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El-Sayed RF, Moqbel NM, Hussein AF, Abdelatty MA, Hanna SA, Azim MSA. Lax Uterosacral Ligament and Urge Urinary Incontinence: MRI Findings in Symptomatic Patients Versus Healthy Volunteers. Int Urogynecol J 2024; 35:793-801. [PMID: 38240800 PMCID: PMC11052867 DOI: 10.1007/s00192-023-05722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/15/2023] [Indexed: 04/29/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to explore the association between urge urinary incontinence (UUI) and lax uterosacral ligaments (USL) using MRI. METHODS Sixty-seven female participants were recruited prospectively: 41 continent volunteers (control group) and 26 patients with UUI. Static proton density- and T2-weighted turbo spin echo sequences of MR images were used. A radiologist employed a standardized grid system to record structural observations of the USLs on sequentially numbered axial MR images and then applied a four-point grading scale to assess ligament visibility. MR images were interpreted by a radiologist and a urologist, and then validated by an expert radiologist. RESULTS The comparison between the mean length of uterosacral ligaments in the control and UUI groups was highly statistically significant (p < 0.001). The mean length of the right USL was 38 ± 11 mm, and the left USL was 35 ± 12 mm in the UUI group. In the control group, the mean length of the USL was 22 ± 9 mm on the right side and 18 ± 9 mm on the left side, along their craniocaudal extent. The highest inter-observer agreement was on the level of origin and insertion (image numbers), whereas the lowest agreement was on the anatomical site of origin and insertion of the USL in both the control and UUI groups. CONCLUSIONS The average length of USLs in patients with UUI is significantly longer than that in healthy continent women, indicating laxity. Our findings support the relationship between the laxity of the USL and UUI symptoms and have therapeutic implications.
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Affiliation(s)
- Rania F El-Sayed
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Noha M Moqbel
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Ahmed F Hussein
- Department of Urology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Mohamed A Abdelatty
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt.
| | - Sameh A Hanna
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Mohamed S Abdel Azim
- Department of Urology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
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Sebastian L, Alina J, Fabinshy T, Dominik R, Axel S, Jens H, Kilian W, Claudia R, Leonidas K, Julia R, Nadja T, Christian E. AbsorbaTack ™ vs. ProTack ™ vs. sutures: a biomechanical analysis of cervical fixation methods for laparoscopic apical fixations in the porcine model. Arch Gynecol Obstet 2023; 307:863-871. [PMID: 36404354 PMCID: PMC9984508 DOI: 10.1007/s00404-022-06827-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/16/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Treatment of pelvic organ prolapse (POP) often requires the use of synthetic mesh. In case of a novel and standardized bilateral apical fixation, both uterosacral ligaments are replaced by polyvinylidene-fluoride (PVDF) tapes. One of the main problems remains the fixation method, which should be stable, but also simple and quick to use. The current study evaluated biomechanical differences between the cervical tape fixation with sutures (group 1), non-absorbable tacks (group 2) and absorbable tacks (group 3) in an in vitro porcine model. METHODS A total of 28 trials, conducted in three groups, were performed on porcine, fresh cadaver uteri. All trials were performed until mesh, tissue or fixation device failure occurred. Primary endpoints were the biomechanical properties maximum load (N), displacement at failure (mm) and stiffness (N/mm). The failure mode was a secondary endpoint. RESULTS There was a significant difference between all three groups concerning the maximum load. Group 1 (sutures) supported a maximum load of 64 ± 15 N, group 2 (non-absorbable tacks) yielded 41 ± 10 N and group 3 (absorbable tacks) achieved 15 ± 8 N. The most common failure mode was a mesh failure for group 1 and 2 and a fixation device failure for group 3. CONCLUSION The PVDF-tape fixation with sutures supports 1.5 times the load that is supported by non-absorbable tacks and 4.2 times the load that is supported by absorbable tacks. Nevertheless, there was also a stable fixation through tacks. Sutures are the significantly stronger and cheaper fixation device but may prolong the surgical time in contrast to the use of tacks.
