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Bosio S, Perossini S, Torella M, Braga A, Salvatore S, Serati M, Frigerio M, Manodoro S. The association between vulvodynia and interstitial cystitis/bladder pain syndrome: A systematic review. Int J Gynaecol Obstet 2024. [PMID: 38655714 DOI: 10.1002/ijgo.15538] [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: 06/07/2023] [Revised: 03/10/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Vulvodynia (VVD) is a debilitating chronic vulvar pain significantly affecting patients' quality of life. Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and complex illness characterized by an unpleasant sensation related to the filling of the bladder and it strongly impacts patients' lives. The exact mechanisms of the two syndromes remain unknown, but there is an overlap between suspected pathophysiologies. OBJECTIVE To present an overview of the current research on the association between VVD and IC/BPS. SEARCH STRATEGY A systematic search of three electronic databases was conducted. Studies examining the correlation between VVD and IC/BPS with male and female patients aged over 18 years were included. SELECTION CRITERIA Studies assessing the coexistence of VVD and IC/BPS were included. Reviews, letters to the editor, conference abstracts, book chapters, guidelines, Cochrane reviews, and expert opinions were excluded. DATA COLLECTION AND ANALYSIS Two reviewers screened the studies for eligibility. Eligible studies were screened for quality. MAIN RESULTS A total of 13 studies were included in the final review. Among them, 11 presented a positive association between the two syndromes. The studies highlighted that VVD and IC/BPS share common comorbidities and possibly etiopathogenic pathways. CONCLUSION VVD and IC/BPS are both complex and multifactorial syndromes. This review highlights an association between them, but additional studies on the topic should be conducted for a more precise conclusion.
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Affiliation(s)
- Sara Bosio
- ASST Franciacorta, Mellino Mellini Hospital, Chiari, Italy
| | - Silvia Perossini
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
- University of Milano, Milan, Italy
| | | | | | | | - Maurizio Serati
- Del Ponte Hospital, Varese, Italy
- Dell'Insubria University, Varese, Italy
| | | | - Stefano Manodoro
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
- University of Milano, Milan, Italy
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Ruffolo AF, Tsiapakidou S, Daykan Y, Salvatore S, Athanasiou S, Braga A, Meschia M, Phillips C, Serati M. European Urogynaecological Association Position Statement: The role of urodynamics in stress urinary incontinence evaluation and treatment decision. Eur J Obstet Gynecol Reprod Biol 2024; 297:176-181. [PMID: 38669769 DOI: 10.1016/j.ejogrb.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
Stress urinary incontinence (SUI) is defined as a condition characterized by the involuntary leakage of urine during activities that increase intra-abdominal pressure which may decrease quality of life with a significant economic impact on health systems, necessitating the implementation of cost-effective management plans. Urodynamics (UDS) has been considered during the last decades as the gold standard for assessment of lower urinary tract symptoms (LUTS) due to their high reproducibility. At the same time, concerns about the systematic use of UDS before SUI surgery were raised due to a limited evidenced base to recommend their routine use. In uncomplicated female patients with SUI, UDS can offer further insights into LUTS, potentially assisting the physician in determining the appropriate therapeutic approach. However, it has not been shown that preoperative UDS can directly impact the surgical outcome for continence. Indeed, evidence supports the conclusion that pre-operative UDS in women with uncomplicated, clinically demonstrable, SUI does not improve the outcome of surgery for SUI. Nevertheless, asymptomatic detrusor overactivity (DO) identified by urodynamic testing or pre-existing voiding dysfunction are associated with an increased occurrence of postoperative overactive bladder (OAB) and voiding dysfunction, respectively. The EUGA Working Group concluded that the evidence does not support the systematic preoperative use of UDS for uncomplicated cases. However, in cases where mixed symptoms, voiding dysfunction, previous surgery, or concomitant prolapse are present, preoperative UDS are advised as they can be beneficial in anticipating postoperative outcomes. This aids in conducting comprehensive and thorough preoperative counseling. The Group recommend performing preoperative UDS considering the patient's specific clinical situation and the surgeon's judgment, with consideration given to the potential benefits, risks, and impact on treatment decisions and patient outcomes.
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Affiliation(s)
| | - Sofia Tsiapakidou
- 1(st) Department of Obstetrics and Gynecology Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, Scientific Institute, Milan, Italy
| | - Stavros Athanasiou
- Urogynecology Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland
| | - Michele Meschia
- Co-Chair of Scientific Committee of European Urogynaecological Association (EUGA)
| | - Christian Phillips
- Basingstoke and North Hampshire Hospital, Urogynaecology, Basingstoke, Hampshire, United Kingdom
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; President of European Urogynaecological Association (EUGA)
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Braga A, Papadia A, Serati M. Re: Autologous Platelet Rich Plasma (A-PRP) Combined with Pelvic Floor Muscle Training for the Treatment of Female Stress Urinary Incontinence (SUI): A Randomized Control Clinical Trial. Eur Urol 2024:S0302-2838(24)02227-9. [PMID: 38531701 DOI: 10.1016/j.eururo.2024.03.009] [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] [Received: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Andrea Papadia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Obstetrics and Gynecology, EOC-Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
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Braga A, Papadia A, Serati M. Re: Laparoscopic Sacrocolpopexy Versus Vaginal Sacrospinous Fixation for Vaginal Vault Prolapse: A Randomised Controlled Trial and Prospective Cohort (SALTO-2 Trial). Eur Urol 2024:S0302-2838(24)02226-7. [PMID: 38531700 DOI: 10.1016/j.eururo.2024.03.008] [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] [Received: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Andrea Braga
- Department of Gynaecology and Obstetrics, EOC-Beata Vergine Hospital, Mendrisio, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Andrea Papadia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Gynaecology and Obstetrics, EOC-Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, Del Ponte Hospital, University of Insubria, Varese, Italy
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Bolze P, Schoenen S, Margaillan M, Braga A, Sauthier P, Elias K, Seckl M, Winter M, Coulter J, Lok C, Joneborg U, Undurraga Malinverno M, Hajri T, Massardier J, You B, Golfier F, Goffin F. Chemotherapy is not needed when complete evacuation of gestational choriocarcinoma leads to hCG normalization. Eur J Surg Oncol 2024; 50:108012. [PMID: 38350264 DOI: 10.1016/j.ejso.2024.108012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The standard treatment for gestational choriocarcinoma is chemotherapy. OBJECTIVE To describe the risk of recurrence with expectant management of gestational choriocarcinoma that has reached a normal human chorionic gonadotropin level after tumor removal without adjuvant chemotherapy. METHODS A retrospective multicenter international cohort study was conducted from 1981 to 2017 involving 11 gestational trophoblastic disease reference centers with patient's follow-up extended until 2023. Clinical and biological data of included patients were extracted from each center's database. The inclusion criteria were i) histological diagnosis of gestational choriocarcinoma in any kind of placental tissue retrieved, ii) spontaneous normalization of human chorionic gonadotropin level following choriocarcinoma retrieval, iii) patient did not receive any oncological treatment for the choriocarcinoma, iv) and at least 6 months of follow-up after the first human chorionic gonadotropin level normalization. RESULTS Among 80 patients with retrieved gestational choriocarcinoma and whose human chorionic gonadotropin level normalized without any other oncological therapy, none had a recurrence of choriocarcinoma after a median follow-up of 50 months. The median interval between choriocarcinoma excision and human chorionic gonadotropin level normalization was 48 days. The International Federation of Gynecology and Obstetrics/World Health Organization risk score was ≤6 in 93.7% of the cases. CONCLUSIONS This multicenter international study reports that selected patients with gestational choriocarcinoma managed in gestational trophoblastic disease reference centers did not experience any relapse when the initial tumor evacuation is followed by human chorionic gonadotropin level normalization without any additional treatment. Expectant management may be a safe approach for highly selected patients.
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Affiliation(s)
- Pa Bolze
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France.
| | - S Schoenen
- Centre Belge de Référence des Maladies Trophoblastiques, Liège, Belgium.
| | - M Margaillan
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
| | - A Braga
- Rio de Janeiro Trophoblastic Disease Reference Center, Rio de Janeiro, Brazil
| | - P Sauthier
- Réseau des Maladies Trophoblastiques Du Québec, Montréal, Canada
| | - K Elias
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, USA
| | - M Seckl
- Charing Cross Gestational Trophoblastic Disease Center, London, UK
| | - M Winter
- Sheffield Center for Trophoblastic Diseases, Sheffield, UK
| | - J Coulter
- Department of Gynaecology Obstetrics, Cork University Maternity Hospital, Cork, Ireland
| | - C Lok
- Center of Gynaecologic Oncology, Amsterdam, Netherlands
| | - U Joneborg
- Department of Women's and Children's Health and Department of Pelvic Cancer, Karolinska Institutet/University Hospital, Stockholm, Sweden
| | - M Undurraga Malinverno
- Unité D'oncogynécologie, Département de Gynécologie et Obstétrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - T Hajri
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
| | - J Massardier
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
| | - B You
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
| | - F Golfier
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
| | - F Goffin
- Centre Belge de Référence des Maladies Trophoblastiques, Liège, Belgium
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Braga A, Galli L, Caccia G, Amato G, Papadia A, Torella M, Salvatore S, Scancarello C, Baruch Y, Serati M. Is Diastasis Recti Abdominis Rehabilitation after Childbirth Able to Prevent the Onset of Stress Urinary Incontinence? A Case-Control Study. Medicina (Kaunas) 2023; 59:2182. [PMID: 38138285 PMCID: PMC10744874 DOI: 10.3390/medicina59122182] [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: 09/24/2023] [Revised: 10/26/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a role in the prevention of pelvic floor disorders. Some studies have shown a significant correlation between diastasis recti abdominis (DRA) and stress urinary incontinence (SUI). Nevertheless, the evidence reported in the literature is controversial and based on low-quality data. The aim of the study is to clarify whether DRA-specific abdominal rehabilitation is needed in women with SUI after childbirth. Materials and Methods: All consecutive women who had at least one delivery and complained of symptoms of pure SUI that were urodynamically proven were considered for the study. The group of symptomatic patients was compared with a series of consecutive women, identified during the same study period, without any symptoms of SUI. In both groups, we measured the inter-rectal distance (IRD) with an ultrasound scanner above and below the navel. Results: A total of 102 women eligible for the study group and 100 women who did not report any symptoms of SUI were enrolled. The inter-rectal distance above the umbilicus showed no significant difference between the two groups (2.12 ± 0.98 vs. 2.1 ± 0.77; p = 0.94). In contrast, the data from the sub-umbilical measurements showed a significant difference. Surprisingly, the asymptomatic group showed significantly greater (0.98 ± 0.9 vs. 1.33 ± 0.87 p-value: 0.009) IRD compared to the symptomatic group. Conclusions: The study shows that DRA is not a risk factor for SUI in women after childbirth. Therefore, specific abdominal wall rehabilitation after childbirth does not seem to be indicated.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (G.C.); (G.A.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (L.G.); (A.P.)
| | - Livia Galli
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (L.G.); (A.P.)
