The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Linda Cardozo - One of the best experts on this subject based on the ideXlab platform.
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narrated video of a re do Colposuspension
Neurourology and Urodynamics, 2017Co-Authors: Linda Cardozo, Dudley Robinson, Fevzi ShakirAbstract:Aims To present a narrated video designed to demonstrate the steps involved in an open re-do Colposuspension. Methods This was in a 70-year-old woman who presented with recurrent severe stress urinary incontinence. Urodynamics confirmed severe urodynamic stress incontinence, with no detrusor over activity. Her maximum urethral closure pressure (MUCP) was 8 cm/water. She previously had a total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO) and Colposuspension in 1998. Subsequently, she had a TVT in 2002 and then partial excision of the tape in 2003 due to erosion. This was followed by a Zuidex bulking agent in 2005 and subsequent TOT in 2006. After counselling she opted for a re-do Colposuspension. Results If primary urinary incontinence surgery has failed the decision as to what treatment should then be undertaken is controversial. The options that are available include a repeat mid urethral sling (either retropubic or transobturator), urethral bulking agents, autologous fascial slings and re-do Colposuspension. Conclusion A re-do Colposuspension is a sensible choice that is likely to achieve a better success rate than a second tape procedure. Although, Colposuspension is an operation that most gynaecologists have now become deskilled in and rarely perform, mainly due to the popularity of tapes. This video demonstrates a re-do Colposuspension, with particular attention to the specific nuances that can results in a successful operation.
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what do we do when a midurethral tape fails rediscovery of open Colposuspension as a salvage continence operation
International Urogynecology Journal, 2012Co-Authors: Ilias Giarenis, Linda Cardozo, Heleni Mastoroudes, Dudley RobinsonAbstract:Introduction and hypothesis Our aim was to evaluate the outcome of open Colposuspension for women with urodynamic stress incontinence who had previously undergone a failed midurethral tape.
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Surgical treatment for female stress urinary incontinence: what is the gold-standard procedure?
International Urogynecology Journal, 2009Co-Authors: Maurizio Serati, Linda Cardozo, Giacomo Novara, Walter Artibani, Stefano Salvatore, Stefano Uccella, Pierfrancesco BolisAbstract:In the last few years, the Burch Colposuspension and the fascial slings were often defined from the pages of the most relevant journals of general medicine, as gold-standard procedures for the surgical treatment of stress urinary incontinence (SUI), whereas mid-urethral slings (tension-free vaginal tape (TVT) and tension-free vaginal tape obturator) were attributed a marginal and almost experimental role in this field. This poorly reflect the current scenario of the surgical management of SUI: Recently, a number of meta-analysis have demonstrated that TVT is significantly more effective if compared to Colposuspension and that it is followed by significantly lower perioperative morbidity if compared to pubovaginal slings. It is not realistic to suggest to general practitioners that the surgical gold standard for SUI includes the performance of a wide laparotomy, long hospital stays and a high risk of long-lasting intermittent self-catheterisation. This would inevitably discourage women from embarking on surgical treatment, which instead could actually improve their quality of life.
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is tension free vaginal tape more effective than laparoscopic Colposuspension for stress incontinence
Nature Clinical Practice Urology, 2007Co-Authors: Sushma Srikrishna, Dudley Robinson, Linda CardozoAbstract:Is tension-free vaginal tape more effective than laparoscopic Colposuspension for stress incontinence?
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a comparison of the objective and subjective outcomes of Colposuspension for stress incontinence in women
Obstetrical & Gynecological Survey, 2001Co-Authors: John Bidmead, Linda Cardozo, Vik Khullar, Anne Mclellan, C KelleherAbstract:Objectives To investigate the impact of Colposuspension for stress incontinence on the symptoms and quality of life of women undergoing both primary and repeat surgery for genuine stress incontinence and in addition to assess the use of a condition specific quality of life questionnaire as an outcome measure following surgery. Design Prospective case series: videocystourethrography performed before and between six and twelve months after surgery. Validated condition specific quality of life (QoL) questionnaires completed by women before and six to twelve months after surgery. Setting A tertiary referral Urogynaecology Unit in a teaching hospital. Participants A consecutive series of 83 women undergoing Colposuspension between March 1995 and December 1997. Pre-operative assessment and surgery was performed by, or was under the direct supervision of, the unit director. Intervention Modified Burch Colposuspension. Main outcome measures Objective results of surgery assessed with videocystourethrography. Subjective results evaluated using a condition specific QoL tool, the Kings Health Questionnaire (KHQ). Symptom severity was evaluated as a component of the condition specific QoL questionnaire. Results Objective cure was demonstrated in 92% of women undergoing primary surgery with an 8% incidence of de-novo detrusor instability and a 10% incidence of voiding difficulties. In the group of women having repeat surgery the objective cure rate was 81% with no de-novo detrusor instability and a 6% incidence of post-operative voiding difficulties. QoL scores improved in 95% of women. Improvements of over 25% were seen in 70% of women and of over 50% in 28%. However, 2.4% of women recorded a deterioration in QoL scores. Conclusions Colposuspension performed in this setting, assessed using both objective and standardised subjective measures, completed by women themselves, appears to produce good objective and subjective results and leads to enhanced quality of life in the great majority of women.
