Vaginal Erosion Research Articles

Long-term follow-up of laparoscopic sacrocolpopexy

This study evaluates the long-term results of laparoscopic sacrocolpopexy. In a prior publication, we demonstrated that laparoscopic sacrocolpopexy is a safe method with excellent anatomical results and low recurrence rates after a 12-month follow-up. This study now evaluates the long-term objectives and subjective outcomes of laparoscopic sacrocolpopexy after 5years (mean). From 2003 to 2007, a prospective study enrolling 101 patients was conducted to evaluate laparoscopic sacrocolpopexy as a treatment for pelvic organ prolapse. The long-term results were assessed postoperatively after 5years by gynecological examinations, including the Pelvic Organ Prolapse Quantification (POP-Q) system and quality of life assessments using validated questionnaires. A total of 68 patients received a full clinical follow-up exam between July and September 2011, and 17 patients were assessed by questionnaires only. Altogether, six anatomical recurrences in the anterior, four in the posterior, and one in the apical compartment were found during the 5years after surgery; 83.8% of patients had no prolapse in any compartment or stage 0 prolapse according to the International Continence Society (ICS) classification. The total reoperation rate was 3.5%. Two mesh erosions into the bladder occurred, though no vaginal erosion occurred. The preoperative quality of life index improved from 5.6 to 9.1 (12months) and 8.3 (60months) postoperatively, resulting in a subjective cure rate of 95.3%. Laparoscopic sacrocolpopexy has demonstrated excellent anatomical and functional long-term results. With the ongoing debate about the complications of vaginal mesh surgery, laparoscopic sacrocolpopexy should be considered a favorable treatment option for patients with pelvic organ prolapse.

Biodistribution of protoporphyrin IX in female genital erosive lichen planus after topical application of hexaminolevulinate

Genital erosive lichen planus (GELP) is a chronic inflammatory disease, in women characterized by painful vulvar and vaginal erosions. To prepare for a clinical trial on photodynamic treatment (PDT), we applied hexyl 5-aminolevulinate hydrochloride (HAL) in clinically normal and affected mucosa in 12 women with GELP using two different doses (6.25 or 50mg/ml). Biopsies were taken after 30 min and 3h. The biodistribution of HAL, measured as photoactive protoporphyrin IX (PpIX), was studied using non-invasive superficial fluorescence measurements and microscopic fluorescence photometry. More PpIX was detected after application of 12.5mg HAL than after 100mg, with large inter-individual variations. PpIX levels after 3h were overall higher than after 30 min. PpIX fluorescence was not detected in skin distant to the genital area. In conclusion, 6.25mg/ml HAL applied for 3h seems adequate for HAL absorption and conversion to PpIX in submucosal inflammatory and epithelial cells and can be used in a PDT trial of GELP.

Skin and vaginal erosion after adjustable miduretral sling operation

Skin and vaginal erosion after adjustable miduretral sling operation

Patient-Reported Outcomes of Retropubic versus Trans-Obturator Mid-Urethral Slings for Urinary Stress Incontinence: The Malaysian Experience

Introduction: Studies reported that trans-obturator mid-urethral sling (TOT) is superior in safety and efficacy when compared with retro-pubic trans-vaginal tape (TVT) with regard to bladder, vascular and urethral injury. The purpose of this study is to determine if the TOT is equivalent to the TVT by using patient-reported outcomes for the treatment of urodynamic stress urinary incontinence (USI) at Ipoh Hospital. Methods: It is a cross-sectional study on all consecutive patients who underwent TVT procedure between Jan 2005 and Jan 2006 and TOT procedure from Jan 2006 to Jun 2008. Post operatively; all women were followed up at one month, three months, 12 months and annually, thereafter. Data was retrieved from the patients’ records based on the standard pre-operative assessment sheet and follow up record. Then, interviews were made via a telecommunication to assess the patients’ symptoms and satisfaction using a validated questionnaire. Data analysis were performed using IBM SPSS Statistics for Windows version 19 (SPSS Inc., Chicago, Illinois) considering a significant level of P < 0.05. Results: Total of 51 subjects in TVT group and 52 in TOT group were available for analysis. At 12 months, the stress urinary incontinence (SUI) cure rate is higher in the TVT (90.2%) compared to TOT (80.8%) group; however, it was not statistically significant (p=0.279). The lower urinary tract symptoms (LUT) were improved post-operatively in both groups with urgency and urgency incontinence being significantly better in the TVT group. Four (7.4%) subjects in the TVT group had a bladder perforation (p=0.992) and one case of vaginal erosion reported in the TOT group. Conclusion: TVT had a higher successful rate in the treatment of SUI; however, it increases the risk of bladder perforation. Over active bladder symptom (OAB) were significantly improved in the TVT compared to TOT group.

