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Van Rest KLC, Gielen MJCAM, Warmerdam LM, Kowalik CR, Roovers JPWR, Zwaans WAR. Prediction of successful revision surgery for mesh-related complaints after inguinal hernia and pelvic organ prolapse repair. Hernia 2024; 28:401-410. [PMID: 36753034 PMCID: PMC10997688 DOI: 10.1007/s10029-023-02748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/22/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE With this retrospective case series, we aim to identify predictors for reduction of pain after mesh revision surgery in patients operated for inguinal hernia or pelvic organ prolapse with a polypropylene implant. Identifying these predictors may aid surgeons to counsel patients and select appropriate candidates for mesh revision surgery. METHODS Clinical records before and after mesh revision surgery from 221 patients with chronic postoperative inguinal pain (CPIP) and 59 patients with pain after pelvic organ prolapse (POP) surgery were collected at two experienced tertiary referral centers. Primary outcome was patient reported improvement of pain after revision surgery. A multivariable logistic regression model was used to specify predictors for pain reduction. RESULTS The multivariable logistic regression was performed for each patient group separately. Patients with CPIP had higher chances of improvement of pain when time between mesh placement and mesh revision surgery was longer, with an OR of 1.19 per year. A turning point in chances of risks and benefits was demonstrated at 70 months, with improved outcomes for patients with revision surgery ≥ 70 months (OR 2.86). For POP patients, no statistically significant predictors for reduction of pain after (partial) removal surgery could be identified. CONCLUSION A longer duration of at least 70 months between implantation of inguinal mesh and revision surgery seems to give a higher chance on improvement of pain. Caregivers should not avoid surgery based on a longer duration of symptoms when an association between symptoms and the location of the mesh is found.
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Affiliation(s)
- K L C Van Rest
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - M J C A M Gielen
- Department of Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands
| | | | - C R Kowalik
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Bergman Clinics Vrouw, Amsterdam, The Netherlands
- Research Consortium Mesh, Utrecht, The Netherlands
| | - J P W R Roovers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Bergman Clinics Vrouw, Amsterdam, The Netherlands
- Research Consortium Mesh, Utrecht, The Netherlands
| | - W A R Zwaans
- Department of Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands
- Research Consortium Mesh, Utrecht, The Netherlands
- SolviMáx, Center of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC+, Maastricht, The Netherlands
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Latul YP, Ince C, van Trommel NE, van den Brandhof-van den Berg A, Roovers JPWR, Kastelein AW. Handheld vital microscopy for the identification of microcirculatory alterations in cervical intraepithelial neoplasia and cervical cancer. Microvasc Res 2024; 151:104608. [PMID: 37690508 DOI: 10.1016/j.mvr.2023.104608] [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: 08/07/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Ninety percent of cervical cancer (CC) diagnoses and deaths occur in low and middle-income countries (LMICs). Especially in these countries, where human and material resources are limited, there is a need for real-time screening methods that enable immediate treatment decisions (i.e., 'see and treat'). OBJECTIVE To evaluate whether handheld vital microscopy (HVM) enables real-time detection of microvascular alterations associated with cervical intraepithelial neoplasia (CIN) and CC. METHODS A cross-sectional study was conducted in an oncologic hospital and outpatient clinic, and included ten healthy controls, ten women with CIN, and ten women with CC. The microvasculature was assessed in four quadrants of the uterine cervix using HVM. The primary outcome was the presence of abnormal angioarchitecture (AA). Secondary outcomes included capillary loop density (CD), total vessel density (TVD), functional capillary density (FCD), and the proportion of perfused vessels (PPV). RESULTS 198 image sequences of the cervical microvasculature were recorded. Compared to healthy controls, significantly more abnormal image sequences were observed in women with high-grade CIN (11 % vs. 44 %, P < 0.001) and women with CC (11 % vs. 69 %, P < 0.001). TVD, FCD, and PPV were lower in women with CIN and CC. CONCLUSIONS HVM enables easy, real-time, non-invasive assessment of cervical lesions through the detection of microvascular alterations. Thereby, HVM potentially provides an opportunity for point-of-care screening, which may enable immediate treatment decisions (see and treat) and reduce the number of unnecessary surgical interventions.