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Affiliation(s)
- Ludwig Sebastian
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.
| | - Jansen Alina
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Thangarajah Fabinshy
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Ratiu Dominik
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Sauerwald Axel
- Department of Gynecology and Obstetrics, St. Marien Hospital Düren, Düren, Germany
| | - Hachenberg Jens
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Wegmann Kilian
- Department for Trauma, Hand and Elbow Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rudroff Claudia
- Department of General Surgery, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany
| | - Karapanos Leonidas
- Department of Urology, Uro-Oncology, Faculty of Medicine and University Hospital Cologne, Robot- Assisted and Reconstructive Surgery, University of Cologne, Cologne, Germany
| | - Radosa Julia
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Trageser Nadja
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Eichler Christian
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.,Breast Cancer Center, St. Franziskus-Hospital Münster, 48145, Münster, Germany
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Page AS, Page G, Deprest J. Cervicosacropexy or vaginosacropexy for urinary incontinence and apical prolapse: A systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 279:60-71. [DOI: 10.1016/j.ejogrb.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/01/2022] [Indexed: 11/26/2022]
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Jansen AK, Ludwig S, Malter W, Sauerwald A, Hachenberg J, Pahmeyer C, Wegmann K, Rudroff C, Karapanos L, Radosa J, Trageser N, Eichler C. Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model. Arch Gynecol Obstet 2021; 305:631-639. [PMID: 34842976 PMCID: PMC8918131 DOI: 10.1007/s00404-021-06343-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/18/2021] [Indexed: 12/01/2022]
Abstract
Purpose There is a novel surgical procedure, called cervicosacropexy (CESA) and vaginosacropexy (VASA) to treat pelvic organ prolapse and a concomitant urgency and mixed urinary incontinence. As there is little experience with the tapes so far and literature is scanty, the aim of this study was to investigate biomechanical properties for the fixation of the PVDF-tapes with three different fixation methods in context of apical fixations. Methods Evaluation was performed on porcine, fresh cadaver sacral spines. A total of 40 trials, divided into 4 subgroups, was performed on the anterior longitudinal ligament. Recorded biomechanical properties were displacement at failure, maximum load and stiffness in terms of the primary endpoints. The failure mode was a secondary endpoint. Group 4 was a reference group to compare single sutures on porcine tissue with those on human tissue. Biomechanical parameters for single sutures on the human anterior longitudinal ligament were evaluated in a previous work by Hachenberg et al. Results The maximum load for group 1 (two single sutures) was 65 ± 12 N, for group 2 (three titanium tacks arranged in a row) it was 25 ± 10 N and for group 3 (three titanium tacks arranged in a triangle) it was 38 ± 12 N. There was a significant difference between all three groups. The most common failure mode was a “mesh failure” in 9/10 trials for groups 1–3. Conclusion The PVDF-tape fixation with two single sutures endures 2.6 times more load than titanium tacks arranged in a row and 1.7 times more load than titanium tacks arranged in a triangle. The presacral fixation with titanium tacks reduced surgical time compared to the fixation with sutures, nevertheless sutures represent the significantly stronger and cheaper fixation method.
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Affiliation(s)
- Alina Katharina Jansen
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany.