A late complication of transobturator tape procedure: vaginocutaneous fistula formation with vaginal mesh erosion

Transobturator tape procedures are a common treatment modality in patients with stress urinary incontinence (SUI). Various complications have been reported related to this procedure. We present a rare case of vaginocutaneous fistula formation 5 years after transobturator tape surgery. A 56-year-old woman presented with complaints of increased vaginal discharge, difficulty in coitus, and serosanguineous discharge from the left groin 5 years after transobturator tape surgery for SUI. Pelvic examination revealed 2-3 cm of extruded mesh at the anterior vaginal wall. The vaginocutaneous fistula was detected at surgery. The suburethral tape was removed, and the fistula tract was excised and repaired primarily. Postoperative period was uneventful, and the patient was still continent 6 weeks postoperatively. With widespread use of mesh for treating SUI, we will likely see a variety of complications in the long term.

Posterior Intravaginal Slingplasty versus Unilateral Sacrospinous Ligament Fixation in Treatment of Vaginal Vault Prolapse

Objective. To investigate the differences in efficacy, postoperative complications, and patient satisfaction between posterior intravaginal slingplasty (PIVS) and unilateral sacrospinous ligament fixation (SSLF) procedures. Study Design. A retrospective study of thirty-three women who underwent PIVS or SSLF treatment for vaginal vault prolapse in Oulu University Hospital. The patients were invited to a follow-up visit to evaluate the objective and subjective outcomes. Median follow-up time was 16 months (range 6–52). The anatomical outcome was detected by the Pelvic Organ Prolapse Quantification (POP-Q) system. Information on urinary, bowel, and sexual dysfunctions and overall satisfaction was gathered with specific questionnaire. The data were analyzed using Mann-Whitney U test and Fisher's exact test. Results. Mesh erosion was found in 4 (25%) patients in the PIVS group. Anatomical stage II prolapse or worse (any POP-Q point ≥−1) was detected in 8 (50%) patients in the PIVS group and 9 (53%) patients in the SSLF group. Overall satisfaction rates were 62% and 76%, respectively. Conclusion. The efficacy of PIVS and SSLF is equally poor, and the rate of vaginal erosion is intolerably high with the PIVS method. Based on our study, we cannot recommend the usage of either technique in operative treatment of vaginal vault prolapse.

Implantation de sphincter artificiel urinaire par voie laparoscopique chez des femmes avec incontinence urinaire d’effort sévère

To evaluate, feasibility, efficacy and morbidity of laparoscopic artificial urinary sphincter (AUS) implantation in women with severe stress urinary incontinence. Twenty-six women with severe stress urinary incontinence were treated between October 2007 and January 2012 by laparoscopic implantation of an AUS AMS 800 (American medical Systems, Inc., Minnetonka, Minnesota). For 18 patients AUS was primary implanted and, for eight, AUS was revised for a mechanical failure. Three patients had a concomitant laparoscopic vaginal prolapse repair. Mean value was for age 64 years, BMI 27.8kg/m2, and mean maximal urethral closure pressure was 26.75cm of water. Most of the patients (88%) had a history of pelvic or incontinence surgery. The study was a retrospective analysis of operative parameters, complications and functional results. Three conversions in open surgery and five bladder injuries were described. Mean operative time was 149 minutes. Bladder catheter was removed at a mean of day 3.8. Mean post-operative stay was 5 days. Early postoperative complications consist in eight acute transient urinary retentions, two pump migrations, and one vaginal injury. Late post-operative complications consist in one vaginal erosion. Explantation of AUS was performed for these last two patients. Mean follow-up was 20 months. Sixteen patients are totally continent, five have a social continence (1 pad/day) and three need more than one pad/day. Our results compare favorably to literature either for laparoscopic or conventional approach with a limited learning curve. Laparoscopic implantation of AUS in women with severe stress urinary incontinence was feasible and efficient.

