Treatment Of Prolapse Research Articles

Outcome of a novel porcine-derived UBM/SIS composite biological mesh in a rabbit vaginal defect model.

To investigate the tissue reactions of a novel porcine-derived urinary bladder matrix/small intestinal submucosa (UBM/SIS) biological mesh and SIS mesh implanted in a rabbit vaginal defect model. Thirty-two rabbits were implanted with UBM/SIS mesh (Group A) and SIS mesh (Group B), respectively. Rabbits were sacrificed at 7, 14, 60, and 180days after implantation. The tensile strength, elongation at break, and elastic modulus of the tissue were measured using biomechanical methods. The inflammatory response, cell infiltration, vascularization, and collagen fibers were observed. Compared with Group B, the tensile strength and elongation at break of group A was higher at 14, 60, and 180days. The elastic modulus of group A was lower at 180days. Inflammatory response of group A was milder at 14, 60, and 180days. There was more cell infiltration in group A at 7 and 14 days. Vascularization was higher in group A at 7 days and 14 days. The order of collagen in group A was better at 14, 60, and 180days. The proportion of thick red fibers in both groups showed an increasing trend. At 14days, group A had more thick red fibers. The novel UBM/SIS composite mesh had a milder inflammatory response; earlier induction of cell infiltration, angiogenesis, and collagen regeneration. Collagen fibers had a better order. It has a higher tensile strength and greater elongation at break, and can be used as a potential material for the treatment of pelvic organ prolapse.

Evaluation of the clinical effectiveness of modified sacrospinous ligament fixation via the anterior vaginal wall path for pelvic organ prolapse: A feasibility report based on 50 patients.

To describe the surgical techniques and short-term outcomes for 50 cases of modified sacrospinous ligament fixation via the anterior vaginal wall path for pelvic organ prolapse. 100 patients with pelvic organ prolapse (stage III or stage IV based on POP-Q staging) from January 2018 to January 2020 were retrospectively analyzed. Among them, 50 patients received modified sacrospinous ligament fixation via the anterior vaginal wall path for pelvic organ prolapse (mSSLF group), while the other 50 patients received pelvic reconstruction using T4 mesh (T4 group). Operative time, blood loss, postoperative POP-Q score, length of the hospital stay, complications, and postoperative pain were compared between the two groups. The duration of the operation in mSSLF group was (50 ± 15.2 min), which was shorter than that of the T4 group (60 ± 14.8 min) (p = 0.02). No intraoperative complications were reported from the mSSLF group, whereas one vascular injury occurred in the T4 group. In both groups, postoperative pain and painful intercourse was significantly lower in the mSSLF group than in the SSLF group (p < 0.001). The exposed mesh rate was lower than T4 group. The rates of intraoperative complications, postoperative pain and mesh erosion were significantly lower than those of the T4 group, but there was no significant difference in the efficacy and safety of the treatment of pelvic organ prolapse. So mSSLF may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety.

Laparoscopic Nerve-Sparing Sacropexy: Tips and Tricks for a Safe and Anatomical Surgical Procedure

