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1.
Zhonghua Yi Xue Za Zhi ; 101(24): 1908-1914, 2021 Jun 29.
Artigo em Chinês | MEDLINE | ID: mdl-34619852

RESUMO

Objective: To investigate the long-term mesh-related complications and treatment outcome of total pelvic reconstruction surgery with tension-free transvaginal mesh (PROSIMATM pelvic floor repair system). Methods: From July 2010 to June 2012, 48 patients with severe pelvic organ prolapse(POP)who underwent PROSIMATM were enrolled and treated in Peking Union Medical College Hospital. 29 patients (60.4%) were followed up periodically for at least 3 years to observe the occurrence of long-term mesh-related complications, and the clinical characteristics, classification of complications and treatment outcome of these cases were summarized. Results: The 29 cases with an average age of (65.1±5.2) years were followed up for an average of (71.6±21.2) months. The last follow-up was 36-105 months after treatment. The long-term success rate of the treatment was 79.3% (n=23). There were 18 cases of mesh exposure (18/48, 37.5%), of which 10 cases (55.6%) were new and persistent. 4 cases (4/18) had symptoms; the rest were found by pelvic examination. Ten patients (10/18) were positive for vaginal swab culture. As for treatment outcome, one case suffered from mesh erosion into the bladder. 4 patients (6.9%) complained of postoperative pain. Twenty-nine patients were divided into the exposure group (n=18) and the non-exposure group (n=11) according to mesh exposure occurrence. There was a significant difference in the proportion of positive swab culture results between the two groups (P=0.019), but no significant difference in the incidence of postoperative pain (P=0.566). Conclusion: The incidence of long-term mesh exposure in PROSIMATM is not low, and most of patients with which had no symptoms.


Assuntos
Prolapso de Órgão Pélvico , Slings Suburetrais , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas/efeitos adversos
2.
Ultrasound Q ; 37(3): 237-243, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478421

RESUMO

ABSTRACT: Translabial ultrasound (TLUS) is an inexpensive, noninvasive imaging modality traditionally used for assessment of pelvic organ prolapse. The utility of TLUS has recently been expanded to the evaluation of synthetic midurethral slings (MUS) surgically implanted for management of stress urinary incontinence. The purpose of this article is to familiarize radiologists with translabial ultrasound technique and provide a technical protocol for TLUS execution because it can be optimized for imaging and assessment of MUS, including identification of MUS configuration and recognition of common complications. This article provides example images of transobturator and retropubic slings and their associated complications, as visualized on TLUS. Accurate imaging and assessment of MUS is helpful in the evaluation of the patient presenting with symptoms suspicious for sling-related complications and in the planning of surgical revision.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Humanos , Slings Suburetrais/efeitos adversos , Ultrassonografia , Incontinência Urinária por Estresse/diagnóstico por imagem , Incontinência Urinária por Estresse/cirurgia
3.
Am J Obstet Gynecol ; 225(5): 564.e1-564.e9, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34480873

RESUMO

BACKGROUND: Pelvic pain is a debilitating condition that is common among women with pelvic floor disorders. Limited information is known about the impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery. OBJECTIVE: This study aimed to compare the outcomes after vaginal reconstructive surgery between women with and without preoperative pelvic pain. STUDY DESIGN: Baseline and postoperative data were analyzed from the "Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial." The multicenter trial involved women with anterior prolapse without symptoms of stress incontinence randomized to receive either a midurethral sling or sham incisions during a vaginal reconstructive surgery. Participants completed the visual analog scale adapted for suprapubic pain and Pelvic Floor Distress Inventory at baseline, 3 months, and 12 months. Preoperative pelvic pain was defined as a response of "5" or greater on pain on the visual analog scale or answering "moderately" or "quite a bit" on the Pelvic Floor Distress Inventory question, "Do you usually experience pain in the lower abdomen or genital area?" Outcomes and complication rates were compared between women with and without pelvic pain. RESULTS: The "Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial" participants included 112 women with pelvic pain (58 had a midurethral sling and 54 had sham incisions) and 212 women without pelvic pain (105 had a midurethral sling and 107 had sham incisions). Women who had a midurethral sling and pelvic pain were younger than women without pelvic pain (60.3±12.1 vs 65.1±8.6; P=.004). Women who had sham incisions and pelvic pain were more likely of Hispanic ethnicity than women without pelvic pain (27.8% vs 9.4%; P=.002). Patient improvement based on the Patient Global Impression of Improvement scale did not differ between arms. Women with pelvic pain had greater improvement on the visual analog scale pain scores after a surgical procedure at 3 months (-3.1±2.9 vs -0.4±1.6; P<.001) and at 12 months (-3.4±3.0 vs -0.6±1.6; P<.001) than women without pain, although their pain scores remained higher than those without preoperative pelvic pain at all time points (P<.001 for all). Similar improvements were found on the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. The differences observed were not affected by whether women were in the midurethral sling or sham arm of the trial. Postoperative urinary tract infection and incomplete bladder emptying did not differ between the groups. CONCLUSION: Women with preoperative pelvic pain experienced significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery and had similar subjective improvement postoperatively compared with women without preoperative pelvic pain. Reassuringly, the performance of a midurethral sling did not have an impact on the results.


