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Rechberger E, Wróbel A, Kulik-Rechberger B, Miotla P, Ziętek A, Rechberger T. The clinical efficacy and safety of outside-in transobturator sling with additional paraurethral fixation - The prospective longitudinal study. Eur J Obstet Gynecol Reprod Biol 2023; 290:22-26. [PMID: 37713944 DOI: 10.1016/j.ejogrb.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
Stress urinary incontinence (SUI) is a common condition that affect 30-40% of women in their lifetime. Midurethral slings (MUS) either suprapubic or transobturator can be safely used in the surgical treatment of SUI. The aim of this study was to collect clinical long-term data regarding safety and performance of transobturator sling with an additional tape fixation in women with urinary incontinence. This prospective longitudinal study was conducted on a group of 2086 female patients diagnosed with stress urinary incontinence. Follow up visits where scheduled 6 weeks, 6 and 12 months after surgery followed by annual checking when possible. Patients underwent transobturator sling procedure from 01.01.2011 to 31.12.2021. All patients had a monofilament tape inserted at the mid-urethra using outside-in technique (TOT) with 2 absorbable sutures parallel to the urethra. Success of surgery was defined as lack of any leakage during cough stress test whereas the subjective cure rate was determined by Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF). 87% of patients who were operated at least 10 years before assessment reported ICIQ -SF < 6. Main postoperative complications were storage symptoms - de novo urgency and voiding difficulties. TOT is safe and highly effective surgical treatment for (SUI) in a long-term observation.
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Affiliation(s)
- Ewa Rechberger
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Andrzej Wróbel
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Beata Kulik-Rechberger
- Department of Paediatric Propedeutics, Medical University of Lublin, ul. A. Gebali 9, 20-091 Lublin, Poland
| | - Pawel Miotla
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland.
| | - Alicja Ziętek
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Tomasz Rechberger
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
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2
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McMaster T, Mori K, Lee S, Manasa S, Stelmach W, To H. Innovations and Implementation of Telemedicine in Surgical Clinics Beyond COVID-19: A Narrative Review. Telemed J E Health 2023; 29:50-59. [PMID: 35736794 DOI: 10.1089/tmj.2021.0409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction: Telemedicine has emerged as a powerful tool in the delivery of health care to surgical patients and innovations are developing to address challenges in the technology, enhancing consumer-provider encounters while located remotely. Our study aims at collating and commenting on the published evidence for how current challenges in telemedicine for surgical clinics are met by innovations currently in development. We also comment on the implementation and monitoring strategies for telemedicine. Methods: Databases searched included: PubMed, OVID Medline, Embase, Scopus, Web of Science, and review of reference lists. Key words used were "telemedicine"; "telehealth"; "videoconference"; "outpatient"; and "surgical clinic." For inclusion, articles required to be in English, published between 2000 and 2021, were in an outpatient surgical setting, and if they had a focus during the COVID-19 pandemic. Results: Three hundred forty-five articles were identified and screened, so that 73 articles were included in the review. Almost all articles were from Western countries (n = 69), mostly in surgical journals (n = 39) and from a range of sub-specialties, but pre-dominantly orthopedics (n = 12) and general surgery (n = 9). The majority were original comparative studies, with 31 studies directly comparing telemedicine with in-person appointments and 22 articles focused on implementation during COVID-19. Discussion/Conclusion: Advanced telecommunication technology has enabled telemedicine to become an effective and safe form of health care delivery, with high consumer and provider satisfaction. Innovative protocol and technology developments have addressed the limitations of telemedicine. Sophisticated and familiar medical software integrates with electronic medical records to automate and streamline documentation, consent, and billing processes. Surgical clinics are investing in telehealth workflow co-ordination and information technology support to troubleshoot any technical difficulties as well as education for providers and consumers to address technology illiteracy. As health care services continue to transition their systems to an online network, further research is required to understand the ability and assess the feasibility of telemedicine to fully integrate.
