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Carracedo Calvo D, Pereira Rodriguez N, Moscatiello P, Jerez Izquierdo T, Meilán Hernández E, Toledo Jimenez M, Hernández Bermejo I, Gimbernat Diaz H, Sánchez Encinas M. Robotic sacrocolpopexy for the treatment of pelvic organ prolapse in elderly women: comparative analysis of safety and efficacy versus younger women. Actas Urol Esp 2024:S2173-5786(24)00072-6. [PMID: 38740262 DOI: 10.1016/j.acuroe.2024.05.012] [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: 02/06/2024] [Accepted: 04/20/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Pelvic organ prolapse is a condition with high prevalence in elderly women. With increasing life expectancy and a desire for improved quality of life, a rise in the frequency of surgical treatments for these women is anticipated. The aim is to compare complication, success, and satisfaction rates among elderly patients (aged >70 years) in comparison to younger women undergoing robotic sacrocolpopexy, thereby assessing the safety and efficacy of this surgery in this group of patients. METHOD A prospective observational comparative study of 123 robotic sacrocolpopexies conducted between December 2016 and June 2022. Patients were stratified by age (cutoff point: 70 years). Baseline characteristics, type, and grade of prolapse, intra and postoperative data, complications, functional and anatomical outcomes, and satisfaction levels were collected. RESULTS Among the 123 patients, 62.6% were under 70 years old, while 37.4% were 70 years or older, exhibiting similar baseline characteristics, prolapse grade, and type. The percentages of intraoperative (6.5%) and postoperative complications (4.4-9%) were comparable in both age groups. Furthermore, success and satisfaction rates exceeded 90%, with no significant differences between women under and over 70 years during a two-year follow-up. CONCLUSION Robotic sacrocolpopexy is at least as effective and safe in women aged 70 years or older as in younger individuals, with no higher rates of intra and postoperative complications and similar rates of anatomical and subjective success.
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Affiliation(s)
| | | | - P Moscatiello
- Hospital Universitario Rey Juan Carlos, Madrid, Spain
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Fayyad A, Harris R, Ibrahim S. Two-year anatomical and functional outcomes of laparoscopic sacrocolpopexy using light-weight Y shaped mesh for post hysterectomy vaginal prolapse. Eur J Obstet Gynecol Reprod Biol 2022; 270:139-143. [DOI: 10.1016/j.ejogrb.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 11/16/2022]
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Vasconcelos CTM, Gomes MLS, Geoffrion R, Saboia DM, Bezerra KDC, Vasconcelos Neto JA. Pessary evaluation for genital prolapse treatment: From acceptance to successful fitting. Neurourol Urodyn 2020; 39:2344-2352. [PMID: 32846016 DOI: 10.1002/nau.24493] [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: 02/21/2020] [Revised: 07/30/2020] [Accepted: 08/14/2020] [Indexed: 11/06/2022]
Abstract
AIMS To determine the percentage of women with symptomatic pelvic organ prolapse who opted for pessary and had a successful pessary fitting trial; to identify the most commonly used size of pessary for stage of prolapse; and to identify risk factors associated with unsuccessful fitting. METHODS We conducted a prospective cohort study of women with symptoms of genital prolapse referred to a public hospital tertiary care clinic (2013-2019). We used ring and ring with support pessaries for fittings. We collected patient demographics, pelvic organ prolapse quantification, size of pessary used and evaluated factors associated with pessary fittings. We defined unsuccessful fit as failure to continue pessary use at 4 weeks post fitting trial. We used Mann-Whitney and χ2 tests to compare variables between groups of successfully and unsuccessfully fitted. Using logistic regression, we built a prediction model for unsuccessful fit. RESULTS All 170 women with symptomatic prolapse referred to our clinic accepted to undergo a pessary fitting. More than 70% (n = 124/72.9%) were successfully at 4 weeks. We used an average of 1.7 pessaries (range: 1-6) per patient to identify the best-fitting pessary and #2, 5, 3, 7, and 4 were the sizes commonly used (78.2%). Women with body mass index ≥30 kg/m2 (odds ratio [OR]: 4.74; 95% confidence interval [CI], 1.98-11.32; P < .001), total vaginal length <7.5 cm (OR: 3.78; 95% CI, 1.98-11.32; P < .001), and sexually active women (OR: 2.26; 95% CI, 1.04-4.91; P = .035) were associated with increased unsuccessful fitting. CONCLUSION The vaginal pessary proved to be an excellent choice, with high acceptance and successful fitting rates.
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Affiliation(s)
| | - Maria Laura Silva Gomes
- Department of Nursing, Faculty of Pharmacy, Dentistry, and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Roxana Geoffrion
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dayana Maia Saboia
- Department of Nursing, Faculty of Pharmacy, Dentistry, and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Karine de Castro Bezerra
- Department of Nursing, Faculty of Pharmacy, Dentistry, and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Prolapse repair in the elderly patient: contemporary trends and 30-day perioperative complications. Int Urogynecol J 2020; 31:2095-2100. [DOI: 10.1007/s00192-020-04365-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
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Athanasiou S, Zacharakis D, Kalantzis C, Protopapas A, Chatzipapas I, Grigoriadis T. Women living with a midurethral sling in their 80s: long-term outcomes. Int Urogynecol J 2019; 31:2669-2674. [PMID: 31828402 DOI: 10.1007/s00192-019-04174-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Surgical outcomes of elderly women who have been treated using midurethral slings could be influenced by confounding factors, such as age-related comorbidities. Aim of this study is to assess elderly patients (>75 years) who underwent a transobturator sling procedure with a follow-up of at least 13 years. METHODS This is a prospective follow-up observational study including elderly women of current age ≥ 75 years old who underwent TVT-O placement at least 13 years prior to the study period. Main outcome measures were the objective and subjective cure rates at the follow-up visit. Secondary outcome measures included: patient-reported success rate, de novo urgency symptoms rate, evaluation of other subjective parameters related to the lower urinary tract function, and assessment of the health-related quality of life. RESULTS Seventy-two out of 85 women (84.7%) meeting the inclusion and exclusion criteria were assessed at the follow-up visit. The mean follow-up period was 13.7 years (SD = 0.8). The overall objective and subjective cure rates were 80.5% (58 out of 72) and 84.7% (61 out of 72) respectively, whereas 9.7% of the patients (7 out of 72) reported being subjectively improved. The patient-reported success rate was 91.7% (66 out of 72). De novo urgency rate was 23.7% (9 out of 38), whereas 26.5% of the patients (9 out of 34) reported aggravation of preexisting urgency. CONCLUSIONS In women of advanced age, the TVT-O procedure is a highly effective and long-lasting treatment. The safety profile of the TVT-O was not influenced by geriatric conditions, whereas the long-term presence of a polypropylene sling did not appear to trigger the onset of medical disorders.
