351 results on '"UTERINE prolapse"'
Search Results
2. Clinician perspectives on hysterectomy versus uterine preservation in pelvic organ prolapse surgery: A systematic review and meta-analysis.
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Porcari I, Zorzato PC, Bosco M, Garzon S, Magni F, Salvatore S, Franchi MP, and Uccella S
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- Humans, Female, Postoperative Complications epidemiology, Uterus surgery, Reoperation statistics & numerical data, Operative Time, Pelvic Organ Prolapse surgery, Hysterectomy methods, Hysterectomy adverse effects, Organ Sparing Treatments methods
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Background: Previous reviews on hysterectomy versus uterine-sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned., Objectives: To provide up-to-date evidence by examining only studies investigating techniques currently in use for POP repair., Search Strategy: MEDLINE and Embase databases were searched from inception to January 2023., Selection Criteria: We included randomized and non-randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded., Data Collection and Analysis: A random effect meta-analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI)., Main Results: Thirty-eight studies were included. Hysterectomy and uterine-sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74-1.17), intraoperative major (OR 1.34; 95% CI 0.79-2.26) and minor (OR 1.38; 95% CI 0.79-2.4) complications, postoperative major (OR 1.42; 95% CI 0.85-2.37) and minor (OR 1.18; 95% CI 0.9-1.53) complications, and objective (OR 1.38; 95% CI 0.92-2.07) or subjective (OR 1.23; 95% CI 0.8-1.88) success. Uterine preservation was associated with a shorter operative time (-22.7 min; 95% CI -16.92 to -28.51 min), shorter hospital stay (-0.35 days, 95% CI -0.04 to -0.65 days), and less blood loss (-61.7 mL; 95% CI -31.3 to -92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups., Conclusions: No major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors., (© 2024 International Federation of Gynecology and Obstetrics.) more...
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- 2024
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Catalog
3. Is the Presence of Levator Ani Muscle Avulsion Relevant for the Diagnosis of Uterine Prolapse?
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Universidad de Sevilla. Departamento de Cirugía, García Mejido, José Antonio, Martín Martínez, Alicia, García Jiménez, Rocío, González Díaz, Enrique, Núñez-Matas, María José, Fernández-Palacín, Fernando, Carballo-Rastrilla, Sonia, Fernández-Fernández, Camino, Sáinz Bueno, José Antonio, Universidad de Sevilla. Departamento de Cirugía, García Mejido, José Antonio, Martín Martínez, Alicia, García Jiménez, Rocío, González Díaz, Enrique, Núñez-Matas, María José, Fernández-Palacín, Fernando, Carballo-Rastrilla, Sonia, Fernández-Fernández, Camino, and Sáinz Bueno, José Antonio more...
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Objective To determine if the addition of the assessment of levator ani muscle (LAM) avulsion to the measurement of the difference in the pubis-uterine fundus distance between rest and with the Valsalva maneuver could increase the diagnostic capacity of ultrasound for uterine prolapse (UP). Methods This multicenter, observational and prospective study included 145 patients. Ultrasound assessment was performed, establishing the diagnosis of UP as a difference between the pubic-uterine fundus distance at rest and during the Valsalva maneuver ≥15 mm (standard technique), while LAM avulsion was defined as an abnormal LAM insertion in three central slices using multislice ultrasound. A binary multivariate logistic regression model was made using nonautomated methods to predict surgical UP (general population, premenopausal, and postmenopausal patients), including the difference between the pubis-uterine fundus distance at rest and with the Valsalva maneuver as well as LAM avulsion. Results A total of 143 patients completed the study. The addition of LAM avulsion criteria to the standard dynamic distance-based protocol for the diagnosis of UP resulted in a higher sensitivity for the general population (79.7 vs 68.1%) as well as for premenopausal (89.3 vs 79.9%) and postmenopausal patients (76 vs 66.1%). In contrast, the standard technique showed a higher specificity than the model based on the standard technique associated with LAM avulsion for the general population (89.2 vs 74.3%) and premenopausal women (91.7 vs 63.2%). For postmenopausal patients, the model based on the standard technique associated with LAM avulsion had a higher sensitivity (76 vs 66.1%) and specificity (91.7 vs 86.8%) than the ultrasound diagnosis of UP. Conclusion The implementation of the assessment of LAM avulsion in the ultrasound diagnosis of UP is useful in postmenopausal patients, increasing sensitivity and specificity relative to the ultrasound assessment based only on the difference between more...
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- 2023
4. Is it possible to diagnose surgical uterine prolapse with transperineal ultrasound? Multicenter validation of diagnostic software
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Universidad de Sevilla. Departamento de Cirugía, Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública, García Mejido, José Antonio, Martín-Martínez, A., González-Díaz, E., Núñez-Matas, M. J., Fernández Palacín, Ana, Carballo-Rastrilla, S., Fernández-Fernández, C., García-Jiménez, R., Sáinz Bueno, José Antonio, Universidad de Sevilla. Departamento de Cirugía, Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública, García Mejido, José Antonio, Martín-Martínez, A., González-Díaz, E., Núñez-Matas, M. J., Fernández Palacín, Ana, Carballo-Rastrilla, S., Fernández-Fernández, C., García-Jiménez, R., and Sáinz Bueno, José Antonio more...
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Objectives—To validate an ultrasound software that uses transperineal ultrasound to diagnose uterine prolapse (UP). Methods—Multicenter, observational and prospective study with 155 patients that had indications for surgical intervention for dysfunctional pelvic floor pathology. Each patient underwent an examination with Pozzi tenaculum forceps was performed in the operating room with the patient anesthetized, followed by surgical correction of stages II–IV UP. Transperineal ultrasound was used to assess the difference in the pubis–uterine fundus measurement. With a multivariate logistic regression binary model (with the measurement ultrasound at rest, the Valsalva maneuver and age) using nonautomated methods to predict UP. With the purpose of evaluating the model, a table with coordinates of the receiver operating characteristic (ROC) curve, after which sensitivity and specificity were assessed. Results—A total of 153 patients were included (73 with a diagnosis of surgical UP). It was obtained from the AUC (0.89) of the probabilities predicted by the model (95% confidence interval, 0.84–0.95; P < .0005). Based on the ROC curve for the model, obtaining a sensitivity of 91.8% and a specificity of 72.7%, values that were superior to those for the clinical exam for surgical UP (sensitivity: 80.8%; specificity: 71.3%). Conclusions—We validated software that uses transperineal ultrasound of the pelvic floor and patient age to generate a more reliable diagnosis of surgical UP than that obtained from clinical examinations. more...
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- 2023
5. Identification of surgical uterine prolapse in premenopausal patients with clinical or ultrasound criteria? A multicenter comparative study
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Universidad de Sevilla. Departamento de Cirugía, Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública, García Mejido, José Antonio, Martín-Martínez, Alicia, González-Díaz, Enrique, Núñez-Matas, María José, Fernández Palacín, Ana, Carballo-Rastrilla, Sonia, Fernández-Fernández, Camino, Sáinz Bueno, José Antonio, Universidad de Sevilla. Departamento de Cirugía, Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública, García Mejido, José Antonio, Martín-Martínez, Alicia, González-Díaz, Enrique, Núñez-Matas, María José, Fernández Palacín, Ana, Carballo-Rastrilla, Sonia, Fernández-Fernández, Camino, and Sáinz Bueno, José Antonio more...
- Abstract
Objectives—It is unknown whether diagnosing uterine prolapse (UP) via ultrasound or surgical criteria is superior. Our objective is to determine whether the diagnostic capacity of ultrasound with surgical criteria differs from that of surgical criteria only. Methods—This was a multicenter prospective observational study with 54 premenopausal patients with surgical criteria for a dysfunctional pelvic floor pathology who were consecutively recruited for 1 year. Clinical UP with surgical criteria was defined when UP stage II–IV was identified (during pelvic floor consultation), and UP diagnosed by ultrasound with surgical criteria was established when a difference ≥15 mm was found between rest and Valsalva applied to the pubis-uterine fundus. The sensitivity, specificity and positive and negative predictive values were determined to evaluate clinical and ultrasound methodologies as diagnostic tests. Results—UP diagnosed by ultrasound with surgical criteria presented better sensitivity (78.57 vs 35.71%), specificity (92.11 vs 81.58%), positive predictive value (61.83 vs 23.99%), and negative predictive value (96.35 vs 11.37%) than UP diagnosed by surgical criteria only. Conclusion—Ultrasound with surgical criteria is superior to surgical criteria alone when diagnosing UP. more...
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- 2023
6. Uterine and Vaginal Prolapse
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Pieter Nelissen
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Gynecology ,medicine.medical_specialty ,CATS ,business.industry ,medicine ,Urology ,Uterine prolapse ,medicine.disease ,business - Published
- 2022
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7. Vaginal pessary sharpens uterocervical angle in uterine prolapse during pregnancy. A case report
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Hisami Matsumine, Miki Tagawa, Yohei Shirai, Miki Matsumine, Minako Hattori, and Yoshio Matsuda
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Gynecology ,Cervical pessary ,medicine.medical_specialty ,Pregnancy ,Spontaneous vaginal delivery ,business.industry ,Obstetrics and Gynecology ,Uterine prolapse ,Vaginal pessary ,medicine.disease ,medicine.anatomical_structure ,medicine ,Vagina ,Gestation ,business ,Cervical length - Abstract
A 37-year-old multiparous woman complained of uterine prolapse at 14 weeks of gestation. A silicone ring-shaped middle-size vaginal pessary (# 62 mm) was placed into the vagina to reduce prolapsed uterus. Because the cervical length became shortened at 25 weeks of gestation, we decided to start intramuscular administration of progesterone (250 mg) weekly. At 33 weeks of gestation, she complained of the vaginal pessary spontaneous falling out, so we inserted a vaginal pessary of the same size again. The uterocervical angle became acute, going from 100° to 60° after placing the vaginal pessary into the vagina. We took the vaginal pessary out at 37 weeks of gestation. The patient gave birth at 39 weeks by spontaneous vaginal delivery to a healthy baby. A vaginal pessary may help continue a pregnancy via the same mechanism as a cervical pessary, which sharpens the uterocervical angle. more...
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- 2021
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8. How common are complications following polypropylene mesh, biological xenograft and native tissue surgery for pelvic organ prolapse? A secondary analysis from the PROSPECT trial
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Reid, FM, Elders, A, Breeman, S, Freeman, RM, Glazener, CMA, Hemming, C, Cooper, KG, Smith, ARB, Hagen, S, Montgomery, I, Kilonzo, M, Boyers, D, McDonald, A, McPherson, G, MacLennan, G, and Norrie, J
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Heterografts/transplantation ,Adult ,medicine.medical_specialty ,Constipation ,Polypropylenes/therapeutic use ,Reconstructive Surgical Procedures/methods ,Population ,Polypropylenes ,Pelvic Organ Prolapse ,law.invention ,Cohort Studies ,Pelvic Organ Prolapse/surgery ,Gynecologic Surgical Procedures ,Postoperative Complications ,Randomized controlled trial ,Uterine Prolapse ,law ,Collagen/therapeutic use ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,education ,Uterine Prolapse/surgery ,education.field_of_study ,Urinary retention ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,Plastic Surgery Procedures ,Surgical Mesh ,Surgery ,Treatment Outcome ,Patient Satisfaction ,Gynecologic Surgical Procedures/methods ,Heterografts ,Female ,Patient-reported outcome ,Collagen ,medicine.symptom ,Complication ,business ,Cohort study - Abstract
Objective: To report complication rates following prolapse surgery using polypropylene mesh inlay, polypropylene mesh kit, biological collagen xenografts and native tissue repairs. Design: Secondary analysis of the PROSPECT randomised controlled trial and cohort study. Setting: Thirty-five UK hospitals. Population: A total of 2632 women undergoing anterior and/or posterior vaginal prolapse repair. Methods: Event rates were calculated for all complications. Analysis was by treatment received. Main outcome measures: IUGA/ICS classification of complications and validated patient reported outcome measures. Results: At baseline, 8.4% of women had ‘generic’ pain/discomfort; at 2 years following surgery, there was an improvement in all four groups; however, 3.0% of women developed de novo extreme generic pain. At 24 months de novo vaginal tightness occurred in 1.6% of native tissue, 1.2% of biological xenograft, 0.3% of mesh inlay and 3.6% of mesh kit. Severe dyspareunia occurred in 4.8% of native tissue, 4.2% of biological xenograft, 3.4% of mesh inlay repairs and 13.0% of mesh kits. De novo severe dyspareunia occurred in 3.5% of native tissue, 3.5% of biological xenograft, 1.4% of mesh inlays and 4.8% of mesh kits. Complications requiring re-admission to hospital, unrelated to mesh, affected 1 in 24 women; the most common reasons for re-admission were vaginal adhesions, urinary retention, infection and constipation. Conclusions: This is the first study to address the complications of vaginal mesh used for prolapse surgery alongside data from both native tissue and biological xenograft. It demonstrates the complexity of assessing pain and that all types of prolapse surgery have low surgical morbidity and a low rate of severe complications. Tweetable abstract: A prospective study of 2362 women undergoing vaginal mesh, xenograft or native tissue repair found low surgical morbidity and low rates of severe complications. more...
