Subjective Success Rates Research Articles

Gluteal and Posterior Thigh Pain in the Postoperative Period and the Need for Intervention After Sacrospinous Ligament Colpopexy

One transvaginal option for surgical repair of vaginal apex prolapse is sacrospinous ligament (SSL) colpopexy. Several studies evaluating outcomes of SSL suspension have shown favorable results: the subjective success rate ranges from 84% to 99% and the objective success rate ranges from 67% to 93%. To facilitate the SSL colpopexy technique, the Capio suture-capturing device was developed in 1997. Safe suture placement into the SSL with easy suture retrieval has been achieved with this device. A postoperative complication of SSL colpopexy reported in a number of studies is gluteal and posterior thigh pain, which occurs in 6% to 14% of patients. Few studies have compared the Capio device with other suturing techniques used to perform the SSL colpopexy procedure, and none have investigated the incidence of gluteal and posterior thigh pain with this device. This retrospective cohort study determined the rate of gluteal and posterior thigh pain both in the immediate postoperative period and at the 6-week postoperative visit after use of the Capio device to perform SSL colpopexy in patients with vaginal apex prolapse. The risk for needing intervention for this type of pain was also investigated. The study was conducted at a single urogynecology center between 2007 and 2012. Demographic, intraoperative, and immediate as well as 6-week postoperative data were obtained from the electronic inpatient and outpatient medical records. A total of 242 women underwent SSL colpopexy with the Capio device for vaginal apex prolapse. The mean patient age and body mass index were 66 (10) years and 28.7 (5.4) kg/m2, respectively. Of the 242 patients, 134 (55.4%) experienced gluteal or posterior thigh pain immediately after surgery and 36 (15.3%) had persistent pain at 6 weeks. Five patients (2.1%) required intervention to manage pain (95% confidence interval, 0.8%-4.7%); interventions used were physical therapy (3), trigger point injection (1), or both (1), and no patient required reoperation. Pain at 6 weeks was associated with concomitant midurethral sling placement (P = 0.008) and the number of sutures placed: 4 sutures placed in the SSL was more likely to be associated with intervention than 2 or 3 sutures placed (60% vs 15.6%, P = 0.03). Neither concomitant hysterectomy nor anterior versus posterior dissection approach was associated with gluteal or posterior thigh pain. These data show a high rate of postoperative gluteal and posterior thigh pain immediately after SSL colpopexy for vaginal apex prolapse. The rate of pain at 6 weeks, however, is much lower, and the need for intervention was even lower.

Endoscopic vs external dacryocystorhinostomy-comparison from the patients' aspect.

To compare the success and complication rates, duration of surgeries and clinical comfort after endoscopic dacryocystorhinostomy (END-DCR) or external dacryocystorhinostomy (EXT-DCR). Fifty patients who underwent EXT- or END-DCR between January 2010-2012 were involved in the study. A questionnaire was applied to patients preoperatively, and postoperatively. Subjective success was defined by absence of epiphora, objective success by a normal nasolacrimal lavage and a positive functional endoscopic dye test (FEDT). Postoperative pain and cosmetic result of surgery were interpreted by the patients, who were also asked whether they would offer this surgery to a friend or would prefer this surgery once more if necessary. Twenty-five patients underwent END-DCR and 25 underwent EXT-DCR. Mean duration of surgeries were 35min both for EXT-DCR (30-50) and END-DCR (35-50) (P=0.778). Intraoperative bleeding were documented in 48% of EXT-DCR and 4% of END-DCR cases (P<0.001). In total 96% of EXT-DCR and 100% of END-DCR patients had subjective success. Objective success was 100% in each group. There was no significant difference between the epiphora scorings and FDDT results in postoperative visits among the groups. END-DCR group reported less pain in first week and month (P<0.05, P<0.05). More patients in END-DCR group were happy with the cosmetic result in first week and month (P<0.001, P<0.001). More patients in END-DCR group offered this surgery to a friend (P<0.001). All patients in END-DCR group preferred this surgery once more if necessary, only 48% in EXT-DCR preferred the same method (P<0.001). Although both END- and EXT-DCRs provide satisfactory outcomes with similar objective and subjective success rates, we demonstrated that the endonasal approach caused significantly less pain in early postoperative period than the external approach. Clinical comfort defined by the patients was quite higher in END-DCR group, in which patients mainly were pleased to encounter a sutureless surgical area.

