Aims
Primary outcome was to evaluate patients' satisfaction after being treated with bulk injection therapy polydimethylsiloxane Urolastic (PDMS‐U) for stress urinary incontinence (SUI). Secondary ...outcomes were: subjective cure, objective cure, severity of SUI symptoms, complications, reintervention rate, and disease‐specific quality of life. Furthermore, to determine if outcomes worsened during time‐after‐treatment (time‐frames: 0‐12, 13‐24, and ≥25 months).
Methods
In a cross‐sectional design, patients treated with PDMS‐U were recruited for hospital revisit. The primary outcome, patients' satisfaction, was assessed by the surgical satisfaction questionnaire. Subjective cure, objective cure, and severity of symptoms were assessed by the patients global impression of improvement, standardized cough stress test, and Sandvik severity scale, respectively. Medical charts and face‐to‐face interviews were used to determine complications and reinterventions.
Results
About 110 patients participated, 87 revisited the hospital. Median follow‐up was 25 months (interquartile range: 14;35 months). Patients' satisfaction rate was 51%. Subjective and objective cure were respectively 46% and 47%. Most prevalent complications were: urinary retention (22%), pain (15%), and dyspareunia (15%). Exposure and erosion occurred in 7% and 5%, respectively. Reintervention rate of reinjection and excision of bulk material was 6% and 18.0%, respectively. Objective cure significantly worsened during time‐after‐treatment (P = < .05).
Conclusions
About half of the patients being treated with PDMS‐U were satisfied and subjectively cured 2 years after treatment, although the majority still experienced symptoms of SUI. Most complications were mild and transient, however, in 18% excision of bulk material was indicated for severe or persistent complications such as pain, exposure, or erosion.
Data of 101 patients with retained products of conception (RPOC), treated with office hysteroscopy (OH) from 2012 to 2015 at the University Medical Centre Ljubljana were analysed. Patients with >30 ...mm RPOC thickness or strong vascularisation on ultrasound (US) were excluded. Procedures were successfully completed in 94/101 (93%). Mean duration was 18 min (4-60), patient pain estimation with VAS was 2.3 (0-8). No intraoperative complications > Grade II according to Clavien-Dindo classification occurred. Uncompleted cases were safely referred to procedures in general anaesthesia. Follow-up after one month was performed in 78/101 (77%) patients with OH (69) or US (9). Only three patients reported endometritis, three cases of intrauterine adhesions were related to curettage or pre-existing adhesions. We compared preoperative findings of completed and uncompleted cases. Larger size of RPOC and the presence of irregular tissue-myometrial border on US was statistically significantly higher in uncompleted OH (p<.05); mild vascularisation and β-hCG levels up to 80 U/L did not affect the outcome.
Impact statement
What is already known on this subject? In the last three decades research has focussed on comparing hysteroscopic resection (HR) to traditional dilation and curettage in removing retained products of conception (RPOC). Office hysteroscopy (OH) without hospitalisation or general anaesthesia enables women to return to their daily routine immediately (especially desired by breastfeeding mothers) and is used where available, yet there is little published data to evaluate its role in the management of RPOC.
What do the results of this study add? To the best of our knowledge, this article is unique in addressing success, safety and possible limiting factors of OH in removing placental polyps. According to our findings, OH is highly successful (93%), safe, and well tolerated in removing RPOC up to 30 mm in thickness and with no or minimal vascularisation on ultrasound. Thorough follow-up (68% with OH, 9% with US after 1 month) adds to strength of data.
What are the implications of these findings for clinical practice and/or further research? Removing large and vascularised RPOC can be a very demanding procedure, yet a majority of patients might benefit from an outpatient approach. Prospective studies on limiting factors and more data on long term reproductive outcomes are needed to fully compare OH to other methods of removal.
Outcome of laparoscopic sacropexy with polypropilene mesh Starič, Kristina Drusany; Lukanović, Adolf; Norčič, Gregor ...
European journal of obstetrics & gynecology and reproductive biology,
November 2016, Letnik:
206
Journal Article
Background: Preoperative assessment of the depth of endometrial cancer invasion is not reliable. Surgical treatment consists of hysterectomy and pelvic lymphadenectomy. Sentinel lymph node (SLN) ...biopsy can replace radical pelvic lymphadenectomy in patients with a low and intermediate risk of disease recurrence. Methods: From January 2016 to June 2017, 35 patients were included in the clinical audit of SLN biopsy at the UMC Ljubljana’s Division of Gynaecology and Obstetrics. We recorded the reliability of the preoperative histological and ultrasound estimates and the degree of surgical detection of the SLN with an intracervical application of indocyanine green (ICG). All the removed tissues were sent for histological examination by hematoxylin and eosine (H & E) staining method. Results: Unilateral and bilateral success rate of the surgical detection of SLN was 85.7 % (75 %–93 %) and 80.0 % (63 %–92 %) respectively. The sentinel lymph node was histologically positive in two cases. Ultrasound assessment of myometrial invasion had 100 % (15.8 %–100 %) sensitivity and 78.9 % (54.4 %–93.9 %) specificity, whereas the ultrasound assessment of cervical stromal invasion only had 33 % (0.8 %–90.6 %) sensitivity and 94.4 % (72.7 %–99.8 %) specificity. Postoperative histological differentiation was upgraded in 5.7 % and downgraded in 8.6 % of cases. Conclusion: SLN biopsy at the time of surgery allows a personalized treatment approach in patients with endometrial cancer and a secure abandonment of pelvic lymphadenectomy in patients at low and intermediate risk of recurrence. Its final inclusion in the treatment guidelines will require additional experience regarding patient selection, surgical treatment quality tracking, as well as urgent implementation of histological ultrastaging of the removed SLN.
