101
|
Constantin F, Veit-Rubin N, Ramyead L, Dubuisson J. Rouhier’s colpocleisis with concomitant vaginal hysterectomy: an instructive video for female pelvic surgeons. Int Urogynecol J 2018; 30:495-497. [DOI: 10.1007/s00192-018-3765-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022]
|
102
|
Dheresa M, Worku A, Oljira L, Mengistie B, Assefa N, Berhane Y. Factors associated with pelvic floor disorders in Kersa District, eastern Ethiopia: a community-based study. Int Urogynecol J 2018; 30:1559-1564. [PMID: 30259062 DOI: 10.1007/s00192-018-3776-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pelvic floor disorders, which diminish the quality of life, disproportionally affect women in developing countries. However, there is a knowledge gap in the understanding of the factors associated with the problem in many countries including Ethiopia. Therefore, we aimed to assess the factors associated with pelvic floor disorders in Ethiopia. MATERIALS AND METHODS A community-based cross-sectional study was conducted among 3432 ever-married women selected through a stratified multistage sampling procedure from the Kersa Health and Demography Surveillance System. Data were collected using structured questionnaires through face-to-face interviews. A Poisson regression model with robust variance estimation was used to investigate the association of the independent variable with pelvic floor disorder. The results are reported in adjusted prevalence ratios with 95% confidence intervals. RESULTS Overall, the prevalence of pelvic floor disorders was 20.5% (95% CI: 19%-22%). Women who had no education (APR = 1.47; 95% CI: 1.06, 2.04) or had undergone five or more vaginal deliveries (APR = 1.56; 95% CI: 1.18, 2.05), an abortion (APR = 1.85; 95% CI: 1.43, 2.38) or episiotomy (APR = 1.39; 95% CI: 1.02, 1.90) were independently associated with having pelvic floor disorders. CONCLUSION Obstetric events are strongly associated with pelvic floor disorders. This finding highlights the greater need for policies to focus on prevention, diagnosis and treatment services to mitigate women's suffering from pelvic floor disorders.
Collapse
Affiliation(s)
- Merga Dheresa
- Health and Medical Sciences College, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Alemayehu Worku
- Addis Continental Institutes of Public Health, Addis Ababa, Ethiopia.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lemessa Oljira
- Health and Medical Sciences College, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Bezatu Mengistie
- Health and Medical Sciences College, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Nega Assefa
- Health and Medical Sciences College, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Yemane Berhane
- Addis Continental Institutes of Public Health, Addis Ababa, Ethiopia
| |
Collapse
|
103
|
Zuchelo LTS, Bezerra IMP, Da Silva ATM, Gomes JM, Soares Júnior JM, Chada Baracat E, de Abreu LC, Sorpreso ICE. Questionnaires to evaluate pelvic floor dysfunction in the postpartum period: a systematic review. Int J Womens Health 2018; 10:409-424. [PMID: 30123009 PMCID: PMC6087030 DOI: 10.2147/ijwh.s164266] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Pelvic floor dysfunctions (PFDs) affect the female population, and the postpartum period can be related to the onset or aggravation of the disease. Early identification of the symptoms and the impact on quality of life can be achieved through assessment instruments. Objective The purpose of this systematic review is to evaluate questionnaires used to assess PFD in the postpartum period. Methods A systematic review study was conducted, following Preferred Reporting Items for the Systematic Reviews and Meta-Analyses (PRISMA) criteria, using the databases: PubMed, Biblioteca Virtual de Saúde (BVS), Web of Science, and Scopus, and the keywords PFD or pelvic floor disorders, postpartum or puerperium, and questionnaire. Articles published up till May 2018 were included, searching for articles using validated questionnaires for the evaluation of PFDs in postpartum women. The articles included were evaluated according to a checklist, and the validation studies and translated versions of the questionnaires were identified. Results The search of the databases resulted in 359 papers, and 33 were selected to compose this systematic review, using nine validated questionnaires to assess PFDs in the postpartum period: International Consultation on Incontinence Questionnaire – Vaginal Symptoms (ICIQ-VS), Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), PFDI-46, Pelvic Floor Impact Questionnaire (PFIQ-31), Pelvic Floor Bother Questionnaire (PFBQ), Female Pelvic Floor Questionnaire, electronic Personal Assessment Questionnaire – Pelvic Floor, and PFD questionnaire specific for pregnancy and postpartum. The most frequently reported questionnaires included PFDI-20, PFIQ-7, and ICIQ-VS and are recommended by ICI. In addition, the review identified a specific questionnaire, recently developed, to access PFD during pregnancy and postpartum. Conclusion The questionnaires used to evaluate PFD during postpartum period are developed for general population or urology/gynecology patients with incontinence and reinforce the paucity of highly recommended questionnaires designed for postpartum, in order to improve early and specific approach for this period of life.