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Affiliation(s)
- Y P Latul
- Amsterdam University Medical Centers location University of Amsterdam, Dept. of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - C Ince
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - N E van Trommel
- The Netherlands Cancer Institute (NKI), Department of Gynaecologic Oncology, Antoni van Leeuwenhoek Hospital (AvL), Amsterdam, the Netherlands
| | - A van den Brandhof-van den Berg
- Amsterdam University Medical Centers location University of Amsterdam, Dept. of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
| | - J P W R Roovers
- Amsterdam University Medical Centers location University of Amsterdam, Dept. of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands; Bergman Clinics, Department of Gynaecology & Sexology, Bergman Vrouwenzorg, Amsterdam, the Netherlands
| | - A W Kastelein
- Amsterdam University Medical Centers location University of Amsterdam, Dept. of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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van Bavel J, Ravelli ACJ, Roovers JPWR, Abu-Hanna A, Mol BW, de Leeuw JW. Risk indicators for obstetrical anal sphincter injury in vaginal birth after caesarean section compared to first vaginal delivery. Eur J Obstet Gynecol Reprod Biol 2023; 288:198-203. [PMID: 37572448 DOI: 10.1016/j.ejogrb.2023.07.019] [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: 04/20/2023] [Revised: 07/02/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES Comparison of the rate of obstetric anal sphincter injury (OASI) between women having their first vaginal birth after caesarean section (CS) and true nulliparous women with a vaginal delivery. Assessment of risk indicators for OASI in women with vaginal birth after one CS (VBAC). STUDY DESIGN 28 535 women with their first VBAC and a cohort of 275 439 nulliparous women with a vaginal delivery of a liveborn infant in a cephalic position from the Dutch perinatal registry were analyzed. We compared the OASI rate with univariate and multivariate analysis. In women with VBAC possible risk indicators for OASI were assessed using univariate and multivariate logistic regression analysis. RESULTS The rate of OASI was 5.2% in women with vaginal birth after CS and 4.0% in women with a first vaginal delivery. The adjusted OR (aOR) for vaginal birth after an elective CS was higher (aOR 1.34, 95% CI 1.23-1.47) compared to vaginal birth after an emergency CS (aOR 1.16, 95% CI 1.08-1.25). In women with vaginal birth after emergency CS, the aOR for the indication non-progressive labor was 1.18 (95% CI 1.08-1.29), whereas CS for suspected fetal distress was not significantly associated with obstetric anal sphincter injury in VBAC. In the 28 535 women with a VBAC, mediolateral episiotomy (MLE), birth weight < 3000 g and maternal age < 25 years were associated with a significantly lower rate of OASI. A gestational age of 42 weeks, birth weight ≥ 3500 g, operative vaginal delivery and duration of the 2nd stage of labour of ≥ 60 min were associated with a significantly higher rate of OASI. CONCLUSIONS Women with a VBAC have a higher rate of OASI in comparison with women with a first vaginal delivery, with the exception of women with a vaginal birth after an emergency CS for suspected fetal distress. Factors associated with a significantly lower rate for OASI were MLE, maternal age < 25 and birth weight < 3000 g. A gestational age of 42 weeks, birth weight between 3500 and 4000 g and ≥ 4000 g, operative vaginal delivery and duration of the 2nd stage of delivery longer dan 60 min were associated with a significantly higher rate of OASI.
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Affiliation(s)
- J van Bavel
- Department of Obstetrics and Gynaecology, Amphia Hospital Breda, The Netherlands.
| | - A C J Ravelli
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands; Amsterdam Public Health, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands.
| | - J P W R Roovers
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands.
| | - A Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands; Amsterdam Public Health, Amsterdam, The Netherlands.
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK.
| | - J W de Leeuw
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands.
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4
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Kastelein AW, de Graaf BC, Latul YP, Verhorstert KWJ, Holthof J, Guler Z, Roovers JPWR. Ultra-high-frequency ultrasound: promising technique to visualize pelvic floor mesh in vivo. Ultrasound Obstet Gynecol 2021; 57:653-654. [PMID: 32621365 DOI: 10.1002/uog.22137] [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] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/20/2020] [Accepted: 06/26/2020] [Indexed: 06/11/2023]
Affiliation(s)
- A W Kastelein
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - B C de Graaf
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Y P Latul
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - K W J Verhorstert
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - J Holthof
- Fujifilm Visualsonics, Amsterdam, The Netherlands
| | - Z Guler
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - J P W R Roovers
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
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5
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van der Ploeg JM, van der Steen A, Zwolsman S, van der Vaart CH, Roovers JPWR. Prolapse surgery with or without incontinence procedure: a systematic review and meta-analysis. BJOG 2017; 125:289-297. [DOI: 10.1111/1471-0528.14943] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 11/27/2022]
Affiliation(s)
- JM van der Ploeg
- Department of Obstetrics and Gynaecology; Martini Hospital; Groningen the Netherlands
| | - A van der Steen
- Department of Obstetrics and Gynaecology; Ziekenhuisgroep Twente; Almelo the Netherlands
| | - S Zwolsman
- Department of Obstetrics and Gynaecology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - CH van der Vaart
- Department of Gynaecology and Reproductive Medicine; University Medical Centre Utrecht; Utrecht the Netherlands
| | - JPWR Roovers
- Department of Obstetrics and Gynaecology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
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Kroese JA, van der Velde M, Morssink LP, Zafarmand MH, Geomini P, van Kesteren PJM, Radder CM, van der Voet LF, Roovers JPWR, Graziosi GCM, van Baal WM, van Bavel J, Catshoek R, Klinkert ER, Huirne JAF, Clark TJ, Mol BWJ, Reesink-Peters N. Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial. BJOG 2016; 124:243-249. [DOI: 10.1111/1471-0528.14281] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- JA Kroese
- Department of Obstetrics and Gynaecology; Medical Spectrum Twente; Enschede the Netherlands
| | - M van der Velde
- Department of Obstetrics and Gynaecology; Medical Spectrum Twente; Enschede the Netherlands
| | - LP Morssink
- Department of Obstetrics and Gynaecology; Medical Centre Leeuwarden; Leeuwarden the Netherlands
| | - MH Zafarmand