A review on the role of laparoscopic sacrocervicopexy.

To provide an update on the outcomes and complications of laparoscopic (or robot-assisted) sacrocervicopexy with and without supracervical hysterectomy, and highlight the differences with sacrocolpopexy technique based on the most recent evidence. Laparoscopic and robot-assisted sacrocervicopexy with supracervical hysterectomy and sacrohysteropexy have good success rates, with a mean objective success rate of 96% (range 90-100%), subjective success rates of 80-95% and mean reoperation rate of 3%. Also, pelvic symptoms and quality of life improved after laparoscopic sacrocervicopexy. These results are similar to laparoscopic and abdominal sacrocolpopexy, and are confirmed by the results of two comparative studies. Mesh erosion risk is very low in patients treated with laparoscopic sacrocervicopexy. Studies that compare laparoscopic sacrocolpopexy with concomitant total hysterectomy and sacrocervicopexy with subtotal hysterectomy show that total hysterectomy is associated with a greater prevalence of vaginal mesh exposure when compared with a subtotal hysterectomy. In case of sacralpexy, if it is decided to proceed with a hysterectomy, it is recommended to limit this to a subtotal. The benefits of laparoscopic sacrocervicopexy with or without supracervical hysterectomy in terms of outcomes and reduced risk of mesh erosion in comparison with sacrocolpopexy and concomitant total hysterectomy have to be confirmed by randomized controlled trials. Moreover, standardization of surgical technique is mandatory.

Analyse à 7 ans d’une série de 331 bandelettes I-Stop trans-obturatrices implantées pour traitement de l’incontinence urinaire d’effort de la femme

The aim was to evaluate results and morbidity for the I-Stop sling using the transobturator approach with seven years of follow-up on a large number of patients. Three hundred and thirty-one files out of 430 surgeries performed in 2005 by four different surgeons has been reviewed, collecting data in sending a detailed form. A statistical and correlation analysis has been performed then. After seven years, the subjective success rate was 72% and 80% of the patients were satisfied. Cases of revision were rare and a systemic analysis has been performed: 0.9% of second surgery for SUI and 0.3% of sling exposure. Recurrence of SUI and decrease of efficacy occurred on older population. Functional results are similar to those published already but complication rate is significantly lower. Decrease of efficacy by time occurred mainly after 80 years old seemed to be related to tissue aging.

The Relationship Between System Effectiveness and Subjective Usability Scores Using the System Usability Scale

This article examines the relationship between users’ subjective usability assessments, as measured using the System Usability Scale (SUS), and the ISO metric of effectiveness, using task success as the measure. The article reports the results of two studies designed to explore the relationship between SUS scores and user success rates for a variety of interfaces. The first study was a field study, where stereotypical usability assessments on a variety of products and services were performed. The second study was a well-controlled laboratory study where the level of success that users were able to achieve was controlled. For both studies, the relationship between SUS scores and their attendant performance were examined at both the individual level and the average system level. Although the correlations are far from perfect, there are reliable and reasonably strong positive correlations between subjective usability measures and task success rates, for both the laboratory and field studies at both the individual and system level.

Long-term use of solifenacin in pediatric patients with overactive bladder: Extension of a prospective open-label study.