Martius Graft for Management of Exposed Vaginal Prolapse Mesh

Although the use of vaginal mesh kits in treatment of pelvic organ prolapse (POP) has decreased the number of surgical failures, mesh exposure can occur. When conservative management fails, removing the exposed material is associated with the risk of recurrence of POP and could be challenging. We report a successful outcome of treatment of exposed mesh via use of a Martius bulbocavernosus fat pad. A 46-year-old woman had urinary incontinence and POP, which was treated using a vaginal mesh kit and tension-free vaginal tape. At 2 months after the procedure, the mesh was found to be exposed. After failed conservative management, use of a Martius graft was used, with preservation of the mesh. At 2-, 5-, and 10-month follow-up, the patient was completely asymptomatic and continent. This procedure may be a practical alternative in patients with synthetic mesh–induced vaginal erosion after failed conservative management.

Transobturator vaginal tape for the treatment of stress urinary incontinence in elderly women without concomitant pelvic organ prolapse: is it effective and safe?

To evaluate the efficacy and safety of the transobturator approach (TVT-O) for the surgical management of stress urinary incontinence (SUI) in older women. Between 2007 and 2010, all consecutive women with SUI undergoing an isolated TVT-O procedure were prospectively enrolled in this study. Patients were divided into two groups by age: older women (≥ 70 years old) were included in group 1, while younger women (< 70 years old) in group 2. Intra- and post-operative outcomes were compared between the groups. During the study period 181 women met the inclusion criteria and were included for final analysis. Among these women, 60 (33.1%) and 121 (66.9%) were included in groups 1 and 2 respectively. After a median follow-up of 26 (IQR 15-41) months for the younger and 25 (IQR 18-40) months for older patients (p>0.99), no differences were observed between the two groups in terms of cure rate (92.5% vs. 88.3%; p=0.40). No differences were observed in terms of voiding dysfunction, vaginal erosion and persistent groin pain, or in terms of onset of de novo overactive bladder (9.0% vs. 13.3%; p=0.44). TVT-O appears to be a safe and effective procedure for the management of stress urinary incontinence also in elderly population.

Groin abscess due to a forgotten midurethral sling connector

Midurethral slings (MUS) have been used for female stress urinary incontinence throughout the past decade on a worldwide scale. Although this minimally invasive treatment has high success rates, formation of groin abscesses, as well as vaginal and urethral erosions, can occur after the procedure. We report a patient presenting with groin abscess and sinus tract formation after a transobturator tape procedure. The patient exhibited a swollen sinus tract, which drained the abscess at the site of the tape entry to the obturator foramen within her inner left groin. She was referred to our department after unsuccessful medical and surgical treatments. Surgical exploration revealed a forgotten MUS connector located between the mesh and hook within the skin incision. To the best of our knowledge, this is the first report of such a case.

Delayed vaginal and urethral mesh exposure: 10 years after TVT surgery

Delayed mesh exposure after tension-free vaginal tape (TVT) procedure is rare. We report a case of mesh exposure into the vagina and urethra that developed 10 years after TVT surgery. A 58-year-old postmenopausal woman presented with mixed urinary incontinence. She was investigated, and her stress urinary incontinence was cured with a TVT procedure 10 years ago. She was then scheduled follow-up annually. Two years postsurgery, a granulation tissue was observed and excised at the vaginal incision site. Vaginal examination 10 years postsurgery showed vaginal mesh erosion 0.5 cm from urethral meatus. Cystoscopy revealed concomitant urethral erosion at the posterior urethral wall. Mesh excision was performed, and urethra and vagina were repaired in layers. Postoperative recovery was uneventful. This finding shows that, although rare, complications can occur even after 10 years of TVT surgery.

