From the Departments of 1Surgical Sciences and 2Health Sciences, University of L'Aquila, L'Aquila; and 3Department of Urology, Mazzini Hospital, Teramo, Italy.
OBJECTIVE:: The aim of this study was to evaluate the relationship between body mass index (BMI) and female sexual dysfunction (FSD) among perimenopausal and postmenopausal women with urinary incontinence (UI).
METHODS:: From 2005 to 2008, we enrolled 208 consecutive women affected by UI; all underwent a comprehensive history including two validated questionnaires, physical examination, and urodynamic evaluation. Based on BMI, participants were grouped into normal weight, overweight, and obese.
RESULTS:: A total of 158 participants completed both questionnaires (76% response rate); 41 (26%) were normal weight, 73 (46%) were overweight, and 44 (28%) were obese. The increasing Urogenital Distress Inventory score had a direct correlation with age (P < 0.01), year of menopause onset (P < 0.05), and BMI (P < 0.01). FSD was diagnosed in 97 women (61%): 31 (32%) with hypoactive sexual desire, 20 (21%) with sexual arousal disorder, 7 (7%) with orgasmic deficiency, and 39 (40%) with sexual pain disorder. BMI greater than 30 kg/m was independently associated with an increased risk of FSD (odds ratio [OR], 2.02) and UI (OR, 2.03). With adjustment for BMI, the OR for FSD was 1.22 for overweight women and 1.56 for obese women, with respect to healthy participants. The total Female Sexual Function Index score correlated with BMI (r = -0.82, P = 0.0001); in particular, arousal (r = -0.82), orgasm (r = -0.72), lubrication (r = -0.61), and satisfaction (r = -0.63, all P < 0.001) showed an inverse correlation with BMI, whereas desire and pain did not.
CONCLUSIONS:: Increased BMI early in menopause represents a risk both for UI and for sexual dysfunction. Weight control has an essential role in postmenopause and should be considered early in perimenopause to safeguard female quality of life as well as to prevent or improve UI and female sexual dysfunction symptoms.
Monday, May 25, 2009
Friday, May 22, 2009
Technique eradicates problems in most patients with Barrett's esophagus
A procedure that uses heat generated by radio waves to treat Barrett's esophagus, a condition caused by acid reflux (severe heartburn), can eliminate signs of the potentially cancer-causing disorder and reduce the risk that the disease will progress.
Findings from the first multicenter trial of the procedure, called radiofrequency ablation, could mean patients have an alternative to surgery for treating Barrett's esophagus. The procedure uses a scope inserted through the mouth to destroy the abnormal tissue. The investigators report their findings in the May 28 issue of the New England Journal of Medicine.
"Patients with Barrett's esophagus can go on to develop esophageal cancer," says Steven A. Edmundowicz, M.D., lead investigator at the study site at Washington University School of Medicine in St. Louis. "Cancer of the esophagus usually is deadly. Less than 15 percent of patients with esophageal adenocarcinoma survive for five years, and in those with advanced Barrett's esophagus, the risk that the condition will advance to become cancer is about 6 percent per year."
In Barrett's esophagus, part of the lining of the esophagus is replaced with cells that resemble intestinal cells. As the condition progresses, these cells become increasingly disordered. Long-standing acid reflux disease is common in those who develop Barrett's esophagus, which affects about 1 percent of adults in the United States.
The surgical option is offered to patients with Barrett's esophagus found to have severe dysplasia or cancer. The type of surgery varies, but it usually involves removing most of the esophagus, pulling a portion of the stomach up into the chest and attaching it to what remains of the esophagus
Shaheen NJ, et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. New England Journal of Medicine, vol 330 (22), May 28, 2009.
Findings from the first multicenter trial of the procedure, called radiofrequency ablation, could mean patients have an alternative to surgery for treating Barrett's esophagus. The procedure uses a scope inserted through the mouth to destroy the abnormal tissue. The investigators report their findings in the May 28 issue of the New England Journal of Medicine.
"Patients with Barrett's esophagus can go on to develop esophageal cancer," says Steven A. Edmundowicz, M.D., lead investigator at the study site at Washington University School of Medicine in St. Louis. "Cancer of the esophagus usually is deadly. Less than 15 percent of patients with esophageal adenocarcinoma survive for five years, and in those with advanced Barrett's esophagus, the risk that the condition will advance to become cancer is about 6 percent per year."
In Barrett's esophagus, part of the lining of the esophagus is replaced with cells that resemble intestinal cells. As the condition progresses, these cells become increasingly disordered. Long-standing acid reflux disease is common in those who develop Barrett's esophagus, which affects about 1 percent of adults in the United States.
The surgical option is offered to patients with Barrett's esophagus found to have severe dysplasia or cancer. The type of surgery varies, but it usually involves removing most of the esophagus, pulling a portion of the stomach up into the chest and attaching it to what remains of the esophagus
Shaheen NJ, et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. New England Journal of Medicine, vol 330 (22), May 28, 2009.
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