Assuntos
Avaliação de Resultados da Assistência ao Paciente , Dor Pélvica/epidemiologia , Período Pré-Operatório , Slings Suburetrais , Prolapso Uterino/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Escala Visual Analógica
4.
Int Urogynecol J ; 32(11): 2937-2946, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34351464

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective was to examine the effect of the surgical removal of vaginally placed prolapse and incontinence mesh on sexual function. We hypothesize that patients with painful complications of mesh will experience improvement in dyspareunia and sexual function after mesh removal. METHODS: The eligible cohort consisted of 133 women who presented with a new onset of pain attributed to mesh-augmented incontinence or prolapse surgery and who elected to undergo mesh removal between 1 August 2012 and 1 July 2013. Sexual function symptoms were assessed before and after mesh removal surgery using the Pelvic Organ Prolapse and Urinary Incontinence Sexual Function Questionnaire short form (PISQ-12). Multivariate analysis was performed to identify predictors of improvement in dyspareunia. RESULTS: Ninety-four patients undergoing mesh removal completed a pre-operative questionnaire, 63 of whom also completed a post-operative questionnaire. After mesh removal, there was a nearly 50% reduction in the proportion of women reporting always experiencing post-operative pain with intercourse among those experiencing pre-operative pain. There was a statistically significant quantitative improvement in pain with intercourse after mesh removal based on mean change score of PISQ-12 question 5 "How often do you experience pain with intercourse?". In multivariate analysis, only history of vaginal delivery was associated with symptom improvement. CONCLUSION: Removal of transvaginal prolapse mesh is associated with improvement in self-reported dyspareunia based on a standardized question on a validated instrument in a small cohort of women. Although larger studies are needed to confirm the relationship between mesh-augmented surgeries and post-procedural dyspareunia, these data suggest that consideration of mesh removal is a reasonable step for patients with painful intercourse attributed to mesh-augmented prolapse and incontinence surgeries.


Assuntos
Dispareunia , Prolapso de Órgão Pélvico , Slings Suburetrais , Dispareunia/etiologia , Dispareunia/cirurgia , Feminino , Humanos , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Inquéritos e Questionários
5.
Obstet Gynecol Clin North Am ; 48(3): 449-466, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34416931

RESUMO

Synthetic midurethral slings offer optimal cure rates for the minimally invasive treatment of stress urinary incontinence in women. Performed via a retropubic or transobturator technique, midurethral sling approaches demonstrate comparable efficacy, with unique adverse event profiles. Single incision slings were introduced to minimize the complication of groin pain with full-length transobturator slings and enhance operative recovery. The earliest therapies for stress urinary incontinence including urethral bulking, retropubic colposuspension, and autologous sling offer alternative methods of surgical management without using synthetic mesh. These methods boast satisfactory efficacy with low rates of complications, and may be ideal for appropriately selected patients.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Feminino , Humanos , Dor Pélvica , Prevenção Secundária , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos
6.
Curr Opin Urol ; 31(5): 473-478, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397505

