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Hann-chorng Kuo - One of the best experts on this subject based on the ideXlab platform.
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Repeat retropubic suburethral sling procedure is effective for recurrent female stress urinary incontinence.
LUTS: Lower Urinary Tract Symptoms, 2018Co-Authors: Hueih Ling Ong, Yuan-hong Jiang, Hann-chorng KuoAbstract:OBJECTIVE The aim of the present study was to investigate the effectiveness of repeat retropubic suburethral sling for recurrent stress urinary incontinence (SUI) in women. METHODS A retrospective review was performed of 35 women with SUI who underwent repeat retropubic suburethral sling procedures between May 1994 and November 2014. Treatment outcome was assessed directly or by telephone interview. Sling position and urethral incompetence during straining and coughing after the procedure were evaluated. RESULTS The overall continence rate after repeat suburethral sling procedures was 60% (21/35). Among the 35 women, 19 underwent a simple retropubic suburethra sling procedure and 16 underwent combined suburethral sling and other pelvic floor surgery; the success rate for these 2 groups was 84.2% (16/19) and 31.3% (5/16; P = .001), respectively. The success rate was 60% in patients with normal detrusor function (n = 18/30) and in those with detrusor underactivity (n = 3/5; P = 1.0). For patients with intrinsic sphincter deficiency and Bladder Base hypermobility, the success rate was 63.6% (n = 14/22) and 53.8% (n = 7/13), respectively (P = .36). Among the 25 patients with transrectal ultrasound follow-up data, the success rate following placement of the second sling at the Bladder neck, proximal urethra, middle urethra, and distal urethra was 50% (2/4), 87.5% (7/8), 36.4% (4/11), and 0% (0/2), respectively (P = .122). CONCLUSION Repeat suburethral sling procedures for recurrent SUI are safe and effective. The position of the second sling at the proximal urethra resulted in a relatively higher continence rate relative to other sites.
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Bladder Base trigone injection is safe and as effective as Bladder body injection of onabotulinumtoxina for idiopathic detrusor overactivity refractory to antimuscarinics
Neurourology and Urodynamics, 2011Co-Authors: Hann-chorng KuoAbstract:Purpose The purpose of this study was to evaluate the efficacy and safety of onabotulinumtoxinA injections at Bladder Base/trigone and compare with injections at Bladder body or Bladder body/trigone for the treatment of idiopathic detrusor overactivity (IDO) refractory to antimuscarinics. Materials and Methods A single blind, randomized, paralleled, actively controlled trial was performed in patients with urodynamically proven IDO who failed antimuscarinic therapy. Patients were randomly assigned to receive intravesical injections of 100 U of onabotulinumtoxinA into three different Bladder sites. All treatments were evaluated by voiding diary variables, urgency severity score, urodynamic studies, and patient perception of Bladder condition. Long-term success rates over 12 months were also determined. Results Among the patients, 37 were randomized to injections in the Bladder body, 35 into the Bladder body/trigone, and 33 into the Bladder Base/trigone. Successful results were reported in 76 (72%) patients at 3 months: 26 (70%) in the Bladder body group, 26 (74%) in the Bladder body/trigone group, and 24 (73%) in the Bladder Base/trigone group. There were no significant differences in success rates, changes in urgency and urgency incontinence episodes, urodynamic variables, or long-term success rates among the three subgroups. The incidence of adverse events was similar among three groups. No vesicoureteral reflux was noted in all patients with or without involving trigone injection. Conclusion Intravesical onabotulinumtoxinA injection is an effective treatment for IDO regardless of the Bladder injection site. Bladder Base/trigone injection is as safe and effective as Bladder body injections with or without trigone involvement. Neurourol. Urodynam. 30:1242–1248, 2011. © 2011 Wiley-Liss, Inc.
