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KIM YEONGJIN, NA YOUNGJIN, KIM SOOBYEONG, YI JEONGYOON, AHN BUMMO. INFRA-OBTURATOR TENSION SLING FOR URINARY INCONTINENCE TREATMENT. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Stress incontinence occurs due to the inability to control an urge to urinate, which affects the quality of daily life. Although there is an existing therapeutics with polymer mesh tape, it is hard to fix around the urethra to restore the function of the pubourethral ligament. Therefore, in this research, an infra-obturator tension (IOT) sling was introduced to minimize the mobility of the bladder and urethra against intra-abdominal pressure. To verify the IOT performance, two different hypotheses were formulated: The hardness and volume of the IOT support the urethra and help prevent it from deforming by intra-abdominal pressure. The rotatory motion of the IOT can bend the urethra at the contact point and help restore the function of pubourethral ligament to increase vaginal tension. For the first hypothesis, a finite element simulation was conducted using three-dimensional geometrical model obtained by the computed tomography images of patients. For the second hypothesis, surgeons performed an IOT insertion operation and analyzed the sling rotation from the patients’ CT images (mean: 21∘). From the results, the mobility of the urethra was decreased because of IOT insertion. The mobility was also decreased because of the subsequent fibrotic changes from the encapsulation of the IOT.
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Affiliation(s)
- YEONGJIN KIM
- Division of Thermal and Fluids Science, Institute for Computational Science, Faculty of Electrical and Electronics Engineering, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Department of Mechanical Engineering, Incheon National University, 8-204, 119 Academy-ro, Yeonsu-gu, Incheon, Korea
| | - YOUNGJIN NA
- Division of Mechanical Systems Engineering, Sookmyung Women’s University, 100 Cheongpa-ro, Yongsan-gu, Seoul 04310, Korea
| | | | | | - BUMMO AHN
- Robotics R&BD Group, Korea Institute of Industrial Technology, 143 Hanggaul-ro, Sangnok-gu, Ansan-si, Gyeonggi-do 15588, Korea
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Current treatment of pelvic organ prolapse correlated with chronic pelvic pain, bladder and bowel dysfunction. Curr Opin Urol 2018; 27:274-281. [PMID: 28306603 DOI: 10.1097/mou.0000000000000395] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to critically analyze the relationship between symptoms of abnormal emptying of the bladder, urgency, pelvic pain, anorectal dysfunction and pelvic organ prolapse (POP) and to present evidence in order to show how many of the above mentioned symptoms can be cured or substantially improved by repair of specific pelvic ligaments. RECENT FINDINGS In this review, we provide evidence to show how often these dysfunctions occur and how they can be cured in 42-94% by appropriate pelvic floor surgery in the longer term, up to 2 years. Laxity in ligaments and/or vaginal membrane due to damaged connective tissue may prevent the normal opening and closure mechanism of urethra and anus, because muscles need finite lengths to contract properly. Hypermobility of the apex can irritate the pelvic plexus causing chronic pelvic pain. In consequence, dysfunctions as abnormal emptying of the bladder, urgency, pelvic pain, fecal incontinence and obstructed defecation can occur in women with different degrees of POP. SUMMARY In conclusion, it has to be recognized that women bothered by these symptoms should be examined for POP and appropriately advised for possibility of cure by pelvic floor surgery after careful selection. VIDEO ABSTRACT.
