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Biomedical subjects

V Khullar

Publications and source records attributed to V Khullar.

At least 19 recordsLinked to original sources
PubMed2004

Effects of Burch colposuspension on the relative positions of the bladder neck to the levator ani muscle: An observational study that used magnetic resonance imaging.

OBJECTIVE: The purpose of this study was to use magnetic resonance imaging to observe the changes of the position of the levator ani muscle relative to the bladder neck after Burch colposuspension. STUDY DESIGN: Women with urodynamic stress incontinence underwent Burch colposuspension. Magnetic resonance imaging was performed 1 week before surgery and 1 year after the operation. The levator ani muscle and the bladder neck were imaged in the parasagittal and sagittal planes, respectively; and their position was measured in relation to the pubococcygeal line. The reproducibility of these measures was investigated. Changes that occurred to levator ani muscle anatomy after the operation were correlated to surgical success. Surgical outcome was assessed objectively at 1 year with urodynamic testing. RESULTS: Of the 73 women who were studied, only 28 women were included in the study because the medial edge of the levator ani was visible clearly on a parasagittal magnetic resonance image. At the 1-year follow-up, the objective cure rate was 86%. Measures of bladder neck and levator ani position in relation to the pubococcygeal line were found to be reproducible. Burch colposuspension produces a significant elevation of the levator ani, with a reduced distance between the bladder neck and the levator ani muscle. Surgical success was associated significantly with a shorter distance between bladder neck and levator ani muscle. CONCLUSION: The anatomy of the levator ani muscle is changed by colposuspension. The apposition of the levator ani muscle to the bladder neck may play a role in the restoration of continence.

Anal Canal↗
PubMed2004

A randomized controlled trial comparing medical and expectant management of first trimester miscarriage.

BACKGROUND: We aimed to determine whether outpatient treatment of miscarriage with vaginal misoprostol is more effective than expectant management in reducing the need for surgical evacuation of retained products of conception (ERPC). METHODS: Of 131 eligible women with first trimester miscarriage, 104 agreed to randomization to either 600 microg misoprostol or placebo intravaginally. They were assessed the following day and administered a second dose of their allocated treatment if miscarriage was not complete. Those not successful after two doses were seen on day 7, and, if miscarriage was not complete, an ERPC was performed. RESULTS: The success rate of medical management was 88.5% (46/52) compared with 44.2% (23/52) for expectant management. There was no significant difference in success rate (100 versus 85.7%) in women treated with an incomplete miscarriage. Women with early pregnancy failure had a success rate of 87% with misoprostol compared with 29% with expectant management [odds ratio (OR) 15.96; 95% confidence interval (CI) 5.26, 48.37]. The complete miscarriage rate was achieved quicker in the medical group than the expectant group by day 1 (32.7 versus 5.8%) and by day 2 (73.1 versus 13.5%) of treatment. There were no differences in side-effects, bleeding duration, analgesia use, pain score and satisfaction with treatment. Women in the expectant group made more outpatient visits (5.06 versus 4.44%; OR = -0.62, 95% CI -1.04, -0.19). More women in the medical group (90.4 versus 73.1%; OR 1.26, 95% CI 1.05, 1.50) would elect the same treatment in the future. CONCLUSIONS: Medical management using 600 microg misoprostol vaginally is more effective than expectant management of early pregnancy failure. Misoprostol did not increase the side-effect profile and patient acceptability was superior to expectant management.

Abortifacient Agents, Nonsteroidal↗
PubMed2002

Morbidity after ambulatory urodynamics.

AIMS: To identify urinary symptoms and morbidity after ambulatory urodynamics. METHODS: One hundred consecutive women underwent ambulatory urodynamics for a variety of urinary complaints. Urinary symptom questionnaires were collected before investigation and again 48 hours later, reporting dysuria and haematuria. Women were screened for urinary tract infection before investigation and again 48 hours later. RESULTS: Of the 91 women who completed the study, 1 (1.1%) had a positive urinary culture after the investigation but was asymptomatic. Seventeen women reported mild to moderate de novo dysuria. CONCLUSIONS: Urinary symptoms and morbidity after ambulatory monitoring is low.

