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Allègre L, Callewaert G, Coudray C, Demattei C, Panel L, Carlier-Guerin C, Letouzey V, de Tayrac R, Fatton B. Prospective ultrasonographic follow-up of transvaginal lightweight meshes: a 1-year multicenter study. Int Urogynecol J 2020; 32:1505-1512. [PMID: 32803342 DOI: 10.1007/s00192-020-04483-2] [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: 06/01/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The use of new lightweight meshes in pelvic organ prolapse (POP) surgery may reduce complications related to mesh retraction (chronic pain, dyspareunia, and mesh exposure). The aim of this study was to investigate changes in the area and position of Uphold Lite™ mesh 6 weeks and 12 months after anterior and/or apical prolapse repair. METHODS This observational prospective multicenter study included patients who had undergone transvaginal surgery for symptomatic POP-Q stage ≥ II anterior and/or apical compartment prolapse with placement of Uphold Lite mesh. The dimensions and position of the mesh were evaluated at 6 weeks and 12 months by ultrasonography. Correlations between ultrasonographic mesh characteristics and POP recurrence were analyzed. RESULTS Fifty evaluable women with an average age of 66.8 years were included. No statistically significant difference in mesh area was found between week 6 and month 12 postoperatively, either at rest (1746.92 vs. 1574.48 mm2; p = 0.15) or on Valsalva (1568.81 vs. 1542.98 mm2; p = 0.65). The ROC-AUC of the distance between the mesh and the bladder neck (M-BN) at 6 weeks for predicting cystocele recurrence at 12 months was 0.764 (95% CI 0.573-0.955) at rest and 0.724 (95% CI 0.533-0.916) on Valsalva. An M-BN distance > 12.5 mm could predict cystocele recurrence at month 12 with a sensitivity of 80% and a specificity of 69%. CONCLUSIONS Ultrasonographic measurements of the Uphold Lite™ mesh appear to remain stable between 6 weeks and 12 months postoperatively. M-BN distance correlates with cystocele recurrence. These results appear to confirm the value of ultrasound in mesh evaluation.
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Affiliation(s)
- Lucie Allègre
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France.
| | - Geertje Callewaert
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
| | - Charles Coudray
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
| | - Christophe Demattei
- Department of BESPIM (Biostatistics, Epidemiology, Public Health, and Innovation in Methodology), Nîmes University Hospital, Nîmes, France
| | - Laure Panel
- Department of Gynecology, Clinique Beau Soleil, Montpellier, France
| | | | - Vincent Letouzey
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
| | - Renaud de Tayrac
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
| | - Brigitte Fatton
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
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Orazov MR, Toktar L, Rybina A, Gevorgian D, Dostieva S, Lologaeva M, Karimova G. MAGNETIC RESONANCE IMAGING OF PELVIC FLOOR DYSFUNCTION, REVIEW. REPRODUCTIVE MEDICINE 2020. [DOI: 10.37800/rm2020-1-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pelvic floor dysfunction is an important medical and social problem in the female population. The impact of pelvic floor disorders (PFD) is likely to grow as the prevalence of these disorders increases with an aging population. Pregnancy and delivery are considered major risk factors in the development of POP and stress urinary incontinence. Pelvic floor dysfunction may involve pelvic organ prolapse and/or pelvic floor relaxation. Organ prolapse can include any combination of the following: urethra (urethrocele), bladder (cystocele), or both (cystourethrocele), vaginal vault and cervix (vaginal vault prolapse), uterus (uterineprolapse), rectum (rectocele), sigmoid colon (sigmoidocele),and small bowel (enterocele).Given the paucity of understanding of PFD pathophysiology ,multicompartmental pathology, the high rate of recurrence and repeat surgery imaging plays a major role in its clinical management.The magnetic resonance imaging (MRI) allows noninvasive, radiation-free, rapid, high-resolution evaluation the multicompartment defects in one examination.Findings reported at MR imaging of the pelvic floor are valuable for selecting candidates for surgical treatment and for indicating the most appropriate surgical approach.
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Kobi M, Flusberg M, Paroder V, Chernyak V. Practical guide to dynamic pelvic floor MRI. J Magn Reson Imaging 2018; 47:1155-1170. [PMID: 29575371 DOI: 10.1002/jmri.25998] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/13/2018] [Indexed: 01/23/2023] Open
Abstract
Pelvic floor dysfunction encompasses a spectrum of functional disorders that result from impairment of the ligaments, fasciae, and muscles supporting the pelvic organs. It is a prevalent disorder that carries a lifetime risk over 10% for undergoing a surgical repair. Pelvic floor weakness presents as a wide range of symptoms, including pain, pelvic pressure or bulging, urinary and fecal incontinence, constipation, and sexual dysfunction. A correct diagnosis by clinical examination alone can be challenging, particularly in cases involving multiple compartments. Magnetic resonance imaging (MRI) allows noninvasive, radiation-free, high soft-tissue resolution evaluation of all three pelvic compartments, and has proved a reliable technique for accurate diagnosis of pelvic floor dysfunction. MR defecography with steady-state sequences allows detailed anatomic and functional evaluation of the pelvic floor. This article provides an overview of normal anatomy and function of the pelvic floor and discusses a practical approach to the evaluation of imaging findings of pelvic floor relaxation, pelvic organ prolapse, fecal incontinence, and obstructed defecation. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1155-1170.