Lesiones vaginales por pesario. Estudio de casos y revisión de la literatura

ObjectiveWe studied the adverse events occurring with the use of vaginal ring pessaries. MaterialWe report a series of nine cases of adverse events involving vaginal pessaries occurring within a 4-year period with over 23719 consultations and representing an incidence of 0.03%. ResultsThe mean age of the patients was 83 years (range: 70-96), and the mean parity was 3.77 (range: 2-6 children). The mean age of onset of the use of a pessary was 80 years. The mean number of years of use was 3 (range 1-5 years).The indications for pessary use were contraindication of surgery due to heart disease and, in women with prior surgery, the recurrence of prolapse or vaginal vault prolapse, and waiting for surgery.The adverse events found consisted of vaginal erosion and bleeding in 4/9 (44.44%) and vaginal discharge with vaginal infection in 5/9 (55.55%). ConclusionThe use of a pessary warrants special care and hygiene measures to ensure long-term successful use.

Ajust single incision transobturator sling procedure for stress urinary incontinence: results after 1-year follow-up

Data on the Ajust, a new single-incision sling procedure for female stress urinary incontinence (SUI) management, remain scarce and limited to a 1-year follow-up. Our goal was to assess the efficacy of this procedure after a 1-year follow-up. This prospective evaluation involved 95 consecutive patients implanted with Ajust at a single centre. All patients had SUI on urodynamics due to urethral hypermobility, 33 % had preoperative overactive bladder (OAB) symptoms and none had detrusor overactivity. Ninety-two patients were treated on an outpatient basis, and 3 patients had general anaesthesia. Postoperative assessment was conducted at 1, 6, 12 months, and yearly thereafter. The main outcome measure was pad usage. Secondary parameters were self-reported SUI episodes, OAB symptoms, data of clinical examination, satisfaction using the Patient Global Impression of Improvement (PGI-I) scale, postoperative pain, and adverse events. After a mean follow-up of 21 ± 6 months (12-32), 76 out of 95 patients used no pads or one dry security pad, showing a success rate of 80 %. Seventy-nine out of 95 patients had no more SUI-related leakage. Only 6 patients experienced late recurrence of SUI after 6 months' follow-up. Perioperative complications included 1 case of vaginal hematoma, 1 case of acute urinary retention, 2 cases of urinary tract infection, all managed conservatively. Half of the patients had no pain after day 1, free of medications. Late complications were vaginal erosion in 1 case, and pain during exertion in 2 cases. The Ajust single incision transobturator sling is a safe and effective procedure, with durable results after 1 year.

Porcine urinary bladder matrix-polypropylene mesh: a novel scaffold material reduces immunorejection in rat pelvic surgery

The present study set out to modify polypropylene vaginal surgical material using porcine urinary bladder matrix (UBM) in order to improve biocompatibility. The aim was to develop a compound scaffold that induced less vaginal erosion and to evaluate host immunoreactivity to this material in vivo. Forty-eight Sprague-Dawley rats were randomly divided into four equal groups. One group underwent a sham operation, and the other groups underwent vaginal implantation with different materials: UBM (U); UBM + polypropylene (UP); or polypropylene (P). The host tissue response was determined by macro-observation, and by histological and immunohistochemical methods at 7, 14, 21, or 28 days after surgery. The inflammation reaction was strongest throughout the entire observation time in Group P, but was weaker and had a tendency to decrease with time in Groups U and UP. The presence of the UBM material in the compound scaffold allowed the polypropylene to fuse with newly proliferating surrounding tissue and resulted in less rejection of the material by the host, as indicated by the reduced appearance of CD4-, and CD8-positive cells. Porcine UBM allowed mechanical isolation of polypropylene, and also reduced the immune reaction to polypropylene. This study suggests that the UBM + polypropylene compound scaffold may be a promising material for clinical use in pelvic reconstruction surgery.

