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Trans Vaginal Mesh Lawsuit : There is considerable overlap of symptoms between women with DO and those with urodynamic stress incontinence (USI)10 such that symptomatology may not be relied upon to accurately diagnose either condition. In one study11 urgency and urge incontinence were found to have a sensitivity of 77.9% but a specificity of only 38.7% for DO. Approximately 34.9% of women complaining solely of USI were found to have DO. The likelihood of women having DO increases as the number of appropriate symptoms increases, with 89% probability of DO being diagnosed in the presence of all four major symptoms.

Medical and behavioural therapies for DO are often expensive and time-consuming. Accurate diagnosis helps aid uptake and compliance by ensuring that the right people are offered the right treatments. Frequency-volume charts give objective quantification of fluid intake, voiding frequency and functional bladder capacity. Urinary incontinence and episodes of urgency should also be documented. Typical features of DO are an increased diurnal urinary frequency associated with urgency and episodes of urge incontinence. Nocturia is one of the most salient features of DO.

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Cranberry juice contains fructose, which could interfere with the adhesion of the fimbriae of uropathic bacteria to the bladder mucosa.11 A well-designed study has demonstrated a reduction in episodes of bacteruria and pyuria in a population of 153 elderly women (mean age 78.5 years) who drink 300 ml of either cranberry juice or a placebo drink, per day.12 Subjects randomized to the cranberry beverage had a risk of bacteruria (defined as organisms numbering a 105/ml) with pyuria that was only 42% of that in the control group (p=0.004).

heir chance of remaining bacteruric-pyuric, given that they were bacteruric-pyuric in the previous month, was only 27% of the chance in the control group (p=0.006). Both cranberry tablets and cranberry juice have also been shown to reduce the risk of UTI in sexually active women (aged 21-72) experiencing at least one symptomatic UTI per year (to 20% and 18% respectively) compared with placebo (to 32%) (p<0.05).13 Cost-effectiveness ratios revealed that cranberry tablets were twice as cost effective as organic cranberry juice.

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Bearing in mind the potential for side-effects and the likelihood of resistant bacteria in patients receiving conventional antibiotic prophylaxis, the opportunity of giving a safe, naturally occurring substance, such as cranberry juice, deserves further consideration. Treatment should be aimed at relieving or removing the underlying cause of infection. Incomplete emptying should be investigated and treated to reduce or overcome outflow obstruction. This can be done surgically or by use of clean intermittent self-catheterization. Surgical repair of a cystocele may unkink the urethra and aid voiding; urethrotomy to a urethral stricture may overcome the limitation to flow.

Numerous conditions can affect the bladder without causing incontinence. Careful investigation is required to identify the underlying aetiology as the treatments are very different. Some conditions, such as a urinary tract infection (UTI) or poor habit, are easily rectified. Some of the other causes tend to run a chronic course and include a number of very disabling conditions.

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