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Affiliation(s)
- Stavros Athanasiou
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece.
| | - Dimitrios Zacharakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Christos Kalantzis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Athanasios Protopapas
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Ioannis Chatzipapas
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Themos Grigoriadis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
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Apostolopoulos NV, Alexandraki KI, Gorry A, Coker A. The early benefits of Laparoscopic Sacrocolpopexy. J Gynecol Obstet Hum Reprod 2019; 48:799-804. [PMID: 31276843 DOI: 10.1016/j.jogoh.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 06/22/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Prospective evaluation of the 6 months functional and clinical outcome of 27 patients treated with Laparoscopic Sacrocolpopexy (LSC). METHODS Pelvic organ prolapse was assessed by Baden-Walker system along with a validated quality of life questionnaire preoperatively and at 6 months postoperatively to assess vaginal, urinary, bowel and sexual symptoms. RESULTS At a mean 6 months follow-up, 96% of the symptomatic women had successful vaginal vault support with no recurrence of prolapse symptoms. Successful anatomical outcome (any prolapse ≤ stage 1) was found in 89%. Regarding the urinary functional symptoms, significant improvement was reported in the voiding function, painful symptoms and the relevant quality of life. Stress urinary incontinence resolved in 67% without concomitant continence surgery; 4% from the stress incontinence was de novo. Bowel symptoms were common, both pre- and postoperatively; 40% from the postoperative bowel symptoms was de novo. Sexually active women reported significant improvement in sexual function; there was one case of de novo dyspareunia. CONCLUSION LSC is an effective treatment for vault prolapse as soon as in the 6-months follow-up. The outcome for anterior and posterior support is less predictable. The pelvic organ vaginal, urinary and sexual functional symptoms improve. The effects on bowel function are less clear. Long-term prospective studies are required to establish the duration of the benefits.
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Affiliation(s)
| | | | - Anwen Gorry
- Department of Obstetrics and Gynaecology, Queen's Hospital, Rom Valley Way, Romford, RM70AG, UK
| | - Adeyemi Coker
- Department of Obstetrics and Gynaecology, Queen's Hospital, Rom Valley Way, Romford, RM70AG, UK
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Lone FW, Raveendran A. Urogynecology Service at a District General Hospital in the United Kingdom - Changing Needs or a Better Understanding? J Midlife Health 2019; 10:131-134. [PMID: 31579186 PMCID: PMC6767961 DOI: 10.4103/jmh.jmh_50_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Context: The urogynecological problems in women increase with age. The National Health Services (NHS) is experiencing an increase in the demand for and costs of health and social care for women in midlife. It is a relatively new subspecialty which requires a holistic approach to a patient symptoms and expert skills to overcome demands from aging female population and fulfilling patient expectations. Aims: The aim of the study was to analyze the referral pattern in relation to urogynecological symptoms referred to district general hospital in the United Kingdom and in turn to understand the gravity of the situation for improving the care of these women. Subjects and Methods: This was a retrospective study of case notes of women attending the gynecological outpatient clinic led by an urogynecology subspecialist at district general hospital in the United Kingdom having attended the clinic with symptoms suggestive of pelvic floor dysfunction. Results: We identified 777 women who attended the clinic with symptoms of pelvic floor dysfunction. The most frequently stated reason for referral was pelvic organ prolapse, followed by primary urinary incontinence. Majority of the patients (44%) had prolapse at diagnosis and 26% of the patients had multiple symptoms related to pelvic floor dysfunction after a urogynecologist's consultation, 5% of the patients had combined symptoms diagnosed at urogynaecology clinic. Majority of the referrals were from the general practitioners (43%). Conclusions: The study revealed that health practitioner referring the women needs better understanding of the urogynecological symptoms and with a better understanding and a thorough symptom treatment can be initiated for various symptoms at the same time. This allows patients' multiple symptoms improvement, avoids repeat referrals from primary care, avoids repeat visits to the clinics, avoids repeat interventions, and improves patients' satisfaction and therefore saves NHS resources.
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Affiliation(s)
- Farah Wali Lone
- Department of Obstetrics and Gynaecology, Royal Cornwall Hospital NHS Trust, Truro, TR1 3LJ, United Kingdom
| | - Ainharan Raveendran
- Department of Obstetrics and Gynaecology, Royal Cornwall Hospital NHS Trust, Truro, TR1 3LJ, United Kingdom
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Marcu D, Diaconu C, Iorga L, Bratu O, Mischianu D. Mesh colposacropexy in the management of anterior vaginal compartment prolapse. J Med Life 2019; 12:65-70. [PMID: 31123527 PMCID: PMC6527416 DOI: 10.25122/jml-2019-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pelvic organ prolapse is a frequent female pathology, often causing a negative impact on the patient’s quality of life. The purpose of this paper is to present the results that we have achieved in 32 patients with anterior vaginal compartment prolapse, managed using the transvaginal mesh approach. Over a period of twelve months, we have performed 32 transvaginal reconstructive procedures using a four arms polypropylene mesh. The superior arms of the mesh have been passed through the obturator foramen while the inferior arms have been passed through the sacrospinous ligament. The surgery has lead to a significant improvement in the quality of life in this group of patients, this being assessed using self-administered questionnaires that evaluated the quality of life, the sexual function, and urinary continence. Anatomical success was achieved in 96.87% of the cases. In terms of postoperative complications, we mention one case of vaginal erosion, one case of de novo dyspareunia and three cases of pelvic discomfort. So far we have not encountered any mesh exposure cases nor prolapse recurrence. Considering the results that we have achieved in our study, we can conclude that the transvaginal polypropylene mesh approach can prove itself to be a viable solution for the management of genital prolapse, especially if we consider the high postoperative rates of anatomical success and low rates of postoperative complications, as well as improving the patient’s quality of life. In spite of these encouraging results, the fact that in recent years FDA has emitted several warnings in terms of postoperative complications following such procedures, as well as the fact that our study was conducted on a small group of patients, limits the strength of our research, its only purpose being to present our experience for this surgical approach over a limited period of time.
