E. Koldewijn, D. Oerlemans, A. Beulens, M. D. De Wildt, V. Vandoninck, S. de Wachter
A fully bioresorbable polycaprolactonebased bioresorbable bulking agent was evaluated for safety and efficacy in female patients with mild to moderate stress urinary incontinence who attempted and failed prior pelvic floor muscle training. Fifty female subjects were treated by transurethral sub-mucosal injection. Safety was evaluated over a 24-monts follow-up period. At the 12-months visit, a cystoscopy was performed for visual inspection of the injected area. Efficacy was assessed with the same intervals with the Stamey Grading System (SGS) among others. Only 6/50 subjects reported transient mild adverse events. The results show for the SGS grade more than 55% of the participants had an improvement in SGS grade, 40% of whom were cured within the first 12 months after treatment. During the second year of follow- up the effect seems to falter with an improvement of 50% of the subjects of whom 25% were cured. The results of the study suggest that treatment of mild-tomoderate stress urinary incontinence with a bioresorbable PCL-based bulking agent is a safe and effective alternative to permanent bulking agents and intermediate treatment option before the use of the permanent midurethral sling.
{"title":"Treatment of mild to moderate stress urinary incontinence with a novel polycaprolactonebased bioresorbable urethral bulking agent","authors":"E. Koldewijn, D. Oerlemans, A. Beulens, M. D. De Wildt, V. Vandoninck, S. de Wachter","doi":"10.4081/uij.2022.287","DOIUrl":"https://doi.org/10.4081/uij.2022.287","url":null,"abstract":"A fully bioresorbable polycaprolactonebased bioresorbable bulking agent was evaluated for safety and efficacy in female patients with mild to moderate stress urinary incontinence who attempted and failed prior pelvic floor muscle training. Fifty female subjects were treated by transurethral sub-mucosal injection. Safety was evaluated over a 24-monts follow-up period. At the 12-months visit, a cystoscopy was performed for visual inspection of the injected area. Efficacy was assessed with the same intervals with the Stamey Grading System (SGS) among others. Only 6/50 subjects reported transient mild adverse events. The results show for the SGS grade more than 55% of the participants had an improvement in SGS grade, 40% of whom were cured within the first 12 months after treatment. During the second year of follow- up the effect seems to falter with an improvement of 50% of the subjects of whom 25% were cured. The results of the study suggest that treatment of mild-tomoderate stress urinary incontinence with a bioresorbable PCL-based bulking agent is a safe and effective alternative to permanent bulking agents and intermediate treatment option before the use of the permanent midurethral sling.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46583341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Moegni, Anthonyus Natanael, Tyas Priyatini, A. Meutia, B. Santoso
Pelvic Organ Prolapse (POP) is defined as the descent of the pelvic viscera (uterus, bladder, urethra, and rectum) from its normal position. There are different stages of POP starting from early asymptomatic until late obvious symptomatic stages. Levator Anal Muscle (LAM) which plays an important part in POP pathogenesis, showed that there was difference in Levator Hiatal (LH) area and anteroposterior length on every grade of POP. It is important to determine early diagnose of asymptomatic POP clinically by anteroposterior length measurement, and determined its relation with LH area measurement using Ultrasound (US) imaging. To compare LH area and anteroposterior length between POP subject with and without bulging symptom. A cross-sectional study was conducted among women diagnosed as POP with and without bulging symptom in a Urogynecology Clinic between November 2019 to March 2021. Patients were examined using the POP-Q system and 3D/4D imaging of the LH area using Voluson type systems. Data were analyzed to compare LH area and anteroposterior length between groups. A total of 109 subjects were included in this study. There was a significance difference in LH area (28.9+5.59 cm2 vs 19.6+4.63 cm2, p < 0.05 during valsalva maneuver, 15.2+4.08 cm2 vs 12.5+3.15 cm2, p <0.05 during contraction) and anteroposterior length (8.6+1.06 cm, vs 6.8+1.13 cm, p<0.05) between groups with and without bulge symptom. LH area and anteroposterior length cut-off to differentiate between subject with and without bulging symptom was respectively 25,1 cm2 [sensitivity 84,6%, specificity 92,9%, AUC 0,925 (0,864-0,986)] and 7,75 cm [sensitivity 87,2%, specificity 77,1%, AUC 0,859 (0,787-0,932)]. In patient without bulging symptom there was a significant difference of anteroposterior length between prolapse stage 1, 2, and 3. Post hoc analysis with Tukey test showed a significant difference of anteroposterior length only between grade 0 and 2, and grade 1 and 2. There was a significant difference in LH area and anteroposterior length between groups with and without bulging symptom. LH area cut-off at 25,1 cm2, anteroposterior length cut-off at 7.75 cm showed good sensitivity and specificity to differentiate between 2 groups.
