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Folegati P, Ferragut R, Toso V, Anzi L, Cacciatori M, Duchini M, Frigerio M, Ostinelli A, Cherubini R, De Nadal V. Positron annihilation spectroscopy for fundamental studies of living cells. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Palmieri S, De Bastiani SS, Degliuomini R, Ruffolo AF, Casiraghi A, Vergani P, Gallo P, Magoga G, Cicuti M, Parma M, Frigerio M. Prevalence and severity of pelvic floor disorders in pregnant and postpartum women. Int J Gynaecol Obstet 2021; 158:346-351. [PMID: 34778951 DOI: 10.1002/ijgo.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This multicenter study aimed to evaluate risk factors, prevalence and severity of pelvic floor disorders (PFDs) as well as their consequences on women's emotional well-being, using a questionnaire validated specifically for pregnancy and postpartum. METHODS Prospective study conducted in eight teaching hospitals in Italy and Italian-speaking Switzerland. Pregnant and postpartum women completed the Italian Pelvic Floor Questionnaire for Pregnancy and Postpartum anonymously. Prevalence of, severity of, and risk factors for PFDs were evaluated for all the four domains considered: bladder, bowel, prolapse, and sexual function. RESULTS A total of 2007 women were included: 983 of the patients were bothered by at least one kind of PFD: bladder, bowel, and sexual dysfunction were more frequently reported. There were no significant differences in PFD prevalence between pregnancy and postpartum, except for bladder disorders, which were more prevalent in pregnancy. Familiarity for PFDs, pelvic floor contraction inability, cigarette smoking, body mass index more than 25 (calculated as weight in kilograms divided by the square of height in meters), and age more than 35 years were confirmed risk factors for the development of PFDs during pregnancy and postpartum. CONCLUSION Almost half of the women included in the study suffered from PFD-related symptoms with important consequences on quality of life. Validated questionnaires are fundamental in early diagnosis and treatment of PFDs.
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Manodoro S, Frigerio M, Barba M, Bosio S, de Vitis LA, Marconi AM. Stem Cells in Clinical Trials for Pelvic Floor Disorders: a Systematic Literature Review. Reprod Sci 2021; 29:1710-1720. [PMID: 34596887 PMCID: PMC9110489 DOI: 10.1007/s43032-021-00745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 09/17/2021] [Indexed: 11/24/2022]
Abstract
Pelvic floor disorders (PFDs) include a series of conditions that can be poorly tolerated, negatively affecting the quality of life. Current treatment options show unsatisfactory results and new ones are therefore needed. Stem cell (SC) therapy might be an alternative treatment strategy. This systematic review aims to define the state of art of SC therapy for PFDs in clinical trials, by systematically reviewing the available evidence. A systematic search strategy was conducted up to November 7, 2020, in PubMed, Scopus, Cochrane Library, and ISI Web of Science. Preclinical studies on animal models were not considered. Studies were included when the patients were affected by any PFDs and cells were isolated, cultured, and characterized as SC. The study protocol was registered in PROSPERO (CRD42020216551). A total of 11 prospective clinical studies were included in the final assessment, specifically 7 single-arm studies dealing with SC therapy for stress urinary incontinence and 4 with anal incontinence. Among the latter, there were two prospective, single-arm studies and two randomized controlled trials. No papers concerning the use of SC for prolapse repair were retrieved. Due to the great heterogeneity, data pooling was not possible. Stem cell injection resulted in a safe procedure, with few mild adverse side effects, mostly related to harvesting sites. However, a clear beneficial impact of SC treatment for the treatment of pelvic floor disorders could not be demonstrated. Further larger targeted studies with control arms are needed before any conclusions can be made.
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Frigerio M, Milani R, Barba M, Locatelli L, Marino G, Spelzini F, Donatiello G, Manodoro S. Response to a letter to the editor: "Single-incision slings for the treatment of stress urinary incontinence: efficacy and adverse effects at 10-year follow up". Int Urogynecol J 2021; 32:2887-2888. [PMID: 34125242 DOI: 10.1007/s00192-021-04894-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
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D'Alessandro G, Frigerio M, Barra F, Costantini S, Gustavino C, Ferrero S. Systematic review and meta-analysis on the impact of the levonorgestrel-releasing intrauterine system in reducing risk of ovarian cancer. Int J Gynaecol Obstet 2021; 156:418-424. [PMID: 33969485 PMCID: PMC9290617 DOI: 10.1002/ijgo.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/07/2021] [Accepted: 05/07/2021] [Indexed: 11/12/2022]
Abstract
Background Ovarian carcinoma (OC) is one of the most widespread tumors in the world and is characterized by low survival rates. Objective To determine whether the levonorgestrel‐releasing intrauterine system (LNG‐IUS) can prevent OC. Search strategy The literature until December 2020 were systematically reviewed according to the PRISMA Statement for Reporting Systematic Reviews (PROSPERO: CRD42019137957). Selection criteria Studies assessing the impact of LNG‐IUS on the risk of OC were included. Data collection and analysis Data were extracted independently by two authors to ensure accuracy and consistency. Main results A total of 34 323 records were obtained, of which three satisfied the inclusion criteria. In total, 1687 events of OC in a population of 20 461 311 person‐years were considered. Data pooling revealed that the use of LNG‐IUS did not confer a lower risk of OC relative to the never‐use of LNG‐IUS, with an estimated odds ratio of 0.66 (95% confidence interval 0.41–1.08; I2 = 84%; P = 0.002). Conclusion The meta‐analysis did not demonstrate a preventive role of LNG‐IUS on OC. However, it was carried out on a few papers, and a definitive conclusion on the topic still cannot be drawn. Further studies are indicated in the future to define the impact of LNG‐IUS on OC. The meta‐analysis carried out on three papers did not demonstrate a preventive role of the levonorgestrel‐releasing intrauterine device on ovarian cancer.
