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Chill HH, Dick A, Zarka W, Vilk Ayalon N, Rosenbloom JI, Shveiky D, Karavani G. Factors Associated with Obstetric Anal Sphincter Injury During Vacuum-Assisted Vaginal Delivery. Int Urogynecol J 2024:10.1007/s00192-024-05785-5. [PMID: 38703223 DOI: 10.1007/s00192-024-05785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetric anal sphincter injury (OASI) is a major complication associated with vacuum-assisted vaginal delivery (VAVD). The aim of this study was to evaluate risk factors related to vacuum extraction that are associated with OASI. METHODS This was a case-control study performed at a tertiary university teaching hospital. Included were patients aged 18-45 years who had a singleton pregnancy resulting in a live, term, VAVD. The study group consisted of women diagnosed with OASI following vacuum extraction. The control group included women following VAVD without OASI. Matching at a ratio of 1:2 was performed. Groups were compared regarding demographic, obstetric. and labor-related parameters, specifically focusing on variables related to the vacuum procedure itself. RESULTS One hundred and ten patients within the study group and 212 within the control group were included in the final analysis. Patients in the OASI group were more likely to undergo induction of labor, use of oxytocin during labor, increased second stage of labor, higher likelihood of the operator being a resident, increased number of pulls, procedure lasting under 10 min, occipito-posterior head position at vacuum initiation, episiotomy, increased neonatal head circumference, and birthweight. Multivariate logistic regression analysis revealed that increased week of gestation (OR 1.67, 95% CI 1.25-2.22, p < 0.001), unsupervised resident performing the procedure (OR 4.63, 95% CI 2.17-9.90), p < 0.001), indication of VAVD being fetal distress (OR 2.72, 95% CI 1.04-7.10, p = 0.041), and length of procedure under 10 min (OR 4.75, 95% CI 1.53-14.68, p = 0.007) were associated with OASI. Increased maternal age was associated with lower risk of OASI (OR 0.9, 95% CI 0.84-0.98, p = 0.012). CONCLUSIONS When performing VAVD, increased week of gestation, unsupervised resident performing the procedure, fetal distress as vacuum indication, and vacuum procedure under 10 min were associated with OASI. In contrast, increased maternal age was shown to be a protective factor.
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Affiliation(s)
- Henry H Chill
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago, Northshore University Health System, 9650 Gross Point Road, Suite 3900, Skokie, IL, USA.
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Aharon Dick
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wajdy Zarka
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Naama Vilk Ayalon
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Stern S, Khalaileh A, Shveiky D, Lessans N. Laparoscopic Resection of a Giant Liver Tumor in Pregnancy. J Minim Invasive Gynecol 2023; 30:683-684. [PMID: 37196885 DOI: 10.1016/j.jmig.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/30/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Shira Stern
- Department of Obstetrics and Gynecology (Drs. Stern, Shveiky, and Lessans), Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Abed Khalaileh
- Department of Surgery (Dr. Khalaileh), Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology (Drs. Stern, Shveiky, and Lessans), Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Naama Lessans
- Department of Obstetrics and Gynecology (Drs. Stern, Shveiky, and Lessans), Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Chill HH, Cohen A, Dick A, Reuveni-Salzman A, Shveiky D. The effect of uterine volume on surgical outcomes following uterine preserving apical prolapse repair. Eur J Obstet Gynecol Reprod Biol 2023; 281:49-53. [PMID: 36535070 DOI: 10.1016/j.ejogrb.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/22/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In recent years uterine preservation has become a popular option in women undergoing pelvic organ prolapse repair. The aim of this study was to evaluate the effect of uterine volume on outcomes following uterine preserving surgical treatment for apical prolapse. METHODS We performed a retrospective comparative study at a tertiary university hospital. Included were women who had uterine preserving surgical treatment for apical prolapse. The cohort was divided into two groups: 1) Patients with a uterine volume ≥ 35 cm3 (large uterus group); 2) Patients with uterine volume < 35 cm3 (small uterus group). Pre-, intra-, and post-operative data were compared between groups. Our primary outcome was composite outcome success including clinical and anatomical success and no need for reoperation. Secondary outcomes included clinical success, anatomical success, and patient satisfaction evaluated using the PGI-I questionnaire. RESULTS Eighty-four patients were included in the final analysis. The large uterus group (≥35 cm3) consisted of 37 patients as opposed to 47 in the small uterus group (<35 cm3). Clinical (91.9 % vs 87.1 %, p = 0.725) and anatomical success (84.8 % vs 90.9 %, p = 0.508) were high and did not differ between groups. Composite outcome success was 76.1 % in the small uterus group compared to 87.9 % in the large uterus group, but this difference was not statistically significant. Post-operative points Ba, C and Bp were similar between groups. No difference was found in patient satisfaction measured using the PGI-I questionnaire. CONCLUSION Women undergoing uterine preserving apical prolapse repair with uterine volume ≥ 35 cm3 have comparable surgical outcomes to patients with a smaller uterus.
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Affiliation(s)
- Henry H Chill
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA.
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Aharon Dick
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Adi Reuveni-Salzman
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
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Loyfer N, Magenheim J, Peretz A, Cann G, Bredno J, Klochendler A, Fox-Fisher I, Shabi-Porat S, Hecht M, Pelet T, Moss J, Drawshy Z, Amini H, Moradi P, Nagaraju S, Bauman D, Shveiky D, Porat S, Dior U, Rivkin G, Or O, Hirshoren N, Carmon E, Pikarsky A, Khalaileh A, Zamir G, Grinbaum R, Abu Gazala M, Mizrahi I, Shussman N, Korach A, Wald O, Izhar U, Erez E, Yutkin V, Samet Y, Rotnemer Golinkin D, Spalding KL, Druid H, Arner P, Shapiro AMJ, Grompe M, Aravanis A, Venn O, Jamshidi A, Shemer R, Dor Y, Glaser B, Kaplan T. A DNA methylation atlas of normal human cell types. Nature 2023; 613:355-364. [PMID: 36599988 PMCID: PMC9811898 DOI: 10.1038/s41586-022-05580-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 11/18/2022] [Indexed: 01/05/2023]
Abstract
DNA methylation is a fundamental epigenetic mark that governs gene expression and chromatin organization, thus providing a window into cellular identity and developmental processes1. Current datasets typically include only a fraction of methylation sites and are often based either on cell lines that underwent massive changes in culture or on tissues containing unspecified mixtures of cells2-5. Here we describe a human methylome atlas, based on deep whole-genome bisulfite sequencing, allowing fragment-level analysis across thousands of unique markers for 39 cell types sorted from 205 healthy tissue samples. Replicates of the same cell type are more than 99.5% identical, demonstrating the robustness of cell identity programmes to environmental perturbation. Unsupervised clustering of the atlas recapitulates key elements of tissue ontogeny and identifies methylation patterns retained since embryonic development. Loci uniquely unmethylated in an individual cell type often reside in transcriptional enhancers and contain DNA binding sites for tissue-specific transcriptional regulators. Uniquely hypermethylated loci are rare and are enriched for CpG islands, Polycomb targets and CTCF binding sites, suggesting a new role in shaping cell-type-specific chromatin looping. The atlas provides an essential resource for study of gene regulation and disease-associated genetic variants, and a wealth of potential tissue-specific biomarkers for use in liquid biopsies.
