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Biomedical subjects

Peter K Sand

Publications and source records attributed to Peter K Sand.

At least 19 recordsLinked to original sources
PubMed2007

Detrusor overactivity and urge urinary incontinence following trans obturator versus midurethral slings.

AIMS: To compare the rates of resolution of detrusor overactivity (DO) and subjective urge urinary incontinence (UUI) as well as de novo DO and UUI between the Monarc, TVT, and SPARC midurethral sling procedures. METHODS: Two hundred and seventy-six subjects with urodynamic stress or mixed urinary incontinence underwent retropubic midurethral slings (TVT, N = 99; SPARC, N = 52) or transobturator slings (Monarc, N = 125). All evaluable subjects had a routine office evaluation, subjective assessment of UUI, and multichannel urodynamic testing pre- and 3 months postoperatively. Comparisons were made using Student's t-test, ANOVA, McNemar's test, and Chi-Square test where appropriate. Multivariate logistic regression was performed to detect possible confounding factors such as sling type, and differences in concomitant surgical procedures. RESULTS: De novo subjective UUI differed significantly between the Monarc and the other two slings (33% TVT vs. 8% Monarc vs. 17% SPARC, P = 0.04). Fourteen to Sixteen percents of patients with preoperative UUI who underwent TVT or SPARC had worsening of their UUI symptoms while only 6% of the Monarc group did (P = 0.02). There was no difference in rates of resolution of DO among the three groups (40% vs. 48% vs. 32%, P = 0.39) or de novo DO (32% vs. 22% vs. 22%, P = 0.64) at 3 months. CONCLUSIONS: Patients who undergo transobturator procedures have significantly lower rates of de novo UUI than those who undergo midurethral sling procedures. Rates of resolution of DO, UUI, and de novo DO do not differ between groups.

Cohort Studies↗
PubMed2006

Is transobturator tape as effective as tension-free vaginal tape in patients with borderline maximum urethral closure pressure?

INTRODUCTION: The purpose of this study was to compare transobturator tape (MONARC) with tension-free vaginal tape in patients with borderline low maximum urethral closure pressure. STUDY DESIGN: Historical cohort analysis of 3-month outcomes in 145 subjects (MONARC = 85; tension-free vaginal tape = 60). A cut-off point of 42 cm H2O for preoperative maximum urethral closure pressure was identified as predictor of success in the entire cohort. The cohort was stratified by sling type and analyzed. Outcome variables included urodynamic stress incontinence, urethral pressure profiles, subjective stress incontinence symptoms, and complications. RESULTS: The relative risk of postoperative urodynamic stress incontinence 3 months after surgery in patients with a preoperative maximum urethral closure pressure of 42 cm or less H2O was 5.89 (1.02 to 33.90, 95% confidence interval) when we compared MONARC with tension-free vaginal tape. Subjects in the MONARC and tension-free vaginal tape groups did not differ significantly in baseline characteristics. We defined subjects as failures if they demonstrated postoperative objective stress incontinence on multichannel urodynamic testing. CONCLUSION: In subjects with maximum urethral closure pressure of 42 cm or less H2O, the MONARC was nearly 6 times more likely to fail than tension-free vaginal tape at 3 months after surgery. Long-term follow-up and randomized controlled trials are needed.

Adult↗
PubMed2006

Perceptions and behaviours of women with bladder control problems.

