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Baker MV, Teles Abrao Trad A, Tamhane P, Weaver AL, Visscher SL, Borah BJ, Klingele CJ, Gebhart JB, Trabuco EC. Abdominal and robotic sacrocolpopexy costs following implementation of enhanced recovery after surgery. Int J Gynaecol Obstet 2022; 161:655-660. [PMID: 36504261 DOI: 10.1002/ijgo.14623] [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: 07/06/2022] [Revised: 11/04/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare perioperative costs and morbidity between open and robotic sacrocolpopexy after implementation of enhanced recovery after surgery (ERAS) pathway. METHODS The present retrospective cohort study of patients undergoing open or robotic sacrocolpopexy (January 1, 2014, through November 30, 2017) used an ERAS protocol with liposomal bupivacaine infiltration of laparotomy incisions. Primary outcomes were costs associated with index surgery and hospitalization, determined with Medicare cost-to-charge ratios and reimbursement rates and adjusted for variables expected to impact costs. Secondary outcomes included narcotic use, length of stay (LOS), and complications from index hospitalization to postoperative day 30. RESULTS For the total of 231 patients (open cohort, 90; robotic cohort, 141), the adjusted mean cost of robotic surgery was $3239 higher compared with open sacrocolpopexy (95% confidence interval [CI] $1331-$5147; P < 0.001). Rates were not significantly different for intraoperative complications (robotic, 4.3% [6/141]; open, 5.6% [5/90]; P = 0.754), 30-day postoperative complications (robotic, 11.4% [16/141]; open, 16.7% [15/90]; P = 0.322), or readmissions (robotic, 5.7% [8/141]; open, 3.3% [3/90]; P = 0.535). The percentage of patients dismissed on postoperative day 1 was greater in the robotic group (89.4% [126/141] vs. 48.9% [44/90], P < 0.001). CONCLUSIONS Decreased LOS associated with ERAS provided significant cost savings with open sacrocolpopexy versus robotic sacrocolpopexy without adverse impacts on perioperative complications or readmissions.
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Affiliation(s)
- Mary V Baker
- Department of Obstetrics and Gynecology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Ayssa Teles Abrao Trad
- Department of Obstetrics and Gynecology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Prajakta Tamhane
- Department of Family Medicine, Reid Health, Richmond, Indiana, USA
| | - Amy L Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Sue L Visscher
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bijan J Borah
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - John B Gebhart
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Emanuel C Trabuco
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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Linder BJ, Gebhart JB, Weaver AL, Fick FR, Harvey-Springer RR, Trabuco EC, Klingele CJ, Occhino JA. Comparison of outcomes between pessary use and surgery for symptomatic pelvic organ prolapse: A prospective self-controlled study. Investig Clin Urol 2022; 63:214-220. [PMID: 35244996 PMCID: PMC8902417 DOI: 10.4111/icu.20210395] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/01/2022] [Accepted: 01/13/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose We compared the degree of pelvic floor symptom improvement between pessary use and prolapse surgery. Materials and Methods Pessary-naïve women who elected prolapse surgery were enrolled and used a pessary preoperatively (for ≥7 days and ≤30 days). Pelvic floor symptoms were assessed at baseline, after pessary use, and at 3 months postoperatively. The primary outcome was concordance in the degree of symptoms improvement between pessary use and surgery, as assessed by Patient Global Impression of Improvement (PGI-I). Secondary outcomes were related to prolapse specific symptoms on validated questionnaires (POPDI-6, PFIQ-7). The McNemar test was used for comparisons of discordant pairs for comparisons of the PGI-I ratings after pessary use and surgery. Results Sixty-one participants were enrolled (March 2016 through April 2019) and 58 patients used a pessary. Mean±standard deviation age was 60.7±10.7 years; 24.1% had prior hysterectomy, and 13.8% had prior prolapse surgery. While both treatments demonstrated symptomatic improvement, concordance in the degree of overall improvement on the PGI-I score was poor (n=40); responses significantly favored more improvement postoperatively (p<0.001). Pessary use and surgery were associated with significant improvements in prolapse symptoms from baseline on POPDI-6 (both p<0.001) and POPIQ-7 (pessary, p=0.002; surgery, p<0.001). The degree of improvement was larger postoperatively compared to post-pessary use on POPDI-6 (p<0.001) and PFIQ-7 (p=0.004). Conclusions Both pessary use and surgery significantly improved pelvic floor symptoms from baseline. However, concordance in degrees of improvement between these treatments was poor, with more favorable outcomes after surgery for prolapse symptoms.
