Search PubMed⌕ Search

Biomedical subjects

S L Stanton

Publications and source records attributed to S L Stanton.

At least 19 recordsLinked to original sources
PubMed1992

The incidence of genital prolapse after the Burch colposuspension.

OBJECTIVE: Our objective was to determine the incidence of postoperative genital prolapse after the Burch colposuspension and to identify risk factors for the development of subsequent prolapse. STUDY DESIGN: The charts of 131 patients who had a Burch colposuspension performed by the senior author (S.L.S.) between 1977 and 1986 were reviewed at the Urodynamic Unit of St. George's Hospital, London. Emphasis was placed on the degree of genital prolapse on clinical examination and whether further surgery was required to correct the prolapse. RESULTS: Thirty-five patients (26.7%) required a total of 40 operations to correct genital prolapse after colposuspension. At 20 operations, more than one procedure was required to correct combined prolapse. The patient's age, weight, parity, menopausal status, and prior pelvic surgery did not affect the incidence of postoperative prolapse. The only preoperative risk factor identified was the presence of a large cystocele. CONCLUSION: Postoperative genital prolapse is a significant complication of the Burch colposuspension. It is unclear whether this is due to a disruption of the vaginal axis or to an intrinsic weakness of the pelvic floor in these women.

Adult↗
PubMed1992

Perineal video-ultrasonography in the assessment of vaginal prolapse: early observations.

OBJECTIVE: To investigate the efficacy of perineal ultrasonography in the assessment of vaginal prolapse. DESIGN: A prospective descriptive study. SETTING: Urodynamic Unit, St. George's Hospital, London. SUBJECTS: Six women, three of them were awaiting colposuspension and three had had a colposuspension. INTERVENTIONS: Perineal ultrasound scans were performed on women with and without incontinence and prolapse, both before and after continence surgery. Movement of the bladder, urethra, uterus, vaginal vault and enterocele were observed during coughing and the valsalva manoeuvre. MAIN OUTCOME MEASURES: To assess reproducibility, six patients had six different measurements taken of bladder neck and prolapse position and movement relative to the symphysis. The measurements were plotted upon an X-Y co-ordinate axis. Each measurement was repeated three times and one way analysis of variance performed upon the readings. RESULTS: Perineal ultrasonography clearly demonstrated movement of the whole pelvic floor. Minor degrees of both anterior and posterior vaginal wall prolapse could be seen and quantified. An increase in posterior vaginal wall mobility was noted in women after colposuspension. All measurements taken were found to be reproducible. CONCLUSIONS: Perineal ultrasonography is easy to perform and is reproducible. It may improve understanding of why some women develop posterior vaginal wall prolapse after colposuspension and, conversely, why some women develop incontinence following anterior repair for prolapse.

Cough↗
PubMed1992

Measurement of oxybutynin and its N-desethyl metabolite in plasma, and its application to pharmacokinetic studies in young, elderly and frail elderly volunteers.

1. A quantitative h.p.l.c. plasma assay for oxybutynin (OB) and its active metabolite, N-desethyl oxybutynin (DEOB) is described. The method is linear with coefficients of variation ranging between 4 and 11.8% for OB and 4.6-9.1% for DEOB over the typical concentration range measured. Minimum detectable levels were 0.5 and 5 ng/ml for OB and DEOB respectively from a 2 ml sample. 2. Pharmacokinetic parameters were obtained after a single oral dose of OB and after administration two or three times daily to frail elderly and elderly volunteer groups respectively. Single dose results were also compared with data from young healthy volunteers. 3. There was a wide range in peak blood levels and high levels of parent drug were matched by high DEOB metabolite levels. Plasma levels on repeated administration were as would be predicted from the single dose kinetics. 4. Area under the plasma time course curve for DEOB metabolite was less than or equal to 5 than that of the parent drug. 5. A trend of increasing peak plasma levels and bioavailability was observed with increasing age and frailty, with the differences more apparent between the active elderly and frail elderly groups than between the active elderly and young volunteers. 6. Results indicate that for frail elderly patients a lower initial starting dose of 2.5 mg OB given two or three times a day may provide adequate therapeutic blood levels of the drug.

Administration, Oral↗
PubMed1991

Psychological aspects of 211 female patients attending a urodynamic unit.

