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A Martan

Publications and source records attributed to A Martan.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Hydrogen expandable implants in the treatment of stress incontinence in women--a pilot study].

OBJECTIVE: The aim of the study was to evaluate the use of new-type implants for the treatment of female urinary stress incontinence. The patients with intrinsic sphincter deficiency were also included, the other were after previous surgery for GSI. DESIGN: Original article. SETTING: Departments of Obstetrics and Gynaecology, Faculty Hospital Na Bulovce and General Faculty Hospital, 1. Faculty of Medicine, Charles University, Prague, Institute of Macromolecular Chemistry, Czech Academy of Science, Prague. METHODS: We operated 9 patients, two of them with type III (McGuire) urinary stress incontinence the rest after operations for GSI in general anesthesia. Six to nine hydrogel swelling implants were introduced into the submucosa of proximal urethra under the transrectal ultrasound guidance. We evaluated the effect 6 to 9 months after the operation. RESULTS: Two patient were dry (negative stress-test and pad-weight test), one patient had substantial improvement, 4 had mild improvement and 2 did not notice any change. We found de novo urge symptoms in four patients, two of them were of the motor type. CONCLUSION: The new type of implants reached the success rate of other currently used materials. The improvement of stress incontinence was on the cost of de novo urge symptoms in some patients. The urgency was successfully managed with spasmolytic drugs.

Female↗
PubMed2001

Ultrasound imaging of the lower urinary system in women after Burch colposuspension.

OBJECTIVE: Most of the relevant surgical procedures employed in the management of genuine stress urinary incontinence (GSI) involve the technique of bladder neck elevation. The appropriate level of suspension is an important (but frequently overlooked) consideration as the clinical consequences of over-correction of the posterior angle are voiding dysfunction and urgency symptoms. The aim of our study was to compare ultrasound characteristics in women with GSI with those of women before and after Burch colposuspension. The findings of our study should have implications for GSI management. DESIGN: Prospective randomized clinical study at the Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. METHODS: Seventy women with previously untreated GSI (preoperative group) and 52 women (42 of whom had been in the preoperative group) who were studied 3-12 months after receiving Burch colposuspension (postoperative group) took part in the study. The standard transperineal and introital ultrasound scans were performed. The mobility of the bladder neck was assessed transperineally with a curved array probe after instillation of 300 mL of saline. The bladder was then evacuated and the thickness of the urinary bladder wall in the sagittal plane in defined regions (base, vertex and anterior wall) was measured. RESULTS: We found significant differences in bladder neck position, mobility, and in bladder wall thickness. Where symptoms of urgency occurred, the average bladder wall thickness was > 5 mm, the gamma angle < 40 degrees, and lower bladder neck mobility was evident. CONCLUSION: These findings supported our hypothesis that signs of urgency follow over-elevation of the bladder neck. These results helped us significantly to refine our GSI management.

Case-Control Studies↗
PubMed2001

[Psychology of urinary incontinence. I. Comparison of women with urgent and stress incontinence before initiation of therapy].

OBJECTIVE OF STUDY: Comparison of psychological characteristics of untreated female patients with urgent and stress urinary incontinence. DESIGN: First stage of a perspective comparative study. SETTING: Gynaecological and Obstetric Department of the Municipal Hospital Neratovice, Urogynaecological out-patient dept. of the Institute for Mother and Child in Prague-Podolí, the Urogynaecological out-patient dept. of the Gynaecological and Obstetric Clinic of the First Medical Faculty Charles University and General Faculty Hospital Prague. METHODS: The study compares a group of 54 patients with stress incontinence and a group of 16 patients with urgent incontinence. Before the onset of therapy the patients were examined by a series of psychodiagnostic tests: MMPI/100 (Minnesota Multiphasic Personality Inventory, abridged version), STAI (State-Trait Anxiety Inventory), SCL-90 (Symptom Check List), Lüscher's colour test, guided interview. For statistical evaluation the sign test and t-test were used. RESULTS: In the MMPI/100 and SCL-90 questionnaires a significant difference was found, i.e. a greater psychopathology in women with urgent incontinence (in both instances p < 0.01). The two groups did not differ in any single scale. STAI and the interview did not reveal any significant differences with the exception of greater importance of sexual contact in women with urgent incontinence (p < 0.05). CONCLUSION: In the group of women with urgent incontinence a higher non-specific psychopathology was proved as compared with women with stress incontinence.