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Sivaslioglu AA. Letters to the Editor. Cent European J Urol 2018; 70:453. [PMID: 29410906 PMCID: PMC5791412 DOI: 10.5173/ceju.2017.1590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ahmet Akin Sivaslioglu
- Mugla Sitki Kocman University, Training and Research Hospital, Obstetrics and Gynecology, Muğla, Turkey
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Petros P. A ligamentous explanation for overactive bladder symptoms as defined by International Continence Society in the female. Cent European J Urol 2017; 71:105-107. [PMID: 29732215 PMCID: PMC5926643 DOI: 10.5173/ceju.2017.1597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/24/2017] [Accepted: 11/26/2017] [Indexed: 01/22/2023] Open
Abstract
The International Continence Society (ICS) committee has defined overactive bladder (OAB) as "a syndrome characterized by symptoms of urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia (increased night time urination). The term OAB can only be used if there is no proven infection or other obvious pathology". Though the ICS gives no anatomical basis for OAB, it is suggested that the cause is from the detrusor itself. In this review, urodynamic evidence is presented that OAB in the female may be a prematurely activated but normal micturition reflex, as predicted by the Integral Theory. Anatomically, a trampoline analogy explains how loose ligaments prevent the vaginal stretching so important for support of the bladder base stretch receptors which control the reflex. Surgical cure of OAB by repair of loose cardinal/ uterosacral ligaments are an important proof that the origins of OAB are outside the bladder, laxity of the suspensory ligaments which in turn, inactivate the striated muscle vector forces which contract against them. This concept is not in in conflict with the definitions of the ICS. Rather it provides a causative anatomical background to the definitions.
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Affiliation(s)
- Peter Petros
- University of Western Australia, Perth, Australia Professorial Department of Surgery University of NSW St. Vincent's Hospital Sydney, Australia
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Liedl B, Inoue H, Sekiguchi Y, Haverfield M, Richardson P, Yassourides A, Wagenlehner F. Is overactive bladder in the female surgically curable by ligament repair? Cent European J Urol 2017; 70:53-59. [PMID: 28461989 PMCID: PMC5407336 DOI: 10.5173/ceju.2017.938] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 11/23/2016] [Accepted: 01/16/2017] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Overactive bladder (OAB) symptoms (urge, frequency, nocturia) are not generally considered surgically curable by learning institutions. The Integral Theory hypothesizes that OAB is a prematurely activated, but normal micturition reflex caused by loose suspensory ligaments and potentially curable surgically by repairing such ligaments. To test this hypothesis by surgical repair of loose cardinal and uterosacral ligaments in patients with 2nd degree or greater uterine/apical prolapse. MATERIAL AND METHODS Multicenter prospective case control audit. 611 females, mean age 70. Inclusions: symptomatic apical prolapse of 2nd or greater degree, (POPQ stages 2-4), and at least two pelvic symptoms. Exclusions: Comorbid medical problems known to cause chronic pelvic pain (e.g., infection), sphincter tears, neurological bladder conditions. Surgery: minimally invasive cardinal/uterosacral ligament repair using the TFS (Tissue Fixation System). Primary outcome: Uterine prolapse cure; Secondary outcomes; bladder, bowel, and pain symptoms improvement. RESULTS 90% prolapse cure in 611 patients. Symptom incidence (% Cure at 12 months in brackets) was: urge incontinence: n = 310 (85%); frequency: n = 317 (83%); nocturia: n = 254 (68%); chronic pelvic pain (CPP): n = 194 (77%); fecal incontinence: n = 93 (65%). Statistics: McNemar x2-tests to test for significant changes in the symptoms' incidence-frequency from baseline (preoperative) to the postoperative phase. For each symptom the null hypothesis H0: P(baseline) = P(12 months after surgery)versus H1: P(baseline) ≠ P(12 months after surgery) was tested, with P indicating prevalence or incidence rate. CONCLUSIONS Bladder & bowel incontinence and chronic pelvic pain occur in predictable groupings and are associated with apical prolapse. OAB symptom improvement with the TFS ligament repair provides a good alternative to anticholinergics, especially when considering their association with dementia causation. Application of the Integral Theory System has the potential to significantly improve clinical practice, QoL for ageing women, delaying entry into Nursing Homes and creating new scientific research directions. The take home message is that symptoms of chronic pelvic pain, bladder and bowel dysfunction occur in relatively predictable groups, caused by lax suspensory ligaments and can be cured or improved by TFS mini sling ligament repair.
