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Pessaries for pelvic organ prolapse in women with severe dementia: an ethical challenge. Int Urogynecol J 2023; 34:1007-1008. [PMID: 36786853 DOI: 10.1007/s00192-023-05478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
Pelvic organ prolapse is commonly treated with intravaginal devices to support the pelvic organs and maintain comfort. Pessaries generally require regular maintenance with removal, cleaning, and replacement. For women with severe dementia, this process can be extremely distressing. We present an illustrative case of a woman in whom the progression of her dementia led to a challenging ethical dilemma about continuing the use of a pessary and call for a conversation about these issues in the urogynaecology community.
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Haylen B, Oelke M. RE: Joint terminology documents: Quality and a justifiable need, not quantity. Neurourol Urodyn 2022; 41:1185-1186. [PMID: 35366383 DOI: 10.1002/nau.24916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/03/2022] [Accepted: 03/03/2022] [Indexed: 11/07/2022]
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D’Ancona CAL, Nunes RLV, Antunes AA, Fraga RD, Mosconi A, Abranches-Monteiro L, Haylen B. Tradução para a língua portuguesa do artigo original em inglês “ The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction”. EINSTEIN-SAO PAULO 2021. [PMCID: PMC8253591 DOI: 10.31744/einstein_journal/2021ae5694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introdução No desenvolvimento da terminologia do trato urinário inferior, devido à sua crescente complexidade, a terminologia para os sintomas e a disfunção do trato urinário inferior masculino e assoalho pélvico precisa ser atualizada, utilizando abordagem específica masculina e por meio de um relatório de consenso clinicamente embasado. Métodos Este relatório combina a contribuição de membros do Standardisation Committee da International Continence Society em um Grupo de Trabalho com especialistas reconhecidos no campo, assistido por muitos julgadores externos. Categorias clínicas centrais apropriadas e uma subclassificação foram desenvolvidas para fornecer uma codificação numérica para cada definição. Um extenso processo de 22 rodadas de revisão interna e externa foi desenvolvido para examinar exaustivamente cada definição, com tomada de decisão por opinião coletiva (consenso). Resultados Um relatório de terminologia para os sintomas e a disfunção do trato urinário inferior e do assoalho pélvico foi desenvolvido, abrangendo cerca de 390 definições/descritores separados. É clinicamente embasado nos diagnósticos mais comuns definidos. A clareza e a facilidade de uso foram os principais objetivos para torná-lo interpretável por profissionais e estagiários em todos os diferentes grupos de especialidades envolvidos na disfunção do trato urinário inferior e do assoalho pélvico masculino. Imagens específicas para homens (ultrassonografia, radiologia, tomografia computadorizada e ressonância magnética) foram um adicional importante, enquanto figuras apropriadas foram incluídas para complementar e ajudar a esclarecer o texto. Conclusões Um relatório de terminologia com base em consenso para sintomas e disfunção do trato urinário inferior e do assoalho pélvico masculino foi produzido visando ser um auxílio significativo para a prática clínica e um estímulo para a pesquisa.
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Anglim B, Phillips C, Shynlova O, Alarab M. The effect of local estrogen therapy on the urinary microbiome composition of postmenopausal women with and without recurrent urinary tract infections. Int Urogynecol J 2021; 33:2107-2117. [PMID: 34003309 DOI: 10.1007/s00192-021-04832-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Recurrent urinary tract infections (rUTIs) occur in 2-10% of postmenopausal women. Local estrogen therapy (LET) has been shown to reduce UTIs. This study aimed to compare the urinary microbiome between patients with and without a history of rUTIs and to examine whether treatment with LET influences the diversity and richness of microbiome species in two groups. METHODS Postmenopausal women with and without rUTIs attending the urogynecology clinic between April 2019 and December 2020 were recruited. Participant baseline characteristics and demographics were recorded. Aseptic transurethral urine samples were collected at recruitment and at 3-6 months following treatment with LET. The V1-V2 and ITS regions of the 16S rRNA gene were sequenced to identify bacteria. RESULTS A total of 37 women were recruited, 20 controls and 17 patients with rUTI. During follow-up, symptomatic UTIs occurred in 3/17 (17.6%) and 0/20 in the rUTI group and control group, respectively. Klebsiella aerogenes was present in 80% of rUTI samples and in 53.3% of control samples before LET. Abundance of Finegoldia magna was present in 33.3% of samples before LET, but only in 6.7% after LET. There was no change in relative abundance of lactobacillus species following LET in both groups. CONCLUSIONS Treatment with vaginal LET altered the local hormonal environment of the urinary bladder and likely protected women from development of rUTI by decreasing the presence of F. magna. To confirm the significance of this bacterial species in rUTI symptomatology, our finding needs to be validated on a larger patient cohort.