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Milani R, D'Alessandro G, Barba M, Cola A, Volontè S, Frigerio M. Transvaginal primary layered repair of postsurgical urethrovaginal fistula. Int Urogynecol J 2021; 32:1941-1943. [PMID: 33950308 DOI: 10.1007/s00192-021-04819-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urethrovaginal fistula (UVF) is a rare disorder, which implies the presence of an abnormal communication between the urethra and the vagina. METHODS Surgical repair options include transurethral, transabdominal and transvaginal procedures, either with or without tissue interposition. The vaginal route is considered a safe and effective option to correct UVF. This video is aimed to present a case of direct transvaginal layered repair of urethrovaginal fistula, without the use of tissue interposition. The featured patient is a 66-year-old woman who developed a symptomatic UVF after a complicated laparoscopic hysterectomy for endometrial cancer 3 years before. Cystoscopy demonstrated the presence of a 7 mm urethral orifice a few millimeters caudal from the bladder neck. After proper informed consent, the patient was admitted to transvaginal primary layered repair, according to the technique demonstrated in the video. The featured procedure was completed in 60 min and blood loss was < 100 ml. No surgical complications were observed. RESULTS The procedure was successful in restoring the anatomy and relieving the symptoms. CONCLUSION Transvaginal layered repair without tissue interposition represents a safe and effective procedure for the surgical management of postsurgical urethrovaginal fistula.
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D'Alessandro G, Palmieri S, Cola A, Barba M, Manodoro S, Frigerio M. Detrusor underactivity prevalence and risk factors according to different definitions in women attending urogynecology clinic. Int Urogynecol J 2021; 33:835-840. [PMID: 33929561 PMCID: PMC9021137 DOI: 10.1007/s00192-021-04796-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is still no consensus on definitions of detrusor underactivity; therefore, it is difficult to estimate the prevalence. The primary objective of the study was to evaluate the prevalence of detrusor underactivity in a cohort of patients with pelvic floor disorders according to different proposed urodynamics definitions. The secondary objectives were to estimate the association between detrusor underactivity and symptoms, anatomy and urodynamic findings and to build predictive models. METHODS Patients who performed urodynamic evaluation for pelvic floor disorders between 2008 and 2016 were retrospectively analyzed. Detrusor underactivity was evaluated according to Schafer's detrusor factor, Abrams' bladder contractility index and Jeong cut-offs. The degree of concordance between each method was measured with Cohen's kappa, and differences were tested using Student's t test, Wilcoxon test and Pearson's chi-squared test. RESULTS The prevalence of detrusor underactivity among a cohort of 2092 women, concerning the three urodynamic definitions, was 33.7%, 37.0% and 4.1%, respectively. Age, menopausal status, voiding/bulging symptoms, anterior and central prolapse, first desire to void and positive postvoid residual were directly related to detrusor underactivity. Conversely, stress urinary incontinence, detrusor pressures during voiding and maximum flow were inversely associated. Final models for detrusor underactivity resulted in poor accuracy for all considered definitions. CONCLUSIONS The prevalence of detrusor underactivity varies depending on the definition considered. Although several clinical variables resulted as independent predictors of detrusor underactivity, instrumental evaluation still plays a key role in the diagnosis.
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D'Alessandro G, Palmieri S, Cola A, Barba M, Manodoro S, Frigerio M. Clinical and urodynamic predictors of Q-tip test urethral hypermobility. Minerva Obstet Gynecol 2021; 74:155-160. [PMID: 33876905 DOI: 10.23736/s2724-606x.21.04766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Urodinamics and Q-tip test represent diagnostic tools for the assessment of stress urinary incontinence. The aim of the present study is to investigate the possibility to predict the Q-tip test urethral hypermobility on the basis of clinical and urodynamic parameters. METHODS We analyzed all women performed urodynamics between 2008 and 2016 presenting urodynamic stress urinary incontinence. Symptoms were collected by the Incontinence Questionnaire-Short Form questionnaire. RESULTS A total of 501 women presented urodynamic stress incontinence, of which 270 had urethral hypermobility, according to the Q-tip test. Patients with urethral hypermobility were younger (p<0.0001) and presented a more advanced anterior compartment descensus according to the POP-Q system (Aa point p=0.0155; Ba point p=0.0374), a higher detrusor pressure at maximum flow (p=0.0075) and maximum flow rate compared to controls. CONCLUSIONS Age, Aa POP-Q point and detrusor pressure at maximum flow were found to be independent predictors of Q-tip test urethral hypermobility. However, the final model can not be used as an effective predictor of the Q-tip test result.