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Affiliation(s)
- Mariya Kobi
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | - Milana Flusberg
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Center, New York, New York, USA
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
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Prudente A, Favaro WJ, Reis LO, Riccetto CLZ. Nitric oxide coating polypropylene mesh increases angiogenesis and reduces inflammatory response and apoptosis. Int Urol Nephrol 2017; 49:597-605. [PMID: 28181115 DOI: 10.1007/s11255-017-1520-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/18/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the effect of implanted S-nitrosoglutathione (GSNO) coating polypropylene mesh in foreign-body response of rats. METHODS Thirty female rats underwent to subcutaneous implant of five polypropylene (PP) fragments: uncoated PP (control); PP polyvinylalcohol (PVA) coated and PP PVA + GSNO (1, 10 and 70 mMol) coated. After euthanasia (4 and 30 days), eight slides were prepared from each animal: hematoxylin-eosin (inflammatory response); unstained (birefringence collagen evaluation); TUNEL technique (apoptosis); and five for immunohistochemical processing: CD-31 (angiogenesis), IL-1 and TNF-α (proinflammatory cytokynes), iNOS (NO synthesis) and MMP-2 (collagen metabolism). The inflammation area, birefringence index, apoptotic index, immunoreactivity and vessel density were objectively measured. RESULTS Inflammatory reaction area at 4 days was 11.3, 15.2, 25.1, 17.1 and 19.3% of pure PP, PVA, GSNO 1, 10 and 70 mM, respectively, p = 0.0006 (PP × Others). At 30 days lower inflammatory area was observed in GSNO 10 and 70 mM compared to pure PP (5.3, 5.2 and 11.1%, respectively, p = 0.0001). Vessel density was higher for GSNO 1 mM (25.5%) compared to pure PP (19.6%) at 30 days only, p = 0.0081. Apoptotic index at 4 days was lower for GSNO 1 mM (49.3%) than pure PVA (60.6%), p = 0.0124. GSNO 10 and 70 mM reduced their apoptotic index at 30 days compared to 4 days (49.9 vs. 36.9 and 59.1 vs. 47.5%, respectively, p = 0.0397). Birefringence index, IL-1, TNF, MMP-2 and iNOS were not different. CONCLUSIONS Depending on concentrations, GSNO can increase angiogenesis, reduce inflammation and apoptosis compared to pure PP, without impact on cytokine, collagen organization/metabolism and endogenous NO synthesis.
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Affiliation(s)
- Alessandro Prudente
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil. .,, 4405, Engenheiro Anysio da Rocha Compasso st, Porto Velho, Rondônia, 76821-331, Brazil.
| | - Wágner José Favaro
- Institute of Biology, University of Campinas, Campinas, São Paulo, Brazil
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5
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Midterm results of robot-assisted sacrocolpopexy. Int Urogynecol J 2015; 26:1321-6. [DOI: 10.1007/s00192-015-2688-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
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Multicenter, randomized trial comparing native vaginal tissue repair and synthetic mesh repair for genital prolapse surgical treatment. Int Urogynecol J 2014; 26:335-42. [DOI: 10.1007/s00192-014-2501-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/24/2014] [Indexed: 02/03/2023]
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STEWARD MJ, TAYLOR SA, BRUNELL C. Advances in MRI assessment of pelvic floor structure and function: a review. IMAGING 2013. [DOI: 10.1259/imaging.20100059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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8
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Burgess KL, Elliott DS. Robotic/Laparoscopic prolapse repair and the role of hysteropexy: a urology perspective. Urol Clin North Am 2012; 39:349-60. [PMID: 22877718 DOI: 10.1016/j.ucl.2012.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Approximately 11% of women will undergo a surgical procedure for the treatment of pelvic organ prolapse (POP) or urinary incontinence by age 80 years. Abdominal sacrocolpopexy has been found in multiple studies to have high long-term success rates for repair of severe vault prolapse. Robotic or laparoscopic sacrocolpopexy offer similar success to an open approach. This article describes the techniques of laparoscopic sacrocolpopexy and robotic sacrocolpopexy. The role of hysteropexy for the treatment of POP is also discussed.
