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Wiegersma M, Panman CMCR, Hesselink LC, Malmberg AGA, Berger MY, Kollen BJ, Dekker JH. Predictors of Success for Pelvic Floor Muscle Training in Pelvic Organ Prolapse. Phys Ther 2019; 99:109-117. [PMID: 30329105 DOI: 10.1093/ptj/pzy114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 06/18/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although the effectiveness of pelvic floor muscle training in women with prolapse has been demonstrated in several studies, there seem to be subgroups of responders and nonresponders. OBJECTIVE The objective of this study was to identify factors that predict treatment success in women receiving pelvic floor muscle training for prolapse. DESIGN The design was a secondary analysis of data from 2 randomized controlled trials comparing conservative prolapse treatments. METHODS After 12 months, 172 women subjectively assessed treatment success ("better") or failure ("the same" or "worse"). Potential predictors were identified by a literature search and by consultation with experts in the field of urogynecology and pelvic floor muscle training. The relationship between potential predictors and treatment success was explored using logistic regression analysis. RESULTS Treatment was successful in 94 women (55%) and unsuccessful in 78 women (45%). The presence of ≥1 indicators of obstetric trauma (eg, high birth weight, episiotomy, perineal laceration during vaginal delivery, forceps delivery, or vacuum extraction) (odds ratio = 4.4; 95% CI = 1.6-12.0) and younger age (odds ratio = 0.94 per year; 95% CI = 0.9-1.0) independently predicted treatment success. The area under the receiver operating characteristic curve for the final model was 0.65 (95% CI = 0.57-0.74), and the model explained 11.7% of the variance. LIMITATIONS Although attempts were made to include all relevant predictors, the selection or operationalization of variables could have been incomplete or insufficient. CONCLUSIONS Identifying women who have prolapse and are likely to benefit most from pelvic floor muscle training is of great importance to clinical practice. In this study, 2 factors that independently predicted favorable outcomes were identified with this management approach. However, further research is needed to identify other predictive factors and to validate a new model in another population.
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Affiliation(s)
- Marian Wiegersma
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | | | | | - Janny H Dekker
- Department of General Practice, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, Postbus 196/FA21, Groningen, the Netherlands
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Rios de Araújo Mathias AE, de Oliveira MS, Haruta CM, de Lima FM, de Petribú KCL, de Aguiar Cavalcanti G, Swift SE, Digesu A. Transcultural translation and validation of the FIGO Assessment Scoring System (FASS) to Portuguese language. Int Urogynecol J 2018; 30:131-137. [PMID: 30357470 DOI: 10.1007/s00192-018-3789-x] [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: 08/15/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our aim was to validate the Brazilian Portuguese version of the International Federation of Gynecology and Obstetrics (FIGO) Assessment Scoring System (FASS) to identify and quantify signs and symptoms related to pelvic floor dysfunction. METHODS One hundred and seventy-nine women aged 18-82 (47.68 ± 14.42) years participated in this validation study. Collected data included a sociodemographic and clinical questionnaire, application of the FASS, and physical examination using the Pelvic Prgan Prolapse Quantification (POP-Q) system. The translation and cross-cultural adaptation were performed following the international methodology. The psychometric properties tested were criterion validity, construct validity, stability, and reliability. For this purpose, the comparison with POP-Q findings and between symptomatic and asymptomatic patients, test-retest and internal consistency (Cronbach's alpha) were used, respectively. The intraclass correlation coefficient (ICC) was calculated to assess the level of agreement between evaluations (inter- and intraobservers). P < 0.05 was considered statistically significant. RESULTS The calculated Cronbach's alpha coefficient was 0.76, indicating strong reliability for the validation sample. Symptomatic women had different scores on all FASS items as well as total score when compared with asymptomatic women (p < 0.001). Intraobserver coefficient ranged from 0.91 (urinary symptoms) to 0.98 (FASS total score), indicating excellent concordance level in all items. Interobserver coefficient ranged from 0.47 (intestinal symptoms) to 0.90 (FASS total score), indicating moderate to excellent correlation. CONCLUSIONS The psychometric properties tested in the FASS Portuguese version proved to be a valid and reliable for evaluating signs and symptoms related to pelvic floor function in Brazilian women.
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Affiliation(s)
| | | | | | | | | | - Geraldo de Aguiar Cavalcanti
- Federal University of Pernambuco (UFPE), Recife, Brazil. .,University of Pernambuco (UPE), campus Recife, Recife, Brazil.
| | - Steven E Swift
- Medical University of South Carolina (MUSC), Charleston, SC, USA
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Treatment of Anterior Vaginal Wall Prolapse Using Transvaginal Anterior Mesh With Apical Fixation: A Prospective Multicenter Study With up to 2 Years of Follow-up. Int Neurourol J 2018; 22:177-184. [PMID: 30286580 PMCID: PMC6177730 DOI: 10.5213/inj.1836036.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/25/2018] [Indexed: 12/05/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of a surgical polypropylene mesh for correction of anterior vaginal prolapse, with or without apical defects, by providing simultaneous reinforcement at the anterior and apical aspects of the vagina with a single-incision approach. Methods This was a prospective, multicenter, single-arm study involving women with baseline stage ≥2 anterior and/or apical vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system. The primary endpoint was defined as achievement of POP-Q stage ≤1 status. Additionally, patient-reported outcomes were assessed using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). The device under evaluation was Calistar A, which is fixed posteriorly to the sacrospinous ligaments with a novel tissue-anchoring system (TAS) and anteriorly to the obturator internus muscles. Postoperative follow-ups were scheduled at 7 days and at 6, 12, and 24 months. Results Ninety-seven women were treated and assessed for the primary outcome. They were followed for up to 2 years (n=43), with a median of 12 months. Objective cure was achieved in 86 of the 97 patients (88.7%) (P<0.0005). The mean reduction in the ICIQ-VS scores was in the range of 70%–90% for every time point (P<0.05). No bleeding or surgical revision was reported. Mesh exposure occurred in 7 patients (7.2%), urinary retention in 5 (5.2%), de novo dyspareunia in 3 (3.1%), and urinary tract infections in 7 (7.2%). Conclusions This midterm follow-up showed that apical and anterior vaginal reinforcement with a polypropylene implant fixed with a TAS provided good anatomical correction, with no major complications.