1555 PUBOVAGINAL SLING IN THE TREATMENT OF CONCOMITANT FEMALE URETHRAL DIVERTICULA AND STRESS URINARY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology I1 Apr 20121555 PUBOVAGINAL SLING IN THE TREATMENT OF CONCOMITANT FEMALE URETHRAL DIVERTICULA AND STRESS URINARY INCONTINENCE Ekene Enemchukwu, W. Stuart Reynolds, Harriette Scarpero, Melissa Kaufman, and Roger Dmochowski Ekene EnemchukwuEkene Enemchukwu Nashville, TN More articles by this author , W. Stuart ReynoldsW. Stuart Reynolds Nashville, TN More articles by this author , Harriette ScarperoHarriette Scarpero Nashville, TN More articles by this author , Melissa KaufmanMelissa Kaufman Nashville, TN More articles by this author , and Roger DmochowskiRoger Dmochowski Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Female urethral diverticulum is a rare condition with nonspecific symptoms. Consequently, diagnosis is often delayed. There is a paucity of data on the management and outcomes. Surgical management of female urethral diverticula and concomitant stress urinary incontinence (SUI) with pubovaginal sling (PVS) has been shown to be safe and effective in small series. We present our experience with concomitant repair. METHODS Retrospective chart review from 2006 to 2009 identified 22 women undergoing concomitant diverticulectomy and autologous fascia PVS. Demographics, symptoms, urodynamics (UDS), prior treatments, concomitant procedures, pads per day (PPD), outcomes and complications were evaluated. RESULTS Mean age was 50.2. Mean duration of symptoms was 71.2 months. Follow up was 307 days. Magnetic resonance imaging was utilized in 19 patients and 3 were evaluated with voiding cystourethrogram. Seven patients presented with recurrent diverticula status post >1 repairs. All women had demonstrable SUI on exam or UDS. Two patients experienced post-operative retention, one requiring short term intermittent catheterization. Pre and post-operative PPD were 2.6 and 0, respectively. 60% patients reported mixed urinary symptoms prior to repair. Of these, 8 had complete resolution while 5 had significant improvement. Overall, 16 (73%) patients reported cure, while 5 (22%) were improved. One patient experienced recurrence of her urethral diverticulum with SUI after 23 months. No de novo detrusor overactivity, perioperative complications, including hemorrhage, vaginal erosion, fistula or hernias were observed. CONCLUSIONS To our knowledge, this represents the largest series of concomitant repair of SUI and urethral diverticulum. In this series, autologous fascia PVS is a safe and effective in women undergoing primary as well as repeat diverticulectomy. In addition to treatment of SUI symptoms, placement of a PVS may provide tissue interposition to reduce erosion, fistula, and additional post-operative complications. Future directions include determining the prevalence of SUI in those with recurrent urethral diverticula, as this population may be at higher risk and require more preoperative evaluation. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e630-e631 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ekene Enemchukwu Nashville, TN More articles by this author W. Stuart Reynolds Nashville, TN More articles by this author Harriette Scarpero Nashville, TN More articles by this author Melissa Kaufman Nashville, TN More articles by this author Roger Dmochowski Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1358 PROSPECTIVE EVALUATION OF THE AJUST SINGLE INCISION TRANSOBTURATOR SLING PROCEDURE FOR STRESS URINARY INCONTINENCE IN WOMEN: RESULTS OVER ONE YEAR FOLLOW-UP

