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Biomedical subjects

Michael Heit

Publications and source records attributed to Michael Heit.

11 recordsLinked to original sources
PubMed2004

Comorbidities affect the impact of urinary incontinence as measured by disease-specific quality of life instruments.

The aim of this study was to determine if the impact of urinary incontinence on activities of daily living, as measured by a disease-specific quality of life instrument, is dependent on comorbid conditions. Incontinent kidney transplant recipients participated in a survey to determine the impact of urinary incontinence on activities of daily living using the Incontinence Impact Questionnaire (IIQ-7). Similar information was collected from the charts of nontransplant incontinent women. Participants were matched for age, incontinence severity, pads per day, and leaks per day noted in a 3-day 24-h bladder diary. IIQ-7 scores from participants were compared using Mann-Whitney U tests. Nontransplant incontinent women reported a 200% greater affect of incontinence on activities of daily living than incontinent renal transplant recipients (35.5+/-26.5 vs 12.9+/-15.4, p<0.0001) despite similarities in incontinence severity measures. Urinary incontinence has less of an impact on activities of daily living for renal transplant recipients than nontransplant incontinent women with similar incontinence severity measures because the disease-specific quality of life instrument used in this study was sensitive to their comorbid condition (transplant status).

Activities of Daily Living↗
PubMed2004

Does socioeconomic status explain racial differences in urinary incontinence knowledge?

OBJECTIVE: This study was undertaken to discover whether urinary incontinence knowledge differs between racial/ethnic groups. If incontinence knowledge differs between racial/ethnic groups, is the difference explained by socioeconomic status (SES). STUDY DESIGN: In this cross-sectional study, 212 women from 3 counties in California were interviewed by telephone. Urinary incontinence knowledge was measured by an Incontinence Quiz. SES was calculated. Race was categorized as white or minority (non-Hispanic black, Hispanic, and other). RESULTS: White women scored better than minority women on the Incontinence Quiz (6.16 +/- 2.86 vs 5.46 +/- 2.66, P=.071). Higher SES was significantly associated with higher Incontinence Quiz total score (r=0.177, P=.010). Racial differences in Incontinence Quiz total score no longer trended toward significance after adjusting for SES in multivariable analysis. Race/ethnicity and SES were analyzed for association with each question of the Incontinence Quiz CONCLUSION: Socioeconomic status explains racial differences in total urinary incontinence knowledge. Consideration of socioeconomic status may improve the effectiveness of urinary incontinence educational programs.

Adult↗
PubMed2004

Prevalence and severity of urinary incontinence in kidney transplant recipients.

OBJECTIVE: To estimate the prevalence and severity of urinary incontinence and its impact on activities of daily living in kidney transplant recipients. METHODS: The continence status, severity, and impact of urinary incontinence on activities of daily living in female kidney transplant recipients was studied by using Sandvik's Incontinence Severity Index and the Incontinence Impact Questionnaire. Clinical and sociodemographic data from post-transplant incontinent and continent participants were compared by using chi(2), Student t, and Mann-Whitney U tests. RESULTS: One hundred of 123 female kidney transplant recipients completed the survey for a response rate of 81.3%. The prevalence of urinary incontinence in female kidney transplant recipients was 28%. The mean Sandvik's Incontinence Severity Index score was 5.1 (median 3.5; 95% confidence interval 3.6, 6.6). The mean Incontinence Impact Questionnaire score was 12.9 (median 4.8; 95% confidence interval 6.7, 18.9). Incontinent kidney transplant recipients recorded a greater daily fluid intake on their 3-day diaries than continent kidney transplant recipients (2,951.9 +/- 1,228.6 mL compared with 1,854.6 +/- 614.8 mL, P =.04). CONCLUSIONS: The prevalence rate of urinary incontinence from interviewed kidney transplant recipients was 28%, which had minimal impact on activities of daily living and may not be predicted by a history of incontinence before kidney failure. LEVEL OF EVIDENCE: II-3

Adult↗
PubMed2004

Stress urinary incontinence.

