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C H van der Vaart

Publications and source records attributed to C H van der Vaart.

16 recordsLinked to original sources
PubMed2006

Feasibility and patient satisfaction with pelvic organ prolapse and urinary incontinence day surgery.

We performed a prospective cohort study to characterize the feasibility of urinary stress incontinence and pelvic organ prolapse surgery in day care. Two hundred and one women were prepared for day surgery by a standardised protocol; 132 women underwent a single Tension-free Vaginal Tape/Tension-free Vaginal Tape-Obturator procedure, and 69 women had additional or only pelvic organ prolapse surgery. The main outcome measures were complications, satisfaction score and recommendation to others, recorded after 3 days and 6-10 weeks. We found that it is feasible and safe to perform pelvic organ prolapse and urinary incontinence surgery in day care. Patients' satisfaction is high in all aspects of care and the majority would recommend it to others. In multivariate logistic regression analysis, only dissatisfaction with the care provided by the staff of the surgical ward was significantly associated with a negative recommendation to others (odds ratio 7.3, 95% confidence interval 1.6-33.5).

Adult↗
PubMed2006

Medium-term efficacy of pelvic floor muscle training for female urinary incontinence in daily practice.

The purpose of this paper is to assess the efficacy of physiotherapy and quality of life in women treated for urinary incontinence by specialized physiotherapists in daily community-based practices. Three hundred and fifty-five women were treated in five physiotherapy practices between January 2000 and December 2004. After a minimum follow-up of 12 months, these women received a questionnaire at home. With the questionnaire, we collected demographic data, data on the efficacy of treatment, satisfaction with the result, and the Urogenital Distress Inventory, and Incontinence Impact Questionnaire. Additional information was derived from the medical files. One hundred and eighty-seven women responded. Fifty percent of women were satisfied with the result of physiotherapy. After a mean follow-up of 32 months, 123 out of 130 women (94.6%), who only had physiotherapy, recorded to experience incontinence episodes daily to several times a week. Women who underwent additional incontinence surgery after insufficient physiotherapy recorded significantly less urinary incontinence symptoms and a better quality of life. Pelvic floor muscle training for urinary incontinence is effective in half of the women. If not successful, women seem to benefit significantly from incontinence surgery.

Adult↗
PubMed2006

The Pregnancy Mobility Index: a mobility scale during and after pregnancy.

BACKGROUND: During pregnancy, every second woman will experience some degree of back or pelvic pain. While several validated instruments to assess back pain exist for the general population, these are not suitable for application in a pregnant population and have not been validated for this purpose. A pregnant population not only differs from the general population regarding the type of back pain--frequently a pelvic girdle component is added--but pregnant women also have different mobility patterns and expectations. We therefore present in this study a self-report mobility scale specifically designed for a pregnant population: the Pregnancy Mobility Index. METHODS: Longitudinal cohort study including 672 nulliparous women with a singleton low-risk pregnancy. The Pregnancy Mobility Index consists of items concerning day-to-day activities selected through literature research and clinical experience. Participating women completed the questionnaire at 12 and 36 weeks' gestation and one year after delivery. Reliability, construct and criterion validity were tested. RESULTS: The internal consistency (Cronbach's alpha) was 0.8 or higher. The Pregnancy Mobility Index scales correlated best with the physical and pain scale of the RAND-36, indicating a good construct validity. The assumptions that the Pregnancy Mobility Index scores increase during pregnancy and decrease after delivery and that women with back or pelvic problems scored higher on the Pregnancy Mobility Index domains than women without back or pelvic pain were confirmed, indicating a good criterion validation. CONCLUSION: The Pregnancy Mobility Index has been shown to be a reliable and valid questionnaire well suited for use during and after pregnancy.

Activities of Daily Living↗
PubMed2006

Psychosocial factors and mode of delivery.

