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Biomedical subjects

A M Weber

Publications and source records attributed to A M Weber.

At least 19 recordsLinked to original sources
PubMed2002

The cost-effectiveness of preoperative testing (basic office assessment vs. urodynamics) for stress urinary incontinence in women.

OBJECTIVE: To compare the cost-effectiveness of preoperative testing strategies in women with stress incontinence symptoms, as although urodynamic testing is used to improve the diagnostic accuracy in women with incontinence, the clinical and economic consequences of different levels of testing have not been evaluated. MATERIALS AND METHODS: Decision analysis was used to evaluate basic office assessment (BOA) and urodynamic testing for women with stress incontinence symptoms who were candidates for primary surgical treatment. Costs were calculated using the Federal Register. Parameter estimates for the effectiveness of treatment for different diagnoses of incontinence were based on published reports. Incremental cost-effectiveness was defined as the cost in dollars per additional patient cured of incontinence. RESULTS: Urodynamics did not improve the effectiveness of treatment; both strategies of a BOA and urodynamic testing resulted in a cure rate of 96% after initial and secondary treatments. The mean cost of care (including initial and secondary treatments and outcomes) was similar for the two strategies ($5042 for BOA, $5046 for urodynamic testing). With BOA reduced testing costs were balanced by increased costs for patients who failed the initial treatment. Under baseline assumptions, one additional cure of incontinence (incremental cost-effectiveness) using the urodynamic strategy cost $3847, compared with BOA. By sensitivity analyses, BOA was less costly than urodynamics when the prevalence of genuine stress incontinence was > or = 80%. CONCLUSION: These findings do not support the routine use of urodynamics before surgery in women likely to have genuine stress incontinence, and provide the justification for randomized trials of preoperative testing strategies.

Aged↗
PubMed2001

The standardization of terminology for researchers in female pelvic floor disorders.

The lack of standardized terminology in pelvic floor disorders (pelvic organ prolapse, urinary incontinence, and fecal incontinence) is a major obstacle to performing and interpreting research. The National Institutes of Health convened the Terminology Workshop for Researchers in Female Pelvic Floor Disorders to: (1) agree on standard terms for defining conditions and outcomes; (2) make recommendations for minimum data collection for research; and (3) identify high priority issues for future research. Pelvic organ prolapse was defined by physical examination staging using the International Continence Society system. Stress urinary incontinence was defined by symptoms and testing; 'cure' was defined as no stress incontinence symptoms, negative testing, and no new problems due to intervention. Overactive bladder was defined as urinary frequency and urgency, with and without urge incontinence. Detrusor instability was defined by cystometry. For all urinary symptoms, defining 'improvement' after intervention was identified as a high priority. For fecal incontinence, more research is needed before recommendations can be made. A standard terminology for research on pelvic floor disorders is presented and areas of high priority for future research are identified.

Fecal Incontinence↗
PubMed2001

Sugar composition of biofilms produced by paper mill bacteria.

Biofilms of paper mill bacteria were cultivated in paper mill white water-simulating conditions on glass slides or stainless steel coupons in a laboratory culture system. The sugar content and composition of the biofilms were analysed and compared with the sugar composition of paper mill slimes. Acid methanolysis followed by gas chromatography revealed that Burkholderia was the major biofilm producer in pure culture, producing up to 50 microg of biofilm sugar cm(-2) in 5 days in rich medium and 10 microg in paper mill simulating medium. A mixture of simulated paper mill water with a culture medium yielded more biofilm (100 microg cm(-2)) than either of the media alone, so the biofilm accumulation was not proportional to the available substrate. More biofilm accumulated on stainless steel coupons than on glass slides, and the steel-coupon biofilms contained slightly more uronic acids. The biofilm sugars contained mainly galactose, glucose, mannose, and rhamnose. In paper mill medium, the Burkholderia biofilm contained more galactose and glucose, and less rhamnose, than in rich laboratory medium. The sugar composition of paper mill slimes was quite similar to those of steel-cultured Burkholderia cepacia biofilms. This suggests that Burkholderia cepacia is responsible for much of the slime in the paper mill.

Biofilms↗
PubMed2001

Functional and anatomic follow-up of enterocele repairs.