Stress urinary incontinence, the complaint of involuntary leakage during effort or exertion, occurs at least weekly in one third of adult women. The basic evaluation of women with stress urinary incontinence includes a history, physical examination, cough stress test, voiding diary, postvoid residual urine volume, and urinalysis. Formal urodynamics testing may help guide clinical care, but whether urodynamics improves or predicts the outcome of incontinence treatment is not yet clear. The distinction between urodynamic stress incontinence associated with hypermobility and urodynamic stress incontinence associated with intrinsic sphincter deficiency should be viewed as a continuum, rather than a dichotomy, of urethral function. Initial treatment should include behavioral changes and pelvic floor muscle training. Estrogen is not indicated to treat stress urinary incontinence. Bladder training, vaginal devices, and urethral inserts also may reduce stress incontinence. Bulking agents reduce leakage, but effectiveness generally decreases after 1-2 years. Surgical procedures are more likely to cure stress urinary incontinence than nonsurgical procedures but are associated with more adverse events. Based on available evidence at this time, colposuspension (such as Burch) and pubovaginal sling (including the newer midurethral synthetic slings) are the most effective surgical treatments.

Female↗
PubMed2003

Predicting treatment choice for patients with pelvic organ prolapse.

OBJECTIVE: To evaluate which clinical factors were predictive of treatment choice for patients with pelvic organ prolapse. METHODS: One hundred fifty-two patients were enrolled in this cross-sectional study to collect clinical data on potential predictors of treatment choice. Continuous parametric, continuous nonparametric (ordinal), and categoric data were compared with chosen management plan (expectant, pessary, surgery) using analysis of variance, the Kruskal-Wallis test, and the chi(2) test for association, respectively. All significant predictors (P <.05) of treatment choice for pelvic organ prolapse identified during univariate analysis were entered into a backward elimination polytomous logistic regression analysis for predicting surgery versus pessary versus expectant management, with surgery as the reference group. RESULTS: The probability of choosing expectant management rather than surgery 1). increases as the preoperative pelvic pain score increases (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.07, 2.40; P =.024) and 2). decreases as the prolapse severity increases (OR 0.46; 95% CI 0.29, 0.72; P =.001). The probability of choosing pessary rather than surgery 1). increases as age increases (OR 1.1; 95% CI 1.05, 1.16; P <.001), 2). decreases as the prolapse severity increases (OR 0.77; 95% CI 0.60, 0.99; P =.042), and 3). is less if the participant had prior prolapse surgery (OR 0.23; 95% CI 0.07, 0.76; P =.017). CONCLUSION: Age, prior prolapse surgery, preoperative pelvic pain scores, and pelvic organ prolapse severity were independently associated with treatment choices in a predictable way and provide physicians with medical evidence necessary to support a patient's decision.

Aged↗
PubMed2003

Bacterial colony counts during vaginal surgery.

OBJECTIVE: To describe the bacterial types and colony counts present before and during vaginal surgery. METHODS: A descriptive study was undertaken of patients undergoing vaginal hysterectomy with or without reconstructive pelvic surgery. Aerobic and anaerobic bacterial cultures were obtained immediately before and throughout the surgical cases at preselected time intervals. Standard antimicrobial prophylaxis was administered in all cases. Mean total colony counts and mean anaerobic colony counts were determined by adding all colonies regardless of bacteria type. 'Contamination' was defined as > or = 5000 colony-forming units/ml. RESULTS: A total of 31 patients aged 26 to 82 years (mean age +/- SD, 51 +/- 15) were included. The highest total and anaerobic colony counts were found at the first intraoperative time interval. On the first set of cultures (30 minutes after the surgical scrub), 52% (16/31) of the surgical fields were contaminated, and at 90 minutes, 41% (12/29) were contaminated. A negligible number of subsequent cultures were contaminated. CONCLUSIONS: Any future interventions designed to minimize bacterial colony counts should focus on the first 30 to 90 minutes of surgery.

Adult↗
PubMed2002

Is pelvic organ prolapse a cause of pelvic or low back pain?

OBJECTIVE: To test the null hypothesis that there is no association between pelvic organ prolapse and pelvic or low back pain. METHODS: A total of 152 consecutive patients with pelvic organ prolapse completed a visual faces scale to quantify the amount of pelvic or low back pain present. Pelvic organ prolapse severity was graded by three techniques: 1) pelvic organ prolapse quantification staging; 2) descent of the leading edge of prolapse; and 3) dynamic cystoproctography. Linear and nonlinear associations of pelvic organ prolapse quantification staging, descent of the leading edge of prolapse, and dynamic cystoproctography findings with pelvic or low back pain were assessed. We also characterized the nature of any significant nonlinear associations. RESULTS: Descent of the leading edge of prolapse was linearly associated with low back pain. Patients with greater descent of the leading edge of their prolapse reported less low back pain (r = -0.176, P =.034). Bladder descent during dynamic cystoproctography was nonlinearly associated with low back pain (P =.037). Neither of these associations was statistically significant after controlling for patient age and prior prolapse surgery. There were no linear or nonlinear associations between pelvic organ prolapse and pelvic pain. CONCLUSION: Based on the data, pelvic organ prolapse is not a cause of pelvic or low back pain.

