Prevalence of bladder neck mobility in asymptomatic non-pregnant nulliparous volunteers

Antenatal bladder neck mobility is known to be associated with postpartum stress incontinence. Whether this represents a normal feature of pregnancy or a pathological process is unclear. Forty-eight nulliparous volunteers had perineal ultrasound scans to assess bladder neck mobility. Using previously defined cutoffs (for incontinence), 50% had increased linear movement and 39% increased angle of rotation. This suggests that bladder neck mobility is common in asymptomatic nulliparous women. Furthermore, it could represent a risk factor for stress incontinence after pregnancy and in the longer term.

Urinary tract infection after urodynamic studies in women: incidence and natural history

OBJECTIVE

To study the incidence, natural history and symptomatic effects of bacteriuria after urodynamic studies in women.

PATIENTS AND METHODS

In a prospective study in the urogynaecology clinic of a large District General Hospital, 214 women (mean age 52.3 years, range 23-81) underwent urodynamic studies. Bacteriuria was detected by semiquantitative culture at 2 and 7 days after the test. Women completed a 7-day diary of symptoms and events.

RESULTS

The incidence of bacteriuria after urodynamic studies was 7.9%. Bacteriuria was transient in four of 17 women but persisted in nine and developed late in four; only one of 17 infections gave rise to symptoms. Irritative bladder symptoms after the test occurred in 34% of women, but only three went to their doctors because of concern about a possible urinary tract infection. Advancing age was the only variable associated with bacteriuria after urodynamic studies (P= 0.05). Menopausal status, past history of urinary tract infection, number of urethral instrumentations required, order number in a session, peak urinary flow rate and urodynamic diagnosis were not associated variables.

CONCLUSIONS

In a large series of women presenting to a urogynaecology clinic, urodynamic investigations were associated with a high incidence of transient irritative symptoms but a low incidence of bacteriuria (8%). Infection was asymptomatic in most patients, but its natural history was unpredictable. Transient, persistent and late cases of bacteriuria all occurred. In this population, urodynamic studies are associated with a low level of morbidity.

The effect of a metal-back without a stem upon the fixation of a tibial prosthesis

Three methods of tibial component fixation without cement (as part of TKA) have been used at the London Hospital. All three methods have used the same polyethylene component fixed with two HDP (Day) pegs. A metal-back without a stem was added to the HDP in group 1. Group 2 consisted of an HDP-only component. In group 3 a stem was added to the metal-back used in group 1. Radiological comparison showed the fixation of the polyethylene component with metal back but no stem to be inadequate; the component tilted into varus more frequently than the other configurations. It is suggested that failure was due to the increased rigidity of the metal-backed component (as compared with the HDP only) and that the rigidity (and the resultant tendency to rock) can be offset by a stem. It is concluded that rigid (ie, metallic) tibial components should have a stem.

Normal murine and porcine embryos recruit NK cells to the uterus

Decidual NK cells, indistinguishable from those found in lymphoid tissues, are present in cell suspensions prepared from maternal decidua of random-bred mice between Days 6.5 and 10.5 of first gestation. The stringency of the correlation between NK cells and normal embryos during successful pregnancy is unknown. Our previous finding that active NK cells were unable to mediate lysis of fresh embryonic tissues at any stage during gestation suggests that if NK cells play a functional role in normal pregnancy it would be a noncytolytic role. Before studies on the function of uterine NK cells were undertaken, evidence that the association of NK cells with normal embryos is widespread was sought by assessing NK cell activity in cell suspensions from decidua of syngeneically mated mice, from decidua of multiparous, random-bred mice, and from the endometrium of pigs during first pregnancy. Neither parity nor maternal-fetal compatibility changed the pattern of high levels of decidual NK cell activity early in pregnancy followed by decline. Porcine NK cell activity was not detected in uterine cells isolated from cycling pigs but in pregnant animals it gradually increased during the preattachment period and reached levels greater than those in blood, postattachment (Day 28). Some of this activity was hormone dependent but sustained increases in NK cell activity required the presence of an embryo. These studies demonstrate that the association of functional NK cells with normal embryos is widespread during early pregnancy.