Saturday, March 31, 2012

The Journal of Sexual Medicine Volume 9, Issue 4 Pages 947 - 1232, April 2012

Effects of vaginal prolapse surgery on sexuality in women and men; results from a RCT on repair with and without mesh. J Sex Med 12;9:1200–1211
Of course PTs do not give input to which type of surgery is chosen but it is interesting to follow the mesh issues.  This study shows improvement in sexual functioning after anterior colporrhaphy but not after mesh placement. 

From “sex toy” to intrusive imposition: A qualitative examination of women's experiences with vaginal dilator use following treatment for gynecological cancer. J Sex Med 12;9:1162–1173.
This study interviewed 10 women who used vaginal dilators prophylactically during and after radiation for pelvic cancer.  It outlines 5 themes.  These were: (i) embarrassing sex toy; (ii) reliving the invasion of treatment; (iii) aversive “hands-on” experience; (iv) not at the forefront of my recovery; and (v) minimizing the resistance.  It is important for us to be sensitive to patients emotional component in using dilators. 

Provoked vestibulodynia—Women's experience of participating in a multidisciplinary vulvodynia program. J Sex Med 12;9:1086–1093.
Another study using interviews and another 5 themes.  Five main themes emerged and included: increased knowledge, gained tools/skills, perceived improved mood/psychological well-being, a sense of validation and support, and an enhanced sense of empowerment.  This certainly gives support to our efforts with this very difficult patient population even if we are not able to “cure”. 

Friday, March 23, 2012

April 4, 2012 Pelvic Physiotherapy Distance Journal Club

April 4, 2012 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour
  • 209-647-1000 access code 436790#
  • Email Beth if you are having trouble accessing the call -
  • Please keep background noise to a minimum (see below for more details)
This month’s discussion
Lin Y, Yu T, Chia-Hsiang, Wand H, Lu K. Effects of early pelvic floor muscle exercises for sexual dysfunction in radical prostatectomy recipients. Cancer Nursing 2012;35(2):106-114.

Culligan PJ, Scherer J, Dyer K, Priestley JL, Guingon-White G, Delvecchio D, Vangeli M. A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength. Int Urogynecol J 2010;21:401-408.

Thursday, March 15, 2012

Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial.

Another study in favor of post prostatectomy treatment of UI.  In this RCT the treatment group received one pre op visit and post op visits at one month intervals till UI was gone.  Visits included instruction and “biofeedback”  (I can only get the abstract so not sure what kind of biofeedback).   Author discussion on MedScape states they do not think exactly what is offered is important – several studies with different patterns of treatment have come up with the same conclusion – it is just important to make sure the patient is doing the exercises correctly and that they keep doing them.  In this study significantly more patients in the exercise and biofeedback group achieved complete continence at one, three, and six months of follow-up (p=0.02, 0.01 and 0.002, respectively).  QOL scores did not reach significance – this has been the common finding in other studies also.  One of the down falls of this paper is the relatively short follow up.  Many studies point out the lack of a significant difference between groups one year after surgery.  Still there seems to be an overall change in the thoughts about post-operative UI and many urologists are offering treatment to all men after prostate surgery.  If the urologists in your area are not, you may want to collect some articles and approach them with a plan as outlined in this (or other) papers. 

Sunday, March 11, 2012

Anal sphincter fatigue: is the mechanism peripheral or central?

Anal sphincter fatigue: is the mechanism peripheral or central? Schabrun SM, Stafford RE, Hodges PW. Neurourol and Urodynam 2011;30:1550-1556.

Beth Shelly March 7, 2012 - Thank you to primary author Siobhan Schabrun for joining us on the call.

Primary aim – does the anal sphincter (AS) have greater susceptibility to central fatigue than the biceps
Central fatigue – decrease in activation of neurons in the motor cortex leading to decreased voluntary activation of the muscle. Skeletal limb muscles have up to 25% decrease force due to central fatigue.
Peripheral fatigue - loss of muscle force related to decrease in function of the neuromuscular junction or the muscle itself.

Healthy volunteers – 8 female, 2 male, no control group, no blinding

Investigation of optimal cues to instruction for pelvic floor muscle contraction: A pilot study using 2D ultrasound imaging in pre-menopausal, nulliparous, continent women.

Investigation of optimal cues to instruction for pelvic floor muscle contraction: A pilot study using 2D ultrasound imaging in pre-menopausal, nulliparous, continent women.  Crotty K, Bartram CI, Pitkin J, Cairns MC, Taylor PC, Dorey G, Chatoor D. Neurourol and Urodynam 2011 30:1620-1626.

Beth Shelly  March 7, 2012

Primary aim – to investigate which cue for PFM contraction results in the best overall contraction and elevation of the urethra.

Continent, nulliparous, pre-menopausal women, who could perform an “inward moving PFM contraction” on US and contract various portions of the PFM on EMG. 
All subjects received the same instruction – no control group – no blinding of subjects or trainers. 
US angle of urethral inclination was read by 2 blinded practitioners experienced in reading US.

Monday, March 5, 2012

Vaginal diazepam use with urogenital pain/ pelvic floor dysfunction

Vaginal diazepam use with urogenital pain/ pelvic floor dysfunction: serum diazepam levels and efficacy data.  Carrico DJ, Peters KM. Urological Nursing 2011;31(5):279-299.
This paper discusses the authors’ experience in using vaginal valium for pelvic floor muscle dysfunction and pain in 21 women.  This is not a randomized control trial. Dosing was 2 to 10 mg up to every 8 hours.  Usual start 5 mg increasing to 10 mg after 7 to 10 days if needed.  Oral tablet was crushed and mixed with vaginal lubricant or the tablet was inserted whole into the vagina.  15 women used vaginal valium 2 to 3 times per day; the remaining used it 1 to 7 times per week.  After one month 62% were moderately or markedly improved.