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Song C, Wen W, Pan L, Sun J, Bai Y, Tang J, Zhong C, Han B, Xia S, Zhu Y. Analysis of the anatomical and biomechanical characteristics of the pelvic floor in cystocele. Acta Obstet Gynecol Scand 2023; 102:1661-1673. [PMID: 37632276 PMCID: PMC10619611 DOI: 10.1111/aogs.14657] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/08/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) occurs due to disruption of the pelvic floor anatomy; however, the complexity of the pelvic floor support structures and individual patient differences make it difficult to identify the weak points in the pelvic floor support that cause SUI to occur, develop, and recur. This study aimed to analyze the pelvic floor anatomy, structural features, and biomechanics of cystoceles to develop more effective treatment plans with individualized and precise healthcare. MATERIAL AND METHODS In this observational case-controlled study (clinical trial identifier BOJI201855L), 102 women with normal pelvic floor function and 273 patients diagnosed with cystocele degrees I-III were identified at Shanghai General Hospital from October 2016 to December 2019. We combined ultrasound and vaginal tactile imaging (VTI) to assess the anatomy and biomechanical functions of the anterior and posterior vaginal walls. Both examinations included relaxation and muscle tension tests. RESULTS Of the 42 VTI parameters, 13 were associated with the degree of cystocele, six with an increase in the urethral rotation angle (pointing to the mobility of the urethra), and six with a decrease in the retrovesical angle (pointing to hypsokinesis and decrease in bladder position). According to these data, the strength of tissues, especially the muscles in both the anterior and posterior compartments, contributes to the stability of the pelvic floor structure. The strength of the levator ani muscle (LAM) is important for the degree of cystocele, mobility of the urethra, hypsokinesis, and decrease in bladder position. CONCLUSIONS In general, the biomechanical status of the pelvic floor in patients with cystocele is complex and involves various muscles, ligaments, tendons, and fascia. Of these, repair and exercise of the LAM have not received much attention in the treatment of patients with cystoceles, which may be an important risk factor for the high recurrence rate.
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Affiliation(s)
| | - Wei Wen
- Shanghai General HospitalShanghaiChina
| | - Lei Pan
- Shanghai General HospitalShanghaiChina
| | | | - Yun Bai
- Shanghai General HospitalShanghaiChina
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Oxlad M, Edwards G, McKinlay KA. Patients' perspectives about doctor-patient communication regarding transvaginal mesh implant surgery. Patient Educ Couns 2022; 105:3534-3539. [PMID: 36114043 DOI: 10.1016/j.pec.2022.08.021] [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] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Many women experience pelvic floor disorders which may require medical intervention such as transvaginal mesh implant surgeries (TVM; the abdominal or vaginal insertion of woven netting to support pelvic tissue). We examined women's perceptions of communication with their health professionals concerning TVM. DESIGN We analysed 153 women's written submissions to an Australian Government Inquiry regarding their experiences of transvaginal mesh surgery to explore their perceptions of TVM-related doctor-patient communication. Data were analysed using deductive and inductive reflexive thematic analysis. RESULTS Women expressed several challenges in their communication with their health professionals. Three themes regarding communication were generated: Insufficient information was abundant; Normalisation and minimisation of the procedure and risks; and, Desired communication interactions. CONCLUSIONS According to women's accounts, doctor-patient communication was poor. Health professionals must be knowledgeable about medical procedures and their potential complications and provide their patients with adequate, accurate information to make informed choices about their health. Health professionals should also document informed consent. PRACTICE IMPLICATIONS Health professionals should be well-informed about TVM, including best-practice treatments for pelvic floor disorders, indications for TVM, the risks, outcomes and potential complications from various forms of TVM, and ways to adequately communicate sufficient information to women.
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Affiliation(s)
- Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia.
| | - Georgina Edwards
- School of Psychology, The University of Adelaide, Adelaide, Australia.
| | - Kate A McKinlay
- School of Psychology, The University of Adelaide, Adelaide, Australia
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McKinlay KA, Oxlad M. 'I have no life and neither do the ones watching me suffer': women's experiences of transvaginal mesh implant surgery. Psychol Health 2022:1-22. [PMID: 36134476 DOI: 10.1080/08870446.2022.2125513] [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: 08/27/2021] [Revised: 07/08/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Objective: Many women are affected by pelvic floor disorders, such as stress urinary incontinence and pelvic organ prolapse. In recent years, these disorders have been treated with transvaginal mesh implant surgeries involving the vaginal insertion of woven netting. We explored women's experiences of transvaginal mesh implant surgery through a biopsychosocial lens. Design: We analysed women's submissions to an Australian Parliament Senate Inquiry on transvaginal mesh implant surgery using thematic analysis. Main Outcome Methods: One-hundred and fifty-three publicly available submissions detailing women's experiences of transvaginal mesh implant surgery to an Australian Parliament Senate Inquiry were analysed. Adverse and positive accounts were eligible for inclusion. Results: We generated nine themes in three categories relating to the Biopsychosocial Model: Physical Health - comprising three themes; Psychological Health - comprising two themes; and Social Wellbeing - comprising four themes. Physical, psychological and social experiences interacted, resulting in reduced quality of life for women. Conclusion: Most women who made submissions to an Australian government inquiry about transvaginal mesh implant surgery described devastating impacts on physical, psychological, and social wellbeing. We provide recommendations to guide psychologists in assisting women with adverse transvaginal mesh-related outcomes. Further research should explore women's long-term experiences of the various transvaginal mesh procedures.
