scholarly journals TENSION-FREE TECHNIQUES IN UROGYNAECOLOGICAL SURGERY

2010 ◽  
Vol 19 (2-3) ◽  
pp. 5
Author(s):  
V. LEANZA ◽  
M. BOLOGNA ◽  
N. GASBARRO
Keyword(s):  
Correct Diagnosis ◽  
Transobturator Tape ◽  
Pelvic Organ ◽  
Therapeutic Success ◽  
Anterior Compartment ◽  
Tension Free ◽  
Treatment Techniques ◽  
Apical Compartment ◽  
Posterior Ivs ◽  
The Right

The new tension-free techniques for treatment of either stress urinary incontinence or pelvic organ prolapse are shown. They are divided as follows. Techniques for the anterior compartment: TVT (Tension-free Vaginal Tape), Retropubic TUS (Tension-free Urethral Suspension), TOT (Transobturator Tape), Prepubic TUS (Tension-free Urethral Suspension), TCR (Tension-Free Cystocele Repair), Retropubic TICT (Tension-free Incontinence Cystocele Treatment), Prepubic TICT (Tension-free Incontinence Cystocele Treatment); Techniques for the apical compartment: Indirect abdominal colposacropexy; Techniques for the postero- apical compartment: Posterior IVS; Techniques for the posterior compartment: Colpoperineoplasty with mesh. Both a correct diagnosis and an appropriate procedure are the right key to achieve a greater therapeutic success.

Evaluation of the Female Sexual Function after Vaginal Surgery Using the FSFI (Female Sexual Function Index)

2007 ◽  
Vol 74 (4) ◽  
pp. 242-246
Author(s):  
F. Di TONNO ◽  
C. Mazzariol ◽  
G. Optale ◽  
N. Piazza ◽  
M. Ciaccia ◽  
...  
Keyword(s):  
Sexual Function ◽  
Great Majority ◽  
Vaginal Surgery ◽  
Pelvic Organ ◽  
Female Sexual Function ◽  
Coital Incontinence ◽  
Tension Free ◽  
Number Of Patients ◽  
Posterior Ivs ◽  
Preoperative Score

Urinary Incontinence (UI) and Pelvic Organ Prolapse (POP) have a detrimental effect on Female Sexual Function (FSF). We decided to focus on the effect of vaginal surgery for UI and/or POP on FSF. Materials and Methods 72 women (aged 42–80, mean age: 62) were given the FSFI questionnaire after undergoing the following operations: 54 Tension-Free Vaginal Slings (TFVS), 12 Kelly plications, 3 hysterectomies+Kelly 2 Tension-Free Vaginal Slings+Kelly 1 hysterectomy+Kelly+posterior IVS. Results 35 women did not answer the questionnaire, 6 women were sexually inactive and answered only partially; 31 patients answered completely. Mean pre- and postoperative scores were, respectively, 25.26 and 25.22 (normal >26.55). 9 patients had a normal preoperative score, whereas 22 a pathological score. The FSFI score did not change postoperatively in 26 women; it worsened in 3 and improved in 2 women treated because of coital incontinence. Conclusions Vaginal surgery for UI and/or POP does not seem to affect FSF in the great majority of cases; conditions may worsen or improve, the latter definitely resulting from the treatment of Coital Incontinence. The high number of patients not answering the questionnaire deserves further studies and it could be - at least partially - explained on the basis of psychological and/or cultural problems regarding the highly emotional issues of sex, incontinence and prolapse.

scholarly journals Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases

2021 ◽  
Vol 10 (18) ◽  
pp. 4267
Author(s):  
Gina Nam ◽  
Sa-Ra Lee ◽  
Sung-Hoon Kim ◽  
Hee-Dong Chae
Keyword(s):  
Pelvic Organ Prolapse ◽  
Predictive Value ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Translabial Ultrasound ◽  
Posterior Compartment ◽  
P Values ◽  
Anterior Compartment ◽  
Aging Society ◽  
Apical Compartment

The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen’s kappa (κ). p values < 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.

scholarly journals Pelvic organ prolapse surgery and overactive bladder symptoms—a population-based cohort (FINPOP)