| | - Sebastian Ludwig
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Axel Sauerwald
- Department of Gynecology and Obstetrics, St. Marien Hospital Düren, Düren, Germany
| | - Jens Hachenberg
- Department of Gynacology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Caroline Pahmeyer
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Kilian Wegmann
- Faculty of Medicine and University Hospital Cologne, Department for Trauma, Hand and Elbow Surgery, University of Cologne, Cologne, Germany
| | - Claudia Rudroff
- Department of General Surgery, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany
| | - Leonidas Karapanos
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Radosa
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Nadja Trageser
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Christian Eichler
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
- Breast Cancer Center, St. Franziskus- Hospital Münster, 48145, Münster, Germany
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JÄger W, Ludwig S, Neumann E, Mallmann P. Evidence of Common Pathophysiology Between Stress and Urgency Urinary Incontinence in Women. In Vivo 2020; 34:2927-2932. [PMID: 32871834 DOI: 10.21873/invivo.12122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM Urinary incontinence in women is commonly categorized as stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). SUI occurs due to an increased intra-abdominal pressure caused by an unstable anatomical outlet of the bladder and can be successfully treated surgically. UUI, a combination of a symptom (urgency to void) and urinary incontinence, is considered to be caused by a neurological dysfunction of the bladder. Current treatment options can reduce the feeling of urgency, but effects on restoration of continence are less impressive. However, surgery for pelvic organ prolapse reduction leads to cure UUI, indicating a critical role of pelvic anatomy in the etiology of UUI. We hypothesized that incontinence in patients with UUI is caused by an anatomical instability at the bladder outlet leading to incontinence even under minor physical stress exerted on the bladder base. PATIENTS AND METHODS Patients with UUI symptoms were asked to specify exactly when (in which body position) they involuntary lose urine after the feeling of urgency to void. RESULTS In total, 569 patients were evaluated between 2012 and 2020. Overall, 96% of the patients lost urine when they got up from a sitting position on their way to the toilet. Of the total study patients 3% lost urine already in the sitting position when they felt the urgency to void. CONCLUSION The current treatment options for UUI are based on the hypothesis that UUI is a neurological disorder. This study demonstrated that urinary incontinence in patients with UUI is dependent on an intact anatomical stability of the urethro-vesical junction under pressure. Therefore, treatment modalities should focus on the anatomical repair or support in that area.
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Affiliation(s)
- Wolfram JÄger
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Elke Neumann
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University Hospital Cologne and Medical Faculty, Cologne, Germany
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Yildiz Ş, Cengiz H, Kural A, Kaya C, Alay İ, Ekin M. Association between overactive bladder and serum nerve growth factor concentrations in women with high-grade uterine prolapse. Int Urogynecol J 2020; 32:345-351. [PMID: 32440884 DOI: 10.1007/s00192-020-04336-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The association between overactive bladder (OAB) and uterine prolapse remains unclear. The extent of the role of serum nerve growth factor (NGF) levels in this relationship is also not known. Therefore, our study evaluated the association among OAB, high-grade uterine prolapse and serum NGF levels. METHODS A total of 90 patients participated in our study and were grouped as follows. Group I included patients with high-grade uterine prolapse and OAB, group II included patients with only high-grade uterine prolapse, and group III included healthy women without uterine prolapse or OAB. Serum NGF level analysis was performed in all groups. RESULTS Serum NGF levels varied greatly among the three groups, with significantly higher levels in group 1 than in groups 2 and 3 (p < 0.001). Serum NGF levels with a cutoff point of 120.49 pg/ml identified women with significant OAB symptoms to discriminate among groups with a sensitivity of 80%, specificity of 86.7%, positive predictive value of 75.0%, negative predictive value of 89.7% and positive likelihood ratio of 6.01 (p < 0.001). CONCLUSIONS Our study showed that NGF-related pathways may play an active role in the pathophysiology of OAB with high-grade uterine prolapse patients based on obstruction hypothesis.