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Affiliation(s)
- Netanel Loyfer
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Judith Magenheim
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ayelet Peretz
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | - Agnes Klochendler
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ilana Fox-Fisher
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sapir Shabi-Porat
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Merav Hecht
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tsuria Pelet
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua Moss
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zeina Drawshy
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | | | - Dvora Bauman
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shay Porat
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Uri Dior
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gurion Rivkin
- Department of Orthopedics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Or
- Department of Orthopedics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Hirshoren
- Department of Otolaryngology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Einat Carmon
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Alon Pikarsky
- Surgery Division, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Abed Khalaileh
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gideon Zamir
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Grinbaum
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Machmud Abu Gazala
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ido Mizrahi
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noam Shussman
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Korach
- Department of Cardiothoracic Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ori Wald
- Department of Cardiothoracic Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Uzi Izhar
- Department of Cardiothoracic Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eldad Erez
- Department of Cardiothoracic Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yaacov Samet
- Department of Vascular Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Devorah Rotnemer Golinkin
- Department of Endocrinology and Metabolism, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kirsty L Spalding
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Druid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Medicine, The National Board of Forensic Medicine, Stockholm, Sweden
| | - Peter Arner
- Department of Medicine (H7) and Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A M James Shapiro
- Department of Surgery and the Clinical Islet Transplant Program, University of Alberta, Edmonton, Alberta, Canada
| | - Markus Grompe
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Alex Aravanis
- GRAIL, Inc., Menlo Park, CA, USA
- Illumina, Inc., San Diego, CA, USA
| | | | | | - Ruth Shemer
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Dor
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Benjamin Glaser
- Department of Endocrinology and Metabolism, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Tommy Kaplan
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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Chill HH, Karavani G, Lipschuetz M, Yishai K, Winer J, Shimonovitz T, Shveiky D. Birthweight difference between deliveries and the risk of obstetric anal sphincter injury in parous women. Int Urogynecol J 2022; 33:3401-3406. [PMID: 35471584 DOI: 10.1007/s00192-022-05207-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS While obstetric anal sphincter injury (OASI) is less frequent in parous compared to nulliparous women, it remains a major concern affecting quality of life of women worldwide. The aim of this study was to evaluate the association between birthweight (BW) difference between deliveries and risk of OASI in parous women. METHODS We performed a retrospective case-control study including parous women with at least one previous vaginal delivery who were diagnosed with OASI. The control group consisted of parous women who did not have OASI during vaginal delivery. Controls were matched in a 1:2 ratio by year of birth, maternal age, and parity. Medical history, obstetric background, and current labor-related data were compared. Further univariate and multivariable analyses were performed, assessing for risk factors for OASI. RESULTS One hundred eight parous women who had a diagnosis of OASI and a control group of 216 parturients who delivered without OASI were included in the final analysis. Differences between the current BW and the preceding and maximal previous BW were evaluated. There were significantly higher rates of women who had a larger neonate with > 500 g difference between the current and previous BW in the OASI group than in those with no OASI (28.7% vs. 12.30%, respectively; p < 0.001). Following a multivariable analysis for the dependent parameter of OASI, the following parameters were found to be independently associated with OASI outcome: previous operative vaginal delivery, BW ≥ 90th percentile, and current BW ≥ 500 g compared to previous maximal BW. CONCLUSIONS In parous women, neonatal BW increase between deliveries of > 500 g is associated with OASI.
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Affiliation(s)
- Henry H Chill
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA.
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Keren Yishai
- Hebrew University Medical School, Jerusalem, Israel
| | - Joel Winer
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
| | - Tzvika Shimonovitz
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Chill HH, Shusel O, Dick A, Moss NP, Cohen A, Reuveni-Salzman A, Shveiky D. The Effect of Age on Surgical Outcomes Following Uterine Preserving Surgery for Treatment of Apical Prolapse. J Minim Invasive Gynecol 2022; 29:1303-1309. [PMID: 35995324 DOI: 10.1016/j.jmig.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the effect of age on outcomes after uterine-preserving surgical treatment for apical prolapse. DESIGN Retrospective cohort study. SETTING Female pelvic medicine and reconstructive surgery unit at a tertiary, university-affiliated teaching medical center. PATIENTS Women who underwent surgical management of apical prolapse with uterine preservation between 2010 and 2020. Excluded were women who had ≤1 month of follow-up and those for whom medical records were substantially incomplete. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Included in the study were 140 women who underwent apical prolapse repair with uterine preservation and who met the inclusion criteria. The cohort was divided into 2 groups: (1) women aged 65 years and older (≥65 group) and (2) women younger than 65 years of age (<65 group). Pre-, intra-, and postoperative data were compared between the groups. A total of 103 women (73.6%) were in the <65 group and 37 women (26.4%) in the ≥65 group. Mean age for the entire cohort was 58 ± 9.8 years, body mass index 25.9 ± 4.8 kg/m2, and duration of follow-up was 25.9 ± 21.0 months. Women in the ≥65 group had more comorbidities, were less sexually active, and were less likely to have a midurethral sling performed during their surgery. Clinical and anatomical success rates were somewhat higher in the ≥65 group; however, these differences did not reach statistical significance (97.3% vs 85.4%, p = .069 and 89.2% vs 81.2%, p = .264, respectively). Composite outcome success was higher in the ≥65 group (89.2% vs 72.5%, p = .039). Patient satisfaction recorded using the Patient Global Impression of Improvement questionnaire was high for both groups. A multivariable logistic regression analysis for the dependent parameter of composite outcome success was performed, during which none of the parameters investigated reached statistical significance. Subgroup analysis was performed including only women who were postmenopausal. This was done to address the possible confounding effect that menopausal status may have had on our results. No differences were found between the groups with regard to clinical, anatomical, and composite outcomes. CONCLUSION Uterine-preserving surgery is a safe and effective surgical treatment for women aged ≥65 years.
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Affiliation(s)
- Henry H Chill
- Division of Urogynecology, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, NorthShore University HealthSystem (Drs. Chill and Moss), Skokie, Illinois.
| | - Ofek Shusel
- Hebrew University Medical School (Mr. Shusel), Jerusalem, Israel
| | - Aharon Dick
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel
| | - Nani P Moss
- Division of Urogynecology, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, NorthShore University HealthSystem (Drs. Chill and Moss), Skokie, Illinois
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel
| | - Adi Reuveni-Salzman
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Reuveni-Salzman and Shveiky), Ein Kerem, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Reuveni-Salzman and Shveiky), Ein Kerem, Jerusalem, Israel
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Stern S, Lessans N, Shveiky D, Saar TD, Tevet A, Dior UP. Repair of Uterine Rupture Following Vaginal Delivery: A Comparison between Minimally invasive and Open Repair. Int J Gynaecol Obstet 2022; 161:942-948. [PMID: 36433868 DOI: 10.1002/ijgo.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare operative data and patient satisfaction between open and laparoscopic surgery for postpartum-diagnosed uterine rupture. METHODS In this questionnaire-based cohort study, the authors collected all cases of postpartum-diagnosed uterine rupture after vaginal delivery between 2016 and 2020 in a single academic tertiary center. The cohort was divided according to surgical method of repair, and demographic, clinical, operative and postoperative data were collected and compared between groups. A phone questionnaire on various satisfaction domains was conducted and satisfaction rates were compared between groups. RESULTS Eight cases of uterine rupture following vaginal delivery were treated by laparoscopy and eight were treated by laparotomy. The median operative time was 103 min (interquartile range [IQR], 86.3-129.0 min) for the laparoscopy group and 61 min (IQR, 59.0-75.0 min) for the laparotomy group (P = 0.04). Blood transfusion was required in 25% of women who underwent laparoscopy, as compared with 88% of women who underwent laparotomy (P = 0.01 < 0.05). Median hospitalization time was 3 days (IQR, 3-4 days) in the laparoscopy group and 4 days (IQR, 4-4 days) in the laparotomy group (P = 0.2). Overall satisfaction, satisfaction from recovery, satisfaction from scars, satisfaction from ability to care for the neonate, and postoperative pain and mood were all improved in the laparoscopy group, as compared with the laparotomy group. CONCLUSION Minimally invasive surgery is a viable surgical option for patients with uterine rupture diagnosed after vaginal delivery and may result in better patient recovery and satisfaction.
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Affiliation(s)
- Shira Stern
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Naama Lessans
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Tal D. Saar
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Aharon Tevet
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Uri P. Dior
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
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Chill HH, Ben-Porat L, Winer J, Moss NP, Cohen A, Shveiky D. Infected pelvic hematoma following vaginal hysterectomy with uterosacral ligament suspension for treatment of apical prolapse. Eur J Obstet Gynecol Reprod Biol 2022; 271:97-101. [DOI: 10.1016/j.ejogrb.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/08/2022] [Indexed: 11/04/2022]
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Wilkinson HN, Reubinoff B, Shveiky D, Hardman MJ, Menachem-Zidon OB. Epithelial arginase-1 is a key mediator of age-associated delayed healing in vaginal injury. Front Endocrinol (Lausanne) 2022; 13:927224. [PMID: 36034415 PMCID: PMC9410732 DOI: 10.3389/fendo.2022.927224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
Pelvic organ prolapse is a disorder that substantially affects the quality of life of millions of women worldwide. The greatest risk factors for prolapse are increased parity and older age, with the largest group requiring surgical intervention being post-menopausal women over 65. Due to ineffective healing in the elderly, prolapse recurrence rates following surgery remain high. Therefore, there is an urgent need to elucidate the cellular and molecular drivers of poor healing in pelvic floor dysfunction to allow effective management and even prevention. Recent studies have uncovered the importance of Arginase 1 for modulating effective healing in the skin. We thus employed novel in vitro and in vivo vaginal injury models to determine the specific role of Arginase 1 in age-related vaginal repair. Here we show, for the first time, that aged rat vaginal wounds have reduced Arginase 1 expression and delayed healing. Moreover, direct inhibition of Arginase 1 in human vaginal epithelial cells also led to delayed scratch-wound closure. By contrast, activation of Arginase 1 significantly accelerated healing in aged vaginal wounds in vivo, to rates comparable to those in young animals. Collectively, these findings reveal a new and important role for Arginase 1 in mediating effective vaginal repair. Targeting age-related Arginase 1 deficiency is a potential viable therapeutic strategy to promote vaginal healing and reduce recurrence rate after surgical repair of pelvic organ prolapse.