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Affiliation(s)
- Breffini Anglim
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
| | - Caleb Phillips
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Oksana Shynlova
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Lunenfeld-Tanenbaum Research Institute at Sinai Health System, Toronto, ON, Canada
| | - May Alarab
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Lunenfeld-Tanenbaum Research Institute at Sinai Health System, Toronto, ON, Canada
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Abdelbary A, Al-Dessoukey AA, Moussa AS, El-nasr MS, Elmarakbi AA, Ragheb AM, Elbatanouny AM, Abdellateef A, Sayed O, Lotfy A, Mohyelden K, Abdelhamid AM, Galal EM, Massoud A, Ibrahim RM. Overactive bladder symptoms recurrence after sudden versus gradual weaning of Solifenacin. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00100-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To evaluate and compare the recurrence rate of overactive bladder (OAB) symptoms after solifenacin treatment in patients who stop the drug suddenly versus those who gradually wean the drug after improvement of their condition.
Methods
Our study included 60 patients with idiopathic OAB and treated with solifenacin 5 mg twice daily for one month. After improvement of their condition, we divided the responders into two groups, group I stopped the drug suddenly, while group II underwent gradual weaning of the drug.
Results
The recurrence rate of symptoms of OAB was 33.3% and 60% after 1 and 3 months in patients who stopped the solifenacin suddenly after improvement of their symptoms, while it was 6.7% and 23.3% after 1 and 3 months in patients who gradually weaned solifenacin.
Conclusion
After the improvement of OAB symptoms, gradual weaning of solifenacin can help in decreasing the recurrence rate of symptoms.
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Fritel X, Campagne‐Loiseau S, Cosson M, Ferry P, Saussine C, Lucot J, Salet‐Lizee D, Barussaud M, Boisramé T, Carlier‐Guérin C, Charles T, Debodinance P, Deffieux X, Pizzoferrato A, Curinier S, Ragot S, Ringa V, Tayrac R, Fauconnier A. Complications after pelvic floor repair surgery (with and without mesh): short‐term incidence after 1873 inclusions in the French VIGI‐MESH registry. BJOG 2019; 127:88-97. [DOI: 10.1111/1471-0528.15956] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- X Fritel
- INSERM CIC 1402 CHU de Poitiers Service de gynécologie‐obstétrique Université de Poitiers Poitiers France
- CESP Inserm U1018 Paris France
| | | | - M Cosson
- CHU de Lille Service de gynécologie‐obstétrique Université de Lille Lille France
| | - P Ferry
- CH de La Rochelle Service de gynécologie‐obstétrique La Rochelle France
| | - C Saussine
- CHU de Strasbourg Service d’urologie Université de Strasbourg Strasbourg France
| | - J‐P Lucot
- Hôpital Saint‐Vincent‐de‐Paul Service de gynécologie‐obstétrique Lille France
| | - D Salet‐Lizee
- Groupe Hospitalier Diaconesses‐Croix‐Saint‐Simon Service de gynécologie Paris France
| | - M‐L Barussaud
- CHU de Poitiers Service de chirurgie viscérale Poitiers France
| | - T Boisramé
- CHU de Strasbourg Service de gynécologie‐obstétrique Strasbourg France
| | - C Carlier‐Guérin
- CH de Châtellerault Service de gynécologie‐obstétrique Châtellerault France
| | - T Charles
- CHU de Poitiers Service d’urologie Poitiers France
| | - P Debodinance
- CH de Dunkerque Service de gynécologie‐obstétrique Dunkerque France
| | - X Deffieux
- APHP Antoine‐Béclère Service de gynécologie‐obstétrique Université Paris‐Sud Clamart France
| | | | - S Curinier
- CHU Estaing Service de gynécologie‐obstétrique Clermont‐Ferrand France
| | - S Ragot
- INSERM CIC 1402 Université de Poitiers Poitiers France
| | - V Ringa
- CESP Inserm U1018 Paris France
| | - R Tayrac
- CHU Carémeau Service de gynécologie‐obstétrique Université de Nîmes Nîmes France
| | - A Fauconnier
- CHI Poissy‐Saint‐Germain Service de gynécologie‐obstétrique UVSQ Poissy France
