PubMed Health⌕ Search

Biomedical subjects

P Toozs-Hobson

Publications and source records attributed to P Toozs-Hobson.

At least 19 recordsLinked to original sources
PubMed2005

A comparison of the efficacy and tolerability of solifenacin succinate and extended release tolterodine at treating overactive bladder syndrome: results of the STAR trial.

OBJECTIVE: To compare two new generation antimuscarinics at their recommended doses for treatment of overactive bladder syndrome (OAB). METHODS: A prospective, double blind, double-dummy, two-arm, parallel-group, 12-week study was conducted to compare the efficacy and safety of solifenacin 5 or 10 mg and tolterodine extended release (ER) 4 mg once daily in OAB patients. After 4 weeks of treatment patients had the option to request a dose increase but were dummied throughout as approved product labelling only allowed an increase for those on solifenacin. RESULTS: Solifenacin, with a flexible dosing regimen, showed greater efficacy to tolterodine in decreasing urgency episodes, incontinence, urge incontinence and pad usage and increasing the volume voided per micturition. More solifenacin treated patients became continent and reported improvements in perception of bladder condition assessments. The majority of side effects were mild to moderate in nature, and discontinuations were comparable and low in both groups. CONCLUSIONS: Solifenacin, with a flexible dosing regimen, was found to be superior to tolterodine ER with respect to the majority of the efficacy variables.

Analysis of Variance↗
PubMed2004

Correlating structure and function: three-dimensional ultrasound of the urethral sphincter.

OBJECTIVE: Three-dimensional (3D) ultrasound facilitates assessment of the anatomy of the urethral sphincter, a decrease in sphincter volume being associated with stress incontinence. Urethral pressure profilometry (UPP) is used to assess urethral sphincter function although it is not diagnostic of stress incontinence. The aim of this pilot study was to determine whether 3D sphincter volume can be correlated with the area under the UPP curve. METHODS: Primigravid women were recruited antenatally between 32 and 42 weeks' gestation. 3D transvaginal ultrasound scans of the urethra were performed in modified lithotomy position with a comfortably full bladder. Length and cross-sectional area were measured allowing the sphincter volume to be calculated. UPP measurements were performed with a Gaeltec solid-state pressure transducer and the area under the curve mapped out and calculated. All scans and measurements were repeated between 3 and 6 months postpartum. RESULTS: Nineteen women participated in the study. Antenatal and postnatal data were available in all cases. There was a statistically significant correlation between antenatal sphincter volumes and area under the UPP curve although this relationship was lost following delivery. CONCLUSIONS: There appears to be a correlation between structural anatomy and functional anatomy in the antenatal period although following delivery this is lost.

Adult↗
PubMed2002

A multicentre review of the tension-free vaginal tape procedure in clinical practice.

A multicentre study was conducted to determine the success of the TVT in a clinical practice and to try to identify factors which may be associated with operative failure or postoperative complications. Three hundred and twenty women were included; the overall subjective success rate was 92.2%; 245 patients had reliable documentation regarding postoperative voiding, 25 had voiding problems (10.2%). Operative success did not appear to be diminished by previous surgery. Increased patient weight had a positive effect on outcome. Irritative symptoms preoperatively had an odds ratio of 1.8 for postoperative voiding difficulties. This study shows that the TVT appears to be an effective operation for genuine stress incontinence with low intra and postoperative complication rates. These results also show that it is highly successful in patients who may not be ideal candidates for other continence procedures either because of previous pelvic surgery or body weight.

Adult↗
PubMed2001

Three-dimensional ultrasound: a novel technique for investigating the urethral sphincter in the third trimester of pregnancy.

OBJECTIVES: To measure urethral sphincter volume by three-dimensional (3D) ultrasound. To assess the reproducibility of this measurement technique and to compare volumes obtained using 3D ultrasound with volumes calculated from a formula based on 2D ultrasound measurements. METHODS: Women were recruited as part of an ongoing study of changes to the pelvis resulting from pregnancy and childbirth. One hundred and eleven women in the third trimester of pregnancy (between 32 and 41 completed weeks' gestation) underwent a 3D transvaginal ultrasound scan of the urethra. In 10 cases the scan was analyzed twice by different observers to assess the reproducibility of the measurements from the scans and the results were analyzed using limits of agreement. RESULTS: The interobserver error was consistent between all the linear, 2D and 3D measurements obtained from the area scanned. There was a significant difference between volumes calculated directly by 3D ultrasound and the approximated volumes from conventional 2D measurements. CONCLUSIONS: Three-dimensional ultrasound appears to be a useful tool in measuring urethral sphincter volume. The error is consistent with that of linear and 2D imaging. However, the increase in normal range generated by biological variation in all three planes makes 3D ultrasound a more sensitive method of evaluating change to the urethral sphincter.

Adult↗
PubMed2001

Refining surgical technique to prevent occurrence of vault haematoma after vaginal hysterectomy.

