25 research outputs found
Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis
No full textIntroduction and hypotheses: One of the most relevant topics in the field of pelvic floor dysfunction treatment is the long-term efficacy of surgical procedures, in particular, the use of prosthesis. Hence, a systematic review and meta-analysis was conducted to evaluate the long-term effectiveness and safety of midurethral sling (MUS) procedures for stress urinary incontinence (SUI), as reported in randomised controlled trials (RCTs) and non-randomised studies. Methods: This systematic review is based on material searched and obtained via PubMed/Medline, Scopus, and the Cochrane Library between January 2000 and October 2016. Peer-reviewed, English-language journal articles evaluating the long-term (â¥5 years) efficacy and safety of MUS in women affected by SUI were included. Results: A total of 5,592 articles were found after the search, and excluding duplicate publications, 1,998 articles were available for the review process. Among these studies, 11 RCTs (0.6%) and 5 non-RCTs (0.3%) could be included in the qualitative and quantitative synthesis. Objective and subjective cumulative cure rates for retropubic technique (TVT) and transobturator tape (TOT; both outâin and inâout) were 61.6% (95% CI: 58.5â64.8%) and 76.5% (95% CI: 73.8â79.2%), and 64.4% (95% CI: 61.4â67.4%) and 81.3% (95% CI: 78.9â83.7%) respectively. When considering TOT using the outâin technique (TOT-OI) and TOT using the inâout technique (TVT-O) the objective and subjective cumulative cure rates were 57.2% (95% CI: 53.7â60.7%) and 81.6% (95% CI: 78.8â84.4%), and 68.8% (95% CI: 64.9â72.7%) and 81.3% (95% CI: 77.9â84.7%) respectively. Furthermore, this article demonstrates that both TVT and TOT are associated with similar long-term objectives (OR: 0.87 [95% CI: 0.49â1.53], I2 = 67%, p = 0.62) and subjective (OR: 0.84 [95% CI: 0.46â1.55], I2 = 68%, p = 0.58) cure rates. Similarly, no significant difference has been observed between TTOT-OI and TVT-O) in objective (OR: 3.03 [95% CI: 0.97â9.51], I2 = 76%, p = 0.06) and subjective (OR: 1.85 [95% CI: 0.40â8.48], I2 = 88%, p = 0.43) cure rates. In addition, this study also shows that there was no significant difference in the complication rates for all comparisons: TVT versus TOT (OR: 0.83 [95% CI: 0.54â1.28], I2 = 0%, p = 0.40), TOT-OI versus TVT-O (OR: 0.77 [95% CI: 0.17â3.46], I2 = 86%, p = 0.73). Conclusions: Independent of the technique adopted, findings from this systematic review and meta-analysis suggest that the treatment of SUI with MUS might be similarly effective and safe at long-term follow-up
Sacral nerve modulation for patients with fecal incontinence: long-term outcome and effects on sexual function
No full textSacral nerve modulation has become an established treatment for fecal and urinary incontinence, and sexual disorders. The objective of this study was to evaluate the long-term outcome of sacral neuromodulation in patients with fecal or combined fecal and urinary incontinence (double incontinence), assessing its safety, efficacy, and impact on quality of life and sexual function. This was a multicentric, retrospective, cohort study including patients with fecal or double incontinence who received sacral neuromodulation at seven European centers between 2007 and 2017 and completed a 5-year follow-up. The main outcome measures included improvements of incontinence symptoms and quality of life compared with baseline, evaluated using validated tools and questionnaires at 1-, 6-, 12-, 36- and 60-month follow-up. 108 (102 women, mean age 62.4 & PLUSMN; 13.4 years) patients were recruited, of whom 88 (81.4%) underwent definitive implantation of the pacemaker. Patients' baseline median Cleveland Clinic Incontinence Score was 15 (10-18); it decreased to 2 (1-4) and 1 (1-2) at the 12- and 36-month follow-up (p < 0.0001), remaining stable at the 5-year follow-up. Fecal incontinence quality of life score improved significantly. All patients with sexual dysfunction (n = 48) at baseline reported symptom resolution at the 5-year follow-up. The study was limited by the retrospective design and the relatively small patient sample. Sacral nerve modulation is an effective treatment for fecal and double incontinence, achieving satisfactory long-term success rates, with resolution of concomitant sexual dysfunction
Polypropylene Pelvic Mesh: What Went Wrong and What Will Be of the Future?
