Mini-Slings: Do They Stand the Test of Time? A 10-Year Cohort

2020 ◽  
pp. 1-5
Author(s):  
Margarida Manso ◽  
Francisco Botelho ◽  
Carlos Silva ◽  
Francisco Cruz
Keyword(s):  
De Novo ◽  
Treatment Success ◽  
Anticholinergic Drugs ◽  
Patient Global Impression ◽  
High Satisfaction ◽  
Patient Reported ◽  
De Novo Urgency ◽  
Satisfaction Rates ◽  
Mini Sling

<b><i>Introduction:</i></b> It is known that failures after midurethral slings increase with the follow-up time. Nevertheless, data concerning mini-slings are sparse. To clarify this statement, we analyze a mini-sling cohort with a median follow-up of 10 years. Although the brand used, MiniArc<sup>®</sup>, is no longer available, an identical device, Solyx™, can still be used, which makes the analysis of the cohort clinically relevant. <b><i>Material and Methods:</i></b> A total of 172 women with predominant stress urinary incontinence (SUI) were consecutively treated with the mini-sling MiniArc<sup>®</sup> from 2006 until 2013. They were reevaluated in 2018. The primary outcome, treatment success, was defined as no self-reported SUI symptoms and no reintervention. Secondary outcomes included the response to patient-reported outcomes. Adverse events were assessed. <b><i>Results:</i></b> After a median follow-up time of 113 months, 115 (66.9%) women were available for reevaluation. Forty-four (38.3%) women self-reported SUI. Seventeen women had been reoperated, 14 (12.2%) due to the reappearance of SUI and 3 due to complications. Altogether, MiniArc<sup>®</sup> had an overall success rate of 47.0% at 10 years. Among those not reoperated, 63.3% stated that they were much better or very much better in Patient Global Impression of Improvement (PGI-I) and 71.4% affirmed that their continence problem was normal or mild in Patient Global Impression of Severity (PGI-S). Almost 85% would repeat the surgery. Reoperation due to complications was rare (2.6%). De novo urgency appeared in 30.6% of the patients and it was managed with anticholinergic drugs with favorable outcomes. <b><i>Discussion/Conclusion:</i></b> This report adds evidence to the long-term outcomes of mini-slings, confirming that they can cure or improve SUI and give patients high satisfaction rates, at the expense of low morbidity.

scholarly journals Our Minimally Invasive Sacrocolpopexy Experiences in Pelvic Organ Prolapse Treatment

2021 ◽  
Author(s):  
Kamil Gökhan Şeker ◽  
Emre Sam ◽  
Yusuf Arıkan ◽  
Ahmet Hacıislamoğlu ◽  
Abdulmuttalip Şimşek ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Minimally Invasive ◽  
Operative Time ◽  
De Novo ◽  
Treatment Success ◽  
Conservative Surgery ◽  
Pelvic Organ ◽  
Robotic Sacrocolpopexy ◽  
De Novo Urgency

Objective: We aimed to evaluate the results of our minimally invasive (laparoscopic and robotic) sacrocolpopexy operations in patients with pelvic organ prolapse (POP). Materials and Methods: Demographic characteristics, intraoperative and postoperative data of 15 patients for whom we applied laparoscopic or robotic sacrocolpopexy due to symptomatic Grade 2 or higher apical POP based on POP-Q classification between September 2014 and September 2018. Treatment success was defined as Grade 0 or 1 POP in POP examination in the final surveillance. Results: Mean age of the patients was 60.4 ± 8.3 (49-82) years. Four patients (26.7%) were operated using robotic and eleven patients (73.3%) using laparoscopic methods. Uterus conservative surgery was applied in all patients excluding one. Mean operative time was 183.3 ± 21.4 (145-220) minutes and mean hospital stay of the patients was 2.8 ± 0.7 (2-4) days. Intraoperative and postoperative complications developed in a total of two patients (13.3%). Mean duration of follow-up was calculated as 12.1 ± 4.8 (8-24) months. De novo urgency urinary incontinence developed in two patients and stress incontinence in one patient. Based on the physical examination in the follow-ups, 14 patients (93.3%) had Grade 0 and one patient had (6.7%) asymptomatic Grade 2 anterior POP. Conclusion: Minimally invasive sacrocolpopexy is an efficient and safe surgical option for prolapse repair in symptomatic advanced stage POP cases.

scholarly journals Acceptability of no-test medical abortion provided via telemedicine: analysis of patient-reported outcomes

