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7 results

  • Chapter 27 - Urinary Incontinence

  • from Section 5 - Post-Reproductive Care
  • Edited by Tahir Mahmood, Charles Savona-Ventura, Ioannis Messinis, Sambit Mukhopadhyay
  • Book:
    The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
    Published online:
    24 November 2021
    Print publication:
    02 December 2021, pp 218-226

  • Summary

    Urinary incontinence is a common condition in women. All cases require a basic assessment, while urodynamic studies are indicated in those with complex or refractory symptoms. Initial treatment includes lifestyle advice, behavioural modifications, bladder retraining and pelvic floor muscle training. Synthetic mid-urethral sling procedures have revolutionized stress incontinence surgery and reduced the popularity of ‘traditional’ procedures, such as colposuspensions and pubovaginal slings. With regard to urgency urinary incontinence, antimuscarinic agents are the mainstay of current medical management, while a selective β3-adrenergic receptor agonist (Mirabegron) offers an alternative pharmacological option. Intravesical botulinum toxin and neuromodulation (peripheral or sacral) are available to women with refractory symptoms

  • Comparison of patulous Eustachian tube patients with and without a concave defect in the anterolateral wall of the tubal valve

  • S-W Choi, J-H Park, S Lee, S-J Oh, S-K Kong
  • Journal:
    The Journal of Laryngology & Otology / Volume 134 / Issue 6 / June 2020
    Published online by Cambridge University Press:
    11 June 2020, pp. 526-532
    Print publication:
    June 2020
  • Objective

    Patulous Eustachian tube appears to be caused by a concave defect in the anterolateral wall of the tubal valve of the Eustachian tube. This study aimed to compare the clinical features of patulous Eustachian tube patients with or without a defect in the anterolateral wall of the tubal valve.

    Methods

    Sixty-six patients with a patulous Eustachian tube completed a questionnaire, which was evaluated alongside endoscopic findings of the tympanic membrane, nasal cavity and Eustachian tube orifice.

    Results

    Females were more frequently diagnosed with a patulous Eustachian tube, but the valve defect was more common in males (p = 0.007). The ratio of patulous Eustachian tube patients with or without defects in the anterolateral wall of the tubal valve was 1.6:1. Weight loss in the previous six months and being refractory to conservative management were significantly associated with the defect (p = 0.035 and 0.037, respectively). Symptom severity was significantly higher in patients with the defect.

    Conclusion

    Patulous Eustachian tube patients without a defect in the anterolateral wall of the tubal valve can be non-surgically treated more often than those with the defect. Identification of the defect could assist in making treatment decisions for patulous Eustachian tube patients.

  • Management of priapism with a trial of exercise in the emergency department

  • Jonathan Gravel, Constance LeBlanc, Catherine Varner
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 21 / Issue 1 / January 2019
    Published online by Cambridge University Press:
    16 March 2018, pp. 150-153
    Print publication:
    January 2019
    • Article
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  • Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is a genitourinary emergency that necessities prompt work-up and appropriate management, as there is a time-dependent relationship between total duration of erection and an increasing risk of permanent erectile dysfunction. Confirming the type of priapism is key to proper management, but the majority of cases presenting to the emergency department are ischemic in nature. Conservative management strategies for ischemic priapism are sparsely described in the literature but generally include ice pack application to the area, cold showers, masturbation and rarely, exercise. These strategies lack sound evidence, but the risks of attempting them are minimal as long as access to more definitive treatment is not delayed. Lower-limb exercise as a first-line treatment warrants further study in the undifferentiated emergency department priapism population. The case we present and discuss here illustrates the potential benefits of a trial of acute lower-limb exercise, specifically stair climbing, as a treatment for medication-induced priapism. If effective, this simple non-invasive management strategy may decrease the time to effective treatment, requires minimal resource utilization, and ultimately, avoids the need for more invasive treatment.

  • Management of paediatric acute mastoiditis: systematic review

  • R Loh, M Phua, C-K L Shaw
  • Journal:
    The Journal of Laryngology & Otology / Volume 132 / Issue 2 / February 2018
    Published online by Cambridge University Press:
    07 September 2017, pp. 96-104
    Print publication:
    February 2018
  • Background:

    Acute mastoiditis remains the commonest intratemporal complication of otitis media in the paediatric population. There has been a lack of consensus regarding the diagnosis and management of acute mastoiditis, resulting in considerable disparity in conservative and surgical management.

