1
|
Dykes N, Lim YN, Zilberlicht A, Dwyer PL. Are older patients with prolapse likely to continue pessary use? A retrospective observational study. Int Urogynecol J 2023; 34:2919-2923. [PMID: 37572122 DOI: 10.1007/s00192-023-05627-w] [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: 04/03/2023] [Accepted: 07/10/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To review the outcomes and complications of vaginal prolapse management with pessaries in women aged 75 years or older, to ascertain whether pessaries are providing satisfactory long-term outcomes for older women. METHODS A retrospective observational study was performed on women aged 75 years or older presenting to a tertiary Urogynaecology service with vaginal prolapse who opted for management with a vaginal pessary. Demographic and clinical data were collected by reviewing clinical files. The primary outcome was the proportion of women who opted for pessary management who later required prolapse surgery. Secondary outcomes included pessary complications and risk factors for failure. Kaplan-Meier survival estimates were performed to analyse pessary failure. RESULTS Of the 218 women who presented with prolapse, 78% opted for pessary management, and pessary fitting was successful in 84%. Sixty-nine percent of women who opted for initial pessary management underwent surgery later, with a mean time from pessary insertion to surgery of 21.6 months. Vaginal erosions were reported in 42% of pessary users. Risk factors for pessary failure were younger age and previous history of hysterectomy or prolapse surgery. CONCLUSIONS Although vaginal pessary use was the preferred first-line management choice for vaginal prolapse in most older women, surgery for prolapse was ultimately required in two-thirds of those conservatively managed. As three-quarters of older women presenting with prolapse had surgery as either a primary or secondary procedure; patients need to be advised of the high chance of requiring surgery at a later stage if they opt for pessary management.
Collapse
Affiliation(s)
- Nicola Dykes
- Department of Obstetrics and Gynaecology, North Shore Hospital, Te Whatu Ora Waitemata, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand.
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Australia.
| | - Yik N Lim
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Australia
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Peter L Dwyer
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Australia
| |
Collapse
|
2
|
Collins SA, O'Shea M, Dykes N, Ramm O, Edenfield A, Shek KL, van Delft K, Beestrum M, Kenton K. International Urogynecological Consultation: clinical definition of pelvic organ prolapse. Int Urogynecol J 2021; 32:2011-2019. [PMID: 34191102 DOI: 10.1007/s00192-021-04875-y] [Citation(s) in RCA: 5] [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] [Received: 03/01/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This segment of Chapter 1 of the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) reviews the literature on the clinical definition of POP with the intent of creating standard terminology. METHODS An international group containing nine urogynecologists and one university-based medical librarian performed a search of the literature using pre-specified search terms in PubMed, Embase, and Scopus. Publications were eliminated if not relevant to the clinical definition of POP, and those articles remaining were evaluated for quality using the Specialist Unit for Review Evidence (SURE). The resulting list of articles was used to inform a comprehensive review and creation of the clinical definition of POP. RESULTS The original search yielded 31,931 references, of which 167 were used by the writing group. Ultimately, 78 are referenced in the manuscript. CONCLUSIONS The clinical definition of POP for this review of the literature is: "anatomical prolapse with descent of at least one of the vaginal walls to or beyond the vaginal hymen with maximal Valsalva effort WITH the presence either of bothersome characteristic symptoms, most commonly the sensation of vaginal bulge, or of functional or medical compromise due to prolapse without symptom bother."