2021 ◽  
pp. bmjsrh-2020-200954
Author(s):  
Chelsey Porter Erlank ◽  
Jonathan Lord ◽  
Kathryn Church
Keyword(s):  
Patient Reported Outcomes ◽  
Medical Abortion ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Post Procedure ◽  
High Satisfaction ◽  
First Choice ◽  
Patient Reported ◽  
At Home

IntroductionThe English government approved both stages of early medical abortion (EMA), using mifepristone and misoprostol under 10 weeks’ gestation, for at-home use on 30 March 2020. MSI Reproductive Choices UK (MSUK), one of the largest providers of abortion services in England, launched a no-test telemedicine EMA pathway on 6 April 2020. The objectives of this study were to report key patient-reported outcome measures and to assess whether our sample was representative of the whole population receiving no-test telemedicine EMA.MethodsA sample of all MSUK’s telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. A total of 1243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within 5 days post-procedure.ResultsPatients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. The sample responding were broadly equivalent to the whole population receiving telemedicine. No patient reported that they were unable to consult privately. The majority (1035, 83%) of patients reported preferring the telemedicine pathway, with 824 (66%) indicating that they would choose telemedicine again if COVID-19 were no longer an issue.ConclusionsTelemedicine EMA is a valued, private, convenient and more accessible option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make telemedicine EMA permanent.

scholarly journals The Olympia anatomic polished cemented stem is associated with a high survivorship, excellent hip-specific functional outcome, and high satisfaction levels: follow-up of 239 consecutive patients beyond 15 years

2021 ◽  
Author(s):  
Gareth S. Turnbull ◽  
Claire Marshall ◽  
Jamie A. Nicholson ◽  
Deborah J. MacDonald ◽  
Nicholas D. Clement ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Femoral Stem ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
High Satisfaction ◽  
Age At Surgery ◽  
Patient Reported ◽  
Cemented Stem ◽  
Oxford Hip Score

Abstract Introduction The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. Patients and methods Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3–17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen’s zones Results Mean patient age at surgery was 68.0 years (SD 10.9, 31–93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%–100%) and at 15 years was 97.5% (94.6%–100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%–100%) at 10 years and 95.9% (92.4%–99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7–11.3) follow-up, mean OHS was 39 (SD 10.3, range 7–48) and 94% of patients reported being very satisfied or satisfied with their THA. Conclusions The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.

scholarly journals Guideline-defined futility or patient-reported outcomes to assess treatment success after TAVI: what to use? Results from a prospective cohort study with long-term follow-up

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000879 ◽  
Author(s):  
Martijn Stefan van Mourik ◽  
Jeroen Vendrik ◽  
Mohammad Abdelghani ◽  
Floortje van Kesteren ◽  
Jose P S Henriques ◽  
...  
Keyword(s):  
Symptom Relief ◽  
Treatment Success ◽  
Heart Association ◽  
Patient Reported Outcome Measures ◽  
Symptomatic Improvement ◽  
Low Flow ◽  
Chronic Obstructive ◽  
Transfemoral Approach ◽  
Patient Reported

ObjectiveTranscatheter aortic valve implantation (TAVI) provides a significant symptom relief and mortality reduction in most patients; however, a substantial group of patients does not experience the same beneficial results according to physician-determined outcomes.MethodsSingle-centre prospective design; the population comprises all consecutive patients undergoing TAVI in 2012–2017. TAVI futility was defined as the combined endpoint of either no symptomatic improvement or mortality at 1 year. We actively gathered telephone follow-up using a predefined questionnaire.ResultsGuideline defined TAVI futility was present in 212/741 patients. Multivariate regression showed lower albumin and non-transfemoral approach to be predictive for futility. In addition to these, chronic obstructive pulmonary disease, lower estimated glomerular filtration rate, atrial fibrillation, low-flow–low-gradient aortic stenosis and lower Body Mass Index were predictive for 1-year mortality. Patients who showed symptomatic benefit estimated the percentage in which their symptoms were remedied higher than patients who did not (80% vs 60%, p<0.001). Guideline-defined TAVI futility occurs frequently, contrasting with patient-reported outcome measures (PROMs). The vast majority in both groups would again choose for TAVI treatment.ConclusionLower albumin and non-transfemoral access route were predictors for guideline-defined TAVI futility, defined as mortality within 1 year or no objective symptomatic improvement in New York Heart Association class. Futility according to this definition occurred frequently in this study, contrasting with much more positive PROMs. The majority of patients would undergo a TAVI again, underlining the patients’ experienced value of TAVI and putting the definition of TAVI futility further on debate. In the near future, less-strict criteria for TAVI futility, that is, using a shorter warranted life expectancy and incorporating patients’ perceived outcomes, should be used.