Paul Hilton - One of the best experts on this subject based on the ideXlab platform.
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tension free vaginal tape versus Colposuspension for primary urodynamic stress incontinence 5 year follow up
British Journal of Obstetrics and Gynaecology, 2007Co-Authors: Karen Ward, Paul HiltonAbstract:Objective To compare the long-term outcomes of tension-free vaginal tape (TVT) and Colposuspension as primary treatment for stress incontinence. Study design Multicentre randomised controlled trial. Setting Secondary and tertiary care gynaecology, urology and urogynaecology departments in 14 centres in the UK and Eire. Population Women with urodynamically confirmed stress incontinence and who had previously failed to respond to conservative treatment were invited to participate. Methods Three hundred and forty-four women were randomised; 175 to TVT and 169 to Colposuspension. This paper reports the 5-year outcomes. Main outcome measures The primary outcome at 5 years was a 1-hour perineal pad test; other outcomes included clinical examination, Short Form-36 (SF-36) health status and Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaires. Results A negative 1-hour pad test was recorded in 58/72 (81%) women in the TVT group and 44/49 (90%) in the Colposuspension group (P= 0.21, Fisher’s exact test) at 5 years. There was an increase in enterocoele and rectocele in the Colposuspension group; three late tape complications were seen in the TVT group. Conclusion This study did not detect a significant difference between TVT and Colposuspension for the cure of stress incontinence at 5 years. The effect of both procedures on cure of incontinence and improvement in quality of life is maintained in the long term. Vault and posterior vaginal wall prolapse are seen more commonly after Colposuspension. Tape erosion may occur several years after surgery.
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a prospective multicenter randomized trial of tension free vaginal tape and Colposuspension for primary urodynamic stress incontinence two year follow up
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Karen Ward, Paul HiltonAbstract:Abstract Objective This study was undertaken to compare tension-free vaginal tape (TVT) with Colposuspension as the primary treatment for stress incontinence. Study design The trial was conducted in gynecology or urology departments in 14 centers in the United Kingdom and Ireland. Three hundred forty-four women with urodynamic stress incontinence were randomly assigned to groups: 175 to TVT and 169 to Colposuspension. Patients were assessed using the Short Form-36 health status questionnaire, the Bristol Female Lower Urinary Tract Symptoms questionnaire, clinical examination, and a 1-hour perineal pad test. Unpaired and paired data were analyzed with the Wilcoxon rank sum and matched pairs tests, respectively, and proportions were compared with the Fisher exact test. Results When data were analyzed on an intention-to-treat basis, assuming patients with missing data to be treatment failures, 63% of the TVT group and 51% of the Colposuspension group were objectively cured at 2 years (odds ratio 1.67, 95% CI 1.09-2.58). Conclusion The TVT procedure appears to be as effective as Colposuspension for the treatment of urodynamic stress incontinence at 2 years.
