A new intravaginal device for stress incontinence in women.

Objective: To compare two versions of the same type of disposable intravaginal device (the Conveen Continence Guard, CCG, and the Contrelle Continence Tampon, CCT, Coloplast a/s, Humlebaek, Denmark) for treating stress incontinence in women.

Patients And Methods: Women with the predominant symptom of stress incontinence were recruited from four centres in Denmark, Australia and the UK. The women were assessed using a 24-h pad-test, uroflowmetry, postvoid residual urine volume and a voiding diary before treatment, and after 5 weeks using each of the two devices.

Confocal examination of nonmelanoma cancers in thick skin excisions to potentially guide mohs micrographic surgery without frozen histopathology.

Precise removal of nonmelanoma cancers with minimum damage to the surrounding normal skin is guided by the histopathologic examination of each excision during Mohs micrographic surgery. The preparation of frozen histopathology sections typically requires 20-45 min per excision. Real-time confocal reflectance microscopy offers an imaging method potentially to avoid frozen histopathology and prepare noninvasive (optical) sections within 5 min.

Genital prolapse: vaginal versus abdominal route of repair.

In the presence of an ageing population, we can expect to see a dramatic increase in the prevalence of genital prolapse including vault and recurrent vaginal prolapse. The best approach for managing upper genital prolapse remains controversial. We review the surgical management of genital prolapse, with a focus on comparing the vaginal and abdominal approaches.

Confocal scanning laser microscopy of benign and malignant melanocytic skin lesions in vivo.

Background: The ability of physicians for early diagnosis of cutaneous melanomas is less than perfect, prompting research into noninvasive methods for diagnosis.

Objective: Our purpose was to evaluate confocal scanning laser microscopy (CSLM) for noninvasive imaging of benign and malignant melanocytic lesions in vivo.

Methods: Forty pigmented skin lesions (including adjacent normal skin as control) in vivo were imaged with near-infrared CSLM.

Iliococcygeus or sacrospinous fixation for vaginal vault prolapse.

Objective: To compare iliococcygeus (prespinous) and sacrospinous fixation for vaginal vault prolapse.

Methods: Between 1994 and 1998, 78 women underwent sacrospinous colpopexy and 50 underwent iliococcygeus fixation for the management of symptomatic vaginal vault prolapse. A matched case-control study was designed to compare the two approaches.

Pubovaginal or vicryl mesh rectus fascia sling in intrinsic sphincter deficiency.

The aim of this study was to compare the pubovaginal sling with a new Vicryl mesh rectus fascia (VMRF) sling in the surgical treatment of low urethral pressure genuine stress incontinence. Fifty-one consecutive women who had a VMRF (n = 27) or a pubovaginal sling (n = 24) procedure between March 1995 and December 1997 were evaluated. The patient-determined subjective success rate of the VMRF sling (85%) was significantly higher than that of the pubovaginal sling (58%) in women with low urethral pressure stress incontinence (P=0.

Percutaneous sacral nerve root neuromodulation for intractable interstitial cystitis.

Purpose: We evaluated the efficacy of percutaneous sacral nerve root neuromodulation in women with refractory interstitial cystitis.

Material And Methods: We prospectively evaluated 15 consecutive women with a mean age of 62 years who had refractory interstitial cystitis to determine the efficacy of percutaneous stimulation of the S3 sacral roots. The mean duration of symptoms before evaluation was 5.

Urinary levels of substance P and its metabolites are not increased in interstitial cystitis.

Objectives: To determine whether interstitial cystitis is associated with the increased release of substance P from the bladder wall into urine, by measuring urinary excretion rates of substance P and its metabolites in women with interstitial cystitis and in a control group of women with stress incontinence and normal bladder function.

Patients And Methods: Catheter urine was collected from 13 patients and 10 controls during a water diuresis ( approximately 10 mL/min) before and after instilling the bladder with 100 mL of water. The contribution of the bladder wall to urinary substance P peptides was assessed by measuring the change in substance P peptide levels after 2 min of bladder stasis before and after instillation.

A prospective evaluation of the pathogenesis of detrusor instability in women, using electron microscopy and immunohistochemistry.

Objective: To characterize the types of detrusor smooth muscle junctions in the bladders of women with detrusor instability and in a control group without, and to assess whether there are differences in the cell junctions between these groups.

Patients And Methods: The study included 13 women with detrusor instability (median age 57 years, range 32-86) and 11 control women (median age 50 years, range 33-62). Bladder biopsies were taken from each participant, processed for electron microscopy and immunohistochemistry (using a labelled antibody to vinculin) and analysed by investigators who were unaware of the patients' diagnoses.