scholarly journals Twenty-Two-Year Outcome of Cartilage Repair Surgery by Perichondrium Transplantation

Cartilage ◽  
2020 ◽  
pp. 194760352095814 ◽  
Author(s):  
Maarten P. F. Janssen ◽  
Esther G. M. van der Linden ◽  
Tim A. E. J. Boymans ◽  
Tim J. M. Welting ◽  
Lodewijk W. van Rhijn ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Revision Surgery ◽  
Treatment Success ◽  
Patient Characteristics ◽  
Long Term Outcome ◽  
Major Revision ◽  
Increased Risk ◽  
Patient Reported ◽  
Ikdc Score

Objective The main purpose of the present study was to assess the risk for major revision surgery after perichondrium transplantation (PT) at a minimum of 22 years postoperatively and to evaluate the influence of patient characteristics. Design Primary outcome was treatment success or failure. Failure of PT was defined as revision surgery in which the transplant was removed, such as (unicondylar) knee arthroplasty or patellectomy. The functioning of nonfailed patients was evaluated using the International Knee Documentation Committee (IKDC) score. In addition, the influence of patient characteristics was evaluated. Results Ninety knees in 88 patients, aged 16 to 55 years with symptomatic cartilage defects, were treated by PT. Eighty knees in 78 patients were eligible for analysis and 10 patients were lost to follow-up. Twenty-eight knees in 26 patients had undergone major revision surgery. Previous surgery and a longer time of symptoms prior to PT were significantly associated with an increased risk for failure of cartilage repair. Functioning of the remaining 52 patients and influence of patient characteristics was analyzed using their IKDC score. Their median IKDC score was 39.08, but a relatively young age at transplantation was associated with a higher IKDC score. Conclusions This 22-year follow-up study of PT, with objective outcome parameters next to patient-reported outcome measurements in a unique group of patients, shows that overall 66% was without major revision surgery and patient characteristics also influence long-term outcome of cartilage repair surgery.

Comparison of 5-Year Patient-Reported Outcomes (PROMs) of Total Ankle Replacement (TAR) to Total Knee Replacement (TKR) and Total Hip Replacement (THR)

2020 ◽  
Vol 41 (7) ◽  
pp. 767-774
Author(s):  
Jayasree Ramaskandhan ◽  
Anjum Rashid ◽  
Simon Kometa ◽  
Malik S. Siddique
Keyword(s):  
Mental Health ◽  
Hip Replacement ◽  
Patient Reported Outcomes ◽  
Ankle Replacement ◽  
Sf 36 ◽  
Patient Reported ◽  
Total Knee ◽  
End Stage ◽  
Satisfaction Rates

Background: Total ankle replacement (TAR) is becoming a more common alternative to ankle arthrodesis for the improvement of pain and function in end-stage arthritis of the ankle. The effects of end-stage arthritis of the ankle are similar to those of end-stage hip arthritis. There is a paucity of literature on patient-reported outcome measures (PROMs) following TARs in comparison with total hip replacement (THR) or total knee replacement (TKR). We aimed to study the 1-, 3-, and 5-year outcomes of TAR in comparison with TKR and THR. Methods: PROMs data from patients who underwent a primary THR, TKR, or TAR performed between March 2008 and 2013 over a 5-year period were collected from our hospital patient registry. They were divided into 3 groups based on the type of primary joint replacement. Patient demographics and patient-reported outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 36-item Short-Form (SF-36) scores, and patient satisfaction scores at follow-up) were compared preoperatively and at the 1-, 3-, and 5-year follow-ups. Results: There were data available on 2672 THR, 3520 TKR, and 193 TAR patients preoperatively. Preoperatively, TAR patients reported statistically significantly higher function scores when compared with THR and TKR patients (40 vs 33; P = .001 [ P < .05] and 40 vs 36; P = .001 [ P < .05]). For SF-36 scores, there was no statistically significant difference between groups for the general health and role emotional components ( P = .171 and .064, respectively [ P > .05]); TAR patients reported similar scores to TKR patients for physical domains at the 3- and 5-year follow-ups ( P > .05), and TAR patients also reported similar scores to both THR and TKR patients for the mental domains ( P > .05). At 5 years postoperatively, TAR patients reported lower scores than THR and TKR patients for function and stiffness. For SF-36 scores, TAR patients reported similar outcomes to THR and TKR patients for mental health components ( P > .05), similar scores to TKR patients for 3 of 4 physical domains ( P < .05), but lower satisfaction rates for activities of daily living (ADL) and recreation when compared with THR ( P < .05). Conclusion: TAR patients had similar outcomes to THR and TKR patients for disease-specific and mental health domains, and lower patient satisfaction rates in terms of pain relief, ADL, and recreation. Further research is warranted including clinical outcomes along with PROMs with a long-term follow-up. Level of Evidence: Level III, retrospective comparative series.