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Affiliation(s)
- Holly N. Wilkinson
- Centre for Biomedicine, Hull York Medical School, University of Hull, Hull, United Kingdom
- *Correspondence: Ofra Ben Menachem-Zidon, ; Holly N. Wilkinson,
| | - Benjamin Reubinoff
- The Hadassah Human Embryonic Stem Cell Research Center and the Goldyne Savad Institute of Gene Therapy, Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Obstetrics and Gynecology, Hadassah – Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah – Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
- Section of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Matthew J. Hardman
- Centre for Biomedicine, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Ofra Ben Menachem-Zidon
- The Hadassah Human Embryonic Stem Cell Research Center and the Goldyne Savad Institute of Gene Therapy, Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Ofra Ben Menachem-Zidon, ; Holly N. Wilkinson,
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Badrieh A, Elazary R, Ben Porat T, Sakran N, Dior U, Shveiky D, Rottenstreich A. Reproductive-health counseling, menstruation, contraception and conception after sleeve gastrectomy: A cross-sectional study. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chill HH, Lipschuetz M, Atias E, Shwartz T, Shveiky D, Karavani G. Association between birth weight and head circumference and obstetric anal sphincter injury severity. Eur J Obstet Gynecol Reprod Biol 2021; 265:119-124. [PMID: 34488037 DOI: 10.1016/j.ejogrb.2021.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify risk factors for increasing severity of OASI and evaluate its possible correlation with two known risk factors-birth weight (BW) and neonatal head circumference (HC). METHODS We performed a retrospective cohort study at a university affiliated hospital between 2003 and 2019. We compared five groups of patients - according to presence and degree of perineal laceration - 3a, 3b, 3c and 4 and patients without OASI. Additionally, four parameters were defined to assess their relation to the severity of OASI: (1) BW ≥ 90th and HC < 90th percentiles; (2) BW < 90th and HC ≥ 90th percentile; (3) BW and HC ≥ 90th percentile and (4) BW and HC < 90th percentiles. RESULTS During the study period, 150,221 deliveries were evaluated. Parturients were allocated according to OASI severity - 455 patients had a 3rd (3a, 3b or 3c) or 4th degree perineal tear, while 110,966 patients had no OASI. Allocation to subgroups according to offspring anthropomorphic measures showed that as fetal size parameters increased, the rate of more severe tears increased, particularly in women delivering neonates with HC ≥ 90th percentile. Multinomial regression analysis was performed for each 3rd degree OASI subgroup. This analysis demonstrated the odds for OASI gradually increase with tear severity for BW ≥ 90th percentile and the combined BW and HC ≥ 90th percentile parameters, as compared with neonates with HC and BW < 90th percentile. CONCLUSIONS Birth weight and head circumference above the 90th percentile are correlated with increased degree of OASI severity.
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Affiliation(s)
- Henry H Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Ein-Kerem Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Michal Lipschuetz
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Eyal Atias
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Tomer Shwartz
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Ein-Kerem Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Gilad Karavani
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
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Chill HH, Lipschuetz M, Atias E, Shimonovitz T, Shveiky D, Karavani G. Obstetric anal sphincter injury in adolescent mothers. BMC Pregnancy Childbirth 2021; 21:564. [PMID: 34407794 PMCID: PMC8371773 DOI: 10.1186/s12884-021-04045-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Obstetric anal sphincter injury (OASI) is a debilitating complication of vaginal delivery which has yet to receive ample attention in adolescents. The aim of this study was to describe risk for OASI in adolescent mothers compared to adults. We further attempted to compare risk factors for OASI between these two age groups. Methods We performed a retrospective cohort study between 2003 and 2019. Primiparous women who delivered vaginally, 21 years and younger were compared to women ages 26–35. Excluded were preterm, multifetal, non-vertex, cesarean deliveries as well as intrauterine fetal death. Rate of OASI as well as obstetric and labor characteristics of women with OASI, were compared between groups. Finally, risk factors were assessed for each group separately. Univariate and multivariate logistic regression model were performed. Results Final analysis was performed on 5113 nulliparous adolescents and 13,845 nulliparous in the 26–35 age group. Allocation to study groups was according to OASI – Sixty-seven adolescents (1.3%) had a 3rd or 4th degree perineal tear and were defined as the OASI group, while 5046 patients (98.7%) did not have such a tear. In the adult group, 199 out of 13,845 patients (1.4%) were diagnosed with OASI. Occurrence of OASI did not differ between groups (p = 0.510). Comparison of women with OASI in the adolescent group vs. adult group found differences with regard to operative vaginal delivery, (20.9% vs. 36.2%, respectively; p = 0.023) and meconium stained amniotic fluid (9.1% vs. 21.3%, respectively; p = 0.027). Following multivariate analysis the only parameter independently associated with OASI in the adolescent age group was head circumference ≥ 90th percentile with an adjusted odds ratio of 3.08 (CI 1.48–6.38, p = 0.003). In the adult group the similar analysis revealed operative vaginal delivery (OR = 2.44, CI 1.72–3.47, p < 0.001) and a birthweight≥90th percentile (OR = 2.23, CI 1.19–4.18, p = 0.012) to be independent risk factors for OASI. Conclusion Adolescents have similar risk for OASI compared to adults but differ in risk factors leading to OASI. Head circumference ≥ 90th percentile was found to be associated with OASI in this age group.
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Affiliation(s)
- Henry H Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. .,Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Michal Lipschuetz
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Atias
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tzvika Shimonovitz
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gilad Karavani
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Chill HH, Karavani G, Lipschuetz M, Berenstein T, Atias E, Amsalem H, Shveiky D. Obstetric anal sphincter injury following previous vaginal delivery. Int Urogynecol J 2021; 32:2483-2489. [PMID: 34100977 DOI: 10.1007/s00192-021-04872-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetric anal sphincter injury (OASI) is a debilitating complication of vaginal delivery. The aim of this study was to identify risk factors for OASI in women with a previous vaginal delivery. We further attempted to detect specific risk factors for severe OASI in this subgroup. METHODS We conducted a retrospective cohort study between 2003 and 2019. The study group included women who had a singleton, live, vertex, vaginal delivery at term and who also had at least one previous vaginal delivery. The control group included women with at least one previous vaginal delivery without OASI. General medical history, obstetric history, and ante-, intra- and post-partum data were collected and compared between groups. RESULTS Following implementation of the inclusion criteria, 79,176 women were included. Allocation to study groups was according to OASI occurrence: 135 patients (0.2%) had a third- or fourth-degree perineal tear, while 79,041 patients (99.8%) had no such injury. Multivariate analysis revealed that one previous vaginal delivery, birthweight ≥ 3900 g (90th percentile), vacuum-assisted vaginal delivery and episiotomy were associated with increased risk of OASI. Comparison of more severe OASI (3C and 4th-degree) cases to the control group showed similar results with the addition of prolonged second stage and younger age to risk factors associated with severe OASI while episiotomy was no longer significant. CONCLUSION In women with a previous vaginal delivery, one vs. two or more previous vaginal deliveries, increased birthweight, vacuum-assisted vaginal delivery and episiotomy are risk factors for OASI.
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Affiliation(s)
- Henry H Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Jerusalem, Ein Kerem, Israel.
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Gilad Karavani
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Eyal Atias
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Amsalem
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Jerusalem, Ein Kerem, Israel
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Chill HH, Parnasa SY, Shussman N, Alter R, Helou B, Cohen A, Pikarsky AJ, Shveiky D. Urinary dysfunction in women following total mesorectal excision versus partial mesorectal excision for treatment of rectal cancer. BMC Womens Health 2021; 21:237. [PMID: 34092222 PMCID: PMC8183065 DOI: 10.1186/s12905-021-01381-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022]
Abstract
Background Colorectal cancer is a condition which is associated with substantial morbidity and mortality. The aim of this study was to assess urinary dysfunction and its effect on quality of life in women who underwent total mesorectal excision compared to women treated by partial mesorectal excision for treatment of rectal cancer. Methods We performed a retrospective cohort study at a tertiary university hospital between January 2014 and December 2019. A comparison was performed between women who underwent total mesorectal excision as opposed to partial mesorectal excision for treatment of rectal cancer. Pre-operative, intra-operative and post-operative data were compared between groups. Data regarding radiation therapy was recorded and compared as well. Urinary dysfunction and its impact on quality of life were assessed using UDI-6 and USIQ questionnaires. Further univariate and multivariate analyses were performed in the attempt of assessing risk factors for urinary dysfunction. Results A total of 107 women were included in the study, 73 women underwent partial mesorectal excision as opposed to 34 women who were treated by total mesorectal excision. Twenty-five women in the TME group underwent radiation therapy prior to surgery as opposed to none in the PME group (p < 0.001). Urinary dysfunction following surgery as assessed using the UDI-6 questionnaire did not differ between groups. Similar findings were recorded with regard to the impact of urinary dysfunction on quality of life as assessed using the USIQ questionnaire. Following multivariate analysis longer hospital stay was associated with increased risk of some degree of urinary dysfunction. Conclusions Women undergoing total mesorectal excision have comparable results to partial mesorectal excision with regard to urinary dysfunction.