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Affiliation(s)
- Bernhard Liedl
- Zentrum für Urogenital Chirurgie BBZ, Fachkliniken München AG, Germany
| | - Hiromi Inoue
- Urogynaecology Center, Shonan Kamakura General Hospital, Kamakura, Japan
- LUNA Pelvic Floor Total Support Clinic, Women’s Clinic LUNA Group, Yokohama, Japan
| | - Yuki Sekiguchi
- LUNA Pelvic Floor Total Support Clinic, Women’s Clinic LUNA Group, Yokohama, Japan
| | - Max Haverfield
- Department of Gynaecology, The Northern Hospital, Melbourne Victoria, Australia
| | - Peter Richardson
- Department of Health, Medical and Applied Sciences, University of Central Queensland, Australia University of Central Queensland, Australia
| | | | - Florian Wagenlehner
- Clinic for Urology, Pediatric Urology und Andrology, Justus-Liebig-University Giessen, Germany
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Abstract
INTRODUCTION AND HYPOTHESIS The aim was to review the safety and efficacy of pelvic organ prolapse surgery for vaginal apical prolapse. METHODS Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials (RCT) or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 case reports. The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and or 3 studies, or "majority evidence" from RCTs. Grade C recommendation usually depends on level 4 studies or "majority evidence from level 2/3 studies or Delphi processed expert opinion. Grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. RESULTS Abdominal sacral colpopexy (ASC) has a higher success rate than sacrospinous colpopexy with less SUI and postoperative dyspareunia for vault prolapse. ASC had greater morbidity including operating time, inpatient stay, slower return to activities of daily living and higher cost (grade A). ASC has the lowest inpatient costs compared with laparoscopic sacral colpopexy (LSC) and robotic sacral colpopexy (RSC). LSC has lower inpatient costs than RSC (grade B).In single RCTs the RSC had longer operating time than both ASC and LSC (grade B). In small trials objective outcomes appear similar although postoperative pain was greater in RSC. LSC is as effective as ASC with reduced blood loss and admission time (grade C). The data relating to operating time are conflicting. ASC performed with polypropylene mesh has superior outcomes to fascia lata (level I), porcine dermis and small intestine submucosa (level 3; grade B). In a single RCT, LSC had a superior objective and subjective success rate and lower reoperation rate compared with polypropylene transvaginal mesh for vault prolapse (grade B).Level 3 evidence suggests that vaginal uterosacral ligament suspension, McCall culdoplasty, iliococcygeus fixation and colpocleisis are relatively safe and effective interventions (grade C). CONCLUSION Sacral colpopexy is an effective procedure for vault prolapse and further data are required on the route of performance and efficacy of this surgery for uterine prolapse. Polypropylene mesh is the preferred graft at ASC. Vaginal procedures for vault prolapse are well described and are suitable alternatives for those not suitable for sacral colpopexy.
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Posterior Intravaginal Slingplasty versus Unilateral Sacrospinous Ligament Fixation in Treatment of Vaginal Vault Prolapse. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:958670. [PMID: 23997961 PMCID: PMC3755413 DOI: 10.1155/2013/958670] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/17/2013] [Indexed: 11/17/2022]
Abstract
Objective. To investigate the differences in efficacy, postoperative complications, and patient satisfaction between posterior intravaginal slingplasty (PIVS) and unilateral sacrospinous ligament fixation (SSLF) procedures. Study Design. A retrospective study of thirty-three women who underwent PIVS or SSLF treatment for vaginal vault prolapse in Oulu University Hospital. The patients were invited to a follow-up visit to evaluate the objective and subjective outcomes. Median follow-up time was 16 months (range 6–52). The anatomical outcome was detected by the Pelvic Organ Prolapse Quantification (POP-Q) system. Information on urinary, bowel, and sexual dysfunctions and overall satisfaction was gathered with specific questionnaire. The data were analyzed using Mann-Whitney U test and Fisher's exact test. Results. Mesh erosion was found in 4 (25%) patients in the PIVS group. Anatomical stage II prolapse or worse (any POP-Q point ≥−1) was detected in 8 (50%) patients in the PIVS group and 9 (53%) patients in the SSLF group. Overall satisfaction rates were 62% and 76%, respectively. Conclusion. The efficacy of PIVS and SSLF is equally poor, and the rate of vaginal erosion is intolerably high with the PIVS method. Based on our study, we cannot recommend the usage of either technique in operative treatment of vaginal vault prolapse.
