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J W Barrington

Publications and source records attributed to J W Barrington.

At least 19 recordsLinked to original sources
PubMed2006

Prevalence of anorectal dysfunction in women attending health care services.

The aim of this study was to assess the prevalence of different bowel symptoms (constipation, faecal incontinence and faecal evacuation dysfunction) and associated urinary symptoms in women attending health care services. All women attending colposcopy clinics and general gynaecology clinics in a district general hospital in the southwest of England were invited to participate in the study. In addition, women attending the local family planning clinic were also recruited. Women attending these clinics routinely completed a history sheet and were asked to complete the Birmingham Bowel and Urinary Symptoms Questionnaire. Two hundred women participated in the study: 116 (64.4%) had at least one bowel symptom from the list in the questionnaire and 57 (31.6%) of women thought they had a bowel problem but only 26 (14.4%) consulted their family doctor regarding the problem while four (2.2%) were referred for specialist opinion. Six were unsure about their bowel symptoms. There were 46 (25.5%) of women who had constipation, 99 (55%) had faecal incontinence and 97 (53.8%) complained of faecal evacuation dysfunction. Only 48 (26.6%) of women were free of any bowel complaint. One patient with faecal incontinence discussed her problem with her midwife but no further action was taken as she was too embarrassed to discuss it with her doctor. Seventy-eight (43.3%) of patients had urinary symptoms. Fifty-five (30.5%) thought they had a urinary problem but only 29 (16.1%) consulted their doctor and 17 (9.4%) were referred for specialist opinion. Sixty-one (33.8%) of those who admitted to have urinary incontinence also had faecal incontinence. Forty-nine (27.2%) of the patients were free of all symptoms. The mode of delivery as well as previous surgery did not have any influence on urinary incontinence nor on anal incontinence. This study has demonstrated a high prevalence of bowel symptoms in women attending health care services.

Adolescent↗
PubMed2006

A simple visual analogue scale to assess the quality of life in women with urinary incontinence.

AIM: The objective of this study is to determine whether a simple visual analogue scale; "incontinence bothersome scale (IBS)" can reliably assess the quality of life in women with urinary incontinence. DESIGN: A prospective cohort study in a UK district general hospital. METHODS: Two hundreds women with urinary incontinence participated in the study over 1-year period. They completed Kings health questionnaire version 7 (KHQ) and the incontinence bothersome scale (IBS). The results of the IBS were then compared to the total KHQ score and to each domain separately, using the Pearson correlation test. Women in the study were then classified into two main groups according to their urodynamics diagnosis (urodynamic stress incontinence group/detrusor overactivity group) and the total KHQ scores were compared with the IBS scores in each group. RESULTS: The IBS scores had poor correlation with the total KHQ scores (r=0.656) and the difference between both arms was not statistically significant (p=0.084). Further analysis of KHQ domains showed that except for the impact of incontinence domain (r=0.728) all other domains correlated poorly to the IBS. This poor correlation pertained in sub-analysis of women with DO and USI (r=0.65 and 0.48, respectively). CONCLUSION: This study has shown that a simple visual scale is not a reliable tool in assessing the QoL in women with urinary incontinence. A formal, validated and reliable QoL questionnaire is still the method of choice for QoL assessment, even if it takes longer to complete.

Adult↗
PubMed2005

Bladder augmentation using Pelvicol implant for intractable overactive bladder syndrome.

The objective of the study was to evaluate the effectiveness of an implant of porcine dermis to augment the bladder in women with refractory overactive bladder syndrome (OAB). Twelve women underwent a Pelvicol bladder augmentation. A visual analogue score for severity of incontinence and a quality of life questionnaire was carried out pre-operatively and at 12 months post-operatively. Follow up cystoscopy was carried out in three women in addition. Three women were dry and cured; five women were significantly improved; two women were slightly improved and the procedure was unsuccessful in the remaining two women. There were no significant complications and voiding was spontaneous in every case. A bladder augmentation using porcine dermis may have a role in the surgical management of non-neuropathic women with OAB that has failed to respond to conservative therapy.

Adult↗
PubMed2005

The accuracy of Bardscan: a new tool for the measurement of the bladder volume.

The Bardscan has been recently introduced into clinical practice with the potential advantage of providing real time ultrasound imaging and hence the ability for an accurate estimation of bladder volume, and concurrently the detection of any incidental bladder pathology. Independent clinical data regarding this machine is limited, and therefore this study was carried out to ascertain whether the Bardscan machine is accurate in the estimation of bladder volume for women in the urodynamic clinic and in the postoperative period. Fifty four women had a Bardscan estimation of their bladder volume which was compared with an immediately obtained catheter volume. The results show that the Bardscan volumes correlate closely with the bladder volumes detected on catheterization (r =0.982, p=0.16). This study has shown that the Bardscan is an accurate tool in the measurement of bladder volume in women with the advantages of being safe, non-invasive and well tolerated by patients. The aim of this study was to evaluate the accuracy of the Bardscan machine in the measurement of urinary bladder volume.