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Bhattarai A, Staat M. Computational comparison of different textile implants to correct apical prolapse in females. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2018. [DOI: 10.1515/cdbme-2018-0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractProsthetic textile implants of different shapes, sizes and polymers are used to correct the apical prolapse after hysterectomy (removal of the uterus). The selection of the implant before or during minimally invasive surgery depends on the patient’s anatomical defect, intended function after reconstruction and most importantly the surgeon’s preference. Weakness or damage of the supporting tissues during childbirth, menopause or previous pelvic surgeries may put females in higher risk of prolapse. Numerical simulations of reconstructed pelvic floor with weakened tissues and organ supported by textile product models: DynaMesh®-PRS soft, DynaMesh®-PRP soft and DynaMesh®-CESA from FEG Textiletechnik mbH, Germany are compared.
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Affiliation(s)
- Aroj Bhattarai
- 1Biomechanics Laboratory, Institute of Bioengineering, FH Aachen University of Applied Sciences,Jülich, Germany
| | - Manfred Staat
- 1Biomechanics Laboratory, Institute of Bioengineering, FH Aachen University of Applied Sciences,Jülich, Germany
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155
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Anatomical outcomes 1 year after pelvic organ prolapse surgery in patients with and without a uterus at a high risk of recurrence: a randomised controlled trial comparing laparoscopic sacrocolpopexy/cervicopexy and anterior vaginal mesh. Int Urogynecol J 2018; 30:545-555. [PMID: 29987345 DOI: 10.1007/s00192-018-3702-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Few studies have compared the different approaches of mesh surgery in patients with severe pelvic organ prolapse (POP). In addition to laparoscopic sacrocolpopexy/cervicopexy (LSC-Cx), anterior vaginal mesh (AVM) may be an effective approach for correcting anterior vaginal wall associated with apical POP in women with advanced POP. METHODS A randomised controlled trial (RCT; January 2011 to March 2016) including 120 patients (60/group) with advanced symptomatic POP, with a predominant anterior vaginal wall descent stage III or greater in combination with a stage II or III apical defect (uterus or vaginal vault). Patients underwent four visits: baseline, 3, 6 and12 months after surgery. The main outcome was anatomical success defined as anterior and posterior vaginal wall not descending beyond the hymen and vaginal apex descent no more than one third into the vagina. Secondary variables: PFDI, ICIQ-UI-SF, intraoperative variables, postoperative morbidity and complications. RESULTS Anatomical success was achieved with LSC-Cx in 79% and with AVM in 76% (NS). No statistically significant differences were found among POP-Q anterior vaginal wall points between groups, whereas better results were obtained with LSC-Cx in posterior vaginal wall points and total vaginal length. Intraoperative outcomes were similar in the two groups, except for operating time (78.05 min LSC-Cx vs 44.28 min AVM). There were no statistically significant differences related to de novo stress urinary incontinence and dyspareunia. Worse results were found in the CRADI-8 in the LSC-Cx group, owing to constipation. Late postoperative complications and reinterventions were similar in the two groups. CONCLUSIONS No differences were found in the anatomical correction of anterior and apical POP. The LSC-Cx group presented better correction of posterior vaginal wall defects and a longer total vaginal length.
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Abdulaziz M, Kavanagh A, Stothers L, Macnab AJ. Relevance of open magnetic resonance imaging position (sitting and standing) to quantify pelvic organ prolapse in women. Can Urol Assoc J 2018; 12:E453-E460. [PMID: 29989885 DOI: 10.5489/cuaj.5186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In pelvic organ prolapse (POP), posture and gravity impact organ position and symptom severity. The advanced magnet configuration in open magnetic resonance imaging (MRO) allows patients to be imaged when sitting and standing, as well in a conventional supine position. This study evaluated if sitting and standing MRO images are relevant as a means of improving quantification of POP because they allow differences in organ position not seen on supine imaging to be identified. METHODS Forty women recruited from a university urogynecology clinic had MRO imaging (0.5 T scanner) with axial and sagittal T2-weighted pelvic scans obtained when sitting, standing, and supine. Pelvic reference lines were used to quantify the degree of POP, and the relevance of imaging position on the detection of POP compared. RESULTS Images from 40 participants were evaluated (20 with POP and 20 asymptomatic controls). Our results indicate that the maximal extent of prolapse is best evaluated in the standing position using H line, M line, mid-pubic line, and perineal line as reference lines to determine POP. CONCLUSIONS MRO imaging of symptomatic patients in a standing position is relevant in the quantification of POP. Compared with supine images, standing imaging identifies that greater levels of downward movement in the anterior and posterior compartments occur, presumably under the influence of posture and gravity. In contrast, no appreciable benefit was afforded by imaging in the sitting position, which precluded use of some reference lines due to upward movement of the anorectal junction.