Study Objective to demonstrate a nerve-sparing technique during laparoscopic sacropexy (LSP) for treatment of multicompartment pelvic organ prolapse. Design A step-by-step demonstration of our surgical procedure of laparoscopic sacropexy (LSP). Setting Sacropexy is the 'gold standard' procedure for apical prolapse. This procedure is characterized by a complete dissection of the avascular spaces and is nerve sparing technique saving superior and inferior hypogastric plexus and the hypogastric nerves. Patients or Participants Patients with POP-Q Stage III and IV/prolapse of uterine Interventions Our surgical nerve-sparing LSP technique proceeds in 10 steps: Step 1: Suspension of the sigma to the abdominal wall. Step 2: Opening the peritoneum and exposure of sacral promontory and of the longitudinal anterior vertebral ligament. Step 3: Dissection of the right medial pararectal space (Okabayashi's Space), respecting the integrity of the presacral fascia and of the rHN contained within it. Step 4: Dissection of the rectovaginal space with a latero-medial approach expecting the integrity of the rectal fascia. The lateral limits were defined by the uterosacral and rectovaginal ligaments, and the base was represented by the perineal body and levator ani muscle. Step 5: Dissection of the vesicovaginal space through the creation of an avascular space with the apex at the dorsal end of the bladder trigone and laterally limited by the vesicouterine ligaments. Step 6: Subtotal hysterectomy. Step 7: A first synthetic mesh (posterior) fixed with a total of five no. 3–0 non-absorbable sutures. Step 8: A second synthetic mesh (anterior) fixed with five no. 3–0 non-absorbable sutures. Step 9: Mesh fixation on the cervical stump and ligamentum longitudinale. Step 10: Mesh peritonealization. Measurements and Main Results LSP combines the high efficacy of reconstructive surgery using non-absorbable mesh with the fast recovery and low complication rate resulting from minimal tissue trauma and laparoscopicalprocedure precision. Conclusion A nerve-sparing approach to pelvic spaces during LSP is feasible following well-defined surgical steps. to demonstrate a nerve-sparing technique during laparoscopic sacropexy (LSP) for treatment of multicompartment pelvic organ prolapse. A step-by-step demonstration of our surgical procedure of laparoscopic sacropexy (LSP). Sacropexy is the 'gold standard' procedure for apical prolapse. This procedure is characterized by a complete dissection of the avascular spaces and is nerve sparing technique saving superior and inferior hypogastric plexus and the hypogastric nerves. Patients with POP-Q Stage III and IV/prolapse of uterine Our surgical nerve-sparing LSP technique proceeds in 10 steps: Step 1: Suspension of the sigma to the abdominal wall. Step 2: Opening the peritoneum and exposure of sacral promontory and of the longitudinal anterior vertebral ligament. Step 3: Dissection of the right medial pararectal space (Okabayashi's Space), respecting the integrity of the presacral fascia and of the rHN contained within it. Step 4: Dissection of the rectovaginal space with a latero-medial approach expecting the integrity of the rectal fascia. The lateral limits were defined by the uterosacral and rectovaginal ligaments, and the base was represented by the perineal body and levator ani muscle. Step 5: Dissection of the vesicovaginal space through the creation of an avascular space with the apex at the dorsal end of the bladder trigone and laterally limited by the vesicouterine ligaments. Step 6: Subtotal hysterectomy. Step 7: A first synthetic mesh (posterior) fixed with a total of five no. 3–0 non-absorbable sutures. Step 8: A second synthetic mesh (anterior) fixed with five no. 3–0 non-absorbable sutures. Step 9: Mesh fixation on the cervical stump and ligamentum longitudinale. Step 10: Mesh peritonealization. LSP combines the high efficacy of reconstructive surgery using non-absorbable mesh with the fast recovery and low complication rate resulting from minimal tissue trauma and laparoscopicalprocedure precision. A nerve-sparing approach to pelvic spaces during LSP is feasible following well-defined surgical steps.

