Introduction and hypothesis A study was conducted to validate a constipation questionnaire based ... more Introduction and hypothesis A study was conducted to validate a constipation questionnaire based on the Rome III criteria. Methods Women attending outpatient clinics completed a constipation questionnaire based on the Rome III Criteria. The internal reliability, the test–retest as well as the content and construct validity of the questionnaire were evaluated. Results Two hundred one women were studied. Of the women, 28% (56/201) reported constipation but only 14% of these (8/56) could be defined as constipated accordingly to the Rome III Criteria. Nine percent of women (13/145) who did not report constipation were classified as constipated accordingly to the Rome III Criteria. The questionnaire had good reliability (Cronbach’s alpha of 0.85 and ICC of 0.85). However, the questionnaire did not have significant construct validity with patients’ self-report of constipation, stool frequency and stool form (Pearson chi-square P > 0.05). Conclusions The Rome III Criteria questionnaire is a reliable and reproducible tool but does not appear to be a valid instrument in diagnosing constipation.
Introduction and hypothesis This study aimed to evaluate the women’s’ views and expectations abou... more Introduction and hypothesis This study aimed to evaluate the women’s’ views and expectations about outcomes and complications of botulinum toxin treatment for overactive bladder (OAB) symptoms. Methods Consecutive women with OAB symptoms and detrusor overactivity were requested to fill out a multiple choice questionnaire to assess whether they would consider botulinum and what outcomes as well as complications they would find acceptable to undergo this treatment. Results Two hundred sixty-one women, mean age of 58 (range, 38–78) years, were studied. Two hundred twenty-four were treatment-naive women (group A), while 37 were no responders to anticholinergics (group B). Only 49.6% of women in group A and 54% in group B would accept botulinum toxin. No significant differences were found between treatment-naive women and non-responders to anticholinergics (p > 0.05). Conclusions Acceptance of botulinum toxin treatment involves a complex interaction of efficacy and possible complications. The balance of these factors changes the acceptability of the treatment.
The assessment of patients with pelvic floor dysfunction necessitates a combination of clinical s... more The assessment of patients with pelvic floor dysfunction necessitates a combination of clinical skills and adjunct investigations, including detailed imaging. This article reviews a variety of static and dynamic imaging modalities available in the field of urogynaecology, with an emphasis on their clinical implication in identifying the structural and functional causes of pelvic floor disorders. A number of different modalities have been used including X-rays, ultrasound and magnetic resonance imaging. Their place and value are discussed with comments on the validity of the various techniques.
Introduction and hypothesis The aim of this study was to assess the relationship between ultrasou... more Introduction and hypothesis The aim of this study was to assess the relationship between ultrasound estimation of bladder weight (UEBW), symptoms and urodynamic diagnosis. Methods Women with lower urinary tract symptoms underwent urodynamics studies and measurement of UEBW at a fixed bladder volume. Results Women with overactive bladder symptoms had a median UEBW of 48.3 g (95% CI 44–52), with stress urinary incontinence a median UEBW of 35.1 g (95% CI 30–41) and with mixed urinary incontinence a median UEBW of 40.0 g (95% CI 37–43) (p < 0.001). Women with detrusor overactivity had a median UEBW of 48.0 g (95% CI 46–51), with urodynamic stress incontinence a median UEBW of 30 g (95% CI 29–31) and detrusor overactivity and urodynamic stress incontinence a median UEBW of 37.3 g (95% CI 33–41) (p < 0.001). Conclusions UEBW is higher in women with overactive bladder and detrusor overactivity. UEBW may be a useful tool in women with lower urinary tract symptoms.
Introduction and hypothesis The aim of this study was to validate a technique to measure the vagi... more Introduction and hypothesis The aim of this study was to validate a technique to measure the vaginal wall thickness (VWT) using two-dimensional ultrasound. Methods Women were scanned by two independent operators and by the same operator at two separate visits at the level of the bladder neck, the apex of the bladder, the anterior fornix, the anorectal junction, rectum and posterior fornix. Fresh female cadavers were scanned and ultrasound thickness of the vagina was compared to histological thickness. Results Bland Altman analysis revealed a low mean difference between operators and between visits by the same operator. The 95% confidence intervals as a percentage of the mean vaginal wall thickness ranged between 2.8% and 7.4%. There was a low percentage difference between ultrasound and histological vaginal wall thickness. Conclusion Ultrasound vaginal wall thickness demonstrated good intra- and interoperator reliability, as well as consistency with histological measurement. It is a valid technique.
Introduction and hypothesis The aim of the study was to assess the sensory and motor effects of a... more Introduction and hypothesis The aim of the study was to assess the sensory and motor effects of antimuscarinic treatment on the bladder in women with overactive bladder, detrusor overactivity demonstrated on urodynamics and a mean bladder wall thickness (BWT) greater than 5 mm. Methods Fifty-eight women underwent treatment with antimuscarinics in 12 weeks. Before treatment and at 1, 2, 6 and 12 weeks of treatment, women completed the patient perception of bladder condition (PPBC) single-item global questionnaire, indicated the severity of their urgency on a visual analogue scale (VAS) and underwent transvaginal ultrasound to determine mean bladder wall thickness (BWT). Results PPBC and VAS scores for urgency declined throughout the treatment course whereas mean BWT declined during the first 6 weeks of treatment and then reached a plateau after falling to below 5 mm. Conclusion The mechanism of action of antimuscarinics appears to be a complex interaction of sensory and motor components.
