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P Hilton

Publications and source records attributed to P Hilton.

At least 19 recordsLinked to original sources
PubMed2001

Vesico-vaginal fistula: new perspectives.

The present review is based essentially on the literature relating to vesico-vaginal fistulae (VVF) published during the past 2 years. It highlights the major publications regarding aetiology, epidemiology, assessment and management, and indicates my opinions as to the significance of the various contributions. In particular, the route of repair, the value of interposition grafting and the place of diversionary procedures remain topical. Medico-legal aspects of the condition as it arises in the developed world and their impact on management strategies are also covered.

Female↗
PubMed2001

Cellular proliferation in the female lower urinary tract with reference to oestrogen status.

OBJECTIVE: To assess cell proliferation throughout the tissues of the female lower urinary tract and to compare cell proliferation rates in women of varying oestrogen status. DESIGN: Prospective observational study. SETTING: A large teaching hospital. SAMPLE: Fifty-nine women undergoing surgery for urogynaecological conditions of whom 23 were premenopausal, 20 were postmenopausal and taking no oestrogen supplementation and 16 were postmenopausal and receiving some form of hormone replacement therapy. Biopsies were taken during surgery from the bladder dome, trigone, the proximal and distal urethra, vagina and vesico-vaginal fascia in the region of the bladder neck. METHODS: Formalin-fixed paraffin-embedded biopsies were labelled by an avidin-biotin technique with a monoclonal antibody raised against part of the nuclear matrix known as Ki-67 antigen. MAIN OUTCOME MEASURES: Ki-67 expression was assessed in the epithelial, subepithelial and muscle or deep fascial regions of all tissues and related to oestrogen status. RESULTS: Ki-67 expression was only found in high levels in biopsies containing squamous epithelia. Significantly higher levels of Ki-67 expression were observed in the tissues of oestrogen replete women in the premenopausal and hormone replacement groups, compared with postmenopausal women receiving no oestrogen supplementation. CONCLUSIONS: Squamous epithelia of the female lower urinary tract exhibit greater levels of cell proliferation in oestrogen replete as compared with oestrogen deficient women. As these same squamous epithelia also consistently express oestrogen receptors, the findings suggest a mechanism by which oestrogen exerts its effect on the lower urinary tract and also provide an explanation for the success of oestrogen in the treatment of some conditions causing lower urinary tract dysfunction in postmenopausal women.

Cell Division↗
PubMed2001

Prevalence and management of (non-fistulous) urinary incontinence in women following radical hysterectomy for early stage cervical cancer.

OBJECTIVES: 1) to determine the prevalence of urinary incontinence before and after radical surgical treatment for early cervical cancer, 2) to retrospectively analyse the outcome results following the investigation/treatment of incontinence in these women. PATIENTS AND METHODS: 27 women were studied prospectively by questionnaire prior to surgery and six weeks and three months after surgery (group 1). Seventy-seven women who were more than 12 months post-radical surgery were questioned directly at the follow-up clinic (group 2). Three hundred and two satisfactory responses were obtained to questionnaires sent to general practitioners of patients previously treated by radical surgery for early cervical cancer (group 3). RESULTS: 14.8% of women reported regular incontinence prior to surgery, and 48.1% and 29.6% of women, respectively, reported regular incontinence six weeks and three months after surgery; 31.2% of women also reported regular incontinence more than 12 months after post-radical surgery. Of the women in the 12-month post-radical surgery group, 16.6% had considered their symptoms of regular incontinence severe enough to attend their local practice for treatment and 14.6% (44 women) were referred for further management. In six of these 44 patients (13.6%), spontaneous resolution of incontinence occurred at varying intervals within the first 12 months following radical surgery. Twenty-four of the 44 women who were referred underwent urodynamic investigation. Of these 24 women, in 17 cases the diagnosis was genuine stress incontinence (GSI), of which, in seven cases (41%) GSI was the sole urodynamic abnormality. In six of these seven cases (85.7%), the women were cured or very greatly improved following treatment with either physiotherapy or surgery. However, only six of the remaining ten cases (60%) with coexistent abnormalities achieved this result. Patients with coexistent impaired bladder compliance showed the poorest result, as only two of the six cases (33%) achieved satisfactory improvement following treatment. CONCLUSION: Non-fistulous urinary incontinence following radical pelvic surgery for carcinoma of the cervix despite being a common problem shows a significant spontaneous improvement rate within the first 12 months following surgery. Urodynamics should be a mandatory investigation in patients who complain of persisting problems thereafter. Subjective improvement rates for women with genuine stress incontinence alone are in excess of 85%, being comparable to those of women without any prior history of radical pelvic surgery.

