Abstract Context Surgery represents the mainstay of treatment for pelvic organ prolapse (POP). Among different surgical procedures, abdominal sacrocolpopexy (SC) is the gold standard for apical or ...multicompartmental POP. Research has recently focused on the role of robot-assisted sacrocolpopexy (RASC). Objective To conduct a systematic review on the outcomes of RASC. Evidence acquisition PubMed, Scopus, and Web of Science databases as well as ClinicalTrials.gov were searched for English-language literature on RASC. A total of 509 articles were screened; 50 (10%) were selected, and 27 (5%) were included. Studies were evaluated per the Grading of Recommendations, Assessment, Development, and Evaluation system and the European Association of Urology guidelines. Evidence synthesis Overall, data on 1488 RASCs were collected from 27 studies, published from 2006 to 2013. Objective and subjective cures ranged from 84% to 100% and from 92% to 95%, respectively. Conversion rate to open surgery was <1% (range: 0–5%). Intraoperative, severe postoperative complications, and mesh erosion rates were 3% (range: 0–19%), 2% (range: 0–8%), and 2% (range: 0–8%), respectively. Surgical-related outcomes have improved with increased experience, with an estimated learning curve of about 10–20 procedures. Laparoscopic SC is less costly than RASC, although the latter has lower costs than abdominal SC. Conclusions RASC is a safe and feasible procedure for POP; it allows the execution of complex surgical steps via minimally invasive surgery without medium- and long-term anatomic detriments. Further prospective studies are needed to confirm these findings. Patient summary We looked at the outcomes of robotic sacrocolpopexy for prolapse. We found that the use of robotic technology is safe and effective for the treatment of prolapse in women.
This article reviews the literature regarding the safety and efficacy of the use of a pulsed CO2 laser for the treatment of vulvovaginal atrophy (VVA).
Prospective observational studies have ...demonstrated histological changes after the use of pulsed CO2 laser vaginally in atrophic conditions. Increased collagen and extracellular matrix production has been reported together with an increase in the thickness of the vaginal epithelium with the formation of new papilla. Three different observational studies reported a significant improvement of VVA assessed subjectively (with a 10-point visual analogue scale) and objectively (using the Vaginal Health Index) after a cycle of three treatments of pulsed CO2 laser. Also sexual function (assessed with the Female Sexual Function Index) and quality of life (evaluated with the SF12 questionnaire) significantly improved. No complications or side-effects were reported during or after the laser procedure that was performed in an outpatient setting.
Increasing evidence with histological and clinical data supports the use of pulsed CO2 lasers in the treatment of VVA; however, no randomized control trial (sham versus treatment) has yet been produced and no data on the duration of therapy are currently available.
•Vaginal repair of isthmocele is a feasible, safe and effective technique.•Improving the thickness of healthy myometrium reduce the risk of uterine rupture/dehiscence.•Residual myometrial thickness ...is a predictor of uterine rupture risk during labor.•The systematic review retrieved very low-quality evidences.
Although vaginal repair of isthmocele is an effective and safe surgical option, data on reproductive and obstetrical outcomes are lacking. The aim of this study is to evaluate reproductive outcomes of women undergone vaginal repair of isthmocele. We also systematically reviewed the existent literature to offer a general view of available data.
Retrospective analysis of a database prospectively collected between January 2018 and January 2022 at San Raffaele Hospital, Milan, Italy. We included secondary infertile women with ultrasound documented isthmocele who undergone vaginal repair. Post-surgical clinical, reproductive and obstetric outcomes were recorded. An advanced systematic search of the literature up to January 2023 was conducted.
17 women were included. The mean age of the included patients was 37.2 ± 2.7 years. The median of previous caesarian sections was 1 (1–2). One intra-operative complication (5.9 %) was reported (bladder injury, repaired at the time of surgery). At follow up, bleeding was successfully treated in 8 women (8/10; 80 %). Pregnancy was obtained in 7 women (7/17; 41.2 %): the conception was spontaneous in 4 women (4/7; 57.1 %) and trough assisted reproductive technology in 3 patients (3/7; 42.9 %). The mean time from surgery to pregnancy was 10.8 (±6.7) months. One spontaneous abortion was reported (1/7; 14.3 %), while live birth was achieved in 6 pregnancies (6/7; 85.7 %). All deliveries were by caesarian section at a median gestational age of 37.5 (36–38.25) weeks. No obstetrical complications were reported. At the time of caesarean section, no defects on the lower segment were retrieved. Regarding the systematic research, among the 21 studies screened, only 4 articles were included in the review. Pregnancy rate was around 60–70 % with very few obstetrical complications (0.01 %) such as abnormal placentation or preterm birth.