OBJECTIVES: To evaluate women's perceptions about bladder control problems. METHODS: 757 Women with one or more bladder control symptoms (frequency, urgency, stress or urge urinary incontinence and nocturia) participated in an Internet-based survey. A separate study involved 12 focus groups including a total of 180 women with bladder control problems. RESULTS: Respondents in the survey reported multiple symptoms, e.g. stress urinary incontinence (72%), frequency (56%), nocturia (45%), urge urinary incontinence (43%) and urgency (33%). Women in both the survey and the focus groups revealed extensive use of coping mechanisms to manage their symptoms. The focus groups revealed that many women were not aware that overactive bladder (OAB) is a pathophysiological condition. Approximately 30% of respondents in the survey felt uncomfortable talking to their doctor about their condition. Among women who did speak with their doctor, stress-related symptoms were described more readily than urge-related symptoms. In the survey, only about half (56%) of the women felt their OAB medication was effective, and half (50%) stopped taking their medication at some point. Information from the focus groups suggested that some women may have unrealistic expectations of onset of efficacy or extent of benefit and may be unprepared for managing side effects. CONCLUSIONS: Feelings of embarrassment and limited understanding of the pathophysiology of OAB can contribute to miscommunication between a woman and her doctor. Patient education regarding reasonable expectations coupled with suggestions for coping with unwanted side effects will likely result in better management.

Adaptation, Psychological↗
PubMed2006

Biomechanical characterization of vaginal versus abdominal surgical wound healing in the rabbit.

OBJECTIVE: The objective of the study was to compare biomechanical properties of vaginal versus abdominal surgical wound healing in the rabbit. STUDY DESIGN: Bilateral 6-mm full-thickness circular segments were excised from the vagina and abdominal skin in 38 New Zealand White female rabbits. Animals were killed 0, 4, 7, 10, 14, 21, 28, and 35 days after wounding, and the wounds were assessed for surface area and tensile properties. RESULTS: Wound closure and scar contraction were significantly faster in the vagina than the abdomen (P = .001). Baseline tensile strength (P = .05), modulus (P = .001), and tensile energy to break (P = .18) were higher in the abdomen, whereas maximal tissue elongation was higher in the vagina (P = .13). After wounding, a drop in tensile strength, modulus, and tensile energy to break was observed in both tissues through postwounding day 4, followed by a progressive recovery of these properties. A progressive loss of elasticity was noted in both tissues after wounding. CONCLUSION: The surgical wound closes and contracts faster in the rabbit vagina than in its abdomen. Although these tissues have different biomechanical properties at baseline, they regenerate their tensile strength and lose their elasticity at a similar rate.

Abdomen↗
PubMed2006

The impact of the overactive bladder syndrome on sexual function: a preliminary report from the Multicenter Assessment of Transdermal Therapy in Overactive Bladder with Oxybutynin trial.

OBJECTIVE: The objective of the study was to determine the impact of overactive bladder on sexual function from a preliminary analysis of the Multicenter Assessment of Transdermal Therapy in Overactive Bladder with Oxybutynin study. STUDY DESIGN: The Multicenter Assessment of Transdermal Therapy in Overactive Bladder with Oxybutynin study was an open-label, prospective trial of 2878 subjects with overactive bladder, treated with transdermal oxybutynin for 6 months or less. The impact of overactive bladder on sexual function before and after treatment was assessed via item responses from the King's Health Questionnaire and Beck Depression Inventory-II (kappa-test). RESULTS: At baseline, 586 (23.1%) reported that overactive bladder had an impact on their sex life. Coital incontinence in 569 (22.8%) decreased after treatment to 438 (19.3%). Effects of overactive bladder on subjects' sex lives improved in 19.1% (worsened in 11.2%), and the effect on relationships with partners improved in 19.6% (worsened in 11.9%). Reduced interest in sex, reported by 52.1% at baseline, improved significantly. (all P < .0001). CONCLUSION: Overactive bladder negatively affects sexual function. Treatment with transdermal oxybutynin improved sexual function and marital relationships.

Administration, Cutaneous↗
PubMed2006

Disruptive effects of overactive bladder and urge urinary incontinence in younger women.

Although most studies of overactive bladder (OAB) have investigated older patients, many younger women suffer from OAB syndrome with and without urge urinary incontinence. OAB in these women is associated with an increased risk of depression, sexual dysfunction, sleep disruption, and lost productivity in the workplace. Many patients adopt coping strategies rather than seeking treatment; therefore, available treatments are underused in this population.

Adult↗
PubMed2006

Management of incontinence for family practice physicians.

