Biomedical subjects

Mary Pat Fitzgerald

Publications and source records attributed to Mary Pat Fitzgerald.

12 recordsLinked to original sources

PubMed2006

Quality of life in women with stress urinary incontinence.

The objective of this study was to identify clinical and demographic factors associated with incontinence-related quality of life (QoL) in 655 women with stress urinary incontinence who elected surgical treatment. The following factors were examined for their association with QoL as measured with the Incontinence Impact Questionnaire (IIQ): number of incontinence (UI) episodes/day; self-reported type of UI symptoms (stress and urge); sexual function as measured by the Prolapse/Urinary Incontinence Sexual Questionnaire; symptom bother as measured by the Urogenital Distress Inventory; as well as other clinical and sociodemographic factors. A stepwise least-squares regression analysis was used to identify factors significantly associated with QoL. Lower QoL was related to the greater frequency of stress UI symptoms, increasing severity, greater symptom bother, prior UI surgery or treatment, and sexual dysfunction (if sexually active). Health and sociodemographic factors associated with lower incontinence-related QoL included current tobacco use, younger age, lower socioeconomic status, and Hispanic ethnicity.

Adult↗

PubMed2006

Recurrent stress incontinence is associated with decreased neuromuscular function in the striated urethral sphincter.

OBJECTIVE: The study aim was to compare urethral neuromuscular function in stress incontinent women with and without previous incontinence surgery. STUDY DESIGN: Urethral electromyographic (EMG) data for women with recurrent urodynamic stress incontinence following 1 previous continence procedure were compared to age- and parity-matched women with urodynamic stress incontinence (USI) without previous incontinence surgery. The cases with recurrent USI included 13 women with 1 previous sling and 13 women with 1 previous Burch. EMG signals were obtained at rest, with cough, and during pelvic floor contraction using an automated software program. EMG data from recurrent cases were compared with controls. RESULTS: Women with recurrent stress incontinence after 1 previous continence procedure had lower quantitative EMG values than women without previous surgery. Specifically, we observed that women with previous sling had significantly lower quantitative EMG values with cough (P = .007), while baseline and squeeze values were not significantly different. Women with previous Burch had cough EMG values intermediate between the control and previous sling group, which trended toward statistical significance (P = .057). CONCLUSION: Women with recurrent urodynamic stress incontinence after previous slings have poorer urethral neuromuscular function than stress incontinent women without previous incontinence surgery.

Adult↗

PubMed2006

What is a clinician to do-believe the patient or her urinary diary?

PURPOSE: We determined if patient recall of incontinence episodes correlates with urinary diary record. MATERIALS AND METHODS: Women with 1 or more urge incontinence episode per week completed 2, 7-day diaries, the Urinary Distress Inventory and Incontinence Impact Questionnaire, and responded to 2 recall questions. RESULTS: The median number of incontinence episodes participants recalled (6.5, 5) was higher than those recorded in the diary (1.9, 1.1) at both points. Incontinence episodes in 2, 7-day diaries correlated strongly (rho = 0.921, p <0.005) while participant recall of incontinence episodes correlated weakly (rho = 0.309, p <0.059). When subjects reported being only slightly or not bothered by urge incontinence, recall and diary record correlated strongly (rho = 0.812, p = 0.014). With increasing bother (moderate or great), recall and diary were not significantly correlated (rho = 0.528, p = 0.115). CONCLUSIONS: Women with urge incontinence either overestimate or under record incontinence episode frequency in the urinary diary. This effect is more pronounced in women who are more bothered by incontinence.

Adult↗

PubMed2006

Childhood urinary symptoms predict adult overactive bladder symptoms.

PURPOSE: A relationship between childhood urinary symptoms and adult lower urinary tract symptoms in women is often clinically suspected. In this analysis we investigated the relationship between childhood and adult urinary symptoms in middle-aged women. MATERIALS AND METHODS: A population based cohort of 2,109 women 40 to 69 years old who were members of a large health maintenance organization was randomly selected from age and race strata. Through self-reported questionnaires, women recalled a childhood history of and current urinary lower urinary tract symptoms, including frequent daytime urination, nocturia, urinary incontinence, nocturnal enuresis and UTIs. Current incontinence was also classified as urge or stress incontinence. Multivariate analysis was used to evaluate the association between childhood and current lower urinary tract symptoms controlling for age, race, hysterectomy status, parity, oral estrogen use, body mass index and diabetes. RESULTS: Women who reported childhood daytime frequency were more likely to report adult urgency (OR 1.9, 95% CI 1.3-2.6, p < 0.001). Frequent nocturia in childhood was strongly associated with adult nocturia (OR 2.3, 95% CI 1.5-3.5, p < 0.001). Childhood daytime incontinence was associated with adult urge incontinence (OR 2.6, 95% CI 1.1-5.9, p < 0.05), as was childhood nocturnal enuresis (OR 2.7, CI 1.3-5.5, p < 0.01). A history of more than 1 childhood UTI was associated with adult UTIs (OR 2.6, 95% CI 1.5-4.5, p < 0.001). CONCLUSIONS: Childhood urinary symptoms and UTIs were significantly associated with adult overactive bladder symptoms. There is a need to investigate the significance of childhood symptoms as predictors of eventual adult disorders to determine whether treatment of childhood symptoms will alter the prevalence of eventual adult disorders, and if such a history should alter clinical care of the older adult with OAB symptoms.