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Affiliation(s)
- Brian J. Linder
- Department of Urology, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - John B. Gebhart
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Amy L. Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Felecia R. Fick
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | - Emanuel C. Trabuco
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Christopher J. Klingele
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics and Gynecology, Olmsted Medical Center, Rochester, MN, USA
| | - John A. Occhino
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Singh R, Hokenstad ED, Wiest SR, Kim-Fine S, Weaver AL, McGree ME, Klingele CJ, Trabuco EC, Gebhart JB. Randomized controlled trial of silver-alloy-impregnated suprapubic catheters versus standard suprapubic catheters in assessing urinary tract infection rates in urogynecology patients. Int Urogynecol J 2018; 30:779-787. [PMID: 30145671 DOI: 10.1007/s00192-018-3726-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 04/24/2018] [Accepted: 07/13/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Catheter-associated urinary tract infections (UTI) are the most common health-care-related infections. We aimed to compare the UTI rate among women undergoing urogynecological procedures with a silver-alloy suprapubic catheter (SPC) and a standard SPC, and identify the risk factors predisposing patients to UTI. METHODS Patients who were to undergo placement of an SPC as part of pelvic organ prolapse surgery were enrolled between 1 August 2011 and 30 August 2017, and randomized to either standard SPC or silver-alloy SPC. Follow-up was performed at a postoperative visit or via a phone call at 6 weeks. The primary outcome was UTI. RESULTS Of the 288 patients who were randomized, 127 with standard SPC and 137 with silver-alloy SPC were included in the analysis. Twenty-nine out of 123 women with standard SPC (23.6%) and 24 out of 131 (18.3%) with silver-alloy SPC were diagnosed with UTI within 6 weeks postoperatively (p = 0.30). In univariate analysis, non-white race (odds ratio [OR] 5.36, 95% CI 1.16-24.73) and diabetes (OR 2.80, 95% CI 1.26-6.23) were associated with increased risk of UTI. On multivariate analysis, only diabetes remained an independent risk factor. Comparisons between groups were evaluated using two-sample t test for age, Chi-squared tests for diabetes, and Wilcoxon rank sum test for all other variables. CONCLUSION There was only a 5% difference in 6-week UTI rates between those who received standard vs silver-alloy SPC; the study was not powered to detect such a small difference. Diabetes was identified as a risk factor for SPC-associated UTI in women undergoing pelvic reconstructive surgeries.
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Affiliation(s)
- Ruchira Singh
- Department of Obstetrics and Gynecology, University of Florida, 653-1 W. 8th Street, Jacksonville, FL, 32209, USA.
| | - Erik D Hokenstad
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Sheila R Wiest
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Amy L Weaver
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Emanuel C Trabuco
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - John B Gebhart
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Linder BJ, Anand M, Klingele CJ, Trabuco EC, Gebhart JB, Occhino JA. Outcomes of Robotic Sacrocolpopexy Using Only Absorbable Suture for Mesh Fixation. Female Pelvic Med Reconstr Surg 2017; 23:13-16. [DOI: 10.1097/spv.0000000000000326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim-Fine S, El-Nashar SA, Linder BJ, Casiano ER, Woelk JL, Gebhart JB, Klingele CJ, Trabuco EC. Patient Satisfaction After Sling Revision for Voiding Dysfunction After Sling Placement. Female Pelvic Med Reconstr Surg 2016; 22:140-5. [DOI: 10.1097/spv.0000000000000242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Linder BJ, Anand M, Weaver AL, Woelk JL, Klingele CJ, Trabuco EC, Occhino JA, Gebhart JB. Assessing the learning curve of robotic sacrocolpopexy. Int Urogynecol J 2015; 27:239-46. [PMID: 26294206 DOI: 10.1007/s00192-015-2816-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 06/05/2015] [Accepted: 07/30/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim was to evaluate the learning curve of robotic sacrocolpopexy, adjusted for surgical risk. METHODS The charts of 145 robotic sacrocolpopexies performed by urogynecologists at Mayo Clinic, Rochester, MN, USA, from 2007 to 2013, were reviewed. Outcomes of interest included operative time, intraoperative complications, and postoperative complications with a Clavien-Dindo grade 2 or higher. Risk-adjusted cumulative summation analysis was performed by comparing a calculated complication risk score with observed patient outcomes, and then cumulatively recalculating the rate of expected vs observed complications after each procedure. Proficiency was defined as the point at which the surgeon's complication rates were better than expected, given the patient's risk factors. RESULTS The median operative time decreased significantly, from 5.3 to 3.6 h, during the 7-year period, and plateaued after the first 60 cases. A higher ASA classification was associated with an increased risk of intraoperative complications (p = 0.02), and a higher Charlson comorbidity index was associated with an increased risk of intraoperative or postoperative complications (p = 0.01). In risk-adjusted CUSUM analyses, accounting for these factors, and for body-mass index and vaginal parity, proficiency was identified at 55 cases for intraoperative complications and 84 cases for intraoperative or postoperative complications. CONCLUSIONS Operative time plateaued after the first 60 cases, whereas complication rates continued to decrease beyond this. Proficiency, as determined by a risk-adjusted CUSUM analysis for complication rates, was achieved after approximately 84 cases. Evaluation of postoperative complications in addition to intraoperative complications, in a risk-adjusted model, is critical in depicting the surgical learning curve.
