摘要:

ObjectiveTo assess the efficacy of cyclic postmenopausal hormone replacement in treating urinary incontinence in hypoestrogenic women.MethodsEighty-three hypoestrogenic women complaining of urinary incontinence were included. All patients were community-dwelling, age 45 years or older, with involuntary loss of urine occurring at least once a week and urodynamic evidence of genuine stress incontinence and/or detrusor instability. Evaluation consisted of a comprehensive clinical and urodynamic research protocol. The hypoestrogenic entry criterion was a plasma estradiol level of 30 pg/mL or less. Parabasal cells on vaginal smears were also monitored. The primary outcome was the number of incontinent episodes per week, as documented on a standardized urinary diary. Secondary outcomes were the quantity of fluid loss, voluntary diurnal and nocturnal micturition frequency, generic and condition-specific health-related quality of life measurements, and patient satisfaction. A randomized, placebo-controlled, double-blind design was used. Subjects in the treatment group were given conjugated equine estrogens (0.625 mg) and medroxyprogesterone (10 mg) cyclically for 3 months. Controls received placebo tablets.Results(All results are presented as mean ± standard deviation.) Subjects were 67 ± 9 years old. The menopause duration was 18 ± 11 years. The duration of incontinence was 9 ± 9 years. Estradiol level at baseline was 9 ± 9 pg/mL, and the parabasal cell count was 42 ± 44%. The number of incontinent episodes at baseline was 13 ± 10 for the treatment group and 16 ± 4 for controls. No significant changes occurred in the number of incontinent episodes after treatment: 10 ± 10 for the treatment group, and 13 ± 14 for the controls (P= .7). Also, fluid loss was not changed: 176 ± 106 g for the treatment group and 64 ± 88 g for the control group at baseline, and 101 ± 150 and 51 ± 69 g after treatment, respectively (P= .7). There were no significant differences for either diurnal or nocturnal voluntary micturition, quality of life measures, or patient's perception of improvement.ConclusionThree-month cyclic hormone replacement therapy did not affect either clinical or quality of life variables of incontinent, hypoestrogenic women. Long-term effects are unlikely to be substantially different. The use of estrogen supplementation as preventive or adjuvant therapy was not evaluated in this study.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo define the urethral structures visible on magnetic resonance imaging (MRI) relevant to stress urinary incontinence.MethodsThe urethra and surrounding tissues were harvested from 13 female cadavers (ages 21–81) and fixed in 10% buffered formalin. High-resolution T1- and T2-weighted images were obtained at 1.5 tesla. Mallory trichrome-stained histologic sections were prepared in corresponding planes from the cadaveric specimens. Immunohistologic stains for smooth muscle (actin) and vascular endothelium (CD-34 and factor VIII) were obtained on two specimens. Histology and MRI were compared using side-by-side correlation of projected images and by superimposing projected images. Comparison was also made to a non-cadaveric urethral MRI of a 29-year-old woman and to the MRI of another specimen imaged pre- and post-fixation.ResultsDistinct layers of the cadaveric urethra were seen best on proton density and T2-weighted images. From the center to the periphery, a series of concentric rings were visible: an inner bright ring, the mucosa; a dark ring, the submucosa; an outer bright ring, the smooth muscle of the urethra in a loose connective tissue matrix; and a peripheral dark ring, the striated urogenital sphincter muscle of the urethra in dense connective tissue. No significant alterations were caused by fixation. These cadaveric images matched the non-cadaveric MRI of the 29-year-old woman.ConclusionThe internal urethral anatomy visible on high-resolution MRI can be identified and confirmed histologically, and these findings may form the basis for future anatomic investigation of stress urinary incontinence and other urethral abnormalities.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo determine the efficacy and safety of transvaginal pelvic floor stimulation in the treatment of women with genuine stress incontinence and detrusor instability complicated by a low-pressure urethra.MethodsTwenty-six consecutive women with mixed incontinence complicated by a low-pressure urethra who elected to try pelvic floor stimulation were studied. Visual analogue symptom scales and weekly incontinence episodes were compared before and after 8 weeks of twice-daily device use.ResultsThe symptoms of stress and urge incontinence were completely resolved in six (23%) and ten (38%) women, respectively. Ten of 26 subjects (38%) had greater than 50% overall symptomatic improvement, and two subjects (8%) were completely dry during their last week of therapy. Symptoms of urinary frequency, urgency, and stress incontinence improved significantly. No factors were found to be predictive of treatment success.ConclusionPelvic floor stimulation was found to be an effective and safe treatment for some patients with genuine stress incontinence and detrusor instability complicated by a low-pressure urethra.