Collapse
Affiliation(s)
- Lea Tami Suzuki Zuchelo
- Study Design and Scientific Writing Laboratory at ABC Medical School, Santo André, Brazil, .,Research Laboratory of Uninorte (Barão do Rio Branco Faculty), Rio Branco, Brazil
| | - Italla Maria Pinheiro Bezerra
- Study Design and Scientific Writing Laboratory at ABC Medical School, Santo André, Brazil, .,School of Sciences of Santa Casa de Misericórdia de Vitoria, Vitória, Brazil
| | - Adna Thaysa Marcial Da Silva
- Study Design and Scientific Writing Laboratory at ABC Medical School, Santo André, Brazil, .,Faculty of Medicine, University of São Paulo, São Paulo, Brazil,
| | - Jéssica Menezes Gomes
- Study Design and Scientific Writing Laboratory at ABC Medical School, Santo André, Brazil, .,Faculty of Medicine, University of São Paulo, São Paulo, Brazil,
| | | | | | - Luiz Carlos de Abreu
- Study Design and Scientific Writing Laboratory at ABC Medical School, Santo André, Brazil, .,School of Sciences of Santa Casa de Misericórdia de Vitoria, Vitória, Brazil
| | - Isabel Cristina Esposito Sorpreso
- Study Design and Scientific Writing Laboratory at ABC Medical School, Santo André, Brazil, .,Faculty of Medicine, University of São Paulo, São Paulo, Brazil,
| |
Collapse
|
104
|
Colla C, Paiva LL, Ferla L, Trento MJB, de Vargas IMP, Dos Santos BA, Ferreira CF, Ramos JGL. Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery. Int J Gynaecol Obstet 2018; 143:94-100. [PMID: 29876920 DOI: 10.1002/ijgo.12561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/15/2018] [Accepted: 06/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify and assess postpartum pelvic floor dysfunction (PFD) between vaginal delivery, elective cesarean delivery (ECD), and intrapartum cesarean delivery (ICD). METHODS The present prospective observational study included women aged at least 18 years with no history of pelvic surgery or lower urinary tract malformation, and who had not undergone pelvic floor muscle (PFM) training in the preceding 12 months, who underwent delivery at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil between August 1, 2016, and May 31, 2017. Participants were assessed at 48 hours (phase 1), 1 month (phase 2), and 3 months (phase 3) after delivery. Assessments included the International Consultation on Incontinence Questionnaire, Short Form (ICIQ-SF); the Jorge-Wexner anal incontinence scale; a self-rated visual analog scale for pelvic pain; the pelvic organ prolapse quantification (POP-Q) system; and a PFM perineometer. RESULTS A total of 227 women were assessed in phase 1 (141 vaginal deliveries; 28 ICDs; and 58 ECDs), 79 in phase 2, and 41 in phase 3. The ICIQ-SF, Jorge-Wexner scale, visual analog scale, and perineometer measurements did not identify significant differences in relation to the type of delivery (P>0.05). CONCLUSION The type of delivery was not associated with differences in the short-term development of postpartum PFD.
Collapse
Affiliation(s)
- Cássia Colla
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciana L Paiva
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Physical Therapy Course, School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lia Ferla
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria J B Trento
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Isadora M P de Vargas
- Physical Therapy Course, School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bianca A Dos Santos
- Physical Therapy Course, School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Charles F Ferreira
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - José G L Ramos
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
105
|
Dheresa M, Worku A, Oljira L, Mengiste B, Assefa N, Berhane Y. One in five women suffer from pelvic floor disorders in Kersa district Eastern Ethiopia: a community-based study. BMC WOMENS HEALTH 2018; 18:95. [PMID: 29902997 PMCID: PMC6003007 DOI: 10.1186/s12905-018-0585-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/05/2018] [Indexed: 12/16/2022]
Abstract
Background Hundreds of millions of women suffer from pelvic floor disorders globally, often in silence. Women in developing countries do not disclose their problems due to associated social stigma or lack of access to services. Thus, the extent of the problem remains largely unknown. This study was conducted to assess the magnitude of pelvic floor disorders in Kersa district Eastern Ethiopia. Method We conducted a community-based cross-sectional study among ever married women who reside in Kersa district, Eastern Ethiopia. The study subjects were selected through stratified multistage probability sampling. The data were collected using a structured questionnaire through face-to-face interviews. The prevalence of various pelvic floor disorders are presented along with the 95% Confidence Intervals (CI). Results A total of 3432 women participated in the study, of which 704 (20.5%; 95% CI; 19.2, 21.8) reported at least one type of pelvic floor disorder and 349 (49.6%; 95% CI: 46.0, 53.0) reported two or more pelvic floor disorders. The most common pelvic floor disorders included an over active bladder (15.5%; 95% CI: 14.4, 16.8), pelvic organ prolapse (9.5%; 95% CI: 8.5,10.4), stress urinary incontinence (8.3%; 95% CI: 7.4, 9.2) and anal incontinence (1.9%; 95% CI: 1.5, 2.4). More than two-thirds of the women with pelvic floor disorders (68.0%; 95% CI:64.4, 71.3) reported having severe distress but had never sought health care. Conclusions The magnitude of the health problem and the low level of health seeking behavior indicates the silent suffering of many women in the study area. Extrapolating these figure to national statistics would indicate the staggering number of women suffering from pelvic floor disorders in the country. This calls for urgent action to improve prevention, diagnosis and treatment services to mitigate the suffering of women from pelvic floor disorders.