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Affiliation(s)
- Şükrü Yildiz
- University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, 34180, Istanbul, Turkey.
| | - Hüseyin Cengiz
- Istanbul Aydin University, Faculty of Medicine, Department of Obstetrics and Gynecology, 34140, Istanbul, Turkey
| | - Alev Kural
- University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Deparment of Biochemistry, 34180, Istanbul, Turkey
| | - Cihan Kaya
- University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, 34180, Istanbul, Turkey
| | - İsmail Alay
- University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, 34180, Istanbul, Turkey
| | - Murat Ekin
- University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, 34180, Istanbul, Turkey
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Ludwig S, Becker I, Mallmann P, Jäger W. Comparison of Solifenacin and Bilateral Apical Fixation in the Treatment of Mixed and Urgency Urinary Incontinence in Women: URGE 1 Study, A Randomized Clinical Trial. In Vivo 2020; 33:1949-1957. [PMID: 31662524 DOI: 10.21873/invivo.11690] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aetiology of urgency urinary incontinence is a matter of debate. Current treatment options are based on the hypothesis of a neurological disorder of bladder innervation. However, it has also been hypothesised that one main cause is the reduced function of the bladder-holding apparatus, that is, insufficient suspension of the vesico-urethral junction. This study compared the effects of surgical apical vaginal elevation with those of solifenacin on urgency urinary incontinence in women. PATIENTS AND METHODS Women with mixed and urgency urinary incontinence were randomised to either an established pharmacological arm (10 mg/day solifenacin) or the surgical arm (bilateral uterosacral ligament replacement, cervicosacropexy, CESA; or vaginosacropexy, VASA. Clinical and objective outcomes were assessed at 4 months after each type of intervention. RESULTS The study was terminated early; 55 patients were operated on and 41 patients received pharmacological treatment. After surgical treatment, 23 patients (42%, 95% confidence intervaI=29-55%) became continent compared to four patients (10%, 95% confidence intervaI=1-19%) during solifenacin treatment. CONCLUSION Compared to pharmacological treatment, the surgical repair of the apical vaginal end restored urinary continence in significantly more patients.
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Affiliation(s)
- Sebastian Ludwig
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Ingrid Becker
- Institute for Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Peter Mallmann
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Wolfram Jäger
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
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Rexhepi S, Rexhepi E, Stumm M, Mallmann P, Ludwig S. Laparoscopic Bilateral Cervicosacropexy and Vaginosacropexy: New Surgical Treatment Option in Women with Pelvic Organ Prolapse and Urinary Incontinence. J Endourol 2019; 32:1058-1064. [PMID: 30244596 PMCID: PMC6247383 DOI: 10.1089/end.2018.0474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: Sacrocolpopexy (SCP) is the gold standard for apical prolapse treatment. However, the technical performance of each SCP is strongly dependent on the surgeon's own discretion and comparison of clinical outcomes with respect to urinary incontinence (UI) is difficult. We developed a comprehensible laparoscopic surgical technique for the treatment of apical prolapse with UI. Methods: A total of 120 women with UI underwent laparoscopic bilateral SCP for apical prolapse. Thereby, the uterosacral ligaments (USLs) were bilaterally replaced by polyvinylidene fluoride (PVDF) tapes of identical length and shape, which were fixed at defined anatomical landmarks (cervix/vaginal vault and S1). Results: The restoration of apical vaginal support was achieved in 116 patients (97%); restoration failed in the first 4 patients owing to the use of fast-absorbable sutures. Seventy-eight patients (65%) with mixed and urgency UI symptoms before surgery achieved continence. The mean hospitalization was 3 days; no major complications were observed intraoperatively. Conclusion: The advantage of laparoscopic cervicosacropexy (laCESA) and laparoscopic vaginosacropexy (laVASA) lies in the comprehensible surgical technique (clearly defined technique) and the minimal amount of material used (no polypropylenes). The possibility of a short operating time and short hospitalization depicts this laparoscopic bilateral USL replacement as one treatment alternative in patients with apical prolapse suffering from UI.