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adverse events of intravesical botulinum toxin a injections for idiopathic detrusor overactivity risk factors and influence on treatment outcome
European Urology, 2010Co-Authors: Hann-chorng Kuo, Chunhou Liao, Shiudong ChungAbstract:Abstract Background Intravesical injection of botulinum toxin type A (BoNTA) provides effective treatment for detrusor overactivity and overactive Bladder (OAB). However, the high rates of treatment-related adverse events (AEs) prevent its more widespread use. Objective To investigate the risk factors of increasing AEs after BoNTA injection for idiopathic detrusor overactivity (IDO). Design, setting, and participants This study included a total of 217 patients receiving their first intravesical BoNTA injection for refractory IDO in a tertiary university hospital from 2004 to 2009. Measurements AE incidence was analyzed according to gender, age, comorbidities, prostate condition in men, OAB subtype, BoNTA dose, injection site, and Baseline urodynamic parameters. Successful outcome was determined Based on patient perception of improvement of Bladder condition at 3 mo. Results and limitations Successful outcomes were reported by 144 (66.3%) patients. By multivariable analysis, male gender ( p =0.013) and Baseline postvoid residual (PVR) ≥100ml ( p =0.003) were independent predictors of acute urinary retention (AUR). Baseline PVR ≥100ml ( p =0.007) and receiving >100 U BoNTA ( p =0.029) were predictors of straining to void. The incidence of large PVR after treatment was associated with comorbidity ( p =0.011). Urinary tract infection occurred more frequently in women ( p =0.003) and in men with retaining prostate ( p =0.008). No AUR developed after Bladder Base/trigonal injection. Nevertheless, the occurrence of AUR or large PVR did not affect therapeutic outcome. This study is limited by nonconsecutive enrollment of patients. Conclusions Male gender, Baseline PVR ≥100ml, comorbidity, and BoNTA dose >100 U are risk factors for increasing incidence of AEs after intravesical BoNTA injection for IDO.
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comparison of effectiveness of detrusor suburothelial and Bladder Base injections of botulinum toxin a for idiopathic detrusor overactivity
The Journal of Urology, 2007Co-Authors: Hann-chorng KuoAbstract:Purpose: We compared the effectiveness of detrusor, suburothelial and Bladder Base injections of botulinum toxin type A in patients with idiopathic detrusor overactivity.Materials and Methods: A total of 45 patients with idiopathic detrusor overactivity refractory to antimuscarinic therapy were randomly allocated to receive 100 U botulinum toxin type A injected into detrusor, suburothelial and Bladder Base. Videourodynamic studies were performed at Baseline and 3 months after treatment. Data collected included symptom score, urgency and incontinence episodes, and urgency severity score. A general satisfaction rating was also assessed as excellent, moderately improved, mildly improved or stationary. A moderately improved or excellent result was defined as successful treatment.Results: A total of 15 patients were allocated to each treatment group. A successful result at 3 months was achieved in 14 (93%) patients with detrusor, 12 (80%) with suburothelial and 10 (67%) with Bladder Base injection. The success...
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correlation of Bladder Base elevation with pelvic floor hypertonicity in women with lower urinary tract symptoms
Neurourology and Urodynamics, 2007Co-Authors: Feichi Chuang, Hann-chorng KuoAbstract:Aims To determine whether the Bladder Base elevation as revealed by cystogram under fluoroscopy is associated with pelvic floor hypertonicity or Bladder outlet obstruction (BOO) in women. Methods Sixty-two women who were referred to our videourodynamic laboratory for assessment of lower urinary tract symptoms (LUTS) were included in this retrospective analysis. Thirty-one of these women with Bladder Base elevation—revealed by cystogram under fluoroscopy during videourodynamic study—served as the experimental group, and another group of 31 women without Bladder Base elevation served as control. None of the patients had neuropathy, previous pelvic surgery or chronic urinary retention. The clinical symptoms, urodynamic diagnosis, and parameters were compared between the two groups. Results The mean voiding pressure (Pdet.Qmax) and postvoid residual (PVR) were significantly greater, and maximum flow rate (Qmax) and voided volume were significantly lower in the Bladder Base elevation group. When a Pdet.Qmax of ≥35 cmH2O combined with a Qmax of ≤15 ml/sec in pressure flow study was used to diagnose BOO, significantly more patients in the Bladder Base elevation group had BOO than controls (51.6% vs. 9.7%, P = 0.0003). Pelvic floor muscle electromyogram (EMG) was dyscoordinated during the voiding phase in 18 (58.1%) and 9 (29%) of the patients with and without Bladder Base elevation, respectively (P = 0.0212). Conclusion Women with LUTS and Bladder Base elevation revealed in the filling phase of videourodynamic study had significantly higher voiding pressure and incidence of dyscoordinated pelvic floor EMG activities during voiding, suggesting a higher incidence of BOO and pelvic floor hypertonicity. Neurourol. Urodynam. 26:502–506, 2007. © 2007 Wiley-Liss, Inc.
