire, arousal, orgasm and satisfaction. Each phase of the sexual cycle was assessed separately using a score of 1-4. Total sexual function (TSF) score was calculated by combining the scores of the four examined parameters (range 4-16). Analysis revealed statistically significant (P < 0.05) lower TSF scores in patients with detrusor instability (DI) than in those with genuine stress incontinence, sensory urge or mixed urodynamic diagnoses (8.65 +/- 4 versus 12.22 + 3.6, 10.25 +/- 4.1 and 11.47 +/- 4.1, respectively). Three per cent of the elderly women (>60 years) compared to 29% of the younger women (< or = 60 years) reported urinary incontinence during sexual activity. Sexual function should therefore be routinely evaluated in women presenting with urinary symptoms.

Adult↗
PubMed1999

Prevalence and characteristics of voiding difficulties in women: are subjective symptoms substantiated by objective urodynamic data?

OBJECTIVES: To examine the prevalence and characteristics of voiding difficulties in women. METHODS: Two hundred six consecutive female patients who attended a urogynecology clinic were recruited. Patients were interviewed regarding the presence and severity of symptoms that would suggest voiding difficulties (ie, hesitancy, straining to void, weak or prolonged stream, intermittent stream, double voiding, incomplete emptying, reduction, and positional changes to start or complete voiding). Urodynamic evidence of voiding difficulty was considered as a peak flow rate less than 12 mL/s (voided volume greater than 100 mL), or residual urine volume greater than 150 mL, on two or more readings. Residual urinary volume, flow patterns, and pressure-flow parameters were analyzed and compared between symptomatic and asymptomatic patients who had urodynamic parameters of voiding difficulties. RESULTS: One hundred twenty-seven (61.7%) women reported having voiding difficulty symptoms; 79 others (38.3%) were free of such symptoms. Urodynamic diagnosis of voiding difficulty was made in 40 women (19.4% of the study population): 27 in the symptomatic group and 13 in the asymptomatic group (21.2% and 16.5%, respectively). Only 1 patient had voiding difficulty due to bladder outlet obstruction. All other cases of low flow rate were due to impaired detrusor contractility. CONCLUSIONS: Objective evidence of voiding difficulty may be found in both symptomatic and asymptomatic patients and is usually due to impaired detrusor contractility. The clinical significance of the abnormal flow parameters in asymptomatic patients is unclear.

Female↗
PubMed1999

Incidence and obstetric risk factors of postpartum anal incontinence.

BACKGROUND: Anal incontinence in young women may be the result of injury to the pelvic floor during vaginal delivery. This study was conducted to evaluate the relationship between obstetric risk factors and the prevalence of anal incontinence 3 months and 1 year after delivery. METHODS: Three hundred consecutive women who delivered in the obstetric ward of the Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, were prospectively interviewed 3 months postpartum with regard to the symptom of anal incontinence. Patients with anal incontinence that started after delivery were questioned about the type, frequency, and severity of the problem, concomitant stress urinary incontinence (SUI), previous colorectal assessment, and wish for further evaluation and treatment. Obstetric data were collected from the women's medical charts. Symptomatic patients were followed-up 1 year postpartum. RESULTS: Anal incontinence was reported by 21 patients: 19 were incontinent to gas, whereas only 2 patients were incontinent to solid feces (6.3% and 0.7% of the study population, respectively). Five patients (24% of the anal-incontinent patients) also had concomitant SUI. The length of the first and second stages of labor, operative vaginal delivery, and episiotomy were found to be associated (P < 0.05) with the development of anal incontinence at 3 months postpartum. At I year postpartum all patients with combined anal incontinence and SUI had persistent symptoms. CONCLUSION: The major obstetric risk factors for postpartum anal incontinence are prolonged first and second stages of labor, operative vaginal delivery, and the use of episiotomy.

Adult↗
PubMed1999

Timing of sonohysterography in menstruating women.

A prospective, blind study was carried out on 44 patients to evaluate the most suitable time to perform transvaginal sonohysterography. On the day of arrival at our unit, regardless of their cycle day, the women underwent sonohysterographic evaluation, which was repeated during the first 10 days of the next cycle. Patients with sonohysterographic findings underwent hysteroscopy. According to the timing of the first examination, they were divided into two groups, i.e. group 1 for the first 10 days of the cycle, and group 2 for days 16 through 28. At the end of the study the groups were compared. The results showed a false-positive rate of 27% in group 2, while no false-positive was found in group 1. We concluded that the best time for sonohysterography in patients who still have their menstrual period is during the first 10 days of the cycle.

Adult↗