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Milani R, Barba M, Manodoro S, Locatelli L, Palmieri S, Frigerio M. Inability to walk and persistent thigh pain after transobturator tape procedure for stress urinary incontinence: surgical management. Int Urogynecol J 2021; 32:1317-1319. [PMID: 33660003 PMCID: PMC7927782 DOI: 10.1007/s00192-020-04666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/22/2020] [Indexed: 10/31/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Groin pain after transobturator tape is often a self-limiting situation, but can occasionally persist and be associated with serious neurological sequelae. The video is aimed at presenting the surgical management of persistent groin pain and inability to walk after transobturator sling placement and subsequent partial removal. METHODS The featured patient is a 31-year-old woman unable to walk after transobturator sling implantation 2 years before. She reported left thigh pain immediately after surgery that was not responsive to postoperative medication. Six months later, suburethral portion excision was performed but no pain relief was obtained. She was unable to walk, and needed a wheelchair. Electromyography showed axonal injury of the left obturator nerve. After providing proper informed consent, the patient was admitted for combined transvaginal and transcutaneous transobturator tape arm removal. RESULTS The featured procedure was completed in 120 min and blood loss was <100 ml. No surgical complications were observed. The patient is currently doing left leg rehabilitation, has regained the ability to walk with the aid of a crutch, and the need for chronic pain control medication is greatly reduced. CONCLUSION This represents a valid surgical approach for the late management of this mesh-related complication.
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Paolillo S, Salvioni E, Perrone Filardi P, Bonomi A, Sinagra G, Gentile P, Gargiulo P, Scoccia A, Cosentino N, Gugliandolo P, Badagliacca R, Lagioia R, Correale M, Frigerio M, Perna E, Piepoli M, Re F, Raimondo R, Minà C, Clemenza F, Bussotti M, Limongelli G, Gravino R, Passantino A, Magrì D, Parati G, Caravita S, Scardovi AB, Arcari L, Vignati C, Mapelli M, Cattadori G, Cavaliere C, Corrà U, Agostoni P. Corrigendum to "Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database" [Int J Cardiol. 2020 Oct 15; 317: 103-110. PMID: 32360652]. Int J Cardiol 2021; 333:252. [PMID: 33640418 DOI: 10.1016/j.ijcard.2021.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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De Vitis LA, Barba M, Lazzarin S, Molinari S, Spinelli M, Arosio E, Manodoro S, Frigerio M. Female Genital Hair-Thread Tourniquet Syndrome: A Case Report and Literature Systematic Review. J Pediatr Adolesc Gynecol 2021; 34:65-70. [PMID: 32693024 DOI: 10.1016/j.jpag.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022]
Abstract
"Hair-thread tourniquet syndrome" (HTTS) describes the condition in which fibers of hair or thread wrap around an appendage (ie, toes, fingers, genital structures, tongue, uvula, and neck), eventually causing ischemia and tissue necrosis. To date, few cases of female genitalia HTTS have been described. We report a case of female genitalia HTTS in a 5-year-old girl and report the state of the art by systematically reviewing all existing evidence about female genital HTTS. A total of 29 studies, describing a total of 34 patients, were identified. The presence of a hair-thread wrapping genitalia should be suspected in prepubertal girls complaining of genital pain associated with vulvar/vaginal swelling, wide-based gait, and voiding symptoms. Genital examination disclosing an extremely tender, swollen, and erythematous lesion on the clitoris or labia minora encircled by a hair confirms the diagnosis. The aim of the management is to remove the hair-thread in the shortest time possible, with the use of forceps, scissors, or scalpels, and this is often performed under sedation/anesthesia because of the patient's pain reaction. When the hair-thread is difficult to find or when the lesion is necrotic, excision of the lesion itself can be the only option. Complications include partial or total amputation because of tissue necrosis and recurrence.