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (G.C.); (G.A.)
| | - Giulia Amato
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (G.C.); (G.A.)
| | - Andrea Papadia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (L.G.); (A.P.)
- Department of Obstetrics and Gynecology, EOC-Civico Hospital, 6900 Lugano, Switzerland
| | - Marco Torella
- Department of Gyanecology, Obstetric and Reproductive Science, Second University of Naples, 80100 Naples, Italy;
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (M.S.)
| | - Yoav Baruch
- Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (M.S.)
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Barba M, Cola A, Melocchi T, Braga A, Castronovo F, Manodoro S, Pennacchio M, Munno GM, Ruffolo AF, Degliuomini RS, Salvatore S, Torella M, Frigerio M. Italian validation of the Pelvic Floor Distress Inventory (PFDI-20) questionnaire. Int Urogynecol J 2023; 34:2459-2465. [PMID: 37195425 DOI: 10.1007/s00192-023-05572-8] [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: 03/12/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The use of validated Quality of Life (QoL) questionnaires is useful in the standardization and interpretation process of pelvic floor patient symptoms, due to their functional nature and high prevalence. The Pelvic Floor Distress Inventory QoL questionnaire (PFDI-20) serves both as a symptom inventory and a measure of the degree of bother and distress caused by pelvic floor symptoms. It includes items related to pelvic organ prolapse and lower gastrointestinal and bladder dysfunction. METHODS After consensus translation and a comprehension test, the Italian version of the questionnaire was submitted to patients reporting bowel, bladder, or pelvic disorders (cases) and to asymptomatic women (controls). Cases received the questionnaire once again 2 weeks later by email. RESULTS A total of 254 patients answered the questionnaire. Construct validity was demonstrated by discriminating between cases and controls. Convergent validity was demonstrated for each domain (F < 0.001). In-ernal consistency reliability showed a satisfactory range (0.816-0.860). CONCLUSIONS The PFDI-20 allows a comprehensive assessment of the effect of pelvic floor disorders on the quality of life of women. Moreover, the PFDI-20 represents a very solid QoL tool, since it has been extensively used in literature, and its use is highly recommended by the International Consultation on Incontinence. The present study demonstrated good features for the Italian version of the PFDI-20 questionnaire.
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Affiliation(s)
| | - Alice Cola
- Gynecology Unit, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | | | - Andrea Braga
- EOC Beata Vergine, Mendrisio, Switzerland
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy
| | | | - Stefano Manodoro
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy.
- ASST Santi Paolo E Carlo, San Paolo University Hospital, University of Milano, Via Antonio Di Rudinì 8, 20142, Milan, Italy.
| | - Marika Pennacchio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetano Maria Munno
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Ferdinando Ruffolo
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rebecca Susanna Degliuomini
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Salvatore
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Torella
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Matteo Frigerio
- Gynecology Unit, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy
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Ruffolo AF, Serati M, Casiraghi A, Benini V, Scancarello C, Di Dedda MC, Garbagnati C, Braga A, Candiani M, Salvatore S. The Impact of Systemic Sclerosis on Sexual Health: An Italian Survey. Healthcare (Basel) 2023; 11:2346. [PMID: 37628543 PMCID: PMC10454073 DOI: 10.3390/healthcare11162346] [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: 06/09/2023] [Revised: 08/05/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To evaluate the impact of systemic sclerosis (SSc) on vulvovaginal atrophy (VVA) and sexual health in an Italian population. METHODS An Italian survey about the prevalence and severity of VVA (on a 0 to 10 scale) and sexual dysfunction (using the Female Sexual Function Index-FSFI) through an anonymous online questionnaire. We investigated couple relationships and intimacy with partners, the predisposition of patients to talk about their sexual problems, physicians' receptivity, and treatment scenarios. Risk factors for VVA symptoms and sexual dysfunction were assessed. RESULTS A total of 107 women affected by SSc were enrolled. Of these, 83.2% of women (89/107) complained about VVA symptoms and 89.7% (among sexually active women; 87/97) about sexual dysfunction. Menopausal status did not affect VVA symptoms, while age was the only independent risk factor for sexual dysfunction. About 70% (74/107) of women reported a negative impact of disturbances on intimacy with their partner. A total of 63 women (58.9%) had never discussed their sexual problems and VVA condition with a physician. Lubricants were the only treatment prescribed, and 75% of women would welcome new therapies, even if experimental (62.9%). CONCLUSIONS In women with SSc, VVA symptoms and sexual dysfunction are highly prevalent, independently from menopause. In more than half of the investigated women with SSc, we found reluctance to talk about their sexual problems, despite being symptomatic. This should encourage physicians to investigate vulvovaginal and sexual health. SSc patients would welcome the advent of new treatment possibilities for their VVA and sexual complaints.
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Affiliation(s)
- Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (A.C.); (V.B.); (M.C.); (S.S.)
- Gynecological Department, Jeanne de Flandre Hospital, University Hospital of Lille, Avenue Eugène Avinée, 59037 Lille, France
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy;
| | - Arianna Casiraghi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (A.C.); (V.B.); (M.C.); (S.S.)
| | - Vittoria Benini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (A.C.); (V.B.); (M.C.); (S.S.)
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy;
| | - Maria Carmela Di Dedda
- Department of Obstetrics and Gynecology, ASST FBF-SACCO Macedonio Melloni Hospital, 20129 Milan, Italy;
| | - Carla Garbagnati
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Via Commenda 12, 20122 Milan, Italy;
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (A.C.); (V.B.); (M.C.); (S.S.)
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (A.C.); (V.B.); (M.C.); (S.S.)
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Padoa A, Braga A, Fligelman T, Athanasiou S, Phillips C, Salvatore S, Serati M. European Urogynaecological Association Position Statement: Pelvic Organ Prolapse Surgery. Urogynecology (Phila) 2023; 29:703-716. [PMID: 37490710 DOI: 10.1097/spv.0000000000001396] [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] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
| | | | | | - Stavros Athanasiou
- Urogynecology Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Phillips
- Basingstoke and North Hampshire Hospital, Urogynaecology, Basingstoke, Hampshire, United Kingdom
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, Scientific Institute, Milan, Italy
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Braga A, Serati M. New Advances in Female Pelvic Floor Dysfunction Management. Medicina (Kaunas) 2023; 59:1010. [PMID: 37374214 DOI: 10.3390/medicina59061010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Pelvic floor dysfunctions (PFDs), which include various disorders such as urinary and anal incontinence, pelvic organ prolapse, and sexual disorders, are widespread amongst females, so much so that they affect one fifth of adult women [...].
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy
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Braga A, Armengol-Profitós M, Pascua-Solé L, Vendrell X, Soler L, Serrano I, Villar-Garcia IJ, Pérez-Dieste V, Divins NJ, Llorca J. Bimetallic NiFe Nanoparticles Supported on CeO 2 as Catalysts for Methane Steam Reforming. ACS Appl Nano Mater 2023; 6:7173-7185. [PMID: 37205295 PMCID: PMC10186329 DOI: 10.1021/acsanm.3c00104] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/04/2023] [Indexed: 05/21/2023]
Abstract
Ni-Fe nanocatalysts supported on CeO2 have been prepared for the catalysis of methane steam reforming (MSR) aiming for coke-resistant noble metal-free catalysts. The catalysts have been synthesized by traditional incipient wetness impregnation as well as dry ball milling, a green and more sustainable preparation method. The impact of the synthesis method on the catalytic performance and the catalysts' nanostructure has been investigated. The influence of Fe addition has been addressed as well. The reducibility and the electronic and crystalline structure of Ni and Ni-Fe mono- and bimetallic catalysts have been characterized by temperature programmed reduction (H2-TPR), in situ synchrotron X-ray diffraction (SXRD), X-ray photoelectron spectroscopy (XPS), and Raman spectroscopy. Their catalytic activity was tested between 700 and 950 °C at 108 L gcat-1 h-1 and with the reactant flow varying between 54 and 415 L gcat-1 h-1 at 700 °C. Hydrogen production rates of 67 mol gmet-1 h-1 have been achieved. The performance of the ball-milled Fe0.1Ni0.9/CeO2 catalyst was similar to that of Ni/CeO2 at high temperatures, but Raman spectroscopy revealed a higher amount of highly defective carbon on the surface of Ni-Fe nanocatalysts. The reorganization of the surface under MSR of the ball-milled NiFe/CeO2 has been monitored by in situ near-ambient pressure XPS experiments, where a strong reorganization of the Ni-Fe nanoparticles with segregation of Fe toward the surface has been observed. Despite the catalytic activity being lower in the low-temperature regime, Fe addition for the milled nanocatalyst increased the coke resistance and could be an efficient alternative to industrial Ni/Al2O3 catalysts.
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Affiliation(s)
- Andrea Braga
- Institute
of Energy Technologies, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Department
of Chemical Engineering, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Barcelona
Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
| | - Marina Armengol-Profitós
- Institute
of Energy Technologies, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Department
of Chemical Engineering, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Barcelona
Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
| | - Laia Pascua-Solé
- Institute
of Energy Technologies, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Barcelona
Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
| | - Xavier Vendrell
- Institute
of Energy Technologies, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Department
of Chemical Engineering, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
| | - Lluís Soler
- Institute
of Energy Technologies, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Department
of Chemical Engineering, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Barcelona
Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
| | - Isabel Serrano
- Institute
of Energy Technologies, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
| | - Ignacio J. Villar-Garcia
- ALBA
Synchrotron Light Source, Carrer de la Llum 2-26, 08290 Cerdanyola del Vallès Barcelona, Spain
| | - Virginia Pérez-Dieste
- ALBA
Synchrotron Light Source, Carrer de la Llum 2-26, 08290 Cerdanyola del Vallès Barcelona, Spain
| | - Núria J. Divins
- Institute
of Energy Technologies, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Department
of Chemical Engineering, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Barcelona
Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
| | - Jordi Llorca
- Institute
of Energy Technologies, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Department
of Chemical Engineering, Universitat Politècnica
de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
- Barcelona
Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019 Barcelona, Spain
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Serati M, Braga A. Re: CO 2 Surgical Laser for Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial. Eur Urol 2023; 83:373. [PMID: 36604274 DOI: 10.1016/j.eururo.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
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Braga A, Serati M. Re: Single-incision Mini-slings for Stress Urinary Incontinence in Women. Eur Urol 2023; 83:372. [PMID: 36604275 DOI: 10.1016/j.eururo.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
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Serati M, Salvatore S, Torella M, Scancarello C, De Rosa A, Ruffolo AF, Caccia G, Ghezzi F, Papadia A, Baruch Y, Braga A. Hysteropexy and Anterior Vaginal Native Tissue Repair in Women with Anterior and Central Compartment Prolapse: A Long Term Follow-Up. J Clin Med 2023; 12:jcm12072548. [PMID: 37048632 PMCID: PMC10095252 DOI: 10.3390/jcm12072548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Although it is known that hysterectomy (HY) alone cannot resolve apical prolapse, vaginal hysterectomy (VH) remains the most common surgical procedure for this issue. In recent years, various procedures for uterine conservation have been proposed to avoid the surgical risks of HY. Furthermore, most women with symptomatic pelvic organ prolapse (POP) prefer uterine conservation in the absence of considerable benefit in uterine removal. In 2017, we proposed a new technique for hysteropexy and anterior vaginal native tissue repair (NTR) in women with cystocele and apical prolapse. The objective of this study is to assess the efficacy and safety of this new procedure after at least 5 years of follow-up. We included only patients with stage II or greater prolapse of the anterior vaginal wall and a concomitant stage II uterine prolapse in accordance with Pelvic Organ Prolapse Quantification (POP-Q) system. A Patient Global Impression of Improvement (PGI-I) score ≤ 2 in addition with the absence of POP symptoms was defined as subjective success. A descensus with a maximum point of less than −1 in any compartment was considered objective cure. A total of 102 patients who fulfilled the inclusion criteria were enrolled. At 60 months follow-up, 90 out of 102 patients (88%) were subjectively cured, whereas 88 out of the 102 (86%) patients were objectively cured. Subjective and objective cure rates persisted during the entire study period. Uni- and multivariate analysis of possible predictive factors associated with recurrence of prolapse showed that only a preoperative point C > 0 cm and BMI ≥ 25 kg/m2 were risk factors for failure. In conclusion, our study showed that hysteropexy with anterior vaginal native tissue repair may be an effective and safe option for the treatment of anterior vaginal prolapse and concomitant stage II uterine prolapse by at least 5 years of follow-up.