RESUMO

PURPOSE OF REVIEW: Stress urinary incontinence (SUI) is mostly seen after prostate surgery (radical prostatectomy or benign prostatic obstruction [BPO] relief). As new surgical techniques (laser, endoscopic enucleation) have been dramatically expanded in the past decade, a focus on postoperative SUI is necessary to provide the best management in this iatrogenic situation. RECENT FINDINGS: Surgery is the main option for curative management of SUI after BPO as no oral medication is recommended. Preoperative work-up is mandatory to assess concomitant bladder dysfunction. All available surgical options (peri-urethral injections, periurethral balloons, various male slings, and artificial urinary sphincter) have been studied, but the level of evidence is very low. In this setting, SUI after BPO management is widely inspired from post-PR SUI management, mainly based on clinical experience. SUMMARY: The available literature regarding persistent SUI after BPO relief is very scarce and further studies are warranted in this specific population.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Incontinência Urinária , Esfíncter Urinário Artificial , Humanos , Masculino , Prostatectomia/efeitos adversos , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia
7.
Neurourol Urodyn ; 40(8): 1955-1965, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34420231

RESUMO

AIMS: To assess the role of detrusor underactivity (DUA), diagnosed by different urodynamic criteria, on outcomes of women underwent middle urethral sling (MUS) for stress urinary incontinence (SUI). METHODS: In this prospective study, DUA criteria of women with SUI, naïve for SUI surgery, candidates to MUS were: I Pdet@Qmax ≤10 cm H2O and Qmax ≤12 mL/s (Jeong et al.) ii Pdet@Qmax<30 cm H2O and Qmax<10 mL/s (Abarbanel and Marcus) iii Pdet@Qmax<20 cm H2O and Qmax<15 mL/s and BVE < 90% (BVE criteria) iv Pdet@Qmax<20 cm H2O + Qmax (PIP1 Griffiths) Control group (CG) comprised non-DUA patients. Preoperative and at 2-years follow-up evaluation included physical examination, uroflowmetry, post void residual urine (PVR), ICIQ-FLUTS. RESULTS: 102 patients fulfilled 2-years controls. DUA rate range was 16.7% (BVE) - 53.9% (PIP1-Griffith). The POUR rate varied: 20% (PIP1-Griffith) - 35.3% (BVE), 10% in CG. Tape incision rate for POUR was 3.4% in DUA, 4.5% in CG. No patients had urinary retention at 2-years follow-up. In DUA groups, Qmax did not change significantly after surgery and PVR was low. SUI recurrence rate was 2.8% in DUA, 4.5% in CG. Preoperatively, urgency and post-micturition dribble were the most (82.4%) and the less (26.7%) reported symptoms, respectively. At follow-up, frequency was the most prevalent (56.1%), reduced sensation/bladder pain the less usual (23.1%). ICIQ-FLUTS scores were higher in DUA groups. CONCLUSIONS: DUA did not have a negative impact on MUS outcomes in a mid-term follow-up. Early postoperative voiding complication rates changed according to the type of DUA urodynamic criteria.


Assuntos
Slings Suburetrais , Bexiga Inativa , Incontinência Urinária por Estresse , Feminino , Humanos , Estudos Prospectivos , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/cirurgia , Urodinâmica
8.
Neurourol Urodyn ; 40(8): 1966-1971, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34435704

RESUMO

AIMS: To describe the changes in urodynamic parameters after Remeex® placement in women with recurrent stress urinary incontinence (rSUI) or intrinsic sphincteric deficiency (ISD) and to analyze a potential relationship between postoperative bladder outlet obstruction and a successful surgical outcome. METHODS: Retrospective analysis of those women who had undergone Remeex® placement due to rSUI or ISD in our department between 2000 and 2017. All patients underwent urodynamic evaluation before and after the surgery. If tension readjustment was required, postoperative urodynamics was performed after the last regulation, once the final continence status had been achieved. The female Bladder Outlet Obstruction Index (BOOIf) was calculated for all patients postoperatively. Obstruction was considered present if BOOIf was >18. Pre- and postoperative urodynamic variables were compared. Postoperative urodynamic changes were also compared between cured and noncured patients. RESULTS: A total of 205 women were included. After a follow-up of 89 ± 36 months, 165 women (80.5%) were continent. A significant impairment in the majority of the urodynamic parameters was observed. Mean postoperative BOOIf was -11.8 ± 21.5 in cured patients and -15.3 ± 23.1 in noncured patients (p = 0.365); 15 (9.1%) patients in the cured group had a postoperative BOOIf >18, whereas all (100%) patients in the noncured group had a postoperative BOOIf <18. CONCLUSIONS: Most urodynamic parameters may worsen after the Remeex® system placement. Postoperative urodynamic parameters may not differ substantially between cured and noncured patients, although a certain grade of bladder outlet obstruction could be related to postoperative continence status in some patients.