Collapse
Affiliation(s)
- Merga Dheresa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. .,, Harar, Ethiopia.
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,, Addis Ababa, Ethiopia
| | - Lemessa Oljira
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,, Harar, Ethiopia
| | - Bizatu Mengiste
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,, Harar, Ethiopia
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,, Harar, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,, Addis Ababa, Ethiopia
| |
Collapse
|
106
|
Vetuschi A, Pompili S, Gallone A, D'Alfonso A, Carbone MG, Carta G, Festuccia C, Gaudio E, Colapietro A, Sferra R. Immunolocalization of Advanced Glycation End Products, Mitogen Activated Protein Kinases, and Transforming Growth Factor-β/Smads in Pelvic Organ Prolapse. J Histochem Cytochem 2018; 66:673-686. [PMID: 29737911 DOI: 10.1369/0022155418772798] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Collagen and matrix metalloproteinases (MMP) play a pivotal role in the pathophysiology of Pelvic Organ Prolapse (POP) as a switch between type I and III collagen together with a simultaneous activation of MMPs have been observed in the vaginal wall. The aim of this study was to evaluate the Advanced Glycation End (AGE) products, ERK1/2 and transforming growth factor (TGF)-β/Smad pathway expression in muscularis propria in women with POP compared with control patients. We examined 20 patients with POP and 10 control patients treated for uterine fibromatosis. Immunohistochemical analysis using AGE, RAGE, ERK1/2, Smads-2/3, Smad-7, MMP-3, and collagen I-III, TIMP, and α-SMA were performed. Smad-2/3, Smad-7, AGE, ERK1/2, p-ERK, and p-Smad3 were also evaluated using Western-blot analysis. POP samples from the anterior vaginal wall showed disorganization of the normal muscularis architecture. In POP samples, AGE, ERK1/2, Smad-2/3, MMP-3, and collagen III were upregulated in muscularis whereas in controls, Smad-7 and collagen I were increased. The receptor for AGEs (RAGE) was mild or absent both in controls and prolapse. We demonstrated the involvement of these markers in women with POP but further studies are required to elucidate if the overexpression of these molecules could play a crucial role in the pathophysiology of POP disease.
Collapse
Affiliation(s)
- Antonella Vetuschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Simona Pompili
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna Gallone
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Angela D'Alfonso
- Department of Life, Health and Environmental Sciences, Gynecology and Obstetrics Unit, University of L'Aquila, L'Aquila, Italy
| | - Maria Gabriella Carbone
- Department of Life, Health and Environmental Sciences, Gynecology and Obstetrics Unit, University of L'Aquila, L'Aquila, Italy
| | - Gaspare Carta
- Department of Life, Health and Environmental Sciences, Gynecology and Obstetrics Unit, University of L'Aquila, L'Aquila, Italy
| | - Claudio Festuccia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Colapietro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roberta Sferra
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
107
|
Effect of Concurrent Prolapse Surgery on Stress Urinary Incontinence Outcomes After TVTO. Female Pelvic Med Reconstr Surg 2018; 23:244-249. [PMID: 28106648 DOI: 10.1097/spv.0000000000000364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES A variety of pelvic organ prolapse (POP) surgeries are performed concomitant to midurethral sling (MUS) placement. It is unknown whether differing POP surgeries may affect stress urinary incontinence outcomes after MUS placement. METHODS We performed a retrospective cohort analysis of patients undergoing TVT obturator system in conjunction with a variety of POP repair (cystocele with mesh graft, cystocele with cadaveric fascia, colpocleisis, and sacrocolpopexy). Primary outcomes included validated measures of stress urinary incontinence (International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms), measured preoperatively and at 6 week, 1 year, and 2 years postoperatively. Secondary outcomes included validated questionnaire items focused on obstructive and irritative symptoms. Multivariate analyses using mixed-effects regressions were used to assess for differences in outcomes based on POP repair type. RESULTS A total of 102 patients were identified for study analysis (cystocele with mesh graft, n = 45; cystocele with cadaveric fascia, n = 37; sacrocolpopexy, n = 16; colpocleisis, n = 4). Four patients undergoing colpocleisis were excluded from primary analysis given lack of sufficient cohort size. When adjusted for effects of covariates, significant improvements in primary and secondary outcomes were seen throughout follow-up in comparison with baseline. In general, multivariate analysis demonstrated no significant differences between surgeries when assessing primary and secondary outcomes. The only statistically significant difference in change over time comprised CM, which demonstrated superior improvement in International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (preoperative vs 2 year, P = 0.04). CONCLUSIONS Regardless of POP surgery type, patients demonstrate improvements in validated SUI outcomes through 2 years. Multivariate analysis suggests that there is little difference in SUI outcomes after TVT obturator system across several different POP repair types.
