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Biomedical subjects

M E Vierhout

Publications and source records attributed to M E Vierhout.

At least 19 recordsLinked to original sources
PubMed2001

[Low rate of recurrence at a follow-up study of vaginal repair of enterocele].

OBJECTIVE: Evaluation of short and longterm follow-up after vaginal repair of enterocele. DESIGN: Retrospective medical record investigation, questionnaire investigation and outpatient clinic follow-up examination. METHODS: In the Department of Gynaecology, Ikazia and Haven Hospital, Rotterdam, the Netherlands, 66 patients were treated because of enterocele by vaginal repair in 1989-1998. Follow-up results were gathered from medical records, a written questionnaire and recent gynaecological examination. RESULTS: The questionnaire response was 49/66 (74%); of the 17 non-respondents 6 had died. Of the 29 patients who had been routinely examined gynaecologically more than one year before, 25 consented to an additional gynaecological examination. The median follow-up until the questionnaire or the outpatient clinic examination was 3 years and 7 months (range: 1 month to 9 years and 7 months). A recurrent enterocele had been found in 4 patients; 3 of them underwent a repeat repair. A serious short-term complication was one rectovaginal fistula with a temporary artificial outlet. No clear relation of dysfunction of voiding and defaecation with the operation was found. However, problems with coitus were new in 19% of the sexually active group. CONCLUSION: The vaginal repair of enterocele showed good results with a low recurrence rate of 6% in a complex group of patients.

Adult↗
PubMed2001

Severe hemorrhage complicating tension-free vaginal tape (TVT): a case report.

A 59-year-old non-obese woman with genuine stress incontinence underwent an uneventful TVT procedure. Postoperatively a hemorrhage in the space of Retzius became more and more prominent, and a secondary laparotomy was performed. Large clots as well as the TVT tape were removed. No active bleeding was found. She recovered uneventfully but needed 10 units of blood. A coagulation defect could not be diagnosed.

Female↗
PubMed2001

Influence of nonradical hysterectomy on the function of the lower urinary tract.

Hysterectomy will sometimes be identified by the patient as the starting point of lower urinary tract (LUT) symptoms. However, it is questionable whether there is a causal relationship. A number of epidemiological studies have found an increase in the relative risk of LUT symptoms of up to 2.2 in patients after simple hysterectomy. However, in numerous prospective, controlled studies including studies using urodynamic testing before and after the operation, such an effect can not be established. The discrepancy between the two types of studies is striking. A number of possible explanations are presented. It is concluded that there is little or no effect of nonradical hysterectomy on the lower urinary tract function.

Clinical Trials as Topic↗
PubMed2001

Risk factors for third degree perineal ruptures during delivery.

OBJECTIVE: To determine risk factors for the occurrence of third degree perineal tears during vaginal delivery. DESIGN: A population-based observational study. POPULATION: All 284,783 vaginal deliveries in 1994 and 1995 recorded in the Dutch National Obstetric Database were included in the study. METHODS: Third degree perineal rupture was defined as any rupture involving the anal sphincter muscles. Logistic regression analysis was used to assess risk factors. MAIN OUTCOME MEASURES: An overall rate of third degree perineal ruptures of 1.94% was found. High fetal birthweight, long duration of the second stage of delivery and primiparity were associated with an elevated risk of anal sphincter damage. Mediolateral episiotomy appeared to protect strongly against damage to the anal sphincter complex during delivery (OR: 0.21, 95% CI: 0.20-0.23). All types of assisted vaginal delivery were associated with third degree perineal ruptures, with forceps delivery (OR: 3.33, 95%-CI: 2.97-3.74) carrying the largest risk of all assisted vaginal deliveries. Use of forceps combined with other types of assisted vaginal delivery appeared to increase the risk even further. CONCLUSIONS: Mediolateral episiotomy protects strongly against the occurrence of third degree perineal ruptures and may thus serve as a primary method of prevention of faecal incontinence. Forceps delivery is a stronger risk factor for third degree perineal tears than vacuum extraction. If the obstetric situation permits use of either instrument, the vacuum extractor should be the instrument of choice with respect to the prevention of faecal incontinence.

Anal Canal↗
PubMed1998

[Results from laparoscopically assisted vaginal hysterectomy in the Ikazia Hospital, Rotterdam, 1993-1997].