Adult↗
PubMed2001

[Psychological aspects of gynecologic operations].

OBJECTIVE: To make the stress influence of the hospitalisation on patients objective, to determine the factors in the process of therapy, which negatively influence a patient, and to find the consequences between the intensity of anxiety and the occurrence of the post-operational complications followed by the lengths of hospitalisation. DESIGN: Prospective clinical study. SETTING: The Department of Gynecology-Obstetrics of the General Teaching Hospital and the 1 st. Medical Faculty of the Charles University in Prague. METHODS: 63 patients after the planned middle serious operation (abdominal or vaginal hysterectomy, Burche suspension and vaginal plastics) were included into the study. The women were not treated both because of oncological or psychiatric reasons and they did not suffer from some other serious illness. The mean age was 53, mean weight 72 kg and mean parity 1.7. Evaluation of the stress influence of the patients was performed by means of the questionnaires, which were devised by us (Questionnaire A and B), and by means of standard questionnaires (STAI, SCL-90) that were filled in by the patients on the day of their reception and on the day of their release from the hospital. RESULTS: By evaluation of the questionnaires we have received objective parameters of the measure of anxiety and stress the patient is entering the treatment process with, and also subjective evaluation of the concrete stress moments occurring during the hospitalisation. A hypotheses proving that the more the stress load experienced by a patient the higher the probability of the occurrence of complications in the post-operational period and consequently longer hospitalisation has been verified by the methods of the statistic analyses. For our clinical praxis, the results of the descriptive analyses, where our patients evaluated their fear concerning the illness, its operational resolution and particular stress situations during hospitalisation, are mainly important. CONCLUSION: Our results proved that for ensuring optimal course of operation and post-operational period it is most important to reduce stress influence on a patient, i.e. particularly by a personal discussion of a surgeon and a treating doctor with the patient, and by elimination of the negative factors during the period of hospitalisation. Last but not least the most important role plays the clinical psychologist because not only important is professional medical, but also psychological access to the patient.

Anxiety↗
PubMed2001

[Magnetic resonance in urogynecology].

OBJECTIVE: The aim of the study was to review the use of the MRI in urogynaecology and to describe an original method for the construction of 3D computer models of pelvic floor. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynaecology, Institute of Sexuology, 1st Faculty of Medicine, Charles University, Prague, Department of Radiodiagnostics, Charles University, Hradec Králové. METHODS: A review of the use of the MRI in urogynaecology was made. A new method was introduced for creation of computer 3D models of female pelvis based on the data obtained by the MRI. RESULTS: Five complex computer models of the female pelvic organs and pelvic floor were created. Many so far estimated details were visualized. CONCLUSION: The use of MRI in urogynaecology can bring important data about the functional anatomy of female pelvic floor.

Computer Simulation↗
PubMed2000

[Suspension of the lower third of the urethra in ambulatory practice--minimally invasive treatment of urinary stress incontinence--technique and initial experience].

OBJECTIVE: The aim of the article is the presentation of a new, mini-invasive method for the treatment of urethral incompetence in women--TVT (tension-free vaginal tape). DESIGN AND SETTING: The design was a prospective comparison of the first 10 patients at the Department of Obstetrics and Gynaecology of the 1st Medical Faculty and General Faculty Hospital in Prague where urethral incompetence = genuine stress incontinence regardless of their history was diagnosed consecutively. METHODS: We present the technique of the operation, examination procedure including the application of dynamic magnetic resonance before and after operation at rest and under Valsalva, the subjective and objective outcome in the analyzed group. We compare also the parameters of urethrovesical junction mobility in the MR image and discuss their importance for the new continence mechanism in the TVT method. RESULTS: All patients are 10-18 months after the operation continent. The functional morphology of the lower urinary tract and of the pelvic floor on the MR image after TVT did not reveal any relevant changes in bladder neck dynamic mobility. CONCLUSION: The experience of other authors concerning possible complications, postoperative care and results are evaluated; they are without exception positive.

