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Biomedical subjects

Douglas G Tincello

Publications and source records attributed to Douglas G Tincello.

15 recordsLinked to original sources
PubMed2006

Enhancement of rat bladder contraction by artificial sweeteners via increased extracellular Ca2+ influx.

INTRODUCTION: Consumption of carbonated soft drinks has been shown to be independently associated with the development of overactive bladder symptoms (OR 1.62, 95% CI 1.18, 2.22) [Dallosso, H.M., McGrother, C.W., Matthews, R.J., Donaldson, M.M.K., 2003. The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int. 92, 69-77]. We evaluated the effects of three artificial sweeteners, acesulfame K, aspartame and sodium saccharin, on the contractile response of isolated rat detrusor muscle strips. METHODS: Strips of detrusor muscle were placed in an organ bath and stimulated with electrical field stimulation (EFS) in the absence and presence of atropine, and with alpha,beta methylene ATP, potassium, calcium and carbachol. RESULTS: Sweeteners 10(-7) M to 10(-2) M enhanced the contractile response to 10 Hz EFS compared to control (p<0.01). The atropine-resistant response to EFS was marginally increased by acesulfame K 10(-6) M, aspartame 10(-7) M and sodium saccharin 10(-7) M. Acesulfame K 10(-6) M increased the maximum contractile response to alpha,beta methylene ATP by 35% (+/-9.6%) (p<0.05) and to KCl by 12% (+/-3.1%) (p<0.01). Sodium saccharin also increased the response to KCl by 37% (+/-15.2%) (p<0.05). These sweeteners shifted the calcium concentration-response curves to the left. Acesulfame K 10(-6) M increased the log EC(50) from -2.79 (+/-0.037) to -3.03 (+/-0.048, p<0.01) and sodium saccharin 10(-7) M from -2.74 (+/-0.03) to 2.86 (+/-0.031, p<0.05). The sweeteners had no significant effect on the contractile response to carbachol but they did increase the amplitude of spontaneous bladder contractions. DISCUSSION: These results suggest that low concentrations of artificial sweeteners enhanced detrusor muscle contraction via modulation of L-type Ca(+2) channels.

Adenosine Triphosphate↗
PubMed2006

How to repair an anal sphincter injury after vaginal delivery: results of a randomised controlled trial.

OBJECTIVE: To compare two surgical techniques and two types of suture material for anal sphincter repair after childbirth-related injury. DESIGN: Factorial randomised controlled trial. SETTING: Tertiary referral maternity unit. POPULATION: Women with an anal sphincter injury sustained during childbirth. METHOD: Women were randomised into four groups: overlap repair with polyglactin (Vicryl); end-to-end repair with polyglactin (Vicryl); overlap repair with polydioxanone (PDS); and end-to-end repair with PDS. All repairs were completed as a primary procedure by staff trained in both methods. MAIN OUTCOME MEASURES: Suture-related morbidity at six weeks. Bowel symptoms at 3, 6 and 12 months. Anorectal physiology at three months. Quality of life scores at 3 and 12 months. RESULTS: One hundred and fifty women (1.5% of deliveries) were eligible and 112 (75%) were randomised. One hundred and three (92%) attended follow up visit at 6 weeks, 89 (80%) at 3 months, 79 (71%) at 6 months and 60 (54%) at 12 months. At six weeks, there was no difference in suture-related morbidity between groups (P=0.11) and 70% patients were completely asymptomatic. Incidence of bowel symptoms and quality of life disturbances were low, with no differences between the four groups. CONCLUSION: Obstetric anal sphincter repair carried out by appropriately trained staff is associated with low morbidity, irrespective of the suture material and repair method used.

Adult↗
PubMed2005

Interstitial cystitis in the UK: results of a questionnaire survey of members of the Interstitial Cystitis Support Group.