2021 ◽  
Author(s):  
Päivi K. Karjalainen ◽  
Anna-Maija Tolppanen ◽  
Nina K. Mattsson ◽  
Olga A.E. Wihersaari ◽  
Jyrki T. Jalkanen ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Overactive Bladder ◽  
Symptom Severity ◽  
Pelvic Organ ◽  
Population Based ◽  
Urinary Frequency ◽  
Posterior Compartment ◽  
Posterior Repair ◽  
Apical Compartment ◽  
Bothersome Symptom

Abstract Introduction and hypothesis It is unclear how compartment of pelvic organ prolapse (POP) impacts overactive bladder (OAB) symptom severity or improvement after POP surgery. We hypothesized that anterior and apical prolapse are more strongly associated with OAB symptoms than posterior compartment prolapse. Methods A total of 2933 POP surgeries from a prospective population-based cohort were divided into two groups: (1) anterior and/or apical compartment surgery (± posterior repair), N = 2091; (2) posterior repair only, N = 478. Urinary frequency and urgency urinary incontinence (UUI) were evaluated using PFDI-20 (bothersome symptom: score 3–4) at baseline, 6, and 24 months. Association between degree of POP in specific compartments and symptoms at baseline was estimated with generalized linear models and between compartment of surgery and symptom improvement with generalized estimating equations. Results At least one bothersome symptom was reported by 40% at baseline, 14% at 6, and 19% at 24 months. At baseline, urinary frequency was associated with degree of anterior and apical and UUI with anterior compartment prolapse. Women undergoing surgery for anterior/apical compartment started with worse symptoms and experienced greater improvement than women undergoing posterior compartment surgery. Bothersome frequency resolved in 82% after anterior/apical and in 63% after posterior compartment surgery. Bothersome UUI resolved in 75% after anterior/apical and in 61% after posterior compartment surgery. After surgery, symptom severity was comparable between groups. Bothersome de novo symptoms occurred in 1–3%. Conclusions OAB symptoms are more strongly related to anterior and apical than to posterior compartment prolapse, but improvement is seen after surgery for any vaginal compartment.

scholarly journals Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eren Akbaba ◽  
Burak Sezgin
Keyword(s):  
Pelvic Organ Prolapse ◽  
De Novo ◽  
Pelvic Organ ◽  
Laparoscopic Technique ◽  
Life Questionnaire ◽  
Advanced Stage ◽  
Posterior Compartment ◽  
Anterior Compartment ◽  
Mesh Graft ◽  
Laparoscopic Lateral Suspension

Abstract Background Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments. Methods Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used. Results The median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery. Conclusions In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.

scholarly journals Percutaneous C-Arm Free O-Arm Navigated Biopsy for Spinal Pathologies: A Technical Note

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 636
Author(s):  
Masato Tanaka ◽  
Sumeet Sonawane ◽  
Koji Uotani ◽  
Yoshihiro Fujiwara ◽  
Kittipong Sessumpun ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Standard Technique ◽  
Percutaneous Biopsy ◽  
Technical Note ◽  
Spinal Tumors ◽  
Histopathological Diagnosis ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
The Right

Background: Percutaneous biopsy under computed tomography (CT) guidance is a standard technique to obtain a definitive diagnosis when spinal tumors, metastases or infections are suspected. However, specimens obtained using a needle are sometimes inadequate for correct diagnosis. This report describes a unique biopsy technique which is C-arm free O-arm navigated using microforceps. This has not been previously described as a biopsy procedure. Case description: A 74-year-old man with T1 vertebra pathology was referred to our hospital with muscle weakness of the right hand, clumsiness and cervicothoracic pain. CT-guided biopsy was performed, but histopathological diagnosis could not be obtained due to insufficient tissue. The patient then underwent biopsy under O-arm navigation, so we could obtain sufficient tissue and small cell carcinoma was diagnosed on histopathological examination. A patient later received chemotherapy and radiation. Conclusions: C-arm free O-arm navigated biopsy is an effective technique for obtaining sufficient material from spine pathologies. Tissue from an exact pathological site can be obtained with 3-D images. This new O-arm navigation biopsy may provide an alternative to repeat CT-guided or open biopsy.