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Affiliation(s)
- Marwa Abdulaziz
- PhD Candidate, Department of Experimental Medicine, Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Lynn Stothers
- Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Andrew J Macnab
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada.,Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
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157
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Prolapse reduction deteriorates the urethral closure mechanism. Int Urogynecol J 2018; 30:489-493. [DOI: 10.1007/s00192-018-3647-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/28/2018] [Indexed: 11/26/2022]
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Dos Santos RGM, Pepicelli FCA, Batista NC, de Carvalho CV, Bortolini MAT, Castro RA. Collagen XVIII and LOXL-4 polymorphisms in women with and without advanced pelvic organ prolapse. Int Urogynecol J 2018. [PMID: 29532123 DOI: 10.1007/s00192-018-3597-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We verified the presence of single nucleotide polymorphisms (SNP) rs2236479 of the collagen 18 (COL18A1) and rs2862296 of the lysyl oxidase-like 4 (LOXL-4) genes and the association with pelvic organ prolapse (POP) in Brazilian women and determined risk factors for POP development. METHODS We assessed 532 postmenopausal women divided into POP (stages III and IV) and control (stages 0 and I) groups by examination and peripheral blood sample collection. DNA sequences of interest were analyzed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). We used logistic regression models for the analyses, with p < 0.005 for significance. RESULTS The frequency of homozygous polymorphic alleles (AA) in COL18A1 and (GG) in LOXL-4 were similar in both groups (17.5% and 15.4% for COL18A1 and 18.9% and 20.6% for LOXL-4, respectively). There were no associations between those polymorphisms or other genotypes and POP. Multiple logistic regression analysis identified age [odds ratio (OR) = 1.10, confidence interval (CI) 95% = 1.07; 1.14), number of vaginal births (OR = 1.66, CI 95% = 1.36; 2.03), and family history (OR = 2.55 CI 95% = 1.43; 4.55) as independent risk factors for POP. CONCLUSION Our study suggests lack of association between DNA polymorphisms rs2236479 of COL18A1 and rs2862296 of LOXL-4 with advanced POP in this population.
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Affiliation(s)
- Renata G M Dos Santos
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua: Rodolfo Belz, 220/42A, São Paulo, SP, CEP: 04024-002, Brazil
| | - Fernanda C A Pepicelli
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua: Rodolfo Belz, 220/42A, São Paulo, SP, CEP: 04024-002, Brazil
| | - Nilce C Batista
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua: Rodolfo Belz, 220/42A, São Paulo, SP, CEP: 04024-002, Brazil
| | - Cristina V de Carvalho
- Division of Molecular Biology, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Maria A T Bortolini
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua: Rodolfo Belz, 220/42A, São Paulo, SP, CEP: 04024-002, Brazil.
| | - Rodrigo A Castro
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua: Rodolfo Belz, 220/42A, São Paulo, SP, CEP: 04024-002, Brazil
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Duarte TB, Bonacin MAP, Brito LGO, Frawley H, Dwyer PL, Thomas E, Ferreira CHJ. Does pelvic floor muscle maximum voluntary contraction improve after vaginal pelvic organ prolapse surgery? A prospective study. Neurourol Urodyn 2018. [DOI: 10.1002/nau.23503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Thaiana B. Duarte
- Department of Biomechanics; Medicine and Rehabilitation; Postgraduate Program in Rehabilitation and Performance; Ribeirão Preto Medical School; University of São Paulo; Brazil
| | - Marília A. P. Bonacin
- Department of Biomechanics; Medicine and Rehabilitation; Postgraduate Program in Rehabilitation and Performance; Ribeirão Preto Medical School; University of São Paulo; Brazil
| | - Luiz G. O. Brito
- Department of Gynecology and Obstetrics; School of Medical Sciences; University of Campinas; Brazil
| | - Helena Frawley
- Department of Physiotherapy; School of Primary and Allied Health Care; Monash University; Melbourne Australia
| | - Peter L. Dwyer
- Urogynaecology Department; Mercy Hospital for Women; Melbourne Australia
| | - Elizabeth Thomas
- Urogynaecology Department; Mercy Hospital for Women; Melbourne Australia
| | - Cristine H. J. Ferreira
- Department of Biomechanics; Medicine and Rehabilitation; Postgraduate Program in Rehabilitation and Performance; Ribeirão Preto Medical School; University of São Paulo; Brazil
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Panico G, Campagna G, Caramazza D, Amato N, Ercoli A, Scambia G, Cervigni M, Zaccoletti R. Laparoscopic high uterosacral ligament suspension: an alternative route for a traditional technique. Int Urogynecol J 2018; 29:1227-1229. [PMID: 29500517 DOI: 10.1007/s00192-018-3588-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/31/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Uterovaginal prolapse treatment is a challenge for the urogynecologist. Surgical management for apical prolapse can be successful with native tissue and uterosacral ligament (USL) fixation. However, some complications have been described, especially with use of the vaginal approach. The aim of this video is to describe an alternative laparoscopic approach to a traditional vaginal procedure to reduce nerve injury and ureteral complications. METHODS A 75-year-old woman was referred to our unit for symptomatic stage III apical prolapse and underwent laparoscopic USL fixation, according to the technique described herein. RESULTS This surgical technique was successful in correcting apical prolapse. CONCLUSIONS This video tutorial may be useful to urogynecologists for improving surgical technique, thus leading to a reduction in the risk of nerve and ureteral complications. The technique offers the possibility of a correct under-vision suture positioning. Laparoscopic USL fixation can be safely performed to treat apical prolapse.