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- 2021
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9. Gynaecological and reproductive health of women with telomere biology disorders
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Sharon A. Savage, Blanche P. Alter, Pamela Stratton, and Neelam Giri
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Adult ,medicine.medical_specialty ,Adolescent ,media_common.quotation_subject ,medicine.medical_treatment ,Fertility ,Article ,Dyskeratosis Congenita ,03 medical and health sciences ,Surgical Menopause ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,medicine ,Humans ,Caesarean section ,Child ,Aged ,media_common ,Aged, 80 and over ,Uterine Diseases ,business.industry ,Obstetrics ,Uterine prolapse ,Hematology ,Middle Aged ,medicine.disease ,Menopause ,Reproductive Health ,Hormonal contraception ,030220 oncology & carcinogenesis ,Menarche ,Premature Birth ,Female ,business ,030215 immunology - Abstract
Reproductive health may be adversely impacted in women with dyskeratosis congenita (DC) and related telomere biology disorders (TBD). We evaluated gynaecological problems, fertility, and pregnancy outcomes in 39 females aged 10-81 years who were followed longitudinally in our DC/TBD cohort. Twenty-six had bone marrow failure and 12 underwent haematopoietic cell transplantation. All attained menarche at a normal age. Thirteen women reported menorrhagia; ten used hormonal contraception to reduce bleeding. Nine experienced natural normal-aged menopause. Gynaecological problems (endometriosis = 3, pelvic varicosities = 1, cervical intraepithelial neoplasia = 1, and uterine prolapse = 2) resulted in surgical menopause in seven. Twenty-five of 26 women attempting fertility carried 80 pregnancies with 49 (61%) resulting in livebirths. Ten (38%) women experienced 28 (35%) miscarriages, notably recurrent pregnancy loss in five (19%). Preeclampsia (n = 6, 24%) and progressive cytopenias (n = 10, 40%) resulted in maternal-fetal compromise, including preterm (n = 5) and caesarean deliveries (n = 18, 37%). Gynaecological/reproductive problems were noted mainly in women with autosomal-dominant inheritance; others were still young or died early. Although women with TBDs had normal menarche, fertility, and menopause, gynaecological problems and pregnancy complications leading to caesarean section, preterm delivery, or transfusion support were frequent. Women with TBDs will benefit from multidisciplinary, coordinated care by haematology, gynaecology and maternal-fetal medicine. more...
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- 2021
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10. Management of Vaginal, Cervico‐Vaginal, and Uterine Prolapse
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E. Heath King and A.T. Peter
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Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,Uterine prolapse ,business ,medicine.disease - Published
- 2021
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11. Correlations between severity of anterior vaginal wall prolapse and parameters of urethral pressure profile
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Heng-Wei Chang, Soo-Cheen Ng, and Gin-Den Chen
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Male ,medicine.medical_specialty ,Urethral closure ,Urinary Incontinence, Stress ,Urology ,030232 urology & nephrology ,Urinary incontinence ,03 medical and health sciences ,0302 clinical medicine ,Urethra ,Urethral pressure profile ,Uterine Prolapse ,Urethral pressure ,Pressure ,Humans ,Medicine ,PROXIMAL URETHRA ,Anterior vaginal wall prolapse ,030219 obstetrics & reproductive medicine ,business.industry ,medicine.disease ,Menopause ,Urodynamics ,Neurology ,Female ,medicine.symptom ,business ,Body mass index - Abstract
OBJECTIVE Previous studies have shown that anterior vaginal wall prolapse (AVWP) results in reduction of pressure in the proximal urethra. However, the effect of severity of AVWP on urethral pressure is controversial. This study aimed to evaluate parameters of the urethral pressure profile in different stages of AVWP. MATERIALS AND METHODS From 2016 to 2017, 286 consecutive patients with urogynecologic complaints who were referred to our urodynamic unit were enrolled in this study to analyze their urethral pressure profiles. Stages of AVWP were regrouped into three groups ranging from mild to severe stages (groups 1-3). Maximal urethral pressure, urethral closure pressure, functional urethral length, length of continence zone, as well as area of continence zone were compared among these three groups. RESULTS Distribution of age, parity, and menopausal women were significantly different among these three groups. Maximal urethral pressure (pressures for groups 1, 2, and 3 were 74.6∼75.9cmH2O, 69.7∼73.4cmH2O, and 58.3∼60.5cmH2O, respectively; all P more...
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- 2020
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12. Mesh exposure after transvaginal mesh prolapse surgery: Out of permissible range?
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Akinobu Ishiyama, Shoji Suzuki, Hiroki Hirabayashi, Hirotaka Matsui, Kumiko Kato, Ryohei Hattori, Hideji Kawanishi, and Takashi Kato
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medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Ureteral stenosis ,Rectum ,Pelvic Organ Prolapse ,03 medical and health sciences ,0302 clinical medicine ,Ureter ,Uterine Prolapse ,medicine ,Humans ,General hospital ,Retrospective Studies ,business.industry ,Prolapse surgery ,Colostomy ,Surgical Mesh ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Vagina ,Female ,business ,Bladder stone - Abstract
Objectives To investigate the prevalence of postoperative complications after transvaginal mesh prolapse surgery, and whether modified transvaginal mesh prolapse surgery (without transobturator arms or posterior mesh) has less prevalence of mesh exposure compared with conventional transvaginal mesh prolapse surgery. Methods Medical charts were retrospectively examined for 2648 patients who underwent transvaginal mesh prolapse surgery in a general hospital (2006-2017). Conventional transvaginal mesh prolapse surgery (Prolift-type, n = 2258) was used, with a shift from 2015 to modified transvaginal mesh prolapse surgery (Uphold-type, n = 330). Patients were instructed to have >2 years of follow up and to report if they had problems regarding the operation. Results The prevalence of mesh exposure was 34 out of 2648 (1.28%); 18 vagina (0.68%), 10 bladder (0.38%), two ureter (0.08%) and four rectum (0.15%). The modified transvaginal mesh prolapse surgery group had only one case with vaginal exposure. Vaginal exposure was managed transvaginally or followed by observation. Rectal exposure was managed transvaginally without colostomy. Bladder exposure was managed by transurethral resection with saline. Open ureterocystostomy was carried out to treat ureteral exposure. In the conventional transvaginal mesh prolapse surgery group, three cases of ureteral stenosis and one case with vaginal evisceration of the small intestine were managed transvaginally. The prevalence of postoperative chronic pain was 13 out of 2648 (0.49%; with one patient in the modified transvaginal mesh prolapse surgery group). The patients underwent pharmacotherapy, and one patient underwent additional surgical treatment. Conclusions The reoperation rate as a result of complications after transvaginal mesh prolapse surgery seems to be low. The reoperation rate as a result of prolapse recurrence is also low. A shift from conventional transvaginal mesh prolapse surgery to modified transvaginal mesh prolapse surgery might contribute to a further decrease in the risk of complications. more...
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- 2020
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13. Does Vaginal Parity Alter the Association Between Symptoms and Signs of Pelvic Organ Prolapse?
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N. Subramaniam, Daniella Rozsa, Hans Peter Dietz, and Talia Friedman
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medicine.medical_specialty ,Tertiary care ,Pelvic Organ Prolapse ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Childbirth ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Pelvic organ ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Receiver operating characteristic ,Obstetrics ,business.industry ,Rectocele ,Confounding ,Uterine prolapse ,Retrospective cohort study ,medicine.disease ,Parity ,Female ,Parity (mathematics) ,business ,Cystocele - Abstract
OBJECTIVES This study aimed to investigate whether the number of vaginal births a woman has alters the association between symptoms and signs of pelvic organ prolapse. METHODS In this retrospective study, we investigated data on 1748 women seen between April 2012 and January 2016. To elucidate whether the number of vaginal births is a confounder of this relationship, we used receiver operating characteristic statistics to investigate the association between symptoms and signs of prolapse in women of different vaginal parity. RESULTS A higher number of vaginal births was associated with a higher likelihood of symptoms of prolapse for any given degree of prolapse. Multivariate modeling, however, showed this confounding effect to be due to higher vaginal parity in older women (P more...
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- 2020
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14. Success rates and outcomes of laparoscopic mesh sacrohysteropexy
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Magdalena Palacz, Samuel Daniels, Stuart Howell, Danielle Robson, Fariba Behnia-Willison, and Tran Nguyen
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Pelvic Organ Prolapse ,03 medical and health sciences ,Gynecologic Surgical Procedures ,0302 clinical medicine ,Uterine Prolapse ,South Australia ,medicine ,Humans ,Laparoscopy ,Aged ,Retrospective Studies ,Aged, 80 and over ,030219 obstetrics & reproductive medicine ,Hysterectomy ,medicine.diagnostic_test ,business.industry ,Uterus ,Obstetrics and Gynecology ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgical Mesh ,Sacrohysteropexy ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Surgical mesh ,Private practice ,Vagina ,Female ,Median body ,business ,Organ Sparing Treatments - Abstract
BACKGROUND Uterovaginal prolapse is a prevalent gynaecological issue, which can have a negative impact on the quality of life of women. Hysterectomy and vaginal repair are conventional treatments to address apical prolapse; however, women are increasingly requesting uterine-preserving alternatives. AIMS This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. MATERIALS AND METHODS This retrospective cohort study presents outcomes of 157 patients who underwent laparoscopic mesh sacrohysteropexy at a private practice in South Australia during 2007-2017. Primary outcome is the success rate according to the pelvic organ prolapse quantification (POP-Q) system. Secondary measures included complication rates and patients identified as having Stages III-IV prolapse and their outcomes. RESULTS The median age was 58 years (27-86 years), median parity was 2 (0-6), and median body mass index was 26.8 (23-29.9). One hundred and thirty-four women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and four women had an isolated laparoscopic hysteropexy. The mean pre-operative point C was 0.60. The mean change from pre-operative point C to post-operative point C was 7.6 cm (P more...
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- 2020
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15. Position of Ibero‐American Society of Neurourology and UroGynecology (SINUG) on the use of vaginal meshes in pelvic organ prolapse
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Roberto Martínez-García, Montserrat Espuña-Pons, Pedro Blasco-Hernández, Salvador Arlandis-Guzman, Carlos Müller-Arteaga, Carlos Errando-Smet, Alicia Martín-Martínez, Luis López-Fando, Francisco Cruz, David Castro-Diaz, Bárbara Padilla-Fernández, Cristina Ros-Cerro, and Eduardo Vicente‐Palacio more...