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Affiliation(s)
- Henry H Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. .,Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Shani Y Parnasa
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noam Shussman
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roie Alter
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Briggite Helou
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alon J Pikarsky
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Shveiky D, Cohn D, Elyashiv A, Nissenbaum Y, Neuman T, Karavani G, Bloom AI. A novel technology for reversible fallopian tubal occlusion using a reverse thermo-responsive polymer-Preliminary results from a rabbit animal study. Contraception 2021; 104:319-323. [PMID: 33894249 DOI: 10.1016/j.contraception.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine if PF-88, a reverse thermo-responsive polymer designed to create a gel at body temperature and liquefy at a lower temperature (21°C) can reversibly occlude the fallopian tubes in rabbits. STUDY DESIGN Mature female New Zealand White rabbits underwent laparotomy and placement of 22-gage catheter into the lumen of the distil uterine horns for evaluation of tubal patency by fluoroscopy using radio opaque contrast and treatment with PF-88. In the Acute Phase group (n = 5) after PF-88 treatment we immediately cooled the serosal surface of the tube with ice for 90 seconds to liquify the gel then reassessed patency. In the Survival Phase groups, animals recovered from the initial surgery and then underwent a second procedure for evaluation of tubal occlusion and reversibility at 4 (n = 3), 14 (n = 2), and 28 (n = 3) weeks after the initial procedure. We compared the histologic appearance of the treated fallopian tubes to untreated controls (n = 3). RESULTS In the Acute Phase, we found all 10 fallopian tubes patent on initial evaluation, occluded following treatment with PF88, and patent following re-liquification by chilling. Animals in the Survival Group, all but one of the treated tubes appeared blocked at follow-up and patent following chilling. The treatment failure occurred in an animal in the 4-week group. Tubes treated with PF88 showed no histologic evidence of residual material or damage after removal of the polymer. CONCLUSION The PF-88 reverse thermo-responsive polymer demonstrated the ability to reversibly block fallopian tubes for up to 28 weeks. IMPLICATIONS The demonstration of reversible occlusion of the fallopian tube of rabbits using PF-88, a thermo-responsive reverse polymer, support additional studies to evaluate the potential of this polymer as a contraceptive in women.
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Affiliation(s)
- David Shveiky
- Department of Obstetrics and Gynecology, Hadassah Medical Center - Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Daniel Cohn
- The Casali Institute of Applied Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariel Elyashiv
- The Casali Institute of Applied Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yitzhak Nissenbaum
- Department of Medical Imaging, Interventional Radiology Unit, Hadassah Medical Center - Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tzahi Neuman
- Department of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Center - Hebrew University of Jerusalem, Jerusalem, Israel
| | - Allan I Bloom
- Department of Medical Imaging, Interventional Radiology Unit, Hadassah Medical Center - Hebrew University of Jerusalem, Jerusalem, Israel
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Chill HH, Guedalia J, Lipschuetz M, Shimonovitz T, Unger R, Shveiky D, Karavani G. Prediction model for obstetric anal sphincter injury using machine learning. Int Urogynecol J 2021; 32:2393-2399. [PMID: 33710431 DOI: 10.1007/s00192-021-04752-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetric anal sphincter injury (OASI) is a complication with substantial maternal morbidity. The aim of this study was to develop a machine learning model that would allow a personalized prediction algorithm for OASI, based on maternal and fetal variables collected at admission to labor. MATERIALS AND METHODS We performed a retrospective cohort study at a tertiary university hospital. Included were term deliveries (live, singleton, vertex). A comparison was made between women diagnosed with OASI and those without such injury. For formation of a machine learning-based model, a gradient boosting machine learning algorithm was implemented. Evaluation of the performance model was achieved using the area under the receiver-operating characteristic curve (AUC). RESULTS Our cohort comprised 98,463 deliveries, of which 323 (0.3%) were diagnosed with OASI. Applying a machine learning model to data recorded during admission to labor allowed for individualized risk assessment with an AUC of 0.756 (95% CI 0.732-0.780). According to this model, a lower number of previous births, fewer pregnancies, decreased maternal weight and advanced gestational week elevated the risk for OASI. With regard to parity, women with one previous delivery had approximately 1/3 of the risk for OASI compared to nulliparous women (OR = 0.3 (0.23-0.39), p < 0.001), and women with two previous deliveries had 1/3 of the risk compared to women with one previous delivery (OR = 0.35 (0.21-0.60), p < 0.001). CONCLUSION Our machine learning-based model stratified births to high or low risk for OASI, making it an applicable tool for personalized decision-making upon admission to labor.
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Affiliation(s)
- Henry Hillel Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem, Ein Kerem, Israel. .,Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Tzvika Shimonovitz
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem, Ein Kerem, Israel.,Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Chill HH, Navon I, Reuveni-Salzman A, Cohen A, Dick A, Shveiky D. Vaginal Colposuspension Using the Uphold Lite Mesh System versus Transvaginal Hysterectomy with Uterosacral Ligament Suspension for Treatment of Apical Prolapse: A Comparative Study. J Minim Invasive Gynecol 2021; 28:1759-1764. [PMID: 33713835 DOI: 10.1016/j.jmig.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/22/2021] [Accepted: 03/06/2021] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE To compare clinical and anatomic outcomes as well as patient satisfaction in women undergoing vaginal colposuspension using the Uphold Lite system (Boston Scientific Corporation, Marlborough, MA) and transvaginal hysterectomy with uterosacral ligament suspension (VUSLS) for the treatment of apical prolapse. DESIGN Retrospective cohort study. SETTING Female pelvic medicine and reconstructive surgery unit at a university-affiliated tertiary medical center. PATIENTS Women with apical prolapse who underwent either vaginal colposuspension using the Uphold Lite system (uterine-preserving as well as after previous hysterectomy) or VUSLS from 2010 to 2019. Excluded were women with 1 month or less of follow-up. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 164 women were included in the study: 112 women underwent VUSLS, and 52 underwent colposuspension using the Uphold Lite mesh system. Age, body mass index, maximal birth weight, comorbidity rates, and pelvic organ prolapse severity were similar between the groups. The clinical cure rate was similarly high in both groups, with 91.1% in the women who underwent VUSLS and 88.5% in those in the Uphold Lite group (p = .60). No differences were noted between the groups with regard to anatomic cure rate or composite outcome success rate (73.9% vs 76.0%, p = .77 and 70.3% vs 74.0%, p = .63, in the VUSLS and Uphold Lite groups, respectively). An advantage was noted in the VUSLS group with regard to patient satisfaction with 98.1% of the women stating that their condition was very much better (Patient Global Impression of Improvement questionnaire: A) or much better (Patient Global Impression of Improvement questionnaire: B) compared with 83.9% of the women in the Uphold Lite group (p = .023). In an attempt to assess the association between different variables and the composite outcome, a multivariate analysis was performed in which increased body mass index, menopausal status, and increased preoperative genital hiatus were found to decrease composite outcome success. CONCLUSION Vaginal colposuspension using the Uphold Lite system and VUSLS for the treatment of apical prolapse have comparable results with high clinical success rates.
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Affiliation(s)
- Henry H Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Chill, Reuveni-Salzman, and Shveiky); Department of Obstetrics and Gynecology (Drs. Chill, Reuveni-Salzman, Dick, and Shveiky), Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem.
| | - Ido Navon
- Department of Obstetrics and Gynecology, Hebrew University of Jerusalem School of Medicine (Dr. Cohen and Mr. Navon), Jerusalem, Israel
| | - Adi Reuveni-Salzman
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Chill, Reuveni-Salzman, and Shveiky); Department of Obstetrics and Gynecology (Drs. Chill, Reuveni-Salzman, Dick, and Shveiky), Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hebrew University of Jerusalem School of Medicine (Dr. Cohen and Mr. Navon), Jerusalem, Israel
| | - Aharon Dick
- Department of Obstetrics and Gynecology (Drs. Chill, Reuveni-Salzman, Dick, and Shveiky), Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Chill, Reuveni-Salzman, and Shveiky); Department of Obstetrics and Gynecology (Drs. Chill, Reuveni-Salzman, Dick, and Shveiky), Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem
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Shveiky D. Sacrocolpopexy - How Low Can You Go? Lessons Learned from the Dead Poets Society. J Minim Invasive Gynecol 2021; 28:724-725. [PMID: 33515744 DOI: 10.1016/j.jmig.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 11/24/2022]
Affiliation(s)
- David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel.