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Affiliation(s)
- Brian J Linder
- Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Mallika Anand
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Joshua L Woelk
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | - Emanuel C Trabuco
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - John A Occhino
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - John B Gebhart
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Anand M, Woelk JL, Weaver AL, Trabuco EC, Klingele CJ, Gebhart JB. Perioperative complications of robotic sacrocolpopexy for post-hysterectomy vaginal vault prolapse. Int Urogynecol J 2014; 25:1193-200. [PMID: 24715099 DOI: 10.1007/s00192-014-2379-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Open abdominal sacrocolpopexy has been the preferred treatment for post-hysterectomy vaginal vault prolapse. In light of the rise in popularity of less invasive robotic sacrocolpopexy, our objective was to compare perioperative complications of robotic vs open sacrocolpopexy. METHODS This was a single-institution, retrospective cohort study of robotic and open sacrocolpopexies. Robotic sacrocolpopexies performed between 1 January 2007 and 31 December 2009 were compared with open cases performed between 1 January 2002 and 31 December 2006. Baseline and intraoperative variables of the groups were compared. Complications were compared univariately and in a multivariable logistic regression model to adjust for prior transabdominal surgery. RESULTS A total of 50 robotic and 87 open sacrocolpopexies were analyzed. Baseline characteristics were similar, but patients in the open group had more prior transabdominal surgeries. The robotically assisted group had decreased estimated blood loss (median, 100 mL vs 150 mL; P = 0.002) and hospital stay (median, 2 days vs 3 days; P < 0.001), but increased operative time (median, 4.6 vs 2.9 h; P < 0.001), cystotomy (10.0 % [5 out of 50] vs 1.1 % [1 out of 87]; P = 0.02), and vaginotomy (24.0 % [12 out of 50] vs 5.7 % [5 out of 87]; P = 0.003). Two patients in the robotically assisted group had postoperative hernia. There were no differences in rates of ureteral or bowel injury, urinary tract infection, ileus, bowel obstruction, or overall complications. CONCLUSIONS Overall complication rates of robotic and open sacrocolpopexy were not significantly different. The robotically assisted group experienced shorter hospital stay but increased operative times and increased incidence of cystotomy and vaginotomy, possibly reflecting the learning curve of robotic sacrocolpopexy.
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Affiliation(s)
- Mallika Anand
- Division of Gynecologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Madsen AM, El-Nashar SA, Woelk JL, Klingele CJ, Gebhart JB, Trabuco EC. A cohort study comparing a single-incision sling with a retropubic midurethral sling. Int Urogynecol J 2013; 25:351-8. [PMID: 24043128 DOI: 10.1007/s00192-013-2208-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/06/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Despite established comparable efficacy between retropubic midurethral (RMUS) and transobturator slings, there are conflicting data regarding single-incision mini-slings (SIMS). This study tests the null hypothesis that the MiniArc® Single-Incision Sling is equivalent to the ALIGN® Urethral Support System for treatment of stress urinary incontinence (SUI). METHODS Women who underwent a sling for SUI from 1 January 2008 through 31 December 2009 were identified (N = 324). A follow-up survey was mailed. Primary outcomes were treatment failure, defined as International Consultation on Incontinence Questionnaire (ICIQ) score >0 or additional anti-incontinence procedure, and stress-specific incontinence (SSI). Secondary outcomes included Patient Global Impression of Severity and Improvement (PGI-SI), satisfaction, de novo urge, and complications. RESULTS The study included 202 women who returned the survey. The SIMS group had higher body mass index (BMI) (30.7 ± 6.5 vs 28.9 ± 6.0 kg/m(2), P = 0.052) and shorter follow-up (18.6 ± 11.5 vs 22.9 ± 14.6 months, P = 0.019). Treatment failure was higher in SIMS compared with RMUS (76.3 % vs 64.2 %) with adjusted odds ratio of 1.84 (95 % CI, 1.0, 3.5). The SIMS group was more likely to have postoperative SSI, with adjusted OR of 2.4 (95 % CI; 1.3-4.5). The RMUS group reported more improvement and satisfaction. Incidence of de novo urge and complications were similar between groups. Reoperation for mesh erosion was more likely in the RMUS group, while the SIMS had a higher reoperation rate for SUI. CONCLUSIONS Compared with retropubic ALIGN® Slings, MiniArc® Single-Incision Slings are less effective, with more postoperative incontinence, less patient-reported improvement, satisfaction, and higher reoperation rates for SUI.