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Affiliation(s)
- Kate A McKinlay
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
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Tang B, Wang J, Chen D, Wan H, Han X, Wang Q, Zhao Z, Li M. The outcome of patients with stress urinary incontinence combined with pelvic organ prolapse treated by mid‐urethral linear suspension. Surgical Practice 2022. [DOI: 10.1111/1744-1633.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Biao Tang
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Jing Wang
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Dexin Chen
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Hong Wan
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Xu Han
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Qinjie Wang
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Zhigang Zhao
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Ming Li
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
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O’Leary BD, McCreery A, Redmond A, Keane DP. The efficacy and complications of retropubic tension‐free vaginal tapes after twenty years: a prospective observational study. BJOG 2022; 130:107-113. [PMID: 36053874 PMCID: PMC10087949 DOI: 10.1111/1471-0528.17282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/25/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Long-term data regarding risks associated with tension-free vaginal tapes (TVT) are sparse, and where available are limited to small numbers. We analyse patient-reported outcomes of TVT after 16-24 years. DESIGN Prospective observational study. SETTING Single-centre study in a tertiary referral urogynaecology unit. POPULATION A cohort of 350 women who had a TVT inserted between 1999 and 2004, in which 96% had urodynamically proven stress incontinence. METHODS Postal questionnaire survey using the International Consultation on Incontinence Questionnaire, a visual analogue scale and a yes/no question as to whether they would have the procedure again. MAIN OUTCOME MEASURES The primary outcome was cure of stress urinary incontinence, which was assessed using the ICIQ-FLUTS questionnaire. Secondary outcomes included overactive bladder symptoms, pain, sexual dysfunction, and patient satisfaction with the procedure. RESULTS A total of 183/350 (52%) responses were received. The median age of women at follow up was 67 years (range 53-93 years) and the median follow up was 20 years (17-24 years). Stress urinary incontinence was denied by 39.3% of women. Urgency was reported by 42.1%. Bladder pain was reported either 'never' or 'occasionally' by 92.3% of women. The median satisfaction rate was 98/100 and 92.4% said they would have the TVT procedure again. CONCLUSIONS Tension-free vaginal tape has high levels of satisfaction and cure up to 24 years after placement. Pain was uncommon and its impact on quality of life was low. Symptoms of urgency were prevalent but may be related to age. TVT is an effective treatment for SUI more than 20 years after initial placement.
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Affiliation(s)
- Bobby D. O’Leary
- Department of Urogynaecology, National Maternity Hospital, Holles Street Dublin 2 Ireland
| | - Alexandra McCreery
- Department of Urogynaecology, National Maternity Hospital, Holles Street Dublin 2 Ireland
| | - Aisling Redmond
- Department of Urogynaecology, National Maternity Hospital, Holles Street Dublin 2 Ireland
| | - Declan P. Keane
- Department of Urogynaecology, National Maternity Hospital, Holles Street Dublin 2 Ireland
- Royal College of Surgeons in Ireland National Maternity Hospital, Holles Street Dublin 2 Ireland
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Souders CP, Miranda AF, Sahor F, Goueli R, Christie A, Lemack GE, Zimmern PE, Carmel ME. Long-Term Outcomes and Complications of Trans-Vaginal Mesh Removal: a 14-year Experience. Urology 2022; 169:70-75. [PMID: 35970359 DOI: 10.1016/j.urology.2022.07.039] [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: 02/03/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To assess the long-term patient outcomes, including the resolution of symptoms and need for subsequent procedures, after vaginal mesh removals (VMR) we evaluate our 14-year experience with VMR from a tertiary center with three FPMRS-trained surgeons. Although the use of transvaginal mesh (TVM) had decreased significantly before its ban in 2019, surgeons are still treating TVM complications and performing vaginal or open/robotic VMR for mesh-related complications. METHODS A retrospective review of women undergoing VMR with 6 months minimum follow-up was undertaken. The data abstracted included demographics, provider notes, operative reports, pathology findings, outside medical records, peri-operative information, and reoperations. RESULTS From 2006 to 2020, 133 patients were identified, and 113 patients met study criteria with at least 6 months follow-up. The most common presenting symptoms were dyspareunia (77%) and pain (71%). The majority of VMR were performed vaginally (84.5%). Vaginal mesh was removed from anterior (60%), posterior (11%), and anterior and posterior (10%) compartments. Two ureteral injuries and one rectal injury were repaired intraoperatively. VMR resulted in resolution of pain in 50% of patients. Some patients had persistent pain (21%) and a few developed de novo pain (4%). More than half of the patients had dyspareunia resolution (52%), but 12% had persistent dyspareunia and 2% developed de novo dyspareunia. CONCLUSIONS VMR complexity requires advanced surgical expertise. Most patients undergoing VMR had resolution of their presenting symptoms. However, outcomes for pain, sexual function, continence, and/or prolapse can be unpredictable, resulting in multiple surgeries.