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Ohuma EO, Villar J, Feng Y, Xiao L, Salomon L, Barros FC, Cheikh Ismail L, Stones W, Jaffer Y, Oberto M, Noble JA, Gravett MG, Wu Q, Victora CG, Lambert A, Di Nicola P, Purwar M, Bhutta ZA, Kennedy SH, Papageorghiou AT, Katz M, Bhan M, Garza C, Zaidi S, Langer A, Rothwell P, Weatherall SD, Bhutta Z, Villar J, Kennedy S, Altman D, Barros F, Bertino E, Burton F, Carvalho M, Cheikh Ismail L, Chumlea W, Gravett M, Jaffer Y, Lambert A, Lumbiganon P, Noble J, Pang R, Papageorghiou A, Purwar M, Rivera J, Victora C, Villar J, Altman D, Bhutta Z, Cheikh Ismail L, Kennedy S, Lambert A, Noble J, Papageorghiou A, Villar J, Kennedy S, Cheikh Ismail L, Lambert A, Papageorghiou A, Shorten M, Hoch L, Knight H, Ohuma E, Cosgrove C, Blakey I, Altman D, Ohuma E, Villar J, Altman D, Roseman F, Kunnawar N, Gu S, Wang J, Wu M, Domingues M, Gilli P, Juodvirsiene L, Hoch L, Musee N, Al-Jabri H, Waller S, Cosgrove C, Muninzwa D, Ohuma E, Yellappan D, Carter A, Reade D, Miller R, Papageorghiou A, Salomon L, Leston A, Mitidieri A, Al-Aamri F, Paulsene W, Sande J, Al-Zadjali W, Batiuk C, Bornemeier S, Carvalho M, Dighe M, Gaglioti P, Jacinta N, Jaiswal S, Noble J, Oas K, Oberto M, Olearo E, Owende M, Shah J, Sohoni S, Todros T, Venkataraman M, Vinayak S, Wang L, Wilson D, Wu Q, Zaidi S, Zhang Y, Chamberlain P, Danelon D, Sarris I, Dhami J, Ioannou C, Knight C, Napolitano R, Wanyonyi S, Pace C, Mkrtychyan V, Cheikh Ismail L, Chumlea W, Al-Habsi F, Bhutta Z, Carter A, Alija M, Jimenez-Bustos J, Kizidio J, Puglia F, Kunnawar N, Liu H, Lloyd S, Mota D, Ochieng R, Rossi C, Sanchez Luna M, Shen Y, Knight H, Rocco D, Frederick I, Bhutta Z, Albernaz E, Batra M, Bhat B, Bertino E, Di Nicola P, Giuliani F, Rovelli I, McCormick K, Ochieng R, Pang R, Paul V, Rajan V, Wilkinson A, Varalda A, Eskenazi B, Corra L, Dolk H, Golding J, Matijasevich A, de Wet T, Zhang J, Bradman A, Finkton D, Burnham O, Farhi F, Barros F, Domingues M, Fonseca S, Leston A, Mitidieri A, Mota D, Sclowitz I, da Silveira M, Pang R, He Y, Pan Y, Shen Y, Wu M, Wu Q, Wang J, Yuan Y, Zhang Y, Purwar M, Choudhary A, Choudhary S, Deshmukh S, Dongaonkar D, Ketkar M, Khedikar V, Kunnawar N, Mahorkar C, Mulik I, Saboo K, Shembekar C, Singh A, Taori V, Tayade K, Somani A, Bertino E, Di Nicola P, Frigerio M, Gilli G, Gilli P, Giolito M, Giuliani F, Oberto M, Occhi L, Rossi C, Rovelli I, Signorile F, Todros T, Stones W, Carvalho M, Kizidio J, Ochieng R, Shah J, Vinayak S, Musee N, Kisiang’ani C, Muninzwa D, Jaffer Y, Al-Abri J, Al-Abduwani J, Al-Habsi F, Al-Lawatiya H, Al-Rashidiya B, Al-Zadjali W, Juangco F, Venkataraman M, Al-Jabri H, Yellappan D, Kennedy S, Cheikh Ismail L, Papageorghiou A, Roseman F, Lambert A, Ohuma E, Lloyd S, Napolitano R, Ioannou C, Sarris I, Gravett M, Batiuk C, Batra M, Bornemeier S, Dighe M, Oas K, Paulsene W, Wilson D, Frederick I, Andersen H, Abbott S, Carter A, Algren H, Rocco D, Sorensen T, Enquobahrie D, Waller S. Fetal growth velocity standards from the Fetal Growth Longitudinal Study of the INTERGROWTH-21 st Project. Am J Obstet Gynecol 2021; 224:208.e1-208.e18. [PMID: 32768431 PMCID: PMC7858163 DOI: 10.1016/j.ajog.2020.07.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Human growth is susceptible to damage from insults, particularly during periods of rapid growth. Identifying those periods and the normative limits that are compatible with adequate growth and development are the first key steps toward preventing impaired growth. OBJECTIVE This study aimed to construct international fetal growth velocity increment and conditional velocity standards from 14 to 40 weeks' gestation based on the same cohort that contributed to the INTERGROWTH-21st Fetal Growth Standards. STUDY DESIGN This study was a prospective, longitudinal study of 4321 low-risk pregnancies from 8 geographically diverse populations in the INTERGROWTH-21st Project with rigorous standardization of all study procedures, equipment, and measurements that were performed by trained ultrasonographers. Gestational age was accurately determined clinically and confirmed by ultrasound measurement of crown-rump length at <14 weeks' gestation. Thereafter, the ultrasonographers, who were masked to the values, measured the fetal head circumference, biparietal diameter, occipitofrontal diameter, abdominal circumference, and femur length in triplicate every 5 weeks (within 1 week either side) using identical ultrasound equipment at each site (4-7 scans per pregnancy). Velocity increments across a range of intervals between measures were modeled using fractional polynomial regression. RESULTS Peak velocity was observed at a similar gestational age: 16 and 17 weeks' gestation for head circumference (12.2 mm/wk), and 16 weeks' gestation for abdominal circumference (11.8 mm/wk) and femur length (3.2 mm/wk). However, velocity growth slowed down rapidly for head circumference, biparietal diameter, occipitofrontal diameter, and femur length, with an almost linear reduction toward term that was more marked for femur length. Conversely, abdominal circumference velocity remained relatively steady throughout pregnancy. The change in velocity with gestational age was more evident for head circumference, biparietal diameter, occipitofrontal