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E Versi

Publications and source records attributed to E Versi.

At least 19 recordsLinked to original sources
PubMed2000

Proceedings of the American Urogynecologic Society Multidisciplinary Symposium on Defecatory Disorders.

The Multidisciplinary Symposium on Defecatory Disorders was created to delineate the breadth of defecatory disorders and propose investigations to address identified knowledge deficits. Seven experts in defecatory disorders and 24 members of the American Urogynecologic Society were invited. The experts provided brief summaries of the scope of defecatory disorders from the perspectives of their specialties. The group then divided into 3 subgroups that focused on pathophysiology, imaging, and evaluation and treatment. Defecatory disorders, including anal incontinence and constipation, are common among women of all ages. Determination of their prevalence is complicated by a lack of standardized definitions. Defecatory disorders carry lengthy differential diagnoses. Imaging studies and anorectal testing, although not standardized, can aid in distinguishing different causes of dysfunction. The lack of uniformity in diagnosis and evaluation compromises comparisons of different treatments. Standardization of diagnoses and diagnostic modalities is essential to the design of meaningful evaluations of treatments for defecatory disorders.

Aging↗
PubMed2000

Dry mouth with conventional and controlled-release oxybutynin in urinary incontinence. The Ditropan XL Study Group.

OBJECTIVE: To compare the efficacy and safety of controlled-release oxybutynin with conventional, immediate-release oxybutynin and determine rates of dry mouth. METHODS: Patients (n = 226) who were known to be responsive to anticholinergic therapy and who had seven or more urge incontinence episodes per week were randomized to receive controlled-release oxybutynin or immediate-release oxybutynin. After an initial placebo run-in period, dosing in each began at 5 mg per day and increased weekly by 5 mg per day to a maximum of 20 mg per day or when a balance between improvement of incontinence symptoms and tolerability of side effects was achieved. Rates of urge incontinence and dry mouth were compared. Post hoc Kaplan-Meier survival analysis was used to describe elimination of incontinence episodes by dose and to analyze dry mouth risk by dose. RESULTS: Reductions in urge urinary incontinence episodes from baseline to the end of treatment were 18.6 to 2.9 per week (83% mean decrease) and 19.8 to 4.4 per week (76% mean decrease) in the controlled- and immediate-release oxybutynin groups (P =.36), respectively. At equal doses, comparable proportions of patients in both groups reported the absence of urge incontinence (P =.85). The incidence of dry mouth increased with dose in both groups, but there was no difference in dry mouth rates between the groups: 47.7% and 59.1% for the controlled- and immediate-release oxybutynin (P =.09), respectively. However, Kaplan-Meier analysis to examine first report of dry mouth at a given dose revealed that a significantly lower proportion of patients taking controlled-release oxybutynin had moderate to severe dry mouth (P =.007) or any dry mouth (P =.003) compared with those taking immediate-release oxybutynin. CONCLUSION: At the same daily dose, controlled- and immediate-release oxybutynin demonstrated comparable efficacy in reduction of urge incontinence episodes. The incidence of dry mouth was dose dependent but equal in both groups; first report of moderate to severe dry mouth was significantly lower in the controlled-release group.

Chemistry, Pharmaceutical↗
PubMed1998

Efficacy of an external urethral device in women with genuine stress urinary incontinence.

The efficacy of a new external anti-incontinence device in patients with a videourodynamic diagnosis of genuine stress incontinence (GSI) in an open longitudinal study is reported. Fourteen women with GSI underwent assessment before and after 3-4 weeks of device use. Assessment consisted of visual analog scores (VAS), quality of life (QOL) questionnaires, urine for culture and a 1 hour pad test. VAS scores showed a significant improvement for the symptom of stress incontinence (P<0.05). QOL scores improved significantly by 38% (P<0.05) and 29% (P<0.01) for the Incontinence Impact Questionnaire and Urogenital Distress Inventory, respectively. The mean pad weight decreased by 47% (P=0.056). Of the 9 women who had a positive pad test (>2 g) without the device, 5 were dry (<2 g) with the device (P<0.05). These preliminary data suggest that this device is effective in women with GSI.

Adult↗
PubMed1998

A new external urethral occlusive device for female urinary incontinence.