Robert M. Levin - One of the best experts on this subject based on the ideXlab platform.
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effect of the bowman birk inhibitor a soy protein on in vitro Bladder neck urethral and penile corporal smooth muscle activity
Neurourology and Urodynamics, 2003Co-Authors: Bruce S Malkowicz, Alan J. Wein, Ann R Kennedy, Shih-ping Liu, Gregory A. Broderick, Robert M. LevinAbstract:Aims: The Bowman-Birk inhibitor (BBI), is a serine protease inhibitor derived from soy beans, which is presently being evaluated in clinical trials for its ability to serve as a cancer preventive or anti-inflammatory agent. The form of BBI currently in clinical trials is known as Bowman-Birk inhibitor concentrate (BBIC). There have been anecdotal reports from patients of improved voiding and sexual functions in the ongoing BBIC trials. The objective of this study was to quantify the effect of BBI and BBIC on urethral and corporal smooth muscle activity. Methods: In vitro muscle strip studies of New Zealand White rabbit urethra/Bladder neck and penile corpora in the presence or absence of BBI or BBIC incubation (5 mg/mL) were performed. Results: In dose-response curves to alpha stimulation, BBI mediated a shift to the right (decreased receptor sensitivity in Bladder/urethra as well as corpora with no change in the maximal response). Bladder Base/ urethra contraction by field stimulation was significantly inhibited by BBI at higher frequencies (1–32 Hz) (12.2 + 0.8 g vs. 6.3 + 0.75 g, P < 0.05). BBI inhibited field stimulated relaxation of corporal muscle at lower frequencies. Muscarinic contraction of the Bladder neck/urethra in alpha prestimulated tissue was significantly inhibited by BBI (5.3 + 0.2 g vs. 2.7 + 0.1 g, P < 0.05). BBI has an inhibitory effect on alpha adrenergic dose-response curves in Bladder neck/urethral and corpora smooth muscle. BBI also significantly inhibited neurohumoral cholinergic release and in vitro muscarinic contraction of the urethra. The effects on corpora relaxation were less pronounced. Conclusions: The data suggest that the phytochemical BBI may promote physiologic effects of urethral relaxation and improved voiding by unique mechanisms and deserves further study as a pharmacologic agent for lower urinary tract symptoms. Neurourol. Urodynam. 22:54–57, 2003. © 2003 Wiley-Liss, Inc.
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effects of partial outlet obstruction of the rat urinary Bladder on micturition characteristics dna synthesis and the contractile response to field stimulation and pharmacological agents
The Journal of Urology, 1993Co-Authors: Penelope A. Longhurst, Alan J. Wein, Robert M. Levin, Masahiko Saito, Teuvo L J TammelaAbstract:Abstract Partial outlet obstruction is one of the major urological complications induced by benign prostatic hypertrophy (BPH). The current study describes the time course of the effect of mild partial outlet obstruction (in rats) on in vivo micturition parameters, DNA synthesis, and on the in vitro response of the Bladder to field stimulation, bethanechol, methoxamine, ATP, and KCl. Mild partial outflow obstruction was created by placing a catheter (outside diameter: 1.70 mm.) transabdominally in front of the urethra, tying a ligature (2-zero silk) around both the urethra and catheter, and then removing the catheter. The micturition pattern was monitored for 2 days prior to surgery, and then continuously for 14 days following the surgery. The changes in Bladder weight and the in vitro detrusor function of control (sham operated) and obstructed Bladders (1, 3, 5, 7, 14 and 28 days after surgery) were examined. Micturition frequency in the dark cycle decreased immediately after the operation, and then increased linearly reaching a maximum at the 5th day, and stabilized at this increased level for the duration of the micturition study. The frequency of the dark cycle was also decreased immediately after the sham surgery and then gradually increased over the period of observation. Bladder weight increased by day 1 following surgery, and remained high throughout the 28 day study. The contractile response of the obstructed Bladder Base to field stimulation was reduced at days 1 and 3. The response then increased above control for day 5, reached a maximum response at day 7 and remained at this level for days 14 and 28. A similar pattern was observed for the contractile response of the Bladder body to bethanechol and KCl, and for the Bladder Base to methoxamine and KCl. Both obstructed and sham surgeries increased Bladder DNA content and 3 H-thymidine incorporation, which reached maximal values on days 5 and 3, respectively. DNA content and 3 H-thymidine incorporation of obstructed Bladders were greater than those of sham operated Bladders. In conclusion, partial outlet obstruction in the rat resulted in a progressive increase in Bladder mass, an increase in micturition frequency, increases in the in vitro contractile response to field stimulation, bethanechol, methoxamine, and KCl, and increases in Bladder DNA content and 3 H-thymidine incorporation.