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Affiliation(s)
- Colby P Souders
- Department of Urology, University of Texas Southwestern Medical Center. 5323 Harry Hines Blvd. Dallas, TX 75390-9110.
| | - Andre F Miranda
- Department of Urology, University of Texas Southwestern Medical Center. 5323 Harry Hines Blvd. Dallas, TX 75390-9110
| | - Fatou Sahor
- University of Texas Southwestern Medical School. 5323 Harry Hines Blvd. Dallas, TX 75390-9110
| | - Ramy Goueli
- Department of Urology, University of Texas Southwestern Medical Center. 5323 Harry Hines Blvd. Dallas, TX 75390-9110
| | - Alana Christie
- Department of Urology, University of Texas Southwestern Medical Center. 5323 Harry Hines Blvd. Dallas, TX 75390-9110
| | - Gary E Lemack
- Department of Urology, University of Texas Southwestern Medical Center. 5323 Harry Hines Blvd. Dallas, TX 75390-9110
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center. 5323 Harry Hines Blvd. Dallas, TX 75390-9110
| | - Maude E Carmel
- Department of Urology, University of Texas Southwestern Medical Center. 5323 Harry Hines Blvd. Dallas, TX 75390-9110
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Heathcote J, Izett-kay ML, Jackson SR, Price N. Laparoscopic removal of a synthetic retropubic mid-urethral sling (tension-free vaginal tape): step-by-step technique. Int Urogynecol J. [DOI: 10.1007/s00192-021-05023-2] [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] [Received: 08/15/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022]
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Zheng Y, Major N, Silverii H, Lim C, Margules A, Gracely A, Rames R, Cox L, Rovner E. Is it the Surgeon? A Re-examination of Mid-urethral Sling Complications. Urology 2021; 157:269-273. [PMID: 34375650 DOI: 10.1016/j.urology.2021.07.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify potential technical factors during initial mid-urethral sling (MUS) placement that contribute to subsequent sling revision procedures. METHODS A retrospective chart review was performed examining synthetic MUS reoperations at a single institution from 2008-2020. The implanting surgeon's operative note, when available, was critically reviewed with respect to trocar placement, sling location, and tensioning technique. The reoperative report was reviewed for aberrant intraoperative findings relating to the index surgery. RESULTS A total of 306 women underwent revision of their MUS. Operative reports from the implanting surgeon were available for 276 (90.2%) women. Review of index operative reports revealed 47 unambiguous descriptions of improper technique, including 19 cases of described excessive tensioning and 2 cases of MUS placement despite noted urethral injury during the index case. Indications for reoperation were clinical obstruction (63%), pain (40%), and mesh erosion/exposure (33%). In 186 (67.4%) women, there was an intraoperative finding during the revision that likely contributed to the need for reoperation. Among these 186 women, 110 (59.1%) slings were noted to have been placed too proximally, 78 (41.9%) were over-suspended, and 57 (30.6%) were placed too deep in the periurethral fascia. CONCLUSION Review of the index operative note and findings at operative re-exploration of MUS surgeries, often reveals evidence that the initial MUS implantation was technically suboptimal. Such findings suggest that intraoperative surgical technique is a critically important factor contributing to postoperative complications in MUS surgery. This underscores the importance of surgical training and adherence to surgical principles during the placement of a synthetic MUS.
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Affiliation(s)
- Yu Zheng
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Nicholas Major
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Hailey Silverii
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Caitlin Lim
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Andrew Margules
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Alyssa Gracely
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Ross Rames
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Lindsey Cox
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Eric Rovner
- Department of Urology, Medical University of South Carolina, Charleston, SC.