We evaluate the efficacy and safety of solifenacin to treat incontinence in children with non-neurogenic (DO) or neurogenic detrusor overactivity (NDO) refractory to oxybutinin or tolterodine. We updated and extended our previously published non-randomized uncontrolled study on open-label use of adjusted-dose regimens of solifenacin (1.25-10 mg) in children with refractory incontinence. The follow-up included voiding diaries, post-void residuals, urine cultures, ultrasounds and urodynamic studies. Clinical data were updated as of September 2012. Subjective improvement was assessed with the Patient Perception of Bladder Condition (PPBC) scale. The primary end point was efficacy toward continence and secondary end points were tolerability and safety. Overall, 244 patients (112 girls, 132 boys) were enrolled; 53 with NDO and 191 with DO. Minimal follow-up was 5 months, the mean duration of treatment was 21.0 months and the mean age at initiation was 9.2 years. Urodynamic capacity improved from 145 ± 76 mL to 339 ± 152 mL and the amplitude of uninhibited contractions decreased from 66 ± 26 to 20 ± 20 cmH2O (p < 0.0001). The overall success rate is 91%, and more specifically 94% for non-neurogenic and 79% for neurogenic, which is significantly different (p = 0.013). Twenty-three patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 175 patients, mild by 46, moderate by 9, and 14 withdrew due to their side effects. Ten patients developed post-void residuals of ≥20 mL. Although higher in the non-neurogenic group, high subjective and objective success rates were maintained over a longer follow-up with an adjusted-dose regimen of solifenacin to treat pediatric NDO or DO refractory to oxybutynin or tolterodine. Moreover, we found acceptable tolerability and safety profiles.

MP33-18 A COMPARISON OF OUTCOMES AFTER RETROPUBIC MID-URETHRAL SLING, DOES VALSALVA VOIDING AFFECT SUCCESS RATE?

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy I1 Apr 2014MP33-18 A COMPARISON OF OUTCOMES AFTER RETROPUBIC MID-URETHRAL SLING, DOES VALSALVA VOIDING AFFECT SUCCESS RATE? Blake Anderson, David Hatcher, Rena Malik, Jessica Volsky, Gregory Bales, and Doreen Chung Blake AndersonBlake Anderson More articles by this author , David HatcherDavid Hatcher More articles by this author , Rena MalikRena Malik More articles by this author , Jessica VolskyJessica Volsky More articles by this author , Gregory BalesGregory Bales More articles by this author , and Doreen ChungDoreen Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.969AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is known that many women void via valsalva and that retropubic slings (RPS) may cause voiding dysfunction. The aim of this study was to compare outcomes after RPS in women with and without valsalva voiding. METHODS 95 women had RPS placed for stress urinary incontinence (SUI) from 2011 to 2013. Baseline demographics, urodynamic findings, operative parameters, and post-operative course were examined retrospectively. Valsalva voiding was defined as abdominal straining witnessed while voiding during urodynamics. Standardized follow-up was at 1, 3, 6, and 12 months. The primary outcome was subjective success rate (absence of SUI with physical activity, coughing, or sneezing). We also looked at Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7) score, post-void residual (PVR), pad use, complications, and revision rate. Tests of significance were done using Fisher’s exact tests and Student’s t-tests. RESULTS Subjects included 45 (47%) valsalva voiders (VV) and 50 (53%) non-valsalva voiders (NV). No differences were seen between groups in mean age, PVR, or capacity. Abdominal leak point pressure without a catheter was significantly lower in VV (56 vs. 70 cm H2O, p=0.045), yet VV had less severe IIQ-7 at baseline compared to NV, (9 ± 6 vs. 13±7, p=0.01). Catheter time was significantly shorter in VV compared to NV (2.5 vs. 4.1 days, p=0.03). No differences were seen between groups in the rate of passing initial void trial (71% VV vs. 61% NV, p=0.1). In the perioperative period, 4.7% of VV and 11.9% of NV required clean intermittent catheterization (CIC) (p=0.16). No patients required CIC beyond 4 weeks. Complication rates (11.4% VV vs. 9.3% NV, p=0.3) and revision rates (7.1% VV vs. 9.5% NV, p=0.28) were similar. In total, 7 (7%) patients required revisions. Reasons were pain (1 VV, 2 NV), erosion (1 NV), voiding dysfunction (1VV, 1 NV), and sling failure (1 VV). Subjective success rates were similar with no significant differences at 1, 3, 6, and 12 months (91%, 94%, 100%, and 100 % for VV and 88%, 88%, 100%, and 93% for NV). At one month, VV had smaller change in postoperative pad use (-1.2 vs. -2.8, p=0.04), IIQ-7 (-5 vs. -12, p=0.0001), and UDI-6 (-4 vs. -8, p=0.01), but there were no significant differences in these parameters between VV and NV at 3, 6, and 12 months. CONCLUSIONS In women with valsalva voiding, RPS appear to be a safe and effective treatment for SUI. Between VV and NV, no differences were seen in success rate, postoperative voiding dysfunction, complication rate, or revision rate. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e345 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Blake Anderson More articles by this author David Hatcher More articles by this author Rena Malik More articles by this author Jessica Volsky More articles by this author Gregory Bales More articles by this author Doreen Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Apical prolapse