盆腔器官脱垂（POP）是指盆腔脏器（子宫、膀胱、尿道和直肠）从正常位置下降。POP有不同的阶段，从早期无症状到晚期明显症状。肛提肌（LAM）在POP的发病机制中起着重要作用。研究表明，不同级别POP患者的肛提肌面积和前后长度存在差异。通过前后长度测量确定无症状POP的早期诊断，并通过超声（US）成像确定其与LH面积测量的关系，在临床上具有重要意义。比较有和无膨出症状的POP受试者的LH面积和前后长度。在2019年11月至2021年3月期间，在一家泌尿妇科诊所对被诊断为POP并伴有和不伴有膨出症状的女性进行了一项横断面研究。使用POP-Q系统对患者进行检查，并使用Voluson型系统对LH区域进行3D/4D成像。对数据进行分析，比较各组间LH面积和前后长度。本研究共纳入109名受试者。在有和没有隆起症状的组之间，LH面积（28.9±5.59 cm2 vs 19.6±4.63 cm2，在valsalva操作期间p<0.05，15.2±4.08 cm2 vs 12.5±3.15 cm2，在收缩期间p<0.05）和前后长度（8.6±1.06 cm，vs 6.8±1.13 cm，p<0.05）存在显著差异。区分有和没有膨出症状的受试者的LH面积和前后长度界限分别为25.1 cm2[敏感性84,6%，特异性92,9%，AUC 0925（0864-0986）]和7,75 cm[敏感性87,2%，特异性77.1%，AUC 0859（0787-0932）]。在没有膨出症状的患者中，脱垂1期、2期和3期的前后长度有显著差异。Tukey检验的事后分析显示，前后长度仅在0和2级以及1和2级之间存在显著差异。有和无膨出症状组间LH面积和前后长度有显著差异。LH截面积25,1cm2，前后长度7.75cm显示出良好的敏感性和特异性来区分两组。
{"title":"Comparison of levator hiatal area and anteroposterior length between pelvic organ prolapse subject with and without bulging symptoms","authors":"F. Moegni, Anthonyus Natanael, Tyas Priyatini, A. Meutia, B. Santoso","doi":"10.4081/uij.2022.279","DOIUrl":"https://doi.org/10.4081/uij.2022.279","url":null,"abstract":"Pelvic Organ Prolapse (POP) is defined as the descent of the pelvic viscera (uterus, bladder, urethra, and rectum) from its normal position. There are different stages of POP starting from early asymptomatic until late obvious symptomatic stages. Levator Anal Muscle (LAM) which plays an important part in POP pathogenesis, showed that there was difference in Levator Hiatal (LH) area and anteroposterior length on every grade of POP. It is important to determine early diagnose of asymptomatic POP clinically by anteroposterior length measurement, and determined its relation with LH area measurement using Ultrasound (US) imaging. To compare LH area and anteroposterior length between POP subject with and without bulging symptom. A cross-sectional study was conducted among women diagnosed as POP with and without bulging symptom in a Urogynecology Clinic between November 2019 to March 2021. Patients were examined using the POP-Q system and 3D/4D imaging of the LH area using Voluson type systems. Data were analyzed to compare LH area and anteroposterior length between groups. A total of 109 subjects were included in this study. There was a significance difference in LH area (28.9+5.59 cm2 vs 19.6+4.63 cm2, p < 0.05 during valsalva maneuver, 15.2+4.08 cm2 vs 12.5+3.15 cm2, p <0.05 during contraction) and anteroposterior length (8.6+1.06 cm, vs 6.8+1.13 cm, p<0.05) between groups with and without bulge symptom. LH area and anteroposterior length cut-off to differentiate between subject with and without bulging symptom was respectively 25,1 cm2 [sensitivity 84,6%, specificity 92,9%, AUC 0,925 (0,864-0,986)] and 7,75 cm [sensitivity 87,2%, specificity 77,1%, AUC 0,859 (0,787-0,932)]. In patient without bulging symptom there was a significant difference of anteroposterior length between prolapse stage 1, 2, and 3. Post hoc analysis with Tukey test showed a significant difference of anteroposterior length only between grade 0 and 2, and grade 1 and 2. There was a significant difference in LH area and anteroposterior length between groups with and without bulging symptom. LH area cut-off at 25,1 cm2, anteroposterior length cut-off at 7.75 cm showed good sensitivity and specificity to differentiate between 2 groups.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47025056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Fiorello, Andrea Di Benedetto, A. Mogorovich, Daniele Summonti, Sandro Benvenuti, C. A. Sepich
Leiomyomas are benign tumors of smooth muscle origin occurring throughout the genitourinary system. Sometimes paraurethral leiomyoma can cause a bulking effect on the bladder without gross involvement of the urethra. In our work we describe the case of a woman with a vulvar mass found after self-examination. She was investigated pelvic Magnetic Resonance Imaging (MRI) which showed a well encapsulated solid mass, about 24mm (maximum diameter) located at paraurethral level, on right anterolateral side, It showed uptake of contrast, with a compressive-dislocative effect on the urethra, without involvement of the sphincters. Surgery was performed with excission “en-block” of the mass. The procedure was well tolerated under spinal anesthesia and the patient was discharged 24h later, after removing the bladder catheter. No signs of haematuria nor symptoms of incontinence were reported in the following weeks. Pathology of the excised specimen revealed complete resection of a benign, submucus leiomyoma. Although leiomyomas are very common in organs such as the uterus, the presentation of a urethral leiomyoma, as found in the present case, is very rare. The description of these lesions is however important to create a scientific path that can clarify the cause and the evolution. It can also represent an evolution for imaging through MRI, improving its framework and distinguishing it from malignant tumors that require another surgical strategy.