8445 Surgical Management of Urethral Prolapse: A Case Report

<h3>Study Objective</h3> To describe a case of acute urethral prolapse presenting with refractory pain and urinary retention, and to demonstrate surgical management, delineating key surgical steps using a surgical video. <h3>Design</h3> Case report demonstrated in a narrated surgical video <h3>Setting</h3> Patient presented to an academic hospital emergency department and required emergent surgical management in the operating room. In the operating room, patient is positioned in dorsal lithotomy with LoneStar retractor in place. <h3>Patients or Participants</h3> This surgical video describes a case report of a 45-year-old perimenopausal female who presented with acute onset refractory pain and urinary retention, as well as inability to tolerate catheterization, secondary to acute urethral prolapse with thrombosis and necrosis. <h3>Interventions</h3> After appropriate patient positioning, healthy urothelium was identified with cystourethroscopy above the prolapsed tissue. Next, normal appearing urothelium was tagged proximal to the prolapse at 3 o'clock, 6 o'clock and 9 o'clock using interrupted 4-0 Vicryl sutures so that this healthy tissue would not retract once the prolapse was excised. The base of the prolapsed portion of the urethral was injected with 1% lidocaine with epinephrine. The prolapsed portion was excised with Bovie electrocautery in quadrants around the urethra. A 16 French transurethral Foley catheter was placed, and the balloon inflated. Normal healthy appearing urothelium was re-approximated to the external urethral meatus epithelium using interrupted 4-0 Vicryl sutures with repair of one quadrant at a time. This was performed over the Foley catheter to ensure patency and prevent stricture. <h3>Measurements and Main Results</h3> The patient presented in this surgical video had immediate and complete resolution of symptoms. <h3>Conclusion</h3> Urethral prolapse rarely requires surgical intervention; however, when surgical treatment of urethral prolapse is necessary, it can be effective with appropriate surgical technique.

8097 How Do You Do It? a Survey on the Preferences of Surgeons Regarding Uterosacral Ligament Suspension (USLS) Technique

<h3>Study Objective</h3> To describe the practice patterns and techniques for performing uterosacral ligament suspension (USLS) for the treatment of apical prolapse. <h3>Design</h3> Web-based survey performed from October 2021 to April 2022. Study was IRB exempt. Data was collected in RedCap. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Members of AUGS, IUGA, AAGL, and UGSA. <h3>Interventions</h3> A 31-item, deidentified questionnaire. <h3>Measurements and Main Results</h3> We received a total of 595 responses, mostly from the United States (40.7%) and Australia (7.9%). Most of the respondents were Obstetrics and Gynecology and FPMRS specialists (67.9%), followed by general Obstetrics and Gynecology (16.8%) and MIGS (8.4%). Most surgeons were more than 20 years in practice (33.9%) and 49% perform >100 surgeries/year with a mean of 67.7% of cases being for apical support procedures. USLS is the most common apical support surgery taught during their fellowship (44.4%), followed by sacrospinous ligament suspension - SSLS (35.8%) and sacrocolpopexy - SCP (19.9%). Regarding preferences, USLS is performed by 46.3% of respondents >40% of the time for apical support, while 29.1% and 20.1% perform SSLS and SCP, respectively. Vaginal route (72.8% > 60% time) and ipsilateral (64.3%) high USLS technique were the most common route and technique performed. When placing sutures vaginally, 32.3% of respondents used delayed absorbable suture, followed by 24.3% absorbable sutures. Two sutures were the most common choice for ipsilateral or midline USLS plication. There was even distribution between placing sutures at the level of the ischial spine (46.6%) or above the level of the ischial spine (36.4%). A third of surgeons that perform lap/robotic/open USLS perform a relaxing peritoneal incision. Eighteen percent of surgeons routinely identify the inferior hypogastric plexus. Routine cystoscopy is performed by 65.2% and 73.2% of surgeons that perform, respectively, lap/robotic/open and vaginal USLS. <h3>Conclusion</h3> There is significant heterogeneity in the techniques to perform a uterosacral ligament suspension for apical prolapse. Standardization is recommended for future surgical studies.