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a cost utility analysis of tension free vaginal tape versus Colposuspension for primary urodynamic stress incontinence
British Journal of Obstetrics and Gynaecology, 2003Co-Authors: Andrea Manca, Karen Ward, Paul Hilton, Mark SculpherAbstract:Abstract Objective To assess the cost effectiveness of tension-free vaginal tape compared with open Burch Colposuspension as a primary treatment for urodynamic stress incontinence. Design Cost–utility analysis alongside a multicentre randomised comparative trial. Setting Gynaecology or Urology departments in 14 centres in the UK and Ireland, including University-associated teaching hospitals and district general hospitals. Population Women with urodynamic stress incontinence. Exclusion criteria were: (1) detrusor overactivity; (2) major voiding problems; (3) prolapse; (4) previous surgery for incontinence or prolapse. Methods Resource use data were collected on all 344 patients in the trial, including length of hospital stay, time in theatre and management of complications; resource use was costed using UK unit costs at 1999–2000 prices. Main outcome measures Health outcomes were expressed in terms of quality-adjusted life years (QALYs) between baseline and six months follow up, based on women's responses to the EQ-5D health questionnaire. Results Tension-free vaginal tape resulted in a mean cost saving of £243 (95% CI £341 to £201) compared with Colposuspension. Differential mean QALYs per patient (tension-free vaginal tape − Colposuspension) was 0.01 (95% CI −0.01 to 0.03). The probability of tension-free vaginal tape being, on average, less costly than Colposuspension, was 100%, and the probability of tension-free vaginal tape being more cost effective than Colposuspension was 94.6% if the decision-maker was willing to pay £30,000 per additional QALY. Conclusion The results from this trial suggest that, over a post-operative period of six months, tension-free vaginal tape is a cost effective alternative to Colposuspension. The results will need to be reassessed on the basis of longer follow up.
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a cost utility analysis of tension free vaginal tape versus Colposuspension for primary urodynamic stress incontinence
British Journal of Obstetrics and Gynaecology, 2003Co-Authors: Andrea Manca, Karen Ward, Paul Hilton, Mark SculpherAbstract:Abstract Objective To assess the cost effectiveness of tension-free vaginal tape compared with open Burch Colposuspension as a primary treatment for urodynamic stress incontinence. Design Cost–utility analysis alongside a multicentre randomised comparative trial. Setting Gynaecology or Urology departments in 14 centres in the UK and Ireland, including University-associated teaching hospitals and district general hospitals. Population Women with urodynamic stress incontinence. Exclusion criteria were: (1) detrusor overactivity; (2) major voiding problems; (3) prolapse; (4) previous surgery for incontinence or prolapse. Methods Resource use data were collected on all 344 patients in the trial, including length of hospital stay, time in theatre and management of complications; resource use was costed using UK unit costs at 1999–2000 prices. Main outcome measures Health outcomes were expressed in terms of quality-adjusted life years (QALYs) between baseline and six months follow up, based on women's responses to the EQ-5D health questionnaire. Results Tension-free vaginal tape resulted in a mean cost saving of £243 (95% CI £341 to £201) compared with Colposuspension. Differential mean QALYs per patient (tension-free vaginal tape − Colposuspension) was 0.01 (95% CI −0.01 to 0.03). The probability of tension-free vaginal tape being, on average, less costly than Colposuspension, was 100%, and the probability of tension-free vaginal tape being more cost effective than Colposuspension was 94.6% if the decision-maker was willing to pay £30,000 per additional QALY. Conclusion The results from this trial suggest that, over a post-operative period of six months, tension-free vaginal tape is a cost effective alternative to Colposuspension. The results will need to be reassessed on the basis of longer follow up.
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prospective multicentre randomised trial of tension free vaginal tape and Colposuspension as primary treatment for stress incontinence
BMJ, 2002Co-Authors: Karen Ward, Paul HiltonAbstract:Objective To compare tension›free vaginal tape with Colposuspension as primary treatment for stress incontinence. Design Multicentred randomised comparative trial. Setting Gynaecology or urology departments in 14 centres in the United Kingdom and Eire, including university teaching hospitals and district general
June D Cody - One of the best experts on this subject based on the ideXlab platform.