{"title":"Paraurethral leiomyoma in a 52 year-old woman: Clinical and diagnostic features and surgical treatment","authors":"N. Fiorello, Andrea Di Benedetto, A. Mogorovich, Daniele Summonti, Sandro Benvenuti, C. A. Sepich","doi":"10.4081/uij.2022.286","DOIUrl":"https://doi.org/10.4081/uij.2022.286","url":null,"abstract":"Leiomyomas are benign tumors of smooth muscle origin occurring throughout the genitourinary system. Sometimes paraurethral leiomyoma can cause a bulking effect on the bladder without gross involvement of the urethra. In our work we describe the case of a woman with a vulvar mass found after self-examination. She was investigated pelvic Magnetic Resonance Imaging (MRI) which showed a well encapsulated solid mass, about 24mm (maximum diameter) located at paraurethral level, on right anterolateral side, It showed uptake of contrast, with a compressive-dislocative effect on the urethra, without involvement of the sphincters. Surgery was performed with excission “en-block” of the mass. The procedure was well tolerated under spinal anesthesia and the patient was discharged 24h later, after removing the bladder catheter. No signs of haematuria nor symptoms of incontinence were reported in the following weeks. Pathology of the excised specimen revealed complete resection of a benign, submucus leiomyoma. Although leiomyomas are very common in organs such as the uterus, the presentation of a urethral leiomyoma, as found in the present case, is very rare. The description of these lesions is however important to create a scientific path that can clarify the cause and the evolution. It can also represent an evolution for imaging through MRI, improving its framework and distinguishing it from malignant tumors that require another surgical strategy.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70310651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suyog Shetty, A. Chawla, A. Choudhary, Mummalaneni Sitaram, Suraj Jayadeva Reddy, Bathi Sourabh Reddy
Complex vesicovaginal fistulas present a unique challenge to surgeons, and surgical reconstruction outcomes may be suboptimal. The aim is to evaluate the patient’s characteristics as well as the factors influencing the functional outcome of complex vesicovaginal fistula surgical reconstruction. From 2016 to 2020, the medical records of 28 patients with complex fistulas were analyzed retrospectively. Means, ranges, and standard deviations were used in descriptive analysis. For categorical data, the Fisher exact probability test was used. The mean (standard deviation) age at presentation was 44.4 (10.04) years, while 85.7% (24) of patients were below 50 years of age. Hysterectomy was the most common aetiology in 21 (75%) patients, followed by radiotherapy in 3 (10.7%). Surgical repair success was seen in 24 (85.7%) patients. Four (14.2%) patients had an unsuccessful repair, one vaginal and three abdominal approach. All the failed abdominal repairs were radiation-induced fistula (p=0.001). Other factors that significantly influenced repair failure include vaginal mucosal atrophy (3 failures out of 8 patients, p=0.013), severe fibrosis around the fistula (4 failures out of 12 patients, p=0.024), non-placement of suprapubic catheter (2 failures out of 3 patients, p=0.006), and non-placement of interposition tissue flap (p=0.005). Hysterectomy and radiotherapy are the common causes of complex vesicovaginal fistula. The outcome of the repair is hampered by vaginal mucosal atrophy and severe scarring. The use of a suprapubic catheter and an interposition tissue flap improves the outcome. Post-irradiation fistula has a significant impact on repair outcome and necessitates special consideration for a comprehensive management strategy.