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Affiliation(s)
- Dragos Marcu
- Clinic of Urology, "Dr. Carol Davila" Central Military Emergency University Hospital", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Camelia Diaconu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Lucian Iorga
- Clinic of Urology, "Dr. Carol Davila" Central Military Emergency University Hospital", Bucharest, Romania
| | - Ovidiu Bratu
- Clinic of Urology, "Dr. Carol Davila" Central Military Emergency University Hospital", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Academy of Romanian Scientists, Bucharest, Romania
| | - Dan Mischianu
- Clinic of Urology, "Dr. Carol Davila" Central Military Emergency University Hospital", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Academy of Romanian Scientists, Bucharest, Romania
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Tibi B, Vincens E, Durand M, Bentellis I, Salet-Lizee D, Kane A, Gadonneix P, Severac F, Ahallal Y, Chevallier D, Villet R. Comparison of different surgical techniques for pelvic floor repair in elderly women: a multi-institutional study. Arch Gynecol Obstet 2019; 299:1007-1013. [DOI: 10.1007/s00404-019-05076-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 02/01/2019] [Indexed: 11/25/2022]
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Robotic-assisted laparoscopic apical suspension: description of the spiral technique. J Robot Surg 2018; 13:519-523. [DOI: 10.1007/s11701-018-0879-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
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Mizutani H, Sakakibara F, Komuro M, Sasaki E. TAS-303, a Novel Selective Norepinephrine Reuptake Inhibitor that Increases Urethral Pressure in Rats, Indicating Its Potential as a Therapeutic Agent for Stress Urinary Incontinence. J Pharmacol Exp Ther 2018; 366:322-331. [PMID: 29875227 DOI: 10.1124/jpet.118.248039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/30/2018] [Indexed: 12/19/2022] Open
Abstract
Stress urinary incontinence (SUI) is characterized by involuntary leakage associated with exertion, effort, sneezing, coughing, or lifting. Duloxetine, a serotonin norepinephrine reuptake inhibitor, is approved for the treatment of patients with SUI in some European countries, but not in the United States. There is currently no globally approved pharmacological drug for the treatment of patients with SUI. Therefore, a new pharmacological treatment option is required. TAS-303 [4-piperidinyl 2,2-diphenyl-2-(propoxy-1,1,2,2,3,3,3-day7 )acetate hydrochloride] is a novel small-molecule selective norepinephrine reuptake inhibitor that displays significant norepinephrine transporter (NET) inhibitory activity toward the serotonin or dopamine transporters. In this report, we describe the pharmacological properties of TAS-303 and its effects on urethral function, using preclinical in vitro and in vivo studies. Radioligand-binding studies showed that TAS-303 selectively and potently inhibited [3H]norepinephrine binding to the human NET. Oral administration of TAS-303 (3 mg/kg) significantly increased norepinephrine levels in the plasma, whereas it did not significantly affect epinephrine, dopamine, and serotonin levels. TAS-303 (0.3, 1, and 3 mg/kg) dose-dependently increased basal urethral pressure in normal rats and leak point pressure in vaginal distention rats, exhibiting a maximal effect comparable to duloxetine. In the forced swimming test, TAS-303 (100 mg/kg) showed no significant effects on immobility time in rats, raising the possibility that this agent would have minimal central nervous system side effects at an effective dose for urethral function. These results demonstrate that TAS-303 has therapeutic potential for the treatment of patients with SUI.
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Affiliation(s)
- Hiroya Mizutani
- Discovery and Preclinical Research Division, Taiho Pharmaceutical Co., Ltd., Tsukuba, Ibaraki, Japan
| | - Fukumitsu Sakakibara
- Discovery and Preclinical Research Division, Taiho Pharmaceutical Co., Ltd., Tsukuba, Ibaraki, Japan
| | - Masahito Komuro
- Discovery and Preclinical Research Division, Taiho Pharmaceutical Co., Ltd., Tsukuba, Ibaraki, Japan
| | - Eiji Sasaki
- Discovery and Preclinical Research Division, Taiho Pharmaceutical Co., Ltd., Tsukuba, Ibaraki, Japan
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Intra-, peri- and postoperative complications in pelvic organ prolapse surgery in geriatric women. Eur J Obstet Gynecol Reprod Biol 2018; 224:142-145. [PMID: 29605709 DOI: 10.1016/j.ejogrb.2018.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 02/28/2018] [Accepted: 03/22/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Pelvic organ prolapse is a common problem among geriatric women. Advanced age is associated with a high prevalence of comorbidities that can lead to restrictive use of surgical treatment. With rising life expectancy it is predicted that surgical treatment in these women will be seen more frequently. Inconsistently there is a lack of clinical trials giving attention to elderly women suffering from pelvic organ prolapse. The aim of this study was to quantify the rate of complications in elderly women undergoing surgery for pelvic organ prolapse. STUDY DESIGN 72 women aged ≥75 years who underwent surgical correction for pelvic organ prolapse were included in this study. Demographics, comorbidities, intra-, peri- and postoperative severe and non-severe complications were recorded. Additionally we compared the pre- and postoperative presence of symptoms linked to pelvic organ prolapse. Follow-up for the review of pelvic floor symptoms was six month. RESULTS The mean age was 81.4 years. Four (5.6%) of the patients had a severe intra-, peri- or postoperative complication (two bowel injuries, one bleeding requiring blood transfusion, one resuscitation). All women with severe complications showed no persistent problem at the time of discharge or during the follow-up period. There was a significant postoperative decrease in pelvic organ prolapse connected symptoms, such as stress urinary incontinence (p = .013), voiding dysfunction (p < .001), recurrent urinary tract infection (p = .001) and rectal outlet obstruction (p = .006). CONCLUSION Elderly women undergoing an operation for pelvic organ prolapse have a low risk of complication and benefit from surgery. Age alone should not be a contraindication to surgery.
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Altman D, Geale K, Falconer C, Morcos E. A generic health-related quality of life instrument for assessing pelvic organ prolapse surgery: correlation with condition-specific outcome measures. Int Urogynecol J 2018; 29:1093-1099. [DOI: 10.1007/s00192-018-3587-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/29/2018] [Indexed: 02/06/2023]
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Khadzhieva MB, Kolobkov DS, Kamoeva SV, Salnikova LE. Expression changes in pelvic organ prolapse: a systematic review and in silico study. Sci Rep 2017; 7:7668. [PMID: 28794464 PMCID: PMC5550478 DOI: 10.1038/s41598-017-08185-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/05/2017] [Indexed: 01/23/2023] Open
Abstract
Pelvic organ prolapse (POP) is a highly disabling condition common for a vast number of women worldwide. To contribute to existing knowledge in POP pathogenesis, we performed a systematic review of expression studies on both specific gene and whole-genome/proteome levels and an in silico analysis of publicly available datasets related to POP development. The most extensively investigated genes in individual studies were related to extracellular matrix (ECM) organization. Three premenopausal and two postmenopausal sets from two Gene Expression Omnibus (GEO) studies (GSE53868 and GSE12852) were analyzed; Gene Ontology (GO) terms related to tissue repair (locomotion, biological adhesion, immune processes and other) were enriched in all five datasets. Co-expression was higher in cases than in controls in three premenopausal sets. The shared between two or more datasets up-regulated genes were enriched with those related to inflammatory bowel disease (IBD) in the NHGRI GWAS Catalog. ECM-related genes were not over-represented among differently expressed genes. Up-regulation of genes related to tissue renewal probably reflects compensatory mechanisms aimed at repair of damaged tissue. Inefficiency of this process may have different origins including age-related deregulation of gene expression.