Female↗
PubMed2001

The tension-free vaginal tape procedure in women with previous failed stress incontinence surgery.

PURPOSE: The tension-free vaginal tape procedure is an increasingly popular choice for treating female urinary stress incontinence. This ongoing, prospective, open label study presents the results of tension-free vaginal tape surgery at 1 year in women who have previously undergone unsuccessful stress incontinence surgery. MATERIALS AND METHODS: A total of 67 women with previous failed surgery for stress urinary incontinence underwent the tension-free vaginal tape procedure. Treatment outcome was categorized as cure, significant improvement or failure based on cystometry findings and urinary pad loss results at 3 months of followup, and on subjective questioning at 3 months and 1 year of followup. RESULTS: At 12 months 54 women (81%) were cured, 4 (6%) were significantly improved and 9 (13%) were no better. No serious morbidity was noted after the procedure. CONCLUSIONS: The tension-free vaginal tape procedure provides the prospect of a success rate similar to that of a conventional sling procedure in patients with previous failed surgery. It has a low rate of operative complications and postoperative morbidity.

Adult↗
PubMed2000

Oestrogen and progesterone receptor expression in the female lower urinary tract, with reference to oestrogen status.

OBJECTIVE: To assess the incidence and distribution of both oestrogen and progesterone receptors throughout the female lower urinary tract, and to compare receptor expression in women of varying oestrogen status. PATIENTS AND METHODS: The study included 90 women undergoing surgery for urogynaecological conditions; 33 were premenopausal, 26 postmenopausal and taking no oestrogen supplementation, and 31 postmenopausal and receiving some form of hormone-replacement therapy. Biopsies were taken during surgery from the bladder dome, trigone, proximal urethra, distal urethra, vagina and vesicovaginal fascia in the region of the bladder neck. All biopsies were routinely fixed and processed for histopathological assessment, and were then labelled immunohistochemically with monoclonal antibodies directed against human oestrogen (NCL-ERLH2) and progesterone (NCL-PGR) receptors. Both oestrogen and progesterone receptor expression were assessed in the epithelial, subepithelial and muscle/deeper fascial regions of all tissue for overall tissue positivity for each receptor, and by semiquantitative analysis of receptor concentration using histochemical scoring of the tissues. RESULTS: Oestrogen receptors were consistently detected in the squamous epithelia and were consistently absent in the urothelial tissues of the lower urinary tract of all women irrespective of oestrogen status; there was no significant variation in histological score. Progesterone receptor expression was more variable, being mostly subepithelial, and significantly lower in postmenopausal women receiving no oestrogen replacement. CONCLUSION: These findings confirm the female lower urinary tract to be a target organ for the action of oestrogen and progesterone, and shed further light on the areas of the lower urinary tract likely to respond to hormone-replacement therapy. This may have implications for the use of oestrogen supplementation in the treatment of lower urinary tract disorders of postmenopausal women.

Biopsy↗
PubMed2000

Tension-free vaginal tape for primary genuine stress incontinence: a two-centre follow-up study.

OBJECTIVE: To assess the safety and efficacy of the tension-free vaginal tape procedure in the treatment of primary genuine stress incontinence. PATIENTS AND METHODS: A two-centre follow-up study was conducted on 40 women with urodynamically confirmed primary genuine stress incontinence who had a tension-free vaginal tape inserted under local anaesthesia with sedation. Operative details were recorded and all patients followed up both subjectively, and objectively with repeat urodynamic studies and pad testing. RESULTS: The mean (range) age of the women was 51.1 (33-86) years, the median parity 2 (0-4) and mean body mass index 25.1 (19-35). The mean anaesthesia and operative duration was 42 (25-65) min; 93% of the women resumed immediate spontaneous voiding with no need for catheterization. The mean inpatient stay was 2.2 (2-4) days (where 2 days is equivalent to one night in hospital). The follow-up was conducted at a mean interval of 12.3 (6-24) months. Subjectively, 80% of women were cured and 17.5% significantly improved; objectively, genuine stress incontinence was cured in 95%. Symptomatic postoperative detrusor instability was found in 15% of women and symptoms of voiding dysfunction identified in 5% of women. There were no defects in healing or tape rejection. CONCLUSION: The tension-free vaginal tape procedure is a promising new technique that, in this short-term analysis, appears to be safe and effective. Intra-operative complications are uncommon and both hospital stay and recovery are short. Voiding complications are rare but symptomatic postoperative detrusor instability had an incidence of 15%.

