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Morciano A, Marzo G, Schiavi MC, Zullo MA, Frigerio M, Tinelli A, Cervigni M, Scambia G. From 3D to 2D-4K laparoscopic sacral colpopexy: are we addicted to technology? MINIM INVASIV THER 2024:1-7. [PMID: 38648419 DOI: 10.1080/13645706.2024.2343855] [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: 05/17/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE A study analyzing perioperative outcomes related to a sudden switch from 3D to 2D-4K technology for laparoscopic sacral colpopexy by expert pelvic surgeons: are we addicted to technology? MATERIAL AND METHODS After a sudden transition from 3D to 2D-4K laparoscopic technology, a total of 115 consecutive pelvic prolapse patients who underwent sacral colpopexy from June 2020 to September 2021 were retrospectively assessed from our database. Perioperative parameters, operative times (OT), and intraoperative difficulty scales were assessed. One-year follow-ups were analyzed for the study. Primary endpoints were OT; secondary endpoint was the evaluation of complications linked to this procedure. RESULTS We found statistical differences in OT and intraoperative difficulty scales between medians of the last 3D procedures and the first ten 2D-4K surgeries, without differences between operators. Only after more than 20 surgeries, we observed no significant differences between 3D and 2D-4K sacral colpopexy. We observed no statistical differences in terms of anatomic failure, PGI-I, and intra-postoperative complications. CONCLUSION The transition of urogynecology from an exclusive vaginal approach to 2D-3D-4K laparoscopy significantly increased the level of technology necessary for surgical treatment of prolapse. This could, as a result, lead to pelvic surgeons becoming increasingly dependent on technology.
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Affiliation(s)
- Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Lecce, Italy
| | - Giuseppe Marzo
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Lecce, Italy
| | | | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, "Campus Biomedico" University, Roma, Italy
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, "Veris Delli Ponti" Hospital, Lecce, Italy
| | - Mauro Cervigni
- Department of Urology, "La Sapienza" University, ICOT-Latina, Latina, Italy
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
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Campanella L, Gabrielli G, Chiodo E, Stefanachi V, Pennacchini E, Grilli D, Grossi G, Cignini P, Morciano A, Zullo MA, Palazzetti P, Rappa C, Calcagno M, Spina V, Cervigni M, Schiavi MC. Minimally Invasive Treatment of Stress Urinary Incontinence in Women: A Prospective Comparative Analysis between Bulking Agent and Single-Incision Sling. Healthcare (Basel) 2024; 12:751. [PMID: 38610173 PMCID: PMC11012214 DOI: 10.3390/healthcare12070751] [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: 01/26/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION The study aims to compare the efficacy and safety of bulking agents and single-incision slings in the treatment of urinary incontinence in 159 patients during a 29-month follow-up period. MATERIAL AND METHODS Of the 159 patients suffering from stress urinary incontinence, 64 were treated with bulking agents (PAHG Bulkamid®) and 75 with a single-incision sling (Altis®). The ICIQ-UI-SF (Incontinence Questionnaire-Urine Incontinence-Short Form), PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaires short form), FSFI (Female Sexual Function Index), FSDS (Female Sexual Distress Scale), and PGI-I (Patient Global Improvement Index) were used to assess efficiency and quality of life. RESULTS The bulking agents showed high efficacy and safety during the 29-month follow-up. Post-operative complications were recorded in both groups, with only two significant differences. The Bulkamid group experienced no pain, while 10.8% of the ALTIS group experienced groin pain and 5% experienced de novo urgency. Furthermore, patients treated with bulking agents experienced reduced nicturia (0.78 vs. 0.92 in patients treated with single-incision slings.). In both groups, we noticed a significant improvement in QoL (quality of life), with a halved ICIQ-UI-SF (International Consultation on Incontinence Questionnaire-Urine Incontinence-Short Form) score which was completed to assess the impact of urine symptoms. After 24 months of therapy, the Bulkamid group saw a decrease from 14.58 ± 5.11 at baseline to 5.67 ± 1.90 (p < 0.0001), whereas the ALTIS group experience a decrease from 13.75 ± 5.89 to 5.83 ± 1.78. Similarly, we observed an improvement in sexual function, with the number of sexually active patients increasing from 29 to 44 (56.4%) in the Bulkamid group (p = 0.041) and from 31 to 51 (61.7%) in the ALTIS group (p = 0.034). According to the most recent statistics, the PISQ-12, FSFI, and FSDS scores all demonstrated an improvement in women's sexual function. CONCLUSIONS In terms of efficacy and safety, bulking agents had notable results over the 29-month follow-up period. Furthermore, the patients treated with bulking agents reported a lower incidence of postoperative complications and a no discernible difference in terms of quality of life and sexual activity compared to the ones treated with single-incision slings. Bulking agents can be considered a very reliable therapeutic option based on accurate patient selection.
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Affiliation(s)
- Lorenzo Campanella
- Department of Obstetrics and Gynaecology, Ospedale Sandro Pertini, 00157 Rome, Italy; (G.G.); (E.C.); (V.S.); (E.P.); (D.G.); (G.G.); (P.C.); (P.P.); (M.C.S.)
- Department of Obstetrics and Gynaecology, Università di Tor Vergata, 00133 Rome, Italy
| | - Gianluca Gabrielli
- Department of Obstetrics and Gynaecology, Ospedale Sandro Pertini, 00157 Rome, Italy; (G.G.); (E.C.); (V.S.); (E.P.); (D.G.); (G.G.); (P.C.); (P.P.); (M.C.S.)
- Department of Obstetrics and Gynaecology, Università di Tor Vergata, 00133 Rome, Italy
| | - Erika Chiodo
- Department of Obstetrics and Gynaecology, Ospedale Sandro Pertini, 00157 Rome, Italy; (G.G.); (E.C.); (V.S.); (E.P.); (D.G.); (G.G.); (P.C.); (P.P.); (M.C.S.)
- Department of Obstetrics and Gynaecology, Università di Tor Vergata, 00133 Rome, Italy
| | - Vitaliana Stefanachi
- Department of Obstetrics and Gynaecology, Ospedale Sandro Pertini, 00157 Rome, Italy; (G.G.); (E.C.); (V.S.); (E.P.); (D.G.); (G.G.); (P.C.); (P.P.); (M.C.S.)
- Department of Obstetrics and Gynaecology, Università di Tor Vergata, 00133 Rome, Italy
| | - Ermelinda Pennacchini
- Department of Obstetrics and Gynaecology, Ospedale Sandro Pertini, 00157 Rome, Italy; (G.G.); (E.C.); (V.S.); (E.P.); (D.G.); (G.G.); (P.C.); (P.P.); (M.C.S.)
- Department of Obstetrics and Gynaecology, Università di Tor Vergata, 00133 Rome, Italy
| | - Debora Grilli
- Department of Obstetrics and Gynaecology, Ospedale Sandro Pertini, 00157 Rome, Italy; (G.G.); (E.C.); (V.S.); (E.P.); (D.G.); (G.G.); (P.C.); (P.P.); (M.C.S.)
- Department of Obstetrics and Gynaecology, Università di Tor Vergata, 00133 Rome, Italy
| | - Giovanni Grossi
- Department of Obstetrics and Gynaecology, Ospedale Sandro Pertini, 00157 Rome, Italy; (G.G.); (E.C.); (V.S.); (E.P.); (D.G.); (G.G.); (P.C.); (P.P.); (M.C.S.)
| | - Pietro Cignini
- Department of Obstetrics and Gynaecology, Ospedale Sandro Pertini, 00157 Rome, Italy; (G.G.); (E.C.); (V.S.); (E.P.); (D.G.); (G.G.); (P.C.); (P.P.); (M.C.S.)
| | - Andrea Morciano
- Department of Obstetrics and Gynaecology, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy;
- AIUG Research Groups, Associazione Italiana di UroGinecologia e del Pavimento Pelvico, 00168 Rome, Italy; (M.A.Z.); (C.R.); (M.C.)
| | - Marzio Angelo Zullo
- AIUG Research Groups, Associazione Italiana di UroGinecologia e del Pavimento Pelvico, 00168 Rome, Italy; (M.A.Z.); (C.R.); (M.C.)
- Department of Week-Surgery, Policlinico Universitario Campus Bio Medico, 00128 Rome, Italy
| | - Pierluigi Palazzetti
- Department of Obstetrics and Gynaecology, Ospedale Sandro Pertini, 00157 Rome, Italy; (G.G.); (E.C.); (V.S.); (E.P.); (D.G.); (G.G.); (P.C.); (P.P.); (M.C.S.)
| | - Carlo Rappa
- AIUG Research Groups, Associazione Italiana di UroGinecologia e del Pavimento Pelvico, 00168 Rome, Italy; (M.A.Z.); (C.R.); (M.C.)
- Andrea Grimaldi Medical Care, 80122 Naples, Italy
| | - Marco Calcagno
- Department of Obstetrics and Gynecology, Santo Spirito Hospital, 00193 Rome, Italy;
| | - Vincenzo Spina
- Maternal and Child Department, S. Camillo de Lellis Hospital, 02100 Rieti, Italy;
| | - Mauro Cervigni
- AIUG Research Groups, Associazione Italiana di UroGinecologia e del Pavimento Pelvico, 00168 Rome, Italy; (M.A.Z.); (C.R.); (M.C.)
- Department of Female Pelvic Medicine and Reconstructive Surgery, Istituto Marco Pasquali ICOT, 04100 Latina, Italy
| | - Michele Carlo Schiavi
- Department of Obstetrics and Gynaecology, Ospedale Sandro Pertini, 00157 Rome, Italy; (G.G.); (E.C.); (V.S.); (E.P.); (D.G.); (G.G.); (P.C.); (P.P.); (M.C.S.)
- AIUG Research Groups, Associazione Italiana di UroGinecologia e del Pavimento Pelvico, 00168 Rome, Italy; (M.A.Z.); (C.R.); (M.C.)
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Morciano A, Marzo G, Caliandro D, Schiavi MC, Giaquinto A, Rappa C, Zullo MA, Tinelli A, Scambia G, Cervigni M. Local anesthesia for Altis ® single incision sling in women with stress urinary incontinence. MINIM INVASIV THER 2023; 32:207-212. [PMID: 37272036 DOI: 10.1080/13645706.2023.2220382] [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: 01/19/2023] [Accepted: 05/11/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Local anesthesia for single incision slings has shown a good objective and subjective cure rate in women with stress urinary incontinence. The aim of the present study was to verify the efficacy and safety of local anesthesia during Altis® single incision placement. MATERIAL AND METHODS One hundred sixty-six consecutive patients (83 patients for each group: local resp. spinal anesthesia) were selected from our database for this retrospective study among women who underwent an Altis® implantation for SUI from September 2016 to June 2021, after unsuccessful previous conservative treatment. Primary endpoints were objective and subjective cure rates; secondary endpoint was the evaluation of complications linked to this procedure. RESULTS A total of 155 included patients completed our 12 months follow-up. Baseline characteristics were similar between the groups. Operative time (percentage difference of 50%; p < 0.05) and the Intraoperative Difficulty Scale resulted lower in spinal patients. No differences were found between populations in terms of objective (cough stress test and urodynamics) and subjective (PGI-I and FSDS questionnaires) cure rate and postoperative complications. CONCLUSION Local anesthesia for Altis® implantation could be considered a safe alternative to spinal anesthesia and an effective opportunity to avoid general anesthesia, increasing the possibility of outpatient implantation of this sling system.