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medicine.medical_specialty ,Reconstructive surgery ,Urology ,030232 urology & nephrology ,Pelvic Organ Prolapse ,Scientific evidence ,Urogynecology ,Food and drug administration ,03 medical and health sciences ,0302 clinical medicine ,Uterine Prolapse ,medicine ,Humans ,Pop surgery ,Societies, Medical ,Pelvic organ ,030219 obstetrics & reproductive medicine ,Pelvic floor ,Portugal ,United States Food and Drug Administration ,business.industry ,General surgery ,Pelvic Floor ,Prostheses and Implants ,Plastic Surgery Procedures ,Surgical Mesh ,Vaginal mesh ,United States ,Latin America ,medicine.anatomical_structure ,Spain ,Vagina ,Quality of Life ,Female ,Neurology (clinical) ,business - Abstract
AIMS Pelvic organ prolapse (POP) is a very prevalent condition with a great impact on women's quality of life. At present, there is great controversy regarding the use of mesh in POP surgery. To understand the current moment, it is advisable to make a brief summary of the historical evolution of mesh use for pelvic floor pathology. The aim of this paper is to establish the position of the Ibero-American Society of Neurourology and UroGynecology (SINUG for its acronym in Spanish) regarding vaginal mesh reconstructive surgery. METHODS A working committee from the SINUG's scientific board performed a literature search about the use of vaginal meshes for pelvic organ prolapse reconstructive surgery and about the position of different societies. We analyzed the evolution into three periods: before the Food and Drug Administration (FDA) statement, FDA statement, and after the statement. SINUG drew up a position statement regarding vaginal mesh reconstructive surgery, based on the available scientific evidence and the evolution of its use in different contexts. RESULTS Before mesh appearance in the 1990s, native tissue repair was the surgical treatment of choice for POP. Vaginal mesh reconstructive surgery has been frequently accompanied by procedure underestimation by inexperienced surgeons, besides inadequate diagnoses and indications. This situation led to the presentation of serious complications including mesh extrusion, exposure, and contraction. CONCLUSIONS Once reviewed the available evidence and the position of different societies, SINUG presents its vision in this communication, which is a summary of the document prepared by the society's scientific board. more...
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- 2020
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16. Uterine Prolapse Treatment
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John J. Dascanio
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Gynecology ,medicine.medical_specialty ,business.industry ,Retained placenta ,Uterine tissue ,Medicine ,Uterine prolapse ,Abortion ,business ,medicine.disease - Published
- 2021
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17. A systematic review of reported outcomes and outcome measures in randomized trials evaluating surgical interventions for posterior vaginal prolapse to aid development of a core outcome set
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Standards in Urogynaecology, Abdullatif Elfituri, Lina Bergstrom, Christiana Campani Nygaard, Stergios K. Doumouchtsis, Mittal Pattel, Vasilis Pergialiotis, Constantin M. Durnea, Gabriele Falconi, Thais Regina de Mattos Lourenço, Jorge Milhem Haddad, and Cornelia Betschart more...
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medicine.medical_specialty ,Urinary system ,MEDLINE ,Psychological intervention ,Outcome (game theory) ,law.invention ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Randomized controlled trial ,Uterine Prolapse ,law ,Outcome Assessment, Health Care ,Humans ,Medicine ,030212 general & internal medicine ,Set (psychology) ,Randomized Controlled Trials as Topic ,Core (anatomy) ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,General Medicine ,Surgical Mesh ,Treatment Outcome ,Systematic review ,Physical therapy ,Female ,business - Abstract
Background Recent systematic reviews have demonstrated wide variations on outcome measure selection and outcome reporting in trials on surgical treatments for anterior, apical and mesh prolapse surgery. A systematic review of reported outcomes and outcome measures in posterior compartment vaginal prolapse interventions is highly warranted in the process of developing core outcome sets. Objective To evaluate outcome and outcome measures reporting in posterior prolapse surgical trials. Search strategy We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Selection criteria Randomized trials evaluating the efficacy and safety of different surgical interventions for posterior compartment vaginal prolapse. Data collection and analysis Two researchers independently assessed studies for inclusion, evaluated methodological quality, and extracted relevant data. Methodological quality, outcome reporting quality and publication characteristics were evaluated. Main results Twenty-seven interventional and four follow-up trials were included. Seventeen studies enrolled patients with posterior compartment surgery as the sole procedure and 14 with multicompartment procedures. Eighty-three reported outcomes and 45 outcome measures were identified. The most frequently reported outcomes were blood loss (20 studies, 74%), pain (18 studies, 66%) and infection (16 studies, 59%). Conclusions Wide variations in reported outcomes and outcome measures were found. Until a core outcome set is established, we propose an interim core outcome set that could include the three most commonly reported outcomes of the following domains: hospitalization; intraoperative, postoperative urinary, gastrointestinal, vaginal and sexual outcomes; clinical effectiveness. Prospero CRD42017062456. more...
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- 2020
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18. Rectal and Vaginal Fold Prolapse
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Kimberly Woodruff
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Rectal prolapse ,medicine.medical_specialty ,business.industry ,Vaginal mucosa ,Urology ,medicine ,Uterine prolapse ,medicine.disease ,business - Published
- 2019
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19. Surgical resolution of uterine prolapse in three pet rabbits
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V. Del Duca, Paolo Selleri, Alessandro Montani, Dario d'Ovidio, N. Di Girolamo, and Thomas M. Donnelly
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Uterus ,Uterine prolapse ,medicine.disease ,External pressure ,Surgery ,medicine.anatomical_structure ,Laparotomy ,medicine ,Vagina ,Small Animals ,business - Abstract
This report describes a surgical technique for resolution of uterine prolapse in rabbits. Three pet rabbits presented within 24 hours of parturition with a red mass protruding from the vagina, which was diagnosed as uterine prolapse. In the first case, an attempt to reduce the prolapse by manual compression was ineffective. A laparotomy was used to apply internal uterine traction while simultaneously using gentle external pressure with cotton-tip applicators and resulted in successful resolution. After repositioning, an ovariohysterovaginectomy was performed in all three rabbits. All rabbits recovered uneventfully. Laparotomic repositioning of the uterus and ovariohysterovaginectomy, not previously described in rabbits, was easy to perform and permitted resolution of uterine prolapse. more...
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- 2019
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20. Laparoscopic inguinal ligament suspension combined with hysterectomy for the treatment of uterovaginal prolapse
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Huimin Shu, Zhiyuan Dai, and Chunbo Li
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medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Vaginal Diseases ,Inguinal Canal ,Uterovaginal prolapse ,Hysterectomy ,03 medical and health sciences ,0302 clinical medicine ,Uterine Prolapse ,Surveys and Questionnaires ,Humans ,Medicine ,Stage (cooking) ,Aged ,Ligaments ,030219 obstetrics & reproductive medicine ,Pelvic floor ,business.industry ,Obstetrics and Gynecology ,Pelvic Floor ,Perioperative ,Middle Aged ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Satisfaction rate ,Patient Satisfaction ,030220 oncology & carcinogenesis ,Vagina ,Operative time ,Female ,Laparoscopy ,Inguinal ligament ,business - Abstract
Aim To demonstrate the efficacy and safety of a modified technique of laparoscopic inguinal ligament suspension (LILS) with hysterectomy for the treatment of uterovaginal prolapse. Methods A total of 57 patients were treated by LILS combined with hysterectomy between Jan 2014 and Feb 2016. The perioperative parameters, such as operative time, estimated blood loss, length of stay and intra- and postoperative complications were recorded. The Pelvic Organ Prolapse questionnaire classification was applied to evaluate the Pelvic Organ Prolapse stage, and Patient Global Impression of Improvement scale was used to determine the patients' satisfaction. Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire were used to evaluate the functional improvement. All data were collected preoperatively and then at 12 months postoperatively. Results The mean surgical time was 130.4 (82-190) min, the average blood loss was 50.4 (10-300) mL and the mean hospitalization was 5.3 (4-8) days. The rates of intra- and postoperative complications were low. After a minimal of 12 months follow-up, the anatomical success rate was 85.5%, and the subjective satisfaction rate was 92.7%. The functional measures also presented a significant improvement with no recurrence of prolapse. Conclusion LILS combined with hysterectomy was a safe and effective technique and might be considered as an alternative treatment for patients with uterovaginal prolapse. more...
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- 2019
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21. Large pedunculated submucosal leiomyoma mimicking uterine prolapse
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Themos Grigoriadis, Nikolaos Kathopoulis, Lina Michala, Stavros Athanasiou, Kyveli Angelou, Dimitrios Zacharakis, and Artemis Pontikaki
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Leiomyosarcoma ,medicine.medical_specialty ,Medicine (General) ,030204 cardiovascular system & hematology ,pedunculated uterine leiomyoma ,03 medical and health sciences ,0302 clinical medicine ,R5-920 ,Clinical Images ,VAGINAL MASS ,medicine ,Stromal tumor ,neoplasms ,Gynecology ,Uterine leiomyoma ,business.industry ,protruding vaginal mass ,Uterine prolapse ,General Medicine ,medicine.disease ,body regions ,Leiomyoma ,surgical procedures, operative ,030220 oncology & carcinogenesis ,Clinical Image ,submucous leiomyoma ,uterine prolapse ,Medicine ,Differential diagnosis ,business ,Vaginal Vault Prolapse - Abstract
The differential diagnosis of a sudden protrusion of a large vaginal mass includes a uterine or vaginal vault prolapse, a pedunculated uterine leiomyoma or leiomyosarcoma, a uterine stromal tumor or a giant polyp. more...
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- 2021
22. Multicenter study of the evolution of different types of avulsion over the 12 months after delivery.
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García-Mejido JA, González-Diaz E, Ortega I, Martín-Martinez A, Fernández-Palacín A, and Sainz-Bueno JA
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- Female, Humans, Pregnancy, Ultrasonography, Delivery, Obstetric, Pelvic Floor diagnostic imaging, Postpartum Period physiology
- Abstract
Objective: To perform a multicenter study of muscle recovery in levator ani muscle (LAM) avulsion during the first 12 months postpartum according to the type of LAM avulsion suffered., Methods: This was a multicenter prospective observational study including 242 primiparas. Transperineal ultrasound was performed at 6 months and 12 months after delivery. Type I LAM avulsion was present when most of the lateral fibers of the pubovisceral muscle were observed at the muscle's insertion at the pubic level. Type II LAM avulsion was defined as complete detachment of the pubovisceral muscle from its insertion at the pubic level., Results: Among the 56 patients who completed the study (with ultrasound at 6 and 12 months after delivery), 76 avulsions (10 cases of bilateral avulsion) were identified at 6 months after delivery, and the total number of avulsions had decreased to 58 at 12 months after delivery (P < 0.001; 95% confidence interval [CI] 13.9%-33.5%). This decrease was due to the disappearance of 69.2% of the cases of Type I LAM avulsions (P < 0.001; 95% CI: 50.2%-88.2%). However, the number of Type II LAM avulsions remained constant at 6 months and 12 months after delivery., Conclusion: The spontaneous resolution of LAM avulsion during the first 12 months postpartum occurs in cases of Type I LAM avulsion but is not observed in Type II LAM avulsion., (© 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.) more...