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Braga A, Martins S, Ferreira AR, Fernandes J, Vieira T, Fontes L, Coimbra I, Fernandes L, Paiva JA. Influence of Deep Sedation in Intensive Care Medicine Memories of Critical COVID-19 Survivors. J Intensive Care Med 2023:8850666231156782. [PMID: 36803155 PMCID: PMC9941006 DOI: 10.1177/08850666231156782] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Introduction: Critical care survivors sustain a variety of sequelae after intensive care medicine (ICM) admission, and the Coronavirus Disease 2019 (COVID-19) pandemic has added further challenges. Specifically, ICM memories play a significant role, and delusional memories are associated with poor outcomes post-discharge including a delayed return to work and sleep problems. Deep sedation has been associated with a greater risk of perceiving delusional memories, bringing a move toward lighter sedation. However, there are limited reports on post-ICM memories in COVID-19, and influence of deep sedation has not been fully defined. Therefore, we aimed to evaluate ICM-memory recall in COVID-19 survivors and their relation with deep sedation. Materials/Methods: Adult COVID-19 ICM survivors admitted to a Portuguese University Hospital between October 2020 and April 2021 (second/third "waves") were evaluated 1 to 2 months post-discharge using "ICU Memory Tool," to assess real, emotional, and delusional memories. Results: The study included 132 patients (67% male; median age = 62 years, Acute Physiology and Chronic Health Evaluation [APACHE]-II = 15, Simplified Acute Physiology Score [SAPS]-II = 35, ICM stay = 9 days). Approximately 42% received deep sedation (median duration = 19 days). Most participants reported real (87%) and emotional (77%) recalls, with lesser delusional memories (36.4%). Deeply sedated patients reported significantly fewer real memories (78.6% vs 93.4%, P = .012) and increased delusional memories (60.7% vs 18.4%, P < .001), with no difference in emotional memories (75% vs 80.4%, P = .468). In multivariate analysis, deep sedation had a significant, independent association with delusional memories, increasing their likelihood by a factor of approximately 6 (OR = 6.274; 95% confidence interval = 1.165-33.773, P = .032), without influencing real (P = .545) or emotional (P = .133) memories. Conclusions: This study contributes to a better understanding of the potential adverse effects of deep sedation on ICM memories in critical COVID-19 survivors, indicating a significant, independent association with the incidence of delusional recalls. Although further studies are needed to support these findings, they suggest that strategies targeted to minimize sedation should be favored, aiming to improve long-term recovery.
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Affiliation(s)
- A. Braga
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal,António José Falcão Peres Braga, Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - S. Martins
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A. R Ferreira
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - J. Fernandes
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - T. Vieira
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - L. Fontes
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - I. Coimbra
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - L. Fernandes
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal,Psychiatry Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - J. A Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal,Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Braga A, Barba M, Serati M, Soligo M, Li Marzi V, Finazzi Agrò E, Musco S, Caccia G, Castronovo F, Manodoro S, Frigerio M. Update on Italian-validated questionnaires for pelvic floor disorders. Minerva Obstet Gynecol 2023; 75:62-68. [PMID: 34328299 DOI: 10.23736/s2724-606x.21.04901-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Pelvic floor disorders (PFDs), which include urinary incontinence, pelvic organ prolapse, sexual dysfunction and gastrointestinal disorders, affect over 20% of the adult population. Prevalence may also be underestimated, since a certain portion of patients may be reluctant to talk to physicians about PFDs due to embarrassment. Consequently, there is a need for self-assessed diagnostic tools with the capability to screen population and collect clinical information. Symptom and quality of life (QoL) questionnaires - also identified as patient-reported outcomes (PROs) - have been developed with this purpose. Despite the large number of questionnaires available for the assessment of PFDs and QoL-related issues in the English language, few of them have been validated for the Italian language. The objective of this article is to update the list of Italian-validated PROs for PFDs along with practical information concerning literature references and suggestions on how to obtain every single questionnaire. EVIDENCE ACQUISITION PubMed/MEDLINE databases and websites were used to update the list of available Italian-validated questionnaires about PFDs. Once identified, the possibility to get a copy of the questionnaire was verified and steps to obtain it are reported in the tables. EVIDENCE SYNTHESIS Eight additional questionnaires validated into the Italian language, for diagnosis and overall management of common urinary, vaginal, sexual and bowel conditions, were retrieved. The complete list of PFDs PROS is reported in a modular format for consultation. CONCLUSIONS This format is intended to serve as a tool to promote appropriateness in PROs adoption while investigating PFDs in Italian patients.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland - .,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Mendrisio, Switzerland -
| | - Marta Barba
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Milano Bicocca University, Monza, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Marco Soligo
- Department of Obstetrics and Gynecology, Buzzi Hospital, Milan, Italy
| | - Vincenzo Li Marzi
- Department of Urology, AOU Careggi Hospital, University of Florence, Florence, Italy
| | - Enrico Finazzi Agrò
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy
| | - Stefania Musco
- Department of Urology, Careggi Hospital, Florence, Italy
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Fabiana Castronovo
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Stefano Manodoro
- Department of Obstetrics and Gynecology, San Paolo Hospital, Milan, Italy
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Milano Bicocca University, Monza, Italy
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Torella M, Marrapodi MM, Ronsini C, Ruffolo AF, Braga A, Frigerio M, Amabile E, Vastarella MG, Rossi F, Riemma G. Risk of Premature Ovarian Insufficiency after Human Papilloma Virus Vaccination: A PRISMA Systematic Review and Meta-Analysis of Current Evidence. Vaccines (Basel) 2023; 11:vaccines11010140. [PMID: 36679985 PMCID: PMC9866915 DOI: 10.3390/vaccines11010140] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
(1) Background: Premature ovarian insufficiency (POI) has been linked to human papilloma virus (HPV) vaccination in small case-reports. The aim of this meta-analysis was to evaluate the risk of POI after HPV vaccination. (2) Methods: Electronic searches in MEDLINE Scopus, LILACS, ClinicalTrials.gov, EMBASE, PROSPERO, Cochrane CENTRAL and other registries were searched from inception to September 2022. Inclusion criteria were cohort studies of female children or adolescents vaccinated with quadrivalent (4vHPV), bivalent (2vHPV) or 9-valent (9vHPV) vaccine and compared to unvaccinated, other HPV vaccine, or vaccinated with other childhood vaccine girls. Primary outcome was risk of POI after vaccination. (3) Results: Four studies, including 1,253,758 patients, were included. Overall, there was no significant risk for POI between 4vHPV and controls (unvaccinated or other vaccines) (RR 0.47 (95% CI 0.14 to 1.59) I2 = 75%), or unvaccinated only controls (RR 0.75 (95% CI 0.22 to 2.49) I2 = 26%). One study reported a significant reduction of POI risk for 4vHPV relative to the other childhood vaccinations (RR 0.03 (95% CI 0.00 to 0.21)); meanwhile, one study showed no increased risk with 4vHPV relative to 2vHPV and 9vHPV (RR 0.93 (95% CI 0.33 to 2.64)). (4) Conclusions: 4vHPV vaccination does not seem to increase risk of POI relative to unvaccinated people or other childhood vaccines. No difference was seen with 4vHPV vaccine relative to 2vHPV and 9vHPV. Moreover, the risk of POI after HPV vaccination is relatable to worldwide incidence, giving reassurance about safety.