diameter, and femur length than for abdominal circumference when the change was expressed as a percentage of fetal size at 40 weeks' gestation. We have also shown how to obtain accurate conditional fetal velocity based on our previous methodological work. CONCLUSION The fetal skeleton and abdomen have different velocity growth patterns during intrauterine life. Accordingly, we have produced international Fetal Growth Velocity Increment Standards to complement the INTERGROWTH-21st Fetal Growth Standards so as to monitor fetal well-being comprehensively worldwide. Fetal growth velocity curves may be valuable if one wants to study the pathophysiology of fetal growth. We provide an application that can be used easily in clinical practice to evaluate changes in fetal size as conditional velocity for a more refined assessment of fetal growth than is possible at present (https://lxiao5.shinyapps.io/fetal_growth/). The application is freely available with the other INTERGROWTH-21st tools at https://intergrowth21.tghn.org/standards-tools/.
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Barba M, Manodoro S, Bosio S, Locatelli L, Frigerio M. Telephone interview in urogynecology in the era of COVID-19 pandemic. J Turk Ger Gynecol Assoc 2021; 22:8-11. [PMID: 33506670 PMCID: PMC7944235 DOI: 10.4274/jtgga.galenos.2020.2020.0131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: During the Coronavirus disease-2019 (COVID-19) pandemic deferable access, including non-urgent outpatient visits, have been suspended. In our practice non-urgent routine visits for pelvic floor symptom assessment were discontinued and rescheduled, and telephone interview was performed. The aim was to evaluate patients’ satisfaction for this alternative approach. Material and Methods: Telephone interviews were conducted using a validated questionnaire to investigate pelvic floor symptoms. Patients were also asked if they had other symptoms or disorders, to identify patients who may need urgent hospital evaluation. At the end of the phone call, patients were asked to score their satisfaction with the telephone interview by grading their response to three questions from 0 (minimum) to 10 (maximum). The questions were: 1) “Was the telephone interview useful to check your state of health?”; 2) “Was the telephone interview an adequate healthcare tool in consideration of COVID-19 outbreak?”; 3) “Could the telephone interview replace the conventional visit?”. Results: Fifty-three patients were evaluated. All patients showed great satisfaction with telephone interview (Q1 median: 10, IQ range: 10-10) and were similarly positive in response to the second question (Q2 median: 10, IQ range: 10-10). Although fewer patients felt that telephone interview could replace conventional clinic visits most remained positive (Q3 median: 7; IQ range: 6-8). Conclusion: This simple experience showed that phone interviews with validated questionnaires are appreciated and effective to safely perform interview of selected urogynecologic patients.
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Barba M, Locatelli L, Palmieri S, Cola A, Manodoro S, Frigerio M. Hydrouretonephrosis caused by uterine prolapse after gellhorn pessary displacement. Eur J Obstet Gynecol Reprod Biol 2020; 257:150-151. [PMID: 33357964 DOI: 10.1016/j.ejogrb.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/02/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
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Manodoro S, Barba M, Locatelli L, Palmieri S, Marino G, Frigerio M. Urodynamic predictors of de novo overactive bladder after single-incision sling. Int J Gynaecol Obstet 2020; 153:412-416. [PMID: 33251577 DOI: 10.1002/ijgo.13503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/22/2020] [Accepted: 11/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify urodynamic predictors for de novo overactive bladder (OAB) after single-incision sling implantation. METHODS This retrospective study analyzed women with pure, urodynamically proven stress urinary incontinence, without OAB, between 2008 and 2015, in a university hospital. De novo OAB was investigated during clinical interviews. RESULTS A total of 192 patients were analyzed; 21 patients with de novo OAB were considered as group A while 171 control patients formed group B. Univariate analysis demonstrated that patients with de novo OAB have the first desire to void at a lower bladder volume (124 mL versus 160 mL, P = 0.0052), smaller maximum cystometric capacity (357 mL versus 406 mL, P = 0.0061), lower maximum flow (17 mL/s versus 23 mL/s, P = 0.0006), and higher bladder outlet obstruction index (BOOI; -11 versus -23, P = 0.0022) compared with controls. According to multivariate analysis, maximum cystometric capacity (parameter estimate [PE] =0.008, P = 0.04) and BOOI (PE = -0.029, P = 0.01) were independent urodynamic predictors of de novo OAB. The final model showed good predictive accuracy (area under the curve =0.81). CONCLUSION The present study identified maximum cystometric capacity and BOOI as independent predictors of de novo overactive bladder after single-incision sling implantation. Therefore, preoperative urodynamics may be useful to improve preoperative counseling and to tailor surgical treatment.