Psychological aspects of 211 female patients attending a Urodynamic Unit were assessed by means of standardized questionnaires. Patients with genuine stress incontinence (GSI) showed changes comparable to other patients with longstanding physical complaints. Patients with sensory urgency (SU) lacked self esteem and were more anxious than those with GSI. Patients with detrusor instability (DI) were as anxious and lacking in self esteem as patients with sensory urgency and additionally had morbid thoughts and worries and higher scores on the hysteria sub-scale of the Crown-Crisp Experiential Index. Roughly a quarter of all the patients reported that their urinary symptoms rendered life intolerable and they were as anxious, depressed and phobic as psychiatric inpatients.

Adolescent↗
PubMed1991

Distal urethral electrical conductance (DUEC)--a preliminary assessment of its role as a quick screening test for incontinent women.

Measurement of distal urethral electrical conductance (DUEC) has been used to detect the movement of urine along the distal urethra. DUEC was used as a screening test in 100 women attending the urodynamic clinic with incontinence and in the 33 women who voided over 250 ml, the findings correlated well with subsequent urodynamic diagnosis of urethral sphincter incompetence and detrusor instability.

Adult↗
PubMed1991

The surgical management of vaginal vault prolapse.

OBJECTIVE: A review of the results of surgery for vaginal vault prolapse following hysterectomy. DESIGN: A retrospective review of all patients treated surgically for vaginal vault prolapse between 1981 and 1990 in one hospital. SETTING: St George's Hospital, London. SUBJECTS: 28 women. INTERVENTIONS: The 28 patients underwent 33 operations, either a colposacropexy (23 procedures) or a Zacharin procedure (10 procedures). Of the 28 women 25 were seen in the gynaecological clinic within the last year. MAIN OUTCOME MEASURES: Pre- and post-operative data and any interim prolapse surgery was recorded. Success of the procedure in terms of cure, urinary complications, infection and sexual function. RESULTS: The mean follow-up time was 17.1 months for the colposacropexy and 33 months for the Zacharin. The cure rate for colposacropexy was 91% and that for the Zacharin procedure was 70%. The two commonest complications were development of a voiding difficulty and infection. Three women developed voiding difficulty following the Zacharin and one following colposacropexy. Two women following colposacropexy required removal of the Mersilene mesh due to a persistent discharging sinus. CONCLUSION: The colposacropexy had a better success rate and, as it is a simpler operation to perform, has become the operation of choice in this unit. It is, however, associated with a risk of infection which can necessitate removal of the supporting mesh.

Adult↗
PubMed1991

Sensory urgency: how full is your bladder?

OBJECTIVE: To investigate whether women with sensory urgency have an abnormal perception of bladder fullness. DESIGN: Prospective observational study. SETTING: Urodynamic Unit, St George's Hospital, London. SUBJECTS: 15 women with sensory urgency, 15 women with idiopathic detrusor instability and 15 without symptoms of frequency or urgency (control group). INTERVENTIONS: All the women attended for cystometry. Each was asked to complete a visual analogue score of how full she perceived her bladder to be on a scale from 1 to 10. This was done before filling cystometry and at three times during bladder filling. At each time actual filled volume was noted. MAIN OUTCOME MEASURES: Maximum bladder capacity and individual perception of bladder fullness. RESULTS: Women with sensory urgency and detrusor instability had similar maximum bladder capacity although values in both groups were significantly lower than in the control group; thus percentage of maximum bladder capacity was used for analysis. Linear regression was performed for each group of patients and a predicted visual analogue score at 25, 50 and 75% of capacity calculated. These were compared between groups by rank analysis of variance. There was no significant difference between sensory urgency and detrusor instability. However, at 25, 50 and 75% of capacity, both groups had a significantly higher score than the control group. CONCLUSIONS: This abnormal perception would explain symptoms of frequency and urgency in these two groups. These results also confirm the similarity between detrusor instability and sensory urgency.

Adult↗
PubMed1991

Female stress incontinence. Treatment options and indications.

The diagnosis of urethral sphincter incompetence is confirmed by urodynamic studies which essentially involved twin channel subtracted cystometry. Detrusor instability and voiding difficulty must be detected. The indications for and an outline of conservative treatment are reviewed. The indications for surgery and a brief review of the operations and how they work and the management of recurrent incontinence are reviewed.

Female↗
PubMed1990

Caffeine: does it affect your bladder?

Patients with symptoms of frequency and urgency often complain that their symptoms are exacerbated by tea or coffee. A series of 20 women with confirmed detrusor instability and 10 asymptomatic women were given 200 mg of caffeine citrate and urodynamic studies were performed. In the group with detrusor instability there was a statistically significant increase in detrusor pressure on bladder filling following administration of caffeine, but no difference in volume at first contraction, height of contraction or bladder capacity. Normal women had no abnormality on cystometry.

