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Spasm of pelvic floor muscles as a cause of its dysfunction
Hurt, Karel ; Zahálka, František (advisor) ; Martan, Alois (referee) ; Otčenášek, Michal (referee)
Background: Currently, there are no effective therapy strategies for idiopathic, non-organic vulvodynia and dyspareunia in women. ESWT (extracorporeal shock wave therapy) is a nonsurgical/noninvasive technique widely used to treat musculoskeletal diseases, muscle spasticity, hypertonia, renal, biliary calculi and urological disorders. Aim: The goal of our work is to investigate the possibility to eliminate chronic and acute forms of pelvic pain by a non-invasive physical method. We wanted to know if the extracorporeal shock wave technique could fulfill these requirements. Study design: The prospective, randomized, double-blind, placebo-controlled studies were conducted following feasibility studies. Methods: The study 1. included 62 women with vulvodynia for at least 3 months. The women were randomly assigned to either a treatment group (n=31) or a placebo group (n=31). The patients in the treatment group received perineally applied ESWT weekly (3000 pulses each for four consecutive weeks). The position of the shock wave transducer was changed six times after every 500 pulses. Patients in the placebo group underwent the same treatment procedure, but the handpiece was provided with a placebo stand-off that disabled energy transmission. Subjective pain was evaluated by a visual analogue scale (VAS,...
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Delivery and the Pelvic Floor
Kališ, Vladimír ; Rokyta, Zdeněk (advisor) ; Martan, Alois (referee) ; Roztočil, Aleš (referee)
Vaginal Birth in Primiparas and Anal Incontinence Objective: An investigation of incidence and degree of anal incontinence after vaginal delivery among primiparas and characterizing of the risk factors Design: Prospective observational study Setting: Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Pilsen, the Czech Republic Methods: 346 primiparas after consecutive vaginal delivery between 2000 and 2001 were included. All delivered in lithotomy position. Questionnaires were sent few days after delivery and then 2 and 6-9 months later. Analysis of returned questionnaires. 28 obstetric parameteres assessed. Results: 46.5% women responded. 23 women registered leakage of flatus before delivery. Two months postpartum 1 (0.6%) patient reported fecal incontinence and 22 (14.3%) flatus incontinence de novo or impaired already present incontinence. 6-9 months after delivery the same patient (0.6%) reported fecal incontinence and 16 women (10.4%) incontinence of flatus. 10 of them felt impaired quality of life. Anal incontinence gradually improved during the time (in 76%). Risk factors of developing (worsening) of anal incontinence were antenatal anal incontinence (in two months period) and women weight (or BMI) meassured at 6-9 months after birth. None of nine patients after forceps...
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Vascularity of Female Urethra in Correlation to Urinary Incontinence : Diagnostic Algorithms and Its Clinical Implications
Švabík, Kamil ; Martan, Alois (advisor) ; Halaška, Michael (referee) ; Adamík, Zdeněk (referee)
Introduction: Intrinsic and extrinsic urethral factors play a significant role in urinary continence mechanism in women. Urethral wall structure including inervation, perfusion of submucosal layer etc. is not clinically assessed despite its important role in urethral closure function. The association of incontinence and pelvic floor reconstructive surgery is well known. Every postoperative healing process is associated with factors of ischemia and neovascularisation. According those facts we would expect that the healing and scaring should involve intrinsic urethral mechanism. After reconstructive surgery Implants further increase scaring process. Methods: In our study we included patients with anterior compartment defect. We randomized patients into three interventional arms according the surgical approach and use of implants. Before and 3-5 month after the surgery we performed urodynamic studies and pelvic floor ultrasound examination, including Doppler for urethral perfusion assessment. Another early ultrasound scan was added forth day after surgery. We correlated ultrasound and urodynamic parameters. Results: We randomized 87 patients. We couldn't find any correlation between the morphologic changes and severity of incontinence. Methods for urethral perfusion assessment showed high inaccuracy...
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Vascularity of Female Urethra in Correlation to Urinary Incontinence : Diagnostic Algorithms and Its Clinical Implications
Švabík, Kamil ; Martan, Alois (advisor) ; Halaška, Michael (referee) ; Adamík, Zdeněk (referee)
Introduction: Intrinsic and extrinsic urethral factors play a significant role in urinary continence mechanism in women. Urethral wall structure including inervation, perfusion of submucosal layer etc. is not clinically assessed despite its important role in urethral closure function. The association of incontinence and pelvic floor reconstructive surgery is well known. Every postoperative healing process is associated with factors of ischemia and neovascularisation. According those facts we would expect that the healing and scaring should involve intrinsic urethral mechanism. After reconstructive surgery Implants further increase scaring process. Methods: In our study we included patients with anterior compartment defect. We randomized patients into three interventional arms according the surgical approach and use of implants. Before and 3-5 month after the surgery we performed urodynamic studies and pelvic floor ultrasound examination, including Doppler for urethral perfusion assessment. Another early ultrasound scan was added forth day after surgery. We correlated ultrasound and urodynamic parameters. Results: We randomized 87 patients. We couldn't find any correlation between the morphologic changes and severity of incontinence. Methods for urethral perfusion assessment showed high inaccuracy...
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Delivery and the Pelvic Floor
Kališ, Vladimír ; Rokyta, Zdeněk (advisor) ; Martan, Alois (referee) ; Roztočil, Aleš (referee)
Vaginal Birth in Primiparas and Anal Incontinence Objective: An investigation of incidence and degree of anal incontinence after vaginal delivery among primiparas and characterizing of the risk factors Design: Prospective observational study Setting: Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Pilsen, the Czech Republic Methods: 346 primiparas after consecutive vaginal delivery between 2000 and 2001 were included. All delivered in lithotomy position. Questionnaires were sent few days after delivery and then 2 and 6-9 months later. Analysis of returned questionnaires. 28 obstetric parameteres assessed. Results: 46.5% women responded. 23 women registered leakage of flatus before delivery. Two months postpartum 1 (0.6%) patient reported fecal incontinence and 22 (14.3%) flatus incontinence de novo or impaired already present incontinence. 6-9 months after delivery the same patient (0.6%) reported fecal incontinence and 16 women (10.4%) incontinence of flatus. 10 of them felt impaired quality of life. Anal incontinence gradually improved during the time (in 76%). Risk factors of developing (worsening) of anal incontinence were antenatal anal incontinence (in two months period) and women weight (or BMI) meassured at 6-9 months after birth. None of nine patients after forceps...
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