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Affiliation(s)
- Marco Torella
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
- Correspondence:
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | | | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC, Beata Vergine Hospital, 6850 Mendrisio, Switzerland
| | | | - Emanuele Amabile
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Maria Giovanna Vastarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Francesca Rossi
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
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Gonçalves J, Menezes M, Antunes A, Braga A. Round trip without sleep – an information system for predicting sleep while driving and detecting disorder or chronic sleep deprivation. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.814] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Serati M, Giammò A, Carone R, Ammirati E, Gubbiotti M, Ruffolo A, Salvatore S, Scancarello C, Castronovo F, Caccia G, Braga A. Bulking agents for the treatment of recurrent stress urinary incontinence: a suitable option? Minerva Urol Nephrol 2022; 74:747-754. [PMID: 33949184 DOI: 10.23736/s2724-6051.21.04269-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The management of recurrent female stress urinary incontinence (SUI) still needs worldwide standardization. Few data on the role of urethral bulking agents (UBA) for the treatment of recurrent stress urinary incontinence exist. The aim of this study is to assess the efficacy and safety of urethral bulking agents for the treatment of recurrent SUI. METHODS A multicenter, prospective study was conducted in four tertiary referral centers in two countries. All consecutive women with urodynamically-proven recurrent SUI, and with a history of previous failed anti-incontinence surgical procedure (mid-urethral sling or single incision sling), treated by UBAs were included. We evaluated only patients who completed at least a 3-year follow-up. Data regarding subjective outcomes (International Consultation on Incontinence Questionnaire-Short Form, Patient Global Impression of Improvement, Urogenital Distress Inventory score and patient satisfaction score), objective cure (stress test) rates, and adverse events were collected during follow-up. Univariable and multivariable analyses was performed to investigate outcomes. RESULTS Forty-seven consecutive patients were enrolled. At 3-year follow-up, all women were available for the evaluation. At 3 years after surgery, 38 of 47 patients (81%) declared themselves cured. Similarly, at 3-year evaluation, 39 of 47 patients (83%) were objectively cured. Only five patients (10.6%) required re-operation for UBA failure. The urodynamic diagnosis of preoperative detrusor overactivity and the PDet Max filling phase ≥15 cmH<inf>2</inf>O (hazard ratio: 2.74; 95% CI, 1.64-10.7; P=0.009 and 1.62; 95% CI, 1.11-3.42; P=0.04, respectively) were the only predictors of failure. Only four complications were reported (8.5%). CONCLUSIONS The 3-year results of this study showed that bulking agents is an appropriately effective and safe option for the treatment of recurrent SUI. The presence of preoperative concomitant detrusor overactivity is associated with a significant decrease of the efficacy of this procedure.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.,European Urogynecological Association (EUGA), Piacenza, Italy
| | - Alessandro Giammò
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Roberto Carone
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Enrico Ammirati
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marilena Gubbiotti
- Department of Urology, San Donato Hospital, Arezzo, Italy.,InVita Research Center, Serafico Institute, Assisi, Perugia, Italy
| | - Alessandro Ruffolo
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Fabiana Castronovo
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland - .,Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
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Frigerio M, Barba M, Marino G, Volontè S, Melocchi T, De Vicari D, Torella M, Salvatore S, Braga A, Serati M, Manodoro S, Cola A. Coexistent Detrusor Overactivity-Underactivity in Patients with Pelvic Floor Disorders. Healthcare (Basel) 2022; 10:healthcare10091720. [PMID: 36141332 PMCID: PMC9498318 DOI: 10.3390/healthcare10091720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and Hypothesis: Pelvic floor disorders represent a series of conditions that share, in part, the same etiological mechanisms, so they tend to be concomitant. Recently, awareness of a new lower urinary tract clinical syndrome has risen, namely the coexisting overactive–underactive bladder (COUB). The etiopathogenetic process, prevalence, and related instrumental findings of COUB are not well-established. We aimed to evaluate the prevalence, clinical features, and urodynamic findings of patients with COUB in a large cohort of patients with pelvic floor disorders. Methods: A cohort of 2092 women was retrospectively analyzed. A clinical interview, urogenital examination, and urodynamic assessment were performed by a trained urogynecologist. Based on baseline symptoms, patients were divided into COUB and non-COUB groups, and the degree of concordance between COUB and urodynamic findings, and other parameters related to the clinical aspects of these patients were measured and analyzed. Results: 18.8% of patients were classified as COUB. The association between COUB and patients with coexisting detrusor overactivity–underactivity (DOU) was statistically significant and there were substantial similarities in terms of population characteristics, symptoms, and urodynamic findings. Conclusions: Our study showed a high prevalence of COUB, and a link between this clinical syndrome and DOU was demonstrated. They showed substantial similarities in terms of clinical and urodynamics correlates. Based on these findings, we do think that urodynamic tests can be useful to improve knowledge on COUB and may be of help in the management of this condition.
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Affiliation(s)
- Matteo Frigerio
- San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-2339434; Fax: +39-2339433
| | - Marta Barba
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Giuseppe Marino
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Silvia Volontè
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Tomaso Melocchi
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Desirèe De Vicari
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Marco Torella
- Department of Woman, Luigi Vanvitelli University of Campania, 80138 Naples, Italy
| | - Stefano Salvatore
- Obstetrics and Gynaecology Department, Vita-Salute University and IRCCS San Raffaele Hospital, 20133 Milan, Italy
| | - Andrea Braga
- EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland
| | - Maurizio Serati
- Del Ponte Hospital, University of Insubria, 21100 Varese, Italy
| | - Stefano Manodoro
- ASST Santi Paolo e Carlo, San Paolo Hospital, 20132 Milano, Italy
| | - Alice Cola
- San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
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21
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Divins NJ, Braga A, Vendrell X, Serrano I, Garcia X, Soler L, Lucentini I, Danielis M, Mussio A, Colussi S, Villar-Garcia IJ, Escudero C, Trovarelli A, Llorca J. Investigation of the evolution of Pd-Pt supported on ceria for dry and wet methane oxidation. Nat Commun 2022; 13:5080. [PMID: 36038555 PMCID: PMC9424231 DOI: 10.1038/s41467-022-32765-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022] Open
Abstract
Efficiently treating methane emissions in transportation remains a challenge. Here, we investigate palladium and platinum mono- and bimetallic ceria-supported catalysts synthesized by mechanical milling and by traditional impregnation for methane total oxidation under dry and wet conditions, reproducing those present in the exhaust of natural gas vehicles. By applying a toolkit of in situ synchrotron techniques (X-ray diffraction, X-ray absorption and ambient pressure photoelectron spectroscopies), together with transmission electron microscopy, we show that the synthesis method greatly influences the interaction and structure at the nanoscale. Our results reveal that the components of milled catalysts have a higher ability to transform metallic Pd into Pd oxide species strongly interacting with the support, and achieve a modulated PdO/Pd ratio than traditionally-synthesized catalysts. We demonstrate that the unique structures attained by milling are key for the catalytic activity and correlate with higher methane conversion and longer stability in the wet feed.
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Affiliation(s)
- Núria J Divins
- Institute of Energy Technologies, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain. .,Department of Chemical Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain. .,Barcelona Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain.
| | - Andrea Braga
- Institute of Energy Technologies, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain.,Department of Chemical Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain
| | - Xavier Vendrell
- Institute of Energy Technologies, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain.,Department of Chemical Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain
| | - Isabel Serrano
- Institute of Energy Technologies, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain
| | - Xènia Garcia
- Institute of Energy Technologies, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain.,Department of Chemical Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain.,Barcelona Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain
| | - Lluís Soler
- Institute of Energy Technologies, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain.,Department of Chemical Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain.,Barcelona Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain
| | - Ilaria Lucentini
- Institute of Energy Technologies, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain.,Department of Chemical Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain
| | - Maila Danielis
- Dipartimento Politecnico, Università di Udine, and INSTM, Via del Cotonificio 108, 33100, Udine, Italy
| | - Andrea Mussio
- Dipartimento Politecnico, Università di Udine, and INSTM, Via del Cotonificio 108, 33100, Udine, Italy
| | - Sara Colussi
- Dipartimento Politecnico, Università di Udine, and INSTM, Via del Cotonificio 108, 33100, Udine, Italy
| | - Ignacio J Villar-Garcia
- ALBA Synchrotron Light Source, Carrer de la Llum 2-26, 08290, Cerdanyola del Vallès, Barcelona, Spain
| | - Carlos Escudero
- ALBA Synchrotron Light Source, Carrer de la Llum 2-26, 08290, Cerdanyola del Vallès, Barcelona, Spain
| | - Alessandro Trovarelli
- Dipartimento Politecnico, Università di Udine, and INSTM, Via del Cotonificio 108, 33100, Udine, Italy
| | - Jordi Llorca
- Institute of Energy Technologies, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain. .,Department of Chemical Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain. .,Barcelona Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, EEBE, Eduard Maristany 10-14, 08019, Barcelona, Spain.
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22
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Mosca L, Riemma G, Braga A, Frigerio M, Ruffolo AF, Dominoni M, Munno GM, Uccella S, Serati M, Raffone A, Salvatore S, Torella M. Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58080981. [PMID: 35893096 PMCID: PMC9331312 DOI: 10.3390/medicina58080981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Female sexual dysfunctions represent a real widespread problem, usually faced from a psychological point of view; however, millions of women worldwide are impacted by pelvic floor dysfunction, personal shame and social taboos, however, continue to inhibit free conversation on the subject. Women’s quality of life is considerably improved by screening, diagnosing, and controlling urogenital and sexual issues. This review aims to provide a critical perspective of urogenital conditions and common disturbances in female sexual function associated with these issues. It also includes a discussion of postpartum pelvic dysfunction.
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Affiliation(s)
- Lavinia Mosca
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, 20900 Monza, Italy;
| | - Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Gaetano Maria Munno
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37100 Verona, Italy;
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy;
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy;
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80100 Naples, Italy
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Marco Torella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
- Correspondence:
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23
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Serati M, Braga A, Salvatore S, Torella M, Di Dedda MC, Scancarello C, Cimmino C, De Rosa A, Frigerio M, Candiani M, Ruffolo AF. Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures. Medicina (Kaunas) 2022; 58:medicina58060775. [PMID: 35744038 PMCID: PMC9227870 DOI: 10.3390/medicina58060775] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
To avoid complications related to mid-urethral slings (MUS), alternative procedures to treat stress urinary incontinence (SUI), such as urethral bulking agents (UBAs) have been adopted. The aim of this review is to narratively report the efficacy and safety of UBAs for SUI treatment. For this review, research from PubMed and EMBASE was performed to evaluate relevant studies that were undertaken from January 2012 to January 2022. Nineteen prospective studies were included. Several definitions of subjective and objective success were adopted. At a follow-up of <24 months, significant improvement was widely observed, even if with a heterogeneous rate of success between 32.7−90%, and a reinjection rate of 8.3−77.3%. Compared with other procedures, MUS resulted as significantly superior to UBAs but was balanced by a higher complication rate. Acute urinary retention, urinary tract infection and de novo urgency, and other complications, such as injection site rupture, urethral erosion and particle migration have been described after UBAs. SUI after UBAs treatment resulted in improvements in all studies and can be considered a safe and effective option to treat SUI. However, homogenous and longer-term data lack, limiting general recommendations. Thus, larger RCTs evaluating long-term effects are required.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
- Correspondence: ; Tel.: +39-0332-299-309
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC—Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
| | - Marco Torella
- Department of Obstetrics and Gynecology, Second Faculty, 80129 Naples, Italy;
| | - Maria Carmela Di Dedda
- Department of Obstetrics and Gynecology, ASST FBF-SACCO Macedonio Melloni Hospital, 20129 Milano, Italy;
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | - Chiara Cimmino
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | - Andrea De Rosa
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | | | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
| | - Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
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Silva B, Martins S, Ferreira A, Fernandes J, Vieira T, Fontes L, Reis N, Braga A, Coimbra I, Paiva J, Fernandes L. Anxiety symptoms in critically ill COVID-19 survivors and its association with post-discharge health concerns. Eur Psychiatry 2022. [PMCID: PMC9567653 DOI: 10.1192/j.eurpsy.2022.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Evidence suggest that critically ill COVID-19 patients are at higher risk of developing anxiety symptoms, which may be related to or exacerbated by patients concerns regarding their health status and recovery. Objectives To assess anxiety symptoms in critically ill COVID-19 survivors, 1-2 months after hospital discharge and to analyze its association with concerns reported by patients regarding their own health status and recovery. Methods In the framework of MAPA prospective research, this preliminary study included COVID-19 patients admitted in the Intensive Care Medicine Department (ICMD) of a University Hospital. Patients were excluded if they had an ICMD length of stay (LoS) ≤24h, terminal illness, major auditory impairment or inability to communicate at the evaluation time. Participants were assessed at a scheduled telephone follow-up appointment, with Generalized Anxiety Disorder Scale (GAD-7). Additional questions were asked to assess the survivors’ post-discharge concerns regarding discrimination against for COVID-19, infection of a family member, re-infection or sequelae related to COVID-19. Results Eighty-three patients were included (median age=63 years; 63% male) and 24% had anxiety symptoms. Anxiety scores were higher in survivors who reported being afraid of being discriminated against for COVID-19 (30% vs 10%; p=0.034), being re-infected (100% vs 79%; p=0.032) and having sequelae (94% vs 44%; p<0.001). Conclusions These findings revealed that anxiety is common in COVID-19 survivors and is associated with post-discharge patients concerns that may limit patient daily living. This study emphasizes the importance of psychological assessment and follow-up of the COVID-19 survivors, in order to support these patients recovery. Disclosure No significant relationships.