Collapse
|
108
|
Teixeira RV, Colla C, Sbruzzi G, Mallmann A, Paiva LL. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. Int Urogynecol J 2018; 29:1717-1725. [PMID: 29654349 DOI: 10.1007/s00192-018-3651-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/30/2018] [Indexed: 11/27/2022]
Abstract
Urinary incontinence (UI) is any involuntary loss of urine. In female athletes, physical exercise may be a risk factor for UI because of increased intra-abdominal pressure generated during high-impact exercises, which overloads the pelvic organs, predisposing them to UI. This is a systematic review of the prevalence of UI in female athletes in different sports. A search for articles was carried out in the PEDro, Scopus, Cinahl, PubMed, LILACS, SciELO, Science Direct, Web of Science, Embase, and Cochrane databases as well as a manual search of the references of studies already published on the subject with the keywords "athlete," "urinary incontinence," and "women" in Portuguese and English. Only articles published from 2000 to 2016 were included. Observational studies assessing the prevalence of UI in female athletes were selected. Methodological quality was assessed using the Downs and Black scale, and the data collected from the studies were analyzed through meta-analysis. Eight studies met the eligibility criteria. Meta-analysis showed a 36% prevalence of UI in female athletes in different sports, and compared with sedentary women, the athletes had a 177% higher risk of presenting with UI. There is a higher prevalence of UI in female athletes compared with sedentary women. There have been reports of UI in different sports.
Collapse
Affiliation(s)
- Renata Veloso Teixeira
- School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cássia Colla
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Graciele Sbruzzi
- School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Anelise Mallmann
- Specialization in Kinesiology by the School of Physical Education and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana Laureano Paiva
- School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
109
|
de Andrade RL, Bø K, Antonio FI, Driusso P, Mateus-Vasconcelos ECL, Ramos S, Julio MP, Ferreira CHJ. An education program about pelvic floor muscles improved women's knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial. J Physiother 2018; 64:91-96. [PMID: 29574170 DOI: 10.1016/j.jphys.2018.02.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 12/18/2017] [Accepted: 02/05/2018] [Indexed: 11/16/2022] Open
Abstract
QUESTION Does an educational program with instructions for performing 'the Knack' improve voluntary contraction of the pelvic floor muscles, reduce reports of urinary incontinence, improve sexual function, and promote women's knowledge of the pelvic floor muscles? DESIGN Randomised, controlled trial with concealed allocation, intention-to-treat analysis and blinded assessors. PARTICIPANTS Ninety-nine women from the local community. INTERVENTION The experimental group (n=50) received one lecture per week for 4 weeks, and instructions for performing 'the Knack'. The control group (n=49) received no intervention. OUTCOME MEASURES The primary outcome was maximum voluntary contraction of the pelvic floor muscles measured using manometry. Secondary outcomes were: ability to contract the pelvic floor muscles measured using vaginal palpation; severity of urinary incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scored from 0 to 21; self-reported sexual function; and knowledge related to the pelvic floor. Outcomes were measured at baseline and after 4 weeks. RESULTS The intervention did not significantly improve: maximum voluntary contraction (MD 2.7 cmH2O higher in the experimental group, 95% CI -0.5 to 5.9); ability to contract the pelvic floor muscles (RR 2.18, 95% CI 0.49 to 9.65); or self-reported severity of urinary incontinence (MD 1 point greater reduction in the experimental group, 95% CI -3 to 1). Sexual function did not significantly differ between groups, but very few of the women engaged in sexual activity during the study period. The educational program did, however, significantly increase women's knowledge related to the location, functions and dysfunctions of the pelvic floor muscles, and treatment options. CONCLUSION Education and teaching women to perform 'the Knack' had no significant effect on voluntary contraction of the pelvic floor muscles, urinary incontinence or sexual function, but it promoted women's knowledge about the pelvic floor. TRIAL REGISTRATION Brazilian Registry of Clinical Trials, RBR-95sxqv. [de Andrade RL, Bø K, Antonio FI, Driusso P, Mateus-Vasconcelos ECL, Ramos S, Julio MP, Ferreira CHJ (2018) An education program about pelvic floor muscles improved women's knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial. Journal of Physiotherapy 64: 91-96].