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Laparoscopic Sacrocolpopexy Plus Colporrhaphy With a Small Intestine Submucosa Graft Versus Total Pelvic Floor Reconstruction for Advanced Prolapse: A Retrospective Cohort Study. Int Neurourol J 2019; 23:144-150. [PMID: 31260614 PMCID: PMC6606933 DOI: 10.5213/inj.1938014.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/27/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Transvaginal mesh (TVM) results in a greater anatomic cure but more complications. We aimed to compare laparoscopic sacrocolpopexy (LSC) plus colporrhaphy with the small intestine submucosa (SIS) graft versus TVM for advanced pelvic organ prolapse (POP). Methods Patients with advanced POP who underwent LSC plus colporrhaphy with the SIS graft or TVM at a center between September 2015 and November 2016 were studied. Anatomical outcomes were evaluated using POP quantification. Functional outcomes related to POP and sexual life were evaluated using the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). Data regarding surgical procedures and patient demographic variables were recorded. Chi-square and Student t -tests were used for 2 independent samples. Results A total of 76 patients were enrolled in this study with 26 patients in the LSC plus colporrhaphy with the SIS graft group (group A) and 50 patients with TVM group (group B). All patients in both groups demonstrated significant improvement in anatomical outcomes (P<0.05) after surgery. PFDI-20 scores were significantly improved 12 months after operation in both groups (P<0.001). PISQ-12 scores were significantly improved in patients after surgery, especially patients in group A (P<0.001). Mesh exposure occurred in both groups as follows: 8 patients (30.7%) in group A and 5 patients (10%) in group B. Conclusions Even though both surgeries showed excellent results for subjective and objective outcomes, the use of an SIS graft might increase the exposure of polypropylene mesh. We do not recommend LSC plus colporrhaphy with the SIS graft for advanced multiple-compartments prolapse.
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LeFort colpocleisis for recurrent pelvic organ prolapse. Int Urogynecol J 2019; 31:381-384. [PMID: 31069411 DOI: 10.1007/s00192-019-03969-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/22/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The causes of recurrence of pelvic organ prolapse (POP) are sufficiently understood. However, few studies are available evaluating reoperation for recurrence of POP. This study evaluates the efficacy and safety of LeFort colpocleisis for recurrent POP. METHODS We reviewed data from patients with recurrent POP who underwent LerFort colpocleisis at a center between March 2012 and April 2017. Quality of life was assessed using the Pelvic Floor Distress Inventory Questionnaire (PFDI-20) scores. The Patient Global Impression of Improvement scale (PGI-I) was used to assess self-perceived success and subjective measures of satisfaction. The Clavien-Dindo classification (CD) was used to assess the safety of the procedure. Chi-square and paired t-tests were used to compare the same patients before and after treatment in the follow-up. RESULTS Twenty-six patients with recurrent POP after previous prolapse surgery underwent LeFort colpocleisis. Most of these patients had at least one comorbidity. The mean age (years) was 71.8 (7.3). The mean time to recurrent POP was 5.602 (3.643) years. There were no intraoperative bladder lesions or rectal lesions. At mean follow-up of 33.1 months, all patients had no recurrence (< stage 2), significant resolution of awareness of prolapse (P < 0.05), and significantly improved satisfaction on PGI-I after surgery. Minor complications were classified as CD II level in four cases (15.4%). CONCLUSION This study suggests that LeFort colpocleisis is feasible and safe for recurrent POP, especially in older women with comorbidities.
