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M Mildner,
M Stichenwirth,
A Abtin,
L Eckhart, C Sam,
R Gläser,
J-M Schröder,
R Gmeiner,
V Mlitz,
J Pammer,
A Geusau,
E Tschachler
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ABSTRACT: The female urogenital tract requires an efficient defense against bacteria, potentially derived from the adjacent intestinal tract. We have thus sought to identify the factors that protect against Escherichia coli (E. coli) in the female genital tract. Vaginal fluid from healthy human donors consistently killed E. coli in vitro and vaginal epithelium strongly expressed and secreted psoriasin. Psoriasin was constitutively produced in an organotypic vaginal epithelium model, and exposure of these cells to supernatants of E. coli cultures led to an enhanced psoriasin expression. Secreted psoriasin in vaginal fluids accounted for approximately 2.5-3% of total protein. Fractionation of vaginal fluids by high performance liquid chromatography (HPLC) showed that psoriasin co-eluted with a peak of E. coli killing activity. Our data show that normal vaginal fluid contains a powerful intrinsic antimicrobial defense against E. coli and that psoriasin contributes to the innate immune response of the female genital tract.
Mucosal Immunology 11/2010; 3(6):602-9. · 6.96 Impact Factor
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ABSTRACT: To evaluate the prevalence of female sexual dysfunction (FSD) in an outpatient gynecologic and urogynecologic clinic using the current International Consensus Classification.
One hundred fifty-nine patients were asked to answer an anonymous survey about FSD. Patients in the gynecologic (group 1) and urogynecologic (group 2) clinics were compared.
The mean age in group 1 was 37.8 years (range 20 to 76) and in group 2 was 55.7 years (range 18 to 82). The prevalence of FSD was 50% in group 1 and 48% in group 2; 86% of group 1 and 66% of group 2 patients had been sexually active within the past 2 years. The differences found in FSD according to the consensus panel classification achieved no significance. Of the 159 patients, 96% were not embarrassed by filling out this questionnaire about their sexual function.
No statistically significant difference in FSD was found between the younger and older patients seeking help in a gynecologic or urogynecologic outpatient clinic. Because of the high incidence of FSD, we recommend integrating the inquiry about female sexual health concerns into routine gynecologic care. The simple survey based on the International Consensus Conference Classification of FSD gives reliable results, and this systematic framework facilitates methodologic examination.
Urology 10/2003; 62(3):514-8. · 2.43 Impact Factor
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ABSTRACT: The main reason for the restricted use of methotrexate in the treatment of ectopic pregnancy (EP) obviously is the fear of tubal rupture in patients with lower abdominal pain after the administration of methotrexate. Therefore, we wanted to find out if patient characteristics at first presentation, such as age, pretreatment beta-hCG level, adnexal mass as visualized by transvaginal ultrasonography, or history of prior EP, would identify patients at risk for tubal rupture if they were hemodynamically stable and showed no signs of peritoneal irritation. We examined whether more patients could have been treated medically with methotrexate, because tubal rupture was unforeseeable at first presentation and inclusion criteria for methotrexate treatment were fulfilled. From January 1996 to August 1998, 122 patients diagnosed as having EP were treated at the Gynecologic Department of the University Hospital of Vienna. Inclusion criteria for medical treatment with intramuscular methotrexate (50 mg/ m(2) body surface area) were (1) hemodynamic stability, (2) an unruptured ectopic mass < or = 5 cm at the greatest dimension demonstrated at transvaginal ultrasonography; (3) beta-hCG level < or = 5,000 mIU/ml; (4) no cardiac activity of the extrauterine embryo; (5) wish of future fertility, and (6) informed consent. Patients with hemodynamic instability, severe abdominal pain, an ectopic mass > or = 5 cm at the greatest dimension, beta-hCG levels > or = 5,000 mIU/ml, cardiac activity of the extrauterine embryo, and no wish of future fertility, or disagreement with methotrexate treatment, primarily underwent surgery. Despite the fact that none of the above patient characteristics at first presentation identified patients at risk for tubal rupture, only 60/122 patients (49%) actually underwent medical treatment whereas our inclusion criteria would have granted medical treatment in 101/122 patients (83%). We determined the actual and maximal possible percentages of patients with unruptured EP eligible for medical treatment of EP with intramuscular single-dose methotrexate 50 mg/m(2) body surface area. Our data show that tubal rupture in hemodynamically stable patients is not foreseeable and should not lead to a restricted use of medical treatment in patients preferring methotrexate.