8588 Tips and Tricks to Perform Laparoscopic Nerve-Preserving Sacrocolpopexy

<h3>Study Objective</h3> The objective of this video is to show a nerve- preserving surgical approach for apical prolapse in order to diminish the rate of complications of laparoscopic sacrocolpopexy. <h3>Design</h3> Presentation of one case of a patient with POP-Q stage IV and explain the steps of the surgical approach highlighting the tips and tricks to perform a nerve-preserving sacrocolpopexy <h3>Setting</h3> This procedure was performed at Hospital Militar de Especialidades de la Mujer y Neonatología, Mexico in October 2021. <h3>Patients or Participants</h3> A 68-year-old patient is presented with a history 3 vaginal deliveries and obesity grade I. The patient has previously undergone abdominal hysterectomy in 1990 and came into the consultation with foreign body sensation in the vagina of 1 year of evolution. In the physical examination we diagnose a pop-q stage 4. <h3>Interventions</h3> In this video, show a laparoscopic nerve-preserving sacrocolpopexy for treatment of the apical prolapse. <h3>Measurements and Main Results</h3> The surgical treatment was performed successfully with no trans or post-surgical complications, the surgical bleeding was 10 cc, the surgical time was 150 minutes, the patient was discharged 24 hours after the surgical event. At the follow-up at 6 months the patient is without pelvic pain, without voiding dysfunction, or recurrence of the prolapse. <h3>Conclusion</h3> Performing nerve preservation during sacrocolpopexy is a technique that can be performed systematically and safely, since laparoscopy allows identification of the nerve and vascular structures to be preserved in order to reduce the risk of previously described complications derived from denervation during the open procedure.

Increased cost burden associated with robot-assisted rectopexy: do patient outcomes justify increased expenditure?

Robot-assisted surgical techniques have flourished over the years, with refinement in instrumentation and optics allowing for adaptation and increasing utilization across surgical fields. Transabdominal rectopexy with mesh for rectal prolapse may stand to benefit significantly from the use of a robotic platform. However, increased operative times and immediate associated costs of robotic surgery may provide a counterargument to widespread adoption. To determine which approach to the treatment of rectal prolapse, laparoscopic or robotic, is more cost effective and provides better outcomes with fewer complications, a retrospective review was performed at a single tertiary care academic institution from May 2013 to December 2020. Twenty-two patients underwent transabdominal mesh rectopexy through a robot-assisted DaVinci platform (Intuitive Sunnyvale, CA), and thirty through a laparoscopic platform. Main outcome measures included operative, hospital, and total cost as defined by total charges billed. Secondary outcomes included rate of recurrence, intra-operative complications, median operative time, post-operative complications, average hospital length of stay, inpatient pain medication usage, and post-operative functional outcomes. Cost analysis for robot-assisted versus laparoscopic rectopexy demonstrated operating room costs of $46,118 ± $9329 for the robotic group, versus $33,090 ± $15,395 (p = 0.002) for the laparoscopic group. Inpatient hospital costs were $60,723 ± $20,170 vs. $40,798 ± $14,325 (p = 0.001), and total costs were $106,841 ± $25,513 vs. $73,888 ± $28,129 (p ≤ 0.001). When secondary outcomes were compared for the robotic versus laparoscopic groups, there were no differences in any of the aforementioned outcome variables except for operative time, which was 79min longer in the robotic group (p ≤ 0.001). Robot-assisted mesh rectopexy demonstrated no clinical benefit over traditional laparoscopic mesh rectopexy, with significantly higher operative and hospital costs. A reduction in the acquisition and maintenance costs for robotic surgery is needed before large-scale adoption and implementation of the robotic platform for this procedure.

Hemi-circumferential mucosal resection and anastomosis procedure for rectal prolapse following anorectoplasty for anorectal malformations.

Rectal prolapse after radical surgery for anorectal malformations (ARMs) is a common postoperative complication that causes bleeding and stenosis, and sometimes requires surgical treatment. Different surgical techniques have been reported, but most are associated with high recurrence rates and a long postoperative stay. We performed the hemi-circumferential mucosal resection and anastomosis procedure (HCMR) to preserve anal muscle and anal function. Here, we report the success of our minimally invasive surgical approach to correct rectal prolapse in patients with ARMs. The subjects of this retrospective review were patients who underwent HCMR for rectal prolapse after radical surgery for ARMs between January, 2014 and August, 2021. HCMR involves rectal mucosal resection without muscle plication. A collective 15 HCMR procedures were performed in 10 patients. The median age at repair was 1.8years (range, 10months-18years). The median operation time and postoperative length of stay were 46min (range, 17-85min) and 3days (range, 1-7days), respectively. The median postoperative observation period was 3years 4months (range, 8months-7years 10months) and no complications or recurrences were observed. HCMR is a safe and effective surgical treatment for rectal prolapse after radical operation for ARMs, which is minimally invasive and preserves rectal muscle and function.