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comparison of urinary Bladder function in 6 and 24 month male and female rats
The Journal of Urology, 1992Co-Authors: Penelope A. Longhurst, Berit Eika, Robert E. Leggett, Robert M. LevinAbstract:Abstract Micturition characteristics, collagen composition, and in vitro urinary Bladder strip contractility were examined in young adult (six month) and old (24 month) male and female Fischer 344 rats. Although young female rats consumed significantly less water than young males, there were no differences in volumes of urine excreted. Old females excreted significantly more urine than old males, but there were no differences in volumes of water consumed. Old male rats had similar micturition frequencies during the light and dark cycles, in contrast to females and young males, where the number of micturitions during the dark cycle was significantly greater than those during the light cycle. The mean and maximal micturition volumes were significantly greater in old males compared to young males and old females during both the light and dark cycles. Bladders from female rats weighed significantly less than Bladders from males of the same age, and the Bladders from young rats weighed less than those of old rats. The protein and collagen concentrations were significantly less in Bladder bodies from young females than old females. The amount of collagen resistant to digestion by Pronase, and thus thought to be cross-linked, was significantly greater in Bladders from old rats compared to young. No differences between groups were found in the contractile responses of Bladder Base strips. There were trends for the absolute contractile responses of Bladder body strips from old males to field stimulation, carbachol, ATP, and KCl to be larger than the other groups, and for strips from the young females to be smaller. The responses of strips from young females to field stimulation and KCl were significantly less than those of young males or old females, and responses to 10~3 M ATP were less than those of old females. Responses of strips from old males to 60 mM KC1 were significantly greater than those of young males. The differences in contractility could be attributed to the differences in strip mass. It appears, therefore, that urinary Bladder function in male and female rats is unaffected by increasing age between 6 and 24 months.
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effects of pregnancy on adrenergic function in the rabbit urinary Bladder
Neurourology and Urodynamics, 1992Co-Authors: Yatching Tong, Alan J. Wein, Robert M. LevinAbstract:Pregnancy induces morphological as well as functional changes in the urinary tract. Urinary frequency, incontinence, and an increase in residual urine are common clinical findings during gestation. Previous studies from this laboratory have shown a decreased cholinergic response and cholinergic receptor density in the urinary Bladders of pregnant rabbits. In the present study, the adrenergic functions of the Bladders of pregnant and virgin New Zealand White rabbits were compared using isolated muscle strips. Dose-response curves showed that the contractile responses to epinephrine (alpha and beta agonist) and methoxamine (alpha agonist) were significantly reduced in tissues from the Base and the mid-segment, but not the body of the pregnant rabbit Bladders. No significant difference was observed in the degree of isoproterenol (beta agonist) induced relaxations between the two groups. Thus, the results demonstrated a decreased alpha responsiveness in the midsegment and Base of the pregnant Bladders. Physiologically, a decrease in alpha tone at the Bladder Base would be advantageous for Bladder emptying as the resultant relaxation at the Bladder outlet theoretically would alleviate the effect of decreased Bladder body contractility as well as any mechanical stress imposed on the urethra by the enlarging uterus.