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Affiliation(s)
- Thomas McMaster
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Krinal Mori
- Department of Surgery, Northern Health, Epping, Australia
| | - Sharon Lee
- Department of Surgery, Northern Health, Epping, Australia
| | - Siri Manasa
- Department of Surgery, Northern Health, Epping, Australia
| | - Wanda Stelmach
- Department of Surgery, Northern Health, Epping, Australia
| | - Henry To
- Department of Surgery, Northern Health, Epping, Australia.,Department of Surgery, Werribee Mercy Hospital, Werribee, Australia
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3
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Mclaughlin EJ, Ellett LC, Readman E, Mooney S. Telehealth for gynaecology outpatients during the COVID-19 pandemic: Patient and clinician experiences. Aust N Z J Obstet Gynaecol 2022; 62:553-559. [PMID: 35322405 PMCID: PMC9111195 DOI: 10.1111/ajo.13510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The COVID‐19 pandemic has necessitated alterations in provision of health care and how patients access it. Telehealth has replaced traditional face‐to‐face outpatient clinics in an unprecedented manner. This study aimed to assess overall patient and clinician satisfaction with telehealth consultations, to establish acceptability of telehealth during pandemic and non‐pandemic times, and document feedback. Materials and Methods A prospective observational study involving women presenting to a general gynaecology outpatient department was performed. Women who attended for consultation between 13 July and 4 September 2020 were invited to participate in a questionnaire following their telehealth appointment. Clinicians consulting in the outpatient department were invited to complete a questionnaire at the end of the eight‐week study period. Satisfaction, utility and acceptability data were obtained using visual analogue scales (VAS). Results Twenty‐six out of 56 (46.4%) clinicians and 124/870 (14.3%) patients completed the questionnaire. Patients who responded were older and more likely to have been born in Australia than women who did not (P = 0.0355 and P = 0.005, respectively). Overall patient satisfaction with telehealth was high (median VAS (interquartile range), 8.6 (5.6–9.8)). More women found telehealth to be acceptable during a pandemic than afterward (8.9 vs 6.6, P < 0.0001). Clinicians were less satisfied with telehealth than patients (7.1 vs 8.6, P = 0.02); however, most would be happy to continue using telehealth in non‐pandemic times (7.0 (6.2–9.8)). Conclusion Telehealth consultations allow provision of gynaecological care at a time when reducing risk of infection to patients and staff is paramount. Telehealth gynaecology consultations are efficient and convenient without significant detriment to patient or clinician satisfaction.
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Affiliation(s)
- Emma Jane Mclaughlin
- Department of Endosurgery, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | | | - Emma Readman
- Department of Endosurgery, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Mooney
- Department of Endosurgery, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Evidence for the Appropriate Use of Telemedicine in Female Pelvic Medicine and Reconstructive Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2021; 16:97-104. [PMID: 34745407 PMCID: PMC8563823 DOI: 10.1007/s11884-021-00635-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/20/2022]
Abstract
Purpose of Review To summarize the available literature regarding telehealth interventions in the management of pelvic floor disorders. Recent Findings Most Female Pelvic Medicine and Reconstructive Surgery (FPMRS) patients own and feel comfortable operating the technology required to participate in telehealth interventions and would be willing to interact remotely with their providers. Telehealth may be an appropriate and effective tool for patient education about bladder and pelvic physiology and pathophysiology, remote pelvic floor muscle strengthening when in-person physical therapy is not accessible, overactive bladder follow-up and medication management, and for postoperative care following uncomplicated incontinence and prolapse surgery. Summary There is a growing body of literature specific to FPMRS supporting various telehealth interventions that could reasonably be expected to improve access to sub-specialty care while maintaining or improving healthcare quality and reducing costs to the patient and the healthcare system.
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Abstract
Telemedicine, which provides safe, equitable, patient-centered care, has gained significant momentum in recent years. Success using telemedicine has been seen across diverse groups of patients for a variety of diagnoses, including older adults and gynecology patients. In response to the coronavirus disease 2019 pandemic, federal and local governments have issued provisions to improve reimbursement and accessibility to telemedicine. In urogynecology, virtual care is growing in popularity, along with a growing body of literature in support of this method of providing care. Providers should use clinical judgment and existing data to guide them on which clinical conditions are appropriate for virtual care.