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Department of Public Health; Academic Medical Centre; Amsterdam the Netherlands
| | - P Geomini
- Department of Obstetrics and Gynaecology; Maxima Medical Centre; Veldhoven the Netherlands
| | - PJM van Kesteren
- Department of Obstetrics and Gynaecology; Onze Lieve Vrouwe Gasthuis; Amsterdam the Netherlands
| | - CM Radder
- Department of Obstetrics and Gynaecology; Saint Lucas Andreas Hospital; Amsterdam the Netherlands
| | - LF van der Voet
- Department of Obstetrics and Gynaecology; Deventer Hospital; Deventer the Netherlands
| | - JPWR Roovers
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
| | - GCM Graziosi
- Department of Obstetrics and Gynaecology; Antonius Hospital; Nieuwegein the Netherlands
| | - WM van Baal
- Department of Obstetrics and Gynaecology; Flevoziekenhuis; Almere the Netherlands
| | - J van Bavel
- Department of Obstetrics and Gynaecology; Amphia Hospital; Breda the Netherlands
| | - R Catshoek
- Department of Obstetrics and Gynaecology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - ER Klinkert
- Department of Obstetrics and Gynaecology; University Medical Centre Groningen; Groningen the Netherlands
| | - JAF Huirne
- Department of Obstetrics and Gynaecology; Vrije University Medical Centre; Amsterdam the Netherlands
| | - TJ Clark
- Department of Obstetrics and Gynaecology; Birmingham Women's Hospital; Birmingham UK
| | - BWJ Mol
- The Robinson Research Institute; School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - N Reesink-Peters
- Department of Obstetrics and Gynaecology; Medical Spectrum Twente; Enschede the Netherlands
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Vergeldt TFM, Notten KJB, Stoker J, Fütterer JJ, Beets-Tan RG, Vliegen RFA, Schweitzer KJ, Mulder FEM, van Kuijk SMJ, Roovers JPWR, Kluivers KB, Weemhoff M. Comparison of translabial three-dimensional ultrasound with magnetic resonance imaging for measurement of levator hiatal biometry at rest. Ultrasound Obstet Gynecol 2016; 47:636-641. [PMID: 26177611 DOI: 10.1002/uog.14949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/08/2015] [Revised: 06/19/2015] [Accepted: 07/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To compare translabial three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for the measurement of levator hiatal biometry at rest in women with pelvic organ prolapse, and to determine the interobserver reliability between two independent observers for ultrasound and MRI measurements. METHODS Data were derived from a multicenter prospective cohort study in which women scheduled for conventional anterior colporrhaphy underwent translabial 3D ultrasound and MRI prior to surgery. Intraclass correlation coefficients (ICCs) were calculated to estimate interobserver reliability between two independent observers and determine the agreement between ultrasound and MRI measurements. Bland-Altman plots were created to assess the agreement between ultrasound and MRI measurements. RESULTS Data from 139 women from nine hospitals were included in the study. The interobserver reliability of ultrasound assessment at rest, during Valsalva maneuver and during contraction and of MRI assessment at rest were moderate or good. The agreement between ultrasound and MRI for the measurement of levator hiatal biometry at rest was moderate, with ICCs of 0.52 (95%CI, 0.32-0.66) for levator hiatal area, 0.44 (95%CI, 0.21-0.60) for anteroposterior diameter and 0.44 (95%CI, 0.22-0.60) for transverse diameter. Levator hiatal biometry measurements were statistically significantly larger on MRI than on translabial 3D ultrasound. CONCLUSIONS The agreement between translabial 3D ultrasound and MRI for measurement of the levator hiatus at rest in women with pelvic organ prolapse was only moderate. The results of translabial 3D ultrasound and MRI should therefore not be used interchangeably in daily practice or in clinical research. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T F M Vergeldt
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K J B Notten
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Stoker
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J J Fütterer
- Department of Radiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R G Beets-Tan
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R F A Vliegen
- Department of Radiology, Atrium Medical Centre Parkstad, Heerlen, The Netherlands
| | - K J Schweitzer
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F E M Mulder
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - S M J van Kuijk
- Department of Epidemiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J P W R Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - K B Kluivers
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Weemhoff
- Department of Obstetrics and Gynaecology, Atrium Medical Centre Parkstad, Heerlen, The Netherlands
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Vergeldt TFM, Notten KJB, Weemhoff M, van Kuijk SMJ, Mulder FEM, Beets-Tan RG, Vliegen RFA, Gondrie ETCM, Bergmans MGM, Roovers JPWR, Kluivers KB. Levator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study. BJOG 2015; 122:1130-7. [PMID: 25761589 DOI: 10.1111/1471-0528.13340] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate whether increased levator hiatal area, measured preoperatively, was independently associated with anatom-ical cystocele recurrence 12 months after anterior colporrhaphy. DESIGN Multicentre prospective cohort study. SETTING Nine teaching hospitals in the Netherlands. POPULATION Women planned for conventional anterior colporrhaphy without mesh. METHODS Women underwent physical examination, translabial three-dimensional (3D) ultrasound and magnetic resonance imaging (MRI) prior to surgery. At 12 months after surgery the physical examination was repeated. MAIN OUTCOME MEASURES Women with and without anatomical cystocele recurrence were compared to assess the association with levator hiatal area on 3D ultrasound, levator hiatal area on MRI, and potential confounding factors. The receiver operating characteristic (ROC) curve was created to quantify the discriminative ability of using levator hiatal area to predict anatomical cystocele recurrence. RESULTS Of 139 included women, 76 (54.7%) had anatomical cystocele recurrence. Preoperative stage 3 or 4 and increased levator hiatal area during Valsalva on ultrasound were significantly associated with cystocele recurrence, with odds ratios of 3.47 (95% confidence interval, 95% CI 1.66-7.28) and 1.06 (95% CI 1.01-1.11) respectively. The area under the ROC curve was 0.60 (95% CI 0.51-0.70) for levator hiatal area during Valsalva on ultrasound, and 0.65 (95% CI 0.55-0.71) for preoperative Pelvic Organ Prolapse Quantification (POP-Q) stage. CONCLUSIONS Increased levator hiatal area during Valsalva on ultrasound prior to surgery and preoperative stage 3 or 4 are independent risk factors for anatomical cystocele recurrence after anterior colporrhaphy; however, increased levator hiatal area as the sole factor for predicting anatomical cystocele recurrence after surgery shows poor test characteristics.
