We question the use of an important medical research paper as a platform for making a political statement. Dehghan and colleagues1Dehghan M Mente A Rangarajan S et al.Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study.Lancet. 2018; 392: 2288-2297Google Scholar include “occupied Palestinian territory” as one of the 21 participant countries in their study. We presume this is referring to the areas that are described as West Bank and Gaza in official World Bank documents.2World BankThe World Bank in West Bank and Gaza.http://www.worldbank.org/en/country/westbankandgazaDate accessed: November 1, 2018Google Scholar It is not our intention to reopen the debate relating to the long-standing Arab–Israeli conflict. However, it is our opinion that academic research should be a vehicle for international collaboration and a means to build bridges between nations with different cultures, irrespective of underlying geopolitical conflicts, and it should not be divisive. The term occupied Palestinian territory is a political statement with intentional prejudice. The West Bank and Gaza are disputed territories with an unresolved legal status. Since the end of the Turkish Empire and the British Mandate for Palestine, these territories have not been under the recognised de jure sovereignty of any state. Only the UK and Pakistan recognised the occupation and annexation of the West Bank by Jordan, which ended in 1967. According to international law, use of the term occupied requires there to be an internationally recognised legal entity whose territory is occupied. Here, there is no such entity. The World Bank categorisation, which does not specify sovereignty, is definitive. Therefore, use of the word occupied in the term occupied Palestinian territory is incorrect and is inconsistent with international law. The future status of the West Bank and Gaza will be determined by ongoing dialogue and negotiation. Within the medical community, it is essential that academic institutions and researchers remain apolitical and do not use publications as a means of identifying with a political agenda. We declare no competing interests. Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort studyDairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. Full-Text PDF Academic medicine and political agendasPaul Gideon and colleagues1 suggest that the term occupied Palestinian territory is a “political statement with intentional prejudice” and should be avoided in medical academic papers. However, they use an alternative term, disputed territories, to describe the West Bank and Gaza Strip. This term is only used by the Government of Israel and always in the service of Israel's political aims. Full-Text PDF Academic medicine and political agendasWe disagree with Gideon Paul and colleagues1 in their assertion that academic research should not be divisive. Divisive is a subjective term and at times, if research examines or illuminates factors underlying conflict and its impact on populations, it could be seen by some as being divisive. For example, during the USA-backed war on Nicaragua's Sandinista Government, researchers documented the effects on the civilian population, helping to inform the policy debate;2,3 this certainly did not please advocates of US policy. Full-Text PDF

Patient choice is important in choosing appropriate treatments. We aimed to determine patient treatment preferences for urodynamic stress incontinence and reasons for particular preferences. In a survey, based in three urogynaecology departments in two countries, women diagnosed with urodynamic stress incontinence were given: 1) a questionnaire eliciting current knowledge of available urodynamic stress incontinence treatments; 2) information sheets describing pelvic floor muscle training by physiotherapists, the tension-free vaginal tape, and open colposuspension, including success rates and complications; and 3) a questionnaire about the preferred treatment and the reasons for the particular choice. Pelvic floor muscle training was the preferred management choice of 68/104 (65%) of participants; tension-free vaginal tape, 27 (26%); and open colposuspension six (6%) participants. The information sheets were the main basis for the particular choice in 86/104 (83%) of women. For the participants who chose pelvic floor muscle training 34/68 (50%) reported non-invasiveness and low risk as the main reasons for that particular choice. For participants who chose tension-free vaginal tape, the main reason was that it was a minimally invasive procedure.

