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Biomedical subjects

A R B Smith

Publications and source records attributed to A R B Smith.

7 recordsLinked to original sources
PubMed2006

A valsalvometer can be effective in standardising the Valsalva manoeuvre.

A prospective randomised controlled study was performed in order to study the effectiveness of a device designed to reduce the variability in intra-abdominal pressures generated by individuals performing the Valsalva manoeuvre. One hundred women were recruited to take part in the project which compared a traditional Valsalva manoeuvre following standardised verbal instruction with forced expiration through a flow restriction device called a "valsalvometer". The abdominal pressure was measured using an air-filled rectal balloon catheter linked to a pressure transducer. The use of the valsalvometer was associated with a reduction in variation of intra-abdominal pressure between women to 50% of the standard deviation. The new device has the capacity to reduce the variation in intra-abdominal pressure produced when performing the Valsalva manoeuvre. The rise in intra-abdominal pressure may act as a standard against which other measurements are made.

Computer Systems↗
PubMed2006

Laparoscopic versus open colposuspension--results of a prospective randomised controlled trial.

OBJECTIVE: To compare the effectiveness and cost effectiveness of open and laparoscopic colposuspension in the treatment of stress urinary incontinence. DESIGN: A randomised controlled trial. Women were randomised between March 1999 and February 2002 and were seen for assessment at 6, 12 and 24 months, postoperatively. SETTING: Women were recruited from six gynaecology units in the UK. POPULATION: Women with proven stress urinary incontinence requiring surgery. METHODS: Open abdominal retropubic colposuspension or laparoscopic colposuspension. MAIN OUTCOME MEASURES: Primary outcomes were subjective (satisfaction with outcome) and objective (negative 1-hour pad test). Secondary outcomes were operative and postoperative morbidity and quality of life. The study was powered to demonstrate noninferiority, i.e. that the absolute cure rate of laparoscopic colposuspension was no more than 15% below that of open colposuspension. RESULTS: A total of 291 women were randomised, with 24-month data on subjective and objective outcomes in 88 and 82.5%, respectively. The intention-to-treat analysis indicated no significant difference in cure rates between open and laparoscopic surgery. The objective cure rates for open and laparoscopic were 70.1 and 79.7%, respectively. Subjective cure rates by satisfaction were lower than objective cure; 54.6 and 54.9%, respectively, and there was considerable nonconcordance both ways. CONCLUSIONS: Laparoscopic colposuspension is not inferior to open colposuspension in terms of curing stress urinary incontinence.

Female↗
PubMed2006

Cost-effectiveness analysis of open colposuspension versus laparoscopic colposuspension in the treatment of urodynamic stress incontinence.

OBJECTIVES: To compare the cost effectiveness of laparoscopic versus open colposuspension for the treatment of female urinary stress incontinence. DESIGN: Cost utility analysis alongside a randomised controlled trial. SETTING: Six gynaecological surgical centres within the UK. POPULATION/SAMPLE: Women with proven stress urinary incontinence requiring surgery. METHODS: Open abdominal retropubic colposuspension or laparoscopic colposuspension carried out by experienced surgeons. MAIN OUTCOME MEASURES: Cost, measured in pounds sterling and generic health-related quality of life, measured using the EQ-5D. The latter was used to estimate patient-specific quality-adjusted life years (QALYs). RESULTS: Healthcare resource use over 6-month follow up translated into costs of pound 1805 for the laparoscopic arm and pound 1433 for the open arm (differential mean cost pound 372; 95% credibility interval [CrI]: 274-471). At 6 months, QALYs were slightly higher in the laparoscopic arm relative to the open arm (0.005; 95% CrI: -0.012 to 0.023). Therefore, the cost of each extra QALY in the laparoscopic group (the incremental cost-effectiveness ratio [ICER]) was pound 74,400 at 6 months. At 24 months, the laparoscopic arm again had a higher mean QALY score compared to the open surgery group. Thus, assuming that beyond 6 months the laparoscopic colposuspension would not lead to any significant additional costs compared with open colposuspension, the ICER was reduced to pound 9300 at 24 months. Extensive sensitivity analyses were carried out to test assumptions made in the base case scenario. CONCLUSIONS: Laparoscopic colposuspension is not cost effective when compared with open colposuspension during the first 6 months following surgery, but it may be cost effective over 24 months.

Cost-Benefit Analysis↗
PubMed2005

Long term review of laparoscopic sacrocolpopexy.

OBJECTIVE: Assessment of long term outcome following laparoscopic sacrocolpopexy. DESIGN: Retrospective follow up study using standardised examination with pelvic organ prolapse quantification system (POP-Q) and questionnaires. SETTING: A tertiary urogynaecology unit in the North West of England. POPULATION: One hundred and forty consecutive cases who had a laparoscopic sacrocolpopexy at St Mary's Hospital, Manchester, between 1993 and 1999. METHODS: Women completed questionnaires and were examined in gynaecology clinic or sent postal questionnaires if unable to attend the clinic. MAIN OUTCOME MEASURES: Adequacy of vault support and recurrent vaginal prolapse assessed by POP-Q score. Assessment of prolapse, urinary and bowel symptoms and sexual function using questionnaires. RESULTS: One hundred and three women were contacted after a median of 66 months. Sixty-six women were examined and a further 37 women filled in questionnaires only. Recurrent vault prolapse occurred in 4 of the 66 women who were examined. Prolapse had recurred or persisted in 21 of 66 women, with equal numbers of anterior and posterior vaginal wall prolapse. Overall, 81/102 (79%) said that their symptoms of prolapse were 'cured' or 'improved'; 39/103 (38%) still had symptoms of prolapse. For every two women who were cured of their urinary or bowel symptoms, one woman developed worse symptoms. CONCLUSIONS: Among the 66 women available for examination laparoscopic sacrocolpopexy provided good long term support of the vault in 92%. Forty-two percent of these women had recurrent vaginal wall prolapse. Despite this, 79% of women felt that their symptoms of prolapse were cured or improved following surgery.

Colposcopy↗
PubMed2003

Evidence-based practice in urogynaecology.

Urogynaecology practice is rapidly progressing, with a trend towards minimally invasive techniques. This article attempts to cover the evidence behind the assessment and treatment of urinary and anal incontinence, and vaginal prolapse.

Evidence-Based Medicine↗
PubMed2002

Strength-duration testing of the external anal sphincter in females with anorectal dysfunction.

PURPOSE: The strength-duration test has been suggested as a means of assessing external anal sphincter function. This study was designed to investigate this claim by comparing the strength-duration test with established measures of external anal sphincter function. METHODS: Forty-nine females undergoing diagnostic anorectal testing (manometry, rectal sensation, electromyogram, pudendal nerve terminal motor latency, and endoanal ultrasound) also had the strength-duration test performed (which was repeated for each patient after a short rest period). RESULTS: The strength-duration test was repeatable. Statistically significant correlations were found between this test at pulse durations of 3 ms, 1 ms, and 0.3 ms with electromyographic activity of the external anal sphincter and with pressure in the anal canal during voluntary contraction. Significant correlations were found for durations of 100 ms, 30 ms, 10 ms, and 3 ms with the pudendal nerve terminal motor latency on the right and for the 3 ms and 0.3 ms durations with latency on the left. There were no correlations between the strength-duration test and resting pressure in the anal canal. CONCLUSION: The strength-duration test significantly correlates with the established measures of external anal sphincter function and its innervation. Therefore, this simple test appears to provide a simple measure of external anal sphincter denervation.

Adult↗