The diagnostic strength of the 24-h pad test for self-reported symptoms of urinary incontinence in pregnancy and after childbirth.

The clinical impact of incontinence in pregnancy and after childbirth is growing because some studies report the efficacy of physiotherapy in pregnancy and because obstetric choices are supposed to have significant impact on post-reproductive urinary function (Goldberg et al. in Am J Obstet Gynecol 188:1447-1450, 2003). Thus, the need for objective measurement of urinary incontinence in pregnancy is growing.

Displacement and recovery of the vesical neck position during pregnancy and after childbirth.

Aims: (i) To describe the displacement and recovery of the vesical neck position during pregnancy and after childbirth and (ii) to discriminate between compliance of the vesical neck supporting structures with and without pelvic floor contraction.

Methods: We focussed on the biomechanical properties of the vesical neck supporting structures during pregnancy and after childbirth by calculating the compliance and the hysteresis as a result from of abdominal pressure measurements and simultaneous perineal ultrasound.

Results: This study shows that compliance of the supporting structures remains relatively constant during pregnancy and returns to normal values 6 months after childbirth.

Anatomical and functional changes in the lower urinary tract following spontaneous vaginal delivery.

Objective: To assess the incidence of urinary incontinence in pregnancy and after spontaneous vaginal delivery and its relation with changes in the static and dynamic function of the pelvic floor.

Design: The second part of a prospective longitudinal study.

Setting: University Hospital Groningen and Martini Hospital Groningen, the Netherlands.

Anatomical and functional changes in the lower urinary tract during pregnancy.

Objective: To assess the prevalence and the development of urinary incontinence in nulliparous pregnant women, both subjectively and objectively, and to investigate the relation of incontinence with the mobility of the urethro-vesical junction measured by perineal ultrasound.

Design: A prospective longitudinal study.

Setting: University Hospital and Martini Hospital Groningen, the Netherlands.

[Preservation of ovarian function in 2 young women with Hodgkin disease by laparoscopic transposition of the ovaries prior to abdominal irradiation].

Hodgkin's disease was diagnosed in two girls aged 11 and 15 years, in stages IIIB and IIIA, respectively. Because of localizations in the para-aortic and para-iliac lymph nodes, irradiation of these lymph nodes was considered necessary; this would result in loss of the ovarian function. Transposition of the ovaries was performed by laparoscopy; in the first patient both ovaries were fixed behind the uterus to the midline, in the second the right ovary was fixed at the level of the right iliac crest and the left ovary to the pelvic wall in the cranial direction.

Fertility after conservative and radical surgery for tubal pregnancy.

A retrospective cohort study was set up to evaluate the effectiveness of conservative and radical surgery for tubal pregnancy towards subsequent fertility. Consecutive patients undergoing conservative or radical surgery for tubal pregnancy between January 1990 and August 1993 in two university hospitals were included in the study. Outcome measures were spontaneous intrauterine pregnancy (IUP) and repeat ectopic pregnancy (EP).

Laparoscopic placement of PAP catheters for intraperitoneal chemotherapy in ovarian carcinoma.

Objective: To our report our experience with the laparoscopic placement of peritoneal access ports and to compare it to our experience with placement at laparotomy.

Methods: Patients with advanced ovarian carcinoma were enrolled in a study to receive intraperitoneal paclitaxel in combination with intravenous cisplatin and cyclophosphamide as first- or second-line chemotherapy. Patients had a PAP catheter placed at primary laparotomy or by a separate laparoscopic procedure under general anesthesia.

[Hysteroscopic sterilization using Ovabloc].

The authors give an account on 29 sterilizations made by the hysteroscopic route, using the preparation OVABLOC. It is a reversible block of the oviducts by occlusive material. Under hysteroscopic control into the inner orifice of the oviduct by means of a special injecting device under pressure a two-component mixture of silicone and a catalyst is instilled which causes within 5 min.

[Hysteroscopic resection of myomas].

The authors give an account of their initial experience with hysteroscopic resection of myomas. During the investigation period (January 1991-August 1992) 34 of these operations were performed. In all instances at the same time laparoscopy was performed.

[Tubal abnormalities: predisposing factor for extrauterine pregnancy in in-vitro fertilization].

Objective: Determination of the difference in percentages of ectopic pregnancies in patients with and without tubal pathology after in-vitro fertilisation and consequences for prevention.

Setting: Thirteen IVF clinics in the Netherlands.

Method: The clinics submitted data on clinical and ectopic pregnancies and the indication for IVF from the years 1990 and 1991.

Symptomatology, localization and treatment of recurrent cervical carcinoma.

In a group of 367 women treated for invasive carcinoma of the cervix tumor recurrence was discovered at an asymptomatic stage in 16 (23%) patients. The tumor recurrence was localized to the pelvis in 29 (41%) cases, in the vaginal wall in 3 (4%) cases, and 39 (55%) patients had distant metastases (with or without recurrent tumor in the pelvis). Curative treatment (surgery, n = 2; radiotherapy, n = 8) was applied in 5/29 (17%) patients whose recurrent disease was confined to the pelvis, in all 3 patients with vaginal recurrence and in 2/39 (5%) of the patients with distant metastases.