Adult↗
PubMed2005

Serum calcium and magnesium levels in women with detrusor overactivity.

The aim of this study was to determine whether abnormal serum levels of magnesium and calcium occur in women with detrusor overactivity. These were compared with the serum level of magnesium and calcium ions in women with urodynamic stress incontinence as controls to see whether alteration of these levels offer a further therapeutic option. The study included 20 women with urodynamically proven detrusor overactivity compared with 20 women with urodynamic stress incontinence as controls. A blood test was taken to determine serum levels of total magnesium phosphate together with free and corrected calcium. In addition, the calcium and magnesium ratio (Ca:Mg) and calcium corrected and magnesium ratio (Ca Corr:Mg) were calculated. Both parametric and non-parametric tests were used to compare the two groups with respect to these variables. The mean, median and standard deviation of the two groups are very similar for each of the variables. There is no evidence to suggest that there is any difference between detrusor overactivity and urodynamic stress incontinence with respect to these variables. This study has shown that there is no abnormal correlation between serum calcium and magnesium ions in women with detrusor overactivity. There appears to be no therapeutic benefit in calcium and/or magnesium supplements for detrusor overactivity.

Adult↗
PubMed2004

Comparison between porcine dermal implant (Permacol) and silicone injection (Macroplastique) for urodynamic stress incontinence.

The objective of this study was to compare the efficacy of porcine dermal implant injection (Permacol) and silicone injection (Macroplastique) in the treatment of female urodynamic stress incontinence (USI) in a prospective randomized trial. Fifty women with urodynamically proven stress incontinence were recruited and randomised to receive either Permacol or Macroplastique injection. Twenty-five patients were enrolled in each case. An International Continence Society (ICS) standard 1-h pad test was carried out prior to the injection and a subjective analysis of incontinence made using a Stamey scoring system. In addition, a Kings College Hospital Quality of Health Questionnaire (KCQ) was completed. The women were followed up at 6 weeks and 6 months and the same methods used to gauge the success or failure of the operation. Preoperatively there were no significant differences in pad losses, Stamey score or King's score between the two groups. The mean age of the women was 61 years (range 28-80 years). At 6 weeks there were significant reductions in the mean and median values in pad losses, Stamey score and King's score in both Permacol and Macroplastique patients but the effects were more pronounced in Permacol patients than Macroplastique patients. Of the Permacol patients, 64% were improved on quantified pad losses out of which 60% were dry whereas 54% of Macroplastique patients were improved on pad losses of which 41.6% were dry. Of the Permacol patients, 64% and 60% had reduction in Stamey and KCQ score, respectively, whereas Macroplastique patients had 46% reduction in one or more grades of Stamey scores and 42% reduction in KCQ scores. At 6 months the results in the Permacol patients appeared to be sustained but not for Macroplastique patients. This study has shown that Permacol injection when used as a urethral bulking agent appears to have a higher cure rate for urodynamic stress incontinence than Macroplastique and these results persist until the follow-up period of 6 months. The use of Permacol injection is an attractive alternative in the treatment of urodynamic stress incontinence.

Adult↗
PubMed2004

The standard 1-hour pad test: does it have any value in clinical practice?

OBJECTIVES: The aim of this study was to determine whether self subjective assessment of urinary incontinence as perceived by female patients could replace the standard 1-hour pad test in clinical practice. DESIGN: Prospective cohort study. SETTING: District General Hospital, South West of England. METHODS: Ninety women awaiting surgical treatment for urodynamic stress incontinence were recruited. They underwent 160 pad tests; on each test women were asked to classify themselves on a four point scale into one category (0: totally continent to urine, 1: mild/occasional urinary incontinence (UI), 2: moderate UI, 3: severe UI), to complete the King's Health Questionnaire (KHQ) and carry out the standard International Continence Society 1-hour pad test. A pad gain >1 gm was considered a positive result. MAIN OUTCOME MEASURES: Women perception for severity of UI, 1-hour pad gain, KHQ scores. RESULTS: Self subjective assessment of UI (continent vs. incontinent) had good correlation (r = 0.88) with the pad test result (negative vs. positive), and correlated well with the KHQ scores (r = 0.79). Poor correlation was seen between the pad gain and the KHQ scores (r = 0.48) and between the pad gain and the self subjective assessment of UI scale (r = 0.48). The self subjective assessment of UI (incontinent vs. continent) had sensitivity 95.65% and specificity 93.33% to detect the pad test results (positive vs. negative). CONCLUSION: This study suggest that, in either the pre- or postoperative phase, simply asking a woman if she is continent for urine or not was as good as doing the pad test and correlated better with the patient quality of life.