OBJECTIVE: To identify the functional and anatomic outcomes in women who have surgery for pelvic organ prolapse with enterocele repair. METHODS: Fifty-four women had surgery for pelvic organ prolapse which included enterocele repair. Preoperative and postoperative examinations were done by a research nurse, including a pelvic examination using the International Continence Society staging system and standardized questionnaires about bowel function, sexual function, and prolapse symptoms. RESULTS: Fifty-four women had enterocele repairs as part of their surgery. Mean follow-up time was 16 months (range 6-29 months). Postoperatively five women were excluded from the analysis because of fluctuation in stage of prolapse over time. At the apex and posterior wall of the vagina, 33 women had stage 0 or I prolapse, and 16 had stage II prolapse. None had stage III or IV prolapse. Fifty-three percent of women had improvement in bowel function and 91% had improvement in vaginal prolapse symptoms. Functional outcomes were not significantly different in women with and without stage II prolapse at follow-up. CONCLUSION: Most women who had surgery for pelvic organ prolapse with enterocele repair reported improvement in vaginal prolapse symptoms. Functional outcomes did not differ significantly between women with stage 0 and I prolapse and women with stage II prolapse at the vaginal apex and posterior vaginal wall. This was an observational study and the lack of statistically significant findings could result from inadequate sample size; however, the observed differences were judged to be not clinically significant.

Defecation↗
PubMed2001

Enterocele: is there a histologic defect?

OBJECTIVE: To examine the histology of the vaginal wall in women with an enterocele confirmed by physical examination, cystoproctography, and intraoperative exploration. METHODS: Thirteen women with posthysterectomy apical and posterior wall prolapse were evaluated with a detailed physical examination, cystoproctography, and intraoperative exploration. All women had enterocele repair. A specimen of full thickness vaginal wall from the leading edge of the enterocele was excised and examined histologically. The histology of these patients was compared with the histology of two comparison groups, five women undergoing hysterectomy without prolapse and 13 women undergoing radical hysterectomy. RESULTS: One woman with an enterocele repaired intraoperatively did not have an enterocele by cystoproctography. One woman with an enterocele repaired intraoperatively did not have an enterocele detected by physical examination. All women with an enterocele repaired had an intact vaginal wall muscularis. No woman had vaginal wall epithelium in direct contact with the peritoneum. The average vaginal wall muscularis thickness in women with enteroceles was 3.5 +/- 1.4 mm, in women with no prolapse 3.2 +/- 0.8 mm, and in women undergoing radical hysterectomy 2.8 +/- 0.9 mm. CONCLUSION: Women with enteroceles have a well-defined vaginal muscularis between the peritoneum and vaginal epithelium.

Aged↗
PubMed2001

Degradation of paper mill water components in laboratory tests with pure cultures of bacteria.

The degradation of dissolved and colloidal substances from thermomechanical pulp (TMP) by bacteria isolated from a paper mill was studied in a laboratory slide culture system. Burkholderia cepacia strains hydrolysed triglycerides to free fatty acids, and the liberated unsaturated fatty acids were then degraded to some extent. Saturated fatty acids were not notably degraded. However, the branched anteiso-heptadecanoic fatty acid was degraded almost like the unsaturated fatty acids. About 30% of the steryl esters were degraded during 11 days, increasing the concentrations of free sterols. Approximately 25% of the dehydroabietic, and 45% of the abietic and isopimaric resin acids were degraded during 11 days. The degree of unsaturation seemed to be of greater importance for the degradation of fatty acids than the molar mass. No degradation of dissolved hemicelluloses could be observed with any of the nine bacterial strains studied. Burkholderia cepacia strains and one Bacillus coagulans strain degraded monomeric fructose and glucose in winter TMP water, but in summer TMP water, with much lower sugar concentrations, also other Bacillus strains degraded monomeric sugars.

Bacillus↗
PubMed2001

Anterior colporrhaphy: a randomized trial of three surgical techniques.

