Stress Voiding Research Articles

(087) Why Should Pelvic Floor Physical Therapy be Included in Treatment of Vestibulodynia?

Abstract Introduction Vestibulodynia, vulvar pain localized to the vestibule without an identifiable cause, has a multifactorial etiology including neurologic, hormonal, inflammatory, psychologic, and musculoskeletal factors. Key pathophysiologic drivers likely vary from patient to patient. Published studies demonstrate that compared to controls, patients with provoked vestibulodynia are more likely to have pelvic floor hypertonicity and decreased pelvic floor strength, as measured by dynamometric speculum and ultrasound. Further, observational studies describe improvement of vestibulodynia symptoms with pelvic floor physical therapy, suggesting a causal relationship between pelvic floor hypertonicity and vestibulodynia. Objective To describe the pathophysiologic mechanism by which pelvic floor dysfunction and myofascial trigger point development could cause vestibuoldynia, with a focus on pelvic floor anatomy. Methods Literature about vestibulodynia, pelvic floor dysfunction, and pelvic floor anatomy was reviewed and synthesized in conjunction with expert clinical experience of pelvic floor physical therapists and gynecologists. Results The pelvic floor consists of the levator ani muscles (iliococcygeus, pubococcygeus, and puborectalis) and ischiococcygeus, which form a basket to support the pelvic organs. The puborectalis inserts in the posterior vestibule, and hypertonicity can cause allodynia in this region. The levator ani are innervated by the levator ani nerve, which originates from S3-S5 and traverses the visceral surface of the muscles. Some cadaveric studies suggest dual innervation of the levator ani by the pudendal nerve, which originates from S2-S4 and courses over the inferior surface of the muscles. Pelvic floor hypertonicity, increased resting tone of the pelvic floor muscles, can result from many factors including stress, bladder and rectum voiding habits, and painful pelvic processes (i.e. interstitial cystitis, endometriosis). Increased muscle tone can promote sensitization of muscle afferent fibers and neuropathic upregulation. This may be perceived as vestibulodynia because the vestibule contains visceral and somatic sensory nerve fibers, whose signals are integrated at the same spinal levels as those from the levator ani. This anatomy allows for somatovisceral convergence of afferent signals, and thus perception of vestibular pain. Hypertonicity of the pelvic floor muscles decreases circulation creating localized hypoxia that can promote development of myofascial trigger points (tender nodules) in the pelvic floor. These trigger points can cause allodynia, perceived in the vestibule. In some cases, vestibulodynia may develop first and promote pelvic floor hypertonicity. Conclusions As pelvic floor hypertonicity can contribute to the pathogenesis of vestibulodynia, it is imperative for clinicians to include pelvic floor tone evaluation in their assessment of vestibulodynia. If pelvic floor hypertonicity is present, it should be treated concurrently with vestibular pain through a combination of pelvic floor physical therapy, trigger point injections, and botulinum toxin injections as pelvic floor hypertonicity and vestibulodynia may each perpetuate the other. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Johnson & Johnson.

Determining Stress in Metallic Conducting Layers of Microelectronics Devices Using High Resolution Electron Backscatter Diffraction and Finite Element Analysis.

Delayed failure due to stress voiding is a concern with some aging microelectronics, as these voids can grow large enough to cause an open circuit. Local measurements of stress in the metallic layers are crucial to understanding and predicting this failure, but such measurements are complicated by the fact that exposing the aluminum conducting lines will relieve most of their stress. In this study, we instead mechanically thin the device substrate and measure distortions on the thinned surface using high resolution electron backscatter diffraction (HREBSD). These measurements are then related to the stresses in the metallic layers through elastic simulations. This study found that in legacy components that had no obvious voids, the stresses were comparable to the theoretical stresses at the time of manufacture (≈300 MPa). Distortion fields in the substrate were also determined around known voids, which may be directly compared to stress voiding models. The technique presented here for stress determination, HREBSD coupled with finite element analysis to infer subsurface stresses, is a valuable tool for assessing failure in layered microelectronics devices.