Collapse
Affiliation(s)
- Sarah A Collins
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA.
| | - Michele O'Shea
- Department of Obstetrics and Gynecology, Duke University Health System, Raleigh, NC, USA
| | | | - Olga Ramm
- Division of Urogynecology, Department of Obstetrics and Gynecology, Kaiser Permanente East Bay, Alameda, CA, USA
| | - Autumn Edenfield
- Division of Urogynecology, Department of Obstetrics and Gynecology, Medical University of South Carolina, Mt Pleasant, SC, 29464, USA
| | - Ka Lai Shek
- Department of Obstetrics and Gynecology, Liverpool Hospital, University of Western Sydney, Liverpool, NSW, 2170, Australia
| | - Kim van Delft
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Molly Beestrum
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA
| | - Kimberly Kenton
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA
| |
Collapse
|
3
|
Karmakar D, Dwyer PL, Murray C, Schierlitz L, Dykes N, Zilberlicht A. Long-term effectiveness and safety of open Burch colposuspension vs retropubic midurethral sling for stress urinary incontinence-results from a large comparative study. Am J Obstet Gynecol 2021; 224:593.e1-593.e8. [PMID: 33316277 DOI: 10.1016/j.ajog.2020.11.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 09/15/2020] [Revised: 11/12/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are few adequately powered long-term trials comparing midurethral sling and Burch colposuspension. Recent concerns about synthetic mesh with new stringent clinical and research governance support the need for evidence to facilitate shared decision making. OBJECTIVE This study aimed to compare long-term outcomes of open Burch colposuspension with the retropubic midurethral sling. STUDY DESIGN A matched cohort study of 1344 women with urodynamic stress incontinence (without intrinsic sphincter deficiency) who underwent surgery for stress urinary incontinence. Women had either open Burch colposuspension or the retropubic midurethral sling, from January 2000 to June 2018, in a tertiary center. Follow-up was by chart review and one-time phone follow-up until 2019, using a dedicated database. Primary outcomes were the presence or absence of stress urinary incontinence on follow-up, the success of index surgery based on response to validated questionnaires of patient-reported outcomes, and retreatment rates. Secondary outcomes are described below. Matching (1:3) was done at baseline to avoid confounding. RESULTS The study included 1344 women who had either Burch colposuspension (336) or retropubic midurethral sling (1008). Mean follow-up was 13.1 years for Burch colposuspension and 10.1 years for retropubic midurethral sling. In the Burch colposuspension group, 83.0% of patients (279 of 336) reported no ongoing stress urinary incontinence at the time of the latest follow-up vs 85.0% (857 of 1008) in the retropubic midurethral sling group (P=.38). Success in terms of the latest reported International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (defined as International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score of ≤6) where these data were available were similar within both groups: 76.0% (158 of 208 where this was available) in Burch colposuspension vs 72.1% (437 of 606 where this was available) in retropubic midurethral sling (P=.32). Where this information was available, success defined by a Patient Global Impression of Improvement of "very much improved" and "much improved" was similar between Burch colposuspension and retropubic midurethral sling groups (84.1% [243 of 289] vs 82.0% [651 of 794]; P=.88). Where data were available, 88.1% of women (178 of 202) in the Burch colposuspension group said they were very likely to recommend the surgery to family or a friend vs 85.0% (580 of 682) in retropubic midurethral sling (P=.30).Overall, 3.6% needed repeat incontinence procedures (13 in Burch colposuspension group [3.8%] vs 35 in retropubic midurethral sling group [3.5%]; P=.73). The incidence of mesh exposure was 1.0 %. Notably, 1 Burch colposuspension patient had a suture in the bladder during follow-up; 5 patients have reported long-standing pain across the study population. Overall, 51 women reported new-onset overactive bladder symptoms on follow-up: 10 of 336 (3.0%) had Burch colposuspension and 41 of 1008 (4.1%) had retropubic midurethral sling (P=.41). The need for future prolapse surgery per index procedure was 3.3% after Burch colposuspension vs 1.1% postretropubic midurethral sling (P=.01). Moreover, 9 of the 11 patients who needed a prolapse repair after Burch colposuspension required a posterior repair. The incidence of long-term severe voiding difficulty needing self-catheterization was similar in both groups (0.3% in Burch colposuspension and 0.5 % in retropubic midurethral sling group; P=1.00). CONCLUSION This study shows no difference in success, patient satisfaction, or complications between Burch colposuspension and retropubic midurethral sling, although the risk of posterior compartment prolapse operations after Burch colposuspension is increased. Reoperation rates for incontinence were similar in both groups. Chronic pain was a rare outcome.