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Affiliation(s)
- Kimberly L Burgess
- Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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9
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Abstract
PURPOSE OF REVIEW Despite increasing laparoscopic expertise in reconstructive surgery, open procedures still represent the gold standard. Robot-assisted techniques increasingly replace laparoscopy. However, laparoscopy is also developing: by improvement of ergonomics, new instruments, and techniques further reducing access trauma. We evaluated the actual role of laparoscopy focusing on main indications of urologic reconstructive surgery. RECENT FINDINGS We analysed the current literature (PubMed/Medline) concerning indications, perioperative results, complications, and long-term outcome of laparoscopy for pyeloplasty, ureteral reimplantation, stone surgery, management of vesico-vaginal fistula, sacrocolpopexy (including evidence level). For all indications, laparoscopy provides the advantages of less postoperative pain, blood loss, shorter convalescence, and minimal disfigurement. However, it requires expertise with endoscopic suturing. Most experience (N > 1000) exists with laparoscopic pyeloplasty and sacrocolpopexy which can be considered as valuable options (IIB). Concerning ureteral reimplantation and repair of vesico-vaginal fistula, only a limited number of cases were reported (N < 150) (III). Laparoscopic stone surgery may gain importance particularly in developing countries. Robot-assistance will definitively increase the application of laparoscopic techniques providing optimal ergonomics, whereas the role of single-port surgery will be limited. SUMMARY Laparoscopy will increasingly be used for reconstructive urologic surgery. This trend will be supported by the widespread use of the DaVinci device.
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Granese R, Candiani M, Perino A, Romano F, Cucinella G. Laparoscopic sacrocolpopexy in the treatment of vaginal vault prolapse: 8 years experience. Eur J Obstet Gynecol Reprod Biol 2009; 146:227-31. [PMID: 19615810 DOI: 10.1016/j.ejogrb.2009.06.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 05/10/2009] [Accepted: 06/17/2009] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the long-term results of a laparoscopic sacrocolpopexy for the treatment of vaginal vault prolapse. STUDY DESIGN Between January 1999 and January 2007, 165 laparoscopic sacrocolpopexy procedures, using a polypropylene mesh, were performed on women affected by vaginal vault prolapse. Intraoperative complications included: 5 bladder injuries and 3 sigmoid perforations. Postoperative complications included: 10 cases of fever, 5 cases of lumbosciatica, 15 cases of detrusor overactivity, 2 cases of vaginal haematoma, and 5 cases of minimal dispareunia. At 1, 6 and 12 months after surgery, a clinical evaluation was carried out for all patients. After this period, we contacted the women annually. RESULTS We treated 165 women, with an average age of 67 (range 58-76 years; S.D. 19.22), average parity of 3 (range 2-5), and average body mass index of 28 (range 24-30). In many of them, more than one additional procedure was performed. At a median follow-up of 43 months (range 6-96 months), out of a total of 138 patients (27 were lost at follow-up), we obtained successful treatment in 131 women (success rate of 94.9%), with a high rate of satisfaction from the procedure. Recurrent vaginal vault prolapse was registered in seven women (5.07%): in 3, the vaginal vault collapsed after a period ranging from 7 to 20 days, caused by the use of a Vyprol mesh (hence use of same was suspended), and in a further three women the mesh detached after less than 1 month. Finally, in one case, we reported an erosion between the first and the second follow-up and the mesh was visualized in the vagina. CONCLUSIONS Our study shows that laparoscopic sacrocolpopexy, in the hands of an expert surgeon, can be considered a safe, effective procedure for the treatment of vaginal vault prolapse, allowing long-term anatomical restoration (94.9% success rate).
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Affiliation(s)
- R Granese
- Department of Obstetrics and Gynaecology, University Hospital G Martino, Messina, Italy.
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Ganatra AM, Rozet F, Sanchez-Salas R, Barret E, Galiano M, Cathelineau X, Vallancien G. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol 2009; 55:1089-103. [PMID: 19201521 DOI: 10.1016/j.eururo.2009.01.048] [Citation(s) in RCA: 239] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 01/27/2009] [Indexed: 01/05/2023]
Abstract
CONTEXT Pelvic organ prolapse (POP) is a common problem in women that causes morbidity and a decreased quality of life. Sacrocolpopexy can treat women with vaginal vault prolapse (VVP), multicompartmental POP, and/or a history of failed prolapse procedures. Abdominal sacrocolpopexy (ASC) is the gold standard for VVP and is superior to vaginal sacrocolpopexy, with fewer recurrent prolapses and less dyspareunia. Vaginal prolapse repairs, however, are often faster and offer patients a shorter recovery time. Laparoscopic sacrocolpopexy (LSC) aims to bridge this gap and to provide the outcomes of ASC with decreased morbidity. OBJECTIVE This review evaluates the recent literature on LSC as a therapy for POP. EVIDENCE ACQUISITION A PubMed search of the available English literature on LSC was performed. The reference lists of selected articles were reviewed, and additional on-topic articles were included. Some 50 articles were screened, 22 articles were selected, and the reported outcomes from 11 series are presented in this review. EVIDENCE SYNTHESIS Laparoscopic experience with POP has advanced tremendously, and LSC results from >1000 patients in 11 series support this. Conversion rates and operative times have decreased with increased experience. Mean operative time was 158 min (range: 96-286 min) with a 2.7% conversion rate (range: 0-11%) and a 1.6% early reoperation rate (range: 0-3.9%). With a mean follow-up of 24.6 mo (range: 11.4-66 mo), there was, on average, a 94.4% satisfaction rate, a 6.2% prolapse reoperation rate, and a 2.7% mesh erosion rate. Several centers have demonstrated that excellent outcomes with LSC are reproducible in terms of operative parameters, durable results, minimal complications, and high levels of patient satisfaction. CONCLUSIONS LSC upholds the outcomes of the gold standard ASC with minimal morbidity. Longer prospective and randomized trials are needed to confirm these results.