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- 2023
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23. Massive prolapsed submucous fibroid treated with laparoscopic surgery: A case report
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Izumi Kusuki, Kazuya Yabumoto, Fumitake Ito, Taisuke Mori, Hiroshi Matsushima, and Jo Kitawaki
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Hysterectomy ,Uterine fibroids ,business.industry ,Uterine Hemorrhage ,medicine.medical_treatment ,Obstetrics and Gynecology ,Uterine prolapse ,medicine.disease ,female genital diseases and pregnancy complications ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Leiomyoma ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Vagina ,Vaginal bleeding ,medicine.symptom ,business ,Cervical canal - Abstract
Prolapsed uterine fibroids are pedunculated submucous fibroids that prolapse through the cervical canal. Herein, we describe the laparoscopic treatment of massive prolapsed submucous fibroids. A 47-year-old woman had experienced frequent urination and abnormal vaginal bleeding for 7 years. She presented with persistent lower abdominal pain. The uterine fundus was palpable at 3 cm above the umbilicus. Vaginal examination revealed a dark purple and easily bleeding mass in her vagina. Pelvic magnetic resonance imaging revealed a large mass prolapsing from the uterine endometrium, which occupied the cervical canal and vagina, without evidence of malignancy. Under a preoperative diagnosis of uterine fibroids with edematous degeneration, we performed laparoscopic uterine artery cutting, transvaginal removal of the fibroid by twisting, and total laparoscopic hysterectomy. Histopathological examination revealed leiomyoma with partial ischemia. Six days postoperatively, the patient was discharged without complications. This approach may be appropriate for the treatment of massive prolapsed submucous fibroids. more...
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- 2019
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24. Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study
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Debjyoti Karmakar, Lore Schierlitz, Elizabeth A. Thomas, and Peter L. Dwyer
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Reoperation ,Sacrum ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Uterosacral ligament ,Hysterectomy ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Recurrence ,Uterine Prolapse ,medicine ,Humans ,Longitudinal Studies ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,Ligaments ,030219 obstetrics & reproductive medicine ,business.industry ,Suture Techniques ,Uterus ,Australia ,Obstetrics and Gynecology ,Uterine prolapse ,Buttock Pain ,Middle Aged ,Surgical Mesh ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Surgical mesh ,Vagina ,Female ,Peritoneum ,business ,Follow-Up Studies - Abstract
Objectives The study aims to evaluate the long-term results of the extraperitoneal uterosacral ligament suspension (bilateral) technique in women with apical prolapse following hysterectomy. Design Longitudinal clinical follow up conducted between June 2002 and December 2017. Setting Tertiary urogynaecology centre in Melbourne, Australia. Population A total of 472 women with symptomatic vault prolapse who underwent bilateral extraperitoneal uterosacral ligament suspension (EPUSLS). Of these patients, 61% (287/472) had previously had a procedure for pelvic organ prolapse (POP). Methods Follow up using structured, standardised questionnaires and examination by POP-Q and Baden-Walker system pre- and postoperatively. Main outcome measures Functional and anatomical results and surgical complications. Results Mean follow-up duration was approximately 5 years. The objective success rate at vaginal cuff support was 89% (420/472). Only 4% needed revision surgery for vault recurrence. There was improvement in bladder, bowel, and sexual symptoms after the procedure. Mesh exposure rate was 17% (of the 138 having mesh augmentation), with the majority of cases managed conservatively or with minor interventions. The ureteric injury rate was 1% and mainly occurred in patients operated early on in the series. No women had buttock pain. Conclusion EPUSLS is an effective, suture-based procedure for vault prolapse with few complications even on long-term follow up. This technique avoids the need to open the peritoneum vaginally and has a low risk of ureteric injury and gluteal pain. Tweetable abstract Bilateral extraperitoneal USL suspension of vault is effective with low morbidity and a high success rate. more...
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- 2018
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25. Detection of Concealed Uterine Prolapse in the Volume-Rendering Mode of 4-Dimensional Translabial Ultrasound: A Retrospective Observational Study
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Yinbo Li, Zhenzhen Qing, Lieming Wen, and Minghui Liu
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Pelvic organ ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Uterine prolapse ,Retrospective cohort study ,medicine.disease ,Predictive value ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Vaginal canal ,medicine ,Radiology, Nuclear Medicine and imaging ,Translabial ultrasound ,Radiology ,business - Abstract
OBJECTIVES To assess the association between a widened vaginal canal on volume-rendered ultrasound (US) imaging with concealed uterine prolapse. METHODS This work was a retrospective study of 253 women who had an International Continence Society Pelvic Organ Prolapse Quantification System examination and translabial US examination. The anteroposterior diameter of the vaginal canal was measured in the rendered axial plane for all women. The widened vaginal canal was defined as an anteroposterior diameter above the 95th centile in women with normal uterine descent. The performance of the widened vaginal canal for prediction of clinical uterine prolapse was tested. RESULTS Valid data from 233 women were analyzed. A mean anteroposterior diameter of 5.6 mm (range, 2.3-10.5 mm; 95th percentile, 10 mm) was seen in 119 women with normal uterine descent. An eye-shaped vaginal canal with a mean anteroposterior diameter of 17.8 mm (range, 10.7-26.8 mm) was seen in 69 women with uterine prolapse. A widened vaginal canal was defined as an anteroposterior diameter of greater than 10 mm. Of 45 concealed uterine descents, 32 had a widened vaginal canal (ie, anteroposterior diameter > 10 mm), and 27 had clinical uterine prolapse. The κ test showed good agreement between physical and US findings (κ = 0.76; P more...
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- 2018
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26. Risk of prolapse and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor using clean intermittent catheterization versus Valsalva voiding
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C. Richard, Charlène Brochard, Jacques Kerdraon, Laurent Siproudhis, Xavier Gamé, Zine-Eddine Khene, Isabelle Bonan, Quentin Alimi, M. Jezequel, Andrea Manunta, Juliette Hascoet, Mehdi El Akri, B. Peyronnet, CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Mutualiste de Rééducation et de Réadaptation Fonctionnelles de Kerpape, CHU Toulouse [Toulouse], Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse) more...
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Adult ,Male ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Urology ,Urinary system ,030232 urology & nephrology ,acontractile ,urologic and male genital diseases ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Uterine Prolapse ,Intussusception (medical disorder) ,Urinary Bladder, Underactive ,Clinical endpoint ,Humans ,Medicine ,Intermittent Urethral Catheterization ,Urinary Complication ,Urinary Bladder, Neurogenic ,Spinal Dysraphism ,Retrospective Studies ,valsalva pelvic organ prolapse ,030219 obstetrics & reproductive medicine ,Urinary bladder ,business.industry ,Spina bifida ,clean-intermittent catheterization ,medicine.disease ,spina bifida ,body regions ,Rectal prolapse ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Relative risk ,Urinary Tract Infections ,Female ,Neurology (clinical) ,urinary tract infection ,business ,urinary bladder ,rectal prolapse - Abstract
International audience; Aims - To assess the relative risks of pelvic organ prolapse (POP) and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor voiding with Valsalva versus those using clean-intermittent catheterization (CIC). Methods - We conducted a retrospective analysis including all spina bifida patients with neurogenic acontractile detrusor with a minimum follow-up of 12 months. Patients were then divided in two groups according to their bladder management: voiding with Valsalva versus CIC. The primary endpoint was any de novo or worsened rectal and/or pelvic organ prolapse (POP) diagnosed during follow-up. The secondary outcome was urinary complications defined as febrile urinary tract infections (UTI) and/or urolithiasis and/or renal failure. Results - Fifty-five patients (50.9% were males) met the inclusion/exclusion criteria: 28 voiding with Valsalva and 27 performing CIC. At baseline, the rates of vaginal prolapse (44.4% vs 50%; P = 0.99), and rectal prolapse/intussusception (25.9% vs 21.4%; P = 0.76) were similar in both groups. After a median follow-up of 80.6 and 65.6 months, respectively (P = 0.29), the rate of de novo or worsened rectal prolapse/intussusception was higher in the Valsalva voiding group than in the CIC group (32.1% vs 3.7%; P = 0.01). De novo or worsened vaginal prolapses were also more common in the Valsalva voiding group, but it did not reach statistical significance (33.3% vs 11.1%; P = 0.29). Conclusions - Valsalva voiding might be harmful in adult spina bifida patients with neurogenic acontractile detrusor as it may increase the risk of rectal prolapse/intussusception. Overall, the prevalence of POP and rectal prolapse was high in both groups. more...
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- 2018
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27. Synthetic mid-urethral sling complications: Evolution of presenting symptoms over time
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Philippe E. Zimmern, Connie Wang, and Alana Christie
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Adult ,medicine.medical_specialty ,Sling (implant) ,Databases, Factual ,Urology ,Urinary system ,030232 urology & nephrology ,Urinary incontinence ,Mid-Urethral Sling ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Recurrence ,Uterine Prolapse ,Lower urinary tract symptoms ,medicine ,Humans ,Device Removal ,Aged ,Retrospective Studies ,Aged, 80 and over ,Suburethral Slings ,030219 obstetrics & reproductive medicine ,business.industry ,Chronic pain ,Middle Aged ,Urination Disorders ,medicine.disease ,Surgery ,Urinary Incontinence ,Urinary Tract Infections ,Vaginal Pain ,Urologic Surgical Procedures ,Female ,Neurology (clinical) ,Chronic Pain ,medicine.symptom ,Complication ,business - Abstract
INTRODUCTION To study the evolution of type of presenting symptoms after mid-urethral sling (MUS) placement relative to the interval between placement and subsequent synthetic sling removal (SSR) for complication(s). METHODS An IRB-approved, prospectively maintained database of women who underwent SSR was retrospectively reviewed for demographics, interval between MUS placement and SSR, history of chronic pain syndromes and recurrent urinary tract infections (RUTI), anti-incontinence and prolapse repairs, and MUS-related symptoms at presentation, including storage dysfunction, voiding dysfunction, RUTI, vaginal pain, non-vaginal pain, mesh exposure, and urinary incontinence (UI). Comparisons were made between patient groups divided into 2 and 4-year intervals to test the hypothesis that there would be higher rates of mesh exposure, pain and/or dyspareunia earlier, but higher rates of RUTI and UI in later groups. RESULTS Between 2005-2017, 278/435 women met study criteria. Overall, mean number of presenting symptoms per patient was 3.8 ± 1.4 and increased significantly in relation to time since MUS placement (P more...
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- 2018
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28. Laparoscopic versus abdominal sacrocolpopexy for treatment of multi-compartmental pelvic organ prolapse: A systematic review
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Masao Ichikawa, Shigeo Akira, and Hanako Kaseki
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Therapeutic effect ,030232 urology & nephrology ,Uterine prolapse ,General Medicine ,Abdominal cavity ,medicine.disease ,law.invention ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Randomized controlled trial ,law ,Laparotomy ,Severity of illness ,medicine ,sense organs ,business ,Laparoscopy ,Vaginal Vault Prolapse - Abstract
Laparoscopic sacrocolpopexy (LSC) is attracting increasing attention as a minimally invasive surgery that provides excellent therapeutic effects on apical vaginal prolapse. However, its therapeutic effects on multi-compartmental pelvic organ prolapse (POP) remain unclear. Therefore, the aim of this review was to evaluate the efficacy of LSC on multi-compartmental POP compared with abdominal sacrocolpopexy (ASC). We extracted three articles on randomized controlled trials that compared LSC and ASC. A total of 247 patients (123 for LSC, 124 for ASC) were evaluated. There was no evidence of recurrence or reoperation in either group for the apical vaginal compartment. Regarding recurrence within the anterior vaginal compartment, there were no significant between-group differences in either of the two randomized controlled trials targeting vaginal vault prolapse. In contrast, in the randomized controlled trial targeting POP including cases with uteruses, there were more recurrent POP with grade II or more in the LSC group than in the ASC group (11/60 [18.3%] vs 1/60 [1.6%], P = 0.004). Reoperation for the posterior vaginal compartment was performed in three cases (2.5%) in the LSC group and in one case (0.8%) in the ASC group. The combined repeat surgery and mesh removal surgery rate was higher in the LSC group (8/119 [6.7%]) than in the ASC group (2/121 [1.7%], P = 0.049). LSC has an excellent therapeutic effect and is comparable to ASC for the treatment of apical prolapse. However, cystocele recurrence, repeat surgery of the posterior compartment, and mesh-related complications were more frequent in patients who had undergone LSC. more...