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Affiliation(s)
- Miriam C Toaff
- PGY-3, Obstetrics and Gynecology, New York Medical College, 19 Bradhurst Avenue, Hawthorne, NY 10532, USA
| | - Cara L Grimes
- Obstetrics and Gynecology and Urology, New York Medical College, 19 Bradhurst Avenue, Hawthorne, NY 10532, USA.
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6
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McMaster T, Wright T, Mori K, Stelmach W, To H. Current and future use of telemedicine in surgical clinics during and beyond COVID-19: A narrative review. Ann Med Surg (Lond) 2021; 66:102378. [PMID: 33996071 PMCID: PMC8105355 DOI: 10.1016/j.amsu.2021.102378] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction Telemedicine has emerged as a powerful tool in the delivery of healthcare to surgical patients and enhances clinician-patient encounters during all phases of patient care. Our study aims were: to review the current use and applicability of telemedicine; evaluate its suitability, safety and effectiveness in a surgical outpatient setting, particularly in the era of social distancing restrictions and provide insight into future applications. Methods Databases searched included: PubMed, OVID Medline, Embase, Scopus, Web of Science and review of reference lists. Key words used were "telemedicine"; "telehealth"; "videoconference"; "outpatient" and "surgical clinic". For inclusion, articles required to be in English, published between 2000 and 2021, were in an outpatient surgical setting and if they had a focus during the COVID-19 pandemic. Results 335 articles were identified and screened, so that 63 articles were included in the review. Almost all articles were from Western countries (n = 60), mostly in surgical journals (n = 35) and from a range of sub-specialities, but pre-dominantly orthopaedics (n = 12) and general surgery (n = 7). The majority were original comparative studies where 31 studies directly compared telemedicine to in-person appointments and 14 papers focused on implementation during COVID-19. Discussion/conclusions Telemedicine has been safely used across various phases of surgical outpatient care, with its effectiveness evaluated by clinical outcomes, economics and user/provider satisfaction. Telemedicine has multiple accepted benefits including time efficiency, patient/healthcare cost savings and community access, but with reported limitations of clinical uncertainty, technology infrastructure requirements, cybersecurity vulnerabilities and healthcare regulatory restraints. These limitations are being overcome by accelerated implementation during COVID-19 via fast-tracked practice development. Further work is required via development of research protocols to refine the application of emerging telemedicine technologies and their applicability to different surgical sub-specialties.
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Affiliation(s)
- Thomas McMaster
- Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - Timothy Wright
- Department of Surgery, St. Vincent's Hospital, Fitzroy, VIC, Australia
| | - Krinal Mori
- Department of Surgery, Northern Health, Epping, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Wanda Stelmach
- Department of Surgery, Northern Health, Epping, VIC, Australia
| | - Henry To
- Department of Surgery, Northern Health, Epping, VIC, Australia.,Department of Surgery, Werribee Mercy Hospital, Werribee, VIC, Australia
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Giusto LL, Derisavifard S, Zahner PM, Rueb JJ, Deyi L, Jiayi L, Weilin F, de Jesus Moreira R, Gomelsky A, Balzarro M, Goldman HB. Telemedicine follow-up is safe and efficacious for synthetic midurethral slings: a randomized, multi-institutional control trial. Int Urogynecol J 2021; 33:1007-1015. [PMID: 33877376 PMCID: PMC8056194 DOI: 10.1007/s00192-021-04767-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/10/2021] [Indexed: 02/08/2023]
Abstract
Introduction and hypothesis The objective was to assess whether telemedicine-based follow-up is equivalent to office-based follow-up in the early postoperative period after routine synthetic midurethral sling placement. Methods This is a prospective, international, multi-institutional, randomized controlled trial. Patients undergoing synthetic midurethral sling placement were randomized to 3-week postoperative telemedicine versus office-based follow-up. The primary outcome was the rate of unplanned events. Secondary outcomes included patient satisfaction, crossover from telemedicine to office-based follow-up, and compliance with 3- to 5-month office follow-up. Results We included 238 patients (telemedicine: 121 vs office: 117). No differences in demographics or medical comorbidities were noted between the study groups (p = 0.09–1.0). No differences were noted in unplanned events: hospital admission, emergency department visit, or unplanned office visit or call (14% vs 12.9%, p = 0.85) or complications (9.9% vs 8.6%, p = 0.82). Both groups were equally “very satisfied” with their surgical outcomes (71.1% vs 69%, p = 0.2). Telemedicine patients were more compliant with 3- to 5-month office follow-up (90.1% vs 79.3%, p = 0.04). Conclusions After synthetic midurethral sling placement, telemedicine follow-up is a safe patient communication option in the early postoperative period. Telemedicine patients reported no difference in satisfaction compared with office-based follow-up but had greater compliance with 3- to 5-month follow-up.