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Fernandez-Gonzalez S, Martinez Franco E, Martínez-Cumplido R, Molinet Coll C, Ojeda González F, Gómez Roig MD, Amat Tardiu L. Reducing postoperative catheterisation after anterior colporrhaphy from 48 to 24 h: a randomised controlled trial. Int Urogynecol J 2018; 30:1897-1902. [PMID: 30483852 DOI: 10.1007/s00192-018-3818-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is a distinct lack of literature on postoperative management after anterior colporrhaphy (AC). Our traditional postoperative protocol consisted of 24 h of indwelling catheterisation followed by 24 h of self-intermittent catheterisation. We hypothesised that a new protocol consisting of only 24 h of indwelling catheterisation might produce better results without additional complications. METHODS From April 2014 to July 2017, all candidates for AC were randomised to catheter removal 24 or 48 h after surgery. The primary outcome was the postoperative urinary retention (POUR) rate. Secondary outcomes included: asymptomatic bacteriuria (AB), urinary tract infection (UTI) and postoperative pain after 24 h. RESULTS A total of 79 patients were recruited. Thirty-seven and 40 patients were randomised to follow the 48-h protocol and the 24-h protocol respectively. There were no significant differences in relation to the POUR rate: 3 patients (8.1%) vs 1 (2.5%) in the 48-h vs the 24-h group respectively (p = 0.346). The UTI rate was 2 (8.1%) vs 0 patients respectively (p = 0.139) and the postoperative AB rate was 3 (9.1%) vs 0 patients (p = 0.106). In the postoperative pain evaluation, the visual analogue scale score was significantly higher in the 48 h group (0.35 vs 0.13, p = 0.02). CONCLUSIONS According to our results, reducing the catheterisation from 48 to 24 h after AC does not increase the risk of POUR and decreases the rate of UTI, AB and postoperative pain. This new postoperative management protocol of pelvic floor surgery would improve postoperative outcomes and shorten the stay in hospital.
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Affiliation(s)
- Sergi Fernandez-Gonzalez
- BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Institut de Recerca Sant Joan de Déu, c/ Passeig Sant Joan de Déu 2, CP 08950, Esplugues de Llobregat, Barcelona, Spain.
| | - Eva Martinez Franco
- Parc Sanitari Sant Joan de Déu, c/ Cami Vell de la Colonia 25, CP: 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Rubén Martínez-Cumplido
- Consorci Sanitari Garraf, Unitat Sol pelvià, Ronda de Sant Camil, s/n, 08810, Sant Pere de Ribes, Barcelona, Spain
| | - Cristina Molinet Coll
- BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Institut de Recerca Sant Joan de Déu, c/ Passeig Sant Joan de Déu 2, CP 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Funesanta Ojeda González
- BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Institut de Recerca Sant Joan de Déu, c/ Passeig Sant Joan de Déu 2, CP 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Maria Dolores Gómez Roig
- BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Institut de Recerca Sant Joan de Déu, c/ Passeig Sant Joan de Déu 2, CP 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Lluís Amat Tardiu
- BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Institut de Recerca Sant Joan de Déu, c/ Passeig Sant Joan de Déu 2, CP 08950, Esplugues de Llobregat, Barcelona, Spain
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Recommended standardized terminology of the anterior female pelvis based on a structured medical literature review. Am J Obstet Gynecol 2018; 219:26-39. [PMID: 29630884 DOI: 10.1016/j.ajog.2018.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND The use of imprecise and inaccurate terms leads to confusion amongst anatomists and medical professionals. OBJECTIVE We sought to create recommended standardized terminology to describe anatomic structures of the anterior female pelvis based on a structured review of published literature and selected text books. STUDY DESIGN We searched MEDLINE from its inception until May 2, 2016, using 11 medical subject heading terms to identify studies reporting on anterior female pelvic anatomy; any study type published in English was accepted. Nine textbooks were also included. We screened 12,264 abstracts, identifying 200 eligible studies along with 13 textbook chapters from which we extracted all pertinent anatomic terms. RESULTS In all, 67 unique structures in the anterior female pelvis were identified. A total of 59 of these have been previously recognized with accepted terms in Terminologia Anatomica, the international standard on anatomical terminology. We also identified and propose the adoption of 4 anatomic regional terms (lateral vaginal wall, pelvic sidewall, pelvic bones, and anterior compartment), and 2 structural terms not included in Terminologia Anatomica (vaginal sulcus and levator hiatus). In addition, we identified 2 controversial terms (pubourethral ligament and Grafenberg spot) that require additional research and consensus from the greater medical and scientific community prior to adoption or rejection of these terms. CONCLUSION We propose standardized terminology that should be used when discussing anatomic structures in the anterior female pelvis to help improve communication among researchers, clinicians, and surgeons.