{"title":"Complex vesicovaginal fistula: Analysis of patient characteristics & functional outcome of surgical reconstruction","authors":"Suyog Shetty, A. Chawla, A. Choudhary, Mummalaneni Sitaram, Suraj Jayadeva Reddy, Bathi Sourabh Reddy","doi":"10.4081/uij.2022.282","DOIUrl":"https://doi.org/10.4081/uij.2022.282","url":null,"abstract":"Complex vesicovaginal fistulas present a unique challenge to surgeons, and surgical reconstruction outcomes may be suboptimal. The aim is to evaluate the patient’s characteristics as well as the factors influencing the functional outcome of complex vesicovaginal fistula surgical reconstruction. From 2016 to 2020, the medical records of 28 patients with complex fistulas were analyzed retrospectively. Means, ranges, and standard deviations were used in descriptive analysis. For categorical data, the Fisher exact probability test was used. The mean (standard deviation) age at presentation was 44.4 (10.04) years, while 85.7% (24) of patients were below 50 years of age. Hysterectomy was the most common aetiology in 21 (75%) patients, followed by radiotherapy in 3 (10.7%). Surgical repair success was seen in 24 (85.7%) patients. Four (14.2%) patients had an unsuccessful repair, one vaginal and three abdominal approach. All the failed abdominal repairs were radiation-induced fistula (p=0.001). Other factors that significantly influenced repair failure include vaginal mucosal atrophy (3 failures out of 8 patients, p=0.013), severe fibrosis around the fistula (4 failures out of 12 patients, p=0.024), non-placement of suprapubic catheter (2 failures out of 3 patients, p=0.006), and non-placement of interposition tissue flap (p=0.005). Hysterectomy and radiotherapy are the common causes of complex vesicovaginal fistula. The outcome of the repair is hampered by vaginal mucosal atrophy and severe scarring. The use of a suprapubic catheter and an interposition tissue flap improves the outcome. Post-irradiation fistula has a significant impact on repair outcome and necessitates special consideration for a comprehensive management strategy.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46035627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Zigman, S. Handler, S. Amaya, A. Zeno, Y. Takashima, J. Navas, T. Yazdany
Posterior Tibial Nerve Stimulation (PTNS) is a treatment option for refractory Overactive Bladder (OAB). There is currently no evidence to support which maintenance schedule is most effective. The objective of this study is to compare patientreported outcomes between monthly maintenance therapy and sessions scheduled Per patient request (PRN). We hypothesized that there is no difference in these measures between groups. After completing 12 sessions of PTNS, patients were randomized to monthly or PRN maintenance. Quality of life, patient satisfaction, and degree of symptom bother were assessed with validated questionnaires. Thirty six patients were randomized: 19 to monthly follow-up, and 17 to PRN follow-up. The PRN group demonstrated a significantly higher quality of life (p=0.04) with a large effect size (0.82). Over a three-month period, there was no significant difference in the average number of visits between the monthly and PRN groups, with an average of 1.79 (±1.18) and 1.24 (±1.35) visits, respectively (p=0.20). After six months of maintenance therapy, 42% of patients in the monthly group and 53% of patients in PRN group elected to continue therapy (p=0.27). There was no significant difference between the groups with regard to treatment satisfaction (p=0.62) or percent change in OAB symptoms (p=0.13). There is no difference between monthly and PRN follow-up in terms of patient satisfaction and symptom bother. However, the PRN group scored higher on the quality of life measure. PRN maintenance may optimize care for patients treating Overactive Bladder Syndrome with posterior tibial nerve stimulation.
