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Takacs P, Rátonyi D, Koroknai E, van Raalte H, Lucente V, Egorov V, Krasznai ZT, Kozma B. Biomechanical Integrity Score of the Female Pelvic Floor for Stress Urinary Incontinence. Int Urogynecol J 2024:10.1007/s00192-024-05797-1. [PMID: 38739290 DOI: 10.1007/s00192-024-05797-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/26/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION AND HYPOTHESIS This study is aimed at developing and validating a new integral parameter, the Biomechanical Integrity score (BI-score) of the female pelvic floor for stress urinary incontinence conditions. METHODS A total of 130 subjects were included in the observational cohort study; 70 subjects had normal pelvic floor conditions, and 60 subjects had stress urinary incontinence (SUI). A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t test, correlation) to identify the VTI parameters sensitive to the pelvic SUI conditions. RESULTS Twenty-seven parameters were identified as statistically sensitive to SUI development. They were subdivided into five groups to characterize tissue elasticity (group 1), pelvic support (group 2), pelvic muscle contraction (group 3), involuntary muscle relaxation (group 4), and pelvic muscle mobility (group 5). Every parameter was transformed to its standard deviation units using the dataset for normal pelvic conditions, similar to the T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups 1-5 and to the BI-score in standard deviation units. The p value for the BI-score has p = 4.0 × 10-28 for SUI versus normal conditions. CONCLUSIONS Quantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the SUI BI-score in future research and clinical applications.
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Affiliation(s)
- Peter Takacs
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Dávid Rátonyi
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Erzsébet Koroknai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Heather van Raalte
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, PA, USA
| | | | | | - Zoard Tibor Krasznai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Bence Kozma
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary.
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Lucente V, Wright M, Pisan J, Shenoy S, Yedlock R. Single Incision Midurethral Sling Site of Care: Office-based Ambulatory Surgical Unit versus Hosptial-based Ambulatory Surgical Unit Setting. J Minim Invasive Gynecol 2023; 30:665-671. [PMID: 37088282 DOI: 10.1016/j.jmig.2023.04.006] [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: 07/25/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
STUDY OBJECTIVE To compare the economic difference in terms of overall costs between two Ambulatory Surgical Unit (ASU) settings in which a midurethral single incision sling (MSIS) can be performed. DESIGN A retrospective cohort study was carried out, examining the implanting of an MSIS performed at two different ASU settings by a single surgeon. Total cost was determined by assessing differences in charges and subsequent reimbursement associated with the procedure at each ASU setting. Time was measured using an EMR system for tracking both patient entry/exit from the facility as well as intraoperative time. Adverse events commonly associated with the procedure and patient-reported unanticipated adverse events were collected. A validated Surgical Satisfaction Questionnaire was administered postoperatively. SETTING University Health Network Teaching Hospital. PATIENTS A total of 125 women with stress urinary incontinence. INTERVENTION MSIS. MEASUREMENT AND MAIN RESULTS Between January 2016 until August 2020, 125 women underwent an MSIS procedure. The total office-based ASU (O-ASU) charges averaged $4564.00 (reimbursement of $2642.07). The total hospital-based ASU (H-ASU) charges averaged $40 136 (reimbursement of $9000), as well as an anesthesia average charge of $800 (reimbursement of $500). The average O-ASU total patient encounter time was 53.76 minutes versus 344.702 minutes for the H-ASU. There was no difference between commonly associated or unanticipated adverse events nor global patient satisfaction. CONCLUSIONS Based on overall cost, total encounter time, and global patient satisfaction, a certified O-ASU is an optimal site of care for MSIS for surgical management of female stress urinary incontinence.
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Affiliation(s)
- Vincent Lucente
- Institute for Female Pelvic Medicine and Reconstructive Surgery (Drs. Lucente and Wright), Allentown, PA.
| | - Micah Wright
- Institute for Female Pelvic Medicine and Reconstructive Surgery (Drs. Lucente and Wright), Allentown, PA; Department of Minimally Invasive Gynecology (Drs. Wright and Pisan), St. Luke's University Health Network, Bethlehem, PA; Council Oak Comprehensive Health Care (Dr. Wright), Tulsa, OK
| | - John Pisan
- Department of Minimally Invasive Gynecology (Drs. Wright and Pisan), St. Luke's University Health Network, Bethlehem, PA
| | - Sachin Shenoy
- Department of Minimally Invasive Gynecologic Surgery (Dr. Shenoy), University of Alabama, Tuscaloosa, AL
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Wright M, Bond D, Shenoy S, Lucente V. 109 Publication trends among fellows in minimally invasive gynecologic surgery. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2021.04.134] [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: 10/21/2022]
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Ton J, Downing P, Versi E, van Uem S, Ephraim S, Murphy M, Lucente V. Outcomes of a single trigone-only vs. 20 trigone-sparing injections of OnabotulinumtoxinA for refractory overactive bladder (OAB). Int Urol Nephrol 2021; 53:1067-1072. [PMID: 33742316 DOI: 10.1007/s11255-021-02802-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/16/2020] [Accepted: 02/08/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE To compare the safety and durability of a single intravesical trigonal-only versus 20 trigone-sparing injections of OnabotulinumtoxinA (BTA) for refractory OAB. METHODS A chart review of all idiopathic OAB patients treated with BTA from January 2016 to December 2018 was performed. Outcomes measures included: inter-injection interval, post-void residual (PVR), urinary tract infections (UTI), urinary retention requiring catheterization, and procedure time (min). Statistical analyses were performed using independent sample t-tests. RESULTS Baseline characteristics were comparable for the two groups, data on 69 treatments (19 patients trigone-only) were compared to 105 treatments (26 patients trigone-sparing). There were no differences in the inter-injection intervals or rates of UTI. The trigone-only group exhibited a lower mean PVR (113 ml vs 160 ml, p < 0.02), lower proportion with PVR > 150 ml (23% vs. 39%, p < 0.03), lower rate of urinary retention (5.3% vs. 17.4%, p < 0.02), and shorter procedure time (4.3 min vs. 5.7 min, p < 0.01). There were no cases of vesico-ureteral reflux. CONCLUSION While interpretation remains speculative, the results of this observational study suggest that a single trigone-only injection appears to be as safe and durable as multiple trigone-sparing injections but maybe quicker to perform and appears to have a lower impact on voiding function. Larger series and adequately powered prospective randomized clinical trials are warranted to validate the findings of this pilot study.