PURPOSE: To examine the site, severity, and duration, of symptoms in patients with interstitial cystitis. To examine the treatments offered. MATERIALS AND METHODS: Postal questionnaire administered to members of the Interstitial Cystitis Support Group, based in the United Kingdom. RESULTS: 736 of 1148 (64%) questionnaires were returned. 696 (94.6%) patients were women. 471 patients (64%) described daily pain when symptoms were at their worst, and 273 (37%) described daily pain at the time of survey. Most patients reported frequency, urgency and nocturia. A wide range of treatments had been offered, but drugs of proven efficacy were offered to less than a third of patients: cimetidine (36%); antihistamines (5%); pentosan polysulphate (12%); DMSO (33%); and anticonvulsants (2%). 495 patients (67%) reported "considerable impact" or more on their lifestyle and 346 (46%) reported moderate depression or worse. 364 (49%) reported at least considerable difficulties with sexual intercourse. CONCLUSIONS: This survey supports the work of others about the nature of symptoms and their impact upon quality of life. The data highlight the continuing difficulty in making a prompt diagnosis. We recommend that a European survey or registry of interstitial cystitis patients would help to establish a minimum standard of care. A suggested treatment algorithm is provided.

Anticonvulsants↗
PubMed2005

Absence of bacterial and viral DNA in bladder biopsies from patients with interstitial cystitis/chronic pelvic pain syndrome.

PURPOSE: We examined bladder biopsies from women with interstitial cystitis/chronic pelvic pain syndrome (IC/CPPS) for the presence of bacterial and viral DNA sequences using polymerase chain reaction. MATERIALS AND METHODS: Bladder biopsies were taken during cystoscopy from patients under investigation for IC/CPPS, or controls undergoing colposuspension for stress incontinence. Biopsies were snap frozen to -70C. After DNA extraction, polymerase chain reaction (PCR) using specific primers for the hypoxanthine-guanine phosphoribosyl transferase gene confirmed the presence of human DNA. PCR for bacterial and viral gene sequences was performed using specific primers. Positive reactions were repeated to confirm the signal. RESULTS: A total of 92 patients with IC/CPPS (12 who met the National Institute of Diabetes and Digestive and Kidney Diseases criteria and 80 who did not) and 91 controls were recruited. PCR for hypoxanthine-guanine phosphoribosyl transferase gene was positive in all samples. PCR for the 16S ribosomal RNA gene, as well as for adenovirus, cytomegalovirus, herpes simplex virus types I and II, human papillomavirus (all subtypes) and Chlamydia trachomatis were negative in all samples. CONCLUSIONS: IC/CPPS is not associated with persistence of viral and bacterial DNA in the bladder. A chronic infective etiology for the condition is excluded by these findings.

Chronic Disease↗
PubMed2005

Women's experiences after a third-degree obstetric anal sphincter tear: a qualitative study.

BACKGROUND: Little qualitative data are available that address the experiences of women who sustain a third-degree obstetric anal sphincter tear during childbirth. The objective of this study was to explore the views and experiences of women in the postpartum period after sustaining a third-degree obstetric anal sphincter tear. METHODS: A qualitative study was conducted using focus groups in a large maternity hospital in the United Kingdom. Two focus groups used a purposive sample of women who had suffered a third-degree tear. One group (n = 6) had a tear in the index pregnancy and the second group (n = 4) had a subsequent pregnancy after the tear. RESULTS: The main themes identified included apprehension about consequences of the injury in terms of continence; body image and sexual functioning; anxiety about and lack of involvement in planning for future pregnancies; poor information exchange and communication (including both content and timing of discussions); poor emotional support from professionals and family members; physical and emotional impact; and unresolved anxieties in partners. Similarities occurred across both groups. CONCLUSIONS: A third-degree tear causes a significant emotional and psychological impact on women's physical and emotional well-being. We recommend that all staff receive adequate training to deal with the issues that may be raised. The provision of a dedicated, multidisciplinary team involved at an early stage to coordinate the repair and follow-up is recommended to allow a sensitive, consistent, evidence-based approach, particularly in terms of decision-making for subsequent births. The experiences and needs of partners require further study.

Adult↗
PubMed2005

Morbidity of incontinence surgery in women over 70 years old: a retrospective cohort study.