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III1 Apr 20121358 PROSPECTIVE EVALUATION OF THE AJUST SINGLE INCISION TRANSOBTURATOR SLING PROCEDURE FOR STRESS URINARY INCONTINENCE IN WOMEN: RESULTS OVER ONE YEAR FOLLOW-UP Jean-Nicolas Cornu, Ariela Skurnik, Calin Ciofu, Laurence Peyrat, Vincent Lucente, and François Haab Jean-Nicolas CornuJean-Nicolas Cornu Paris, France More articles by this author , Ariela SkurnikAriela Skurnik Paris, France More articles by this author , Calin CiofuCalin Ciofu Paris, France More articles by this author , Laurence PeyratLaurence Peyrat Paris, France More articles by this author , Vincent LucenteVincent Lucente Allentown, PA More articles by this author , and François HaabFrançois Haab Paris, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1741AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ajust™, a novel single incision sling for management of stress urinary incontinence in women, has been presented through two reports with a limited follow-up between 6 and 12 months. Our goal was to assess the efficacy of Ajust™ after a minimum follow-up of one year, the minimal follow-up required to evaluate an incontinence device according to the AUA guidelines. METHODS This prospective evaluation involved 95 consecutive patients managed by Ajust™ sling implantation in a single center. All patients had SUI on urodynamics due to urethral hypermobility. One third of patients had preoperative overactive bladder (OAB) symptoms but none had detrusor overactivity. Ninety two patients were operated on local anesthesia on an outpatient basis, and three patients had general anesthesia. Postoperative assessment was conducted at 1, 6, 12 months and yearly thereafter. The main outcome measure was pad usage. Secondary parameters were self reported SUI episodes, OAB symptoms, data of clinical examination, satisfaction using the Patient Global Impression of Improvement (PGI-I) scale, post-operative pain, and adverse events. RESULTS After a mean follow-up of 24±6 months [16-36], 76/95 patients used no pads or one dry security pad, and 79/95 patients had no more SUI related leakage at self reporting and clinical examination. Only six patients experienced late recurrence of SUI after 6-months follow-up. Time to recurrence is shown on figure (Kaplan Meier analysis). Peri-operative complications were one case of vaginal hematoma, one case of acute urinary retention, two cases of urinary tract infection, all managed conservatively. Half patients had no need for any medication for pain management after day one. Late complications were vaginal erosion in one case, and pain during efforts in two cases. CONCLUSIONS The Ajust™ single incision transobturator sling is a safe and effective procedure, with durable results after one year. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e551 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jean-Nicolas Cornu Paris, France More articles by this author Ariela Skurnik Paris, France More articles by this author Calin Ciofu Paris, France More articles by this author Laurence Peyrat Paris, France More articles by this author Vincent Lucente Allentown, PA More articles by this author François Haab Paris, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1182 A COMPARISON OF THE OUTCOMES WITH “SURGEON-TAILORED” MESH VERSUS INDUSTRIAL KITS IN TRANSOBTURATOR TAPE SURGERY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy II1 Apr 20121182 A COMPARISON OF THE OUTCOMES WITH “SURGEON-TAILORED” MESH VERSUS INDUSTRIAL KITS IN TRANSOBTURATOR TAPE SURGERY Fikret Onol, Fettah Tosun, Serdar Bugday, Ugur Boylu, Eyup Veli Kucuk, and Eyup Gumus Fikret OnolFikret Onol Istanbul, Turkey More articles