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Affiliation(s)
- Annetta M Madsen
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
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Gali B, Burkle CM, Klingele CJ, Schroeder D, Jankowski CJ. Infection after urogynecologic surgery with the use of dexamethasone for nausea prophylaxis. J Clin Anesth 2012; 24:549-54. [DOI: 10.1016/j.jclinane.2012.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 03/06/2012] [Accepted: 03/30/2012] [Indexed: 12/01/2022]
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Abstract
BACKGROUND While bowel and bladder dysfunction are recognized consequences of a radical hysterectomy, the effects of a simple hysterectomy on anorectal sensorimotor functions, particularly rectal sensation, vary among studies and the effects on rectal compliance remain unknown. Our aims were to prospectively evaluate anorectal sensorimotor functions before and after a hysterectomy. METHODS Anal pressures, rectal compliance, capacity, sensation, and bowel symptoms were assessed before, at 2 months, and at 1 year after a simple vaginal hysterectomy for benign indications in 19 patients. Rectal staircase (0-44 mmHg, 4-mmHg steps), ramp (0-200 mL at 50, 200 and 600 mL min(-1)) and phasic distentions (8, 16, and 24 mmHg above operating pressure) were performed. KEY RESULTS Anal resting (63 ± 4 before, 56 ± 4 mmHg after) and squeeze pressures (124 ± 12 before, 124 ± 12 mmHg after), rectal compliance and capacity (285 ± 12 before, 290 ± 11 mL 1 year after), and perception of phasic distentions were not different before vs after a hysterectomy. Sensory thresholds for first sensation and the desire to defecate were also not different, but pressure and volume thresholds for urgency were somewhat greater (Hazard ratio = 0.7, 95% CI [0.5, 1.0]) 1 year after (vs before) a hysterectomy. Rectal pressures were higher (P < 0.0001) during fast compared with slow ramp distention; this rate effect was greater at 1 year after a hysterectomy, particularly at 100 mL (P = 0.04). CONCLUSIONS & INFERENCES A simple vaginal hysterectomy has relatively modest effects (i.e., somewhat reduced rectal urgency and increased stiffness during rapid distention) on rectal sensorimotor functions.
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Affiliation(s)
- A E Bharucha
- Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Division of Gastroenterology and Hepatology, Department of Medicine, Rochester, MN, USA.
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Occhino JA, Casiano ER, Trabuco EC, Klingele CJ. A three-incision approach to treat persistent vaginal exposure and sinus tract formation related to ObTape mesh insertion. Int Urogynecol J 2012; 23:1307-1309. [PMID: 22297705 DOI: 10.1007/s00192-012-1664-8] [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: 07/12/2011] [Accepted: 01/06/2012] [Indexed: 11/27/2022]
Abstract
Mentor Corporation's ObTape has been associated with considerable morbidity. An unacceptably high exposure rate has been noted, and in some cases, multiple procedures may be necessary for complete mesh removal.We evaluated a patient who had prior ObTape placement complicated with persistent vaginal discharge and granulation tissue formation related to persistent mesh exposure (3Bc-T2-S2) followed by sinus tract formation (6Cd-T3-S3) according to the International Urogynecological Association Classification. We performed a three-incision approach (abdominal, vaginal, and groin) for the complete removal of the retained portion of the transobturator tape. This three-incision technique represents a viable option for removal of transobturator tape causing persistent clinical issues.
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Affiliation(s)
- John A Occhino
- Division of Gynecologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Abstract
BACKGROUND While pelvic floor dysfunction may manifest with bladder or bowel symptoms, the relationship between functional defecatory disorders and dysfunctional voiding is unclear. Our hypothesis was that patients with defecatory disorders have generalized pelvic floor dysfunction, manifesting as dysfunctional urinary voiding. METHODS Voiding was assessed by a symptom questionnaire, a voiding diary, uroflowmetry, and by measuring the postvoid residual urine volume in this case-control study of 28 patients with a functional defecatory disorder (36 ± 2 years, mean ± SEM) and 30 healthy women (36 ± 2 years). KEY RESULTS Women with a defecatory disorder frequently reported urinary symptoms: urgency (61%), frequency (36%), straining to begin (21%), or finish (50%) voiding, and the sense of incomplete emptying (54%). Fluid intake and output, the minimum voided volume, and the shortest duration between voids measured by voiding diaries were higher (P < 0.05) in patients than in controls. Uroflowmetry revealed abnormalities in seven controls and 22 patients. The risk of abnormal voiding by uroflowmetry was higher in patients (OR 8.0; 95% CI, 2.3-26.9) than in controls. Patients took longer than controls (P < 0.01) to attain the maximum urinary flow rate (12 ± 2 VS 4 ± 0 s) and to empty the bladder (29 ± 4 VS 20 ± 2 s), but the maximum urinary flow rate and postvoid residual volumes were not significantly different. CONCLUSIONS & INFERENCES Symptoms of dysfunctional voiding and uroflowmetric abnormalities occurred more frequently, suggesting of disordered urination, in women with a defecatory disorder than in healthy controls.