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Affiliation(s)
- Laura L Giusto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Derisavifard
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patricia M Zahner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Jessica J Rueb
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luo Deyi
- West China Hospital of Sichuan University, Chengdu, China
| | - Li Jiayi
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Fang Weilin
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | | | | | - Matteo Balzarro
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Howard B Goldman
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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8
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Barba M, Manodoro S, Bosio S, Locatelli L, Frigerio M. Telephone interview in urogynecology in the era of COVID-19 pandemic. J Turk Ger Gynecol Assoc 2021; 22:8-11. [PMID: 33506670 PMCID: PMC7944235 DOI: 10.4274/jtgga.galenos.2020.2020.0131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: During the Coronavirus disease-2019 (COVID-19) pandemic deferable access, including non-urgent outpatient visits, have been suspended. In our practice non-urgent routine visits for pelvic floor symptom assessment were discontinued and rescheduled, and telephone interview was performed. The aim was to evaluate patients’ satisfaction for this alternative approach. Material and Methods: Telephone interviews were conducted using a validated questionnaire to investigate pelvic floor symptoms. Patients were also asked if they had other symptoms or disorders, to identify patients who may need urgent hospital evaluation. At the end of the phone call, patients were asked to score their satisfaction with the telephone interview by grading their response to three questions from 0 (minimum) to 10 (maximum). The questions were: 1) “Was the telephone interview useful to check your state of health?”; 2) “Was the telephone interview an adequate healthcare tool in consideration of COVID-19 outbreak?”; 3) “Could the telephone interview replace the conventional visit?”. Results: Fifty-three patients were evaluated. All patients showed great satisfaction with telephone interview (Q1 median: 10, IQ range: 10-10) and were similarly positive in response to the second question (Q2 median: 10, IQ range: 10-10). Although fewer patients felt that telephone interview could replace conventional clinic visits most remained positive (Q3 median: 7; IQ range: 6-8). Conclusion: This simple experience showed that phone interviews with validated questionnaires are appreciated and effective to safely perform interview of selected urogynecologic patients.