Adult↗

PubMed2006

Fecal and urinary incontinence in primiparous women.

OBJECTIVE: To prospectively investigate the relationship between anal sphincter tears and postpartum fecal and urinary incontinence. METHODS: The Childbirth and Pelvic Symptoms study was a prospective cohort study performed by the Pelvic Floor Disorders Network to estimate the prevalence of postpartum fecal and urinary incontinence in primiparous women: 407 with clinically recognized anal sphincter tears during vaginal delivery, 390 without recognized sphincter tears (vaginal controls), and 124 delivered by cesarean before labor. Women were recruited postpartum while hospitalized and interviewed by telephone 6 weeks and 6 months postpartum. We assessed fecal and urinary incontinence symptoms using the Fecal Incontinence Severity Index and the Medical, Epidemiological, and Social Aspects of Aging Questionnaire, respectively. Odds ratios were adjusted for age, race, and clinical site. RESULTS: Compared with the vaginal control group, women in the sphincter tear cohort reported more fecal incontinence (6 weeks, 26.6% versus 11.2%; adjusted odds ratio [AOR] 2.8, 95% confidence interval [CI] 1.8-4.3; 6 months, 17.0% versus 8.2%; AOR 1.9, 95% CI 1.2-3.2), more fecal urgency and flatal incontinence, and greater fecal incontinence severity at both times. Urinary incontinence prevalence did not differ between the sphincter tear and vaginal control groups. Six months postpartum, 22.9% of women delivered by cesarean reported urinary incontinence, whereas 7.6% reported fecal incontinence. CONCLUSION: Women with clinically recognized anal sphincter tears are more than twice as likely to report postpartum fecal incontinence than women without sphincter tears. Cesarean delivery before labor is not entirely protective against pelvic floor disorders. LEVEL OF EVIDENCE: II-3.

Adult↗

PubMed2006

Concentric needle electrodes are superior to perineal surface-patch electrodes for electromyographic documentation of urethral sphincter relaxation during voiding.

OBJECTIVE: To compare interpretations of electromyographic (EMG) recordings from perineal surface patch electrodes (PSPEs) to those from urethral concentric needle electrodes (CNEs) during voiding. PATIENTS AND METHODS: Consenting women underwent urodynamic testing with a 30 G, 3.8 cm CNE at the 12 o'clock position in the striated urethral sphincter muscle, and with PSPEs placed at the 2 and 10 o'clock positions around the anus. Pressure-flow studies were conducted with simultaneous input from both EMG electrodes. Representative, de-identified paper copies of EMG signals were assembled by chronology and electrode type. Six examiners unaware of the patient details were asked to determine if the tracings were interpretable and whether there was quiescence of the urethral sphincter motor unit during voiding. The agreement between the interpretations of each tracing was assessed using McNemar and kappa statistics. RESULTS: Twenty-two women undergoing urodynamic testing for incontinence (16), voiding dysfunction (two) or urinary retention (four) participated in this study. CNE tracings were consistently more interpretable than PSPE tracings (mean 89% vs 67%). When tracings were interpretable, a significantly higher percentage of CNE EMG tracings (mean 79%) had urethral sphincter motor unit quiescence than PSPE EMG tracings (mean 28%). The kappa values for agreement among the reviewers' interpretations were highly variable and none were statistically significant. Reviewers unanimously agreed on only 12 of the 44 tracings, and 11 of these showed quiescence when using a CNE. CONCLUSIONS: CNEs are more often interpretable than PSPEs for determining motor unit quiescence during voiding. CNE EMG appears to have greater clinical utility for central reading than PSPEs.

Electrodes↗

PubMed2005

Reliability of health-related quality-of-life measures 1 year after surgical procedures for pelvic floor disorders.