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the influence of streptozotocin induced diabetes mellitus on the sensitivity of rat urinary Bladder body and Base strips to changes in extracellular calcium
General Pharmacology-the Vascular System, 1992Co-Authors: Penelope A. Longhurst, Robert E. Leggett, Thomas P Brotcke, Robert M. LevinAbstract:Abstract 1. 1. The influence of calcium on contractile responses of Bladders from control and 2 month streptozotocin-diabetic rats was investigated. 2. 2. Removal of calcium from the bathing medium caused rapid decreases in the contractile responses of Bladder body and Base strips to carbachol. The responses of strips from control rats were reduced more by calcium removal than were strips from diabetics. 3. 3. Replacement of calcium caused dose-dependent increases in contraction to carbachol. The responses of Bladder body strips from diabetic rats to carbachol were significantly greater at all calcium concentrations than were those of controls. There were no differences in the responsiveness of Bladder Base strips to carbachol. 4. 4. In contrast, Bladder body strips from diabetic rats were more sensitive to calcium than were strips from controls, with an IC 50 value for calcium of 0.38 mM vs 0.72 mM for controls. 5. 5. At the calcium concentration of Krebs buffer (2.5 mM), contractile responses were near maximal, and there were no differences in sensitivity. 6. 6. The calcium antagonist nifedipine caused dose-dependent decreases in the contractile responses of Bladder Base and body strips to nerve stimulation. The responses to nerve stimulation were more sensitive to nifedipine than were those to carbachol. There were no differences between controls and diabetics in the sensitivity of Bladder strips to nifedipine. 7. 7. The findings suggest that although increases in sensitivity to calcium are observed in Bladder body strips from streptozotocin-diabetic rats, they are unlikely to be responsible for the increases in maximal contractile response to nerve stimulation and contractile agents.
J Tzafettas - One of the best experts on this subject based on the ideXlab platform.
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anterior vaginal wall reconstruction anterior colporrhaphy reinforced with tension free vaginal tape underneath Bladder Base
Acta Obstetricia et Gynecologica Scandinavica, 2008Co-Authors: T Tantanasis, C Giannoulis, A Daniilidis, K Papathanasiou, A Loufopoulos, J TzafettasAbstract:Objective. To assess the effectiveness of the polypropylene tape in preventing cystocele recurrence. Methods. Fifty Caucasian women aged 50-77 years (mean age 66.6 years), with stage II–IV pelvic organ prolapse, enrolled into the study. Vaginal reconstructive surgery included an anterior colporrhaphy on all patients, posterior colpoperineorrhaphy on 28 patients and hysterectomy on 36 patients. Patients were divided into a study group of 28 women and a control group of 22 women. As reinforcement to the anterior colporrhaphy procedure, in the study group a polypropylene tape (TVT-O) was placed underneath the Bladder Base and fixed with polyglactin sutures. Postoperative follow-up was carried out every 4 months (total 48 months). The assessment of the anatomic result included both clinical evaluation of the operated sites and perineal sonography. Results. The mean postoperative distance of the Bladder Base to the inferior edge of the symphysis pubis was 1.5 cm (range: 1.0–2.2 cm) in the study group and 2.8 c...