The aim was to review the safety and efficacy of pelvic organ prolapse surgery for vaginal apical prolapse. Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials (RCT) or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 case reports. The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and or 3 studies, or "majority evidence" from RCTs. Grade C recommendation usually depends on level 4 studies or "majority evidence from level 2/3 studies or Delphi processed expert opinion. Grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. Abdominal sacral colpopexy (ASC) has a higher success rate than sacrospinous colpopexy with less SUI and postoperative dyspareunia for vault prolapse. ASC had greater morbidity including operating time, inpatient stay, slower return to activities of daily living and higher cost (grade A). ASC has the lowest inpatient costs compared with laparoscopic sacral colpopexy (LSC) and robotic sacral colpopexy (RSC). LSC has lower inpatient costs than RSC (grade B).In single RCTs the RSC had longer operating time than both ASC and LSC (grade B). In small trials objective outcomes appear similar although postoperative pain was greater in RSC. LSC is as effective as ASC with reduced blood loss and admission time (grade C). The data relating to operating time are conflicting. ASC performed with polypropylene mesh has superior outcomes to fascia lata (level I), porcine dermis and small intestine submucosa (level 3; grade B). In a single RCT, LSC had a superior objective and subjective success rate and lower reoperation rate compared with polypropylene transvaginal mesh for vault prolapse (grade B).Level 3 evidence suggests that vaginal uterosacral ligament suspension, McCall culdoplasty, iliococcygeus fixation and colpocleisis are relatively safe and effective interventions (grade C). Sacral colpopexy is an effective procedure for vault prolapse and further data are required on the route of performance and efficacy of this surgery for uterine prolapse. Polypropylene mesh is the preferred graft at ASC. Vaginal procedures for vault prolapse are well described and are suitable alternatives for those not suitable for sacral colpopexy.

Repeat post‐op voiding trials: An inconvenient correlate with success

This study examined the association between the need for a repeat voiding trial after midurethral sling (MUS) surgery and 1-year success rates. We conducted this secondary analysis of the participants in the Urinary Incontinence Treatment Network trial of midurethral sling (TOMUS) study which compared retropubic versus transobturator MUS. A standard voiding trial was attempted on all subjects. The "repeat voiding trial" group included subjects discharged with catheterization. All others were considered "self voiding." Success rates between the groups at 1-year were compared, followed by multivariate analyses controlling for previously reported clinical predictors of success. Most women (76%) were self-voiding, while 24% required a repeat voiding trial. The objective success rate at 1-year was 85.8% in the repeat voiding trial group and 75.3% in the self-voiding group (P = 0.01). Subjective success rate at 1-year was 61.0% in the repeat voiding trial group and 55.1% in the self-voiding group (P = 0.23). Women in the repeat voiding trial group continued to demonstrate greater objective success than the self-voiding group in multivariate analysis that controlled for previous incontinence surgery, pad weight, urethral mobility, urge score, and type of MUS (P = 0.04, OR 1.82, 95% CI 1.03-3.22). Women who require a repeat voiding trial following MUS surgery have greater objective success at 1-year postoperatively when compared to those who are self-voiding at the time of discharge. These results may help reassure women who require catheterization after MUS surgery that their outcome is not compromised by this immediate transient post-operative result.