Adult↗
PubMed2001

Pharmacological management of detrusor instability.

Urinary incontinence and lower urinary tract dysfunction remain an important cause of morbidity, affecting at least 14% of women over the age of 30 years. Whilst the etiology and pathophysiology of detrusor instability remains to be elucidated drug therapy remains important in the management of women with the irritative symptoms of urgency, frequency and urge incontinence. The number of drugs which have been developed illustrates the point that none are ideal, often having systemic adverse effects limiting their therapeutic usage and affecting compliance. This review aims to assess the current pharmacological management of detrusor instability as well as examining recent progress in the development of new agents, some of which may prove to be efficacious.

Adrenergic alpha-Antagonists↗
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

Evaluating ambulatory urodynamics: a prospective study in asymptomatic women.

OBJECTIVE: To identify abnormal detrusor contractions in asymptomatic women undergoing ambulatory urodynamics, to standardise the investigation technique for women with urinary symptoms for clinical practice. DESIGN: Prospective observational study. SETTING: Two tertiary referral urogynaecology units: one in London, UK and one in Varese, Italy. METHODS: Women without urinary symptoms were recruited into the study. Ambulatory urodynamics was performed according to the King's College Hospital protocol. All the traces were analysed in four different ways: 1. without the second bladder transducer measurements displayed on the screen and without the diary; 2. as in 1. but with the diary; 3. with the second bladder sensor displayed on the screen but without the diary; 4. as in 3. but with the diary. The diary was always interpreted at the end of the test with the woman present. For each method we reported the total number of detrusor contractions and whether the woman would have been diagnosed as having abnormal detrusor contraction. Cochran's Q test was used for statistical analysis. RESULTS: Twenty-six women (mean age 31.7 years) were recruited. Ambulatory urodynamic testing lasted an average of 3.57 hour. The diagnosis of abnormal detrusor contraction varied by 65.4% depending on the method of analysis used. The diary and the women's symptoms during the test were the most discriminating factors. A significant difference between the diagnoses was obtained when comparing the four different ways of analysis. According to our protocol only three women (11.5%) had abnormal detrusor contractions. CONCLUSIONS: Using our protocol almost 90% of asymptomatic women have a stable bladder on ambulatory urodynamics. This is similar to the results of labouratory urodynamic testing of asymptomatic women but is in contrast to previous reports of ambulatory urodynamics of asymptomatic women. The technique used during ambulatory urodynamics determines the tests ability to detect detrusor instability with an accurate symptom diary being the most important.

Adult↗
PubMed2001

A comparison of the objective and subjective outcomes of colposuspension for stress incontinence in women.

OBJECTIVES: To investigate the impact of colposuspension for stress incontinence on the symptoms and quality of life of women undergoing both primary and repeat surgery for genuine stress incontinence and in addition to assess the use of a condition specific quality of life questionnaire as an outcome measure following surgery. DESIGN: Prospective case series: videocystourethrography performed before and between six and twelve months after surgery. Validated condition specific quality of life (QoL) questionnaires completed by women before and six to twelve months after surgery. SETTING: A tertiary referral Urogynaecology Unit in a teaching hospital. PARTICIPANTS: A consecutive series of 83 women undergoing colposuspension between March 1995 and December 1997. Pre-operative assessment and surgery was performed by, or was under the direct supervision of, the unit director. INTERVENTION: Modified Burch colposuspension. MAIN OUTCOME MEASURES: Objective results of surgery assessed with videocystourethrography. Subjective results evaluated using a condition specific QoL tool, the Kings Health Questionnaire (KHQ). Symptom severity was evaluated as a component of the condition specific QoL questionnaire. RESULTS: Objective cure was demonstrated in 92% of women undergoing primary surgery with an 8% incidence of de-novo detrusor instability and a 10% incidence of voiding difficulties. In the group of women having repeat surgery the objective cure rate was 81% with no de-novo detrusor instability and a 6% incidence of post-operative voiding difficulties. QoL scores improved in 95% of women. Improvements of over 25% were seen in 70% of women and of over 50% in 28%. However, 2.4% of women recorded a deterioration in QoL scores. CONCLUSIONS: Colposuspension performed in this setting, assessed using both objective and standardised subjective measures, completed by women themselves, appears to produce good objective and subjective results and leads to enhanced quality of life in the great majority of women.

