1
|
Wallace SL, Enemchukwu EA, Mishra K, Neshatian L, Chen B, Rogo-Gupta L, Sokol ER, Gurland BH. Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery. Int Urogynecol J 2021; 32:2401-2411. [PMID: 33864476 DOI: 10.1007/s00192-021-04778-y] [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: 11/30/2020] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our primary objectives were to compare < 30-day postoperative complications and RP recurrence rates after RP-only surgery and combined surgery. Our secondary objectives were to determine preoperative predictors of < 30-day complications and RP recurrence. METHODS A prospective IRB-approved cohort study was performed at a single tertiary care center from 2017 to 2020. Female patients with symptomatic RP underwent either RP-only surgery or combined surgery based on the discretion of the colorectal and FPMRS surgeons. Primary outcome measures were < 30-day complications separated into Clavien-Dindo (CD) classes and rectal prolapse on physical examination. RESULTS Seventy women had RP-only surgery and 45 had combined surgery with a mean follow-up time of 208 days. Sixty-eight percent underwent abdominal RP repair, and 32% underwent perineal RP repair. Twenty percent had one or more complications, 14% in the RP-only group and 29% in the combined surgery group (p = 0.06). On multivariate analysis, combined surgery patients had a 30% increased risk of complications compared to RP-only surgery patients (RR = 1.3). Most of these complications were minor (14/17, 82.4%) and categorized as CD I or II, including urinary retention and UTI. Twelve percent of this cohort had RP recurrence, 11% in the RP-only group and 13% in the combined surgery group (p = 0.76). Preoperative risk factors for RP recurrence included a primary complaint of rectal bleeding (RR 5.5) and reporting stools consistent with Bristol Stool Scale of 1 (RR 2.1). CONCLUSION Patients undergoing combined RP + POP surgery had a higher risk of complications and equivalent RP recurrence rates compared to patients undergoing RP-only surgery.
Collapse
Affiliation(s)
- Shannon L Wallace
- Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A81, Cleveland, OH, 44195, USA.
| | - Ekene A Enemchukwu
- Department of Urology, Division of Female Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kavita Mishra
- Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A81, Cleveland, OH, 44195, USA
| | - Leila Neshatian
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bertha Chen
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Rogo-Gupta
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric R Sokol
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Brooke H Gurland
- Department of Surgery, Division of Colorectal Surgery, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
2
|
Dallas K, Elliott CS, Syan R, Sohlberg E, Enemchukwu E, Rogo-Gupta L. Association Between Concomitant Hysterectomy and Repeat Surgery for Pelvic Organ Prolapse Repair in a Cohort of Nearly 100,000 Women. Obstet Gynecol 2019; 132:1328-1336. [PMID: 30334856 DOI: 10.1097/aog.0000000000002913] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the association of hysterectomy at the time of pelvic organ prolapse (POP) repair with the risk of undergoing subsequent POP surgery in a large population-based cohort. METHODS Data from the California Office of Statewide Health Planning and Development were used in this retrospective cohort study to identify all women who underwent an anterior, apical, posterior or multiple compartment POP repair at nonfederal hospitals between January 1, 2005, and December 31, 2011, using Current Procedural Terminology and International Classification of Diseases, 9th Revision procedure codes. Women with a diagnosis code indicating prior hysterectomy were excluded, and the first prolapse surgery during the study period was considered the index repair. Demographic and surgical characteristics were explored for associations with the primary outcome of a repeat POP surgery. We compared reoperation rates for recurrent POP between patients who did compared with those who did not have a hysterectomy at the time of their index POP repair. RESULTS Of the 93,831 women meeting inclusion criteria, 42,340 (45.1%) underwent hysterectomy with index POP repair. Forty-eight percent of index repairs involved multiple compartments, 14.0% included mesh, and 48.9% included an incontinence procedure. Mean follow-up was 1,485 days (median 1,500 days). The repeat POP surgery rate was lower in those patients in whom hysterectomy was performed at the time of index POP repair, 3.0% vs 4.4% (relative risk [RR] 0.67, 95% CI 0.62-0.71). Multivariate modeling revealed that hysterectomy was associated with a decreased risk of future surgery for anterior (odds ratio [OR] 0.71, 95% CI 0.64-0.78), apical (OR 0.76, 95% CI 0.70-0.84), and posterior (OR 0.69, 95% CI 0.65-0.75) POP recurrence. The hysterectomy group had increased lengths of hospital stay (mean 2.2 days vs 1.8 days, mean difference 0.40, 95% CI 0.38-0.43), rates of blood transfusion (2.5% vs 1.5, RR 1.62, 95% CI 1.47-1.78), rates of perioperative hemorrhage (1.5% vs 1.1%, RR 1.32, 95% CI 1.18-1.49), rates of urologic injury or fistula (0.9% vs 0.6%, RR 1.66, 95% CI 1.42-1.93), rates of infection or sepsis (0.9% vs 0.4%, RR 2.12, 95% CI 1.79-2.52), and rate of readmission for an infectious etiology (0.7% vs 0.3%, RR 2.54, 95% CI 2.08-3.10) as compared with those who did not undergo hysterectomy. CONCLUSION We demonstrate in a large population-based cohort that hysterectomy at the time of prolapse repair is associated with a decreased risk of future POP surgery by 1-3% and is independently associated with higher perioperative morbidity. Individualized risks and benefits should be included in the discussion of POP surgery.
