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A fetal head volume estimate exceeding MRI-measured pelvic capacity is a frequent finding in nulliparas with cesarean birth due to cephalopelvic disproportion. An appropriate prospective study to determine the benefits of an antepartum diagnosis of cephalopelvic disproportion in high-risk nulliparas is warranted.

To achieve increased reliability of MR imaging pelvimetry in the diagnosis and treatment of dystocia and in predicting labor outcome, new methods assessing fetal-pelvic compatibility, including measurements of the pelvic outlet and the shape and configuration of the pelvis, need to be established and prospectively tested before firm recommendations for clinical use can be made.

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Foley Catheterization After Vaginal Plastic Surgery 7. Schiotz HA. Urinary Tract infections and bacteriuria after gynecological surgery. Experience with 24-hour Foley catheterization, lnt Urogynecol J 1994;5:345-348 8. Schi0tz HA. Pelvic laparotomy and 24-hour Foley catheterization. Acta Obstet Gynecol Scand (submitted) 9. Schi0tz HA. Voiding after gynecologic surgery: experience with 24-hours Foley catheterization. Int UrogynecolJ 1994;5:15-18EDITORIAL COMMENT: From this randomized prospective study it would appear that the time of catheter removal after anterior colporrhaphy with or without other repairs, or a Manchester procedure, is not important as regards the 161 incidence of either infection or retention. No prophylactic antibiotics or cholinergic medications were used. One unanswered question is the degree of retention manifested by these patients. The author defines retention as ~the need for intermittent catheterization at least once' if the patient was 'distressed or a bladder volume >500 ml was suspected'. We are not told what the catheterized volumes were. If the postvoid residual is defined as the inability to void with a truly full bladder during the postoperative period, the term retention is appropriate. However, without a knowledge of the retained volume or the actual bladder capacity it is difficult to interpret the true incidence of retention. Am J Obstet Gynecol 1994; 171:647-652Follow-up evaluation was performed on 87 women who had had Burch colposuspension for stress urinary incontinence over the previous 5 years. All patients met strict criteria for surgery, including stress incontinence, mild pelvic relaxation, hypermobility of the urethrovesical junction and absence of detrusor instability. Preoperative evaluation was extensive and objective, as was the follow-up examination. The technique used two non-absorbable sutures on either side of the urethrovesical junction. Success of surgery was 42/52 patients (80.8%) with no prior surgery, 20/24 (83.3%) for those having one prior operation, and 9/11 (81.8%) for those having had two previous operations. Postoperative studies shows a longer urethral functional length at rest, increased urethral functional length at stress, and increased maximum urethral closure pressure at stress in successful patients. There was a decrease in maximum urethral closure pressure at rest and at stress, and in pressure transmission in the unsuccessful patients.

During the last years tremendous changes have occurred in the epidemiologic knowledge and the diagnostic process of the prostatitis syndrome. A new worldwide-accepted classification system has become the gold standard in contemporary literature. The aim of this study was to compare the inflammatory and infectious status of men with prostatitis syndrome with results from our study cohort from 1992. A total of 168 symptomatic men (mean age 43.2 years; range 18-79) attending the Giessen prostatitis outpatient department were included. All men underwent a standard four-glass-test including leucocyte analysis in all specimens. A routine search for Ureaplasma urealyticum and Chlamydia trachomatis was performed. Ejaculate analysis following World Health Organization (WHO) criteria has been performed including the evaluation of increased number of peroxidase-positive leucocytes (PPL). Men were classified according to the National Institutes of Health (NIH) prostatitis classification. The distribution of patients according to NIH criteria is as follows: NIH II (4.2%), NIH IIIA (31.5%), NIH IIIB (50.0%) and urethroprostatitis (14.3%). Chlamydial infection was present in one man (0.6%). Only two men with increased leucocytes in prostatic secretions demonstrated > or =106 million ml-1 PPL in semen. As compared with our cohort study 10 years ago, the proportion of the different subtypes of the prostatitis syndrome have remained stable. The aetiological spectrum of chronic bacterial prostatitis has not changed whereas, in contrast, the prevalence of C. trachomatis now is found to be strikingly reduced. Using the WHO cutpoints for leucocytospermia the inclusion of seminal leucocytes to the diagnostic process has not influenced the distribution between inflammatory (type NIH IIIA) and noninflammatory (type NIH IIIB) chronic pelvic pain syndrome.

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