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Martins S, Fontes L, Ferreira A, Fernandes J, Vieira T, Reis N, Braga A, Coimbra I, Paiva J, Fernandes L. Depressive symptoms and health-related quality of life in critical COVID-19 survivors: Preliminary results of 1-year follow-up. Eur Psychiatry 2022. [PMCID: PMC9563347 DOI: 10.1192/j.eurpsy.2022.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction A higher risk of mental health consequences in critical COVID-19 patients is expected due to several reasons, including prolonged mechanical ventilation with exposure to high sedation. In this context, post-discharge depression has been reported in previous COVID-19 studies, with a profound impact on patients’ health-related quality of life (HRQoL). Objectives To identify depressive symptoms in COVID-19 survivors 1-year after hospital discharge and to analyse its association with HRQoL. Methods As part of the longitudinal MAPA project, this study enrolled critical COVID-19 patients admitted in the Intensive Care Medicine Department of a University Hospital (March-May 2020). Participants were assessed through telephone by an intensive care nurse and a psychologist, with the Patient Health Questionnaire (PHQ-9) (depressive symptoms), EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and EQ-Visual Analogue Scale (EQ-VAS) (global health status patient record). Results A sample of 55 survivors (median age=66 years; 69% males) were included, with 20% showing depressive symptoms. Pain/discomfort (67%) and anxiety/depression (67%) were the most EQ-5D-5L domains reported. Survivors scoring for depression had more problems in all HRQoL areas (mobility:91%vs.48%, p=0.015; self-care:64%vs.27%, p=0.035; usual activities:91%vs.50%, p=0.017; pain/discomfort:100%vs.59%, p=0.010; anxiety/depression:100%vs.59%, p=0.010). Moreover, they had a lower EQ-VAS median, corresponding a worse self-perception of health status (50vs.80, p=0.010). Conclusions Even after 1-year, a significant proportion of survivors presented depressive symptoms with repercussions in all HRQoL dimensions and association with worse self-perception of global quality of life. Taking this in mind, early screening and treatment of depression in COVID-19 survivors will be crucial, minimizing its impact on quality of life. Disclosure No significant relationships.
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Chorão L, Martins S, Ferreira A, Fernandes J, Vieira T, Fontes L, Reis N, Braga A, Coimbra I, Paiva J, Fernandes L. Delirium and health-related quality of life in severe COVID-19 survivors. Eur Psychiatry 2022. [PMCID: PMC9562393 DOI: 10.1192/j.eurpsy.2022.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Severe COVID-19 survivors experience long-term neuropsychiatric morbidity, particularly those who developed delirium, with a negative impact on health-related quality of life (HRQoL). Objectives To identify the cases of delirium in severe COVID-19 patients and to describe its association with post-hospital discharge HRQoL. Methods In the context of the longitudinal MAPA project, we included adult patients (≥ 18 years old) admitted with COVID-19 to the Intensive Care Medicine Department (ICMD) of a Portuguese University Hospital (October 2020-April 2021). Exclusion criteria were: ICMD length of stay ≤24h, terminal illness, major auditory loss, or inability to communicate at the time of assessment. Delirium during ICMD stay was ascertained based on patients’ clinical records. HRQoL was evaluated using the 5-Level EQ-5D questionnaire (EQ-5D-5L), at a scheduled telephone follow-up appointment on average 1-2 months after hospital discharge. Results Overall, 124 patients were included with a median age of 62 (range: 24-86) years, being mostly male (65%). About 19% had delirium, 42% were deeply sedated and 43% required invasive mechanical ventilation. Most survivors reported problems on the EQ-5D-5L domains: usual activities (85%), mobility (73%) and anxiety/depression (65%). Patients with delirium reported more pain/discomfort (75%vs46%; p=0.011) and considerably anxiety/depression (83%vs60%; p=0.032). Conclusions These findings pointed that COVID-19 patients who experienced delirium reported worse HRQoL, regarding pain/discomfort and anxiety/depression. This study highlights the importance of not only prevention but also early screening of delirium during hospital stay, as well as the crucial role of the timely interventions at discharge, in order to minimize delirium long-term impacts. Disclosure No significant relationships.
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Silva J, Martins S, Ferreira A, Fernandes J, Vieira T, Fontes L, Reis N, Braga A, Coimbra I, Paiva J, Fernandes L. Depression and health-related quality of life in critical COVID-19 survivors. Eur Psychiatry 2022. [PMCID: PMC9566138 DOI: 10.1192/j.eurpsy.2022.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Long-term neuropsychiatric consequences of critical illness are well known. Therefore, it is expected that critical COVID-19 patients might also present several psychiatric symptoms such as depression, with inevitable negative effect on health-related quality of life (HRQoL), commonly used as an indicator of illness and treatment impact. Objectives To identify depressive symptoms in critical COVID-19 survivors and to examine its association with HRQoL domains. Methods This preliminary study involved critical COVID-19 patients admitted into the Intensive Care Medicine Department (ICMD) of a University Hospital, between October and December of 2020. Patients with an ICMD length of stay (LoS)≤24h, terminal illness, major auditory loss, or inability to communicate at the follow-up time were excluded. From 1-2 months after discharge, all participants were evaluated by telephone at follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EuroQol 5-dimension 5-level EQ-5D-5L (HRQoL). This study is part of the longitudinal MAPA project. Results Eighty-three patients were included with a median age of 63 years (range: 31-86) and the majority were male (63%). The most reported problems on EQ-5D-5L domains were usual activities (82%) and mobility (76%). About 27% presented depressive symptoms, and with more problems of self-care (68%vs41%; p=0.029), pain/discomfort (86%vs49%; p=0.002), and anxiety/depression (96%vs54%; p<0.001). Conclusions These preliminary results are in line in previous studies in critical COVID-19 survivors, with depression being associated with worse HRQoL. Bearing this in mind, follow-up approaches with an early screening and treatment of these psychiatric symptoms will be fundamental to optimize the recovery of these patients. Disclosure No significant relationships.
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Braga A, Caccia G, Papadia A, Treglia G, Castronovo F, Salvatore S, Torella M, Ghezzi F, Serati M. Urethral bulking agents for the treatment of recurrent stress urinary incontinence: A systematic review and meta-analysis. Maturitas 2022; 163:28-37. [PMID: 35679770 DOI: 10.1016/j.maturitas.2022.05.007] [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: 03/10/2022] [Revised: 04/30/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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Serati M, Braga A, Rosier PFWM, de Wachter S, Uren A, Finazzi-Agrò E. Acceptability and perceived value of urodynamics from the patient perspective: A narrative review. Neurourol Urodyn 2022; 41:1065-1073. [PMID: 35419867 PMCID: PMC9322284 DOI: 10.1002/nau.24932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/12/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022]
Abstract
Background The value and application of urodynamic evaluation (UDS) have been a controversial topic in recent years. Gaining robust data on the patient viewpoint in this area is important since, even when UDS findings do not change the management plan, the objective diagnostic information gained from UDS may be valued by patients. Moreover, insights from UDS may empower treating physicians to counsel patients more effectively and manage their expectations regarding treatment outcomes. Objective This expert narrative review aims to analyze the findings of published studies in this area, looking at two topics in turn: (a) the tolerability and acceptability of the UDS procedure itself from the patient perspective and (b) patient perceptions of the clinical value of insights provided by UDS. Design, Setting, Participants, and Outcome Measurements An evidence assessment was conducted using selected articles from the literature reporting data on patients' perspectives on the tolerability, acceptability, utility, and value of the urodynamic investigation. Results and Limitations Although pain, discomfort, and infection risks are frequently used as a rationale to skip UDS when initial management fails, there is good evidence that, from the patients' perspective, the procedure is very well tolerated in most cases. There are only a few articles available that assess patient perceptions of the usefulness of UDS, but those that do exist appear to demonstrate that the insights gained from UDS are widely welcomed by patients in the interest of receiving a more tailored and personalized treatment approach. Conclusion From the patient perspective, UDS appears to be a well‐accepted and well‐tolerated diagnostic tool in patients with lower urinary tract symptoms, particularly when an appropriate explanation is provided before the examination. Our review also highlights that patients value the objective information provided by UDS and that this outweighs the temporary invasiveness of the test. This information is particularly relevant in light of the relative lack of evidence in the literature about patient expectations of specialist care in functional urology, which may have hindered progress with quality of care.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Peter F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan de Wachter
- Department of Urology, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Alan Uren
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Enrico Finazzi-Agrò
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
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30
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Frigerio M, Barba M, Cola A, Braga A, Celardo A, Munno GM, Schettino MT, Vagnetti P, De Simone F, Di Lucia A, Grassini G, Torella M. Quality of Life, Psychological Wellbeing, and Sexuality in Women with Urinary Incontinence—Where Are We Now: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58040525. [PMID: 35454364 PMCID: PMC9025831 DOI: 10.3390/medicina58040525] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Urinary incontinence (UI) is a very common condition, negatively affecting social, occupational, domestic, and psychophysical wellbeing. In particular, a peculiar and detrimental effect of UI has been described concerning sexual function. However, the impact of UI on quality of life is not fully understood yet, and further investigation into this issue is warranted. With this narrative review, we aimed to report the current evidence from recent literature regarding the quality of life and psychological wellbeing in patients with urinary incontinence, with a special focus on sexual function and its evolution after UI treatment. There is strong evidence that urinary incontinence—in its different forms, including stress urinary incontinence, urge urinary incontinence, mixed urinary incontinence, and coital urinary incontinence—negatively affects female sexual function. Treatments aimed to cure urinary incontinence—including pelvic floor muscles training, medications, and surgery—seem to improve quality of life by recovering, at least in part, sexual function. In conclusion, there is a substantial association between involuntary urinary loss and sex life quality. However, few studies are available and more evidence is needed before consistent conclusions can be made.