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The Integral Theory System Questionnaire: an anatomically directed questionnaire to determine pelvic floor dysfunctions in women. World J Urol 2013; 32:769-81. [DOI: 10.1007/s00345-013-1150-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022] Open
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Balsak D, Uysal A, Cavus Y, Ince Z, Acar Z, Güngör A, Hacivelioğlu S. Treatment of Vaginal Cuff Prolapses with Posterior Intravaginal Sling and Evaluation of Efficiency with International Consultation on Incontinence Questionnaire-Vaginal Symptoms Method in the Long Term: Preliminary Results. Low Urin Tract Symptoms 2012; 5:140-4. [PMID: 26663449 DOI: 10.1111/luts.12004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to research the efficiency of posterior intravaginal sling (PIVS) procedure in vaginal cuff prolapse, together with possible complications, long-term effects and effects of the method on vaginal and sexual function and quality of life of patients. This retrospective study comprised 21 patients with vaginal cuff prolapse. METHODS PIVS procedure was performed in 21 patients with vaginal cuff prolapse with quantification stages 2, 3, or 4 of pelvic organ prolapse. Patients were assessed according to the International Consultation on Incontinence Questionnaire-Vaginal Symptoms before and after operation. RESULTS The average follow-up period was 24.6 months. The rate of surgical success was 100%, the rate of mesh erosion was 14.2% and the rate of dyspareunia was 33.3%. Vaginal symptom, sexual matter and quality of life scores were statistically significant in the postoperative period compared to the preoperative period (P = 0.001, P = 0.001, P = 0.001, respectively). CONCLUSION PIVS is an effective and reliable method of treating vaginal cuff prolapse. However, its complication profile is not yet at an acceptable level. We believe that the rate of mesh erosion will regress to a more acceptable level with the improvement of mesh technology and postoperative method. The necessary incontinence surgery is easily performed together with PIVS procedure. PIVS restores the vaginal and sexual functions of patients and increases their quality of life significantly.
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Affiliation(s)
- Deniz Balsak
- Department of Obstetrics and Gynecology, Diyarbakır Maternity and Children Hospital, Diyarbakır, TurkeyDepartment of Obstetrics and Gynecology, Çanakkale 18 Mart University, Çanakkale, Turkey
| | - Ahmet Uysal
- Department of Obstetrics and Gynecology, Diyarbakır Maternity and Children Hospital, Diyarbakır, TurkeyDepartment of Obstetrics and Gynecology, Çanakkale 18 Mart University, Çanakkale, Turkey
| | - Yunus Cavus
- Department of Obstetrics and Gynecology, Diyarbakır Maternity and Children Hospital, Diyarbakır, TurkeyDepartment of Obstetrics and Gynecology, Çanakkale 18 Mart University, Çanakkale, Turkey
| | - Zehra Ince
- Department of Obstetrics and Gynecology, Diyarbakır Maternity and Children Hospital, Diyarbakır, TurkeyDepartment of Obstetrics and Gynecology, Çanakkale 18 Mart University, Çanakkale, Turkey
| | - Zuat Acar
- Department of Obstetrics and Gynecology, Diyarbakır Maternity and Children Hospital, Diyarbakır, TurkeyDepartment of Obstetrics and Gynecology, Çanakkale 18 Mart University, Çanakkale, Turkey
| | - Ayşenur Güngör
- Department of Obstetrics and Gynecology, Diyarbakır Maternity and Children Hospital, Diyarbakır, TurkeyDepartment of Obstetrics and Gynecology, Çanakkale 18 Mart University, Çanakkale, Turkey
| | - Servet Hacivelioğlu
- Department of Obstetrics and Gynecology, Diyarbakır Maternity and Children Hospital, Diyarbakır, TurkeyDepartment of Obstetrics and Gynecology, Çanakkale 18 Mart University, Çanakkale, Turkey
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Halaska M, Maxova K, Sottner O, Svabik K, Mlcoch M, Kolarik D, Mala I, Krofta L, Halaska MJ. A multicenter, randomized, prospective, controlled study comparing sacrospinous fixation and transvaginal mesh in the treatment of posthysterectomy vaginal vault prolapse. Am J Obstet Gynecol 2012; 207:301.e1-7. [PMID: 23021692 DOI: 10.1016/j.ajog.2012.08.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 07/16/2012] [Accepted: 08/08/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of the study was to compare recurrence and complication rates for sacrospinous fixation (SSF) and prolene mesh techniques for the primary treatment of posthysterectomy vaginal vault prolapse. STUDY DESIGN Patients undergoing surgery for vault prolapse were included in a multicenter, randomized, controlled study comparing SSF or total mesh (Prolift; Gynecare/Ethicon, Somerville, NJ). The examination included pelvic organ prolapse quantification, urodynamics, ultrasound, and quality-of-life (QoL) questionnaires before and 3 and 12 months after surgery. RESULTS Of 168 randomized patients, 83 underwent SSF and 85 mesh repair. Prolapse recurrence after 12 months occurred in 39.4% of the SSF group and in 16.9% of the mesh group (P = .003). The mesh exposure rate was 20.8%. No difference in QoL improvement as well as of de novo stress urinary incontinence and overactive bladder onset was found. CONCLUSION Mesh exposure occurrence was balanced against a lower prolapse recurrence rate in the patients undergoing mesh surgery compared with those undergoing SSF.