Collapse
Affiliation(s)
- Kai Dallas
- Stanford University School of Medicine, Stanford, and Santa Clara Valley Medical Center, San Jose, California
| | | | | | | | | | | |
Collapse
|
3
|
Sohlberg EM, Dallas KB, Weeks BT, Elliott CS, Rogo-Gupta L. Reoperation rates for pelvic organ prolapse repairs with biologic and synthetic grafts in a large population-based cohort. Int Urogynecol J 2019; 31:291-301. [DOI: 10.1007/s00192-019-04035-3] [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] [Received: 04/15/2019] [Accepted: 06/17/2019] [Indexed: 01/01/2023]
|
4
|
Dallas KB, Trimble R, Rogo-Gupta L, Elliott CS. Care Seeking Patterns for Women Requiring a Repeat Pelvic Organ Prolapse Surgery Due to Native Tissue Repair Failure Compared to a Mesh Complication. Urology 2018; 122:70-75. [PMID: 30170088 DOI: 10.1016/j.urology.2018.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/10/2018] [Accepted: 08/15/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore patient migration patterns in patients requiring repeat surgery after Pelvic Organ Prolapse (POP) repair as there is a limited understanding of care seeking patterns for repeat surgery after POP repair. We hypothesized that undergoing repeat surgery for a prolapse mesh complication would be associated with an increased incidence of migration to a new facility for care compared to those undergoing repeat surgery for recurrent POP. METHODS In this retrospective population based study, all females who underwent an index POP repair procedure (with or without mesh) at nonfederal facilities who subsequently underwent a repeat surgery (recurrent prolapse repair or mesh complication) were identified from the Office of Statewide Health Planning and Development for the state of California (2005-2011). The location of index repair and repeat surgery were identified and factors associated with migration were explored. RESULTS Of the 3,930 women who underwent repeat surgery for either POP recurrence or a mesh complication, 1,331 (33.9%) had surgery at a new facility. Multivariate analysis revealed that mesh complications (odds ratio [OR] 1.28, P = 0.004) or native tissue same compartment recurrence (OR 1.19, P = 0.02) were both associated with increased odds of undergoing surgery at a new facility. Having surgery in a county with multiple centers increased the odds of migration to a new facility for care (OR = 1.33, P < 0.001), unless the initial repair was at a high volume institution (OR = 0.32, P < 0.001). Overall across indications, women changing locations for their second surgery tended to migrate toward select centers in urban areas. CONCLUSION Women who undergo repeat surgery after POP repair have similar patterns of migration to a new facility irrespective of the indication for surgery.