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Affiliation(s)
| | - Stefano Manodoro
- Department of Gynecology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy
| | - Sara Bosio
- University of Milano-Bicocca, Monza, Italy
| | | | - Matteo Frigerio
- Department of Gynecology, ASST Monza, San Gerardo Hospital, Monza, Italy
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Murugesu S, Galazis N, Jones BP, Chan M, Bracewell-Milnes T, Ahmed-Salim Y, Grewal K, Timmerman D, Yazbek J, Bourne T, Saso S. Evaluating the use of telemedicine in gynaecological practice: a systematic review. BMJ Open 2020; 10:e039457. [PMID: 33293306 PMCID: PMC7722813 DOI: 10.1136/bmjopen-2020-039457] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The aim of this systematic review is to examine the use of telemedicine in the delivery and teaching of gynaecological clinical practice. To our knowledge, no other systematic review has assessed this broad topic. DESIGN Systematic review of all studies investigating the use of telemedicine in the provision of gynaecological care and education. The search for eligible studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and focused on three online databases: PubMed, Science Direct and SciFinder. ELIGIBILITY CRITERIA Only studies within gynaecology were considered for this review. Studies covering only obstetrics and with minimal information on gynaecology, or clinical medicine in general were excluded. All English language, peer-reviewed human studies were included. Relevant studies published up to the date of final submission of this review were considered with no restrictions to the publication year. DATA EXTRACTIONS AND SYNTHESIS Data extracted included author details, year of publication and country of the study, study aim, sample size, methodology, sample characteristics, outcome measures and a summary of findings. Data extraction and qualitative assessment were performed by the first author and crossed checked by the second author. Quality assessment for each study was assessed using the Newcastle-Ottawa scale. RESULTS A literature search carried out in August 2020 yielded 313 records published between 1992 and 2018. Following a rigorous selection process, only 39 studies were included for this review published between 2000 and 2018. Of these, 19 assessed gynaecological clinical practice, eight assessed gynaecological education, one both, and 11 investigated the feasibility of telemedicine within gynaecological practice. 19 studies were classified as good, 12 fair and eight poor using the Newcastle-Ottawa scale. Telecolposcopy and abortion care were two areas where telemedicine was found to be effective in potentially speeding up diagnosis as well as providing patients with a wide range of management options. Studies focusing on education demonstrated that telementoring could improve teaching in a range of scenarios such as live surgery and international teleconferencing. CONCLUSIONS The results of this review are promising and demonstrate that telemedicine has a role to play in improving clinical effectiveness and education within gynaecology. Its applications have been shown to be safe and effective in providing remote care and training. In the future, randomised controlled studies involving larger numbers of patients and operators with measurable outcomes are required in order to be able to draw reliable conclusions.
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Affiliation(s)
- Sughashini Murugesu
- Obstetrics and Gynaecology, Hillingdon Hospital NHS Trust, Uxbridge, UK
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nicolas Galazis
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Obstetrics and Gynaecology, Northwick Park Hospital, Harrow, London, UK
| | - Benjamin P Jones
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Institute for Reproductive Development and Biology, Imperial College London, London, UK
| | - Maxine Chan
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Institute for Reproductive Development and Biology, Imperial College London, London, UK
| | | | - Yousra Ahmed-Salim
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Karen Grewal
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Institute for Reproductive Development and Biology, Imperial College London, London, UK
| | - Dirk Timmerman
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Joseph Yazbek
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tom Bourne
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Institute for Reproductive Development and Biology, Imperial College London, London, UK
- Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Srdjan Saso
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Institute for Reproductive Development and Biology, Imperial College London, London, UK
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10