We set out to analyse the effect of refinement of incision and closure technique of the vaginal vault on the incidence of vault haematoma after hysterectomy. All the surgery was performed in the Gynaecology Department, Benenden Hospital, Kent, UK. This was initially a retrospective study followed by a prospective analysis of postoperative morbidity related to vaginal vault haematomas and critical review of surgical technique over 5 years in all cases undergoing vaginal hysterectomy within our unit. Following refinement in surgical technique a significant reduction in the incidence of clinically significant vaginal vault haematomas from 15.7% to 1.7% (P<0.001) was observed over a 4-year period. Adoption of the described surgical techniques is recommended to minimise the risk of clinically significant vaginal vault haematomas after vaginal hysterectomy.

Journal Article↗
PubMed2000

Efficacy of trospium chloride in patients with detrusor instability: a placebo-controlled, randomized, double-blind, multicentre clinical trial.

OBJECTIVES: To assess the efficacy and safety of trospium chloride (TCl, 20 mg twice daily) in the treatment of detrusor instability, compared with placebo. PATIENTS AND METHODS: In all, 208 patients were allocated at random to either TCl or placebo in a double-blind clinical study; the patients were treated for 3 weeks. Urodynamic values were measured at the beginning and end of the treatment period. Adverse events were recorded on patient diary cards. A confirmatory adaptive procedure with one planned interim analysis was used to evaluate efficacy. RESULTS: Trospium chloride produced significant improvements in maximum cystometric bladder capacity (median treatment effect 22.0 mL, mean 37.3 mL, one-sided P = 0. 0054) and urinary volume at first unstable contraction (median treatment effect 45.0 mL, mean 63.6 mL, one-sided P = 0.0015). The patients' assessment of efficacy showed significantly greater clinical improvement in the TCl group than in the placebo group (two-sided P = 0.0047). Furthermore, TCl was well tolerated, with similar frequencies of adverse events reported in both groups (68% in the TCl and 62% in the placebo group). CONCLUSION: Trospium chloride (20 mg twice daily) is an effective and safe option for the treatment of detrusor instability.

Adult↗
PubMed2000

Current trends in management of ectopic pregnancy in the United Kingdom.

The potential advantages of laparoscopic management of ectopic pregnancy include lower morbidity, faster return to work, and less impact on reproductive health. This study aimed to investigate the current management of ectopic pregnancy in the United Kingdom. Thirty-five per cent of ectopic pregnancies are currently managed laparoscopically. Units that tended to operate laparoscopically were more likely to attempt to preserve the fallopian tube at surgery. Ninety per cent of units in the UK feel that they potentially could manage ectopic pregnancies laparoscopically but in practice only 60% managed any of the last three ectopic pregnancies by this technique.

Journal Article↗
PubMed1999

Lower urinary tract symptoms and their impact on women with anorexia nervosa.

Anorexia nervosa is a condition which is associated with extremely low body weight and endocrine problems including persistent anovulation and a hypo-oestrogenic state. As the lower urinary tract is oestrogen sensitive, it is possible that women suffering from anorexia nervosa may experience similar distressing urinary problems. Of 29 anorexic women assessed, the majority had significant irritative urinary symptoms of which frequency, urgency and nocturia were the most common. These symptoms also had an unfavorable impact on their quality of life.

Adolescent↗
PubMed1998

Videocystourethrography with a ring pessary in situ. A clinically useful preoperative investigation for continent women with urogenital prolapse?

The aim of the study was to evaluate the use of a vaginal pessary in the detection of genuine stress incontinence (GSI) in women with urogenital prolapse undergoing urodynamic investigation. Continent women with urogenital prolapse, with or without associated urinary symptoms, were studied. All underwent videocystourethrography using a standardized protocol. None had evidence of incontinence on provocative testing in the upright position. A well-fitting vaginal ring pessary was inserted to reduce the prolapse and mimic a vaginal repair. The provocative tests were then repeated while the bladder was screened. Seventy women with a mean age 59.0 years (range 34-83) were recruited over a 21-month period: 15 women complained of prolapse alone and 55 had concurrent urinary symptoms; 19 women (27%) developed GSI only following the insertion of a vaginal pessary. The women who became incontinent were significantly older (mean age 63.9 years) than those who remained continent (mean age 56.8 years) (P < 0.020). The use of a vaginal pessary increases the detection rate of GSI in continent women with urogenital prolapse undergoing videocystourethrography. These findings are important because women with prolapse and coexisting incontinence should be offered a continence procedure rather than a simple vaginal repair.

Female↗
PubMed1998

Prevalence of faecal incontinence among women with urinary incontinence.

Four hundred and sixty-five women attending a urodynamic clinic were interviewed, and completed a detailed bowel questionnaire, about their urinary and bowel symptoms. All the women underwent video-cystourethrography with pressure and flow studies. The reported incidence of faecal incontinence was 15.3% (n = 71) on direct questioning and 26% (n = 121) on the postal questionnaire. Faecal incontinence was more common in women with a urodynamic diagnosis of detrusor instability (30% (n = 26)) than among women diagnosed as having genuine stress incontinence (21% (n = 38)). Denervation and myogenic injuries sustained during childbirth have been suggested as a common cause for genuine stress and faecal incontinence, but there may be an alternative mechanism to explain why women with detrusor instability suffer from faecal incontinence.

Adult↗