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Affiliation(s)
- Maryam B Khadzhieva
- Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkina str., Moscow, 119333, Russia.,Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, 1 Samory Mashela str., Moscow, 117997, Russia
| | - Dmitry S Kolobkov
- Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkina str., Moscow, 119333, Russia
| | - Svetlana V Kamoeva
- Pirogov Russian National Research Medical University, 1 Ostrovitianov str., Moscow, 117997, Russia
| | - Lyubov E Salnikova
- Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkina str., Moscow, 119333, Russia. .,Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, 1 Samory Mashela str., Moscow, 117997, Russia.
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Abstract
Pelvic organ prolapse (POP) is the descent of pelvic organs through the vagina, and sometimes causes hydronephrosis. Although the association between POP and hydronephrosis has long been recognized, severe hydronephrosis and renal dysfunction are rarely seen. We report a case of 66-year-old woman who had a vaginal delivery presented with externalized uterine and bladder prolapse during the previous 2 years. She had a 3-day history of hypophagia and vomiting, and laboratory analysis resulted in serum creatinine of 5.75 mg/dL and blood urea of 78.1 mg/dL. The patient was treated urgently with vaginal pessary to return the uterine and bladder into the pelvis. After 2 weeks, her serum creatinine dropped to 3.66 mg/dL, but chronic renal failure persisted. Hydronephrosis caused by POP may lead to renal dysfunction and can advance to irreversible renal damage if left untreated. Important is early evaluation of renal function and images of the kidney and ureter.
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Epidemiology, Pathophysiology and Management of Fecal Incontinence in the Older Woman. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0201-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Surgical Treatment and Outcomes for the Management of Stress Urinary Incontinence in the Older Woman. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0204-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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El Sayed RF, Alt CD, Maccioni F, Meissnitzer M, Masselli G, Manganaro L, Vinci V, Weishaupt D. Magnetic resonance imaging of pelvic floor dysfunction - joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group. Eur Radiol 2017; 27:2067-2085. [PMID: 27488850 PMCID: PMC5374191 DOI: 10.1007/s00330-016-4471-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 05/03/2016] [Accepted: 05/11/2016] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD). METHODS The technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding. RESULTS Consensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the "Rule of three" for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system. CONCLUSION This literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD. KEY POINTS • These recommendations highlight the most important prerequisites to obtain a diagnostic PFD-MRI. • Static, dynamic and evacuation sequences should be generally performed for PFD evaluation. • The recommendations were constructed through consensus among 13 radiologists from 8 institutions.
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Affiliation(s)
- Rania Farouk El Sayed
- Genitourinary & Pelvic Floor MR Imaging Unit, Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt.
| | - Celine D Alt
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Duesseldorf, Germany
| | - Francesca Maccioni
- Department of Radiological Sciences, Oncology and Pathology Policlinico Umberto I Hospital, Sapienza University Rome, Viale Regina Elena, Rome, Italy
| | - Matthias Meissnitzer
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gabriele Masselli
- Department of Radiology Dea, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena, Rome, Italy
| | - Valeria Vinci
- Department of Radiological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena, Rome, Italy
| | - Dominik Weishaupt
- Institute of Radiology and Nuclear Medicine, Triemli Hospital Zurich, Zurich, Switzerland
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Emmerson S, Young N, Rosamilia A, Parkinson L, Edwards SL, Vashi AV, Davies-Tuck M, White J, Elgass K, Lo C, Arkwright J, Werkmeister JA, Gargett CE. Ovine multiparity is associated with diminished vaginal muscularis, increased elastic fibres and vaginal wall weakness: implication for pelvic organ prolapse. Sci Rep 2017; 7:45709. [PMID: 28374826 PMCID: PMC5379562 DOI: 10.1038/srep45709] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/03/2017] [Indexed: 12/26/2022] Open
Abstract
Pelvic Organ Prolapse (POP) is a major clinical burden affecting 25% of women, with vaginal delivery a major contributing factor. We hypothesised that increasing parity weakens the vagina by altering the extracellular matrix proteins and smooth muscle thereby leading to POP vulnerability. We used a modified POP-quantification (POP-Q) system and a novel pressure sensor to measure vaginal wall weakness in nulliparous, primiparous and multiparous ewes. These measurements were correlated with histological, biochemical and biomechanical properties of the ovine vagina. Primiparous and multiparous ewes had greater displacement of vaginal tissue compared to nulliparous at points Aa, Ap and Ba and lower pressure sensor measurements at points equivalent to Ap and Ba. Vaginal wall muscularis of multiparous ewes was thinner than nulliparous and had greater elastic fibre content. Collagen content was lower in primiparous than nulliparous ewes, but collagen organisation did not differ. Biomechanically, multiparous vaginal tissue was weaker and less stiff than nulliparous. Parity had a significant impact on the structure and function of the ovine vaginal wall, as the multiparous vaginal wall was weaker and had a thinner muscularis than nulliparous ewes. This correlated with "POP-Q" and pressure sensor measurements showing greater tissue laxity in multiparous compared to nulliparous ewes.