Vaginal repair of isthmocele is a minimally invasive, safe and effective surgical approach in terms of postsurgical residual myometrium tichness. Systematic review to date has found low-quality evidences on the impact of vaginal surgery in the management of secondary infertility and obstetrics outcomes in women with isthmocele.
Highlights • The genitourinary syndrome of menopause involves clinical signs and symptoms in both the genitals and the lower urinary tract. • In our study, Vaginal Maturation Value and Vaginal Health ...Index Score showed signs of improvement after CO2 -laser therapy. • Indications of alleviation of symptoms in the genitals and lower urinary tract were noted. • CO2 -laser therapy might be beneficial for the female sexual function and quality of life.
Pediatric obesity is associated with an increased risk of morbidity during childhood. Alongside the well-known metabolic syndrome, during the last decades scientific research has deeply investigated ...the risk of sleep breathing disorders. Among them, obstructive sleep apnea (OSA) commonly affects children with obesity. The presence of OSA heightens the risk of metabolic impairment and weight gain. Therefore, it deserves specific treatment. However, polysomnography (PSG) is not always available in clinical settings, and alternative diagnostic tools are needed. This study aimed to investigate the predictivity of the pediatric sleep questionnaire (PSQ) for moderate-to-severe OSA diagnosis. Children and adolescents with obesity and suspected OSA with available full-night cardiorespiratory PSG were retrospectively enrolled. Receiver operating curve analysis was performed to test the ability of PSQ in predicting moderate-to-severe OSA (AHI > 5 episode/h). The final sample included 60 children and adolescents. The PSQ showed a good area under the curve (AUC) of 0.88 (95% CI 0.78−0.98, p < 0.0001). Moreover, a value above or equal to 0.65 showed an 80% sensitivity and 100% specificity for moderate and severe OSA. These findings suggest that PSQ might be used in clinical settings with limited access to PSG for stratifying disease severity and for selecting children with urgent need of sleep study.
This work concerns the study of the effective balance equations governing linear elastic
electrostrictive composites
, where mechanical strains can be observed due to the application of a given ...electric field in the so-called
small strain and moderate electric field regime
. The formulation is developed in the framework of the
active elastic composites
. The latter are defined as composite materials constitutively described by an additive decomposition of the stress tensor into a purely linear elastic contribution and another component, which is assumed to be given and quadratic in the applied electric field when further specialised to electrostrictive composites. We derive the new mathematical model by describing the effective mechanical behaviour of the whole material by means of the
asymptotic
(periodic)
homogenisation
technique. We assume that there exists a sharp separation between the
micro-scale
, where the distance among different sub-phases (i.e. inclusions and/or fibres and/or strata) is resolved, and the
macro-scale
, which is related to the average size of the whole system at hand. This way, we formally decompose spatial variations by assuming that every physical field and material property are depending on both the macro-scale and the micro-scale. The effective governing equations encode the role of the micro-structure, and the effective contributions to the global stress tensor are to be computed by solving appropriate linear-elastic-type cell problems on the periodic cell. We also provide analytic formulae for the electrostrictive tensor when the applied electric field is either microscopically uniform or given by a suitable multiplicative decomposition between purely microscopically and macroscopically varying components. The obtained results are consistently compared with previous works in the field, and can pave the way towards improvement of smart active materials currently utilised for engineering (possibly bio-inspired) purposes.