Modified robotic ventral rectopexy with folded single titanized mesh suspension for the treatment of complex pelvic organ prolapse.

The incidence of complex pelvic organ prolapse in female patients is about 38%, and this disorder entails social and sexual restrictions. Treatment for this disorder is complex because it can enhance other, latent, problems. The aim of the present study is to describe a new robotic-assisted technique to simultaneously treat prolapses of different compartments with the use of a single titanized polypropylene mesh. All patients referred from January 2018 to March 2019 to the Proctologic and Pelvic Floor Clinical Centre who were affected by complex pelvic organ prolapse underwent modified robotic ventral rectopexy with a folded single mesh (RVR-FSM). The anatomical and functional outcomes were respectively evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) grading system and Wexner scores of constipation and incontinence. The satisfaction rate was investigated using a five-point scale (1=not satisfied to 5=extremely satisfied). Twenty-two women underwent RVR-FSM with a homogeneous follow-up of 12 months. The mean total operation time was 148 min, without any robot-related or other intraoperative complications. No mesh-related complications occurred. The POP-Q grade improved for every patient, with complete resolution of bulging symptoms in 21 patients (95.4%) at 1year of follow-up. The Wexner constipation score showed a significant improvement, while the incontinence score slightly improved at 1year after surgery. The use of a single mesh that can be folded was shown to provide significant improvement in functional and anatomical results associated with patient satisfaction. The robotic approach allows surgeons to perform an easier procedure with correct and deep mesh fixation.

A Network Meta-Analysis of Surgical Treatment of Complete Rectal Prolapse

A Network Meta-Analysis of Surgical Treatment of Complete Rectal Prolapse

Pessary with perineal suture for treatment of pelvic organ prolapse: description and benefit of the technique

Introduction and hypothesisVaginal pessaries are used as a conservative treatment for POP in women who do not want or are not candidates for surgery, or as a preliminary step to surgery. Our goals are: evaluate the evolution of patients with advanced POP and repeated expulsion of the pessary, who underwent perineal suture to try to maintain the device. Describe the epidemiological characteristics of patients treated with pessaries in our environment, with or without perineal closure.MethodsObservational, descriptive and prospective study (October 2016-March 2021) that includes 352 women with advanced-stage POP treated with a pessary, of which 55, after repeated expulsion of the pessary, were treated with a pessary and perineal suture.ResultsAfter pessary insertion associated with perineal closure, 26 patients (47.2%) expelled the pessary and underwent surgery, and 29 (52.8%) kept the device, avoiding surgery. Regarding the women who required perineal suture: The mean age was higher than in the group of patients who did not need this intervention (75.3 vs. 68.3 years), 94.5% had POP ≥ grade III and 100% had a perineal width > 2.5 cm.ConclusionsTreatment with pessary and perineal closure avoids surgery in women with advanced age and repeated expulsion. Although age should not be an independent factor that limits surgical treatment or the type of intervention, it would be useful to have scales to quantify the frailty of patients, being able to standardize perineal closure in elderly and/or frail women, and in those who do not want or have contraindications for surgery.