Collapse
Affiliation(s)
- Debjyoti Karmakar
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia.
| | - Peter L Dwyer
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
| | - Christine Murray
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
| | - Lore Schierlitz
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
| | - Nicola Dykes
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
| | - Ariel Zilberlicht
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Dykes N, Dwyer P, Rosamilia A, Zilberlicht A. Video and review of the surgical management of recurrent urethral diverticulum. Int Urogynecol J 2020; 31:2679-2681. [DOI: 10.1007/s00192-020-04357-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
|
5
|
Dykes N, Davies M. Damage to powered respirator protective suits. Anaesthesia 2019; 74:407. [DOI: 10.1111/anae.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. Dykes
- Royal Liverpool and Broadgreen University Hospitals NHS Trust; Liverpool UK
| | - M. Davies
- Royal Liverpool and Broadgreen University Hospitals NHS Trust; Liverpool UK
| |
Collapse
|
6
|
Ducharme NG, Hackett RP, Woodie JB, Dykes N, Erb HN, Mitchell LM, Soderholm LV. Investigations into the role of the thyrohyoid muscles in the pathogenesis of dorsal displacement of the soft palate in horses. Equine Vet J 2003; 35:258-63. [PMID: 12755428 DOI: 10.2746/042516403776148200] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [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: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Contributes to the understanding of the pathogenesis of dorsal displacement of the soft palate during exercise so that management of this condition could be enhanced. HYPOTHESIS That the thyrohyoid muscles play an important role in the stability of the laryngo-palatal relationship and that dysfunction of these muscles leads to dorsal displacement of the soft palate (DDSP) during exercise. METHODS Ten horses were exercised on a high-speed treadmill under 4 different treatment conditions: control conditions (n = 10), after resection of thyrohyoid muscles (TH, n = 10), after sham-treatment (n = 5), or after restoration of function of the thyrohyoid muscles with surgical sutures (prosthesis-treatment, n = 6). During trials, the following determinations were made: videoendoscopy of the upper airway, gait frequency and pharyngeal and tracheal static pressures. RESULTS None of the 10 horses developed DDSP during 2 separate treadmill-exercise trials under the control conditions. Seven of the 10 horses developed DDSP after resection of the TH muscles, 4 of 5 of these horses still experienced DDSP after sham-treatment, but 5 of 6 horses no longer experienced DDSP at exercise after the prosthesis-treatment. There were significant anomalies in airway pressures, respiratory frequency, and occurrence of DDSP in both the TH resection and sham-treatment conditions compared to control conditions. In contrast, no statistical differences were noted in any of the parameters measured between the prosthesis-treatment and control conditions. CONCLUSIONS That the function of the TH muscles is important to the stability of the laryngo-palatal relationship and plays a role in the pathophysiology of exercise-induced DDSP. POTENTIAL RELEVANCE Management of horses with DDSP could be enhanced by restoring the function of the TH muscles.
Collapse
Affiliation(s)
- N G Ducharme
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA
| | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
A 6-month-old alpaca presented for lethargy, failure to thrive and leucocytosis. Diagnostic procedures, including thoracic ultrasound, radiographs and a computed tomography scan, were used to document a thoracic mass. Based on appearance and ultrasound-guided aspiration of purulent material, the mass was determined to be a large abscess. The abscess was treated with surgical drainage and long-term antibiotic therapy. The origin of this thoracic abscess was felt to be the caudal mediastinum, secondary to bacterial seeding of the caudal mediastinal lymph nodes. Although an aetiological agent was not definitively determined, the most likely was Actinomyces spp or Arcanobacterium pyogenes. The alpaca made a complete recovery following treatment.