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Affiliation(s)
- Matteo Frigerio
- Gynecology Department, San Gerardo Hospital, Milano Bicocca University, ASST Monza—Via Pergolesi 33, 20900 Monza, Italy; (M.B.); (A.C.)
- Correspondence: ; Tel.: +39-039-233-9434
| | - Marta Barba
- Gynecology Department, San Gerardo Hospital, Milano Bicocca University, ASST Monza—Via Pergolesi 33, 20900 Monza, Italy; (M.B.); (A.C.)
| | - Alice Cola
- Gynecology Department, San Gerardo Hospital, Milano Bicocca University, ASST Monza—Via Pergolesi 33, 20900 Monza, Italy; (M.B.); (A.C.)
| | - Andrea Braga
- Ospedale Regionale di Mendrisio Beata Vergine, 6850 Mendrisio, Switzerland;
| | - Angela Celardo
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Gaetano Maria Munno
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Maria Teresa Schettino
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Primo Vagnetti
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Fulvio De Simone
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Alessandra Di Lucia
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Giulia Grassini
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Marco Torella
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
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Ruffolo AF, Braga A, Torella M, Frigerio M, Cimmino C, De Rosa A, Sorice P, Castronovo F, Salvatore S, Serati M. Vaginal Laser Therapy for Female Stress Urinary Incontinence: New Solutions for a Well-Known Issue. A Concise Review. Medicina (B Aires) 2022; 58:medicina58040512. [PMID: 35454351 PMCID: PMC9028572 DOI: 10.3390/medicina58040512] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/25/2022] [Accepted: 04/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: Insufficient connective urethra and bladder support related to childbirth and menopausal estrogen decrease leads to stress urinary incontinence (SUI). The aim of this review is to narratively report the efficacy and safety of new mini-invasive solutions for SUI treatment as laser energy devices, in particular, the microablative fractional carbon dioxide laser and the non-ablative Erbium-YAG laser. Materials and Methods: For this narrative review, a search of literature from PubMed and EMBASE was performed to evaluate the relevant studies and was limited to English language articles, published from January 2015 to February 2022. Results: A significant subjective improvement, assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) was reported at the 6-month follow up, with a cure rate ranged from 21% to 38%. A reduction of effect was evidenced between 6 and 24–36 months. Additionally, the 1-h pad weight test evidence a significant objective improvement at the 2–6-month follow up. Conclusions: SUI after vaginal laser therapy resulted statistically improved in almost all studies at short-term follow up, resulting a safe and feasible option in mild SUI. However, cure rates were low, longer-term data actually lacks and the high heterogeneity of methods limits the general recommendations. Larger RCTs evaluating long-term effects are required.
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Affiliation(s)
- Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (A.B.); (F.C.)
| | - Marco Torella
- Department of Obstetrics and Gynecology, Second Faculty, 80100 Naples, Italy;
| | | | - Chiara Cimmino
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
| | - Andrea De Rosa
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
| | - Paola Sorice
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
| | - Fabiana Castronovo
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (A.B.); (F.C.)
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
- Correspondence: ; Tel.: +39-03-3229-9309
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Moreira C, Portela Dias J, Barros T, Vieira L, Buchner G, Braga A, Sousa Braga J. 138 Primary mediastinal large b cell lymphoma in pregnancy: How to deal with it? Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Braga A, Caccia G, Papadia A, Castronovo F, Salvatore S, Scancarello C, Torella M, Ghezzi F, Serati M. The subjective and objective very long-term outcomes of TVT in the COVID era: A 20-year follow-up. Int Urogynecol J 2022; 33:947-953. [PMID: 35230479 PMCID: PMC8886556 DOI: 10.1007/s00192-022-05094-9] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
Abstract
Introduction and hypothesis Few studies in literature have assessed the long-term durability and mesh-related complications of mid-urethral slings (MUSs). The aim of this study is to assess the efficacy and safety of retro-pubic tension-free vaginal tape (TVT) 20 years after implantation for the treatment of female stress urinary incontinence (SUI). Methods A prospective observational study was conducted in two urogynaecologic units in two countries. All the patients involved were consecutive women with urodynamically proven pure SUI treated by TVT. The patients underwent preoperative clinical and urodynamic evaluations. Subjective outcomes, objective outcomes and adverse events were recorded during the follow-up period. Results Fifty-two patients underwent a TVT surgical procedure. Twenty years after surgery, 32 out of 36 patients (88.8%) declared themselves cured (p = 0.98). Similarly, 33 out of these 36 patients (91.7%) were objectively cured (p = 0.98). No significant deterioration of subjective and objective cure rates was observed over time (p for trend 0.50 and 0.48). Fifteen of the 36 patients (41.6%) at the 20-year follow-up reported the onset of de novo overactive bladder (OAB) (p = 0.004). No significant vaginal bladder or urethral erosion or de novo dyspareunia was recorded and no patient required tape release or resection during this period. The cause of death of seven out of ten women who died in the last year of the follow-up period was coronavirus disease 19 (COVID 19). Conclusions The 20-year results of this study showed that TVT is a highly effective and safe option for the treatment of SUI. The impact of COVID 19 on the mortality rate of elderly women has drastically reduced the number of eligible patients for future evaluations in our region.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland. .,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Giorgio Caccia
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Andrea Papadia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Obstetrics and Gynaecology, EOC - Civico Hospital, Lugano, Switzerland
| | - Fabiana Castronovo
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Stefano Salvatore
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
| | - Marco Torella
- Department of Gyanecology, Obstetric and Reproductive Science, Second University of Naples, Naples, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
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Sousa M, Almeida A, Meneses T, Braga A, Braga J. 186 Does the cause of early preterm birth have an impact on neonatal outcomes? Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moreira C, Barros T, Braga A, Braga J. 656 Intra-hepatic cholestasis of pregnancy: treatment and obstetric outcomes. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Andrade A, Dias J, Castro L, Gonçalves D, Braga A, Vieira L, Braga J. 191 Giving birth with COVID-19. Eur J Obstet Gynecol Reprod Biol 2022. [PMCID: PMC8941274 DOI: 10.1016/j.ejogrb.2021.11.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barros T, Braga A, Correia A, Braga J. 147. Pregnancy in kidney transplantation: perinatal outcomes and impact on kidney function. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Braga A, Neves E, Guimarães J, Braga J, Vasconcelos C. Th17/Regulatory T cells ratio evolution: A prospective study in a group of healthy pregnant women. J Reprod Immunol 2021; 149:103468. [PMID: 35007917 DOI: 10.1016/j.jri.2021.103468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Abstract
During pregnancy, the maternal immune system is challenged to tolerate a semi-allogenic fetus. A shift toward a tolerogenic profile is essential to ensure a healthy fetal and placental development. One of the most important mechanisms involved in the maternal immune tolerance towards the fetal antigens is expressed in the activity of the regulatory T (Treg) and Th17 cells. The behavior and equilibrium of these two T lymphocyte populations were rarely studied in normal healthy pregnancies through the beginning of gestation to the postpartum period. We conducted a prospective longitudinal observational study where peripheral blood lymphocyte subsets were analyzed in each trimester of pregnancy and postpartum period in a group of healthy pregnant women. Our study observed a consistent reduction in peripheric Treg cell count through all pregnancy while the Th17 cell count remained stable. The Th17/Treg ratio increases significantly throughout pregnancy to the postpartum period. These changes could be justified by the migration of the immunotolerant Treg cells to the maternal decidua and lead to the establishment of a systemic pro-inflammatory profile by the end of pregnancy. This data could explain why systemic syndromes like preeclampsia develop in susceptible women during the second half of pregnancy or why many autoimmune disorders flourish in the first weeks postpartum.
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Affiliation(s)
- A Braga
- Obstetrics Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Oporto, Portugal; Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal.
| | - E Neves
- Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal; Immunology Department, Centro Hospitalar Universitário do Porto, Oporto, Portugal
| | - J Guimarães
- Immunology Department, Centro Hospitalar Universitário do Porto, Oporto, Portugal
| | - J Braga
- Obstetrics Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Oporto, Portugal; Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal
| | - C Vasconcelos
- Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal; Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Oporto, Portugal
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Iacovelli V, Serati M, Bianchi D, Braga A, Turbanti A, Agrò EF. Preoperative abdominal straining in uncomplicated stress urinary incontinence: is there a correlation with voiding dysfunction and de novo overactive bladder after mid-urethral sling procedures? Ther Adv Urol 2021; 13:17562872211058243. [PMID: 34868350 PMCID: PMC8637698 DOI: 10.1177/17562872211058243] [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: 08/06/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives: To evaluate the role of preoperative abdominal straining in predicting
de novo overactive bladder (OAB) and voiding
dysfunction in female patients undergoing suburethral taping by
trans-obturator approach (TVT-O) for uncomplicated stress urinary
incontinence (SUI). Methods: Data from patients who underwent TVT-O surgery for SUI were retrospectively
analyzed. Inclusion criteria included: history of pure SUI. Exclusion
criteria included previous surgery for urinary incontinence, pelvic
radiation, pelvic surgery within the last 3 months, and anterior or apical
pelvic organ prolapse (POP) ⩾ +1 cm. Voiding dysfunction has been defined
through symptoms and or urodynamics (UDS) signs. Accordingly, patients were
divided into group A and group B according to the presence of abdominal
straining during UDS. Patients were observed clinically and with UDS at a
3-year follow-up. Results: A total of 192 patients underwent TVT-O surgery for uncomplicated SUI.
Preoperative abdominal straining was identified in 60/192 patients (Group A:
31.2% vs Group B: 68.8%). Qmax was not different in the two
groups (Group A: 19.5 vs Group B: 20.5 mL/s,
p = 0.76). Demographics was similar for the two groups
regarding age, parity. At 3-year follow-up, voiding dysfunction was reported
in Group A: 9 and Group B: 8 patients (p = 0.056),
de novo OAB was significantly reported in Group A: 23
and Group B: 26 patients (p = 0.007). Conclusion: Preoperative abdominal straining was found to be related to a significant
incidence of de novo OAB. A significant correlation was not
assessed for postoperative voiding dysfunction. Further studies may better
define the impact of preoperative abdominal straining.
