In this video we present a case of rectal injury, which occurred during laparoscopic mesh removal following sacrocervicopexy. Four years after sub-total hysterectomy with laparoscopic ...sacrocervicopexy, a 64-year-old patient still suffered from intense proctalgia and pain while sitting. On physical examination, intense pain could be triggered by palpating the left aspect of the levator ani muscle, raising the suspicion of an association with the mesh and leading to the decision for its removal. The left posterior arm of the mesh was removed completely laparoscopically. During this procedure, a rectal lesion was diagnosed and immediately repaired by a double layer of interrupted sutures. There was an immediate and complete resolution of the symptoms after surgery, with no short-term prolapse recurrence or postoperative complications. Laparoscopy appears to be an efficient approach to mesh excision. A high level of alertness to recognize intraoperative injuries is warranted.
Nenadzorovano uhajanje urina ali urinska inkontinenca je disfunkcija medeničnega dna in se opredeljuje kot vsako nehoteno uhajanje urina. Na vzrok inkontinence vpliva več dejavnikov. Po osnovnih ...patofizioloških mehanizmih nastanka se v grobem deli na stresno, urgentno, mešano in t.i. »overflow« urinsko inkontinenco. Osnovna obravnava bolnice je kompleksna, saj lahko na simptome in znake teh motenj vplivajo ginekološke, internistične, urološke in nevrološke bolezni. V članku na osnovi literature in evropskih smernic prikazujemo algoritem zdravljenja urinske inkontinence s poudarkom na stopenjskem zdravljenju in na pomenu konservativnega zdravljenja. Šele po izčrpanih možnostih konservativnega zdravljenja svetujemo bolnici kirurški poseg.
Abstract
Background
Vitamin D is vital for skeletal integrity as well as optimal muscle work. High incidence and prevalence of vitamin D deficiency as well as pelvic organ prolapse are found in ...postmenopausal women, thus raising the question of whether the entities could be related.
Methods
We compared 50 postmenopausal women aged 50 to 75 years with pelvic organ prolapse (POP) with 48 women of same age without POP. The clinical assessment of the disorder was performed using the Pelvic Organ Prolapse Quantification system (POP-Q). An anamnestic questionnaire was filled out by the participants on their anthropometric data, life habits, reproductive history, previous and actual diseases. A blood sample was collected for determination of 25-OH-vitamin D as well as calcium and phosphorus concentrations.
Results
The group with POP and the control group were comparable in body mass index, physical activity, life habits and general health, but differed significantly in parity (being higher in POP) and vitamin D blood level concentrations, being lower in POP patients. A significantly higher prevalence of vitamin D deficiency (25-OH-vitamin D < 50 nmol/l) was found in the POP group compared to controls. Taking into account the confounding variables the logistic regression model confirmed the significant role of vitamin D for POP.
Conclusions
Vitamin D deficiency might be an important systemic factor associated to pelvic organ prolapse. The determination of vitamin D levels in postmenopausal women and replenishing its deficiency might also be of importance for the pelvic floor.
Izhodišče: Ocena razširjenosti raka endometrija pred operaciji s slikovnimi metodami ni zanesljiva. Od ocene je odvisno, ali naj kirurško zdravljenje vključuje pelvično limfadenektomijo ali ne. ...Biopsija varovalne bezgavke lahko varno nadomesti radikalno pelvično limfadenektomijo pri bolnicah z nizkim in zmernim tveganjem za ponovitev bolezni.Metode: Od januarja 2016 do junija 2017 je bilo na Ginekološki kliniki v Ljubljani v pregled začetnih kliničnih rezultatov ob uvedbi biopsije v varovalni bezgavki v rutinsko klinično prakso vključenih 35 bolnic. Beležili smo zanesljivost histološke in ultrazvočne ocene pred operacijo ter stopnjo uspešne kirurške detekcije v varovalni bezgavki s cervikalno aplikacijo zelenila indocianin. Vsa odstranjena tkiva so bila poslana na histološko preiskavo z barvanjem po metodi hematoksilin in eozin (H&E).Rezultati: Enostranska uspešnost kirurške detekcije varovalne bezgavke je bila 85,7 % (75–93 %), obojestranska pa 80,0 % (63–92 %). Varovalna bezgavka je bila histološko pozitivna v dveh primerih. Ultrazvočna ocena invazije v miometrij je imela občutljivost 100 % (15,8–100 %) in specifičnost 78,9 % (54,4–93,9 %), ultrazvočna ocena invazije v stromo materničnega vratu pa le 33 % (0,8–90,6 %) občutljivosti in 94,4 % (72,7–99,8 %) specifičnosti. Ocena histološke stopnje diferenciacije je bila po operaciji višja (angl. upgrading) v 5,7 %, nižja (angl. downgrading) pa v 8,6 %.Zaključek: Odstranjevanje varovalne bezgavke omogoča individualnejši pristop k zdravljenju bolnic z rakom endometrija in varnejšo opustitev pelvične limfadenektomije pri bolnicah z nizkim in zmernim tveganjem za ponovitev bolezni. Za dokončno umestitev v smernice zdravljenja bodo v našem prostoru potrebne dodatne izkušnje glede izbire bolnic, sledenja kakovosti kirurške obravnave in nujna uvedba res poadrobnega histološkega pregleda – t. i. ultrastaginga (angl. ultrastaging) odstranjene varovalne bezgavke.