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Affiliation(s)
- Jessica Ton
- Anne Arundel Medical Center, Annapolis, MD, USA
| | | | - Eboo Versi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
| | - Stefanie van Uem
- Department of Urology, Stanford University School of Medicine, San Francisco, USA
| | | | - Miles Murphy
- Institute for Female Pelvic Medicine, Allentown, PA, USA
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van Raalte H, Takacs P, Lucente V, Shobeiri S, Hoyte L, Egorov V. 12: Pelvic organ prolapse surgery improves biomechanical conditions and integrity of the weak pelvic floor. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.035] [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: 10/24/2022]
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MacDiarmid S, Staskin DR, Lucente V, Kaaki B, English S, Gilling P, Meffan P, Clark M, Sand PK, Sen SK, Rovner E. Feasibility of a Fully Implanted, Nickel Sized and Shaped Tibial Nerve Stimulator for the Treatment of Overactive Bladder Syndrome with Urgency Urinary Incontinence. J Urol 2019; 201:967-972. [DOI: 10.1016/j.juro.2018.10.017] [Citation(s) in RCA: 25] [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] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Vincent Lucente
- Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, Pennsylvania
| | | | - Sharon English
- Canterbury Urology Research Trust, Christchurch, New Zealand
| | | | - Patrick Meffan
- Tauranga and Roundhay Medical Centre, Nelson, New Zealand
| | - Matthew Clark
- Clark Center for Urogynecology, Stanford, California
| | - Peter K. Sand
- Northshore University Health System, Skokie, Illinois
| | - Subhro K. Sen
- Newport Beach and Stanford University, Stanford, California
| | - Eric Rovner
- Medical University of South Carolina, Charleston, South Carolina
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van Raalte H, Shobeiri S, Hoyte L, Lucente V, Takacs P, Sarvazyan N, Egorov V. 91: Biomechanical mapping of pelvic floor restoration after prolapse surgery. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.121] [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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Egorov V, Lucente V, VAN Raalte H, Murphy M, Ephrain S, Bhatia N, Sarvazyan N. Biomechanical mapping of the female pelvic floor: changes with age, parity and weight. Pelviperineology 2019; 38:3-11. [PMID: 31341548 PMCID: PMC6656381] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into the pathophysiology of pelvic floor disorders including pelvic organ prolapse (POP). An innovative approach - vaginal tactile imaging - allows biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The objective of this study is to explore an extended set of 52 biomechanical parameters to characterize pelvic floor changes with age, parity, and subject weight for normal pelvic floor conditions. 42 subjects with normal pelvic conditions (no POP, no stress urinary incontinence) were included in the data analysis from an observational, case-controlled study. The Vaginal Tactile Imager (VTI) was used with an analytical software package to automatically calculate 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Val-salva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). The ranges, mean values, and standard deviations for all 52 VTI parameters were established. 12 VTI parameters were identified as statistically sen-sitive (p < 0.05; t-test) to the subject age; 9 parameters were identified as statistically sensitive (p < 0.05; t-test) to the subject parity; no sensitivity was found to subject weight. Among the 12 parameters sensitive to women's age, 6 parameters show changes (decrease) in tissue elasticity and 6 parameters show weakness in pelvic muscle functions with age. Among the 9 parameters sensitive to parity, 5 parameters show changes (decrease) in tissue elasticity and 4 parameters show weakness in pelvic muscle functions after giving birth. The biomechanical mapping of the female pelvic floor with the VTI provides a unique set of parameters characterizing pelvic changes with age and parity. These objectively measurable biomechanical transformations of pelvic tissues, support structures, and functions may be used in future research and practical applications.
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Affiliation(s)
| | - Vincent Lucente
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, United States
| | | | - Miles Murphy
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, United States
| | - Sonya Ephrain
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, United States
| | - Nina Bhatia
- Princeton Urogynecology, Princeton, United States
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Ton J, Lucente V. Demonstration of Excision of a Vaginal Mullerian Cyst. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.534] [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: 11/15/2022]
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Egorov V, Lucente V, Shobeiri SA, Takacs P, Hoyte L, van Raalte H. Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions. EC Gynaecol 2018; 7:431-446. [PMID: 31093608 PMCID: PMC6513001] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into the pathophysiology of pelvic organ prolapse (POP). Vaginal tactile imaging is an innovative approach to the biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The Vaginal Tactile Imager (VTI) records high definition pressure patterns through the vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. OBJECTIVE The objective of this study is to explore an extended set of 52 biomechanical parameters of the female pelvis for the differentiation and characterization of uterine prolapse relative to normal pelvic floor conditions. METHODS Sixty subjects were included in the data analysis from observational and case-controlled studies. Out of these 60, forty-two subjects had normal pelvic floor conditions and 18 subjects had uterine prolapse (no anterior, no posterior prolapse). The VTI, model 2S, was used with an analytical software package to automatically calculate 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). RESULTS The ranges, mean values, and standard deviations for all 52 VTI parameters were established. Twenty-two of 52 parameters were identified as statistically sensitive (p < 0.05; t-test) to the development of uterine prolapse. Among these 21 parameters, 6 parameters show changes (decrease) in tissue elasticity, 5 parameters show deteriorations in pelvic support, and 10 parameters show weakness in muscle functions for uterine prolapsed versus normal conditions. CONCLUSION The biomechanical mapping of the female pelvic floor with the VTI provides a unique set of parameters characterizing uterine prolapse versus normal conditions. These objectively measurable biomechanical transformations of pelvic tissues, support structures, and functions under the prolapse conditions may be useful in future research and practical applications.