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Affiliation(s)
- Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione 'Card. G. Panico', Tricase, Lecce, Italy
| | - Giuseppe Marzo
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione 'Card. G. Panico', Tricase, Lecce, Italy
| | - Dario Caliandro
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione 'Card. G. Panico', Tricase, Lecce, Italy
| | | | - Alessia Giaquinto
- Department of Clinical Pathology, 'Santa Caterina Novella' Hospital, Galatina, Lecce, Italy
| | - Carlo Rappa
- Pelvic Floor Unit, 'Villa Angela' Clinic, Napoli, Italy
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, 'Campus Biomedico' University, Roma, Italy
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, 'Veris Delli Ponti' Hospital, Scorrano, Lecce, Italy
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario 'A. Gemelli' - IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Mauro Cervigni
- Department of Urology, 'La Sapienza' University, ICOT-Latina, Italy
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Sala F, Loggia M, Cardella G, Morgani C, Grossi G, Zullo MA, Valensise HCC, Palazzetti PL, Schiavi MC. TOT in combination with solifenacin or intravaginal prasterone in postmenopausal women with mixed urinary incontinence: A retrospective analysis in 112 patients. Low Urin Tract Symptoms 2023; 15:96-101. [PMID: 36869670 DOI: 10.1111/luts.12476] [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: 09/02/2022] [Revised: 01/18/2023] [Accepted: 02/12/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES The aim of this study was to compare the efficacy of the transobturator tape (TOT) procedure combined with solifenacin (TOT-S) or prasterone (TOT-P) in postmenopausal women affected by mixed urinary incontinence (MUI) with a predominant stress urinary incontinence component. METHODS This is a retrospective analysis including 112 patients: 60 patients of the TOT-S group and 52 patients of the TOT-P group. Physical examination, 3-day voiding diary, urodynamic tests, and Vaginal Health Index (VHI) were compared at the beginning of the analysis and after 12 weeks of follow-up (FU). Specific questionnaires were administered to indagate the impact on women's quality of life and sexual function. RESULTS After 12 weeks of FU, the detrusor's peak flow pressure was significantly different between the two groups (p = .02). Detrusor overactivity decreased only in the TOT-P group (p = .05). At the end of FU, 58 patients (96.7%) of the TOT-S group and 50 patients (96.2%) of the TOT-P group were dry at the stress test. A significative group difference was observed in urge urinary incontinence (24 h) (p = .01) but not in the mean number of voids (24 h) and urgent micturition events (24 h). VHI improved only in the TOT-P group (12.57 ± 3.80 vs. 19.75 ± 4.13, p < .0001). The questionnaires and Patient Global Index of Improvement (PGI-I) scores showed comparable improvements, while the Female Sexual Function Index improved especially in the TOT-P group (p < .001). CONCLUSIONS In postmenopausal women with MUI, TOT-P demonstrated the same effectiveness as TOT-S in reducing urinary symptoms. In addition, TOT-P increased VHI and sexual function scores compared with TOT-S.
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Affiliation(s)
- Federica Sala
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, Rome, Italy.,Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy
| | - Melania Loggia
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, Rome, Italy.,Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy
| | - Giorgia Cardella
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, Rome, Italy.,Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy
| | - Claudia Morgani
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, Rome, Italy.,Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy
| | - Giovanni Grossi
- Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy
| | - Marzio Angelo Zullo
- Department of Week-Surgery, Campus Biomedico, University of Rome, Rome, Italy
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Morciano A, Ercoli A, Caliandro D, Campagna G, Panico G, Giaquinto A, Zullo MA, Tinelli A, Scambia G, Marzo G, Cervigni M. Laparoscopic posterior vaginal plication plus sacral colpopexy for severe posterior vaginal prolapse: A randomized clinical trial. Neurourol Urodyn 2023; 42:98-105. [PMID: 36135387 DOI: 10.1002/nau.25052] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 06/04/2022] [Accepted: 09/09/2022] [Indexed: 01/03/2023]
Abstract
AIM A randomized clinical trial proposing a new laparoscopic prosthetic and fascial approach to severe posterior vaginal prolapse. The primary endpoint was to evaluate the objective and subjective outcomes of our laparoscopic posterior plication (LPP) combined to "two-mesh" sacral colpopexy (laparoscopic sacral colpopexy [LSC]) in severe posterior vaginal prolapse, with a 1-year follow-up. The secondary endpoint was to evaluate the safety of this surgical procedure. METHODS This is single-center prospective randomized double-blinded clinical trial. A total of 130 consecutive patients with anterior and/or apical pelvic organ prolapse (POP) (POP-Q stage ≥II) and severe posterior vaginal prolapse (posterior POP-Q stage ≥III) were prospectively assessed for inclusion into the study from November 2018 to January 2020. Patients underwent "two-meshes" LSC and were randomized in Group A (LSC plus LPP) and Group A (LSC alone). Of the 130 included subjects, 8 were excluded, not meeting inclusion criteria. Cure rate was evaluated objectively, using POP-Q study, and subjectively using PGI-I, POPDI-6, and FSDS questionnaires. Complications were assessed intra-, peri-, and postoperatively. Twelve-month follow-ups were analyzed for the study. RESULTS We found in LSC plus LPP Group a significant improvement of Ap and genital hiatus POP-Q points. Our subjective study showed, at 12 months, a statistical difference in PGI-I successful outcomes rate in favor of LPP. Also the FSDS resulted significantly much more improved in Group A. We observed no statistical differences in terms of postoperative complications. CONCLUSIONS Our LPP approach to LSC could be considered an effective and safe technique to POP patients with severe posterior prolapse.
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Affiliation(s)
- Andrea Morciano
- Department of Gynaecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Alfredo Ercoli
- Department of Gynaecology and Obstetrics, Università degli Studi di Messina, Messina, Italy
| | - Dario Caliandro
- Department of Gynaecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Giuseppe Campagna
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Panico
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessia Giaquinto
- Department of Gynaecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, University "Campus Biomedico", Roma, Italy
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, "Veris Delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Marzo
- Department of Gynaecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Mauro Cervigni
- Department of Urology, Università "La Sapienza", ICOT-Latina, Latina, Italy
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Schiavi MC, Carletti V, Yacoub V, Cardella G, Luffarelli P, Valensise HCC, Palazzetti P, Spina V, Zullo MA. Evaluation of the efficacy and safety of single incision sling vs TVT-O in obese patients with stress urinary incontinence: Quality of life and sexual function analysis. Taiwan J Obstet Gynecol 2023; 62:89-93. [PMID: 36720557 DOI: 10.1016/j.tjog.2022.07.011] [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] [Accepted: 07/05/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES The aim of the study is to demonstrate the best stress urinary incontinence (SUI) surgical technique for women with a Body mass index higher than 30. The results of Transvaginal Tension Free Vaginal Tape-Obturator and Mini-sling surgery were analyzed and compared through both clinical examination and standardized questionnaires at 36 months of follow-up. MATERIALS AND METHODS This is a retrospective multicenter study over 159 women with SUI who underwent surgery. Seventy-eight women underwent TVT-O and 81 Mini-sling technique. Intra and post-operative complications were recorded. Patients were monitored for 36 months by analyzing symptoms, voiding diary, quality of life and sexual activity through standardized questionnaires. RESULTS Complications had a low incidence in both groups and inter-group differences were superimposable. Only groin pain was statistically higher after TVT-O than after Mini-sling (12.8% vs1.2%, p = 0.03). At 36 months of follow-up, a statistically significant decrease in Positive stress test (%) and Q-Tip test (grade) was observed in both groups with no differences between them (p = 0.54 and p = 0.32 respectively). The mean number of daily voids was higher after TVT-O (p = 0.04) than after Altis (p = 0.22) with a significant difference in favor of the Altis group (p = 0.03). After 36 months, there were no significant differences between groups in terms of quality of life and sexual activity. PGI-I did not show any difference between groups (p = 0.21). CONCLUSION TVT-O and Minisling had the same efficacy and results in the surgical treatment of SUI in obese women. Both techniques relieved their symptoms and improved their quality of life without any significant difference except for a lower incidence of post- Mini-sling complications.
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Affiliation(s)
| | - Valerio Carletti
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy.
| | - Veronica Yacoub
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
| | - Giorgia Cardella
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
| | - Paolo Luffarelli
- Department of Pelvic Floor Surgery and Proctology, "Campus Biomedico" University, Rome, Italy
| | - Herbert Carmelo Carlo Valensise
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy; Department of Obstetrics and Gynecology, "Casilino" Hospital, Rome, Italy
| | | | - Vincenzo Spina
- UOC Maternal and Child Health Protection, ASL Rieti, Italy
| | - Marzio Angelo Zullo
- Department of Pelvic Floor Surgery and Proctology, "Campus Biomedico" University, Rome, Italy
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Yacoub V, Carletti V, Grilli D, Morgani C, Palazzetti P, Zullo MA, Luffarelli P, Valensise HCC, Schiavi MC. Quality of life and sexual function analysis in a group of Italian postmenopausal women after COVID-19 vaccination. Gynecol Endocrinol 2022; 38:988-991. [PMID: 36203336 DOI: 10.1080/09513590.2022.2132224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIM The aim of the study was to evaluate the impact of SARS-CoV-2 vaccination on quality of life, psychological aspect and sexual life in a group of Italian postmenopausal women during the COVID-19 pandemic. METHODS The study was a prospective, observational analysis of postmenopausal women before and after the COVID-19 vaccination. The population previously answered different questionnaires, such as the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), the 36-Item Short Form Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Twelve weeks after the end of the vaccine cycle, these women were invited to complete the same questionnaires by e-mail to evaluate if vaccination coverage could positively impact the quality of life of postmenopausal women. The Patient Impression of Global Improvement (PGI-I) after three months of treatment was also calculated. RESULTS A total of 114 patients were reported. The median age was 60.96 (52-66) years. Mean sexual intercourses/month increased from 1.28 ± 1.23 to 4.21 ± 1.80 (p = 0.001). The FSFI increased (19.22 ± 3.31 vs 29.24 ± 4.21, p < 0.0001) and the FSDS decreased significantly (20.12 ± 5.23 vs 9.32 ± 5.55, p < 0.0001) 12 weeks after vaccination coverage. The SF-36 increased from 64.23 ± 11.76 to 82.21 ± 10.24 (p < .0001) and the HADS questionnaire improved significantly from 9.3 ± 2.73 to 5.1 ± 1.34 after the COVID-19 vaccine execution (p<.0001). CONCLUSIONS The spread of COVID-19 vaccine coverage positively influenced sexual function, quality of life and psychological aspect in postmenopausal women.