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IUGA terminology and standardization: creating and using this expanding resource. Int Urogynecol J 2017; 28:1613-1616. [DOI: 10.1007/s00192-017-3453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/10/2017] [Indexed: 11/27/2022]
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Eldred-Evans D, Dasgupta P. Use of botulinum toxin for voiding dysfunction. Transl Androl Urol 2017; 6:234-251. [PMID: 28540231 PMCID: PMC5422676 DOI: 10.21037/tau.2016.12.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/11/2016] [Indexed: 01/23/2023] Open
Abstract
The use of botulinum toxin A (BoNT-A) has expanded across a range of lower urinary tract conditions. This review provides an overview of the current indications for BoNT-A in the lower urinary tract and critically evaluates the published evidence within each area. The classic application of BoNT-A has been in the management of refractory neurogenic detrusor overactivity (NDO) and overactive bladder (OAB). There is a large volume of high-quality evidence, including numerous randomized placebo-controlled trials, which demonstrate the efficacy of BoNT-A over a long follow-up period. The culmination of this robust evidence-base has led to onabotulinumtoxin A (onaBoNT-A) receiving regulatory approval as a second-line treatment for NDO at a dose of 200 U and OAB at dose of 100 U. Other applications for BoNT-A are used on an off-license basis and include interstitial cystitis/bladder pain syndrome (IC/BPS), benign prostatic hyperplasia (BPH), and detrusor sphincter dyssynergia (DSD). These applications are associated with a less mature evidence-base although the literature is rapidly evolving. At present, the results for painful bladder syndrome (PBS) are promising and BoNT-A injections are recommended as a fourth line option in recent international guidelines, although larger randomized study with longer follow-up are required to confirm the initial findings. As a treatment for DSD, BoNT-A injections have shown potential but only in a small number of trials of limited quality. No definite recommendation can be made based on the current evidence. Finally, the results for the treatment of BPH have been variable and recent high quality randomized controlled trials (RCTs) have suggested no benefit over placebo so at present it cannot be recommended for routine clinical practice. Future advances of BoNT-A include liposome encapsulated formulations which are being developed as an alternative to intravesical injections.
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Affiliation(s)
- David Eldred-Evans
- Department of Urology, Medical Research Council (MRC) Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - Prokar Dasgupta
- Department of Urology, Medical Research Council (MRC) Centre for Transplantation, King's College London, Guy's Hospital, London, UK
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To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women. Med J Armed Forces India 2017; 73:36-41. [PMID: 28123243 DOI: 10.1016/j.mjafi.2016.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/20/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The prevalence of stress urinary incontinence (SUI) in the middle-aged Indian women is around 16%. The use of transvaginal tapes (TVTs) has revolutionised the surgical management of SUI. Patients who undergo placement of the tape via the transobturator route often complain of persistent thigh pain at the site of trocar insertion. The use of minimally invasive tapes with a single suburethral incision reduces surgical trauma by eliminating thigh incisions, while maintaining the cure achieved by conventional TVTs. The study was conducted to test the efficacy and safety of minimally invasive TVT-Secur tape placement for treatment of SUI in women. METHODS 20 women with stress incontinence were implanted with TVT-Secur tapes and followed up for a year. RESULTS The objective cure rate of SUI was 85% at the end of a year. The improvement in the patient satisfaction and Incontinence-specific QOL scores, of both Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7), was statistically significant at 95% and 99% confidence levels. There were no complaints of thigh pain; however, there were intraoperative complications in the form of bladder perforation in 5% (n = 1), urethral injury in 5% (n = 1) and urethral tape exposure in 10% (n = 2), at 3 months requiring tape sectioning. CONCLUSIONS These cure rates and complications are comparable to the standard TVT implantations at the end of a year, without thigh pain; however, a greater number of patients and a longer follow-up is required to see whether the long-term cure is maintained or not, before recommending the same as a standard of treatment.