OBJECTIVE: Evaluation of experience with laparoscopy-assisted vaginal hysterectomy (LAVH). DESIGN: Retrospective review. SETTING: Dept. of Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands. PATIENTS AND METHODS: Of 84 patients undergoing a LAVH instead of an abdominal hysterectomy in the period 1993-1997, data on indications for surgery, hospital stay and complications were analysed from the medical records. RESULTS: Mean age was 45 years (range: 30-62). The most frequent indication was hypermenorrhoea (75; 89%). The mean duration of the operation was 87 min (range: 45-130). There was one conversion to laparotomy. Three times a major complication was seen: twice a bladder injury and once a major haemorrhage for which laparotomy was performed. Mean hospital stay was 6 days, in accordance with protocol. CONCLUSION: LAVH offers a safe technique to convert some of the abdominal hysterectomies into vaginal ones. The higher costs of disposable equipment and increased operation time must be overcome by a shorter time in hospital and shorter convalescence time.

Adult↗
PubMed1998

Randomized double-blind placebo-controlled multicenter evaluation of efficacy and dose finding of midodrine hydrochloride in women with mild to moderate stress urinary incontinence: a phase II study.

Midodrine is a potent and selective alpha1-receptor agonist and its potential to increase urethral closure pressure could be useful in the treatment of female stress incontinence. The aim of this randomized double-blind placebo-controlled multicenter study was to evaluate the efficacy and safety of midodrine for the treatment of stress urinary incontinence. The primary criterion of efficacy was the maximum urethral closure pressure at rest. Voiding diaries, symptom and incontinence questionnaires and patient/investigator global assessment were also used to evaluate its efficacy. After 4 weeks of treatment no significant changes in MUCP were found. The global assessment by the patient and investigator did indicate that patients on active treatment had a more positive assessment than the placebo group. In conclusion, midodrine did not cause significant improvements in urodynamic parameters, but there were subjective improvements in some of the patients in the treated groups. Furthermore midodrine was well tolerated.

Adrenergic alpha-Agonists↗
PubMed1998

Vaginal ultrasound studies before and after successful colposuspension and in continent controls.

OBJECTIVE: To study the position of the bladder neck in a group of women before and after a successful colposuspension and to compare them with a group of parous continent controls. DESIGN: A single setting longitudinal descriptive study with case controls. SETTING: Ikazia Hospital, Rotterdam, The Netherlands. SUBJECTS: Twenty-five women with urodynamically proven genuine stress incontinence who underwent a Burch colposuspension and fifty controls who volunteered for the study for comparison. MAIN OUTCOME MEASURES: The position of the bladder neck in relation to the symphysis pubis studied with vaginal ultrasound. RESULTS: The cranio caudål displacement during straining was 11 mm in incontinent women, 5 mm after colposuspension and 7 mm in continent controls. In the anterior posterior axis this was 4 mm, 2 mm and 3 mm respectively. The colposuspension reduced the mobility of the bladder neck during straining from 32 degrees pre-operative to 10 degrees post operative. In the control group this was 16 degrees. CONCLUSION: Colposuspension puts the bladder neck in a more cranial and anterior position than in normal parous controls. The rotational mobility of the bladder neck is significantly reduced by the operation. After the operation the bladder neck is less mobile than in a group of continent parous controls.

Adult↗
PubMed1998

Prolonged catheterization after vaginal prolapse surgery.

OBJECTIVE: To evaluate the domestic use of a transurethral Foley catheter after discharge from the hospital in patients with urinary retention after vaginal prolapse surgery. METHODS: We reviewed 27 patients who used a Foley catheter at home after prolapse surgery. All patients were interviewed by postal questionnaire regarding their experience of this procedure. RESULTS: Of 263 vaginal prolapse operations 27 (11%) needed a prolonged catheterization period at home. In all but two patients micturition was successfully restored after removal of the catheter at a median of 13 days after discharge. Thirty-seven percent of the patients had experienced the catheterization period as unpleasant. Seventy-nine percent experienced no longterm bladder emptying problems, the others only mild and occasionally. CONCLUSION: Domestic use of a transurethral Foley catheter is a valid alternative to intermittent or suprapubic catheterization when normal micturition is not easily restored after vaginal prolapse surgery. It is, however, experienced as relatively unpleasant by more than one third of the patients.

Adult↗
PubMed1997

Augmentation of urethral pressure profile by voluntary pelvic floor contraction.

The aim of the investigation was to study the repeatability of urethral pressure profile (UPP) and to quantify the influence of voluntary pelvic floor contraction on the UPP. Seventy-two patients underwent one UPP at rest and one UPP during a pelvic floor contraction. The functional urethral length (FUL) and the maximum urethral closure pressure (MUCP) were recorded. To establish repeatability the UPP was repeated twice in 18 patients in rest, and in 15 patients during a contraction. We used the repeatability coefficient instead of the correlation coefficient. Forty-eight patients, had no major anatomical abnormalities (group A); 24 had grade 2 or more prolapse (group B). In both groups we found a shortening of the FUL and an increase in MUCP during a contraction. The UPP was reproducible, both at rest and during a contraction. In conclusion, we found a significant and constant increase in MUCP and a shortening of the FUL during a contraction. Unlike other studies we found the UPP to have good reproducibility. However, we used the repeatability coefficient instead of the correlation coefficient.

