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E Versi

Publications and source records attributed to E Versi.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1991

Physiotherapy for stress urinary incontinence: a national survey.

OBJECTIVE: To study the physiotherapeutic treatment of urinary stress incontinence in England. DESIGN: Postal questionnaire survey. SETTING: All 192 English district health authorities. SUBJECTS: One physiotherapist from each district who was primarily concerned with urinary incontinence. A consensus view was requested. MAIN OUTCOME MEASURES: Responses to questionnaire and analysis of a visual analogue scale to indicate effectiveness. RESULTS: There was a 98% response rate. Treatment was often by senior physiotherapists (108 senior I grade or above) who, in 117 districts, claimed to have made a specialty of treating the condition. Gynaecologists and obstetricians were far more likely to refer patients than any other agency (147 respondents said that they were the commonest source of referral). One hundred and fifty four respondents stated that physiotherapy was usually used as the first line of treatment. Pelvic floor exercises and interferential treatment were most commonly used (by 178 and 144 respondents respectively) and thought to be the most effective, especially in combination, though various techniques were used in applying them. Positive motivation (108), recent onset of symptoms (55), and youth (40) were viewed optimistically, and obesity (60), previous surgery (59), prolapse (42), and a chronic cough (36) were considered to be bad prognostic features. The number of patients treated varied greatly (range 10-360) between districts and was poorly correlated with catchment size (correlation coefficient 0.3). CONCLUSIONS: As physiotherapists are treating considerable numbers of patients with stress incontinence research is urgently needed to produce efficacy data to enable rationalisation of resources to cater for the whole population.

Exercise Therapy↗
PubMed1991

The significance of an open bladder neck in women.

The significance of an open bladder neck at rest has been investigated in 147 women presenting to a urodynamic clinic. The prevalence of this condition was 21%; there was an association with urethral sphincter incompetence but an open bladder neck was not diagnostic of it. It is suggested that the finding of an open bladder neck at rest during urodynamic investigation is of little consequence.

Female↗
PubMed1991

Urethral pressures: analysis of transmission pressure ratios.

Transmission pressure ratio (TPR) analysis of urethral pressure profilometry data has been advocated for the diagnosis of genuine stress incontinence (GSI). However, the clinical usefulness of the technique has not been adequately evaluated. Using videourodynamics as the gold standard, the TPR results of 150 continent women and 153 with GSI have been compared. The mean TPR for each quartile of the functional urethral length was computed, as was the maximum TPR value (TPR-max) and the position on the urethra where it occurred (TPR-mode). There was a statistically significant difference between the 2 groups for TPR values in the distal 2 quartiles of the urethra and for TPR-max and TPR-mode. With the use of the Kappa statistic it was found that the TPR-mode was the most discriminatory of the TPR parameters. Even using this measure, the overlap between normal and GSI was so great as to make accurate diagnosis impossible. It was therefore concluded that TPR analysis is useless for the diagnosis of GSI. However, such an analysis is helpful for the understanding of the pathophysiology of GSI and its treatment.

Cough↗
PubMed1991

Symptoms analysis for the diagnosis of genuine stress incontinence.

OBJECTIVE: To determine the accuracy of an analysis of symptoms alone for the diagnosis of genuine stress incontinence. DESIGN: A comparison of results of symptoms analysis with urodynamic findings. SETTING: A gynaecological video-urodynamic unit. SUBJECTS: 252 consecutive patients referred for urodynamic investigations. INTERVENTIONS: A questionnaire of 20 symptoms of lower urinary tract dysfunction, midstream specimen of urine, pad testing, uroflowmetry, and video-cystourethrography. MAIN OUTCOME MEASURES: Using the urodynamic diagnosis as the 'gold standard', the accuracy of discriminant function analysis of symptoms was determined. RESULTS: Symptoms analysis achieved a correct classification of 81% with a false positive rate of 16%. Use of an accumulative probability curve defines patients who fall into the equivocal range. CONCLUSIONS: All women presenting with incontinence should undergo preoperative urodynamic studies.

Female↗
PubMed1990

Discriminant analysis of urethral pressure profilometry data for the diagnosis of genuine stress incontinence.

Urethral pressure profilometry (UPP) has been advocated for the diagnosis of genuine stress incontinence (GSI) but no published data exist to define clearly the criteria of measurement that should be used. The aim of this study was to examine the value of UPP in the diagnosis of GSI. Data from 102 urodynamically normal women and 70 women with GSI were compared. Thirty UPP variables from the resting and stress profiles were examined. The urodynamic diagnosis was made on the basis of a pad test, uroflowmetry and videocystourethrography. Each UPP variable was examined singly and thereafter all the measurements were examined by discriminate analysis. The single most discriminatory UPP variable was 'area under the stress profile' but the overlap between normal and GSI patients was too great to allow the test to be used diagnostically. Discriminate analysis resulted in correct classification in 78% of cases. On the basis of these results, UPP is not an accurate test for the diagnosis of GSI.

Discriminant Analysis↗
PubMed1990

The treatment of detrusor instability in post-menopausal women with oxybutynin chloride: a double blind placebo controlled study.

Idiopathic detrusor instability is a common cause of incontinence in the elderly for which anticholinergic agents are regularly prescribed. Oxybutynin chloride combines anticholinergic action with direct muscle relaxant properties. We performed a double blind placebo controlled fixed dose cross over study of oxybutynin chloride in post-menopausal women suffering from detrusor instability. We found oxybutynin chloride significantly more effective than placebo at reducing the symptoms of urgency and urge incontinence and more effective at reducing the height of the highest unstable detrusor contraction. This was at the expense of an increased residual urine and considerable side effects.

Aged↗