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Affiliation(s)
- Anjali M Ganatra
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
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Boyadzhyan L, Raman SS, Raz S. Role of static and dynamic MR imaging in surgical pelvic floor dysfunction. Radiographics 2008; 28:949-67. [PMID: 18635623 DOI: 10.1148/rg.284075139] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pelvic floor dysfunction (PFD) is a hidden women's health epidemic in the United States, with over 10% of women having a lifetime risk for undergoing a surgical repair for this problem. Given the paucity of understanding of PFD pathophysiology and the high rate of recurrence and repeat surgery, imaging plays a major role in its clinical management, especially for the preoperative assessment of patients with multicompartment defects and failed surgical repairs. The recent development of fast magnetic resonance (MR) imaging sequences allows noninvasive, radiation-free, rapid, high-resolution evaluation of the entire pelvis in one examination. The H line, M line, organ prolapse (HMO) classification system, which is applied to dynamic MR images, allows consistent standardization and grading of various forms of PFD. In addition, the HMO system clearly defines and differentiates between the two main components of PFD: pelvic floor relaxation and pelvic organ prolapse. In addition to serving as an objective diagnostic tool in patients with surgical PFD, MR imaging has tremendous potential to be used as a research tool in trying to understand the pathophysiology of these complex disorders.
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Affiliation(s)
- Lousine Boyadzhyan
- Departments of Radiology and Urology, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095-1721, USA.
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Stepanian AA, Miklos JR, Moore RD, Mattox TF. Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic-assisted vaginal hysterectomy: experience of 402 patients. J Minim Invasive Gynecol 2008; 15:188-96. [PMID: 18312989 DOI: 10.1016/j.jmig.2007.11.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 11/10/2007] [Accepted: 11/21/2007] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To estimate the incidence of mesh-related complications including mesh erosion/extrusion rates in patients undergoing laparoscopic sacral colpopexy, with or without concurrent hysterectomy, using macroporous soft polypropylene mesh. DESIGN Historical cohort study (Canadian Task Force classification II-2). SETTING Private urogynecology clinic. PATIENTS A total of 446 consecutive patients with uterovaginal or vaginal vault prolapse underwent laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh from January 2003 through January 2007. In all, 402 consecutive patients met enrollment criteria. Two groups of patients were identified: (1) those receiving concurrent hysterectomy (n = 130); and (2) those with a history of hysterectomy (n = 272). INTERVENTIONS Patients were treated with laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh in conjunction with other laparoscopic and/or vaginal procedures. MEASUREMENTS AND MAIN RESULTS Data were collected in the form of chart reviews and patient questionnaires. Comparisons were made between groups 1 and 2. Patient demographics, history, mesh erosion/extrusion rates, and mesh-related complications were analyzed. Length of follow-up was 1 to 54 months with a median follow-up time of 12 months. No statistically significant differences existed between 2 groups in rates of mesh erosion/extrusion or other mesh-related complications. Overall vaginal mesh erosion/extrusion rate was 1.2% (95% CI 0.5%-2.7%) with an associated mesh revision rate of 1.2% (95% CI 0.5%-2.7%). Patients with concurrent hysterectomy had an erosion/extrusion rate of 2.3% (3/130) as compared with 0.7% (2/272) in patients with a history of hysterectomy, p = .18. No cases of mesh erosion through organs and tissues other than vaginal mucosa were observed. Cuff abscess occurred in 1 patient with concurrent hysterectomy, with an overall infection rate of 0.3% (95% CI 0.01%-1.2%). One more patient developed an inflammatory reaction to the mesh. Excision of exposed mesh was performed in all 5 patients with mesh extrusion. Vaginal approach to excision was uniformly used. Laparoscopic removal of the entire mesh took place in 4 patients with persistent pelvic pain, in 1 patient with cuff abscess, and in one patient with a questionable mesh reaction. An estimated 975 to 17 000 patients were required in each group to achieve power to detect a statistically significant difference in rate of mesh-related complications in this study. CONCLUSION Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1% in our study. No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy. The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study.
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Affiliation(s)
- Assia A Stepanian
- Center for Women's Care and Reproductive Surgery, Atlanta, GA 30328, USA.