Adult↗
PubMed1999

Imaging the urethral sphincter with three-dimensional ultrasound.

OBJECTIVE: To image the striated urethral sphincter (rhabdosphincter) using three-dimensional ultrasound and to compare its size in women with genuine stress incontinence and continent controls. METHODS: Women with no previous continence or prolapse surgery had transvaginal sonography using a 7.5-MHz mechanical sector endoprobe with real-time and three-dimensional facilities. Three perpendicular planes were displayed simultaneously on the screen. Manipulation of the stored images allowed detailed morphologic assessment of the urethra at different levels using several parallel cross-sectional planes along its length. The length, thickness, and volume of the rhabdosphincter were measured. RESULTS: Forty-six women with genuine stress incontinence (27-73 years, mean 48) and 48 continent controls (23-76 years, mean 49) were studied. In the transverse plane, the inner part of the urethra, which consists of urothelium and smooth muscle, appeared hyperechogenic compared with the outer hypoechogenic ring of striated muscle. The two groups studied were not different in age and parity. Women with genuine stress incontinence, compared with continent controls, had a significantly shorter (mean +/- standard deviation 16.9 +/- 1.9 mm compared with 19.2 +/- 3.6 mm; P = .001), thinner (2.1 +/- 0.5 mm compared with 2.5 +/- 0.4 mm; P < .001), and smaller volume (0.8 +/- 0.2 mL compared with 1.2 +/- 0.2 mm; P < .001) of the striated urethral sphincter. There was a close correlation between the urethral sphincter volume and the degree of incontinence assessed on videocystourethrography (r = -.65, P < .001). CONCLUSION: Three-dimensional ultrasound allowed examination of the female urethra in planes that could not be visualized by conventional sonography. The rhabdosphincter had a smaller volume in women with genuine stress incontinence than in continent women.

Adult↗
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

Reducing artefacts in ambulatory urodynamics.

OBJECTIVE: To compare the diagnoses derived from a retrospective analysis of 50 ambulatory urodynamic recordings, unaware of the final diagnosis, and to evaluate the importance of the symptom diary and the presence of two transducers in the bladder rather than one. PATIENTS AND METHODS: Fifty women underwent ambulatory urodynamics (duration 4 h) after video cysto-urethrography. A single solid-state microtip pressure catheter was inserted with both transducers inside the bladder, and another was inserted in the rectum. The women were asked to complete a symptom diary and the results were analysed with the active participation of the patient. Detrusor 'instability' was diagnosed on ambulatory urodynamics if there was a simultaneous increase in detrusor pressure and in the 'urethral' line in the presence of symptoms (urgency or leakage). All 50 recordings were analysed retrospectively in four combinations, i.e. with and without the additional 'urethral' line displayed on the screen and with and without the diary information. The total number of detrusor contractions was then calculated for each reading and 'abnormal detrusor activity' diagnosed when a contraction occurred with or without symptoms as recorded in the diary. The final diagnosis for each reading was then compared with that made at the time of the test with the patient present. RESULTS: Using the information from the diary reduced the number of pressure rises classified as 'abnormal detrusor activity' by 58%; using a second bladder pressure transducer further reduced the number of pressure rises classified as 'abnormal' by 19%. Overall, using both techniques together reduced the number of spurious pressure rises misclassified as 'abnormal detrusor activity' by 64%. CONCLUSIONS: Both the symptom diary and the placement of two transducers in the bladder can decrease, by almost two-thirds, the diagnosis of pathological detrusor activity on ambulatory urodynamics.

Ambulatory Care↗
PubMed1998

Incontinence in the elderly.

This year has seen many advances in the treatment of incontinence in the elderly, particularly the use of devices to control genuine stress incontinence and new drug treatments for detrusor instability to reduce side-effects and improve compliance. The results of existing surgical treatments for genuine stress incontinence have been evaluated more closely and newer techniques, which are less invasive and produce less morbidity, have been applied and evaluated in the elderly.

Aged↗
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↗