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Pelvic Symptoms, Body Image, and Regret after LeFort Colpocleisis: A Long-Term Follow-Up. J Minim Invasive Gynecol 2016; 24:415-419. [PMID: 28027972 DOI: 10.1016/j.jmig.2016.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/13/2016] [Accepted: 12/16/2016] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of LeFort colpocleisis on body image, regret, and pelvic floor symptoms long-term after surgery. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING Tertiary university-affiliated hospital. PATIENTS Between April 2011 and April 2015, 334 patients underwent LeFort colpocleisis. INTERVENTION LeFort colpocleisis. MEASUREMENT AND MAIN RESULTS Patient characteristics (e.g., age, body mass index, parity, blood loss, and length of operation), comorbidities, and complications were obtained from medical records. The Chinese version of the Pelvic Floor Distress Inventory Questionnaire (PFDI-20) was used to evaluate self-perceived quality of life. A modified body image scale was used to assess self-image. Regret was assessed by the following question: "Do you regret choosing to undergo colpocleisis for pelvic organ prolapse (yes or no)?" In total, 278 women responded and were considered for statistical evaluation. Of these women, 234 (84%) had at least 1 comorbid condition. After a median 3-year follow-up (range, 1.5-4.5), only 1 woman had experienced recurrent prolapse and required a second surgery. The mean and total body image scores improved significantly from preoperation (p < .001). Approximately 97% of the patients were satisfied with their decision to undergo surgery, and none of the patients regretted their decision. Pelvic symptoms improved significantly from baseline (i.e., preoperation) to follow-up according to the following measures: PFDI-20, 67.5 ± 23.1 versus 23.8 ± 15.0 (p < .001); Pelvic Organ Prolapse Distress Inventory-6, 33.2 ± 19.6 versus 11.4 ± 10.6 (p < .001); Colorectal-Anal Distress Inventory-8, 10.8 ± 10.3 versus 3.6 ± 5.3 (p < .001); and Urinary Distress Inventory-6, 23.5 ± 18.5 versus 8.8 ± 9.7 (p < .001). CONCLUSIONS LeFort colpocleisis is a highly effective surgical treatment option for pelvic organ prolapse that improves both pelvic floor symptoms and body image. The high satisfaction and low regret in the long term after surgery indicate that LeFort colpocleisis is an excellent option for appropriate patients.
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Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, Goldman HB, Huser M, Milani AL, Moran PA, Schaer GN, Withagen MIJ. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J 2016; 27:165-94. [PMID: 26755051 DOI: 10.1007/s00192-015-2932-1] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The terminology for female pelvic floor prolapse (POP) should be defined and organized in a clinically-based consensus Report. METHODS This Report combines the input of members of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of fourteen rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS A Terminology Report for female POP, encompassing over 230 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction and POP. Female-specific imaging (ultrasound, radiology and MRI) and conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 year) review is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based Terminology Report for female POP has been produced to aid clinical practice and research.
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Affiliation(s)
- Bernard T Haylen
- University of New South Wales, Suite 904, St Vincent's Clinic, 438 Victoria Street, Darlinghurst, 2010, N.S.W, Australia.
| | | | | | | | - Vani Dandolu
- University of Nevada, Las Vegas, Las Vegas, NV, USA.
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Erratum to: An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J 2016; 27:655-84. [DOI: 10.1007/s00192-016-3003-y] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Noctural Enuresis as a Risk Factor for Falls in Older Community Dwelling Women with Urinary Incontinence. J Urol 2015; 195:1512-1516. [PMID: 26626218 DOI: 10.1016/j.juro.2015.11.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE We determined the association of urinary symptoms with fall risk and physical limitations in older community dwelling women with urinary incontinence. MATERIALS AND METHODS We performed an in-depth assessment of daytime and nighttime urinary symptoms, fall risk, physical function, physical performance tests and mental function in older community dwelling women with urinary incontinence who had not sought care for urinary symptoms. All assessments were performed in participant homes. We used univariable and multivariable linear regression to examine the relationship of urinary symptoms to fall risk, physical function and physical performance. RESULTS Of 37 women with a mean ± SD age of 74 ± 8.4 years who had urinary incontinence 48% were at high risk for falls. Nocturnal enuresis was reported by 50% of the women. Increased fall risk was associated with increasing frequency of nocturnal enuresis (p = 0.04), worse lower limb function (p <0.001), worse upper limb function (p <0.0001) and worse performance on a composite physical performance test of strength, gait and balance (p = 0.02). Women with nocturnal enuresis had significantly lower physical performance test scores than women without nocturnal enuresis (median 7, range 0 to 11 vs 9, range 1 to 12, p = 0.04). In a multivariable regression model including age, nocturnal enuresis episodes and physical function only physical function was associated with an increased fall risk (p <0.0001). CONCLUSIONS Nocturnal enuresis is common in older community dwelling women with urinary incontinence. It may serve as a marker of fall risk even in women who do not seek care for urinary symptoms. Interventions targeting upper and lower body physical function could potentially decrease the risk of falls in older women with urinary incontinence.
