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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report 1,000 cases (357 cesarean sections, 230 hysterectomies for benign lesions, 157 conservative utero-adnexal procedures, 128 tubal plasties, 58 prolapse or incontinence procedures, 70 cancers) ,of laparotomies performed according to the technique described by Mouchel in 1980, i.e. strictly supra-pubic and transverse, from skin to peritoneum, including section of the rectus abdominis. This incision enables to perform in ideal technical conditions, with a minimal complication rate (3 hematomas, 2 incisional hernias for 1,000), and satisfactory esthetic results, almost all of the gynecological and obstetrical surgical procedures (90% of two among the authors' practice). The only contra-indications are, except for cases of previous median laparotomy, ovarian tumors. Neither the high risk of infection, nor obesity, extended hysterectomy, nor fetal distress, represent contra-indications, which is a definite advantage over the Pfannenstiel incision. As compared with the median incision which at some time offered similar results, the esthetics and mainly the strength of the abdominal wall are markedly superior.
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PMID:[Low transverse laparotomy with rectus abdominus section in gynecology and obstetrics. Apropos of 1,000 cases]. 296 66

In a series of 368 incontinent women who presented to our urodynamic clinic for assessment, 232 (63%) were diagnosed as having genuine stress incontinence, and 136 (27%) as having detrusor instability. Obesity (greater than 20% more than average weight for height and age) was significantly more common in women with genuine stress incontinence and detrusor instability than in the normal population. In those with detrusor instability the body mass index was found to increase with age and parity. In women with genuine stress incontinence the body mass index increased with age and the number of previous incontinence operations; it was higher in nulliparous than in parous women. There was no significant difference between obese and nonobese women in any of the urodynamic variables measured in the two incontinence groups.
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PMID:Obesity and urinary incontinence in women. 334 13

Possible aetiological factors for urinary incontinence were examined in a prevalence study among a random sample of 1000 women aged 18 and over. Infective factors were not markedly associated with incontinence but mechanical factors such as parity and obesity were. No association was found, however, between a history of perineal damage at childbirth and incontinence. Women with incontinence had on average a higher score for a 'neuroticism' trait elicited by questionnaire than women without the disorder.
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PMID:Factors associated with urinary incontinence in women. 706 57

The key to restoring urinary continence in the female is to raise the internal vesical neck of the bladder to a position behind the symphysis pubis. The operation which accomplishes this with the least morbidity, the most accuracy and the greatest permanency is endoscopic suspension; it is particularly applicable in patients with obesity, multiple operative failures, radiation incontinence, and severe pelvic fractures. Between December 1973 and May 1979, 203 patients underwent 211 operations with a minimum of six months of follow-up study at final review (November 1979). Twenty per cent of the patients were totally incontinent on referral, and 60 per cent lost urine with minimal activity; only 20 per cent of the patients had typical stress urinary incontinence, requiring coughing or sneezing to lose urine. Among the 203 patients, there were 188 previous operations for urinary incontinence, including 74 Marshall-Marchetti retropubic repairs. Forty-seven patients have been followed for over four years, and 156 patients have been followed for six months to four years. While 138 patients had a previous hysterectomy, 65 patients had not; the presence of the uterus did not affect the results. Urinary incontinence is not an indication for hysterectomy. Ninety-one per cent of the 203 patients were cured of their urinary incontinence by endoscopic suspension of the vesical neck. Technical advantages over the retropubic vesical neck suspensions include the use of monofilament heavy nylon (No. 2), a vaginally placed Dacron((R)) buttress to prevent tearing of the pubocervical fascia, less postoperative morbidity, minimal blood loss, functional measurements and anatomic visualization of a restored vesical neck during the operative procedure, easy access to a surgically difficult pelvis, and simultaneous repair of significant rectoceles or substantial cystoceles through the same operative field.
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PMID:Endoscopic suspension of the vesical neck for urinary incontinence in females. Report on 203 consecutive patients. 742 93

Involuntary urinary leakage due to a rise in abdominal pressure caused by stress (cough, laugh, change in position, walking, running or carrying heavy weight) is a clinical entity often experienced by women. Management can be based on physical therapy techniques, drugs or surgery but indications and results to be expected are still very largely debated. Cure of an underlying condition such as obesity, or chronic bronchitis may be sufficient in some cases and others may benefit from "preventive" physical therapy to reinforce the perineum after difficult pregnancy and delivery. Alpha-stimulating drugs have also been proposed to increase sphincter tone. Surgery gives the best results. Several procedures have been proposed, usually based on classical retropubic colposuspension and aponevrosis loops. Success rate is approximately 80 to 90% although the lack of a sufficient understanding of the underlying mechanism involved, makes it impossible to predict outcome. Results in women with recurrent incontinence are less satisfactory.
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PMID:[Treatment of stress urinary incontinence in women]. 854 51