TVT and TOT: a comparison between these two techniques based on our clinical experience

2008 ◽  
Vol 75 (4) ◽  
pp. 232-236
Author(s):  
A. Tamai ◽  
A. Donazzan ◽  
V. Gallo ◽  
S. Durante
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Voiding Dysfunction ◽  
De Novo ◽  
Single Side ◽  
De Novo Urgency ◽  
Group A ◽  
Group B

Aim of the Study A retrospective evaluation and a comparison of results from two minimally invasive surgery techniques that we adopted for the treatment of SUI. Materials and Methods. In this study we evaluated 113 selected patients who underwent SUI minimally invasive surgery from 1–1-2000 to 31–12–2007. 87 patients underwent epidural anesthesia. 26 local anesthesia. In Group A (TVT) 61 patients were enrolled, mean age 57.6 (±22). 43 patients (70%) were on menopause. In Group B (TOT out-in) 52 patients were enrolled (for 34 of them we used the Obtape® sling while for 18 the Obtryx® one), their mean age was 58.5 (±20.5) and 39 patients (75%) were on menopause. Patients from both groups did not undergo any past previous urogynecological surgery and suffered from stress urinary incontinence with cervico-urethral hypermobility butno other associated pathology. The pre-operative work-up included an evaluation of patients based on ICS guidelines. Results. Group A (TVT) - mean follow-up 66.3 months, dry patients 53/61 (86.8%). Bladder perforations resolved by catheterization 3/61 (5%). Transient voiding dysfunction 14/61 (22.8%). “De novo” urgency 8/61 (13%). One patient on self-catheterization due to persistent urinary retention underwent a single-side section of the sling with spontaneous micturition and complete continence recovery. Group B (TOT out-in) - mean follow-up 35.5 months, dry patients 43/52 (82%). 4 patients (7.6%) complained oftransient voiding dysfunction, 5 patients (9.5%) for “de novo” urgency, 1 patient underwent a sling removal due to vaginal erosion 4 months after surgery (Obtape®).

scholarly journals Tension-free Vaginal Tape vs Tension-free Obturator Tape for Treatment of Genuine Stress Urinary Incontinence: A 5-year Follow-up

2017 ◽  
Vol 9 (2) ◽  
pp. 95-99
Author(s):  
Priyanka Bhadana
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
De Novo ◽  
Uterovaginal Prolapse ◽  
Tension Free ◽  
Tension Free Vaginal Tape ◽  
Genuine Stress Urinary Incontinence ◽  
Patients With Diabetes ◽  
De Novo Urgency

ABSTRACT Objective To compare the effectiveness of tension-free vaginal tape (TVT) and tension-free obturator tape (TOT) in treatment of genuine stress urinary incontinence and study the related complications. Materials and methods About 150 cases with complaints of stress urinary incontinence were taken during 5-year period, and they were confirmed urodynamically. Exclusion criteria included patients with diabetes mellitus, neurological disorders, other forms of incontinence, uterovaginal prolapse, urinary tract infection, and pregnancy. Out of 150 cases, 70 underwent TVT procedure and 80 were taken up for TOT. The outcome was studied at the end of 5 years. Results The cure rate in the TOT group was 94%, which was slightly higher than the TVT group, which came out to be 90%. The failure rate in the TVT group was 1.1%, but no failure was encountered in the TOT group. However, the improvement rates were similar in each group. Comparing the complications in each group, the rate of bladder perforation and postoperative retention of urine was much higher in the TVT group. Postoperative voiding difficulties were also noticeably less in TOT group compared with TVT group. However, none of the cases in either group had de novo urgency. Conclusion Both the procedures are a safe and effective method of curing stress incontinence; however, owing to slightly higher improvement rates and lower complications rate, TOT should be preferred over TVT. How to cite this article Bhadana P, Mittal P, Bachani S. Tension-free Vaginal Tape vs Tension-free Obturator Tape for Treatment of Genuine Stress Urinary Incontinence: A 5-year Follow-up. J South Asian Feder Obst Gynae 2017;9(2):89-93.

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