Family practice physicians are likely to encounter urinary incontinence and overactive bladder (OAB) in their patients. An informed family practice physician can generally accurately diagnose the cause and type of incontinence in patients with a properly focused physical examination and, if necessary, auxiliary testing. Accurate diagnosis can lead to effective treatment when physicians are familiar with available treatment options, including pharmacologic, surgical, behavioral therapies, and catheterization.

Family Practice↗
PubMed2006

Symptom bother and health-related quality of life outcomes following solifenacin treatment for overactive bladder: the VESIcare Open-Label Trial (VOLT).

BACKGROUND: Most clinical trials designed to evaluate overactive bladder (OAB) syndrome treatments have focused on measuring micturition variables from bladder diaries. However, although diaries help physicians assess symptoms objectively, they lack information on patients' subjective experience of OAB symptoms and the effects of treatment. OBJECTIVE: The objective of this study was to assess patients' perceptions of improvements in symptom bother and health-related quality of life (HRQOL) with solifenacin succinate 5- and 10-mg treatments in patients with OAB. METHODS: VOLT (VESIcare Open-Label Trial) was a prospective, flexible-dosing trial performed at 207 centers in the United States. Ambulatory adult (aged > or = 18 years) men and women with an established diagnosis of OAB (urgency, urge urinary incontinence, frequency, and/or nocturia for > or = 3 months) and who provided a sterile urine sample received solifenacin QD for 12 weeks. Initially, all patients received 5 mg/d, with the option of adjustment to 10 mg/d at 4 and 8 weeks. Effectiveness was assessed using the Patient Perception of Bladder Condition (PPBC) scale, a visual analog scale (VAS) for the degree of bother caused by individual OAB symptoms, and the overactive bladder questionnaire (OAB-q). Assessments were performed at study initiation and study end or study termination. Adverse events (AEs) were assessed throughout. RESULTS: Patients (N = 2225) were enrolled between June 2004 and April 2005. Patients with baseline data (n = 2205) had a mean (SD) age of 59.7 (14.4) years; most patients were women (1813 [82.2%]) and white (1761 [79.9%]). Of the total patients enrolled, 1743 (78.3%) completed all 12 weeks of the study. After 12 weeks of solifenacin treatment, improvement was observed in the mean values of patient-reported perception of bladder condition. Significant change was observed on the PPBC scale from the mean baseline value to study end (4.4 vs 2.9; P < 0.001). All subscales of HRQOL significantly improved on the OAB-q score (mean changes, 14.7 to 29.6; all, P < 0.001). On the VAS, there was a significant reduction in the degree of bother associated with urgency, urge urinary incontinence, frequency, and/or nocturia (mean changes in VAS ratings, -36.7 to -41.8; all, P < 0.001 vs baseline). Solifenacin was well tolerated in most patients. Treatment-emergent AEs were reported by 1321 (59.4%) patients. Most reported AEs were anticholinergic in nature and of mild to moderate severity: dry mouth, 477 (21.4%); constipation, 295 (13.3%); headache, 76 (3.4%); blurred vision, 57 (2.6%); nausea, 39 (1.8%); dyspepsia, 34 (1.5%); and dry eye, 29 (1.3%). Two hundred sixteen (9.7%) patients discontinued treatment due to AEs. CONCLUSION: Flexibly dosed solifenacin 5 and 10 mg QD was associated with reductions in patient-reported OAB symptom bother and improvements in patients' perception of bladder condition and HRQOL.

Adolescent↗
PubMed2006

Effect of parity on sexual function: an identical twin study.