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Affiliation(s)
- Sokol Rexhepi
- 1 Department of Obstetrics and Gynecology, Hospital Eichstätt , Eichstätt, Germany
| | - Entela Rexhepi
- 1 Department of Obstetrics and Gynecology, Hospital Eichstätt , Eichstätt, Germany
| | - Martin Stumm
- 2 Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Cologne , Köln, Germany
| | - Peter Mallmann
- 2 Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Cologne , Köln, Germany
| | - Sebastian Ludwig
- 2 Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Cologne , Köln, Germany
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Cassis C, Mukhopadhyay S, Morris E. Standardizing abdominal sacrocolpopexy for the treatment of apical prolapse: One year on. Int J Gynaecol Obstet 2019; 147:49-53. [DOI: 10.1002/ijgo.12935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 04/01/2019] [Accepted: 07/11/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Charlotte Cassis
- Gynaecology DepartmentNorfolk and Norwich University Hospital Norwich UK
| | | | - Edward Morris
- Gynaecology DepartmentNorfolk and Norwich University Hospital Norwich UK
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Ludwig S, Morgenstern B, Mallmann P, Jäger W. Laparoscopic bilateral cervicosacropexy: introduction to a new tunneling technique. Int Urogynecol J 2019; 30:1215-1217. [PMID: 30848312 PMCID: PMC6586690 DOI: 10.1007/s00192-019-03911-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 02/12/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To elevate and suspend the apical end of the vagina, the uterosacral ligaments (USL) were replaced by polyvinylidene fluoride (PVDF) structures. These PVDF structures were placed in the peritoneal folds of the USL at the pelvic wall to mimic the lateral and backward tension and to avoid rectal obstruction. A special tunneling device was used, which allowed the semi-circular placement of the structure without destroying the peritoneum. METHODS A 59-year-old woman with mixed urinary incontinence and apical prolapse (pelvic organ prolapse quantification system, POP-Q, stage 2) of the uterus underwent laparoscopic bilateral USL replacement. USLs were replaced by PVDF structures by performing the cervicosacropexy (CESA) technique using a semi-circular tunneling device. RESULTS Apical support was restored (POP-Q stage 0), and the patient was continent thereafter. The tunneling device was pulled through the peritoneal folds of the USLs toward the cervix. The new USL structures were brought to their physiological position. The new technique did not lead to any complications and did not cause any side effects during 1-year follow-up. CONCLUSIONS Restoration of apical prolapse and urinary continence was achieved by bilateral USL replacement using a semi-circular tunneling device that was inserted through the lateral abdominal trocar incision.
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Affiliation(s)
- Sebastian Ludwig
- Faculty of Medicine and University Hospital of Cologne, Department of Gynecology and Obstetrics, University of Cologne, Kerpenerstrasse 34, 50931, Köln, Germany.
| | - Bernd Morgenstern
- Faculty of Medicine and University Hospital of Cologne, Department of Gynecology and Obstetrics, University of Cologne, Kerpenerstrasse 34, 50931, Köln, Germany
| | - Peter Mallmann
- Faculty of Medicine and University Hospital of Cologne, Department of Gynecology and Obstetrics, University of Cologne, Kerpenerstrasse 34, 50931, Köln, Germany
| | - Wolfram Jäger
- Faculty of Medicine and University Hospital of Cologne, Department of Gynecology and Obstetrics, University of Cologne, Kerpenerstrasse 34, 50931, Köln, Germany
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Bhattarai A, Staat M. Computational comparison of different textile implants to correct apical prolapse in females. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2018. [DOI: 10.1515/cdbme-2018-0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractProsthetic textile implants of different shapes, sizes and polymers are used to correct the apical prolapse after hysterectomy (removal of the uterus). The selection of the implant before or during minimally invasive surgery depends on the patient’s anatomical defect, intended function after reconstruction and most importantly the surgeon’s preference. Weakness or damage of the supporting tissues during childbirth, menopause or previous pelvic surgeries may put females in higher risk of prolapse. Numerical simulations of reconstructed pelvic floor with weakened tissues and organ supported by textile product models: DynaMesh®-PRS soft, DynaMesh®-PRP soft and DynaMesh®-CESA from FEG Textiletechnik mbH, Germany are compared.