Vaginal length after a laparoscopic sacropexy Drusany Starič, Kristina; Lukanović, Adolf; Barbič, Matija ...
Urogynaecologia international journal,
04/2019, Letnik:
31, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Vaginal shortening after surgical treatment of pelvic organ prolapse is associated with dyspareunia, which negatively affects women’s sexual life as well as their psychosocial well-being. The aim of ...the study is to determine the vaginal length in women with high-grade pelvic organ prolapse treated with laparoscopic sacropexy. In the prospective study we included 22 women with high-grade prolapse of the uterus or vagina that were treated. They underwent a gynaecological examination with a measurement of the vaginal length, as well as the evaluation of the degree of prolapse prior to the procedure (laparoscopic sacropexy). The second measurement and evaluation of the vaginal length during the follow-up examination between 6 to 12 weeks after surgery was done. The control group included 23 healthy women, without genital prolapse. There was no statistically significant difference in the mean vaginal length before and after surgery in the group of treated women.
Objective
To evaluate improvement of stress urinary incontinence (SUI) and functional status of the urethra after autologous skeletal‐muscle derived cell (aSMDC) implantation.
Methods
Phase I–II, ...open, non‐randomized, single‐center study of ultrasound guided aSMDC implantation (dosed at 0.2 × 106 cells/2 mL) into the external urethral sphincter to treat SUI.
Results
A total of 38 patients were treated and followed for 2 years. SUI measured by Incontinence Episode Frequency score, short pad test, quality of life, patient's and clinician's perception significantly improved and remained improved after 2 years. However, urodynamic urethral properties in general did not improve at 1‐year after treatment. Subgroup analysis revealed that addition of an adjuvant functional electrical stimulation therapy discontinued 4 weeks after injection in the compliant group, gave better urodynamic values and maintained the long‐term SUI improvement at 2 years.
Conclusion
The aSMDC injection was safe and well‐tolerated by patients. The status of SUI improved and with it the quality of life of patients, even if this was not necessarily reflected in the urodynamic urethral properties. Electrical stimulation, as an adjuvant therapy, could have an essential role in the success of the therapy.
Clinical registration
Clinical study was registered under Eudra‐CT number: 2010‐021867‐34 at European Clinical Trial Database (EudraCT), accessible at: EudraCT (europa.eu).
As SUI maintains improved 2 years after aSMDC injection, more in ES compliant group, functional urethral properties measured by urodynamics generally do not change.
Introduction and hypothesis
Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is a condition with an underdeveloped or absent vagina and uterus due to embryological growth failure of the Müllerian ...ducts. Many techniques have been described to construct a neovagina with an acceptable depth that allows penetrative intercourse. This is a step-by-step video tutorial on the Wharton–Sheares–George surgical technique for vaginoplasty in patients with MRKH syndrome.
Method
With Wharton–Sheares–George vaginoplasty, the rudimentary Müllerian ducts are incrementally dilated by pushing Hegar dilators in the direction of the pelvic axis, and the resulting median raphe is then intersected using diathermy. As a result, a neovagina is created and an estriol-coated vaginal mold is inserted for 3 days. The patient receives comprehensive discharge instructions, a self-dilation program three times a day, and a monthly follow-up.
Results
A 3-month follow-up showed a high subjective degree of satisfaction with surgery and sexual satisfaction in both patients.
Conclusion
Wharton–Sheares–George vaginoplasty is a safe and efficient technique for creating a neovagina for patients with MRKH syndrome.