V01-04 ADJUSTABLE AUTOLOGOUS SLING: A FEASIBLE SOLUTION FOR A COMPLEX MESH COMPLICATION

You have accessJournal of UrologyIncontinence & Female Pelvic Medicine/Reconstructive Surgery (V01)1 Sep 2021V01-04 ADJUSTABLE AUTOLOGOUS SLING: A FEASIBLE SOLUTION FOR A COMPLEX MESH COMPLICATION Oriol Colet, Iván Sáez Moreno, Jaime Bolón Marset, Oriol Dagà Martínez, Francisco Gómez Palomo, Adrián Bernal Gómez, Juan Ortiz Salvador, Álvaro Beviá Romero, Salvador Arlandis, Eduardo Morán, Esther Martínez Cuenca, Miguel Ángel Bonillo, Enrique Broseta, and Francisco Boronat Oriol ColetOriol Colet More articles by this author , Iván Sáez MorenoIván Sáez Moreno More articles by this author , Jaime Bolón MarsetJaime Bolón Marset More articles by this author , Oriol Dagà MartínezOriol Dagà Martínez More articles by this author , Francisco Gómez PalomoFrancisco Gómez Palomo More articles by this author , Adrián Bernal GómezAdrián Bernal Gómez More articles by this author , Juan Ortiz SalvadorJuan Ortiz Salvador More articles by this author , Álvaro Beviá RomeroÁlvaro Beviá Romero More articles by this author , Salvador ArlandisSalvador Arlandis More articles by this author , Eduardo MoránEduardo Morán More articles by this author , Esther Martínez CuencaEsther Martínez Cuenca More articles by this author , Miguel Ángel BonilloMiguel Ángel Bonillo More articles by this author , Enrique BrosetaEnrique Broseta More articles by this author , and Francisco BoronatFrancisco Boronat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001970.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One of the main complications caused by the use of surgical techniques for transvaginal correction of pelvic organ prolapse is extrusion of the mesh. This aim of this video is to describe the excision of the mesh and the following treatment of the stress urinary incontinence with an adjustable autologous sling. METHODS: 73-year-old woman with a story of abdominal hysterectomy and cystocele corrected by Prolift mesh, with a recurrence treated by partial colpocleisis with intravesical and vagina extrusion of the mesh, which caused vesicovaginal fistula and stress urinary incontinence diagnosed by cystoscope and pelvic MRI. She suffered an intense pain in the hypogastrium (9/10 points in the Visual Analogue Scale Pain, VASP). The recording was approved by the Institution Ethics Committee. RESULTS: We catheterized both ureters. We removed the calcifications as well as the extruded mesh by an incision in the previous partial colpocleisis. We located and closed the fistula in 3 layers, creating a Martius flap transposed to the vagina. Finally, the stress urinary incontinence was corrected by means of an adjustable autologous sling with the abdominal rectus fascia. The patient presented a favorable postoperative period. Currently, the patient has not pain and has not stress urinary incontinence or voiding and storage symptoms. CONCLUSIONS: The extrusion and calcification of the mesh to correct the prolapse of the pelvic organs is a complication that causes a great impact on the quality life of patients. The treatment of this complication involves the removal of the mesh and the treatment of the associated complications, which can be solved in the same surgical act. The use of an adjustable system with replacement of the synthetic mesh by autologous tissue can be a feasible solution for a complex mesh complication. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e63-e63 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oriol Colet More articles by this author Iván Sáez Moreno More articles by this author Jaime Bolón Marset More articles by this author Oriol Dagà Martínez More articles by this author Francisco Gómez Palomo More articles by this author Adrián Bernal Gómez More articles by this author Juan Ortiz Salvador More articles by this author Álvaro Beviá Romero More articles by this author Salvador Arlandis More articles by this author Eduardo Morán More articles by this author Esther Martínez Cuenca More articles by this author Miguel Ángel Bonillo More articles by this author Enrique Broseta More articles by this author Francisco Boronat More articles by this author Expand All Advertisement Loading ...