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo assess the effect of intracervical injection of dilute (0.05 U/mL) vasopressin solution on blood loss during operative hysteroscopy.MethodsIn a randomized, double-blind study, dilute vasopressin solution or placebo (normal saline) was injected into the cervical stroma of 106 women before dilation of the cervix in preparation for operative hysteroscopy. Intraoperative bleeding was calculated by dividing the number of red blood cells per milliliter of outflow distention fluid by the number of red blood cells per milliliter of the woman's blood immediately before the procedure and multiplying this quotient by the total amount of outflow fluid collected. Pressures were kept constant with a hysteroscopic infusion pump.ResultsThe mean (± standard error of the mean) intraoperative blood loss of the treated (vasopressin) and control (placebo) groups was 20.3 ± 4.1 mL (range 0–135) and 33.4 ± 5.4 ml, (range 0–290), respectively. The volume of distention fluid intravasation in the treated and control groups was 448.5 ± 47.0 ml, (range 30–1410) and 819.1 ± 79.7 mL (range 20–1977), respectively. The operating time in the treated and control groups was 31.1 ± 1.2 minutes (range 18–52) and 34.1 ± 1.3 minutes (range 19–65), respectively. For all three outcome measures, the differences between the two groups were statistically significant, but for visual clarity of the uterine cavity during surgery, the difference was not significant.ConclusionAdministration of dilute vasopressin solution (0.05 U/mL) to the cervical stroma significantly reduces blood loss, distention fluid intravasation, and operative time during hysteroscopy. Further evaluation is required to determine the optimum dosage.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo determine if women who have undergone transcervical resection of the endometrium can be treated safely with estrogens alone.MethodsSixty-two postmenopausal women who had undergone endometrial resection were recruited into a double-blind, randomized study. Twenty-one had menopausal symptoms at the primary operation and were recruited at the time of the surgery, and 38 were recruited an average of 20 months (range 8–42) after the primary endometrial resection and underwent a second resection to remove any residual endometrium before entering the study. Three patients were excluded from the study. Subjects were allocated randomly to one of two hormone replacement therapy (HRT) regimens: 17-β-estradiol 2 mg alone or combined with norethisterone 1 mg. Clinical and ultrasound data were collected every 3 months. Hysteroscopically standardized endometrial biopsies were taken after 1 year.ResultsIn the single-agent therapy group, endometrial hyperplasia without atypia was found in six subjects and proliferative endometrium in eight after 1 year. No such cases occurred among women receiving combined therapy. Endometrial thickness and menstrual bleeding were significantly greater in the single-agent therapy group than in those receiving combined therapy. These differences between single-agent and combined therapy were statistically significant.ConclusionPostmenopausal HRT in patients who have undergone transcervical resection of the endometrium should include progestagen for protection of the endometrium.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo evaluate whether thermal energy produced by laser and bipolar electrosurgery during laparoscopic procedures significantly elevates blood carboxyhemoglobin levels.MethodsWe prospectively studied 27 healthy nonsmoking patients, mean ± standard deviation (SD) age 39.1 ± 8.0 years (range 22–56), scheduled for laparoscopic procedures in which smoke was generated. Prolonged operative laparoscopy involved high-flow carbon dioxide insufflation, intensive evacuation of intra-abdominal smoke, and controlled hyperventilation with 50–100% oxygen. Laser and bipolar electrosurgery were used in all cases. Blood samples were drawn before and after surgery. Carboxyhemoglobin concentrations were measured using a highly accurate gas chromatography method.ResultsThe mean ± SD duration of surgery was 141 ± 72 minutes (range 45–300). The mean ± SD carboxyhemoglobin levels were 0.70 ± 0.15% (range 0.44-1.20%) before surgery and 0.58 ± 0.20% (range 0.30-1.33%) after surgery. A significant decrease (P<.001) in carboxyhemoglobin concentrations occurred during surgery (mean ± SD, 20 - 11%; range 3–46%). The carboxyhemoglobin level was increased at the end of surgery in only one woman. In only one patient did the levels exceed 1% (1.33%), still well below the human threshold tolerance level of 2%. The Spearman correlation coefficient between carboxyhemoglobin concentrations and duration of surgery wasr= 0.308 (P= .12).ConclusionCarbon monoxide (CO) poisoning is not associated with even prolonged laparoscopic surgical procedures. This may be attributed to aggressive smoke evacuation that minimizes exposure to CO, and to active elimination of CO by ventilation with high oxygen concentrations.