    Objectives:

    To review the current literature, proposing recommendations for the management of paediatric acute mastoiditis and appraising the treatment outcomes.

    Method:

    A systematic review was conducted using PubMed, Web of Science and Cochrane Library databases.

    Results:

    Twenty-one studies were included, with a total of 564 patients. Cure rates of medical treatment, conservative surgery and mastoidectomy were 95.9 per cent, 96.3 per cent and 89.1 per cent, respectively.

    Conclusion:

    Mastoidectomy may be the most definitive treatment available; however, reviewed data suggest that conservative treatment alone has high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis, and conservative therapy may be an appropriate first-line management when treating acute mastoiditis.

  • Urinary incontinence in older women: a review of conservative therapeutic interventions

  • Gemma Wright
  • Journal:
    Reviews in Clinical Gerontology / Volume 24 / Issue 1 / February 2014
    Published online by Cambridge University Press:
    03 January 2014, pp. 93-104
    Print publication:
    February 2014

  • Urinary incontinence is a highly prevalent yet largely ignored condition that affects older women. Conservative treatment options are widely under-used and containment methods more widely prescribed. This study sought to review the efficacy of conservative approaches and identify which should be recommended. It was found that there is a strong evidence base in support of pelvic floor muscle and behavioural training with biofeedback as a useful adjunctive treatment. The use of therapeutic electrical stimulation was difficult to evaluate due to the different combinations of treatment available and a paucity of evidence of its use with older women. Lifestyle intervention and complementary therapies both demonstrated some positive outcomes. In conclusion it was felt that there is a place for conservative treatments in the management of urinary incontinence rather than relying on containment products. A combination of different treatment approaches is felt to be the most beneficial.

  • Chapter 33 - In vitro growth systems for human oocytes

  • from Section 8 - In vitro follicle growth and maturation
  • Edited by Jacques Donnez, Université Catholique de Louvain, Belgium, S. Samuel Kim, University of Kansas
  • Book:
    Principles and Practice of Fertility Preservation
    Published online:
    04 February 2011
    Print publication:
    03 February 2011, pp 397-408

  • Summary

    Ovarian cancers are classified as epithelial (including borderline and malignant tumors) and non-epithelial cancers. The standard treatment of borderline ovarian tumours (BOT) consisted of a total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal cytology, omentectomy and multiple peritoneal biopsies. The differential criterion between epithelial ovarian cancer (EOC) and BOT is the invasion of the ovarian stroma. The standard surgical procedure for EOC is a radical hysterectomy with bilateral salpingo-oophorectomy. Non-epithelial malignant tumors are characterized by: the occurrence of disease in younger patients; and a good prognosis of this tumor. Conservative treatment yields good fertility results and does not affect the survival of patients with BOT. It should be considered for young women desiring fertility, even if peritoneal implants are discovered at the time of initial surgery. In case of infertility, medically-assisted procreation techniques may be proposed to patients with stage I BOT with a limited number of stimulation cycles.

  • Conservative treatment for recurrent dislocation of temporomandibular joint

  • K Sato, H Umeno, T Nakashima
  • Journal:
    The Journal of Laryngology & Otology / Volume 123 / Issue S31 / May 2009
    Published online by Cambridge University Press:
    22 May 2009, pp. 72-74
    Print publication:
    May 2009
  • Objective:

    Recurrent dislocation of the temporomandibular joint is difficult to treat with nonsurgical methods. A new nonsurgical method for the treatment of this condition is presented.

    Methods:

    Routine dental arch bars were applied to the teeth, and two latex elastic bands were placed between the two arch bars on either side of the dental arch. Muscular exercises (i.e. active mouth opening) were then performed regularly over approximately three months.

    Results:

    Patients were followed up for two to five years, and the treatment proved successful in five of five cases (i.e. no recurrence was seen). The advantages of this treatment are its simplicity and the lack of special equipment needed. No surgery is required, although patients must perform regular muscular exercises. Surgical complications such as trismus and facial nerve palsy are avoided. The disadvantages of this method are the requirement for patient compliance, and its lack of usefulness in patients without teeth.

    Conclusions:

    The described method is useful for patients complaining of recurrent dislocation of the temporomandibular joint.