MP52-14 INITIAL EXPERIENCE USING THE AXONICS SACRAL NEUROMODULATION SYSTEM IN PATIENTS WITH MULTIPLE SCLEROSIS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (MP52)1 Sep 2021MP52-14 INITIAL EXPERIENCE USING THE AXONICS SACRAL NEUROMODULATION SYSTEM IN PATIENTS WITH MULTIPLE SCLEROSIS Anjali Kapur, Annie Chen, Spencer Mossack, Steven Weissbart, and Jason Kim Anjali KapurAnjali Kapur More articles by this author , Annie ChenAnnie Chen More articles by this author , Spencer MossackSpencer Mossack More articles by this author , Steven WeissbartSteven Weissbart More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002082.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Voiding dysfunction affects about 90% of multiple sclerosis (MS) patients. Sacral neuromodulation (SNM) is effective for the treatment of overactive (OAB) and underactive (UAB) bladder, the two most common lower urinary tract symptoms in MS. Its utility has been limited by MRI incompatibility, as MS patients often require routine MRIs to evaluate for disease progression. The Axonics r-System is the first FDA-approved SNM device that is 1.5T/3T full-body MRI conditionally safe. This study seeks to investigate symptomatic improvement in MS patients after implantation of the Axonics System. METHODS: All MS patients who presented to our academic institution from December 2019-January 2021 and elected for the Axonics SNM were included. Demographic information and scores on the following validated questionnaires were queried: Urogenital Distress Inventory (UDI-6), Incontinent Impact Questionnaire (IIQ-7), and Global Response Assessment (GRA). RESULTS: Eighteen MS patients (4 male, 14 female) were included: 55.6% relapse-remitting, 33.3% secondary-progressive, 5.6% primary-progressive, 5.6% progressive-relapsing. Average time from surgery to questionnaire was 119 days. On UDI-6, 15 patients reported improvement, 1 reported worsening symptoms, and 2 reported no change. Average UDI-6 scores before and after implantation were 54.6 and 22.8, respectively (p<0.0001). Improvements were significant for all questions under irritative and stress voiding subcategories, and 1 of 2 questions under the obstructive voiding subcategory. On IIQ-7, 15 patients reported improvement and 1 reported worsening symptoms. Two patients did not report incontinence and were excluded. Average IIQ-7 scores before and after implantation were 60.7 and 20.8, respectively (p<0.0001). Improvements were significant for travel, social, and emotional subcategories, but not for physical exercise. The average GRA score was 6.2 corresponding to “moderately improved” symptoms. CONCLUSIONS: The vast majority of MS patients reported significant initial symptomatic improvement in voiding function after implantation of the Axonics System. Future studies are needed to determine the long-term outcomes and durability of this MRI full-body conditionally-safe system. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e935-e935 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anjali Kapur More articles by this author Annie Chen More articles by this author Spencer Mossack More articles by this author Steven Weissbart More articles by this author Jason Kim More articles by this author Expand All Advertisement Loading ...

Prevalence of comorbidities in multiple sclerosis patients with neurogenic bladder

The aim of this study was to define the prevalence of comorbidities among multiple sclerosis patients with lower urinary tract symptoms. A retrospective study of data collected prospectively from January 2000 to March 2016 was carried out using a database. Comorbidities were divided into several classes according to the International Classification of Diseases (ICD-10). One hundred and fifty-five patients were included. All had a neurogenic bladder with 150 (96%) overactive bladder. EDSS score was≥6 in 44 patients (28%). Comorbidities were present in 79 (50,9%) and the most frequent ones were cardiovascular (14,2%), endocrinological (10,3%), urological (8,4%), abdominal (7,7%). Overweight (BMI≥25) was observed in 63 (40%). A strict relationship was found for BMI and stress urinary incontinence (P<0.001) as well as voiding dysfunction (P=0.003) without significant association for BMI and overactive bladder. Prevalence of comorbidities is important in MS (more than 50%). A significant association is found between overweight, stress urinary incontinence and voiding dysfunction. Knowledge of these comorbidities in MS is important since the presence of these urinary symptoms not related to neurogenic bladder must lead to a specific treatment. 3.