OBJECTIVE: Determine the efficacy of a new external anti-incontinence urethral device. METHODS: A before-after 1 month trial, open longitudinal study of 155 women complaining of urinary incontinence recruited from a referral urogynecology practice and local media advertising was performed. Primary outcomes included assessing the efficacy of the device using visual analogue scales, quality-of-life questionnaires, 1- and 48-hour standardized pad tests, and voiding diary. Secondary outcomes consisted of the evaluation of the adverse effects and the clinical profile of patients willing to use the device after study completion. RESULTS: Ninety-six (62%) of 155 women enrolled completed the study. Scores on the visual analogue scales improved for the symptoms of stress incontinence, urgency, and urge incontinence (P < .001). The score for irritation/discomfort increased (P < .001). Data from diaries showed that 38 (44%, n = 86) patients were dry. Of 454 recorded patient-days, 325 (72%) were dry days. On pad testing, incontinence was cured in 49% (1-hour pad test, n = 59, P < .001) and 44% (48-hour pad test, n = 32, P < .001) of patients. Quality-of-life scores were significantly improved in 48% (n = 96, Incontinence Impact Questionnaire, P < .001) and 32% (n = 96, Urogenital Distress Inventory, P < .001) of patients. There was no increase in bacteriuria. After study completion, 61 (39%) women chose to continue using the device, but this was not predictable from baseline data. CONCLUSION: Use of this device resulted in a significant reduction in incontinence and improvement in quality-of-life issues with minimal adverse events in the majority of women. This new anti-incontinence device could become a useful addition to the armamentarium of nonsurgical options.

Adult↗
PubMed1998

MR imaging of pelvic floor continence mechanisms in the supine and sitting positions.

OBJECTIVE: Our goal was to determine the anatomic differences in pelvic floor anatomy for continent women and women with stress incontinence using MR imaging and to assess whether these anatomic differences depend on the position of the subject during imaging. SUBJECTS AND METHODS: Eight continent volunteers and eight women with stress incontinence underwent MR imaging in the supine and sitting positions. For imaging, we used an open-configuration 0.5-T magnet. T2-weighted images were obtained in the midline sagittal plane with subjects at rest and at maximal pelvic floor strain in 5 sec using a modified fast spin-echo sequence. In the axial plane, thin-section T2-weighted images were obtained with subjects at rest using a standard fast spin-echo technique. Images were evaluated for mobility of the urethra and bladder neck and for integrity of the vagina, levator ani, and supporting fascia. RESULTS: Pelvic floor laxity and abnormalities of the supporting fascia were more common in incontinent women than in continent women. Both descent of the bladder neck when subjects strained and the posterior urethrovesical angle were not significantly greater when subjects were measured in the sitting position (p < .1). CONCLUSION: Changes of pelvic floor laxity related to incontinence can be seen with subjects in both the supine and the sitting positions but are increased in the sitting position.

Adult↗
PubMed1997

Bacteriuria in pregnancy: a comparison of Bangladeshi and Caucasian women.

During a 5-year period all urine culture results from pregnant Caucasian and Bangladeshi women booked for confinement at the Royal London Hospital, London, UK, were reviewed to determine race-specific rates of bacteriuria. The results showed that the overall prevalence of bacteriuria in the Caucasian group was 6.3% compared to 2.0% for the Bangladeshi women. Caucasian women were found to be at significantly greater risk across all pregnancy outcome and history categories, with the greatest risk observed in grand multiparous women (RR: 4.7, 95% CI: 2.8-8.3). Pregnancies that resulted in preterm delivery showed a strong association of bacteriuria in Caucasian women which was not seen in the Bangladeshi women (RR: 4.4, 95% CI: 2.0-8.7). The data suggest that Caucasian women have a significantly higher prevalence of bacteriuria in pregnancy than their Bangladeshi neighbors. Differences in hygiene practices and clothing may explain the observed differences in the bacteriuria rates.

Adult↗
PubMed1997

Magnetic resonance imaging of the lower urinary tract.

Magnetic resonance imaging with its excellent contrast resolution and direct multiplanar imaging capacity, has become a valuable tool to improve understanding of lower urinary tract function and pelvic floor physiology. Review of the current English language literature shows that the domain of magnetic resonance imaging is research. In comparison with other imaging techniques, magnetic resonance imaging has been shown to yield better soft tissue differentiation and anatomic resolution. Newer techniques also allow some form of dynamic imaging.

Female↗
PubMed1996

Evaluation of the home pad test in the investigation of female urinary incontinence.