Female↗
PubMed1997

Preventive vaginal and intra-urethral devices in the treatment of female urinary stress incontinence.

A number of vaginal and urethral devices have recently been introduced for the treatment of female urinary stress incontinence. Nine recent studies of these were scrutinized. The median corrected subjective cured/improved rate was 63% for the vaginal and 43% for the urethral devices. The latter group have a high percentage of side-effects with related drop-outs. Urinary tract infection and migration of the device into the bladder are particularly worrying. The vaginal devices currently available compete favourably with other non-surgical forms of therapy for stress incontinence in terms of efficacy and safety.

Female↗
PubMed1995

[Diagnosis and therapy of urinary incontinence in Dutch gynecologic practice; a questionnaire study].

OBJECTIVE: Assessment of modalities in diagnosis and treatment of female urinary incontinence by Dutch gynaecologists. DESIGN: Written questionnaire. SETTING: All officially registered Dutch gynaecological practices. METHOD: All 138 gynaecological practices were sent a multiple choice questionnaire. One representative of the practice was requested to respond. Differences were evaluated using the chi 2 test. RESULTS: The response was 87% (93% of the teaching hospitals and 86% of the non-teaching hospitals). Diagnostic and treatment modalities of female urinary incontinence by Dutch gynaecologists proved to vary. Urodynamics are primarily under control of urologists. The Burch colposuspension as operative treatment of stress incontinence is fairly popular among Dutch gynaecologists, but the less successful anterior colporrhaphy with Kelly plication is also still performed rather frequently. Co-operation between gynaecologist and urologist is mainly practised in teaching hospitals at meetings at which patient histories and urodynamics are discussed. CONCLUSION: There is need for systematism in diagnosis and treatment of female urinary incontinence and for intensification of co-operation between gynaecologists and urologists. Adequate training and postgraduate teaching courses in diagnosis and treatment of female urinary incontinence should be provided for both specialisms.

Female↗
PubMed1995

Vaginal ultrasound studies of bladder neck mobility.

OBJECTIVE: To introduce a simple, well-standardised vaginal ultrasound technique and to compare the position and mobility of the bladder neck in continent and stress incontinent women using this technique. DESIGN: A single-centre prospective case-control study. SETTING: Ikazia Hospital, Rotterdam, The Netherlands. SUBJECTS: One hundred and sixty women; sixty randomly chosen women referred to our outpatient department who volunteered for the study to develop a standardised technique, fifty stress-incontinent women and fifty controls who volunteered for the study for comparison using the standardised technique. MAIN OUTCOME MEASURES: Standardisation with regard to bladder volume, horizontal axis and Valsalva force. The position of the bladder neck at rest, during straining and during squeezing. RESULTS: The probe we use does not alter bladder neck mobility. A standardised bladder volume of 250 ml was used rather than maximum bladder capacity. A Foley catheter introduced into the bladder, with the balloon half-filled with soapy water and half with air gives an easily recognisable fluid level, which is parallel to the horizontal axis of the patient. A standardised Valsalva force of 30 cm H2O can exclude differences in bladder neck mobility due to spontaneous and uncontrolled abdominal force. Measurements by two independently working investigators showed good conformity. The position of the bladder neck in the stress incontinent women was significantly lower and significantly more posterior at rest, during straining and during squeezing. At the same time in stress incontinent women there was significantly more descent during straining and less elevation during squeezing. However, there was a considerable overlap between the two groups for all parameters. CONCLUSIONS: This standardised vaginal ultrasound technique is a feasible, acceptable and reproducible technique for the study of female bladder neck mobility. The position and mobility of the bladder neck is significantly different in stress incontinent women as compared to continent controls. The great overlap between the two groups still limits the clinical relevance.

Adult↗
PubMed1994

[Risk of recurrence of retained placenta].

OBJECTIVE: To calculate the risk of recurrence of retained placenta (RP) and to investigate predisposing factors for recurrence. DESIGN: Retrospective. SETTING: Ikazia Hospital Rotterdam, the Netherlands. METHOD: Childbirths of all patients who delivered between 1986 and 1989 and who had a RP were investigated and analysed. RESULTS: A total of 134 patients with RP were included in the study. 17 of 75 patients who had given birth before had a recurrence of RP (23%). 17 of 53 patients (32%) who had a successive pregnancy had a recurrence of RP. Three of five patients with placenta accreta, had RP at the next delivery. Four patients who delivered after two successive RPs all had a third RP. CONCLUSION: The recurrence of RP was high: 32%. Placenta accreta and a history of multiple RPs appear to predispose to recurrence.

Adult↗