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Affiliation(s)
- Stuart Emmerson
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia.,Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia
| | | | - Anna Rosamilia
- Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia.,Monash Health, Clayton, Victoria, 3168, Australia
| | - Luke Parkinson
- School of Computer Science, Engineering and Mathematics, Flinders University, Bedford Park, South Australia 5042, Australia
| | | | | | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia.,Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia
| | - Jacinta White
- CSIRO Manufacturing, Clayton, Victoria, 3168, Australia
| | - Kirstin Elgass
- MicroImaging, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia
| | - Camden Lo
- MicroImaging, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia
| | - John Arkwright
- School of Computer Science, Engineering and Mathematics, Flinders University, Bedford Park, South Australia 5042, Australia
| | - Jerome A Werkmeister
- Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia.,CSIRO Manufacturing, Clayton, Victoria, 3168, Australia
| | - Caroline E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia.,Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia
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The K-Technique: A Novel Technique for Laparoscopic Apical Suspension Using Barbed Sutures. Female Pelvic Med Reconstr Surg 2017; 23:157-161. [PMID: 28118169 DOI: 10.1097/spv.0000000000000381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Hysterectomy is among the most common gynecologic procedures performed for women, second only to cesarean sections, and the proportion of it performed laparoscopically continues to increase. Addressing apical support at the time of the hysterectomy is crucial to minimizing the risk of posthysterectomy prolapse. Barriers to addressing apical support include the lack of experience in laparoscopic suturing and knot tying that require advanced skills and dexterity. The K-technique is a novel modification of the uterosacral ligament suspension procedure using the knot-less barbed suture technology, rendering suturing easier and quicker to perform. METHOD The vaginal cuff epithelium is closed with 2 unidirectional barbed sutures that are started at the lateral fornices and ran until the midsection. The same sutures will then serially purchase the anterior and posterior vaginal endopelvic fascia and the midsegment of the uterosacral ligament. Two more passes are thrown through the same structures, yet farther laterally, back and forth. A video illustration of the procedure is attached. RESULTS Eighteen patients underwent the procedure with no urinary tract injuries documented by cystoscopy and no postoperative morbidity documented during the 6-week postoperative follow-up period. Limited short- and long-term follow-up data are reassuring, but more will be needed to confirm the efficacy of barbed sutures in prolapse repair. CONCLUSIONS The K-technique combines the conventional uterosacral ligament suspension concept with the ease, effectiveness, and safety of barbed sutures. The technique might aid the surgeon to add the apical vaginal support when indicated.
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Davila HH, Bruce L, Goodman L, Gallo T. Robotic Assisted Laparoscopic Apical Suspension. Description of a 4 Points Technique (RALAS-4): First Case Reported. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojog.2017.79095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Giannini A, Russo E, Mannella P, Simoncini T. Single site robotic-assisted apical lateral suspension (SS R-ALS) for advanced pelvic organ prolapse: first case reported. J Robot Surg 2016; 11:259-262. [DOI: 10.1007/s11701-016-0665-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/04/2016] [Indexed: 11/24/2022]
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Boudy AS, Thubert T, Vinchant M, Hermieu JF, Villefranque V, Deffieux X. Outcomes of laparoscopic sacropexy in women over 70: A comparative study. Eur J Obstet Gynecol Reprod Biol 2016; 207:178-183. [DOI: 10.1016/j.ejogrb.2016.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/24/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
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Simoncini T, Russo E, Mannella P, Giannini A. Robotic-assisted apical lateral suspension for advanced pelvic organ prolapse: surgical technique and perioperative outcomes. Surg Endosc 2016; 30:5647-5655. [DOI: 10.1007/s00464-016-4924-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
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Emmerson SJ, Gargett CE. Endometrial mesenchymal stem cells as a cell based therapy for pelvic organ prolapse. World J Stem Cells 2016; 8:202-215. [PMID: 27247705 PMCID: PMC4877564 DOI: 10.4252/wjsc.v8.i5.202] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/23/2015] [Accepted: 02/16/2016] [Indexed: 02/07/2023] Open
Abstract
Pelvic organ prolapse (POP) occurs when the pelvic organs (bladder, bowel or uterus) herniate into the vagina, causing incontinence, voiding, bowel and sexual dysfunction, negatively impacting upon a woman’s quality of life. POP affects 25% of all women and results from childbirth injury. For 19% of all women, surgical reconstructive surgery is required for treatment, often augmented with surgical mesh. The surgical treatment fails in up to 30% of cases or results in adverse effects, such as pain and mesh erosion into the bladder, bowel or vagina. Due to these complications the Food and Drug Administration cautioned against the use of vaginal mesh and several major brands have been recently been withdrawn from market. In this review we will discuss new cell-based approaches being developed for the treatment of POP. Several cell types have been investigated in animal models, including a new source of mesenchymal stem/stromal cells (MSC) derived from human endometrium. The unique characteristics of endometrial MSC, methods for their isolation and purification and steps towards their development for good manufacturing practice production will be described. Animal models that could be used to examine the potential for this approach will also be discussed as will a rodent model showing promise in developing an endometrial MSC-based therapy for POP. The development of a preclinical large animal model for assessing tissue engineering constructs for treating POP will also be mentioned.
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National Assessment of Advancing Age on Perioperative Morbidity and Length of Stay Associated With Minimally Invasive Sacrocolpopexy. Female Pelvic Med Reconstr Surg 2016; 22:482-485. [DOI: 10.1097/spv.0000000000000319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ellington DR, Erekson EA, Richter HE. Outcomes of Surgery for Stress Urinary Incontinence in the Older Woman. Clin Geriatr Med 2015; 31:487-505. [PMID: 26476111 PMCID: PMC4609316 DOI: 10.1016/j.cger.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As population demographics continue to evolve, specifics on age-related outcomes of stress urinary incontinence interventions will be critical to patient counseling and management planning. Understanding medical factors unique to older women and their lower urinary tract conditions will allow caregivers to optimize surgical outcomes, both physical and functional, and minimize complications within this population.