OBJECTIVE: To compare the success rate and complications after colposuspension and tension-free vaginal tape (TVT) insertion in women aged 70 years or more compared with younger women. DESIGN: A retrospective study of patients having surgery between November 2000 and October 2002. SETTING: A tertiary referral, academic urogynaecology unit in a University teaching hospital. POPULATION: Two hundred and twenty-six women having surgical treatment for urinary incontinence. METHODS: Data on cure/improvement and complications were extracted from the notes. Patients were grouped by age at surgery and the odds ratios (OR) and 95% confidence intervals (CI) for each outcome were calculated. MAIN OUTCOME MEASURES: Subjective cure rate and the incidence of complications by age group. RESULTS: One hundred and three patients had colposuspension, 11 (10.7%) aged 70 or more. One hundred and twenty-three patients had TVT insertions, 23 (18.7%) aged 70 or more. The cure rate for each procedure was similar between age groups. After colposuspension, urinary tract infection (UTI; OR 11.33; 95% CI 2.61, 49.28) and long term self-catheterisation (percentage of difference 9.1; 95% CI 3.0, 15.2) were more common in women over 70. After TVT, repeat urodynamics (OR 3.91; 95% CI 1.11, 13.76), recurrent UTI (OR 4.22; 95% CI 1.03, 17.26) and tape division (OR 29.12; 95% CI 3.20, 264.86) were more common in older women. CONCLUSIONS: Incontinence surgery carries a higher risk of complications in the elderly including UTI and voiding dysfunction. Extended antibiotic prophylaxis and intermittent self-catheterisation training should be offered to elderly women before surgery.

Adult↗
PubMed2005

Risk scoring system for prediction of obstetric anal sphincter injury.

OBJECTIVE: The objective was to begin the process of developing an antenatal risk scoring system, as a first step towards examining whether elective Caesarean section for women at high risk of injury could be an effective and acceptable intervention. DESIGN: Retrospective study. SETTING: Tertiary maternity unit in the UK. POPULATION: One hundred and twenty-three women who sustained an obstetric anal sphincter injury (OASI) and 123 controls without OASI. METHODS: Case notes of women with a third or fourth degree tear between 1997 and 1999 were examined for risk factors. Controls matched for age and week of delivery were identified from the maternity record database and case records reviewed for the presence of risk factors. Unweighted and weighted risk scores were produced using odds ratios, and compared between cases and controls. Receiver operating characteristics (ROC) curve analysis of the risk scores was performed to discriminate between cases and controls and to calculate the sensitivity and specificity of each scoring system. MAIN OUTCOME MEASURES: Odds ratio (OR) and 95% confidence interval (CI) for each risk factor. Sensitivity and specificity from ROC curves for weighted and unweighted risk score. RESULTS: Among the cases there were more nulliparous women (OR 1.77; CI 1.05-2.99) and a trend towards more women with an episiotomy (OR 1.57; CI 0.99-2.47). Among women with sphincter injury, trends towards more epidurals (OR 1.64; CI 0.97-2.75), and more babies weighing more than 4000 g among (OR 1.45; CI 0.85-2.49) were noted. The median unweighted risk score was 2 for cases and 2 for controls (P= 0.05), while the weighted risk score was 2.1 and 1.37 (P= 0.03), respectively. The ROC curves approximated to a straight line demonstrating very poor discrimination between cases and controls. CONCLUSION: The predictive test performed poorly, suggesting that the risk factors identified do not exert a large enough effect in a cohort of this size.

Adult↗
PubMed2004

Objective assessment of urinary incontinence in women: comparison of the one-hour and 24-hour pad tests.

OBJECTIVE: To compare the performance and clinical usefulness of the one-hour and 24-hour pad tests in terms of the relationship with reported symptoms and urodynamic diagnosis. METHODS: 341 women aged 40 years and over reporting lower urinary tract symptoms who were recruited to a nurse led continence service, and went on to receive urodynamics, a one-hour and a 24-hour pad test and completed a urinary diary. RESULTS: For both pad tests, there was a significant difference in the amount of urine leaked between the different urodynamic diagnoses (p<0.0001, for the one-hour and p=0.001 for the 24-hour test). Women with sphincter incompetence leaked significantly more than women with detrusor instability, or those with no abnormality. There was a significant difference between the proportion of women dry on a one-hour pad test and those dry on a 24-hour pad test (26.0% versus 38.4%, difference 12.4%; CI 5.5; 19.4). There is a positive relationship between amount of urine leakage and symptom severity expressed in terms of number of incontinent episodes for both pad tests. CONCLUSION: Both pad tests bore little relationship to the underlying urodynamic diagnosis but there was a positive relationship with symptom severity. The 24-hour pad test appears to be clinically a more useful too than the one-hour test. The two types of pad test are probably assessing incontinence in different ways. We suggest that the minimum data set should include structured questions, diaries and the 24-hour pad test.