Caffeine↗
PubMed1990

The Pyridium pad test for diagnosing urinary incontinence. A comparative study of asymptomatic and incontinent women.

Eighteen women with urodynamically proven genuine stress incontinence awaiting surgery and 23 normal, asymptomatic, continent female volunteers took part in a study to compare the accuracy of a qualitative pad test with a quantitative pad-weighing test in detecting urine loss. Each woman took 600 mg of phenazopyridine hydrochloride (Pyridium, Parke-Davis) in three equally divided doses over 18-24 hours and then underwent a standardized, one-hour pad test as described by the International Continence Society. The Pyridium pad test was regarded as positive if there was any orange staining on the pad. The quantitative pad-weighing test was considered positive if there was a weight gain of 1.0 g or more at the end of the one-hour test period. All 18 patients with genuine stress incontinence had positive Pyridium pad tests, and all had pad weight gains of greater than or equal to 1.0 g (mean, 16.5). The maximum pad weight gain in the asymptomatic, continent volunteers was 0.7 g (mean, 0.1), and none was aware of any urinary leakage during the test; however, 12 (52%) had positive Pyridium pad tests. The Pyridium pad test appears 100% sensitive in detecting urine loss in symptomatic women with genuine stress incontinence, but it has a high false-positive rate in healthy, asymptomatic, continent women. If pad-weighing tests are done, the addition of Pyridium generally will not be useful, and if Pyridium is used by itself, the results may be misleading.

Aminopyridines↗
PubMed1990

Stress urinary incontinence.

Stress urinary incontinence due to urethral sphincter incompetence (genuine stress incontinence) afflicts some 5-15% of women. The mechanism of continence is imperfectly understood, as is the precise mode of its cure, whether conservative or surgical. The pathophysiology is a reduction in urethral resistance in the absence of detrusor activity. Aetiological factors include congenital malformation of the bladder neck, denervation of the pelvic floor and sphincter mechanism following childbirth, trauma causing disruption of the urethral sphincter mechanism, fibrosis associated with bladder neck surgery for prolapse, oestrogen deprivation at the menopause, and urethral relaxation or instability. Conventional investigations include urethral pressure measurement, urethral electric conductance, electrophysiological tests, and cystometry or videocystourethrography (the latter procedures diagnose by exclusion). A more precise evaluation of the role of urethral resistance is hampered by lack of suitable techniques for measuring urethral and sphincteric function. Treatments include pelvic floor exercise, drugs to increase urethral resistance, and surgery, either to evaluate the bladder neck or to increase urethral resistance.

Humans↗
PubMed1989

Comparison of ultrasound and lateral chain urethrocystography in the determination of bladder neck descent.

Several methods exist to determine the position of the bladder neck, an important mechanism of urinary continence. Radiologic screening is widespread but involves irradiation and may be imprecise. We compared perineal ultrasound scanning and radiologic scanning of the bladder neck by use of a chain and catheter and found good correlation between the two techniques. Ultrasound scanning is preferred, as it avoids irradiation, is accurate, is portable, and is readily available in most gynecologic departments.

Catheterization↗
PubMed1989

Transvesical phenol injection of pelvic nerve plexuses in females with refractory urge incontinence.

A series of 28 female patients with urge incontinence refractory to other forms of treatment underwent a total of 40 transvesical injections of phenol into the pelvic nerve plexuses. Following primary phenol injection only 8 patients (29%) had a significant response to therapy and all relapsed during follow-up. Only 3 of 11 patients undergoing a second injection had a clinical response to this therapy and 1 developed a vesicovaginal fistula. This suggests that phenol injections have little place in the management of urge incontinence and it is unwise to proceed to 2 or more injections because of the risk of fistula.

Adult↗
PubMed1989

Oxybutinin versus propantheline in the management of detrusor instability. A patient-regulated variable dose trial.

Two of the principal drugs used to treat detrusor instability, oxybutinin hydrochloride and propantheline bromide, were compared using clinical and urodynamic outcome measures in a randomized crossover trial with a patient-regulated variable dose regimen. Of the 23 women in the trial, 14 reported subjective improvement during treatment with oxybutinin hydrochloride compared with 11 during treatment with propantheline bromide. Apart from a greater increase in the maximum cystometric capacity with oxybutinin, there were no other objective differences between the two drugs. Oxybutinin significantly delayed the first desire to void, increased the maximum cystometric capacity and reduced the maximum detrusor pressure rise on filling. Propantheline significantly increased the maximum cystometric capacity and reduced the maximum detrusor pressure rise on filling. Three patients stopped treatment due to side-effects.

Adult↗