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Affiliation(s)
- David R. Ellington
- University of Alabama at Birmingham, Division of Urogynecology and Pelvic Reconstructive Surgery, 176 F Suite 10382, 619 19 Street South, Birmingham, Alabama 35249-7333, Phone: (205)-934-1704, Fax: (205)-975-8893,
| | - Elisabeth A. Erekson
- The Geisel School of Medicine at Dartmouth, Division of Female Pelvic Medicine and Reconstructive Surgery, 1 Medical Center Dr., Lebanon, NH 03756, Phone: (603) 653-9312, Fax: (603) 650-0906,
| | - Holly E. Richter
- University of Alabama at Birmingham, Division of Urogynecology and Pelvic Reconstructive Surgery, 176 F Suite 10382, 619 19 Street South, Birmingham, Alabama 35249-7333
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Bretschneider CE, Robinson B, Geller EJ, Wu JM. The Effect of Age on Postoperative Morbidity in Women Undergoing Urogynecologic Surgery. Female Pelvic Med Reconstr Surg 2015; 21:236-40. [DOI: 10.1097/spv.0000000000000150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Griebling TL. Re: The effect of age on complications in women undergoing minimally invasive sacral colpopexy. J Urol 2015; 193:1314-5. [PMID: 25890533 DOI: 10.1016/j.juro.2015.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/26/2022]
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Kobayashi Y, Kuroda K, Shibuya H, Nishigaya Y, Momomura M, Matsumoto H, Iwashita M. Preoperative evaluation of deep venous thrombosis in patients with pelvic organ prolapse. J Obstet Gynaecol Res 2014; 40:1754-8. [PMID: 24888944 DOI: 10.1111/jog.12375] [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: 07/22/2013] [Accepted: 12/10/2013] [Indexed: 11/29/2022]
Abstract
AIM The incidence of preoperative deep venous thrombosis (DVT) was examined in patients with pelvic organ prolapse (POP). MATERIAL AND METHODS Preoperative screening for DVT was performed on the basis of D-dimer levels; if D-dimer levels were beyond the cut-off limit (0.5 μg/mL), ultrasound examination of the lower extremities was performed. A total of 75 consecutive patients who were scheduled for POP operation in our department were examined retrospectively. RESULTS D-dimer levels were elevated in 24 patients (31.6%). Further, DVT was detected in 10 of the 75 patients, resulting in an incidence rate of 13.3% in the present study. D-dimer levels were significantly higher in the patients with DVT (1.25 ± 0.52 μg/mL vs 0.41 ± 0.26 μg/mL). There was no significant difference in age, and although body mass index and the number of diabetes mellitus cases were relatively higher in the patients with DVT than in those without DVT, there were no statistically significant differences. According to a receiver-operator curve, the suggested cut-off D-dimer value was 0.71 μg/mL (sensitivity and specificity was 0.9 and 0.877, respectively). CONCLUSIONS Although this was a preliminary study, to the best of our knowledge, this is the first report describing the incidence of preoperative DVT in patients with POP. Our study indicates that the incidence of DVT in patients with POP might have been underestimated thus far. Therefore, every surgeon should evaluate patients for DVT prior to any surgical procedure for POP, particularly in those patients with obesity or diabetes mellitus.
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Affiliation(s)
- Yoichi Kobayashi
- Department of Obstetrics and Gynecology, School of Medicine, Kyorin University, Tokyo, Japan
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31
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The effect of age on complications in women undergoing minimally invasive sacral colpopexy. Int Urogynecol J 2014; 25:1251-6. [DOI: 10.1007/s00192-014-2391-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/07/2014] [Indexed: 11/26/2022]
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Kurt S, Canda MT, Tasyurt A. A new surgical method of suprapubic and extraperitoneal approach with uterine preservation for pelvic organ prolapse: kurt extraperitoneal ligamentopexy. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:748232. [PMID: 24455290 PMCID: PMC3877640 DOI: 10.1155/2013/748232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/09/2013] [Indexed: 11/17/2022]
Abstract
Objective. To introduce an alternative surgical approach for the optimal treatment of pelvic organ prolapse (POP). Methods. Twenty symptomatic women with grades 2-4 POP diagnosis who opted to choose this alternative surgery were retrospectively analyzed. Results. A total of 22 cases were included. The mean age of the patients was 50.6 ± 13.2 years (29-72 years) with a mean gravid and parity of 5.5 ± 2.66 and 3.4 ± 2.06, respectively. The mean body-mass index of the patients was 24.25 ± 2.43. Nine (45%) patients were premenopausal and 11 (55%) patients were postmenopausal. Uterine descensus was present in all patients, and additionally cystorectocele in 9 patients (45%), cystocele in 6 patients (30%), rectocele in 4 patients (20%), and elangatio colli in 6 patients (30%) were diagnosed. In addition to the alternative surgery, Manchester procedure and anteroposterior vaginal wall repair or Burch procedure was performed where necessary. Mean follow-up time was 48.95 ± 42.8 months (6-171 months). No recurrence of POP occurred. Conclusions. Suprapubic, extraperitoneal, and minimally invasive ligamentopexy of the round ligament to the anterior rectus fascia offers an alternative to conventional POP surgery with favorable outcomes without any recurrence.
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Affiliation(s)
- Sefa Kurt
- Tepecik Teaching and Research Hospital, Gynecology and Obstetrics Department, Gaziler Caddesi No. 468, Yenişehir, 35330 Izmir, Turkey
| | - Mehmet Tunc Canda
- Kent Hospital, Gynecology and Obstetrics Department, 8229/1 Sokak No. 56, Cigli, 35580 Izmir, Turkey
| | - Abdullah Tasyurt
- Tepecik Teaching and Research Hospital, Gynecology and Obstetrics Department, Gaziler Caddesi No. 468, Yenişehir, 35330 Izmir, Turkey
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Griebling TL. Re: Colpocleisis for Advanced Pelvic Organ Prolapse. J Urol 2013. [DOI: 10.1016/j.juro.2013.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Turner LC, Shepherd JP, Wang L, Bunker CH, Lowder JL. Hysterectomy surgery trends: a more accurate depiction of the last decade? Am J Obstet Gynecol 2013; 208:277.e1-7. [PMID: 23333543 DOI: 10.1016/j.ajog.2013.01.022] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/09/2013] [Accepted: 01/14/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of the study was to describe trends in hysterectomy route at a large tertiary center. STUDY DESIGN We reviewed all hysterectomies performed at Magee-Womens Hospital from 2000 to 2010. This database was chosen over larger national surveys because it has been tracking laparoscopic procedures since 2000, well before laparoscopic hysterectomy International Classification of Diseases, ninth revision (ICD-9) procedure codes were developed. RESULTS There were 13,973 patients included who underwent hysterectomy at Magee-Womens Hospital. In 2000, 3.3% were laparoscopic (LH), 74.5% abdominal (AH), and 22.2% vaginal hysterectomy (VH). By 2010, LH represented 43.5%, AH 36.3%, VH 17.2%, and 3.0% laparoscopic converted to open (LH→AH). Hysterectomies performed for gynecological malignancy represented 24.4% of cases. The average length of stay for benign LH and VH, 1.0 ± 1.0 and 1.6 ± 1.0 days respectively, was significantly shorter than the average 3.1 ± 2.3 day stay associated with AH (P < .001). The average patient age was 46.9 ± 10.9 years for LH, 51.5 ± 12.1 years for AH, and 51.7 ± 14.1 years for VH, and over the study period there was a significant trend of increasing patient age (b1 = 0.517, 0.583, and 0.513, respectively [P < .001 for all]). CONCLUSION The percentage of LH increased over the last decade and by 2010 had surpassed AH. The 43.4% LH rate in 2010 is much higher than previously reported in national surveys. This likely is due to an increase in the number of laparoscopic procedures being performed over the last few years as well as the ability of our study to capture LH prior to development of appropriate ICD-9 procedure codes. Our unique ability to determine hysterectomy route, which predates appropriate coding, may provide a more accurate characterization of hysterectomy trends.