OBJECTIVE: The purpose of this study was to assess the reliability and validity of condition-specific health-related quality-of-life measures in women who are treated surgically for pelvic organ prolapse and urinary incontinence. STUDY DESIGN: The study used the cross-sectional telephone interview-based administration of a health-related quality-of-life measure, with a 2-week follow-up interview for test-retest reliability. RESULTS: Initial and follow-up interviews were completed by 88 women (mean age, 65.7 +/- 11.6 years) approximately 1 year after surgical procedures. Condition-specific measures demonstrated acceptable reliability with test-retest correlation coefficients that approached or exceeded 0.6 and Cronbach's alpha that exceeded 0.8 in most domains. Validity was demonstrated with significant correlations of the urinary domains of the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire, with continence defined by the medical, epidemiologic, and social aspects of aging and Hunskaar severity measures (all P < .001). CONCLUSION: The condition-specific health-related quality-of-life assessment is reliable and valid in women after surgical procedures for pelvic floor disorders. These findings support the inclusion of condition-specific health-related quality-of-life measures in clinical trials for women with pelvic floor disorders.

Aged↗

PubMed2005

Chronic instrumentation with model microstimulators in an animal model of the lower urinary tract.

BACKGROUND: Microstimulators are a new type of neuroprosthetic device that should be considered for applications such as micturition control after spinal cord injury (SCI). These devices are small (less than 25 mm by 5 mm) and the electrodes are located on the ends of the stimulator. The aim of the current study was to develop methods for chronic implantation of model microstimulators (M-Micro) on the bladder wall and pelvic plexus of female cats. A postmortem evaluation of the effects of 3 months of implantation is reported. METHODS: Techniques to produce the M-Micro are described. Four of these devices were implanted in 4 female cats and maintained after the initial instrumentation surgery and a second survival surgery for SCI (at T10). Using a single suture tied around the M-Micro, these devices were secured to the bladder wall or the fat pads adjacent to the pelvic plexus. Additional instrumentation was implanted, including 2 catheters in the bladder, 1 abdominal balloon, and electromyography electrodes in the urethral and anal sphincters. Postmortem observations of the location of the M-Micro on the bladder wall were conducted after fixation. RESULTS: The animals' conditions were good. One animal was sacrificed early because of a skin infection. A single suture was sufficient to anchor the M-Micro. However, during the surgical implantation the pelvic plexus M-Micro ended up close to the bladder neck. Extensive fibrous connective tissue formed around the M-Micro and implanted catheters on the bladder wall. This appeared to result, in part, from multiple devices implanted on or near the bladder wall. CONCLUSIONS: These pilot studies showed that the M-Micro could be easily constructed and secured to the bladder wall or fat pads close to the pelvic plexus. There was a concern that the pelvic plexus location for the M-Micro ended near the bladder neck during the surgical implantation; however, these devices did not appear to migrate over this short, 3-month implantation period. The extensive connective tissue responses of the bladder wall to the tubes, wires, and M-Micro was a major concern. The M-Micro appears to be a good device to assess the potential of commercial microstimulators for use in micturition control.

Animals↗

PubMed2005

A spinal cord injured animal model of lower urinary tract function: observations using direct bladder and pelvic plexus stimulation with model microstimulators.

BACKGROUND: Microstimulators are new devices that should be considered for management of lower urinary tract problems following spinal cord injury (SCI) such as urinary retention. These devices are small (less than 25 mm by 5 mm) with the electrodes located on the ends of the stimulator. However, it is not known whether the small electrodes on these devices would be effective in stimulating the plexus of nerves that innervate the bladder. The aim of the present study was to provide preliminary observations with model microstimulators (M-Micro) for inducing bladder contractions in an SCI animal model. Bladder wall and pelvic plexus stimulation sites were compared. Additional investigations evaluated parameters such as stimulation polarity, frequency, and period as well as bladder filling volume. METHODS: In an initial survival surgery, bilateral M-Micros were implanted on the bladder wall and the pelvic plexus along the urethra in 3 female cats. A second survival surgery was conducted 3 to 5 weeks later to produce a T1 0 SCI. Studies are reported following the second survival surgery. These studies included the effects of stimulation and bladder filling. RESULTS: The postmortem location of the implanted pelvic plexus M-Micro was previously described as near the bladder neck. Therefore, the pelvic plexus location is described in this report as "pelvic plexus (bladder neck)" stimulation. The observations showed effective stimulation with pelvic plexus (bladder neck) stimulation and voiding in some cases. Stimulation was limited by side effects of increased abdominal pressure and leg movement. Other factors also affected the response to stimulation, including the initial bladder volume and stimulating parameters. Fluoroscopy showed that when stimulation did not induce voiding the striated urethral sphincter was closed. CONCLUSIONS: This case series of 3 SCI animals showed that the small electrodes on the M-Micro could be used to stimulate the bladder with contractions and voiding in some cases. The pelvic plexus (bladder neck) location for the M-Micro may be a better location than higher on the bladder wall. Limiting side effects of stimulation included leg movement and increased abdominal pressure. Additional important factors included the stimulation parameters, initial bladder volume, and the function of the skeletal urethral sphincter.

