Perioperative experience of pelvic organ prolapse repair with the Prolift and Elevate vaginal mesh procedures.

INTRODUCTION AND HYPOTHESIS: We compared the operative and immediate postoperative experience of the trocar-based Prolift and non-trocar-based Elevate techniques used to repair vaginal prolapse. METHODS: A retrospective review of Prolift and Elevate repairs was performed. Baseline characteristics and operative and postoperative variables evaluated included compartment(s) repaired, adjacent organ injury, operative time (OT), change in hemoglobin (ΔH), pain score, narcotic use, length of stay (LOS), and short-term complications. Categorical variables were assessed as counts and percent frequency. Data were compared using chi-squared analysis and paired t test. RESULTS: Prolift (n = 143) and Elevate (n = 77) patients were similar in age (p = 0.19). Concurrent hysterectomy was done in 22 (15.4 %) and 24 (31.2 %), respectively, and concurrent midurethral sling placed in 100 (70 %) and 50 (65 %), respectively. LOS (median, 25th,75th) after anterior/apical compartment repairs was shorter with Elevate, whether with (1.0; 1.0,1.5 vs. 2.0 days;1.0, 2.0; p = 0.003) or without (2.0; 1.0, 2.0 vs. 2.0 days; 2.0, 3.0; p = 0.024) hysterectomy, but no differences in OT, ΔH, pain score, or narcotic use occurred. Posterior compartment mean pain scores were lower with Prolift (3.6 ± 2.2 vs. 1.7 ± 1.5, p = 0.035), and three-compartment-repair pain scores were lower with Elevate (0.6 ± 1.3 vs 2.5 ± 1.9; p = 0.013). Three bladder injuries occurred with Prolift but none with Elevate. CONCLUSIONS: Operative and postoperative experiences were similar between groups; however, Elevate anterior/apical repairs had shorter LOS, which might reflect more aggressive discharge planning. There were no bowel or major vascular injuries, and the Prolift trocar bladder injuries did not alter the surgical procedure.

Comparison between reduction in 24-hour pad weight, International Consultation on Incontinence-Short Form (ICIQ-SF) score, International Prostate Symptom Score (IPSS), and Post-Operative Patient Global Impression of Improvement (PGI-I) score in patient evaluation after male perineal sling.

AIMS: We assessed the utility of three self-assessment instruments: the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the post-operative Patient Global Impression of Improvement (PGI-I) score, and the International Prostate Symptom Score (IPSS) by correlating them with an objective outcome, the change in 24-hr pad weight, after a male perineal sling. METHODS: Twenty-six men with urodynamically confirmed stress incontinence underwent a male perineal sling. Patients were evaluated pre-operatively and post-operatively with a 24-hr pad test, IPSS and ICIQ-SF. Patients also completed the PGI-I post-operatively. Changes in study parameters were compared via the paired t-test, and correlations were performed using Spearman's rho. RESULTS: There were significant reductions in 24-hr pad weight (-274 g, P < 0.001), percentage 24-hr pad weight (54.2%), ICIQ-SF score (-6.3, P < 0.001), and the three ICIQ-SF subscores (-1.2, -1.7, -3.4 for Questions 3, 4, and 5, respectively, P < 0.001 for all). The change in total ICIQ-SF score and the post-operative PGI-I score correlated strongly with percentage reduction in 24-hr pad weight (r = -0.68, P < 0.001; r = -0.81, P < 0.001, respectively) and with each other (r = 0.79, P < 0.001). The change in all three ICIQ-SF subscores correlated significantly with percentage reduction in 24-hr pad weight and with post-operative PGI-I score. There was no significant change in the IPSS or the voiding or storage subscores, and none correlated with any other study parameter. CONCLUSIONS: This study validates the construct validity of the ICIQ-SF and PGI-I in the assessment of treatment for male stress incontinence and should make clinicians confident in comparing studies of incontinence treatment utilizing the change ICIQ-SF score, the post-operative PGI-I score, and percentage reduction in 24-hr pad weight as outcome measures.

The male perineal sling: assessment and prediction of outcome.

PURPOSE: The male perineal sling has become an option for treating male stress incontinence. We evaluated its overall efficacy and determined preoperative parameters that could predict success. MATERIALS AND METHODS: A total of 62 men with stress incontinence were prospectively evaluated and underwent a male perineal sling. Preoperatively 24-hour pad weight, urodynamics and a number of validated incontinence questionnaires were completed. At a minimum of 3 months of followup 24-hour pad weight and questionnaires were repeated. Success was assessed using the 1 question Patient Global Impression of Improvement. The Patient Global Impression of Improvement was compared to a number of other subjective and objective measures of outcome. Finally, preoperative parameters were evaluated to determine predictors of outcome. RESULTS: As determined by the Patient Global Impression of Improvement, the success rate was 58%. The only preoperative factor predictive of success was 24-hour pad weight. An individual had a 71% chance of successful surgery if preoperative pad weight was less than 423 gm. There was a statistically significant difference between successes and failures in terms of postoperative pad weight and certain questionnaires, including the UCLA/RAND Prostate Cancer Index urinary function score, International Consultation on Incontinence short form, Incontinence Impact Questionnaire, Urogenital Distress Index and International Prostate Symptom Score. The overall complication rate was 21% and the reoperation rate was 14.5%. CONCLUSIONS: The male perineal sling can be an effective surgical treatment for stress incontinence in the appropriate patient. The procedure is most successful in patients with lesser objective degrees of incontinence. The Patient Global Impression of Improvement is an effective tool for assessing outcome for this population.

Thomas Annandale and the first report of successful orchiopexy.

PURPOSE: We investigate the surgeon and factors behind the first report of successful orchiopexy. MATERIALS AND METHODS: We reviewed the first reports of orchiopexy, and the work and writings concerning Thomas Annandale and the time in which he practiced. RESULTS: Annandale was a surgeon in Edinburgh, Scotland, in the late 19th century. In 1877 he successfully brought down an ectopic testicle in a 3-year-old boy. This first reported successful orchiopexy was due in large part to Lister's antiseptic technique. CONCLUSIONS: Annandale performed the first successful orchiopexy by integrating the surgical and antiseptic ideas of his predecessors and contemporaries.