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Affiliation(s)
- Lindsay C Turner
- Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Pradhan A, Aiken CE, Kearney RM, Slack MC. Evaluation of urogynaecology care of an elderly population in a specialist urogynaecology centre. J OBSTET GYNAECOL 2012; 33:60-3. [PMID: 23259881 DOI: 10.3109/01443615.2012.721819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The ageing population of the UK means that demand for urogynaecology services is expected to increase substantially, particularly in patients aged over 65 years. To assess service provision and predict future needs, we reviewed the demographic profile and service requirements of elderly patients referred to our urogynaecology service. We performed a retrospective review of case notes of 125 patients over 65 years of age who attended our urogynaecology clinic within a 6 month period, including comorbidity scoring using a validated instrument. A substantial proportion (56%) of patients did not require hospital-based management, and none of the patients had an adult comorbidity evaluation (ACE-27) score >2. Hence, we recommend assessing patients using the ACE-27 score and not on chronological age alone. A restructuring of urogynaecology services towards better access to community-based clinics is required to reflect the treatment needs of the patient population. This would be in line with national continence care guidance.
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Affiliation(s)
- A Pradhan
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK.
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Bae EJ, Kang Y, Seo JW, Hwang K, Cho HS, Chang SH, Park DJ. Obstructive uropathy by total uterine prolapse leading to end-stage renal disease. Ren Fail 2012; 34:807-9. [PMID: 22559223 DOI: 10.3109/0886022x.2012.681533] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 74-year-old woman was admitted to our emergency room complaining of general weakness and anorexia that started 20 days earlier. She denied other underlying diseases that might have provoked chronic renal disease. Her serum creatinine was 12.35 mg/dL. A pelvic examination and computed tomography revealed severe bilateral hydroureteronephrosis with marked cortical thinning induced by total uterine prolapse. She was started on emergency hemodialysis due to her uremic symptoms and severe metabolic acidosis. Despite Foley catheter insertion and manual reduction of uterus for 1 month, renal function was not recovered. The department of gynecology was strongly opposed to performing a procedure to reverse the hydroureteronephrosis due to the irreversibility of her renal function. She is undergoing chronic maintenance hemodialysis. This is a case report of rare end-stage renal disease (ESRD) caused by obstructive uropathy due to pelvic organ prolapse (POP). We should consider POP as a cause of ESRD.
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Affiliation(s)
- Eun Jin Bae
- Department of Internal Medicine, School of Medicine, Gyeongsang National University Hospital, Jinju, South Korea
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Prolapse surgery in octogenarians: are we pushing the limits too far? World J Urol 2012; 31:623-8. [DOI: 10.1007/s00345-012-0863-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/23/2012] [Indexed: 11/26/2022] Open
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Lo TS, Long CY, Lin YH, Lin HH. Doppler ureteric jet in urogenital prolapse. Int Urogynecol J 2011; 23:49-56. [PMID: 21927942 DOI: 10.1007/s00192-011-1540-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 08/03/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This work was conducted to study the Doppler ureteric jets in the assessment of pelvic organ prolapse (POP) patients. METHODS Forty POP-Q stage ≧ III patients and 20 without POP were assessed with color Doppler ultrasonography. RESULTS Among 40 POP, 28 had bladder outlet obstruction (BOO) and 4 had hydronephrosis. Comparing POP and controls, the difference in mean frequency, mean duration, and mean maximum velocity of ureteric jets was not statistically significant. The ureteric jets of POP with BOO are of longer duration and lower velocity. The frequency of ureteric jets was lower in POP with hydronephrosis. Plateau-type waveforms were much more common among POP associated with voiding and ureteric dysfunction. CONCLUSIONS The longer duration and lower velocity of the ureteric jet are strongly correlated with prolapse-associated BOO. The plateau-type waveform and decrease in frequency of ureteric jets indicate possible hydronephrosis. Further investigation is needed to confirm the consistency of this study.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Smith AL, Karp DR, Lefevre R, Aguilar VC, Davila GW. LeFort colpocleisis and stress incontinence: weighing the risk of voiding dysfunction with sling placement. Int Urogynecol J 2011; 22:1357-62. [PMID: 21567261 DOI: 10.1007/s00192-011-1441-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 04/17/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study aims to evaluate clinical outcomes of concomitant suburethral sling with LeFort colpocleisis including its effect on postoperative voiding. METHODS We performed a retrospective review of all LeFort colpocleisis procedures from our institution. We reviewed demographics, symptoms of stress urinary incontinence, incontinent events/day, pads usage/day, urodynamic parameters, and presence of voiding dysfunction. RESULTS Two hundred ten patients underwent colpocleisis during the study period. Mean age was 82.2 ± 4.9 and median follow-up was 22 weeks (2-169). Preoperatively, 73 (35%) complained of stress urinary incontinence (SUI) symptoms, and an additional 105 (50%) were diagnosed with occult SUI. One hundred sixty-one (77%) patients underwent concurrent suburethral sling. Overall, sling placement resulted in a 92.5% subjective stress continent rate. Fifty-six patients presented with voiding dysfunction (VD). Postoperatively, VD resolved in 91%. De novo VD occurred in two patients (1.9%) and one (0.6%) required sling revision. CONCLUSIONS Sling placement at time of colpocleisis is associated with high continence rates with minimal risk of postoperative voiding dysfunction.
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Affiliation(s)
- Aimee L Smith
- Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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Rzepka J, Brocker K, Alt C, Corteville C, Sohn C, Lenz F. Pelvic organ prolapse: does the postoperative course of mesh-repair surgery differ in elderly women when compared with younger patients? J OBSTET GYNAECOL 2011; 30:852-6. [PMID: 21126129 DOI: 10.3109/01443615.2010.518257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pelvic organ prolapse (POP) is a common disease in elderly women. Among a wide range of possibilities in POP surgery, the use of partially absorbable meshes appears to be very promising. The problem concerning POP therapy in elderly patients has not yet been not sufficiently investigated. We enrolled 64 patients with POP stages 3 and 4. All patients underwent mesh-repair surgery and afterwards were stratified into two age groups. Data obtained from anamnesis, pelvic organ prolapse quantification (POP-Q) scale, dynamic MRI and prolapse quality of life (P-QoL) questionnaire were analysed and compared between both age groups. A total of 64 patients completed the study protocol. Outcome of the surgery was promising and comparable between both age groups. One recurrence of prolapse and one mesh erosion was reported. P-QoL showed a good overall satisfaction. Our data show that the surgical correction of POP with use of polypropylene mesh in elderly women appears to be a successful method with an acceptable morbidity, adverse events rate and high satisfaction of the patients.