Collapse
Affiliation(s)
- Kai B Dallas
- Stanford University School of Medicine, Stanford, CA.
| | | | | | - Christopher S Elliott
- Stanford University School of Medicine, Stanford, CA; Santa Clara Valley Medical Center, San Jose, CA
| |
Collapse
|
5
|
Dallas KB, Rogo-Gupta L, Elliott CS. What Impacts the All Cause Risk of Reoperation after Pelvic Organ Prolapse Repair? A Comparison of Mesh and Native Tissue Approaches in 110,329 Women. J Urol 2018; 200:389-396. [DOI: 10.1016/j.juro.2018.02.3093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Kai B. Dallas
- Stanford University School of Medicine, Stanford, California
| | - Lisa Rogo-Gupta
- Stanford University School of Medicine, Stanford, California
| | | |
Collapse
|
6
|
Dallas K, Rogo-Gupta L, Elliot C. MP33-02 ARE CARE SEEKING PATTERNS DIFFERENT IN WOMEN REQUIRING A REPEAT PELVIC ORGAN PROLAPSE SURGERY DUE TO NATIVE TISSUE REPAIR FAILURE VERSUS A MESH COMPLICATION? J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1073] [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] [Indexed: 10/17/2022]
|
7
|
Dallas KB, Rogo-Gupta L, Elliott CS. Where do Women go for Revision Surgeries? Geographic Migration Patterns after Urethral Sling Placement in California. Urology Practice 2018. [DOI: 10.1016/j.urpr.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kai B. Dallas
- Stanford University School of Medicine, Stanford, California
| | - Lisa Rogo-Gupta
- Stanford University School of Medicine, Stanford, California
| | - Christopher S. Elliott
- Stanford University School of Medicine, Stanford, California
- Santa Clara Valley Medical Center, San Jose, California
| |
Collapse
|
8
|
Dallas KB, Sohlberg EM, Elliott CS, Rogo-Gupta L, Enemchukwu E. Racial and Socioeconomic Disparities in Short-term Urethral Sling Surgical Outcomes. Urology 2017; 110:70-75. [DOI: 10.1016/j.urology.2017.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/02/2017] [Accepted: 08/15/2017] [Indexed: 12/24/2022]
|
9
|
Dallas KB, Rogo-Gupta L, Elliott CS. Unplanned Hospital Visits in the First 30 Days After Urethral Sling Procedures. Urology 2017; 103:79-83. [PMID: 28153590 DOI: 10.1016/j.urology.2017.01.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/12/2017] [Accepted: 01/24/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate unplanned hospital visits within 30 days of urethral sling placement in the form of emergency department visits, inpatient admissions, or repeat surgery. METHODS We accessed nonpublic data from the Office of Statewide Health Planning and Development in the state of California for the years 2005-2011. All female patients who underwent an ambulatory urethral sling procedure (Current Procedural Terminology 57288) without concomitant surgery (other than cystoscopy) were included. Any subsequent emergency department visit, inpatient admission, or sling revision operation within 30 days of the original surgery were then examined. RESULTS A total of 28,635 women were identified who underwent outpatient urethral sling placement as a sole procedure. Within 30 days, 1630 women (5.7%) had at least 1 unplanned hospital visit. This included 1327 emergency department visits (4.7%), 295 inpatient admissions (1.0%), and 79 sling revisions (0.28%). Urinary retention and Foley catheter problems were the most common emergency department visit diagnoses (18.7% of visits), followed by urinary tract infection (9.3% of visits). CONCLUSION One in 18 women will have an unplanned hospital visit within 30 days of urethral sling placement, the majority of which are emergency department visits (~81%). Our findings can be used to improve patient counseling and suggest areas that one might target to decrease unnecessary emergency department visits in the early postoperative period.
Collapse
Affiliation(s)
- Kai B Dallas
- Stanford University School of Medicine, Stanford, CA.