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Affiliation(s)
| | | | - J.G. Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - John B. Gebhart
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Adil E. Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Trabuco EC, Klingele CJ, Weaver AL, McGree ME, Lightner DJ, Gebhart JB. Medium-term comparison of continence rates after rectus fascia or midurethral sling placement. Am J Obstet Gynecol 2009; 200:300.e1-6. [PMID: 19167695 DOI: 10.1016/j.ajog.2008.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 08/21/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to compare continence rates after placement of rectus fascia or midurethral slings. STUDY DESIGN We performed a retrospective cohort study of 242 women who underwent rectus fascia (n = 79) or midurethral (n = 163) sling procedures to treat urinary incontinence. Outcome was based on responses to validated questionnaires and need for interim treatment for incontinence. Survival free of incontinence was estimated using the Kaplan-Meier method. Associations between patient factors and survival free of incontinence were evaluated by fitting Cox proportional hazards models. RESULTS Women with rectus fascia slings were more likely to report any leakage of urine (P = .04) and were 13 times more likely to require urethrolysis (P < .001) than patients with midurethral slings. Patient satisfaction was lower in the rectus fascia sling group compared with the midurethral sling group (P = .01). CONCLUSION Midurethral slings appear to be more effective than rectus fascia slings and are less likely to cause postoperative voiding complications.
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Blandon RE, Gebhart JB, Trabuco EC, Klingele CJ. Complications from vaginally placed mesh in pelvic reconstructive surgery. Int Urogynecol J 2009; 20:523-31. [PMID: 19209374 DOI: 10.1007/s00192-009-0818-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 01/22/2009] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We describe complications associated with the use of transvaginal mesh for treatment of pelvic organ prolapse. METHODS We retrospectively identified patients referred to our institution from January 2003 through September 2007 who had complications after vaginal placement of mesh. RESULTS We identified 21 patients with a mean (SD) age of 61 (11) years. Types of mesh used included mesh kits (n = 9, 43%), nontrocar mesh augmentation (n = 5, 24%), IVS Tunneller (n = 4, 19%), and unspecified (n = 3, 14%). Eleven patients (52%) underwent more than one procedure before referral. Only three patients were referred by the original treating surgeon. Complications included mesh erosions in 12 women, dyspareunia in ten, and recurrent prolapse in nine. Sixteen patients (76%) were managed surgically. Follow-up survey among sexually active patients showed 50% with persistent dyspareunia. CONCLUSIONS Use of vaginal mesh for pelvic reconstruction can produce complications. Multiple interventions may be necessary, and bothersome symptoms may persist.
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Affiliation(s)
- Roberta E Blandon
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Babalola EO, Bharucha AE, Melton LJ, Schleck CD, Zinsmeister AR, Klingele CJ, Gebhart JB. Utilization of surgical procedures for pelvic organ prolapse: a population-based study in Olmsted County, Minnesota, 1965-2002. Int Urogynecol J 2008; 19:1243-50. [PMID: 18504517 DOI: 10.1007/s00192-008-0613-z] [Citation(s) in RCA: 13] [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: 10/30/2007] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
Abstract
To describe trends in the utilization of surgical procedures for pelvic organ prolapse among women in Olmsted County, MN, we retrospectively identified all county residents undergoing pelvic organ prolapse repair from January 1, 1965 through December 31, 2002. From 1965 to 2002, 3,813 women had pelvic organ prolapse surgeries: 3,126 had hysterectomy combined with pelvic floor repair (PFR) procedures and 687 had PFR alone. The age-adjusted utilization of hysterectomy plus PFR and of PFR alone decreased by 62% (P < 0.001) and 32% (P = 0.02), respectively. In both groups, utilization decreased in all age groups over time except in women aged 80 years and older undergoing hysterectomy plus PFR and women aged 70 years and older undergoing PFR only. The most common indication for PFR was uterovaginal prolapse. Among women in the community, the rate of utilization and age distribution of pelvic organ prolapse surgery changed substantially between 1965 and 2002.
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Blandon RE, Gebhart JB, Lightner DJ, Klingele CJ. Re-operation rates after permanent sacral nerve stimulation for refractory voiding dysfunction in women. BJU Int 2008; 101:1119-23. [PMID: 18190624 DOI: 10.1111/j.1464-410x.2007.07426.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To describe the development of screening tests and to identify re-operation rates after the permanent implant phase, and its characteristics, of the Interstim (Medtronic, Inc., Minneapolis, MI, USA) device for sacral nerve stimulation (SNS). PATIENTS AND METHODS We retrospectively reviewed the charts of women who had SNS between January 1998 and December 2005; their demographic, clinical and surgical information was abstracted. Descriptive statistics, chi-square and analysis of variance were used to compare the results. RESULTS In all, 95 patients had 105 test procedures; 30 peripheral nerve evaluation (PNE) and 75 staged tined leads. Response rates were lower in the PNE than in the tined lead (40% vs 67%, P = 0.01). The indication for SNS was associated with the response rate, with urinary retention having the highest response (71%, P = 0.01). For the 55 implanted devices, there were 18 revisions (33%) and eight explants (15%). The main reasons for revision or explants were loss of efficacy (16/26) and pain at the implant site (six of 26). The median (range) time to intervention after implantation was 17 (1.2-75.0) months, and this was significantly associated with the indication. Revisions due to pain at the implant site were within the first year, and re-operations due to loss of efficacy after 1-2 years, whereas battery replacement was required on average 4 years after initial implantation. CONCLUSIONS This study confirms the higher response rates of the tined-lead staged technique over PNE. Unobstructive urinary retention had the highest response rates. The reason for revision appeared to be largely predicted by the length of time since implantation.