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Kisby CK, Shadrin IY, Rolland TJ, Stalboerger PG, Zhou B, Trabuco EC, Behfar A, Occhino JA. Exosome-Induced Vaginal Tissue Regeneration in a Porcine Mesh Exposure Model. Female Pelvic Med Reconstr Surg 2021; 27:609-15. [PMID: 34554143 DOI: 10.1097/SPV.0000000000001005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The purpose of this study was to explore the utility of an injectable purified exosome product derived from human apheresis blood to (1) augment surgical closure of vaginal mesh exposures, and (2) serve as a stand-alone therapy for vaginal mesh exposure. METHODS Sixteen polypropylene meshes (1×1-3×3 cm) were implanted in the vaginas of 7 Yorkshire-crossed pigs by urogynecologic surgeons (day 0). On day 7, group 1 underwent surgical intervention via vaginal tissue suture reclosure with (n=2 pigs, n=4 meshes) or without (n=2 pigs, n=4 meshes) exosome injection; group 2 underwent medical intervention with an exosome injection (n=3, n=8 meshes). One animal in group 2 was given oral 2'-deoxy-5-ethynyluridine to track cellular regeneration. Euthansia occurred at 5 weeks. RESULTS Mesh exposures treated with surgical closure alone experienced reexposure of the mesh. Exosome treatment with or without surgical closure resulted in partial to full mesh exposure resolution up to 3×3 cm. Exosome-treated tissues had significantly thicker regenerated epithelial tissue (208 μm exosomes-only and 217 μm surgery+exosomes, versus 80 μm for surgery-only; P < 0.05); evaluation of 2'-deoxy-5-ethynyluridine confirmed de novo regeneration throughout the epithelium and underlying tissues. Capillary density was significantly higher in the surgery+exosomes group (P = 0.03). Surgery-only tissues had a higher inflammatory and fibrosis response as compared with exosome-treated tissues. CONCLUSIONS In this pilot study, exosome treatment augmented healing in the setting of vaginal mesh exposure, reducing the incidence of mesh reexposure after suture closure and decreasing the area of mesh exposure through de novo tissue regeneration after exosome injection only. Further study of varied local tissue conditions and mesh configurations is warranted.
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Chang OH, Cadish LA, Kailasam A, Ridgeway BM, Shepherd JP. Impact of the availability of midurethral slings on treatment strategies for stress urinary incontinence: a cost-effectiveness analysis. BJOG 2021; 129:500-508. [PMID: 34314554 DOI: 10.1111/1471-0528.16850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To perform a cost-effectiveness analysis for the surgical and non-surgical management of stress urinary incontinence (SUI) with and without the availability of midurethral sling. DESIGN Cost-effectiveness analysis. SETTING USA, 2019. POPULATION Women with stress urinary incontinence. METHODS We modelled SUI treatment pathways with and without the availability of midurethral slings, including no treatment, incontinence pessary, pelvic floor muscle physical therapy, urethral bulking injection, open and laparoscopic Burch colposuspension, and pubovaginal autologous sling. Time horizon was 2 years after initial treatment. MAIN OUTCOME MEASURES Costs (2019 US$) included index surgery, surgical retreatment, and complications including urinary retention, de novo urgency and mesh exposure. The incremental cost-effectiveness ratio (ICER) was calculated for non-dominated treatment strategies. RESULTS The least costly treatment strategies were incontinence pessary, pelvic floor physical therapy, no treatment and midurethral sling, respectively. Midurethral slings had the highest effectiveness. The strategy with the lowest effectiveness was no treatment. The three cost-effective strategies included pessary, pelvic floor muscle physical therapy and midurethral slings. No other surgical options were cost-effective. If midurethral slings were not available, all other surgical options were still dominated by pelvic floor muscle physical therapy. Multiple one-way sensitivity analyses confirmed model robustness. The only reasonable threshold in which outcomes would change, was if urethral bulking costs decreased 12.6%. CONCLUSIONS The midurethral sling is the most effective SUI treatment and the only cost-effective surgical option. TWEETABLE ABSTRACT Midurethral sling is the only cost-effective surgical treatment option for stress urinary incontinence.
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Affiliation(s)
- O H Chang
- Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Women's Health Institute, Cleveland, OH, USA
| | - L A Cadish
- Providence Saint John's Health Center, Santa Monica, CA, USA
| | - A Kailasam
- Trinity Health of New England, Hartford, CT, USA
| | - B M Ridgeway
- Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Women's Health Institute, Cleveland, OH, USA
| | - J P Shepherd
- Trinity Health of New England, Hartford, CT, USA
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Sun ZJ, Guo T, Wang XQ, Lang JH, Xu T, Zhu L. Current situation of complications related to reconstructive surgery for pelvic organ prolapse: a multicenter study. Int Urogynecol J 2021; 32:2149-2157. [PMID: 34165615 PMCID: PMC8346404 DOI: 10.1007/s00192-021-04892-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/26/2021] [Indexed: 01/23/2023]
Abstract
Introduction and hypothesis This study aimed to investigate the evaluation and management of complications after pelvic floor reconstructive surgery for pelvic organ prolapse in China. Methods Complications of pelvic floor reconstructive surgery for pelvic organ prolapses from 27 institutions were reported from November 2017 to October 2019. All complications were coded according to the category-time-site system proposed by the International Urogynecological Association (IUGA) and the International Continence Society (ICS). The severity of the complications was graded by the Clavien-Dindo grading system. Four scales were used to evaluate patient satisfaction and quality of life after management of the complications: the Patient Global Impression of Improvement (PGI-I), the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7), the Pelvic Organ Prolapse Symptom Score (POP-SS), and a 5-point Likert-type scale that evaluated the patient’s choice of surgery. Results Totally, 256 cases were reported. The occurrence of complications related to transvaginal mesh (TVM) and laparoscopic sacrocolpopexy (LSC) had a significantly longer post-surgery delay than those of native tissue repair surgery (p < 0.001 and p = 0.010, respectively). Both PFIQ-7 and POP-SS score were lower after management of complications (p < 0.001). Most respondents (81.67%) selected very much better, much better, or a little better on the PGI-I scale. Only 13.3% respondents selected unlikely or highly unlikely on the 5-point Likert-type scale. Conclusions The occurrence of complications related to TVM surgery and LSC had a longer post-surgery delay than native tissue repair surgery. Long-term regular follow-up was vital in complication management. Patient satisfaction with the management of TVM complications was acceptable.