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Chill HH, Karavani G, Reuveni-Salzman A, Lipschuetz M, Shimonovitz T, Cohen N, Shveiky D. Urinary bladder injury during cesarean delivery: risk factors and the role of retrograde bladder filling. Int Urogynecol J 2021; 32:1801-1806. [PMID: 33386865 DOI: 10.1007/s00192-020-04630-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary bladder injury during cesarean delivery is an uncommon complication with substantial maternal morbidity. The aim of this study was to identify possible risk factors for bladder injury during cesarean delivery and to describe the role of retrograde bladder filling in the assessment of bladder wall integrity. METHODS A retrospective cohort study at a large tertiary referral center. Women who underwent cesarean delivery between 2003 and 2017 were included. Women diagnosed with urinary bladder injury were compared to women who did not have such injuries. Data retrieved included demographic characteristics, general medical history, obstetric history and intra-partum and intra-operative data. Information regarding use of retrograde bladder filling intra-operatively was retrieved as well. RESULTS During the study period, 21,177 cesarean deliveries were performed of which 68 (0.3%) cases of urinary bladder injury were identified. Two-thirds of injuries were located at the urinary bladder dome with the remaining third located at the posterior bladder wall. Most injuries were formed during uterine incision extension (60.0%) followed by peritoneal entry (22.0%). Following uni- and multivariate analyses, three parameters remained independent risk factors for bladder injury: urinary bladder adhesions, failed vacuum attempt prior to cesarean delivery and size of the uterine incision extension. In 15.4% of cases in which retrograde bladder filling was utilized following bladder repair, leakage of fluid was evident. CONCLUSION Urinary bladder adhesions, failed vacuum attempt prior to cesarean delivery and size of uterine incision extension are independent risk factors for urinary bladder injury during cesarean delivery.
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Affiliation(s)
- Henry H Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel. .,Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Adi Reuveni-Salzman
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.,Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Tzvika Shimonovitz
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nir Cohen
- Hebrew University Medical School, Jerusalem, Israel
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.,Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Karavani G, Chill HH, Reuveni-Salzman A, Guedalia J, Ben Menahem-Zidon O, Cohen N, Elchalal U, Shveiky D. Risk factors for uterine incision extension during cesarean delivery. J Matern Fetal Neonatal Med 2020; 35:2156-2161. [PMID: 32580653 DOI: 10.1080/14767058.2020.1783230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Unintentional extension of uterine incision is a known complication during cesarean delivery estimated to occur in 4-8% of cesarean deliveries. The aim of this study was to examine risk factors associated with unintentional uterine incision extension and to assess which of them are independent risk factors for this condition.Study design: We conducted a retrospective cohort study at a large public university tertiary referral center between 2003 and 2017. Included were women who underwent cesarean delivery during this time period. Demographic, medical, obstetrical and surgical data were collected. The primary outcome was the presence of uterine incision extension during cesarean delivery. Secondary outcomes included detection of risk factors associated with uterine incision extension. A multivariate analysis was additionally performed to identify general and labor related risk factors for unintentional extension of uterine incision among patients that underwent cesarean delivery during second stage of laborResults: During the study period, 25,879 cesarean deliveries performed in our medical center were assessed. Out of them, 731 (2.8%) cases of unintended uterine incision extension were identified. Women in this group had high rates of full cervical dilatation and increased maternal hemorrhage. Assessment of incision extension direction revealed that two-thirds of extensions were lateral, mostly unilateral. Median size of the extension was 2.7 ± 1.2 cm.Independent parameters associated with unintended uterine incision extension included nulliparity, vertex presentation, epidural anesthesia and cesarean section indication. Further analysis including cesarean deliveries performed during the second stage of labor revealed 397 (15.3%) cesarean deliveries in which incision extension was noted and 2205 (84.7%) cesarean deliveries without incision extension. Following multivariate analysis performed in women who underwent cesarean delivery during second stage of labor, two independent parameters associated with unintended uterine incision extension remained significant - past cesarean delivery and failed vacuum attempt.Conclusions: Vacuum extraction attempt and previous cesarean delivery are independent risk factors for uterine incision extension in women undergoing cesarean delivery during the second stage of labor. We also showed the majority of these extensions to be lateral.
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Affiliation(s)
- Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Henry H Chill
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Adi Reuveni-Salzman
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Ofra Ben Menahem-Zidon
- The Hadassah Human Embryonic Stem Cell Research Center, Goldyne Savad Institute of Gene Therapy, Hadassah - Hebrew University Hospital, Jerusalem, Israel
| | - Nir Cohen
- Faculty of Medicine, Hebrew University - Hadassah Medical Center, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Haj-Yahya R, Chill HH, Levin G, Reuveni-Salzman A, Shveiky D. Laparoscopic Uterosacral Ligament Hysteropexy vs Total Vaginal Hysterectomy with Uterosacral Ligament Suspension for Anterior and Apical Prolapse: Surgical Outcome and Patient Satisfaction. J Minim Invasive Gynecol 2020; 27:88-93. [DOI: 10.1016/j.jmig.2019.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
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Chill HH, Yahya RH, Olek M, Herzberg S, Lesser S, Shveiky D. Anatomical outcome and patient satisfaction after two-stitch utero-sacral ligament suspension. CLIN EXP OBSTET GYN 2019. [DOI: 10.12891/ceog4895.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Chill HH, Safrai M, Karavani G, Cohen A, Bahar R, Shveiky D, Shushan A. Reproductive and Obstetric Outcomes Following Operative Hysteroscopy for Treatment of Retained Products of Conception: Does Time from Surgery to Conception Matter? J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zigron R, Chill HH, Pri-Chen H, Levin G, Shushan A, Dior UP, Shveiky D, Benshushan A. 1941 Ovarian Dermoid Cyst as the Cause of Anti-Nmda Receptor Encephalitis: A Case Series. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chill HH, Shveiky D. Regarding "Tension-free vaginal tape for the treatment of stress urinary incontinence: a 13-year prospective follow-up". J Minim Invasive Gynecol 2019; 27:235. [PMID: 31491508 DOI: 10.1016/j.jmig.2019.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/23/2019] [Indexed: 11/26/2022]
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Nathan JH, Goldberg RP, Chill HH, Scherr D, Shveiky D. Novel Incision-free Device for Transvaginal Apical Pelvic Organ Prolapse Repair. J Minim Invasive Gynecol 2019; 27:959-965. [PMID: 31301468 DOI: 10.1016/j.jmig.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to present the feasibility and potential clinical advantages of Apyx (Escala Medical, Israel), a minimally invasive incision-free anchoring device, for apical prolapse repair. DESIGN An experimental prospective animal and cadaver study. SETTING Animal facility and a cadaver laboratory of a tertiary care teaching hospital. PATIENTS Included in this study were 7 ovine models, 2 porcine specimens, and 3 fresh unembalmed female human cadavers. INTERVENTIONS The Apyx device for sacrospinous ligament (SSL) suspension was tested on ovine and porcine models. The pullout force needed to detach the Apyx anchor from the SSL was measured. Safety, reliability, and feasibility of this new incision-free procedure were also tested on an ovine model and human cadavers. The precision in deployment of the Apyx device to the SSL was tested via palpation by the surgeon, tissue dissection, and x-ray imaging. The efficacy was tested both by pullout forces and histologic analysis of the vaginal attachment to the SSL. MEASUREMENTS AND MAIN RESULTS Forty-two anchors were inserted into the SSLs on ovine and porcine models and on cadaver SSLs. No abnormalities or malfunctions were noted in the functional performance of the anchors or the retrieval device. Mean pullout force for the ovine animal model was 38.64 ± 2.80 N. Pullout force in the porcine model was found to be in correlation with the values observed in the ovine model. None of the measured forces was below 20 N. Accuracy and safety tests showed good consistency when deploying the Apyx device to the SSL with no damage to surrounding organs in the ovine or the human cadaver model. Histology demonstrated biologic adhesion characterized by a gross assessment of a newly formed, firm fibrotic tissue 12 weeks after anchor deployment. CONCLUSION The Apyx anchoring system, a novel incision-free minimally invasive prolapse repair device, demonstrated an anatomically feasible, easy-to-use procedure for suspending the vaginal apex to the SSLs. Its clinical safety, efficacy, and impact on patient symptoms and quality of life should be further studied.