No full textBackground: Polypropylene (PP) pelvic mesh is a synthetic mesh made of PP polymer used to treat pelvic organ prolapse (POP). Its use has become highly controversial due to reports of serious complications. This research critically reviews the current management options for POP and PP mesh as a viable clinical application for the treatment of POP. The safety and suitability of PP material were rigorously studied and critically evaluated, with consideration to the mechanical and chemical properties of PP. We proposed the ideal properties of the ‘perfect’ synthetic pelvic mesh with emerging advanced materials. Methods: We performed a literature review using PubMed/Medline, Embase, Cochrane Library (Wiley) databases, and ClinicalTrials.gov databases, including the relevant keywords: pelvic organ prolapse (POP), polypropylene mesh, synthetic mesh, and mesh complications. Results: The results of this review found that although PP is nontoxic, its physical properties demonstrate a significant mismatch between its viscoelastic properties compared to the surrounding tissue, which is a likely cause of complications. In addition, a lack of integration of PP mesh into surrounding tissue over longer periods of follow up is another risk factor for irreversible complications. Conclusions: PP mesh has caused a rise in reports of complications involving chronic pain and mesh exposure. This is due to the mechanical and physicochemical properties of PP mesh. As a result, PP mesh for the treatment of POP has been banned in multiple countries, currently with no alternative available. We propose the development of a pelvic mesh using advanced materials including emerging graphene-based nanocomposite materials
A Novel Graphene-Based Nanomaterial for the Development of a Pelvic Implant to Treat Pelvic Organ Prolapse
No full textGraphene is the wonder material of the 21st century, promising cutting-edge advancements in material science with significant applications across all industries. This study investigates the use of a graphene-based nanomaterials (GBNs) ans trade-registered Hastalex®, as novel materials for surgical implants aimed at treating pelvic organ prolapse (POP). This study investigates the mechanical properties and physicochemical characteristics of the material, mainly focusing on its potential to address the limitations of existing polypropylene (PP) implants, which has been associated with numerous complications and banned across multiple countries. Attenuated total reflectance Fourier transform infrared (ATR-FTIR) confirmed the bonding between functionalised graphene oxide (FGO) and the base polymer chain. Hastalex exhibited excellent mechanical properties with 58 N/mm2 maximum tensile strength at break and 701% elongation at break, whilst maintaining its shape with no plastic deformation. These results were comparable to that of sheep pelvic muscular tissue. Hastalex demonstrated its hydrophilic properties from contact angle measurements. Scanning electron microscopy (SEM) and atomic force microscopy (AFM) showed a uniform plane with surface nanotopography, promoting cell-to-material interaction. The results confirmed the suitability of Hastalex in the development of a new pelvic membrane to treat POP
Correction: Seifalian et al. A Novel Graphene-Based Nanomaterial for the Development of a Pelvic Implant to Treat Pelvic Organ Prolapse. J. Funct. Biomater. 2024, 15, 351
No full textIn the original publication [...
How can we improve the diagnosis and management of bladder pain syndrome? Part 2:ICI-RS 2018
No full textBackground: This paper summarises the discussion in a think tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2018 about the treatment of bladder pain syndrome. Aims: To review the treatments of bladder pain syndrome from behavioural treatments to surgical interventions. Materials and Methods: Review the literature in the light of the think tank discussions. Results: All guidelines recommend different levels of treatment starting with conservative behavioral treatments then introducing oral treatments followed by intravesical instillations. If these treatments fail then more invasive treatments such as botulinum toxin injections, neuromodulation, or surgery could be suggested. Conclusion: Unfortunately for all treatments, the numbers are limited and, therefore, the evidence base is not strong. Further suggestions for research are suggested
Sacral nerve modulation for patients with fecal incontinence: long-term outcome and effects on sexual function
No full textDouble incontinence; Sacral nerve modulation; Urinary incontinenceDoble incontinencia; Modulación del nervio sacro; Incontinencia urinariaDoble incontinència; Modulació del nervi sacre; Incontinència urinàriaSacral nerve modulation has become an established treatment for fecal and urinary incontinence, and sexual disorders. The objective of this study was to evaluate the long-term outcome of sacral neuromodulation in patients with fecal or combined fecal and urinary incontinence (double incontinence), assessing its safety, efficacy, and impact on quality of life and sexual function. This was a multicentric, retrospective, cohort study including patients with fecal or double incontinence who received sacral neuromodulation at seven European centers between 2007 and 2017 and completed a 5-year follow-up. The main outcome measures included improvements of incontinence symptoms and quality of life compared with baseline, evaluated using validated tools and questionnaires at 1-, 6-, 12-, 36- and 60-month follow-up. 108 (102 women, mean age 62.4 ± 13.4 years) patients were recruited, of whom 88 (81.4%) underwent definitive implantation of the pacemaker. Patients’ baseline median Cleveland Clinic Incontinence Score was 15 (10–18); it decreased to 2 (1–4) and 1 (1–2) at the 12- and 36-month follow-up (p < 0.0001), remaining stable at the 5-year follow-up. Fecal incontinence quality of life score improved significantly. All patients with sexual dysfunction (n = 48) at baseline reported symptom resolution at the 5-year follow-up. The study was limited by the retrospective design and the relatively small patient sample. Sacral nerve modulation is an effective treatment for fecal and double incontinence, achieving satisfactory long-term success rates, with resolution of concomitant sexual dysfunction.Open access funding provided by Università degli Studi della Campania Luigi Vanvitelli within the CRUI-CARE Agreement. This research was not funded by any agency in the public, commercial, or not-for-profit sectors
Lack of association of joint hypermobility with urinary incontinence subtypes and pelvic organ prolapse
No full textBurch colposuspension
No full textTo evaluate the historic and pathophysiologic issues which led to the development of Burch colposuspension, to describe anatomic and technical aspects of the operation and to provide an update on current evidence