Ambulatory Surgical Procedures↗
PubMed2000

[The effect of bladder filling on changes in ultrasonography parameters of the lower urinary tract in women with urinary stress incontinence].

OBJECTIVE OF THE STUDY: Was to evaluate the effect of filling the bladder on position and mobility of UV junction, and to determine other possible changes of measured ultrasound parameters of the lower urinary tract in relation to filling of the bladder. TYPE OF STUDY: Prospective randomized clinical study. NAME AND ADDRESS OF THE WORKPLACE: Department of Gynaecology--Obstetrics, 1st Faculty of Medicine of Charles University and VFN in Prague. METHODOLOGY: 20 women were included in our study with proved stress incontinence of urine ("GSI"). Their average age was 46 years, average weight 70 kg, average parity 1.57. Perineal and introital ultrasound examination was performed in a supine position, using Acuson 128 XP 10 equipment, a convex probe of 5 MHz frequency and a vaginal probe of 7.0 MHz. Position and mobility of UVJ was monitored based on the following parameters: angle gamma, abscissas p, h, x, y. Bladder filling was 300 ml, 200 ml and empty bladder. RESULTS: Statistically significant differences were observed in UVJ mobility during contractions of pelvic floor muscles between measurements, when the bladder contained 300 ml of liquid, or was empty (p = 0.00983). UV-junction of and empty bladder is higher during a contraction, and the mobility is greater (p = 0.006). Distances x, y, p in case of an empty bladder are shorter during contraction and the gamma angle is smaller (p = 0.01). The thickness of the bladder wall was greater in an empty bladder (p = 0.01). Changes in area and thickness of the urethral sphincter were not significant. CONCLUSIONS: Based on our preliminary results we can state that a bladder filling of 300 ml is not significant for evaluation of UV-junction mobility. Rather the opposite; a higher mobility of UV-junction was observed with an empty bladder. Monitoring of the inner orifice of the urethra with an empty bladder presents a slight problem. To evaluate vesicalisation of the proximal urethra and to confirm insufficiency of the inner sphincter (ISD), a filling in the bladder is necessary. The thickness of the bladder wall is measured with an empty bladder.

Female↗
PubMed2000

[Ultrasonography of the funneling of the urethra].

OBJECTIVE: The objective of the study was to evaluate possibilities of using contrast substances during transperineal urogenital ultrasound examination. DESIGN: Prospective, pilot study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University, Prague. METHODS: 28 women with stress of incontinence were included in the study. For all women, position and mobility of the bladder neck and funneling of urethra was evaluated by transperineal ultrasound examination, and, subsequently, by ultrasound contrast substance examination. Both examinations were compared. During the Valsalva manoeuvre, the contrast substance enters the proximal urethra and allows a more exact diagnosis of urethra funneling than in the case of examination without the use of contrast substance. When using contrast substance, funneling was diagnosed in 25 patients compared to 7 patients subjected to common transperineal examination. CONCLUSION: Using contrast substance significantly improves visualisation of urethra funneling and opens new possibilities in diagnosing stress incontinence.

Contrast Media↗
PubMed2000

[Ultrasonic evaluation of paravaginal defects before and after surgical treatment in women with urinary stress incontinence].

