Biomedical subjects

Gaye Ellis

Publications and source records attributed to Gaye Ellis.

5 recordsLinked to original sources

PubMed2005

Lithium-induced reduction in urinary concentrating ability and urinary aquaporin 2 (AQP2) excretion in healthy volunteers.

BACKGROUND: Lithium therapy is associated with the development of nephrogenic diabetes inspidus. Experimentally, lithium inhibits arginine vasopressin (AVP)-stimulated translocation of cytoplasmic aquaporin 2 (AQP2) to the apical membrane. Clinically, the actions of lithium on renal tubular function are less clearly established. This study examined the effects of four weeks of lithium therapy on desmopressin (dDAVP)-stimulated urinary concentrating ability in healthy volunteers. METHODS: Eleven healthy volunteers underwent baseline urinary concentrating ability studies which were repeated following 4 weeks therapy with lithium carbonate (250 mg twice a day). Urinary osmolality, urinary AQP2 and cyclic adenosine monophosphate (cAMP) levels were measured following overnight fluid deprivation and after the administration of 40 microg of dDAVP. Baseline values were compared with results after 4 weeks of lithium therapy. RESULTS: Four weeks of lithium therapy reduced dDAVP-stimulated urinary concentrating ability (996 +/- 27 to 945 +/- 26 mOsm/kg) (P < 0.05) and this was associated with significant reduction in urinary AQP2 excretion (99.2 +/- 10.0 to 77.8 +/- 7.4 fmol/micromol creatinine) (P < 0.05) and urinary cAMP excretion (3188 +/- 376 to 2212 +/- 378 units) (P < 0.01). CONCLUSION: Four weeks of lithium therapy in healthy volunteers produced a small but significant reduction in dDAVP-stimulated urinary concentrating ability, which appears to be mediated by the inhibition of AVP-stimulated translocation of cytoplasmic AQP2 to the collecting tubule apical membrane via inhibition of adenyl cyclase.

Adenylyl Cyclase Inhibitors↗

PubMed2004

How important is TVT location?

BACKGROUND: The tension-free vaginal tape (TVT) is claimed to be a midurethral procedure, but data on sling placement are scarce to date. The aim of this study was to investigate tape position and mobility and correlate this with postoperative symptoms of bladder dysfunction. METHODS: One hundred and forty-one women 5 weeks to 2.1 years (mean 0.66 years) after TVT placement took part in a prospective clinical observational study. Appointments consisted of standardized symptom questionnaire, clinical stress test flowmetry and translabial ultrasound. The main outcome measures were patient symptoms, subjective satisfaction and cure/improvement. Paired t-test and anova statistics were employed for continuous, normally distributed parameters. RESULTS: Tape position varied from 30 mm above to 12.7 mm below the symphysis at rest and between 15 mm above to 18.7 mm below the symphysis on Valsalva. The horizontal distance of the tape from the symphysis pubis was weakly associated with recurrent stress incontinence (p = 0.048). More cranial tapes were weakly associated with urge incontinence (p = 0.03), frequency (p = 0.048) and symptoms of voiding dysfunction (p = 0.029). There was no association between tape placement and patient satisfaction or subjective cure/improvement. CONCLUSIONS: Position and mobility of the TVT vary markedly. This may be explained by varying degrees of dissection, localization of incisions and the preoperative degree of anterior vaginal wall prolapse. However, variations in placement seem to have relatively little effect on symptoms.

Adult↗

PubMed2004

Voiding function after tension-free vaginal tape: a longitudinal study.