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Combined anterior vaginal wall mesh with sacrospinous ligament fixation or with posterior intravaginal slingplasty for uterovaginal or vaginal vault prolapse. Eur J Obstet Gynecol Reprod Biol 2011; 157:230-3. [DOI: 10.1016/j.ejogrb.2011.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 03/01/2011] [Accepted: 03/29/2011] [Indexed: 11/24/2022]
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Lee YS, Han DH, Lee JY, Kim JC, Choo MS, Lee KS. Anatomical and functional outcomes of posterior intravaginal slingplasty for the treatment of vaginal vault or uterine prolapse: a prospective, multicenter study. Korean J Urol 2010; 51:187-92. [PMID: 20414395 PMCID: PMC2855447 DOI: 10.4111/kju.2010.51.3.187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 02/23/2010] [Indexed: 11/22/2022] Open
Abstract
Purpose We aimed to evaluate the anatomical and functional outcomes of posterior intravaginal slingplasty (P-IVS) for the treatment of a vaginal vault or uterine prolapse (VP/UP). Materials and Methods This was a 12-month prospective, multicenter, observational study. Women aged over 30 years who presented with stage II or greater VP/UP underwent P-IVS by four urologists at four university hospitals. Preoperatively, pelvic examination by use of the Pelvic Organ Prolapse Quantification (POP-Q) system, the Pelvic Floor Distress Inventory (PFDI) questionnaire, the 3-day frequency volume chart, and uroflowmetry were completed. At the 12-month follow-up, changes in the POP-Q, PFDI, frequency volume chart, and uroflowmetry parameters were assessed. Cure was defined as VP/UP stage 0 and improvement as stage I. Results The cure and improvement rates among the 32 women were 65.6% and 34.4%, respectively. All subscale scores of the Urinary Distress Inventory, the general subscale score of the Pelvic Organ Prolapse Distress Inventory, and the rectal prolapse subscale score of the Colo-Rectal-Anal Distress Inventory were significantly improved. There were no significant changes in the frequency volume chart or uroflowmetry parameters. There was one case of surgery-related transfusion. Conclusions Trans-vaginal repair by P-IVS is an effective and safe procedure for restoring the anatomical defect and improving the associated pelvic floor symptoms in women with VP/UP.