Thirty-two female patients affected by urinary incontinence were enrolled for rehabilitative treatment (functional electro-stimulation by vaginal electrode performed three times a week for one month followed by biofeedback performed three times a week for one month). Complete clinical and urodynamic studies, urethrocystography in order to allow Blaivas and Olsson radiologic evaluation were performed. Echography of the bladder and urine cultures were done too. Patients with severe urogenital prolaxus and obesity, neurologic urinary disorders and surgery for incontinence, were excluded. The same patients were urodynamically reassessed at the end of the treatment and a detailed clinical evaluation was obtained from each patient. 78% of patients reported a considerable improvement in clinical symptoms and only 9% reported no improvement. Urodynamic findings showed an increase of maximum cystometric capacity in 6 patients, improvement of maximum urethral closure pressure and/or functional profile length in 17 patients. Disappearance or reduction of involuntary detrusor contractions were found in 2 out of 6 patients with unstable bladder.
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PMID:Rehabilitative treatment of non-neurogenic female urinary incontinence. Clinical and urodynamic evaluation. 909 56

Morbid obesity is a chronic disease that manifests as a steady, slow, progressive increase in body weight. Because of both emotional and physical reasons, obese people resist pursuing healthcare and may be more difficult to care for. In taking a practical approach to skin and wound care, using an interdisciplinary team is valuable. Difficulty in assessment stems from problems such as equipment that is too small or as patient uncooperativeness. Skin/wound problems which are common, yet more difficult to manage for these patients, include pressure ulcers, tracheostomy care (potentially resulting from ventilatory insufficiency), candidiasis, tape-related skin tears, incontinence and lymphedema. In order to offer care and support to these patients and their families, clinicians must acknowledge and manage any personal prejudice they may have toward this patient population. A comprehensive patient-focused plan of care is the goal. With this article are included four annotated suggested readings introducing topics such as the failure of behavioral and dietary treatments for obesity, theoretical and practical aspects of obesity assessment, current views on obesity (such as a move back to pharmacotherapeutic treatment), and the psychological aspects of severe obesity.
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PMID:Morbid obesity: a chronic disease with an impact on wounds and related problems. 923 36

There is controversy in the literature related with the prognosis of incontinent obese patient. The objective of this study was to demonstrate if obesity has influence on the relapse of postsurgical incontinence in genuine urinary incontinence. 148 patients were included measuring their Body Mass Index and divided in two groups: Group "A" 74 patients without relapse and Group "B" 74 patients with relapse. The results showed in the obese patients the double of surgical failures than in those with our it (P < 0.05). In conclusion obesity is a adverse prognostic factor in the postsurgical evolution in these patients.
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PMID:[Obesity as a risk factor in surgery for urinary incontinence]. 944 Nov 45

The first pubovaginal fascial sling was reported in 1907, however, until recently this procedure was rarely utilized except after other incontinence procedures had failed. Currently, a pubovaginal sling is indicated as the primary incontinence procedure if intrinsic sphincter deficiency or coexisting intrinsic sphincter deficiency and urethral hypermobility are diagnosed preoperatively. Additionally, incontinence secondary to urethral hypermobility should be treated with a pubovaginal sling if the patient has a high risk of postoperative failure due to obesity, chronic cough, or repetitive strenuous activity. Pubovaginal slings are relatively easy to perform and yield reliably good results with minimal morbidity. We describe our current technique and results using pubovaginal slings for stress incontinence in women.
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PMID:Pubovaginal fascial slings. 953 Nov 2

Urinary incontinence, corresponding to the definition of involuntary urine leaks, due to alteration of the physiological mechanisms of continence, experienced as discomfort in everyday life affects approximately 10% of the female population. The main predisposing factors are age, child-birth (particularly the first), recurrent urinary tract infections, and obesity. Pathophysiologically, urine leak occurs when the forces of expulsion resulting from abdominal straining or detrusor contraction, exceed the physiological (urethral sphincter device) and pathological (obstruction) continence forces. These two mechanisms correspond to two types of incontinence, stress and urge incontinence, which are primarily diagnosed on the basis of the clinical interview, which must also strive to evaluate the volume of urine leaks, the circumstances inducing incontinence, and associated urinary symptoms such as dysuria and frequency. Clinical examination, in women in the gynaecological position, demonstrates incontinence on coughing and control of incontinence by supporting the bladder neck (Bonney's manoeuvre); it also evaluates vulval trophicity and the quality of perineal musculature; it analyses the components of possible vaginal prolapse. The objective of complementary investigations is not to confirm the data of the clinical interview and clinical examination, but to complete them by providing additional elements. Radiological examinations have largely been replaced by urodynamic examinations, able to detect detrusor instability and evaluate the quality of sphincter tone, which largely determines the success of surgery. Surgery remains the reference treatment for stress incontinence with a success rate of almost 90%; the main mechanism consists of supporting the bladder neck, allowing it to close during efforts increasing the abdominal pressure. Perineo-sphincter rehabilitation must be tried first, although its results are less lasting. Currently, the only effective medical treatment is anticholinergic drugs in urge incontinence.
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PMID:[Female urinary incontinence. Which assessments? Which treatment?]. 959 38


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