Acute and recurrent urinary tract infections (UTIs) are common auto-infectious diseases transmitted from the intestinal tract. They affect the urinary tract either through recurrence or through persistence. The incidence of UTIs increases with age and comorbidities. In this guideline from the Swiss Society of Gynaecology and Obstetrics (SSGO), diagnosis and treatment of UTIs are grouped into uncomplicated and complicated cases. This is to our knowledge the first guideline that specifically considers UTIs in pregnancy and breastfeeding, and the prevention of UTIs in the context of urogynaecological diagnosis and surgery. Recommendations are based on observational, retrospective or randomised controlled studies. The level of evidence was rated according to recommendations made by the Oxford Centre of Evidence-based Medicine.In non-pregnant women and women <65 years with dysuria, pollakiuria and suprapubic pain, no urine diagnostic testing is needed. If the clinical presentation is unclear, urinary tests such as midstream urine stix or urine analysis should be used, and in cases of unclear or recurrent infections, a urine culture.Routine screening for asymptomatic bacteriuria (ASB) should not be carried out, and antibiotic treatment should be avoided in cases of incidentally detected ASB. As an exception, screening for bacteriuria should be carried out in patients prior to urogynaecological surgery where urinary drainage by catheter is necessary or probable. In pregnancy, systematic screening for ASB is not recommended, because most women with ASB do not develop complications during follow-up, and contamination of urine samples collected in pregnancy is common.Patients should be advised that most UTIs are self-limiting, that the symptoms can be relieved with non-steroidal anti-inflammatory drugs (NSAIDs) and that the same time is required to eradicate the bacteria using antibiotics or NSAIDs. For non-pregnant women with uncomplicated UTIs, a 48-hour-delayed antibiotic prescription is recommended, supplemented by NSAIDs for pain relief. If antibiotics are needed after 48 hours, or in case of direct antibiotic administration in pregnant women, the shortest possible course of treatment should be carried out.There is increasing interest in alternatives or complementary treatments to antibiotic therapy, especially for recurrent UTIs. Different recommendations and alternative medications are summarised. This short and comprehensive guideline provides quick answers for every day clinical questions concerning UTIs, especially for obstetricians and gynaecologists.
Introduction Female genital mutilation (FGM) is defined by the World Health Organization (WHO) as all procedures that involve partial or total removal of the female external genitalia and/or injury to the female genital organs for cultural or any other non-therapeutic reasons. Aim Aim of this study was to determine sexual function before and after defibulation using a CO2 laser in migrant women who had undergone FGM in the past. Main Outcome Measures Female Sexual Function Index (FSFI) before and 6 months after defibulation. Methods Patients were asked to fill the FSFI before surgery and at 6 months follow-up. Defibulation took place under general anesthetic using a CO2 laser. Results Eighteen patients underwent defibulation in a standardized manner and filled in the FSFI completely. Female sexual function improves after surgical defibulation in the domains desire, arousal, satisfaction, and pain whereas lubrification and orgasm remained unchanged. Conclusion Defibulation using CO2 laser may improve some aspects of sexual function in patients who undergo defibulation but not all.