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Affiliation(s)
- Veronica Yacoub
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
| | - Valerio Carletti
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
| | - Debora Grilli
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
- Department of Obstetrics and Gynecology, "Sandro Pertini" Hospital, Rome, Italy
| | - Claudia Morgani
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
- Department of Obstetrics and Gynecology, "Sandro Pertini" Hospital, Rome, Italy
| | | | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, "Campus Biomedico" University, Rome, Italy
| | - Paolo Luffarelli
- Department of Surgery-Week Surgery, "Campus Biomedico" University, Rome, Italy
| | - Herbert Carmelo Carlo Valensise
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
- Department of Obstetrics and Gynecology, "Casilino" Hospital, Rome, Italy
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Morciano A, Caliandro D, Campagna G, Panico G, Giaquinto A, Fachechi G, Zullo MA, Tinelli A, Ercoli A, Scambia G, Cervigni M, Marzo G. Laparoscopic ventral rectopexy plus sacral colpopexy: continuous locked suture for mesh fixation. A randomized clinical trial. Arch Gynecol Obstet 2022; 306:1573-1579. [PMID: 35835920 DOI: 10.1007/s00404-022-06682-2] [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: 04/28/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Laparoscopic ventral rectopexy (LVR) plus sacral colpopexy (LSC) is a high-complexity surgical procedure. The aim of the present study was to evaluate a new approach to rectal-mesh fixation during LVR with continuous locked suture. METHODS This is a prospective randomized double-blinded clinical trial enrolling 80 patients with severe POP and obstructed defecation syndrome (ODS) from November 2016 to January 2021. Patients underwent a "two-meshes" LSC plus LVR and were randomized, regarding rectal mesh fixation, in Group A (extracorporeal interrupted 0 delayed absorbable sutures) and Group B ("U-shaped" running locked 0 delayed absorbable suture). Our primary endpoints were the operative times (OT); the secondary endpoints were the incidence of anatomical failures, vaginal mesh erosions and surgical complications. RESULTS A total of 75 patients completed the study. Baseline characteristics were similar between the groups. Overall OT (156 vs 138 min; p < 0.05; treatment reduction of 11.5%) and LVR mesh fixation time (29 vs 16 min; p < 0.05; treatment reduction of 44%), resulted in significantly lower in Group B. No differences were found in terms of anatomic failure, vaginal mesh erosion or intra- or post-operative complications. PGI-I, FSDS and Wexner questionnaires resulted significantly improved after surgery, without statistical differences between the studied surgical procedures. CONCLUSION Laparoscopic continuous locked 0 absorbable suture for LVR mesh fixation guaranteed a faster and effective alternative to multiple interrupted sutures. The significant OT reduction linked to this technique should be considered even more helpful when performing a highly complex surgery such as LVR. CLINICAL TRIAL REGISTRATION NCT05254860 (13/02/2017).
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Affiliation(s)
- Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy. .,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy.
| | - Dario Caliandro
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giuseppe Campagna
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giovanni Panico
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Alessia Giaquinto
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Giorgio Fachechi
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, University "Campus Biomedico", Rome, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, "Veris Delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Alfredo Ercoli
- Department of Gynaecology and Obstetrics, Università Degli Studi Di Messina, Messina, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Cervigni
- Department of Urology, ICOT, Università "La Sapienza", Latina, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giuseppe Marzo
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
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Zullo MA, Schiavi MC, Luffarelli P, Bracco G, Iuliano A, Grilli D, Esperto F, Cervigni M. Efficacy and safety of anterior vaginal prolapse treatment using single incision repair system: Multicentric study. Taiwan J Obstet Gynecol 2022; 61:646-651. [PMID: 35779915 DOI: 10.1016/j.tjog.2021.10.007] [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] [Accepted: 10/06/2021] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Up to 80% of all POP surgical procedures are due to anterior vaginal wall prolapse. The aim of this study is to evaluate the efficacy and safety of transvaginal anterior mesh for POP surgical repair. MATERIALS AND METHODS 153 consecutive patients with symptomatic or recurrent anterior vaginal prolapse undergoing surgical single-incision mesh (Calistar S) were prospectively enrolled in the study. Preoperative evaluation was performed collecting urogynecological history and performing a clinical exam, 3-day voiding diary and urodynamic testing. All incontinent patients completed the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Operative time, blood loss, perioperative and postoperative complications were prospectively recorded. Postoperative follow-up was scheduled at 1, 6, and 12 months with a urogynecological interview and examination. Success rate was assessed at 1, 6 and 12 months postoperatively. RESULTS The median follow-up was 16.4 months. None of patients had intraoperative complications. Eight patients (5%) required surgical intervention for complications (5 patients (3%) for haematoma and 3 (2%) for vaginal erosion). At 12 months of follow up 130 out of 140 patients (93%) gained the subjective cure criterion, while 129 out of 140 patients (92%) obtained the objective cure criterion. Eleven (7.8%) patients experienced stage 2 or higher prolapse recurrence and three of them with a stage ≥3 underwent reintervention. No significant differences were recorded in primary outcome at 1, 6 or 12 months postoperatively. CONCLUSIONS Anterior compartment prolapse repair by Calistar S (single-incision vaginal mesh) is an effective and safe procedure without significant complications.
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Affiliation(s)
- Marzio Angelo Zullo
- Department of Surgery-Week Surgery, Campus Biomedico University of Rome, Rome, Italy
| | | | - Paolo Luffarelli
- Department of Surgery-Week Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Gianluca Bracco
- Department of Gynecological and Obstetric, San Luca Hospital, Lucca, Italy
| | - Alessandro Iuliano
- Department of Gynecological and Obstetric, San Pietro Hospital, Roma, Italy
| | - Debora Grilli
- Department of Gynecological and Obstetric, Sandro Pertini Hospital, Rome, Italy; Department of Gynecological and Obstetric, Tor Vergata University of Rome, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
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Schiavi MC, Zullo MA, Luffarelli P, Di Pinto A, Oliva C, Palazzetti P. Urogynecological survey in a group of Italian women treated for overactive bladder: Symptoms and quality of life analysis during the Covid-19 period. Taiwan J Obstet Gynecol 2021; 60:674-678. [PMID: 34247805 PMCID: PMC8266265 DOI: 10.1016/j.tjog.2021.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Accepted: 12/09/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives The aim of this study is to assess the impact of life change and social distancing measures, during the Covid-19 outbreak, on the OAB symptoms and quality of life in women underwent different types of treatment. Materials and methods Observational survey analysis in OAB treated patients was performed. The women showed a greater than 50% improvement during specific therapy for OAB. Population had previously completed bladder diary, OAB-Q symptom, OAB HRQL scale, SF-36 and PGI-I questionnaires. Four weeks after the introduction of the restrictive measures, these women were invited to complete the same questionnaires by e-mail for new evaluation during Covid-19 outbreak. Primary endpoint was changes in number of voids/24h, urgent micturitions/24h, urinary incontinence events/24h, nocturia events. Secondary endpoints were the assessment of the change in the OAB-SF, SF-36 questionnaires and PGI-I satisfaction. Results Six hundred seventy-three patients were considered. The mean age was 63.21 ± 10.24 years. Four weeks after the start of the social distancing measures, the increase in mean number of voids/24h (7.13 ± 1.08 vs 9.76 ± 2.12, p < 0.0001), urgent micturition episodes/24h (2.65 ± 1.11 vs 4.57 ± 1.28, p < 0.0001), nocturia episodes (1.19 ± 1.21 vs 2.83 ± 0.94, p < 0.0001) was observed. The OAB symptom scores (32.67 ± 12.88 vs 51.23 ± 12.11, p < 0.0001), OAB-HRQL (75.45 ± 12.76 vs 48.23 ± 10.34, p < 0.0001), and SF-36 (82.15 ± 11.78 vs 69.39 ± 10.85, p < 0.0001) changed significantly. The satisfaction decreased significantly at the PGI-I during the Covid-19 period 79.8% vs 45% (p < 0.0001). Conclusions The Covid-19 outbreak and the restrictive social distancing measures have negatively influenced the OAB symptoms and quality of life in women underwent different types of treatment.
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Affiliation(s)
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Paolo Luffarelli
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Anna Di Pinto
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Cosimo Oliva
- Department of Gynecological and Obstetric, San Filippo Neri Hospital, Rome, Italy
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Schiavi MC, Spina V, Zullo MA, Colagiovanni V, Luffarelli P, Rago R, Palazzetti P. Love in the Time of COVID-19: Sexual Function and Quality of Life Analysis During the Social Distancing Measures in a Group of Italian Reproductive-Age Women. J Sex Med 2020; 17:1407-1413. [PMID: 32653391 PMCID: PMC7342024 DOI: 10.1016/j.jsxm.2020.06.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [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: 04/08/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The beginning of 2020 was characterized by the COVID-19 pandemic. The world governments have adopted restrictive measures to reduce the spread of infection. These measures could affect the sexual function and quality of life of women living with their partner. AIM The aim is to assess the impact of the social distancing measures caused by the COVID-19 pandemic on sexual function and quality of life of noninfected reproductive-age women, living with their sexual partner. METHODS Observational analysis on sexually active women, living with their partner, and without COVID-19 infection was performed. The population previously answered FSFI, FSDS, and SF-36 questionnaires. 4 weeks after the introduction of the restrictive measures, these women were invited to complete the same questionnaires by e-mail for an evaluation during the COVID-19 outbreak. MAIN OUTCOME MEASURES The primary endpoint was the assessment of the women's sex function change during the social restriction period, by analyzing the FSFI and FSDS questionnaires. The secondary endpoint was the evaluation of the impact on the quality of life calculated by the SF-36 questionnaire. RESULTS 89 patients were considered. The median age was 39 (28-50) years. Mean sexual intercourses/month decreased from 6.3 ± 1.9 to 2.3 ± 1.8, mean difference: -3.9 ± 1.2. FSFI decreased significantly (29.2 ± 4.2 vs 19.2 ± 3.3, mean difference: -9.7 ± 2.6) and FSDS increased significantly (9.3 ± 5.5 vs 20.1 ± 5.2, mean difference: 10.8 ± 3.4). The SF-36 showed a significant change from 82.2 ± 10.2 to 64.2 ± 11.8 4 weeks after the introduction of the restrictive measures; mean difference: -17.8 ± 6.7. The univariable analysis identified working outside the home, university educational level, and parity ≥1 as predictive factors of lower FSFI. In multivariable analysis, working outside the home and combination of working outside the home + university educational level + parity ≥1 were the independent factors of a lower FSFI. CLINICAL IMPLICATION The negative impact of the COVID-19 epidemic period on sexual function and quality of life in women shows how acute stress might affect the psychological state. Thus, psychological or sexual support could be useful. STRENGTHS AND LIMITATIONS To our knowledge, this study is the first that analyzes the change in sexual activity in women during the COVID-19 outbreak period. The limitations were the low number of the analyzed participants, psychological tests were not included, and no data were collected on masturbation, self-heroism, solitary, and nonpenetrative sex. CONCLUSION The COVID-19 epidemic and the restrictive social distancing measures have negatively influenced the sexual function and quality of life in not-infected reproductive-age women who live with their sexual partners. Schiavi MC, Spina V, Zullo MA, et al. Love in the Time of COVID-19: Sexual Function and Quality of Life Analysis During the Social Distancing Measures in a Group of Italian Reproductive-Age Women. J Sex Med 2020;17:1407-1413.