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- 2018
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29. A descriptive study on the efficacy and complications of the Capio (Boston Scientific) suturing device for sacrospinous ligament fixation
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Peta Higgs, Vivien Wong, Anita Pelecanos, Alex Mowat, Hannah Krause, and Judith Teng Wah Goh
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medicine.medical_specialty ,Blood transfusion ,medicine.medical_treatment ,Blood Loss, Surgical ,03 medical and health sciences ,Gynecologic Surgical Procedures ,Postoperative Complications ,0302 clinical medicine ,Uterine Prolapse ,medicine.ligament ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Buttocks ,Prospective cohort study ,Aged ,Aged, 80 and over ,Pain, Postoperative ,Ligaments ,030219 obstetrics & reproductive medicine ,business.industry ,Suture Techniques ,Sacrospinous ligament ,Obstetrics and Gynecology ,Uterine prolapse ,Buttock Pain ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Vagina ,Female ,business ,Vaginal Vault Prolapse - Abstract
Background: Sacrospinous colpopexy is an effective vaginal apical support operation. Due to morbidity associated with traditional approaches which require wide dissection, slim-line suture delivery devices have been introduced in the hope of reducing morbidity without compromise to outcomes. Aim: The aim of our series was to report outcomes and complications (particularly buttock pain and blood loss) of the sacrospinous colpopexy using the Capio suturing device and evaluate it against published results using the Miya hook. Methods: This is a prospective, multi-centre descriptive study. The primary outcome is objective success at 12 months. Secondary outcomes include subjective success at 12 months, patient-reported outcomes at 12 months, operating time, estimated blood loss and post-operative buttock pain. Results: Fifty-one consenting patients undergoing sacrospinous colpopexy were recruited at four Queensland hospitals. Objective success at 12 months was 95% (41/43) and subjective success at 12 months was 92% (44/48). Eighty-four percent of patients reported buttock pain at one week, reducing to 16% by six weeks, of which 7% required analgesia. Conclusions: At a mean of 17 months follow up, we found that the sacrospinous colpopexy using the Capio suturing device provided excellent apical support with a low requirement for blood transfusion and an average operating time of seven minutes. We found a high rate of buttock pain immediately post-operatively, but our rates became consistent with previous reports by six weeks post-operation. more...
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- 2017
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30. Repair of damaged ligaments with tissue fixation system minisling is sufficient to cure major prolapse in all three compartments: 5-year data
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Takeshi Kusaka, Remi Watanabe, Mika Monma, Yuina Kubo, Takanori Fukuda, Yosie Uzawa, Hiromi Inoue, and Yutaka Kohata
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medicine.medical_specialty ,Stress incontinence ,030219 obstetrics & reproductive medicine ,Ileus ,business.industry ,Urinary retention ,Urinary system ,030232 urology & nephrology ,Obstetrics and Gynecology ,Uterine prolapse ,Bowel incontinence ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Overactive bladder ,Medicine ,Nocturia ,medicine.symptom ,business - Abstract
Aim The ageing population in Japan brings problems of pelvic organ prolapse (POP), bladder and bowel incontinence, and fragility as regards major pelvic surgery. Existing data from tissue fixation system (TFS) surgery show high cure rates for these conditions, but long-term data are lacking. We aimed to elucidate the usefulness of TFS by assessing 5-year postoperative outcomes. Methods A total of 68 patients, mean age 70 years, underwent total pelvic floor repair. Cystocele, apical prolapse, and rectocele were variously addressed by TFS repair of pubourethral, arcus tendineus fasciae pelvis, cardinal, uterosacral, and perineal body ligaments using a mean 3.2 tapes per patient (n = 216). Patients were followed up at 12 months then yearly. We included patients with third- or fourth-degree uterine/vaginal prolapse (POP Quantification classification). We excluded patients with serious comorbid conditions. Results The mean operating time was 88 min and the mean blood loss was 78 mL. There was minimal postoperative pain and urinary retention, as evidenced by a mean hospital stay of 0.8 days and early return to normal activities. The 5-year cure rates for urinary stress incontinence, urgency, nocturia, and frequency were 82%, 91.7%, 58%, and 52%, respectively. The surgical cure rate for POP was 87.1% at 12 months, falling to 79.0 at 60 months. The cumulative 5-year erosion rate was 0% and 1.7% for all ligaments except the perineal body (25.7%), reducing to 2.6% by year 5 following anchor placement into deep transversus perinei. Two cases of ileus were attributed to incorrect technique. Conclusion Reinforcing up to four ligaments with the TFS was sufficient for cure of third- and fourth-degree POP. The technique is minimally invasive, suitable for elderly women, and effective at 5 years for both anatomical and symptom cure. more...
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- 2017
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31. Laparoscopic extraperitoneal uterine suspension with suture line instead of mesh
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LJ Wu, X Shen, G Chen, YJ Yang, FJ Liu, Q Li, B Ling, J Liang, and L Deng
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medicine.medical_specialty ,Uterine suspension ,Operative Time ,Population ,Blood Loss, Surgical ,030232 urology & nephrology ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Uterine Prolapse ,Humans ,Medicine ,Laparoscopy ,education ,Retrospective Studies ,Analysis of Variance ,education.field_of_study ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Suture Techniques ,Uterus ,Obstetrics and Gynecology ,Uterine prolapse ,Retrospective cohort study ,Perioperative ,Length of Stay ,Middle Aged ,Surgical Mesh ,medicine.disease ,Surgery ,Treatment Outcome ,Surgical mesh ,Patient Satisfaction ,Female ,business - Abstract
To compare the safety and effectiveness of two different materials (mesh and suture line) used in laparoscopic extraperitoneal uterine suspension.A retrospective observational study.Gynaecology departments in two hospitals in China.Women with symptomatic pelvic organ prolapse (POP) of stage II or higher.The women were divided into two groups according to the two different materials for laparoscopic extraperitoneal uterine suspension: mesh or suture line. The baseline characteristics, perioperative details, complications, objective and subjective indexes of the two groups were compared.The primary outcome was subjective satisfaction rate based upon validated questionnaires. The secondary outcome was objective anatomic assessment with the POP-Q system.No difference was found in baseline characteristics and perioperative details except that there were more cases of cardiovascular disease (CVD) and associated other surgeries in the Line than the Mesh group (36 versus 19, P 0.05; 12 versus 2, P 0.05). Statistically significant improvements were found in anatomical measures of points Aa, Ba, Ap, Bp, C and TVL (P 0.01), as well as functional and quality-of-life measures (P 0.01 for PFDI-20 and PFIQ-7) between both groups. The postoperative PFDI-20, PFIQ-7 and PGI-I scores were not different between two groups (P 0.05). Two cases of deep wound infection were observed in Mesh group at 3-month follow up.Laparoscopic extraperitoneal linear uterine suspension is easy to perform and is associated with fewer mesh-related complications. It is more secure, especially in elderly women and in those with physical complications.Laparoscopic extraperitoneal linear uterine suspension is safe, with fewer mesh-related complications. more...
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- 2017
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32. Optimal Pessary Care: A Modified Delphi Consensus Study
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Katharine K O'Dell, Shanna Atnip, and Gwendolyn L Hooper
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Pessary ,Consensus ,Delphi Technique ,Modified delphi ,Delphi method ,Nurses ,Computer-assisted web interviewing ,Pelvic Organ Prolapse ,Vaginal estrogen ,Terminology ,03 medical and health sciences ,0302 clinical medicine ,Documentation ,Nursing ,Uterine Prolapse ,Surveys and Questionnaires ,Prolapse ,Maternity and Midwifery ,Humans ,Medicine ,Nurse Practitioners ,030212 general & internal medicine ,Practice Patterns, Nurses' ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Pessaries ,Gynecology ,Scale (social sciences) ,Practice Guidelines as Topic ,Vagina ,Female ,business - Abstract
Introduction Support pessaries are an important, low-risk treatment option for women with vaginal prolapse but evidence to inform optimal practice is lacking. Currently, gynecologists, urologists, and urogynecologists recommend silicone vaginal support pessaries as first-line treatment for symptomatic vaginal prolapse in women of all ages. It is unknown how many providers who are not physicians prescribe and care for women using pessaries. For this study we attempted to collect opinions of expert nurse providers who fit pessaries on topics related to pessary care and management in an effort to develop consensus to guide practice. Methods A 4-round modified Delphi technique was utilized and included one series of online surveys, 2 rounds of anonymous online questionnaires, and one series of face-to-face meetings at conferences. Respondents were invited to participate in all opportunities to provide opinion. For the first 3 rounds respondents were asked to rate statements on a 3-point scale, (agree, disagree, neutral) and provide written comments for those statements with which they did not agree. The goal of additional rounds was 80% agreement between participants, including no less than 6 nurse pessary experts. Results Greater than 80% consensus was achieved for 22 statements related to patient and provider education, terminology for documentation, pessary management, and follow-up care. Use of vaginal estrogen, antimicrobials, and prevention and management of mechanical injury were areas where no consensus was reached. Discussion Expert pessary providers were able to develop consensus recommendations to inform provider education and clinical care where the evidence base remains sparse. Areas where consensus was not achieved inform the future pessary-related research agenda needed to identify optimal cost-effective pessary care and educational methods for new pessary providers. more...
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- 2017
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33. Pre‐ and postoperative magnetic resonance imaging (MRI) findings in patients treated with laparoscopic sacrocolpopexy. Is it a safe procedure for all patients?
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Athanasios Protopapas, Stavros Athanasiou, Dimitrios Zacharakis, Lia A. Moulopoulos, Charis Bourgioti, Themos Grigoriadis, and Eleni Pitsouni
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Adult ,Spondylodiscitis ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Pelvic Organ Prolapse ,03 medical and health sciences ,Gynecologic Surgical Procedures ,0302 clinical medicine ,Degenerative disease ,Uterine Prolapse ,medicine ,Humans ,In patient ,Postoperative Period ,Aged ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Lumbosacral Region ,Magnetic resonance imaging ,Middle Aged ,Surgical Mesh ,medicine.disease ,Magnetic Resonance Imaging ,Low back pain ,Surgery ,Treatment Outcome ,Surgical mesh ,Preoperative Period ,Female ,Laparoscopy ,Neurology (clinical) ,medicine.symptom ,business ,Vaginal Vault Prolapse ,Mri findings - Abstract
Introduction Laparoscopic sacrocolpopexy (LSCP) is a reference operation for apical compartment prolapse repair. Aim of this study is to describe the early and midterm postoperative MRI findings of the lumbosacral region (LSR) in patients undergoing LSCP and to detect any imaging changes that the presence of the mesh may cause on patients with preexisting degenerative disease of the LSR. Methods Patients with POP-Q grade III and IV uterovaginal or vaginal vault prolapse who were considered eligible for LSCP were invited to participate. An MRI of the LSR was performed preoperatively and then 3 and 12 months postoperatively. Patients with vaginal vault prolapse underwent LSCP, while women with uterovaginal prolapse were treated with the vaginally assisted laparoscopic sacrocolpopexy (VALS). Results A total of 30 patients were included in the study; 18 (60%) underwent LSCP and 12 (40%) VALS. On preoperative MRIs, 83.3% (25/30) of patients had degenerative changes and 70% (21/30) reported having low back pain (LBP). Postoperative MRIs did not reveal any imaging changes compared to the preoperative MRI findings both for patients with or without preexisting degenerative abnormalities of the LSR. No significant changes in the LBP score were observed postoperatively. Conclusions Any bone marrow or soft-tissue changes at MRIs of the LSR early after the insertion of a synthetic mesh, does not constitute an expected postoperative finding and should raise the suspicion of an ongoing inflammatory or infectious spinal process (spondylodiscitis). Additionally, LSCP seems to be a safe surgical approach for women with preexisting degenerative disease of the LSR. more...