Gynecologic and Obstetric Investigation 02/2000; 49(1):6-11. · 1.28 Impact Factor
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ABSTRACT: To measure the pressure profiles at different positions of the urethral circumference simultaneously.
Twenty-two women with symptoms of genuine stress incontinence underwent urogynecologic assessment and multichannel urethral pressure profilometry (UPP) at rest with a specially designed 8-channel urethral catheter with radial openings.
The distribution pattern of maximum urethral closure pressure (MUCP) and functional urethral length (FUL) values were significantly different (P=0.004 and P=0.0004, respectively). Most of the highest MUCP values per patient were found between channels 2 and 4 (P=0.015); most of the greatest FUL values per patient were found between channels 3 and 4 (P=0.15).
The data of our study substantiate asymmetric radial pressure distribution within the urethra and underline the necessity of cautious interpretation of results of conventional single-channel UPP, which might vary because of transducer orientation.
Urology 01/1999; 52(6):1113-7. · 2.43 Impact Factor
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ABSTRACT: To assess the short-term efficacy of transurethral injection of silicone microimplants in women with intrinsic sphincter deficiency.
During January 1995 and December 1996, 32 women (mean age 64.3 years, range 39-85 years) with type III stress incontinence (intrinsic sphincter deficiency) underwent transurethral injection of silicone microimplants under general anesthesia. Twenty-eight had undergone previous continence surgery. Subjective and urodynamic assessments were made at 6 and 12 months after injection to evaluate success and short-term effects.
Objective and subjective success rates were 75% and 59% at 6 and 12 months, respectively. Injections of silicone microimplants significantly increased maximum urethral closure pressure (maximum urethral pressure at rest: 34.40+/-16.46 cm H2O, 95% confidence interval [CI] 28.55, 40.25 versus 25.35+/-10.78 cm H2O, 95% CI 21.52, 29.18; P = .027). There were no complications after surgery up to 1 year.
Transurethral silicone injections were effective in 60% of cases of intrinsic sphincter deficiency, although there was a time-dependent decrease.
Obstetrics and Gynecology 10/1998; 92(3):332-6. · 4.73 Impact Factor
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ABSTRACT: To determine the present state of urogynecological diagnostics, therapy and follow-up in the Departments of Gynecology and Obstetrics in Austria.
We sent questionnaires to all Departments of Gynecology and Obstetrics in Austria. The anonymous questionnaire consisted of 25 multiple choice questions. It was possible to choose one ore more answers by ticking applicable boxes with the casual option to give some additional information in form of free text.
Fifty-eight departments (58%) returned their questionnaires completely answered indicating interest in quality management in medicine. The most remarkable discrepancy was found between the interrogated people's estimation of the expressiveness of examination techniques and the actual use of such techniques.
We regard the results of this survey as a basis for further quality management strategies in the field of urogynecology in Austria.
Acta Obstetricia Et Gynecologica Scandinavica 02/1998; 77(2):222-7. · 1.77 Impact Factor
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ABSTRACT: To evaluate the effect of spinal anaesthesia on the bladder neck position and the urethral closure function in the resting state and during clinical stress test in healthy, continent women.
Controlled clinical trial.
Department of Gynaecology and Obstetrics, Vienna University Medical School.
Fourteen continent women, of which seven were nulliparous and seven parous, underwent minor gynaecological procedures under spinal anaesthesia. Urodynamics and ultrasound investigations were performed before and during spinal anaesthesia.
Changes in the bladder neck position and the urethral closure function before and during spinal anaesthesia.