Modelling Correlated Binary Variables: An Application to Lower Urinary Tract Symptoms

Summary We present a semiparametric model for time evolving vectors of correlated binary variables. We introduce continuous latent variables which are discretized to obtain the sampling model. We assume that the distribution of the latent variables is an infinite mixture of distributions with weights that vary across some covariate space and with mean and covariance matrix being component specific. This distribution includes also an auto-regressive term that captures the time evolution of the latent variables and therefore of the binary observations. The method proposed is motivated by the study of lower urinary tract symptoms observed at subsequent attendance visits. In particular, we evaluate the temporal dependence among the symptoms controlling for the presence of urinary tract infection. The results show that the most recurrent symptoms are stress incontinence and voiding, which are also the most related with presence of pyuria, the best biomarker of infections. Furthermore, we observe that the correlation between symptoms changes over time. The pair of symptoms which appear to be the most correlated are pain and voiding.

Thermal stress in flexible interdigital transducers with anisotropic electroactive cellulose substrates

Thermal stress in flexible interdigital transducers a reliability concern in the development of flexible devices, which may lead to interface delamination, stress voiding and plastic deformation. In this paper, a mathematical model is presented to investigate the effect of material selections on the thermal stress in interdigital transducers. We modified the linear relationships in the composite materials theory with the effect of high curvature, anisotropic substrate and small substrate thickness. We evaluated the thermal stresses of interdigital transducers, fabricated with various electrodes, insulators and substrate materials for the comparison. The results show that, among various insulators, organic polymer developed the highest stress level while oxide showed the lowest stress level. Aluminium shows a higher stress level and curvature as an electrode than gold. As substrate materials, polyimide and electroactive cellulose show similar stress levels except the opposite sign convention to each other. Polyimide shows positive curvatures while electroactive cellulose shows negative curvatures, which is attributed to the stress and thermal expansion state of the metal/insulator composite. The results show that the insulator is found to be responsible for the confinement across the metal lines while the substrate is responsible for the confinement along the metal lines.

Modeling the copper microstructure and elastic anisotropy and studying its impact on reliability in nanoscale interconnects

BackgroundCopper is the primary metal used in integrated circuit manufacturing of today. Even though copper is face centered cubic it has significant mechanical anisotropy depending on the crystallographic orientations. Copper metal lines in integrated circuits are polycrystalline and typically have lognormal grain size distribution. The polycrystalline microstructure is known to impact the reliability and must be considered in modeling for better understanding of the failure mechanisms.MethodsIn this work, we used Voronoi tessellation to model the polycrystalline microstructure with lognormal grainsize distribution for the copper metal lines in test structures. Each of the grains is then assigned an orientation with distinct probabilistic texture and corresponding anisotropic elastic constants based on the assigned orientation. The test structure is then subjected to a thermal stress.ResultsA significant variation in hydrostatic stresses at the grain boundaries is observed by subjecting the test structure to thermal stress due to the elastic anisotropy of copper. This introduces new weak points within the metal interconnects leading to failure.ConclusionsInclusion of microstructures and corresponding anisotropic properties for copper grains is crucial to conduct a realistic study of stress voiding, hillock formation, delamination, and electromigration phenomena, especially at smaller nodes where the anisotropic effects are significant.

Effect of Microstructure and Anisotropy of Copper on Reliability in Nanoscale Interconnects

The mechanical behavior of copper is highly anisotropic. Although it is a face centered cubic crystal, the elastic constants vary considerably for different crystallographic orientations. Typically, the copper metal conductor lines in integrated circuits are polycrystalline in nature. In this paper, we utilize Voronoi tessellation to model the polycrystalline microstructure for the copper metal lines in test structures and then assign textured orientation to each grain and assign corresponding anisotropic elastic constants based on the assigned orientation. By subjecting the test structure through a thermal stress, we observe over 10x variation in normal stresses along the grain boundaries depending on the orientation, dimensions, surroundings, and location of the grains. This may introduce new weak points within the metal interconnects where normal stresses can be very high depending on the orientation of the grains leading to delamination and accumulation sites for vacancies. Hence, inclusion of microstructures and corresponding anisotropic properties for copper grains is critical to conduct a realistic study of both stress voiding and electromigration phenomena, especially at smaller nodes where the anisotropic effects are significant. Further, a comparison between stress levels in test structures with SiCOH and SiO2 as the inter level dielectric was conducted.

Management of Bladder Pain Syndrome: Green-top Guideline No. 70.

Management of Bladder Pain Syndrome: Green-top Guideline No. 70.

