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Biomedical subjects

S M Creighton

Publications and source records attributed to S M Creighton.

7 recordsLinked to original sources
PubMed1992

The incidence of genital prolapse after the Burch colposuspension.

OBJECTIVE: Our objective was to determine the incidence of postoperative genital prolapse after the Burch colposuspension and to identify risk factors for the development of subsequent prolapse. STUDY DESIGN: The charts of 131 patients who had a Burch colposuspension performed by the senior author (S.L.S.) between 1977 and 1986 were reviewed at the Urodynamic Unit of St. George's Hospital, London. Emphasis was placed on the degree of genital prolapse on clinical examination and whether further surgery was required to correct the prolapse. RESULTS: Thirty-five patients (26.7%) required a total of 40 operations to correct genital prolapse after colposuspension. At 20 operations, more than one procedure was required to correct combined prolapse. The patient's age, weight, parity, menopausal status, and prior pelvic surgery did not affect the incidence of postoperative prolapse. The only preoperative risk factor identified was the presence of a large cystocele. CONCLUSION: Postoperative genital prolapse is a significant complication of the Burch colposuspension. It is unclear whether this is due to a disruption of the vaginal axis or to an intrinsic weakness of the pelvic floor in these women.

Adult↗
PubMed1992

Perineal video-ultrasonography in the assessment of vaginal prolapse: early observations.

OBJECTIVE: To investigate the efficacy of perineal ultrasonography in the assessment of vaginal prolapse. DESIGN: A prospective descriptive study. SETTING: Urodynamic Unit, St. George's Hospital, London. SUBJECTS: Six women, three of them were awaiting colposuspension and three had had a colposuspension. INTERVENTIONS: Perineal ultrasound scans were performed on women with and without incontinence and prolapse, both before and after continence surgery. Movement of the bladder, urethra, uterus, vaginal vault and enterocele were observed during coughing and the valsalva manoeuvre. MAIN OUTCOME MEASURES: To assess reproducibility, six patients had six different measurements taken of bladder neck and prolapse position and movement relative to the symphysis. The measurements were plotted upon an X-Y co-ordinate axis. Each measurement was repeated three times and one way analysis of variance performed upon the readings. RESULTS: Perineal ultrasonography clearly demonstrated movement of the whole pelvic floor. Minor degrees of both anterior and posterior vaginal wall prolapse could be seen and quantified. An increase in posterior vaginal wall mobility was noted in women after colposuspension. All measurements taken were found to be reproducible. CONCLUSIONS: Perineal ultrasonography is easy to perform and is reproducible. It may improve understanding of why some women develop posterior vaginal wall prolapse after colposuspension and, conversely, why some women develop incontinence following anterior repair for prolapse.

Cough↗
PubMed1991

Distal urethral electrical conductance (DUEC)--a preliminary assessment of its role as a quick screening test for incontinent women.

Measurement of distal urethral electrical conductance (DUEC) has been used to detect the movement of urine along the distal urethra. DUEC was used as a screening test in 100 women attending the urodynamic clinic with incontinence and in the 33 women who voided over 250 ml, the findings correlated well with subsequent urodynamic diagnosis of urethral sphincter incompetence and detrusor instability.

Adult↗
PubMed1991

The surgical management of vaginal vault prolapse.

OBJECTIVE: A review of the results of surgery for vaginal vault prolapse following hysterectomy. DESIGN: A retrospective review of all patients treated surgically for vaginal vault prolapse between 1981 and 1990 in one hospital. SETTING: St George's Hospital, London. SUBJECTS: 28 women. INTERVENTIONS: The 28 patients underwent 33 operations, either a colposacropexy (23 procedures) or a Zacharin procedure (10 procedures). Of the 28 women 25 were seen in the gynaecological clinic within the last year. MAIN OUTCOME MEASURES: Pre- and post-operative data and any interim prolapse surgery was recorded. Success of the procedure in terms of cure, urinary complications, infection and sexual function. RESULTS: The mean follow-up time was 17.1 months for the colposacropexy and 33 months for the Zacharin. The cure rate for colposacropexy was 91% and that for the Zacharin procedure was 70%. The two commonest complications were development of a voiding difficulty and infection. Three women developed voiding difficulty following the Zacharin and one following colposacropexy. Two women following colposacropexy required removal of the Mersilene mesh due to a persistent discharging sinus. CONCLUSION: The colposacropexy had a better success rate and, as it is a simpler operation to perform, has become the operation of choice in this unit. It is, however, associated with a risk of infection which can necessitate removal of the supporting mesh.

Adult↗
PubMed1991

Sensory urgency: how full is your bladder?

OBJECTIVE: To investigate whether women with sensory urgency have an abnormal perception of bladder fullness. DESIGN: Prospective observational study. SETTING: Urodynamic Unit, St George's Hospital, London. SUBJECTS: 15 women with sensory urgency, 15 women with idiopathic detrusor instability and 15 without symptoms of frequency or urgency (control group). INTERVENTIONS: All the women attended for cystometry. Each was asked to complete a visual analogue score of how full she perceived her bladder to be on a scale from 1 to 10. This was done before filling cystometry and at three times during bladder filling. At each time actual filled volume was noted. MAIN OUTCOME MEASURES: Maximum bladder capacity and individual perception of bladder fullness. RESULTS: Women with sensory urgency and detrusor instability had similar maximum bladder capacity although values in both groups were significantly lower than in the control group; thus percentage of maximum bladder capacity was used for analysis. Linear regression was performed for each group of patients and a predicted visual analogue score at 25, 50 and 75% of capacity calculated. These were compared between groups by rank analysis of variance. There was no significant difference between sensory urgency and detrusor instability. However, at 25, 50 and 75% of capacity, both groups had a significantly higher score than the control group. CONCLUSIONS: This abnormal perception would explain symptoms of frequency and urgency in these two groups. These results also confirm the similarity between detrusor instability and sensory urgency.

Adult↗
PubMed1990

Caffeine: does it affect your bladder?

Patients with symptoms of frequency and urgency often complain that their symptoms are exacerbated by tea or coffee. A series of 20 women with confirmed detrusor instability and 10 asymptomatic women were given 200 mg of caffeine citrate and urodynamic studies were performed. In the group with detrusor instability there was a statistically significant increase in detrusor pressure on bladder filling following administration of caffeine, but no difference in volume at first contraction, height of contraction or bladder capacity. Normal women had no abnormality on cystometry.

Caffeine↗