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Barba M, Schivardi G, Manodoro S, Frigerio M. Obstetric outcomes after uterus-sparing surgery for uterine prolapse: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 256:333-338. [PMID: 33271407 DOI: 10.1016/j.ejogrb.2020.11.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022]
Abstract
Up-to-date there are no guidelines about uterus-sparing prolapse repair procedures for women desiring childbearing. This systematic review and meta-analysis aims to evaluate obstetrical outcomes after uterus-sparing apical prolapse repair in terms of pregnancy rate, obstetrical adverse outcomes and delivery mode according to the type of procedure. To identify potentially eligible studies, we searched PubMed, Scopus, Cochrane Library and ISI Web of Science (up to April 15, 2020). Case reports, reviews, letters to Editor, book chapters, guidelines, Cochrane reviews, and expert opinions were excluded. Twenty-four studies met inclusion criteria and were incorporated into the final assessment, which included 1518 surgical procedures. In total 151 patients got pregnant after prolapse surgical repair, for a resulting pregnancy raw rate of 9.9 %. Overall, adverse obstetric outcomes resulted low, rating 4.6 %. Manchester procedure resulted associated with the highest risk of adverse obstetrical outcomes and preterm premature rupture of membranes (p < 0.0001). After exclusion of Manchester procedure, sacrohysteropexy was found to be associated with higher risk of obstetrical adverse outcomes compared to native-tissue procedures (p = 0.04). Native-tissue surgery might represent the most cautious option for women wishing for pregnancy.
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Ammirati E, Marchetti D, Colombo G, Garascia A, Macera F, Cipriani M, Perna E, D'Angelo L, Frigerio M, Oliva F. Estimation of the right atrial pressure by ultrasound-assessed internal jugular vein in patients with advanced chronic heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In patients with systolic chronic heart failure (CHF) clinical signs of congestion cannot always be evident at clinical examination. Right atrial pressure (RAP) measured by right heart catheterization (RHC) is an accurate and reproducible marker of blood volume. A non-invasive accurate tool to identify CHF patients with normal RAP would be desirable to tailor therapy.
Purpose
To validate an ultrasound (US)-assessed internal jugular vein distensibility (JVD) ratio to identify patients with normal mean RAP (defined as 7 mmHg or less) measured by RHC.
Methods
We first identify the JVD ratio that allows the most accurate identification of patients with normal RAP in a prospective calibration cohort of 100 patients with systolic CHF. Then, we tested the JVD ratio threshold to identify patients with normal RAP in a validation cohort of 101 consecutive patients with systolic CHF. All patients had a left ventricular ejection fraction (LVEF)<50% and underwent RHC in the setting of heart transplant work-up. At the time of jugular vein puncture, we recorded the internal jugular vein diameter by conventional linear probes. JVD ratio was calculated as the ratio between maximum diameter (during Valsalva maneuver) and rest diameter of the vein (FIGURE). Finally, we assessed the prognostic value of the JVD ratio in the follow up of the first 100 patients.
Results
In the calibration cohort (mean age 53 years, 13% female; median LVEF 25%, 81% in NYHA class III/IV) we define the best threshold of the JVD ratio to identify patients with normal RAP that has 1.6 with an area under the curve (AUC of 0.74; p<0.0001). Based on this JVD ratio threshold we defined patients with low JVD ratio (≤1.6; n=58; median RAP 8 mmHg) and patients with high JVD ratio (>1.6, n=42; median RAP 4 mmHg). High JVD ratio and low JVD ratio groups had similar clinical and laboratory characteristics. In the validation cohort (mean age 55 years, 13% female; median LVEF 25%; 56% in NYHA class III/IV) using the previously defined 1.6 JVD ratio threshold, we identified 51 patients with low JVD ratio (median RAP 8 mmHg) and 50 patients with high JVD ratio (median RAP 3 mmHg; p<0.0001) The JVD ratio threshold has an accuracy to identify patients with a normal RAP with an AUC of 0.82 (p<0.0001); a predictive positive value of 0.94, negative predictive value of 0.51, specificity of 0.90, and sensitivity of 0.65. Finally, in the calibration cohort, the CHF patients with low JVD ratio (≤1.6) had a higher cumulative incidence of overall death, heart transplant, or left ventricular assist device (42.7% vs. 16.1% in the high JVD ratio group, p log-rank 0.006) at a median of 13-month follow-up.