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Affiliation(s)
- Michele Carlo Schiavi
- Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy; Department of Gynecological and Obstetrics, University "Sapienza" of Rome, Rome, Italy.
| | - Vincenzo Spina
- Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Vanessa Colagiovanni
- Department of Gynecological and Obstetrics, University "Sapienza" of Rome, Rome, Italy
| | - Paolo Luffarelli
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Rocco Rago
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Pierluigi Palazzetti
- Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy
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12
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Zullo MA, Schiavi MC, Di Pinto A, Prata G, Scudo M, Luffarelli P, Oliva C. Efficacy and safety of oral administration of a product based on hydroxytyrosol as preventive therapy for recurrent vulvo-vaginal candidosis: a prospective observational pilot study. Eur Rev Med Pharmacol Sci 2020; 24:7427-7432. [PMID: 32706082 DOI: 10.26355/eurrev_202007_21911] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate the efficacy and safety of hydroxytyrosol for the prevention of the vulvar vaginal candida infections recurrence. PATIENTS AND METHODS This study is a prospective observational pilot study. Eligible subjects were at least 18 years old, with at least 4 documented episodes of vulvovaginal candidiasis in the last 12 months. Patients were instructed to therapy (2 tabs daily for the first month and then 1 tab daily for 2 other months). Each capsule consists of hydroxytyrosol (HT) and other components: tea tree oil, tabebuia, juglans regia, and copper. Clinical and microbiological assessments took place at baseline and 12 weeks after. The impact on Quality of Life (QoL) was evaluated with the SF-36 and the Patient Global Impression of Improvement (PGI-I) after 3 months of treatment was calculated. RESULTS Sixty patients were enrolled in the study. In the last 1 year the mean number of previous infections was 5.83 ± 2.76. Forty-nine patients (83%) did not have candida episodes during 3 months of treatment. A significant reduction in clinical symptoms, vaginal signs, such as pruritus, burning and vulvar erythema (< 0.0001). The SF-36 showed a significant change (55.67±8.43 vs. 84.56±11.56, p < 0.0001) and the total success at PGI-I was reported in 54 patients (90%). CONCLUSIONS The HT-based product is effective and safe in preventing recurrent candida episodes and improves the quality of life and sexual function of treated women.
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Affiliation(s)
- M A Zullo
- Department of Surgery-Week Surgery, University of Rome "Campus Biomedico", Rome, Italy.
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Zullo MA, Schiavi MC, Luffarelli P, Prata G, Di Pinto A, Oliva C. TVT-O vs. TVT-Abbrevo for stress urinary incontinence treatment in women: a randomized trial. Int Urogynecol J 2019; 31:703-710. [DOI: 10.1007/s00192-019-04077-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
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Schiavi MC, D'Oria O, Aleksa N, Vena F, Prata G, Di Tucci C, Savone D, Sciuga V, Giannini A, Meggiorini ML, Monti M, Zullo MA, Muzii L, Benedetti Panici P. Usefulness of Ospemifene in the treatment of urgency in menopausal patients affected by mixed urinary incontinence underwent mid-urethral slings surgery. Gynecol Endocrinol 2019; 35:155-159. [PMID: 30324854 DOI: 10.1080/09513590.2018.1500534] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The aim of this study was to assess the effectiveness and safety of Ospemifene in the improvement of urgency component in women affected by mixed urinary incontinence (MUI) who underwent surgery with mid-urethral sling (MUS). Eighty-one patients with MUI underwent surgical intervention with MUS were enrolled. After surgical intervention 38 patients received Ospemifene 60 mg one tablet daily per os for 12 weeks. Physical examination, 3-day voiding diary, urodynamic testing were performed at the start and the follow-up after 12 weeks in the Trans-Obturator-Tape (TOT)-Alone group and TOT-Ospemifene. Patients completed the Overactive Bladder Symptom and Health-Related Quality of Life Short-Form (OAB-Q SF), International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), and King' s Health Questionnaire (KHQ). A significant difference between the two groups was observed in peak flow (ml/s), in first voiding desire (ml), in maximum cystometric capacity (ml), and in detrusor pressure at peak flow (cmH2O) at urodynamic evaluation. A significative difference between the two groups at voiding diary was observed in the mean number of voids, urgent micturition episodes/24 h, urge urinary incontinence, and in nocturia events. The OAB-Q symptoms and OAB-Q (HRQL) scores after 12 weeks showed a significative difference between the two groups. Ospemifene is an effective potential therapy after MUSs in women with MUI improving urgency symptoms and quality of life.
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Affiliation(s)
- Michele Carlo Schiavi
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Ottavia D'Oria
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Natalia Aleksa
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Flaminia Vena
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Giovanni Prata
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Chiara Di Tucci
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Delia Savone
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Valentina Sciuga
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Andrea Giannini
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Maria Letizia Meggiorini
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Marco Monti
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Marzio Angelo Zullo
- b Department of Surgery-Week Surgery , Campus Biomedico, University of Rome , Rome , Italy
| | - Ludovico Muzii
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Pierluigi Benedetti Panici
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
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Schiavi MC, Sciuga V, Giannini A, Vena F, D'oria O, Prata G, Di Tucci C, Savone D, Aleksa N, Capone C, Di Mascio D, Meggiorini ML, Monti M, Zullo MA, Muzii L, Benedetti Panici P. Overactive bladder syndrome treatment with ospemifene in menopausal patients with vulvovaginal atrophy: improvement of sexuality? Gynecol Endocrinol 2018; 34:666-669. [PMID: 29463148 DOI: 10.1080/09513590.2018.1441398] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The aim of this study was to assess the effectiveness of ospemifene in the improvement of sexual function in postmenopausal women with vulvovaginal atrophy (VVA) affected by overactive bladder syndrome (OAB) or urge urinary incontinence (UUI). One hundred five postmenopausal patients with VVA affected by OAB and/or UUI were enrolled for the study. All patients received ospemifene 60 mg for 12 weeks. Clinical examination, 3-d voiding diary and the vaginal health index (VHI) were performed at baseline and at 12 weeks. Patients completed the OAB-Q SF, FSFI, FSDS, and SF-36 questionnaires. The patient's satisfaction was also calculated. After 12 weeks, the reduction of urinary symptoms was observed. The OAB-Q symptoms, OAB-Q (HRQL) score were (55.34 ± 13.54 vs. 23.22 ± 9.76; p < .0001) and (22.45 ± 9.78 vs. 70.56 ± 15.49; p < .0001), before and after treatment. SF-36 questionnaire showed a significant improvement (p < .0001). VHI score increased and the women who regularly practice sexual activity increased after treatment. The total FSFI score increased significantly and the FSDS score changed after 12 weeks (p < .0001). The PGI-I after 12 weeks showed a total success rate of 90.5%. Ospemifene is an effective potential therapy for postmenopausal women with VVA affected by OAB or UUI improving sexual function and quality of life.
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Affiliation(s)
- Michele Carlo Schiavi
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Valentina Sciuga
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Andrea Giannini
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Flaminia Vena
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Ottavia D'oria
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Giovanni Prata
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Chiara Di Tucci
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Delia Savone
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Natalia Aleksa
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Carmela Capone
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Daniele Di Mascio
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Maria Letizia Meggiorini
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Marco Monti
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Marzio Angelo Zullo
- b Department of Surgery-Week Surgery, Campus Biomedico , University of Rome , Rome , Italy
| | - Ludovico Muzii
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Pierluigi Benedetti Panici
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
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Schiavi MC, Savone D, Di Mascio D, Di Tucci C, Perniola G, Zullo MA, Muzii L, Benedetti Panici P. Long-term experience of vaginal vault prolapse prevention at hysterectomy time by modified McCall culdoplasty or Shull suspension: Clinical, sexual and quality of life assessment after surgical intervention. Eur J Obstet Gynecol Reprod Biol 2018. [PMID: 29518641 DOI: 10.1016/j.ejogrb.2018.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 10/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effectiveness of modified McCall culdoplasty or Shull suspension in preventing vaginal vault prolapse after vaginal hysterectomy and the long-term impact on quality of life and sexual function. STUDY DESIGN Retrospective analysis in 414 patients underwent vaginal hysterectomy for pelvic organ prolapse (POP) and vaginal suspension through modified McCall culdoplasty (group A) or Shull suspension (group B) was evaluated. Clinical features and concomitant surgical procedures were assessed. Surgical data and perioperative and postoperative complications have also been analyzed. Clinical characteristics, urinary symptoms, POP-Q score classification, Quality of Life and Sexual Function were evaluated at baseline and at median follow up with P-QoL, ICIQ-UI-SF, PISQ-12, FSFI, FSDS questionnaires. RESULTS The median follow up was 8.9 year (5.1-14.2 years). 200 women in group A and 214 in group B were evaluated. Vaginal vault prolapse occurred in 2 patients in group A and in 2 patients in group B. POP-Q score for all compartments showed a significant (p < 0.001) decrease for both groups without significant differences between the 2 groups. The total vaginal length (TVL) was reduced in greater proportion in McCall group (p < 0.001). P-QoL and ICIQ-UI-SF questionnaires documented an improvement for both groups (p < 0.001). The number of patients who regularly practice sexual activity increased in both groups, but patients in group B experienced a better quality of sexual life evaluated with PISQ-12 and FSFI. CONCLUSIONS Both surgical techniques showed effectiveness and safety in preventing vaginal vault prolapse in women who underwent vaginal hysterectomy, with a significant improvement in quality of life and sexuality. Shull technique demonstrated greater improvement in sexual function.
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Affiliation(s)
- Michele Carlo Schiavi
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy.
| | - Delia Savone
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Daniele Di Mascio
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Chiara Di Tucci
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Giorgia Perniola
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, University of Rome "Campus Biomedico", Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
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Schiavi MC, Di Pinto A, Sciuga V, Faiano P, Di Tucci C, D'oria O, Martoccia A, Prata G, Carraro C, Ostuni R, Zullo MA, Muzii L, Benedetti Panici P. Prevention of recurrent lower urinary tract infections in postmenopausal women with genitourinary syndrome: outcome after 6 months of treatment with ospemifene. Gynecol Endocrinol 2018; 34:140-143. [PMID: 28853624 DOI: 10.1080/09513590.2017.1370645] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Aim of this study was to evaluate the efficacy of ospemifene in the prevention of recurrent lower urinary tract infections in postmenopausal women with vulvovaginal atrophy. The study have a retrospective design. Thirty-nine patients were enrolled. Patients underwent clinical examination and urine culture. The urinary symptoms and the quality of life were evaluated with UTISA score, PUF and SF-36 questionnaires before and after treatment. All 39 patients received ospemifene 60 mg one tablet/daily for 6 months. Adverse effects and complications were assessed. Thirty-nine patients were enrolled in the study. Two patients experienced one new UTI episode and the mean number of positive urine culture decreased significantly after 6 months (3.65 ± 2.12 vs 0.25 ± 0.17, p < .0001). The mean number of urinary infection symptoms decreased significantly after treatment; dysuria reduced (4.76 ± 2.45 vs 0.89 ± 1.12). PUF score and SF-36 showed a statistically significant change (22.43 ± 5.89 vs 12.14 ± 3.21) and (52.86 ± 9.21 vs 83.43 ± 10.76). No adverse effects were reported and the total success rate was the 92.3% after 6 months at PGI-I. Ospemifene is a valid alternative with excellent tolerability for the UTIS prevention in postmenopausal patients.