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Affiliation(s)
- Aroj Bhattarai
- 1Biomechanics Laboratory, Institute of Bioengineering, FH Aachen University of Applied Sciences,Jülich, Germany
| | - Manfred Staat
- 1Biomechanics Laboratory, Institute of Bioengineering, FH Aachen University of Applied Sciences,Jülich, Germany
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Senturk MB, Kilicci C, Aydin S, Polat M, Abide Yayla C, Karateke A. Vaginal axis on MRI after unilateral and bilateral sacral hysteropexy: a controlled study. J OBSTET GYNAECOL 2017; 38:115-120. [DOI: 10.1080/01443615.2017.1336754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mehmet B. Senturk
- Departments of Obstetrics and Gynecology, Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Cetin Kilicci
- Departments of Obstetrics and Gynecology, Zeynep Kamil Maternity Teaching and Research Hospital, İstanbul, Turkey
| | - Sibel Aydin
- Departments of Radiology, Haydarpasa Teaching and Research Hospital, İstanbul, Turkey
| | - Mesut Polat
- Departments of Obstetrics and Gynecology, Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Cigdem Abide Yayla
- Departments of Obstetrics and Gynecology, Zeynep Kamil Maternity Teaching and Research Hospital, İstanbul, Turkey
| | - Ates Karateke
- Departments of Obstetrics and Gynecology, Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey
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Zacchè M, Morris E, Mukhopadhyay S. Safety and efficacy of bilateral cervical and vaginal sacrocolpopexy. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rajshekhar S, Mukhopadhyay S, Morris E. Early safety and efficacy outcomes of a novel technique of sacrocolpopexy for the treatment of apical prolapse. Int J Gynaecol Obstet 2016; 135:182-186. [PMID: 27498595 DOI: 10.1016/j.ijgo.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 05/12/2016] [Accepted: 07/18/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy in which both uterosacral ligaments are replaced with polyvinylidene fluoride mesh to provide support to the cervix (cervico-sacropexy [CESA]) or vaginal vault (vagino-sacropexy [VASA]). METHODS A retrospective observational study was undertaken of women with posthysterectomy vault prolapse or recurrent apical prolapse following previous prolapse repair who underwent bilateral sacrocolpopexy between July 1, 2013, and December 31, 2014, in a tertiary referral unit in the UK. Before surgery and 3 months afterwards, prolapse was assessed using the Pelvic Organ Prolapse Quantification scale and functional outcomes were recorded using the International Consultation on Incontinence Questionnaire for vaginal symptoms and urinary incontinence. RESULTS Fifty women were included. At 3 months, 47 (94%) patients reported no bulge symptoms and the mean point C was -7.6. Complications comprised bladder injury in 1 (2%) and minor wound problems in 3 (6%) patients. No mesh erosion was reported. CONCLUSION Bilateral abdominal sacrocolpopexy seems to be a safe and effective option for apical prolapse. Longer-term follow-up is needed to detect prolapse recurrence and mesh-related complications.