{"title":"Continuing posterior tibial nerve stimulation after twelve weekly sessions: a randomized controlled trial","authors":"J. Zigman, S. Handler, S. Amaya, A. Zeno, Y. Takashima, J. Navas, T. Yazdany","doi":"10.4081/uij.2022.251","DOIUrl":"https://doi.org/10.4081/uij.2022.251","url":null,"abstract":"Posterior Tibial Nerve Stimulation (PTNS) is a treatment option for refractory Overactive Bladder (OAB). There is currently no evidence to support which maintenance schedule is most effective. The objective of this study is to compare patientreported outcomes between monthly maintenance therapy and sessions scheduled Per patient request (PRN). We hypothesized that there is no difference in these measures between groups. After completing 12 sessions of PTNS, patients were randomized to monthly or PRN maintenance. Quality of life, patient satisfaction, and degree of symptom bother were assessed with validated questionnaires. Thirty six patients were randomized: 19 to monthly follow-up, and 17 to PRN follow-up. The PRN group demonstrated a significantly higher quality of life (p=0.04) with a large effect size (0.82). Over a three-month period, there was no significant difference in the average number of visits between the monthly and PRN groups, with an average of 1.79 (±1.18) and 1.24 (±1.35) visits, respectively (p=0.20). After six months of maintenance therapy, 42% of patients in the monthly group and 53% of patients in PRN group elected to continue therapy (p=0.27). There was no significant difference between the groups with regard to treatment satisfaction (p=0.62) or percent change in OAB symptoms (p=0.13). There is no difference between monthly and PRN follow-up in terms of patient satisfaction and symptom bother. However, the PRN group scored higher on the quality of life measure. PRN maintenance may optimize care for patients treating Overactive Bladder Syndrome with posterior tibial nerve stimulation.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70311027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Sarrió-Sanz, A. López-López, L. Martínez-Cayuelas, L. Gómez-Pérez, M. A. Ortiz-Gorraiz, J. Romero-Maroto
The use of vaginal mesh in order to correct Pelvic Organ Prolapse (POP) has been banned by the FDA due to the complications associated with them. The objective is to determine efficacy and safety in the short and long term in a sample of women undergoing transvaginal mesh surgery performed by properly trained surgeons, in a referral center and with a protocolized follow-up. We present a longitudinal, descriptive study of a cohort of 53 patients with POP who underwent transvaginal mesh surgery between 2001 and 2015. The efficacy of the treatment is evaluated quantifying both clinical changes and life quality, as well as the rate for prolapse recurrence and the short-and long-term treatment-related complications. A total of 53 patients with average follow-up of 87 months were included. All of them had their surgery performed by three properly-trained surgeons. Indication for mesh placement was assessed in 49.1% of cases due to previous surgery recurrence. Treatment improved urinary incontinence rates, constipation, voiding difficulty, dyspareunia and quality of life. Long-term complication rate was 9.6% (5.7% exposure, 1.9% urinary obstruction and 1.9% pain). None of the patients presented recurrence in the mesh-treated compartment and 6 patients (11.3%) needed surgery after recurrence in a different compartment at the end of follow-up. Vaginal placement of synthetic mesh for POP treatment is safe in the short-, medium- and long-term when performed in referral centers. The correct indication and long-term follow-up are essential to diagnose and treat possible complications.
{"title":"Is pelvic organ prolapse correction with vaginal mesh suitable with a correct indication and protocolized follow-up?","authors":"P. Sarrió-Sanz, A. López-López, L. Martínez-Cayuelas, L. Gómez-Pérez, M. A. Ortiz-Gorraiz, J. Romero-Maroto","doi":"10.4081/uij.2022.280","DOIUrl":"https://doi.org/10.4081/uij.2022.280","url":null,"abstract":"The use of vaginal mesh in order to correct Pelvic Organ Prolapse (POP) has been banned by the FDA due to the complications associated with them. The objective is to determine efficacy and safety in the short and long term in a sample of women undergoing transvaginal mesh surgery performed by properly trained surgeons, in a referral center and with a protocolized follow-up. We present a longitudinal, descriptive study of a cohort of 53 patients with POP who underwent transvaginal mesh surgery between 2001 and 2015. The efficacy of the treatment is evaluated quantifying both clinical changes and life quality, as well as the rate for prolapse recurrence and the short-and long-term treatment-related complications. A total of 53 patients with average follow-up of 87 months were included. All of them had their surgery performed by three properly-trained surgeons. Indication for mesh placement was assessed in 49.1% of cases due to previous surgery recurrence. Treatment improved urinary incontinence rates, constipation, voiding difficulty, dyspareunia and quality of life. Long-term complication rate was 9.6% (5.7% exposure, 1.9% urinary obstruction and 1.9% pain). None of the patients presented recurrence in the mesh-treated compartment and 6 patients (11.3%) needed surgery after recurrence in a different compartment at the end of follow-up. Vaginal placement of synthetic mesh for POP treatment is safe in the short-, medium- and long-term when performed in referral centers. The correct indication and long-term follow-up are essential to diagnose and treat possible complications.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49169440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kaboré, B. Kirakoya, A. Ouattara, Clotaire Yaméogo, Stéphanie Dominique Amida Nama, G. Karsenty, F. A. Kaboré
The objective of the study was to determine the risk factors for development of circumferential fistula. We carried out a crosssectional, multicentric and analytical study over 7 years period, from 1st January, 2010 to 31 December, 2016. We compared circumferential and non- circumferential fistula patients in order to determine the risk factors for circumferential fistula development. Circumferential fistula accounted for 20% (91/456) of all vesico-vaginal fistulas. The mean age of the 456 patients was 35.9 years±12.15 (min 15 years; max 72 years). On univariate analysis, factors associated with the risk of circumferential fistula were: residence (P=0.039; OR=1.7), parity (P=0.04; OR=0.47), marital status before fistula (P=0.002; 4.3), duration of labor (P=0.041; OR=2.7) and fistula aetiology (P=0.038; OR=2.54). In a logistic regression model, two factors remained significant: marital status before fistula (P=0.029; OR=0.13) and duration of labor (P=0.017; OR=0.26). Circumferential fistula occurs in urban, primiparous, unmarried women who have been in labor for more than 41 hours.
