Introduction and hypothesis
A terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological ...(grafts) materials in female pelvic floor surgery.
Methods
This report on the above terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many expert external referees. An extensive process of 11 rounds of internal and external review took place with exhaustive examination of each aspect of the terminology and classification. Decision-making was by collective opinion (consensus).
Results
A terminology and classification of complications related directly to the insertion of prostheses and grafts in female pelvic floor surgery has been developed, with the classification based on category (C), time (T) and site (S) classes and divisions, that should encompass all conceivable scenarios for describing insertion complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids (
www.icsoffice.org/complication
).
Conclusions
A consensus-based terminology and classification report for prosthess and grafts complications in female pelvic floor surgery has been produced, aimed at being a significant aid to clinical practice and research.
An increasing number of scientists have studied the molecular and biochemical basis of pelvic organ prolapse (POP). The extracellular matrix content of the pelvic floor is the major focus of those ...investigations and pointed for potential molecular markers of the dysfunction. The identification of women predisposed to develop POP would help in the patients’ management and care. This article includes a critical analysis of the literature up to now; discusses implications for future research and the role of the genetics in POP.
This study is designed to evaluate the histological effects of uropathogenic Escherichia coli (UPEC) infection in the urinary bladder of female rabbits and compare the differences between the dome ...and trigone. Bacterial cystitis was induced in 13 female rabbits by transurethral inoculation of UPEC into the urinary bladder. Eight animals served as controls. Urine samples were collected by catheterization and cultured for bacterial growth after 12 and 24 hours then every 48 hours. Infection was defined as ≥(1X10
5
) colony-forming unit/ml of UPEC in the first two urine samples. Bladder dome and trigonal specimens were examined by light and scanning electron microscopy eight days after infection. There was a sustained increase in bacterial count, with urethral bleeding and rabbit weakness suggesting bladder colonization in the 10/13 study group (77%). Infection was not demonstrated in two animals and was spontaneously cleared in the third after 48 hours. No control animals developed an infection. In infected rabbits (n = 10), the dome showed inflammatory changes including the epithelial loss or thinning, inflammatory cell infiltration, and congested blood vessels compared to controls. The trigone showed a more pronounced inflammatory response than the dome. The presence of urinary bacterial growth, infection manifestations, and inflammatory changes that were more severe in the trigone than in the dome indicate successful bacterial inoculation and induction of cystitis. This animal model can be used for clinical trials on female cystitis. Our histological findings support a possible role of trigone in the pathogenesis of urinary tract infection.
To reviewe the etiology and management of urogenital fistulas at a tertiary care referral center.
We retrospectively identified all patients with urogenital fistula referred to the King Fahad Medical ...City, Riyadh, Saudi Arabia, between January 2005 and July 2016 from electronic records. We collected data on age, parity, etiology and type of fistula, radiologic findings, management, and outcome. Results: Of the 32 patients with urogenital fistula identified, 17 (53.1%) had vesicovaginal fistula. The mean parity was 5.9 (0-15). Obstetric surgery was the most common etiology, accounting for 22 fistulas (68.8%). Twenty of these (90.9%) were complications of cesarean delivery, of which 16 (80%) were repeat cesarean delivery. Forty surgical repair procedures were performed: 20 (50%) via an abdominal approach, 11 (27.5%) via a vaginal approach, 7 (17.5) via a robotic approach, and 2 (5%) using cystoscopic fulguration. The primary surgical repair was successful in 23 patients (74%), the second repair in 5 (16.1%), and the third repair in one (3.1%). One fistula was cured after bladder catheterization, and 2 patients are awaiting their third repair. Conclusion: Unlike the etiology of urogenital fistulas in other countries, most fistulas referred to our unit followed repeat cesarean delivery: none were caused by obstructed labor, and only a few occurred after hysterectomy. Most patients were cured after the primary surgical repair.
PDF