OBJECTIVE: The purpose of this study was to compare outcomes after anterior colporrhaphy with the use of 3 different surgical techniques. STUDY DESIGN: One hundred fourteen women with anterior vaginal prolapse were randomly assigned to undergo anterior repair by one of 3 techniques: standard, standard plus polyglactin 910 mesh, or ultralateral anterior colporrhaphy. Before and after operation, patients underwent physical examination staging of prolapse; the International Continence Society system was used. Symptoms were assessed by questionnaire and visual analog scales. We defined "cure" as satisfactory (stage I) or optimal (stage 0) outcome at points Aa and Ba. RESULTS: Of 114 patients who were originally enrolled, 109 patients underwent operation, and 83 patients (76%) returned for follow-up. Mean age (+/- SD) was 64.7 +/- 11.1 years. At entry, 7 patients (7%) had stage I anterior vaginal prolapse; 35 patients (37%) had stage II anterior vaginal prolapse; 51 patients (54%) had stage III anterior vaginal prolapse; and 2 patients (2%) had stage IV anterior vaginal prolapse. At a median length of follow-up of 23.3 months, 10 of 33 patients (30%) who were randomly assigned to the standard anterior colporrhaphy group experienced satisfactory or optimal anatomic results, compared with 11 of 26 patients (42%) with standard plus mesh and with 11 of 24 patients (46%) with ultralateral anterior colporrhaphy. The severity of symptoms that were related to prolapse improved markedly (preoperative score, 6.9 +/- 2.7; postoperative score, 1.1 +/- 0.8). Twenty-three of 24 patients (96%) no longer required manual pressure to void after operation. CONCLUSION: These 3 techniques of anterior colporrhaphy provided similar anatomic cure rates and symptom resolution for anterior vaginal prolapse repair. The addition of polyglactin 910 mesh did not improve the cure rate compared with standard anterior colporrhaphy.

Aged↗
PubMed2001

Is urethral pressure profilometry a useful diagnostic test for stress urinary incontinence?

Urethral pressure profilometry is commonly used as a diagnostic test for stress urinary incontinence. The objective of this article is to review the published literature on urethral pressure profilometry to summarize its usefulness. MEDLINE was used to search the published English literature from 1966 to October 2000 for full-length original research articles on urethral pressure profilometry and stress urinary incontinence in women. Terms related to urethral pressure profilometry are defined consistently but techniques are not standardized, introducing variation in test results. Reproducibility of urethral pressure profilometry parameters is poor, both because of biological variation and variation within the test procedure itself (related in part to lack of standardization). Parameters of urethral pressure profilometry do not distinguish between continent and incontinent women and do not characterize the severity of incontinence or urethral incompetence. It is, therefore, concluded that urethral pressure profilometry is not a useful diagnostic test for stress urinary incontinence in women. Its use in clinical management is not supported by current evidence.

Adult↗
PubMed2001

Leak point pressure measurement and stress urinary incontinence.

This article reviews literature on leak point pressure (LPP) measurement as a diagnostic test for stress urinary incontinence in women. LPP is not consistently defined and techniques are not standardized, introducing variation in test results. Reproducibility of LPP is poor, both because of biological variation and variation within the test procedure itself (related in part to lack of standardization). Although not well studied, LPP values do correspond to the severity of incontinence symptoms, as a quantitative indication of the level of urethral dysfunction. However, there is no prospective evidence to support the commonly used cutoff of 60 cm H2O as an indication of intrinsic sphincter deficiency. LPP is potentially useful as a clinical and research tool for evaluating stress urinary incontinence in women. However, its use in clinical management is not well supported by evidence and further research is critically important to define its role.

Aged↗
PubMed2000

Transmission of Mycobacterium tuberculosis from medical waste.

CONTEXT: Washington State has a relatively low incidence rate of tuberculosis (TB) infection. However, from May to September 1997, 3 cases of pulmonary TB were reported among medical waste treatment workers at 1 facility in Washington. There is no previous documentation of Mycobacterium tuberculosis transmission as a result of processing medical waste. OBJECTIVE: To identify the source(s) of these 3 TB infections. DESIGN, SETTING, AND PARTICIPANTS: Interviews of the 3 infected patient-workers and their contacts, review of patient-worker medical records and the state TB registry, and collection of all multidrug-resistant TB (MDR-TB) isolates identified after January 1, 1995, from the facility's catchment area; DNA fingerprinting of all isolates; polymerase chain reaction and automated DNA sequencing to determine genetic mutations associated with drug resistance; and occupational safety and environmental evaluations of the facility. MAIN OUTCOME MEASURES: Previous exposures of patient-workers to TB; verification of patient-worker tuberculin skin test histories; identification of other cases of TB in the community and at the facility; drug susceptibility of patient-worker isolates; and potential for worker exposure to live M tuberculosis cultures. RESULTS: All 3 patient-workers were younger than 55 years, were born in the United States, and reported no known exposures to TB. We did not identify other TB cases. The 3 patient-workers' isolates had different DNA fingerprints. One of 10 MDR-TB catchment-area isolates matched an MDR-TB patient-worker isolate by DNA fingerprint pattern. DNA sequencing demonstrated the same rare mutation in these isolates. There was no evidence of personal contact between these 2 individuals. The laboratory that initially processed the matching isolate sent contaminated waste to the treatment facility. The facility accepted contaminated medical waste where it was shredded, blown, compacted, and finally deactivated. Equipment failures, insufficient employee training, and respiratory protective equipment inadequacies were identified at the facility. CONCLUSION: Processing contaminated medical waste resulted in transmission of M tuberculosis to at least 1 medical waste treatment facility worker. JAMA. 2000;284:1683-1688.