Adrenergic receptors of the β
3
-subtype (β
3
-ADRs) seem to represent a new target for a more effective pharmacological treatment of overactive bladder (OAB), a wide spread urinary disorder. A ...promising opportunity for OAB therapy might rely on the development of selective β
3
-ADR agonists, but an appropriate preclinical screening, as well as investigation of their pharmacological mechanism(s), is limited by poor availability of human bladder samples and of translational animal models. In this study, we used the porcine urinary bladder as experimental tool to ascertain the functions of β
3
-ADRs in the control the parasympathetic motor drive. Tritiated acetylcholine (
3
H-ACh), mainly originated from neural stores, was released by electrical field stimulation (EFS) in epithelium-deprived detrusor strips from pigs bred without estrogens. EFS produced simultaneously
3
H-ACh release and smooth muscle contraction allowing to asses neural (pre-junctional) and myogenic (postjunctional) effects in the same experiment. Isoprenaline and mirabegron produced on the EFS-evoked effects a concentration-dependent inhibition antagonized by L-748,337, a high selective β
3
-ADR antagonist. The analysis of the resultant pharmacodynamic parameters supports the notion that in pig detrusors, as well as in previously described human detrusors, the activation of inhibitory β
3
-ADRs can modulate neural parasympathetic pathways. In such inhibitory control, the involvement of membrane K
+
channels, mainly of the SK type, seems to play a pivotal role similarly to what previously described in humans. Therefore, the isolated porcine detrusor can provide a suitable experimental tool to study the mechanisms underlying the clinical efficacy of selective β
3
-ADR compounds for human use.
We present a mathematical model of the compression of multicellular aggregates, and we specialise it to a compression-release test that is well known in the biological literature. Within the adopted ...mechanical setting, a multicellular aggregate is studied as a biphasic system consisting of a soft solid porous medium saturated with an interstitial fluid. In particular, together with the deformation of the considered aggregate, the characterisation of the model outlined in this work relies on four fundamental features. First, by assuming the interstitial fluid to be macroscopically inviscid and to evolve according to the Darcian regime, we resolve its flow and determine the associated time dependent pressure distribution. Second, we focus our attention on the remodelling of the compressed aggregate, that is, on the rearrangement of its internal structure in response to the external loads applied to it. Specifically, we look at the way in which such a rearrangement is induced by the considered experiment and at how it affects the mechanical behaviour of the aggregate. Moreover, we introduce a remodelling-dependent permeability tensor with the purpose of visualising a more direct influence of remodelling on the dynamics of the aggregate’s interstitial fluid. Finally, we resolve the interactions exchanged between the aggregate and the compressive apparatus. This task necessitates the formulation of an appropriate contact problem, thereby calling for the description of the evolution of the area through which the aggregate and the apparatus exchange mechanical interactions. In particular, the continuity conditions to be applied on such a contact area are discussed. Our numerical simulations show the role played by the different phenomena accounted for in the model and the overall dynamics of the aggregate within the considered experiment.
This study aimed to explore the current situation and existing issues regarding the management of vulvovaginal atrophy (VVA) or the genitourinary syndrome of menopause (GSM). A nationwide web-based ...questionnaire survey was conducted among 1,031 Japanese women aged 40 years or older.
Eligible women were asked to complete a questionnaire about how they dealt with their symptoms and how satisfied they were with their coping methods.
Of those highly conscious of their GSM symptoms (n = 208; 20.2%), 158 had sought medical consultation (15.3%), with only 15 currently continuing to seek consultation (11.5%). Of the specialties consulted, gynecology was the most frequently consulted (55%). Furthermore, those unwilling to seek medical consultation despite their symptoms accounted for the greatest proportion (n = 359; 34.8%), with 42 (23.9%) having never sought consultation. Topical agents, e.g., steroid hormone ointments/creams, were the most frequent treatments provided by the clinics (n = 71; 40.3%), followed by oral and vaginal estrogens (n = 27; 15.5%), suggesting that estrogen therapy was not the first choice of treatment at the clinics. While 65% of patients treated at the clinics reported satisfaction with the treatments, this was inconsistent with the fact that many were reported to have remained untreated and very few continued with treatment.
Survey results suggest that GSM, including VVA, remains underdiagnosed and undertreated in Japan. Medical professionals should deepen their understanding of GSM and raise their level of care to select the appropriate treatment for the condition.
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