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Sling Procedure (sling + procedure)
Kinds of Sling Procedure Selected AbstractsSling procedures for urinary incontinence in womenBJU INTERNATIONAL, Issue 5 2004Z.G. Kassardjian SUMMARY There are many different techniques of sling surgery for female incontinence and numerous materials are available for use as a suburethral sling. Autologous materials are associated with more success and fewer complications than cadaveric material. The objectives of this review are to identity the benefits and adverse effects of suburethral sling procedures. There is no evidence that suburethral slings are better or worse than other surgical or conservative management because no trials have addressed this comparison. [source] Change of sexual function after midurethral sling procedure for stress urinary incontinenceINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008Duk Yoon Kim Objectives: To compare sexual function in women before and after the midurethral sling procedure for stress urinary incontinence (SUI). Methods: A total of 75 women undergoing surgery for SUI between September 2005 and September 2006 were recruited for this study. Those who completed the Female Sexual Function Index (FSFI) preoperatively and 6 months postoperatively were included in the analysis. The FSFI is a validated, 19-item questionnaire, which assesses six domains of sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain. Results: Data were analyzed for 47 patients. Overall sexual function after the midurethral sling procedure was not significantly different. There were no significant differences in overall sexual function or any of the individual FSFI domain scores between patients with and without concomitant posterior colporrhaphy. There were no significant differences in sexual function between the transobturator and the retropubic surgical routes. Conclusions: There is no significant change in overall sexual function in women undergoing the midurethral sling procedure. Posterior colporrhaphy and operative methods do not affect overall sexual function. [source] Sling operations in the treatment of stress urinary incontinence: How to adjust sling tensionJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2003Ibraheem Mahmoud Ezzat Abstract Aim:, To find an objective method of adjusting sling tension in order to avoid postoperative urinary obstruction. Methods:, Thirty-five female patients with type II/III and type III stress urinary incontinence were treated using a sling procedure. Pubovaginal fascial slings were implanted in 20 patients and polytetrafluoroethylene patch slings with nylon sutures were implanted in 15 patients. During the procedures the urinary bladder was partially full and the patients, who were under spinal or epidural anesthesia, were asked to cough and strain. The proper tension that effectively prevents urine leakage was selected and the corresponding suture length was marked. An objective new method to adjust sling tension was used. As part of this method, the abdominal bulge index is added to the suture length before tying. Results:, Short-term follow-up of 6,12 months showed that 33 of 35 patients reported no leakage of urine (94%). Two patients had unsatisfactory urge incontinence. We did not encounter postoperative urinary retention in any patient. No significant post-voiding residual urine was reported. None of our patients in this series have complained of difficulties during micturition or the need to strain during voiding. Conclusion:, Proper adjustment of sling tension using the abdominal bulge index has eliminated postoperative urinary retention and obstructed urine flow, including any appreciable amount of post-voiding residual urine. This method has been found to be both objective and reproducible. [source] Midurethral sling procedures for stress urinary incontinence in women over 80 years,,NEUROUROLOGY AND URODYNAMICS, Issue 7 2010Kobi Stav Abstract Aims To compare the safety and efficacy of midurethral sling surgery for management of urinary stress incontinence in women over 80 years versus younger women. Methods 1225 consecutive women with urodynamic stress incontinence had a synthetic midurethral sling (955 retropubic, 270 transobturator) at our institution between 1999 and 2007. Ninety one percent (n,=,1112) of the patients were interviewed via phone call with a structured questionnaire and were included in the analysis. The mean follow-up was 50,±,24 months (range 12,114). Comparison between elderly (,80 years, n,=,96) and younger patients (<80 years, n,=,1016) was performed. Results The overall subjective cure rate was 85% (elderly 81%, younger 85%, ,=,0.32). There