OBJECTIVE: To assess the impact of childbirth on female sexual function by using an identical twin study design. METHODS: A survey including the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) was administered to 542 twin sisters, and PISQ-12 scores of 29 twin pairs discordant for parity were compared. Multiple linear regression models were used to evaluate impact on total PISQ-12 scores in 276 identical, sexually active twins. Three models were used 1) to evaluate the effect of parity and general risk factors, 2) to examine the impact of birth mode, and 3) to examine the role of episiotomy and operative delivery. RESULTS: Mean PISQ-12 scores were significantly higher for discordant nulliparous twins than for parous twins (102.5 versus 93.5, P < .001). The mean (standard deviation) PISQ-12 score was 99.3 (11.7). Age of 50 years or older (difference in mean scores -5.4, P = .019), stress urinary incontinence (-3.3, P = .02), urge urinary incontinence (-5.9, P < .001), parity (-6.5, P < .001), and fecal incontinence (-5.7, P = .048) were associated with decreased mean PISQ scores in the univariable analysis. Parity (-4.9, P < .001) and urge urinary incontinence (-4.3, P = .009) were the only factors remaining independently predictive of diminished sexual function in the multivariable analysis. Mode of delivery did not significantly affect mean PISQ scores (P = .763). Among women who had vaginal deliveries only, neither episiotomy nor operative delivery was associated with change in PISQ scores (P = .553). CONCLUSION: Nulliparous women reported superior sexual satisfaction scores compared with parous women, regardless of age and mode of delivery. Childbirth appears to have a lasting impact on sexual function, due to psychological more than physical factors, well beyond the postpartum period. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2005

Safety and effectiveness of Colpexin Sphere in the treatment of pelvic organ prolapse.

Our objective was to determine the safety and effectiveness of Colpexin Sphere in women with advanced genital prolapse. A total of 39 subjects were enrolled in our prospective multicenter clinical trial, and 27 completed the full 16-week assessment. At baseline, subjects were fitted with a sphere, instructed on insertion and removal, and educated on a regimen of pelvic floor muscle exercises performed with the device in place. Efficacy was evaluated by a baseline vs 16-week comparison of pelvic organ prolapse staging and pelvic floor muscle strength assessment. Safety evaluation included, but was not limited to, an assessment of vaginal mucosal integrity. Subjects also completed a patient satisfaction questionnaire at the end of the study. Improvement in the prolapse of at least one vaginal segment was seen in 81.5% of the subjects, while 63% exhibited improved muscle function on digital examination at 16 weeks. Twenty-five (92.6%) would recommend the device to treat prolapse, and most found it easy to insert (96.3%) and remove (100%). In short-term usage, problems with urination (29.6%) and defecation (72%) were reported, primarily due to device displacement. Two subjects developed superficial vaginal mucosal ulceration, which resolved spontaneously. No significant adverse events were reported.

Adult↗
PubMed2005

Factors influencing the long-term success of periurethral collagen therapy in the office.

INTRODUCTION: Glutaraldehyde crosslinked bovine collagen has been used for periurethral bulking for the treatment of urodynamic stress incontinence since 1989 with variable success. A retrospective study was undertaken to evaluate the factors involved in the long-term success of glutaraldehyde crosslinked bovine collagen used for periurethral bulking in the office. METHODS: Patients were followed objectively with stress testing after receiving periurethral collagen injection in the office under local anesthesia. Repeat injections were done as necessary during their follow-up appointments. The "success" group was defined as those women who demonstrated negative stress tests for over 1 year following their first injection. RESULTS: Nineteen of 184 women (10.3%) demonstrated negative stress tests for over 1 year following only one initial injection of glutaraldehyde crosslinked collagen. Their success lasted a mean of 829 days up to the time of follow-up. CONCLUSION: Prior anti-incontinence surgery was the one factor analyzed that showed a trend toward this long lasting success. No other factors were predictive of negative stress tests for over 1 year. Prior anti-incontinence surgery seems to represent a factor involved in the long-term success of periurethral bulking in the office with glutaraldehyde crosslinked bovine collagen for the treatment of urodynamic stress incontinence.

Adult↗
PubMed2005

TVT versus SPARC: comparison of outcomes for two midurethral tape procedures.

