The impact of pregnancy and childbirth on pelvic sensation: a prospective cohort study.

Pelvic organ prolapse, urinary, bowel and sexual dysfunction, collectively called pelvic floor dysfunction (PFD) affects 1 in 3 women and has a significant public health impact. The causes of PFD are not fully understood but involve injury to connective tissue and motor nerve during childbirth. Women with PFD also have sensory nerve impairment, and it is likely this occurs during childbirth, but this has never been investigated.

PROSPECT: 4- and 6-year follow-up of a randomised trial of surgery for vaginal prolapse.

Introduction And Hypothesis: Our aim was to compare the mid-term results of native tissue, biological xenograft and polypropylene mesh surgery for women with vaginal wall prolapse.

Methods: A total of 1348 women undergoing primary transvaginal repair of an anterior and/or posterior prolapse were recruited between January 2010 and August 2013 from 35 UK centres. They were randomised by remote allocation to native tissue surgery, biological xenograft or polypropylene mesh.

An assessment of techniques and practices used to elevate intra-abdominal pressure when assessing pelvic floor dysfunction.

Aims: To determine terminology and methods for raising intra-abdominal pressure (IAP) currently used by clinicians to assess pelvic floor dysfunction (PFD) and to measure the effect of these maneuvers on IAP.

Methods: Three-hundred questionnaires were distributed at two scientific meetings in the United Kingdom to determine methods clinicians used to raise IAP and their perceptions of these methods. Twenty healthy volunteers were also recruited to measure the effect of two methods of raising IAP: Valsalva maneuver (VM) and bear down maneuver (BDM).

A UK questionnaire survey of current techniques used to perform pelvic organ prolapse repair.

Introduction And Hypothesis: Evidence-based medicine should result in better standardisation of practice. This study aims to evaluate whether there remains variation in surgical techniques in native tissue and graft/mesh repairs of pelvic organ prolapse (POP) in UK practice.

Methods: A questionnaire survey was conducted to describe current surgical techniques for native tissue and graft/mesh POP repairs performed by a cohort of UK surgeons recruiting to a large multicentre prolapse trial (PROSPECT).

Two parallel, pragmatic, UK multicentre, randomised controlled trials comparing surgical options for upper compartment (vault or uterine) pelvic organ prolapse (the VUE Study): study protocol for a randomised controlled trial.

Background: One in three women who have a prolapse operation will go on to have another operation, though not necessarily in the same compartment. Surgery can result in greater impairment of quality of life than the original prolapse itself (such as the development of new-onset urinary incontinence, or prolapse at a different site). Anterior and posterior prolapse surgery is most common (90 % of operations), but around 43 % of women also have a uterine (34 %) or vault (9 %) procedure at the same time.

Teaching and learning in urogynecology.

This paper was delivered as the Ulf Ulmsten Memorial Lecture in Brisbane, QLD, Australia, in 2012. It emphasises how urogynaecology as a young specialty needs to learn some lessons from its forebears as to how new knowledge should be analysed and incorporated into practice. The paper highlights the value of mentorship and teamwork and the need to be aware of increasing patient expectations.

Can we, and do we need to, define bladder neck hypermobility and intrinsic sphincteric deficiency? ICI-RS 2011.

Aims: Bladder neck hypermobility (BNH, also called urethral hypermobility), and intrinsic sphincteric deficiency (ISD) are terms frequently used in the clinical evaluation and management of stress urinary incontinence, and as subject qualifiers in clinical research. The terms also infer pathophysiologic concepts, as BNH and ISD appear to represent two different aspects of failure of the continence mechanism. Unfortunately, neither term is well-defined, and the various clinical and urodynamic characterizations of these terms do not correlate well with one another.

Managing unsatisfactory outcome after mid-urethral tape insertion.

This article reviews the literature on the assessment and management of women whose previous mid-urethral tape surgery to manage stress urinary incontinence symptoms has failed to produce a satisfactory outcome. In many areas the literature is deficient and the article includes consensus statements drawn from the International Continence Society Research Society meeting in Bristol in June 2010. The need for a structured approach to assessment and management is highlighted, so that further research into areas of uncertainty can be prioritized.

One-year clinical outcomes after prolapse surgery with nonanchored mesh and vaginal support device.