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Affiliation(s)
- Joseph H Nathan
- Bruce and Ruth Rappaport Faculty of Medicine (Dr. Nathan), Technion-Israel Institute of Technology, Haifa, Israel
| | - Roger P Goldberg
- Division of Urogynecology (Dr. Goldberg), NorthShore University Healthsystem, University of Chicago Pritzker School of Medicine, Skokie, Illinois
| | - Henry H Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology (Drs. Chill and Shveiky), Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Douglas Scherr
- Department of Urology (Dr. Scherr), Weill Medical College of Cornell University, New York, New York
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology (Drs. Chill and Shveiky), Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
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Shveiky D, Iglesia CB, Sarkar Das S, Ben Menachem-Zidon O, Chill HH, Ji H, Sandberg K. Age-associated impairments in tissue strength and immune response in a rat vaginal injury model. Int Urogynecol J 2019; 31:1435-1441. [PMID: 31243497 DOI: 10.1007/s00192-019-04008-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/30/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Surgical repair of pelvic organ prolapse often includes native tissue repair during which the patient's own vaginal connective tissue is used to achieve pelvic support. This method, based on plication and suspension often yields suboptimal anatomical outcomes, possibly due to inadequate healing of the vaginal connective tissue. We hypothesized that age might have a negative effect on the time course and tissue biomechanics of vaginal wound healing in a rat model. METHODS Fifty young (12 weeks) and old (12 months) female 344BN Fischer rats were subjected to a posterior midline vaginal incision. The time course of repair was determined by measuring the size of the wound on days 1, 3, 7, and 14 post-injury. These findings correlated with the immune response to injury using a marker of impaired wound healing, the inflammatory cytokine macrophage migration inhibitory factor in the vaginal muscularis. Biomechanical properties of the healed vaginal tissue were tested 30 days post-injury. RESULTS Wound healing was assessed on days 1, 3, 7, and 14 post-injury. On day 3 post-injury, the wounds in the young animals had all closed whereas the wounds in the old animals remained open. Furthermore, on day 7, the wound gap was still filled with granulation tissue in the old rats, whereas for the young rats, the wound area was almost indistinguishable from the non-injured area. Macrophage migration inhibitory factor was highly expressed in the vaginal epithelium and in the vaginal muscularis after injury. When compared with young animals, macrophage migration inhibitory factor levels of old rats began to rise more than 2 days later and the increased tissue expression persisted for 7 days longer. The breakpoint force of the healed vagina of old rats was almost 4-fold weaker than in young rats. At 30 days post-injury, the healed vagina in old rats regained less of the original (healthy) force at breakpoint than the young rats. CONCLUSIONS In this rat model, age impaired vaginal wound healing, which was reflected in the altered inflammatory response to injury and reduced tissue strength.
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Affiliation(s)
- David Shveiky
- Section of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, PO Box 12000, Ein Kerem, Jerusalem, Israel.
| | - Cheryl B Iglesia
- Section of Female Pelvic Medicine & Reconstructive Surgery, Departments of Obstetrics & Gynecology and Urology, Medstar-Washington Hospital Center, Georgetown University, Washington, DC, USA
| | - Srilekha Sarkar Das
- FDA/CDRH/OSEL/Division of Biology, Chemistry, and Materials Science, Silver Spring, MD, USA
| | - Ofra Ben Menachem-Zidon
- The Hadassah Human Embryonic Stem Cell Research Center, Goldyne Savad Institute of Gene Therapy, Hadassah-Hebrew University Hospital, Jerusalem, Israel
| | - Henry H Chill
- Section of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, PO Box 12000, Ein Kerem, Jerusalem, Israel
| | - Hong Ji
- Center for the Study of Sex Differences in Health, Aging and Disease (CSD), Georgetown University, Washington, DC, USA
| | - Kathryn Sandberg
- Center for the Study of Sex Differences in Health, Aging and Disease (CSD), Georgetown University, Washington, DC, USA
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Antosh DD, Yurteri-Kaplan LA, Shveiky D, Liu M, Heisler C, Hegde A, Grimes CL. FPMRS challenges on behalf of the Collaborative Research in Pelvic Surgery Consortium (CoRPS): managing complicated cases : Series 3: Challenging recurrent prolapse in a medically complicated patient. Int Urogynecol J 2019; 30:1039-1043. [PMID: 31037413 DOI: 10.1007/s00192-019-03955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Abstract
This case presents the work-up and management of a spina bifida patient with recurrent prolapse. Four international experts also provide their evaluation of and approach to this complex case. According to the literature, little is known regarding the approach to the management of this specific patient population.
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Affiliation(s)
- Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Ladin A Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Madalena Liu
- Department of Urology, Monash University, Melborune, Australia
| | - Chris Heisler
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA
| | - Aparna Hegde
- Tata Center for Urogynecology and Pelvic Health, Cama Hospital, Grant Government Medical College, Mumbai, India
- Center for Urogynecology and Pelvic Health, New Delhi, India
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
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Levin G, Rottenstreich A, Shveiky D, Yanai N, Porat S. The Torsed Minimally Affected Adnexa. J Minim Invasive Gynecol 2019; 26:585-586. [DOI: 10.1016/j.jmig.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
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Shveiky D, Patchen L, Chill HH, Pehlivanova M, Landy HJ. Prevalence and Location of Obstetric Lacerations in Adolescent Mothers. J Pediatr Adolesc Gynecol 2019; 32:135-138. [PMID: 30447292 DOI: 10.1016/j.jpag.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/27/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE The objective of this study was to describe prevalence and location of obstetric lacerations in adolescents. DESIGN Retrospective cohort study. SETTING We performed an analysis of the Consortium on Safe Labor database including tertiary care university-affiliated urban hospitals. PARTICIPANTS All primiparous women who delivered vaginally were included. INTERVENTIONS Vaginal and perineal lacerations were compared between age groups 15 or younger, 16-21, 22-34, 35-39, and older than 40 years. MAIN OUTCOME MEASURES Outcome measures included vaginal, perineal, labial, and periurethral lacerations. χ2 and Fisher exact tests were used as appropriate, with P < .05 considered significant. RESULTS A total of 9777 patients were included in the analysis. Young adolescents and adolescents had significantly higher rates of labial and periurethral lacerations compared with individuals aged 22-34 years. The prevalence of third- and fourth-degree perineal tears increased with age. CONCLUSION Adolescent primiparous women are less likely to have severe perineal obstetric tears, but have higher rates of labial and periurethral tears.
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Affiliation(s)
- David Shveiky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Loral Patchen
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC
| | - Henry H Chill
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Marieta Pehlivanova
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC
| | - Helain J Landy
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC
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Levin G, Rottenstreich A, Benshushan A, Dior U, Shveiky D, Shushan A, Elchalal U. The role of supracervical hysterectomy in reducing blood products requirement in the management of placenta accreta: a case-control study. J Matern Fetal Neonatal Med 2019; 33:2522-2526. [PMID: 30486702 DOI: 10.1080/14767058.2018.1554049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: While surgical management is the treatment of choice for abnormally invasive placenta, the role of supracervical hysterectomy in this setting is not well established. We aimed to compare supracervical versus total cesarean hysterectomy as a surgical option for abnormally invasive placenta.Methods: We carried out an 8-year retrospective case-control study. Six cases of a patient treated by total hysterectomy were matched and compared to 30 controls treated by supracervical hysterectomy. Matching of cases with controls was based on coexisting placenta previa, a number of previous cesarean sections, and age, with five controls per case. Cases and controls were comparable in placental invasion topography. We compared the operative approach in all histologically identified cases of abnormally invasive placenta.Results: Overall, 36 women with histologically proven abnormally invasive placenta were identified. Composite blood products morbidity was higher among total hysterectomy patients (p = .02). Freshly frozen plasma utilization was greater among total hysterectomy patients (p = .01). Median operative time (142 ± 48 versus 136 ± 58 minutes) and hospitalization time (8.9 ± 3.1 versus 7.3 ± 1.5 days) were comparable between those who underwent supracervical versus total hysterectomy (p > .05). No case of maternal or neonatal death was encountered.Conclusion: The favorable maternal and perinatal outcomes observed in our study, suggest that supracervical hysterectomy should be considered as the first-line approach in cases of abnormally invasive placenta managed operatively.