Adult↗
PubMed2004

Pelvicol pubovaginal sling versus tension-free vaginal tape for treatment of urodynamic stress incontinence: a prospective randomized three-year follow-up study.

OBJECTIVES: The aim of this study was to compare the long-term success rates, complication rates and patient satisfaction rates for Pelvicol pubovaginal sling (Bard) versus TVT (Gynecare) in surgical treatment of urodynamic stress incontinence (USI) in women. DESIGN: Prospective randomized cohort trial. SETTING: District General Hospital, South West of England. METHODS: One hundred and forty-two women with urodynamic stress incontinence were randomized to either surgical procedure (Pelvicol = 74, TVT = 68) with median follow-up of 36 month. A postal questionnaire was sent to all women and the response rate was excellent at approximately 90% in both groups. RESULTS: Cure of incontinence, as identified by a quality of life improvement >90%, and/or patient-determined continent status as dry, were comparable in both groups. When the cure rates were adjusted assuming the non-respondents as failures the figures were almost identical (p > 0.05). Preoperative continence pad usage was similar for both groups. Overall, a postoperative significant decrease in pad score was noted in both groups (p = 0.01) but there was no significant difference between the groups (p > 0.05). Statistical analysis failed to detect significant differences between both groups as regards complication rates such as frequency, nocturia, de-novo urgency or dyspareunia. CONCLUSION: Pelvicol sling is a safe procedure in the surgical management of USI with similar success rate and patient satisfaction rate to TVT up to three years of follow-up.

Adult↗
PubMed2004

Prevalence of bladder tumors in women referred with postmenopausal bleeding.

OBJECTIVES: The aim of this study is to identify the prevalence of urinary bladder (UB) tumors in women presenting with postmenopausal bleeding (PMB). STUDY DESIGN: A prospective cohort study. New patients presenting for the PMB clinic in the period June 2002-June 2003 underwent transvaginal ultrasound scan (TVUS). All cases where bladder pathology was identified during TVUS were referred for urological opinion. Cystoscopy was undertaken in all cases and subsequent histological examination was carried out. MAIN OUTCOME MEASURES: Benign and malignant urinary bladder tumors. RESULTS: Two hundred eighty new referrals were reviewed in the PMB clinic. Three cases of UB tumors were identified on TVUS, none of them had an endometrial pathology and all cases had subsequent cystoscopy that confirmed the TVUS findings and resection of the bladder tumors was undertaken. Histological examination revealed one benign and two malignant urinary bladder tumors that were all completely excised. CONCLUSION: The prevalence of bladder tumors in women presenting with PMB in our population was found to be 1.07%, and the prevalence of bladder cancer was 0.7%.

Aged↗
PubMed2004

Longitudinal study of Pelvicol pubovaginal slings using magnetic resonance imaging.

The mechanism of urinary continence is complicated and is poorly understood. One current opinion is that there is an absence or weakness of the endopelvic fascial supports of the urethra. Pubovaginal slings are rapidly becoming the surgical procedure of choice in the management of urodynamic stress incontinence but their method of action is unclear. This study using magnetic resonance imaging shows how a pubovaginal sling can restore the normal anatomy and continence and adds to the global understanding of this condition.

Female↗
PubMed2003

Questionnaire-based survey on obstetricians and gynaecologists' attitudes towards the surgical management of urinary incontinence in women during their childbearing years.

OBJECTIVE: To determine the appropriate surgical management of incontinence in women who desire to maintain their childbearing capacity. DESIGN: Questionnaire-based survey. METHOD: A postal questionnaire was sent to 251 (every fourth) consultant obstetricians and gynaecologists in the UK practising in both district general hospitals (n=156) and teaching hospitals (n=95). MAIN OUTCOME MEASURES: Clinical consensus in the management of incontinence in women who are interested in childbearing. RESULTS: One hundred and thirty two (53%) consultants responded of which 22 (17%) were not involved in managing this group of women and were therefore excluded from analysis. Thirty-nine (36%) of the replies were from teaching hospital, 71 (65%) were from district general hospitals. Eighty-six (78%) consultants are prepared to perform a continence procedure on women who had not completed their families. One hundred (91%) would offer caesarean section to those continent pregnant women following their continence surgery. (Fisher's exact test' P=0.038). Interestingly, 67 (60.9%) of respondents still perform caesarean section to the pregnant women even if they are incontinent. CONCLUSIONS: The majority of UK consultants would perform a continence procedure in women who wish to maintain their childbearing capacity. Colposuspension is the favoured surgical procedure. If women are continent following surgery, most prefer them to be delivered by caesarean section.