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Affiliation(s)
- Giovanni Panico
- Department of Woman And Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Giuseppe Campagna
- Department of Woman And Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Daniela Caramazza
- Department of Woman And Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Nicola Amato
- Obstetrics and Gynecology Unit, P. Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Maggiore Hospital, Novara, Italy
| | - Giovanni Scambia
- Department of Woman And Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Mauro Cervigni
- Department of Woman And Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Zaccoletti
- Obstetrics and Gynecology Unit, P. Pederzoli Hospital, Peschiera del Garda, Verona, Italy
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Coolen ALWM, Bui BN, Dietz V, Wang R, van Montfoort APA, Mol BWJ, Roovers JPWR, Bongers MY. The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int Urogynecol J 2017; 28:1767-1783. [PMID: 29038834 PMCID: PMC5705749 DOI: 10.1007/s00192-017-3493-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 09/13/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The treatment of post-hysterectomy vaginal vault prolapse (VVP) has been investigated in several randomized clinical trials (RCTs), but a systematic review of the topic is still lacking. The aim of this study is to compare the effectiveness of treatments for VVP. METHODS We performed a systematic review and meta-analysis of the literature on the treatment of VVP found in PubMed and Embase. Reference lists of identified relevant articles were checked for additional articles. A network plot was constructed to illustrate the geometry of the network of the treatments included. Only RCTs reporting on the treatment of VVP were eligible, conditional on a minimum of 30 participants with VVP and a follow-up of at least 6 months. RESULTS Nine RCTs reporting 846 women (ranging from 95 to 168 women) met the inclusion criteria. All surgical techniques were associated with good subjective results, and without differences between the compared technique, with the exception of the comparison of vaginal mesh (VM) vs laparoscopic sacrocolpopexy (LSC). LSC is associated with a higher satisfaction rate. The anatomical results of the sacrocolpopexy (laparoscopic, robotic [RSC]. and abdominal [ASC]) are the best (62-91%), followed by the VM. However, the ranges of the anatomical outcome of VM were wide (43-97%). The poorest results are described for the sacrospinal fixation (SSF; 35-81%), which also correlates with the higher reoperation rate for pelvic organ prolapse (POP; 5-9%). The highest percentage of complications were reported after ASC (2-19%), VM (6-29%), and RSC (54%). Mesh exposure was seen most often after VM (8-21%). The rate of reoperations carried out because of complications, recurrence prolapse, and incontinence of VM was 13-22%. Overall, sacrocolpopexy reported the best results at follow-up, with an outlier of one trial reporting the highest reoperation rate for POP (11%). The results of the RSC are too small to make any conclusion, but LSC seems to be preferable to ASC. CONCLUSIONS A comparison of techniques was difficult because of heterogeneity; therefore, a network meta-analysis was not possible. All techniques have proved to be effective. The reported differences between the techniques were negligible. Therefore, a standard treatment for VVP could not be given according to this review.
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Affiliation(s)
- Anne-Lotte W M Coolen
- Department of Obstetrics and Gynecology, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands.
| | - Bich Ngoc Bui
- Department of Obstetrics and Gynecology, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Viviane Dietz
- Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Rui Wang
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Aafke P A van Montfoort
- Department of Obstetrics and Gynaecology, Maastricht University, Grow School for Oncology and Developmental Biology, Minderbroedersberg 4, 6211 LK, Maastricht, The Netherlands
| | - Ben Willem J Mol
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Jan-Paul W R Roovers
- Department of Gynecology and Obstetrics, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
- Department of Obstetrics and Gynaecology, Maastricht University, Grow School for Oncology and Developmental Biology, Minderbroedersberg 4, 6211 LK, Maastricht, The Netherlands
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Khayyami Y, Lose G, Klarskov N. The urethral closure mechanism is deteriorated after anterior colporrhaphy. Int Urogynecol J 2017; 29:1311-1316. [PMID: 29103165 DOI: 10.1007/s00192-017-3504-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/12/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urethral pressure reflectometry (UPR) has proven highly reproducible in women with pelvic organ prolapse. We hypothesized that urethral parameters would decrease after anterior colporrhaphy. METHODS A prospective, observational study where women with anterior vaginal wall prolapse ≥stage II were assessed before and after anterior colporrhaphy. Assessments consisted of prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining (at a standardized abdominal pressure of 50 cmH2O, PO-Abd 50), standardized stress tests with 300 ml saline, and answering the International Consultation on Incontinence - Urinary incontinence short form. Stress urinary incontinence (SUI) was defined as a positive stress test and a questionnaire with symptoms of SUI and a bother score > 1. Sample size was 30, power was 100% and the level of significance was 5%. We analyzed data with paired t-tests or non-parametric Wilcoxon signed rank tests; p-values <0.05 were considered statistically significant. RESULTS Twenty-eight women who underwent anterior colporrhaphy completed the study. PO-Abd 50 decreased 12 cmH2O after surgery (p < 0.0001). Five women developed postoperative SUI and one had persistent SUI; the six women's preoperative PO-Abd 50 was lower than the rest (p < 0.01). If preoperative PO-Abd 50 was ≤65 cmH2O, the positive predictive value for postoperative SUI was 50%, and if PO-Abd 50 was ≥85 cmH2O, the negative predictive value was 100%. CONCLUSIONS The urethral closure mechanism deteriorates after anterior colporrhaphy. Using UPR, we can calculate a woman's risk of SUI after anterior colporrhaphy.