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Affiliation(s)
- Young-Suk Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Affiliation(s)
- Jong Bo Choi
- Department of Urology, Ajou University College of Medicine, Suwon, Korea
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Inoue H, Sekiguchi Y, Kohata Y, Satono Y, Hishikawa K, Tominaga T, Oobayashi M. Tissue fixation system (TFS) to repair uterovaginal prolapse with uterine preservation: a preliminary report on perioperative complications and safety. J Obstet Gynaecol Res 2009; 35:346-53. [PMID: 19708181 DOI: 10.1111/j.1447-0756.2008.00947.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the effectiveness, perioperative safety and invasiveness of the Tissue Fixation System (TFS) sling operation when used for repair of uterovaginal prolapse with uterine preservation. METHODS Operations using the TFS anchor system were performed on 25 women aged between 44 and 84 years (average 65) for grade 3 or 4 uterine prolapse with or without urinary incontinence. Details of the procedures were as follows: midurethral sling (n=2); posterior sling of the uterosacral ligaments (n=25); U-sling for lateral/central anterior vaginal wall defects (n=24). The defect of the perineal body and rectovaginal fascia were repaired in all cases. RESULTS All patients were followed up for a minimum of 3 months. The mean +/- standard deviation of the operating time and loss of blood were 94.2 (+/-19.3) minutes and 98.1 (+/-129.6) mL, respectively. Twelve patients (48%) were discharged on the same day of surgery and 13 patients (52%) on the following day, with a return to normal activities within 1-7 days. There were no intra- or postoperative complications. At the 3-month follow up, cure rates of symptoms due to pelvic laxity were: urinary frequency 85.7% (n=14); nocturia 66.6% (n=12); urgency 93.3% (n=15); and dragging pain 100% (n=6). There was one recurrent uterovaginal prolapse and one recurrent cystocele. CONCLUSION The TFS procedure delivers satisfactory results for uterine prolapse repair with uterine preservation. The procedure is useful because of the short duration of the operation, the short term of recovery, its safety profile and minimal invasiveness. There is a significant improvement in the quality of life, especially for older women. However, long-term results are currently unknown.
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Affiliation(s)
- Hiromi Inoue
- Division of the ULrogynecological Center, Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan.
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Bjelic-Radisic V, Hartmann G, Abendstein B, Tamussino K, Riss PA. The posterior intravaginal slingplasty operation: Results of the Austrian registry. Eur J Obstet Gynecol Reprod Biol 2009; 144:88-91. [DOI: 10.1016/j.ejogrb.2009.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 01/29/2009] [Accepted: 02/04/2009] [Indexed: 11/16/2022]
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Short-term results of posterior intravaginal slingplasty in grade 4 uterine prolapse. Arch Gynecol Obstet 2009; 281:55-8. [DOI: 10.1007/s00404-009-1062-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
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Luck AM, Steele AC, Leong FC, McLennan MT. Short-term efficacy and complications of posterior intravaginal slingplasty. Int Urogynecol J 2007; 19:795-9. [DOI: 10.1007/s00192-007-0527-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 11/23/2007] [Indexed: 12/11/2022]
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The Integral Theory of continence. Int Urogynecol J 2007; 19:35-40. [PMID: 17968480 DOI: 10.1007/s00192-007-0475-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 09/07/2007] [Indexed: 12/23/2022]
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Mikos T, Tsalikis T, Papanikolaou A, Pournaropoulos F, Bontis JN. Gluteo-vaginal sinus formation complicating posterior intravaginal slingplasty followed by successful IVS removal. A case report and review of the literature. Int Urogynecol J 2007; 19:449-52. [PMID: 17891497 DOI: 10.1007/s00192-007-0454-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Accepted: 08/26/2007] [Indexed: 11/30/2022]
Abstract
Posterior intravaginal slingplasty (IVS) is a technique used for the treatment of apical prolapse. Type III meshes have been mostly used with this technique. In this article, a case of bilateral gluteo-vaginal sinus tract formation that complicated a posterior vaginal slingplasty with a type III mesh is presented. At 3 months follow-up, the patient complained for bulking through the vagina, continuous offensive vaginal discharge, and constant pain at the buttocks. She had prolapse recurrence, and there was defective healing at the gluteal entry points of the posterior IVS. Ten months after the initial surgery, she underwent a laparotomic subtotal hysterectomy and sacrocervicopexy with prolene type I mesh. At the same time, the posterior mesh was removed allowing the surgeon to discover communication of the canal of the mesh extending from gluteal incisions to the vagina epithelium. The sinus tract was managed surgically with excision of the surrounding tissues. There was no recurrence or other complications at 2 months follow-up.
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Affiliation(s)
- Themistoklis Mikos
- Unit of Urogynecology, 1st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papageorghiou General Hospital, Ring Road N. Efkarpias, Thessaloniki, Greece.
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