Adult↗
PubMed2000

Assessment and investigations for urinary incontinence.

Assessment of a woman complaining of urinary incontinence includes full urological, gynaecological, medical, surgical and drug histories. General, neurological, abdominal and pelvic examinations are undertaken and with the history, enable a presumptive diagnosis to be formulated. Investigations for incontinence should be selected to suit the individual woman's need. Non-specialist investigations include urine testing, completion of a urinary diary and symptom score, pad testing, measurement of residual urine volume and biochemical tests. Specialist investigations include uroflowmetry, conventional and ambulatory cystometry, urethral pressure profilometry and measurement of urethral electrical conductance and leak point pressure. Imaging using ultrasound, X-ray, magnetic resonance or isotopes is sometimes indicated. While neurophysiological testing has little clinical application, cystourethroscopy is of value in various subgroups of women. Thorough assessment and appropriate investigation together result in an accurate diagnosis which in turn allows appropriate treatment for urinary incontinence to be initiated.

Female↗
PubMed1999

The incidence of detrusor instability before and after colposuspension: a study using conventional and ambulatory urodynamic monitoring.

OBJECTIVE: To determine the incidence of detrusor instability (DI) detected by conventional and ambulatory bladder pressure monitoring, any link between urodynamic findings before and after colposuspension, and between patients' symptoms and the urodynamic findings. PATIENTS AND METHODS: Sixty-five patients, scheduled to undergo colposuspension on the basis of pure genuine stress incontinence on conventional cystometrography (CMG), also underwent ambulatory monitoring (AM) before surgery. All were requested to return 3 months afterward for repeat CMG and AM in random order. In all, 56 patients completed all assessments before and after surgery. In addition to the urodynamic assessment, the patients' symptoms before and after surgery were compared using a detailed questionnaire. RESULTS: On AM before surgery, half the patients showed some DI; afterward, the incidence on AM was 70% and on CMG was 27%. However, on AM, 25% of patients who had DI before surgery showed no evidence of it afterward. Of the 19 women who complained of urgency preoperatively, 16 showed DI on preoperative AM. However, of the 37 women denying urgency preoperatively, 12 (32%) also showed evidence of DI on preoperative AM. CONCLUSIONS: There is a significant incidence of DI detected by CMG after colposuspension in patients who are stable before surgery. The incidence of DI on AM was significantly higher than on CMG both before and after surgery. However, the preoperative urodynamic finding of increased DI on AM does not exclusively predict its presence postoperatively on AM or CMG. In addition, a patient history of urgency does not correlate well with the urodynamic findings before or after surgery. Therefore, from this study it appears that the postoperative symptomatic or urodynamic state cannot be predicted reliably from those before surgery.

Adult↗
PubMed1998

Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years' experience in southeast Nigeria.

The aim of the study was to determine the epidemiological background, clinical details and surgical outcome of patients presenting with urogenital fistulae to St Luke's Hospital, Uyo, and the associated VVF Unit at Mbribit Itam, Akwa Ibom State, Nigeria, between January 1970 and December 1994. A retrospective review of hospital operating theater records and case notes was carried out. Clinical details and outcome were assessed for the total cohort of 2484 patients. Epidemiological data were extracted from the case notes of 715 patients presenting between January 1990 and December 1994. Of these 92.2% were of obstetric etiology, 80.3% following neglected obstructed labor, 6.9% following cesarean section, and 5.0% followed ruptured uterus; 4.4% followed pelvic surgery and the remaining 3.4% of miscellaneous causes included malignancy, coital injury, infection and trauma; 8% had a coexisting rectovaginal fistula or third-degree perineal tear. Only 37.3% of patients were aware of their age; the median age of this group was 28 years. Literacy was difficult to judge reliably, although 29% were able to sign their name. Parity ranged from 0 to 17, and only 31.4% of fistulae related to first pregnancies. Although 73.1% were delivered in hospital, in 97.1% labor was initially managed at home, with a traditional birth attendant, in a maternity home, or in church; 34.1% were delivered by cesarean section, although the live-birth rate was only 10.3% in the causative pregnancy. For a variety of reasons 124 women were not operated upon: 1954 underwent only one operation, giving a presumptive cure rate at first operation of 81.2%; 247 underwent two, 116 three, 32 four, and 11 five operations during the study period. The ultimate closure rate was 97.7%, with only 0.6% undergoing urinary diversion. The type and distribution of fistulae recorded in this series is consistent with previous series of largely obstetric fistulae from the developing world. Surgical cure rates are also comparable. The epidemiological background is at variance with previous reports in several respects; this may reflect biosocial differences in the population studied.