Bladder neck position was found to be lower and more posterior during spinal anaesthesia as compared with pre-operative assessment. The posterior urethrovesical angle increased significantly both at rest and during maximum straining. We observed a significant increase in bladder compliance, and all parameters of the urethral pressure profile decreased significantly. While none of the nulliparous women had a positive clinical stress test during spinal anaesthesia, 4/7 parous women demonstrated leakage (Fisher's exact test, P = 0.003).
Blockage of nerve supply to the pelvic floor muscles in continent women is associated with a significant loss of support of the bladder neck region confirming the theory of an active mechanism of muscular elements providing continence.
British Journal of Obstetrics and Gynaecology 02/1998; 105(1):103-6.
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ABSTRACT: Our objective was to investigate the possible role of three-dimensional transvaginal ultrasound in the visualization of an intrauterine device (IUD) for routine follow-up after insertion. A total of 96 women were examined after insertion of a TCu380A IUD. Three-dimensional ultrasonographic imaging was carried out using a special vaginal probe and a commercially available ultrasound machine at a mean interval of 22 days after insertion. Complete simultaneous imaging of all parts of the IUD was possible in 95% of cases. In the three-plane mode, all parts of the IUD could be visualized in 64% and in a further 30 cases this was possible only after volume rendering. In two women, incomplete opening of the two arms of the device was demonstrated. In one of these cases, the entire IUD was displaced into the cervical canal. In another case, an intrauterine pregnancy was found together with an IUD in the correct position. Three-dimensional ultrasound provides useful information on the location of the IUD following insertion. It enables imaging of the entire IUD, i.e. the shaft and the arms, simultaneously. Additionally, the examination time can be kept to a minimum with this new technique.
Ultrasound in Obstetrics and Gynecology 11/1997; 10(4):289-92. · 3.01 Impact Factor
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ABSTRACT: To evaluate whether the transcervical approach for fallopian tissue sampling is a practicable and safe method to establish an etiologic diagnosis of salpingitis.
Controlled clinical study.
Academic research environment.
Twenty women with primary or secondary sterility undergoing hysteroscopy and laparoscopy.
During hysteroscopy, fallopian tissue samples were obtained from the proximal parts of both tubes with a cytobrush inserted through the working channel of the hysteroscope. Diagnostic laparoscopy with assessment of tubal patency was performed in the same session. The specimens were split and used for chlamydial testing by both cell culture and polymerase chain reaction. Serum samples were evaluated for the presence of antichlamydial antibodies.
Practicability and safety of the method.
The sampling procedure was performed in all patients without complications. Adequate samples were obtained from both tubes in all 20 patients. The fallopian specimens showed evidence of chlamydial infection in one patient.
Those data indicate that transcervical fallopian tissue sampling with a cytobrush is a reliable and safe technique.
Fertility and Sterility 04/1997; 67(3):580-2. · 3.56 Impact Factor
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G Schär,
H Kölbl,
R Voigt,
E Merz,
C Anthuber,
R Niemeyer,
G Ralph,
W Bader,
D Fink,
E Grischke,
E Hanzal,
O R Köchli,
K Köhler,
E Munz,
D Perucchini,
U Peschers, C Sam,
A Schwenke
Ultraschall in der Medizin 03/1996; 17(1):38-41. · 2.40 Impact Factor
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G. Schaer,
H. Koelbl,
R. Voigt,
E. Merz,
Ch. Anthuber,
R. Niemeyer,
G. Ralph,
W. Bader,
D. Fink,
E. Grischke,
E. Hanzal,
O. R. Koechli,
K. Koehler,
E. Munz,
D. Perucchini,
U. Peschers, C. Sam,
A. Schwenke
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ABSTRACT: Ultrasound is a complementary evaluation for the study of female urinary incontinence which allows functionalmorphological documentation. A reliable urogynecologic examination is based on the patient's history, clinical evaluation, urodynamics and imaging. Training in sonography of the female lower urinary tract should be performed within the scope of urogynecological evaluations.
International Urogynecology Journal 02/1996; 7(2):105-108. · 1.83 Impact Factor
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G Schär,
H Kölbl,
R Voigt,
E Merz,
C Anthuber,
R Niemeyer,
G Ralph,
W Bader,
D Fink,
E Grischke,
E Hanzal,
O R Köchli,
K Köhler,
E Munz,
D Perucchini,
U Peschers, C Sam,
A Schwenke
Gynäkologisch-geburtshilfliche Rundschau 02/1996; 36(1):33-6.