{"title":"Characteristics of circumferential vesico-vaginal fistulas: A cross-sectional and multicentric study","authors":"M. Kaboré, B. Kirakoya, A. Ouattara, Clotaire Yaméogo, Stéphanie Dominique Amida Nama, G. Karsenty, F. A. Kaboré","doi":"10.4081/uij.2021.269","DOIUrl":"https://doi.org/10.4081/uij.2021.269","url":null,"abstract":"The objective of the study was to determine the risk factors for development of circumferential fistula. We carried out a crosssectional, multicentric and analytical study over 7 years period, from 1st January, 2010 to 31 December, 2016. We compared circumferential and non- circumferential fistula patients in order to determine the risk factors for circumferential fistula development. Circumferential fistula accounted for 20% (91/456) of all vesico-vaginal fistulas. The mean age of the 456 patients was 35.9 years±12.15 (min 15 years; max 72 years). On univariate analysis, factors associated with the risk of circumferential fistula were: residence (P=0.039; OR=1.7), parity (P=0.04; OR=0.47), marital status before fistula (P=0.002; 4.3), duration of labor (P=0.041; OR=2.7) and fistula aetiology (P=0.038; OR=2.54). In a logistic regression model, two factors remained significant: marital status before fistula (P=0.029; OR=0.13) and duration of labor (P=0.017; OR=0.26). Circumferential fistula occurs in urban, primiparous, unmarried women who have been in labor for more than 41 hours.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44430874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There has been an increasing interest in mesh-free surgical options for Stress Urinary Incontinence (SUI). Traditionally rectus fascia autologous slings were placed at the bladder neck but more recently they are positioned at the mid-urethra (aMUS). The long-term outcomes for these patients are described. A retrospective analysis of aMUS patients between 2009-2014 by a single surgeon for primary SUI was performed. All patients were evaluated preoperatively with urodynamics. Patient reported outcomes were collected via postal questionnaire using the ICIQ-UI short-form questionnaire, 7-point Global Impression of Improvement score, questions on pad usage, self-catheterisation, overactive bladder treatment and re-operation rates. Results included 31 patients (response rate 63.8%). The median age was 49 years and median BMI was 27. Twenty-seven per cent (27%) of patients had stress predominant mixed urinary incontinence pre-operatively. Median length of follow up was 8 years (5- 11); 60% of patients were dry and pad-free. Seventy-seven per cent (77%) found the surgery led to “much improvement” or “very much improvement” in quality of life. Thirteen per cent (13%) of patients reported a deterioration in quality of life. The median ICIQ-UI short form score was 5.5. 16.7% were taking medication and 1 patient received botulinum toxin therapy for overactive bladder symptoms. All these patients had mixed urinary incontinence on preoperative urodynamics. The re-operation rate was 13.3%. One patient was selfcatheterising. Three out of 31 (10%) had experienced pelvic pain, with 2 out of 31 (6%) experiencing dyspareunia. AMUS shows good long-term continence outcomes and is associated with low rates of de-novo overactive bladder symptoms and voiding dysfunction.