Long-term outcomes of synthetic transobturator nonabsorbable anterior mesh versus anterior colporrhaphy in symptomatic, advanced pelvic organ prolapse surgery

Anterior vaginal mesh (AVM) combined with sacrospinous ligament fixation (SSF) yields better long-term success rates over anterior colporrhaphy (AC) in advanced pelvic organ prolapse (POP) surgery, with a low rate of mesh-related complications. Medical records of 198 patients who underwent surgery for POP between January 2006 and March 2010 were reviewed retrospectively. Patients' assessment at baseline and third-year postoperative follow-up were analyzed. SSF plus AC or AVM was performed for apical and anterior compartment repair. Primary outcome was objective cure [Pelvic Organ Prolapse Quantification (POP-Q) stage ≤ 1)], and subjective cure defined as negative response to questions 2 and 3 on the POPDI-6. Secondary outcomes were complications, symptoms severity and quality of life as measured with validated questionnaires. Post-operative data were available for 186 patients, 72 in AC group and 114 in AVM group were analyzed. The mean age, parity and operating time in AVM group were significantly higher as compared to AC group. The overall objective and subjective cure rate in AVM group was significantly higher than AC group (90.3 % and 88.6 % versus 73.6 % and 70.8 %, with P value = 0.003 and 0.002 respectively). Mesh exposure rate was 3.5 %. Improvement in both POPDI-6 and PISQ-12 in AVM group was statistically significant compared to AC group. Transobturator synthetic nonabsorbable AVM combined with SSF yielded a favorable and sustainable result over 5 years as compared to traditional AC, both in anatomical and subjective success rate. Mesh related morbidities were low and acceptable.

Where to for pelvic organ prolapse treatment after the FDA pronouncements? Comment

Dear Editor, With great interest I read the recently published article in the International Urogynecology Journal from Van Geelen and Dwyer titled “Where to for pelvic organ prolapse treatment after the FDA pronouncements?” [1]. One of the issues the authors try to address is the ongoing debate on the optimal approach for apical prolapse repair. They state that there is level I evidence that abdominal sacrocolpopexy (ASC), either by laparotomy or laparoscopy or with the aid of a robotic device, is more effective and durable in correcting anterior and apical anatomy than the vaginal approach using sacrospinous colpopexy. As a reference, they use an article byMaher et al. published in 2004 [2]. In this article, ASC is compared with vaginal sacrospinous colpopexy in 95 women. The objective success rate was 76 % in the abdominal group and 69 % in the vaginal group (P=0.48). The abdominal approach was associated with a longer operating time, a slower return to activities of daily living, and a greater cost than the sacrospinous colpopexy (P<0.01). Both surgeries significantly improved the patient’s quality of life (P<0.05). The subjective success rate was 94% in the abdominal and 91 % in the vaginal group (P=0.19). This level I evidence does not support the above-mentioned statement of the authors that ASC is more effective than vaginal sacrospinous colpopexy. On the contrary, it shows that there is no significant difference in terms of objective and subjective cure rate between ASC and vaginal sacrospinous colpopexy. Also, it does not justify the extrapolation of ASC data by laparotomy to other techniques, such as laparoscopy or robotassisted laparoscopy. In this light, the recently published article by Nygaard et al. is also very interesting [3]. These authors temper the general feeling that ASC is superior in terms of durability. By year 7, the estimated probability of composite (symptomatic or anatomic) pelvic organ prolapse failure after abdominal sacrocolpopexy was 0.48 when combined with a Burch urethropexy and 0.34 without a Burch urethropexy.

Where to for pelvic organ prolapse treatment after the FDA pronouncements? Reply to Pelikan

Dear Editor, We thank Dr. Pelikan [1] for his interest and comments regarding our review article on the treatment of pelvic organ prolapse (POP) after the US Food and Drug Administration (FDA) pronouncements [2]. The author rightly observes that the study by Maher et al. [3] does not support the statement that abdominal sacral colpopexy (ASC) is more effective than vaginal sacrospinous colpopexy (VSC). Indeed, in their randomized controlled trial (RCT) study comparing ASC and VSC, they conclude that both procedures are highly effective for treating vaginal vault prolapse. There were no differences in subjective and objective success rates between the two groups after 2 years follow-up. The International Consultation on Incontinence (ICI) committee reviewed surgery for POP [4] and identified three RCTs designed to compare vaginal and abdominal routes for surgical correction, including Maher et al.’s study [3]. The results are summarized in a Cochrane review byMaher et al. [5] in which they state that these trials provide level I evidence that the overall outcome (including quality of life) is similar between abdominal and vaginal approaches but that sacrospinousbased vaginal procedures have higher anterior and apical anatomical and dyspareunia recurrence rates than ASC. This is somewhat offset by the higher short-term morbidity of open abdominal sacrocolpopexy [4]. Therefore we should have referred to reference 10 instead of reference 14 in our manuscript to support the statement of higher apical success of ASC. A recently published study by Nygaard et al. on the longterm (7 years) outcomes following ASC for POP, with or without Burch urethropexy, reported increasing failure rates after 7 years, which emphazises the need for RCTs with longterm follow-up [6].