| | | | - Christopher S Elliott
- Stanford University School of Medicine, Stanford, CA; Santa Clara Valley Medical Center, San Jose, CA
| |
Collapse
|
10
|
Rogo-Gupta L, Litwin MS, Saigal CS, Anger JT. Trends in the surgical management of stress urinary incontinence among female Medicare beneficiaries, 2002-2007. Urology 2013; 82:38-41. [PMID: 23706251 DOI: 10.1016/j.urology.2012.10.087] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/25/2012] [Accepted: 10/02/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe trends in the surgical management of female stress urinary incontinence (SUI) in the United States from 2002 to 2007. METHODS As part of the Urologic Diseases of America Project, we analyzed data from a 5% national random sample of female Medicare beneficiaries aged 65 and older. Data were obtained from the Centers for Medicare and Medicaid Services carrier and outpatient files from 2002 to 2007. Women who were diagnosed with urinary incontinence identified by the International Classification of Diseases, Ninth Edition (ICD-9) diagnosis codes and who underwent surgical management identified by Current Procedural Terminology, Fourth Edition (CPT-4) procedure codes were included in the analysis. Trends were analyzed over the 6-year period. Unweighted procedure counts were multiplied by 20 to estimate the rate among all female Medicare beneficiaries. RESULTS The total number of surgical procedures remained stable during the study period, from 49,340 in 2002 to 49,900 in 2007. Slings were the most common procedure across all years, which increased from 25,840 procedures in 2002 to 33,880 procedures in 2007. Injectable bulking agents were the second most common procedure, which accounted for 14,100 procedures in 2002 but decreased to 11,320 in 2007. Procedures performed in ambulatory surgery centers and physician offices increased, although those performed in inpatient settings declined. Hospital outpatient procedures remained stable. CONCLUSION The surgical management of women with SUI shifted toward a dominance of procedures performed in ambulatory surgery centers from 2002 to 2007, although the overall number of procedures remained stable. Slings remained the dominant surgical procedure, followed by injectable bulking agents, both of which are easily performed in outpatient settings.
Collapse
Affiliation(s)
- Lisa Rogo-Gupta
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | | | | | | | | |
Collapse
|
11
|
Nakamura L, Jellison F, Rogo-Gupta L, Hartshorn T, Chow D, Rodriguez L, Kim JH, Raz S. 560 INCONTINENCE SYMPTOMS FOLLOWING SUBURETHRAL SLING REMOVAL. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1956] [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] [Indexed: 10/27/2022]
|
12
|
Jellison F, Ng G, Rogo-Gupta L, Nakamura L, Chow D, Kim JH, Rodriguez L, Raz S. V263 ROTATIONAL LABIAL AND INFERIOR PUDENDIAL ARTERY BASED INNER THIGH FLAPS IN VAGINAL RECONSTRUCTION. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1646] [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] [Indexed: 10/27/2022]
|
13
|
Jellison F, Nakamura L, Rogo-Gupta L, Chow D, Baxter C, Kim JH, Rodriguez L, Raz S. 563 TRANSLABIAL ULTRASOUND (TLUS) DETECTION IN URETHRAL MESH SLING REVISION: FACTORS ASSOCIATED WITH THE NEED FOR INTERPOSITIONAL TISSUE FLAP OR URETHRAL RECONSTRUCTION. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1959] [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] [Indexed: 11/26/2022]
|
14
|
Anger JT, Le TX, Nissim HA, Rogo-Gupta L, Rashid R, Behniwal A, Smith AL, Litwin MS, Rodriguez LV, Wein AJ, Maliski SL. How dry is "OAB-dry"? Perspectives from patients and physician experts. J Urol 2012; 188:1811-5. [PMID: 22999694 DOI: 10.1016/j.juro.2012.07.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Overactive bladder is subtyped into overactive bladder-wet and overactive bladder-dry, based on the presence or absence, respectively, of urgency incontinence. To better understand patient and physician perspectives on symptoms among women with overactive bladder-wet and overactive bladder-dry, we performed patient focus groups and interviews with experts in urinary incontinence. MATERIALS AND METHODS Five focus groups totaling 33 patients with overactive bladder symptoms, including 3 groups of overactive bladder-wet and 2 groups of overactive bladder-dry patients, were conducted. Topics addressed patient perceptions of overactive bladder symptoms, treatments and outcomes. A total of 12 expert interviews were then done in which experts were asked to describe their views on overactive bladder-wet and overactive bladder-dry. Focus groups and expert interviews were transcribed verbatim. Qualitative data analysis was performed using grounded theory methodology, as described by Charmaz. RESULTS During the focus groups sessions, women screened as overactive bladder-dry shared the knowledge that they would probably leak if no toilet were available. This knowledge was based on a history of leakage episodes in the past. Those few patients with no history of leakage had a clinical picture more consistent with painful bladder syndrome than overactive bladder. Physician expert interviews revealed the belief that many patients labeled as overactive bladder-dry may actually be mild overactive bladder-wet. CONCLUSIONS Qualitative data from focus groups and interviews with experts suggest that a spectrum exists between very mild overactive bladder-wet and severe overactive bladder-wet. Scientific investigations are needed to determine whether urgency without fear of leakage constitutes a unique clinical entity.