Collapse
Affiliation(s)
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Science, Oslo, Norway
| | | | - Patricia Driusso
- Postgraduate Program in Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | | | | | | | | |
Collapse
|
110
|
Making Progress in Pelvic Floor Disorders Research: We Can't Do It Alone. Female Pelvic Med Reconstr Surg 2018; 24:319-320. [PMID: 29369841 DOI: 10.1097/spv.0000000000000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
111
|
Fekete Z, Surányi A, Rénes L, Németh G, Kozinszky Z. Efficacy of anchoring the four-arm transvaginal mesh to the mid-urethra vs original surgery as a surgical correction for stress urine incontinence in coexisting anterior vaginal prolapse grades II and III: study protocol for a randomized controlled trial. Trials 2017; 18:624. [PMID: 29282115 PMCID: PMC5746023 DOI: 10.1186/s13063-017-2314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 10/31/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The prevalence of obesity with aging is escalating alarmingly; and pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are now becoming a growing epidemic among the elderly. Synthetic transvaginal mesh has been employed with increasing popularity in the treatment of POP and is usually highly effective in controlling the principal symptoms of prolapse. However, studies have reported that mesh operations provide fairly unfavorable SUI cure rates. Therefore, additional anti-incontinence surgical strategies are increasingly being scrutinized to achieve better postoperative continence without any significant side-effects for patients with both POP and SUI. We hypothesize that the modification with the fixing of the mesh to the mid-urethra is superior to the original transvaginal mesh operation (TVM) with regard to anti-incontinence. METHODS One hundred and thirty patients diagnosed with POP-Q II-III and concomitant SUI requiring surgical treatment will be included in this prospective, randomized, double-blind, controlled clinical trial. Patients will be randomly allocated to receive either original TVM (TVM group, n = 65) or modified TVM surgery (mTVM group, n = 65). As the primary outcome parameter, we will evaluate the objective SUI and POP cure rates. Secondary endpoints include postoperative morbidity as assessed with the International Urogynaecological Association classification and subjective prolapse and incontinence cure rates reported by questionnaires. DISCUSSION Recognizing the importance of an additional surgical procedure for anti-incontinence management, we aim to investigate whether a stabilizing suturing of the mesh to the mid-urethra delivers superior SUI correction compared to the original prosthesis surgery. TRIAL REGISTRATION ClinicalTrials.gov, NCT02935803. Registered on 20 May 2016.
Collapse
Affiliation(s)
- Zoltán Fekete
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Szeged, Semmelweis u. 1., 6725, Szeged, Hungary.
| | - Andrea Surányi
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Szeged, Semmelweis u. 1., 6725, Szeged, Hungary
| | - Lórand Rénes
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Szeged, Semmelweis u. 1., 6725, Szeged, Hungary
| | - Gábor Németh
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Szeged, Semmelweis u. 1., 6725, Szeged, Hungary
| | - Zoltan Kozinszky
- Department of Obstetrics and Gynaecology, Blekinge Hospital, Karlskrona, Sweden
| |
Collapse
|
112
|
Meekins AR, Siddiqui NY, Amundsen CL, Kuchibhatla M, Dieter AA. Improving Postoperative Efficiency: An Algorithm for Expedited Void Trials After Urogynecologic Surgery. South Med J 2017; 110:785-790. [PMID: 29197314 DOI: 10.14423/smj.0000000000000733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the relation between voided volume and void trial "success" to create an algorithm that minimizes the need for postvoid residual volume (PVR) assessment in backfill-assisted void trials. METHODS This article is an ancillary analysis of deidentified data from a randomized trial evaluating prophylactic antibiotics after urogynecologic surgery. Void trials were routinely performed after surgery; voided volumes, PVR, and void trial outcomes were collected. The void trial regimen was as follows: the bladder was backfilled with 300 mL of normal saline or until the patient reported the urgency to void, the catheter was removed, and the participant was prompted to void immediately. PVR volume was measured either by sonographic bladder scan or catheterization. Voided volumes were categorized in 25-mL increments from 50 to 225 mL. For each voided volume range, the PVR and void trial outcome data were incorporated to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in terms of ability of voided volume alone to predict a passing void trial result. An algorithm was created using the voided volumes that optimize PPV and NPV. RESULTS The study population included 255 participants. Voided volumes <100 mL and ≥200 mL were identified as optimal thresholds to predict failure and passage of backfill-assisted void trials, respectively. When patients voided <100 mL, 3% passed their void trial (NPV odds ratio 96.7, 95% confidence interval 88.6-99.5). When patients voided ≥200 mL, 97% passed (PPV odds ratio 97.4, 95% confidence interval 93.5-99.3). CONCLUSIONS We propose an algorithm for void trials after urogynecologic surgery. After backfilling the bladder if voided volume is ≥200 mL, the void trial is successful and no PVR is needed; if voided volume is between 100 and 199 mL, the void trial is indeterminate and PVR is recommended; and if voided volume is <100 mL, the void trial is unsuccessful and catheterization is needed. Applying this algorithm to our study population would have eliminated the need for PVR in 85% of patients. Calculated PPVs and NPVs depend on the prevalence of voiding dysfunction in the population being studied, and therefore may be unique to our institution.