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Affiliation(s)
- T F M Vergeldt
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - K J B Notten
- Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M Weemhoff
- Obstetrics and Gynaecology, Atrium Medical Centre Parkstad, Heerlen, the Netherlands
| | - S M J van Kuijk
- Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - F E M Mulder
- Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - R G Beets-Tan
- Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - R F A Vliegen
- Radiology, Atrium Medical Centre Parkstad, Heerlen, the Netherlands
| | - E T C M Gondrie
- Obstetrics and Gynaecology, Orbis Medical Centre, Sittard, the Netherlands
| | - M G M Bergmans
- Obstetrics and Gynaecology, Laurentius Medical Centre, Roermond, the Netherlands
| | - J P W R Roovers
- Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - K B Kluivers
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands
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9
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Kop PAL, van Wely M, Mol BW, de Melker AA, Janssens PMW, Arends B, Curfs MHJM, Kortman M, Nap A, Rijnders E, Roovers JPWR, Ruis H, Simons AHM, Repping S, van der Veen F, Mochtar MH. Intrauterine insemination or intracervical insemination with cryopreserved donor sperm in the natural cycle: a cohort study. Hum Reprod 2015; 30:603-7. [PMID: 25637621 DOI: 10.1093/humrep/dev004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does intrauterine insemination in the natural cycle lead to better pregnancy rates than intracervical insemination (ICI) in the natural cycle in women undergoing artificial insemination with cryopreserved donor sperm. SUMMARY ANSWER In a large cohort of women undergoing artificial insemination with cryopreserved donor sperm, there was no substantial beneficial effect of IUI in the natural cycle over ICI in the natural cycle. WHAT IS KNOWN ALREADY At present, there are no studies comparing IUI in the natural cycle versus ICI in the natural cycle in women undergoing artificial insemination with cryopreserved donor sperm. STUDY DESIGN, SIZE, DURATION We performed a retrospective cohort study among all eight sperm banks in the Netherlands. We included all women who underwent artificial insemination with cryopreserved donor sperm in the natural cycle between January 2009 and December 2010. We compared time to ongoing pregnancy in the first six cycles of IUI and ICI, after which controlled ovarian stimulation was commenced. Ongoing pregnancy rates (OPRs) over time were compared using life tables. A Cox proportional hazard model was used to compare the chances of reaching an ongoing pregnancy after IUI or ICI adjusted for female age and indication. PARTICIPANTS/MATERIALS, SETTING, METHODS We included 1843 women; 1163 women underwent 4269 cycles of IUI and 680 women underwent 2345 cycles of ICI with cryopreserved donor sperm. MAIN RESULTS AND THE ROLE OF CHANCE Baseline characteristics were equally distributed (mean age 34.0 years for the IUI group versus 33.8 years for the ICI group), while in the IUI group, there were more lesbian women than in the ICI group (40.6% for IUI compared with 31.8% for ICI). Cumulative OPRs up to six treatment cycles were 40.5% for IUI and 37.9% for ICI. This corresponds with a hazard rate ratio of 1.02 [95% confidence interval (CI) 0.84-1.23] after controlling for female age and indication. Increasing female age was associated with a lower OPR, in both the IUI and ICI groups with a hazard ratio for ongoing pregnancy of 0.94 per year (95% CI 0.93-0.97). LIMITATIONS, REASONS FOR CAUTION This study is prone to selection bias due to its retrospective nature. As potential confounders such as parity and duration of subfertility were not registered, the effect of these potential confounders could not be evaluated. WIDER IMPLICATIONS OF THE FINDINGS In women inseminated with cryopreserved donor sperm in the natural cycle, we found no substantial benefit of IUI over ICI. A randomized controlled trial with economic analysis alongside, it is needed to allow a more definitive conclusion on the cost-effectiveness of insemination with cryopreserved donor sperm. STUDY FUNDING/COMPETING INTERESTS No funding was used and no conflicts of interest are declared.
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Affiliation(s)
- P A L Kop
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academical Medical Center, Amsterdam, The Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academical Medical Center, Amsterdam, The Netherlands
| | - B W Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia
| | - A A de Melker
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academical Medical Center, Amsterdam, The Netherlands
| | - P M W Janssens
- Department of Clinical Chemistry and Haematology/Semenbank,Rijnstate Hospital, Arnhem, The Netherlands Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, The Netherlands
| | - B Arends
- MCK Fertility Centre, Leiden, The Netherlands
| | | | - M Kortman
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Nap
- Department of Clinical Chemistry and Haematology/Semenbank,Rijnstate Hospital, Arnhem, The Netherlands Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, The Netherlands
| | - E Rijnders
- Department of Obstetrics and Gynaecology, Reinier de Graafgroup, Voorburg, The Netherlands
| | - J P W R Roovers
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academical Medical Center, Amsterdam, The Netherlands
| | - H Ruis
- Stichting Geertgen, Elsendorp, The Netherlands
| | - A H M Simons
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - S Repping
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academical Medical Center, Amsterdam, The Netherlands
| | - F van der Veen
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academical Medical Center, Amsterdam, The Netherlands
| | - M H Mochtar
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academical Medical Center, Amsterdam, The Netherlands
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Weber MA, Limpens J, Roovers JPWR. Assessment of vaginal atrophy: a review. Int Urogynecol J 2014; 26:15-28. [DOI: 10.1007/s00192-014-2464-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/19/2014] [Indexed: 01/14/2023]
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Notten KJB, Essers BA, Weemhoff M, Rutten AGH, Donners JJAE, van Gestel I, Kruitwagen RFPM, Roovers JPWR, Dirksen CD. Do patients prefer mesh or anterior colporrhaphy for primary correction of anterior vaginal wall prolapse: a labelled discrete choice experiment. BJOG 2014; 122:873-880. [PMID: 25041082 DOI: 10.1111/1471-0528.12924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated patients' preferences for anterior colporrhaphy or mesh surgery as surgical correction of anterior vaginal wall prolapse. DESIGN Labelled discrete choice experiment. SETTING Three Dutch teaching hospitals. POPULATION Women with anterior vaginal wall prolapse Pelvic Organ Prolapse Quantification stage 2 or more, indicated for anterior colporrhaphy (n = 100). METHODS Discrete choice experiments are an attribute-based survey method for measuring preferences. In this experiment, women were asked to choose between two treatment scenarios, mesh surgery or anterior colporrhaphy. These surgical treatments differed in four treatment attributes: (i) recurrence rate, (ii) exposure rate, (iii) infection rate, (iv) dyspareunia. Data were analysed using a multinomial logit model. MAIN OUTCOME MEASURES Women's preferences for anterior colporrhaphy or mesh surgery for the repair of vaginal wall prolapse. RESULTS All treatment attributes, i.e. recurrence, exposure, infection and dyspareunia, proved to be significant in the woman's decision to choose mesh surgery (P < 0.001), while only two attributes out of three, recurrence and infection, were significant for anterior colporrhaphy (P < 0.001). The relative importance data showed that with regards to the four statistically significant attributes for mesh, dyspareunia was the most important attribute, and of the two significant attributes for anterior colporrhaphy, the risk of infection. Based on the attributes and levels in our discrete choice experiment, anterior colporrhaphy was preferred in 74% as a primary correction of anterior vaginal wall prolapse, followed by a preference for mesh in 26% of all choices. CONCLUSION This study showed that next to the risk of recurrence, other aspects like risk of infection, dyspareunia and exposure play a role in the woman's preference for a surgical treatment. In addition, our results indicate that anterior colporrhaphy is preferred in the majority of the choices, followed by a preference for mesh surgery in a quarter of all choice sets. However, these results represent the average preference of a sample of women and cannot be taken as the preference of each individual. In the medical decision-making context, information from the current study should be personalised to fit patient's unique circumstances. For patients to construct their own, individual preferences, they should be well informed about the existence and magnitude of the potential benefits and risks related to either anterior colporrhaphy or mesh surgery.