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Affiliation(s)
- Zhi-Jing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Tao Guo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Xiu-Qi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China.
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Prodromidou A, Zacharakis D, Athanasiou S, Protopapas A, Michala L, Kathopoulis N, Grigoriadis T. The Emerging Role on the Use of Platelet-Rich Plasma Products in the Management of Urogynaecological Disorders. Surg Innov 2021; 29:80-87. [PMID: 33909538 DOI: 10.1177/15533506211014848] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The regenerative efficacy of platelet-derived products has been recently investigated in the treatment of pelvic floor disorders (PFDs). We aimed to synthesize the current evidence of platelet-rich plasma (PRP) products used in urogynaecological disorders including vaginal atrophy, pelvic organ prolapse (POP), urinary incontinence, vaginal fistulas and vaginal mesh exposure. Methods: A meticulous search of the currently available literature on the use of PRP for the management of PFDs was performed using 3 electronic databases. Results: PRP could be a feasible alternative modality for the management of vaginal atrophy with favourable outcomes in vaginal atrophy parameters and patients' satisfaction, especially when hormone therapy is contraindicated. In patients with POP, an increase in collagen concentration after PRP application was observed while the use of PRP resulted in improvement of stress urinary incontinence symptoms. A considerable proportion of vesicovaginal fistulas were treated after application of PRP-based injections. Conclusions: There is only limited evidence of the use of PRP for PFDs. Platelet-rich plasma appears to be a promising, easy to apply, cost-effective and feasible alternative therapeutic modality for the management of various urogynaecological disorders. Future randomized trials are needed to confirm the efficacy of PRP in the treatment of urogynaecological disorders.
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Affiliation(s)
- Anastasia Prodromidou
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Stavros Athanasiou
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Athanasios Protopapas
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Lina Michala
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Themos Grigoriadis
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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Naumann G, Hüsch T, Mörgeli C, Kolterer A, Tunn R. Mesh-augmented transvaginal repair of recurrent or complex anterior pelvic organ prolapse in accordance with the SCENIHR opinion. Int Urogynecol J 2021; 32:819-827. [PMID: 32970175 PMCID: PMC8009781 DOI: 10.1007/s00192-020-04525-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the performance of mesh-augmented repair of anterior pelvic organ prolapse (POP) with or without apical vaginal wall involvement in women with recurrent or complex prolapse. METHODS This multicenter cohort study included women undergoing surgery with Calistar S (Promedon, Argentina) for anterior POP between 2016 and 2018. The SCENIHR opinion was considered for patient selection, surgeon's experience and choice of implant. Patients were prospectively invited to assess effectiveness and safety by anamnesis, validated questionnaires and pelvic examination. A composite endpoint defined by POP-Q ≤ 1, absence of a vaginal bulge symptom and repeated surgery for POP was used to define treatment success. Descriptive statistics were applied. McNemar or Wilcoxon signed rank tests were used as paired samples tests. The significance level was set at 5%. RESULTS A total of 107 non-fertile women with a mean age of 70.6 years were enrolled. Ninety-three (86.9%) women presented with recurrent prolapse. The mean follow-up time was 18.5 months. Treatment success was achieved in 76% of cases according the composite endpoint, with 98% reaching POP-Q ≤ 1 and a significant improvement in quality of life (p < 0.001). Mesh exposure occurred in six (5.6%) patients, although none required further surgery. Four (3.7%) patients reported dyspareunia, and a single (0.9%) patient displayed a prominence due to mesh folding. CONCLUSIONS Mesh-augmented repair of anterior POP is effective and safe in women with recurrent or complex prolapse. Hence, in a select patient population, the benefits of mesh-augmented POP repair still outweigh the risks.
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Affiliation(s)
- Gert Naumann
- Department of Gynecology and Obstetrics, Helios Hospital Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany.