Objective: The purpose of this study was to evaluate outcomes after standardized transvaginal prolapse repair with nonanchored mesh and a vaginal support device.

Study Design: Postoperative vaginal support was assessed by pelvic organ prolapse quantitative examination after repair of symptomatic stage II/III prolapse. Validated questionnaires assessed pelvic symptoms and sexual function.

Prospective study of anterior transobturator mesh kit (Prolift™) for the management of recurrent anterior vaginal wall prolapse.

Introduction And Hypothesis: Assessment of the 2-year outcome of anterior Prolift™ for women with recurrent anterior vaginal wall prolapse. This is a prospective study which was conducted in a tertiary unit in the North West of England and comprised 36 consecutive women with recurrent anterior vaginal wall prolapse.

Methods: Women were assessed preoperatively and postoperatively at 6 months and 2 years.

Is mid-urethral placement of synthetic minimal access tapes important in stress urinary incontinence surgery?

The introduction of the tension free vaginal tape over a decade ago heralded the adoption of sub-urethral sling placement under the mid-urethra rather than the proximal urethra. This paper reviews the literature which led to the change in practice and also looks at which factors concerning tape position influence surgical outcome with particular reference to the position along the urethra. There is conflicting evidence on the importance of the mid-urethral position and there is also evidence that other factors such as the configuration of the tape under the urethra at rest and under strain and the proximity of the tape to the urethral mucosa may be as important in influencing outcome.

The long-term outcome of laparoscopic colposuspension: a 10-year cohort study.

Introduction And Hypothesis: The aim of this study is to provide long-term outcome data, at least 10 years, following laparoscopic colposuspension.

Methods: The study includes a control group who underwent open colposuspension. A consecutive series of 139 women who had undergone laparoscopic colposuspension were reviewed and compared to 52 women who had an open colposuspension in the same unit.

How accurate is symptomatic and clinical evaluation of prolapse prior to surgical repair?

The aim of this study is to assess the accuracy of pre-operative evaluation of pelvic organ prolapse. The design is a prospective observational audit set at the gynaecology department, Teaching Hospital, UK. The population is composed of patients undergoing surgery for prolapse.

Laparoscopic versus open colposuspension: which one should we choose?

Purpose Of Review: The aim of this review is to present a summary of recently published research comparing laparoscopic and open colposuspension. It also examines the place of colposuspension in light of the continuing development other minimally invasive procedures for stress urinary incontinence.

Recent Findings: The results of two large multicentre randomised controlled trials were published in 2006 comparing open and laparoscopic colposuspension.

Which questionnaire? A psychometric evaluation of three patient-based outcome measures used to assess surgery for stress urinary incontinence.

Aims: The aim of the study was to further validate three patient-based outcome measures (PBOM) used to assess the outcome of surgery for stress urinary incontinence and to compare their psychometric properties with a view to determining the most appropriate measure for clinical use.

Methods: The work was embedded within a randomized controlled trial of laparoscopic and open colposuspension. The trial recruited 291 women from six centers.

Ambulatory surgery in urogynaecology.

Ambulatory surgery offers advantages to both patients and providers. It is imperative to ensure appropriate case selection, pre-operative counseling, a suitable environment, trained staff, adequate analgesia and post-operative care both in the hospital and the community. Many well-established urogynaecological procedures such as cystoscopy and vaginal repair may be performed in an ambulatory setting.

Opening detrusor pressure and the influence of age on success following colposuspension.

Objective: Women with urodynamic stress incontinence (USI) have lower opening and closing detrusor pressures than women without USI. This study was undertaken to determine whether a change occurs in opening and closing detrusor pressures after colposuspension, whether cure is associated with change, and whether age influences cure.

Design: Retrospective cohort study.

Stress incontinence and pelvic floor neurophysiology 15 years after the first delivery.

Unlabelled: HEADLINE: This is a longitudinal study of a cohort of primigravidae recruited between 1985 and 1987 and followed up 7 and 15 years later. Pelvic floor neurophysiology was performed and questionnaires were administered to determine the natural history of stress incontinence and to establish whether pelvic floor denervation after the first delivery is associated with symptoms of stress urinary incontinence in the future.

Objectives: To study the natural history of stress urinary incontinence arising during the first pregnancy, to determine whether postnatal pelvic floor denervation progresses with time and whether it predisposes to stress urinary incontinence in the future.