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LAPAROSCOPIC RETROPUBIC COLPOSUSPENSION FOR THE TREATMENT OF GENUINE STRESS INCONTINENCE. LONG TERM FOLLOW-UP
No full textObjectives: The minimal surgical treatment of stress urinary
incontinence with endoscopic operation has four basic advantages
compared with traditional open procedures: decreased blood loss
due to better visualization of the space of Retzius, decreased
postoperative pain, shorter hospitalization and faster recovery.
Comparative studies have shown a higher subjective and objective
cure rate for the retropubic urethropexy(Burch procedure) than
for the anterior colporraphy or endoscopic needle urethropexy(1).
The aim of this study is to evaluate the safety, the efficacy and
morbility of laparoscopic Burch procedure for the surgical treatment
of genuine stress incontinence.
Methods: We reviewed the results of 87 patients who underwent
L.B. between 1997 and 2003 by the same surgeon. The main age
was 52 years (range 42-71), the mean body weight was 65 Kg.(range
50-73) and the mean parity was 3 (range 1-5) . 55 post menopausal
pts. (63,5%) were taken a systemic or local estrogen therapy.
All pts. preoperativelly underwent a complete urogynaecological
work-up (Q tip test, Vaginal profile, Pad test, Urodynamic
investigation and Urethrocystoscopy). All the pts. showed S.U.I.
mainly grade II (according to Ingelman Sundeberg) and urethral
hypermobility nearly always associated with cystocele of I-II degree
and uterus-prolapse or vault prolapse of different degree. For this
reason we performed associated laparoscopic procedures like total
hysterectomy on 52 pts(60%), Mc Call culdoplasty on 70 pts
(80%), paravaginal repair on 35 pts (40%) and colposacropexy on
24 pts.(28%). We perfomed LPS Burch alone on 10 of the patients
(9%). A follow-up questionaire on urinary function and quality of
life was obtained.
Results: The main operative time for L.B. was 67 minutes
(range 40-120), estimated blood loss was minimum and mean
hospital stay was 24 hours. The foley catheter was removed after
6-12 h. No bladder or uretheral injures occurred. At 5 years followup
60 pts (69%) were continent, 5 pts. (5.7%) de novo instability,
6 pts (%) were somewhat improved and 17 pts were complete
failures.
Conclusions: Laparoscopic Burch procedure seems to be a
feasible alternative to the open Burch today for a different and less
traumatic approach, for a lower morbility and for a shorter hospital
sta
A PROSPECTIVE RANDOMIZED STUDY COMPARING LAPAROSCOPIC BURCH VERSUS TVT. SHORT AND LONG TERM FOLLOW-UP
No full textObjective: To report short and long-terms results of a prospective
randomized laparoscopic Burch vs TVT for the treatment of
stress incontinence (GSI).
Methods: Since January 1999 to January 2003 we performed 66
LB and 67 TVT. In the LB group the mean age was 51years ( range
38–65), mean body weight 73 Kg.(range 48–88), mean parity 2,5
(range 1–5), menopause 38 (57,5%), while in the TVT group the
mean age was 53years (range 37–72), mean body weight 70Kg. (range
46–84), mean parity 2,3 (range 1–4), menopause 19 (28,3%). All pts.
preoperativelly underwent a complete urogynaecological work-up .
All the pts. showed S.U.I. mean grade II (according to Ingelman
Sundeberg) and urethra hypermobile. The surgical precedure was
carried out under epidural anaesthesia for TVT and general for LB.
Post menopausal pts were taking systemic or local estrogen therapy.
We introduced in the study patients that never underwent a previous
surgery for GSI. The choice of the patients to treat with Burch or
TVT was casual. In the study we excluded pts. that needed an additional
surgical procedure to repair coexisting pelvic floor defects.
Results: There were clinical differences between the two methods:
procedure time was 1–1,5 h for LB and<30 min for TVT,
hospitalization was 2 days and 1 day respectively, anaesthesia was
general for LB and local for TVT, invasiveness mini for LB and
micro for TVT, learning curve: 6 months training for LB and 15
days for TVT. Complications: 2 (3,3%) cases of hematoma Retzius
in LB and 3 (4,4%) bladder perforations in TVT. Blood loss was
absent in both methods. The Foley catheter was removed 3–4 h
after procedures in both groups while in the patients with bladder
injuries we put on indwelling catheter for 2 days. At 3 months
follow-up all patients were completely dry. At 6–36 months followup
in the TVT group 63 (94%) were continent, 3 pts. (4%) were
significantly improvement, only 1 (1,5%) failed. In the LB group
60 (91%) were continent, 2 (3,1%) was significantly improvement,
5 pts. (7,5%) failed. In the TVT group we found 3 pts (4,5%) with
de novo instability and in the LB group, we found 2 pts (3%) with
de novo instability at the post-operative follow-up.