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Affiliation(s)
| | - Vincent Lucente
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, United States
| | | | - Peter Takacs
- Eastern Virginia Medical School, Norfolk, United States
| | - Lennox Hoyte
- The Pelvic Floor Institute, Tampa, United States
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Ton J, Hornis C, Herrera A, Ephraim S, Lucente V. Single-Incision Mid-Urethral Slings (SIMS) Performed in the Office: An Update on Clinical Outcomes. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.651] [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: 10/28/2022]
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Egorov V, Shobeiri SA, Takacs P, Hoyte L, Lucente V, van Raalte H. Biomechanical Mapping of the Female Pelvic Floor: Prolapse versus Normal Conditions. ACTA ACUST UNITED AC 2018; 8:900-924. [PMID: 31080695 PMCID: PMC6508651 DOI: 10.4236/ojog.2018.810093] [Citation(s) in RCA: 12] [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] [Indexed: 11/20/2022]
Abstract
Background: Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into pathophysiology of pelvic organ prolapse (POP). An innovative approach—vaginal tactile imaging—allows biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The Vaginal Tactile Imager (VTI) records high definition pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. Objective: To explore an extended set of 52 biomechanical parameters for differentiation and characterization of POP relative to normal pelvic floor conditions. Methods: 96 subjects with normal and POP conditions were included in the data analysis from multi-site observational, case-controlled studies; 42 subjects had normal pelvic floor conditions and 54 subjects had POP. The VTI, model 2S, was used with an analytical software package to calculate automatically 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). The groups were equalized for subject age and parity. Results: The ranges, mean values, and standard deviations for all 52 VTI parameters were established. 33 of 52 parameters were identified as statistically sensitive (p < 0.05; t-test) to the POP development. Among these 33 parameters, 11 parameters show changes (decrease) in tissue elasticity, 8 parameters show deteriorations in pelvic support and 14 parameters show weakness in muscle functions for POP versus normal conditions. Conclusions: The biomechanical mapping of the female pelvic floor with the VTI provides a unique set of parameters characterizing POP versus normal conditions. These objectively measurable biomechanical transformations of pelvic tissues, support structures, and functions under POP may be used in future research and practical applications.
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Affiliation(s)
| | | | | | | | - Vincent Lucente
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, USA
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MacDiarmid S, Lucente V, Kaaki B, English S, Meffan P, Gilling P, Clark M, Sen S, Sand P. MP75-18 SAFETY & EFFICACY OF THE ECOIN™ IMPLANTABLE TIBIAL NERVE STIMULATION DEVICE FOR OVERACTIVE BLADDER SYNDROME. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2110] [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: 10/17/2022]
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Egorov V, Murphy M, Lucente V, van Raalte H, Ephrain S, Bhatia N, Sarvazyan N. Quantitative Assessment and Interpretation of Vaginal Conditions. Sex Med 2017; 6:39-48. [PMID: 29273316 PMCID: PMC5815972 DOI: 10.1016/j.esxm.2017.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Few means exist to provide quantitative and reproducible assessment of vaginal conditions from biomechanical and functional standpoints. Aim To develop a new approach for quantitative biomechanical characterization of the vagina. Methods Vaginal tactile imaging (VTI) allows biomechanical assessment of soft tissue and function along the entire length of the anterior, posterior, and lateral vaginal walls. This can be done at rest, with applied vaginal deformation, and with pelvic muscle contraction. Results Data were analyzed for 42 subjects with normal pelvic floor support from an observational case-controlled clinical study. The average age was 52 years (range = 26–90 years). We introduced 8 VTI parameters to characterize vaginal conditions: (i) maximum resistance force to insertion (newtons), (ii) insertion work (millijoules), (iii) maximum stress-to-strain ratio (elasticity; kilopascals per millimeter), (iv) maximum pressure at rest (kilopascals), (v) anterior-posterior force at rest (newtons), (vi) left-right force at rest (newtons), (vii) maximum pressure at muscle contraction (kilopascals), and (viii) muscle contraction force (newtons). We observed low to moderate correlation of these parameters with subject age and no correlation with subject weight. 6 of 8 parameters demonstrated a P value less than .05 for 2 subject subsamples divided by age (≤52 vs >52 years), which means 6 VTI parameters change with age. Conclusions VTI allows biomechanical and functional characterization of the vaginal conditions that can be used for (i) understanding “normal” vaginal conditions, (ii) quantification of the deviation from normality, (iii) personalized treatment (radiofrequency, laser, or plastic surgery), and (iv) assessment of the applied treatment outcome. Egorov V, Murphy M, Lucente V, et al. Quantitative Assessment and Interpretation of Vaginal Conditions. Sex Med 2018;6:39–48.
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Affiliation(s)
| | - Miles Murphy
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, PA, USA
| | - Vincent Lucente
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, PA, USA
| | | | - Sonya Ephrain
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, PA, USA
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Palvia V, Gonzalez Rios A, Ephraim S, Lucente V. Laparoscopic Sacrocolpopexy with Prior Transvaginal Mesh. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.240] [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: 10/18/2022]
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Ting M, Gonzalez A, Ephraim S, Murphy M, Lucente V. The importance of a full thickness vaginal wall dissection. Comment on "Transvaginal mesh: a historical review and update of the current state of affairs in the United States". Int Urogynecol J 2017; 28:1609-1610. [PMID: 28871356 DOI: 10.1007/s00192-017-3463-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/14/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Michael Ting
- Department of Obstetrics and Gynecology, St Luke's University Hospital, Allentown, PA, 18103, USA.
| | - Angel Gonzalez
- Department of Obstetrics and Gynecology, St Luke's University Hospital, Allentown, PA, 18103, USA
| | - Sonya Ephraim
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, 3050 Hamilton Blvd, Suite 200, Allentown, PA, 18103, USA
| | - Miles Murphy
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, 3050 Hamilton Blvd, Suite 200, Allentown, PA, 18103, USA
| | - Vincent Lucente
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, 3050 Hamilton Blvd, Suite 200, Allentown, PA, 18103, USA
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Abstract
BACKGROUND Further progress in restoring a woman's health may be possible if a patient with a damaged pelvic floor could undergo medical imaging and biomechanical diagnostic tests. The results of such tests could contribute to the analysis of multiple treatment options and suggest the optimal one for that patient. AIM To develop a new approach for the biomechanical characterization of vaginal conditions, muscles, and connective tissues in the female pelvic floor. METHODS Vaginal tactile imaging (VTI) allows biomechanical assessment of the soft tissue along the entire length of the anterior, posterior, and lateral vaginal walls at rest, with manually applied deflection pressures and with muscle contraction, muscle relaxation, and Valsalva maneuver. VTI allows a large body of measurements to evaluate individual variations in tissue elasticity, support defects, as well as pelvic muscle function. Presuming that 1) the female pelvic floor organs are suspended by ligaments against which muscles contract to open or close the outlets and 2) damaged ligaments weaken the support and may reduce the force of muscle contraction, we made an attempt to characterize multiple pelvic floor structures from VTI data. RESULTS All of the 138 women enrolled in the study were successfully examined with the VTI. The study subjects have had normal pelvic support or pelvic organ prolapse (stages I-IV). The average age of this group of subjects was 60±15 years. We transposed a set of 31 VTI parameters into a quantitative characterization of pelvic muscles and ligamentous structures. Interpretation of the acquired VTI data for normal pelvic floor support and prolapse conditions is proposed based on biomechanical assessment of the functional anatomy. CONCLUSION Vaginal tactile imaging allows biomechanical characterization of female pelvic floor structures and tissues in vivo, which may help to optimize treatment of the diseased conditions such as prolapse, incontinence, atrophy, and some forms of pelvic pain.
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Affiliation(s)
- Vincent Lucente
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA, USA
| | | | - Miles Murphy
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA, USA
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Garely AD, Lucente V, Vapnek J, Smith N. Solifenacin for Overactive Bladder with Incontinence: Symptom Bother and Health-Related Quality of Life Outcomes. Ann Pharmacother 2016; 41:391-8. [PMID: 17341526 DOI: 10.1345/aph.1h581] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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] Open
Abstract
Background: Approximately one-third of patients with overactive bladder (OAB) experience incontinence, a bothersome symptom with a clear negative effect on quality of life. Objective: To assess OAB patients' perceptions of improvements in symptom bother and quality of life after taking solifenacin under conditions reflecting day-today practice. Methods: VOLT (the VESIcare Open-Label Trial) was a prospective, open-label study in patients with OAB (defined as urgency, urge urinary incontinence, daytime frequency, or nocturia for ≥3 mo) who were treated with flexibly dosed, once-daily solifenacin for 12 weeks. This study included subjects enrolled in VOLT who, at baseline, had urge incontinence and reported incontinence as their most bothersome symptom. All patients were started on solifenacin 5 mg/day; at week 4, the dosage could be increased to 10 mg/day and at week 8 could be maintained or decreased back to 5 mg/day. Efficacy was assessed by 3 independent patient-reported outcomes: the Patient Perception of Bladder Condition (PPBC) scale, a visual analog scale (VAS) for assessing individual symptoms, and the Overactive Bladder Questionnaire (OAB-q). Results: Of the 2205 patients in the VOLT full analysis set, 1586 (71.9%) had urge incontinence at baseline, of which 582 (36.7%) reported incontinence as their most bothersome symptom. In this cohort, mean PPBC score at baseline was 4.6 (indicating moderate-to-severe problems) and at endpoint had decreased significantly to 2.9 (very minor to some minor problems; p < 0.001). At endpoint, 80.4% of patients achieved improvement in their PPBC score. These patients reported significant improvements from baseline in urinary urgency, urge incontinence, frequency, and nocturia on the VAS (p < 0.001) and all OAB-q domains (symptom severity, coping, concern, sleep, social, health-related quality of life) at endpoint (p < 0.001). Conclusions: Patients reporting urge incontinence as their most bothersome OAB symptom can be expected to demonstrate significant improvements in multiple patient-related outcomes following treatment with flexibly dosed solifenacin.
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Affiliation(s)
- Alan D Garely
- Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY 11501, USA.
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Gonzalez Rios AR, Chu Lam MT, Anasti J, Lucente V. Failed Endometrial Ablation: Who Is at Risk? J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.115] [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: 10/20/2022]
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Gonzalez Rios AR, Ephraim S, Murphy M, Lucente V. In Office Single Incision Sling Procedure: A Safe, Cost-Effective Approach for the Surgical Management of Stress Urinary Incontinence. J Minim Invasive Gynecol 2016; 22:S247. [PMID: 27679174 DOI: 10.1016/j.jmig.2015.08.862] [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: 11/28/2022]
Affiliation(s)
- A R Gonzalez Rios
- Minimally Invasive Gynecologic Surgery, St. Luke's University Hospital, Bethlehem, Pennsylvania
| | - S Ephraim
- Minimally Invasive Gynecologic Surgery, St. Luke's University Hospital, Bethlehem, Pennsylvania
| | - M Murphy
- Minimally Invasive Gynecologic Surgery, St. Luke's University Hospital, Bethlehem, Pennsylvania
| | - V Lucente
- Minimally Invasive Gynecologic Surgery, St. Luke's University Hospital, Bethlehem, Pennsylvania
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Mellgren A, Zutshi M, Lucente VR, Culligan P, Fenner DE, Chern H, Culligan P, Fenner D, Gurland B, Karram M, Lowry A, Lucente V, Marcet J, Matthews C, Mellgren A, Murphy M, McNevin S, Nihira M, Pickron B, Rahbar R, Rasheid S, Raybon B, Salamon C, Sands D, Shobeiri A, Varma M, Zutshi M. A posterior anal sling for fecal incontinence: results of a 152-patient prospective multicenter study. Am J Obstet Gynecol 2016; 214:349.e1-8. [PMID: 26493933 DOI: 10.1016/j.ajog.2015.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/30/2015] [Accepted: 10/09/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The transobturator posterior anal sling (TOPAS) system is a posterior anal sling that is a minimally invasive, self-fixating polypropylene mesh intended to treat fecal incontinence (FI) in women who have failed conservative therapy. OBJECTIVE We are reporting 1-year outcome in a prospective, multicenter study under investigational device exemption, evaluating this new treatment modality. STUDY DESIGN A total of 152 women were implanted with the TOPAS system at 14 centers in the United States. FI was assessed preoperatively and at the 12-month follow up with a 14-day bowel diary, Cleveland Clinic Incontinence Scores, and FI Quality of Life questionnaires. Treatment success was defined as reduction in number of FI episodes of ≥50% compared to baseline. Missing bowel diary data were considered treatment failures. The Wilcoxon signed rank test was used to compare changes observed at 12 months vs baseline. RESULTS Mean age was 59.6 years old (SD 9.7). The mean duration of FI was 110 mo (range 8-712) months. Mean length of the implant procedure was 33.4 (SD 11.6) minutes. Mean EBL was 12.9 (SD 10.5) mL. Average follow-up was 24.9 months. At 12 months, 69.1% of patients met the criteria for treatment success, and 19% of subjects reported complete continence. FI episodes/wk decreased from a median of 9.0 (range 2-40) at baseline to 2.5 (range 0-40) (P < .001). FI days decreased from a median of 5.0 (range 1.5-7) at baseline to 2.0 (range 0-7) (P < .001) over a 7-day period. FI associated with urgency decreased from a median at baseline of 2.0 (range 0-26) to 0 (range 0-14.5) (P < .001). The mean Cleveland Clinic Incontinence Scores decreased from 13.9 at baseline to 9.6 at 12 months (P < .001). FI Quality of Life scores for all 4 domains improved significantly from baseline to 12 months (P < .001). A total of 66 subjects experienced 104 procedure- and/or device-related adverse events (AEs). Most AEs were short in duration and 97% were managed without therapy or with nonsurgical interventions. No treatment-related deaths, erosions, extrusions, or device revisions were reported. The most common AE categories were pelvic pain (n = 47) and infection (n = 26). Those subjects experiencing pelvic pain had a mean pain score (0-10 scale, 0 = no pain) during the 12-month follow-up of 1.2 (SD 2.4). CONCLUSION The TOPAS system provides significant improvements in FI symptoms and quality of life with an acceptable AE profile and may therefore be a viable minimally invasive treatment option for FI in women.
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Capo' JP, Lucente V, Forero-Schwanhaeuser S, He W. Efficacy and Tolerability of Solifenacin in Patients Aged ⩾ 65 Years with Overactive Bladder: Post-Hoc Analysis of 2 Open-Label Studies. Postgrad Med 2015; 123:94-104. [DOI: 10.3810/pgm.2011.01.2250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Based on the growing evidence within our literature, mesh is clearly needed for long-term success for the repair of anterior/apical defects. Clear credentialing and clinical privilege criteria policies are long overdue. Current data are rapidly growing, with level I studies completed that demonstrate that when transvaginal mesh-augmented repair is used in appropriately selected patients for the repair of pelvic organ prolapse, the procedure has a favorable risk/benefit ratio when compared with suture repair. This article highlights the evolving clinical-based experiences of the authors that are primarily grounded in reality-based medicine with the consideration and incorporation of evidence-based medicine.
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Affiliation(s)
- Vincent Lucente
- Department of OB/GYN, St Luke's Hospital & Health Network, Allentown, PA 18103, USA.
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Cornu JN, Skurnik A, Ciofu C, Peyrat L, Lucente V, Haab F. 1358 PROSPECTIVE EVALUATION OF THE AJUST SINGLE INCISION TRANSOBTURATOR SLING PROCEDURE FOR STRESS URINARY INCONTINENCE IN WOMEN: RESULTS OVER ONE YEAR FOLLOW-UP. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Murphy M, Holzberg A, van Raalte H, Kohli N, Goldman HB, Lucente V. Time to rethink: an evidence-based response from pelvic surgeons to the FDA Safety Communication: "UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse". Int Urogynecol J 2011; 23:5-9. [PMID: 22086260 DOI: 10.1007/s00192-011-1581-2] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/30/2011] [Indexed: 02/03/2023]
Abstract
In July of 2011 the U.S. Food and Drug Administration (FDA) released a safety communication entitled "UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse." The stated purpose of this communication is to inform health care providers and patients that serious complications with placement of this mesh are not rare and that it is not clear that these repairs are more effective than nonmesh repair. The comments regarding efficacy are based on a systematic review of the scientific literature from 1996-2011 conducted by the FDA. Our review of the literature during this time yields some different conclusions regarding the safety and efficacy of mesh use in prolapse repair. It may be useful to consider this information prior to making recommendations regarding mesh use in prolapse surgery according to the recent UPDATE.
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Affiliation(s)
- Miles Murphy
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, 1010 Horsham Rd, North Wales, PA 18103, USA.
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Jeffery ST, De Jong P, Abdool Z, Van Wijk F, Lucente V, Murphy M. Single-incision sling operations for urinary incontinence in women. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Murphy M, Sternschuss G, Haff R, van Raalte H, Saltz S, Lucente V. Quality of life and surgical satisfaction after vaginal reconstructive vs obliterative surgery for the treatment of advanced pelvic organ prolapse. Am J Obstet Gynecol 2008; 198:573.e1-7. [PMID: 18455537 DOI: 10.1016/j.ajog.2007.12.036] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 11/17/2007] [Accepted: 12/31/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to compare quality of life and patient satisfaction after obliterative vs reconstructive surgery. STUDY DESIGN A retrospective cohort study of women who met the following inclusion criteria: age 65 years or older, leading edge of prolapse 4 cm or greater beyond the hymen, and vaginal reconstructive or obliterative surgery. Preoperative responses to the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were collected retrospectively. We then mailed the same questionnaires, and the Surgical Satisfaction Questionnaire (SSQ-8), to these subjects postoperatively. RESULTS Mode of surgery was evenly split (n = 45 per group) between the 90 patients meeting the inclusion criteria. Improvements from the preoperative to postoperative Incontinence Impact Questionnaire and Urogenital Distress Inventory were comparable as were postoperative Surgical Satisfaction Questionnaire scores. CONCLUSION Improvements in condition-specific quality of life and postoperative patient satisfaction measures are comparable in women with prolapse who undergo either reconstructive or obliterative surgery.
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Capo' JP, Laramée C, Lucente V, Fakhoury A, Forero-Schwanhaeuser S. Solifenacin treatment for overactive bladder in Hispanic patients: patient-reported symptom bother and quality of life outcomes from the VESIcare Open-Label Trial. Int J Clin Pract 2008; 62:39-46. [PMID: 18036164 DOI: 10.1111/j.1742-1241.2007.01644.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The primary goal of overactive bladder (OAB) treatment is to reduce symptoms and improve health-related quality of life (HRQoL). Although trials open enrolment to everyone, most OAB studies feature Caucasians. Here we present Hispanic data. METHODS VESIcare Open-Label Trial was a 12-week, open-label, flexible-dosing study in patients with OAB symptoms for >or=3 months. All patients started on solifenacin 5 mg/day, with a dosing option of 5 or 10 mg/day at weeks 4 and 8. Three patient-reported outcome (PRO) measures assessed symptom improvement and treatment satisfaction: the Patient Perception of Bladder Condition (PPBC) scale, a Visual Analogue Scale (VAS), the Overactive Bladder Questionnaire (OAB-q). RESULTS 94/2205 patients in the full population were Hispanic. Urgency was most frequently reported at baseline (93.6%), followed by frequency (91.5%), nocturia (84.0%) and urge incontinence (UI) (67.0%). Frequency was reported as the most bothersome symptom (MBS) by a higher proportion of Hispanics than the full population (40.4% vs. 28.1%). UI was reported as the MBS by a smaller proportion of Hispanics (18.1% vs. 27.3%). Patients reporting moderate-to-severe problems related to bladder condition at baseline reported improvement to 'some minor problems' at week 12. Over 72.0% of patients experienced PPBC score improvement. Both groups reported significant improvements in urgency, UI, frequency and nocturia on the VAS (all p<0.001) and all OAB-q domains (all p<0.001) at week 12. CONCLUSION Although numbers were small, Hispanics receiving solifenacin for OAB reported improvement from baseline in symptom bother and HRQoL, as assessed by three independent PRO measures.
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Affiliation(s)
- J P Capo'
- Internal Medicine Associates of Atlanta, Atlanta, GA 30342, USA.
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Schwartz M, Abbott KR, Glazerman L, Sobolewski C, Jarnagin B, Ailawadi R, Lucente V. Positive symptom improvement with laparoscopic uterosacral ligament repair for uterine or vaginal vault prolapse: Interim results from an active multicenter trial. J Minim Invasive Gynecol 2007; 14:570-6. [PMID: 17848317 DOI: 10.1016/j.jmig.2007.01.008] [Citation(s) in RCA: 9] [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] [Received: 10/28/2006] [Revised: 01/12/2007] [Accepted: 01/22/2007] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE To evaluate the use of laparoscopic uterosacral ligament repair for long-term patient symptom improvement in patients with uterine prolapse or posthysterectomy vaginal vault prolapse and to evaluate how laparoscopic instrumentation kits facilitate procedure performance for the surgeon. DESIGN Nonrandomized, prospective, multicenter case series (Canadian Task Force classification II-2). SETTING Five clinical sites consisting of 4 community hospitals and 1 university medical center. PATIENTS Seventy-two patients with stage II or worse uterine prolapse (58%, n = 42) or posthysterectomy vaginal vault prolapse (42%, n = 30). One patient with stage I vaginal vault prolapse was included in the group due to her significant symptoms. INTERVENTIONS Laparoscopic uterosacral ligament repair was performed on all patients; round ligament truncation was also performed selectively on patients with uterine prolapse. Fifty-seven percent (41 patients) had concomitant pelvic procedures. MEASUREMENTS AND MAIN RESULTS At 12-month follow-up, Pelvic Organ Prolapse Quantification (POP-Q) scores and patient self-reported symptom scores were significantly improved over baseline after laparoscopic repair of pelvic organ prolapse. Positive mean change in POP-Q score was 14.4 (p = .0003) for uterine prolapse repair and 9.28 (p = .017) for vaginal vault prolapse repair. Positive mean change in total symptom score was 20.36 (p <.0001) for uterine prolapse repair and 11.43 (p = .005) for vaginal vault prolapse repair. Surgeons reported a mean procedure time of 31.6 minutes for uterine prolapse repair and 21.7 minutes for vaginal vault prolapse repair. A mean rating of 7.5 was documented for ease of use for the uterine prolapse kit and 4.1 for the vaginal vault prolapse kit on a scale of 1 to 10. CONCLUSION Laparoscopic uterosacral ligament repair improves symptoms and POP-Q scores over the long term in patients with uterine or vaginal vault prolapse. Laparoscopic instrumentation kits facilitate procedure performance for the surgeon with expedited surgery times.
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Affiliation(s)
- Marlan Schwartz
- Lifeline Medical Associates, Piscataway, New Jersey 08854, USA.
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Sand P, Zinner N, Newman D, Lucente V, Dmochowski R, Kelleher C, Dahl NV. Oxybutynin transdermal system improves the quality of life in adults with overactive bladder: a multicentre, community-based, randomized study. BJU Int 2007; 99:836-44. [PMID: 17187655 DOI: 10.1111/j.1464-410x.2006.06658.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [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: 11/28/2022]
Abstract
OBJECTIVE To assess health-related quality-of-life (HRQoL) and safety with the oxybutynin transdermal system (OXY-TDS) (Oxytrol), Watson Pharma, Corona, CA, USA) in the Multicentre Assessment of Transdermal Therapy in Overactive Bladder With Oxybutynin (MATRIX) study, as HRQoL measurements are increasingly important in evaluating pharmacotherapy for overactive bladder (OAB). PATIENTS AND METHODS This randomized, open-label, community-based study enrolled 2878 participants aged >/=18 years who had been given a diagnosis of OAB. The 327 study sites were representative of various practice types. All participants were treated with OXY-TDS 3.9 mg/day for </=6 months. HRQoL was assessed using the King's Health Questionnaire (KHQ); the primary endpoint was the change in KHQ scores from baseline to study end. RESULTS Most enrolees (2052/2625; 78.2%) had moderate to severe OAB at baseline (Patient Perception of Bladder Condition score >/= 4 on a scale of 1-6), and most (1632/2859; 57.1%) had been given previous drug treatment for OAB. Of 2592 with evaluable baseline KHQ scores, 92.2% reported urgency and 88.2% reported urge urinary incontinence. The most impaired domains at baseline were Incontinence Impact (69.3), Symptom Severity (55.9), and Sleep/Energy (54.2). There were clinically meaningful and statistically significant improvements in nine of 10 domains at the study end; the greatest improvements were in Incontinence Impact (-13.5), Symptom Severity (-12.4), and Role Limitations (-13.3). The treatment was well tolerated, with low incidences of drug-related anticholinergic adverse effects such as dry mouth (75; 2.6%), constipation (44; 1.5%), and dizziness (21; 0.7%). There were drug-related application-site reactions, including pruritus, erythema, dermatitis and irritation, in 14.0% of participants. CONCLUSIONS OXY-TDS treatment was well tolerated in this diverse, community-based population, and resulted in clinically significant improvements in HRQoL, regardless of baseline characteristics.
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Affiliation(s)
- Peter Sand
- Evanston Continence Center, Evanston Northwestern Healthcare, Northwestern University, Feinburg School of Medicine, Evanston IL, USA
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Kelleher C, Cardozo L, Kobashi K, Lucente V. Solifenacin: as effective in mixed urinary incontinence as in urge urinary incontinence. Int Urogynecol J 2005; 17:382-8. [PMID: 16283422 DOI: 10.1007/s00192-005-0023-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 09/04/2005] [Indexed: 11/28/2022]
Abstract
Patients with mixed urinary incontinence (MUI) are frequently treated with antimuscarinic therapy, despite little data being previously published for this patient group. We present a subgroup analysis of patients with overactive bladder syndrome, assessing the efficacy of once-daily solifenacin succinate in patients with MUI (n = 1041) or urge urinary incontinence (UUI; n = 1648) only. A greater proportion of patients receiving solifenacin achieved resolution of incontinence in both the MUI and UUI groups (MUI: 5 mg = 43%, 10 mg = 49%; UUI: 5 mg = 55%, 10 mg = 54%) compared with patients receiving placebo (MUI 33%, UUI 35%). Baseline to endpoint improvements in all other symptoms were statistically significant vs placebo for both solifenacin doses in both cohorts. The incidence of adverse events was comparable between the MUI and UUI cohorts. This analysis shows that once-daily solifenacin was as effective and well tolerated in patients with MUI as in patients with UUI.
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Affiliation(s)
- Con Kelleher
- Guys and St. Thomas' Hospital NHS Trust, 8 Devonshire Place, W1G 6HP, London, UK.
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Mattox TF, Lucente V, McIntyre P, Miklos JR, Tomezsko J. Abnormal spinal curvature and its relationship to pelvic organ prolapse. Am J Obstet Gynecol 2000; 183:1381-4; discussion 1384. [PMID: 11120500 DOI: 10.1067/mob.2000.111489] [Citation(s) in RCA: 53] [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: 11/22/2022]
Abstract
OBJECTIVE Intra-abdominal vector forces have been implicated in the development of genital prolapse. Because the normal spinal curvature appears to protect the pelvic cavity from direct upper abdominal forces, variations in spinal curvature may alter these vector forces and possibly potentiate the development of pelvic organ prolapse. This study was undertaken to evaluate the relationship of spinal curvature and pelvic organ prolapse, specifically, the loss of lumbar lordosis or pronounced thoracic kyphosis. STUDY DESIGN A total of 363 patients referred for various complaints of urinary incontinence or pelvic organ prolapse were included in this multicenter, prospective, case-control study. All patients underwent a detailed history with site-specific examinations; pelvic organ prolapse was quantitatively assessed according to the POPQ (pelvic organ prolapse quantitation) staging system. Spinal curvature was measured with a flexi-curve malleable rod when patients were in a fully erect position. Spinal curvature was then transferred to graph paper by tracing the flexi-curve. Thoracic and lumbar curvatures were determined by measuring thoracic and lumbar lengths and widths, respectively. RESULTS Ninety-two patients had abnormal spinal curvature according to the study criteria. Complete loss of lumbar lordosis was found in 69 patients. Of the 92 patients with an abnormal curvature, 84 currently had or previously had pelvic organ prolapse (sensitivity, 91%). When compared with patients with a normal curvature, patients with an abnormal spinal curvature were 3. 2 times more likely to have development of pelvic organ prolapse (odds ratio, 3.18; 95% confidence interval, 1.46 to 6.93; P =.002). There was no difference in the number of vaginal deliveries, weight of largest vaginally delivered infant, or body mass index. Only 11% (8/72) of patients with stage 0 prolapse had an abnormal spinal curvature, which increased to 30% (28/99) in patients with stage III prolapse (P =.042). CONCLUSION An abnormal change in spinal curvature, specifically, a loss of lumbar lordosis, appears to be a significant risk factor in the development of pelvic organ prolapse.
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Affiliation(s)
- T F Mattox
- Greenville Hospital System, Division of Urogynecology, Department of Obstetrics and Gynecology, University of South Carolina, Greenville, USA
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Abstract
BACKGROUND Many hospitals have recognized the need to develop policies and procedures for female sexual assault victims' prompt access to emergency medical care and for collecting law enforcement evidence. At Lehigh Valley Hospital (Allentown, Penn), care in the emergency department (ED) for sexual assault victims was covered by oncall obstetricians and gynecologists. Although many aspects of rape management were in place, a busy ED with varying levels of physician response and exposure to the process of rape management contributed to a lack of standardized, objective, timely, and compassionate medical management of sexual assault victims. DEVELOPING THE PROGRAM: The Sexual Assault Nurse Examiner (SANE) interdisciplinary approach to care of sexual assault victims was implemented in May 1998. Community education and awareness projects emphasized prevention of sexual assault and domestic violence, as well as minimization of trauma for victims by promoting services that provide a supportive, caring, and healing environment. RESULTS Comparing a baseline group of 130 sexual assault victims with 39 patients who were evaluated after the SANE approach was implemented indicated increased clinical interaction and significant improvements in quality indicators, such as completeness of evaluation and information gathered relevant to medical-legal issues. DISCUSSION Law enforcement staff developed a more collaborative relationship with SANE examiners through the interdisciplinary team approach. Collaborative relationships were initiated with several other hospitals in the hospital's integrated delivery system to help offset some of the program's training, continuing education, and on-call costs and to allow for joint outcomes collection. The SANE program became a core ED service in July 1999.
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Affiliation(s)
- F Derhammer
- Department of Community Health and Health Studies, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
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Abstract
Vesicovaginal fistula repair is most commonly undertaken via a transvaginal approach. We report a recurrent case of vesicovaginal fistula which was ultimately repaired using a laparoscopic approach. The fistula followed a hysterectomy and persisted despite two operations using the Latzko partial colpocleisis and prolonged catheterization. The fistulous tract was ultimately repaired by closing the vagina and bladder with an interposing omental flap utilizing a laparoscopic approach.