Objective: To evaluate the incidence of prolapse and prolapse-related symptoms following vaginal hysterectomy. Methods: Data were reviewed from women who underwent vaginal hysterectomy between 1988, and 1995, at St George's Hospital, London, UK, and attended long-term follow-up. Outcome measures included a questionnaire for prolapse, urinary, bowel, and sexual symptoms; and a vaginal examination. Results: Among 94 women attending long-term evaluation, the mean follow-up time was 100.7 months (range 67.0-156.0 months). Before vaginal hysterectomy, urgency was noted among 23 (24.5%), urge incontinence among 11 (11.7%), and stress incontinence among 8 (8.5%) women. At follow-up, these symptoms were observed among 23 (24.5%), 13 (13.8%), and 6 (6.4%) women, respectively. De novo urge incontinence and de novo stress incontinence were observed among 3 (3.2%) and 2 (2.1%) women, respectively. Vaginal examination data were compared for 70 women, of whom 18 (25.7%) had grade 1, 40 (57.1%) had grade 2, and 6 (8.6%) had grade 3 uterine prolapsed before surgery. Postoperatively, vaginal vault prolapse occurred in 7 (10.0%) women and correlated with degree of posterior prolapse (P=0.007), but not with severity of uterine descent (P=0.205) or previous prolapse surgery (P=0.573). Conclusion: The incidence of post-hysterectomy vault prolapse correlated with the degree of preoperative rectocele. (C) 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

#### Summary points In 2010, the International Continence Society restated the definition of overactive bladder syndrome as a condition with characteristic symptoms of “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology.”1 In 2009, disease specific total expenditures for this syndrome exceeded $24.9bn (£15.76bn; €19.01bn).2 However, overactive bladder syndrome remains underdiagnosed and undertreated, despite prevalence estimates in men and women of 17% in the United States (National Overactive Bladder Evaluation study) and 12-17% in six European nations.2 3 One population based prevalence study found that 60% of older or disabled patients seek treatment but only 27% receive it.4 The study also showed that overactive bladder syndrome is associated with worse quality of life scores than those in hypertension, depression, diabetes, and asthma. In fact, many patients are unaware that useful medical treatment is available.4 Retrospective observational studies have shown that the medical and surgical consequences of overactive bladder—particularly in older or disabled patients—include depression, falls, fractures, urinary …

Over the past century over 150 operations have been described for the treatment of urodynamic stress incontinence. The spectrum of operative approaches that are used reflect its variety of causes. Classical sling procedures provide bladder neck support, permitting urethral compression or kinking with increases in intra‐abdominal pressure and decreasing voiding dysfunction. There are well‐documented complications associated with sling procedures. Modifications of operative technique and sling materials, in particular the tension‐free vaginal tape, have lowered complication rates and operative morbidity. This article discusses potential benefits and risks associated with different surgical options, to aid selection of the most appropriate treatment for any individual.

The aim of the study was to assess the quality of life (QoL) in women with stress urinary incontinence (SUI) while using a novel disposable intravaginal device.

#### Summary points Interstitial cystitis or painful bladder syndrome is a chronic, often debilitating, condition largely defined by symptoms of urinary urgency and frequency associated with pelvic pain that varies with bladder filling.1 Unlike bladder inflammation caused by bacterial infection, the condition occurs in the absence of urinary tract infection or other obvious pathology. Resulting discomfort may range from abdominal tenderness to intense pain. This difficult clinical entity has prompted debate with regard to definition, aetiology, and best methods of treatment. This review discusses the diagnosis and management of interstitial cystitis according to current best evidence. Few Oxford scale levels 1 and 2 evidence based research studies in interstitial cystitis are available because of the ethical difficulties in conducting randomised trials in this area. We have therefore referred to evidence that represents the majority opinion of researchers as being clinically relevant. #### Sources and selection criteria We conducted a Medline search for the years 1988-2009, using the key words “interstitial cystitis”, “painful bladder syndrome”, and “bladder inflammation.” We initially selected 118 references, but only 26 were used. The pathological features of bladder epithelial damage and related blood vessel …

After an adequate trial of physiotherapy, surgery should be offered, which may either be minimally or majorly invasive. It is important to be aware of the cure rates and complications, and an adequate follow-up is always needed to assess these.

OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of a novel disposable Intravaginal device for treatment of stress urinary incontinence (SUI) in women.STUDY DESIGN: Sixty women with severe SUI were recruited from 2 sites in Israel to wear preweighed pads during a 7-day control period followed by a 28-day device usage period in which the device and preweighed pads were worn daily for 8 hours. The primary endpoint was the percentage of women who achieved a - 70% reduction in pad weight gain (PWG) from the control period to the last 14 days of device usage.RESULTS: Sixty women who enrolled into the study and used the device for any period of time were included in the intent to treat (ITT) population. Eighty-five percent of them achieved a >= 70% reduction in PWG (P =.01). Improvements in overall quality of life, subjective perception of incontinence, and satisfaction with the device were observed.CONCLUSION: The Intravaginal device is easy to use, well-tolerated, and effective in reducing SUI.