OBJECTIVE: The aim of our study was to analyze whether transabdominal and introital ultrasonography can accurately identify paravaginal defect associated with GSI (Genuine stress urinary incontinence) and to determine the changes after paravaginal defect repair. DESIGN: Prospective randomised clinical study. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. METHODS: Sixteen women with GSI, who had previously not undergone anti-incontinence surgery were involved. Their average age was 52 years, average weight 71 kg and average parity 2.0. Within vaginal examination our attention was focussed on the diminution of sulsus superioris vaginae during Valsalva maneuver. The bladder of a patient in supine position was filled with 300 ml of sterile saline. Than a 5 MHz curved array probe was used to assess the bladder neck mobility from the perineal approach, and the same probe was used from the abdominal approach to determine paravaginal defect and subsequently a vaginal probe from introital approach was used for the rest of the examination. After Burch colposuspension and paravaginal defect repair US scanning was performed 6 till 8 days and 5 or 6 weeks after operation. RESULTS: We found significant differences in bladder neck position and mobility before and after the operation. In women with symptoms of GSI we found from abdominal approach unilateral or bilateral paravaginal defect in fifteen women. Unilateral defect was found on the right side six times and on the left side only once. In eight women the defect was bilateral. The introital approach obtained similar results, only in two patients with bilateral defect the examination concluded unilateral right defect. After the operation we did not find PVD in patients after paravaginal defect repair. We obtained worse results from vaginal examination, where preoperatively PVD was correctly determined (sensitivity) only in 82.6%. CONCLUSION: From our preliminary results we can suggest performing US scanning to conform paravaginal defect before anti-incontinence surgery and possibly adding to the Burch colposuspension paravaginal defect repair to correct cystourethrocele.

Female↗
PubMed2000

[The suspensory system of the vagina--present views].

OBJECTIVE: To describe vaginal support levels according to the DeLancey's classification, their appearance in transversal magnetic resonance images and clinical categories caused by their defects. DESIGN: Review. SETTING: Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University, Prague; Department of Radiodiagnostics, Charles University, Medical Faculty in Hradec Králové. METHODS: A review of literature, examinations of female pelvis with magnetic resonance imaging (MRI) and 3 dimensional computer reconstructions were made. RESULTS: We performed 20 MRI studies and 5 computer spatial reconstructions of female pelvis. Selected results of a review of literature and our MRI examinations were correlated with various types of vaginal descensus. CONCLUSIONS: The questions about the supporting structures of female vagina are still not fully answered. Great advance was achieved by some recent pathological studies and by the introduction of modern magnetic resonance units in this field. The DeLancey's classification goes well in accord with clinical examination, imaging methods and cadaver studies.

Female↗
PubMed1999

[Ultrasound imaging of the lower urinary tract in post-menopausal women with urinary stress or combined type of incontinence before and after intravaginal administration of estriol].

The finding that climacteric symptoms are caused mainly by a decline of the oestrogen level and that their development can practically always be prevented by long-term local or general oestrogen treatment was a great asset to the treatment of this problem. Oestriol, a less effective natural oestrogen, has a favourable effect on urogenital tissues without stimulating the endometrium [2]. The objective of the present investigation was to analyze ultrasonographic parameters of the lower urinary tract in women after the menopause with the stress or mixed type of urinary incontinence before and after two-month local oestriol treatment (Ovestin). The trial comprised 40 women with confirmed stress (GSI) or the mixed type of urinary incontinence. The group with GSI comprised 124 patients and the group suffering from the mixed type of incontinence comprised 26 women. The type of incontinence was assessed by urogynaecological examination. This was followed by transperineal and introital ultrasound examination of patients in a supine position by means of an Acuson 128 XP10 apparatus using a convex probe with a frequency of 5 MHz and a vaginal probe with a frequency of 7.0 MHz. Assessment of the position and mobility of the urethrovesical junction was implemented by the transperineal route using a convex probe and filling the bladder with 300 ml. After urination followed assessment of the urethral sphincter by the introital route in a vertical plane whereby the authors followed the anterior and posterior surface of the rhabdosphincter, and in a horizontal plane its left and right surface (10). The authors assessed also in both planes the maximal thickness of the sphincter. In the vertical plane and in a proximal position in relation to the urethra they evaluated the vascular supply qunatitatively (minimal-1 to very abundant-4) and also the arterial flow-the pulsatile index PI was investigated as well as the resistance index RI. In the vertical plane 1 cm from the urethrovesical junction the authors assessed the thickness of the urethral mucosa; at the same level they evaluated the thickness of the urinary bladder wall; the anterior wall, the vertex and the area of the trigone. They assessed also the thickness of pelvic floor muscles. The assessments were made before and after two-month intravaginal oestriol administration (Ovestin crm)-two weeks 0.5 mg/day and then 0.5 mg twice a week. After treatment no statistically significant differences in thickness and areas of the urethral sphincter were found nor in the thickness of the pelvic floor muscles before and after oestriol administration. Statistically significant differences were recorded in the mobility of the urethrovesical junction and there was a significant increase in the thickness of the urethral mucosa and a more abundant vascularization was recorded during the quantitative evaluation and evaluation of PI. In women with the mixed type of incontinence after oestrogen treatment a decline in the thickness of the urinary bladder was found. Ultrasound examination of the lower urinary tract before and after oestriol treatment (Ovestin crm) is a useful supplement of common examination methods and it confirms its favourable therapeutic effect when administered by the intravaginal route.