Collapse
Affiliation(s)
- A Rebecca Meekins
- From the Departments of Obstetrics and Gynecology and Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, and the Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill
| | - Nazema Y Siddiqui
- From the Departments of Obstetrics and Gynecology and Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, and the Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill
| | - Cindy L Amundsen
- From the Departments of Obstetrics and Gynecology and Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, and the Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill
| | - Maragatha Kuchibhatla
- From the Departments of Obstetrics and Gynecology and Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, and the Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill
| | - Alexis A Dieter
- From the Departments of Obstetrics and Gynecology and Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, and the Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill
| |
Collapse
|
113
|
Metz SA. Commentary on "Improving Postoperative Efficiency: An Algorithm for Expedited Void Trials After Urogynecologic Surgery". South Med J 2017; 110:791. [PMID: 29197315 DOI: 10.14423/smj.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Stephen A Metz
- From the Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
| |
Collapse
|
114
|
Darwish A, Bahlol M, Ahmad A, Fekry M. Uterus-sparing vaginolaparoscopic sacrocolpopexy for apical pelvic organ prolapse. Int Urogynecol J 2017; 29:1455-1461. [DOI: 10.1007/s00192-017-3511-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/05/2017] [Indexed: 11/28/2022]
|
115
|
Sammarco AG, Nandikanti L, Kobernik EK, Xie B, Jankowski A, Swenson CW, DeLancey JO. Interactions among pelvic organ protrusion, levator ani descent, and hiatal enlargement in women with and without prolapse. Am J Obstet Gynecol 2017; 217:614.e1-614.e7. [PMID: 28709583 DOI: 10.1016/j.ajog.2017.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/14/2017] [Accepted: 07/06/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pelvic organ prolapse has 2 components: (1) protrusion of the pelvic organs beyond the hymen; and (2) descent of the levator ani. The Pelvic Organ Prolapse Quantification system measures the first component, however, there remains no standard measurement protocol for the second mechanism. OBJECTIVE We sought to test the hypotheses that: (1) difference in the protrusion area is greater than the area created by levator descent in prolapse patients compared with controls; and (2) prolapse is more strongly associated with levator hiatus compared to urogenital hiatus. STUDY DESIGN Midsagittal magnetic resonance imaging scans from 30 controls, 30 anterior predominant, and 30 posterior predominant prolapse patients were assessed. Levator area was defined as the area above the levator ani and below the sacrococcygeal inferior pubic point line. Protrusion area was defined as the protruding vaginal walls below the levator area. The levator hiatus and urogenital hiatus were measured. Bivariate analysis and multiple comparisons were performed. Bivariate logistic regression was performed to assess prolapse as a function of levator hiatus, urogenital hiatus, levator area, and protrusion. Pearson correlation coefficients were calculated. RESULTS The levator area for the anterior (34.0 ± 6.5 cm2) and posterior (35.7 ± 8.0 cm2) prolapse groups were larger during Valsalva compared to controls (20.9 ± 7.8 cm2, P < .0001 for both); similarly, protrusion areas for the anterior (14.3 ± 6.2 cm2) and posterior (14.4 ± 5.7 cm2) prolapse groups were both larger compared to controls (5.0 ± 1.8 cm2, P < .0001 for both). The levator hiatus length for the anterior (7.2 ± 1 cm) and posterior (6.9 ± 1 cm) prolapse groups were longer during Valsalva compared to controls (5.2 ± 1.5 cm, P < .0001 for both); similarly, urogenital hiatus lengths for the anterior (5.7 ± 1 cm) and posterior (6.3 ± 1.1 cm) prolapse groups were both longer than controls (3.8 ± 0.8 cm, P < .0001 for both). The difference in levator area in prolapse patients compared with controls was greater than the difference in protrusion area (14.0 ± 7.2 cm2 vs 9.4 ± 5.9 cm2, P < .0002). The urogenital hiatus was more strongly associated with prolapse than the levator hiatus (odds ratio, 12.9; 95% confidence interval, 4.1-39.2, and odds ratio, 4.3; 95% confidence interval, 2.3-7.5). Levator hiatus and urogenital hiatus are both correlated with levator and protrusion areas, and all were associated with maximum prolapse size (P ≤ .001, for all comparisons). CONCLUSION In prolapse, the levator area increases more than the protrusion area and both the urogenital hiatus and levator hiatus are larger. The odds of prolapse for an increase in the urogenital hiatus are 3 times larger than for the levator hiatus, which leads us to reject both the original hypotheses.