Conclusions: The mean hospital cost of TVT is lower than the
one of LB. The learning curve for the surgeons is longer for the LB.
There is a different cost-effectiveness between the two form of
management: TVT has to be considered more cost-effectiveness
than LB. Anyway the immediate results for both procedures at long
follow-up are encouragin
NEW TREATMENT FOR STRESS URINARY INCONTINENCE
No full textObjective: The aim of this study is to evaluate the safety and
efficacy of the Zuidex implacement for the treatment of type III
incontinence.
Methods: We evaluated 36 women (median age 51) with type III
( MUCP<20 cm H2O and VLPP<60 cm H2O), with fixed urethra
demonstrated (Delta Value<30 at Q-tip test). 21 (58.3%) had
undergone previous continence surgery .They were recluted by a
complete urogynaecological work-up( Vaginal profile, Q- tip test,
Endoscopy and Urodynamic study, one hour Pad test, Ultrasonography).
We defined as cured patients that were dry after the
implant was performed, and as improved those who decreased in
number of pads and symptoms.We underwent all patients an intraurethral
injection of Zuidex, in four different points at the
bladder neck level under local anesthesia. Subjective and urodynamic
assessments were made at 6 months after injection to
evaluate success and short term effects. No catheter was placed
after procedure and each patient was invited to void spontaneously
after four hours before discharge. We introduced the Implacer
(with the tube covering the needles) so that the top of the tube is
located approximately at the mid-urethra level. It is important that
the tube does not move backwards during the insertion into the
urethra. To avoid this apply pressure on the rear end of the tube
while inserting. Pull back the tube to release the needles within the
urethra. The position of the needle eyes is then approximately at
the mid-urethra. With a firm grip on the hand piece, retract one
syringe 5–10 mm and then push it forward to its bottom position
Symptom Pre-op (no.) 24 mth post-op (no.)
Urge 52 12
UI 40 7
Constipation 21 2
Dyspareunia 20 6
Voiding difficulty 32 1
S28
in order to penetrate the mucosa. Inject the contents of the syringe.
Leave the emptied syringe in place. Going clockwise, repeat this
manoeuvre with the remaining 3 syringes. Remove the syringes
with the needles one by one and thereafter the implacer.The syringes,
needles and the Implacer must be discarded after the treatment
session.
Results: Objective success rates at six months were 53%(19 pts),
significantly improvement 25%(9pts), failures 22%(8 pts). At the
follow-up there was no change in mean bladder capacity, urinary
flow rate, bladder compliance and stability; UPP showed a statistically
significant increase in functional urethral length and MPCU.
Conclusions: Our clinical studies on use of Zuidex in the endoscopic
correction of type III incontinence show that up to 78%
of patients can be cured or significantly improved. It is easy to use
and safe and does not complicate or preclude open surgery at a
later date
Laparoscopic Sacrocolpopexy in the treatment of Vaginal Vault Prolapse and Rectocele. Retrospective Study of 85 cases
No full text
TENSION FREE CYSTOCELE REPAIR. FOUR YEARS FOLLOW-UP
No full textAims of study: Anterior vaginal wall descensus is one of the most
frequent alteration in patients with pelvic defects. At least 50% of
women that had delivered two or more times presented a certain
degree of this pathologic alteration of the anatomy, even thought
only 10-20% of the patients complained of associated pains. The
use of synthetic biocompatible materials has become more common
in gynecology surgery(1)-(3). Polypropylene mesh to be
proposed as a mean of surgical correction of moderate severe
cystocele (Cervigni 1998)(2)
Methods: 97 patients aged 42-75, parity 1-5, body weight 45-90,
menopause 41 pts. (61%).Irritative sintoms( nocturia, frequency,
urgency, dysuria and urge incontinence, were present in different
percentage). All the patients underwent a complete urogynecological
work up:
Physical examination: Vaginal profile, Q-tip test, pad test;
Instrumental evaluation: Urodynamic investigation, endoscopy,
x-ray.