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Novara G, Checcucci E, Crestani A, Abrate A, Esperto F, Pavan N, De Nunzio C, Galfano A, Giannarini G, Gregori A, Liguori G, Bartoletti R, Porpiglia F, Scarpa RM, Simonato A, Trombetta C, Tubaro A, Ficarra V. Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic? Eur Urol 2020; 78:786-811. [PMID: 32616405 PMCID: PMC7301090 DOI: 10.1016/j.eururo.2020.06.025] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Context Coronavirus disease 2019 (COVID-19) pandemic has caused increased interest in the application of telehealth to provide care without exposing patients and physicians to the risk of contagion. The urological literature on the topic is sparse. Objective To perform a systematic review of the literature and evaluate all the available studies on urological applications of telehealth. Evidence acquisition After registration on PROSPERO, we searched PubMed and Scopus databases to collect any kind of studies evaluating any telehealth interventions in any urological conditions. The National Toxicology Program/Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies was used to estimate the risk of bias. A narrative synthesis was performed. Evidence synthesis We identified 45 studies (11 concerning prostate cancer [PCa], three hematuria management, six urinary stones, 14 urinary incontinence [UI], five urinary tract infections [UTIs], and six other conditions), including 12 randomized controlled trials. The available literature indicates that telemedicine has been implemented successfully in several common clinical scenarios, including the decision-making process following a diagnosis of nonmetastatic PCa, follow-up care of patients with localized PCa after curative treatments, initial diagnosis of hematuria, management diagnosis and follow-up care of uncomplicated urinary stones and uncomplicated UTIs, and initial evaluation, behavioral therapies, and pelvic floor muscle training in UI patients, as well as follow-up care after surgical treatments of stress urinary incontinence or pelvic organ prolapse. The methodological quality of most of the reports was good. Conclusions Telehealth has been implemented successfully in selected patients with PCa, UI, pelvic organ prolapse, uncomplicated urinary stones, and UTIs. Many urological conditions are suitable for telehealth, but more studies are needed on other highly prevalent urological malignant and benign conditions. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine. More robust data on long-term efficacy, safety, and health economics are necessary. Patient summary The diffusion of coronavirus disease 2019 (COVID-19) infections has recently increased the interest in telehealth, which is the adoption of telecommunication to deliver any health care activity. The available literature indicates that telemedicine has been adopted successfully in selected patients with several common clinical urological conditions, including prostate cancer, uncomplicated urinary stones, uncomplicated urinary infections, urinary incontinence, or pelvic organ prolapse. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine, but more robust data on long-term efficacy, safety, and costs are necessary.
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Affiliation(s)
- Giacomo Novara
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Italy.
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Alberto Abrate
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre, "Santa Maria della Misericordia" Hospital, Udine, Italy
| | | | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, Urologic Unit, University of Pisa, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Alchiede Simonato
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Urology Unit, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
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11
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Is electronic follow-up using a mobile phone application after mid-urethral sling placement feasible and efficient? World J Urol 2020; 39:863-869. [PMID: 32430570 DOI: 10.1007/s00345-020-03245-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess and report the feasibility and efficacy of electronic follow-up in patients after mid-urethral sling (MUS) operation. METHODS All 235 patients after MUS operation for stress urinary incontinence (SUI) were divided into the WeChat follow-up (WFU) and the outpatient follow-up (OFU) groups. Patients completed electronic or paper-validated questionnaires. Demographic and clinical characteristics, questionnaire scores, loss to follow-up rate, patient satisfaction, and complications were compared and analyzed. RESULTS Overall, 189 patients completed the follow-up assessment. The OFU group showed a higher rate of loss to follow-up (25.6% vs. 13.2%, p = 0.016). The mean preoperative International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) scores were 18.22 ± 2.64 and 18.06 ± 2.75 in the WFU and OFU groups, respectively (p = 0.672). The mean postoperative ICIQ-UI SF scores were 3.70 ± 1.65 and 3.86 ± 1.48, respectively (p = 0.489). There were 84.8% of WFU patients and 80% of OFU patients reported "very much better" or "much better" on the Patient Global Impression of Improvement (PGI-I) scale (p = 0.381). Patient satisfaction rate was higher in the WFU group than in the OFU group (87.9% vs. 74.4%, p = 0.018). Seventeen patients reported postoperative complications (9 and 8 patients in the WFU and OFU groups, respectively, p = 0.961). CONCLUSIONS It appears that electronic follow-up using a mobile phone application is feasible and efficient for patients after MUS operation, and may be associated with improved rates of satisfaction and retention.