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Affiliation(s)
- K J B Notten
- Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Mulder FEM, Hakvoort RA, Schoffelmeer MA, Limpens J, Van der Post JAM, Roovers JPWR. Postpartum urinary retention: a systematic review of adverse effects and management. Int Urogynecol J 2014; 25:1605-12. [DOI: 10.1007/s00192-014-2418-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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Lakeman MME, Roovers JPWR. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2013; 120:777. [PMID: 23565958 DOI: 10.1111/1471-0528.12163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 11/28/2022]
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Lakeman MME, Hakvoort RA, Van de Weijer EP, Emanuel MH, Roovers JPWR. Anterior colporrhaphy does not induce bladder outlet obstruction. Int Urogynecol J 2012; 23:723-8. [PMID: 22314892 PMCID: PMC3357473 DOI: 10.1007/s00192-012-1688-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 01/25/2012] [Indexed: 11/25/2022]
Abstract
Introduction and hypothesis We aimed to evaluate if anterior colporrhaphy causes incomplete voiding due to bladder outlet obstruction. Methods Women scheduled for anterior colporrhaphy were asked to undergo multichannel urodynamic investigation before surgery and the first postoperative day. Bladder outlet obstruction was assessed using the Blaivas–Groutz voiding nomogram. Maximum flow rate, detrusor pressure and residual volume were compared between pre- and postoperative measurements and between women with and without an abnormal post-void residual volume (PVR; volume exceeding 150 ml). Results Seventeen women participated. One woman who was unobstructed before surgery was obstructed after surgery. Overall, detrusor pressure and maximum flow rate before and after surgery did not differ. After surgery, six women had an abnormal PVR, one was unable to void, four were mildly obstructed and one moderately obstructed. Conclusion Urodynamic investigation the first day after anterior colporrhaphy did not show that anterior colporrhaphy induces bladder outlet obstruction. The explanation for postoperative urinary retention can therefore also lie in non-anatomical causes such as postoperative pain and psychological factors.
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Affiliation(s)
- M M E Lakeman
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Room H4-205, PO Box 22700, 1105 DE Amsterdam, The Netherlands.
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Lakeman MME, The S, Schellart RP, Dietz V, ter Haar JF, Thurkow A, Scholten PC, Dijkgraaf MGW, Roovers JPWR. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2012; 119:1473-82. [DOI: 10.1111/j.1471-0528.2012.03484.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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16
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Mulder FEM, Schoffelmeer MA, Hakvoort RA, Limpens J, Mol BWJ, van der Post JAM, Roovers JPWR. Risk factors for postpartum urinary retention: a systematic review and meta-analysis. BJOG 2012; 119:1440-6. [DOI: 10.1111/j.1471-0528.2012.03459.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lakeman MME, Zijta FM, Peringa J, Nederveen AJ, Stoker J, Roovers JPWR. Dynamic magnetic resonance imaging to quantify pelvic organ prolapse: reliability of assessment and correlation with clinical findings and pelvic floor symptoms. Int Urogynecol J 2012; 23:1547-54. [PMID: 22531955 PMCID: PMC3484313 DOI: 10.1007/s00192-012-1772-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [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: 12/28/2011] [Accepted: 03/20/2012] [Indexed: 11/29/2022]
Abstract
Introduction and hypothesis The aim of this study was to assess the interobserver agreement of magnetic resonance imaging (MRI)-based staging of pelvic organ prolapse (POP) and to quantify associations between MRI-based POP staging, findings at pelvic examination, and pelvic floor symptoms. Methods This was a cross-sectional study of ten symptomatic POP patients, ten symptomatic patients without POP, and ten nulliparous asymptomatic women. Three different observers performed MRI-based POP staging using the pubococcygeal line (PCL), midpubic line (MPL), perineal line, and H line as references. Results The interobserver agreement of MRI-based staging of the anterior and middle compartment was good to excellent. In symptomatic women without prolapse, MRI-based and pelvic-examination-based POP staging were poorly correlated. In none of the women were MRI-based POP Quantification (POP-Q) staging and pelvic floor symptoms strongly associated. Conclusion The interobserver agreement of MRI-based POP staging is excellent, but the added clinical value of such staging is questionable due to poor association with clinical findings and pelvic floor symptoms.