Conclusions
We found that US-assessed JVD ratio is a convenient and accurate diagnostic tool to identify patients with advanced systolic CHF with normal vs. increased RAP. This tool could be tested in the ambulatory setting to modulate therapies, particularly diuretics and vasodilators.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Barba M, Frigerio M, Manodoro S, Bernasconi DP, Cola A, Palmieri S, Fumagalli S, Vergani P. Postpartum urinary retention: Absolute risk prediction model. Low Urin Tract Symptoms 2020; 13:257-263. [PMID: 33118328 DOI: 10.1111/luts.12362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the incidence and assess clinical factors that can predict the occurrence of postpartum urinary retention (PPUR). PPUR is a puerperal condition defined as the inability to void over 6 hours after birth or after catheter removal in case of cesarean section, requiring catheterization. Lack of prompt diagnosis of this condition may lead to severe sequelae, including infection, chronic voiding difficulties, and renal failure. METHODS This retrospective cohort study analyzed all deliveries from January 2011 to December 2017 in a single Italian university hospital. We used multivariate logistic regression to develop a predictive score for PPUR. RESULTS By multivariate logistic regression, our analysis shows as minor (odds ratio [OR] < 2) risk factors for PPUR: non-Caucasian ethnicity (OR = 1.46, CI = 1.05-2.03), nulliparity (OR = 1.47, CI = 1.01-2.14), body mass index (BMI) at the end of the pregnancy <30 kg/m2 (OR = 1.54, CI = 1.10-2.17). On the other hand, epidural analgesia (OR = 3.93, CI = 2.96-5.22), meconium-stained amniotic fluid (OR = 2.07, CI = 1.54-2.77), nonoperative vaginal birth vs cesarean section (OR = 6.25, CI = 2.16-18.13), vacuum extraction vs cesarean section (OR = 8.80, CI = 2.86-27.01), pushing stage ≥60 minutes (OR = 3.00,CI = 2.26-3.97), and perineal tear (OR = 2.87, CI = 1.86-4.43) proved to be major (OR > 2) risk factors for PPUR. Using our final model (area under curve = 0.84), we created a nomogram for PPUR absolute risk calculation. Specifically, a 116-point cutoff might be used to identify high-risk patients who deserve more intensive micturition monitoring. CONCLUSIONS Our study identified non-Caucasian ethnicity, nulliparity, and a BMI <30 kg/m2 at the end of the pregnancy as minor and epidural analgesia, meconium-stained amniotic fluid, vaginal nonoperative birth, vacuum extraction, pushing stage ≥60 minutes, and perineal tear as major independent risk factors for PPUR.
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Frigerio M, Milani R, Barba M, Locatelli L, Marino G, Donatiello G, Spelzini F, Manodoro S. Single-incision slings for the treatment of stress urinary incontinence: efficacy and adverse effects at 10-year follow-up. Int Urogynecol J 2020; 32:187-191. [PMID: 32902762 DOI: 10.1007/s00192-020-04499-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Single-incision slings are not considered a first-choice surgical treatment owing to a lack of data about long-term outcomes. We aimed to assess the long-term results of urinary incontinence treatment after single-incision sling implantation at 10 years' follow-up and to investigate possible deterioration over time. METHODS This retrospective study analyzed women with subjective and urodynamically proven stress urinary incontinence who underwent single-incision sling procedure. The objective cure rate was assessed with a 300-ml stress test. The subjective cure rate was determined by the Patient Global Impression of Improvement (PGI-I) questionnaire. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire scores and self-answered patient-satisfaction scales were collected to assess symptom severity. Findings were compared with short-term outcomes in the same patients, available through our previous database, in order to detect possible outcome deterioration over time. RESULTS The records of 60 patients were analyzed. Nine patients (15%) were lost to follow-up. A total of 51 patients completed the evaluation, with a mean follow-up of 10.3 ± 0.7 years. Objective and subjective cure resulted 86.3% and 88.2% respectively. Mean PGI-I scores and ICIQ-SF were 1.5 ± 1.0 and 3.2 ± 4.8 respectively. Patients' satisfaction scored 8.6 ± 2.6 out of 10. No long-term complications occurred. Comparison of short-term (2.6 ± 1.4 years after surgery) and long-term follow-up did not show a significant deterioration of outcome over time. CONCLUSIONS Single-incision slings were shown to be a procedure with a great efficacy and safety profile at very long-term follow-up. Cure rates and functional outcomes did not show any deterioration over time compared with short-term results.