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Affiliation(s)
- J Rzepka
- Maria Sklodowska-Curie Cancer Centre, Warsaw, Poland.
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LEE J, DWYER PL. Age-related trends in female stress urinary incontinence surgery in Australia - Medicare data for 1994-2009. Aust N Z J Obstet Gynaecol 2010; 50:543-9. [DOI: 10.1111/j.1479-828x.2010.01217.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kitta T, Miyazato M, Chancellor MB, de Groat WC, Nonomura K, Yoshimura N. Alpha2-adrenoceptor blockade potentiates the effect of duloxetine on sneeze induced urethral continence reflex in rats. J Urol 2010; 184:762-8. [PMID: 20639053 DOI: 10.1016/j.juro.2010.03.106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Serotonin and norepinephrine reuptake inhibitors such as duloxetine have clinical efficacy for stress urinary incontinence. However, the therapeutic dose of duloxetine is often associated with unwanted side effects. We examined whether combined alpha(2)-adrenoceptor antagonists could decrease the duloxetine dose due to synergistic effects. MATERIALS AND METHODS We used normal female rats and rats with stress urinary incontinence induced by vaginal distention. Urethral responses were measured using a microtransducer tipped catheter. We evaluated the effect of low dose duloxetine (0.1 mg/kg), alpha(2)-adrenoceptor antagonists (idazoxan or yohimbine) and sequential administration of drugs on urethral pressure response amplitude during sneezing and urethral baseline pressure. Sneeze induced leak point pressure was also measured. RESULTS In normal and vaginally distended rats low dose duloxetine did not alter urethral pressure response amplitude during sneezing but it significantly increased urethral baseline pressure. When low dose duloxetine was co-applied with alpha(2)-adrenoceptor antagonists, urethral pressure response amplitude during sneezing was significantly increased. In all 7 vaginally distended rats leakage was observed during sneezing. After low dose duloxetine administration fluid leakage still occurred during sneezing. However, after low dose duloxetine and idazoxan co-administration fluid leakage disappeared in 2 of 7 rats and sneeze induced leak point pressure was significantly increased in the remaining incontinent rats with vaginal distention. CONCLUSIONS Findings support the concept that combination therapy with alpha(2)-adrenoceptor antagonists may be an effective, novel strategy to reinforce the clinical efficacy of serotonin and norepinephrine reuptake inhibitors for stress urinary incontinence.
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Affiliation(s)
- Takeya Kitta
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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Patient-reported outcomes after combined surgery for pelvic floor disorders in older compared to younger women. Am J Obstet Gynecol 2009; 201:534.e1-5. [PMID: 19729141 DOI: 10.1016/j.ajog.2009.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 05/26/2009] [Accepted: 07/07/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to compare patient-reported outcomes after combined surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) between older and younger women. STUDY DESIGN This was a retrospective cohort study including 122 younger (<65 years) and 70 older women (>/=65 years old) who underwent combined POP and SUI surgery. SUI and POP treatment failure were based on validated measures. Logistic regression was used to calculate adjusted odds ratios and 95% confidence interval [CI]. RESULTS Mean follow-up was 10 +/- 1.2 months. Women in both age groups reported significant improvement in symptoms and life impact postoperatively. In multivariable analyses, older women had an increased odds of SUI treatment failure (adjusted odds ratio [AOR], 1.10; 95% CI, 1.05-2.5), but not POP treatment failure (AOR, 0.90; 95% CI, 0.29-2.8). CONCLUSION Women 65 years and older undergoing combined surgery for POP and SUI are at risk for recurrent SUI, but still experience significant improvements in symptoms and life impact.
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Current world literature. Curr Opin Obstet Gynecol 2009; 21:450-5. [PMID: 19724169 DOI: 10.1097/gco.0b013e3283317d6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oliphant SS, Wang L, Bunker CH, Lowder JL. Trends in stress urinary incontinence inpatient procedures in the United States, 1979-2004. Am J Obstet Gynecol 2009; 200:521.e1-6. [PMID: 19375571 DOI: 10.1016/j.ajog.2009.01.007] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 11/08/2008] [Accepted: 01/12/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to describe national trends in surgery for female stress urinary incontinence (SUI). STUDY DESIGN We used data from the National Hospital Discharge Survey, a federal dataset sampling patient discharges from US inpatient hospitals. We analyzed patient and hospital demographics and International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) diagnostic and procedures codes for 1979-2004. Age-adjusted rates per 1000 women were calculated with 1990 US Census population data. RESULTS The number of women who have undergone SUI surgery each year increased from 48,345 in 1979 to 103,467 in 2004. In women > or = 52 years old, the age-adjusted rate more than doubled from 0.64-1.60 procedures per 1000 women; in women < 52 years old, the age-adjusted rate fell from 0.57-0.47. Age-adjusted rates for retropubic urethral suspension (ICD-9-CM, 59.5) fell from 0.37 in 1979 to 0.14 in 2004. For suprapubic sling procedures (ICD-9-CM, 59.4), the age-adjusted rates rose from 0.02 in 1979 to a peak of 0.10 in 1997 and then fell to 0.03 in 2004. Age-adjusted rates for other repair of urinary stress incontinence (ICD-9-CM, 59.79) rose from 0.06 in 1979 to 0.64 in 2004. CONCLUSION The number of women who have undergone SUI surgery increased significantly from 1979-2004. Because the National Hospital Discharge Survey data do not include ambulatory procedures, accurate information on same-day surgeries is unavailable. Currently no ICD-9-CM procedure code exists specifically for midurethral sling procedures. Both missed sampling of same-day procedures and nonspecific or inaccurate coding may explain the surprising decline in suprapubic sling procedures and the rise in rates of other repair of SUI. A national ambulatory surgical database and a specific code for midurethral sling are needed to capture these important data.
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Costantini E, Lazzeri M. Editorial comment on: The current status of laparoscopic sacrocolpopexy: a review. Eur Urol 2009; 55:1104-5. [PMID: 19201520 DOI: 10.1016/j.eururo.2009.01.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hydronephrosis and Pelvic Organ Prolapse. Urology 2009; 73:263-7. [DOI: 10.1016/j.urology.2008.08.480] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 08/12/2008] [Accepted: 08/14/2008] [Indexed: 11/19/2022]
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