To compare the subjective and objective cure rates in women who underwent either the SPARC or the TVT midurethral sling for the treatment of stress urinary incontinence. This retrospective study included all 122 consecutive women undergoing a TVT or SPARC midurethral sling procedure for objective stress urinary incontinence between January 2000 and March 2003 at the Evanston Continence Center. Primary outcomes were subjective and objective stress incontinence cure rates. Subjects underwent multichannel urodynamics preoperatively and 14 weeks postoperatively, and stress testing at last follow-up. The two groups were compared using univariate and multivariate analyses. Seventy-three subjects underwent a TVT and 49 subjects had a SPARC procedure. There were no statistical differences in demographic factors between the two groups. Subjects undergoing SPARC were more likely to void by Valsalva effort. One hundred and seven women returned for objective postoperative evaluation after surgery. The TVT procedure was associated with higher subjective (86 vs. 60%, P = 0.001) and objective (95 vs. 70%, P < 0.001) stress incontinence cure rates. There was no difference between the TVT and SPARC groups in the resolution of subjective and objective urge urinary incontinence. TVT was associated with a higher stress urinary incontinence cure rate than SPARC in this retrospective study. As new midurethral sling products are introduced, prospective randomized controlled trials should be conducted to evaluate their relative efficacy and safety.

Aged↗
PubMed2005

Successful treatment of Zoon's vulvitis with high potency topical steroid.

Zoon's vulvitis is a rare, chronic condition of the vulva that presents with burning, pruritus, and dysuria with characteristic lesions and histopathology. Several treatment options have been reported with limited success. A 63-year-old woman with Zoon's vulvitis diagnosed on histopathology was treated with clobetasol propionate 0.05%. Complete resolution of her symptoms and lesions occurred in less than 1 week. No recurrence of her symptoms has occurred after 9 months. Zoon's vulvitis may be successfully and expeditiously treated with high potency topical steroids.

Anti-Inflammatory Agents↗
PubMed2005

Do alterations in vaginal dimensions after reconstructive pelvic surgeries affect the risk for dyspareunia?

OBJECTIVE: The purpose of this study was to determine whether changes in vaginal dimensions after transvaginal reconstructive pelvic surgeries affect the risk for postoperative dyspareunia. STUDY DESIGN: Charts of all sexually active patients who underwent transvaginal reconstructive pelvic surgeries in our institution between July 1998 and June 2002 with 1 year of follow-up evaluations were reviewed. Data were analyzed with the Student t, chi2, Pearson's correlation tests and a logistic regression model. RESULTS: Two hundred twenty-eight women aged 44 to 83 years were included. Dyspareunia increased after operation (16% vs 7%; P = .001); total vaginal length (7.6 vs 8.8 cm; P = .001) and genital hiatus (2.7 vs 3.5 cm; P = .001) dimensions significantly decreased after operation, with no predilection for any specific procedure. No correlation was found between these changes in vaginal dimensions and the risk for dyspareunia. CONCLUSION: The prevalence of dyspareunia increases after transvaginal reconstructive pelvic surgeries. Despite a postoperative decrease in vaginal dimensions, a causal relationship between dyspareunia and changes in vaginal dimensions may not exist.

Aged↗
PubMed2005

Histopathologic changes of porcine dermis xenografts for transvaginal suburethral slings.

OBJECTIVE: The purpose of this study was to examine the histopathologic changes of HMDI (Hexamethylene di-isocyanate) cross-linked porcine dermis grafts used for suburethral sling surgery. STUDY DESIGN: Twelve patients underwent reoperation with graft removal for urinary retention or recurrent stress urinary incontinence after transvaginal sling surgery. Tissue specimens were available for pathologic evaluation in 7 patients. Graft specimens underwent histologic preparation including hematoxylin and eosin staining. A single pathologist reviewed the slides blinded to clinical outcomes. RESULTS: Histopathologic analyses revealed only limited collagen remodeling, and evidence of a foreign body type reaction was present in some specimens. In cases of recurrent stress incontinence, implants appeared to be completely replaced by dense fibroconnective tissue and moderate neovascularization without evidence of inflammation or graft remnants. CONCLUSION: HMDI cross-linked porcine dermal collagen implants result in variable tissue reactions that may have unpredictable clinical outcomes in different patients, raising questions about the overall tolerability and efficacy of these grafts in pelvic reconstructive surgery.

Animals↗