Nicolette S. Horbach

George Washington University, Washington, D. C., DC, United States

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Publications (4)13 Total impact

  • Nicolette S. Horbach, Donald R. Ostergard
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    ABSTRACT: To determine whether specific clinical characteristics can be used to identify women with stress urinary incontinence due to intrinsic urethral sphincter dysfunction without the aid of urodynamic testing. A retrospective analysis was performed of 263 consecutive patients who underwent complete urodynamic evaluation for complaints of urinary leakage. Intrinsic sphincter dysfunction was defined as a maximum urethral closure pressure of 20 cm H2O or less in the sitting position at maximum cystometric capacity. Women with sphincter dysfunction were then compared to the group with normal pressure (greater than 20 cm H2O) using t test, chi 2, and logistic regression analyses for 13 clinical indices, endoscopic appearance of the proximal urethra, and eight urodynamic criteria. The group with intrinsic sphincter dysfunction totaled 132 women (50.2%). Univariate analysis revealed that women in this group were older and were more likely to have undergone a hysterectomy and at least one anti-incontinence procedure compared to the women with normal urethral pressure. However, multivariate analysis revealed that age greater than 50 years was the only independent variable that could predict the presence of intrinsic sphincter dysfunction in women with stress incontinence (odds ratio 1.6, 95% confidence interval 1.2-2.2). The two groups were similar in all other preoperative clinical characteristics. The only preoperative clinical index that predicted the presence of intrinsic urethral sphincter dysfunction, as defined by low urethral closure pressure, was age over 50 years. In view of previous studies reporting a higher rate of surgical failure in women with low urethral pressure, urodynamic testing should be considered in surgical candidates over age 50 to allow adequate preoperative counseling.
    Obstetrics and Gynecology 09/1994; 84(2):188-92. DOI:10.1097/00006254-199504000-00015 · 4.37 Impact Factor
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    ABSTRACT: Ten patients with pure detrusor instability were treated in a prospective fashion with transdermal scopolamine. Seventy percent of patients experienced moderate to severe untoward symptoms requiring discontinuation of medication. Three of 10 patients (30%) demonstrated a subjective improvement although only 1 was able to tolerate the medication. No objective change in detrusor instability was demonstrated.
    Urology 02/1990; 35(1):96-7. · 2.13 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ten patients with pure detrusor instability were treated in a prospective fashion with, transdermal scopolamine. Seventy percent of patients experienced moderate to severe untoward symptoms requiring discontinuation of medication. Three of 10 patients (30 %) demonstrated subjective improvement although only 1 was able to tolerate the medication. No objective change in detrusor instability was demonstrated.
    Urology 01/1990; 35(1):96-97. DOI:10.1016/0090-4295(90)80025-I · 2.13 Impact Factor
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    ABSTRACT: One indication for suburethral sling procedures has been recurrent genuine stress incontinence after previous incontinence surgery. Patients with low urethral closure pressures (20 cm H2O or less) in association with genuine stress incontinence are at particular risk for failure of standard anti-incontinence procedures. Urodynamic evaluation was used to select 17 patients with genuine stress incontinence and low urethral closure pressures for surgical treatment with a sling procedure using polytetrafluoroethylene. The technique of the procedure, cure rate, and postoperative complications were assessed. An 85% subjective and objective cure rate was found on urodynamic testing three months postoperatively. Complications included wound seroma, urinary tract infection, and urinary retention.
    Obstetrics and Gynecology 05/1988; 71(4):648-52. · 4.37 Impact Factor

Publication Stats

100 Citations
13.00 Total Impact Points

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Institutions

  • 1994
    • George Washington University
      • Department of Obstetrics and Gynecology
      Washington, D. C., DC, United States
  • 1988–1990
    • University of California, Irvine
      • Department of Obstetrics & Gynecology
      Irvine, CA, United States