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Affiliation(s)
| | | | - Edward Morris
- Norfolk and Norwich University Hospital, Norwich, UK
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Laparoscopic versus robotic-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review. ACTA ACUST UNITED AC 2016; 13:115-123. [PMID: 27226787 PMCID: PMC4854942 DOI: 10.1007/s10397-016-0930-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/11/2016] [Indexed: 12/23/2022]
Abstract
The use of robot-assisted surgery (RAS) has gained popularity in the field of gynaecology, including pelvic floor surgery. To assess the benefits of RAS, we conducted a systematic review of randomized controlled trials comparing laparoscopic and robotic-assisted sacrocolpopexy. The Cochrane Library (1970–January 2015), MEDLINE (1966 to January 2015), and EMBASE (1974 to January 2015) were searched, as well as ClinicalTrials.gov and the International Clinical Trials Registry Platform. We identified two randomized trials (n = 78) comparing laparoscopic with robotic sacrocolpopexy. The Paraiso 2011 study showed that laparoscopic was faster than robotic sacrocolpopexy (199 ± 46 vs. 265 ± 50 min; p < .001), yet in the ACCESS trial, no difference was present (225 ± 62.3 vs. 246.5 ± 51.3 min; p = .110). Costs for using the robot were significantly higher in both studies, however, in the ACCESS trial, only when purchase and maintenance of the robot was included (LSC US$11,573 ± 3191 vs. RASC US$19,616 ± 3135; p < .001). In the Paraiso study, RASC was more expensive even without considering those costs (LSC US$ 14,342 ± 2941 vs. RASC 16,278 ± 3326; p = 0.008). Pain was reportedly higher after RASC, although at different time points after the operation. There were no differences in anatomical outcomes, pelvic floor function, and quality of life. The experience with RASC was tenfold lower than that with LSC in both studies. The heterogeneity between the two studies precluded a meta-analysis. Based on small randomized studies, with surgeons less experienced in RAS than in laparoscopic surgery, robotic surgery significantly increases the cost of a laparoscopic sacrocolpopexy. RASC would be more sustainable if its costs would be lower. Though RASC may have other benefits, such as reduction of the learning curve and increased ergonomics or dexterity, these remain to be demonstrated.
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Sabadell J, Larrain F, Gracia-Perez-Bonfils A, Montero-Armengol A, Salicrú S, Gil-Moreno A, Poza JL. Comparative study of polyvinylidene fluoride and polypropylene suburethral slings in the treatment of female stress urinary incontinence. J Obstet Gynaecol Res 2015; 42:291-6. [DOI: 10.1111/jog.12899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/31/2015] [Accepted: 10/01/2015] [Indexed: 01/26/2023]
Affiliation(s)
- Jordi Sabadell
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology; Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona; Barcelona Spain
- General Surgery Research Group. Gynecology, Pediatric Diseases and Experimental Surgery Area. Vall d'Hebron Research Institute; Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona; Barcelona Spain
| | - Francisco Larrain
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology; Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Gynecology; Hospital San José; Santiago Chile
- Department of Gynecology; Clínica Alemana; Santiago Chile
| | - Ana Gracia-Perez-Bonfils
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology; Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona; Barcelona Spain
| | - Anabel Montero-Armengol
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology; Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona; Barcelona Spain
| | - Sabina Salicrú
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology; Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona; Barcelona Spain
| | - Antonio Gil-Moreno
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology; Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona; Barcelona Spain
| | - Jose L. Poza
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology; Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona; Barcelona Spain
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Han A, Karaman E, Alkiş İ, Ark HC, Akça A, Numanoğlu C, Alptekin BB, Tunca AF. The Effect of Patient Position during Mid-Urethral Sling Operations on the Postoperative Outcomes of Sling Success: A Randomized Clinical Study. Gynecol Obstet Invest 2015; 81:302-7. [DOI: 10.1159/000441620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/12/2015] [Indexed: 11/19/2022]