Patients with squamous cell versus adeno(squamous) carcinoma of the cervix, what factors determine the prognosis?

Patients with squamous cell carcinoma of the cervix FIGO stages IB to IV (n = 306) were compared to patients with adeno(squamous) carcinoma (n = 70). There was no difference between the mean ages of the groups. In the patients who underwent radical surgical treatment, whether or not in combination with radiotherapy (n = 209), stepwise regression analysis showed that a positive lymph node status was the most unfavorable prognostic factor, followed by the histologic type (adeno(squamous) carcinoma) and the tumor diameter (> 3 cm).

Compensatory mechanisms which prevent urinary incontinence in aging women.

The relationship between age and urodynamic parameters was studied cross-sectionally in a group of 28 women in whom clinically and urodynamically both stress incontinence and detrusor instability were excluded (no proven incontinence, NPI) and in a group, matched for age, with genuine stress incontinence (GSI). At all ages the maximal urethral closing pressure (MUCP) was higher in the NPI than in the GSI group; in both groups there was, however, a similar decrease in MUCP with age. The transmission rate increased significantly with age in the NPI group; this was not found in the women with GSI.

Perineal ultrasonography in women with stress incontinence and controls: the role of the pelvic floor muscles.

With a curved array real-time ultrasound scanning machine and the probe placed sagitally onto the vulva, symphysis, bladder, urethra and the pelvic floor can be visualized in one frame. With this technique we studied 10 women with stress incontinence and 10 control women. In both groups active contraction of the pelvic floor resulted in a similar elevation of the urethrovesical junction (UVJ).

Prognostic significance of single versus multiple lymph node metastases in cervical carcinoma stage IB.

From January 1, 1970, to December 31, 1985, 51 patients with stage IB (FIGO) carcinoma of the cervix with lymph node metastases were treated at the University Hospital, Groningen, The Netherlands. The survival rate was 54% and the average duration of follow-up was 78 months (range 47-132). Important clinical variables for survival were investigated retrospectively: the survival rate in patients with a single lymph node metastasis (with tumor confined to the node itself) (n = 23) appeared to be much better than that of patients with multiple node involvement and/or single nodes with extranodular tumor infiltration (n = 28); survival was 85 and 24%, respectively (P less than 0.

Detection, prevalence, and prognosis of asymptomatic carcinoma of the cervix.

Between 1979-1986, 82 of 407 patients (20%) treated for infiltrative carcinoma of the cervix were asymptomatic at the time of diagnosis. Sixteen (20%) of these 82 patients had stage IA, 60 (73%) had stage IB, and six (7%) had stage IIA disease. Asymptomatic patients represented 16 of 23 (70%) of stage IA, 60 of 196 (31%) of stage IB, and six of 77 (8%) of stage IIA.

Doubling time and hCG score for the early diagnosis of ectopic pregnancy in asymptomatic women.

In a group of 20 asymptomatic women at increased risk for ectopic pregnancy, serum analyses were conducted prospectively early in pregnancy (amenorrhea less than or equal to 45 days) at 2-4-day intervals, to examine the rate of increase in hCG values. The initial serum hCG level, which was determined at the time of the first transvaginal ultrasound examination, was below the discriminatory zone of 1000 IU/l (2nd International Standard). In 8 out of the 9 women who were ultimately diagnosed as having an ectopic pregnancy, the increase in hCG progressed only slowly, with a doubling time exceeding 2.

Radical surgery compared with intracavitary cesium followed by radical surgery in cervical carcinoma stage IB. Analysis of patients less than or equal to 45 years of age with small tumors with regard to treatment results and ovarian preservation in the primary surgery group.

Forty-nine patients aged less than or equal to 45 years, with cervical carcinoma stage IB (less than or equal to 3 cm) were treated with either primary radical surgery (n = 26), or intracavitary irradiation followed by radical surgery (n = 23). With primary surgery, ovarian function had been preserved in 15 of the 25 patients, who were alive and well. Seven of the primary surgery patients were irradiated postoperatively and 2 others with a central recurrence were cured by irradiation.

Is there a role for simple hysterectomy after irradiation for bulky cervical carcinoma?

Twenty eight patients with bulky cervical carcinoma, who were treated by irradiation and simple hysterectomy, were studied. Eight of these patients had non-radical pre-operative irradiation. The patients had various FIGO-stages.

Factors related to semen improvement and fertility after varicocele operation.

Factors related to semen improvements and fertility after high ligation of the left internal spermatic vein were investigated in 97 men from infertile couples. Changes in some semen characteristics after operation suggest a relationship between varicocele size and semen improvements and an inverse relationship between preoperative semen values and semen improvements. An inverse relationship seemed to exist between varicocele grades and deterioration of semen values.