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- 2017
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34. Short-term complications associated with the use of transvaginal mesh in pelvic floor reconstructive surgery: Results from a multi-institutional prospectively maintained dataset
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Devin Haddad, Maxx Caveney, Gopal H. Badlani, Majid Mirzazadeh, and Catherine A. Matthews
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medicine.medical_specialty ,Reconstructive surgery ,Hernia ,Databases, Factual ,Urology ,030232 urology & nephrology ,Postoperative Hemorrhage ,Pelvic Organ Prolapse ,03 medical and health sciences ,Gynecologic Surgical Procedures ,Postoperative Complications ,0302 clinical medicine ,Uterine Prolapse ,Humans ,Surgical Wound Infection ,Medicine ,Aged ,030219 obstetrics & reproductive medicine ,Pelvic floor ,business.industry ,Uterine prolapse ,Pelvic Floor ,Perioperative ,Middle Aged ,Plastic Surgery Procedures ,Surgical Mesh ,medicine.disease ,Surgery ,Surgical mesh ,medicine.anatomical_structure ,Vagina ,Current Procedural Terminology ,Female ,Neurology (clinical) ,business ,Cystocele - Abstract
AIMS Vaginal reconstructive surgery can be performed with or without mesh. We sought to determine comparative rates of perioperative complications of native tissue versus vaginal mesh repairs for pelvic organ prolapse. METHODS Using the National Surgical Quality Improvement Program (NSQIP) database, we concatenated surgical data from vaginal procedures for prolapse repair, including anterior and posterior colporrhaphy, paravaginal defect repair, enterocele repair, and vaginal colpopexy using Current Procedural Terminology (CPT) coding. We stratified this data by the modifier associated with mesh usage at the time of the procedure. We then compared 30-day perioperative outcomes, postoperative complications (bleeding, infection, etc), and readmission rates between women with and without mesh-based repairs. RESULTS We identified 10 657 vaginal reconstructive procedures without mesh and 959 mesh-based repairs from 2009 through 2013. Patients undergoing mesh repair were more likely to experience at least one complication than native tissue repair (9.28% vs 6.15%, P more...
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- 2017
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35. Under what circumstances should stress incontinence surgery be performed at the same time as prolapse surgery? ICI-RS 2015
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Ralf Anding, David Castro-Diaz, Roger R. Dmochowski, Dudley Robinson, Linda Cardozo, and Vik Khullar
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medicine.medical_specialty ,Stress incontinence ,Time Factors ,Diagnostic methods ,Urinary Incontinence, Stress ,Urology ,030232 urology & nephrology ,Urinary incontinence ,Surgical methods ,Prosthesis Implantation ,03 medical and health sciences ,Gynecologic Surgical Procedures ,0302 clinical medicine ,Uterine Prolapse ,medicine ,Humans ,Suburethral Slings ,030219 obstetrics & reproductive medicine ,business.industry ,Prolapse surgery ,Pessaries ,medicine.disease ,Occult ,Surgery ,Continence surgery ,Female ,Neurology (clinical) ,medicine.symptom ,business - Abstract
AIMS An International Consultation on Incontinence-Research Society (ICI-RS) Think Tank in 2015 discussed and evaluated the evidence of when stress incontinence surgery should be performed with prolapse surgery and highlighted evidence gaps, with the aim of recommending further clinical and research proposals. METHODS A review of the literature assessing randomized studies where women with vaginal prolapse have been randomized to vaginal prolapse surgery with or without continence surgery were evaluated. The different clinical presentations were also evaluated and their impact on outcome was critically reviewed. RESULTS There are three symptomatic groups of women with vaginal prolapse who are treated. The first group is continent women with vaginal prolapse. The second group has stress urinary incontinence (SUI) and vaginal prolapse. The last group has vaginal prolapse and have been found through testing to have occult SUI. The studies have reported a range of outcomes for each of these groups. There are different outcomes based on the surgical method used to correct the prolapse and also the different continence surgical techniques. There are insufficient studies to allow firm conclusions to be drawn. The economic impact of the different management pathways is also discussed although costs vary according to different national medical funding systems. CONCLUSIONS There is considerable uncertainty about the optimal method of managing women with vaginal prolapse and stress incontinence due to the different surgical techniques available. In particular the group of women with occult SUI are a challenge as the optimal diagnostic method has not yet been defined. more...
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- 2017
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36. Taking the tube: Uptake of salpingectomy at the time of hysterectomy for benign indications
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Susannah Lyes, Yee S. Lin, Erika K. Hunter, and Alana M. Cole
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Blood Loss, Surgical ,Uterovaginal prolapse ,Salpingectomy ,03 medical and health sciences ,0302 clinical medicine ,Uterine Prolapse ,Hysterectomy, Vaginal ,medicine ,Humans ,Intraoperative Complications ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Surgical approach ,Hysterectomy ,business.industry ,Obstetrics ,Incidence (epidemiology) ,Age Factors ,Obstetrics and Gynecology ,Uterine prolapse ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,030220 oncology & carcinogenesis ,Female ,Uterine Hemorrhage ,Ovarian cancer ,business - Abstract
Background International guidelines recommend the fallopian tubes be removed at the time of hysterectomy, to lower the incidence of ovarian cancer in women. Aims To determine the rate of salpingectomy at the time of hysterectomy at our institution and to discuss a standard rate. Materials and methods Hysterectomies (n = 200) performed for benign indications from 13 January 13, 2015 until 26 April 26, 2016 were reviewed. Results The overall rate of salpingectomy was 76.0%. Factors associated with non-completion were uterovaginal prolapse indication and vaginal surgical approach. Conclusions Rates of completing salpingectomy with hysterectomy are high. There may be additional opportunity for ovarian cancer reduction. No standard rate has been published but considering difficulty with removal of fallopian tubes in certain cases, it may not be 100%. Our data allows for comparison by other units performing similar studies. We recommend the formal adoption of local guidelines regarding salpingectomy at the time of hysterectomy for benign indications in order to keep local practice up to date with international recommendations. more...
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- 2017
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37. Re: Mesh inlay, mesh kit or native tissue repair for women having repeat anterior or posterior prolapse surgery: randomised controlled trial (PROSPECT)
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Gunter Hartel and Christopher G. Maher
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medicine.medical_specialty ,Inlay ,business.industry ,Prolapse surgery ,MEDLINE ,Obstetrics and Gynecology ,Uterine prolapse ,Surgical Mesh ,medicine.disease ,Pelvic Organ Prolapse ,Surgery ,law.invention ,Surgical mesh ,Randomized controlled trial ,Uterine Prolapse ,law ,Native tissue ,medicine ,Humans ,Female ,business - Published
- 2020
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38. Recurrent surgery in uterine prolapse: A nationwide register study.
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Brunes M, Johannesson U, Drca A, Bergman I, Söderberg M, Warnqvist A, and Ek M
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- Female, Gynecologic Surgical Procedures methods, Humans, Postoperative Complications epidemiology, Recurrence, Treatment Outcome, Pelvic Organ Prolapse surgery, Uterine Prolapse surgery
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Introduction: One in three women with pelvic organ prolapse (POP) undergoing surgery have a relapse. Currently, no optimal surgical treatment has been identified for correcting a uterine prolapse. This population-based register study aims to compare the relapse rate in patients with uterine prolapse undergoing hysterectomy with suspension or uterine-sparing surgical procedures., Material and Methods: All women with uterine prolapse undergoing prolapse surgery in Sweden from January 1, 2015 to December 31, 2018, were identified from the Gynecological Operation Register (GynOp). The primary outcome was the number of recurrent POP surgeries up to December 31, 2020., Results: Sacrospinous hysteropexy (SSHP) without graft and sacrohysteropexy (SHP) were associated with a significantly higher rate of recurrent POP surgery (SSHP without graft: adjusted odds ratio [aOR] 2.6, 95% CI 2.0-3.5; SHP aOR 2.6, 95% CI 1.8-3.7) and patients describing a sense of globe (SSHP without graft, aOR 2.0, 95% CI 1.6-2.6; SHP, aOR 1.8, 95% CI 1.1-3.1) compared with cervical amputation with uterosacral ligament fixation (Manchester procedure). There was no difference in the reoperation rate or sense of a globe between SSHP with graft and Manchester procedure. Patients undergoing SSHP without graft had a higher frequency of 1-year postoperative complications compared with Manchester procedure (aOR 2.0, 95% CI 1.6-2.6) and SHP (aOR 2.4, 95% CI 1.4-3.9). Moreover, the frequency of 1-year postoperative complications was higher in SSHP with graft (aOR 1.6, 95% CI 1.1-2.2) than in Manchester procedure., Conclusions: The Manchester procedure was associated with a low rate of recurrent POP surgery, symptomatic recurrence and low surgical morbidity compared with other surgical methods in women with uterine prolapse., (© 2022 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).) more...
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- 2022
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39. Levator ani trauma and pelvic organ prolapse - a comparison of three translabial ultrasound scoring systems
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Hans Peter Dietz, Daniela Ulrich, Ixora Kamisan Atan, Andrew J. Martin, and Gerda Trutnovsky
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Adult ,medicine.medical_specialty ,Adolescent ,Physical examination ,Severity of Illness Index ,Pelvic Organ Prolapse ,Vulva ,Avulsion ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Odds Ratio ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,030219 obstetrics & reproductive medicine ,Pelvic floor ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Obstetrics and Gynecology ,Uterine prolapse ,Retrospective cohort study ,Pelvic Floor ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Logistic Models ,medicine.anatomical_structure ,Levator ani ,ROC Curve ,Female ,business ,Puborectalis muscle - Abstract
Introduction The study aimed to analyze the relation between the degree of puborectalis muscle trauma and subjective symptoms and objective findings of pelvic organ prolapse (POP), comparing two continuous scoring systems with a discrete scoring system for translabial ultrasound imaging. Material and methods In this retrospective observational study the records of patients attending a tertiary urogynecological unit between January 2012 and December 2014 were analyzed. POP assessment included a standardized interview, clinical examination using Pelvic Organ Prolapse Quantification and four-dimensional translabial ultrasound. Puborectalis muscle trauma was assessed with tomographic ultrasound imaging using two continuous scoring systems and a previously established discrete system. Receiver operating characteristics and adjusted odds ratios were used for comparison of scoring systems in predicting symptoms and signs of POP. Results Of 1258 women analyzed, 52.6% complained of prolapse symptoms. On ultrasound imaging, 65.7% of women had sonographically significant POP. Complete avulsion was diagnosed in 25.3% of women, being unilateral in 13.9% and bilateral in 11.4%. A maximum score in the 6-point and the 12-point tomographic ultrasound imaging scale increased the odds for a diagnosis of any significant POP on ultrasound by 4.4 and 4.8 times, respectively, compared with 4.6 times for the discrete diagnosis of bilateral avulsion. For all avulsion scoring systems the relation was strongest for cystocele and uterine prolapse. Conclusions A continuous avulsion scoring system based on tomographic findings does not provide superior performance for the prediction of subjective symptoms and objective findings of prolapse compared with a discrete diagnostic system of unilateral or bilateral avulsion. more...