Adult↗
PubMed2003

Effect of a new guideline on outcome following third-degree perineal tears: results of a 3-year audit.

The aim of this study was to assess the impact of a new guideline on the outcome of repair of obstetric anal sphincter tears by examining adherence to the guideline and the effect upon the incidence of symptoms of anal incontinence. An audit of third-degree perineal tears was conducted in 1997. A reaudit was completed in 1998 and 1999 after the introduction of a new guideline. The audits were conducted in a tertiary obstetric unit with 5000 deliveries per annum. Over the 3-year period between 1997 and 1999 124 women with a third-degree tear were identified; 14 381 women who had delivered vaginally without third-degree tears were used as controls. The main outcome measure was the number of cases with adherence to the protocol, and the number of patients with ongoing symptoms. Cases were identified from the hospital database, and case notes were reviewed to obtain clinical data. The incidence of third-degree perineal tears was 0.81% over the 3-year period. Following the introduction of a new guideline there was a significant increase in the number of repairs performed in theatre (70% vs 82% vs 97%, P<0.05), using Prolene (64% vs 76% vs 93%, P< 0.05), with adequate anesthesia (70% vs 82% vs 97%, P<0.05). At follow-up there was a transient improvement in defecatory symptoms in the first year of the protocol only (45% vs 32% vs 50%, P<0.01). More patients had complete follow-up data after introduction of the protocol: 66% vs 86% vs 80% ( P<0.001). There were more cases of Prolene suture migration (7% vs 34% vs 16%, P<0.01). We concluded that the introduction of a new guideline was followed by improved performance of appropriate repair. There was no sustained improvement in fecal symptoms at follow-up.

Anal Canal↗
PubMed2003

The influence of pad test loss on management of women with urodynamic stress incontinence.

Members of the International Continence Society (UK section) were randomised to receive a scenario comprising clinical and urodynamic data of a woman with urodynamic stress incontinence, including a one-hour pad loss of either 42 g (large loss) or 7 g (small loss). Members were asked to indicate their initial management choice from a list of four options. Three hundred and fifteen of 440 (72%) members responded. Gynaecologists and urologists were significantly more likely to choose surgical treatment for patients with a large pad loss (24% vs 8%; difference 15.8%, 95% CI 2.9-28.7), despite published data demonstrating the poor reproducibility and reliability of the pad test.

Clinical Competence↗
PubMed2003

Differences in episiotomy technique between midwives and doctors.

OBJECTIVES: To examine the practice of making an episiotomy and to determine any differences in practice between professional groups. DESIGN: A prospective survey. SETTING: A large tertiary referral obstetric hospital and the obstetric department of a district general hospital. POPULATION: All staff routinely involved in the care of women in labour. METHODS: A novel validated pictorial questionnaire was designed, validated and distributed to the study population. Differences in outcome measures were compared by profession and by seniority. MAIN OUTCOME MEASURES: Measurements taken from the questionnaire: the length of episiotomy drawn; the distance from the sagittal plane at which the episiotomy was begun; and the angle of the episiotomy from the sagittal plane. RESULTS: Fifty doctors and 78 midwives completed the forms. Median distance of the episiotomy from the midline was 0 mm (-2 to 11). Episiotomies drawn by doctors were significantly longer and more angled than those drawn by midwives (P = 0.002 and P = 0.001). Sixteen percent of doctors and 1% of midwives drew an episiotomy longer than 20 mm (difference 15%, 95% CI 6 to 24). Twenty-three percent of midwives and 2% of doctors drew an episiotomy angled 30 degrees or less (difference 21%, 95% CI 9 to 34). CONCLUSIONS: This study has demonstrated differences in the reporting of episiotomy practice by doctors and midwives. Theoretically, the differences demonstrated could predispose to a greater risk of anal sphincter injuries. These data need to be confirmed by observational studies of actual practice and by studies to investigate the mechanics of sphincter injury during childbirth.