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Retained surgical needle after laparoscopic sacrocolporectopexy: usefulness of CT fluoroscopy-guided hook-wire placement before surgical removal. Clin Radiol 2008; 63:688-90. [PMID: 18455561 DOI: 10.1016/j.crad.2007.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 11/08/2007] [Accepted: 11/17/2007] [Indexed: 11/23/2022]
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Amblard J, Cosson M, Dabadie-Louasil C, Debodinance P, Fatton B, Jacquetin B. Du TVM au Prolift® (Gynecare): évolution d’une technique de renfort prothétique pour la cure de prolapsus par voie vaginale à propos d’une série multicentrique rétrospective de 794 patientes (684 TVM/110 Prolift®). ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s11608-007-0100-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Debodinance P, Amblard J, Fatton B, Cosson M, Jacquetin B. [The prosthetic kits in the prolapse surgery: is it a gadget?]. ACTA ACUST UNITED AC 2007; 36:267-75. [PMID: 17400401 DOI: 10.1016/j.jgyn.2007.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 01/24/2007] [Accepted: 02/27/2007] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To search if the prosthetic kits bring an interest, other that financier. MATERIALS AND METHOD Authors have counted 5 firms presenting the varied kits. The Prolift kit with synthetic pre- cut mesh made of polypropylene, standardized needle, cannulas and protective devices of recovery of mesh arms in 3 versions, anterior, posterior and total. Perigee and Apogee systems in a synthetic version (IntePro) and a biological version (InteXen ++LP) matched of specific needles for the different obturator passages and infra coccygeus. The Avaulta kit declines in a biosynthetic version and a hybrid version with a specific needle for its anterior kit and an other for its posterior kit. The Biomesh Soft system presents a polypropylène mesh posed on a multi pattern sheet to carve following dots with a share of 3 needles according to the type of arm passage ended by a recuperator thread. The Nazca POP Repair System, in its anterior version claims to be able to correct in the same time a urinary incontinence by pre-pubic arms. The polypropylene mesh is perforated and is had with the help a needle for its anterior and posterior kit. Authors have been interested in the research of studies on prosthesis with and without kit. RESULTS The Prolift kit contains the alone prosthesis having been evaluated without (TVM) and with kit. Authors remind results of two studies, understanding 684 cases without kit and 110 cases with kit. The rate of early per and postoperative complications has been decreased half, the rate of mesh exposure decreased from 11,3 to 4,7%. Studies on Perigee and Apogee IntePro kits, whose meshe and the procedure are similar to the Prolift seem to obtain from results equal. The Biological version has not made the object of study. For the Avauta kit, alone the mesh in plate not pre-cut has been well studied as for its tolerance for the biosynthetic version. Nothing on the hybrid version. No study is found for the Biomesh Soft kit and Nazca POP repair system. DISCUSSION The cost of these kits, varying 1 to 4, is to take in consideration and to put in scale with the returned service. Alone TVM/Prolift allows to advance in a reply. The utilization of needles, presents in all the kits, but especially devices facilitating the passage and the recovery of prosthesis arms, presents solely in the Prolift kit, reduce the utilization of valves and the risk of tear tissues during their job. The improvement of techniques by elements of the kit make that the surgical procedure become mini invasive. CONCLUSION The full kits allow a best security of procedures, facilitate the surgical gesture and limit complications. It is necessary to remain vigilant in the evaluation of these new materials "ready to wear" and to require pre clinic and clinic studies before their distribution.
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Affiliation(s)
- P Debodinance
- Service de Gynécologie-Obstétrique, Centre Hospitalier Dunkerque, Rue des Pinsons, Saint-Pol-Sur-Mer, France.
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Sola V, Pardo J, Ricci P, Guiloff E. Tension free monofilament macropore polypropylene mesh (Gynemesh PS) in female genital prolapse repair. Int Braz J Urol 2007; 32:410-4; discussion 415. [PMID: 16953907 DOI: 10.1590/s1677-55382006000400005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transvaginal free tension technique. MATERIALS AND METHODS Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% of patients, with a pursuit between 1 and 8 months. DISCUSSION The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.
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Affiliation(s)
- Vicente Sola
- Urogynecology and Vaginal Surgery Unit, Gynecology and Obstetrics Department, Las Condes Clinic, Chile University Clinical Campus, Santiago, Chile.
