Menopause Update Nov 2008

In this edition of Menopause Update the following new articles are available for download: November 2008

	Advances in Uro-Gynaecology The modern patient is well informed and evidence based medicine is the level of expertise expected from the practicing clinician. The gold standard is evidence-based on prospective, randomised, placebo controlled studies. However, it is evident in urogynaeclogy that science frequently follows a product/technique developed by industry rather than the product/technique following the science ... READ MORE
	Cancer of the bladder in women Bladder cancer is the second most common cancer of the genitourinary tract and accounts for 7% of cases in men and 2% in women. The average age at diagnosis is 65 years and 75% are localised to the bladder. About 25% show spread to regional glands and beyond at the time of presentation. It is noteworthy that 90% are urothelial tumours involving the transitional urothelium, whilst the remaining tumours are squamous, columnar, undifferentiated or adenocarcinomas. Melanomas or sarcomas do occur, but they are rare. Secondary malignant deposits in the bladder from cancers arising from the cervix, uterus, colon and more distant structures including stomach, breast, lung, liver and lymphoma should also be considered. ... READ MORE
	A balanced approach to controlled trials The recent publications from the LIFT1 and Wisdom2 studies further highlight the importance of a balanced approach to interpreting the evidence obtained from randomised controlled trials. The WISDOM study was initially planned as a sister study to the WHI study and like WHI investigated the use of conjugated equine estrogen 0.625mg together with medroxyprogesterone acetate 2.5mg compared to placebo. Recruitment was stopped soon after publication of the original WHI publication. Ultimately in this study 3721 women aged between 50 and 69 years were assessed as to Health related Quality of Life (HQOL) for one year. 1043 treated patients and 1087 patients on placebo remained for assessment at one year ... READ MORE
	SAMS PERSONALITY PROFILE: Professor Franco Guidozzi Professsor Franco Guidozzi completes his term as president of the South African Society of Obstetricians and Gynaecologists this year. He has been the President of SASOG since 2005. Franco completed his schooling at Jeppe Boys High in 1969. His pursuit of excellence was evident from an early age, initially in the sporting field where he received full colours for both rugby and athletics. He completed his MB B Ch at the University of the Witwatersrand in 1975 and received his MRCOG in 1983, his FCOG in 2001 by peer review and his FRCOG in 2003. He became a Principal consultant at the Johannesburg Hospital in 1991 and Associate Professor in 1996. ... READ MORE
	Aetiology & Management of the overactive bladder INTRODUCTION ncontinence occurs in approximately a third of people presenting clinically with Overactive Bladder (OAB), and approximately a third of them have a mixed picture of combined sphincteric weakness and detrusor overactivity. The prevalence of OAB is higher among the elderly population; it is estimated to be approximately 30-40% among persons older that 75 years, and this may have additional ramifications as both urinary urgency, associated incontinence and nocturia have been shown to be associated with an increased incidence of falls and fractures among elderly. The intensity of urinary urgency has a significant association with other symptoms of OAB. Urgency is the driving symptom in OAB, those experiencing OAB frequently experience urgency at inconvenient and unpredictable times and consequently, often lose control before reaching the toilet ... READ MORE
	Surgical Management of stress incontinence Urinary incontinence (UI) is a very common global problem and approximately 1 in 3 women will have symptoms. Of the different types of UI, stress urinary incontinence (SUI) is the most common type, either in the pure or mixed form. As women grow older though the ratio of SUI to urge incontinence changes and bladder overactivity becomes more common. Most women try to manage the problem themselves by restricting physical activities, adjusting fluid intake and wearing protective pads.... READ MORE
	Vault Prolapse Vault prolapse follows on a previous hysterectomy when the top of the vagina (vault) descends into the vagina. The bladder is usually pulled down as well, and posteriorly it is accompanied by an enterocoele. In fact, Nichols1 described vault prolapse as a variant of enterocoele, while Menefee and Wall2 described an enterocoele as "herniation of small bowel into the vaginal lumen". This is actually what happens with vault prolapse as well, indicating the close relationship between these two entities ... READ MORE