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Affiliation(s)
- Valerio Iacovelli
- Department of Surgical Sciences, Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, University of Rome Tor Vergata, Via Aurelia 275, 00165 Rome, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Daniele Bianchi
- Department of Surgical Sciences, Urology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | | | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Urology Unit, University of Rome Tor Vergata, Rome, Italy
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Balzarro M, Rubilotta E, Mancini V, Serati M, Gubbiotti M, Braga A, Saleh O, Torrazzina M, Malanowska E, Serni S, Carrieri G, Antonelli A, Marzi VL. Wound dehiscence prevalence and relationship with prosthetic material extrusion in women underwent anterior colpotomy. Ther Adv Urol 2021; 13:17562872211058246. [PMID: 34819996 PMCID: PMC8606916 DOI: 10.1177/17562872211058246] [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: 07/23/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022] Open
Abstract
Aim: To assess the prevalence of anterior vaginal wall dehiscence in women who
underwent anterior vaginal wall colpotomy for pelvic organ prolapse or
stress urinary incontinence and to evaluate the influence of suture
materials and techniques on wound dehiscence. Materials and Methods: This multicenter, prospective study enrolled naïve women for urogynecological
surgery affected by anterior vaginal wall defect or stress urinary
incontinence. Performed surgical procedures were anterior vaginal wall
repair (AVWR) with native tissue (N-AVWR) or polypropylene mesh (M-AVWR),
trans-obturator polypropylene in-out middle urethral sling (MUS). Used
suture materials were Vicryl 2-0, Vicryl Rapide 2-0, and Monocryl 3-0.
Suture techniques were running interlocking or interrupted. Follow-up was
performed daily during hospitalization and in outpatient clinic after 10–14,
30 days, and after 3 months. Results: A total of 1139 patients were enrolled. AVWR were 790: 89.1% N-AVWR, and
10.9% M-AVWR. Polypropylene MUS were 349. Women with prosthetic implantation
were 38.2%, while 61.8% had native tissue repair. Overall Vicryl was used in
53.9%, Vicryl Rapide in 37.4%, and Monocryl in 8.7%. Overall running
interlocking sutures were 66.5%, while interrupted were 33.5%. Overall wound
dehiscence prevalence was 0.9% (10/1139). Wound dehiscence rate of 0.6%
(5/790) was documented in AVWR: 0.3% (2/704) in N-AVWR, and 3.5% (3/86) in
M-AVWR. Among women underwent MUS, 1.4% (5/349) showed wound dehiscence. In
patients who underwent prosthetic surgery, the overall dehiscence prevalence
was 1.8% (8/435). A statistically significant higher rate of wound
dehiscence was found in women with implanted prosthetic materials. Discussion: We reported for the first time the prevalence of wound dehiscence in females
who underwent colpotomy for AVWR or MUS. Wound dehiscence occurrence was
low, but non-negligible. We found that this complication was poorly
associated to the suture methods and materials, while prosthetic material
represented a risk factor for wound healing.
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Affiliation(s)
- Matteo Balzarro
- Department of Urology, Azienda Ospedaliero Universitaria of Verona, University of Verona, Piazzale Stefani n1, 37126 Verona, Italy
| | - Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliero Universitaria of Verona, University of Verona, Verona, Italy
| | - Vito Mancini
- Section of Urology and Renal Transplantation, University of Foggia, Policlinico di Foggia, Foggia, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | | | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Omar Saleh
- Department of Surgery, Urology, Morgagni Pierantoni Hospital, Forli, Italy
| | - Marco Torrazzina
- Unità Operativa Complessa of Obstetrics and Gynecology, Magalini Hospital, Villafranca di Verona, Italy
| | - Ewelina Malanowska
- Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Sergio Serni
- Unit of Minimally Invasive, Robotic Urologic Surgery and Kidney Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Giuseppe Carrieri
- Section of Urology and Renal Transplantation, University of Foggia, Policlinico di Foggia, Foggia, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliero Universitaria of Verona, University of Verona, Verona, Italy
| | - Vincenzo Li Marzi
- Unit of Minimally Invasive, Robotic Urologic Surgery and Kidney Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
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Sacco R, Braga A, Disanto G, Digesu GA, Maino P, Koetsier E, Caccia G, Serati M, Renard J, Gobbi C, Zecca C. Effectiveness of percutaneous posterior tibial nerve stimulation for the management of bowel dysfunction in multiple sclerosis patients. Mult Scler 2020; 27:1577-1584. [PMID: 33179574 DOI: 10.1177/1352458520972267] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neurogenic bowel dysfunctions (NBDs) in the form of both fecal incontinence (FI) and functional constipation (FC) are frequent in multiple sclerosis (MS) patients and significantly affect their quality of life. Therapeutic options are limited. OBJECTIVE To investigate effectiveness of percutaneous posterior tibial nerve stimulation (PTNS) in MS patients suffering from FI and FC. METHODS Prevalence and severity of FI and FC were prospectively collected among MS patients undergoing 12 weeks of PTNS for neurogenic bladder. The Cleveland Clinic Fecal Incontinence Score (CCFIS) and the Rome III criteria were used to define FI and FC, respectively. Subjective treatment satisfaction was estimated using the Benefit Satisfaction and Willingness to Continue (BSWC) questionnaire. RESULTS A total of 60 patients undergoing PTNS suffered from NBDs (25 FI+/FC+, 5 FI+/FC-, 30 FI-/FC+). Median CCFIS decreased after PTNS from 12.0 (11.0-13.0) to 8.5 (7.0-11.0, p < 0.001), with particular improvements in liquid and flatal incontinence, pads' need, and lifestyle restrictions. Seven patients became FC free after PTNS and no patients developed FC during the study (p = 0.023). More than 50% of the patients were satisfied and willing to continue PTNS at study end. CONCLUSION PTNS represents a valid minimally invasive alternative treatment for MS patients suffering from NBDs.
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Affiliation(s)
- Rosaria Sacco
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Giulio Disanto
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | | | - Paolo Maino
- Anestesiologia, Ospedale Regionale di Lugano, Lugano, Switzerland/Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Eva Koetsier
- Anestesiologia, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Julien Renard
- Urology, Ospedale Regionale di Bellinzona e Valli-San Giovanni Bellinzona, Bellinzona, Switzerland
| | - Claudio Gobbi
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland/Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland/Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Braga A, Vasconcelos C, Braga J. Autoimmune hepatitis and pregnancy. Best Pract Res Clin Obstet Gynaecol 2020; 68:23-31. [DOI: 10.1016/j.bpobgyn.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/01/2020] [Accepted: 03/05/2020] [Indexed: 02/08/2023]
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Braga A, Serati M, Papadia A, Caccia G. Re: Letter to the editor: Update in native tissue vaginal vault prolapse repair. Int Urogynecol J 2020; 31:2695. [PMID: 32915246 DOI: 10.1007/s00192-020-04509-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Università della Svizzera Italiana, Via Turconi 23 CP 1652, 6850, Mendrisio, Switzerland.
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.,European Urogynaecological Association (EUGA), Varese, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, EOC-Civico Hospital, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Università della Svizzera Italiana, Via Turconi 23 CP 1652, 6850, Mendrisio, Switzerland
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Montanha D, Martins L, Braga A. Distribution of breast cancer and the relationship with contaminated areas in Brazil. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Breast cancer is a worldwide public health issue. The distribution of the disease presents different behavior depending on the region. In Brazil, for the triennium 2020/2022, approximately 66.28 per 100,000 new cases are expected each year, with the highest incidence in the southeast region 81.06 per 100,000. The region of this study has high mortality rates from the disease and several environmental contaminants classified as carcinogenic.
Methodology
A spatial and temporal ecological study of the breast cancer distribution in the municipalities of the Baixada Santista with secondary data from 2000 to 2011, in women 20 years or older. The cancer data of 3,233 cases were provided by the Oncocentro Foundation of São Paulo, of the contaminated areas were provided by the Technology of Environmental Sanitation Company, and the population at risk were provided by the State Data Analysis System. Standardized coefficients of annual breast cancer rates for each municipality, to characterize exposure, an indicator of contamination per municipality was constructed. Pearson's correlation was used to analyze breast cancer rates and environmental contamination rates. Cartographic sequencing to analyze the distribution and spatiotemporal evolution of outcome and exposure. Trend analysis used linear regression.
Results
The municipality of Santos presented the highest rates of the disease. Pearson's correlation was positive, with r = 0.7 (p = 0.036). Spatially, the most contaminated areas had the highest rates of breast cancer, except in one municipality. Trend analysis in eight of the nine municipalities in the region signaled an increased number of cases.
Conclusions
The study confirmed that environmental contamination interferes with the distribution of breast cancer and the temporal trend signaled an increase in the disease in eight of the nine municipalities in the region.
Key messages
Environmental Contamination. Breast Cancer.
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Affiliation(s)
- D Montanha
- Nursing, Centro Universitário Lusíada - UNILUS, Santos, Brazil
| | - L Martins
- Postgraduate Program, Universidade Católica de Santos, Santos, Brazil
| | - A Braga
- Postgraduate Program, Universidade Católica de Santos, Santos, Brazil
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Martins L, Fernandes J, Pamplona Y, Barbieri C, Vaz J, Braga A, Pereira L. Factors associated with high-risk pregnancy: role of environmental contaminants, Brazil. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The Região Metropolitana da Baixada Santista (RMBS) is considered as a region with the worst maternal and child mortality rates in the state of São Paulo, Brazil. Besides this, RMBS has the worst rates of environmental contamination. High-Risk Pregnancy is one of the factors that lead to a higher chance of morbidity and mortality of the mother and fetus binomial.
Objective
Evaluate the relationship between exposure to environmental contaminants and high-risk pregnancy.
Methodology
Case-control study, using a probabilistic sample composed of 402 pregnant women divided into with and without high-risk pregnancy. The instrument used was a self-administered questionnaire and secondary data on contaminated areas obtained from the Environmental Company of the State of São Paulo. Descriptive analysis, Chi-square test, univariate and multiple logistic regression analysis were performed. The participants were also georeferenced by place of residence.
Results
It was observed an association, by chi-square test between high-risk pregnancy and age over 35 years (p < 0.05), use of insecticide (p < 0.001), consumption of foods packed in plastics (p = 0.050) and manipulation with oil paint (p = 0.002). The final multiple logistic regression model demonstrated that those who live in contaminated areas are 2 times more likely to have a risk pregnancy (OR = 1.993; 95%CI: 1.02; 3.90), as well as identified as jointly important risk factors for pregnancy: working in health services (OR = 3.97 (95%CI: 1.00; 16.09)), use of insecticide (OR = 3.45 (95%CI: 1.66; 7.16)) and use of oil paint (OR = 6.96 (95%CI: 1.38; 35.09)).
Conclusions
Environmental contaminants play an important role in pregnancy, and mitigating measures are needed to improve the environment and reduce high-risk pregnancy in RMBS.
Key messages
Exposure to the environmental contaminants is an important rik factor in the pregnancy. The Região Metropolitana da Baixada Santista (RMBS) is considered as a region with the worst maternal and child mortality rates in the state of São Paulo, Brazil.