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Affiliation(s)
- Yasmine Khayyami
- Department of Obstetrics and Gynecology, Herlev Gentofte University Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Gunnar Lose
- Department of Obstetrics and Gynecology, Herlev Gentofte University Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Niels Klarskov
- Department of Obstetrics and Gynecology, Herlev Gentofte University Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
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Ismail S, Chartier-Kastler E, Perrouin-Verbe MA, Rose-Dite-Modestine J, Denys P, Phé V. Long-Term Functional Outcomes of S3 Sacral Neuromodulation for the Treatment of Idiopathic Overactive Bladder. Neuromodulation 2017; 20:825-829. [PMID: 28967986 DOI: 10.1111/ner.12696] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/25/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the long-term functional outcomes of sacral neuromodulation (SNM) in the treatment of refractory idiopathic overactive bladder (IOAB) and to determine predictive factors for success. MATERIALS AND METHODS To obtain long-term data, all consecutive patients suffering from IOAB and treated by SNM at a single tertiary care center between December 1996 and December 2004 were included. Data regarding patient demographics, past medical, and surgical history, bladder diary, complications as well as device revision and removal rates were collected. Success was defined as an improvement ≥ 50% of any clinical parameter. RESULTS Overall, 34 patients, with a median age of 57.8 years (IQR 44.8-65.7) were included. Immediately after definitive implantation, 2 (6%) patients were lost to follow-up. After a median follow-up of 9.7 years (IQR 4.7-12.0), SNM was considered successful in 20 (63%) patients. Mean amount of protections used per 24 hours significantly decreased (4.1 preoperatively vs. 1.8 at the last follow-up visit, p = 0.02). Devices were removed in 2 (6%) patients due to pain and lack of efficacy. Twenty-two revision surgeries were performed in 15 (47%) patients. First revision surgery occurred after a mean of 6.2 years (± 3.1). Revision surgeries were mainly performed for end of battery life/device dysfunction (n = 18, 82%). No significant predictor for success was identified. CONCLUSIONS With a median follow-up time of 9.7 years, this retrospective SNM study reports a 63% efficacy rate (≥ 50% improvement) for the treatment of refractory IOAB. Moreover, it is a well-tolerated and minimally invasive therapy.
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Affiliation(s)
- Salima Ismail
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France.,Departments of Rehabilitation and Neurourology, Garches Academic Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France.,Inserm Research Unit 1179, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Marie-Aimée Perrouin-Verbe
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
| | - Johan Rose-Dite-Modestine
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
| | - Pierre Denys
- Departments of Rehabilitation and Neurourology, Garches Academic Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France.,Inserm Research Unit 1179, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
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Robinson D, Thiagamoorthy G, Cardozo L. Post-hysterectomy vaginal vault prolapse. Maturitas 2017; 107:39-43. [PMID: 29169578 DOI: 10.1016/j.maturitas.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/28/2017] [Indexed: 11/25/2022]
Abstract
Post-hysterectomy vaginal vault prolapse (PHVP) is a recognised although rare complication following both abdominal and vaginal hysterectomy and the risk is increased in women following vaginal surgery for urogenital prolapse. The management of PHVP remains challenging and whilst many women will initially benefit from conservative measures, the majority will ultimately require surgery. The purpose of this paper is to review the prevalence and risk factors associated with PHVP as well to give an overview of the clinical management of this often complicated problem. The role of prophylactic primary prevention procedures at the time of hysterectomy will be discussed as well as initial conservative management. Surgery, however, remains integral in managing these complex patients and the vaginal and abdominal approach to managing PHVP will be reviewed in detail, in addition to both laparoscopic and robotic approaches.
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Affiliation(s)
- Dudley Robinson
- Department Of Urogynaecology, Kings College Hospital, United Kingdom.
| | | | - Linda Cardozo
- Department Of Urogynaecology, Kings College Hospital, United Kingdom
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165
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Song XC, Zhu L, Liang S, Xu T. Changes in voiding function after laparoscopic sacrocolpopexy for advanced pelvic organ prolapse: a cohort study of 76 cases. Int Urogynecol J 2017; 29:505-512. [PMID: 28721481 DOI: 10.1007/s00192-017-3412-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/21/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We evaluated changes in voiding function at 3 months after laparoscopic sacrocolpopexy (LSC) for advanced pelvic organ prolapse (POP) patients and identified risk predictors for postoperative voiding dysfunction. METHODS Seventy-six patients with advanced POP who underwent LSC were enrolled in this retrospective cohort study. Pre- and postoperative objective voiding function was assessed by uroflowmetry plus postvoid residual (PVR) volumes. Voiding dysfunction was defined as a maximum flow rate (Qmax) < 15 ml/s, average flow rate (Qave) < 10 ml/s, or PVR > 50 ml. Statistical analyses were performed using paired-sample t tests, McNemar's tests, and multivariate regression analyses. RESULTS Thirty patients (39%) showed evidence of voiding dysfunction preoperatively, but two thirds of these patients were asymptomatic. Voiding dysfunction decreased significantly from baseline to 3 months after surgery (39% vs. 21%, p = 0.009), including a decrease among patients with Qave < 10 ml/s (32% vs. 17%, p = 0.043) and PVR > 50 ml (24% vs. 9%, p = 0.019). Voiding difficulty decreased significantly from baseline to 3 months after surgery (32% vs. 9%, p < 0.001); urgency and urinary incontinence symptoms did not exhibit significant improvement (p > 0.05). Multivariate analysis identified Qave < 10 ml/s as the independent predictor of postoperative voiding dysfunction [p = 0.014, odds ratio (OR) = 4.77, 95% confidence interval (CI) 1.37-16.54]. CONCLUSIONS Preoperative voiding dysfunction is common among patients with POP and significantly improves at 3 months following LSC. A preoperative Qave < 10 ml/s was an independent risk factor for postoperative voiding dysfunction.