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Mothes AR, Wanzke L, Radosa MP, Runnebaum IB. Bilateral minimal tension sacrospinous fixation in pelvic organ prolapse: an observational study. Eur J Obstet Gynecol Reprod Biol 2015; 188:1-5. [PMID: 25766786 DOI: 10.1016/j.ejogrb.2015.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 02/08/2015] [Accepted: 02/13/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the safety and the subjective and objective outcomes of bilateral minimal tension sacrospinous fixation for pelvic organ prolapse. STUDY DESIGN This was a single-centre observational study conducted at the University Hospital, Urogynaecological Unit, with a certified urogynaecological surgeon. A cohort of 110 patients receiving modified bilateral sacrospinous fixation following a diagnosis of grade II-IV pelvic organ prolapse and defects of three pelvic compartments. Non-absorbable sutures were placed on each side of the sacrospinous ligament. The main aim was to achieve a minimal tension situation by intentionally leaving suture bridges on both sides of the suspension. The post-surgical follow-up period was 14±7 months. The three characteristics of cure in functional surgery - anatomy, function, and subjective patient's judgement - were evaluated in this study. Primary outcomes were anatomic, functional, and subjective cures, that were measured pre- and postoperatively using the POP-Q system values, a validated pelvic quality-of-life questionnaire (P-QoL/D), and interviews regarding expectations, goal-setting, goal achievement, and satisfaction. Secondary outcome measures included data on surgical complications. Data analysis was performed with descriptive statistics, Wilcoxon tests, and Mann-Whitney U-tests. RESULTS A total of 110 patients underwent anterior and posterior colporrhaphy and minimal tension bilateral sacrospinous fixation. An objective anatomic cure was reported for 94.5% of patients, and significant improvement of all prolapse symptoms was observed following surgery (p<0.001). Full or partial fulfilment of the criteria for a subjective cure was demonstrated in 96% of the patients. Only 5.5% of the patients experienced postoperative urinary tract infections. No other complications requiring medical or surgical interventions were reported. CONCLUSION Bilateral minimal tension sacrospinous fixation was associated with low morbidity, as well as excellent anatomic, functional, and subjective results at follow-up.
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Affiliation(s)
- Anke R Mothes
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstreet 18, D-07743 Jena, Germany
| | - Luise Wanzke
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstreet 18, D-07743 Jena, Germany
| | - Marc P Radosa
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstreet 18, D-07743 Jena, Germany
| | - Ingo B Runnebaum
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstreet 18, D-07743 Jena, Germany.
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Systematic assessment of surgical complications in 438 cases of vaginal native tissue repair for pelvic organ prolapse adopting Clavien–Dindo classification. Arch Gynecol Obstet 2014; 291:1297-301. [DOI: 10.1007/s00404-014-3549-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/07/2014] [Indexed: 02/03/2023]
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Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, Athanasiou S, Swift S, Whitmore K, Ghoniem G, de Ridder D. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J 2012; 23:527-35. [PMID: 22476543 DOI: 10.1007/s00192-012-1726-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Standardized terminology has yet to be developed for reporting the outcomes for surgery for pelvic organ prolapse (POP). METHODS This report combines the input of the Terminology and Standardization Committees of the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a joint Working Group on this topic, as well as expert external referees. The aim was to present a standardized terminology for the definitions of surgery and propose a structure for reporting the outcomes of surgical procedures for POP. An extensive drafting and review process was undertaken, as well as open review on both IUGA and ICS websites. RESULTS A terminology report was developed outlining the recommended structure for reporting outcomes of surgical trials involving POP. This document does not define success and failure. The report includes patient-reported, subjective and objective outcomes to enable researchers to report on their results and compare them with other studies. CONCLUSIONS A consensus-based method for standardizing terminology for reporting outcome measures of POP surgery was developed to aid clinicians working in this area of research.
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