Overactive bladder.

Overactive bladder syndrome is highly prevalent, and increasingly so with aging. It is characterized by the presence of urinary urgency, and can be associated with incontinence, increased voiding frequency, and nocturia. Assessment needs to exclude serious medical disorders that might present with similar symptoms, and a bladder diary is an invaluable part of understanding the presentation. Initial management is conservative, comprising education, bladder training, and advice on fluid intake. Drug therapy options include antimuscarinic medications and beta-3 adrenergic receptor agonists. Persistent overactive bladder syndrome, despite initial therapy, requires a review of the patient’s understanding of conservative management and compliance, and adjustment of medications. For refractory cases, specialist review and urodynamic testing should be considered; this may identify detrusor overactivity or increased filling sensation, and needs to exclude additional factors, such as stress incontinence and voiding dysfunction. Botulinum neurotoxin-A bladder injections can be used in severe overactivity, provided the patient is able and willing to do intermittent self-catheterisation, which is necessary in about 5% of treated patients. Sacral nerve stimulation and tibial nerve stimulation are other approaches. Major reconstructive surgery, such as augmentation cystoplasty, is rarely undertaken in modern practice but remains a possibility in extreme cases.

Secondary surgery after vaginal prolapse repair with mesh is more common for stress incontinence and voiding dysfunction than for mesh problems or prolapse recurrence.

To explore the need for secondary surgical procedures after transvaginal prolapse repair with mesh. Women that had prolapse repair (Prolift(®) or Elevate(®)) were reviewed for reoperation and clinical/demographic data such as prior prolapse repair, prolapse grade, operative details, length of stay (LOS) and time to reoperation. Pearson's Chi-square, Fisher's exact tests and Wilcoxon rank tests were used. 77/335 women (23%) had 100 additional procedures. Median (range) time to reoperation was 51 (5-1168) days: four (1%) had primary prolapse surgery at a different site, three (1%) repeat prolapse repair from the same site, 23 (7%) surgery for complications and 50 (15%) had stress urinary incontinence (SUI)/sling-related procedures. When no reoperation versus reoperation groups were compared, mean LOS (1.8 vs. 2.0 days; p = 0.044) and follow-up (228 vs. 354 days; p = 0.002) were longer in the reoperations group; postoperative hemoglobin was lower (10.8 vs. 10.4; p = 0.031). Patients with a prolapse reoperation were 10 years younger (67 vs. 57 years; p = 0.027) than patients that either had a reoperation for other reasons or had no reoperations. Patients with concomitant sling and persistent SUI requiring repeat SUI surgery were older (mean 72 vs. 66 years; p = 0.038), had prior prolapse repair (53 vs. 27%; p = 0.017) and had anterior compartment mesh (84 vs. 56%; p = 0.037); median operative times (78 vs. 104 min; p = 0.008) and mean LOS were shorter (median 1.6 vs. 1.9 days; p = 0.045). For patients without concomitant sling, no demographic or perioperative differences were found between those that did (n = 10) and did not (n = 86) develop de novo SUI that required reoperation. Most reoperations were for sling management and SUI; few were for mesh complications or prolapse recurrence.

Effects of Surface Cleaning on Stressvoiding and Electromigration of Cu-Damascene Interconnection

The purpose of this paper is to study the effects of surface-clean process on stressvoiding (SV) and electromigration (EM) of Cu-dual-damascene metallization. Prior to the deposition of copper diffusion-barrier metal, conventional argon bombardment is used to clean Cu surface. Higher preclean bias power and shorter preclean time demonstrate remarkable low via resistance and excellent Cu-reliability performance. In addition, the via-diameter effect to Cu stressmigration is explored. A superior Cu precleaning process condition is developed to improve Cu stress-induced voiding and EM. The preclean bias power of argon plasma should be kept as high as possible but not too high to avoid damaging underlying metal, while the resputtering clean time should keep as short as possible but sufficiently long in order to clean via bottoms. To improve ultralarge-scale integrated-circuit yield and reliability of Cu-damascene metallization, the cleaning process of Cu surface becomes more and more critical as CMOS technology continues shrinking.

