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Prolapse Repair (prolapse + repair)
Selected AbstractsSacrocolpopexy using xenogenic acellular collagen in patients at increased risk for graft-related complications,,NEUROUROLOGY AND URODYNAMICS, Issue 4 2010Filip Claerhout Abstract Aims We studied the long-term anatomical and functional outcome following sacrocolpopexy for apical vaginal prolapse using xenogenic grafts in a population at increased risk for graft-related complications (GRCs). Methods Twenty-two consecutive patients with symptomatic apical prolapse were scheduled for laparoscopic sacrocolpopexy (LSC) with porcine grafts because they were presumed to be at risk for GRC, because of pre-existing vaginal ulcerations (n,=,4), concomitant vaginal prolapse repair (n,=,15), total hysterectomy (n,=,1), or intra-operative abdominal contamination due to accidental laceration of the vagina, bowel perforation (n,=,1) or the presence of infection (n,=,1). Either small intestinal submucosa (n,=,8) or dermal collagen (n,=,14) was used. Outcome measures were GRCs, anatomical cure (,Stage I at any compartment), subjective cure, impact on bowel, bladder, and sexual function measured by a standardized interview. Results At study closure 20 (91%) patients were available for functional evaluation and 16 (73%) for anatomical evaluation at a mean follow-up period of 27.4 months. The GRC rate was 25% (n,=,4) prompting reintervention in half, and including two patients with spondylodiscitis. The anatomical cure rate was 31.5%. Failures at the vault, anterior, and posterior compartments occurred in, respectively, 31%, 18.8%, and 50% of patients. The subjective cure rate was 60% and three patients (15%) underwent redo-LSC. Conclusion The strategy of using xenografts in patients at risk for GRC, did not prevent these to occur and was associated with a high anatomical and functional failure rate as well as reoperation rate. Neurourol. Urodynam. 29:563,567, 2010. © 2009 Wiley-Liss, Inc. [source] Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation,,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Jonathan S. Starkman Abstract Aims We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. Methods A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: significant response (,80% improvement), moderate response (,50% and <80% improvement), and poor response (<50% response). Results Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal fistula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P,<,0.001). There were no significant differences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Conclusion Sacral neuromodulation appears to be an effective therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Surgical complications and medium-term outcome results of tension-free vaginal tape: A prospective study of 313 consecutive patientsNEUROUROLOGY AND URODYNAMICS, Issue 1 2004Ishai Levin Abstract Objective A prospective study was undertaken to examine the incidence of surgical complications and medium-term outcomes of tension-free vaginal tape (TVT) surgery in a large, heterogeneous group of stress-incontinent women. Methods Surgery was tailored according to preoperative clinical and urodynamic findings: stress-incontinent women underwent TVT surgery, whereas those with concomitant urogenital prolapse underwent combined TVT and prolapse repair. Post-operatively the patients were scheduled for evaluation at 1, 3, 6, and 12 months, and annually thereafter. All underwent urodynamics at 3 months post-operatively. Results Three hundred and thirteen consecutive patients were prospectively studied. The mean follow-up period was 21.4,±,13.5 months. Sixteen (5.1%) cases of intravesical passage of the prolene tape occurred in our series, two of which were diagnosed at 3 and 15 months post-operatively. Eight (2.5%) patients had post-operative voiding difficulties, necessitating catheterization for more than 7 days. However, transvaginal excision of the tape was required in one case only. Vaginal erosion of the tape was diagnosed in four (1.3%) patients, all of whom were successfully treated by local excision of the eroded tape. Outcome analysis was restricted to 241 consecutive patients with at least 12 months of follow-up. Subjectively, 16 (6.6%) patients had persistent mild stress urinary incontinence, although urodynamics revealed asymptomatic sphincteric incontinence in 17 (7%) other patients. De-novo urge incontinence developed post-operatively in 20 (8.3%) patients. Conclusions The TVT procedure is associated with good medium-term cure rates, however, it is not free of troublesome complications and the patients should be informed accordingly. Only well-trained surgeons, familiar with pelvic anatomy, surgical alternatives, and endoscopic techniques should perform the operation. Neurourol. Urodynam. 23:7,9, 2004. © 2003 Wiley-Liss, Inc. [source] The TFS mini-sling for uterine/vault prolapse repair: A three-year follow-up reviewAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Peter E. P. PETROS Aims: To assess the three-year prolapse recurrence rate of the tissue fixation system (TFS) posterior mini-sling, an operation that works much like a McCall procedure. Patients and methods: Patients who originally presented with major symptomatic prolapse were contacted by telephone three years after a posterior TFS mini-sling operation, and invited to attend for review. All patients were questioned as to recurrence of any lumps, ,dragging pain', satisfaction with the procedure and existence of any vaginal discharge. Results: Of the original group of 39 patients, 35 were interviewed, 22 attended for review and four patients were uncontactable. Symptomatic cure was reported by 30 patients (86%), improvement in two (6%), and failure in three (9%). Conclusions: The longer-term results from the TFS posterior sling are encouraging. The procedure is evolving, and more studies are required. [source] Barriers to seeking treatment for women with persistent or recurrent symptoms in urogynaecologyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2009M Basu The aim of this study was to identify the reasons why women with recurrent bothersome urogynaecological symptoms do not seek further treatment. A cohort of 17 women with recurrent incontinence or prolapse symptoms following a prolapse repair were identified and interviewed about their reasons for not seeking help when their symptoms recurred. The mean time between the surgery and the interview was 3 years. The interview transcripts were analysed using constant comparison derived from Grounded Theory. Dominant themes were beliefs about ageing, attitudes towards incontinence, health professionals and treatment and access to services. These factors may be important when counselling women postoperatively. [source] | ||||||||||