In melanotrophs, neuroendocrine cells from the intermediate lobe of the rat pituitary gland, glutamate causes a rise in intracellular Ca
2+ suggesting the presence of ionotropic NMDA and non-NMDA ...AMPA/K receptors. However, the Ca
2+-dependent release of the major peptide hormone, α-melanocyte stimulating hormone (α-MSH), in response to glutamate stimulation has not been studied yet in this cell model. Significant spontaneous secretion of the peptide, which results in hormone deposits on the perimeter of the cells, has been confirmed by using confocal microscopy. Co-staining with a membrane area marker FM 1-43, which co-localized with the immunocytochemically marked hormone deposits, showed that fusion-competent sites on the plasma membrane coincided with secretion-competent sites. Stimulation of the cells with glutamate and high K
+ saline induced a significant increase in the plasma membrane area covered with α-MSH deposits compared to control cells incubated with glutamate and CNQX, a glutamate channel blocker. The optical approach to monitor the secretory activity of a single neuroendocrine cell revealed that glutamate stimulates the release of α-MSH at distinct exocytotic membrane domains only.
Pelvic organ prolapse and stress urinary incontinence remain a clinical challenge as they have unclear pathophysiology and suboptimal treatments. These common pelvic floor disorders (PFD) are ...characterized by the weakening of the pelvic floor supportive tissues that are directly related to their biomechanical properties. Characterizing the biomechanical properties of the pelvic floor tissues has been the focus of recent studies and researchers are using tools that are not always well understood by clinicians. Therefore, the aim of this review is to provide an overview of the most used methods to test the passive biomechanical properties of the human pelvic floor tissues. We also summarize recent findings from studies looking into the passive properties of the pelvic floor in pelvic floor disorders using the ex vivo tensile test and emerging in vivo techniques. Together, these studies provide valuable quantitative information about the different biomechanical properties of the supportive tissues of the pelvic floor under normal and pathological conditions. Results from ex vivo tests provide valuable data that needs to be correlated to the in vivo data and the clinical manifestations of the symptoms of the PFD. As more research is conducted we will obtain an enhanced understanding of the effect of age, PFD, and treatments on the biomechanical properties of the pelvic floor. This information can contribute to better identify individuals at risk, improve clinical diagnosis, and develop new treatments to advance clinical practice.
Pelvic floor disorders are characterized by the weakening of the pelvic floor tissues that is directly related to their biomechanical properties. Such properties change with age, disease, and treatments. This review provides the physician with an overview of the most used methods to investigate the passive biomechanical properties of the human pelvic floor tissues in the context of pelvic floor disorders.
Sling Surgery for Female Incontinence Sievert, Karl-Dietrich; Abufaraj, Mohammad; Kernig, Karoline ...
European urology supplements : official journal of the European Association of Urology,
April 2018, 2018-04-00, Letnik:
17, Številka:
3
Journal Article
The pelvic floor is at an increased risk of damage during the lifespan of women. Pregnancy, vaginal delivery, aging, menopause, previous pelvic surgery, and lifestyle factors have a negative ...influence on the connective tissue and muscular components of the pelvic floor leading to urinary incontinence (UI). Pregnancy and vaginal delivery have been identified as the most important risk factors for incontinence. Cystocele, rectocele, uterine, vault prolapse, and/or incontinence can occur due to lacerations of the connective tissue support at different levels. Moreover, muscular damage of the levator complex can lead to widening of the levator hiatus, giving way to the descent of pelvic organs resulting in UI. Although some genetic abnormalities have been identified, their clinical implications remain unclear. Diagnostic evaluations should be performed in accordance with established evidence-based guidelines. Although short-term results of single-incision midurethral slings indicate similar efficacy to conventional midurethral slings, their long-term outcome is still not determined. Scientists continue to investigate the exact causes of stress UI as well as the optimum substitute material using the best surgical reconstructive approach. The recent European Association of Urology consensus statement underlines an imperative requirement for an optimal solution using minimal amount of material related to the indication and higher competence of surgeons for this surgery. High-quality trials with a longer follow-up are currently an unmet need.
Urinary incontinence has multifactorial etiology that affects a significant number of women worldwide. This review article provides clinicians with the pathophysiological background of urinary incontinence as well as possible treatment options when counseling patients. Patients must be clearly informed of the various options and potential risks of each therapy based on European Association of Urology and European Urogynecological Association guidelines.
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