Electromigration and Stress Voiding of Cu/low-k Semiconductor Interconnects—65 nm Interconnect Technology and Beyond

Electromigration and Stress Voiding of Cu/low-k Semiconductor Interconnects—65 nm Interconnect Technology and Beyond

FEM-based method to determine mechanical stress evolution during process flow in microelectronics, application to stress–voiding

Mechanical stress is a major concern in microelectronics: reliability of VLSI interconnects is mainly controlled by the stress levels. The increasing complexity of processes and the shrinking of feature sizes make necessary to use quantitative modelling in order to optimise process parameters and device geometries. We had developed a method based on the use of some finite element analysis (FEA) tools, to quantitatively determine the stress evolution along the process flow. This method allows us to simulate material deposition, etching and thermal ramping steps. It was used to monitor the stress level is in two metallic levels interconnected by a via during the fabrication. Our numerical results were analysed regarding the so-called stress–voiding phenomenon: these results allow us to point out the critical interface to focus on. All the obtained results are in good agreement with experimental observations. This method can be used to determine the evolution of the most probable void position as the geometry varies and then to optimise both the geometry and the process to minimize stress-induced voiding.

In-Line Phase and Texture Control in Microelectronics Industry

We present the principles of operation and a summary of results from in-fab automated X-ray diffraction (XRD) metrology in support of copper damascene roduction. The automated XRD tools (an example is shown in Figure 1) are capable of rapid mapping of 300 mm wafers (with a throughput rate of 40 wafers/hour) of quantitative information about the film crystallographic composition, texture and thickness with a spatial resolution down to 30 microns. Microstructure control plays an increasingly important role in improving the performance and reliability of ULSI devices that use the damascene copper technology at 130 nm node and below. The problems related to delamination, stress voiding, and electromigration failures could be mitigated by the selection of proper materials, processing methods, and manufacturing tools. The optimum process would result in a tailored microstructure of barrier/seed/electroplated copper aggregate. At the same time, the microstructure could be used as an internal sensor, sensitive to process excursions and providing guidance for corrective actions. The texture and crystallographic phase data can be used as a direct measure of the deposition process in terms of film quality, reproducibility, and stability over time. The spatial distribution of crystallographic texture and phase can be measured on a single wafer in order to check wafer uniformity. More importantly, the same measurements can be carried out at predetermined intervals on wafers from a single deposition tool, and the results used to create a database that can be applied to trend charting and tool qualification. Examples of microstructure control in damascene copper processing include: process development and qualification, process control and stability, process excursion and post maintenance stability, deposition tool qualification, and on-line R&amp;D. The examples of texture control will refer to materials and processes typical of damascene copper technology for ULSI. A typical processing route includes the PVD deposition of a barrier layer and copper seed layer, followed by copper electroplate, anneal and chemical- mechanical planarization. All the processing steps affect the texture of annealed copper, and therefore affect directly the performance of interconnects. We will also present examples of application to processing of metal gates (NiSi films) and ferroelectric non-volatile memory (PZT films).

Texture Control in Manufacturing of ULSI Devices

The rapid adoption of damascene copper processing has brought about an increased need to understand and control microstructure in the barrier, seed and electroplated copper layers during manufacture. We will discuss an in-line, x-ray diffraction based metrology for rapidly characterizing thin film polycrystalline microstructures on 300 mm silicon wafers in terms of crystallographic texture, phase composition, and film thickness. The microstructure control plays an increasingly important role in improving the performance and reliability of ULSI devices that use the damascene copper technology at 0.13-µm node and below. The problems related to delamination, stress voiding, and electromigration failures could be mitigated by the selection of proper materials, processing methods, and manufacturing tools. The optimum process would result in a tailored microstructure of barrier/seed/electroplated copper aggregate. At the same time, the microstructure could be used as an internal sensor, sensitive to process excursions and providing guidance for the corrective actions. The texture and crystallographic phase data can be used as a direct measure of the deposition process in terms of film quality, reproducibility, and stability over time. The spatial distribution of crystallographic texture and phase can be measured on a single wafer in order to check wafer uniformity. More importantly, the same measurements can be carried out at predetermined intervals on wafers from a single deposition tool, and the results used to create a database that can be applied to trend charting and tool qualification. Examples of microstructure control in damascene copper processing include: process development and qualification, process control and stability, deposition tool qualification, and on-line R&amp;D. Examples of texture control will refer to materials and processes typical of damascene copper technology for ULSI. A typical processing route includes the PVD deposition of a barrier layer and copper seed layer, followed by copper electroplate (EP), anneal, and chemical-mechanical planarization (CMP). All the processing steps affect the texture of annealed copper, and therefore affect directly the performance of interconnects.