Childbirth is a substantial physical and emotional endeavor. Because emergency Cesarean and instrumental vaginal delivery impose a greater mortality and physical and emotional morbidity on both the mother and the infant than normal vaginal delivery, it is important to identify factors that are associated with the risk of operative delivery. In previous investigations, some associations have been found, but the effect of psychosocial factors is not clear. In this study we examined several factors which could be associated with the risk for instrumental and surgical delivery. In addition to biomedical factors we included psychosocial factors such as depressive symptoms, quality of the relationship of the woman with her partner, personality, lifestyle and educational level. We assessed 354 healthy nulliparous pregnant women with a child in vertex presentation and spontaneous onset of term labor using validated questionnaires. We found that social support from the woman's partner in pregnancy, lack of depressive symptoms and specific personality traits are not protective against instrumentally assisted vaginal delivery or emergency Cesarean section. Predictive factors for operative delivery after spontaneous onset of labor are higher fetal weight, non-occiput anterior presentation and advanced gestational age, and foremost fetal distress during parturition.

Adult↗
PubMed2006

Which factors determine the sexual function 1 year after childbirth?

OBJECTIVE: To evaluate which factors determine sexual activity and satisfaction with the sexual relationship 1 year after the first delivery. DESIGN: Prospective longitudinal cohort study. SETTING: Ten midwifery practices. POPULATION: Three hundred and seventy-seven nulliparous women were included. METHODS: The Maudsley Marital Questionnaire is a standardised and validated questionnaire with 15 items relating to marital and sexual adjustment, with a nine-point (0-8) scale appended to each question. Scores on the sexual scale (MMQ-S) range from 0 to 40. Higher scores are indicative of greater dissatisfaction. Sexual intercourse was dichotomised into having sexual intercourse or not having sexual intercourse. Several obstetric and maternal factors were analysed. MAIN OUTCOME MEASUREMENTS: Sexual intercourse at 1 year postpartum and dissatisfaction with the sexual relationship as assessed by the MMQ-S scale. RESULTS: In multiple logistic regression analysis, the main predictive factor for no sexual intercourse 1 year postpartum was no sexual intercourse at 12 weeks of gestation (beta 11.0 [4.01-30.4]). Women were five times less likely to be sexually active after a third/fourth degree anal sphincter tear as compared with women with an intact perineum (beta 0.2 [0.04-0.93]). Dissatisfaction with the sexual relationship 1 year after childbirth, assessed with the MMQ-S scale, is associated with not being sexually active at 12 weeks of gestation (beta- 0.208, P= 0.004) and with an older maternal age at delivery (beta 0.405, P= 0.032). CONCLUSION: An important prognostic factor for dissatisfaction with the sexual relationship 1 year postpartum was not being sexually active in early pregnancy. Satisfaction with the sexual relationship seems not to depend on pregnancy- and parturition-associated factors.

Adult↗
PubMed2005

A randomized comparison of post-operative pain, quality of life, and physical performance during the first 6 weeks after abdominal or vaginal surgical correction of descensus uteri.

AIMS: With respect to urogenital function, vaginal hysterectomy combined with anterior and/or posterior colporraphy has been shown to be superior to abdominal sacrocolpopexy with preservation of the uterus. We performed a randomized trial to compare the effects of both procedures on pain, quality of life and physical performance during the first six weeks after surgery. METHODS: Eighty-two patients were randomized to have surgery either by vaginal or abdominal approach. All patients were asked to complete the RAND-36 before surgery and 6 weeks after surgery and to keep a diary for the first 6 weeks after surgery. This diary assessed the pain perception and use of pain medication, bother of limitations due to the surgery and performance of daily activities after surgery. These outcomes were compared. RESULTS: All patients completed the RAND-36 and 68 patients completed the diary. Patients who had undergone abdominal surgery had a statistically lower score on the health change domain (56 vs 68), bodily pain domain (63 vs 80) and mental health domain (74 vs 81) of the RAND-36, as compared to patients who had undergone vaginal prolapse surgery. During hospital stay, the abdominal group experienced on average more days of pain (4.5 vs 3.0) and impaired mobility (3.7 vs 2.9) as compared to the vaginal group. Patients received more pain medication following abdominal surgery as compared to vaginal surgery. CONCLUSIONS: The vaginal operation to correct a descensus uteri is associated with less pain, better quality of life and better mobility during the first 6 weeks of the recovery period as compared to the abdominal approach.

Abdomen↗
PubMed2004

The association between overactive bladder symptoms and objective parameters from bladder diary and filling cystometry.