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tension free vaginal tape underneath Bladder Base does it prevent cystocele recurrence
Hippokratia, 2008Co-Authors: T Tantanasis, C Giannoulis, A Daniilidis, K Papathanasiou, A Loufopoulos, J TzafettasAbstract:OBJECTIVE The target of the current prospective study was to assess the effectiveness of the polypropylene tapes in preventing recurrence of cystocele formation when placed underneath the Bladder Base. MATERIALS AND METHODS Twenty-two Caucasian women, predominantly postmemopausal with marked descent of the anterior, middle and/or posterior pelvic segment, participated in the study. Vaginal reconstructive surgery including anterior colporrhaphy and Kelly placation, posterior colpoperineorrhaphy and/or hysterectomy, was undertaken in all subjects. The polypropylene tape was placed not under the midurethra, as often performed in stress urine incontinence (SUI) cases, but underneath the Bladder Base as an adjunct to the anterior colporrhaphy sutures. The postoperative follow up lasted 2 years and was carried out every 4 months. The assessment of the anatomic result included evaluation of the operated sites and the position of the tapes inserted on clinical grounds and after perineal sonography. Urodynamic assessment was performed in the presence of urinary incontinence. RESULTS In all patients the postoperative correction of the anterior vaginal wall was sufficient, 14 subjects did not present genitourinary symptoms and therefore were considered as cured; three patients were designated as improved because despite sufficient anatomic correction of the anterior vaginal segment they reported urinary incontinence symptoms. Retropubic haematoma occurred in 1 patient, transient urge incontinence in 1, transient stress incontinence in 1, and persistent stress incontinence also in 1. There was no erosion of the tape noticed. Mean residual urine was 30 ml, mean Bladder Base distance to the inferior edge of the symphysis pubis was 1.2 cm and the mean total vaginal length was 7 cm. CONCLUSION Despite the relative short follow up period and the limited number of patients enrolled, we conclude from our study that the use of polypropylene tapes as an adjunct for fortification of the anterior pelvic segment could provide an option in preventing recurrence of cystocele formation.
Lesley Marson - One of the best experts on this subject based on the ideXlab platform.
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identification of central nervous system neurons that innervate the Bladder body Bladder Base or external urethral sphincter of female rats a transneuronal tracing study using pseudorabies virus
The Journal of Comparative Neurology, 1997Co-Authors: Lesley MarsonAbstract:Transneuronal tracing techniques were used to identify the putative spinal and brainstem neurons involved in continence and voiding in the female rat. Pseudorabies virus, Bartha's K strain, was injected into either the external urethral sphincter, the Bladder Base, or the Bladder body. After 3–5 days, the rats were perfused with fixative, and virus-labelled cells were identified by using immunohistochemistry. External urethral sphincter (EUS) injections resulted in labelling of pudendal motoneurons in the dorsolateral nucleus of L6. Putative spinal interneurons were found in the medial cord from T13 to S1 and in the lateral gray of T13–L2 and L5–S1. After both Bladder Base and Bladder body injections, the majority of pseudorabies virus-labelled cells were found in the lateral gray and medial cord of L6–S1. A number of those found in the intermediolateral cell column resembled the parasympathetic preganglionic neurons; the remaining neurons in the lateral and medial gray were presumed to be interneurons. Very few pseudorabies virus-labelled cells were found rostral to T10. In the brainstem, transneuronally labelled cells were found in the parapyramidal medullary reticular formation, Barrington's nucleus, raphe magnus, raphe pallidus, subcoeruleus pars alpha, locus coeruleus, the A5 noradrenergic cell group, and ventromedial periaqueductal gray after all injection sites. Pseudorabies virus-labelled cells were also seen in the forebrain following the longest survival times; areas consistently labelled included the lateral hypothalamus, the parvocellular region of the paraventricular nucleus, and the medial preoptic area. These studies indicate that there is a substantial overlap of central nervous system neurons that innervate the EUS and the Bladder in the female. J. Comp. Neurol. 389:584–602, 1997. © 1997 Wiley-Liss, Inc.
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identification of central nervous system neurons that innervate the Bladder body Bladder Base or external urethral sphincter of female rats a transneuronal tracing study using pseudorabies virus
The Journal of Comparative Neurology, 1997Co-Authors: Lesley MarsonAbstract:Transneuronal tracing techniques were used to identify the putative spinal and brainstem neurons involved in continence and voiding in the female rat. Pseudorabies virus, Bartha's K strain, was injected into either the external urethral sphincter, the Bladder Base, or the Bladder body. After 3-5 days, the rats were perfused with fixative, and virus-labelled cells were identified by using immunohistochemistry. External urethral sphincter (EUS) injections resulted in labelling of pudendal motoneurons in the dorsolateral nucleus of L6. Putative spinal interneurons were found in the medial cord from T13 to S1 and in the lateral gray of T13-L2 and L5-S1. After both Bladder Base and Bladder body injections, the majority of pseudorabies virus-labelled cells were found in the lateral gray and medial cord of L6-S1. A number of those found in the intermediolateral cell column resembled the parasympathetic preganglionic neurons; the remaining neurons in the lateral and medial gray were presumed to be interneurons. Very few pseudorabies virus-labelled cells were found rostral to T10. In the brainstem, transneuronally labelled cells were found in the parapyramidal medullary reticular formation, Barrington's nucleus, raphe magnus, raphe pallidus, subcoeruleus pars alpha, locus coeruleus, the A5 noradrenergic cell group, and ventromedial periaqueductal gray after all injection sites. Pseudorabies virus-labelled cells were also seen in the forebrain following the longest survival times; areas consistently labelled included the lateral hypothalamus, the parvocellular region of the paraventricular nucleus, and the medial preoptic area. These studies indicate that there is a substantial overlap of central nervous system neurons that innervate the EUS and the Bladder in the female.