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Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Avi Benshushan
- Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Uri Dior
- Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Asher Shushan
- Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
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Shlain I, Lavy Y, Arbel R, Shveiky D, Woloski Wruble A, Liebergall-Wischnitzer M. Urinary incontinence type, symptoms, and quality of life: A comparison between grand multipara and non-grand multipara women aged ≥50 years. Jpn J Nurs Sci 2018; 15:309-317. [DOI: 10.1111/jjns.12200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 08/31/2017] [Accepted: 10/01/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Iris Shlain
- Department of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Yuval Lavy
- Department of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Revital Arbel
- Department of Obstetrics and Gynecology; Shaare Zedek Medical Center; Jerusalem Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Anna Woloski Wruble
- School of Nursing, Faculty of Medicine; Henrietta Szold Hadassah-Hebrew University; Jerusalem Israel
| | - Michal Liebergall-Wischnitzer
- Department of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
- School of Nursing, Faculty of Medicine; Henrietta Szold Hadassah-Hebrew University; Jerusalem Israel
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Chill HH, Malyanker N, Karavani G, Haj-Yahya R, Herzberg S, Bahar R, Shveiky D, Dior UP. Association between uterine position and transvaginal misoprostol treatment for early pregnancy failure. J Obstet Gynaecol Res 2017; 44:248-252. [PMID: 29094502 DOI: 10.1111/jog.13512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/15/2017] [Indexed: 11/27/2022]
Abstract
AIM We aimed to determine the importance of uterine position as a predicting factor of success rate in medically treated early pregnancy failure (EPF). METHODS We carried out a retrospective cohort study at the Obstetrics and Gynecology Department of a tertiary medical center between January 2011 and June 2012. We included women diagnosed with EPF, which we defined as women diagnosed with missed abortion up to 13 gestational weeks. Patients were treated with one or two doses of 800 μg of misoprostol vaginally in accordance with the department's protocol. Demographic, clinical, and treatment success data were collected from patient electronic records. RESULTS A total of 255 women were included in our study. The success rate after treatment with misoprostol for the anterior uterine group was 78.7% as compared to the non-anterior uterine group, which achieved a success rate of 88.1%. This difference was not statistically significant (P = 0.180). In a multivariate analysis comparing patients for whom treatment with misoprostol was successful as opposed to patients for whom treatment failed, only embryonic sac size showed a statistically significant difference, measuring shorter in the success group. CONCLUSION Uterine position has no effect on success rate of misoprostol treatment for EPF.
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Affiliation(s)
- Henry H Chill
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nirit Malyanker
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Rani Haj-Yahya
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shmuel Herzberg
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Raz Bahar
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Uri P Dior
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Shveiky D, Hants Y, Helman S. Drug Delivery in Obstetrics and Gynecology. Drug Deliv 2017. [DOI: 10.1201/9781315117584-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Liebergall-Wischnitzer M, Braverman N, Shveiky D, Noble A. Obstetric anal sphincter injuries and the role of the midwife. Pract Midwife 2017; 20:28-30. [PMID: 30549959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Obstetric anal sphincter injuries (OASIS) can have a very negative impact on women's health and quality of life. Literature exists concerning the role of the surgeon and physiotherapist after OASIS, but there is a dearth of literature pertaining to the role of the midwife in the management of women following an obstetric anal sphincter injury. This article examines the midwife's role and describes a new service instituted at Hadassah-Hebrew University medical centre, Jerusalem, utilised in the early postpartum period while the woman is still in hospital, entitled Special Services for Perineal Trauma.
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Haj YR, Asfour A, Levin G, Lesser S, Shveiky D. Short-Term Anatomical Outcome and Patient Satisfaction After Laparoscopic Uterine-Preserving Uterosacral Ligament Suspension for Anterior and Apical Prolapse. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Friedman N, Shushan A, Rojansky N, Shveiky D, Levitzki R, Chaouat M, Ben-Bassat H. Targeting leiomyomas with all-trans-retinoic acid at phosphoinositide 3-kinase pathway suppression: Effective roles of β-catenin and of signaling interactions. J Obstet Gynaecol Res 2016; 42:1343-1353. [PMID: 27354299 DOI: 10.1111/jog.13068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/01/2016] [Indexed: 12/31/2022]
Abstract
AIM Leiomyomas, monoclonal tumors developed by the transformation of myometrium somatic stem cells, are a major health concern that can severely impair quality of life. Pathological alterations of signaling pathways have been recognized as a key feature in a variety of human diseases. Our objective was to analyze treatment with all-trans-retinoic acid (ATRA) by suppression of the phosphoinositide 3-kinase (PI3K) pathway on growth, signaling pattern and interactions among PI3K/B-cell lymphoma 2 (Bcl2)/retinol leiomyoma proteins. METHODS Cultures of paired myometrium and leiomyoma cells from premenopausal women undergoing hysterectomy were collected. Western blot and analysis of variance were used for analysis. RESULTS Significant differences were detected between treatment with ATRA alone or with LY294002 (a PI3K growth suppressor) in response to treatment and among cell samples and cell numbers. Leiomyoma cells were less affected. Immunochemical analysis of signaling patterns demonstrated that treatments affected most of the examined protein levels differently. Significant differences between the cell type responses to treatment in pyruvate phosphate dikinase 1 (pPDK1), Bad and pβ-catenin levels were identified. The pβ-catenin level showed highly significant interaction between response to treatment and cell type. CONCLUSIONS ATRA treatment on PI3K pathway suppression significantly affected growth, signaling pattern and interactions among PI3K/Bcl2/retinol proteins involved in the growth, survival and apoptosis of leiomyomas. Interpretation of our results suggests that increasing knowledge of the role of signaling interplay in the pathogenesis of leiomyomas may present an opportunity to use specific signal transduction inhibitors for treating and preventing this disorder.
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Affiliation(s)
- Noa Friedman
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel.,Laboratory of Experimental Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Asher Shushan
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
| | - Nathan Rojansky
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
| | - Rubina Levitzki
- Laboratory of Experimental Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Malka Chaouat
- Israel National Skin Bank, Hadassah Medical Center, Jerusalem, Israel.,Laboratory of Experimental Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Hannah Ben-Bassat
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel. .,Israel National Skin Bank, Hadassah Medical Center, Jerusalem, Israel.
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Yurteri-Kaplan LA, Antosh DD, Iglesia CB, Sokol AI, Shveiky D, Gutman RE. Significance of cystoscopic bladder trabeculations in women undergoing midurethral sling. Can J Urol 2015; 22:7890-7895. [PMID: 26267027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION To determine the significance of bladder trabeculations seen on preoperative cystoscopy prior to midurethral sling surgery with respect to lower urinary tract symptoms and sling outcomes. MATERIALS AND METHODS This retrospective study included women with preoperative cystoscopy who underwent midurethral slings for urinary incontinence from 2006-2009. Cystoscopic findings of bladder trabeculations, as well as pre and postoperative urinary symptoms were recorded. Patients with and without bladder trabeculations were compared with respect to baseline characteristics, lower urinary tract symptoms, and sling outcomes. RESULTS Of the 241 women included in the study, 14.9% had trabeculations on preoperative cystoscopy. At baseline, women with trabeculations were more likely to be older (64.8 years versus 57.8 years, p < 0.01), and have lower mean maximum cystometric capacity (341 mL +/- 136 versus 436 mL +/- 148, p < 0.01), compared to those without trabeculations. More women with trabeculations had mixed incontinence (p < 0.01) and less pure stress incontinence (p < 0.01) preoperatively. There was no difference between women with and without trabeculations with respect to pre and postoperative symptoms of urgency, frequency, and nocturia. Women with preoperative trabeculations were more likely to have preoperative treatment with anticholinergics (p = 0.02) and had a three times higher risk of postoperative sling failure (HR 2.95 [CI 1.11-7.85], p = 0.03). CONCLUSIONS Preoperative cystoscopic bladder trabeculations are associated with significantly higher rate of midurethral sling failure. Trabeculations were not associated with pre or postoperative lower urinary tract symptoms.
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Affiliation(s)
- Ladin A Yurteri-Kaplan
- Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/ Georgetown University School of Medicine, Washington, DC, USA
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Parkes IL, Shveiky D. Sacrocolpopexy for Treatment of Vaginal Apical Prolapse: Evidence-Based Surgery. J Minim Invasive Gynecol 2014; 21:546-57. [DOI: 10.1016/j.jmig.2014.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/29/2013] [Accepted: 01/06/2014] [Indexed: 11/16/2022]
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Kudish BI, Shveiky D, Gutman RE, Jacoby V, Sokol AI, Rodabough R, Howard BV, Blanchette P, Iglesia CB. Hysterectomy and urinary incontinence in postmenopausal women. Int Urogynecol J 2014; 25:1523-31. [DOI: 10.1007/s00192-014-2422-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
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Feghali MN, Khoury JC, Timofeev J, Shveiky D, Driggers RW, Miodovnik M. Asymmetric large for gestational age newborns in pregnancies complicated by diabetes mellitus: is maternal obesity a culprit? J Matern Fetal Neonatal Med 2012; 25:32-5. [PMID: 21957900 DOI: 10.3109/14767058.2012.626925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evaluate the association between body mass index (BMI) and the delivery of an asymmetrically large for gestational age (A-LGA) newborn in women with diabetes. METHODS Retrospective analysis of 306 pregnancies complicated by Type 1 and 55 by Type 2 diabetes. RESULTS The prevalence of Type 1 and Type 2 diabetics delivering large for gestational age (LGA) infants was 42% and 49%, respectively. Of these 49% and 55% were A-LGA, respectively. Pre-pregnancy BMI was not associated with increased odds of delivering an A-LGA newborn in women with Type 1 or 2 diabetes. However, in Type 1 diabetics, each one-pound increase in maternal weight during pregnancy resulted in 4% increased odds of delivering an A-LGA newborn. For Type 2 diabetics, the odds of delivering an A-LGA infant was decreased by 10% for each 0.1 unit/kg increase in insulin dose. CONCLUSION Although there is a known association between obesity and LGA in women with diabetes, we found that overweight and obese women with Type 1 or Type 2 diabetes do not have increased odds of delivering an A-LGA newborn. However, insulin dose in Type 2 diabetes and maternal weight gain in Type 1 diabetes were significantly associated with the odds of delivering an A-LGA neonate.
