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Three-dimensional ultrasound allowed examination of the female urethra in planes that could not be visualized by conventional sonography. The rhabdosphincter had a smaller volume in women with genuine stress incontinence than in continent women.

Objective To evaluate the outcome of colposuspension for genuine stress incontinence in women who had previously undergone bladder neck surgery.Design Prospective observational study.Setting Tertiary referral urogynaecology unit.Participants Fifty-two consecutive women with recurrent genuine stress incontinence operated on Sixty-five continence procedures had been performed previously, with 13 women (25%) having had more than one operation. Nine months post-operatively the subjective cure rate was 80% and objective cure rate 78%. Intraoperative complications were few but included two bladder injuries and one rectus muscle tear whch required repair. Seven women (13%) developed voiding difficulties which required clean intermittent self-catheterisation, but only one needed to continue this for six months. None of the women developed detmsor instability. ConclusionsIn this setting colposuspension after previous bladder neck surgery offers a high rate of success. However, long term follow up is needed to see if this effect is maintained.

The aim of the study was to evaluate the use of a vaginal pessary in the detection of genuine stress incontinence (GSI) in women with urogenital prolapse undergoing urodynamic investigation. Continent women with urogenital prolapse, with or without associated urinary symptoms, were studied. All underwent videocystourethrography using a standardized protocol. None had evidence of incontinence on provocative testing in the upright position. A well-fitting vaginal ring pessary was inserted to reduce the prolapse and mimic a vaginal repair. The provocative tests were then repeated while the bladder was screened. Seventy women with a mean age 59.0 years (range 34-83) were recruited over a 21-month period: 15 women complained of prolapse alone and 55 had concurrent urinary symptoms; 19 women (27%) developed GSI only following the insertion of a vaginal pessary. The women who became incontinent were significantly older (mean age 63.9 years) than those who remained continent (mean age 56.8 years) (P < 0.020). The use of a vaginal pessary increases the detection rate of GSI in continent women with urogenital prolapse undergoing videocystourethrography. These findings are important because women with prolapse and coexisting incontinence should be offered a continence procedure rather than a simple vaginal repair.

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Anorexia nervosa is a condition which is associated with extremely low body weight and endocrine problems including persistent anovulation and a hypo-oestrogenic state. As the lower urinary tract is oestrogen sensitive, it is possible that women suffering from anorexia nervosa may experience similar distressing urinary problems. Of 29 anorexic women assessed, the majority had significant irritative urinary symptoms of which frequency, urgency and nocturia were the most common. These symptoms also had an unfavorable impact on their quality of life. IntroductionAnorexia nervosa is an eating disorder characterised by a distorted body image and an intense wish to be thin, resulting in a relentless pursuit of low body weight. The female to male ratio is 1O:l and among women aged 15 to 34 years the incidence is up to 10.8 per 100,000 per year'. School girls are also at risk, with a prevalence of 1 % to 2%'. The aetiology is unclear, but there is thought to be a strong individual predisposition with social factors and family relationships playing a part. The medical problems associated with this condition occur as a result of a dysfunction of body mechanisms (e.g. appetite, thirst, temperature and sleep and autonomic balance) regulated by the hypothalmus. In addition, failure to maintain a critical level of body fat leads to suppression of gonadotrophin releasing hormone (GnRH) secretion, anovulation, amenorrhoea and oestrogen deficiency. This hypooestrogenic state has been described in anorexia nervosa and may lead to osteoporosis, loss of skin thickness and collagen content?-'. Osteoporosis was first demonstrated in 1984 with up to 90% of anorexic women showing a loss of 6%-8% mineral content of bone. It has been suggested that the oestrogen deficiency with longer duration of amenorrhoea is a major contributor to the bone loss in women with anorexia nervosa4. Significant osteoporosis affects over half of all women with anorexia nervosa with a marked trabecular and cortical bone loss (4%-10% per year) which can lead to osteoporotic fracturesh. Savvas et al. (1989) have also shown a loss of bone mass and co-existent reduction of skin thickness and skin collagen content in these women compared with healthy controlss. Oestrogen and progesterone receptors are present in the bladder and urethra and the lower urinary tract is sensitive to these hormones7. Fluctuations in hormone levels may lead to symptoms, cytological and functional changes during the menstrual cycle and in pregnancy8.Y. Also, deteriorating ovarian function at the time of the menopause has been shown to result in significant morbidity, with over 50% of women suffering urogenital problems and over 16% experiencing urinary symptoms"'. Our observations, that women with eating disorders referred to the urogynaecology unit often complain of similar urinary symptoms, prompted further investigation. The aim of our study was to determine the incidence and impact of urinary dysfunction in women with anorexia nervosa. MethodsIn a prospective study conducted over...

BLAIR BELL RESEARCH SOCIETY Papers presented at the Royal College of Obstetricians and Gynaecologists, London, December 1997 *A randomised controlled trial of computer data processing in the antenatal booking clinic. Steer P. Department Inherited predisposition to ovarian cancerthe contribution of mutations in BRCA1.

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