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Affiliation(s)
- Roberta E Blandon
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Trabuco EC, Klingele CJ, Gebhart JB. Xenograft use in reconstructive pelvic surgery: a review of the literature. Int Urogynecol J 2007; 18:555-63. [PMID: 17225930 DOI: 10.1007/s00192-006-0288-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [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: 04/18/2006] [Accepted: 12/04/2006] [Indexed: 10/23/2022]
Abstract
Xenografts, bovine or porcine acellular collagen bioprostheses derived from dermis, pericardium, or small-intestine submucosa, were introduced to overcome synthetic mesh-related complications. Although there are eight commercially available xenografts, there is a paucity of empiric information to justify their use instead of the use of synthetic grafts. In addition, limited data are available about which graft characteristics are important and whether graft-reinforced repairs reduce recurrences and improve outcomes. To address these knowledge gaps, we conducted a Medline search of published reports on xenografts in animal and human trials. Histologic host response to implanted xenograft material depends primarily on chemical cross-linking and porosity, and it is limited to four responses: resorption, incorporation, encapsulation, and mixed. No clinical data unequivocally demonstrate an improved benefit to graft-reinforced repair.
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Affiliation(s)
- Emanuel C Trabuco
- Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
Eight cases of vesicouterine fistula (VUF) (obstetrical etiology in six cases and inflammatory bowel disease in two) have been treated in the past 14 years. All six obstetrical cases were related to cesarean section. Both cases of colovesicouterine fistula presented acutely with watery vaginal discharge or fecaluria. Presenting complaints were vaginal urinary incontinence (five cases), hematuria (three), and vaginal discharge (two). Diagnosis was made with cystoscopy in seven cases and computed tomography in one. VUF usually was between posterior bladder and anterior uterine walls above the internal os. Of the initial treatments, six were surgical (three hysterectomies) with an abdominal (five) or transvaginal (one) approach. Mean follow up was 9 months (range, 2-24). Urinary incontinence resolved in all surgically treated patients. Two patients reporting cyclic hematuria were initially managed medically (medroxyprogesterone injections), with delayed surgical repair elsewhere. Surgical repair is the primary treatment for VUF. Successful pregnancy and cesarean delivery have been reported after VUF repair, without sequelae.
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Affiliation(s)
- Connice S DiMarco
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Babalola EO, Famuyide AO, McGuire LJ, Gebhart JB, Klingele CJ. Vaginal erosion, sinus formation, and ischiorectal abscess following transobturator tape: ObTape implantation. Int Urogynecol J 2005; 17:418-21. [PMID: 16186998 DOI: 10.1007/s00192-005-0005-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [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: 06/01/2005] [Accepted: 08/05/2005] [Indexed: 11/28/2022]
Abstract
A 50-year-old woman was referred for evaluation with an 8-month history of intermittent malodorous vaginal discharge initially noted 2 months after placement of a transobturator tape for stress urinary incontinence. Evaluation revealed erosion of the tape through the vaginal wall with a sinus tract associated with an ischiorectal abscess. Surgical removal of the tape with excision of the sinus tract, drain placement, and antibiotic therapy was needed for complete resolution of the symptoms. Infectious complications need to be considered when counseling women prior to synthetic sling placement. A high index of suspicion, meticulous sub- and periurethral inspection, along with aggressive surgical management are required to treat an infected draining abscess following synthetic transobturator sling placement.
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Affiliation(s)
- Ebenezer O Babalola
- Urogynecology/Reconstructive Pelvic Surgery, Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
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Abstract
OBJECTIVE To compare the prevalence of pelvic organ prolapse in subjects with defecatory disorders with that in control subjects. METHODS In 55 subjects with fecal incontinence, 42 subjects with obstructed defecation, and 45 healthy subjects without defecatory symptoms, a urogynecologist assessed pelvic organ prolapse by the pelvic organ prolapse quantification system, and a gastroenterologist evaluated perineal descent during simulated evacuation. A multiple logistic regression model evaluated whether obstetric-gynecological variables, including pelvic organ prolapse, could discriminate among controls, subjects with fecal incontinence, and subjects with obstructed defecation. RESULTS Fifty-five percent of controls, 42% of those with obstructed defecation, and 29% of those with fecal incontinence had stage II or greater prolapse by clinical examination. Eleven percent of controls, 7% of those with obstructed defecation, and 47% of subjects with fecal incontinence had a forceps delivery. Eighteen percent of controls, 31% of those with obstructed defecation, and 64% of those with fecal incontinence had a hysterectomy. Even after controlling for a higher prevalence of obstetric risk factors and hysterectomy, fecal incontinence was associated with a lower risk of stage II or greater pelvic organ prolapse (odds ratio for fecal incontinence in > or = stage II pelvic organ prolapse relative to stage 0 pelvic organ prolapse = 0.1, 95% confidence interval 0.01-0.53). In contrast, pelvic organ prolapse severity was not associated with control versus obstructed defecation status. Seven percent of controls, 18% of subjects with obstructed defecation, and 7% of those with fecal incontinence had increased perineal descent during simulated evacuation. Excessive perineal descent was associated (P < .01) with pelvic organ prolapse. CONCLUSION Despite a higher prevalence of risk factors for pelvic floor injury, pelvic organ prolapse severity was lower in those with fecal incontinence than in subjects without bowel symptoms. However, a subset of subjects with defecatory disorders, predominantly obstructed defecation, have excessive perineal descent, which is associated with pelvic organ prolapse.