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Affiliation(s)
- Maisa N Feghali
- Department of Obstetrics & Gynecology, Washington Hospital Center, MedStar Health, Washington DC, USA.
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Sokol AI, Iglesia CB, Kudish BI, Gutman RE, Shveiky D, Bercik R, Sokol ER. One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol 2012; 206:86.e1-9. [PMID: 21974992 DOI: 10.1016/j.ajog.2011.08.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 07/06/2011] [Accepted: 08/04/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to show 12-month outcomes of a randomized trial that compared vaginal prolapse repair with and without mesh. STUDY DESIGN Women with stage ≥2 prolapse were assigned randomly to vaginal repair with or without mesh. The primary outcome was prolapse stage ≤1 at 12 months. Secondary outcomes included quality of life and complications. RESULTS All 65 evaluable participants were followed for 12 months after trial stoppage for mesh exposures. Thirty-two women had mesh repair; 33 women had traditional repair. At 12 months, both groups had improvement of pelvic organ prolapse-quantification test points to similar recurrence rates. The quality of life improved and did not differ between groups: 96.2% mesh vs 90.9% no-mesh subjects reported a cure of bulge symptoms; 15.6% had mesh exposures, and reoperation rates were higher with mesh. CONCLUSION Objective and subjective improvement is seen after vaginal prolapse repair with or without mesh. However, mesh resulted in a higher reoperation rate and did not improve 1-year cure.
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Affiliation(s)
- Andrew I Sokol
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Women and Infants' Services, Washington Hospital Center/Georgetown University School of Medicine, Washington, DC, USA.
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Feghali M, Khoury JC, Shveiky D, Miodovnik M. Association of vaginal delivery efforts with retinal disease in women with type I diabetes. J Matern Fetal Neonatal Med 2011; 25:27-31. [DOI: 10.3109/14767058.2012.626924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mejia-Gomez J, Kogan L, Mintz Y, Shveiky D, Benshushan A. [Robotic-assisted gynecological surgeries: a series of the first 14 cases]. Harefuah 2011; 150:709-751. [PMID: 22026054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To present the outcomes of the first 14 robotic-assisted gynecological surgeries from Israel. METHOD A total of 14 patients, who underwent robotic-assisted gynecological surgeries including total and subtotal hysterectomies with and without bilateral salpingo-oopherectomy, as well as one unilateral salpingo-oopherectomy and omental biopsy, were included in this study. Patients' demographics, surgical procedures, operative and postoperative complications, hospital stay, conversion to laparotomy, time data including all operative times and pathological specimen's weight were recorded. All the surgeries were performed by the same surgeon. RESULTS All surgeries were completed robotically with no conversion to taparotomy. The mean and range of operating time were 156.6 and 108-218 minutes, respectively. The mean docking time was 9.5 min. [range 4-20 minutes]. The mean anesthesia time was 214.5 min. (range 160-280 min.). The mean specimen's weight was 138.8 grams (range 55-240 grams). The mean and range of the hospital stay were 2.8 days (range 1-7.5 days). Only one complication occurred: one partial ureteral stenosis which was treated by insertion of ureteral stent. CONCLUSION Robotic-assisted gynecological surgeries are feasible and safe for women with benign and precancerous pathologies, although there are limitations that may be overcome with further experience.
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Affiliation(s)
- Javier Mejia-Gomez
- Department of Obstetrics and Gynecology Hadassah Medical Center, Hebrew University, Ein-Kerem, Jerusalem, Israel
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Shveiky D, Sokol AI, Gutman RE, Kudish BI, Iglesia CB. Vaginal mesh colpopexy for the treatment of concomitant full thickness rectal and pelvic organ prolapse: a case series. Eur J Obstet Gynecol Reprod Biol 2011; 157:113-5. [PMID: 21439707 DOI: 10.1016/j.ejogrb.2011.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/18/2011] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To present our case series of concomitant rectal and pelvic organ prolapse (POP) treated with vaginal colpopexy with synthetic mesh. STUDY DESIGN Charts of patients with full thickness rectal prolapse and POP were reviewed for presenting symptoms, physical examination with POP-Q including rectal prolapse evaluation, and perioperative complications and outcomes. RESULTS Four patients aged 63-78 were identified with full thickness rectal prolapse and POP. All of them had symptoms related to both conditions. Rectal prolapse protrusion ranged from 2 cm to 3 cm outside the anus. All patients had vaginal mesh colpopexy; two of them with anterior and posterior vaginal mesh and 2 with posterior mesh only. At a follow-up of 6-44 months, all patients had resolution of both POP and rectal prolapse signs and symptoms. CONCLUSION Vaginal colpopexy with mesh may be a unique treatment to address both POP and full thickness rectal prolapse in selected patients. Further research is needed to determine the safety and efficacy of this method.
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Affiliation(s)
- David Shveiky
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC, United States.
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Spies J, Shveiky D, Iglesia C, Lee J, Jones M, Peterson J, Huang C. Abstract No. 168: The impact of uterine fibroid embolization (UFE) on lower urinary tract symptoms. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Naaman Y, Shveiky D, Ben-Shachar I, Shushan A, Mejia-Gomez J, Benshushan A. Uterine sarcoma: prognostic factors and treatment evaluation. Isr Med Assoc J 2011; 13:76-79. [PMID: 21443030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Uterine sarcoma constitutes a highly malignant group of uterine tumors. It accounts for 2-6% of uterine malignancies and its incidence is 1.7 in 100,000 women. The three most common variants of uterine sarcoma are endometrial stromal sarcoma, leiomyosarcoma and carcinosarcoma. Based on relatively small case series, the literature provides little information on the risk factors, the natural course of the disease and the preferred treatment. OBJECTIVES To evaluate uterine sarcoma patients treated in a tertiary referral center in Israel over a 20 year period (1980-2005). METHODS We conducted a retrospective review of the charts of 40 uterine sarcoma patients, including their tumor characteristics, stage at diagnosis, treatment modalities, follow-up and survival. RESULTS The patients' mean age was 53 years (range 32-76); 30% of the patients had carcinosarcoma, 55% had leiomyosarcoma and 15% had ESS. Half of the patients presented with stage I disease, 23% stage II, 10% stage III and 15% stage IV. Thirty-nine patients were treated with surgery. Adjuvant radiotherapy was administered to 39% of the patients, adjuvant chemotherapy to 21% and combined radiotherapy and chemotherapy to 9%. The mean follow-up period was 44 months, at which time disease had recurred in 44% of the patients. The disease stage was correlated with the 5-year survival rate, which was 73.1% for stages I-II and 22.2% for stages III- IV. CONCLUSIONS In accordance with other larger studies our data show that the only prognostic factor that was significantly correlated with prognosis was the stage of the disease at diagnosis. Despite advances in diagnosis and treatment, survival has not improved over the last 25 years.
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Affiliation(s)
- Yael Naaman
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center (Ein Kerem Campus), Jerusalem, Israel
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Liebergall-Wischnitzer M, Paltiel O, Hochner-Celnikier D, Lavy Y, Shveiky D, Manor O. Concordance Between One-hour Pad Test and Subjective Assessment of Stress Incontinence. Urology 2010; 76:1364-8. [DOI: 10.1016/j.urology.2010.05.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/27/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
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Marshall D, George S, McDonald M, Shveiky D, Park A, Gutman R, Sokol A. Short-Term Outcomes of Robotic vs. Conventional Laparoscopic Sacrocolpopexy. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sokol A, Shveiky D, Nghiem H, Gutman R, Paraiso M, Iglesia C. Steps To Improve Efficiency of Robotic Sacral Colpopexy. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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