Introduction and hypothesis
Bulking agents are a minimally invasive treatment option for women with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI). Recurrent ...SUI is a major challenge for most clinicians because there is little evidence in the literature on the best option after midurethral sling (MUS) failure.
Methods
Bulkamid® (Contura International A/S), a urethral bulking agent, is a homogenous gel without particles, consisting of a polyacrylamide hydrogel that is nonbiodegradable.
Results
In this video case report, we demonstrate the Bulkamid® injection procedure. This procedure can be carried out as an office-based procedure under local anesthesia, with no down time and only minor possible complications.
Conclusions
We consider it a valid option for patients with recurrent or persistent SUI after failed MUS surgery.
Stress urinary incontinence (SUI) is a common complaint in women after childbirth. It affects their quality of life and sexual satisfaction and is one of the major reasons for gynaecological surgery. ...There is a need for effective non-invasive treatment alternatives. The aim of this study was to evaluate the efficacy and safety of non-ablative Er:YAG laser therapy in the treatment of SUI and improvement of sexual gratification in parous women.
114 premenopausal parous women with SUI were randomized in two groups of 57 women; a laser intervention group and sham group. Both groups were treated according to the IncontiLase® clinical treatment protocol for SUI with non-ablative thermal-only Er:YAG laser, except that there was no energy output when treating the sham group. Patients were blinded to the allocation. At baseline and 3 months after treatment patients were clinically examined, answered questionnaires for SUI severity and sexual function assessment and their pelvic floor muscle (PFM) function was assessed with perineometry. Validated International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF) was used as the primary outcome measure. The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and The Female Sexual Function Index (FSFI) were used to assess the sexual function. Patients were monitored for discomfort and side-effects during treatment and follow-up period.
3 months after treatment the ICIQ-UI SF (p < 0.001), PISQ-12 (p = 0.014) and FSFI (p = 0.025) scores were significantly more improved in the laser group than in the sham control group. All perineometry variables improved in the laser group after treatment; duration and maximum pressure had statistically significantly better improvement than the sham group, whereas average pressure did not. 21% of laser treated patients were dry (ICIQ-UI SF = 0) at follow up compared to only 4% of the sham control patients. No serious adverse effects were observed or reported. The treatment was well tolerated by patients.
The non-ablative Er:YAG laser therapy improves the impact of SUI symptoms on quality of life and sexual function in premenopausal parous women significantly better than placebo. It provides a promising minimally-invasive safe treatment alternative for SUI.
Introduction and Hypothesis
The primary objective is to identify determinants of dissatisfaction after surgical treatment of vaginal prolapse ± rectal prolapse, using laparoscopic mesh ...sacrohysteropexy (LSH) or sacrocolpopexy (LSC) ± ventral mesh rectopexy (VMR). The secondary objective is the evaluation of complications and objective/subjective recurrence rates.
Methods
The study performed was a single-surgeon retrospective review of prospectively collected data. LSH/LSC ± VMR were performed between July 2005 and September 2022. Primary investigated outcome was patients’ satisfaction, assessed using the Patient Global Impression of Improvement (PGI-I) score and the bother visual analog scale (VAS) obtained postoperatively (at a 1-month interval and on a 6-month/yearly basis thereafter). We looked for a correlation between the level of satisfaction (as reflected by the VAS) and potential determinants.
Results
There were 355 patients with a mean age of 62 ±12 years. Nearly all the patients (94.3%) had a stage 3 or 4 prolapse according to the POP-Q classification. The mean postoperative bother VAS was 1.8, with only 12.7% of patients reporting a bother VAS score ≥ 3/10, indicating a dissatisfaction. PGI-I showed improvement in the vast majority of patients (96.4% scoring 1 to 3). Patients with anal incontinence preoperatively scored higher on the bother VAS postoperatively (r=0.175,
p
< 0.05). The use of a posterior arm mesh (for posterior vaginal prolapse) correlated with better satisfaction overall (r= −0.178,
p
= 0.001), whereas the performance of VMR was associated with a bothering sensation (r = 0.232,
p
< 0.001). A regression analysis confirmed the impact of posterior mesh and VMR on satisfaction levels, with odds of dissatisfaction being 2.18 higher when VMR was combined with LSH/LSC.
Conclusions
Posterior mesh use improves patient satisfaction when the posterior compartment is affected. In patients with concomitant vaginal and rectal prolapse, combining VMR with anterior LSC/LSH appears to negatively impact patients’ satisfaction. Preoperative anal incontinence was demonstrated to be a risk factor for postoperative dissatisfaction.
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