Collapse
|
116
|
|
117
|
Arnouk A, De E, Rehfuss A, Cappadocia C, Dickson S, Lian F. Physical, Complementary, and Alternative Medicine in the Treatment of Pelvic Floor Disorders. Curr Urol Rep 2017; 18:47. [DOI: 10.1007/s11934-017-0694-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
118
|
Towards a more scientific approach to measuring barriers to seeking health care in women with fecal incontinence: the BCABL questionnaire. Int Urogynecol J 2017; 28:505-506. [DOI: 10.1007/s00192-017-3287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
|
119
|
The Relationship of Anterior Vaginal and Apical Position to Postvoid Residual Urine. Female Pelvic Med Reconstr Surg 2017; 23:310-314. [DOI: 10.1097/spv.0000000000000390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
120
|
Zhang Q, Liu C, Hong S, Min J, Yang Q, Hu M, Zhao Y, Hong L. Excess mechanical stress and hydrogen peroxide remodel extracellular matrix of cultured human uterosacral ligament fibroblasts by disturbing the balance of MMPs/TIMPs via the regulation of TGF-β1 signaling pathway. Mol Med Rep 2016; 15:423-430. [DOI: 10.3892/mmr.2016.5994] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/31/2016] [Indexed: 11/06/2022] Open
|
121
|
Simultaneous self-created transobturator tape and laparoscopic extraperitoneal vaginal support in patients with stress urinary incontinence and prolapse of the anterior and apical vaginal compartments. Eur J Obstet Gynecol Reprod Biol 2016; 204:117-21. [PMID: 27566193 DOI: 10.1016/j.ejogrb.2016.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 06/10/2016] [Accepted: 06/28/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Stress urinary incontinence (SUI) is frequently associated with prolapse of the apical and anterior vaginal compartments. The standard treatment of SUI is transobturator tape (TOT). The usual treatment of prolapse (anterior colporrhaphy) has a high recurrence rate. The aim of this study is to evaluate the results of the treatment of SUI and concomitant anterior and apical prolapse with self-created transobturator tape and simultaneous laparoscopic anterior and apical support. STUDY DESIGN A total of 36 patients with SUI and prolapse of the anterior and apical compartments were underwent operations. The mean follow-up was 18 months. Self-created transobturator tape and laparoscopical support of the anterior and apical compartment prolapse were performed in all patients. The most important symptoms of prolapse and incontinence, the anatomical outcome, and complications were evaluated before and after the surgery. RESULTS Treatment of incontinence and anterior and apical prolapse was successful in 33/36 (91.7%), 30/36 (83.3%) and 31/36 (86.1%) patients, respectively (p<0.0001). There is a significant reduction of vaginal bulging and pelvic pressure (p<0.0001). Frequency and urgency were significantly reduced (p<0.0007 and p<0.03 respectively). There was no significant deterioration of the posterior compartment. The most important complications were bladder perforation in 2/36 (5.5%) patients and temporary urinary retention in 3/36 (8.3%) patients (Clavien-Dindo grade 3). CONCLUSION Simultaneous laparoscopic anterior and lateral extraperitoneal support and transobturator tape are effective in the treatment of patients with both conditions.