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Töz E, Balsak D, Başoğul N, Özdemir AA, Okay G, Apaydın N, Özcan A. Outcomes of Transobturator Tape Surgery with Safyre T® Slings for Female Stress Urinary Incontinence after 96 Months of Follow-Up. Gynecol Obstet Invest 2015; 81:000433536. [PMID: 26112313 DOI: 10.1159/000433536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/21/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To report the outcomes of transobturator tape (TOT) surgery with Safyre T® (Promedon, Argentina) slings for female stress urinary incontinence (SUI) at a 96- month follow-up. METHODS We conducted a clinical follow-up study of 153 patients diagnosed with SUI between January 2005 and December 2014. Patients were provided with detailed a priori information pertaining to the TOT procedure and were invited to attend follow-up visits at 1, 3, 12, 24, 48, 72 and 96 months. Follow-up visits included physical examination involving sling palpation, checking of the vaginal mucosa for erosion, cough test, as well as validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) questionnaires. RESULTS The overall objective success rates, based on cough test results, were 91.3% at 12 months, 86.8% at 48 months and 77.6% at 96 months. Similarly, the overall subjective success rate, based on the validated UDI-6 and IIQ-7 scales, was 77.6% at 96 months. CONCLUSION The cure rates achieved, following TOT treatment of SUI at 1-year follow-up, showed a statistically significant decline over an 8-year period, especially at months 48 and 96. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Emrah Töz
- Department of Gynecology and Obstetrics, İzmir Tepecik Education and Research Hospital, İzmir, Turkey
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A Novel Operative Procedure for Pelvic Organ Prolapse Utilizing a MRI-Visible Mesh Implant: Safety and Outcome of Modified Laparoscopic Bilateral Sacropexy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:860784. [PMID: 25961042 PMCID: PMC4417564 DOI: 10.1155/2015/860784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/07/2014] [Indexed: 01/17/2023]
Abstract
Introduction. Sacropexy is a generally applied treatment of prolapse, yet there are known possible complications of it. An essential need exists for better alloplastic materials. Methods. Between April 2013 and June 2014, we performed a modified laparoscopic bilateral sacropexy (MLBS) in 10 patients using a MRI-visible PVDF mesh implant. Selected patients had prolapse POP-Q stages II-III and concomitant OAB. We studied surgery-related morbidity, anatomical and functional outcome, and mesh-visibility in MRI. Mean follow-up was 7.4 months. Results. Concomitant colporrhaphy was conducted in 1/10 patients. Anatomical success was defined as POP-Q stage 0-I. Apical success rate was 100% and remained stable. A recurrent cystocele was seen in 1/10 patients during follow-up without need for intervention. Out of 6 (6/10) patients with preoperative SUI, 5/6 were healed and 1/6 persisted. De-novo SUI was seen in 1/10 patients. Complications requiring a relaparoscopy were seen in 2/10 patients. 8/10 patients with OAB were relieved postoperatively. The first in-human magnetic resonance visualization of a prolapse mesh implant was performed and showed good quality of visualization. Conclusion. MLBS is a feasible and safe procedure with favorable anatomical and functional outcome and good concomitant healing rates of SUI and OAB. Prospective data and larger samples are required.
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Henriques HN, Bergmann de Carvalho AC, Pantaleão JAS, Guzmán-Silva MA. Morphology and histomorphometry of the bladder and urethra in ovariectomized rats after long-term use of tibolone. Gynecol Obstet Invest 2014; 78:12-5. [PMID: 24852939 DOI: 10.1159/000360536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/10/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to evaluate the effect of long-term high-dose tibolone on the bladders and urethras of ovariectomized rats. METHODS Bilateral ovariectomy was performed in 14 young adult rats randomly divided into 2 groups. Experimental rats (n = 9) received 1 mg/day of tibolone orally; control rats (n = 6) received a placebo. After 150 days, the bladders and urethras were removed. Bladder cell proliferation was analyzed by Ki-67 immunohistochemistry. A histomorphometric analysis was performed for epithelial thickness and the percent areas of collagen fibers and blood vessels. Data were compared using a Mann-Whitney test (significance level at p < 0.05). RESULTS Urothelial thickness and the percent area of collagen fibers and blood vessels were not significantly different between the tibolone and control groups in the bladder and urethra. In addition, urothelium cell proliferation in the bladder showed a low immunopositivity in both groups. Furthermore, the glycogen and glycoprotein contents in urethral epithelium were slightly modified by tibolone and no change was observed in the bladder. CONCLUSION Long-term administration of tibolone has no effect on urothelial trophism, collagen fibers, the number of vessels, or cell proliferation in the urethra and bladder of the ovariectomized rat.
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