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
- Promedon GmbH, Clinical Research, Kolbermoor, Germany
| | - Claudia Mörgeli
- Department of Urogynecology, St. Hedwig Hospital, Berlin, Germany
| | - Anna Kolterer
- Department of Gynecology and Obstetrics, Helios Hospital Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany
| | - Ralf Tunn
- Department of Urogynecology, St. Hedwig Hospital, Berlin, Germany
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Wang L, Wang Y, Xiang Y, Ma J, Zhang H, Dai J, Hou Y, Yang Y, Ma J, Li H. An In Vitro Study on Extracellular Vesicles From Adipose-Derived Mesenchymal Stem Cells in Protecting Stress Urinary Incontinence Through MicroRNA-93/F3 Axis. Front Endocrinol (Lausanne) 2021; 12:693977. [PMID: 34484115 PMCID: PMC8415505 DOI: 10.3389/fendo.2021.693977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022] Open
Abstract
Since the potential roles of extracellular vesicles secreted by adipose-derived mesenchymal stem cells (ADSCs) are not well understood in collagen metabolism, the purpose of this research was to evaluate the effects of ADSCs-extracellular vesicles in stress urinary incontinence and the regulatory mechanism of delivered microRNA-93 (miR-93). ADSCs were isolated and cultured, and ADSCs-extracellular vesicles were extracted and identified. Stress urinary incontinence primary fibroblasts or satellite cells were treated with ADSCs-extracellular vesicles to detect the expression of Elastin, Collagen I, and Collagen III in fibroblasts and Pax7 and MyoD in satellite cells. After transfecting ADSCs with miR-93 mimics or inhibitors, extracellular vesicles were isolated and treated with stress urinary incontinence primary fibroblasts or satellite cells to observe cell function changes. The online prediction and luciferase activity assay confirmed the targeting relationship between miR-93 and coagulation factor III (F3). The rescue experiment verified the role of ADSCs-extracellular vesicles carrying miR-93 in stress urinary incontinence primary fibroblasts and satellite cells by targeting F3. ADSCs-extracellular vesicles treatment upregulated expression of Elastin, Collagen I, and Collagen III in stress urinary incontinence primary fibroblasts and expression of Pax7 and MyoD in stress urinary incontinence primary satellite cells. miR-93 expression was increased in stress urinary incontinence primary fibroblasts or satellite cells treated with ADSCs-extracellular vesicles. Extracellular vesicles secreted by ADSCs could deliver miR-93 to fibroblasts and then negatively regulate F3 expression; ADSCs-extracellular vesicles could reverse the effect of F3 on extracellular matrix remodeling in stress urinary incontinence fibroblasts. miR-93 expression was also increased in stress urinary incontinence primary satellite cells treated by ADSCs-extracellular vesicles. Extracellular vesicles secreted by ADSCs were delivered to satellite cells through miR-93, which directly targets F3 expression and upregulates Pax7 and MyoD expression in satellite cells. Our study indicates that miR-93 delivered by ADSCs-extracellular vesicles could regulate extracellular matrix remodeling of stress urinary incontinence fibroblasts and promote activation of stress urinary incontinence satellite cells through targeting F3.
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Abstract
PURPOSE OF REVIEW To discuss considerations and current evidence for the diagnosis and management of vaginal mesh exposures following female mesh-augmented anti-incontinence and pelvic organ prolapse surgery. RECENT FINDINGS Since the introduction of mesh into female pelvic surgery, various applications have been reported, each with their own unique risk profile. The most commonly encountered mesh-related complication is vaginal mesh exposure. Current evidence on the management of vaginal mesh exposure is largely limited to observational studies and case series, though this is continuing to expand. We present a synthesis of the available data, as well as clinical and surgical approaches to managing this complication. It is important for surgeons to be familiar with the management of vaginal mesh exposures. Depending on the patient's presentation and goals, there is a role for conservative measures, mesh revision, or mesh excision. Further study is warranted to standardize mesh resection techniques and explore non-surgical treatments.
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Rechberger E, Skorupska K, Rechberger T, Kołodyńska A, Miotła P, Kulik-Rechberger B, Wróbel A. The Influence of Vaginal Native Tissue Repair (VNTR) on Various Aspects of Quality of Life in Women with Symptomatic Pelvic Organ Prolapse-A Prospective Cohort Study. J Clin Med 2020; 9:jcm9061634. [PMID: 32481614 PMCID: PMC7355538 DOI: 10.3390/jcm9061634] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/29/2022] Open
Abstract
Pelvic organ prolapse (POP) and the associated functional disorders are a major epidemiological problem that compromises the quality of life (QoL). The aim of this study was to assess the impact of lower urinary tract symptoms (LUTS) related to POP and vaginal native tissue repair (VNTR) on QoL. Two hundred patients with symptomatic POP were stratified into four groups according to the dominant storage phase function disorders: Urgency; stress urinary incontinence (SUI); mixed urinary incontinence (MUI), and without clinically significant symptoms from lower urinary tract (LUT). They underwent VNTR from January 2018 to February 2019. After 12 months, the QoL was assessed by the Prolapse Quality of Life (P-QoL) and visual analogue scale (VAS) questionnaires. The data were analyzed with Statistica package version 12.0 (StatSoft, Krakow, Poland), using the Kalmogorow–Smirnoff, Shapiro–Wilk W and the one-way analysis of variance with post hoc Tukey tests. The results of P-QoL showed significant improvement (p < 0.05) in all the study groups in most domains assessed before surgery and 12 months after surgery. Significant improvements in all the symptoms assessed by the VAS scale results were found in groups Urgency and MUI. The LUTS questionnaire revealed significant improvement in all voiding and post voiding symptoms in these groups. VNTR effectively eliminated LUTS and significantly improved the patients’ QoL associated with POP.