Collapse
|
122
|
Ghandour L, Minassian V, Al-Badr A, Abou Ghaida R, Geagea S, Bazi T. Prevalence and degree of bother of pelvic floor disorder symptoms among women from primary care and specialty clinics in Lebanon: an exploratory study. Int Urogynecol J 2016; 28:105-118. [PMID: 27394129 DOI: 10.1007/s00192-016-3080-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/14/2016] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The prevalence of pelvic floor disorders (PFD) and their impact on quality of life of women vary among different populations. The purpose of this study was to assess the prevalence of symptoms of PFD, and their degree of bother in a convenience sample of Lebanese women, and to evaluate health-care seeking (HCS) behavior related to PFD. METHODS Women visiting clinics in a University Medical Center in Beirut, Lebanon, completed the self-filled validated Arabic version of the Global Pelvic Floor Bother Questionnaire (PFBQ). Data covering demographics, comorbidities, and HCS behavior related to PFD were collected. Total individual PFBQ scores, individual PFD symptom scores and HCS behavior were correlated to demographic data and comorbidities. RESULTS The study participants included 900 women. PFBQ scores were significantly higher in women of older age, women with a lower level of education, women with higher vaginal parity, and women who engaged in heavy lifting/physical activity. BMI >25 kg/m2 was the strongest independent risk factor for the presence of PFD symptoms. The overall prevalence of urinary incontinence was 42 %. Anal incontinence was the most bothersome PFD. Almost two thirds of the women reported HCS due to any aspect of PFD. Among symptomatic women who believed that their PFD warranted HCS, financial concern was the most common obstacle irrespective of age and educational level. CONCLUSIONS In this convenience sample of Lebanese women, PFD symptoms were common and were significantly correlated with demographic characteristics and self-reported comorbidities. The key reason for not seeking health care related to PFD was financial concern.
Collapse
Affiliation(s)
- Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Vatche Minassian
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmed Al-Badr
- King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Rami Abou Ghaida
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sandra Geagea
- Department of Obstetrics and Gynecology, Faculty of Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Tony Bazi
- Department of Obstetrics and Gynecology, Faculty of Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| |
Collapse
|
123
|
Bazi T, Takahashi S, Ismail S, Bø K, Ruiz-Zapata AM, Duckett J, Kammerer-Doak D. Prevention of pelvic floor disorders: international urogynecological association research and development committee opinion. Int Urogynecol J 2016; 27:1785-1795. [PMID: 26971276 DOI: 10.1007/s00192-016-2993-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/18/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor disorders (PFD), including urinary incontinence, anal incontinence, and pelvic organ prolapse, are common and have a negative effect on the quality of life of women. Treatment is associated with morbidity and may not be totally satisfactory. Prevention of PFDs, when possible, should be a primary goal. The purpose of this paper is to summarise the current literature and give an evidence-based review of the prevention of PFDs METHODS: A working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the prevention of PFDs was drafted, based on a review of the English-language literature. After evaluation by the entire IUGA R&D Committee, revisions were made. The final document represents the IUGA R&D Committee Opinion on the prevention of PFDs. RESULTS This R&D Committee Opinion reviews the literature on the prevention of PFDs and summarises the findings with evidence-based recommendations. CONCLUSIONS Pelvic floor disorders have a long latency, and may go through periods of remission, thus making causality difficult to confirm. Nevertheless, prevention strategies targeting modifiable risk factors should be incorporated into clinical practice before the absence of symptomatology.
Collapse
Affiliation(s)
- Tony Bazi
- Department of Obstetrics and Gynecology, Faculty of Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Sharif Ismail
- Brighton and Sussex Medical School, Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK
| | - Kari Bø
- Norwegian School of Sport Sciences, Oslo, Norway
| | - Alejandra M Ruiz-Zapata
- Department of Obstetrics and Gynecology, Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonathan Duckett
- Directorate of Women's Health, Medway NHS Foundation Trust, Gillingham, UK
| | - Dorothy Kammerer-Doak
- Women's Pelvic Specialty Care of New Mexico, University of New Mexico Hospital, Albuquerque, NM, USA
| |
Collapse
|
124
|
Richter LA, Sokol AI. Pelvic Organ Prolapse---Vaginal and Laparoscopic Mesh: The Evidence. Obstet Gynecol Clin North Am 2016; 43:83-92. [PMID: 26880510 DOI: 10.1016/j.ogc.2015.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This report summarizes the current literature on abdominal, laparoscopic, and transvaginal mesh for the treatment of pelvic organ prolapse. This article reviews objective and subjective cure rates as well as complications associated with synthetic mesh use for pelvic organ prolapse repair. The focus is on the latest literature that provides evidence for when synthetic mesh use is most appropriate. The use of mesh for the repair of urinary incontinence is not reviewed in this article.
Collapse
Affiliation(s)
- Lee A Richter
- Departments of Obstetrics and Gynecology, and Urology, National Center for Advanced Pelvic Surgery, MedStar Washington Hospital Center, 106 Irving Street NW POB South #405, Washington, DC 20010, USA.
| | - Andrew I Sokol
- Departments of Obstetrics and Gynecology, and Urology, National Center for Advanced Pelvic Surgery, MedStar Washington Hospital Center, 106 Irving Street NW POB South #405, Washington, DC 20010, USA
| |
Collapse
|
125
|
Aizawa N. Editorial Comment from Dr Aizawa to Propiverine increases urethral wall catecholamine levels and bladder leak point pressure in rats. Int J Urol 2015; 23:100-1. [PMID: 26611173 DOI: 10.1111/iju.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Naoki Aizawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
| |
Collapse
|