Operative Genitalangleichung bei Mann-zu-Frau-Transsexualität: Gibt es Leitlinien oder Standards?

In 2011 the WPATH (World Professional Association for Transgender Health) published the 7th version of their "Standards of Care" for diagnosis and treatment of transsexual people. In face of further recent peer-reviewed reports of experienced centres on surgical sex reassignment it should be examined whether or not genital sex reassignment in male-to-female transsexuals actually can be based on evidence-based guidelines or standards. The indication for surgery is widely standardised and evidence-based. Most critical steps of the operation are also founded on grade B recommendations. Most experienced authors rely on penoscrotal pedicled flaps for neovaginal lining. The topic of ideal reconstruction of the vulva, especially the clitoro-labial complex is still a field of debate. Due to the high frequency of further corrective surgeries which exceeds 50% in most experienced centres, some authors prefer a primary 2-step procedure for genital reassignment. The indication and principal operative steps in surgical genital reassignment in male-to-female patients rely on evidence-based recommendations. By respecting these recommendations subjective success rates of over 80% can be expected.

Comparative randomized study on the efficaciousness of endoscopic bipolar prostate resection versus monopolar resection technique. 3 year follow-up

Transurethral resection of the prostate (TURP) is the current optimal thera- py for the relief of bladder outflow obstruction, with subjective and objective success rate of 85 to 90%. Aim of this study was to evaluate efficacy and safety of Plasmakinetic ener- gy (Gyrus electro surgical system), which produces vaporization of tissue immersed in isotonic saline against standard monopolar transurethral resection of the prostate. From January 2002 to April 2002, 160 consecutive patients, who had low urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH) were enrolled in this study. Patients were randomised to undergo bipolar TURP (80 patients) or monopolar TURP (80 patients). Preoperative work-up was assessed by administering IPSS, IIEF-5 and Qol questionnaires. All patients were submitted to uroflowmetry, transrectal ultrasound (TRUS), post-voidal residual urine measurement and PSA determination. In the two groups, IPSS, IIEF-5 and Qol, uroflowme- try, TRUS, post-voidal residual urine measurement, PSA determination and number of reopera- tions were evaluated at 1, 3, 6, 12, 18, 24, 30 and 36 months follow up, and then every year. Furthermore, in both groups operative time, resected tissue weight and perioperative complica- tions were analysed. Total postoperative catheter time, total post-operative hospital stay, haemo- globin loss were also recorded in the two groups. Comparative data on IPSS symptom score, IIEF-5, Qol, PSA, peak urinary flow rate and post-void residual urine volume were similar in the two groups but showed a significant improve- ment respect to baseline values. The postoperative haemoglobin levels, postoperative catheteri- zation time, hospital stay and 3-year overall surgical re-treatment-free rate were significantly better in the bipolar group. Bipolar TURP has a comparable outcome to standard monopolar TURP at short and medium term regard to subjective and objective outcome measurements. Its impact on blad- der outlet function is also similar to that of monopolar TURP. Improvement in IPSS, Qol index, IIEF-5, Qmax and post-void residual urine volume were comparable in both group denoting sim- ilar efficacy of the techniques.