Surgical treatment of prolapse can be deferred until symptoms become intrusive. Conditions that raise the intraabdominal pressure should be reduced. Sometimes a decision may have to be made between a vaginal or an abdominal approach, and whether to use a supportive biological or synthetic tissue. More properly controlled trials with a realistic follow-up are needed to help decision-making.

You have accessJournal of Urology1 Apr 2008THE LEAK SCORE – A NOVEL INSTRUMENT TO ASSESS SUBJECTIVE SEVERITY OF FEMALE STRESS URINARY INCONTINENCE AND EFFICACY OF TREATMENT Elan Ziv, Stuart L Stanton, and Joseph Abarbanel Elan ZivElan Ziv More articles by this author , Stuart L StantonStuart L Stanton More articles by this author , and Joseph AbarbanelJoseph Abarbanel More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61515-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "THE LEAK SCORE – A NOVEL INSTRUMENT TO ASSESS SUBJECTIVE SEVERITY OF FEMALE STRESS URINARY INCONTINENCE AND EFFICACY OF TREATMENT." The Journal of Urology, 179(4S), p. 513 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 513 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Elan Ziv More articles by this author Stuart L Stanton More articles by this author Joseph Abarbanel More articles by this author Expand All Advertisement PDF downloadLoading ...

The aim of this study was to compare the maximum urethral closure pressure (MUCP) measures with two different techniques: water perfused catheter and microtip transducer catheters with respect to reproducibility and comparability for urethral pressure measurements. Eighteen women with stress urinary incontinence had repeat static urethral pressure profilometry on a different day using a dual microtip transducer and water perfused catheter (Brown and Wickham). The investigators were blinded to the results of the other. The microtip measurements were taken in the 45° upright sitting position with the patient at rest at a bladder capacity of 250 ml using an 8 Fr Gaeltec® double microtip transducer withdrawn at 1 mm/s, and the transducer was orientated in the three o’clock position. Three different measures were taken for each patient. Three water perfusion measurements were performed with the patient at rest in the 45° upright position at a bladder capacity of 250 ml using an 8 Fr BARD dual lumen catheter withdrawn at 1 mm/s. The mean water perfusion MUCP measure was 26.1 cm H20, significantly lower than the mean microtip measure of 35.7 cm H20. The correlation coefficient comparing each water perfusion measurement with the other water perfusion measures in the same patient was excellent, at 0.95 (p = 0.01). Correlation coefficient comparing each microtip measure with the other microtip measure in the same patient was also good, ranging from 0.70 to 0.80. This study confirms that both water perfusion catheters and microtip transducers have excellent or very good reproducibility with an acceptable intraindividual variation for both methods.