Cistocele of grade II (according to HWS classification) in 27
pts. (28%) associated with type 1 and 2 SUI; grade III in 33 pts
(34%); grade IV in 37 pts (38%). Rectocele>of grade II in 78 pts
(80.4%). Menopausal patients were treated by local or systemic
estrogen therapy. We performed vaginal hysterectomy in 56 pts.
(57.7%), levator miorraphy in 78 pts. (80.4%), IVS in 9 pts. (9.3%)
and TVT in 18 pts. (18.55%). After anterior colpotomy a preshaped
polypropylene (Incontinence mesh angiologica BM) in two
different dimension in relation to the size of the cystocele was
placed up on the perivescical fascia proximal to the bladder neck
without anchorage stitches.
Results: No intraoperative complications occurred. All patients
underwent objective follow-up (pelvic examination, Q-tip test) and
instrumental evaluation (cystography, urodinamic investigation
endoscopy) after 6, 12, 24, 48 months. 24 patients (88.9%) were
continent, 2 (7.4%) improved and 1 (3.7%) failed.
We obtained, after 48 mos, erosion in 7 (7.2%)pts, migration
in 4 (4.1%), dyspareunia in 8 (8.2%)pts, recurrent cystocele in
8(8,2%) pts.
Conclusions: The use of polypropylene mesh in urogynecology
surgery is an interesting approach of recurrent cystocele after
previous surgery and in patients with meiopragic perivescical fascia
with moderate severe cystocele
LAPAROSCOPIC SACROCOLPOPEXY IN THE TREATMENT OF VAGINAL VAULT PROLAPSE AND RECTOCELE. RETROSPECTIVE STUDY OF 64 CASES
No full textObjectives: To evaluate the results of the laparoscopic sacrocolpopexy
using a polypropylene mesh.
Methods: We performed laparoscopic sacrocolpopexy on 64 pts
who presented a prolapse of the vaginal vault between the II and the
IV degree according to HWS classification. The mean age was 65
(range 58-76) with variable parity. The vaginal vault prolapse was
present after abdominal hysterectomy in 33 pts.(51%) and after
vaginal hysterectomy in 24 pts. (38%). 7 pts. (11%) were affected by
an isterocele of III -IV . 8pts(12%) presented a vault prolapse of I
degree, 16pts.(25%) of II degree, 15pts.(23%) of III degree,
18 pts.(%) of VI degree.They were also affected by different degrees
of cystourethrocele and rectocele, respectively 45 pts. (70%) and 40
pts. (60%).Moreover 40 pts.(62.5%) were also affected by SUI type
II. All the women underwent a complete urogynecological work up
(Q tip test, Vaginal profile, Pad test, Stress test, Urodynamic
investigation and Urethrocistoscopy). We used a polypropylene
mesh modelled in a y shaped to repair a vaginal vault prolapse fixed
with a no reabsorbable suture (Ethibond) respectively to the anterior
and posterior vaginal wall, the tail of the y is fixed to the sacral
ligament. In patients with rectocele we positioned a mesh in
rectovaginal space until to pubo- coccigeo muscle to substitute
recto-vaginal septum. In those pts. with SUI we performed
colposospension according to Burch and in those ones with cystocele
and paravaginal defect we associated a paravaginal repair.
Results: The mean operating time was 118 min. (range 90-150
min.). Intraoperative complications were: 2 bladder injuries and 1
sigma perforation (5%; all laparoscopicaly repaired). Post-operative
complications were: 2 lumbosciatica, 2 de novo instability, 1
vaginal haemathoma, 3 cases of minimal dispareunia. Mean hospital
stay was 3 days (2-7d). Our goal is to anaslyse the results with
a (after) five year follow-up. In this moment we have reached a 30
months follow-up (6-42 m.): the procedure was successefull in 59
pts (92%). Failures were registred in 5 pts (8%): 3 of these were
treated(cured) with Vyprol mesh (so we stopped to use them). No
erosions were reported.
Conclusions: Laparoscopic sacrocolpopexy is the first choice
procedure for the treatment of vaginal vault prolapse. Is a feasible
method that allows to fully exploit of the advantages of laparoscop
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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