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Affiliation(s)
- Ewa Rechberger
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
| | - Katarzyna Skorupska
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
- Correspondence: ; Tel.: +48-604418512
| | - Tomasz Rechberger
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
| | - Aleksandra Kołodyńska
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
| | - Paweł Miotła
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
| | - Beata Kulik-Rechberger
- Department of Paediatric Propedeutics, Medical University of Lublin, Gębali 6, 20-093 Lublin, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
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Hermieu N, Schoentgen N, Aoun R, Neveu P, Grassano Y, Egrot C, Kassem A, Xylinas E, Ouzaid I, Hermieu JF. [Surgical management of suburethral sling complications and functional outcomes]. Prog Urol 2020; 30:402-410. [PMID: 32409239 DOI: 10.1016/j.purol.2020.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify various clinical presentation leading to the diagnosis of mid-urethral sling (MUS) complications and to analyze the functional outcomes after surgical management of these complications. METHOD Retrospective observational monocentric study of all patients treated by MUS section or removal, between December 2005 and October 2019, in a pelviperineology centre. RESULTS During this study, 96 patients were included. MUS complications surgically managed were vaginal mesh exposure (48 %), urethral mesh exposure (17 %), bladder mesh exposure (10 %); dysuria (30 %), pain (6 %), and infection (3 %). The mean time to diagnosis was 2 years. This diagnosis delay was caused by a non-specific and heterogeneous symptomatology. Surgical management consisted in MUS partial removal (79 %) and MUS simple section (21 %) with low perioperative morbidity. At three months follow-up, 36 patients (53 %) had stress urinary incontinence (SUI), including 13 (19 %) de novo (meaning no SUI before MUS section/removal) and 19 (28 %) had overactive bladder, including 9 (13 %) de novo. Half of the patients with SUI after MUS section/removal were able to be treated by a second MUS with a success rate of 83 % at 3 years. CONCLUSION Clinical presentation of MUS complications is heterogeneous. Surgical treatment was associated with low morbidity in our study. Post-operatively, half of the patients had SUI and a second MUS was a relevant treatment option after proper evaluation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Hermieu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - N Schoentgen
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
| | - R Aoun
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Neveu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - Y Grassano
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - C Egrot
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Kassem
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - E Xylinas
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - I Ouzaid
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - J F Hermieu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
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Orhan A, Ozerkan K, Kasapoglu I, Ocakoglu G, Aslan K, Uncu G. A Meshless Practical Laparoscopic Sacrohysteropexy Modification and Long-term Outcomes. J Minim Invasive Gynecol 2020; 27:1573-1580. [PMID: 32135244 DOI: 10.1016/j.jmig.2020.02.011] [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] [Received: 12/18/2019] [Revised: 02/08/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To describe a new modification of laparoscopic sacrohysteropexy without using a mesh and report the 3-year outcomes. DESIGN A prospective cohort study. SETTING Minimally Invasive Gynecology Unit, Bursa Uludag University Hospital, Turkey. PATIENTS Women who were diagnosed with ≥ stage 2 uterine prolapse. INTERVENTIONS A laparoscopic sacrohysteropexy modification using a polyester fiber suture instead of a standard polypropylene mesh. MEASUREMENTS AND MAIN RESULTS The primary outcome was the anatomic success of the repair, with success defined as objective parameters using the pelvic organ prolapse quantification system. The secondary outcomes were subjective outcomes, which were assessed using the quality-of-life scales. Forty-seven women who underwent the procedure were followed up for a minimum of 3 years. Forty-four of the 47 patients had stage 0 or 1 prolapse at the end of the second year, according to the primary outcomes. The anatomic success rate was 93.6%. In the secondary outcomes, 2 patients were not satisfied with their pelvic floor after the second year. The subjective cure rate was 95.7%. There was a statistically significant improvement in both pelvic organ prolapse quantification and quality-of-life scores in the third postoperative year. The mean operating time was 84.6 minutes, and the mean estimated blood loss was 21.3 mL. There were no bladder or bowel complications in the perioperative or postoperative period. CONCLUSION Laparoscopic sacrohysteropexy can be performed safely with this meshless modification in uterine prolapse as an alternative.
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Affiliation(s)
- Adnan Orhan
- Department of Obstetrics and Gynecology, Urogynecology, and Minimally Invasive Gynecology Unit (Drs. Orhan, Ozerkan, Kasapoglu, Aslan, and Uncu).