was no significant difference in cure rate between retropubic and transobturator sling in the elderly group (82% vs. 79.3%, P,=,0.75). The bladder perforation rate was similar between the two groups (3%). The hospitalization time was significantly longer in the elderly (1.6,±,1.7 days vs. 0.7,±,1.1 days, P<0.001). However, major perioperative complications were uncommon (1%). Of the patients who had an isolated sling procedure, 37% of the elderly and 9% of the young patients failed their 1st trial of void (P,<,0.001). However, the long-term rate of voiding difficulty was similar between the two groups (elderly 8% vs. young 6%, P,=,0.21). The rate of de novo urge incontinence was similar between the two groups (7%). Conclusion Retropubic and transobturator slings in women older than 80 years are effective and safe but are associated with an increased risk of transient postoperative voiding difficulty. Neurourol. Urodynam. 29:1262,1266, 2010. © 2010 Wiley-Liss, Inc. [source] Urodynamic evaluation of the human bladder response tgo an increase in outlet resistanceNEUROUROLOGY AND URODYNAMICS, Issue 6 2002Jason D. Engel Abstract Aim. We prospectively evaluated the response of the human bladder to a chronic increase in urethral resistance according to the indices of pressure, volume flow rate, total (external) bladder work, and maximum and average detrusor power. Methods. Six men with incontinence after radical prostatectomy were evaluated urodynamically before and 3,6 months after undergoing a bulbourethral sling procedure. Results. None of the men suffered from significant obstructive or irritative voiding symptoms preoperatively. Urodynamic evaluation showed postoperative increases in both average detrusor pressure and pressure at maximum flow, but there were no significant changes in voided volume, void time, or postvoid residual urine volume. Maximum detrusor power, average detrusor power, and total (external) bladder work were all significantly increased. Conclusion. These data confirm that the human bladder possesses a functional reserve, which is elicited by an increase in urethral resistance. Neurourol. Urodynam. 21:524,528, 2002. © 2002 Wiley-Liss, Inc. [source] Long-term outcomes of patients who failed to attend following midurethral sling surgery , A comparative study and analysis of risk factors for non-attendanceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010Kobi STAV Background and aims:, To assess long-term subjective cure and subjective complication rates of women who underwent midurethral sling (MUS) for stress urinary incontinence (SUI) in those who failed to attend (FTA) versus those who attended for postoperative follow-up. Predictive factors for non-attendance were identified. Methods:, A total of 1225 consecutive women with urodynamic SUI had a synthetic MUS at our institution between 1999 and 2007. Patients were interviewed via phone call with a structured questionnaire. Comparison between FTA and non-FTA patients was performed and multivariate analysis was utilised to identify risk factors for non-attendance. Results:, Univariate analysis revealed that the FTA rate was lower in patients who underwent concomitant prolapse surgery (29% vs. 84%, P < 0.001), FTA patients were younger (mean age 56 vs. 67 years, P < 0.001) and more depressed (14% vs. 4%, P < 0.05). At a mean follow-up of 50 ± 24 months, the subjective cure rate was similar between the two groups (84% vs. 86%, NS). The incidence of overactive bladder symptoms was significantly higher in the non-FTA patients (34% vs. 6%P < 0.001). Isolated sling procedure (OR = 2.71, P < 0.01) and age <50 years (OR = 3.15, P < 0.05) were significant predictors for failed attendance. Conclusions:, Our results indicate that the subjective cure rate is similar between non-FTA and FTA patients subsequent to a MUS procedure. However, the rate of overactive bladder symptoms is higher in the non-FTA patients. Isolated MUS procedure and younger age are significant risk factors of failure to attend in the longer term. [source] Colpo-wrap: a new continence procedureBJU INTERNATIONAL, Issue 7 2005Thomas M. Boemers OBJECTIVE To present a new surgical method to increase bladder outlet resistance for the treatment of urinary incontinence in girls and women. PATIENTS AND METHODS Six patients (mean age 9.6 years), with urinary incontinence were operated using the new technique within the last 3 years. The principle of the procedure is tightening of the bladder neck by mobilizing the anterior vaginal wall and wrapping it around the bladder neck and proximal urethra, in the sense of a vaginoplication (colpoplication). The underlying conditions and causes for urinary incontinence was