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Affiliation(s)
- Xiao-Chen Song
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifu Road, Dongcheng District, Beijing, People's Republic of China, 100730
| | - Lan Zhu
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifu Road, Dongcheng District, Beijing, People's Republic of China, 100730.
| | - Shuo Liang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifu Road, Dongcheng District, Beijing, People's Republic of China, 100730
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, People's Republic of China
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Posterior colporrhaphy does not affect the urethral closure mechanism. Int Urogynecol J 2017; 29:125-130. [PMID: 28695343 DOI: 10.1007/s00192-017-3401-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Studies have suggested that a posterior vaginal wall prolapse might compress the urethra and mask stress urinary incontinence (SUI), much like an anterior vaginal wall prolapse. A recent study with urethral pressure reflectometry (UPR) has shown that the urethral closure mechanism deteriorates after anterior colporrhaphy; this could explain the occurrence of postoperative de novo SUI. We hypothesized that urethral pressure would also decrease after posterior colporrhaphy. METHODS This was a prospective, observational study where women with posterior vaginal wall prolapse ≥stage II were examined before and after posterior colporrhaphy. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining, and standardized stress tests with 300 ml saline. The women filled out International Consultation on Incontinence-Urinary incontinence (ICIQ-UI) short forms. The sample size was 18, with a power of 99.9% and a level of significance of 5%. Parameters were compared using paired t tests or Fisher's exact test, where appropriate; p values <0.05 were considered statistically significant. RESULTS Eighteen women with posterior vaginal wall prolapse ≥stage II were recruited. One woman did not undergo surgery. There were no changes in urethral pressure at rest (p = 0.4), during squeezing (p = 0.2) or straining (p = 0.2), before and after surgery. The results of the stress tests and ICIQ-UI short forms were the same after surgery. CONCLUSIONS The urethral closure mechanism is not affected by posterior colporrhaphy. Our study does not support the theory that the posterior vaginal wall prolapse compresses the urethra and masks SUI.
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Reoperation for pelvic organ prolapse: a Danish cohort study with 15-20 years' follow-up. Int Urogynecol J 2017; 29:119-124. [PMID: 28674735 DOI: 10.1007/s00192-017-3395-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 06/03/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objectives were to determine the reoperation rate of primary pelvic organ prolapse (POP) surgery, to describe the age distribution of the women at primary surgery for those undergoing a reoperation, and to describe the incidence of second and third reoperations. METHODS We carried out a population-based registry study of Danish women above the age of 18 years when undergoing primary surgery for POP during the period 1996-2000. Data were retrieved from the Danish National Patient Register. All women were followed until one of the following events occurred: reoperation for POP, death, emigration, or end of follow-up period. Reoperation was defined as "repeated surgery in same compartment". The cumulative incidence rate of reoperation was divided into three compartments (anterior, apical, and posterior) and was calculated using Kaplan-Meier plots. RESULTS A total of 18,382 procedures were performed on 11,805 women. After 20 years' follow-up, the cumulated incidence rate of reoperation for POP in the anterior, apical, and posterior compartments was 12.4%, 7.9%, and 12.1% respectively. The overall rate of reoperation was 11.5%. Of women aged between 18 and 49 years of age at primary surgery, 26.9% had a reoperation, whereas in women between 50 and 90+ years of age at primary surgery, only 10.1% had a reoperation. CONCLUSIONS This large study with up to 20 years' follow-up has found that reoperation for POP is modest, that the reoperation rate is lowest for the apical compartment, but highest in all three compartments during the first year after primary surgery. The reoperation rate peaks in the group of women who had their primary surgery before the menopause in all three compartments.
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168
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Pellino G, Ramage L, Simillis C, Warren O, Kontovounisios C, Tan E, Tekkis P. Evaluation of sexual dysfunction in female patients presenting with faecal incontinence or defecation disorder. Int J Colorectal Dis 2017; 32:667-674. [PMID: 28299421 DOI: 10.1007/s00384-017-2795-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Female patients with pelvic floor diseases may suffer from several sexual disorders and sexual life impairments. The aim of this manuscript was to evaluate sexual dysfunction in female patients presenting with faecal incontinence (FI) and defecation disorder (DD). METHODS A retrospective review was performed of a prospectively collected database of sexually active women referred to the pelvic floor clinic, who completed the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 (PISQ-12) at first visit. Statistical analysis was performed to evaluate and compare sexual dysfunction between patients with FI and DD and with published data on the general population. Regression analysis was used to identify predictors of sexual dysfunction and surgery. RESULTS Three hundred thirteen patients were included, 192 (61%) with FI and 121 (39%) with DD. The patients with DD received more non-gynaecological surgical procedures (p = 0.023). More patients with DD received surgery for their current pelvic floor disease (p < 0.001). Major sexual impairment (PISQ-12 < 30) was found in 100 patients (31.9%). The mean PISQ-12 (33.2 ± 7.2) score was by 5 points lower than those reported in the general population from PISQ-validating studies. Prior anorectal surgery (odds ratio (OR) = 15.4), partner ejaculation problems (PISQ item 11, OR = 2.5), reduced sexual arousal (item 2, OR = 2.1), and orgasm perception (item 13, OR = 2.1) were the strongest predictors of worse sexual function in patients with FI. Patients with DD were almost 15 times more likely to receive subsequent surgery (OR = 14.6, p < 0.001), whereas fear of urine leakage almost doubled the risk. CONCLUSIONS Sexual dysfunction is prevalent among patients suffering from FI and DD, and questionnaires are useful in recognizing these patients. Subsequent surgery is more common for patients with DD compared to those with FI.