Collapse
Affiliation(s)
- Jennifer T Anger
- Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, California 90211, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Le NB, Rogo-Gupta L, Raz S. Surgical options for apical prolapse repair. Womens Health (Lond) 2012; 8:557-66. [PMID: 22934729 DOI: 10.2217/whe.12.44] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pelvic organ prolapse is a common medical condition that affects the quality of life of many women. Approximately 50% of parous women have pelvic organ prolapse and the lifetime risk for surgical intervention is 6.7% at the age of 80 years. In the USA, the number of women at risk for symptomatic prolapse is increasing, which is consistent with the recent increase in the overall number of prolapse and incontinence procedures being performed. Although prolapse is usually multicompartmental and isolated defects are rare, the apical compartment deserves special attention because apical support is integral to a durable prolapse repair. Since many women may initially present to their primary care physicians, all members of the medical community should have a basic understanding of the diagnosis and treatment for apical prolapse.
Collapse
Affiliation(s)
- Ngoc-Bich Le
- Division of Pelvic Medicine & Reconstructive Surgery, Department of Urology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | | | | |
Collapse
|
16
|
Rogo-Gupta L, Hartshorn TG, Chow D, Le NB, Jellison F, Ackerman AL, Rodriguez LV, Raz S. 1546 COMPLICATIONS OF MESH-AUGMENTED PELVIC ORGAN PROLAPSE AND INCONTINENCE REPAIRS: CASE SERIES OF 319 PROCEDURES. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1316] [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] [Indexed: 11/28/2022]
|
17
|
Rogo-Gupta L, Baxter ZC, Le NB, Raz S, Rodriguez LV. 1188 LONG-TERM DURABILITY OF THE DISTAL URETHRAL POLYPROPYLENE SLING PROCEDURE FOR STRESS URINARY INCONTINENCE: MINIMUM 10-YEAR FOLLOW-UP. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1433] [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] [Indexed: 10/28/2022]
|
18
|
Rogo-Gupta L, Le NB, Raz S. Foreign body in the bladder 11 years after intravaginal pessary. Int Urogynecol J 2012; 23:1311-3. [PMID: 22402642 DOI: 10.1007/s00192-012-1722-2] [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: 10/04/2011] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
Vaginal pessaries used for symptomatic pelvic organ prolapse (POP) rarely develop complications when regularly monitored. However, many reports of complications of neglected pessaries have been described. Patients presenting with pessary complications report a variety of symptoms ranging from malodorous discharge or recurrent infections to more severe symptoms such as vaginal bleeding, complete urinary incontinence, or defecatory obstruction. Complete pessary encapsulation within the bladder is rare. We present the case of a 79-year-old postmenopausal woman referred to a tertiary care center for treatment of a large intravesical foreign body 11 years after pessary placement. The patient successfully underwent minimally invasive surgery to remove the foreign body and repair the bladder defect. Physicians should have a low threshold for diagnostic imaging in patients presenting with unclear history. Large intravesical foreign bodies can be removed by a vaginal approach with good outcomes.
Collapse
Affiliation(s)
- Lisa Rogo-Gupta
- Division of Pelvic Medicine and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA, USA.
| | | | | |
Collapse
|
19
|
Le NB, Baxter ZC, Rogo-Gupta L, Lee U, Morrisroe S, Staack A, Kim JH, Rodriguez L, Raz S. 2076 A NEW MESH-LESS TECHNIQUE TO REPAIR CYSTOCELES WITH BOTH CENTRAL AND LATERAL DEFECTS. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2371] [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] [Indexed: 11/15/2022]
|
20
|
Staack A, Rogo-Gupta L, Una L, Morrisroe S, Le NB, Kim JH, Rodriguez LV, Raz S. 1346 TRANSLABIAL ULTRASONOGRAPHY OF SUBURETHRAL SLINGS IN PATIENTS WITH RECURRENT URINARY INCONTINENCE AFTER SYNTHETIC SLING PLACEMENT. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1167] [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] [Indexed: 11/30/2022]
|