Administration, Intravaginal↗
PubMed1998

[Hormone therapy and urogynecology].

The female genital and urinary systems exists in close anatomical and functional proximity, disorders of one resulting in dysfunction of the other. The investigation and management of lower urinary tract disorders must take this important relationship into consideration, as neither can be viewed in isolation. The value of estrogen replacement therapy as a treatment of urinary incontinence is controversial and until today there is a little substantial evidence to conclude that estrogen therapy alone is of value in the treatment of this symptom. This conflicting evidence concerning the therapeutic benefit of estrogen therapy in stress urinary incontinence seems to be outweighed with other advantages of estrogen replacement therapy. Clear evidence exists to suggest that recurrent urinary tract infections can be prevented or even treated by the use of estrogen therapy. Systemic estrogen replacement appears to relieve the symptoms of urgency, urge incontinence, frequency, nycturia and dysuria, and low-dose topical estrogen is effective in the management of atrophic vaginitis. Even with postulating the HRT to be of enormous therapeutic value to postmenopausal women in urogynecology it may stay only a mean of support of other causal methods of treatment of dysfunction of lower urinary tract.

Estrogen Replacement Therapy↗
PubMed1998

[Changes in the position of the ureterovesical junction during maximal voluntary contractions and during maximal vaginal electric stimulation of the pelvic floor muscles].

The objective of the study was to evaluate and compare the effect of the maximal voluntary muscle contraction of the pelvic floor (PFM) and contractions of the PFM evoked by maximal electric stimulation using an electrostimulation apparatus Conmax by monitoring the position of the urethrovesical junction by ultrasound. The trial comprised 20 women with confirmed stress incontinence of urine. With the patients in a supine position with abducted lower extremities an electrostimulation probe was inserted into the vagina. This was followed by perineal ultrasound (US) examination using an ACUSON 128 XP-10 apparatus and a convex tube 5 MHz. The ultrasound examination was made using the electrostimulation probe--at rest and during maximal voluntary contraction of the PFM. This was followed by maximal electric stimulation and after five minutes during stimulation the US examination was repeated. It was performed also during maximal electric stimulation (MES) concurrently with maximal voluntary contraction of the PFM. For electrostimulation a Conmax appartus was used. The applied frequency was 50 Hz, amplitude from 0 to 90 mA (grade 0-6), duration of pulse 0.75 ms. The maximum intensity of stimulation was determined by the patient, i.e. when stimulation was not yet painful. During US the authors investigated the gamma angle, i.e. the angle between the axis of the symphysis and the connecting line between the UV junction and the lower borderline of the symphysis. The mean difference of the gamma angle during voluntary contraction of the PFM and at rest was 13.6. During contraction caused by maximal electric stimulation of the PFM and at rest this difference was 21.3. The difference did not differ significantly during maximal electric stimulation of the PFM and during maximal electric stimulation and voluntary contraction of the PFM. From the trial ensues that contraction of the pelvic floor muscles during maximal electric stimulation is stronger as compared with the intensity of contraction caused by maximal voluntary contraction. The results confirm the favourable therapeutic effect of MES muscles of the pelvic floor in the treatment of urinary incontinence in women. These changes help to increase the muscular tonus and contractibility of pelvic floor muscles and thus promote also elevation of the neck of the urinary bladder. Elevation of the neck of the urinary bladder promotes normalization of intraabdominal transfer of pressure to the proximal urethra.

Electric Stimulation Therapy↗
PubMed1998

[Ultrasonography of pelvic floor muscles in women with urinary stress incontinence].