BACKGROUND: The tension-free vaginal tape (TVT) has become popular for the surgical treatment of urodynamic stress incontinence. It seems to function via an intermittent obstructive effect that is easily demonstrated on imaging, although there is no agreement regarding its effect on voiding. AIMS: The present study was designed to longitudinally evaluate flowmetry indices and voiding symptoms after TVT placement. METHODS: A total of 145 consecutive patients were seen at yearly intervals after TVT placement, and 108 have now attended at least twice. A standardised questionnaire was filled in and a clinical stress test performed. The patients were asked to void for flowmetry; ultrasound was performed translabially for residual urine, tape position and mobility. RESULTS: After TVT placement, maximum flow rate (MFR) centiles dropped from 49.66 (SD 32.45) to 22.86 (SD 23.56), P < 0.001. However, when first and last postoperative visits were compared, there was a significant increase in MFR centiles (20.07 (SD 20.83) to 24.92 (SD 23.94), P = 0.021). This effect appeared to be almost linear over time when analysed on anova. The residuals decreased highly significantly (P < 0.001). This was accompanied by a reduction in symptoms of voiding dysfunction such as 'poor stream' (P = 0.024), 'straining to void' (P = 0.038) and 'incomplete emptying' (P = 0.019). CONCLUSIONS: The tension-free vaginal tape reduces MFR and flow rate centiles. It can have an obstructive effect on voiding, although this does not appear to be a major clinical problem. Voiding seems to improve over time, and this is accompanied by a reduction in the prevalence of symptoms of voiding dysfunction.

Female↗

PubMed2003

Effectiveness of anticholinergic drugs compared with placebo in the treatment of overactive bladder: systematic review.

OBJECTIVE: To determine the effectiveness of anticholinergic drugs for the treatment of overactive bladder syndrome. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: Published papers and abstracts. STUDY SELECTION: Randomised controlled trials with anticholinergic drug treatment in one arm and placebo in another. DATA EXTRACTION: Primary outcomes of interest were patient perceived cure or improvement in symptoms, differences in number of incontinent episodes and number of voids in 24 hours, and side effects. Secondary outcomes of interest were urodynamic measures of bladder function (volume at first contraction, maximum cystometric capacity, and residual volume) and adverse events. DATA SYNTHESIS: 32 trials were included, totalling 6800 participants. Most trials were described as double blind but were variable in other aspects of quality. At the end of treatment, cure or improvement (relative risk 1.41, 95% confidence interval 1.29 to 1.54), differences in incontinent episodes in 24 hours (estimated mean difference 0.6, 0.4 to 0.8), number of voids in 24 hours (0.6, 0.4 to 0.8), maximum cystometric capacity (54 ml, 43 ml to 66 ml), and volume at first contraction (52 ml, 37 ml to 67 ml), were significantly in favour of anticholinergics (P<0.0001 for all). Anticholinergics were associated with significantly higher residual volumes (4 ml, 1 ml to 7 ml; P=0.02) and an increased rate of dry mouth (relative risk 2.56, 2.24 to 2.92; P<0.0001). Sensitivity analysis, although affected by small numbers of studies, showed little likelihood of an effect of age, sex, diagnosis, or choice of drug. CONCLUSIONS: Although statistically significant, the differences between anticholinergic drugs and placebo were small, apart from the increased rate of dry mouth in patients receiving active treatment. For many of the outcomes studied, the observed difference between anticholinergics and placebo may be of questionable clinical significance. None of these studies provided data on long term outcome.

Cholinergic Antagonists↗

PubMed2003

Does the tension-free vaginal tape stay where you put it?

OBJECTIVE: The tension-free vaginal tape (TVT) is a widely used procedure for the surgical treatment of urodynamic stress incontinence. Long-term follow-up data remain scarce. It has been speculated that scar formation leads to tape shortening and stiffening. This study was designed to longitudinally investigate tape position and mobility. STUDY DESIGN: An observational clinical study was performed using ultrasound parameters of tape position and mobility on Valsalva maneuver as main outcome parameters. RESULTS: Of 92 women eligible for a minimum of two postoperative assessments, 72 (78%) attended at least twice after TVT placement, at a median interval of 1.6 years. Sixty-eight data sets remained after exclusion of 4 patients who had undergone tape division. At the last visit, the tape was found to be more caudal, at rest (P <.001) and on Valsalva maneuver (P =.002). Tape mobility on Valsalva maneuver remained virtually unchanged. CONCLUSION: The TVT does not seem to contract or shorten over a median observation period of 1.6 years. On the contrary, it appears to slowly migrate caudally.

Adult↗