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traditional suburethral sling operations for urinary incontinence in women
Cochrane Database of Systematic Reviews, 2017Co-Authors: Lucky Saraswat, June D Cody, Haroon Rehman, Muhammad Imran Omar, Patricia Aluko, Cathryn GlazenerAbstract:Background Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional suburethral slings are one of the surgical operations used to treat women with symptoms of stress urinary incontinence. Objectives To determine the effects of traditional suburethral slings on stress or mixed incontinence in comparison with other management options. Search methods We searched the Cochrane Incontinence Group Specialised Register (searched 3 June 2010) and the reference lists of relevant articles. Selection criteria Randomised or quasi-randomised trials that included traditional suburethral slings for the treatment of stress or mixed urinary incontinence. Data collection and analysis At least three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, we calculated a summary statistic: a relative risk for dichotomous data and a weighted mean difference for continuous data. Main results We included 26 trials involving 2284 women. The quality of evidence was moderate for most trials and there was generally short follow-up ranging from 6 to 24 months. One medium-sized trial compared traditional suburethral sling operations with oxybutynin in the treatment of women with mixed urinary incontinence. Surgery appeared to be more effective than drugs in treating participant-reported incontinence (n = 75, risk ratio (RR) 0.18, 95% confidence interval (CI) 0.08 to 0.43). One trial found that traditional slings were more effective than transurethral injectable treatment (RR for clinician-assessed incontinence within a year 0.21, 95% CI 0.09 to 0.21) Seven trials compared slings with open abdominal retropubic Colposuspension. Participant-reported incontinence was lower with the slings after one year (RR 0.75, 95% CI 0.62 to 0.90), but not when assessed by clinicians. Colposuspension, however, was associated with fewer peri-operative complications, shorter duration of use of indwelling catheter and less long-term voiding dysfunction. One study showed there was a 20% lower risk of bladder perforation with the sling procedure but a 50% increase in urinary tract infection with the sling procedure compared with Colposuspension. Fewer women developed prolapse after slings (compared with after Colposuspension) in two small trials but this did not reach statistical significance. Twelve trials addressed the comparison between traditional sling operations and minimally invasive sling operations. These seemed to be equally effective in the short term (RR for incontinence within first year 0.97, 95% CI 0.78 to 1.20) but minimally invasive slings had a shorter operating time, fewer peri-operative complications (other than bladder perforation) and some evidence of less post-operative voiding dysfunction and detrusor symptoms. Six trials compared one type of traditional sling with another. Materials included porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia. Participant-reported improvement rates within the first year favoured the traditional autologous material rectus fascia over other biological materials (RR 0.45, 95% CI 0.21 to 0.98). There were more complications with the use of non-absorbable Gore-Tex in one trial. Data for comparison of bladder neck needle suspension with suburethral slings were inconclusive because they came from a single trial with a small specialised population. No trials compared traditional suburethral slings with anterior repair, laparoscopic retropubic Colposuspension or artificial sphincters. Most trials did not distinguish between women having surgery for primary or recurrent incontinence when reporting participant characteristics. For most of the comparisons, clinically important differences could not be ruled out. Authors' conclusions Traditional slings seem to be as effective as minimally invasive slings, but had higher rates of adverse effects. This should be interpreted with some caution however, as the quality of evidence for the studies was variable, follow-up short and populations small, particularly for identifying complication rates. Tradional sling procedures appeared to confer a similar cure rate in comparison to open retropubic Colposuspension, but the long-term adverse event profile is still unclear. A brief economic commentary (BEC) identified two studies suggesting that traditional slings may be more cost-effective compared with collagen injection but not cost-effective when compared with minimally invasive sling operations. Reliable evidence to clarify whether or not traditional suburethral slings may be better or worse than other surgical or conservative management options is lacking.
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open retropubic Colposuspension for urinary incontinence in women
Cochrane Database of Systematic Reviews, 2017Co-Authors: Marie Carmela M Lapitan, June D CodyAbstract:Background Urinary incontinence is a common and potentially debilitating problem. Stress urinary, incontinence as the most common type of incontinence, imposes significant health and economic burdens on society and the women affected. Open retropubic Colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure to correct stress urinary incontinence. Objectives The review aimed to determine the effects of open retropubic Colposuspension for the treatment of urinary incontinence in women. A secondary aim was to assess the safety of open retropubic Colposuspension in terms of adverse events caused by the procedure. Search methods We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 5 May 2015), and the reference lists of relevant articles. We contacted investigators to locate extra studies. Selection criteria Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic Colposuspension surgery in at least one trial group. Data collection and analysis Studies were evaluated for methodological quality or susceptibility to bias and appropriateness for inclusion and data extracted by two of the review authors. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated. Main results This review included 55 trials involving a total of 5417 women. Overall cure rates were 68.9% to 88.0% for open retropubic Colposuspension. Two small studies suggested lower incontinence rates after open retropubic Colposuspension compared with conservative treatment. Similarly, one trial suggested lower incontinence rates after open retropubic Colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower incontinence rate after open retropubic Colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (risk ratio (RR) for incontinence 0.46; 95% CI 0.30 to 0.72 before the first year, RR 0.37; 95% CI 0.27 to 0.51 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond five years). Evidence from 22 trials in comparison with suburethral slings (traditional slings or trans-vaginal tape or transobturator tape) found no overall significant difference in incontinence rates in all time periods evaluated (as assessed subjectively RR 0.90; 95% CI 0.69 to 1.18, within one year of treatment, RR 1.18; 95%CI 1.01 to 1.39 between one and five years, RR 1.11; 95% CI 0.97 to 1.27 at five years and more, and as assessed objectively RR 1.24; 95% CI 0.93 to 1.67 within one year of treatment, RR 1.12; 95% CI 0.82 to 1.54 for one to five years follow up, RR 0.70; 95% CI 0.30 to 1.64 at more than five years). However, subgroup analysis of studies comparing traditional slings and open Colposuspension showed better effectiveness with traditional slings in the medium and long term (RR 1.35; 95% CI 1.11 to 1.64 from one to five years follow up, RR 1.19; 95% CI 1.03 to 1.37). In comparison with needle suspension, there was a lower incontinence rate after Colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.56; 95% CI 0.39 to 0.81), and beyond five years (RR 0.32; 95% CI 15 to 0.71). Patient-reported incontinence rates at short, medium and long-term follow-up showed no significant differences between open and laparoscopic retropubic Colposuspension, but with wide confidence intervals. In two trials incontinence was less common after the Burch (RR 0.38; 95% CI 0.18 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five year follow-up. There were few data at any other follow-up times. In general, the evidence available does not show a higher morbidity or complication rate with open retropubic Colposuspension compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Voiding problems are also more common after sling procedures compared to open Colposuspension. Authors' conclusions Open retropubic Colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85% to 90%. After five years, approximately 70% of women can expect to be dry. Newer minimal access sling procedures look promising in comparison with open Colposuspension but their long-term performance is limited and closer monitoring of their adverse event profile must be carried out. Open Colposuspension is associated with a higher risk of pelvic organ prolapse compared to sling operations and anterior colporrhaphy, but with a lower risk of voiding dysfunction compared to traditional sling surgery. Laparoscopic Colposuspension should allow speedier recovery but its relative safety and long-term effectiveness is not yet known. A Brief Economic Commentary (BEC) identified five studies suggesting that tension-free vaginal tape (TVT) and laparoscopic Colposuspension may be more cost-effective compared with open retropubic Colposuspension.
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open retropubic Colposuspension for urinary incontinence in women a short version cochrane review
Neurourology and Urodynamics, 2009Co-Authors: Marie Carmela M Lapitan, June D Cody, Adrian GrantAbstract:Background Urinary incontinence is a common and potentially debilitating problem. Open retropubic Colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure. Objectives To assess the effects of open retropubic Colposuspension for the treatment of urinary incontinence. Search Strategy We searched the Cochrane Incontinence Group Specialized Register (searched June 30, 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies. Selection Criteria Randomized or quasi-randomized controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic Colposuspension surgery in at least one trial group. Data Collection and Analysis Studies were evaluated for methodological quality/susceptibility to bias and appropriateness for inclusion and data extracted by two of the reviewers. Trial data were analyzed by intervention. Where appropriate, a summary statistic was calculated. Main Results This review included 46 trials involving a total of 4,738 women. Overall cure rates were 68.9–88.0% for open retropubic Colposuspension. Two small studies suggest lower failure rates after open retropubic Colposuspension compared with conservative treatment. Similarly, one trial suggests lower failure rates after open retropubic Colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower failure rate for subjective cure after open retropubic Colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (RR of failure 0.51; 95% CI 0.34–0.76 before the first year, RR 0.43; 95% CI 0.32–0.57 at 1–5 years, RR 0.49; 95% CI 0.32–0.75 in periods beyond 5 years). In comparison with needle suspensions there was a lower failure rate after Colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42–1.03), after the first year (RR 0.48; 95% CI 0.33–0.71), and beyond 5 years (RR 0.32; 95% CI 15–0.71). Evidence from 12 trials in comparison with suburethral slings found no significant difference in failure rates in all time periods assessed. Patient-reported failure rates in short, medium and long-term follow-up showed no significant difference between open and laparoscopic retropubic Colposuspension, but with wide confidence intervals. In two trials failure was less common after Burch (RR 0.38 95% CI 0.18–0.76) than after the Marshall-Marchetti-Krantz procedure at 1–5-year follow-up. There were few data at any other follow-up time. In general, the evidence available does not show a higher morbidity or complication rate with open retropubic Colposuspension, compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Authors' Conclusions The evidence available indicates that open retropubic Colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85–90%. After 5 years, approximately 70% of patients can expect to be dry. Newer minimal access procedures such as tension free vaginal tape look promising in comparison with open Colposuspension but their long-term performance is not known and closer monitoring of their adverse event profile must be carried out. Laparoscopic Colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet. Neurourol. Urodyn. 28:472–480, 2009. © 2009 Wiley-Liss, Inc.