Animals↗

PubMed2004

Sexual activity predicts continued pessary use.

OBJECTIVE: The purpose of this study was to determine which clinical variables predict continued pessary use. STUDY DESIGN: After IRB approval, charts of consecutive women at Loyola Women's Pelvic Medicine Center who bought a pessary from August 2000 to December 2002 were reviewed. Demographic information, length of pessary use, and reason for pessary discontinuation were recorded. Current pessary "users" were compared with "nonusers" (women who stopped wearing the pessary during the study period). RESULTS: Of the 136 study women, 82 (60%) were "users," and 54 (40%) were "nonusers." Women who were sexually active were more likely to continue pessary use (beta=2.204, P=.021). This was true regardless of indication for pessary placement. Women with prolapse were more likely than women with incontinence to continue with long-term pessary use (beta=2.031, P=.049). No other demographic characteristics predicted continued pessary use. CONCLUSION: Long-term pessary use is acceptable to sexually active women. Women being treated for pelvic organ prolapse are more likely to continue pessary use than women being treated for urinary incontinence. Additionally, the majority of women (60%) who accept a pessary for prolapse or urinary incontinence continue this treatment.

Adult↗

PubMed2004

Voiding frequency in a sample of asymptomatic American men.

PURPOSE: There are sparse published data concerning the urinary habits of asymptomatic American men. We studied those urinary habits, as revealed by a 24-hour voiding diary. MATERIALS AND METHODS: Men without lower urinary tract symptoms completed the International Prostate Symptom Score (I-PSS) and a 24-hour voiding diary. Demographic and diary data were analyzed using multivariate linear and logistic regression. RESULTS: A total of 284 asymptomatic males 18 to 66 years old returned interpretable diaries. Subjects voided a median of 7 times in 24 hours (range 2 to 21) with 95% voiding fewer than 12 times daily. Median 24-hour urine volume was 1,650 ml (range 290 to 6,840). Median fluid intake was 2,747 ml (range 500 to 10,520). Of the men 82 (29%) reported at least 1 nocturic episode. The 24-hour frequency was related to total urine volume (beta = 1.2, p <0.001) and total fluid intake (beta = 0.1, p <0.001), inversely related to mean voided volume (beta = -1.1, p <0.001) and lower in white men (beta = 0.1, p <0.02) but independent of age and body mass index. The probability of nocturia was highly related to the nighttime diuresis rate (beta = 15, p <0.001), inversely related to mean voided volume (beta = 1, p = 0.001) and less likely in white men. Median I-PSS was 2 (range 0 to 22). I-PSS increased with age, body mass index and total urinary frequency, and it was lower in white men. CONCLUSIONS: This study suggests that the threshold of 8 to define abnormal urinary frequency may not be correct since more than a third of our sample of asymptomatic men voided more than 8 times daily. It is probably inadvisable to apply a single set of normative values to all American men because of significant variability in regional climates and populations.

Adolescent↗

PubMedDate not supplied

Bladder-wall and pelvic-plexus stimulation with model microstimulators: Preliminary observations.

Severe urinary retention is not a common condition, but may occur following some pelvic surgeries or other medical conditions. Electrical stimulation of the bladder has been examined as a means of managing this difficult problem. We conducted preliminary investigations in cats to prove the hypothesis that pelvic-plexus (bladder-neck) stimulation would produce greater micturition response with reduced side effects, such as animal movement or discomfort, than bladder-wall stimulation with electrodes implanted higher on the bladder wall. We used model microstimulators that mimic the look and function of commercial microstimulators, but that we constructed. We instrumented four female cats during a survival surgery. Animals recovered well and studies were conducted over a 1-month period in the conscious animal and under anesthesia. We performed a variety of studies with different stimulation parameters and electrode locations to evaluate our hypothesis. In the active animal, we supplied only low currents, but two animals responded to stimulation with bladder contractions and voiding. Following anesthesia, higher stimulating currents resulted in greater bladder contractions during stimulation in two of the three animals. In two cases, pelvic-plexus (bladder-neck) stimulation induced greater micturition responses than direct bladder-wall stimulation. In conclusion, we learned from these preliminary observations that stimulation at the pelvic plexus (bladder neck) may induce a better micturition response than stimulation higher on the bladder-wall. Newly available commercial microstimulators should be further studied for the treatment of urinary retention.

Animals↗