Assuntos
Slings Suburetrais , Obstrução do Colo da Bexiga Urinária , Incontinência Urinária por Estresse , Feminino , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Incontinência Urinária por Estresse/cirurgia , Urodinâmica
10.
Int Urogynecol J ; 32(10): 2737-2745, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34292341

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective was to identify incidence and risk factors of de novo urgency and detrusor overactivity (DO) following mid-urethral slings (MUS) in patients with urodynamic stress incontinence (USI) without urgency. METHODS: A total of 688 women between January 2004 and July 2017 were reviewed retrospectively. De novo urgency was established with a positive response to question 2 on the Urogenital Distress Inventory-6 questionnaire (UDI-6). Objective cure of USI is no involuntary urine leakage during filling cystometry and pad test < 2 g. Subjective cure of stress urinary incontinence (SUI) is defined as a negative response to question 3 on UDI-6. Multivariate logistic regression was used to identify risk factors for failure. RESULTS: Forty-four out of 688 women (6.4%) developed de novo urgency, with 16 out of 688 (2.3%) demonstrating de novo DO. Subjective cure for women with de novo urgency was significantly lower at 35 out of 44 (79.5%) compared with 556 out of 644 (86.3%) in those with no urgency (p < 0.001). Objective cure for women with de novo DO was significantly lower at 8 out of 16 (50%) compared with 599 out of 672 (89.1%) in those with detrusor stability (p < 0.001). Quality of life improved for all. Age ≥ 66 (OR, 1.23; 1.07), increased bladder sensation (OR, 4.18; 3.80), lower bladder capacity (OR, 5.28; 4.97), lower maximum urethral closure pressure (OR, 2.32; 5.20), and pad test > 100 g (OR, 1.08; 1.15) were independent risk factors for de novo urgency and DO. Diabetes (OR, 1.32) was an independent predictor of de novo urgency. CONCLUSION: Cure is significantly reduced in women who report symptoms of de novo urgency or demonstrate DO after MUS at 1 year. Independent risk factors include age ≥ 66, increased bladder sensation, lower bladder capacity, lower maximum urethral closure pressure, greater pad loss, and diabetes.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Feminino , Humanos , Qualidade de Vida , Estudos Retrospectivos , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Urodinâmica
11.
Obstet Gynecol ; 138(2): 199-207, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34237755

RESUMO

OBJECTIVE: To evaluate characteristics associated with treatment failure 1 year after midurethral sling in women with mixed urinary incontinence. METHODS: Four-hundred three women who participated in a randomized trial that compared midurethral sling and behavioral and pelvic floor muscle therapy (combined group) compared with midurethral sling alone for mixed incontinence with 1-year follow-up data were eligible for this planned secondary analysis. Overall treatment failure was defined as meeting criteria for subjective or objective failure or both. Subjective failure was defined as not meeting the minimal clinical important difference for improvement on the UDI (Urogenital Distress Inventory) total score (26.1 points). Objective failure was defined as not achieving 70% improvement on mean incontinence episodes of any type per day or having undergone any additional treatment for persistent urinary symptoms at 12 months postoperative. Logistic regression models for treatment failure were constructed. Independent variables included site and treatment group, and clinical and demographic variables based on bivariate comparisons (P<.2). Treatment group interaction effects were evaluated. RESULTS: One hundred twelve of 379 (29.6%) women had overall treatment failure, with 56 of 379 (14.7%) undergoing additional treatment but only two needing intervention for stress incontinence. Previous overactive bladder (OAB) medication (unadjusted odds ratio [OR] 2.19, adjusted odds ratio [aOR] 1.96, 95% CI 1.17-3.31); detrusor overactivity on cystometrogram (OR 2.25, aOR 2.82, 95% CI 1.60-4.97); and higher volume at first urge (OR 1.03, aOR 1.04, 95% CI 1.01-1.07) were associated with overall failure. Worse UDI-urgency scores were associated with failure, with an added interaction effect in the midurethral sling-alone group. CONCLUSIONS: Certain clinical and urodynamic variables are associated with treatment failure after midurethral sling in women with mixed urinary incontinence. Women with more severe urgency symptoms at baseline may benefit from perioperative behavioral and pelvic floor muscle therapy combined with midurethral sling. Overall, the need for additional urinary treatment was low and primarily for OAB. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01959347.