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Affiliation(s)
- Michele Carlo Schiavi
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Anna Di Pinto
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Valentina Sciuga
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Pierangelo Faiano
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Chiara Di Tucci
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Ottavia D'oria
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Angela Martoccia
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Giovanni Prata
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Carlo Carraro
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Rosa Ostuni
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Marzio Angelo Zullo
- b Department of Surgery-Week Surgery , University of Rome "Campus Biomedico" , Rome , Italy
| | - Ludovico Muzii
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Pierluigi Benedetti Panici
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
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Schiavi MC, Zullo MA, Faiano P, D'Oria O, Prata G, Colagiovanni V, Giannini A, Di Tucci C, Perniola G, Di Donato V, Monti M, Muzii L, Benedetti Panici P. Retrospective analysis in 46 women with vulvovaginal atrophy treated with ospemifene for 12 weeks: improvement in overactive bladder symptoms. Gynecol Endocrinol 2017; 33:942-945. [PMID: 28490209 DOI: 10.1080/09513590.2017.1323859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AIMS The aim of this study was to assess the effectiveness and safety of ospemifene in the improvement of overactive bladder (OAB) symptoms in postmenopausal women affected by vulvovaginal atrophy (VVA). METHODS Forty-six postmenopausal patients affected by VVA with OAB syndrome were enrolled for the study. All patients received Ospemifene 60 mg for 12 weeks. Clinical examination, 3-day voiding diary, urodynamic testing, ultrasound measurement of endometrial and bladder wall thickness (BWT) and the Vaginal Health Index (VHI) were performed at baseline and 12 weeks. Patients completed the OAB-Q SF and UDI-6. RESULTS After 12-weeks, the number of patients with detrusor overactivity decreased from 39% to 13% (p = 0.04). The reduction in the mean number in 24 h of voids (9.57 ± 2.12 vs. 6.63 ± 1.22, p < 0.0001), urgent micturition episodes/24 h (5.63 ± 1.46 vs. 1.44 ± 1.31, p < 0.0001), nocturia episodes (3.17 ± 0.85 vs. 1.11 ± 1.18, p < 0.0001), urinary incontinence episodes/24 h (0.85 ± 0.96 vs. 0.33 ± 0.64, p = 0.003) was observed. The UDI-6, OAB-Q symptoms, OAB-Q (HRQL) scores were 8.95 ± 0.91 vs. 5.56 ± 1.40, 62.60 ± 14.70 vs. 20.08 ± 10.83 and 18.71 ± 7.41 vs. 79.45 ± 14.47 (p < 0.001) before and after 12 weeks. CONCLUSION Ospemifene is an effective potential therapy for postmenopausal women with VVA improving OAB symptoms and quality of life.
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Affiliation(s)
- Michele Carlo Schiavi
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Marzio Angelo Zullo
- b Department of Surgery-Week Surgery, Campus Biomedico , University of Rome , Rome , Italy
| | - Pierangelo Faiano
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Ottavia D'Oria
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Giovanni Prata
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Vanessa Colagiovanni
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Andrea Giannini
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Chiara Di Tucci
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Giorgia Perniola
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Violante Di Donato
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Marco Monti
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Ludovico Muzii
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
| | - Pierluigi Benedetti Panici
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy and
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Schiavi MC, Di Tucci C, Colagiovanni V, Faiano P, Giannini A, D'Oria O, Prata G, Perniola G, Monti M, Zullo MA, Muzii L, Benedetti Panici P. A medical device containing purified bovine colostrum (Monurelle Biogel) in the treatment of vulvovaginal atrophy in postmenopausal women: Retrospective analysis of urinary symptoms, sexual function, and quality of life. Low Urin Tract Symptoms 2017; 11:O11-O15. [PMID: 29057583 DOI: 10.1111/luts.12204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 07/07/2017] [Revised: 08/01/2017] [Accepted: 08/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study assessed the effectiveness and safety of a medical device containing purified bovine colostrum (Monurelle Biogel; Zambon, Bresso, Italy) in improving vulvovaginal atrophy (VVA), sexual function, urinary symptoms, and quality of life (QoL) in postmenopausal women. METHODS In all, 172 postmenopausal women with VVA were included in the study. All women were treated with vaginal Monurelle Biogel daily for 12 weeks. Patients underwent clinical examinations, completed a 3-day voiding diary, and had VVA graded using the Vaginal Health Index (VHI) at baseline and 12 weeks. Patients also completed the Female Sexual Function Index (FSFI), overactive bladder questionnaire (OAB-Q), and the Urogenital Distress Inventory (UDI-6), among others. RESULTS After 12 weeks, there were significant increases in mean (± SD) VHI (12.53 ± 3.67 vs. 19.31 ± 3.49; P < .0001), the number of patients engaging in regular sexual activity 102 (59.3%) vs. 144 (83.7%), and in the total FSFI score (21.64 ± 2.99 vs. 28.16 ± 1.93; P < .0001) compared with baseline. In addition, there were significant reductions in the mean number of 24-hour voids (9.57 ± 2.12 vs. 7.13 ± 1.22; P < .0001), urgent micturition episodes per 24 hours (1.75 ± 0.76 vs. 1.14 ± 0.87; P = .001), nocturia episodes (1.58 ± 0.85 vs. 0.97 ± 1.18; P = .0002), and urinary incontinence episodes per 24 hours (0.74 ± 0.59 vs. 0.28 ± 0.52; P = .003). Finally, after 12 weeks treatment, there were significant differences in UDI-6 (7.85 ± 0.81 vs. 5.56 ± 1.40), OAB-Q symptom (53.60 ± 12.57 vs. 22.08 ± 9.63), and OAB-Q health-related QoL (21.75 ± 8.51 vs. 69.34 ± 14.59) scores compared with baseline (P < .0001 for all). The Patient Impression of Global Improvement scale revealed global improvement in 143 women (83.14%). CONCLUSIONS Monurelle Biogel is an effective treatment for VVA in postmenopausal women, improving sexual life, urinary symptoms, and QoL.
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Affiliation(s)
- M C Schiavi
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - C Di Tucci
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - V Colagiovanni
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - P Faiano
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - A Giannini
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - O D'Oria
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - G Prata
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - G Perniola
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - M Monti
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - M A Zullo
- Department of Surgery-Week Surgery, Campus Biomedico, University of Rome, Rome, Italy
| | - L Muzii
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - P Benedetti Panici
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
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Schiavi MC, Perniola G, Di Donato V, Visentin VS, Vena F, Di Pinto A, Zullo MA, Monti M, Benedetti Panici P. Severe pelvic organ prolapse treated by vaginal native tissue repair: long-term analysis of outcomes in 146 patients. Arch Gynecol Obstet 2017; 295:917-922. [DOI: 10.1007/s00404-017-4307-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/27/2017] [Indexed: 02/03/2023]
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Angioli R, Terranova C, De Cicco Nardone C, Cafà EV, Damiani P, Portuesi R, Muzii L, Plotti F, Zullo MA, Panici PB. A comparison of three different entry techniques in gynecological laparoscopic surgery: a randomized prospective trial. Eur J Obstet Gynecol Reprod Biol 2013; 171:339-42. [PMID: 24103531 DOI: 10.1016/j.ejogrb.2013.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 08/12/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Laparoscopic entry techniques vary and still remain debated. We conducted a randomized control trial to compare three entry techniques. STUDY DESIGN Women aged 18-70 years, nominated for laparoscopic surgery at University of Rome Campus Bio-Medico, were randomized into three different groups: Veress needle (VER), Direct trocar insertion (DIR) and Open technique (OP). For each group, minor complications (extra-peritoneal insufflation, trocar site bleeding, omental injury and surgical site infection), failed entry and time of entry of the main trocar were evaluated. Major complications were also considered. Between-group comparisons were performed using chi-square test. Significance P value was <0.05. RESULTS A series of 595 consecutive procedures were included: 193 in the VER group, 187 in the DIR group and 215 in the OP group. Minor complications occurred in 36 cases: extraperitoneal insufflation (n=6) in the VER group only, site bleeding (n=2 in the VER group, n=2 in the DIR group and n=1 in the OP group), site infection (n=5 in the VER and n=6 in OP group), and omental injury (n=6 in the VER group and n=3 in the DIR group). Failed entry occurred in 4 cases of the VER group and 1 case of the DIR group. Mean time of entry was 212.4, 71.4 and 161.7s for the VER, DIR and OP groups respectively. Among major complications, one bowel injury resulted following the Veress technique. CONCLUSIONS In our series, DIR and OP entry presented a lower risk of minor complications compared with VER. In addition, time of entry was shorter in DIR than with OP entry.
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Affiliation(s)
- Roberto Angioli
- Department of Gynecology, University Campus Bio-Medico, Rome, Italy
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Angioli R, Montera R, Plotti F, Aloisi A, Montone E, Zullo MA. Success rates, quality of life, and feasibility of sacral nerve stimulation in elderly patients: 1-year follow-up. Int Urogynecol J 2012; 24:789-94. [PMID: 22961496 DOI: 10.1007/s00192-012-1928-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 08/11/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urgency urinary incontinence (UUI) frequently occurs in elderly. International guidelines recommend pharmacological therapy as first-line treatment, but elderly do not respond in many cases. The purpose of this study was to report cure rates, quality of life, and feasibility of sacral neurostimulation (SNS) as an alternative option in the elderly. MATERIALS AND METHODS From October 2008 to April 2010, women >65 years with UUI who were refractory to pharmacological treatments were enrolled in this study and underwent SNS. At 12 months after surgery, patients were asked to compile a 3-day voiding diary and a urogynecologic standardized questionnaire: the Overactive Bladder Questionnaire (OAB-q). RESULTS Eighteen patients met our inclusion criteria. Fifteen (83.3 %) underwent implantation of the neuromodulator. Twelve months after surgery, an overall success rate of 83.3 % was registered. A statistically significant difference (P<0.0001) between baseline and postsurgery OAB-q scores was recorded. CONCLUSIONS SNS can be considered an alternative treatment for UUI in older women.
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Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynaecology, University of Rome Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128, Rome, Italy
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Plotti F, Zullo MA, Angelucci M, Oronzi I, Damiani P, Montera R, Dugo N, Guzzo F, De Oronzo MA, Ricciardi R, Aloisi A, Hyseni E, Luvero D, Portuesi RAV, Scaletta G, Capriglione S, Miranda A, Li Destri M, Benedetti Panici P, Angioli R. The novel biomarker HE4 versus CA125 in detecting endometrial cancer: A case control prospective study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5094] [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] [Indexed: 11/20/2022] Open
Abstract
5094 Background: In endometrial cancer, there are no markers routinely used in clinical practice. This study prospectively investigates the sensitivity and specificity of new marker HE4 in detection of endometrial cancer. Methods: Serum samples were prospectively obtained 24 hours before surgery from 25 patients with endometrial cancer and from 25 patients with uterine benign pathology, operated from January 2011 to October 2011 at University Campus Bio-Medico of Rome. Preoperative CA125 levels were evaluated by a one-step “sandwich” radioimmunoassay. HE4 levels were determined using the HE4 enzymatic immune assay. The CA125 normal value is considered less than 35 U/mL. Two HE4 cut-off are considered: less than 70 pmol/L and less than 150 pmol/L. The specificity analysis was performed using the parametric T-Test for comparing the HE4 series and the Mann-Whitney test for the CA125 series. The level of statistical significance is set at p < 0.05. Results: The sensitivity of CA125 in detecting endometrial cancer is 16% whereas the sensitivity of HE4 is 48% and 28 % for 70 pmol/L and 150 pmol/L cut-off respectively. The specificity of HE4 is 100% (positive predictive value = 100%, negative predictive value = 65.79% and 58.14% considering the two HE4 cut-off, respectively), whereas the CA125 specificity is 72 % (positive predictive value = 36.36%, negative predictive value = 46.15%) in detection of endometrial cancer. Conclusions: HE4 has a good sensitivity and a specificity of 100% in detection of endometrial cancer and may be useful for detecting early stage endometrial cancer. In particular the HE4 at cut-off of 70 pmol/L yields the best sensitivity and specificity.