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- 2016
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40. Long-term functional outcomes following mesh-augmented posterior vaginal prolapse repair
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Menahem Neuman, Talia Friedman, Yael Baumfeld, Joerg Neymeyer, Haim Krissi, and Adi Y. Weintraub
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Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Hysterectomy ,Single Center ,Logistic regression ,Odds ,03 medical and health sciences ,Gynecologic Surgical Procedures ,Postoperative Complications ,0302 clinical medicine ,Recurrence ,Uterine Prolapse ,medicine ,Humans ,Prospective Studies ,Israel ,Aged ,030219 obstetrics & reproductive medicine ,business.industry ,Prolapse repair ,Obstetrics and Gynecology ,Granulation tissue ,General Medicine ,Middle Aged ,Surgical Mesh ,Surgery ,Logistic Models ,Urinary Incontinence ,medicine.anatomical_structure ,Telephone interview ,Multivariate Analysis ,Vagina ,Cohort ,Female ,business - Abstract
Objective To assess long-term patient-centered functional outcomes following posterior vaginal wall repair using mesh implants. Method The present prospective telephone interview study enrolled a cohort of women who had undergone posterior vaginal wall repair with mesh between January 1, 2006 and February 28, 2009, at a single center in Israel. Patients were asked to report long-term outcomes, and demographic, clinical, intraoperative, and postoperative follow-up data were retrieved from patients’ medical files. Multivariable logistic regression models were used to asses associations between baseline characteristics and long-term outcomes. Results In total, 102 patients were contacted, with 80 (78.4%) at 61–83 months after surgery agreeing to participate. A recurrence of prolapse symptoms was reported by 14 patients (18%) (12 required a corrective procedure), mesh had been removed from two patients owing to erosion/extrusion, and two others had undergone removal of granulation tissue. Long-term, bothersome symptoms were reported by 13 (16%) patients. Parity and previous hysterectomy were associated with lower odds of long-term adverse outcomes, and the location of the apical (C/D) pelvic organ prolapse quantification point and a change in its position following surgery were associated with increased odds of adverse outcomes. Conclusion The long-term adverse-outcome rate was low for patients who underwent posterior vaginal mesh augmentation. These results highlight the importance of apical support for good long-term functional outcomes. more...
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- 2016
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41. Combined sacrospinous hysteropexy and cystopexy using a single anterior incision
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Anna Garofalo, Stefano Cosma, Silvia Parisi, Michela Chiadò Fiorio Tin, Tullia Todros, and Paolo Petruzzelli
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Vaginal approach ,medicine.medical_specialty ,030232 urology & nephrology ,03 medical and health sciences ,Gynecologic Surgical Procedures ,Postoperative Complications ,0302 clinical medicine ,Quality of life ,Uterine Prolapse ,Surveys and Questionnaires ,Operating time ,Humans ,Medicine ,Postoperative Period ,Prospective Studies ,Major complication ,Stage (cooking) ,Prospective cohort study ,Aged ,Ligaments ,030219 obstetrics & reproductive medicine ,business.industry ,Suture Techniques ,Uterus ,Significant difference ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,Surgery ,Treatment Outcome ,Italy ,Single incision ,Vagina ,Quality of Life ,Urologic Surgical Procedures ,Female ,business - Abstract
To evaluate the safety, efficacy, and feasibility of a minimally invasive vaginal approach for treating advanced utero-vaginal prolapse.A prospective study enrolled consecutive patients attending the Gynecology and Obstetrics Department, Turin University for treatment of Pelvic Organ Prolapse Quantification (POP-Q) stage III of higher symptomatic utero-vaginal prolapse between February 1, 2013 and November 30, 2014. Participants underwent a combined sacrospinous hysteropexy and cystopexy procedure using a single anterior vaginal incision. Surgical procedures were performed by one of two surgeons, either an experienced senior surgeon or a resident surgeon under supervision. POP-Q staging, patient symptoms, and quality of life were evaluated before and after surgery.The present study enrolled 42 patients and 19 (45%) were discharged on the first post-operative day. The mean operating time was 40.5±10.6minutes and there was no significant difference in operating time between the two surgeons. With an average follow-up duration of 13months, significant post-surgical improvements were recorded across both POP-Q anterior (P0.001) and apical (P0.001) domains, and in both prolapse impact (P0.001) and urinary impact (P=0.001) quality-of-life measures; one apical recurrence and no major complications were recorded.Combined sacrospinous hysteropexy and cystopexy through a single incision appears to be a safe and efficacious procedure that was relatively easy for surgeons to learn and resulted in a fast post-surgical recovery. more...
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- 2016
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42. Efficacy and pregnancy outcomes of laparoscopic single sheet mesh sacrohysteropexy
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Abdalla Fayyad, Ivilina Pandeva, and Minesh Mistry
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Urology ,030232 urology & nephrology ,Uterine prolapse ,Retrospective cohort study ,Perioperative ,Sacrohysteropexy ,medicine.disease ,Miscarriage ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Surgical mesh ,Quality of life ,Medicine ,Neurology (clinical) ,business ,Laparoscopy - Abstract
Aims To evaluate outcomes following laparoscopic single sheet mesh sacrohysteropexy for the management of uterine prolapse. Methods One hundred and fifty-nine women underwent the procedure between August 2010 and August 2014. One hundred and forty-four patients completed the follow up assessment. At each visit, the prolapse symptoms were assessed using the prolapse quality-of-life (P-QOL) questionnaire and objectively with the use of the Pelvic Organ Prolapse Quantification (POPQ) score. The subjective outcomes were also evaluated with the use of the Patient Global Impression of Improvement (PGII) questionnaires. Perioperative complications and further surgery for prolapse were evaluated. Women who conceived following the procedure were evaluated for pregnancy outcomes and prolapse recurrence. Results Pre-operatively, 85% (135/159) had uterine prolapse ≥ stage 2. Postoperatively, 95.1% (137/144) of women had anatomical success rate defined as stage 0 uterine descent. Eighty-two percent (118/144) of women reported cure of prolapse symptoms and feeling "much better" or "very much better" on postoperative PGII assessment. Eight women (5%) became pregnant following the laparoscopic sacrohysteropexy- seven had full term pregnancies and one had a miscarriage. Six out of the seven (86%) had stage 0 apical prolapse and PGII of "much better" at 6 months postpartum. One patient had symptomatic prolapse recurrence and underwent perineorrhaphy at 3 years. Conclusion Laparoscopic single sheet mesh sacrohysteropexy is associated with subjective and objective improvement in prolapse symptoms and QoL that is maintained up to 48 months. Laparoscopic sacrohysteropexy can be offered to women desiring future fertility; however, further research is needed to advise on best surgical approach in women of childbearing age. Neurourol. Urodynam. 36:787-793, 2017. © 2016 The Authors. Neurourology and Urodynamics Published by Wiley Periodicals, Inc. more...
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- 2016
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43. Combined reconstructive surgery involving uterosacral colpopexy and anterior vaginal mesh implantation for pelvic organ prolapse
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Sakika Yanai, Yasushi Kurihara, Akihiro Hamuro, Haijiao Wang, Hiroko Katayama, Masayasu Koyama, Masami Hayashi, Takuya Misugi, Akemi Nakano, and Daisuke Tachibana
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Reconstructive surgery ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,Uterosacral ligament ,Obstetrics and Gynecology ,Uterine prolapse ,medicine.disease ,Surgery ,03 medical and health sciences ,Dissection ,0302 clinical medicine ,medicine.anatomical_structure ,Obstetrics and gynaecology ,Hymen ,Medicine ,030212 general & internal medicine ,business ,Prospective cohort study ,Vaginal Vault Prolapse - Abstract
Aim The optimal treatment for pelvic organ prolapse has been the subject of much discussion. The aim of this study was to assess the utility of a combination of uterosacral colpopexy and anterior vaginal mesh implantation. Methods A single-center prospective cohort study was conducted. Twenty-eight patients with stage III–IV cystocele and uterine prolapse underwent reconstructive surgery. A combination of vaginal hysterectomy, McCall culdeplasty, and trocar-guided anterior vaginal mesh implantation was performed, and the patients' postoperative outcomes were analyzed. Patient satisfaction was investigated using the modified Short Form 12 version 2 (SF-12v2) questionnaire, and interviews regarding sexual behavior were conducted at 1 postoperative year. Results A bladder injury occurred during the dissection in one case (3.6%). Recurrent vaginal vault prolapse beyond the hymen was observed in one patient (cure rate: 96.4%), and further mesh augmentation was required in this case. Another patient developed mild cystocele (Ba = 0), but was simply observed because she did not complain of any symptoms caused by vaginal descent. We did not experience any other mesh-related complications, such as protrusion, chronic pain, or chronic inflammation, during the follow-up period. The patients' modified SF-12 scores at 12 months were significantly better than their preoperative scores in all eight domains. Conclusion The satisfactory correction of pelvic organ prolapse was achieved using a combination of vaginal hysterectomy and uterosacral ligament colpopexy augmented by anterior vaginal mesh implantation. © 2016 Japan Society of Obstetrics and Gynecology more...
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- 2016
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44. Vaginal cancer possibly caused by pessary and immunocompromised condition: Multiple risk factors may influence vaginal cancer development
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Nana Akino, Yutaka Osuga, Katsutoshi Oda, Tomoyuki Fujii, Takahide Arimoto, Yoko Matsumoto, Kei Kawana, and Osamu Wada-Hiraike
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Gynecology ,Pessary ,Vaginal cancer ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Uterine prolapse ,Vaginal pessary ,medicine.disease ,Multiple risk factors ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Vagina ,Human papillomavirus ,business ,Idiopathic interstitial pneumonia - Abstract
Primary cancer of the vagina is a rare entity, comprising only 1-2% of all gynecologic malignancies. Infection of human papillomavirus, immunocompromised condition, and chronic irritation of the vagina by prolonged pessary usage are known to contribute to the development of vaginal cancer. We experienced a rare case of vaginal cancer that occurred after usage of a vaginal pessary while the patient was prescribed with oral prednisolone for idiopathic interstitial pneumonia. Previous reports of vaginal cancer that occurred after pessary usage are mostly neglected pessaries, but in this case the patient was managed properly. We suspect that her immunocompromised condition, as well as her pessary usage, may have accelerated the development of vaginal cancer. The presence of multiple risk factors could be related to the pathogenesis of vaginal cancer, and therefore proper management is required after pessary insertion for uterine prolapse treatment. more...
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- 2016
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45. Transvaginal treatment of anterior or central urogenital prolapse using six tension-free straps and light mesh
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Emmanuel Delorme and Aurélie Guyomard
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Adult ,medicine.medical_specialty ,Urinary Incontinence, Stress ,Postoperative hematoma ,030232 urology & nephrology ,Urinary incontinence ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Hematoma ,Recurrence ,Uterine Prolapse ,medicine ,Humans ,Prospective Studies ,Orgasm ,Prospective cohort study ,Aged ,030219 obstetrics & reproductive medicine ,Genitourinary system ,business.industry ,Obstetrics and Gynecology ,Uterine prolapse ,General Medicine ,Middle Aged ,Surgical Mesh ,medicine.disease ,Surgery ,Dyspareunia ,medicine.anatomical_structure ,Surgical mesh ,Patient Satisfaction ,Vagina ,Female ,France ,medicine.symptom ,business ,Cystocele ,Follow-Up Studies - Abstract
Objective To evaluate the feasibility, efficacy, complications, and outcomes of treatment of anterior or central compartment urogenital prolapse by placement of an anteroposterior 22-g/m 2 mesh with six straps through one anterior vaginal incision. Methods In a prospective study, patients treated for urogenital prolapse at a center in France between February 2008 and June 2011 were enrolled. Previous treatments, related interventions, intraoperative and postoperative complications, and anatomic outcomes were recorded during 3 years of follow-up. Failure was defined as recurrence of prolapse of stage II or higher according to the Pelvic Organ Prolapse Quantification system. Results Overall, 74 patients were included. Preoperatively, 55 (74%) patients had stage III cystocele, 13 (18%) had stage IV cystocele, and 44 (59%) had associated uterine prolapse of at least stage II. Postoperative hematoma occurred in three patients and vaginal exposure in two patients. There were no cases of visceral injury. Vaginal comfort improved postoperatively: 68 (92%) patients were satisfied with the outcome and there were no cases of de novo dyspareunia. Seventeen (23%) patients subsequently had stress urinary incontinence that was treated by placement of suburethral tape. The anatomic outcomes were satisfactory for 72 (97%) women, including sexually active patients. Conclusion Transvaginal prolapse repair by placement of an anteroposterior six-strap 22-g/m 2 mesh was feasible and effective with satisfactory 3-year outcomes. more...