T Tantanasis - One of the best experts on this subject based on the ideXlab platform.
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anterior vaginal wall reconstruction anterior colporrhaphy reinforced with tension free vaginal tape underneath Bladder Base
Acta Obstetricia et Gynecologica Scandinavica, 2008Co-Authors: T Tantanasis, C Giannoulis, A Daniilidis, K Papathanasiou, A Loufopoulos, J TzafettasAbstract:Objective. To assess the effectiveness of the polypropylene tape in preventing cystocele recurrence. Methods. Fifty Caucasian women aged 50-77 years (mean age 66.6 years), with stage II–IV pelvic organ prolapse, enrolled into the study. Vaginal reconstructive surgery included an anterior colporrhaphy on all patients, posterior colpoperineorrhaphy on 28 patients and hysterectomy on 36 patients. Patients were divided into a study group of 28 women and a control group of 22 women. As reinforcement to the anterior colporrhaphy procedure, in the study group a polypropylene tape (TVT-O) was placed underneath the Bladder Base and fixed with polyglactin sutures. Postoperative follow-up was carried out every 4 months (total 48 months). The assessment of the anatomic result included both clinical evaluation of the operated sites and perineal sonography. Results. The mean postoperative distance of the Bladder Base to the inferior edge of the symphysis pubis was 1.5 cm (range: 1.0–2.2 cm) in the study group and 2.8 c...
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tension free vaginal tape underneath Bladder Base does it prevent cystocele recurrence
Hippokratia, 2008Co-Authors: T Tantanasis, C Giannoulis, A Daniilidis, K Papathanasiou, A Loufopoulos, J TzafettasAbstract:OBJECTIVE The target of the current prospective study was to assess the effectiveness of the polypropylene tapes in preventing recurrence of cystocele formation when placed underneath the Bladder Base. MATERIALS AND METHODS Twenty-two Caucasian women, predominantly postmemopausal with marked descent of the anterior, middle and/or posterior pelvic segment, participated in the study. Vaginal reconstructive surgery including anterior colporrhaphy and Kelly placation, posterior colpoperineorrhaphy and/or hysterectomy, was undertaken in all subjects. The polypropylene tape was placed not under the midurethra, as often performed in stress urine incontinence (SUI) cases, but underneath the Bladder Base as an adjunct to the anterior colporrhaphy sutures. The postoperative follow up lasted 2 years and was carried out every 4 months. The assessment of the anatomic result included evaluation of the operated sites and the position of the tapes inserted on clinical grounds and after perineal sonography. Urodynamic assessment was performed in the presence of urinary incontinence. RESULTS In all patients the postoperative correction of the anterior vaginal wall was sufficient, 14 subjects did not present genitourinary symptoms and therefore were considered as cured; three patients were designated as improved because despite sufficient anatomic correction of the anterior vaginal segment they reported urinary incontinence symptoms. Retropubic haematoma occurred in 1 patient, transient urge incontinence in 1, transient stress incontinence in 1, and persistent stress incontinence also in 1. There was no erosion of the tape noticed. Mean residual urine was 30 ml, mean Bladder Base distance to the inferior edge of the symphysis pubis was 1.2 cm and the mean total vaginal length was 7 cm. CONCLUSION Despite the relative short follow up period and the limited number of patients enrolled, we conclude from our study that the use of polypropylene tapes as an adjunct for fortification of the anterior pelvic segment could provide an option in preventing recurrence of cystocele formation.