Adult↗
PubMed1998

Periurethral injection of autologous fat for the treatment of post-fistula repair stress incontinence: a preliminary report.

The aim of the study was to assess the effectiveness of periurethral injection of autologous fat for the treatment of stress incontinence caused by inherent sphincter weakness in women following the repair of obstetric urogenital fistulae. Ten patients with symptomatic stress incontinence following repair of vesicovaginal or urethrovaginal fistula of obstetric origin were assessed clinically, by cystourethroscopy, and by Valsalva leak-point pressure (VLPP). Four showed some degree of bladder neck mobility and were treated by bladder neck suspension procedures. Six appeared to have pure sphincter weakness and were treated by periurethral injection of autologous fat. For logistic reasons, the initial follow-up was undertaken 2 weeks postoperatively, including clinical assessment and VLPP. Two patients were subjectively cured, 2 improved and 2 perceived no change in their symptoms following the procedure. The symptomatic changes correlated with the operative appearance, and with the subsequent changes in VLPP. Although numbers are small and follow-up short, we feel that these preliminary results justify further investigation of the technique in this most difficult group of patients.

Adipose Tissue↗
PubMed1998

Urodynamic findings in patients with urogenital fistulae.

OBJECTIVE: To assess the feasibility of carrying out a urodynamic investigation in patients with a urogenital fistula and to establish the incidence of abnormal lower urinary tract function in such patients. PATIENTS AND METHODS: Of 38 patients referred within the last 3 years with a diagnosis of lower urinary tract genital fistula, 30 were investigated by dual-channel subtracted cystometry before surgical treatment of their fistula; in addition, urethral pressure profilometry was carried out in 19 patients. Fourteen of the patients had fistulae into the vaginal vault; the urodynamic findings in this subgroup were compared with those of 12 patients with bladder neck and urethrovaginal fistulae. Twenty-six of the 30 patients underwent surgical treatment and 24 (92%) were cured anatomically by their first procedure. Ten patients complained of residual lower urinary tract symptoms and were re-investigated. RESULTS: Of the 38 patients, 47% had genuine stress incontinence, 40% showed systolic detrusor instability and 17% impaired bladder compliance. Half had evidence of voiding dysfunction; most appeared to be of a hypotonic detrusor type, although four cases showed an obstructive pattern. Fifteen patients had more than one abnormality and only five (17%) had entirely normal urodynamic findings. The overall incidence of functional abnormality was highest in the patients with urethral or bladder neck fistulae, with only one showing entirely normal urodynamic findings. Genuine stress incontinence was found more than twice as often associated with urethral or bladder neck fistulae and detrusor instability was also more common in this group. Voiding dysfunction of both hypotonic and obstructive types was found equally in the two groups. After surgical treatment, most patients became continent and free from lower urinary tract symptoms, although one complained of residual stress incontinence and nine of urgency or urge incontinence. Of the latter, six were found to have detrusor instability, one after repair of vault fistula, three after urethral or bladder neck fistulae and the other two after mid-vaginal fistulae. CONCLUSION: There is a high incidence of abnormal lower urinary tract function in patients with urogenital fistulae. Patients with urethral or bladder neck fistulae had a higher incidence of both detrusor instability and genuine stress incontinence than those with fistulae into the vaginal vault. Many of these abnormalities appear to resolve after successful repair of the fistula, although detrusor instability may persist and require further treatment in some women. These findings are relevant to the counselling of patients before repair and may be of medico-legal significance.

Adult↗
PubMed1997

Ambulatory monitoring.

Ambulatory monitoring has been hailed as the 'way forward' in urodynamic investigation. Its introduction has caused much excitement and there is no doubt that it detects more abnormalities than does conventional cystometry. It is, however, labour intensive and time consuming for both operator and patient, and requires commitment from both to be successful. No standards have been set as to how long a test ought to last, how many voids are required and how to interpret traces. To date the standard cystometric criteria of normality have been applied, but this would appear to be inappropriate. Several commercial companies have developed systems and are marketing them widely as an adjunct, or alternative, to conventional cystometry. It is recommended that before this technique is introduced into routine clinical practice it is fully evaluated, with standardization of terminology relating to its use.