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Neuman M, Lavy Y. Posterior intra-vaginal slingplasty for the treatment of vaginal apex prolapse: Medium-term results of 140 operations with a novel procedure. Eur J Obstet Gynecol Reprod Biol 2007; 140:230-3. [PMID: 17267096 DOI: 10.1016/j.ejogrb.2006.07.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 07/03/2006] [Accepted: 07/04/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Urogynecologists are constantly looking for simple, safe and effective ways to cure vaginal apex prolapse. A novel surgical technique, posterior intra-vaginal slingplasty (PIVS), was reported recently to include both a high therapeutic rate and a low complication rate. The present study was aimed at evaluating the preliminary data of a series of PIVS-treated patients. STUDY DESIGN A total of 140 patients with vaginal apex prolapse underwent the PIVS operation in a daycare setting. Pre-operative demographics, operative details and post-operative follow-up data were prospectively collected for all patients. RESULTS The PIVS procedure dose requires neither laparotomy nor deep transvaginal dissection as previously required for operative intervention. No intra-operative complications were recorded. The hospitalization period was relatively short. Three patients (2.1%) presented with surgical failure, whereas 137 (97.8%) of the operated patients reported satisfaction with the therapeutic results. One patient had post-operative unilateral gluteal skin infection. She was treated by surgical removal of the infected hemi-tape. Twelve (8.6%) patients had vaginal tape protrusion, of which 11 underwent segmental tape resection at the outpatient clinic. Two patients had spontaneous rejection of the tape while the vaginal apex remained well suspended. One patient suffered from post-operative fever of unknown origin, which was effectively treated with oral antibiotics. CONCLUSIONS The novel PIVS operation reduces the complication rate and shortens the rehabilitation period previously reported for the types of operation designed in the past to cure vaginal apex prolapse. The current list of results supports the previously reported efficacy, safety and simplicity of this procedure. However, more long-term data are required to be able to draw solid conclusions concerning the superiority of the discussed operative technique.
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Affiliation(s)
- M Neuman
- Urogynecology, Department of Gynecology, "Shaare Zedek", M.C. and the Ben-Gurion University of the Negev, Jerusalem, Israel.
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Kim HS, Choi S. Mid-term Results and Complications of Posterior Intravaginal Slingplasty for Patients with Uterine and Vaginal Vault Prolapse. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.9.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Han-Seok Kim
- Department of Urology, Kosin University College of Medicine, Busan, Korea
| | - Seong Choi
- Department of Urology, Kosin University College of Medicine, Busan, Korea
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Neuman M, Lavy Y. Conservation of the prolapsed uterus is a valid option: medium term results of a prospective comparative study with the posterior intravaginal slingoplasty operation. Int Urogynecol J 2006; 18:889-93. [PMID: 17136484 DOI: 10.1007/s00192-006-0262-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 10/30/2006] [Indexed: 10/23/2022]
Abstract
It has been reported that, by the age of 80, the risk of women to undergo surgery for the treatment of pelvic organ prolapse (POP) exceeds 10%, a percentage expected to increase with the rise in life expectancy. The vaginal approach for POP reconstructive operations is associated with fewer complications and results in a shorter rehabilitation period than the abdominal route, whereas hysterectomy is widely performed concomitantly whenever the uterus is significantly prolapsed. However, there is no clear evidence supporting the role of hysterectomy in improving surgery outcome. We present our experience with a new minimally invasive procedure--the posterior intravaginal slingplasty (PIVS) for correction of advanced uterine prolapse--at the same time, comparing additive vaginal hysterectomy to uterine preservation, to evaluate the therapeutic significance of hysterectomy when vaginal apical prolapse is reconstructed with PIVS. Seventy-nine women presenting with moderate to severe uterine prolapse were enrolled into the current PIVS study. Vaginal hysterectomy was concomitantly performed upon patient's request (44 patients), whereas those wishing to preserve their uterus underwent reconstructive surgery only (35 patients). No intraoperative or postoperative major complications were recorded during an average follow-up of 29.8 months: One patient (1.3%) presented with surgical failure, whereas 71 (89.9%) of the operated patients reported satisfaction with the therapeutic results. Bladder overactivity symptoms declined from three thirds of the patients preoperatively to below 10% postoperatively. Ten (12.7%) patients had vaginal tape protrusion; all underwent segmental tape resection at the out-patient clinic. Because the PIVS procedure does not require either laparotomy or deep transvaginal dissection, as previously required for operative intervention, the hospitalization period was relatively short: 4.2 days for the hysterectomy group and 1.5 for the non-hysterectomy group. Other statistically significant differences between the hysterectomy and non-hysterectomy groups were the average ages (63.5 vs 51.0 years, respectively) and concomitant surgery (87% vs 69%, respectively, the higher percentage due to additive amputation of elongated uterine cervices). No other significant differences were recorded. The current results support the previously reported efficacy, safety, and simplicity of the PIVS procedure as well as the legitimacy of uterine preservation. Moreover, unstable bladder symptoms were found to be improved after this operation. However, long-term data are required to be able to draw solid conclusions concerning the superiority of the discussed operation.
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Affiliation(s)
- M Neuman
- Urogynecology, Department of Gynecology, Shaare Zedek M.C., The Ben-Gurion University of the Negev, Jerusalem, Assuta M.C., Tel Aviv, Israel.