Ultrasound examinations have become since beginning of the eighties one of the auxiliary examination methods in urogynaecology. Evaluation of the position and mobility of the neck of the urinary bladder practically replaced lateral chain urethrocystography. With the improving differentiating capacity of ultrasound equipment it is possible to visualize some periurethral and paravaginal structures which participate in the support of the urethra and urethrovesical junction by paravaginal and periurethral structures in women (fig. 1). In recent years many papers were published where for visualization nuclear magnetic resonance (NMR) is used [1, 12, 19]. The functional and physiological condition of these tissues is assessed by physical, urodynamic and ultrasonographic examinations and also by cystourethroscopy and manometry [7, 11, 10, 13, 14, 15, 16]. Despite this the greater part of anatomical knowledge of the supporting apparatus is derived from pathological studies and peroperative observations.

Female↗
PubMed1998

[Ultrasonic imaging of the lower urinary tract in women with urinary stress incontinence and in women after the Burch colpopexy].

The prevalence of urinary incontinence varies from 5% in young to 50% in elderly women. The weak anatomical support of the urethrovesical junction, base of the urinary bladder and proximal urethra lead to its prolapse and hypermobility which is considered the main anatomical basis of stress incontinence. The majority of surgical procedures which resolve this problem describes elevation of the cervix of the urinary bladder. The final step of these operations, i.e. how much the urethrovesical junction should be pulled up, is described only rarely and superficially. The clinical consequence which may develop are complications associated with hypercorrection of the posterior urethrovesicular angle, i.e. problems with micturition-difficult micturition, or stage-wise micturition and symptoms of detrusor instability. The objective of the present investigation was: to analyze ultrasonic parameters of the lower urinary tract in women with stress incontinence (GSU), furthermore in women after colpopexy by Burch's method, and with regard to these results, possibly modify the surgical procedure. In the investigation in the first group 30 women were enlisted with confirmed stress incontinence. The second group was formed by 30 women three to nine months after colpopexy. The ultrasound examination was made by the perineal and introital route with the patient in a supine position, using a Acuson 128 XP 10 apparatus with a convex probe with a frequency of 5 MHz and by means of as vaginal probe with a frequency of 7.0 MHz. Assessment of the site and mobility of the urethrovesical junction was made by the transperineal route by means of a convex probe with a 300 ml filling of the urinary bladder; after micturition assessment of the areas of the urethral sphincter in a vertical and horizontal plane followed. In the vertical plane and anterior surface of the sphincter also the blood flow was measured and the pulsatile index (PI) and resistance index (RI) were assessed. The authors investigated also the thickness of the pelvic floor muscles and in the vertical plane the thickness of the urinary bladder wall on the anterior wall, in the vertex and in the area of the trigon. The authors found significant differences in ultrasound parameters in groups of women with GSI and women after colpopexy as regards the site and mobility of the urethrovesical junction and thickness of the urinary bladder wall (p < 0.01). In women with symptoms of urgency after colpopexy the authors found a mean thickness of the urinary bladder wall of more than 5 mm and mean values of the gamma angle smaller than 40 degrees and they recorded also a reduced mobility of the urethrovesical junction. These findings confirmed their expectations that in women with persisting symptoms of urgency frequently slight hypercorrection of the position of the urethrovesical junction is involved. These findings are important for the correction of the surgical approach and the evaluation of the above mentioned parameters is helpful in the diagnosis of urgency.

Female↗
PubMed1998

[Treatment of cyclical mastodynia using an extract of Vitex agnus castus: results of a double-blind comparison with a placebo].

The aim of study presented here was to gather the data about the tolerability and efficacy of Vitex agnus castus (VACS) extract. The study was designed as double-blind, placebo controlled in two parallel groups (each 50 patients). Treatment phase lasted 3 consequent menstrual cycles (2 x 30 drops/day = 1.8 ml of VASC) or placebo. Mastalgia during at least 5 days of the cycle before the treatment was the strict inclusion condition. For assessment of the efficacy visual analogue scale was used. Altogether 97 patients were included into the statistical analysis (VACS: n = 48, placebo: n = 49). Intensity of breast pain diminished quicker with VACS group. The tolerability was satisfactory. We found VACS to be useful in the treatment of cyclical breast pain in women.

Adult↗