Episiotomy↗
PubMed2002

Antenatal screening for postpartum urinary incontinence in nulliparous women: a pilot study.

UNLABELLED: Antenatal screening for postpartum urinary incontinence in nulliparous women: a pilot study. OBJECTIVE: To examine the utility of joint mobility scoring (JMS) as a screening test for postpartum urinary incontinence. STUDY DESIGN: A prospective cohort study in a teaching hospital involving 150 nulliparous women. JMS was calculated. The incidence of incontinence and pad use was recorded. Univariate and multiple logistic regression analyses were used to identify factors independently associated with incontinence. RESULTS: Hundred and three women completed the study. 43.7% of subjects were incontinent antenatally and 4.9% remained incontinent at the study end. JMS was normally distributed and similar in continent and incontinent women. Elbow hyperextension (>180 degrees ) was associated with postnatal incontinence (odds ratio 10.6; 95% CI 1.24, 90.8). Elbow hyperextension had a sensitivity of 80%, specificity of 75%, positive predictive value of 14%, and negative predictive value of 99% for postnatal incontinence. CONCLUSION: Joint hypermobility score is not a useful screening test. Elbow hyperextension is associated with an increased likelihood of postnatal urinary incontinence. It is unclear whether this test has clinical utility outside a research setting.

Adult↗
PubMed2002

Effect of delays in primary care referral on survival of women with epithelial ovarian cancer: retrospective audit.

OBJECTIVE: To examine referral pathways from primary care for patients with epithelial ovarian cancer and to identify factors related to survival at 18 months. DESIGN: Retrospective review of patient notes. SETTING: General practices and receiving hospitals within Mersey region. SUBJECTS: 135 patients with epithelial ovarian cancer identified from an audit in the Mersey area between 1992 and 1994. MAIN OUTCOME MEASURES: Delays between onset of symptoms and treatment attributable to patient, general practitioner, and hospital. RESULTS: 105 (78%) women first presented to their general practitioner within four weeks of the onset of symptoms. 99 (73%) women were referred to hospital by their general practitioners within four weeks of presentation, and 95 (70%) were seen in hospital within two weeks of referral. Multivariate analysis with survival as the dependent variable identified age (odds ratio 0.96, 95% confidence interval 0.93 to 0.99) cancer stage III or more (0.15, 0.05 to 0.43), and non-specific symptoms (0.36, 0.14 to 0.89) as significant variables. CONCLUSION: Most patients attended their general practitioner within four weeks and were referred within two weeks. No evidence was found that delays in referral or diagnosis adversely affected survival at 18 months. Stage of disease at surgery was the most important adverse factor. An effective screening programme is the most likely method to improve survival.

Aged↗
PubMed2002

Leukocyte populations in interstitial cystitis and idiopathic reduced bladder storage.

OBJECTIVES: Mast cells and leukocyte populations in bladder biopsies from women with interstitial cystitis (IC) or idiopathic reduced bladder storage (sensory urgency [SU]) were compared to determine whether any evidence of a common etiology between these conditions could be found. METHODS: Biopsies from 40 patients (9 meeting the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases criteria [IC] and 31 who did not [SU]) and 20 controls (having colposuspension for stress incontinence) were stained with monoclonal antibodies against leukocyte antigens and mast cell tryptase. The median cell counts from 10 high power fields were calculated and compared between cases and controls. The clinical and urodynamic data were also compared. RESULTS: Nocturia (odds ratio 26.7; 95% confidence interval 3.3 to 245.5) and bladder pain (odds ratio 18.5; 95% confidence interval 1.8 to 193.1) were associated with significant odds ratios for disease (IC or SU compared with controls) in logistic regression analysis. Patients with IC were significantly older than those with SU (P = 0.05). Leukocyte populations showed only increased CD20+ cells in patients with IC compared with the others (P = 0.03). CONCLUSIONS: The analysis of the clinical, urodynamic, and cystoscopic data showed no differences between patients with IC and those with SU, except for age. Nocturia or bladder pain discriminated between patients and controls. The lymphocytic infiltrate in SU is similar to that seen in IC but with fewer CD20+ cells. These data support the work of others and may indicate that SU has a common etiology with IC.

Case-Control Studies↗