Introduction and hypothesis A study was conducted to validate a constipation questionnaire based ... more Introduction and hypothesis A study was conducted to validate a constipation questionnaire based on the Rome III criteria. Methods Women attending outpatient clinics completed a constipation questionnaire based on the Rome III Criteria. The internal reliability, the test–retest as well as the content and construct validity of the questionnaire were evaluated. Results Two hundred one women were studied. Of the women, 28% (56/201) reported constipation but only 14% of these (8/56) could be defined as constipated accordingly to the Rome III Criteria. Nine percent of women (13/145) who did not report constipation were classified as constipated accordingly to the Rome III Criteria. The questionnaire had good reliability (Cronbach’s alpha of 0.85 and ICC of 0.85). However, the questionnaire did not have significant construct validity with patients’ self-report of constipation, stool frequency and stool form (Pearson chi-square P > 0.05). Conclusions The Rome III Criteria questionnaire is a reliable and reproducible tool but does not appear to be a valid instrument in diagnosing constipation.
Introduction and hypothesis This study aimed to evaluate the women’s’ views and expectations abou... more Introduction and hypothesis This study aimed to evaluate the women’s’ views and expectations about outcomes and complications of botulinum toxin treatment for overactive bladder (OAB) symptoms. Methods Consecutive women with OAB symptoms and detrusor overactivity were requested to fill out a multiple choice questionnaire to assess whether they would consider botulinum and what outcomes as well as complications they would find acceptable to undergo this treatment. Results Two hundred sixty-one women, mean age of 58 (range, 38–78) years, were studied. Two hundred twenty-four were treatment-naive women (group A), while 37 were no responders to anticholinergics (group B). Only 49.6% of women in group A and 54% in group B would accept botulinum toxin. No significant differences were found between treatment-naive women and non-responders to anticholinergics (p > 0.05). Conclusions Acceptance of botulinum toxin treatment involves a complex interaction of efficacy and possible complications. The balance of these factors changes the acceptability of the treatment.
The assessment of patients with pelvic floor dysfunction necessitates a combination of clinical s... more The assessment of patients with pelvic floor dysfunction necessitates a combination of clinical skills and adjunct investigations, including detailed imaging. This article reviews a variety of static and dynamic imaging modalities available in the field of urogynaecology, with an emphasis on their clinical implication in identifying the structural and functional causes of pelvic floor disorders. A number of different modalities have been used including X-rays, ultrasound and magnetic resonance imaging. Their place and value are discussed with comments on the validity of the various techniques.
Introduction and hypothesis The aim of this study was to assess the relationship between ultrasou... more Introduction and hypothesis The aim of this study was to assess the relationship between ultrasound estimation of bladder weight (UEBW), symptoms and urodynamic diagnosis. Methods Women with lower urinary tract symptoms underwent urodynamics studies and measurement of UEBW at a fixed bladder volume. Results Women with overactive bladder symptoms had a median UEBW of 48.3 g (95% CI 44–52), with stress urinary incontinence a median UEBW of 35.1 g (95% CI 30–41) and with mixed urinary incontinence a median UEBW of 40.0 g (95% CI 37–43) (p < 0.001). Women with detrusor overactivity had a median UEBW of 48.0 g (95% CI 46–51), with urodynamic stress incontinence a median UEBW of 30 g (95% CI 29–31) and detrusor overactivity and urodynamic stress incontinence a median UEBW of 37.3 g (95% CI 33–41) (p < 0.001). Conclusions UEBW is higher in women with overactive bladder and detrusor overactivity. UEBW may be a useful tool in women with lower urinary tract symptoms.
Introduction and hypothesis The aim of this study was to validate a technique to measure the vagi... more Introduction and hypothesis The aim of this study was to validate a technique to measure the vaginal wall thickness (VWT) using two-dimensional ultrasound. Methods Women were scanned by two independent operators and by the same operator at two separate visits at the level of the bladder neck, the apex of the bladder, the anterior fornix, the anorectal junction, rectum and posterior fornix. Fresh female cadavers were scanned and ultrasound thickness of the vagina was compared to histological thickness. Results Bland Altman analysis revealed a low mean difference between operators and between visits by the same operator. The 95% confidence intervals as a percentage of the mean vaginal wall thickness ranged between 2.8% and 7.4%. There was a low percentage difference between ultrasound and histological vaginal wall thickness. Conclusion Ultrasound vaginal wall thickness demonstrated good intra- and interoperator reliability, as well as consistency with histological measurement. It is a valid technique.
Introduction and hypothesis The aim of the study was to assess the sensory and motor effects of a... more Introduction and hypothesis The aim of the study was to assess the sensory and motor effects of antimuscarinic treatment on the bladder in women with overactive bladder, detrusor overactivity demonstrated on urodynamics and a mean bladder wall thickness (BWT) greater than 5 mm. Methods Fifty-eight women underwent treatment with antimuscarinics in 12 weeks. Before treatment and at 1, 2, 6 and 12 weeks of treatment, women completed the patient perception of bladder condition (PPBC) single-item global questionnaire, indicated the severity of their urgency on a visual analogue scale (VAS) and underwent transvaginal ultrasound to determine mean bladder wall thickness (BWT). Results PPBC and VAS scores for urgency declined throughout the treatment course whereas mean BWT declined during the first 6 weeks of treatment and then reached a plateau after falling to below 5 mm. Conclusion The mechanism of action of antimuscarinics appears to be a complex interaction of sensory and motor components.
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