by this author , Fettah TosunFettah Tosun Istanbul, Turkey More articles by this author , Serdar BugdaySerdar Bugday Istanbul, Turkey More articles by this author , Ugur BoyluUgur Boylu Istanbul, Turkey More articles by this author , Eyup Veli KucukEyup Veli Kucuk Istanbul, Turkey More articles by this author , and Eyup GumusEyup Gumus Istanbul, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1427AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The costs of commercial kits for transobturator tape (TOT) have limited their use in several health systems. In this study, we evaluated the outcomes of a TOT procedure done with “surgeon-tailored” mesh. METHODS Between January 2007 and May 2011, 92 women underwent outside-in TOT treatment for stress or stress predominant mixed incontinence. A 1.cm-wide strip tailored from a 30×30 cm. polypropylene mesh (Gal-Mesh™, Gallini medical devices, Mantova, Italy) was used as sling in group 1 (Figure 1), n=47) and a commercial kit (Safyre-t™, Promedon medical devices, Cordoba, Argentina) was used in group 2 (n=45). All patients underwent subjective assessment of the impact of voiding symptoms with International Consultation on Incontinence Questionnaire (ICIQ-SF), physical examination with a cough test, urinalysis, uroflowmetry and urinary tract ultrasound. Voiding and incontinence symptoms, and complications were prospectively assessed at 1, 3, 6, and 12 months postoperatively, and yearly thereafter. Surgical outcomes at the last follow-up and complications were compared between the two groups using Pearson's Chi-Square and Students t-tests. RESULTS Demographic characteristics and preoperative ICIQ- SF scores were similar between the groups. Follow-up in the 1st group was significantly longer (table 1)., p<0.001). At the last visit, there was no significant difference between the 2 groups in terms of the success of stress incontinence treatment (89.3% vs. 93.3%). Subjective resolution of preoperative urge symptoms was significantly higher in group 2 (table 1). “De-novo” urge symptoms developed in similar rates between the 2 groups (20% vs. 25%, p>0.05). One and 2 patients with respect to groups required mesh incision in the first postoperative month because of obstructive symptoms. Vaginal mesh erosion occured significantly higher in group 2 (0 vs. 6.6%, p<0.001). Table 1. The outcomes of surgeon-tailored mesh (group 1) and industrial kit (group 2) groups for TOT surgery at the last follow-up: number of patients (percent), Group 1 Group 2 p value Patients (n) 47 45 Follow-up (months) 28±14.46 12.1±2.07 <0.001⁎ Postop.ICIQ-SFscore 4.56±4.4 3.61±4.7 0.458⁎ Postop. 1 hr. pad test (grams) 1.32±1.73 1.53±2.49 0.415⁎ STRESS INCONTINENCE: 0.305 ⁎cured 42(89.3) 42(93.3) ⁎significantly improved 3(6.3) 2(4.4) ⁎failed 2(4.4) 1(2.3) URGE INCONTINENCE: 0.04 ⁎resolved 14(51.8) 19(57.5) ⁎significantly improved 7(25.9) 14(42.5) ⁎unchanged 6(22.3) 0(0) De-novo urgency 4(20) 3(25) 0.85 Postop. obstructive voiding 1 2 0.89 Urethra/bladder erosion 0 0 Vaginal erosion 0 3(6.6) <0.001⁎ ⁎ Students t-test, Pearson chi-square test. CONCLUSIONS “Surgeon-tailored” polypropylene mesh seems as a safe and effective sling material for TOT surgery. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e479 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fikret Onol Istanbul, Turkey More articles by this author Fettah Tosun Istanbul, Turkey More articles by this author Serdar Bugday Istanbul, Turkey More articles by this author Ugur Boylu Istanbul, Turkey More articles by this author Eyup Veli Kucuk Istanbul, Turkey More articles by this author Eyup Gumus Istanbul, Turkey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