Efficacy of pneumatic dilatation as a definitive therapeutic modality for classic achalasia

ObjectiveTo evaluate pneumatic dilatation (PD) for cases of cardiac achalasia as a first-line therapy. Patients and methodsThe study included 35 patients. All patients were assessed for disease severity using Valiukenas Achalasia Severity (VAS) scoring system and the disease was staged using Kostic esophageal dilatation (KED) staging system. Patients underwent manometric esophageal pressure (MEP) measurement. All patients underwent PD. Patients were followed up for 12-months, failure of symptomatic relief or recurrence of symptoms was followed by another PD attempt or laparoscopic Heller’s myotomy combined with Dor fundoplication and follow-up for another 12months. ResultsTwenty-seven patients took their 1st oral intake after 9–12h and 25 patients (71.5%) were managed as one-day procedure. At 12-M follow-up, three patients (8.5%) required three attempts of PD, five patients (14.3%) required two attempts and 27 patients had only one attempt to achieve relief of symptoms. At the end of 12-M follow-up period; 26 patients showed sustained complete relief of symptoms and scored zero on VAS scoring and had stage I on KED staging. For these 26 the subjective and objective success rate was 74.4%. Nine patients who had failed PD trials were planned for surgery. Subjective surgical success rate was 66.7% and objective success rate was 77.8%. Comparison of outcome of both modalities showed nonsignificant subjective improvement in favor of PD, while surgery showed non-significant objective improvement compared to PD. ConclusionPD could be considered as safe, effective and cost-effective therapeutic modality for patients having classic achalasia with high subjective and objective success rate.

Abdominal Sacral Colpopexy In Treatment Of Vaginal Vault Prolapse: By Less Invasive Method

Objective: To assess the outcomes of abdominal sacral colpopexy in less invasive method. Study design: It was a prospective study conducted in Comilla Medical College Hospital and Comilla General Hospital during the period from 2005 to 2009.Method: Thirty women with vaginal vault prolapse were selected by inclusion and exclusion criteria in a consecutive, exhaustive method. Primary outcome measurements were included subjective, objective and patient-determined success rate. Secondary outcome included the impact on bowel, bladder, sexual function and quality of life. Result: Result shows that, vault prolapse is mostly associated with older patients, age more than sixty (66.7%), para &gt;5 (60%) and menopausal women (66.7%). Vault prolapse was mostly associated with cystocele (93.3%), stress incontinence (76.7%) and more common following abdominal hysterectomy (70%). During operation the dissection was less (3-4cm). Average operating time was 54.33/min; average estimated blood loss was 49.17/ml. One patient required blood transfusion, one developed haematoma during surgery, no gut injury or haemodynamic instability developed. Post operatively, no internal haemorrhage, 4 patient developed fever (13.3%), wound infection one (3.3%), UTI 4 patients (13.3%), no voiding difficulty or thromboembolism and one patient developed mesh rejection (3.3%). After one year follow-up success rate was 96.7%. Conclusion: Abdominal sacral colpopexy is a safe and effective method for correction of vaginal vault prolapse. DOI: http://dx.doi.org/10.3329/bjog.v25i1.13723 Bangladesh J Obstet Gynaecol, 2010; Vol. 25(1) : 3-8

Outpatient periurethral injections of polyacrylamide hydrogel for the treatment of female stress urinary incontinence: effectiveness and safety

To investigate the effectiveness and safety of periurethral injections (PIs) of polyacrylamide hydrogel (PAHG, Bulkamid(®)) for the treatment of female stress urinary incontinence (SUI). This double-centre prospective study included 82 female patients with SUI who were treated with PIs of PAHG between January 2008 and December 2010 in outpatient setting. The International Consultation on Incontinence Questionnaire short form (ICIQ-SF) and the Patient Global Improvement Impression (PGI-I) were used to assess incontinence and patient satisfaction after treatment. The impact of incontinence on quality of life (QoL) was investigated using the Incontinence Impact Questionnaire (IIQ-7). All patients were discharged on the same day of treatment and there was no intraoperative complication. At 1-year follow-up, the efficacy of PIs of PAHG (subjective success rate) was 74.4 %. The subjective responder rate was 86.6 %, 8.5 % of patients had no change and no patient reported worsening of symptoms. The mean number of episodes of urine leakage/24 h and the mean leakage/24 h significantly decreased after treatment. At 1-year follow-up, the IIQ-7 results were significantly improved compared with baseline. 25.6 % of patients had adverse events (mainly urinary tract infections and injection site pain). This study demonstrates that PIs of PAHG are effective and safe and cause significant improvement of the QoL at 1-year follow-up. PIs of PAHG can be safely performed in an ambulatory setting and patients may be discharged on the day of the procedure.