AIMS: To investigate the association between overactive bladder symptoms and objective parameters from the bladder diary and conventional filling cystometry. METHODS: We reviewed the records of the 95 consecutive patients presenting at our center for urodynamic investigation. These women were asked to self-complete a questionnaire and a bladder diary for 48 hr. Urogenital symptoms and disease-specific quality of life were assessed with standardized questionnaire, namely the Dutch version of the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). RESULTS: The frequency symptom as well as the urge incontinence symptom is significantly associated with the presence of detrusor overactivity. In univariate analysis both frequency and urgency symptoms are associated with lower micturition and bladder sensation volumes. In multivariate (ANOVA) analysis, the frequency symptom is associated with a higher 24-hr frequency, lower maximum volume voided, and mean volume voided per micturition on the bladder diary. It is also associated with lower sensation volumes on the filling cystometry. CONCLUSIONS: Of the four symptoms that are currently considered to be part of the overactive bladder syndrome, the frequency symptom is the best associated with objective parameters from the bladder diary, filling cystometry, and with the occurrence of detrusor overactivity. Therefore, we would like to suggest that reporting subjective symptoms frequency is obligatory for considering one to have an overactive bladder.

Adult↗
PubMed2003

Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms.

One hundred and three women underwent sacrospinous hysteropexy (n=54) or vaginal hysterectomy with a vaginal vault suspension (n=49) for the management of descensus uteri. They were sent a postal questionnaire. Logistic regression analysis was used to obtain crude and adjusted odds ratios. Seventy-four (72%) women responded. The adjusted odds ratios for urge incontinence is 3.4 (1.0-12.3) and for overactive bladder 2.9 (0.5-16.9) greater after vaginal hysterectomy. The women recovered significantly more quickly after sacrospinous hysteropexy. There were no differences in anatomical outcome or recurrence rate. When performed to correct a descensus uteri of grade 2 or more we found that vaginal hysterectomy is associated with a three times higher risk for urge incontinence and overactive bladder symptoms. In addition, the women who underwent sacrospinous hysteropexy also reported a quicker recovery from surgery. Sacrospinous hysteropexy, therefore, appears to be promising for the correction of descensus uteri.

Female↗
PubMed2002

Abdominal versus vaginal approach for the management of genital prolapse and coexisting stress incontinence.

Patients who undergo surgery because of genital prolapse and coexisting stress incontinence can be treated by a combination of surgical procedures via a unified route. We performed a retrospective study among 47 patients to compare micturition, defecation and prolapse symptoms after surgery, as well as duration of hospital stay and complication rate between patients who underwent a unified vaginal or abdominal surgical correction. All patients were treated between January 1995 and December 1997 in the University Medical Center Utrecht or St Antonius Hospital Nieuwegein, The Netherlands. Abdominal surgery was associated with a higher prevalence of difficulty in bladder emptying (relative risk (RR) 2.3 (95% CI 1.4-8.4)), fecal incontinence (RR 3.4, CI 1.1-10.7) and soiling (OR 2.8, CI 1.2-6.2), as well as with a longer postoperative hospital stay (8.6 vs 7.3 days) and a higher complication rate (25.0% vs. 11.4%) than vaginal surgery. These results suggest that a unified vaginal surgical correction of genital prolapse and coexisting stress incontinence appears to be preferable to a unified abdominal surgical correction.

Aged↗
PubMed2002

The contribution of hysterectomy to the occurrence of urge and stress urinary incontinence symptoms.

OBJECTIVE: To study the contribution of hysterectomy to the occurrence of urge-or stress urinary incontinence symptoms. DESIGN: A population-based, cross-sectional cohort study conducted in 1999. SETTING: A university medical centre in The Netherlands. POPULATION: Random sample of 2322 women, between 35 and 70 years of age, from a suburban area in the central part of The Netherlands. METHODS: Self-report questionnaire with questions from the Urogenital Distress Inventory, sociodemographic variables and data on obstetric and gynaecological history. MAIN OUTCOME MEASURES: Multivariate logistic regression analysis was used to obtain odds ratios with 95% confidence interval of the type and bothersomeness of urinary incontinence for hysterectomy. RESULTS: One thousand, six hundred and twenty-six women (70%) responded. The adjusted odds of urge (1.9, 1.4;2.6) and bothersome urge (2.6, 1.4;4.4) urinary incontinence were increased for women who had a hysterectomy. This association was not limited to the elderly but also occurred in women under 60 years of age. No increased odds of stress or bothersome stress incontinence were found. CONCLUSIONS: Meta-analysis has shown that hysterectomy increases the odds of urinary incontinence by 30%. However, a distinction between the different types of urinary incontinence symptoms has not been made. Such a distinction is of importance since urge incontinence gives a significantly greater reduction in health-related quality of life as compared with stress incontinence. Therefore, our finding that women scheduled for hysterectomy have an increased risk of developing urge incontinence symptoms indicates that these women should be counselled about this particular consequence.