De novo pain and relief of pain after abdominal synthetic mesh implants

Introduction:This study assessed the incidence, severity and risk factors for pain after abdominal mesh usage in pelvic floor prolapse surgery. Methods:Prospective observational cohort study (NCT01598467, clinical trials.gov) performed in a tertiary referral center for patients with gynecological prolapse. Women undergoing robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy for the treatment of pelvic organ prolapse were​ included (2014–2018). Primary outcome was presence and degree of pre- and postoperative pain. Secondary outcomes were quality of life, dyspareunia and risk factors for postoperative pain. Pre- and postoperative interviews and validated questionnaires were used to assess pain severity and location. A Numeric rating scale (NRS; 0-10; 0 no pain and 10 highest pain score) was included in the questionnaire. ‘De novo pain’, ‘ongoing pain’ and ‘resolved pain’ were respectively described as: Pain solely present postoperatively, pain present both pre- and postoperatively and pain present preoperatively, but resolved postoperatively. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the quality of life Pelvic Floor Impact Questionnaire (PFIQ-7) were used. Results:115 subjects who underwent abdominal mesh implant surgery were included. Mean follow-up duration was 12.8 3.7 months. The preoperative prevalence of patient self-reported pain was 52%, postoperative self-reported pain was 24%. De novo pain was found in 4.3%. Self-reported ongoing pain was noted in 18%. In 29%of patients the pain had resolved after surgery. Preoperative pain and previous intra-abdominal surgery were identified risk factors for postoperative pain (intra-abdominal surgery OR 3.6, 95% CI 1.2-10.7; preoperative NRS pain score OR 1.4, 95% CI 1.1-1.7). Less women reported dyspareunia postoperatively (49% versus 36%). Total PFIQ-7 scores decreased significantly (Total PFIQ-7: -49) postoperatively, indicating improvement in quality of life. Conclusion:Pain is mostly reduced or resolved and less dyspareunia is reported after abdominal pelvic floor surgery with mesh implants for pelvic organ prolapse.

Analysis of the efficacy and Safety of Vaginal Hysterectomy Combined with Anterior and Posterior Vaginal Wall Repair in the Treatment of Uterine Prolapse

Analysis of the efficacy and Safety of Vaginal Hysterectomy Combined with Anterior and Posterior Vaginal Wall Repair in the Treatment of Uterine Prolapse

Uterine-sparing laparoscopic lateral suspension in the treatment of pelvic organ prolapse.

Apical prolapse is an important component of pelvic organ prolapse. The aim of our study was to investigate the effectiveness of laparoscopic lateral suspension (LLS) surgery, which we performed while sparing the uterus. LLS surgery was performed on 62 patients due to apical prolapse, preserving their uterus. The patients' pelvic organ prolapse quantification system (POP-Q) points and sexual function using pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) prior to and 12 months following the surgery were compared, and the results were evaluated. The POP-Q points and PISQ-12 scores evaluating sexual function of the patients who underwent LLS were significantly improved compared to pre-operation values (p˂0.001). No intraoperative complications were observed in the patients. Recurrence was observed in 6 (9.6%) of 62 total cases in post-operative follow-up. Apical prolapse was seen in two patients (3.2%), and anterior vaginal wall recurrence was observed in one patient (1.6%). Posterior vaginal wall recurrence was seen in three patients (4.8%). Pelvic pain complications were observed in four patients (6.4%) in the postoperative follow-up. Mesh erosion was not observed in any of the cases. It was observed that 5 (38%) of 13 patients with stress urinary incontinence (SUI) had improved SUI complaints after surgery. The mean operation time was 66.3 ± 12.3 min. LLS is an effective and safe method for patients with apical prolapse who want to preserve their uterus. LLS can be applied as an alternative to the sacrocolpopexy procedure, which has risks such as potentially serious neurological and life-threatening vascular injury in the sacral region.

Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation

BackgroundVentral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. However, despite good anatomical results, the improvement of functional symptoms (constipation or incontinence) cannot always be obtained and in some cases these symptoms may even worsen. The aim of the present study was to identify possible predictors of functional failure after VMR.MethodsData of all consecutive patients who had VMR for the treatment of rectal prolapse and/or obstructed defecation between January 2017 and December 2020 in three different pelvic floor surgical centres in Italy were analysed to identify possible predictors of functional failure, intended as persistence, worsening or new onset of constipation or faecal incontinence. Symptom severity was assessed pre- and postoperatively with the Wexner Constipation score and Obstructed Defecation Syndrome score. Quality of life was assessed, also before and after treatment, with the Patients Assessment of Constipation Quality of Life questionnaire, the Pelvic Floor Disability Index and the Pelvic Floor Impact Questionnaire. Faecal incontinence was evaluated with the Cleveland Clinic Incontinence Score. The functional outcomes before and after surgery were compared.ResultsSixty-one patients were included (M:F ratio 3:60, median age 64 years [range 33–88 years]). Forty-two patients (68.9%) had obstructed defecation syndrome, 12(19.7%) had faecal incontinence and 7 patients (11.5%) had both. A statistically significant reduction between pre- and postoperative Obstructed Defecation Syndrome and Wexner scores was reported (p < 0.0001 in both cases). However, the postoperative presence of constipation occurred in 22 patients (36.1%) (this included 3 cases of new-onset constipation). The presence of redundant colon and the pre-existent constipation were associated with an increased risk of persistence of constipation postoperatively or new-onset constipation (p = 0.004 and p < 0.0001, respectively). The use of postoperative pelvic floor rehabilitation (p = 0.034) may reduce the risk of postoperative constipation.ConclusionsVMR is a safe and effective intervention for correcting the anatomical defect of rectal prolapse. The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. Postoperative rehabilitation treatment may reduce this risk.

Predictors of mitral valve hemodynamics after mitral valve repair for degenerative mitral regurgitation: a subanalysis of the CAMRA randomized trial

Abstract Introduction Intra-operative predictors of mid-to-late mitral valve dysfunction after surgical repair of mitral regurgitation (MR) caused by prolapse remain poorly characterized. This study aims to evaluate the effect of annuloplasty prosthesis size on post-operative MV hemodynamics at rest and during exercise, and to identify perioperative predictors of MV dysfunction. Methods 104 patients were randomly assigned to resection and preservation for surgical treatment of posterior leaflet prolapse in the Canadian Mitral Research Alliance CardioLink-2 study. Echocardiograms were performed at baseline and 1 year postoperatively. Intraoperative TEE was performed to assess immediate MV gradients. Exercise TTE was performed 1 year after repair. Linear regression analysis was used to identify associations between MV indices (rest and peak exercise gradients) at 12 months, and perioperative echocardiographic and clinical factors. Results Mean age of participants was 65±10 years, and 83% were male. Larger annuloplasty size was associated with lower transmitral gradients at rest and during peak exercise. In multivariable analysis, annuloplasty size ≥34mm was associated with lower mean and peak rest and exercise gradients at 12 months, after adjustment for repair type, age, sex, and BSA (p&amp;lt;0.001). Higher pre-operative pulmonary artery pressures were associated with reduced functional capacity post-operatively. Intra-operative TEE gradients predict resting and exercise MV hemodynamics at 1 year. Conclusion Annuloplasty size ≥34mm is associated with improved MV hemodynamics at rest and during peak exercise 1 year post MV repair. MV repair prior to onset of pulmonary hypertension confers favourable post operative functional capacity. Finally, intra-operative TEE can be used to identify patients at risk of mitral valve dysfunction within 1 year of repair. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The Heart and StrokeFoundation of Ontario (GIA 16-00014666)

