June 2005

IVF-ET: Past, Present & Future Howard Jones Jr ObG Survey to 1.5 Million IVF Babies in the World – 1% of Births in USA Indication: Tubal Disease / Endometriosis / Male Factor

Future of IVF Non invasive detection of Oocyte with potential to achieve Singleton PGD to overcome Chromosomal aberration Fusion of Meisis-induced Somatic cells Exogenesis

RP6 Robots Sr Mary & Dr Robbie Start Ward Rounds from 18 May 05 at St Mary Hospital, London Face to Face interface with Consultant far away

Needle Suspension for SUI Systematic Review - Cochrane library Feb Trials – 347 women – 9 Different NS Procedures Abdominal Retropubic Suspension Vs NS: Failure after 1 year: 16% Vs 29% Morbidity same Anterior Vaginal Repair Vs NS: Failure: 36% Vs 33% (Same) Conclusion: NS probably not as good as Abdominal Suspension More Studies needed

DULOXETINE for Stress Incontinence Selective Serotinin (5-HT) & Nor Epinephrine Reuptake Inhibitor Rhabdosphincter Activity Efferent Pudendal nerve Activity Pelvic Floor Tonus Marketed as “ULOZET” - 40 mg bd (Inca) -Urol 2004;6 (Suppl 3)

RCT: BJOG March women 40 mg bid x 4 weeks Incontinence Episode Frequency (IEF) reduced by >50% Incontinence Quality Of Life (I-QOL) Improved after 4 to 12 weeks of treatment

Tolterodine L-tartarate Reduces Urinary Frequency Reduces Urgency

DESMOPRESSIN Controls Nocturia Minirin 0.1 mg OD Potent Antidiuretic Reduces Nocturnal Voids Better sleep

Parameters for Prediction of Caesarean Section

Variables Parity ( more in Primi ) Height: 5% at 170 cm Vs 30% at 140 cm McGuinness & Trivedi 1999 Increased Maternal Age Main et al 2000 Male Fetus: Delayed maturation of Sympatho adrenal system = Less catecholamine during hypoxia & acidosis Lieberman et al 1997 Anthropoid pelvis: Occ.Tr & Occ Postr caldwell & Moloy 1933

Occipito Posterior & CS CS Rate of 30-42% -Sizer&Nirmal 2000 Disproportion due to Deflexion -Floberg et al 1987 Inadequate Head to Cx Forces – Less uterine activity -Allman et al 1997 Increased Fetal Distress: Decelerations Longer labor Increased rate of Augmentation

USG Diagnosis of Occ Postr in Early labor to predict CS -Nicolaides et al Int J ObG June cephalic singletons at onset of labor Vaginal Delivery 86% & CS14% CS in Occ postr 19% Vs Non OP 11% Conclusion: Diagnosis of Occ postr at onset useful predictor of CS among other parameters

Intra Vaginal Ejaculation Latency Time ( IVELT ) Definition: ”Persistent or Recurrent ejaculation with minimal sexual stimulation before during or after intromission and before the man wishes it”

IVELT Systematic Review of 21 RCTs 79 Publications between 1944 & 2003 Incidence: 31% Traditionally Treated with Antibiotics / Neuroleptics / Anti depressants Anti Depressants effective Waldinger et al Int J Impotence Res 2004

Dapoxetine Anti depressant Increases Sexual Stamina (IVELT) 3-fold Will earn J&J $400 million by 2007 Am Urol Assocn 24 May 2005