Assuntos
Slings Suburetrais , Falha de Tratamento , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Diafragma da Pelve/fisiopatologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/terapia , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária por Estresse/terapia , Incontinência Urinária de Urgência/cirurgia , Incontinência Urinária de Urgência/terapia , Urodinâmica/fisiologia
12.
Neurourol Urodyn ; 40(6): 1686-1694, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34196027

RESUMO

AIMS: This is a prospective cohort study comparing de novo lower urinary tract symptoms (LUTS) in subjects undergoing a retropubic mid-urethral sling who either did or did not develop a postoperative retropubic hematoma within 6 weeks of surgery. The secondary objective was to measure the incidence and prevalence of retropubic hematomas, and subject characteristics associated with retropubic hematomas. METHODS: Eligible subjects were recruited before undergoing a retropubic mid-urethral sling with or without concurrent pelvic reconstructive surgery. Validated urinary symptom questionnaires were completed before surgery and at 6 weeks postoperatively. An abdominal ultrasound was used to establish baseline lower urinary tract imaging. Ultrasound was repeated immediately after surgery and 6 weeks later to assess for the presence of retropubic hematomas. RESULTS: Ninety-four subjects were enrolled. Baseline urgency and frequency were measured in 35% (33/93) of subjects. At 6 weeks postoperatively, 2% (1/52) had de novo LUTS which were not associated with a retropubic hematoma at any time. Immediately after surgery, the incidence of retropubic hematomas was 17% (16/94) while the prevalence of retropubic hematomas 6 weeks after surgery was 4% (3/75). There was no significant difference in the change in hemoglobin before and after surgery between those with and without postoperative retropubic hematomas. CONCLUSIONS: There is no significant association with de novo LUTS and retropubic hematomas. Though there is a 17% incidence of retropubic hematomas detected immediately after surgery, those with hematomas who were not lost to follow-up resolved by the 6-week postoperative visit and is of unclear clinical significance.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Feminino , Hematoma/diagnóstico por imagem , Hematoma/epidemiologia , Hematoma/etiologia , Humanos , Estudos Prospectivos , Slings Suburetrais/efeitos adversos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia
13.
Eur J Obstet Gynecol Reprod Biol ; 263: 7-14, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34129963

RESUMO

OBJECTIVE: In July 2018, NHS England, introduced a pause on vaginal mesh, including the mid-urethral sling (MUS) for treatment of stress urinary incontinence (SUI). NICE guidelines recommend MUS as one of the surgical options for SUI. The aim of our study was to investigate healthcare professionals choices for surgical treatment of SUI, if conservative measures failed. STUDY DESIGN: The urogynaecology department at our tertiary level hospital devised a questionnaire using SurveyMonkey. This was distributed via email to 1058 healthcare professionals of different medical backgrounds. The surgical options were based on the NICE guideline and its patient decision making aid. We also used surgical information from the British society of Urogynaecology (BSUG) and British association of urological surgeons (BAUS). RESULTS: We received 214 responses of which 204 were complete. Twenty six percent of replies were from obstetricians and gynaecologists, 36 % had over 20 years experience and 79 % were female. Forty four percent had no previous knowledge of surgical options. Mid-urethral sling was the most popular choice based on description, success and specific complications. Urethral bulking agent was the only option that increased in popularity after describing complications. Twenty two percent would avoid surgery due to the risk of complications. CONCLUSION: This is the first study evaluating healthcare professionals surgical choice for SUI. Despite negative media publicity and NHS pause on MUS, it was still the most popular choice before and after informing of specific complications. The urethral bulking agent was the only surgical treatment, which increased in popularity after considering complications.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Atenção à Saúde , Inglaterra , Feminino , Humanos , Centros de Atenção Terciária , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos
14.
J Sex Med ; 18(7): 1167-1180, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34176756