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo investigate recovery times and need for laparoscopy in women with ectopic pregnancy who were treated for 5 days 2.5 mg/day of oral methotrexate or placebo.MethodsSixty women with ectopic pregnancy among patients of an outpatient clinic specializing in early pregnancy disorders were selected for medical treatment in a double-blind, placebo-controlled study. The diagnosis was made by transvaginal sonography and serum hCG determinations, either at admission or after repeated examinations. Women were recruited for the study if they had mild symptoms: the hCG increase was less than 50% within 2 days, the diameter of the ectopic pregnancy was less than 40 mm, there were no signs of intra-abdominal bleeding by transvaginal sonography, and there were no secondary reasons for laparoscopy. Either 2.5 mg of methotrexate or placebo was given orally for 5 days. Serum hCG was determined after 2 days, and hCG, red blood cell count, white blood cell count, platelet count, and serum glutamic-oxaloacetic transaminase were measured; transvaginal sonography was performed after 5 and 12 days. Expectant management was continued individually with check-ups at 1–3-week intervals. Laparoscopy was performed if the patient developed abdominal pain or intra-abdominal hemorrhage, as seen by transvaginal sonography. Statistical analysis was by paired or unpairedttest, Mann-WhitneyUtest, regression analysis, and repeated measures analysis of variance.ResultsSeventy-seven percent of the patients recovered without the need for laparoscopy in both groups, and there were no significant differences in recovery times or the need for laparoscopy between groups.ConclusionOral methotrexate, 2.5 mg for 5 days, does not appear to be more effective than placebo in the treatment of ectopic pregnancy in women eligible for expectant management.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo assess whether Doppler indices of intraovarian blood flow are related to the subsequent follicular response in an in vitro fertilization (IVF) program.MethodsOne hundred five women underwent ultrasonographic assessment of ovarian morphology, transvaginal color Doppler measurement of intraovarian blood flow and immunoassay of serum FSH during the early follicular phase of an IVF cycle. The subsequent follicular response was related to the Doppler data.ResultsMean ovarian stromal peak systolic blood flow velocity was significantly correlated with the follicular response (P= .001), even after adjusting for the age of patient, type of ovary (polycystic or normal), total number of human menopausal gonadotropin ampules used, and serum FSH. Mean ovarian stromal pulsatility index was not related to the follicular response. Mean ovarian stromal peak systolic blood flow velocity was significantly lower (P= .007) in the poor-response group. The adjusted odds of a poor response increased significantly by an estimated 22% per cm/second decrease in velocity (P= .02).ConclusionOvarian stromal blood flow at the baseline ultrasound scan is correlated with subsequent follicular response and may be a new indicator for predicting ovarian responsiveness in an IVF program.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo investigate the effects of cigarette smoking on ovarian function and fertility in women undergoing assisted reproduction cycles.MethodsWe assessed the effects of smoking on ovarian function and fertility in a cohort of 499 women. Questionnaires were designed to quantify past smoking exposure and to determine whether the woman was smoking during the treatment cycle. Ovarian function characteristics and pregnancy rates were compared among current smokers, past smokers, and nonsmokers.ResultsCompared with nonsmokers, both current and past smokers have reduced gonadotropin-stimulated ovarian function. A history of increasing tobacco exposure was associated with decreasing serum estradiol concentrations, numbers of retrieved oocytes, and numbers of embryos. On average, for every 10 pack-years of cigarette smoking, 2.5 fewer mature oocytes and 2.0 fewer embryos were obtained. Women who smoked during their treatment cycle had approximately a 50% reduction in implantation rate and ongoing pregnancy rate compared with women who had never smoked. Women who quit smoking before their treatmentcyclehad the same pregnancy rate as nonsmokers.ConclusionCigarette smoking is associated with a prolonged and dose-dependent adverse effect on ovarian function. Smoking appears to have a more transient toxic effect on fertility, because current smokers, but not past smokers, had a markedly reduced pregnancy rate after treatment cycles compared with nonsmokers. Women should quit smoking before assisted reproduction cycles.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective: To find out if ovarian endocrine function is hampered by laparoscopic tubal sterilization.MethodsSalivary progesterone levels were measured in 55 women undergoing a laparoscopic tubal sterilization with Hulka or Filshie clips. The participants were 31–43 years old (mean 37) and were menstruating regularly. The saliva was collected every morning during three menstrual cycles: on the cycle preceding sterilization, and 3 and 12 months after the procedure. Salivary progesterone levels were determined by a radioimmunoassay.ResultsTotal progesterone secreted in the luteal phase declined slowly after the sterilization, resulting in the lowest values 1 year after the procedure (1780 ± 807 versus 2431 ± 1187 pmol/L before surgery,P= .001). The luteal peak progesterone values were lowest 3 months after sterilization (277 # 137 pmol/L). Although the peak progesterone secretion seemed to have started to recover at 12 months (318 ± 171 pmol/L), it was still significantly less than before surgery (378 ± 150 pmol/L,P= .015). The length of the entire menstrual cycle and the lengths of the follicular and luteal phases were not affected.ConclusionAlthough the menstrual pattern was not affected, laparoscopic tubal sterilization caused measureable changes in the luteal function. However, these changes may be temporary in nature.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID