1
|
Cohen N, Nasra LA, Paz M, Kaufman Y, Lavie O, Zilberlicht A. Pain and anxiety management with virtual reality for office hysteroscopy: systemic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1127-1134. [PMID: 37917158 DOI: 10.1007/s00404-023-07261-9] [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: 08/05/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Office hysteroscopy (OH) is a commonly performed procedure, although it might be associated with some degree of pain and anxiety. Our aim was to determine the effects of virtual reality on pain and anxiety levels felt by patients undergoing OH. METHODS MEDLINE, Embase, Google Scholar, Cochrane Library, clinicaltrials.gov, ProQuest, Grey literature, and manual searching of references within studies found in the initial search were systematically searched using the terms 'Virtual Reality' and 'Hysteroscopy' without time or language limitations. The review considered all studies assessing the impact of virtual reality (VR) over OH outcomes, and prospective randomized trials were included in the meta-analysis. Retrospective and case - control studies were excluded from the meta-analysis. RESULTS We identified 17 studies, of which four randomized controlled studies were included in the meta-analysis (327 participants, 168 in the VR group and 159 in the control group). On a 0-10 scale, pain sensation and maximal pain sensation during the operation were not statistically different between study and control groups (relative risk (RR) = -0.64, 95% C.I (-1.57)0.29) and (RR = -0.93, 95% C.I (-3.33) - 1.47), respectively. Anxiety measurement was statistically lower in the study group (RR = -1.73, 95% C.I (-2.79) - ( -0.67)). CONCLUSIONS The available data suggest that VR techniques do not decrease the pain sensation during OH however, they do contribute to a reduction in the anxiety levels experienced by patients. PROSPERO registration number CRD42023432819.
Collapse
Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel.
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel.
| | - Lelia Abu Nasra
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Moran Paz
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Yuval Kaufman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| |
Collapse
|
2
|
Nahshon C, Abramov Y, Zilberlicht A. The effect of subsequent pregnancy and childbirth on stress urinary incontinence recurrence after midurethral sling procedure: a response. Am J Obstet Gynecol 2024:S0002-9378(24)00452-6. [PMID: 38522718 DOI: 10.1016/j.ajog.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Chen Nahshon
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yoram Abramov
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
3
|
Shalabna E, Haya N, Zilberlicht A, Sadeh R, Abramov Y. Colporrhaphies versus Colpocleisis Following Vaginal Hysterectomy for the Treatment of Advanced Pelvic Organ Prolapse: A Comparative Study. Isr Med Assoc J 2024; 26:169-173. [PMID: 38493328] [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: 03/18/2024]
Abstract
BACKGROUND Obliterative vaginal procedures may offer lower perioperative morbidity and equal success rates as reconstructive procedures for frail and elderly women who no longer desire future coital function. The combination of vaginal hysterectomy with either reconstructive or obliterative vaginal procedures has not yet been investigated. OBJECTIVES To compare peri- and postoperative outcomes of vaginal hysterectomy with pelvic floor reconstruction (VHR) vs. vaginal hysterectomy with colpocleisis (VHC). METHODS We conducted a retrospective study comparing medical and surgical data of patients undergoing either VHR or VHC between 2006 and 2015. Data were obtained from inpatient and outpatient medical records including peri- and postoperative course, as well as long-term (24 months) follow-up data. RESULTS We identified 172 patients who underwent VHR and 44 who underwent VHC. Patients in the VHC group were significantly older (71.3 ± 4.5 vs. 68.6 ± 6.5 years, P = 0.01), and more likely to have medical co-morbidities (P = 0.001 and P = 0.029, respectively). Patients in the VHC group experienced shorter operative time (2.3 ± 0.58 vs. 2.7 ± 1.02 hours, P = 0.007), lower perioperative blood loss (P < 0.0001), shorter hospital stay (P < 0.0001), and lower rates of postoperative urinary retention. Long-term pelvic organ prolapse (POP) recurrence rates were significantly higher among the VHR group. Postoperative resolution of both stress urinary incontinence and overactive bladder were common in both groups. CONCLUSIONS VHC is associated with lower perioperative blood loss, shorter operative time, shorter hospital stay, shorter time with an indwelling catheter, and lower long-term objective POP recurrence rates.
Collapse
Affiliation(s)
- Eiman Shalabna
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nir Haya
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rotem Sadeh
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Yoram Abramov
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
4
|
Nahshon C, Karmakar D, Abramov Y, Kugelman N, Lavie O, Zilberlicht A. Risk factors for pelvic organ prolapse recurrence following colpocleisis: A meta-analysis. Int J Gynaecol Obstet 2024; 164:848-856. [PMID: 37488940 DOI: 10.1002/ijgo.14999] [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: 06/04/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Studies aimed to assess risk factors for pelvic organ prolapse (POP) recurrence following colpocleisis with nonconclusive results. OBJECTIVE To investigate risk factors for POP recurrence following colpocleisis. SEARCH STRATEGY MEDLINE, PUBMED, Embase, Web of Science, and Cochrane databases were systematically searched. SELECTION CRITERIA Experimental and non-experimental studies investigating POP recurrence following colpocleisis. DATA COLLECTION AND ANALYSIS We assessed the association between preoperative and postoperative physical examination findings, demographics and medical history, and the risk of recurrence following colpocleisis. MAIN RESULTS A total of 954 studies were identified, of which five studies comprising 2978 patients were eligible for analysis. Both preoperative and postoperative genital hiatus length were significantly longer in the recurrence group (mean difference [MD] 0.48, 95% confidence interval [CI] 0.01-0.94, P = 0.04, I2 = 0% and MD 1.15, 95% CI 0.50-1.81, P = 0.005, I2 = 0%; respectively). Preoperative total vaginal length (TVL) did not differ between groups (MD 0.05, 95% CI -0.40 to 0.50, P = 0.83, I2 = 6%), postoperative TVL was found significantly longer in the recurrence group (MD 0.07, 95% CI -0.03 to 1.38, P = 0.04, I2 = 68%). Both preoperative and postoperative perineal body did not differ between groups. Women with a previous POP surgery were more likely to experience recurrence following colpocleisis (relative risk 2.09, 95% CI 1.18-3.69, P = 0.01, I2 = 0%). Patient's age and previous hysterectomy did not affect recurrence rates. CONCLUSION Wider preoperative and postoperative genital hiatus as well as longer post-operative TVL and previous POP surgery were associated with a higher risk for recurrence following colpocleisis, highlighting the importance of appropriate patient selection and surgical technique in minimizing this risk.
Collapse
Affiliation(s)
- Chen Nahshon
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Yoram Abramov
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nir Kugelman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
5
|
Nahshon C, Abramov Y, Kugelman N, Cohen N, Lavie O, Zilberlicht A. The effect of subsequent pregnancy and childbirth on stress urinary incontinence recurrence following midurethral sling procedure: a meta-analysis. Am J Obstet Gynecol 2024; 230:308-314.e5. [PMID: 38036163 DOI: 10.1016/j.ajog.2023.11.1244] [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: 07/21/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE This study aimed to assess the risk of stress urinary incontinence recurrence and reoperation after a midurethral sling procedure in women with subsequent childbirth and to assess the effect of delivery mode on this risk. DATA SOURCES An electronic database search was performed using MEDLINE with the OvidSP interface and PubMed, Embase, Web of Science, and the Cochrane Library up to September 20, 2023. STUDY ELIGIBILITY CRITERIA This study included experimental and nonexperimental studies, composed of randomized controlled and observational (case-control, cohort, and cross-sectional) studies assessing the risk factors for stress urinary incontinence recurrence and reoperation after childbirth in women who had previously undergone a midurethral sling procedure for stress urinary incontinence. METHODS Analysis was performed using RevMan (version 5.3; Cochrane Collaboration, Oxford, United Kingdom). Quantitative synthesis was used if the included studies were sufficient in numbers and homogeneity. The overall certainty of the evidence was assessed using criteria recommended by the Grading of Recommendations Assessment, Development, and Evaluation Working Group. RESULTS A total of 2001 studies were identified, of which 6 were eligible for analysis, composed of 381 patients who had at least 1 childbirth after a midurethral sling procedure (study group) and 860 patients who underwent a midurethral sling without having a subsequent childbirth (control group). All included studies were observational, the patients' mean age at the time of the midurethral sling procedure ranged from 34 to 36 years, and the mean time from midurethral sling procedure to delivery ranged from 21 to 31 months. No difference in stress urinary incontinence recurrence (relative risk, 0.1.02; 95% confidence interval, 0.78-1.33) or reoperation (relative risk, 1.37; 95% confidence interval, 0.87-2.17) was found between the study and control groups. The average follow-up time among the included studies of this comparison was 9.8 years (range, 2-18). Furthermore, the mode of delivery (vaginal vs cesarean) did not seem to affect the risk of stress urinary incontinence recurrence. CONCLUSION Subsequent pregnancy and childbirth did not increase the risk of stress urinary incontinence recurrence or reoperation after a midurethral sling procedure.
Collapse
Affiliation(s)
- Chen Nahshon
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yoram Abramov
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nir Kugelman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nadav Cohen
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
6
|
Cohen N, Cohen B, Karmakar D, Lavie O, Zilberlicht A. When Do Women with Second Trimester Pregnancy Loss Need Repeated Doses of Misoprostol? Insights from a Teaching Hospital. Isr Med Assoc J 2023; 25:799-803. [PMID: 38142318] [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: 12/25/2023]
Abstract
BACKGROUND Cases of second trimester pregnancy loss can be treated either pharmacologically or by surgical evacuation. Misoprostol, an E1-prostaglandin analog, is used to facilitate the evacuation of the uterus. OBJECTIVES To determine the risk factors associated with patients who were treated with five or more repeated doses of misoprostol. METHODS We conducted a retrospective study of patients treated with vaginal misoprostol at our institution between December 2016 and October 2021 for second trimester pregnancy loss. RESULTS In total, 114 patients were eligible for analysis; 83 were treated with < 5 doses and 31 with ≥ 5. We recorded each case in which repeated doses were administered, irrespective of predetermined conditions such as gravidity, parity, maternal age, or gestational age. Moreover, cases of five or more misoprostol dosing were not associated with an increased complications rate, except for the increased duration of hospitalization (3.1 vs. 2.2 days, P-value < 0.01). CONCLUSIONS Repeated dosing could not be predicted before treatment among those treated with vaginally administered misoprostol for second trimester pregnancy loss. However, low complication rates of repeated dosing may reassure both physicians and patients regarding safety, efficacy, and future fertility.
Collapse
Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Bracha Cohen
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Ofer Lavie
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
7
|
Cohen N, Kedem HI, Abu-Foul L, Paz M, Kaufman Y, Lavie O, Zilberlicht A. Does vaginal cleansing with iodine decreases infection rate in office hysteroscopy? Arch Gynecol Obstet 2023; 308:1791-1796. [PMID: 37653251 DOI: 10.1007/s00404-023-07199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To determine whether preoperative vaginal cleansing with iodine-based solution prior to hysteroscopy, reduces postoperative infection rate compared to no vaginal cleansing. METHODS A retrospective study at a single tertiary, university affiliated hospital of all individuals who have had an office hysteroscopy. Study group consisted of patients who have had preoperative vaginal cleansing with iodine-based solution and were compared to those who have not. Any procedural related complaints at the 30 days following the hysteroscopy were recorded. RESULTS A total of 505 were available for analysis, 183 in the study group and 322 in the control group. The most common indications for operation were infertility evaluation (33.9% vs. 28.6%) and retained products of conception (33.3% vs. 29.2%), and most common procedures were diagnostic only (49.7% vs. 42.5%) followed by adhesiolysis (12% vs. 14.3%). No statistical differences were noted with regards to postoperative infections, as only one case of pelvic inflammatory disease was noted, in the iodine cleansing group (0.19% for postoperative infection). CONCLUSION Our comparative study may suggest that the use of preoperative iodine solution prior to office hysteroscopy does not decrease the postoperative infection rate up to 30 days, thus can be avoided.
Collapse
Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel.
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Hagit Itzhak Kedem
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Luna Abu-Foul
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Moran Paz
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yuval Kaufman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
8
|
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
|
9
|
Zilberlicht A, Karmakar D, DwyeR PL, Murray C, Kugelman N. Predictors of Surgical Failure of Open Burch Colposuspension Versus Retropubic Midurethral Sling for Stress Urinary Incontinence. Urology 2023; 177:69-73. [PMID: 37141976 DOI: 10.1016/j.urology.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To identify and compare long-term predictors for 'surgical failures' in matched groups of Midurethral sling (MUS) and Burch colposuspension (BC). METHODS A secondary analysis of patients with urodynamic stress incontinence who were treated either by open BC or retropubic MUS. The study had a cohort of 1344 women with a ratio of 1:3 (BC: MUS). We defined surgical success or failure by combining Patient Reported Outcome Measures and the need for repeat surgery. Risk factors for failure identified by multivariate analysis. RESULTS Of the 1344 women included, 336 had BC, and 1008 had MUS. Patients were followed-up for 13.1 and 10.1 years, and the rate of failure was 22% and 20%, for BC and MUS, respectively (P = 0.35). Significant predictors for MUS failure were Body mass index (BMI) > 30, preoperative anticholinergic medication use, smoking, diabetes, and previous surgery for incontinence (Hazard ratio 3.6, 2.6, 2.5, 1.8, 2.3, respectively). BMI > 25, preoperative use of anticholinergic medication, age > 60, previous surgery for incontinence, and loss of follow-up>5 years (Hazard ratio: 3.2, 2.8, 2.6, 2.5, 2.1, respectively), were significant predictors of BC failure. CONCLUSION This study shows similar predictors for surgical failure for BC and MUS, with high BMI, mixed urinary incontinence, and previous continence procedures being the most important.
Collapse
Affiliation(s)
- Ariel Zilberlicht
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Peter L DwyeR
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
| | | | - Nir Kugelman
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
10
|
Zilberlicht A, Karmakar D, Dwyer PL, Chan G, Schierlitz L. Counseling for stress urinary incontinence in the era of adverse publicity around mesh usage: Results from a large-sample global survey. Int J Gynaecol Obstet 2023; 160:579-587. [PMID: 35986609 DOI: 10.1002/ijgo.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 08/06/2022] [Accepted: 08/10/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate doctors' opinions of the use of synthetic mesh for the treatment of stress urinary incontinence (SUI) and the effect on patient's attitude following recent adverse publicity and legal findings. METHODS Electronic survey approved by International Urogynecological Association (IUGA) and American Urogynecologic Society (AUGS), distributed to their members. RESULTS A total of 593 respondents completed the survey. The preferred initial surgical treatment for SUI was retropubic midurethral sling (MUS) (62%), followed by trans-obturator MUS (19%), mini-slings (10%), and then bulking agents (5%). Despite prolongation of consultation, most respondents (87%) believed that clinicians should provide a patient information leaflet (PIL) for their patients. However, only 70% of respondents were doing this. Most participants would use either the IUGA PIL or their institution PIL (61%). Only 8% felt that patients have a positive preconception of synthetic mesh for SUI. Eighty-three per cent of respondents had not changed their recommendations for treatment and the consent process. A logistic regression model identified preferences of certain geographic areas as predictors of consenting practices. CONCLUSION Despite the negative publicity and the current medicolegal litigation involving MUS for SUI treatment, the majority of respondents still prefer this as the initial surgical treatment. Most clinicians value PIL in the surgical consent process.
Collapse
Affiliation(s)
- Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Debjyoti Karmakar
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Peter L Dwyer
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Garson Chan
- Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lore Schierlitz
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Sadeh R, Schmidt M, Hod Y, Zilberlicht A, Feferkorn I, Haya N, Abramov Y. A Comparative Study of Colpocleisis vs. Vaginal Hysterectomy for the Treatment of Advanced Pelvic Organ Prolapse. Isr Med Assoc J 2022; 25:842-846. [PMID: 36573781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Vaginal hysterectomy (VH) and colpocleisis are both used for the treatment of advanced pelvic organ prolapse (POP). OBJECTIVES To compare short- and long-term outcomes of vaginal hysterectomy vs. colpocleisis for advanced POP. METHODS Hospital and outpatient charts of patients who underwent VH or colpocleisis at our institution between January 2006 and December 2015 were reviewed. Clinical data were obtained and analyzed. RESULTS In this study, 188 patients underwent VH and 32 patients underwent colpocleisis. The colpocleisis group was significantly older than the VH group (79.5 ± 4.5 vs. 69 ± 6.1 years respectively, P < 0.0001) and presented with significantly higher co-morbidity rates and a higher degree of POP. Perioperative blood loss was significantly lower (250 ± 7.6 ml vs. 300 ± 115 ml, P < 0.0001) and postoperative hospitalization was significantly shorter (2 ± 2.7 vs. 3 ± 2.2 days, P = 0.015) among the colpocleisis group. None of the patients from the colpocleisis group required an indwelling urethral catheter after discharge, compared to 27.5% of the patients from the VH group (P = 0.001). Total postoperative complication rate was significantly lower among the colpocleisis group (25% vs. 31% P < 0.0001). Objective recurrence of POP was significantly more common among the VH group (7% vs. 0% and 21% vs. 0% for the anterior and posterior compartments, respectively, P = 0.04). CONCLUSIONS Colpocleisis is associated with faster recovery, lower perioperative morbidity, and higher success rates than VH and should be considered for frail and elderly patients.
Collapse
Affiliation(s)
- Rotem Sadeh
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Meirav Schmidt
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Yael Hod
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Ido Feferkorn
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Nir Haya
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Yoram Abramov
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| |
Collapse
|
12
|
Chan G, Yanko E, Qu L, Zilberlicht A, Karmakar D, Pirpiris A, Gani J. Surgical mesh information on YouTube(TM): Evaluating the usage and reliability of videos for patient education. Can Urol Assoc J 2022; 16:E399-E402. [DOI: 10.5489/cuaj.7706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Patients in search of answers to health-related questions often seek out information on the internet. The current study aimed to evaluate the quality of videos on the topic of mesh pertaining to its use in the treatment of stress urinary incontinence or pelvic organ prolapse.
Methods: A total of 100 videos on the topic of mesh on YouTubeTM were screened in this study. From that, a further 30 were selected for review. Five experts in the medical field reviewed each video anonymously, using two video assessment tools. Video characteristics were collected and evaluated. Videos were assessed based on a Global Assessment Score (GAS) and Patient Education Tool for Audiovisual Materials (PEMAT-A/V) scale for ease of patient access and comprehension. The overall correlation between raters and videos was also compared.
Results: The GAS and PEMAT-A/V ratings correlation across multiple raters demonstrated excellent inter-rater reliability. We found that the overall GAS score and recommendation was substandard, and the median PEMAT-A/V understandability score was 70% (poorly understandable). Most videos contained some form of marketing, and a scarce number had reliable sources of information. Evidence of neutrality was low.
Conclusions: Through the expert assessment of videos using quality assessment tools, this study demonstrated the overall variable quality of mesh videos on YouTubeTM and the need for further education regarding patient resources.
Collapse
|
13
|
Kugelman N, Nahshon C, Shaked-Mishan P, Cohen N, Sher ML, Gruber M, Marom I, Zolotarevsky A, Lavie O, Damti A, Zilberlicht A, Bardicef M, Kedar R. Maternal and Neonatal SARS-CoV-2 Immunoglobulin G Antibody Levels at Delivery After Receipt of the BNT162b2 Messenger RNA COVID-19 Vaccine During the Second Trimester of Pregnancy. JAMA Pediatr 2022; 176:290-295. [PMID: 34932066 PMCID: PMC8693209 DOI: 10.1001/jamapediatrics.2021.5683] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE BNT162b2 messenger RNA (mRNA) COVID-19 vaccination in the third trimester was found to be associated with a strong maternal humoral IgG response that crossed the placenta and approached maternal titers in the newborn. OBJECTIVE To evaluate maternal and neonatal SARS-CoV-2 immunoglobulin G (IgG) antibody levels at birth after mRNA COVID-19 vaccination during the second trimester of pregnancy. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study, conducted at a single medical center in Haifa, Israel, from May to July 2021, included women with a singleton pregnancy over 24 weeks of gestation at least 7 days after receipt of their second COVID-19 vaccine dose who were not known to be previously infected with COVID-19. EXPOSURES BNT162b2 (Pfizer/BioNTech) vaccination. MAIN OUTCOMES AND MEASURES The primary outcomes were SARS-CoV-2 IgG antibody titers measured in the parturient at admission and in the umbilical cord blood within 30 minutes after delivery. Secondary outcomes were the correlation between antibody titers, feto-maternal characteristics, maternal adverse effects after vaccination, and time interval from vaccination to delivery. RESULTS Antibody levels were measured for 129 women (mean [SD] age, 31.9 [4.9] years) and 114 neonates, with 100% of the tests having positive results. The mean (SD) gestational age at administration of the second vaccine dose was 24.9 (3.3) weeks. Neonatal IgG titers were 2.6 times higher than maternal titers (median [range], 3315.7 [350.1-17 643.5] AU/mL vs 1185.2 [146.6-32 415.1] AU/mL). A positive correlation was demonstrated between maternal and neonatal antibodies (r = 0.92; 95% CI, 0.89-0.94). Multivariable analysis revealed that for each week that passed since receipt of the second vaccine dose, maternal and neonatal antibody levels changed by -10.9% (95% CI, -17.2% to -4.2%; P = .002) and -11.7% (95% CI, -19.0 to -3.8%; P = .005), respectively. For each 1-year increase in the mother's age, maternal and neonatal antibody levels changed by -3.1% (95% CI, -5.3% to -0.9%; P = .007) and -2.7% (95% CI, -5.2% to -0.1%; P = .04), respectively. CONCLUSIONS AND RELEVANCE In this cohort study, receipt of the BNT162b2 mRNA COVID-19 vaccine during the second trimester of pregnancy was associated with maternal and neonatal humoral responses, as reflected in maternal and neonatal SARS-CoV-2 IgG antibody levels measured after delivery. These findings support COVID-19 vaccination of pregnant individuals during the second trimester to achieve maternal protection and newborn safety during the pandemic.
Collapse
Affiliation(s)
- Nir Kugelman
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Chen Nahshon
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Nadav Cohen
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Maayan Lahav Sher
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Maya Gruber
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Inbal Marom
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Avi Zolotarevsky
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amit Damti
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mordehai Bardicef
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Reuven Kedar
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
14
|
Kugelman N, Nahshon C, Shaked-Mishan P, Cohen N, Sher ML, Gruber M, Marom I, Zolotarevsky A, Lavie O, Damti A, Zilberlicht A, Bardicef M, Kedar R. Newborn and maternal immunity following 2nd trimester mRNA COVID-19 vaccination. Am J Obstet Gynecol 2022. [PMCID: PMC8696683 DOI: 10.1016/j.ajog.2021.11.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
15
|
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
|
16
|
Zilberlicht A, Abramov D, Kugelman N, Lavie O, Elias Y, Abramov Y. The Effect of Population Age and Climate on COVID-19 Morbidity and Mortality. Isr Med Assoc J 2021; 23:336-340. [PMID: 34155843] [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: 06/13/2023]
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) is an infectious disease that presents an urgent challenge to global health and economy. OBJECTIVES To assess the effects of population median age and mean ambient temperature on the COVID-19 global pandemic burden. METHODS We used databases from open access public domains to record population median age, mean ambient temperature, and the numbers of COVID-19 cases and deaths on days 14 and 28 from the pandemic outbreak for each country in the world. We then calculated the correlation between these parameters. RESULTS The analysis included 202 countries. A univariate analysis showed that population median age significantly correlated with the cumulative number of cases and deaths, while mean ambient temperature showed a significant inverse correlation with the cumulative number of deaths on days 14 and 28 from the epidemic outbreak. After a multivariate logistic regression analysis only population median age retained its statistically significant correlation. CONCLUSIONS Country population median age significantly correlated with COVID-19 pandemic burden while mean ambient temperature shows a significant inverse correlation only in univariate analysis. Countries with older populations encountered a heavier burden from the COVID-19 pandemic. This information may be valuable for health systems in planning strategies for combating this global health hazard.
Collapse
Affiliation(s)
- Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dan Abramov
- Department of Cardiothoracic Surgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Nir Kugelman
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yossef Elias
- College of Management Academic Studies, Rishon LeZion, Israel
| | - Yoram Abramov
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
17
|
Kugelman N, Toledano-Hacohen M, Karmakar D, Segev Y, Shalabna E, Damti A, Kedar R, Zilberlicht A. Consequences of the COVID-19 pandemic on the postpartum course: Lessons learnt from a large-scale comparative study in a teaching hospital. Int J Gynaecol Obstet 2021; 153:315-321. [PMID: 33523481 PMCID: PMC9087621 DOI: 10.1002/ijgo.13633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the consequences of COVID‐19 pandemic restrictions on the postpartum course. Methods A retrospective cross‐sectional study compared women who gave birth between March and April 2020 (first wave), between July to September 2020 (second wave), and a matched historical cohort throughout 2017–2019 (groups A, B, and C, respectively). Primary outcomes were postpartum length of stay (LOS), presentations to the emergency department (ED), and readmissions 30 days or longer after discharge. Following Bonferroni correction, p < 0.016 was considered statistically significant. Results In total, 3377 women were included: 640, 914, and 1823 in groups A, B, and C, respectively. LOS after birth (both vaginal and cesarean) was shorter in groups A and B compared to the control group (2.28 ± 1.01 and 2.25 ± 0.93 vs 2.55 ± 1.10 days, p < 0.001). Rates of ED presentations 30 days after discharge were higher in groups C and B compared to group A (6.63% and 6.45% vs 3.12%, p = 0.006). Rates of readmissions 30 days after discharge were 0.78%, 1.42%, and 1.09% (groups A, B, and C, respectively), demonstrating no statistical difference (p = 0.408). Conclusion During the COVID‐19 pandemic, there was a reduction or no change in rates of ED presentations and readmissions, despite the shortened LOS after delivery. A shift in policy regarding the postpartum LOS could be considered. Length of stay after delivery was shortened during the COVID‐19 pandemic without a surge in postpartum presentations to the emergency department or rates of readmission.
Collapse
Affiliation(s)
- Nir Kugelman
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mirit Toledano-Hacohen
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Debjyoti Karmakar
- Division of Women and Children, Mercy Health, Melbourne, Vic, Australia
| | - Yakir Segev
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eiman Shalabna
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amit Damti
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Reuven Kedar
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
18
|
Zilberlicht A, Dwyer PL, Karmakar D, Carswell F, Schierlitz L. Extraperitoneal high vaginal cuff suspension at the time of vaginal hysterectomy for advanced uterovaginal prolapse: Results of a modified McCall technique from a longitudinal clinical study. Aust N Z J Obstet Gynaecol 2020; 61:258-262. [PMID: 33346932 DOI: 10.1111/ajo.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women with high-grade uterovaginal prolapse have a greater risk of recurrent prolapse after pelvic organ prolapse surgery. Royal College of Obstetricians and Gynaecologists guidelines have recommended sacrospinous suspension (sacrospinous fixation) at the time of vaginal hysterectomy, whenever there is a marked uterovaginal prolapse. We have modified the McCall culdoplasty by placing sutures extraperitoneally, higher and more lateral into the uterosacral/cardinal ligaments to re-support the vaginal cuff at the time of a vaginal hysterectomy. AIMS To evaluate the results of a modified technique of McCall high culdoplasty and native tissue repair at time of vaginal hysterectomy in women with advanced uterovaginal prolapse. MATERIAL AND METHODS Longitudinal clinical follow-up conducted between 2000-2018, in a tertiary urogynaecology centre for patients presenting with stage 3-4 uterovaginal prolapse, who underwent vaginal hysterectomy and modified McCall vault suspension. RESULTS There were 176 cases meeting the inclusion criteria. Mean follow-up was 19.35 months. There were 25 recurrences (14%) of ≥ stage 2 (76% not symptomatic). Twelve of these recurrences (48%) occurred in anterior compartment, six (25%) posterior, three (12%) combined anterior/posterior, two (8%) combined posterior/central and one case had recurrence in all compartments. Only six cases (3%) required another surgical procedure for symptomatic prolapse, all with an enterocele recurrence. CONCLUSIONS Our described modified McCall technique incorporates high extraperitoneal approach to apical resuspension along with closure of any existing large hiatal defects of the levator plate at the time of vaginal hysterectomy for advanced uterine prolapse has excellent outcomes and extremely low complication rates and avoids the need for sacrospinous fixation.
Collapse
Affiliation(s)
- Ariel Zilberlicht
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Peter L Dwyer
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Debjyoti Karmakar
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Frida Carswell
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Lore Schierlitz
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| |
Collapse
|
19
|
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]
|
20
|
Zilberlicht A, Haya N, Goldschmidt E, Feferkorn I, Lavie O, Abramov Y. Obstructive voiding symptoms in female patients with overactive bladder syndrome. Eur J Obstet Gynecol Reprod Biol 2019; 242:12-16. [PMID: 31525694 DOI: 10.1016/j.ejogrb.2019.08.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/07/2019] [Accepted: 08/27/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To characterize obstructive voiding symptoms (OVS) in patients with overactive bladder (OAB) and normal postvoid residual volume (PVR) and assess their impact on patients' quality of life (QoL) and sexual function. STUDY DESIGN Patients with OAB and normal PVR who visited our urogynecologic clinic between November 2016 and June 2017 were asked to fill a questionnaire comprising of 14 statements regarding Obstructive VOiding Symptoms (the OVOS questionnaire). Patients additionaly completed the UDI-6 and IIQ-7 questionnaires. Statistical analysis was performed to determine the prevalence of each OVS and its correlation with the UDI-6 and IIQ-7 scores. RESULTS Thirty-eight women enrolled in this study. The OVOS questionnaire was found to have good reliability (Cronbach's alpha = 0.75) and construct validity. Thirty-six (95%) women reported having at least one, while 34 (90%) had at least two, and 31 (82%) had at least three OVS. The statement: `I feel that I am unable to empty my bladder completely` significantly correlated with the sense of frustration (r = 0.44, p = 0.006), as well as with the overall negative impact of urinary incontinence on QoL (r = 0.36, p = 0.03). The statement: `I feel a sensation of fullness immediately after I empty my bladder` significantly correlated with the total impact of urinary incontinence on sexual function (r = 0.42, p = 0.031). CONCLUSIONS Most patients with OAB and normal PVR complain of OVS which may increase the burden on their QoL and sexual function. Some OVS correlate with various segments of the UDI-6 and IIQ-7 questionnaires, suggesting that storage and OVS may share common pathophysiological mechanisms.
Collapse
Affiliation(s)
- Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
| | - Nir Haya
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Eyal Goldschmidt
- Department of Obstetrics and Gynecology, Bnei-Zion Medical Center, Haifa, Israel
| | - Ido Feferkorn
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Ofer Lavie
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoram Abramov
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| |
Collapse
|
21
|
Nakad B, Fares F, Azzam N, Feiner B, Zilberlicht A, Abramov Y. Estrogen receptor and laminin genetic polymorphism among women with pelvic organ prolapse. Taiwan J Obstet Gynecol 2018; 56:750-754. [PMID: 29241914 DOI: 10.1016/j.tjog.2017.10.008] [Citation(s) in RCA: 8] [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] [Accepted: 06/01/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Laminin is a connective tissue component. The LAMC1 gene encodes for gamma-1 chain of laminin, which is associated with familial clustering of POP. The ERα gene which encodes for cellular estrogen receptor has also been associated with POP. The aim of this study was to evaluate a possible correlation between polymorphism in these genes and the risk for developing POP. MATERIALS AND METHODS Blood samples were drawn from 33 women with advanced POP (study group) and 33 women without POP (control group). DNA was extracted, and the presence of the rs10911193 C/T mutation in LAMC1 and of the rs2228480 G/A mutation in ERα was detected using the PCR technique. RESULTS 26 samples were available for each group regarding ERα. 33 samples were available for each group, regarding LAMC1. The prevalence of homozygotes for the ERα rs2228480 G/A mutation was 19.2% and 0% among women with and without POP, respectively (OR 39.77, 95% CI 1.93-817.0, P = 0.00046). The prevalence of heterozygotes for this mutation was 83.3% and 11.5%, respectively (OR 19.2, 95% CI 4.15-88.6, P < 0.0001). The prevalence of homozygotes for the LAMC1 gene rs10911193 C/T mutation was 3.6% and 6.1% among women with and without POP (NS), while the respective for heterozygotes for this mutation was 21.4% and 33.3% (NS). CONCLUSIONS Polymorphism in the ERα gene is associated with an increased risk for advanced POP. However, polymorphism in the LAMC1 gene does not seem to be associated with such risk.
Collapse
Affiliation(s)
- Bothaina Nakad
- Department of Surgery, Bnei-Zion Medical Center, Haifa, Israel
| | - Fuad Fares
- Department of Human Biology, University of Haifa, Haifa, Israel; Laboratory of Molecular Genetics, Carmel Medical Center, Haifa, Israel
| | - Naiel Azzam
- Laboratory of Molecular Genetics, Carmel Medical Center, Haifa, Israel
| | - Benjamin Feiner
- Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Carmel Medical Center, Technion Medical Faculty, Haifa, Israel.
| | - Yoram Abramov
- Department of Obstetrics and Gynecology, Carmel Medical Center, Technion Medical Faculty, Haifa, Israel
| |
Collapse
|
22
|
Zilberlicht A, Haya N, Feferkorn I, Goldschmidt E, Kaldawy A, Abramov Y. Somatic, psychological, and sexual triggers for overactive bladder syndrome in women. Neurourol Urodyn 2017; 37:163-168. [PMID: 28220549 DOI: 10.1002/nau.23236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/22/2016] [Revised: 01/01/2017] [Accepted: 01/07/2017] [Indexed: 11/06/2022]
Abstract
AIMS Patients with overactive bladder (OAB) often describe somatic, psychological, and sexual triggers for their symptoms. The aim of this study was to characterize these triggers and assess their impact on patients' symptoms and quality of life (QoL). METHODS Patients who visited our urogynecologic clinic between August 2015 and March 2016 and diagnosed with OAB syndrome were asked to fill a questionnaire comprising 34 statements regarding SOmatic, Psychological, and Sexual Triggers for OAB (SOPSETO). Patients additionaly completed the UDI-6 and IIQ-7 questionnaires. Statistical analysis was performed to determine the prevalence of each trigger and its correlation with the UDI-6 and IIQ-7 scores. RESULTS Sixty four women enrolled in this study. The SOPSETO questionnaire was found to be relaiable with Cronbach's alpha of 0.73-0.88. Construct validity was high with good correlation between the SOPSETO and the UDI-6 and IIQ-7 questionnaires. The triggers which had the highest correlation with the total UDI-6 scores were: Being far from toilets (r = 0.32, P = 0.004), swimming (r = 0.44, P = 0.02), taking a shower/bath (r = 0.36, P = 0.004), touching water (r = 0.35, P = 0.004), stepping out of a car (r = 0.32, P = 0.014), and experiencing an orgasm (r = 0.59, P = 0.001). The triggers: Experiencing an orgasm (r = 0.4, P = 0.033), having intercourse (r = 0.53, P = 0.002), stepping out of a car (r = 0.45, P = 0.001), and touching water (r = 0.28, P = 0.03) most significantly correlated with the total IIQ-7 scores. CONCLUSIONS Certain somatic, psychological, and sexual factors may trigger OAB symptoms and are therefore potential targets for behavioral therapy of this disorder, and for further research regarding its pathophysiological mechanisms.
Collapse
Affiliation(s)
- Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Nir Haya
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Ido Feferkorn
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Eyal Goldschmidt
- Department of Obstetrics and Gynecology, Bnei-Zion Medical Center, Haifa, Israel
| | - Anis Kaldawy
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoram Abramov
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| |
Collapse
|
23
|
Feferkorn I, Schmidt M, Segev Y, Zilberlicht A, Auslender R, Abramov Y. Vaginal cuff closure technique and the risk for infected pelvic hematoma after vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol 2016; 206:194-197. [PMID: 27723550 DOI: 10.1016/j.ejogrb.2016.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Infected pelvic hematoma is a relatively common complication of vaginal hysterectomy, manifesting with postoperative pain and fever which often necessitate surgical drainage. We aimed to assess the effect of the surgical technique for vaginal cuff closure on the incidence of this complication. STUDY DESIGN Until March 31, 2010, our surgical protocol for vaginal hysterectomy included complete vaginal cuff closure. After this date, all surgeries were performed using another technique, by which a patent tract was left at the vaginal cuff for drainage of blood, secretions and debris. We reviewed medical records of all women who underwent vaginal hysterectomy for pelvic organ prolapse in our institution between January 2006 and November 2015, including demographic, clinical and surgical data. We compared the incidence of postoperative infected pelvic hematomas before and after March 31, 2010. RESULTS We identified 325 women who underwent vaginal hysterectomy during the first time period (group I) and 243 women who underwent this procedure during the second time period (group II). While demographic and clinical data were not significantly different between the two groups, the incidence of infected pelvic hematomas necessitating hospitalization was significantly lower in group II (3.8% vs. 13.5%, p<0.0001). CONCLUSIONS A significant reduction in the incidence of infected pelvic hematoma following vaginal hysterectomy was noted using a surgical technique that allows for drainage of blood and debris through the vaginal cuff.
Collapse
Affiliation(s)
- Ido Feferkorn
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
| | - Meirav Schmidt
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yakir Segev
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Ron Auslender
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoram Abramov
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| |
Collapse
|
24
|
Zilberlicht A, Lavy Y, Auslender R, Abramov Y. Transvaginal repair of a urethrovaginal fistula using the Latzko technique with a bulbocavernosus (Martius) flap. Int Urogynecol J 2016; 27:1925-1927. [PMID: 27423455 DOI: 10.1007/s00192-016-3085-6] [Citation(s) in RCA: 5] [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] [Received: 04/22/2016] [Accepted: 06/22/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urethrovaginal fistula is a rare disorder that may occur following sling procedures for stress urinary incontinence, excision of a urethral diverticulum, anterior vaginal wall repair, radiation therapy, and prolonged indwelling urethral catheter. The most common clinical manifestation is continuous urinary leakage through the vagina, aggravated by an increase in the intra-abdominal pressure. Appropriate management, including timing of the surgical intervention and the preferred technique, remains controversial. METHODS This video presentation describes the transvaginal repair of a urethrovaginal fistula using the Latzko technique and a bulbocavernosus (Martius) flap. RESULTS The patient's postoperative course was uneventful. At her follow-up visit 2 months later, she was free of urinary leakage, and a pelvic examination revealed excellent healing, with complete closure of the fistula. CONCLUSIONS Transvaginal repair using the Latzko technique with a vascular bulbocavernosus (Martius) flap is an effective and safe mode of treatment.
Collapse
Affiliation(s)
- Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Rappaport Faculty of Medicine, Technion University, 7 Michal Street, Haifa, Israel, 31048.
| | - Yuval Lavy
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ron Auslender
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Rappaport Faculty of Medicine, Technion University, 7 Michal Street, Haifa, Israel, 31048
| | - Yoram Abramov
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Rappaport Faculty of Medicine, Technion University, 7 Michal Street, Haifa, Israel, 31048
| |
Collapse
|
25
|
Zilberlicht A, Molnar R, Pal-Ohana H, Haya N, Auslender R, Abramov Y. Characterization of the median sacral artery course at the sacral promontory using contrast-enhanced computed tomography. Int Urogynecol J 2016; 28:101-104. [DOI: 10.1007/s00192-016-3074-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022]
|
26
|
Lavi N, Shapira G, Zilberlicht A, Benyamini N, Farbstein D, Dann EJ, Bar-Shalom R, Avivi I. Integration of CT-Based Measurements into Surveillance PET/CT in Patients with Diffuse Large B Cell Lymphoma. Isr Med Assoc J 2016; 18:411-417. [PMID: 28471564] [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: 06/07/2023]
Abstract
BACKGROUND Despite the lack of clinical studies supporting the use of routine surveillance FDG-positron emission tomography (PET) in patients with diffuse large B cell lymphoma (DLBCL) who achieved remission, many centers still use this strategy, especially in high risk patients. Surveillance FDG-PET computed tomography (CT) is associated with a high false positive (FP) rate in DLBCL patients. OBJECTIVES To investigate whether use of specific CT measurements could improve the positive predictive value (PPV) of surveillance FDG-PET/CT. METHODS This retrospective study included DLBCL patients treated with CHOP or R-CHOP who achieved complete remission and had at least one positive surveillance PET. CT-derived features of PET-positive sites, including long and short diameters and presence of calcification and fatty hilum within lymph nodes, were assessed. Relapse was confirmed by biopsy or consecutive imaging. The FP rate and PPV of surveillance PET evaluated with/without CT-derived measurements were compared. RESULTS Seventy surveillance FDG-PET/CT scans performed in 53 patients were interpreted as positive for relapse. Of these studies 25 (36%) were defined as true-positive (TP) and 45 (64%) as FP. Multivariate analysis found long or short axis measuring ≥ 1.5 and ≥ 1.0 cm, respectively, in PET-positive sites, International Prognostic Index (IPI) ≥ 2, lack of prior rituximab therapy and FDG uptake in a previously involved site, to be independent predictors of true positive surveillance PET (odds ratio 5.4, 6.89, 6.6, 4.9, P < 0.05 for all). CONCLUSIONS PPV of surveillance PET/CT may be improved by its use in selected high risk DLBCL patients and combined assessment of PET and CT findings.
Collapse
Affiliation(s)
- Noa Lavi
- Department of Hematology
- Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Gali Shapira
- Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Ariel Zilberlicht
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noam Benyamini
- Department of Hematology
- Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Dan Farbstein
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eldad J Dann
- Department of Hematology
- Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rachel Bar-Shalom
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Irit Avivi
- Department of Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
27
|
Zilberlicht A, Feiner B, Haya N, Auslender R, Abramov Y. Surgical removal of a large vaginal calculus formed after a tension-free vaginal tape procedure. Int Urogynecol J 2016; 27:1771-1772. [PMID: 27324756 DOI: 10.1007/s00192-016-3065-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/06/2016] [Indexed: 11/25/2022]
Abstract
Vaginal calculus is a rare disorder which has been reported in association with urethral diverticulum, urogenital sinus anomaly, bladder exstrophy and the tension-free vaginal tape (TVT) procedure. We report a 42-year-old woman who presented with persistent, intractable urinary tract infection (UTI) following a TVT procedure. Cystoscopy demonstrated an eroded tape with the formation of a bladder calculus, and the patient underwent laser cystolithotripsy and cystoscopic resection of the tape. Following this procedure, her UTI completely resolved and she remained asymptomatic for several years. Seven years later she presented with a solid vaginal mass. Pelvic examination followed by transvaginal ultrasonography and magnetic resonance imaging demonstrated a large vaginal calculus located at the lower third of the anterior vaginal wall adjacent to the bladder neck. This video presents the transvaginal excision and removal of the vaginal calculus.
Collapse
Affiliation(s)
- Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, 7 Michal St., Haifa, Israel, 31048.
| | - Benjamin Feiner
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Nir Haya
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, 7 Michal St., Haifa, Israel, 31048
| | - Ron Auslender
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, 7 Michal St., Haifa, Israel, 31048
| | - Yoram Abramov
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, 7 Michal St., Haifa, Israel, 31048
| |
Collapse
|
28
|
Zilberlicht A, Feferkorn I, Younes G, Damti A, Auslender R, Riskin-Mashiah S. The mutual effect of pregestational body mass index, maternal hyperglycemia and gestational weight gain on adverse pregnancy outcomes. Gynecol Endocrinol 2016; 32:416-20. [PMID: 27052494 DOI: 10.3109/09513590.2015.1127911] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the mutual effect of obesity, gestational diabetes (GDM) and gestational weight gain (GWG) on adverse pregnancy outcomes. METHODS Charts of patients who delivered in our hospital between June 2001 and June 2006 singleton, live births >24 weeks gestation were reviewed. Univariate and multivariate logistic regression were used to assess pregnancy outcomes defined as large for gestational age (LGA), primary cesarean section (PCS) and a composite outcome of LGA and/or PCS. RESULTS A total of 8595 women were included. Frequency of composite outcome increased with increasing body mass index (BMI), increasing hyperglycemia and above-recommended GWG. In the multivariate logistic regression analysis compared to women with normal BMI, odds ratio (OR) for composite outcome was 1.23 (95% confidence interval [CI] 1.06-1.44) in overweight women, OR = 1.86 (1.51-2.31) in obese women and in severe obesity OR = 2.97 (2.15-4.11). Compared to normoglycemic women, odds for composite outcome in women with abnormal glucose challenge test OR = 1.46 (1.20-1.79), impaired glucose tolerance OR = 1.65 (1.14-2.4) and GDM OR = 1.56 (1.16-2.10). Women with GWG above recommended had OR = 1.58, (1.37-1.81) for composite outcome. CONCLUSIONS Higher pregestational BMI, maternal hyperglycemia and above-recommended GWG independently contribute to adverse pregnancy outcomes. Furthermore, there is mutual effect between these three factors and adverse outcomes. Appropriate pregestational weight and adequate GWG might reduce risk of adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Ariel Zilberlicht
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Ido Feferkorn
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Grace Younes
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Amit Damti
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Ron Auslender
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Shlomit Riskin-Mashiah
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| |
Collapse
|
29
|
Zilberlicht A, Wiener-Megnazi Z, Sheinfeld Y, Grach B, Lahav-Baratz S, Dirnfeld M. Habits of cell phone usage and sperm quality – does it warrant attention? Reprod Biomed Online 2015. [DOI: 10.1016/j.rbmo.2015.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
30
|
Zilberlicht A, Voldavsky E, Lavie O, Auslender R, Shai A. Prolonged survival in a patient with isolated skull recurrence of cervical carcinoma - Case report and review of the literature. Gynecol Oncol Rep 2015; 11:20-2. [PMID: 26076088 PMCID: PMC4434164 DOI: 10.1016/j.gore.2014.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/16/2014] [Indexed: 11/19/2022] Open
Abstract
A 58 years old woman was diagnosed with squamous cell carcinoma of the uterine cervix FIGO stage IIB and was treated by concomitant radio-chemotherapy followed by simple hysterectomy. Several months later a single metastasis to the skull was diagnosed. The patient underwent craniotomy and radiotherapy and achieved a prolonged disease free survival of 20 months. Bone metastases from cervical carcinoma are usually part of widespread metastatic disease. Skull metastases are extremely rare. Selected cases of solitary bone metastases can be treated radically and achieve long term disease free survival. Cervical carcinoma can rarely spread to the bones of the skull. Symptoms include headache and a palpable mass. Radical therapy with surgery and radiotherapy for an isolated bone recurrence can result in prolonged disease free survival.
Collapse
Affiliation(s)
- Ariel Zilberlicht
- Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Haifa 34362, Israel
| | | | - Ofer Lavie
- Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Haifa 34362, Israel ; Bruce Rappaport Faculty of Medicine, Technion-Israeli Intitute of Technology, Haifa, Israel
| | - Ron Auslender
- Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Haifa 34362, Israel ; Bruce Rappaport Faculty of Medicine, Technion-Israeli Intitute of Technology, Haifa, Israel
| | - Ayelet Shai
- Department of Oncology, Lin and Carmel Medical Centers, Haifa, Israel ; Bruce Rappaport Faculty of Medicine, Technion-Israeli Intitute of Technology, Haifa, Israel
| |
Collapse
|
31
|
Zilberlicht A, Kedar R, Riskin-Mashiah S, Lavie O. [The incredible story about the cesarean section from ancient times till nowadays]. Harefuah 2014; 153:471-497. [PMID: 25286639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
During its evolution the cesarean section has meant different things to different people. The indications for it have changed throughout the course of history. From the initial purpose to retrieve an infant from a dead or dying mother in order to bury the child separately from his mother, to contemporary indications. This article strives to follow the roots of this common procedure--starting from the descriptions in the ancient Greek mythology, through the imperial Roman law, aspects of Judaism and the evolution of the procedure throughout modern history. Major improvements in the surgical techniques, the introduction of anesthesia and aseptic procedures contributed to the decline in mortality and morbidity rates. We will attempt to find the etymology for the expression "cesarean section" which has commonly been accounted to Julius Caesar's name, although history denies it. This review takes us on a historical journey, from ancient times to nowadays, in which we follow the course and nature of a procedure being performed daily in thousands of hospitals.
Collapse
|
32
|
Avivi I, Zilberlicht A, Dann EJ, Leiba R, Faibish T, Rowe JM, Bar-Shalom R. Strikingly high false positivity of surveillance FDG-PET/CT scanning among patients with diffuse large cell lymphoma in the rituximab era. Am J Hematol 2013; 88:400-5. [PMID: 23423884 DOI: 10.1002/ajh.23423] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/13/2013] [Accepted: 02/14/2013] [Indexed: 11/11/2022]
Abstract
Predictive value (PV) of surveillance fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with diffuse large B-cell lymphoma (DLBCL) treated with chemotherapy-rituximab (R) versus chemotherapy only, remains unclear. The aim of the current study was to compare the performance of surveillance PET in DLBCL patients receiving CHOP (cyclophosphamide, hydroxydaunorubicin hydrochloride, vincristine, and prednisone) alone versus CHOP-R. Institutional database was retrospectively searched for adults with newly diagnosed DLBCL, receiving CHOP or CHOP-R, who achieved complete remission and underwent surveillance PETs. Follow-up (FU) PET was considered positive for recurrence in case of an uptake unrelated to physiological or known benign process. Results were confirmed by biopsy, imaging and clinical FU. One hundred nineteen patients, 35 receiving CHOP and 84 CHOP-R, who underwent 422 FU-PETs, were analyzed. At a median PET-FU of 3.4 years, 31 patients relapsed (17 vs. 14, respectively; P = 0.02). PET detected all relapses, with no false-negative studies. Specificity and positive PV (PPV) were significantly lower for patients receiving CHOP-R vs. CHOP (84% vs. 87%, P = 0.023; 23% vs. 74%, P < 0.0001), reflecting a higher false-positive (FP) rate in subjects receiving CHOP-R (77% vs. 26%, P < 0.001). In the latter group, FP-rate remained persistently high up to 3 years post-therapy. Multivariate analysis confirmed rituximab to be the most significant predictor for FP-PET. In conclusion, routine surveillance FDG-PET is not recommended in DLBCL treated with rituximab; strict criteria identifying patients in whom FU-PET is beneficial are required.
Collapse
Affiliation(s)
| | - Ariel Zilberlicht
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa; Israel
| | | | - Ronit Leiba
- Biostatistics Unit; Rambam Health Care Campus; Haifa; Israel
| | - Tal Faibish
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa; Israel
| | | | | |
Collapse
|