{"title":"Autologous mid-urethral fascial sling for stress urinary incontinence: Long term outcomes","authors":"T. Malthouse, I. Rudd, C. Down, James A Moore","doi":"10.4081/uij.2021.272","DOIUrl":"https://doi.org/10.4081/uij.2021.272","url":null,"abstract":"There has been an increasing interest in mesh-free surgical options for Stress Urinary Incontinence (SUI). Traditionally rectus fascia autologous slings were placed at the bladder neck but more recently they are positioned at the mid-urethra (aMUS). The long-term outcomes for these patients are described. A retrospective analysis of aMUS patients between 2009-2014 by a single surgeon for primary SUI was performed. All patients were evaluated preoperatively with urodynamics. Patient reported outcomes were collected via postal questionnaire using the ICIQ-UI short-form questionnaire, 7-point Global Impression of Improvement score, questions on pad usage, self-catheterisation, overactive bladder treatment and re-operation rates. Results included 31 patients (response rate 63.8%). The median age was 49 years and median BMI was 27. Twenty-seven per cent (27%) of patients had stress predominant mixed urinary incontinence pre-operatively. Median length of follow up was 8 years (5- 11); 60% of patients were dry and pad-free. Seventy-seven per cent (77%) found the surgery led to “much improvement” or “very much improvement” in quality of life. Thirteen per cent (13%) of patients reported a deterioration in quality of life. The median ICIQ-UI short form score was 5.5. 16.7% were taking medication and 1 patient received botulinum toxin therapy for overactive bladder symptoms. All these patients had mixed urinary incontinence on preoperative urodynamics. The re-operation rate was 13.3%. One patient was selfcatheterising. Three out of 31 (10%) had experienced pelvic pain, with 2 out of 31 (6%) experiencing dyspareunia. AMUS shows good long-term continence outcomes and is associated with low rates of de-novo overactive bladder symptoms and voiding dysfunction.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48902144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maherah Kamarudin, J. Hong, Yogeeta Gunasagran, Chua Shiao Chuan, N. A. Razif, S. Khong, M. Tan
Urinary Incontinence (UI) negatively impact women’s physical, psychological and health-related quality of life. Pelvic strengthening exercise is the first line management in UI. We hypothesized that Hyacinth exercise is better than Pelvic Floor Exercise (PFE) in strengthening pelvic floor muscles, thus reducing female urinary incontinence. This randomized controlled trial involved 180 women with UI. Participants were taught on either Hyacinth exercise or PFE alone. Improvement in urinary symptoms and pelvic muscle strength were evaluated using a validated female pelvic floor questionnaire and objectively measured at 2 months and 6 months. Significant improvement in urinary symptoms and pelvic muscle strength post treatment at 2 months and 6 months was seen in both groups with p≤0.001. Although earlier improvement seen in Hyacinth group, it did not reach level of significant when compared, between the two exercises. Mean bladder score (PFE vs Hyacinth arm) 9.13±6.54 vs. 8.74±5.21, p=0.93 (2 months) and 5.80±4.15 vs. 5.79±4.22, p=0.92 (6 months). Although there was no statistical difference between the two groups for our primary and secondary outcomes, Hyacinth group demonstrated earlier improvement in urinary symptoms at 2 months.
{"title":"Is hyacinth exercise better than pelvic floor exercise alone for urinary incontinence: A randomized trial","authors":"Maherah Kamarudin, J. Hong, Yogeeta Gunasagran, Chua Shiao Chuan, N. A. Razif, S. Khong, M. Tan","doi":"10.4081/uij.2021.266","DOIUrl":"https://doi.org/10.4081/uij.2021.266","url":null,"abstract":"Urinary Incontinence (UI) negatively impact women’s physical, psychological and health-related quality of life. Pelvic strengthening exercise is the first line management in UI. We hypothesized that Hyacinth exercise is better than Pelvic Floor Exercise (PFE) in strengthening pelvic floor muscles, thus reducing female urinary incontinence. This randomized controlled trial involved 180 women with UI. Participants were taught on either Hyacinth exercise or PFE alone. Improvement in urinary symptoms and pelvic muscle strength were evaluated using a validated female pelvic floor questionnaire and objectively measured at 2 months and 6 months. Significant improvement in urinary symptoms and pelvic muscle strength post treatment at 2 months and 6 months was seen in both groups with p≤0.001. Although earlier improvement seen in Hyacinth group, it did not reach level of significant when compared, between the two exercises. Mean bladder score (PFE vs Hyacinth arm) 9.13±6.54 vs. 8.74±5.21, p=0.93 (2 months) and 5.80±4.15 vs. 5.79±4.22, p=0.92 (6 months). Although there was no statistical difference between the two groups for our primary and secondary outcomes, Hyacinth group demonstrated earlier improvement in urinary symptoms at 2 months.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42120473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Porru, A. de Silvestri, Edda Buffa, C. Klersy, B. Gardella, A. Spinillo, H. Jallous
The results of several studies reveal that antibiotics may promote treatment resistance by causing alterations in the intestinal flora. The development of a gut reservoir of resistant bacteria promotes the development of UTIs through autoinfection. This review aims to address clinical reliability, efficacy and safety of long-term treatment with oral D mannose for the prevention of Recurrent Urinary Tract Infections (RUTI) in females. A comprehensive MEDLINE, Embase, Scopus and Cochrane search was performed for English language reports published before December 2018 using the term “recurrent urinary tract infections and D mannose” was carried out. We searched Medline, Embase, Scopus and the Cochrane Register of Controlled Trials from January 2010 to December 2018. Eligible studies did not include non-oral therapy, local (vaginal) treatment in women with recurrent UTIs. We identified eligible original articles. A few limitations of the review are the heterogeneity of the available studies, their different rational and aim, the assumption of D mannose for prophylaxis or treatment of recurrent UTIs. Oral D mannose performs well in the prevention of UTIs recurrences, significant improvement of urinary symptoms was observed, the disease- free time was longer in the groups of patients under prophylaxis with D mannose in comparison with control groups (no treatment, antibiotic prophylaxis, prophylaxis with Proanthocyanidin (PAC) etc. The review has limitations, as the studies are heterogeneous, the meta-analysis requires classifications that can also be arbitrary. Furthermore, single-arm studies are not included. Some of the authors found this evidence inconclusive, which results as a limitation of the study. D mannose prolonged the recurrence-free interval of recurrent UTIs, thus reducing the prolonged or cyclical use of antibiotics, improving clinical symptoms, with a significant difference between treatment and control groups (no treatment, antibiotic prophylaxis, prophylaxis with Proanthocyanidin). However, most clinical trials used an association of different substances commingled with D mannose, dosages and regimens of D mannose were different. For this reason, the evidence of the efficacy of D mannose remains low.