Female↗
PubMed1996

Clinical skills laboratories: teaching practical nursing.

This article describes the development and subsequent use of a clinical skills laboratory in one school of nursing and midwifery. It aims to allow students more time to practise psychomotor skills which clinicians, managers, educationalists and students themselves have perceived to be lacking in students since the implementation of Project 2000. The author suggests that this teaching strategy facilitates skill acquisition, increases students' confidence, and may in the long term help to bridge the theory-practice gap.

Clinical Competence↗
PubMed1996

Doctors leaving the training grades in obstetrics and gynaecology: a study of the years 1985 to 1988.

OBJECTIVES: To determine the numbers of doctors leaving the specialty after obtaining the Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG), and the factors influencing their decisions to seek alternative career paths. DESIGN: Retrospective postal questionnaire based survey. PARTICIPANTS: One hundred and sixty-eight doctors who had passed the MRCOG examination between 1985 and 1988 but were not known to have achieved Consultant or Senior Registrar status in the British Isles by 1993. RESULTS: The response rate was 80%. The crude leaving rate was 31%, although 7.5% had never intended to seek consultant appointment in the specialty in the UK. The majority left shortly after obtaining the Part 2 MRCOG examination, 75% within the first two years thereafter. The perception of the lifestyle of a consultant and poor job prospects were commonly seen as the critical factors causing trainees of both sexes to leave the specialty, although hours of work was the single most commonly cited factor among female trainees. CONCLUSIONS: A consistently high rate of loss from the specialty of obstetrics and gynaecology has been demonstrated in surveys covering the period 1978 to 1988. Approximately one-quarter of this loss reflects trainees who had never intended to pursue consultant appointment in the specialty in the British Isles, half reflects factors which may improve with the implementation of the recommendations contained in the New Deal and the 'Calman' report, and one-quarter reflects loss for inevitable reasons. Loss of trainees for these reasons is therefore a crucial element in manpower calculations.

Career Mobility↗
PubMed1996

Ambulatory monitoring and conventional cystometry in asymptomatic female volunteers.

OBJECTIVES: Ambulatory monitoring continues to gain acceptance and increasing clinical application. There remains, however, a sparsity of published data asymptomatic volunteers, particulary women. Our aim was, by study of such a group, to establish normal ranges for cystometric variables on ambulatory monitoring. PARTICIPANTS: We recruited 22 women from staff and gynaecological inpatients. A standard questionnaire of urinary complaints was administered and any woman with significant symptoms was excluded. Conventional cystometry and ambulatory monitoring were undertaken in all volunteers in random order. Volunteers were asked to go about everyday activities and to keep a detailed event diary whilst undergoing ambulatory monitoring. RESULTS: Using standard International Continence Society terminology, detrusor instability was found in 18% of volunteers on conventional cystometry and in 68% on ambulatory monitoring. Significant differences were found between ambulatory monitoring and conventional cystometry with respect to the detrusor pressure rise on filling (P < 0.001) and voided volumes (P < 0.001). A significant difference was also present with respect to voiding pressures (P < 0.001), although the absence of simultaneous flow rate measurement makes absolute separation of voiding pressure from post-voiding after contractions difficult. CONCLUSIONS: Ambulatory monitoring detects a greater number of abnormalities based on conventional cystometric criteria of normality. Before we can usefully apply the method to symptomatic patients we must first define normal ranges for filling and voiding cystometry for the technique. This study moves towards this goal. (The addition of flow rate data will permit accurate identification and measurement of voiding pressures.)

Adult↗
PubMed1996

Sexual risk behavior among urban women of childbearing age: implications for clinical practice.

Cox's interaction model of client health behavior was used as an organizing framework to describe the demographic characteristics, motivation, problem-solving, self-esteem, and sexual risk behaviors among urban women of childbearing age (N = 125; average age = 32 years). Eighty-five percent of the women were African American. Sexual risk behaviors were defined as more than one sex partner and not using a condom. Eight women were at the highest risk in that they reported having more than one sex partner and not using condoms. Participants reported low self-esteem, intrinsic motivation, and adequate problem-solving abilities. Motivation scores were significantly different based on number of sex partners (t = 2.26, p = .03). Women with more than one partner had lower scores compared to women with only one partner. There was a significant variation in reported self-esteem among women who used condoms (t = 2.36; p = .22). Women who did not use condoms reported lower self-esteem than women who said that they used condoms.

Adult↗