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- 2016
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46. Editorial Comment to Techniques of transvaginal mesh prolapse surgery in Japan, and the comparison of complication rates by surgeons’ specialty and experience
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Hikaru Tomoe
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Surgeons ,medicine.medical_specialty ,business.industry ,Urology ,Prolapse surgery ,General surgery ,Specialty ,MEDLINE ,Uterine prolapse ,Surgical Mesh ,medicine.disease ,Pelvic Organ Prolapse ,Japan ,Uterine Prolapse ,medicine ,Humans ,Female ,business ,Complication - Published
- 2020
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47. A systematic review on reporting outcomes and outcome measures in trials on synthetic mesh procedures for pelvic organ prolapse: Urgent action is needed to improve quality of research
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Jorge Milhem Haddad, Vasilis Pergialiotis, Constantin M. Durnea, Cornelia Betschart, Gabriele Falconi, James Duffy, Thais Regina de Mattos Lourenço, Stergios K. Doumouchtsis, Abdullatif Elfituri, University of Zurich, and de Mattos Lourenco, Thais R more...
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2748 Urology ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Clinical Neurology ,610 Medicine & health ,Pelvic Organ Prolapse ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Gynecologic Surgical Procedures ,Randomized controlled trial ,law ,Uterine Prolapse ,Outcome Assessment, Health Care ,medicine ,Humans ,Organ perforation ,Minimum Data Set ,Pelvic organ ,Clinical Trials as Topic ,030219 obstetrics & reproductive medicine ,business.industry ,Research ,Outcome measures ,Middle Aged ,Surgical Mesh ,medicine.disease ,Jadad scale ,10174 Clinic for Gynecology ,Systematic review ,2728 Neurology (clinical) ,Treatment Outcome ,Vagina ,Physical therapy ,Female ,Neurology (clinical) ,business ,Surgical interventions - Abstract
The use of synthetic mesh in pelvic organ prolapse surgery is being closely scrutinized because of serious concerns regarding life‐changing complications such as erosion, pain, infection, bleeding, dyspareunia, organ perforation, and urinary problems. Randomized trials and their syntheses in meta‐analysis offer a unique opportunity to assess efficacy and safety. However, outcomes and outcome measures need to be consistently selected, collected, and reported across randomized trials to be effectively combined in systematic reviews. Aims We evaluated outcome and outcome measure reporting across randomized controlled trials on surgical interventions using synthetic mesh for pelvic organ prolapse. Methods Systematic review of randomized controlled trials using synthetic mesh for the treatment of pelvic organ prolapse. The selected studies were evaluated using Jadad and MOMENT criteria. Outcomes and outcome measures were systematically identified and categorized. Results Seventy‐one randomized trials were included. Twenty‐four different types of mesh were identified. Included trials reported 110 different outcomes and 60 outcome measures. Erosion (40 trials, 78%), pain (29 trials, 56%), bleeding (31 trials, 61%), and dyspareunia (25 trials, 49%) were the most frequently reported outcomes. The longest follow up was 74 months. Conclusions Most randomized trials evaluating surgical interventions using synthetic mesh for pelvic organ prolapse failed to report on clinically important outcomes and to evaluate efficacy and safety over the medium‐ and long‐term. Developing and implementing a minimum data set, known as a core outcome set, in future vaginal prolapse trials could help address these issues. more...
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- 2018
48. Surgery for women with posterior compartment prolapse
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Alex, Mowat, Declan, Maher, Kaven, Baessler, Corina, Christmann-Schmid, Nir, Haya, and Christopher, Maher
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Reoperation ,Medicine General & Introductory Medical Sciences ,030219 obstetrics & reproductive medicine ,Urinary Incontinence, Stress ,Awareness ,Surgical Mesh ,Pelvic Organ Prolapse ,03 medical and health sciences ,Dyspareunia ,Gynecologic Surgical Procedures ,Postoperative Complications ,0302 clinical medicine ,Recurrence ,Uterine Prolapse ,Humans ,Female ,Pharmacology (medical) ,030212 general & internal medicine ,Randomized Controlled Trials as Topic - Abstract
BACKGROUND: Posterior vaginal wall prolapse (also known as 'posterior compartment prolapse') can cause a sensation of bulge in the vagina along with symptoms of obstructed defecation and sexual dysfunction. Interventions for prevention and conservative management include lifestyle measures, pelvic floor muscle training, and pessary use. We conducted this review to assess the surgical management of posterior vaginal wall prolapse. OBJECTIVES: To evaluate the safety and effectiveness of any surgical intervention compared with another surgical intervention for management of posterior vaginal wall prolapse. SEARCH METHODS: We searched the Cochrane Incontinence Group Specialised Register of controlled trials, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (searched April 2017). We also searched the reference lists of relevant articles, and we contacted researchers in the field. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing different types of surgery for posterior vaginal wall prolapse. DATA COLLECTION AND ANALYSIS: We used Cochrane methods. Our primary outcomes were subjective awareness of prolapse, repeat surgery for any prolapse, and objectively determined recurrent posterior wall prolapse. MAIN RESULTS: We identified 10 RCTs evaluating 1099 women. Evidence quality ranged from very low to moderate. The main limitations of evidence quality were risk of bias (associated mainly with performance, detection, and attrition biases) and imprecision (associated with small overall sample sizes and low event rates). Transanal repair versus transvaginal repair (four RCTs; n = 191; six months' to four years' follow‐up) Awareness of prolapse is probably more common after the transanal approach (risk ratio (RR) 2.78, 95% confidence interval (CI) 1.00 to 7.70; 2 RCTs; n = 87; I(2) = 0%; low‐quality evidence). If 10% of women are aware of prolapse after transvaginal repair, between 10% and 79% are likely to be aware after transanal repair. Repeat surgery for any prolapse: Evidence is insufficient to show whether there were any differences between groups (RR 2.42, 95% CI 0.75 to 7.88; 1 RCT; n = 57; low‐quality evidence). Recurrent posterior vaginal wall prolapse is probably more likely after transanal repair (RR 4.12, 95% CI 1.56 to 10.88; 2 RCTs; n = 87; I(2) = 35%; moderate‐quality evidence). If 10% of women have recurrent prolapse on examination after transvaginal repair, between 16% and 100% are likely to have recurrent prolapse after transanal repair. Postoperative obstructed defecation is probably more likely with transanal repair (RR 1.67, 95% CI 1.00 to 2.79; 3 RCTs; n = 113; I(2) = 10%; low‐quality evidence). Postoperative dyspareunia: Evidence is insufficient to show whether there were any differences between groups (RR 0.32, 95% CI 0.09 to 1.15; 2 RCTs; n = 80; I(2) = 5%; moderate‐quality evidence). Postoperative complications: Trials have provided no conclusive evidence of any differences between groups (RR 3.57, 95% CI 0.94 to 13.54; 3 RCTs; n = 135; I(2) = 37%; low‐quality evidence). If 2% of women have complications after transvaginal repair, then between 2% and 21% are likely to have complications after transanal repair. Evidence shows no clear differences between groups in operating time (in minutes) (mean difference (MD) 1.49, 95% CI ‐11.83 to 8.84; 3 RCTs; n = 137; I(2) = 90%; very low‐quality evidence). Biological graft versus native tissue repair Evidence is insufficient to show whether there were any differences between groups in rates of awareness of prolapse (RR 1.09, 95% CI 0.45 to 2.62; 2 RCTs; n = 181; I(2) = 13%; moderate‐quality evidence) or repeat surgery for any prolapse (RR 0.60, 95% CI 0.18 to 1.97; 2 RCTs; n = 271; I(2) = 0%; moderate‐quality evidence). Trials have provided no conclusive evidence of a difference in rates of recurrent posterior vaginal wall prolapse (RR 0.55, 95% CI 0.30 to 1.01; 3 RCTs; n = 377; I(2) = 6%; moderate‐quality evidence); if 13% of women have recurrent prolapse on examination after native tissue repair, between 4% and 13% are likely to have recurrent prolapse after biological graft. Evidence is insufficient to show whether there were any differences between groups in rates of postoperative obstructed defecation (RR 0.96, 95% CI 0.50 to 1.86; 2 RCTs; n = 172; I(2) = 42%; moderate‐quality evidence) or postoperative dyspareunia (RR 1.27, 95% CI 0.26 to 6.25; 2 RCTs; n = 152; I(2) = 74%; low‐quality evidence). Postoperative complications were more common with biological repair (RR 1.82, 95% CI 1.22 to 2.72; 3 RCTs; n = 448; I(2) = 0%; low‐quality evidence). Other comparisons Single RCTs compared site‐specific vaginal repair versus midline fascial plication (n = 74), absorbable graft versus native tissue repair (n = 132), synthetic graft versus native tissue repair (n = 191), and levator ani plication versus midline fascial plication (n = 52). Data were scanty, and evidence was insufficient to show any conclusions about the relative effectiveness or safety of any of these interventions. The mesh exposure rate in the synthetic group compared with the native tissue group was 7%. AUTHORS' CONCLUSIONS: Transvaginal repair may be more effective than transanal repair for posterior wall prolapse in preventing recurrence of prolapse, in the light of both objective and subjective measures. However, data on adverse effects were scanty. Evidence was insufficient to permit any conclusions about the relative effectiveness or safety of other types of surgery. Evidence does not support the utilisation of any mesh or graft materials at the time of posterior vaginal repair. Withdrawal of some commercial transvaginal mesh kits from the market may limit the generalisability of our findings. more...
- Published
- 2018
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49. Management of uterine prolapse: is hysterectomy necessary?
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Natalia Price, Simon Jackson, and Helen Jefferis
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Pelvic floor ,Hysterectomy ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,Uterine prolapse ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Colpocleisis ,Hysterectomy vaginal ,Cohort ,Medicine ,Fertility preservation ,business ,Vaginal surgery - Abstract
Key content Management of uterine prolapse is currently heavily influenced by patient and surgeon preferences. The traditional approach to uterine prolapse is vaginal hysterectomy. However, this does not address the underlying deficiency in connective tissue pelvic floor support, and prolapse recurrence is common. Uterine preservation surgery is increasing in popularity, both with surgeons and patients; there is currently little evidence to show superior outcome to hysterectomy. Fertility preservation remains the one absolute indication for hysteropexy. Other potential advantages include stronger apical support and reduced vaginal surgery. Colpocleisis remains a valid option for a small cohort of patients. Learning objectives Options for the management of uterine prolapse. How to help patients decide on a management plan. more...
- Published
- 2016
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50. Postpartum emergencies in cows
- Author
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Gwen Rees
- Subjects
General Veterinary ,040301 veterinary sciences ,business.industry ,0402 animal and dairy science ,Uterine prolapse ,04 agricultural and veterinary sciences ,medicine.disease ,040201 dairy & animal science ,0403 veterinary science ,Anticipation (artificial intelligence) ,medicine ,Medical emergency ,Rural practice ,business ,First aid - Abstract
Postpartum emergencies in cattle are an important element of mixed or farm animal practice in the UK and, for many veterinarians, a call to such a situation can elevate the heart rate in anticipation of what might be to come. Swift and confident decision making is essential to ensure the best outcome for the animal; this often needs to be achieved with little support (due to the isolated nature of rural practice), in a highly charged situation and frequently after hours. This article considers three of the more challenging postpartum emergencies that veterinarians have to treat: uterine prolapse, haemorrhage and postcalving paralysis. It gives a brief outline of the prevalence, risk factors, first aid, treatment and prognosis for these conditions, and presents the latest research available in each area. more...
- Published
- 2016
- Full Text
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