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Foss Hansen M, Bóel Sigurdardòttir H, Oren Gradel K, Schiøler Kesmodel U, Lose G. A nationwide cohort study of hospital contacts after surgical treatment for urinary incontinence. Neurourol Urodyn 2019; 39:665-673. [PMID: 31782980 DOI: 10.1002/nau.24244] [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: 08/23/2019] [Accepted: 11/16/2019] [Indexed: 11/11/2022]
Abstract
AIMS The aim was to assess complications of urinary incontinence (UI) for women who had a hospital contact within 30 days and to evaluate the conventional method of classifying complications vs grading complications into the Clavien-Dindo classification (CDC) system. METHODS A historical cohort study based on a nationwide population of women who had hospital contact within 30 days of surgical treatment for UI during a 5-year period. RESULTS There were 874 (16.2%) hospital contacts to the Department of Obstetrics and Gynecology, among 5393 procedures. For retropubic midurethral sling (RPMUS) and transobturator midurethral sling (TOMUS), the most common reasons for hospital contacts were voiding dysfunction, self-reported pain within 14 days and acute cystitis and for urethral injection therapy (UIT) persisting UI, acute cystitis, and voiding dysfunction. Voiding dysfunction requiring surgery, use of catheter or both, occurred more frequently in women who had RPMUS as compared with TOMUS (30.5% vs 21.7%; P = .01). Women, who received RPMUS and TOMUS, had surgical complications classified as up to CD IIIb, whereas women who had UIT were classified as up to CD II. CONCLUSIONS Sixteen percent of the women had a hospital contact within 30 days. A more obstructive character of RPMUS than for TOMUS was indicated, as more women with voiding dysfunction required surgery or catheter following RPMUS. The CDC system in its current form does not improve the overall characterization of complications in terms of type and severity following synthetic midurethral sling and UIT treatment.
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Affiliation(s)
- Margrethe Foss Hansen
- Center for Clinical Epidemiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hrefna Bóel Sigurdardòttir
- Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gunnar Lose
- Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Balzarro M, Rubilotta E, Trabacchin N, Mancini V, Costantini E, Artibani W, Antonelli A. A Prospective Comparative Study of the Feasibility and Reliability of Telephone Follow-Up in Female Urology: The Patient Home Office Novel Evaluation (PHONE) Study. Urology 2019; 136:82-87. [PMID: 31726182 DOI: 10.1016/j.urology.2019.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determinate the feasibility, reliability, and patient satisfaction of telephonic follow-up in women treated for stress urinary incontinence (SUI) or pelvic organ prolapse (POP): Patient-Home-Office-Novel-Evaluation (PHONE) study. METHODS This is a prospective comparative study in women following surgery for SUI underwent middle urethral sling (MUS) (Group A), or symptomatic anterior vaginal wall (AVW) defect underwent AVW repair (fascial/mesh/biomesh) (Group B). The 1-year follow-up included a telephonic interview using a checklist and validated questionnaires followed by a standard outpatient clinic visit 7-12 days later including: an interview, validated questionnaires, objective examination, and score satisfaction with the telephone follow-up. RESULTS We enrolled 420 pts: 215 for SUI in Group A, and 205 for POP in Group B. SUI recurrence was 19.1% and 11.6% at the telephone and office follow-up, respectively. De-novo urgency urinary incontinence rate was 7.5%. Telephone follow-up was able to detect POP recurrence and related symptoms. Tape and mesh extrusions were detected only at the objective evaluation: 1.9% and 4.4% respectively. No difference was found at the questionnaires. Satisfaction with the telephone follow-up was high. CONCLUSION Due to the wrongly interpretation of de-novo urge urinary incontinence as a recurrence of SUI, a telephone interview may lose reliability in case of reported incontinence. Thus, telephone follow-up was feasible and reliable in women not reporting incontinence. In patients treated for POP the phone interview was a valid tool only in case of no-prosthetic surgery due to the absence of extrusion in these cases.