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Affiliation(s)
| | | | | | - Irma Oronzi
- Campus Bio-Medico University of Rome, Rome, Italy
| | | | | | - Nella Dugo
- Campus Bio-Medico University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Rome, Italy
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Damiani P, Plotti F, Zullo MA, De Cicco Nardone C, Montera R, Cafà EV, Guzzo F, Ricciardi R, Aloisi A, Montone E, Hyseni E, Luvero D, Capriglione S, Lopez S, Scaletta G, Miranda A, Benedetti Panici P, Angioli R. Surgical primary treatment of stage IVA cervical cancer: A multicenter retrospective study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15551] [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] [Indexed: 11/20/2022] Open
Abstract
e15551 Background: The aim of the present study is to describe feasibility, surgical technique, perioperative data, early and late complications of anterior and total pelvic exenteration after neoadjuvant chemotherapy as primary treatment for stage IVa cervical cancer. Methods: It is a retrospective study which included 73 consecutive patients affected by stage IVa cervical cancer who required anterior or total pelvic exenteration referred to 3 international gynaecologic oncology centres. The steps of this extirpative surgical procedure were: 1) staging laparotomy; 2) frozen section biopsy of the paraaortic lymph nodes; 3) systematic lymphadenectomy, radical hysterectomy with adnexectomy and total or anterior pelvic exenteration; 4) continent urinary diversions and low colorectal anastomosis if it was possible. Results: The treatment of patients affected by FIGO stage IVA cervical cancer remains one of the most complex procedures gynecologic oncologists are faced with. Our study focused on clinical and operative data , in terms of overall survival (OS) and disease free survival (DFS) at 5 years. 5-year OS of our series was 43%. Conclusions: The surgical treatment of stage IVA cervical cancer appears therefore a suitable and valid alternative. Stage IVA cervical cancer patients in good general condition, with a disease resectable with clear surgical margins, should be considered for primary exenteration in referral centers where the surgical experience to perform this procedure is available.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Rome, Italy
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Angioli R, Plotti F, Ricciardi R, Terranova C, Zullo MA, Damiani P, Montera R, Guzzo F, Scaletta G, Muzii L. The use of novel hemostatic sealant (Tisseel) in laparoscopic myomectomy: a case-control study. Surg Endosc 2012; 26:2046-53. [PMID: 22302534 DOI: 10.1007/s00464-012-2154-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 06/30/2011] [Accepted: 12/20/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND This is the first case-control study on the use of a fibrin sealant (Tisseel) on uterine suture during laparoscopic myomectomy (LM), with the primary endpoint to evaluate the intraoperative bleeding and postoperative blood loss. In addition, we evaluated the time required to achieve hemostasis using Tisseel and how much it can influence operative time. METHODS From December 2009 to January 2011, consecutive patients older than 18 years with symptomatic isolate intramural myoma with maximal diameter B6 cm and ≥ 4 cm and with a sonographically diagnosed free myometrium margin ≥ 0.5 cm were included in the study. We selected from our institute's database a group of consecutive patients with homogeneous features of the study group, who underwent laparoscopic myomectomy without Tisseel application. RESULTS Fifteen women with symptomatic myoma were enrolled in the study (group A). Regarding the control group (group B), we selected a homogenous group of 15 patients with the same preoperative characteristics of the study group. Mean operative time was 47.7 min and 62.1 min, for groups A and B respectively (p < 0.05). Mean time required to achieve complete haemostasis was 195.5 s in group A and 361.8 in control group B (p < 0.0001). Mean estimated blood loss was 111.3 mL and 230 mL in groups A and B, respectively (p < 0.05). Mean hemoglobin decrease was 1.36 g/dL and 2.04 g/dL in groups A and B, respectively (p < 0.05). CONCLUSIONS The use of Tisseel during LM may represent a valid alternative solution for obtaining hemostasis, reducing intra- and postoperative bleeding. Furthermore, it may help the surgeon to obtain a rapid healing of the injured surfaces, probably reducing the use of electrocoagulationand traumatisms.
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Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio Medico University of Rome, Via Álvaro del Portillo, 200-00128 Rome, Italy.
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Angioli R, Montera R, Plotti F, Terranova C, Aloisi A, Zullo MA. Suburethral sling in autoimmune patients: complications, quality of life, and success rate. Int Urogynecol J 2011; 23:453-7. [DOI: 10.1007/s00192-011-1595-9] [Citation(s) in RCA: 2] [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] [Received: 05/23/2011] [Accepted: 10/18/2011] [Indexed: 11/24/2022]
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Plotti F, Zullo MA, Montera R, Angioli R, Pierluigi BP. Bladder function after laparoscopic nerve-sparing radical hysterectomy. Gynecol Oncol 2010; 120:315; author reply 315-6. [PMID: 21129769 DOI: 10.1016/j.ygyno.2010.10.027] [Citation(s) in RCA: 3] [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] [Received: 08/30/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
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Angioli R, Plotti F, Muzii L, Montera R, Panici PB, Zullo MA. Tension-Free Vaginal Tape Versus Transobturator Suburethral Tape: Five-Year Follow-up Results of a Prospective, Randomised Trial. Eur Urol 2010; 58:671-7. [PMID: 20709444 DOI: 10.1016/j.eururo.2010.08.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 08/03/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynaecology, Campus Bio-Medico University of Rome, Rome, Italy
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Angioli R, Plotti F, Muzii L, Montera R, Panici PB, Zullo MA. Reply from Authors re: Elisabetta Costantini, Massimo Lazzeri. Elephants Can Remember. Eur Urol 2010;58:678–9. Eur Urol 2010. [DOI: 10.1016/j.eururo.2010.08.045] [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: 10/19/2022]
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Zullo MA, Ruggiero A, Montera R, Plotti F, Muzii L, Angioli R, Panici PB. An ultra-miniinvasive treatment for stress urinary incontinence in complicated older patients. Maturitas 2010; 65:292-5. [DOI: 10.1016/j.maturitas.2009.11.022] [Citation(s) in RCA: 13] [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: 10/30/2009] [Accepted: 11/23/2009] [Indexed: 11/30/2022]
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Muzii L, Sereni MI, Battista C, Zullo MA, Tambone V, Angioli R. [Tubo-peritoneal factor of infertility: diagnosis and treatment]. Clin Ter 2010; 161:77-85. [PMID: 20393685] [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: 05/29/2023]
Abstract
Infertility, defined as the inability to conceive despite regular unprotected sexual intercourse over 12 years, affects approximately 10% of the fertile population. The commonest cause of tubal damage is pelvic inflammatory disease (PID), which in the developed world is caused mainly by Chlamydia trachomatis infection. The incidence of tubal damage after one episode of pelvic infection is approximately 12%, 23% after two episodes and 54% after three episodes. Other causes of tubal damage include postsurgical adhesions or endometriosis. Tubal patency can be diagnosed by hysterosalpingography (HSG) or laparoscopy with chromopertubation. Surgery represents the best therapeutic approach for tubal pathology, with a term pregnancy rate of 70% after surgery in selected patients, while the latest results in Italy of assisted reproductive technology (ART) report a live birth rate per cycle of 13.8%. In conclusion, tubal reconstructive surgery remains an important option for many couples and surgery should be the fi rst line approach for a correct diagnosis and treatment of tubal infertility.
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Affiliation(s)
- L Muzii
- Dipartimento di Ginecologia, Università Campus BioMedico, Roma, Italia.
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Angioli R, Muzii L, Montera R, Damiani P, Bellati F, Plotti F, Zullo MA, Oronzi I, Terranova C, Panici PB. Feasibility of the Use of Novel Matrix Hemostatic Sealant (FloSeal) to Achieve Hemostasis during Laparoscopic Excision of Endometrioma. J Minim Invasive Gynecol 2009; 16:153-6. [DOI: 10.1016/j.jmig.2008.11.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 10/24/2008] [Accepted: 11/06/2008] [Indexed: 12/15/2022]
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Angioli R, Muzii L, Zullo MA, Battista C, Ruggiero A, Montera R, Guzzo F, Montone E, Musella A, Di Donato V, Benedetti Panici P. [Use of bulking agents in urinary incontinece]. Minerva Ginecol 2008; 60:543-550. [PMID: 18981980] [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: 05/27/2023]
Abstract
Urinary incontinence consist in voluntary urine leakage. Female affected in the world are about 200 thousand. Urinary incontinence affect severely women quality of life. There are different kinds of urinary incontinence that can be treated in different ways. We can use pelvic floor rehabilitation, drug therapy, invasive and non-invasive surgical treatment. Different treatments are used for different incontinence types. Periurethral injection is the most common procedure between non-invasive surgery. The most recent bulking agents occasionally determine severe adverse reaction or complication. Frequently we can have just pain during injection and a temporary urine retention. During the latest years we used a lot of bulking agents: bovine collagen, autologous fat, carbon particles, macroplastique, calcium hydroxylapatite, ethylene vinyl alcohol copolymer, dextranomer. Urethral injection have success in 40-90%. We can assert that macroplastique is the most efficacy and safe on the basis of literature data and of our experience data. This surgical procedure, in fact, has good percentage of success in accurately selected patients. In our experience Macroplastique can also be used in oncological patients, in elderly women, in patients with important comorbidity and with high surgical risk with good objective and subjective results.
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Affiliation(s)
- R Angioli
- Dipartimento di Ostetricia e Ginecologia, Università Campus Bio-Medico di Roma, Italia.
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Plotti F, Angelo Zullo M, Sansone M, Di Giovanni A, Benedetti Panici P. Urinary incontinence after gynecologic cancer treatment. Acta Obstet Gynecol Scand 2008; 87:788; author reply 789. [PMID: 18607813 DOI: 10.1080/00016340802220360] [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: 10/21/2022]
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Zullo MA, Ruggiero A, Plotti F, Bellati F, Basile S, Manci N, Muzii L, Angioli R, Panici PB. Anterior Colporrhaphy Plus Inside-out Tension-free Vaginal Tape for Associated Stress Urinary Incontinence and Cystocele. J Minim Invasive Gynecol 2008; 15:446-51. [DOI: 10.1016/j.jmig.2008.03.014] [Citation(s) in RCA: 10] [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: 01/18/2008] [Revised: 03/22/2008] [Accepted: 03/29/2008] [Indexed: 11/26/2022]
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Plotti F, Zullo MA, Palaia I, Angioli R, Panici PB. Urinary incontinence after radical vulvectomy treated with Macroplastique implantation. J Minim Invasive Gynecol 2008; 15:113-5. [PMID: 18262159 DOI: 10.1016/j.jmig.2007.08.607] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 05/30/2007] [Revised: 08/04/2007] [Accepted: 08/11/2007] [Indexed: 11/18/2022]
Abstract
Postradical vulvectomy urinary incontinence is a common surgery-related complication, especially after subtotal urethrectomy. However, only 1 trial has been reported in the previous literature that described a case of total urinary incontinence treated with an Aldridge sling operation. We present 2 cases of patients affected by postradical vulvectomy, with partial urethral resection and total incontinence successfully treated by transurethral Macroplastique injection. This procedure could be considered as a valid, minimally invasive surgical option to improve the well-being of patients with vulvar cancer affected by postradical vulvectomy urinary incontinence, especially in elderly patients at high operative risk.