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Affiliation(s)
- J R Miklos
- Lehigh Valley Hospital, Allentown, Pennsylvania, USA
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Miklos JR, Kohli N, Lucente V, Saye WB. Site-specific fascial defects in the diagnosis and surgical management of enterocele. Am J Obstet Gynecol 1998; 179:1418-22; discussion 1822-3. [PMID: 9855575 DOI: 10.1016/s0002-9378(98)70004-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [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: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to assess the surgical feasibility and clinical outcomes of a vaginal enterocele repair that was based on the theory of site-specific defects in the vaginal fascia. STUDY DESIGN Seventeen patients during a 2-year period with a diagnosis of enterocele and vaginal vault descensus with or without coexisting rectocele underwent surgical correction with a site-specific fascial defect repair. An enterocele was defined as vaginal wall prolapse seen during the operation in which the peritoneum was found to be in direct contact with the vaginal epithelium, with no intervening fascia. Patients were examined at 4 weeks after the operation and then at 6-month intervals, with site-specific analysis of pelvic prolapse at the vaginal apex and posterior vaginal segment. RESULTS Identification and site-specific fascial defect repair of the enterocele were successfully performed in all 17 cases. All patients also underwent a uterosacral ligament vaginal vault suspension, and 15 patients (88%) underwent concurrent posterior colporrhaphy. There were no intraoperative complications. At a mean follow-up of 6.3 months (range 1-17 months), 2 patients (12%) had mild, asymptomatic vaginal vault descensus but no patients (0/17) had evidence of a recurrent enterocele or rectocele. CONCLUSION Enterocele correction through a fascial defect repair is easily performed through the vaginal route and is associated with excellent surgical outcomes on short-term follow-up.
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Affiliation(s)
- J R Miklos
- Department of Obstetrics and Gynecology, Northside Hospital, Good Samaritan Hospital, Lehigh Valley Medical Center, and Advanced Laparoscopy Training Center, Atlanta, Georgia, USA
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Affiliation(s)
- W B Dupree
- Department of Pathology, Health Network Laboratories, Allentown, Pennsylvania 18103, USA
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Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 1996; 175:1418-21; discussion 1421-2. [PMID: 8987919 DOI: 10.1016/s0002-9378(96)70084-4] [Citation(s) in RCA: 376] [Impact Index Per Article: 13.4] [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: 02/03/2023]
Abstract
OBJECTIVES Our purpose was to determine whether a vaginal or abdominal approach is more effective in correcting uterovaginal prolapse. STUDY DESIGN Eighty-eight women with cervical prolapse to or beyond the hymen or with vaginal vault inversion > 50% of its length and anterior vaginal wall descent to or beyond the hymen were randomized to a vaginal versus abdominal surgical approach. Forty-eight women underwent a vaginal approach with bilateral sacrospinous vault suspension and paravaginal repair, and 40 women underwent an abdominal approach with colposacral suspension and paravaginal repair. Ancillary procedures were performed as indicated. Detailed pelvic examination was performed postoperatively by the nonsurgeon coauthor yearly up to 5 years. The women were examined while standing during maximum strain. Surgery was classified as optimally effective if the woman remained asymptomatic, the vaginal apex was supported above the levator plate, and no protrusion of any vaginal tissue beyond the hymen occurred. Surgical effectiveness was considered unsatisfactory if the woman was symptomatic, the apex descended > 50% of its length, or the vaginal wall protruded beyond the hymen. RESULTS Eighty women (vaginal 42, abdominal 38) were available for evaluation at 1 to 5.5 years (mean 2.5 years). The groups were similar in age, weight, parity, and estrogen status, and 56% had undergone prior pelvic surgery. There was no significant difference between the groups in morbidity, complications, hemoglobin change, dyspareunia, pain, or hospital stay. The vaginal group had longer catheter use, more urinary tract infections, more incontinence, decreased operative time, and lower hospital charge. Surgical effectiveness was optimal in 29% of the vaginal group and 58% of the abdominal group and was unsatisfactory leading to reoperation in 33% of the vaginal group and 16% of the abdominal group. The reoperations included procedures for recurrent incontinence in 12% of the vaginal and 2% of the abdominal groups. The relative risk of optimal effectiveness by the abdominal route is 2.03 (95% confidence interval 1.22 to 9.83), and the relative risk of unsatisfactory outcome using the vaginal route is 2.11 (95% confidence interval 0.90 to 4.94). CONCLUSIONS Reconstructive pelvic surgery for correction of significant pelvic support defects was more effective with an abdominal approach.
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Affiliation(s)
- J T Benson
- Department of Obstetrics and Gynecology, Methodist Hospital Medical Center, Indianapolis, IN, USA
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Abstract
OBJECTIVE To determine if there is an association between the degree of thoracic kyphosis and the prevalence of advanced uterine prolapse in women. METHODS A retrospective case-control study compared the degree of thoracic kyphosis among white women with advanced uterine prolapse with that of matched controls. Medical records were reviewed for 412 consecutive women who underwent either abdominal or vaginal hysterectomy. The cases were those with uterine prolapse to or beyond the level of the introitus, and women with no evidence of prolapse served as controls. Spinal curvature was measured preoperatively for each patient using a lateral chest x-ray and the Ferguson method. Forty-eight cases were matched to 48 controls for age, weight, menopausal status, and hormonal status. Results were stratified to analyze the effect of parity on the relationship between uterine prolapse and thoracic kyphosis. RESULTS The degree of thoracic kyphosis was higher in patients with uterine prolapse than in controls (mean paired difference = 4.9 degrees, 95% confidence interval [CI] 3.1-6.7; P < .001). Patients with uterine prolapse had a mean spinal curvature of 13.0 degrees (95% CI 11.5-14.5), whereas controls had one of 8.1 degrees (95% CI 6.9-9.4). A higher degree of thoracic kyphosis was associated with an incremental higher occurrence of uterine prolapse (odds ratio 1.35, 95% CI 1.11-1.65; P < .01). CONCLUSION Thoracic kyphosis appears to be associated with uterine prolapse.
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Affiliation(s)
- L R Lind
- Department of Obstetrics and Gynecology, North Shore University Hospital-Cornell University Medical Center, Manhasset, New York, USA
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Lucente V, Benson JT. Vaginal müllerian cyst presenting as an anterior enterocele: a case report. Obstet Gynecol 1990; 76:906-8. [PMID: 2216253] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case is discussed of an extremely large vaginal müllerian cyst that presented as an anterior enterocele. Sonographic and radiologic studies are described. The patient underwent operative excision of the cyst with reconstructive vaginoplasty.
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Affiliation(s)
- V Lucente
- Department of Obstetrics and Gynecology, Graduate Medical Center, Methodist Hospital of Indiana, Inc., Indianapolis
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