Age Distribution↗
PubMed2002

Urethral sphincter morphology in women with detrusor instability.

OBJECTIVE: To determine whether sonographic urethral sphincter morphology is different in patients with detrusor instability than in those with normal urodynamic testing. METHODS: Patients from a population of women presenting for evaluation of urinary incontinence or pelvic organ prolapse underwent intraurethral ultrasonography before multichannel urodynamic testing. Maximal rhabdosphincter thickness, total urethral diameter, total urethral circumference, and longitudinal smooth muscle thickness, diameter, and circumference were measured. For patients with detrusor instability, the strength of the involuntary detrusor contraction and the bladder volume at its onset were recorded. These data were compared with information from history questionnaires and urodynamic evaluations. RESULTS: The 17 patients with detrusor instability and 16 patients with normal urodynamic testing did not differ with respect to age, vaginal parity, race, weight, body mass index, prior continence surgery, or maximal total urethral closure pressure. Patients with detrusor instability, had decreased urethral longitudinal smooth muscle thickness (3.0 +/- 0.9 mm vs 4.1 +/- 0.7 mm, P =.001), total urethral diameter (18.0 +/- 1.6 mm vs 19.4 +/- 1.4 mm, P =.01), and total urethral circumference (5.65 +/- 0.5 cm vs 6.1 +/- 0.4 cm, P =.012) compared with those with normal urodynamic tests. A linear relationship between rhabdosphincter thickness and strength of involuntary detrusor contraction was observed (r =.686, P =.002). CONCLUSION: Urethral sphincter morphology is different in patients with detrusor instability compared with those who have normal urodynamic tests. These findings provide an anatomic basis for the physiologic findings in patients with "urethrogenic" detrusor instability.

Adult↗
PubMed2002

Rupture of the symphysis pubis during vaginal delivery followed by two subsequent uneventful pregnancies.

BACKGROUND: Rupture of the symphysis pubis during vaginal delivery is a rare but debilitating complication. Factors contributing to rupture are poorly defined. CASE: A healthy primigravida suffered a rupture of her symphysis pubis during an otherwise uncomplicated vaginal delivery. She experienced significant pain and difficulty walking for 6 months after the injury. Her 5-cm symphyseal separation was managed successfully with physical therapy and activity restriction. The patient's two subsequent deliveries (one vaginal and one via cesarean delivery) were uneventful. CONCLUSION: Severe symphyseal rupture during vaginal delivery can be managed without surgery. Risk factors for rupture are not well defined. Based on a literature review, there is a significant risk of repeat symphyseal rupture with subsequent vaginal delivery.

Adult↗
PubMedDate not supplied

Intraurethral sonography and the test-retest reliability of urethral sphincter measurements in women.

PURPOSE: The purpose of this prospective study was to determine the test-retest reliability of urethral sphincter morphologic measurements obtained with intraurethral sonography. METHODS: The cross-sectional urethral sphincter anatomy of 29 asymptomatic nulliparous women was studied in a blinded fashion. Each patient returned for a repeat examination on a different day. At the point of maximal rhabdosphincter thickness, the urethral diameter and circumference and the longitudinal smooth muscle and rhabdosphincter thickness, diameter, circumference, and area were measured using the ultrasound scanner's integrated software. For each measured variable, the reliability between patients was assessed with a paired t test. Intraclass correlation coefficients were calculated to assess the reliability of each intraurethral sonographic measurement obtained from the same patient. RESULTS: On test-retest analysis, the differences for each measured variable between patients were not statistically significant (p > 0.05). Of the measurements obtained from the same patient, however, longitudinal smooth muscle thickness (rho = 0.44; p = 0.006), diameter (rho = 0.49, p = 0.003), circumference (rho = 0.49, p = 0.003), and area (rho = 0.43; p = 0.009) were significantly correlated. CONCLUSIONS: The urethral longitudinal smooth muscle layer is the only structure that can be measured reliably using sonography for diagnostic use. Sonographic measurements of the rhabdosphincter may not be reliable because the outer portion of that structure lies outside the depth of penetration of a 12.5-MHz transducer.

Cross-Sectional Studies↗