Adult↗
PubMed2002

The effect of urinary incontinence and overactive bladder symptoms on quality of life in young women.

OBJECTIVE: To assess the consequences that the symptoms of urinary incontinence and an overactive bladder have on the quality of life in young, community-dwelling women. SUBJECTS AND METHODS: A population-based, cross-sectional cohort study was conducted in women aged 20-45 years. Urogenital symptoms and quality of life were assessed using standardized questionnaires, e.g. the Urogenital Distress Inventory and Incontinence Impact Questionnaire. RESULTS: The prevalence of symptoms of stress incontinence (39%), urge incontinence (15%) and an overactive bladder (12%) was high in this young population. Compared with urge incontinence, the symptoms of an overactive bladder similarly reduced the quality of life, but stress incontinence did not significantly affect the quality of life. Women with symptoms of an overactive bladder were especially limited in their mobility, whereas urge incontinence was especially associated with feelings of embarrassment. Although many women reported to be bothered by their symptoms, only a minority consulted their physician for them. CONCLUSIONS: The symptoms of urinary incontinence and overactive bladder are common among young adult women and have the same detrimental effect on quality of life as urge incontinence. The reduction in mobility associated with overactive bladder symptoms may be especially distressing for these young and active women.

Adult↗
PubMed2000

[The influence of urinary incontinence on quality of life of community-dwelling, 45-70 year old Dutch women].

OBJECTIVE: To establish the prevalence of urinary incontinence in non-institutionalized Dutch women and determine the consequences of urinary incontinence for their quality of life. DESIGN: Cross sectional questionnaire survey. METHOD: A random sample of 1905 women aged 45-70 years of the population of Zeist, the Netherlands, were sent a questionnaire. Generic quality of life was measured with the RAND-36 and disease specific quality of life was measured with a Dutch translation of the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ). Based on the answers to the questionnaire four groups of women were formed: no incontinence, only stress, only urge or a combination of stress and urge incontinence. These 4 groups were compared as to questionnaire scores. RESULTS: A total of 1086 questionnaires could be analysed. The prevalence of urinary incontinence was 57.1%: 28.7% stress incontinence, 5.6% urge incontinence and 22.7% both. Of those who reported urinary incontinence 6% were severely inconvenienced by it. Women with urinary incontinence reported a decrease in physical functioning and vitality as compared with women without incontinence (RAND-36). Especially women with urge or a combination of stress and urge incontinence had more severe impairment of their quality of life as compared to women with only stress incontinence. CONCLUSION: The prevalence of urinary incontinence is higher than it is usually reported. Especially the urge component affects the quality of life in a negative way.

Aged↗
PubMed1990

Combined therapy in the treatment of gastric epithelioid leiomyosarcoma.

In recent years it has been reported that the chemotherapeutic CYVADIC regime has contributed well to the treatment of advanced soft tissue sarcomas. We treated a patient with a large gastric epithelioid leiomyosarcoma with a combination of surgery and the CYVADIC regime. We believe that our result warrants further investigation in this field.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

CO2-laser therapy in patients with vulvar intraepithelial neoplasia.

It is generally accepted to consider vulvar intraepithelial neoplasia grade III (VIN III) a premalignant condition. The lesion is more frequently diagnosed in younger patients. Conventional surgical treatment is often mutilating and recurrence rates have been reported of approximately 30%. Laser vaporization is a promising alternative therapy. Ten patients with VIN III were treated with CO2 laser. Two patients were retreated with laser for residual disease, and two patients for recurrent disease. One failure was observed, and one patient was off-study. In all patients excellent cosmetic results were obtained. Laser vaporization appears to be an effective and nonmutilating therapy, and preferable for young VIN patients.

Adult↗