neurogenic bladder-sphincter dysfunction caused by myelodysplasia in three girls and anorectal malformation combined with a tethered spinal cord in one. In one case incontinence was caused by a cloacal anomaly and one girl had intrinsic sphincter insufficiency after repetitive Otis urethrotomies. The colpo- wrap was combined with a bladder augmentation and Mitrofanoff in three patients, the three other girls undergoing isolated procedures. RESULTS The result of the method is a constant increase in outlet resistance and coaptation of the urethra, comparable with the effect of a vaginal sling procedure. Five patients are completely dry after surgery, one girl with cloaca needed an additional bladder neck injection with hyaluranon/dextranomer copolymer. Transurethral catheterization was possible after surgery with no problems in all patients who required intermittent catheterization. CONCLUSION Considering the feasibility of this technique the colpo-wrap is a reasonable alternative for treating urinary incontinence in females. [source] Day-case sling surgery for stress urinary incontinence: feasibility and safetyBJU INTERNATIONAL, Issue 6 2005Subhasis K. Giri OBJECTIVE To prospectively assess the feasibility for discharge 10 h after a porcine dermal pubovaginal sling procedure (PVS), to examine the surgical factors (postoperative complications) affecting discharge, and to measure the short-term cure rate for stress urinary incontinence (SUI). PATIENTS AND METHODS Between June 2003 and December 2003, 40 consecutive patients with SUI and scheduled for treatment using a porcine dermal sling were enrolled in this prospective study. Patients were admitted with a planned overnight stay and returned to the ward with no urinary catheter. Outcome measures were bladder emptying efficiency (EE) at 10 h after surgery, time intervals to the first three spontaneous voids, EE of the first three voids, time required to achieve an EE of ,,75%, a visual analogue scale pain score, perioperative complications, and short-term cure rate of SUI. Patients were considered suitable for discharge from hospital when the EE was ,,75% or when they were self-catheterizing confidently with adequate pain control and no significant complication. All patients were followed for 6 months. RESULTS The median EE at 10 h was 61%; 16 patients (40%) achieved efficient emptying and were suitable for discharge 10 h after surgery. The median intervals to the first three spontaneous voids were 7, 10 and 17 h, and the median EEs for the first three voids 46%, 61% and 75%. The median visual analogue scale pain score was 3.5. Patients with intrinsic sphincter deficiency (ISD) were significantly less likely to achieve efficient emptying at 10 h (39% vs 70%). Overall SUI was cured or improved in 90% of patients at the 6-month follow-up. CONCLUSIONS In the present study only 40% of patients were suitable for day-case sling surgery. Early bladder emptying inefficiency was the main limiting factor. Exclusion of patients with ISD and possibly decreasing the EE threshold to 50% would improve the discharge rate. The short-term results of this PVS are similar to those obtained with the autologous fascial sling. [source] Minimally invasive harvesting of fascia lata for use in the pubovaginal sling procedureBJU INTERNATIONAL, Issue 3 2001S.J. Foley No abstract is available for this article. [source] A case of mucormycosis limited to the parotid glandHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2005Arun Chandu BDSc, FDSRCS(Eng), MBBS(Hons) Abstract Background. Mucormycosis is a rare fungal infection commonly affecting structures in the head and neck such as air sinuses, orbits, and the brain. Common predisposing factors include diabetes and immunosuppression. To date, only one case of mucormycosis involving the parotid gland has been reported, and this infection was associated with a fatal outcome. Methods. We report a case of parotid gland mucormycosis in a 45-year-old woman with type 2 diabetes, who was successfully treated with a superficial parotidectomy and intravenous amphotericin B. Results. After initial surgical and antifungal therapy, the patient was left with a residual facial nerve palsy for which multiple sling procedures were performed. She is currently alive and well 6 years after the diagnosis of mucormycosis. Conclusions. Mucormycosis of the parotid gland is a rare form of this often-fatal infection. In this case, infection remained isolated to the parotid gland and was diagnosed soon after presentation. The patient most likely survived because of the early diagnosis, successful surgical removal of all infected tissue, use of intravenous amphotericin therapy, and the aggressive management of comorbidities such as her diabetes. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Midurethral sling procedures for stress urinary incontinence in women over 80 years,,NEUROUROLOGY AND URODYNAMICS, Issue 7 2010Kobi Stav Abstract Aims To compare the safety and efficacy of midurethral sling surgery for management of urinary stress incontinence in women over 80 years versus younger women. Methods 1225 consecutive women with urodynamic stress incontinence had a synthetic midurethral sling (955 retropubic, 270 transobturator) at our institution between 1999 and 2007. Ninety one percent (n,=,1112) of the patients were interviewed via phone call with a structured questionnaire and were included in the analysis. The mean follow-up was 50,±,24 months (range 12,114). Comparison between elderly (,80 years, n,=,96) and younger patients (<80 years, n,=,1016) was performed. Results The overall subjective cure rate was 85% (elderly 81%, younger 85%, ,=,0.32). There was no significant difference in cure rate between retropubic and transobturator sling in the elderly group (82% vs. 79.3%, P,=,0.75). The bladder perforation rate was similar between the two groups (3%). The hospitalization time was significantly longer in the elderly (1.6,±,1.7 days vs. 0.7,±,1.1 days, P<0.001). However, major perioperative complications were uncommon (1%). Of the patients who had an isolated sling procedure, 37% of the elderly and 9% of the young patients failed their 1st trial of void (P,<,0.001). However, the long-term rate of voiding difficulty was similar between the two groups (elderly 8% vs. young 6%, P,=,0.21). The rate of de novo urge incontinence was similar between the two groups (7%). Conclusion Retropubic and transobturator slings in women older than 80 years are effective and safe but are associated with an increased risk of transient postoperative voiding difficulty. Neurourol. Urodynam. 29:1262,1266, 2010. © 2010 Wiley-Liss, Inc. [source] Open retropubic colposuspension for urinary incontinence in women: A short version cochrane review,,NEUROUROLOGY AND URODYNAMICS, Issue 6 2009Marie Carmela M. Lapitan Abstract Background Urinary incontinence is a common and potentially debilitating problem. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure. Objectives To assess the effects of open retropubic colposuspension for the treatment of urinary incontinence. Search Strategy We searched the Cochrane Incontinence Group Specialized Register (searched June 30, 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies. Selection Criteria Randomized or quasi-randomized controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group. Data Collection and Analysis Studies were evaluated for methodological quality/susceptibility to bias and appropriateness for inclusion and data extracted by two of the reviewers. Trial data were analyzed by intervention. Where appropriate, a summary statistic was calculated. Main Results This review included 46 trials involving a total of 4,738 women. Overall cure rates were 68.9,88.0% for open retropubic colposuspension. Two small studies suggest lower failure rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggests lower failure rates after open retropubic colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower failure rate for subjective cure after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (RR of failure 0.51; 95% CI 0.34,0.76 before the first year, RR 0.43; 95% CI 0.32,0.57 at 1,5 years, RR 0.49; 95% CI 0.32,0.75 in periods beyond 5 years). In comparison with needle suspensions there was a lower failure rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42,1.03), after the first year (RR 0.48; 95% CI 0.33,0.71), and beyond 5 years (RR 0.32; 95% CI 15,0.71). Evidence from 12 trials in comparison with suburethral slings found no significant difference in failure rates in all time periods assessed. Patient-reported failure rates in short, medium and long-term follow-up showed no significant difference between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials failure was less common after Burch (RR 0.38 95% CI 0.18,0.76) than after the Marshall-Marchetti-Krantz procedure at 1,5-year follow-up. There were few data at any other follow-up time. In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension, compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Authors' Conclusions The evidence available indicates that open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85,90%. After 5 years, approximately 70% of patients can expect to be dry. Newer minimal access procedures such as tension free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known and closer monitoring of their adverse event profile must be carried out. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet. Neurourol. Urodyn. 28:472,480, 2009. © 2009 Wiley-Liss, Inc. [source] Detrusor overactivity and urge urinary incontinence following trans obturator versus midurethral slingsNEUROUROLOGY AND URODYNAMICS, Issue 1 2007Sylvia M. Botros Abstract Aims To compare the rates of resolution of detrusor overactivity (DO) and subjective urge urinary incontinence (UUI) as well as de novo DO and UUI between the Monarc, TVT, and SPARC midurethral sling procedures. Methods Two hundred and seventy-six subjects with urodynamic stress or mixed urinary incontinence underwent retropubic midurethral slings (TVT, N,=,99; SPARC, N,=,52) or transobturator slings (Monarc, N,=,125). All evaluable subjects had a routine office evaluation, subjective assessment of UUI, and multichannel urodynamic testing pre- and 3 months postoperatively. Comparisons were made using Student's t -test, ANOVA, McNemar's test, and Chi-Square test where appropriate. Multivariate logistic regression was performed to detect possible confounding factors such as sling type, and differences in concomitant surgical procedures. Results De novo subjective UUI differed significantly between the Monarc and the other two slings (33% TVT vs. 8% Monarc vs. 17% SPARC, P,=,0.04). Fourteen to Sixteen percents of patients with preoperative UUI who underwent TVT or SPARC had worsening of their UUI symptoms while only 6% of the Monarc group did (P,=,0.02). There was no difference in rates of resolution of DO among the three groups (40% vs. 48% vs. 32%, P,=,0.39) or de novo DO (32% vs. 22% vs. 22%, P,=,0.64) at 3 months. Conclusions Patients who undergo transobturator procedures have significantly lower rates of de novo UUI than those who undergo midurethral sling procedures. Rates of resolution of DO, UUI, and de novo DO do not differ between groups. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Sling procedures for urinary incontinence in womenBJU INTERNATIONAL, Issue 5 2004Z.G. Kassardjian SUMMARY There are many different techniques of sling surgery for female incontinence and numerous materials are available for use as a suburethral sling. Autologous materials are associated with more success and fewer complications than cadaveric material. The objectives of this review are to identity the benefits and adverse effects of suburethral sling procedures. There is no evidence that suburethral slings are better or worse than other surgical or conservative management because no trials have addressed this comparison. [source] Tissue reaction of the rabbit urinary bladder to tension-free vaginal tape and porcine small intestinal submucosaBJU INTERNATIONAL, Issue 6 2002D.M. Rabah Objectives ,To compare the histological tissue reactions of urinary bladder in close contact with polypropylene mesh tension-free vaginal tape (TVT) or porcine small intestinal submucosal (SIS) grafts, as the commercial availability of various materials has considerably simplified sling procedures for treating urinary incontinence, but erosion and infection after using artificial sling materials remain an important concern. Materials and methods ,Thirty female New Zealand rabbits were randomized to three groups, i.e. group A (TVT, 12 animals), group B (SIS, 12) and group C (surgical control, six). Through a laparotomy under anaesthesia and an aseptic technique, the bladder was approached at its dome, where a 0.5 × 1 cm piece of TVT or SIS was fixed in direct contact with the bladder wall. The control group underwent only bladder manipulation with no material applied. Half the animals in each group were killed after 6 weeks and the other half after 12 weeks. The urinary bladder was harvested and examined histologically. Results ,The grafts in both groups were characterized by dense foreign-body type reactions and were mostly attached loosely to the bladder wall by a thin layer of fibrovascular tissue. More importantly, the bladder wall reactions showed no inflammation in all 12 animals in group A (TVT) but three of them had various grades of fibrosis. There was severe transmural inflammation in one animal in group B (SIS); one rabbit had grade I and two had grade II fibrosis. The controls, as expected, showed no bladder wall reactions. Conclusion ,In this descriptive analysis of reaction types elicited on the urinary bladder by these grafts, both materials appeared to be safe. Although TVT elicited fewer and less severe adverse reactions, no statistical conclusions can be drawn. The clinical significance of these findings should emerge from long-term clinical data when they become available. [source] | ||||||||||||||||||||||