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Affiliation(s)
- Francesco Plotti
- Department of Obstetrics and Gynecology, La Sapienza University of Rome, Rome, Italy.
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Plotti F, Zullo MA, Sansone M, Calcagno M, Panici PB. Where should bulking agents for female urodynamic stress incontinence be injected? Int Urogynecol J 2008; 19:1723-4. [PMID: 18437271 DOI: 10.1007/s00192-008-0625-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Accepted: 03/24/2008] [Indexed: 11/30/2022]
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Angioli R, Zullo MA, Plotti F, Bellati F, Basile S, Damiani P, Perniola G, Calcagno M, Panici PB. Urologic function and urodynamic evaluation of urinary diversion (Rome pouch) over time in gynecologic cancers patients. Gynecol Oncol 2007; 107:200-4. [PMID: 17692906 DOI: 10.1016/j.ygyno.2007.06.020] [Citation(s) in RCA: 6] [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: 04/06/2007] [Revised: 06/27/2007] [Accepted: 06/28/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the urologic late complications and urodynamics outcome adopting teniamyotomies technique to create a low-pressure reservoir using the cecum, ascending colon and proximal part of the transverse colon without detubularization (Rome pouch). METHODS Twenty-eight consecutive patients affected by gynecological cancer and submitted urinary diversion with "Rome pouch" technique were included. After 3 and 12 months from the surgical procedure patients were submitted to urodynamic evaluation of the neobladders. Excretory urography was performed in all patient. Abdominal X-ray, serum electrolytes, creatinine and cultures of the reservoir are obtained during every visit. Long-term urologic complications were recorded. Patient quality of life was assessed using a 10 cm grade visual analog scale (VAS). RESULTS Urodynamics performed 12 months postoperatively showed that the mean maximum reservoir capacity was 439.9+/-58.9 cm H(2)O. The mean reservoir pressure at maximum capacity was 19.2+/-8.4 cm H(2)O (no contractive wave during the filling in any patient). The mean maximum closure pressure in the efferent tube, at maximum capacity, was 88.8+/-32.3 cm H(2)O. Continence was excellent for 26 (93%) and 23 (92%) patients at 3 and 12 months respectively. A total of 9 (32%) and 6 (24%) patients suffered late complications at 3 and 12 months follow-up respectively. However only one patient with pouch leakage underwent surgical pouch revision. CONCLUSION Our experience demonstrated that Rome pouch creation with multiple teniamyotomies has good capacity with low internal pressure and good continence with a low rate of late urologic complications. Thus, comparing results to those of other continent pouch models, the Rome pouch technique represents a valid alternative.
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Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio Medico, University of Rome, Rome, Italy
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Panici PB, Angioli R, Plotti F, Muzii L, Zullo MA, Manci N, Palaia I, Galluci M. Continent ileocolonic urinary diversion (Rome pouch) for gynecologic malignancies: Technique and feasibility. Gynecol Oncol 2007; 107:194-9. [PMID: 17689594 DOI: 10.1016/j.ygyno.2007.06.018] [Citation(s) in RCA: 7] [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: 04/06/2007] [Revised: 06/19/2007] [Accepted: 06/19/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the technique, feasibility and early complications of "Rome pouch" urinary diversion. METHODS Thirty-five consecutive patients affected by advanced or recurrent gynecological cancers who required anterior or total pelvectomy entered the study. Rome pouch technique starts with the transection of terminal ileum about 12 cm from the ileocecal valve; the large colon is transected 15-20 cm distal to the hepatic flexure. The intestinal wall tension and internal pressure are reduced using 5-8 transverse teniamyotomies of the cecum. The efferent segment of the pouch is created either with the appendix or with the distal ileum. Operative data, intra- and early postoperative complications were recorded. RESULTS Between February 2000 and March 2006, an ileocolonic urinary diversion (Rome pouch) was carried out in 35 patients affected by advanced or recurrent gynecologic malignancies. The average operative time to complete the anterior and total exenteration including reconstruction procedure was 285 (range, 230-350) and 320 (range 280-415) min, respectively. The average time in performing the Rome pouch technique was 60 min (range, 45-90). Overall postoperative complication rate (major and minor complications) was 82% (29 patients). Febrile morbidity occurred in 26 patients (74%). Wound complications and pelvic collection were found in 7 (20%) and 6 (17%) patients, respectively. CONCLUSION Our experience demonstrated that Rome pouch technique represents a valid alternative in gynecology oncology for continent urinary diversion. This technique showed low rate of medical and early urologic complications. The simplicity of performing the procedure and the reduced operating time are the best goals reached by Rome pouch technique. Future comparative trials will better define the role that the Rome pouch will have in these patients.
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Affiliation(s)
- Pierluigi Benedetti Panici
- Department of Obstetrics and Gynecology, La Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Benedetti Panici P, Perniola G, Angioli R, Zullo MA, Manci N, Palaia I, Bellati F, Plotti F, Calcagno M, Basile S. Bulky lymph node resection in patients with recurrent epithelial ovarian cancer: impact of surgery. Int J Gynecol Cancer 2007; 17:1245-51. [PMID: 17425680 DOI: 10.1111/j.1525-1438.2007.00929.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [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: 11/28/2022] Open
Abstract
The aim of this study was to evaluate the role of systematic lymphadenectomy, feasibility, complications rate, and outcome in epithelial ovarian cancer (EOC) patients with recurrent bulky lymph node disease. A prospective observational study of EOC patients with pelvic/aortic lymph node relapse was conducted between January 1995 and June 2005. After a clinical and laparoscopic staging, secondary cytoreduction, including systematic lymphadenectomy, were performed. The eligibility criteria were as follows: disease-free interval ≥6 months, radiographic finding suggestive of bulky lymph node recurrence, and patients' consent to be treated with chemotherapy. Forty-eight EOC patients with lymph node relapse were recruited. Twenty-nine patients were amenable to cytoreductive surgery. Postoperatively, all patients received adjuvant treatment. The median numbers of resected aortic and pelvic nodes were 15 (2–32) and 17 (8–47), respectively. The median numbers of resected aortic and pelvic positive lymph nodes were 4 (1–18) and 3 (1–17), respectively. The mean size of bulky nodes was 3.3 cm. Four patients (14%) experienced one severe complication. No treatment-related deaths were observed. After a median follow-up of 26 months, among cytoreduced patients, 18 women were alive with no evidence of disease, nine were alive with disease. Among the 11 patients not amenable to surgery, five women were alive with persistent disease, six patients died of disease, at a median follow-up of 18 months. Estimated 5-year overall survival and disease-free interval for operated women were 87% and 31%, respectively. In conclusion, patients with bulky lymph node relapse can benefit from systematic lymphadenectomy in terms of survival. The procedure is feasible with an acceptable morbidity rate
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Affiliation(s)
- P Benedetti Panici
- Department of Obstetrics and Gynecology, University La Sapienza of Rome, Rome, Italy.
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Benedetti Panici P, Palaia I, Basile S, Perniola G, Sansone M, Gradinaru N, Zullo MA, Angioli R. Conservative approaches in early stages of cervical cancer. Gynecol Oncol 2007; 107:S13-5. [PMID: 17727934 DOI: 10.1016/j.ygyno.2007.07.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 07/06/2007] [Accepted: 07/06/2007] [Indexed: 11/19/2022]
Abstract
Several authors have proposed the use of a less aggressive surgery (i.e. conization, trachelectomy plus laparoscopic lymphadenectomy, modified or type 2 radical hysterectomy) for patients affected by early stages invasive cervical carcinoma. Tumor size and pelvic nodal status are parameters that must be evaluated to better select a patient's population suitable of a less aggressive surgery, with the aim of sparing morbidity without jeopardizing cancer cure.
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Affiliation(s)
- Pierluigi Benedetti Panici
- Institute of Gynecology, Perinatology and Child Health, La Sapienza University, Viale del Policlinico, 155, 00100 Rome, Italy.
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Muzii L, Basile S, Zupi E, Marconi D, Zullo MA, Manci N, Bellati F, Angioli R, Benedetti Panici P. Laparoscopic-assisted vaginal hysterectomy versus minilaparotomy hysterectomy: A prospective, randomized, multicenter study. J Minim Invasive Gynecol 2007; 14:610-5. [PMID: 17848323 DOI: 10.1016/j.jmig.2007.05.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [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: 02/16/2007] [Revised: 05/15/2007] [Accepted: 05/18/2007] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to compare operative and early postoperative outcomes of laparoscopic-assisted vaginal hysterectomy (LAVH) and minilaparotomy in a randomized clinical trial including patients undergoing total hysterectomy for benign gynecologic disease and having 1 or more of the generally considered contraindications to vaginal route. DESIGN Prospective, randomized, multicenter trial (Canadian Task Force classification I). SETTING Departments of Gynecology from 3 major university hospitals in Rome. PATIENTS Eighty-one patients who were candidates for abdominal hysterectomy. INTERVENTIONS Laparoscopic-assisted vaginal hysterectomy and minilaparotomy hysterectomy. MEASUREMENTS AND MAIN RESULTS Forty patients were randomized to LAVH and 41 to minilaparotomy. Characteristics of patients and indications for surgery in the 2 arms were comparable. In the minilaparotomy group, complications were as follows: 1 case (2.4%) of delayed laparotomy with 2 units of red blood cell transfusion, 2 cases (4.8%) of wound infection, and 3 cases (7.3%) of fever of unknown origin. No minor or major complications were observed in the LAVH group. Postoperative visual analog scale pain scores at days 1 and 2 were significantly lower in the LAVH group (p <.05). The complication rate between the 2 groups was significantly lower for LAVH (p = .026). CONCLUSION Because LAVH was associated with significantly lower early postoperative pain scores and complication rates, in general LAVH should be preferred to minilaparotomy hysterectomy when the vaginal approach cannot be used.
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Affiliation(s)
- Ludovico Muzii
- Department of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy.
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Plotti F, Panici PB, Zullo MA, Angioli R. Re: Axelsen SM, Bek KM, Petersen LK. 2007. Urodynamic and ultrasound characteristics of incontinence after radical hysterectomy. Neurourol Urodynam. Neurourol Urodyn 2007; 27:260-1; author reply 261. [PMID: 17638310 DOI: 10.1002/nau.20477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Benedetti Panici P, Bellati F, Manci N, Pernice M, Plotti F, Di Donato V, Calcagno M, Zullo MA, Muzii L, Angioli R. Neoadjuvant Chemotherapy Followed by Radical Surgery in Patients Affected by FIGO Stage IVA Cervical Cancer. Ann Surg Oncol 2007; 14:2643-8. [PMID: 17562114 DOI: 10.1245/s10434-007-9408-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 02/14/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Concomitant chemoradiotherapy represents the standard treatment for patients affected by locally advanced cervical cancer. Survival rates in patients affected by FIGO stage IVA disease remain poor. Some authors have suggested that neoadjuvant chemotherapy followed by radical surgery might be a valid alternative to standard treatment. The objective of this study was to analyze the feasibility and results obtained by neoadjuvant chemotherapy in patients affected by stage IVA disease. METHODS Eighteen patients affected by FIGO stage IVA cervical cancer were treated with 175 mg/m(2) paclitaxel and 75 mg/m(2) cisplatin every 21 days for three courses followed by radical surgery when feasible. RESULTS All patients were subjected to the three planned chemotherapy courses. Two patients achieved a complete clinical response, and 10 patients achieved a partial clinical response. Ten patients were subjected to anterior pelvic exenteration, whereas the remaining eight patients were treated with chemotherapy, radiotherapy, and concomitant chemoradiotherapy. The estimated 3-year and 5-year overall survival rates were 47.4% and 31.6%, respectively. Patients eligible for surgery benefited from significantly longer survival rates. CONCLUSIONS Neoadjuvant chemotherapy followed by radical surgery is feasible in approximately half of patients affected by FIGO stage IVA cervical cancer. Overall survival rates appear similar to those reported with concomitant chemoradiotherapy. Patients who are amenable to radical surgery after chemotherapy may benefit from long-term survival rates.