2139 PELVIC ORGAN PROLAPSE AND PESSARY USE: IS IT A VIABLE LONG TERM TREATMENT OPTION?

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20122139 PELVIC ORGAN PROLAPSE AND PESSARY USE: IS IT A VIABLE LONG TERM TREATMENT OPTION? Sophie Ramsay, Frederick Bouchard, and Le Mai Tu Sophie RamsaySophie Ramsay Sherbrooke, Canada More articles by this author , Frederick BouchardFrederick Bouchard Sherbrooke, Canada More articles by this author , and Le Mai TuLe Mai Tu Sherbrooke, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2310AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The main objective of this retrospective study is to evaluate whether long-term use of vaginal pessaries is an appropriate conservative treatment for women with pelvic organ prolapses (POP). METHODS From 1998 to 2010, 429 women with POP had a pessary trial. Vaginal atrophy and constipation were addressed prior to the trial. Patients were encouraged to use topical estrogen and mucolytic cream at home. A follow-up appointment was scheduled at one month where a pessary maintenance regime was chosen. Additional follow-up visits were then scheduled yearly, or before as patient needs. Data collected included specific information concerning pessary use, incidence of vaginal erosions or other associated morbidities, and subjective satisfaction rate. RESULTS Average age at presentation was 71.1 ± 9.7 years old. 50% of patients had had hysterectomy and 22% had had a prior prolapse surgery. 62% (n = 258) of women had a successful pessary trial, defined as a one-month use of the pessary with subjective improvement of symptoms and no significant complication. Median duration of pessary use was 35 months (1-136). 96% of women were satisfied or very satisfied with their pessaries. 66% (n = 170) of patients could handle pessary by self-maintenance, while 23% (n = 59) needed assistance from a regional nurse, and 11% (n = 28) necessitated maintenance by our clinic nurses. Pessary self-maintenance regime was associated with a prolonged pessary use (38 months vs 30 months for the nurse group vs 27 months for the clinic group, p = 0.021). The overall erosion rate was 16%. Multivariate analysis demonstrated that erosions are associated with older age (p = 0.011), constipation (p = 0.018), and use of topical estrogen cream (p = 0.001). The severity of vaginal atrophy increased with older age (p < 0.001) and older patients were therefore more likely to use topical estrogen cream (p < 0.001). Both the severity of vaginal atrophy and intensive estrogen treatment before pessary trial were associated with a higher rate of erosions (p < 0.001 and p = 0.04). There was no major complication. 66% (n = 170) of women who underwent a successful pessary trial are still using a pessary. CONCLUSIONS Vaginal pessaries appear to be an appropriate treatment option for women with troublesome POP. These long-term results show that patient's satisfaction is excellent and most women who underwent a successful pessary trial continue to use pessary through time. Regular maintenance and follow-up are essential, especially as the occurrence of vaginal erosions is difficult to predict. Erosions do not seem totally preventable by the use of topical estrogen. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e864 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sophie Ramsay Sherbrooke, Canada More articles by this author Frederick Bouchard Sherbrooke, Canada More articles by this author Le Mai Tu Sherbrooke, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Anatomic and Functional Outcomes with the Prolift Procedure in Elderly Women with Advanced Pelvic Organ Prolapse Who Desire Uterine Preservation

Study ObjectiveTo assess the clinical outcomes of total mesh repair with the Prolift technique as treatment of advanced pelvic organ prolapse in elderly patients who desire uterine preservation. DesignCase control series study (Canadian Task Force classification II-2). SettingMedical school–affiliated hospital. PatientsSixty-eight patients over the age of 70 years with advanced pelvic organ prolapse, Pelvic Organ Prolapse Quantification stage III (n = 59) or IV (n = 9), underwent a total Prolift procedure and were followed up for a minimum of 2 years. InterventionsTransvaginal pelvic floor repairs were performed with a total Prolift system. The concurrent pelvic surgery included midurethral sling operation with a TVT-O, if indicated. The assessment included intraoperative and postoperative complications, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores. Measurements and Main ResultsObjective and subjective data were available for 68 patients. The anatomic success rate was 97.1% after 2 years. Complications included bladder perforation in 1 patient (1.5%), de novo stress urinary incontinence in 20 patients (29.4%), dyspareunia in 4 patients (22.2%), and vaginal erosion in 1 patient (1.5%). The Pelvic Organ Prolapse Quantification stages, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores all improved significantly after surgery. ConclusionsThe total Prolift procedure is an alternative surgical option that uses a minimally invasive transvaginal approach to surgically treat elderly patients with advanced pelvic organ prolapse.

Three-year outcome of transvaginal mesh repair for the treatment of pelvic organ prolapse

To evaluate the clinical and urodynamic outcomes of transvaginal mesh repair (TVM) for the treatment of pelvic organ prolapse (POP). One hundred and twenty-four women with POP stage II to IV were scheduled for a TVM procedure. Preoperative and postoperative assessments included pelvic examination, urodynamic testing, and a personal interview about urinary symptoms using a standard questionnaire. We found a significant improvement at points Aa, Ba, C, Ap, and Bp (P<0.001) except for total vaginal length (P=0.08), and the overall success rate was 93.5% (116/124). Various urinary symptoms improved significantly following TVM (P<0.01). In addition, residual urine, functional urethral length, and the rate of detrusor overactivity, improved significantly after surgery (P<0.05). Apart from vaginal erosion (14/124; 11.3%), the rates of other surgical complications were acceptably low. TVM is an effective procedure for the treatment of POP and urinary symptoms, this being possibly related to postoperative release of urethral obstruction. Vaginal erosion is less likely to occur beyond the learning curve.