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Affiliation(s)
- L Martins
- Collective Health, Unisantos, São Paulo, Brazil
| | - J Fernandes
- Collective Health, Unisantos, São Paulo, Brazil
| | - Y Pamplona
- Collective Health, Unisantos, São Paulo, Brazil
| | - C Barbieri
- Collective Health, Unisantos, São Paulo, Brazil
| | - J Vaz
- Collective Health, Unisantos, São Paulo, Brazil
| | - A Braga
- Collective Health, Unisantos, São Paulo, Brazil
| | - L Pereira
- Collective Health, Unisantos, São Paulo, Brazil
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Manodoro S, Braga A, Barba M, Caccia G, Serati M, Frigerio M. Update in fertility-sparing native-tissue procedures for pelvic organ prolapse. Int Urogynecol J 2020; 31:2225-2231. [PMID: 32809111 DOI: 10.1007/s00192-020-04474-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
Uterine-sparing prolapse surgery has been gaining back popularity with clinicians and patients. Although both prosthetic and native-tissue surgery procedures are described, the latter is progressively regaining a central role in pelvic reconstructive surgery, owing to a lack of mesh-related complications. Available native-tissue procedures have different advantages and pitfalls, as well as different evidence profiles. Most of them offer anatomical and subjective outcomes comparable with those of hysterectomy-based procedures. Moreover, native-tissue procedures in young women desiring childbearing allow to avoid synthetic material implantation, which may lead to potentially serious complications during pregnancy. As a consequence, we do think that offering a reconstructive native-tissue procedure for uterine preservation (with the exception of the Manchester procedure) is the safest option in women wishing for pregnancy. Sacrospinous ligament hysteropexy and high uterosacral ligament hysteropexy may be considered first-line options in consideration of the higher level of evidence and lack of adverse obstetrical outcomes.
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Affiliation(s)
| | - Andrea Braga
- EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | | | | | | | - Matteo Frigerio
- San Gerardo University Hospital, Via Pergolesi 33, 20900, Monza, Italy.
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Soligo M, Torella M, Balzarro M, Matarazzo MG, Braga A, Serati M. An innovative device in the management of female urodynamic stress incontinence: a perception survey. Minerva Ginecol 2020; 72:219-228. [PMID: 33000935 DOI: 10.23736/s0026-4784.20.04675-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Urinary incontinence significantly affects daily life of suffering women. Minimally invasive solutions to cope with urine leakage would be of great interest. METHODS A survey to investigate efficacy and compliance of an innovative intravaginal device (Diveen®) to reduce the risk of urine leakage was performed in 5 Urogynecological Centers across Italy. Women with urodynamic diagnosis of stress incontinence, included mixed conditions, underwent the survey. RESULTS The device was effective (60%) independently from severity of Incontinence or the presence of concomitant detrusor overactivity (mixed forms) with a positive impact on quality of life in more than half of the women. Also compliance with the device was satisfactory (up to 73%). Clinically symptomatic prolapse and age >65 years are the only limiting factors in terms of efficacy and compliance, while the menopausal status would not seem to affect these aspects. CONCLUSIONS Despite global satisfactory outcomes, 46% of the surveyed women declare their propensity to use the device. This data deserves further investigation.
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Affiliation(s)
- Marco Soligo
- Unit of Urogynecology, Department of Woman, Mother, and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy -
| | - Marco Torella
- Department of Gynecology, Obstetric and Reproductive Science, Second University of Naples, Naples, Italy
| | - Matteo Balzarro
- Department of Urology, University Hospital of Verona, Verona, Italy
| | - Maria G Matarazzo
- Gynecological Clinic, University Polyclinic of Catania, Catania, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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Serati M, Cantaluppi S, Coluccia AC, Scancarello C, Cimmino C, Braga A, Salvatore S, Finazzi Agrò E, Ghezzi F. Is urodynamic evaluation able to change and improve the management of women with idiopathic overactive bladder? Minerva Urol Nephrol 2020; 73:823-830. [PMID: 32573171 DOI: 10.23736/s2724-6051.20.03801-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND For women with overactive bladder (OAB), current guidelines recommend the use of urodynamic studies (UDS) only in complicated cases. This study aimed to investigate whether UDS can also be helpful in uncomplicated cases. Specific aims of the study were: 1) to evaluate objective benefit and subjective patient satisfaction with tailored treatment based on the UDS diagnosis compared to the outcomes of the pharmacological treatment only based on the symptoms; 2) to investigate the correlation between symptoms and UDS findings in women with uncomplicated idiopathic OAB symptoms; 3) to assess the ability of UDS to modify management decisions in these patients. METHODS Women presenting to our clinic with a history of uncomplicated OAB symptoms for the past three months or more, and who completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), were considered for this study. We proposed UDS to all participants. In women who accepted UDS (group 1), management decisions were made on the basis of urodynamic findings and post-treatment evaluation was scheduled at three months. The outcomes of treatments in these patients were compared to the results in women who did not accept UDS and who received pharmacological treatment symptoms-based (group 2). Objective outcomes were based on completion of a 3-day micturition diary. Subjective outcomes were captured using the Overactive Bladder Questionnaire Short Form (OABq-SF), the Patient Global Impression of Improvement (PGI-I) scale, and a patient satisfaction scale. RESULTS A total of 680 women were enrolled in the study; 478 underwent UDS and 202, at the contrary, declined UDS. In 53.6% of cases, UDS led to modification of the proposed management approach. At the 3-month follow-up, the overall patient satisfaction rate in group 1 and group 2 was 77% and 65.8%, respectively (P=0.003). CONCLUSIONS We showed that OAB management tailored according to the UDS diagnosis results in higher subjective satisfaction if compared with a pharmacological treatment symptoms-based. Our study confirmed a lack of correlation between OAB symptoms and the urodynamically proven diagnosis of detrusor overactivity (DO). It also suggested that UDS can determine the underlying pathophysiology of every woman with OAB syndrome, whether complicated or uncomplicated, allowing treatment to be appropriately tailored with better results.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Simona Cantaluppi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Anna C Coluccia
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Chiara Cimmino
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Stefano Salvatore
- Unit of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy.,Unit of Urology, Tor Vergata University Hospital, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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Braga A, Serati M, Salvatore S, Torella M, Pasqualetti R, Papadia A, Caccia G. Update in native tissue vaginal vault prolapse repair. Int Urogynecol J 2020; 31:2003-2010. [PMID: 32556408 DOI: 10.1007/s00192-020-04368-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/25/2020] [Indexed: 02/03/2023]
Abstract
The lifetime risk of women for undergoing surgery for pelvic organ prolapse (POP) is estimated to be 11-19%, and 30% of these women will require subsequent reoperation over time. Following hysterectomy, 3.6 per 1,000 person-years need surgical correction of prolapse, and in two-thirds of these cases multi-compartment prolapse is present. In the last decades, vaginally synthetic meshes were widely used in pelvic reconstructive surgery. However, after the decision of the Food and Drug Administration in 2019 to stop selling all surgical mesh devices for transvaginal prolapse repair, native tissue (NT) vaginal repair seems to regain an important role in pelvic reconstructive surgery. In the literature, various surgical techniques have been described for apical repair, but the best surgical approach is still to be proven. This paper analyzes the current evidence from recent literature on NT vaginal vault prolapse (VVP) repair, with special focus on the safety and efficacy of the various vaginal techniques.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Via Turconi 23 CP 1652, 6850, Mendrisio, Switzerland.
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Torella
- Department of Obstetrics and Gynecology, Second Faculty, Naples, Italy
| | - Roberto Pasqualetti
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Via Turconi 23 CP 1652, 6850, Mendrisio, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, EOC-Civico Hospital, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Via Turconi 23 CP 1652, 6850, Mendrisio, Switzerland
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Marinheiro R, Neves JP, Morgado F, Carmo P, Cavaco D, Abecassis M, Madeira M, Magro P, Braga A, Marques M, Boshoff S, Calquinha J, Costa F, Carmo J, Adragao P. P1508A single center analysis of a 10-year period of lead removal. Europace 2020. [DOI: 10.1093/europace/euaa162.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The number of lead removal of cardiac implantable electronic devices (CIED) has increased in recent years. The recent European registry (ELECTRa) did not include all European centers and not all lead extractions are possible to be performed transvenously.
AIMS
We aim to analyze all lead extraction procedures (transvenous or open surgery) performed in our center and the short- and long-term follow-up of these patients (pts).
METHODS
We retrospectively reviewed all lead extractions performed from 2008 to 2017. We analyzed pts´ characteristics (personal history, cardiovascular risk factors, indication for device implantation, laboratory tests); indications for extraction; techniques used and personnel that participate in the procedure, complications peri- and post-procedural and short and long-term follow-up.
RESULTS
A total of 189 pts (330 leads) were included (mean 69 ± 14 years, 73% male). The follow-up was 54 (IQR 20-87) months. Median time after implant was 47 (IQR 19-98) months. Lead explant was performed in 30 patients (16%) and lead extraction (at least one lead implanted >1 year or a lead requiring assistance of specialized equipment) in 159 (84%). Indications for removal are presented in figure A. In those who were infected, isolation of the microorganism was possible in 35% and Staphylococcus aureus was the most common agent (51%). 101 procedures (53%) occurred in the operating room, while 89 (47%) were performed in the electrophysiology laboratory, but 47% of those with the participation of a surgeon. On the total, cardiac surgeons were responsible for 75% of the procedures. Removal was tried in 330 leads (98 atrium lead, 199 right ventricle lead (79 defibrillator lead) and 33 coronary sinus lead). Of those, 298 were completely removed, 14 were partially removed (<4cm of a lead remained in the patient body) and 18 were not removed (radiologic failure). On an individual patient basis, clinical success was achieved in 185 patients (97%). Techniques used in the 330 leads were distributed in figure B. Surgical approach was necessary in 14 pts due to unsuccessful transvenous removal (n = 3), large vegetation in the lead (n = 4), concomitant valvular endocarditis (n = 2), other indication for open surgery (n = 4) and complicated transvenous removal (n = 1). Complications occurred in 6 patients: 3 persistent infections, 1 stroke, 2 vessel rupture. Related-procedural mortality was 1.5% (n = 3). The long-term survival of pts who performed open heart surgery was not different from those who underwent transvenous lead removal (logrank, p = 0.27) (figure C).
CONCLUSION
Although being a low volume center (19 procedures/year) and including pts with transvenous and open surgery, lead removal was associated with a high success rate with low all cause complication and mortality rates. Emergent surgery due to acute complications was very rare (0.5%) and open heart surgery was mostly programmed and not associated with a worse outcome.
Abstract Figure.
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Affiliation(s)
| | - J P Neves
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - F Morgado
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - P Carmo
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - D Cavaco
- Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - M Madeira
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - P Magro
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - A Braga
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Marques
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - S Boshoff
- Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - F Costa
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - J Carmo
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - P Adragao
- Hospital de Santa Cruz, Carnaxide, Portugal
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