Adult↗
PubMed2000

Clinical presentation of enterocele.

OBJECTIVE: To characterize preoperative signs and symptoms in women with and without enteroceles. METHODS: Three hundred ten women completed preoperative questionnaires and had prolapses graded according to the International Continence Society system. Signs and symptoms in 77 women (25%) with enteroceles confirmed at surgery were compared with those in 233 women without enteroceles. Comparisons were tested for statistical significance with chi(2) tests, Fisher exact tests, Wilcoxon rank-sum tests, and analysis of covariance. RESULTS: Women with enteroceles were statistically significantly older (median 67 versus 59 years, P <.001) and more likely to be postmenopausal (88% versus 76%, P =.04). More women with enteroceles had histories of hysterectomies (76% versus 39%, P =.001) and vaginal prolapse repairs (24% versus 11%, P =.008). Women with enteroceles had more advanced prolapses at points Ap, Bp, and C (all P <.001) but not point D. There were no significant differences in symptoms related to bowel function (infrequent bowel movements, straining, manual evacuation, and fecal incontinence) in women with and without enteroceles. Women with enteroceles were more bothered by symptoms caused by vaginal prolapse than women without enteroceles, but not after we controlled for stage of prolapse. CONCLUSION: Women with enteroceles have more advanced apical and posterior vaginal prolapses than women without enteroceles, but do not differ from them in bowel function.

Adult↗
PubMed2000

Burch procedure compared with sling for stress urinary incontinence: a decision analysis.

OBJECTIVE: To compare the relative risks and benefits of Burch colposuspension and sling procedure for primary genuine stress urinary incontinence in women. METHODS: We developed a decision analytic model to compare Burch procedure and sling for primary surgical treatment of genuine stress incontinence with urethral hypermobility in women. Risks and benefits were estimated from published literature. The main outcome measure was effectiveness of treatment, defined as cure of incontinence after initial and secondary treatments. We considered four outcomes of primary surgical treatment: cure, persistent incontinence (either caused by intrinsic sphincter deficiency without urethral hypermobility or genuine stress incontinence with hypermobility), de novo detrusor instability, and permanent urinary retention. Secondary treatment included repeated surgery for genuine stress incontinence, collagen injection for intrinsic sphincter deficiency, medical treatment for detrusor instability, and urethrolysis for retention. One-way sensitivity analyses were used to estimate the effect of varying each characteristic through its range; all other characteristics were fixed at their baseline values. RESULTS: The overall effectiveness of Burch and sling operations (percentages of women cured after initial and secondary treatments) was similar (94.8% and 95.3%, respectively). In sensitivity analyses, the Burch arm of the model was more effective than sling when the risk of retention after sling was higher than 9.0% or when the risk of de novo detrusor instability after sling was higher than 10.3%. Conversely, when the risk of de novo detrusor instability after Burch was higher than 6.8%, the sling arm of the model was more effective. CONCLUSION: The Burch and sling procedures are similarly effective for primary surgical treatment of genuine stress incontinence in women. Overall effectiveness is substantially influenced by relative rates of complications.

Decision Support Techniques↗
PubMed2000

Intraoperative cystoscopy in conjunction with anti-incontinence surgery.