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Manodoro S, Braga A, Barba M, Caccia G, Serati M, Frigerio M. Update in fertility-sparing native-tissue procedures for pelvic organ prolapse. Int Urogynecol J 2020; 31:2225-2231. [PMID: 32809111 DOI: 10.1007/s00192-020-04474-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
Uterine-sparing prolapse surgery has been gaining back popularity with clinicians and patients. Although both prosthetic and native-tissue surgery procedures are described, the latter is progressively regaining a central role in pelvic reconstructive surgery, owing to a lack of mesh-related complications. Available native-tissue procedures have different advantages and pitfalls, as well as different evidence profiles. Most of them offer anatomical and subjective outcomes comparable with those of hysterectomy-based procedures. Moreover, native-tissue procedures in young women desiring childbearing allow to avoid synthetic material implantation, which may lead to potentially serious complications during pregnancy. As a consequence, we do think that offering a reconstructive native-tissue procedure for uterine preservation (with the exception of the Manchester procedure) is the safest option in women wishing for pregnancy. Sacrospinous ligament hysteropexy and high uterosacral ligament hysteropexy may be considered first-line options in consideration of the higher level of evidence and lack of adverse obstetrical outcomes.
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Barba M, Frigerio M, Manodoro S. Pelvic floor ultrasonography for the evaluation of the rectum-vaginal septum before and after prolapse native-tissue repair. MINERVA GINECOLOGICA 2020; 72:426-428. [PMID: 32744450 DOI: 10.23736/s0026-4784.20.04620-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Braun O, Brambatti M, Shah P, Cipriani M, Veenis J, Bui Q, Hong K, de Heyning C, Perna E, Timmermans P, Cikes M, Gjesdal G, Partida C, Potena L, Masetti M, Loforte A, Jakus N, Nilsson J, De Bock D, Minto J, Brugts J, Sterken C, Van den Bossche K, Rega F, Sing R, Russo C, Pretorius V, Klein L, Frigerio M, Adler E, Ammirati E. ICD Therapy Confers No Survival Advantage in a Global LVAD Population: Insights from the Trans-Atlantic Registry on VAD and Transplant (TRAViATA). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Palmieri S, Cola A, Ceccherelli A, Manodoro S, Frigerio M, Vergani P. Italian validation of the German Pelvic Floor Questionnaire for pregnant and postpartum women. Eur J Obstet Gynecol Reprod Biol 2020; 248:133-136. [PMID: 32203824 DOI: 10.1016/j.ejogrb.2020.03.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The only available validated questionnaire for pelvic floor disorders in pregnant and postpartum women is in German. The aim of this study was to translate and validate the German Pelvic Floor Questionnaire for pregnant and postpartum women into Italian. STUDY DESIGN The questionnaire was translated into Italian by standardized procedural steps. The final version of the questionnaire was submitted to women in the third trimester of pregnancy or within 6 weeks post partum. Construct validity was tested using the Wilcoxon test, and internal consistency was tested using Cronbach's alpha. Test-retest reliability was measured with Cohen's kappa and intraclass correlation coefficient. RESULTS Fifty women answered the questionnaire. Construct validity was demonstrated, as the questionnaire discriminated significantly between patients with and without symptoms for four domains of pelvic floor disorders. Internal consistency was satisfactory (0.62-0.93). Cohen's kappa values for test-retest reliability were between 0.46 (moderate agreement) and 1.00 (complete agreement). Intraclass correlation coefficients ranged between 0.93 and 0.96, indicating very satisfactory overall agreement for each functional domain. CONCLUSIONS The Italian version of the German Pelvic Floor Questionnaire for pregnant and postpartum women is reliable, valid and consistent.
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Milani R, Manodoro S, Passoni P, Locatelli L, Barba M, Frigerio M. Surgical management of bladder erosion and pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse. Int Urogynecol J 2020; 31:843-845. [PMID: 32140753 DOI: 10.1007/s00192-020-04261-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/11/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Mesh-augmented lateral suspension for prolapse repair seems to be associated with few complications. However, mesh-related complications can negatively affect the quality of life and may be challenging to manage. This video is aimed at presenting the surgical management of a case of severe pelvic pain and dyspareunia after lateral laparoscopic suspension associated with mesh erosion in the bladder. METHODS A 46-year-old woman was referred to our Unit for severe pelvic pain and inability to have sexual intercourses since undergoing a uterus-sparing laparoscopic lateral suspension procedure for genital prolapse 2 years before in another hospital. Moreover, she reported bladder pain and recurrent urinary tract infections. Cystoscopy showed mesh erosion in the bladder. She was admitted to laparoscopic hysterectomy plus subtotal mesh excision and bladder reconstruction (video). RESULTS No surgical complications were observed. The postoperative course was uneventful. At the current follow-up, the patient reported complete resolution of her symptoms. CONCLUSION The featured video shows laparoscopic subtotal mesh excision, concomitant hysterectomy and bladder repair for pelvic pain, dyspareunia and bladder erosion after lateral suspension. This video may be useful in providing anatomical views and surgical steps necessary for achieving successful surgical management of this mesh-related complication.
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Buda A, Yaprak E, MIlani R, Frigerio M, Perego R, Jaconi M, Meregalli S. Locally-advanced vaginal cancer with complete utero-vaginal prolapse. Int J Gynecol Cancer 2020; 30:705-708. [PMID: 32139436 DOI: 10.1136/ijgc-2020-001326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2020] [Indexed: 11/04/2022] Open
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