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Affiliation(s)
- Christopher J Klingele
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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Klingele CJ. Advances in urogynecology. Int J Fertil Womens Med 2005; 50:18-23. [PMID: 15971717] [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: 05/03/2023]
Abstract
Pelvic floor disorders include urinary incontinence, pelvic organ prolapse, and bowel dysfunction, all of which can cause considerable disability and anxiety. One third of all women will suffer from these disorders at some point in their life. All are often embarrassing and may act as barriers to healthy living as many women suffer in silence. The field of urogynecology has evolved over time to meet the needs of women who struggle with disorders of the pelvic floor. An increase in the awareness and treatment of these disorders has led to improved scientific research in the form of prospective randomized clinical trials to develop a unified understanding of their epidemiology, biology, and treatment. This review explores the literature that has promoted advances in the understanding of pelvic floor disorders and discusses some of the new technology and research that is being done in the field.
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Croak AJ, Schulte V, Klingele CJ, Gebhart JB, Lee RA, Lesnick TG, Peron S. Needle tip control and its effect in reducing intraoperative complications during tension-free vaginal tape placement. Int Urogynecol J 2004; 15:138-44; discussion 144. [PMID: 15014943 DOI: 10.1007/s00192-003-1110-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2002] [Accepted: 10/22/2003] [Indexed: 11/28/2022]
Abstract
Tactile needle tip control was used to aid perforation during standard tension-free vaginal tape (TVT) placement to treat urinary incontinence. The success and complications of this novel method were compared retrospectively with the reported results of the standard technique. One hundred nine patients had TVT placement between 1998 and 2001, with follow-up continuing into 2002. Preoperatively, the severity of urinary incontinence was assessed objectively. Postoperatively, TVT effectiveness was assessed subjectively by standardized questionnaire, completed by 78 of the 109 patients (72%). Objective 2-year rates for continence or improvement and most complication rates were similar to previously reported results. Needle tip control was helpful in lowering the occurrence of bladder perforation. Longer postoperative recovery times associated with postoperative dysuria or obstruction did not decrease patient satisfaction if the patient experienced a marked improvement in leakage.
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Affiliation(s)
- Andrew J Croak
- Section of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, MN 55905, USA.
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Abstract
OBJECTIVE To characterize vaginal rupture and evisceration. METHODS We reviewed medical records (1970-2001) for use of the diagnostic terms "vaginal rupture," "vaginal evisceration," and "ruptured enterocele." RESULTS Twelve clinical cases were identified. Patients usually presented with pain, vaginal bleeding, and abdominal pressure. In 9 of 12 women, rupture was primarily associated with postmenopausal prolapse and a history of pelvic surgery. Women with a history of abdominal hysterectomy tended to rupture through the vaginal cuff, and those with a history of vaginal hysterectomy tended to rupture through a posterior enterocele. Premenopausal rupture in 1 woman occurred postcoitally and involved the posterior fornix. Prolapse recurrence after repair was limited to 1 woman. CONCLUSIONS Vaginal rupture and evisceration should be considered in women presenting with acute vaginal bleeding and pelvic pain. Evaluation is especially important in postmenopausal women with a history of pelvic surgery. In some cases, surveillance after pelvic surgery may prevent rupture, evisceration, and incarceration. LEVEL OF EVIDENCE II-3
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Affiliation(s)
- Andrew J Croak
- Section of Gynecologic Surgery, Division of Biostatistics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Klingele CJ, Gebhart JB, Croak AJ, DiMarco CS, Lesnick TG, Lee RA. McIndoe procedure for vaginal agenesis: Long-term outcome and effect on quality of life. Am J Obstet Gynecol 2003; 189:1569-72; discussion 1572-3. [PMID: 14710067 DOI: 10.1016/s0002-9378(03)00938-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate quality of life, sexual function, and long-term outcome in women after undergoing the McIndoe procedure for vaginal agenesis. STUDY DESIGN This was a retrospective descriptive study of patients who were treated with the McIndoe procedure for vaginal agenesis. Participants answered a structured questionnaire to describe self-reported outcomes in quality of life, sexual function and satisfaction, and body image after the McIndoe procedure. Patient characteristics along with short- and long-term findings were abstracted from the medical record. RESULTS Eighty-six patients responded to the questionnaire. Average age (+/-SD) at surgery was 21+/-6 years (range, 12-49 years). The mean number of years (+/-SD) since surgery was 23+/-12 (range, 2-50 years). Seventy-nine percent of the respondents stated that the McIndoe procedure improved their quality of life. Ninety-one percent of the respondents were sexually active, with 75% able to achieve orgasm. Reported self-image was improved in 55% of the women. CONCLUSION The McIndoe procedure improves quality of life and sexual satisfaction and provides a functional vagina with minimal complications.