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ABSTRACT: To evaluate the validity of the Gaudenz-Incontinence-Questionnaire in the differential diagnosis of genuine stress-incontinence and detrusor instability.
Diagnoses based on questionnaire-results were compared to those following complete urogynecologic assessment including urodynamics in 1938 patients with lower urinary tract symptoms.
Sensitivity and specificity for diagnosis of stress-incontinence were 0.559 and 0.447, respectively, for detrusor instability 0.615 and 0.563, respectively.
The low sensitivity and specificity of the test do not justify its use as a diagnostic tool in patients with urinary incontinence. These results show that the scores may be misleading in a large proportion of patients and should not therefore be the only determinant of diagnosis, nor should strategies be based on history alone.
Acta Obstetricia Et Gynecologica Scandinavica 10/1995; 74(8):635-7. · 1.77 Impact Factor
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ABSTRACT: To assess the influence of spinal anesthesia on bladder neck position and a clinical stress test in continent women.
In a prospective investigation, 14 women underwent urodynamic, sonographic and clinical assessment during spinal anesthesia. Results were compared to those obtained immediately preoperatively in the same patient.
During spinal anesthesia, the bladder neck was found to be located significantly lower and more posterior, and in 4/7 parous patients (0/7 nullipara) the clinical stress test was positive.
These data provide additional evidence for the importance of neuromuscular function in the etiology of pelvic floor dysfunction and genuine stress incontinence.
Gynäkologisch-geburtshilfliche Rundschau 02/1995; 35(3):173-4.
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ABSTRACT: A retrospective analysis of women treated microsurgically using the CO2 laser in sterility treatment was performed. The aim of the study was to determine women's personal feeling about the procedure, prognostic factors, success rates, and complications. Included were 192 patients with tubal occlusions or pelvic adhesions treated by means of CO2 laser microsurgery between February 1984 and July 1992. A standardized questionnaire was used to evaluate women's procedure-related stress, extrauterine and intrauterine pregnancy rates, pregnancy complications, and postoperative complaints. In 75 cases, records and questionnaires contained sufficient data and were included for further analysis. Adhesiolysis alone, unilateral neosalpingostomy, bilateral neosalpingostomy, or new implantation was done in 7%, 52%, 33%, and 8%, respectively. In the range of 1-10, a medium degree procedure-related stress (mean 4.3, range 1-10) was expressed by the treated women. No surgery-related complications were observed. The overall pregnancy rate was 37.3%, and 10.7% were tubal pregnancies. In 26.7%, fertility surgery resulted in intrauterine pregnancies, and 21.3% of the treated women delivered living children. Three women had two consecutive pregnancies after surgery. Women with intrauterine pregnancy, extrauterine pregnancy, and no pregnancy had a mean age of 29.5 +/- 3.8, 27.3 +/- 5.3, and 32.3 +/- 4.2 years, respectively (p = NS). Mean duration of infertility before start of surgical treatment was 42.4 +/- 34.6, 41.6 +/- 25.8, and 48.8 +/- 33.2 months, respectively (p = NS). Intraabdominal instillation of streptokinase to prevent reformation of adhesions had no significant impact on tubal patency results or pregnancy rates.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Gynecologic Surgery 02/1994; 10(4):221-7.
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Gynäkologisch-geburtshilfliche Rundschau 02/1993; 33 Suppl 1:314.
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ABSTRACT: The extensive intraductal component (EIC) in infiltrating ductal carcinoma (IDC) was reported to be a predictor of local recurrence. We investigated the influence of this histopathological parameter on nodal status and overall survival. In 115 patients suffering from an IDC with tumor stage FIGO I and II, 35 were EIC positive. We did not find a correlation with the nodal status. The mean follow up was 73 (+/- 38) months. EIC showed no influence on overall survival. Based on our findings, the presence of EIC is not a criterion for therapeutic decisions in IDC.
Anticancer research 15(5B):2285-6. · 1.73 Impact Factor