Infants and Children who Experience From Rectal Prolapse

Aim and Objective: to understand the outcomes of treating pediatric rectal prolapse with injection sclerotherapy using 5% phenol in almond oil. Setting &amp; Design: Department of Pediatric Surgery MTI / LRH, Peshawar, Pakistan. A- Descriptive Study the duration of study from June 2021 to June 2022 Material &amp; Method: In Pediatric Surgery, rectal prolapse is a prevalent issue with various potential solutions. Injection sclerotherapy was one of the techniques studied in this analysis of treatments for children with rectal prolapse. Patients who have had complete prolapse for more than three months were considered. Patients were checked in 24 hours before surgery. Before the procedure began, a Kleen Enema was administered. This operation was done while the patient was under general anesthesia. Sclerotherapy was performed by injecting a solution of 5% phenol in almond oil. While the patient was unconscious, an injection was placed in the rectum's submucosa. 8-10mL of a 5% phenol in almond oil solution was injected at 3-4 linear locations. Every patient was monitored for a whole month to look for signs of recurrence. Results: A total of 42 individuals were seen. There were 32 men and ten women among the total number of patients. Children as young as two years old and as elderly as eight years old were involved. A prolapse might endure between three months to four years. For 26 people, chronic diarrhea was a recognized problem. Sclerotherapy injections were administered to a total of 26 patients. There were no issues from the anesthesia or the procedure itself. There was no evidence of a recurrence during the one-month follow-up. Practical implication: This study will review our experience with the treatment of rectal prolapse in children and to formulate a management strategy based on outcome. Conclusions: Rectal prolapse may be successfully treated securely, affordably, and efficiently with injectable therapy using 5% phenol and almond oil. Keywords: Recto Prolapse, Sclerotherapy, children, injectable therapy, Sclerotherapy

Cupping therapy in the treatment of uterine prolapse complicated with stress urinary incontinence: A nursing case report

Cupping therapy in the treatment of uterine prolapse complicated with stress urinary incontinence: A nursing case report

Pessary Management Approach Affects Likelihood of Surgery.

It is unknown whether the pessary management type influences the need for surgery. The aim of this study was to evaluate the rate of surgical treatment for pelvic organ prolapse or stress urinary incontinence with the type of pessary management (self-management or office management). We conducted a retrospective cohort study that included first-time pessary users treated at a tertiary urogynecologic clinic from 2012 to 2014 for pelvic organ prolapse, stress urinary incontinence, or both. For the primary outcome, we explored the relationship between pessary management type and the likelihood of surgery using multivariable Cox proportional hazards models. Secondary outcomes assessed relationships between patient factors (eg, demographics and clinical attributes) and pessary management type using multivariable logistics regression models. There were 218 patients included in our analysis. Of all pessary users, 59 (27.1%) required office management and 159 (72.9%) participated in self-management. Surgery was performed in 22 (35.1%) office-managed patients and 33 (19.3%) self-managed patients. Women who self-managed their pessaries were significantly less likely to undergo surgery than those who received office management (multivariable hazards ratios, 0.416; P = 0.005). In the multivariable logistic regression model for pessary management type, increasing age (odds ratio [OR], 1.098; P ≤ 0.0001), increasing body mass index (OR, 1.078; P < 0.05), and increasing genital hiatus (OR, 1.547; P < 0.05) were associated with increased odds of pessary office management compared with self-management. In a urogynecology clinic setting, pessary self-management is associated with lower rates of surgical treatment compared with office management. Factors associated with office management include increased age, body mass index, and large genital hiatus.

Mitral valve prolapse: do we correctly understand the problem in a particular child?

The lecture is devoted to the role of mitral valve prolapse in children and adolescents, in the population and in the formation of health. Particular attention is paid to the mechanisms of its formation, the evolution of the mitral valve prolapse criteria. The reasons for its overdiagnosis,risk factors, as well asthe high frequency of complications are explained. The interrelation of this pathology with connective tissue dysplasias and the inappropriateness of classifying the defect as a group of minor heart anomalies are emphasized. Primary mitral valve prolapse is an independent disease. There is no proven basis to consider it a marker or «affiliation” of systemic connective tissue dysfunction. An algorithm of modern treatment and prevention of mitral valve prolapse for modern pediatric practice is presented.