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Affiliation(s)
- Gianluca Pellino
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Lisa Ramage
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Constantinos Simillis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Oliver Warren
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK. .,Academic Surgery, 3rd Floor, Chelsea and Westminster Hospital, Imperial College London, Fulham Road, London, SW3 6JJ, UK.
| | - Emile Tan
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK.,Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Paris Tekkis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
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169
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STRES ÜRİNER İNKONTİNANSLI KADINLARDA PELVİK TABAN KAS EĞİTİMİNE EK OLARAK UYGULANAN ELEKTROMYOGRAFİK BİOFEEDBACK EĞİTİMİNİN ETKİNLİĞİNİN İNCELENMESİ. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2017. [DOI: 10.21673/anadoluklin.301479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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170
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Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, Bader A, Calligaro A, Elias JA, Gambaciani M, Gaviria JE, Iglesia CB, Selih-Martinec K, Mwesigwa PL, Ogrinc UB, Salvatore S, Scollo P, Zerbinati N, Nelson JS. Light and energy based therapeutics for genitourinary syndrome of menopause: Consensus and controversies. Lasers Surg Med 2017; 49:137-159. [PMID: 28220946 DOI: 10.1002/lsm.22637] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 11/09/2022]
Abstract
Gynecologist and plastic surgeons pioneered the application of lasers in medicine and surgery almost 5 decades ago, initially used to treat cervical and vaginal pathologies. Ever since, energy-based devices have been deployed to treat pelvic pathologies and improve fertility. Recent technological developments triggered an unprecedented wave of publications, assessing the efficacy of fractional laser, and radiofrequency on the vaginal wall in reversing natural aging processes. Studies have shown that a certain degree of thermal energy deposited on the vaginal wall stimulates proliferation of the glycogen-enriched epithelium, neovascularization, and collagen formation in the lamina propria, and improves natural lubrication and control of urination. This review aimed to review such data and to guide future research. A unique assembly of experts from around the globe, compiled and edited this manuscript based on a thorough literature review and personal experience. Lasers Surg. Med. 49:137-159, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yona Tadir
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| | - Adrian Gaspar
- Department of Laser Surgery, Mendoza Hospital, Mendoza, Argentina
| | - Ahinoam Lev-Sagie
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Macrene Alexiades
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Red Alinsod
- South Coast Urogynecology, Laguna Beach, California
| | - Alex Bader
- Reconstruction & Cosmetic Gynecology, London, UK
| | - Alberto Calligaro
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Jorge A Elias
- Urogynecology and Aesthetic Gynecology Clinic, Boenos Aires, Argentina
| | - Marco Gambaciani
- Department of Obstetrics and Gynecology, University Hospital Pisa, Pisa, Italy
| | - Jorge E Gaviria
- Aesthetics and Laser Medical Educational Center, Korpo Laser, Caracas, Venezuela
| | - Cheryl B Iglesia
- Departments of Obstetrics and Gynecology, Georgetown University, Washington, District of Columbia
| | | | - Patricia L Mwesigwa
- Departments of Obstetrics and Gynecology, Georgetown University, Washington, District of Columbia
| | | | - Stefano Salvatore
- Department of Obstetrics and Gynecology, San Raffaele University, Milan, Italy
| | - Paolo Scollo
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy
| | - Nicola Zerbinati
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - John Stuart Nelson
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
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171
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Dekker JH. Pelvic organ prolapse: prevention by training? Lancet 2017; 389:336-337. [PMID: 28010990 DOI: 10.1016/s0140-6736(16)32108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Janny H Dekker
- Department of General Practice, University Medical Center Groningen, PO Box 196, 9700 AD Groningen HPC FA21, Netherlands.
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172
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Nair R, Nikolopoulos K, Claydon L. Clinical outcomes in women undergoing laparoscopic hysteropexy: A systematic review. Eur J Obstet Gynecol Reprod Biol 2017; 208:71-80. [DOI: 10.1016/j.ejogrb.2016.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/18/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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Urethral pressure reflectometry in women with pelvic organ prolapse: a study of reproducibility. Int Urogynecol J 2016; 28:705-710. [PMID: 27826638 DOI: 10.1007/s00192-016-3187-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The mechanism of continence in women with pelvic organ prolapse (POP) before and after surgery remains unknown. Urethral pressure reflectometry (UPR) separates women with stress urinary incontinence (SUI) from continent women by measuring urethral opening pressure at an abdominal pressure of 50 cmH2O (P O-Abd 50). UPR can help identify women with POP at risk of postoperative de novo SUI. The aim of this study was to investigate the reproducibility of UPR in women with POP. METHODS Women with anterior or posterior vaginal wall prolapse were recruited for this prospective, observational study from our outpatient clinic. The women were examined with UPR on two occasions. Measurements were done at rest, and during squeezing and straining. Statistical analyses were performed using SAS 9.4. A Bland-Altman analysis with limits of agreement and coefficients of variation was used to determine the level of agreement between measurements. Paired t tests were used to estimate the difference; a two-tailed P value of <0.05 was considered significant. RESULTS We recruited 19 women with anterior vaginal wall prolapse and 11 women with posterior vaginal wall prolapse. There were no significant differences in the opening pressures at rest or during squeezing or in the values of P O-Abd 50. P O-Abd 50 showed limits of agreement of 15.3 cmH2O and a coefficient of variation of 9.9 %. CONCLUSIONS UPR was found to be a highly reproducible method in women with POP. UPR may be used in future studies to help reveal urodynamic features predictive of postoperative de novo SUI in women with POP.