Collapse
Affiliation(s)
- J Adolf
- The Cornell University Hospital for Animals, Department of Clinical Sciences and Radiology, Ithaca, New York 14853, USA
| | | | | | | |
Collapse
|
8
|
Phillips S, Barr S, Dykes N, Scrivani P, Kraus M, Rishniw M, Valentine B. Bronchiolitis obliterans with organizing pneumonia in a dog. J Vet Intern Med 2000; 14:204-7. [PMID: 10772495] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
- S Phillips
- Department of Clinical Sciences, Cornell University, Ithaca, NY, USA
| | | | | | | | | | | | | |
Collapse
|
9
|
Affiliation(s)
- S H Foerster
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14852, USA
| | | | | | | |
Collapse
|
10
|
Abstract
An eight-year-old, sexually intact, male, 37 kg crossbred dog was referred for investigation of two acute episodes of intestinal bleeding and severe anaemia within a five-month period. There was no evidence of coagulopathy or underlying systemic disease. Technetium-labelled red blood cell scintigraphy suggested the colon as the site of bleeding. Colonoscopy identified a focal area of dilated and tortuous mucosal blood vessels. Histopathology of the resected colon revealed vascular ectasia (angiodysplasia). At nine months post-resection, the dog remained healthy and free of any overt intestinal haemorrhage.
Collapse
Affiliation(s)
- T M Fan
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14583, USA
| | | | | | | | | |
Collapse
|
11
|
DeMarco J, Center SA, Dykes N, Yeager AE, Kornreich B, Gschrey E, Credille KA, Guffroy M, del Piero F, Valentine BA. A syndrome resembling idiopathic noncirrhotic portal hypertension in 4 young Doberman pinschers. Vet Med (Auckl) 1998; 12:147-56. [PMID: 9595375 DOI: 10.1111/j.1939-1676.1998.tb02110.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 11/30/2022]
Abstract
We describe 4 young male Doberman Pinschers (3 littermates and 1 unrelated dog) with a syndrome resembling idiopathic or noncirrhotic portal hypertension of humans. Each dog was evaluated for a hepatopathy resulting in portal hypertension, development of portosystemic collateral vessels, and hepatic encephalopathy. These dogs differ from previous reports of young dogs with hepatic insufficiency associated with portal hypertension and acquired portal systemic shunting by their lack of intrahepatic arteriovenous fistulae, portal vein atresia, or intrahepatic fibrosis. Clinicopathologic features included erythrocyte microcytosis, normal to mildly increased liver enzyme activities, increased concentrations of serum bile acids, reduced plasma indocyanine green clearance, and normal total bilirubin concentration. Abdominal ultrasonography disclosed a small liver and portosystemic collateral vessels. Radiographic imaging studies confirmed hepatofugal portal circulation and discounted hepatic arteriovenous fistulae. Histopathologic features in liver tissue from each dog were similar and consistent in all sections examined. Common findings included increased cross-sectional views of hepatic arterioles; hepatic lobular atrophy; scanty increase in connective tissue around some large portal triads; and absence of inflammation, disturbed lobular architecture, bile duct proliferation, or intrahepatic cholestasis.
Collapse
Affiliation(s)
- J DeMarco
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853-6401, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
A bitch was presented for a vaginal prolapse of five years' duration. The prolapse was confirmed by physical examination and evaluated by contrast radiography. Herniation of the uterine body, urinary bladder, and distal aspect of the colon was identified within the prolapse. The prolapse was reduced surgically, and an ovariohysterectomy, cystopexy, and colopexy were performed. Compared to other vaginal disorders, vaginal prolapse is an uncommon condition in the bitch. The secondary involvement of abdominal viscera appears to be exceptionally rare.
Collapse
Affiliation(s)
- P S McNamara
- Companion Animal Hospital, Cornell Veterinary Medical Teaching Hospital, Cornell University, Ithaca, New York 14853, USA
| | | | | |
Collapse
|
13
|
|