几项研究结果表明，抗生素可能通过引起肠道菌群的改变而促进治疗耐药性。肠道耐药菌库的发展通过自身感染促进了尿路感染的发展。本综述旨在探讨长期口服D甘露糖预防女性复发性尿路感染(RUTI)的临床可靠性、有效性和安全性。综合MEDLINE、Embase、Scopus和Cochrane检索2018年12月之前发表的英文报告，检索词为“复发性尿路感染和D -甘露糖”。我们检索了Medline、Embase、Scopus和Cochrane Register of Controlled Trials，检索时间为2010年1月至2018年12月。符合条件的研究不包括复发性尿路感染妇女的非口服治疗、局部(阴道)治疗。我们确定了符合条件的原创文章。本综述的一些局限性是现有研究的异质性，其合理性和目的不同，假设甘露糖D用于预防或治疗复发性尿路感染。口服D甘露糖可有效预防尿路感染复发，尿路症状明显改善，与对照组(未治疗、抗生素预防、原花青素预防等)相比，D甘露糖预防组的无病时间更长。该综述有局限性，因为研究是异质的，荟萃分析需要的分类也可能是任意的。此外，单臂研究未包括在内。一些作者认为这一证据不具有结论性，这是研究的局限性。D甘露糖延长了复发性uti的无复发间隔，从而减少了抗生素的长期或周期性使用，改善了临床症状，治疗组与对照组(不治疗、抗生素预防、原花青素预防)的差异有统计学意义。然而，大多数临床试验使用不同物质与D -甘露糖混合，D -甘露糖的剂量和方案是不同的。因此，D -甘露糖有效的证据仍然很低。
{"title":"Oral D mannose in the prevention and treatment of recurrent urinary tract infections: A review","authors":"D. Porru, A. de Silvestri, Edda Buffa, C. Klersy, B. Gardella, A. Spinillo, H. Jallous","doi":"10.4081/UIJ.2021.239","DOIUrl":"https://doi.org/10.4081/UIJ.2021.239","url":null,"abstract":"The results of several studies reveal that antibiotics may promote treatment resistance by causing alterations in the intestinal flora. The development of a gut reservoir of resistant bacteria promotes the development of UTIs through autoinfection. This review aims to address clinical reliability, efficacy and safety of long-term treatment with oral D mannose for the prevention of Recurrent Urinary Tract Infections (RUTI) in females. A comprehensive MEDLINE, Embase, Scopus and Cochrane search was performed for English language reports published before December 2018 using the term “recurrent urinary tract infections and D mannose” was carried out. We searched Medline, Embase, Scopus and the Cochrane Register of Controlled Trials from January 2010 to December 2018. Eligible studies did not include non-oral therapy, local (vaginal) treatment in women with recurrent UTIs. We identified eligible original articles. A few limitations of the review are the heterogeneity of the available studies, their different rational and aim, the assumption of D mannose for prophylaxis or treatment of recurrent UTIs. Oral D mannose performs well in the prevention of UTIs recurrences, significant improvement of urinary symptoms was observed, the disease- free time was longer in the groups of patients under prophylaxis with D mannose in comparison with control groups (no treatment, antibiotic prophylaxis, prophylaxis with Proanthocyanidin (PAC) etc. The review has limitations, as the studies are heterogeneous, the meta-analysis requires classifications that can also be arbitrary. Furthermore, single-arm studies are not included. Some of the authors found this evidence inconclusive, which results as a limitation of the study. D mannose prolonged the recurrence-free interval of recurrent UTIs, thus reducing the prolonged or cyclical use of antibiotics, improving clinical symptoms, with a significant difference between treatment and control groups (no treatment, antibiotic prophylaxis, prophylaxis with Proanthocyanidin). However, most clinical trials used an association of different substances commingled with D mannose, dosages and regimens of D mannose were different. For this reason, the evidence of the efficacy of D mannose remains low.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47499241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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