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174
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Variability in practice patterns in stress urinary incontinence and pelvic organ prolapse: results of an IUGA survey. Int Urogynecol J 2016; 28:735-744. [PMID: 27752749 DOI: 10.1007/s00192-016-3174-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Members of the International Urogynecological Association (IUGA) come from different geographic locations and practice settings. A member survey regarding practice patterns provides valuable information for practitioners and researchers alike, and allows the IUGA to discover areas to focus on education and information dissemination. METHODS A questionnaire was developed by the IUGA Research and Development committee and distributed electronically to IUGA surgeons. Answers were analyzed in reference to demographics, geographic distribution, and academic affiliation. RESULTS Five hundred sixty-four members answered the questionnaire, representing a 28 % response rate, and closely reflecting the geographic distribution of IUGA membership. Preferred surgical treatment for uncomplicated SUI was the mid-urethral trans-obturator sling (49.7 %). Vaginal mesh was mainly used for repair of recurrent POP (20.4 %). Pessary use was offered "always" or "frequently" by 61.5 %, with no difference in academic affiliation, but significant differences based on region of practice. Compared to practitioners in non-academic centers, those with academic affiliation utilized Urodynamic studies (UDS) and Magnetic Resonance Imaging (MRI) more frequently in the evaluation of POP. Regions of practice significantly influenced the majority of practice patterns, with the highest impact found in the use of robotic assistance. CONCLUSIONS Many practice patterns in the evaluation and treatment of POP and SUI depend on academic affiliation and geographic location. Practice patterns are not always based on most recent evidence-based data.
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175
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Bray R, Derpapas A, Fernando R, Khullar V, Panayi DC. Does the vaginal wall become thinner as prolapse grade increases? Int Urogynecol J 2016; 28:397-402. [PMID: 27678142 PMCID: PMC5331079 DOI: 10.1007/s00192-016-3150-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/01/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The pathophysiology of prolapse is not well understood. However, two main theories predominate: either the fibromuscular layer of the vagina develops a defect/tears away from its supports, or its tissues are stretched and attenuated. The aim of this study was to assess how vaginal wall thickness (VWT) is related to vaginal prolapse. METHODS The study group comprised 243 women with symptomatic prolapse recruited from the Outpatient Department of a tertiary referral centre for urogynaecology. A history was taken and women were examined to determine their POP-Q score. Using a previously validated technique, ultrasonography was used to measure the mean VWT at three anatomical sites on the anterior and posterior walls. Scores were then compared using t tests, the Kruskal-Wallis test and the Friedman test. RESULTS The mean age of the patients was 59.7 years (SD 12.0 years range 38 - 84 years). For each measurement VWT reduced as prolapse grade increased until the prolapse extended beyond the hymen. Women with grade 3 prolapse had a significantly higher mean VWT than women with grade 1 or 2 contained prolapse. Menopause status did not have a significant effect on the VWT. CONCLUSIONS VWT is lower in women with vaginal prolapse until the prolapse extends beyond the hymen and then VWT is thicker and comparable with women without prolapse. This may be explained by changes in the vaginal tissue including reduction of collagen, elastin and smooth muscle, as well as fibrosis in exposed tissues, rather than by defects in the vagina.
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Affiliation(s)
- Rhiannon Bray
- Department of Urogynaecology, St Mary's Hospital, Imperial NHS Trust, London, W2 1NY, UK.
| | - Alex Derpapas
- Department of Urogynaecology, St Mary's Hospital, Imperial NHS Trust, London, W2 1NY, UK
| | - Ruwan Fernando
- Department of Urogynaecology, St Mary's Hospital, Imperial NHS Trust, London, W2 1NY, UK
| | - Vik Khullar
- Department of Urogynaecology, St Mary's Hospital, Imperial NHS Trust, London, W2 1NY, UK
| | - Demetri C Panayi
- Department of Urogynaecology, Pelvic Floor and Childbirth Injury, Epsom and St. Helier NHS Trust, Carshalton, UK
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Ismail S, Duckett J, Rizk D, Sorinola O, Kammerer-Doak D, Contreras-Ortiz O, Al-Mandeel H, Svabik K, Parekh M, Phillips C. Recurrent pelvic organ prolapse: International Urogynecological Association Research and Development Committee opinion. Int Urogynecol J 2016; 27:1619-1632. [DOI: 10.1007/s00192-016-3076-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/14/2016] [Indexed: 12/13/2022]
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Native Tissue Surgery for Prolapse versus Graft/Mesh Use: Current Trends in Reconstructive Surgery. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0147-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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178
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Subjective and Objective Outcomes of Robotic and Vaginal High Uterosacral Ligament Suspension. Female Pelvic Med Reconstr Surg 2016; 22:420-424. [DOI: 10.1097/spv.0000000000000306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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