Alterations in the hormonal milieu associated with the menstrual cycle appear to influence the dynamic interaction between the bladder and urethra as well as detrusor function, probably because of the common embryological origin of the lower genital and urinary tracts. In this retrospective study we investigated the effect of the menstrual cycle on cystometric diagnosis. A retrospective case note review of 687 consecutive patients attending the urogynecology unit of St Georges University Hospital, a tertiary referral center, was carried out. The study group comprised 57 women with regular menstrual periods. In both patients whose symptoms were adversely affected premenstrually and those whose symptoms were not influenced by the menstrual cycle, the majority of normal cystometric diagnoses were made in the luteal phase: 45.5% vs. 25% ( P ⩽0.002) and 38.5% vs. 4.8% ( P ⩽0.05), respectively. Diagnoses of genuine stress incontinence, detrusor instability and mixed genuine stress incontinence and detrusor instability were most frequently made in the follicular phase of the cycle. More normal cystometric diagnoses were made in the influenced group (36.8%) than in the uninfluenced group (21%) ( P <0.02). The results of this preliminary study indicate that the timing of cystometric evaluation may influence the detection of a positive diagnosis. The luteal phase may not be the correct time to make an accurate diagnosis, especially in patients whose symptoms are influenced by their menstrual cycle.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 112, Issue 5 p. 534-546 The tension-free vaginal tape reviewed: an evidence-based review from inception to current status Michelle J. Atherton, Michelle J. Atherton aConsultant Urogynaecologist and Clinical Lecturer King Edward Memorial Hospital for Women and University of Western Australia, School of Women's and Infants' Health, Subiaco, Western Australia, AustraliaSearch for more papers by this authorStuart L. Stanton, Stuart L. Stanton aConsultant Urogynaecologist and Clinical Lecturer King Edward Memorial Hospital for Women and University of Western Australia, School of Women's and Infants' Health, Subiaco, Western Australia, AustraliaSearch for more papers by this author Michelle J. Atherton, Michelle J. Atherton aConsultant Urogynaecologist and Clinical Lecturer King Edward Memorial Hospital for Women and University of Western Australia, School of Women's and Infants' Health, Subiaco, Western Australia, AustraliaSearch for more papers by this authorStuart L. Stanton, Stuart L. Stanton aConsultant Urogynaecologist and Clinical Lecturer King Edward Memorial Hospital for Women and University of Western Australia, School of Women's and Infants' Health, Subiaco, Western Australia, AustraliaSearch for more papers by this author First published: 12 January 2005 https://doi.org/10.1111/j.1471-0528.2004.00498.xCitations: 61Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1 Petros P, Ulmsten U. An integral theory of female urinary incontinence. 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The objective of our study was to evaluate the surgical feasibility, efficacy and safety of the digital needle driver (DND 202), a modified, flexible surgical device, during iliococcygeal fixation (ICF) for vaginal vault prolapse and enterocele repair. A prospective longitudinal study was carried out among 21 consecutive patients who underwent bilateral iliococcygeal fixation at St George's Hospital, London. All patients filled a comprehensive questionnaire for pre‐ and post‐operative prolapse, urinary, bowel and sexual symptoms and underwent pre‐ and post‐operative site‐specific vaginal examination, following the standardized International Continence Society scoring for prolapse, pre‐operative urodynamic studies and analysis of the surgical results. The outcome measures were the feasibility of the procedure, the time needed, intra‐ and post‐operative complications, short‐term post‐operative prolapse‐associated symptoms and pelvic organ prolapse quantification. The mean age of the patients was 65 [5] years and the mean body mass index (kg/m2) was 23 [2.7]. In addition to ICF, 8 patients underwent vaginal hysterectomy, 18 had posterior repairs, 7 had anterior repairs and 6 had TVT. The mean time for ICF was 20 [11] minutes, the mean blood loss per surgical procedure was 264 [225] mL and the mean hospitalization time was 4.6 [1.2] days. Postoperatively, one patient had mesh erosion. At short‐term post‐operative evaluation none of the patient had prolapse symptoms. There was a statistically significant improvement in all stages of the apical and posterior walls prolapse (p < 0.001). The mean total vaginal length was significantly shorter postoperatively (7.8 [1.0] cm vs 6.6 [1.4] cm, p < 0.001). Thus, we can conclude that the use of DND device may facilitate the vaginal approach for vaginal vault prolapse and enterocele repair.

Objective: This study compares the effect of abdominal sacrocolpopexy with posterior Teflon mesh interposition with and without concomitant Burch colposuspension on the posterior compartment.Study design: This retrospective review includes 49 consecutive women who underwent sacrocolpopexy for vault or uterine prolapse stage 2 or higher and rectocele; 25 of them had a concomitant Burch colposuspension for urodynamic stress incontinence. Postoperative bladder, bowel and sexual function and recurrent pelvic organ prolapse was assessed at >= 12 months.Results: There was no recurrent vault prolapse. Rectoceles (stage 2) recurred in 5 women (21%) without and in 8 women (36%) with Burch colposuspension (P > .05). The mesh became detached by > 2 cm from its perineal position in 30% of the cases, which was associated with excessive defecation straining (P = .04). Rectocele stages significantly correlated with mesh detachment (P > .001) but not with obstructed defecation (P > .05).Conclusion: Sacrocolpopexy was effective if the mesh did not become detached from its perineal position. Concomitant Burch colposuspension did not seem to affect the posterior compartment adversely in this small case series. (c) 2005 Elsevier Inc. All rights reserved.