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Kim DY, Choi S. Efficacy of Posterior IVS for the Patients with Vaginal Vault and Uterine Prolapse. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.3.263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Du Yong Kim
- Department of Urology, Kosin University College of Medicine, Busan, Korea
| | - Seong Choi
- Department of Urology, Kosin University College of Medicine, Busan, Korea
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Ross JW, Preston M. Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome. J Minim Invasive Gynecol 2005; 12:221-6. [PMID: 15922979 DOI: 10.1016/j.jmig.2005.03.017] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 12/08/2004] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE To assess the efficacy of the laparoscopic sacrocolpopexy in the treatment of severe vaginal prolapse. DESIGN (Canadian Task Force classification II-1). SETTING Private clinic. PATIENTS Fifty-one consecutive posthysterectomy patients with severe vaginal prolapse (Baden-Walker Grade 3 or 4). INTERVENTIONS The patients were treated by laparoscopic sacrocolpopexy in conjunction with other laparoscopic and/or vaginal procedures, as indicated. MEASUREMENTS AND MAIN RESULTS Of the 43 patients seen at 5-year follow-up, 3 had recurrent vaginal prolapse (objective cure rate 93%). In the patients with recurrence, the polypropylene mesh had torn partially or completely from the vaginal apex. When the posterior strip of mesh was extended to the perineal body, there were fewer recurrences of posterior compartment defects. Postoperatively, two patients had a partial small bowel obstruction secondary to bowel adherence to the mesh. Four patients had mesh erosion at the vaginal apex: two responded to local treatment, and two required vaginal flaps to cover the defect. CONCLUSION Laparoscopic sacrocolpopexy can be used safely with cure rates similar to abdominal sacrocolpopexy. Extending the mesh to the perineum appears to decrease posterior vault defects. There is a protracted learning curve. Patient recovery is greatly enhanced, in most cases requiring only an overnight hospitalization.
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Affiliation(s)
- Jim W Ross
- Department of Obstetrics and Gynecology, UCLA School of Medicine, Salinas, California 93901, USA.
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Rozet F, Mandron E, Arroyo C, Andrews H, Cathelineau X, Mombet A, Cathala N, Vallancien G. Laparoscopic sacral colpopexy approach for genito-urinary prolapse: experience with 363 cases. Eur Urol 2005; 47:230-6. [PMID: 15661419 DOI: 10.1016/j.eururo.2004.08.014] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2004] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the surgical outcome, complications and benefits of laparoscopic double promonto-fixation for patients with pelvic prolapse. METHODS Women with genito-urinary prolapse underwent a transperitoneal placement of a 100% polyester mesh on the anterior vaginal wall and a posterior mesh on the levator ani muscle. Both of these were anchored to the sacral promontory. A TVT was placed simultaneously in patients who had concurrent stress urinary incontinence. RESULTS A total of 363 patients were operated upon between 1996 and 2002. Their mean age was 63 (range 35-78), average follow-up was 14.6 months, the mean operating time was 97 minutes. There were 8 conversions due to anesthetic or surgical difficulties. Follow up was done by a postal questionnaire and physical examination at 6 months and then yearly. 96% were satisfied with the results of their operation and no patients complained of sexual dysfunction. There was a 4% recurrence rate of prolapse, 3 vaginal erosions, 2 urinary retentions that required TVT section, 1 bowel incarcerations, 1 spondylitis and 2 mesh infection. CONCLUSIONS Laparoscopic promonto-fixation is feasible and highly effective technique that offers good long-term results with complication rates similar to open surgery, with the added benefits of minimally invasive surgery.
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Affiliation(s)
- Francois Rozet
- Department of Urology, Institut Mutualiste Montsouris, Université René Descartes, 42 Boulevard Jourdan, 75674 Paris cedex, France.
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Govier FE, Kobashi KC, Kozlowski PM, Kuznetsov DD, Begley SJ, McGonigle KF, Muntz HG. High complication rate identified in sacrocolpopexy patients attributed to silicone mesh. Urology 2005; 65:1099-103. [PMID: 15913735 DOI: 10.1016/j.urology.2004.12.056] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2004] [Revised: 11/19/2004] [Accepted: 12/10/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To report on our experience using a preconfigured Y-shaped silicone-coated polyester mesh and polypropylene mesh for vaginal vault suspension. A variety of materials have been used for both open and laparoscopic sacrocolpopexy in the management of vaginal vault prolapse. Recently, a preconfigured Y-shaped silicone-coated polyester mesh was introduced to facilitate the vaginal cuff suspension to the sacrum. METHODS We reviewed the data of 45 consecutive patients who underwent abdominal (n = 28) or laparoscopic (n = 17) sacrocolpopexy. Of the 45 patients, 21 underwent silicone mesh suspension of the vaginal cuff to the anterior sacrum, with a mean follow-up of 23 months (range 16 to 41). A comparative analysis was performed of 24 patients who underwent the same procedure with polypropylene mesh. RESULTS Of the 21 patients in the silicone group, 5 (23.8%) have had a major complication (four vaginal mesh erosions and one mesh infection) after a median follow-up of 9.5 months (range 4 to 20). The presenting symptoms were persistent or new vaginal discharge and/or nonspecific pelvic pain. One patient underwent successful removal of the mesh transvaginally, but the rest required abdominal exploration. To date, the 24 patients who underwent vaginal cuff suspension with polypropylene mesh have had no vaginal mesh extrusions or infections, with a mean follow-up of 12 months (range 1 to 38). CONCLUSIONS Silicone-coated polyester mesh has recently been associated with a high rate of vaginal erosion when used as a transvaginal suburethral sling. Our experience specifically with vaginal vault suspension corroborates this. We have abandoned the use of silicone mesh because of the unacceptably high extrusion rate and presently use polypropylene mesh.