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cost effectiveness of tension free vaginal tape for the surgical management of female stress incontinence
International Journal of Technology Assessment in Health Care, 2004Co-Authors: Mary Kilonzo, June D Cody, Cathryn Glazener, Adrian Grant, Luke Vale, Sally C Stearns, Sheila A Wallace, Kirsty MccormackAbstract:Objectives: Stress urinary incontinence affects between 10 percent and 50 percent of women. Surgery is commonly recommended for troublesome incontinence that does not respond to nonsurgical management. Tension-free vaginal tape (TVT) is a newer, minimal access surgical sling procedure, which is being increasingly adopted worldwide. The cost-effectiveness of TVT in comparison with other surgical procedures, particularly open Colposuspension, is assessed. Methods: Effectiveness estimates came from a systematic review of TVT compared with other surgical procedures (open and laparoscopic Colposuspension, traditional slings, and injectables). Deterministic and probabilistic analyses were used to assess the likelihood of TVT being cost-effective. Sensitivity analyses assessed the impact of changing assumptions about cure rates and costs for TVT, cure rates for retreatment open Colposuspension, and proportions of women who choose retreatment. Results: Reliable estimates of relative effectiveness were difficult to derive because the few randomized controlled comparisons had not been optimally analyzed or fully reported. Results of the economic model suggested that TVT dominates open Colposuspension (lower cost and same quality of life years[QALYs]) within 5 years after surgery. Stochastic analysis indicated that the likelihood of TVT being cost-effective was 100 percent if decision-makers are unwilling to pay for additional QALYs. TVT's dominance depended on the assumption fact that retreatment open Colposuspension has lower cure rates than a first Colposuspension. Conclusions: Analysis based on current short-term data indicates dominance of TVT over open Colposuspension from approximately 5 years. There is a need for longer-term follow-up data from methodologically rigorous randomized trials to provide a sounder basis for estimating the relative benefits and cost implications.
Carl Gustaf Nilsson - One of the best experts on this subject based on the ideXlab platform.
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tvt versus laparoscopic mesh Colposuspension 5 year follow up results of a randomized clinical trial
International Urogynecology Journal, 2015Co-Authors: A Valpas, Seija Alanissila, Eija Tomas, Carl Gustaf NilssonAbstract:Before the introduction of the tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence, the Colposuspension operation was regarded as the “gold standard” procedure. The laparoscopic variant of the Colposuspension was introduced as a less invasive operation. The aim of the present trial was to compare the new minimally invasive TVT procedure with laparoscopic mesh Colposuspension (LCM). A multicenter randomized clinical trial conducted in six public hospitals in Finland including primary cases of stress incontinence. Objective treatment success criteria were a negative stress test and no retreatment for stress incontinence. Patient satisfaction was assessed by Patients Global Impression of Improvement, a visual analog scale, and the Urinary Incontinence Severity Score. Of 128 randomized patients, 121 underwent the allocated operation. At the 5-year follow-up 77 % in the TVT group and 84 % in the LCM group could be assessed according to the protocol. The objective cure rate was significantly higher in the TVT group (94 %) than in the LCM group (78 %). Subjective treatment satisfaction (completely satisfied with the procedure) was significantly higher in the TVT group (64 %) than in the LCM group (51 %). By per protocol analysis both objective and subjective cure rates were significantly higher in the TVT group than in the LCM group. If cases that were lost to follow-up were regarded as failures, the intension-to-treat analysis found no difference between the groups.
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tension free vaginal tape and laparoscopic mesh Colposuspension for stress urinary incontinence
Obstetrics & Gynecology, 2004Co-Authors: A Valpas, Aarre Kivela, Jorma Penttinen, Erkki Kujansuu, Mervi Haarala, Carl Gustaf NilssonAbstract:OBJECTIVE:To compare objective and subjective outcomes after the tension-free vaginal tape procedure (TVT) with laparoscopic mesh Colposuspension as a primary treatment for female stress urinary incontinence. Objective outcome measures were stress test and 48-hour pad test.METHODS:In 6 departments o
Massimo Porena - One of the best experts on this subject based on the ideXlab platform.