Role of laparoscopic in diagnosis and treatment of undescended testis in children at Viet Duc Hospital

2018 ◽  
Vol 8 (4) ◽  
Author(s):  
Viet Hoa Nguyen
Keyword(s):  
Laparoscopic Surgery ◽  
Undescended Testis ◽  
Correct Diagnosis ◽  
Diagnosis And Treatment ◽  
Highly Sensitive ◽  
The Mean ◽  
The Right ◽  
Time Of Operation

Abstract Introduction: Evaluating the role of laparoscopic for diagnosis and treatment of undescended testis in children. Material and Methods: Restrospective study, between 6/ 2014 and 6/2017. All the patients are aged from 1 to 16 years with undescended testis underwent laparoscopic surgery for diagnosis and treatment in Deparment of pediatric surgery – Viet Duc hospital enrolled. Results: Of 95 patiens in total had 106 undescended testis diagnosed and treated by laparoscopy. The mean age of patients was 7,5 ± 3,8 years. 44,2% undescended were on the left side, 44,2% were on the right and 11,6% were undescended bilateral. The correct diagnosis by ultrasound accounted in 79,4%. The locations of testis diagnosed by laparoscopic are : intra abdomen in 45,3%, deep inguinal orifice in 16,9%, extra inguinal orifice in 26,4%, no testicle found in 11,4%. The mean time of operation were 67,33± 28,01 pht. Scrotal positions were achieved 74,5%, remove atrophic testis accounted in 7,6%. Stephen- Flowler technique including step I were in 4,7%, step II in 1,9%. The outcome evaluated by testicular positions following 3 months after operation are : good in 79,2%, moderate 13,2%, poor in 7,6%; By classification of Aubert are : good in 81,1%, moderate in 11,3% and poor in 7,6 %. Conclusion: Laparoscopic surgery is not only a highly sensitive diagnostic method to find accurately the location and size of the testes, but also the most effective method to treat impalpable undescended testes.

The Art of the Clinician

2021 ◽  
Vol 6 (09) ◽  
pp. 612-615
Author(s):  
Rodríguez-Guerra, Miguel, MD ◽  
Pandey, Neelanjana MD ◽  
Shrestha, Elina, MD ◽  
Vittorio, Timothy J. MD
Keyword(s):  
Correct Diagnosis ◽  
Critical Time ◽  
Mitral Valve Regurgitation ◽  
Intercostal Space ◽  
Av Fistula ◽  
Severe Aortic Regurgitation ◽  
Fibrin Sheath ◽  
Diastolic Murmur ◽  
Small Perforation ◽  
The Right

Background: The promotion of clinical abilities could represent a significant factor leading the clinicians to in making the correct diagnosis in a timely matter. Case: Our patient is a 42-year-old African male with a history of Hypertension, ESRD on hemodialysis via right-sided Permcath (PC), Mastoidectomy & Right ear surgery due to trauma in childhood, AV Fistula (Needed intervention 4 times) in left upper extremity, admitted due to witnessed seizures in the setting of hypertensive emergency. The patient denied family history and toxic habits. While the patient was at the emergency room, CT head revealed stable curvilinear hyper-attenuation thought to be a thrombosed developmental vein more likely than small subarachnoid hemorrhage. He was loaded with levetiracetam, received Ativan 1mg IV and HD done as per Nephrology. The patient was transferred to the floor he was not in acute distress and was asymptomatic, the cardiovascular (CV) examination showed regular pulse, normal S1, S2, S4+ appreciated with 2/4 diastolic murmur at second right intercostal space (ICS); 2/6 pansystolic murmur at third right intercostal space left parasternal border (LPSB) radiated to the right parasternal border (RPSB) and right mid-clavicular line (MCL); 3/6 systolic murmur at 5LICS MCL radiated to the posterior axillar line (PAL). Point of maximal impulse (PMI) displaced to mid axillar line (MAL). Parasternal heave present; the neurological exam was preserved. Endocarditis was suspected and echocardiogram was expedited, it showed severe aortic regurgitation, 1.60cm x 1.68cm mass in the tip of the catheter in the right atrium, possible vegetation in the tricuspid valve with mild regurgitation, moderate mitral valve regurgitation. Later, staphylococcus epidermidis was identified in blood cultures twice, as well as the culture from the PC. The transesophageal echocardiogram found 2.41 X 0.62 cm mass appears to be a fibrin sheath, possibly remnant of a prior catheter, small perforation in the non-coronary cusp likely in the setting of healed endocarditis. Infectious disease onboard for antibiotic management. Conclusion: The art of the clinician goes beyond the available technology; it could prevent the loss of critical time as well as unnecessary studies, guiding a better assessment and treatment of our patients and potentially improving their outcomes.

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