OBJECTIVE: To evaluate the use of the home pad test in the management of patients with urinary dysfunction with reference to feasibility, normal data, reproducibility, compliance and accuracy when compared to video urodynamics. DESIGN: A prospective study to determine 1. the accuracy of weighing pads by healthcare workers compared to weighing by patients with a spring balance; 2. the effects of evaporation; 3. the pad weight increase in continent women; 4. the compliance over 194 tests in terms of acceptability and feasibility; 5. the reproducibility in 112 women for the 24 h and 48 h tests, 6. the comparison with video urodynamic studies in 149 patients. SETTING: A London teaching hospital. MAIN OUTCOME MEASURES: Coefficient of variation and mean deviation analysis were employed to determine the accuracy of measurement. Percentage changes in standardised wet pad weights over a period of 8 weeks were used to determine the rate of weight loss due to evaporation. The percentage of patients completing the test satisfactorily was documented. The increase in the weights of all pads worn during the test period was measured in continent volunteers and incontinent patients. Video urodynamic diagnoses were used as the Gold Standard for comparison. RESULTS: Twelve perineal pads were weighed by 15 healthcare workers with a resulting coefficient of variation equal to 1.55% (standard error = 0.09%). The mean deviation between patient-measured pad weights and staff-measured weights was 49% (SD = 132%). Pads wetted with saline showed no difference in weight after 1 week and less than 5% change in weight after 8 weeks, with the upper 95% confidence limit of less than 10% loss. The mean pad weight increase over 48 h in continent women was 7.13 g (SD = 4.32 g) giving a 95% upper confidence level of less than 15 g. Compliance was reasonably high with 161 (83%) carrying out the test perfectly. Test-retest analysis of the 24 h and 48 h tests showed a strong relationship with correlation coefficients of 0.90 and 0.94 respectively. The reproducibility was also good, with differences as a percentage of the mean between the first and second test being 6.9% and 1.6% for the 24 h and 48 h tests respectively. There was good concordance when the urodynamic study data was compared with pad weight data in terms of incontinence compared with no incontinence (kappa = 0.65), but a high false positive rate was detected for the pads. When eight of these patients with a false positive pad test had repeat video urodynamic studies, six were found to have detrusor instability on the second study. CONCLUSIONS: The home pad test combined with frequency volume chart documentation is an easy test to perform. It is quite robust and reasonably reproducible. This test should be added to complement the routine urodynamic tests and may have a role in detecting occult detrusor instability.

Female↗
PubMed1996

Urethral function.

Our understanding of the pathophysiological mechanisms of the urethra is still limited but improving. The valsalva leak point pressure measurement has been proposed as a simple and reproducible technique for the evaluation of urethral resistance, and progress has been made in the elucidation of urethral closure pressure generation that may lead to effective pharmacological therapy for treatment of functional obstruction. Magnetic resonance imaging is the newest technique for providing detailed anatomical information on the urethra and peri-urethral tissues.

Animals↗
PubMed1995

Obstetric outcome of Bangladeshi women in east London.

OBJECTIVE: To study the obstetric outcome of women of Bangladeshi origin in comparison with the white caucasian population in East London. DESIGN: A retrospective study of 16718 pregnancies over a five year period (1987-1991). SETTING: An East London teaching hospital district. SUBJECTS: Six thousand four hundred and sixty Bangladeshi women compared with 7592 white caucasian women. MAIN OUTCOME MEASURES: Maternal: antenatal complications; induction and augmentation rates; analgesia and anaesthesia; instrumental delivery and caesarean section rates; third stage complications. Fetal: gestation and weight at birth; perinatal mortality rates. RESULTS: The following statistically significant findings were noted: Bangladeshi women had a longer reproductive age span and were of greater parity including grand multiparity. They suffered fewer antenatal complications except for gestational diabetes. They had lower induction rates and, among the parous group, lower augmentation rates. During labour they required less analgesia but more commonly had general anaesthesia for caesarean section deliveries. They required instrumental delivery less often but there was no difference in overall caesarean section rate for the two groups. However, overall Bangladeshi women had a lower elective caesarean section rate, although parous Bangladeshi women had a higher emergency section rate. In the third stage there were no differences in the complication rates for the nulliparous women, however the parous Bangladeshi women had a higher postpartum haemorrhage rate and a lower perineal repair rate consistent with their higher parity. Whilst preterm births were more common in Bangladeshi women, significant prematurity (less than 28 weeks gestation) was less common. Similarly, although Bangladeshi babies weighed less at birth, they had fewer babies weighing less than 1500 grammes. There was no statistically significant difference in the perinatal mortality rate between the two groups, being 8.1 per thousand births overall. Whilst there was a statistically insignificant decline in death rates over the five-year period, between the groups there was no consistent difference. CONCLUSION: Pregnant Bangladeshi women in East London constitute a relatively high parity, low risk population who have less obstetric intervention and yet manage an equivalent (or better) perinatal outcome compared to their white caucasian neighbours.

Adolescent↗
PubMed1993

Prolonged pregnancy.

The perceived risks to the fetus of the postmature syndrome have led to the obstetrician's dilemma of whether to await spontaneous parturition or to artificially bring forward the onset of labor to an arbitrarily defined gestation. A prolonged or post-term pregnancy relates to a gestation of greater than 42 weeks and should not be regarded as synonymous with postmaturity. The latter describes a clinical syndrome thought to be a consequence of failing placental function. It is the difficulty in identifying the 'at risk' fetus which has led to routine induction policies. But is such a policy justified in terms of fetal outcome, and if so, is the mother put at increased risk? This review puts into perspective the most recent publications and points out areas requiring further study.

Algorithms↗