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pelvic organ prolapse repair with and without prophylactic concomitant burch Colposuspension in continent women a randomized controlled trial with 8 year followup
The Journal of Urology, 2011Co-Authors: Elisabetta Costantini, Alessandro Zucchi, Vittorio Bini, Massimo Lazzeri, Michele Del Zingaro, Massimo PorenaAbstract:Purpose: We reevaluated and brought up to date the 8-year followup of a previous published, randomized, controlled trial of the impact of Burch Colposuspension as a prophylactic anti-incontinence procedure in patients without urinary incontinence who underwent abdominal pelvic organ prolapse repair.Materials and Methods: A total of 66 continent women with pelvic organ prolapse were randomly assigned to abdominal pelvic organ prolapse repair and concomitant Burch Colposuspension in 34 (group 1) or pelvic organ prolapse repair alone without an anti-incontinence procedure in 32 (group 2). Primary study end points were the anatomical outcome and changes in incontinence status. Secondary end points were changes in subjective symptoms and quality of life.Results: Median followup was 97 months (range 72 to 134). Three group 1 and 1 group 2 patients were lost to followup. Three group 1 patients had a stage I rectocele and 1 had a stage I cystocele. Four group 2 patients had a stage I rectocele and 3 had a stage I...
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burch Colposuspension does not provide any additional benefit to pelvic organ prolapse repair in patients with urinary incontinence a randomized surgical trial
The Journal of Urology, 2008Co-Authors: Elisabetta Costantini, Alessandro Zucchi, Vittorio Bini, Massimo Lazzeri, Michele Del Zingaro, Massimo PorenaAbstract:Purpose: We evaluated the impact of Burch Colposuspension as an anti-incontinence measure in patients with urinary incontinence undergoing abdominal surgery for pelvic organ prolapse repair.Materials and Methods: A total of 47 women with pelvic organ prolapse and urinary incontinence were randomly assigned to abdominal pelvic organ prolapse repair and concomitant Burch Colposuspension (24 patients, group A) or pelvic organ prolapse repair alone without an anti-incontinence procedure (23 patients, group B). They were followed up at 3, 6 and 9 months after surgery, and then annually. The primary outcome measures were anatomical outcome and changes in incontinence status as indicated by a bladder diary, the number of daily pads and the stress test. Secondary end points were changes in subjective symptoms and quality of life as measured by the Urogenital Distress Inventory and the Incontinence Impact Questionnaire.Results: In group A 13 of 24 patients (54.2%) were still incontinent after surgery compared with...
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must Colposuspension be associated with sacropexy to prevent postoperative urinary incontinence
European Urology, 2007Co-Authors: Elisabetta Costantini, Alessandro Zucchi, A Giannantoni, Luigi Mearini, Vittorio Bini, Massimo PorenaAbstract:Abstract Objectives This prospective, randomised study investigated whether a prophylactic procedure, performed during colposacropexy for prolapse repair, prevents ex novo postoperative incontinence. Sixty-six consecutive continent patients with advanced prolapse were randomised into two groups: group A underwent sacropexy combined with a Burch Colposuspension; no anti-incontinence procedure was performed in group B patients. Methods Work-up included clinical assessment (Halfway System and International Continence Society [ICS] classification for prolapse and Ingelman Sunderberg scale for incontinence), the Urogenital Distress Inventory and Impact Incontinence Quality of Life questionnaires, urogynaecologic ultrasound scans, and complete urodynamic testing that included the urethral pressure profile and Valsalva leak point pressure with reduced prolapse. Check-ups were done at 3, 6, 12 mo postoperatively and then yearly. Mean follow-up time was 39.5 mo. Results The mean age (± standard deviation) was 62±9 yr. All patients presented with grade (G) 3–4 prolapse. Postoperative incontinence was present in 12 of the 34 patients in group A: 7 G1; 4 G2, and 1 G3. Postoperative incontinence was present in 3 of the 32 patients in group B: 2 G1, 1 G3. The frequency of postoperative incontinence was significantly greater in patients who had undergone Colposuspension ( p Conclusions These preliminary data cast doubt on whether Colposuspension should be performed during sacropexy for severe urogenital prolapse as prophylaxis for postoperative incontinence because it seems to emerge as overtreatment. Incontinence developed ex novo in 35% of continent patients treated with Colposuspension combined with sacropexy.