Bladder Dysfunction in Sexual Abuse Survivors

We determined the incidence of genitourinary dysfunction and urinary incontinence in self-identified sexual abuse survivors. In a preliminary study an incontinence and genitourinary symptom questionnaire was distributed to female members of sexual abuse survivor support groups and a control group of patients attending a general gynecology clinic. The 52 item questionnaire contained questions regarding general physical and psychological health, incontinence and voiding dysfunction symptoms, and sexual abuse history. Fischer's exact test was used to compare responses between groups. Questionnaires from 58 sexual abuse survivors and 51 controls were included in the statistical analysis. Mean age +/- SD was higher in the control than in the abuse survivor group (47.8 +/- 18.5 vs 9.1 +/- 41.5 years, p = 0.03) but there was no difference in parity between groups (1.65 +/- 1.85 vs 1.36 +/- 1.44, p = 0.37). Of abuse survivors 72% and of controls 22% reported ever experiencing urinary incontinence symptoms (p <0.001). Many symptoms of stress incontinence, urge incontinence and voiding dysfunction were also reported by a greater percent of abuse survivors than controls. Sexual abuse survivors have a significantly higher incidence of genitourinary dysfunction symptoms, including stress and urge incontinence, and voluntary urinary retention. Abuse survivors should be questioned about these symptoms, and evaluation and therapy should be recommended. This preliminary study demonstrates that the impact of psychological counseling in addition to medical therapy for urinary dysfunction in this group of patients deserves further study.

Ag metallization with high electromigration resistance for ULSI

Electromigration is investigated for sputtered Ag lines patterned by a novel hybrid etching technique. This new patterning technique works in two steps. After employing an oxygen plasma in the first step, a hydrogen peroxide solution is used in the second step. The electromigration is tested by an accelerated stress test. It was found that Ag lines show an increased electromigration resistance in comparison to chemical vapor deposition- and PVD-Cu lines from literature. The lifetime values of the lines show variations between different testchips. This is assumed to be due to thermal induced stress voiding in the lines. This can be prevented by improving the adhesion properties by applying suitable etching conditions or an additional adhesion layer.

Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders.

Retrospective. To evaluate the safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress incontinence in females with neuropathic bladders. London Spinal Injuries Unit, Stanmore & Institute of Urology, London, UK. Twelve women (mean age 53.3 years; range 41-80 years) with neuropathic bladder dysfunction and stress urinary incontinence were treated with tension-free vaginal tape (TVT) between November 1997 and December 2000. The group consisted of women with: (i) traumatic spinal cord injuries (n=3); (ii) post lumbar spinal surgery (n=6); (iii) spinal stenosis (n=3). Four of the 12 patients had previously failed surgery for stress incontinence. All patients underwent pre- and post-TVT evaluation with video-urodynamic studies. Mean follow-up was 27.1 months (range 17-54 months). Three patients were voiding spontaneously (stress voiding) before surgery and continued to do so post-operatively. The remaining 9 were performing clean intermittent self-catheterisation before the insertion of TVT and continued to do so after the surgery. At follow up 10 patients (83.3%) were dry. The procedure failed in one patient and the other complained of mild leakage, but she reported a decrease in the number of pads used. One patient developed detrusor hyperreflexia on post-operative video-urodynamics but there was no evidence of stress incontinence. One patient had a bladder perforation on insertion of TVT, managed successfully with extended use of a urethral catheter post-operatively. Three patients developed post-operative urinary tract infection successfully treated with oral antibiotics. Tension-free vaginal tape insertion is minimally invasive, safe and effective for the treatment of stress incontinence in females with bladder neuropathy with intrinsic sphincter deficiency. Previous surgery for incontinence did not affect post-operative complications or outcome.