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Affiliation(s)
- Pierluigi Benedetti Panici
- Department of Obstetrics and Gynecology, University of Rome La Sapienza, Viale del Policlinico, 155, Rome, Italy.
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Zullo MA, Plotti F, Calcagno M, Marullo E, Palaia I, Bellati F, Basile S, Muzii L, Angioli R, Panici PB. Reply to Francesco Araco et al.’s Letter to the Editor re: Marzio Angelo Zullo, Francesco Plotti, Marco Calcagno, Elettra Marullo, Innocenza Palaia, Filippo Bellati, Stefano Basile, Ludovico Muzii, Roberto Angioli and Pierluigi Benedetti Panici. One-Year Follow-up of Tension-free Vaginal Tape (TVT) and Trans-obturator Suburethral Tape from Inside to Outside (TVT-O) for Surgical Treatment of Female Stress Urinary Incontinence: A Prospective Randomised Trial. Eur Urol 2007;51:1376–84. Eur Urol 2007. [DOI: 10.1016/j.eururo.2007.01.081] [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: 10/23/2022]
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Zullo MA, Plotti F, Calcagno M, Marullo E, Palaia I, Bellati F, Basile S, Muzii L, Angioli R, Panici PB. One-Year Follow-up of Tension-free Vaginal Tape (TVT) and Trans-obturator Suburethral Tape from Inside to Outside (TVT-O) for Surgical Treatment of Female Stress Urinary Incontinence: A Prospective Randomised Trial. Eur Urol 2007; 51:1376-82; discussion 1383-4. [PMID: 17110021 DOI: 10.1016/j.eururo.2006.10.066] [Citation(s) in RCA: 86] [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: 07/25/2006] [Accepted: 10/26/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare tension-free vaginal tape (TVT) and trans-obturator suburethral tape from inside to outside (TVT-O) for surgical treatment of stress urinary incontinence (SUI) for complications (primary end point) and success rate (secondary end point). METHODS Seventy-two consecutive patients, with a mean age of 53.2 yr (range: 38-69 yr) and affected by SUI, were included in this randomised controlled trial. After preoperative assessment, patients were randomly allocated to the TVT or TVT-O procedure. Operative time, perioperative complications, and hospital stay were prospectively recorded. Cure of SUI was defined as no leakage of urine during the stress test at urodynamic testing at the 12-mo evaluation. The Wilcoxon signed rank sum test, Mann-Whitney U test, McNemar test, and Fisher exact test were used to verify statistical significance, set at p<0.05. RESULTS All patients were evaluable at the 12-mo follow-up. The characteristics of patients were well balanced between groups after randomisation. The mean operative time was significantly shorter in the TVT-O group. Perioperative complications were significantly more common after the retropubic approach (5% and 27% in TVT-O and TVT groups, respectively, p<0.04). The groups did not differ significantly in intraoperative blood loss, hospital stays, and time to return to normal activities. Sixty-five patients (90%) were successfully treated for SUI 12 mo after the operation (89% and 91% for TVT-O and TVT groups, respectively). CONCLUSIONS Both techniques appear to be equally effective in the surgical treatment of SUI. However, TVT-O had a shorter operative time and lower overall perioperative complication rate.
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Affiliation(s)
- Marzio Angelo Zullo
- Department of Obstetrics and Gynecology, University of Rome Campus Bio-medico, Via Longoni 83, 00155 Rome, Italy.
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Bellati F, Pernice M, Manci N, Palaia I, Tomao F, Marchetti C, Zullo MA, Muzii L, Angioli R, Benedeth Panici P. Hemoglobin variation and blood transfusion rates in patients affected by locally advanced cervical cancer undergoing neo-adjuvant chemotherapy followed by radical surgery: the role of erythropoietic growth factors. Ann Oncol 2007; 18:722-9. [PMID: 17307758 DOI: 10.1093/annonc/mdl491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/14/2022] Open
Abstract
BACKGROUND The objectives of the present study were to evaluate hemoglobin levels and consequent clinical behaviors related to anemia developed in patients affected by locally advanced cervical cancer treated with neo-adjuvant chemotherapy in the last decade and to evaluate the impact that the introduction of erythropoietic growth factors had in the clinical practice. PATIENTS AND METHODS Blood chemistries, prospectively recorded from 98 cervical cancer patients, treated with neo-adjuvant chemotherapy and, if necessary, erythropoietic growth factors, were compared with matched historical controls before the introduction of growth factors in clinical practice. RESULTS Hemoglobin level in the study group did not differ significantly during chemotherapy. At the third cycle of chemotherapy and at the end of chemotherapy, hemoglobin level was significantly higher in the study group compared with the control group. Transfusion rates in the study group were significantly lower. The analysis within the study group revealed that hemoglobin level in patients who suffer at diagnosis from anemia tends to increase whereas hemoglobin level in nonanemic patients tends to decrease. CONCLUSIONS Erythropoietic growth factors increase hemoglobin level and reduce blood transfusions in cervical cancer patients undergoing neo-adjuvant chemotherapy followed by radical surgery. An appropriate autologous blood donation program can noticeably reduce homologous blood transfusions.
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Affiliation(s)
- F Bellati
- Department of Gynecology, Obstetrics and Perinatology, University of Rome La Sapienza, Viale Regina Elena 324, 00161 Rome, Italy
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Angioli R, Palaia I, Calcagno M, Manci N, Zullo MA, Bellati F, Perniola G, de Vivo A, Benedetti Panici P. Liposome-encapsulated doxorubicin citrate in previously treated recurrent/metastatic gynecological malignancies. Int J Gynecol Cancer 2007; 17:88-93. [PMID: 17291237 DOI: 10.1111/j.1525-1438.2007.00825.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/23/2022] Open
Abstract
The aim of this study was to evaluate the safety and efficacy of liposome-encapsulated doxorubicin citrate (LEDC) in patients affected by recurrent/metastatic gynecological malignancies scheduled for palliative chemotherapy. Inclusion criteria were proven recurrent/advanced gynecological neoplasms, measurable/assessable disease, adequate organ function, left ventricular ejection fraction >50% as determined by echocardiography, informed consent. LEDC was administered intravenously over 1 h at the dose of either 75 mg/m(2) or 60 mg/m(2) (every 3 weeks until disease progression or toxicity prohibiting further therapy). From May 2003 to September 2005, 36 patients were enrolled. Primary disease was ovarian, endometrial, and cervical cancers in 15 (42%), 11 (30%), and 10 (28%) patients, respectively. LEDC was employed as third- or fourth-line chemotherapy in 25 (70%) and 11 (30%) patients, respectively. The median number of courses of LEDC received was 3 (range 2-9). Six patients (17%) achieved a partial response to treatment lasting 27 weeks and 10 patients (28%) experienced stable disease lasting 18 weeks. The predominant toxicity was hematological, especially neutropenia. Among patients receiving a dose of 75 mg/m(2), two (11%) suspended therapy for febrile neutropenia, and nine (50%) required a dose reduction of 25%. As a result, the next 18 patients were treated at a reduced dose (60 mg/m(2)) of LEDC. Severe neutropenia (G3-G4) was significantly less common in this group (61% versus 22%; P= 0.04). LEDC has shown antineoplastic activity in previously treated recurrent/metastatic gynecological cancer patients and the toxicity profile could be considered acceptable at a 60 mg/m(2) dosage.
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Affiliation(s)
- R Angioli
- Department of Obstetrics and Gynecology, University Campus Bio-Medico, Rome, Italy
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Panici PB, Plotti F, Zullo MA, Muzii L, Manci N, Palaia I, Ruggiero A, Angioli R. Pelvic lymphadenectomy for cervical carcinoma: Laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecol Oncol 2006; 103:859-64. [PMID: 16806442 DOI: 10.1016/j.ygyno.2006.05.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 05/07/2006] [Accepted: 05/17/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare transperitoneal, extraperitoneal and laparoscopic pelvic lymphadenectomy in terms of feasibility and morbidity in patients affected by cervical cancer undergoing radical hysterectomy. METHODS Consecutive patients affected by stage IB-IIB cervical carcinoma scheduled for radical surgery entered the study. Patients were randomly assigned to transperitoneal (TPL), extraperitoneal (EPL) or laparoscopic pelvic lymphadenectomy (LPL). All patients underwent classical radical hysterectomy. Perioperative data were recorded. Follow up examinations were performed at the 15th, 30th and 60th day after surgery. RESULTS 168 patients entered the study. The mean operative times were: 63+/-7.6, 54+/-6.7 and 75+/-8.4 min (TPL vs EPL P<0.001; EPL vs LPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. The feasibility of the procedures, analyzed on an intention-to-treat basis, was 96%, 93% and 95% for TPL, EPL and LPL group respectively (P=ns). The average hospitalizations were: 5.6+/-0.9, 3.2+/-0.4 and 3.1+/-0.3 days (TPL vs EPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. CONCLUSIONS EPL and LPL are as feasible and effective as TPL and can be adequately performed with a reasonable complication rate. LPL showed a statistically significant longer operative time. However, both EPL and LPL can minimize some postoperative complications reducing length of stay.
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Plotti F, Di Donato V, Zullo MA, Angioli R, Panici PB. An unusual case of secondary fibrosarcoma after treatment for breast cancer. Gynecol Oncol 2006; 103:1133-6. [PMID: 16919710 DOI: 10.1016/j.ygyno.2006.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 05/03/2006] [Revised: 06/21/2006] [Accepted: 07/01/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Post-irradiation breast sarcoma is a rare and highly aggressive tumor, associated with poor prognosis. However, the mean latent periods reported for postradiation sarcomas after treatment of breast cancer ranges from 5 to 10 years. CASE We present a rare case of fibrosarcoma of the axilla, diagnosed 23 months after breast surgery and irradiation for medullary poorly differentiated carcinoma, treated with wide local excision with resection of the serratus anterior muscle until pleural wall. CONCLUSION This case confirm a possible early appearance of sarcoma in the irradiation field after radiotherapy. Thus, when a nodule appears in the irradiation field even if within 2 years after radiotherapy, physician should be alert for a possible sarcoma and wide biopsy with histologic confirmation is auspicable.
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Affiliation(s)
- Francesco Plotti
- Department of Gynecology, Obstetrics and Perinatology, University of Rome La Sapienza, Viale del Policlinico 155-00161 Rome, Italy.
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