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Affiliation(s)
- Mariëlle M E Lakeman
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Room H4-205, PO Box 22700, 1105 DE, Amsterdam, The Netherlands.
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Kanta Goswami S, Banerjee S, Saha P, Chakraborty P, Kabir SN, Karimzadeh MA, Mohammadian F, Mashayekhy M, Saldeen P, Kallen K, Karlstrom PO, Rodrigues-Wallberg KA, Salerno A, Nazzaro A, Di Iorio L, Marino S, Granato C, Landino G, Pastore E, Ghoshdastidar B, Chakraborty C, Ghoshdastidar BN, Ghoshdastidar S, Partsinevelos GA, Papamentzelopoulou M, Mavrogianni D, Marinopoulos S, Dinopoulou V, Theofanakis C, Anagnostou E, Loutradis D, Franz C, Nieuwland R, Montag M, Boing A, Rosner S, Germeyer A, Strowitzki T, Toth B, Mohamed M, Vlismas A, Sabatini L, Caragia A, Collins B, Leach A, Zosmer A, Al-Shawaf T, Beyhan Z, Fisch JD, Danner C, Keskintepe L, Aydin Y, Ayca P, Oge T, Hassa H, Papanikolaou E, Pados G, Grimbizis G, Bili H, Karastefanou K, Fatemi H, Kyrou D, Humaidan P, Tarlatzis B, Gungor F, Karamustafaoglu B, Iyibozkurt AC, Ozsurmeli M, Bastu E, Buyru F, Di Emidio G, Vitti M, Mancini A, Baldassarra T, D'Alessandro AM, Polsinelli F, Tatone C, Leperlier F, Lammers J, Dessolle L, Lattes S, Barriere P, Freour T, Elodie P, Assou S, Van den Abbeel E, Arce JC, Hamamah S, Assou S, Dechaud H, Haouzi D, Van den Abbeel E, Arce JC, Hamamah S, Tiplady S, Johnson S, Jones G, Ledger W, Eizadyar N, Ahmad Nia S, Seyed Mirzaie M, Azin SA, Yazdani Safa M, Onaran Y, Iltemir Duvan C, Keskin E, Ayrim A, Kafali H, Kadioglu N, Guler B, Var T, Cicek MN, Batioglu AS, Lichtblau I, Olivennes F, de Mouzon J, Dumont M, Junca AM, Cohen-Bacrie M, Hazout A, Belloc S, Cohen-Bacrie P, Allegra A, Marino A, Sammartano F, Coffaro F, Scaglione P, Gullo S, Volpes A, Cohen-Bacrie P, Cohen-Bacrie M, Hazout A, Lichtblau I, Dumont M, Junca AM, Belloc S, Prisant N, de Mouzon J, Saare M, Vaidla K, Salumets A, Peters M, Jindal UN, Thakur M, Shvell V, Diamond MP, Awonuga AO, Veljkovic M, Macanovic B, Milacic I, Borogovac D, Arsic B, Pavlovic D, Lekic D, Bojovic Jovic D, Garalejic E, Jayaprakasan K, Eljabu H, Hopkisson J, Campbell B, Raine-Fenning N, Kop P, van Wely M, Mol BW, Melker AA, Janssens PMW, Nap A, Arends B, Roovers JPWR, Ruis H, Repping S, van der Veen F, Mochtar MH, Sargin A, Yilmaz N, Gulerman C, Guven A, Polat B, Ozel M, Bardakci Y, Vidal C, Giles J, Remohi J, Pellicer A, Garrido N, Javdani M, Fallahzadeh H, Davar R, Sheibani H, Leary C, Killick S, Sturmey RG, Kim SG, Lee KH, Park IH, Sun HG, Lee JH, Kim YY, Choi EM, Van Loendersloot LL, Van Wely M, Repping S, Bossuyt PMM, Van Der Veen F, Roychoudhury Sarkar M, Roy D, Sahu R, Bhattacharya J, Eguiluz Gutierrez- Barquin I, Sanchez Sanchez V, Torres Afonso A, Alvarez Sanchez M, De Leon Socorro S, Molina Cabrillana J, Seara Fernandez S, Garcia Hernandez JA, Ozkan ZS, Simsek M, Kumbak B, Atilgan R, Sapmaz E, Agirregoikoa JA, DePablo JL, Abanto E, Gonzalez M, Anarte C, Barrenetxea G, Aleyasin A, Mahdavi A, Agha Hosseini M, Safdarian L, Fallahi P, Bahmaee F, Guler B, Kadioglu N, Sarikaya E, Cicek MN, Batioglu AS, Segawa T, Teramoto S, Tsuchiyama S, Miyauchi O, Watanabe Y, Ohkubo T, Shozu M, Ishikawa H, Yelian F, Papaioannou S, Knowles T, Aslam M, Milnes R, Takashima A, Takeshita N, Kinoshita T, Chapman MG, Kilani S, Ledger W, Dadras N, Parsanezhad ME, Zolghadri J, Younesi M, Floehr J, Dietzel E, Wessling J, Neulen J, Rosing B, Tan S, Jahnen-Dechent W, Lee KS, Joo JK, Son JB, Joo BS, Risquez F, Confino E, Llavaneras F, Marval I, D'Ommar G, Gil M, Risquez M, Lozano L, Paublini A, Piras M, Risquez A, Prochazka R, Blaha M, Nemcova L, Weghofer A, Kim A, Barad DH, Gleicher N, Kilic Y, Bastu E, Ergun B, Howard B, Weiss H, Doody K, Dietzel E, Wessling J, Floehr J, Schafer C, Ensslen S, Denecke B, Neulen J, Veitinger T, Spehr M, Tropartz T, Tolba R, Egert A, Schorle H, Jahnen-Dechent W, Bastu E, Alanya S, Yumru H, Ergun B. FEMALE (IN)FERTILITY. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.80] [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: 11/14/2022] Open
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Lakeman MME, van der Vaart CH, Roovers JPWR. A long-term prospective study to compare the effects of vaginal and abdominal hysterectomy on micturition and defecation. BJOG 2011; 118:1511-7. [DOI: 10.1111/j.1471-0528.2011.03080.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lakeman MME, van der Vaart CH, Roovers JPWR. Hysterectomy and lower urinary tract symptoms: a nonrandomized comparison of vaginal and abdominal hysterectomy. Gynecol Obstet Invest 2010; 70:100-6. [PMID: 20299800 DOI: 10.1159/000297507] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 01/19/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS It has been reported that lower urinary tract symptoms (LUTS) are more prevalent in patients who have undergone hysterectomy. However, the effects of surgical approach of hysterectomy on micturition have not been well documented. The aim of this study is to compare LUTS between patients who underwent vaginal and abdominal hysterectomy. METHODS Prospective observational study among 430 patients undergoing vaginal or abdominal hysterectomy for benign disease other than genital prolapse. Participating patients completed a validated disease-specific questionnaire before surgery, 6 months and 3 years after surgery. RESULTS 112 women underwent vaginal hysterectomy and 318 abdominal hysterectomy. After correction for differences in uterine size, descent of the uterus and other differences, LUTS were more common at 3 years after surgery following vaginal than following abdominal hysterectomy (OR 2.2, 95% CI 1.3-4.0). After adjustment for descent of the uterus, uteral size, parity and indication for hysterectomy, this difference was still statistical significant (adjusted OR 3.0, 95% CI 1.4-6.2). CONCLUSION As compared to abdominal hysterectomy, LUTS appear to be more common following vaginal hysterectomy.