| | - Kemal Ozerkan
- Department of Obstetrics and Gynecology, Urogynecology, and Minimally Invasive Gynecology Unit (Drs. Orhan, Ozerkan, Kasapoglu, Aslan, and Uncu)
| | - Isil Kasapoglu
- Department of Obstetrics and Gynecology, Urogynecology, and Minimally Invasive Gynecology Unit (Drs. Orhan, Ozerkan, Kasapoglu, Aslan, and Uncu)
| | - Gokhan Ocakoglu
- Department of Biostatistics (Dr. Ocakoglu), Uludag University Hospital, Bursa, Turkey
| | - Kiper Aslan
- Department of Obstetrics and Gynecology, Urogynecology, and Minimally Invasive Gynecology Unit (Drs. Orhan, Ozerkan, Kasapoglu, Aslan, and Uncu)
| | - Gurkan Uncu
- Department of Obstetrics and Gynecology, Urogynecology, and Minimally Invasive Gynecology Unit (Drs. Orhan, Ozerkan, Kasapoglu, Aslan, and Uncu)
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Orhan A, Rantell A, Ozerkan K, Kasapoglu I, Ocakoglu G, Aslan K, Mert SN, Uncu G, Cardozo L. Social media awareness among non-urogynecologists regarding the current mesh discussions in urogynecology: a survey study. Int Urogynecol J 2020; 31:1231-1243. [PMID: 32067058 DOI: 10.1007/s00192-020-04242-3] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/23/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS There has been a great deal of discussion about mesh complications in urogynecology in recent years. However, awareness of other doctors who are not urogynecologists is unknown. This study was aimed at determining the level of awareness of mesh discussions among medical doctors whose specialty is not urology or gynecology. METHODS A survey study was administered, and all medical doctors, except gynecologists and urologists, were invited. Respondent doctors were classified into four groups: King's College Hospital (KCH), UK; Uludag University Hospital (UUH), Turkey; the United States (USA); and the world (WORLD). The primary outcome was the awareness of mesh discussion in urogynecology, and the secondary outcome was the social media awareness of the mesh discussion. RESULTS 1231 doctors responded to the survey. The awareness of the current mesh problems among the respondent doctors was 15.8% in KCH, 15.4% in UUH, 26.9% in the USA, and 16.2% in WORLD. The social media awareness about mesh problems was 20.8% in KCH, 20.3% in UUH, 32.8% in the USA, and 20.6% in WORLD. Although there were no differences among three of the groups with regard to primary and secondary outcomes, the USA group score was statistically significantly higher than the others. CONCLUSIONS Social media can influence doctors' thinking on controversial academic issues. In this survey study, non-urogynecologist doctors in the USA cohort have higher awareness levels and a higher social media awareness level than other groups.
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Affiliation(s)
- Adnan Orhan
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey.
| | - Angie Rantell
- Department of Urogynecology, King's College Hospital, London, UK
| | - Kemal Ozerkan
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey
| | - Isil Kasapoglu
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey
| | - Gokhan Ocakoglu
- Department of Biostatistics, Uludag University Hospital, Bursa, Turkey
| | - Kiper Aslan
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey
| | - Sevde Nur Mert
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey
| | - Gurkan Uncu
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey
| | - Linda Cardozo
- Department of Urogynecology, King's College Hospital, London, UK
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Tepe NB, Bayrak Ö, Şen H, Uğur MG, Erturhan S, Seçkiner İ. Comparison of the efficiency of partial versus subtotal mesh removal on urogenital distress and sexual functions after stress urinary incontinence surgery. Turk J Urol 2019; 46:140-145. [PMID: 31657696 DOI: 10.5152/tud.2019.19113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/17/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the efficiency of the partial mesh removal (PMR) versus subtotal mesh removal (SMR) on urogenital distress and sexual functions in patients who experienced vaginal mesh extrusion. MATERIAL AND METHODS Between June 2014 and January 2018, 45 patients who experienced vaginal mesh extrusion following midurethral sling surgeries and therefore underwent mesh excision were evaluated retrospectively. The effectiveness of PMR and SMR was compared using the "Urinary Distress Inventory-6 (UDI-6)" and "Female Sexual Function Index (FSFI)" forms, at the 6th month postoperatively. RESULTS Fourteen PMR-patients and 21 SMR-patients who met the study criteria were evaluated for the study. There was a significant improvement in UDI-6 scores and FSFI scores in both PMR and SMR groups at the 6th month postoperatively (p=0.001, p=0.001, p=0.001, and p=0.001, respectively). When the two groups were compared in terms of improvement rates, there was no significant difference in UDI-6 scores [(-)30.21±6.56% vs. (-)26.33±9.01%, p=0.222]. However, there was a statistically significant improvement in the FSFI scores in the SMR group [(+)83.71±14.81% vs. (+)124.42±36.82%, p=0.001]. There was no significant difference in overactive bladder symptoms between the two groups, with a decrease of 75% in the PMR group and 71.42% in the SMR group (p=0.721). Recurrent stress urinary incontinence was observed in two (14.2%) patients in the PMR group and four (19.1%) patients in the SMR group at the 6th month postoperatively (p=0.544). CONCLUSION In cases where extrusion is developed, subtotal/total mesh removal provides a significant improvement in patients' complaints of sexual dysfunction related to extrusion.
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Affiliation(s)
- Neslihan Bayramoğlu Tepe
- Department of Obstetrics and Gynecology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Ömer Bayrak
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Haluk Şen
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Mete Gürol Uğur
- Department of Obstetrics and Gynecology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Sakıp Erturhan
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - İlker Seçkiner
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
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