RESUMO

BACKGROUND: Female sexual dysfunction, including female orgasm disorder, has been reported following mid-urethral sling (MUS) surgery to treat bothersome stress urinary incontinence. Anterior vaginal wall-female periurethral tissue (AVW-FPT) likely contains autonomic and sensory innervation involved in the female sexual response, and injury to these nerves may result from MUS implantation. AIM: To characterize, using fresh cadaveric tissue, autonomic and sensory nerves in AVW- FPT using immunohistochemistry (IHC), and to assess their proximity to an implanted MUS. METHODS: AVW-FPT was excised following careful dissection from four fresh cadavers. Prior to dissection, one cadaver underwent simulation of the MUS procedure by a urogynegologist, using a fascial sling. All samples were paraffin embedded, sectioned, and stained with hematoxylin. Serial sectioning and IHC were performed to identify nerves. IHC markers were used to characterize the sensory and autonomic innervation. OUTCOMES: IHC localization of autonomic and sensory nerve markers consistent with neural tissue within the region of MUS implantation. RESULTS: IHC of AVW-FPT using protein gene product 9.5 (PGP9.5), a general nerve stain, revealed innervation throughout the region targeted by the MUS implantation. More specifically, immunoreactivity for both autonomic (tyrosine hydroxylase, TH) and sensory (Nav1.8 and S100ß) nerves were found in close proximity (<1 mm) to the implanted MUS. In addition, a subset of S100ß positive nerves also showed immunoreactivity for calcitonin gene-related peptide (CGRP). Combining the IHC findings with the surgical simulation of the MUS implantation revealed the potential for damage to both autonomic and sensory nerves as a direct result of the MUS procedure. CLINICAL TRANSLATION: The identified autonomic and sensory nerves of the AVW-FPT may contribute to the female sexual response, and yet are potentially negatively impacted by MUS procedures. Given that surgeries performed on male genital tissue, including the prostate, may cause sexual dysfunction secondary to nerve damage, and that urologists routinely provide informed consent regarding this possibility, urogynaecologists are encouraged to obtain appropriate informed consent from prospective patients undergoing the MUS procedure. STRENGTHS & LIMITATIONS: This is the first study to characterize the sensory and autonomic innervation within the surgical field of MUS implantation and demonstrate its relationship to an implanted MUS. The small sample size is a limitation of this study. CONCLUSION: The present study provides evidence of potential injury to autonomic and sensory innervation of AVW-FPT as a consequence of MUS implantation, which may help explain the underlying mechanisms involved in the reported post-operative female sexual dysfunction in some women. Giovannetti O, Tomalty D, Gaudet D, et al. Immunohistochemical Investigation of Autonomic and Sensory Innervation of Anterior Vaginal Wall Female Periurethral Tissue: A Study of the Surgical Field of Mid-Urethral Sling Surgery Using Cadaveric Simulation. J Sex Med 2021;18:1168-1180.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Cadáver , Feminino , Humanos , Masculino , Estudos Prospectivos , Vagina/cirurgia
15.
Medicine (Baltimore) ; 100(24): e26257, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128853

RESUMO

BACKGROUND: There are 3 different types of mid-urethral sling, retropubic, transobturator and single incision performed for women with stress urinary incontinence. Prior studies comparing these three surgeries merely focused on the successful rate or efficacy. But nevertheless, what is more clinically important dwells upon investigating postoperative complications as a safety improvement measure. METHODS: A systematic review via PubMed, Ovid, and the Cochrane Database of Systematic Review and studies were applied based on the contents with clearly identified complications. Selected articles were reviewed in scrutiny by 2 individuals to ascertain whether they fulfilled the inclusion criteria: complications measures were clearly defined; data were extracted on study design, perioperative complications, postoperative lower urinary tract symptoms, postoperative pain, dyspareunia, and other specified late complications. RESULTS: A total of 55 studies were included in the systemic review. Perioperative complications encompassed bladder perforation, vaginal injury, hemorrhage, hematoma, urinary tract infection. There were postoperative lower urinary tract symptoms including urine retention and de novo urgency. Furthermore, postoperative pain, tape erosion/ extrusion, further stress urinary incontinence surgery, and rarely, deep vein thrombosis and injury of inferior epigastric vessels were also reported. CONCLUSIONS: Complications of mid-urethral sling are higher than previously thought and it is important to follow up on their long-term outcomes; future research should not neglect to address this issue as a means to improve patient safety.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Complicações Pós-Operatórias/etiologia , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Adulto , Feminino , Humanos , Metanálise como Assunto , Pessoa de Meia-Idade , Segurança do Paciente/normas , Melhoria de Qualidade , Projetos de Pesquisa , Slings Suburetrais/normas , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Bexiga Urinária/lesões , Vagina/lesões , Adulto Jovem
17.
Int J Clin Pract ; 75(10): e14527, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34125984