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Affiliation(s)
- Fred E Govier
- Department of Surgery, Continence Center, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
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Abstract
Clinicians are constantly being challenged to improve services and the care provided for individual patients. This article looks at the current approach to the management of uterovaginal prolapse in women and explores new developments in the assessment of prolapse and related pelvic floor disorders.
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Affiliation(s)
- Stephen Radley
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield S10 2SF
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Lin ATL, Wang SJ, Chen KK, Chang LS. IN VIVO TENSION SUSTAINED BY FASCIAL SLING IN PUBOVAGINAL SLING SURGERY FOR FEMALE STRESS URINARY INCONTINENCE. J Urol 2005; 173:894-7. [PMID: 15711313 DOI: 10.1097/01.ju.0000153694.49749.73] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE In pubovaginal sling surgery arguments have focused on selecting stronger sling materials, better suturing methods and superior fixation techniques. However, the grounding information prerequisite for these arguments is still lacking, ie the in vivo tension sustained by the sling. We designed this study to obtain this information. MATERIALS AND METHODS A total of 10 female patients (mean age 65.4 years) underwent pubovaginal sling surgery while under epidural anesthesia. A strip of rectus fascia (2 x 6 cm) was isolated. Each end of the fascia was anchored with a 1-zero Prolene suture (Ethicon, Somerville, New Jersey). The fascial sling was placed over the proximal urethra. Both ends of the prolene (polypropylene) sutures were transferred to the lower abdominal incision and tied on each other. The fascial sling was adjusted just to touch the proximal urethra without elevating it. We hooked the tied polypropylene suture on a digital force gauge to measure the tension sustained by the fascial sling. Patients were instructed to cough, and the tension was measured at different bladder volumes (100, 200, 300, 400 ml) and in 2 positions (horizontal and operative table tilted head-up 20 degrees). Intravesical pressure was monitored with a pressure transducer to ensure adequate cough strength. We also investigated the in vitro length-tension relationship and tensile strength of 3 rectus fascia strips (0.5 x 6 cm) obtained from 3 of these patients. RESULTS Mean tension +/- SEM sustained by the fascial sling during cough in the horizontal position was 0.046 +/- 0.004, 0.043 +/- 0.006, 0.0475 +/- 0.006 and 0.0485 +/- 0.007 kg at 100, 200, 300 and 400 ml bladder volume, respectively. Bladder volume did not statistically affect the sustained tension. The 20-degree head-up position also did not statistically change the tension sustained. In vitro study showed that the fascia strip could be stretched for a mean of 0.4 cm before sling tension began to increase. A mean load of 2.4 kg broke 0.5 x 6 cm strips. CONCLUSIONS In the horizontal and mild tilting positions during an increase in intra-abdominal pressure, the fascial sling only sustains minor tension, which is far less than the maximal load needed to break fascial strips. The excellent elasticity of the fascia may dissipate the straining force and partly explains the measured small sustained tension.
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Affiliation(s)
- Alex Tong Long Lin
- Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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Solá Dalenz V, Pardo Schanz J, Ricci Arriola P, Guiloff Fische E. Malla de polipropileno monofilamento libre de tensión en la reparación concomitante de cistocele y rectocele. Actas Urol Esp 2005; 29:977-80. [PMID: 16447597 DOI: 10.1016/s0210-4806(05)73380-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We presented our experience in the concomitant correction of cystocele and rectocele with polypropylene monofilament mesh (Gynemesh PS), with transvaginal free tension technique. METHOD During 2004 correction was made in 7 patients, Urogynecologic and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Medium age 54 years old, weight 64 kgs. In four patients we used a third mesh for correction of urinary incontinence by TVT-O. RESULTS They don't present intraoperative complications, neither in immediate or delayed postoperative time. We not observed hematoma, infection, erosion or exposition mesh. Cure of cystocele and rectocele was in the 100% of patients. Complications have not appeared, 4 cases completed three months of observation, 2 cases two months and 1 case one month. DISCUSSION The use of protesic polypropylene multifilament macropore mesh in the concomitant correction of cistocele and rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.
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Affiliation(s)
- V Solá Dalenz
- Unidad de Uroginecología y Cirugía Vaginal, Departamento de Ginecología y Obstetricia, Clínica Las Condes, Santiago, Chile
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