Pathophysiology of interstitial cystitis.

Despite being described over 80 years ago, interstitial cystitis remains a disease of undetermined aetiology and poor treatment outcomes. Generally agreed diagnostic criteria of this condition, which occurs primarily in females, are frequency, urgency and pain, a low-capacity hypersensitive bladder, and mucosal haemorrhages and tearing on bladder distention. Although current theories of pathophysiology are predominantly conjecture, important elements of the disease process are increased afferent and efferent neuronal activity, an excess of inflammatory mediators, increased epithelial permeability and possibly reduced bladder vascularity.

Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis.

This study examined the efficacy of an 8-week telephone-administered cognitive-behavioral therapy (CBT) for the treatment of depressive symptomatology in multiple sclerosis (MS) patients. The treatment, Coping with MS (CMS), included a patient workbook designed to structure the treatment, provide visual aids, and help with homework assignments. Thirty-two patients with MS, who scored at least 15 on the Profile of Mood States Depression-Dejection scale, were randomly assigned to either the telephone CMS or to a usual-care control (UCC) condition.

Oral methotrexate in the management of refractory interstitial cystitis.

To establish the safety and efficacy of low-dose oral methotrexate in treating refractory interstitial cystitis, 9 women who fulfilled internationally accepted criteria for the diagnosis of interstitial cystitis were enrolled in a prospective study. All had proven unresponsive to conventional treatment modalities. Assessment by pain score and frequency volume charts was performed pretreatment and up to 6 months during therapy.

Confirmation of onychomycosis by in vivo confocal microscopy.

Onychomycosis is common in adults and constitutes 20% of all nail disease. Widely used methods to confirm a clinical diagnosis of onychomycosis often yield negative results (ie, potassium hydroxide [KOH] preparation) or are slow (ie, dermatophyte cultures). We report a case of onychomycosis in which we used in vivo confocal microscopy to diagnose the disease; we also correlated our findings with results from routine KOH preparations.

Optical integrating balloon device for photodynamic therapy.

Background And Objectives: It is difficult to deliver light uniformly and efficiently over the complex shapes presented by various organs for photodynamic therapy (PDT). A balloon delivery device for photodynamic therapy was designed and tested for treatment of various anatomic tissues. The device uses the principle of optical integration by multiple internal diffuse reflections to achieve uniform output illumination.

Colposuspension or sling for low urethral pressure stress incontinence?

The aim of this study was to compare Burch colposuspension with the pubovaginal sling in the management of low urethral pressure urinary stress incontinence. Forty-five women with low urethral pressure stress incontinence were retrospectively reviewed: 21 underwent colposuspension and 24 a pubovaginal sling. The subjective success rate of the Burch colposuspension and the pubovaginal sling was 90% and 71% (P = 0.

Transanal repair of rectocele corrects obstructed defecation if it is not associated with anismus.

Purpose: Rectocele is often associated with anorectal symptoms. Various surgical techniques have been described to repair the rectocele. The surgical results are variable.

Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy.

Objective: To review the frequency of lower urinary tract injuries after major gynecologic surgery and the role of routine intraoperative cystoscopy during major gynecologic surgery in the detection of lower urinary tract injuries.

Data Sources: We combined a MEDLINE search for reports from 1966 to October 1998, using the terms "urinary tract injury," "ureter/ureteric/ureteral obstruction/fistula/injury," "bladder fistula/injury," and "vesico-vaginal fistula," with a second search for all reports of gynecologic surgical procedures. Additional references were obtained from relevant articles and review articles.

Course of depression during the initiation of interferon beta-1a treatment for multiple sclerosis.

Objective: To examine the hypothesis that increases in depression after initiation of treatment with interferon beta-1a for multiple sclerosis can be explained as representing a return to pretreatment levels of depression.

Design: Level of depression in patients with multiple sclerosis was assessed at 3 time points: 2 weeks before initiation of interferon beta-la treatment, at initiation of treatment, and at 2-month follow-up.

Setting: A health maintenance organization.

The Burch colposuspension for recurrent urinary stress incontinence following retropubic continence surgery.

Objective: To evaluate the Burch colposuspension with Cherney incision in women with recurrent urinary stress incontinence after retropubic continence surgery.

Design: A retrospective review.

Participants: All 53 women had recurrent urinary stress incontinence after retropubic continence surgery with an average of 2.