RESUMO

OBJECTIVE: Report the progress of the treatment of female stress urinary incontinence (SUI) in Brazil through vaginal and abdominal approaches and the direct costs by hospitalisation, using DATASUS-a public entity of the Strategic and Participative Management Secretary of Health Ministry, with the responsibility of collecting, processing, and disseminating public health information. DESIGN: Epidemiological study using the Brazilian Public Health Data Center System (DATASUS). PARTICIPANTS/MATERIALS, SETTING, AND METHODS: Data were collected on all hospital admissions associated with treatment from 2008 to 2019 from the DATASUS. We analysed the records of hospitalisations associated with an abdominal or vaginal surgical SUI treatment. RESULTS: The total number of procedures for the treatment of female SUI performed from 2008 to 2019 was 84.378, of which 70 238 were vaginal and 14 140 abdominal. There was an overall decrease in the number of SUI procedures in Brazil over the years analysed (F = 52.72; P < .0001); only exception was the South region (F = 1.38; P = .267). A declining trend was identified for the abdominal approach, with an increased trend of the vaginal approach (F = 170.11; P < .0001). A declining number of hospitalisation days was noted in the vaginal procedures (P = .002). Despite the fact that no differences were noted between abdominal and vaginal expenses (P = .054), hospital expenditure increased over the years for both vaginal and abdominal approaches, with no significant differences between either approaches. However, a statistically significant professional expenditure was observed in the abdominal approach (P < .001). Analysing hospitalisation and professional expenses, the total mean in the period was statistically higher for the abdominal approach (P < .0001). CONCLUSIONS: The number of procedures to treat female SUI in Brazil has decreased from 2008 to 2019. Total financial expenditure per procedure and length of hospital stay were both higher for the abdominal approach (Burch colposuspension). A preference for a vaginal approach (pubovaginal sling or midurethral sling) has increased significantly since 2008, and our study favours this approach.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Brasil/epidemiologia , Feminino , Humanos , Prevalência , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos
19.
Int Urogynecol J ; 32(10): 2841-2846, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34160634

RESUMO

INTRODUCTION AND HYPOTHESIS: The aim of this study is to evaluate the trends in stress urinary incontinence (SUI) surgery since the 2018 pause on use of the polypropylene (PP) mid-urethral sling (MUS) and to quantify the effect this has had on surgical training. METHODS: Two anonymous surveys were sent to all current urology trainees and to all consultant surgeons who specialise in stress urinary incontinence surgery. RESULTS: Prior to the pause, 86% (6 out of 7) of consultant urologists and 73% (11 out of 15) of consultant gynaecologists would "always"/"often" perform MUS for SUI. After that, 100% (22 out of 22) of consultants reported that they "never" perform MUS. There has been a modest increase in the use of urethral bulking agent (UBA) procedures among urologists, with 43% (3 out of 7) now "often" performing this, compared with 71% (5 out of 7) "never" performing it pre-2018. Trainee exposure to SUI surgery reduced by 75% between 2016 and 2020. Despite a ten-fold increase in UBA procedures logged by trainees, the decline in MUS has resulted in a major reduction in total SUI surgeries. Coinciding with this decrease in surgeries, there was a 56% reduction in trainees' self-assessed competence at SUI surgery. Thirteen percent of trainees are interested in specialising in Female Urology and those trainees had significantly greater exposure to SUI procedures during their training than those who did not (p = 0.0072). CONCLUSIONS: This study has identified a downward trend in SUI surgery, which is concerning for the undertreatment of females with SUI. A decline in SUI surgery training has resulted in reduced trainee confidence and interest in this subspecialty.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Urologia , Feminino , Humanos , Irlanda , Masculino , Uretra , Incontinência Urinária por Estresse/cirurgia
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