Introduction Pelvic organ prolapse is a common condition among women with a prevalence of 11% and may affect the anterior, posterior, or apical compartment with a negative impact on sexual function. Aim Aim of the current study was to evaluate sexual function before and after surgical rectocele fascial repair in sexually active patients who suffer from symptomatic rectoceles. Main Outcome Measures Female Sexual Function Index (FSFI) and anatomical outcome after rectocele repair. Methods Between December 2000 and December 2009, we asked sexually active female patients who were to undergo rectocele fascial repair for symptomatic rectoceles to participate in this study. The patients were gynecologically examined before and after surgery and prolapse staging was performed using the ICS-Pelvic Organ Prolapse Staging. Patients were asked to fill in the FSFI before surgery and at 6 months follow-up. For statistical analysis, Graph Pad Prism version 5.0 for Windows was used (Graph Pad, La Jolla, CA, USA). Student’s t-test was used after normality tests to compare groups and α was set 0.05. Results Sixty-eight patients were included in this study. Median age was 72 years (range 47–91), median parity of 2 (range 0–3) and median body mass index was 29 kg/m2 (range 23–31). Main complaints preoperatively were painful prolapse feeling (n = 52), dyspareunia (n = 59), and a feeling of vaginal heaviness (n = 39). One patient who had suffered from postoperative infection that resulted in excessive scar tissue of the posterior wall suffered from de novo dyspareunia. Statistical analyses (paired t-test) showed significant improvement for desire (P < 0.001), satisfaction (P < 0.0001), and pain (P < 0.0001) and no significant changes for arousal (P = 0.0897), lubrication (P = 1), and orgasm (P = 0.0893). Conclusion Posterior fascial repair improves some domains of sexual function but not all in sexually active patients with symptomatic rectoceles, and local oestrogene treatment may contribute to this finding.
Introduction Pelvic organ prolapse affects approximately 50% of parous women over 50 years of age and has a lifetime risk of 30–50%. Vault descent or prolapse occurs in about 20% after hysterectomy and can have a negative effect on sexual function. Sacrocolpopexy is the gold standard of surgical treatment for apical prolapse in fit, sexually active patients. Few data exist which determine sexual function after sacrocolpopexy. Aim The aim of this study was to determine sexual function in sexually active patients before and after sacrocolpopexy for the treatment of vault prolapse or descent. Main Outcome Measures Main outcome measures were the International Continence Society (ICS) Pelvic Organ Prolapse (ICS POP) Staging and the Female Sexual Function Index, which were filled in before the intervention and at follow-up. Methods Between December 2000 and December 2009, we asked sexually active female patients who were to undergo sacrocolpopexy for vault descent or prolapse to participate in this study. The patients were gynecologically examined before and after surgery and prolapse staging was performed using the ICS POP Staging. Results Sixty-two patients were included in the study and follow-up was 24 months. The domains sexual desire, arousal, lubrication, satisfaction, and pain improved significantly postoperatively but orgasm remained unchanged. There was no vaginal shortening postoperatively, and no serious intra- or postoperative complications occurred. Conclusion Sacrocolpopexy is a valuable option for sexually active patients with vault descent or prolapse with an amelioration of most aspects of sexual function but not all. Other factors as hormonal treatment, concomitant surgery, physiological, and psychological factors have to be taken into consideration.
Objectives: The need for pelvic floor surgery will increase with an aging population in the future. Aim of this prospective study was to evaluate the evolution of cognitive function in elderly women after urogynaecological surgery. Material and methods: Between 2010 and 2014, 51 female patients 70 years and older who underwent urogynaecological surgery participated in this study. Geriatric and urogynaecological assessment were performed before and six weeks after surgery, including the Mini-COG test, the clock-drawing test, a depression scale, an activities of daily living questionnaire, and the German pelvic floor questionnaire. Results: Mean age was 77 years (range 70-91). Overall, 15 women were operated for incontinence, 31 for prolapse, and five for miscellaneous reasons. Only two (3.9%) of the 51 women developed postoperative delirium. Abnormal cognitive findings increased from preoperatively 15.7% to 39.2% six weeks after surgery (odds ratio 3.4, 95% confidence interval 1.3 to 8.7, p < 0.001). There were no statistically significant pre-post differences in activities of daily living and depression scores. Pelvic floor function indices improved significantly Conclusion: This study shows an overall decline of cognitive function in a vulnerable group of elderly women during the short-term postoperative period. Postoperative cognitive dysfunction (POCD) after surgery has been described for other types of non-cardiac surgery but has been understudied in urogynaecological surgery. These patients need interdisciplinary management to prevent or minimize adverse effects of surgery on cognitive function.
If obstruction is resolved, bladder wall thickness decreases. Preoperatively elevated residual urine may increase the risk of persistent obstruction after urethrolysis.
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