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Croak AJ, Gebhart JB, Klingele CJ, Lee RA, Rayburn WF. Therapeutic strategies for vaginal Müllerian agenesis. J Reprod Med 2003; 48:395-401. [PMID: 12856508] [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: 03/03/2023]
Abstract
Mayer-Rokitansky-Kuster-Hauser syndrome is challenging to diagnose and manage. A multisystem approach serves patients best. Appropriate treatment successfully improves patient self-image and sexual satisfaction.
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Affiliation(s)
- Andrew J Croak
- Section of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Carley ME, Klingele CJ, Boldt KL, Gebhart JB. Concomitant urethral and uterovaginal prolapse in a postmenopausal woman. A case report. J Reprod Med 2002; 47:939-42. [PMID: 12497686] [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: 02/28/2023]
Abstract
BACKGROUND Urethral prolapse is frequently encountered in girls. Although its occurrence in elderly women is not rare, little published information exists regarding this clinical condition or its management. CASE A 90-year-old woman (gravida 1, para 1) with a four-year history of intermittent vaginal bleeding had both urethral and uterovaginal prolapse. The condition was initially managed conservatively with estrogen and a pessary. Ultimately, surgical intervention was required for complete resolution. CONCLUSION Urethral prolapse can occur in elderly women and may present concomitantly with other forms of pelvic floor dysfunction such as uterovaginal prolapse. Conservative treatment with estrogen is partially effective in reducing the size of the urethral prolapse and may point to hypoestrogenism as one potential cause of this condition in elderly women. However, surgical management may ultimately be required for complete resolution of these problems, even in medically compromised patients.
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Affiliation(s)
- Michael E Carley
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Carley ME, Klingele CJ, Gebhart JB, Webb MJ, Wilson TO. Laparoscopy versus laparotomy in the management of benign unilateral adnexal masses. J Am Assoc Gynecol Laparosc 2002; 9:321-6. [PMID: 12101329 DOI: 10.1016/s1074-3804(05)60411-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To compare operative characteristics and charges of laparoscopy and laparotomy for women with a benign unilateral adnexal mass 7 cm or less in greatest diameter. DESIGN Historical cohort study (Canadian Task Force classification II-2). SETTING Clinic department of obstetrics and gynecology. PATIENTS One hundred six women. INTERVENTION Unilateral oophorectomy or unilateral salpingo-oophorectomy performed by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS When patients were compared on an intent to treat basis, no differences in greatest mass diameter (4.2 vs 4.5 cm), patient age (49.2 vs 46.4 yrs), or body mass index (26.0 vs 27.0 kg/m(2)) were found between 62 laparoscopies and 44 laparotomies. Laparoscopy was associated with longer operating times (94 vs 63 min, p <0.001), shorter hospital stay (1.6 vs 2.5 days, p <0.001), higher sterile supply charges ($1031 vs $40, p <0.001), and lower hospital room charges ($672 vs $1351, p <0.0001). No significant differences in total hospital charges, febrile morbidity, or transfusion rates were identified. CONCLUSION Patient charges and early operative morbidity are similar for laparoscopy and laparotomy. Therefore, patient and surgeon preference should be a primary consideration when deciding on operative approach in carefully selected women with a unilateral adnexal mass.
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Affiliation(s)
- Michael E Carley
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Klingele CJ, Carley ME, Hill RFC. Patient characteristics that are associated with urodynamically diagnosed detrusor instability and genuine stress incontinence. Am J Obstet Gynecol 2002; 186:866-8. [PMID: 12015497 DOI: 10.1067/mob.2002.123405] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to compare characteristics of patients with urodynamically diagnosed detrusor instability or genuine stress incontinence. STUDY DESIGN A retrospective audit of 293 consecutive women who were referred to a urogynecologist for evaluation of urinary incontinence between June 1996 and April 2000. RESULTS Of the 293 patients, 289 women had a physical examination and urodynamic testing, which revealed genuine stress incontinence (35%), detrusor instability (32%), mixed incontinence (29%), or normal urodynamic function (4%). Compared with patients with detrusor instability, those women with genuine stress incontinence were more likely to be white than African American (P <.0001) and to have a cystocele(P =.027), rectocele (P <.0001), or paravaginal defect (P =.004). No differences in age, gravidity, parity, estrogen treatment, or previous anti-incontinence procedure were identified between women with detrusor instability and women with genuine stress incontinence. CONCLUSION In a tertiary referral center, the distribution of urinary incontinence is evenly divided among genuine stress incontinence, detrusor instability, and mixed incontinence. Patients with genuine stress incontinence are more likely to be white and to have pelvic floor prolapse and symptoms of pure stress incontinence.
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