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Affiliation(s)
- M M E Lakeman
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
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Timmerman E, Roovers JPWR, Ankum WM, Hajenius PJ. [Interstitial pregnancy: a rare type of ectopic pregnancy]. Ned Tijdschr Geneeskd 2008; 152:787-791. [PMID: 18491819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Three women, aged 21, 28 and 37 years, respectively, were diagnosed with interstitial pregnancies. The first patient presented with lateral abdominal pain, the second patient was asymptomatic and consulted the physician for a routine first trimester scan and the third patient had painless vaginal bleeding in the first trimester. Each was treated with systemic methotrexate in a multiple dose regimen, which was successful in the latter two patients. The first patient was discharged in good condition after her last methotrexate injection, but developed severe abdominal pain and collapsed at home after the interstitial pregnancy had ruptured. She underwent surgery and recovered. Today, the incidence of ectopic pregnancy in the Netherlands is around 8 per 1000 live births. Interstitial pregnancies, which nidate in the portion of the fallopian tube embedded in the uterine wall, account for 2-3% of all ectopic pregnancies. A urinary pregnancy test should be performed for any fertile woman with abdominal pain or abnormal vaginal bleeding. If the result is positive, the patient should be referred to a gynaecologist for transvaginal ultrasound to exclude ectopic pregnancy. In case of a pregnancy of unknown location, one should search for specific ultrasound markers of non-tubal ectopic pregnancy and assess serum human chorionic gonadotropin (HCG). Interstitial ectopic pregnancy should be considered if the serum HCG level is above 2000 U/l.
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Affiliation(s)
- E Timmerman
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Verloskunde en Gynaecologie, Amsterdam
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Roovers JPWR, Weenen M, van der Bom JG, van der Vaart CH. [Defecation complaints after hysterectomy because of a benign condition are rare; a prospective study]. Ned Tijdschr Geneeskd 2007; 151:1239-43. [PMID: 17583093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To determine the frequency of defecation symptoms after hysterectomy. DESIGN Prospective multicentre study, 3 year follow-up. METHODS 404 patients from 13 teaching or non-teaching hospitals in The Netherlands, who underwent hysterectomy for benign disease other than symptomatic uterine prolapse or known endometriosis, were asked to complete the defecation distress inventory before and 3 years after surgery. The defecation distress inventory is a validated disease specific quality of life questionnaire for assessment of the presence and experienced inconvenience of defecation symptoms. RESULTS A response rate of 328/372 (88%) of 404 patients whose address could be recovered after 3 years was found. De novo constipation occurred in 2% of the patients following hysterectomy. Sensation of anal blockage and incomplete defecation occurred in more than 15% of the patients. Defecation symptoms reported before surgery had persisted in about half of the patients at 3 years after hysterectomy. A feeling of incomplete defecation at 3 years after hysterectomy was more common after subtotal hysterectomy than after total or vaginal hysterectomy (adjusted odds ratio: 2.1 (95% CI: 1.1-3.8) and 1.4 (95% CI: 0.7-2.7), respectively). CONCLUSION Defecation symptoms seldom developed after hysterectomy for benign disease. The type of operation did not play a role.
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Affiliation(s)
- J P W R Roovers
- Universitair Medisch Centrum Utrecht, afd. Obstetrie en Gynaecologie, Utrecht.