Adult↗
PubMed2003

The accuracy of Bladderscan in intrapartum care.

This study was carried out to ascertain whether the Bladderscan machine is accurate in the measurement of bladder volume of women in labor. This would help avoid unnecessary intervention for a significant number of women who have small bladder volumes. Fifty women had a Bladderscan measurement during labor which was compared with an immediately obtained catheter volume. The overall correlation was weak (r = 0.593) but was influenced by the absence or presence of amniotic fluid. In women with ruptured membranes the relationship between Bladderscan volume and catheter-obtained volume was good (r = 0.851), but poor if the membranes were intact (r = 0.128). The Bladderscan may have a role in measuring bladder volume in women in labor and may therefore reduce the frequency of unnecessary catheterization, with the inherent increased incidence of urinary tract infection.

Adult↗
PubMed2003

Randomized trial of porcine dermal sling (Pelvicol implant) vs. tension-free vaginal tape (TVT) in the surgical treatment of stress incontinence: a questionnaire-based study.

The objective of this study was to compare porcine dermal sling (Pelvicol implant, Bard) with tension-free vaginal tape (TVT) in the surgical treatment of stress incontinence. One hundred and forty-two women with genuine stress incontinence (GSI) were randomly assigned to either Pelvicol implant pubovaginal sling (n=74) or TVT (n=68). They were followed up at a minimum of 6 months (range 6-24 months), with a median follow-up of 12 months. The majority (n=109) of procedures were carried out in a day surgery unit. The median operation time was 35 minutes (range 15-60) in the TVT group and 30 minutes (range 20-80) in the Pelvicol implant group; 81% of the TVT group and 77% of the Pelvicol implant group were able to void urine within 24 hours, and had insignificant residual bladder volumes. The prevalence of postoperative symptomatic voiding dysfunction was 3.4% after TVT and 1.4% after Pelvicol implant. Nine percent of the TVT group developed de novo urge incontinence and 6% of the Pelvicol implant group had de novo urge incontinence 6 months after the procedure. Postoperative evaluation was done at the outpatient department, and a postal questionnaire was also completed to determine subjective continence status. The patient-determined cure rate was 85% in the TVT group and 89% in the Pelvicol implant group. The Pelvicol implant sling had a comparable patient- determined success rate with TVT and should be considered in the surgical treatment of women with genuine stress incontinence.

Animals↗
PubMed2002

Post-colposuspension syndrome following a tension-free vaginal tape procedure.

A 51-year-old nurse underwent an uneventful TVT procedure. Two weeks postoperatively she developed intractable suprapubic pain directly over the iliopectineal ligaments consistent with a "post-colposuspension syndrome". This failed to respond to conservative therapy and she subsequently underwent exploration of the retropubic space. The TVT sling was found to be densely adherent to the iliopectineal ligaments, from which it was dissected free and then divided, leaving the part where it passes through the endopelvic fascia intact. The pain resolved immediately and the woman remained continent. This diagnosis should be considered in a woman presenting with groin pain following a sling procedure.

Broad Ligament↗
PubMed2002

The use of porcine dermal implant in a minimally invasive pubovaginal sling procedure for genuine stress incontinence.

OBJECTIVE: To assess the outcome of a suburethral sling using a porcine dermal implant (Pelvicoltrade mark, Bard Urology, UK) in the surgical management of urinary stress incontinence. PATIENTS AND METHODS: Forty women with urodynamically confirmed genuine stress incontinence were recruited into the study and followed up at 6 weeks and at least 6 months (mean 12 months, range 6-18). The sling was inserted using a minimal-access technique, which allowed 23 women to be operated as day-cases. Outcome measures included continence rates, voiding dysfunction, satisfaction scores and whether the patients would recommend the operation to a friend or relative. RESULTS: The cure rate was 85%, with sustained benefit; a further 10% of the women were improved by surgery. Voiding dysfunction rates were low and satisfaction scores high. Most women would undergo the procedure again if they became incontinent in the future and would recommend the procedure to a friend or relative. CONCLUSION: A minimal access pubovaginal sling using Pelvicoltrade mark is effective in treating stress incontinence. The complication rate is low and the procedure can be performed as a day-case with no loss of efficacy.

Adult↗