OBJECTIVE: To determine the frequency of lower urinary tract injury detected by routine intraoperative cystoscopy after anti-incontinence surgery. METHODS: We reviewed charts from women who had anti-incontinence surgery and routine intraoperative cystoscopy done by a single surgeon from June 1, 1995, to June 1, 1998, and assessed preoperative and intraoperative variables. RESULTS: We reviewed 351 patient records. Four records were incomplete and there were nine injuries in the other 347 cases (2.6%, 95% confidence interval [CI] 1.2, 4.9). Four cystotomies occurred during laparoscopic Burch procedures and were detected before cystoscopy. Five injuries were detected at cystoscopy, a rate of 1.5% (95% CI 0. 5, 3.4). Four injuries occurred during 161 pubovaginal sling procedures (2.5%, 95% CI 0.7, 6.2). One woman had sutures in her bladder from a prior procedure detected at cystoscopy. In 186 Burch procedures (48 laparoscopic, 138 open), there were no previously unrecognized injuries detected by cystoscopy. All injuries were repaired during original surgery. It was not possible to assess preoperative and intraoperative risk factors because of the low rate of injury. CONCLUSION: The rate of injury to the lower urinary tract during anti-incontinence surgery in this series was 2.6% (95% CI 1.2, 4.9). Injuries during Burch procedures were all detected before cystoscopy.

Aged↗
PubMed2000

Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence.

OBJECTIVE: We sought to describe sexual function in women before and after surgery for either prolapse or urinary incontinence, or both. STUDY DESIGN: Women completed questionnaires, and vaginal dimensions were measured before and at least 6 months after surgery for prolapse or incontinence. Comparisons were made with signed-rank tests or the McNemar test. RESULTS: Eighty-one (49%) of 165 women were sexually active before and after surgery; their mean age was 54. 0 +/- 9.9 years. Mean frequency of intercourse did not change. Dyspareunia was reported by 6 (8%) women preoperatively and 15 (19%) women after surgery; dyspareunia persisted postoperatively in 1 woman, developed in 14, and resolved in 5 (P =.04). Dyspareunia occurred in 14 (26%) of 53 women after posterior colporrhaphy (P =. 01) and in 8 (38%) of 21 women who had Burch colposusupension and posterior colporrhaphy performed together (P =.02). Vaginal dimensions decreased slightly after surgery; however, this did not correlate with any change in sexual function. Preoperatively, 66 (82%) women were satisfied with their sexual relationships, compared with 71 (89%) who were satisfied postoperatively. CONCLUSION: Sexual function and satisfaction improved or did not change in most women after surgery for either prolapse or urinary incontinence, or both. However, the combination of Burch colposusupension and posterior colporrhaphy was especially likely to result in dyspareunia.

Adult↗
PubMed2000

Cost-effectiveness of urodynamic testing before surgery for women with pelvic organ prolapse and stress urinary incontinence.

OBJECTIVE: This study was undertaken to compare cost-effectiveness between 2 preoperative testing strategies for women with pelvic organ prolapse and stress urinary incontinence symptoms. STUDY DESIGN: We developed decision-analytic models that evaluated the cost-effectiveness of basic office evaluation before surgery in women with prolapse and stress urinary incontinence symptoms and contrasted it with that of urodynamic testing. Costs were obtained from the Federal Register; effectiveness of treatment for urinary incontinence was based on the published literature. RESULTS: The strategies of basic office evaluation and urodynamic testing had the same cure rate of urinary incontinence (96%) after initial and secondary treatment. Under baseline assumptions incremental cost-effectiveness (cost for single extra cure of urinary incontinence) of urodynamic testing was $328,601. According to sensitivity analyses, basic office evaluation was more cost-effective than urodynamic testing when the prevalence of pure detrusor instability was <8% or when the cost of urodynamic testing was >$103. CONCLUSION: Urodynamic testing before surgery in women with prolapse and stress urinary incontinence symptoms is not cost-effective relative to basic office evaluation.

Cost-Benefit Analysis↗
PubMed1999

Functional outcomes and satisfaction after abdominal hysterectomy.

OBJECTIVES: Our aim was to compare urinary, lower gastrointestinal, and sexual function and to describe patients' expectations and satisfaction before and after hysterectomy. STUDY DESIGN: Forty-three women completed questionnaires before and about 1 year after abdominal hysterectomy for benign gynecologic conditions. Symptoms related to urinary, lower gastrointestinal, and sexual function and satisfaction with treatment were assessed. To account for multiple comparisons, only P </=.002 was considered statistically significant. RESULTS: There were no statistically significant changes in urinary or bowel symptoms before and after hysterectomy, with preoperative symptoms resolving in some women after surgery and developing in others. Sexual function including orgasmic ability did not change in the 34 sexually active women. The level of satisfaction with treatment was very high. CONCLUSIONS: Women experience high degrees of satisfaction and no consistent changes in urinary, lower gastrointestinal, or sexual function after abdominal hysterectomy for benign gynecologic conditions.

Adult↗