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Affiliation(s)
- Matteo Balzarro
- Dept. of Urology Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Emanuele Rubilotta
- Dept. of Urology Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nicolò Trabacchin
- Dept. of Urology Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Vito Mancini
- Dept. of Urology and Renal Transplantation, University of Foggia, Italy
| | - Elisabetta Costantini
- Dept. of Andrology and Urogynecology, Santa Maria Hospital Terni, University of Perugia, Via Tristano di Joannuncio, Terni, Italy
| | - Walter Artibani
- Dept. of Urology Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial. Int Urogynecol J 2019; 30:1639-1646. [PMID: 30783704 DOI: 10.1007/s00192-019-03895-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our aim was to determine whether postoperative telephone follow-up was noninferior to in-person clinic visits based on patient satisfaction. Secondary outcomes were safety and clinical outcomes. METHODS Women scheduled for pelvic surgery were recruited from a single academic institution and randomized to clinic or telephone follow-up. The clinic group returned for visits 2, 6, and 12 weeks postoperatively and the telephone group received a call from a nurse at the same time intervals. Women completed the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) questionnaire, Pelvic Floor Distress Inventory (PFDI)-20, and pain scales prior to and 3 months postoperatively. Randomized patients who completed the S-CAHPS at 3 months were included for analysis. Sample size calculations, based on a 15% noninferiority limit in the S-CAHPS global assessment surgeon rating, required 100 participants, with power = 80% and alpha = 0.025. RESULTS From October 2016 to November 2017, 100 participants were consented, underwent surgery, were randomized, and included in the final analysis (clinic group n = 50, telephone group n = 50). Mean age was 58.5 ± 12.2 years. Demographic data and surgery type, dichotomized into outpatient and inpatient, did not differ between groups. The S-CAHPS global assessment surgeon rating from patients in the telephone group was noninferior to the clinic group (92 vs 88%, respectively, rated their surgeons 9 and10, with a noninferiority limit of 36.1; p = 0.006). Adverse events did not differ between groups (n = 26; 57% fclinic vs 43% telephone; p = 0.36). Patients in the telephone group did not require additional emergency room or primary care visits. Clinical outcome measures improved in both groups, with no differences (all p > 0.05). CONCLUSIONS Telephone follow-up after pelvic floor surgery results in noninferior patient satisfaction, without differences in clinical outcomes or adverse events. Telephone follow-up may improve healthcare quality and decrease patient and provider burden for postoperative care. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , www.clinicaltrials.gov , NCT02891187.
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AUA Guidelines on Stress Urinary Incontinence: What Is New in the Guidelines? CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0467-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kobashi KC, Albo ME, Dmochowski RR, Ginsberg DA, Goldman HB, Gomelsky A, Kraus SR, Sandhu JS, Shepler T, Treadwell JR, Vasavada S, Lemack GE. Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline. J Urol 2017. [PMID: 28625508 DOI: 10.1016/j.juro.2017.06.061] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Stress urinary incontinence is a common problem experienced by many women that can have a significant negative impact on the quality of life of those who suffer from the condition and potentially those friends and family members whose lives and activities may also be limited. MATERIALS AND METHODS A comprehensive search of the literature was performed by ECRI Institute. This search included articles published between January 2005 and December 2015 with an updated abstract search conducted through September 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS The AUA (American Urological Association) and SUFU (Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction) have formulated an evidence-based guideline focused on the surgical treatment of female stress urinary incontinence in both index and non-index patients. CONCLUSIONS The surgical options for the treatment of stress urinary incontinence continue to evolve; as such, this guideline and the associated algorithm aim to outline the currently available treatment techniques as well as the data associated with each treatment. Indeed, the Panel recognizes that this guideline will require continued literature review and updating as further knowledge regarding current and future options continues to grow.
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Affiliation(s)
- Kathleen C Kobashi
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Michael E Albo
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Roger R Dmochowski
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - David A Ginsberg
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Howard B Goldman
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Alexander Gomelsky
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Stephen R Kraus
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Jaspreet S Sandhu
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Tracy Shepler
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Jonathan R Treadwell
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Sandip Vasavada
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Gary E Lemack
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
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Kummerow Broman K, Roumie CL, Stewart MK, Castellanos JA, Tarpley JL, Dittus RS, Pierce RA. Implementation of a Telephone Postoperative Clinic in an Integrated Health System. J Am Coll Surg 2016; 223:644-51. [DOI: 10.1016/j.jamcollsurg.2016.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/30/2016] [Accepted: 07/18/2016] [Indexed: 02/08/2023]
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