Robotic Sacrocolpopexy: How Does It Compare with Other Prolapse Repair Techniques?

Abdominal sacrocolpopexy has been shown to have the highest, most durable success rates among techniques for apical pelvic organ prolapse repair. Recently, there has been increased application of minimally invasive techniques, such as laparoscopic and robotic approaches, to performing a sacrocolpopexy. We report an overview of the literature in order to compare between robotic sacrocolpopexy and other surgical techniques for the repair of apical pelvic organ prolapse. Our review will include a discussion of operative techniques, anatomic and subjective success rates, costs, and complications.

A novel technique to improve the results of conventional dacryocystorhinostomy

Purpose The objective of this study was to evaluate the results of the use of dried lyophilized amniotic membrane to increase the survival of external dacryocystorhinostomy (EX-DCR) with respect to the efficacy and complications. Patients and methods This was a prospective controlled study that included 22 eyes of 20 patients. All had nasolacrimal duct obstruction and were selected from the outpatient clinic; they were classified into two groups, 11 patients each. The first group patients were treated by EX-DCR using dried lyophilized amniotic membrane (group I) that was wrapped around the silicon tube after its implantation in the lacrimal passage (between the lacrimal passage and nasal cavity). The second group (II) patients were treated by the standard EX-DCR only, which served as the control group. Results The study included 22 eyes of 20 patients: 13 were female patients (65%) and seven (35%) were male patients, with mean age of 50.8 ± 6.5 and 48.2 ± 7.1 for groups I and II, respectively. Demographic characteristics showed insignificant difference between both groups. With respect to the success rate, all patients in both groups showed 100% subjective (symptomatic relief) and objective success rate (on examination) at 3-month follow-up (at the time of removal of silicon tube), but at the end of follow-up (8 months) the success rate decreased to 90.9% in the first group and 72.7% in the second group, and this difference was statistically significant ( P = 0.0288). One of the complications encountered in this study was epistaxis in five patients (45.4%) in group I and in six patients (54.5%) in group II. Other complication was periorbital ecchymosis in two patients in each group. In one patient in group I, the lower punctum was slit and opened (cheese wiring) using a silicon tube. The complication rate was statistically insignificant between the two groups ( P = 0.897). Conclusion The use of amniotic membrane with EX-DCR was effective in improving the results and increasing the survival of the ostium between the sac and the nasal cavity, with no added complications. However, larger multicenter studies with longer follow-up are needed before establishment of this treatment strategy.

Periurethral Injection of Polyacrylamide Hydrogel for the Treatment of Stress Urinary Incontinence: The Impact on Female Sexual Function

Urinary incontinence can negatively affect sexual function. To investigate sexual function in female patients treated for urodynamic stress incontinence (USI) by periurethral injections. This double-center prospective study included 29 female patients who were treated for USI by periurethral injections of polyacrylamide hydrogel (Bulkamid(®); Ethicon Women's Health and Urology, Contura, Denmark). Patients answered the International Consultation on Incontinence Questionnaire short form, the Incontinence Impact Questionnaire, and the Patient Global Improvement Impression. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) was used to evaluate sexual function at baseline and at 1-year follow-up. Patients were also asked to rate their sexual activity by using a 10-mm visual analog scale at baseline and at 12-month follow-up. Subjective and objective success was examined. All patients were discharged on the same day of treatment and there was no intraoperative complication. At 1-year follow-up, the subjective success rate was 89.7% and the objective success rate was 79.3%. At 1 year from the first treatment, all the 23 sexually active patients continued to have regular sexual life. Six women reestablished sexual activity after the treatment. The total PISQ-12 scores showed a significant improvement in quality of sexual life of patients who were sexually active before surgery. Periurethral injections of polyacrylamide hydrogel to treat USI are clinically effective and safe. These surgical procedures cause significant improvements in sexual function and sexual satisfaction of patients.