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1.  Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis 
The objective was to study the effect of colpocleisis on pelvic support, symptoms, and quality of life and report-associated morbidity and postoperative satisfaction. Women undergoing colpocleisis for treatment of pelvic organ prolapse (POP) were recruited at six centers. Baseline measures included physical examination, responses to the Pelvic Floor Distress Inventory, and Pelvic Floor Impact Questionnaire. Three and 12 months after surgery we repeated baseline measures. Of 152 patients with mean age 79 (±6) years, 132 (87%) completed 1 year follow-up. Three and 12 months after surgery, 90/110 (82%) and 75/103 (73%) patients following up had POP stage ≤1. All pelvic symptom scores and related bother significantly improved at 3 and 12 months, and 125 (95%) patients said they were either ‘very satisfied’ or ‘satisfied’ with the outcome of their surgery. Colpocleisis was effective in resolving prolapse and pelvic symptoms and was associated with high patient satisfaction.
PMCID: PMC3691385  PMID: 18690402
Pelvic organ prolapse; Urinary incontinence; Pelvic floor disorders; Colpocleisis; Quality of life; Surgical outcomes
2.  Five Year Continence Rates, Satisfaction and Adverse Events of Burch Urethropexy and Fascial Sling Surgery for Urinary Incontinence 
The Journal of urology  2012;187(4):1324-1330.
To characterize continence, satisfaction, and adverse events in women at least 5 years after a Burch urethropexy or fascial sling with longitudinal follow-up of randomized clinical trial participants at least 5 years post-operatively.
482 (73.6520 (79.4%) of 655 women participated in a randomized surgical trial comparing efficacy of the Burch and sling treatments enrolled in this long-term observational study. Urinary continence status was assessed yearly for a minimum of five years postoperatively. Continence was defined as no urinary leakage on a three-day voiding diary and no self-reported stress incontinence symptoms AND no stress incontinence surgical retreatment.
Incontinent participants were more likely to enroll in the follow-up study than continent patients (85.5% vs. 52.2%), regardless of surgical group (p <0.0001). Overall the continence rates were lower in the Burch urethropexy group than in the fascial sling group (p=0.002). The continence rates at five years were 24.1% (95% CI 18.5% to 29.7%) compared to 30.8% (24.7% to 36.9%), respectively.
Satisfaction at 5 years was related to continence status and higher in women undergoing a sling (83% vs. 73%, p=0.04). Satisfaction declined over time (P=0.001) and remained higher in the sling group (p=0.03). The two groups had similar adverse event rates (10% Burch vs.9 % sling) and similar numbers of participants with adverse events (23 Burch vs. 22 sling).
Continence rates in both groups declined substantially over five years, yet most women reported satisfaction with their continence status. Satisfaction was higher in continent women and those who underwent fascial sling, despite the voiding dysfunction associated with this procedure.
PMCID: PMC3586411  PMID: 22341290
Surgical Outcome; Stress Incontinence; Longitudinal Study
3.  Tolterodine extended release is well tolerated in older subjects 
To investigate the tolerability of tolterodine extended release (ER) in older subjects with overactive bladder (OAB).
This was a retrospective analysis of pooled data from five large, randomised, double-blind, placebo-controlled trials. Subjects with OAB symptoms, including urinary frequency and urgency (and nocturia in two studies) with or without urgency urinary incontinence, received qd treatment with tolterodine ER (4 mg) or placebo for 8–12 weeks. Data were stratified post hoc by age group: < 65 (n = 2531), 65–74 (n = 1059) and ≥ 75 years (n = 573). Tolerability was assessed by evaluating the occurrence of adverse events (AEs). AE occurrences from each study were mapped to the MedDRA coding dictionary of preferred terms.
Discontinuation rates were slightly higher among subjects ≥ 75 years of age vs. those < 65 years of age; however, this was observed in subjects treated with placebo as well as tolterodine ER. Overall, there were no significant differences in the occurrence of dry mouth, headache, constipation, nausea, urinary tract infection, blurred vision, dry eye, dizziness and micturition disorder in older (65–74 or ≥ 75 years) vs. younger (< 65 years) subjects treated with tolterodine ER relative to placebo (treatment × age; all p > 0.1). Dry mouth was the only AE consistently associated with tolterodine ER treatment (< 65 years, 17%; 65–74 years, 16%; ≥ 75 years, 15%). The occurrence of all other AEs was ≤ 5% in most age and treatment cohorts. Most AEs were mild or moderate in all age and treatment cohorts.
The nature and frequency of AEs associated with tolterodine ER treatment were similar across age groups in subjects with OAB, suggesting that tolterodine ER was not associated with an increased risk of AEs in older vs. younger subjects and, thus, is a suitable first-line pharmacotherapy treatment for OAB in this population.
PMCID: PMC2737749  PMID: 19624787

Results 1-3 (3)