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Roovers JPWR, van Laar JOEH, Loffeld C, Bremer GL, Mol BW, Bongers MY. Does urodynamic investigation improve outcome in patients undergoing prolapse surgery? Neurourol Urodyn 2007; 26:170-5. [PMID: 17016798 DOI: 10.1002/nau.20328] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS Without solid evidence, it has been advocated to perform urodynamic investigation in all patients scheduled for prolapse surgery. If urodynamic investigations were to be valuable in the diagnostic work-up, patients with normal and abnormal findings would have different treatment results. Our policy to never combine prolapse surgery and stress-incontinence surgery allowed us to study whether incontinence after surgery can be predicted from urodynamic investigation results. METHODS A retrospective study was performed in consecutive patients undergoing vaginal prolapse surgery (anterior colporraphy and/or posterior colporraphy, and/or vaginal hysterectomy) between 2002 and 2004. All patients underwent pre-operative urodynamic investigation, including filling cystometry, urethral pressure profile measurement, and free flow cystometry. Data were collected from the files about medical history, findings at pelvic examination, findings at urodynamic investigation and presence of stress- and/or urge-incontinence after surgery. RESULTS We studied 76 patients, of whom 5 (7%) patients reported stress-incontinence and 5 (7%) patients reported urge-incontinence after surgery. Findings at urodynamic investigation could not predict the presence of stress- or urge-incontinence after surgery. Likelihood ratios (LR) of prior presence of urge and stress-incontinence for the presence of post-operative urge- and stress-incontinence were 4.5 and 1.2, respectively. Of all findings at urodynamic investigation, only negative transmission during cough test was associated with presence of stress-incontinence (LR = 1.5). CONCLUSIONS The prevalence of incontinence after prolapse surgery is low. None of the investigated parameters of the urodynamic investigation tests was associated with the presence of urinary incontinence after surgery.
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Affiliation(s)
- J P W R Roovers
- Department of Obstetrics and Gynecology, Academic Medical Centre, 1105 DE Amsterdam, The Netherlands.
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Roovers JPWR, van der Bom JG, van der Vaart CH, van Leeuwen JHS, Scholten PC, Heintz APM. A randomized comparison of post-operative pain, quality of life, and physical performance during the first 6 weeks after abdominal or vaginal surgical correction of descensus uteri. Neurourol Urodyn 2005; 24:334-40. [PMID: 15924355 DOI: 10.1002/nau.20104] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS With respect to urogenital function, vaginal hysterectomy combined with anterior and/or posterior colporraphy has been shown to be superior to abdominal sacrocolpopexy with preservation of the uterus. We performed a randomized trial to compare the effects of both procedures on pain, quality of life and physical performance during the first six weeks after surgery. METHODS Eighty-two patients were randomized to have surgery either by vaginal or abdominal approach. All patients were asked to complete the RAND-36 before surgery and 6 weeks after surgery and to keep a diary for the first 6 weeks after surgery. This diary assessed the pain perception and use of pain medication, bother of limitations due to the surgery and performance of daily activities after surgery. These outcomes were compared. RESULTS All patients completed the RAND-36 and 68 patients completed the diary. Patients who had undergone abdominal surgery had a statistically lower score on the health change domain (56 vs 68), bodily pain domain (63 vs 80) and mental health domain (74 vs 81) of the RAND-36, as compared to patients who had undergone vaginal prolapse surgery. During hospital stay, the abdominal group experienced on average more days of pain (4.5 vs 3.0) and impaired mobility (3.7 vs 2.9) as compared to the vaginal group. Patients received more pain medication following abdominal surgery as compared to vaginal surgery. CONCLUSIONS The vaginal operation to correct a descensus uteri is associated with less pain, better quality of life and better mobility during the first 6 weeks of the recovery period as compared to the abdominal approach.
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Affiliation(s)
- J P W R Roovers
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, The Netherlands.
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Roovers JPWR, van der Bom JG, van der Vaart CH, Schagen van Leeuwen JH, Heintz APM. Abdominal versus vaginal approach for the management of genital prolapse and coexisting stress incontinence. Int Urogynecol J 2002; 13:224-31. [PMID: 12189427 DOI: 10.1007/s001920200049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients who undergo surgery because of genital prolapse and coexisting stress incontinence can be treated by a combination of surgical procedures via a unified route. We performed a retrospective study among 47 patients to compare micturition, defecation and prolapse symptoms after surgery, as well as duration of hospital stay and complication rate between patients who underwent a unified vaginal or abdominal surgical correction. All patients were treated between January 1995 and December 1997 in the University Medical Center Utrecht or St Antonius Hospital Nieuwegein, The Netherlands. Abdominal surgery was associated with a higher prevalence of difficulty in bladder emptying (relative risk (RR) 2.3 (95% CI 1.4-8.4)), fecal incontinence (RR 3.4, CI 1.1-10.7) and soiling (OR 2.8, CI 1.2-6.2), as well as with a longer postoperative hospital stay (8.6 vs 7.3 days) and a higher complication rate (25.0% vs. 11.4%) than vaginal surgery. These results suggest that a unified vaginal surgical correction of genital prolapse and coexisting stress incontinence appears to be preferable to a unified abdominal surgical correction.
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Affiliation(s)
- J P W R Roovers
- University Medical Center, Department of Obstetrics and Gynecology, Utrecht, The Netherlands.
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Abstract
OBJECTIVE To assess the consequences that the symptoms of urinary incontinence and an overactive bladder have on the quality of life in young, community-dwelling women. SUBJECTS AND METHODS A population-based, cross-sectional cohort study was conducted in women aged 20-45 years. Urogenital symptoms and quality of life were assessed using standardized questionnaires, e.g. the Urogenital Distress Inventory and Incontinence Impact Questionnaire. RESULTS The prevalence of symptoms of stress incontinence (39%), urge incontinence (15%) and an overactive bladder (12%) was high in this young population. Compared with urge incontinence, the symptoms of an overactive bladder similarly reduced the quality of life, but stress incontinence did not significantly affect the quality of life. Women with symptoms of an overactive bladder were especially limited in their mobility, whereas urge incontinence was especially associated with feelings of embarrassment. Although many women reported to be bothered by their symptoms, only a minority consulted their physician for them. CONCLUSIONS The symptoms of urinary incontinence and overactive bladder are common among young adult women and have the same detrimental effect on quality of life as urge incontinence. The reduction in mobility associated with overactive bladder symptoms may be especially distressing for these young and active women.
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Affiliation(s)
- C H van der Vaart
- Research Group of Pelvic Floor, Department of Obstetrics and Gynaecology, University Medical Centre, Utrecht, The Netherlands.
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