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Eric R. Sokol - One of the best experts on this subject based on the ideXlab platform.
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does the degree of Cystocele predict de novo stress urinary incontinence after prolapse repair further analysis of the colpopexy and urinary reduction efforts trial
Female pelvic medicine & reconstructive surgery, 2017Co-Authors: Michael T Davenport, Eric R. Sokol, Craig V. Comiter, Christopher S. ElliottAbstract:INTRODUCTION Cystoceles may cause urethral obstruction by altering the vesicourethral angle. Restoration of normal anatomy after pelvic organ prolapse (POP) repair can relieve this obstruction but may unmask stress urinary incontinence (SUI). The association between the severity of Cystocele and developing de novo SUI after prolapse repair, however, is poorly understood. We hypothesized that, in women undergoing prolapse repair, increasing degrees of bladder prolapse would be associated with increasing rates of postoperative de novo SUI. MATERIALS AND METHODS We performed a secondary analysis of the Colpopexy and Urinary Reduction Efforts (CARE) trial data. Using the control arm (women undergoing prolapse repair without a prophylactic SUI procedure), we identified de novo SUI using a composite definition based on original trial criteria. We performed logistic regression to evaluate the relationship between the degree of Cystocele and the development of new SUI. RESULTS Of the 164 women who underwent abdominal sacrocolpopexy alone, 54% developed de novo postoperative SUI. Stratifying by the degree of anterior prolapse (point Ba), we found a linear increase in the rate of SUI with worsening preoperative Cystocele. The incidence of de novo SUI based on the POP Quantification stage of anterior prolapse was 41.3%, 52.5%, and 66.1%, for stage 2, early stage 3, and advanced stage 3 or stage 4, respectively. Point Ba was found to be significantly associated with de novo SUI on both univariate (odds ratio = 1.17, P = 0.015) and multivariate analysis (odds ratio = 1.16, P = 0.04). CONCLUSIONS The incidence of de novo SUI after prolapse repair directly correlates to the degree of Cystocele on preoperative examination. This simple yet novel relationship should further guide discussions about potential postoperative incontinence.
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the predictive value of a Cystocele for concomitant vaginal apical prolapse
The Journal of Urology, 2013Co-Authors: Christopher S. Elliott, Judy Yeh, Craig V. Comiter, Bertha Chen, Eric R. SokolAbstract:Purpose: Recent studies showing a correlation between descent of the anterior and apical vaginal compartments suggest that Cystoceles may recur if associated apical prolapse is not corrected. However, to date the anatomical relationship of apical prolapse with respect to Cystocele has been incompletely reported. We present the predictive value of a Cystocele for clinically significant vaginal apical prolapse.Materials and Methods: We retrospectively reviewed the records of all new patient visits to a urogynecology clinic in a 30-month period. Women with a point Ba value of −1 or greater (stage 2 Cystocele and above) were included in analysis. Predictive values of clinically significant apical prolapse, defined as point C −3 or greater, were calculated and stratified by Cystocele stage.Results: A total of 385 women were included in study. Point Ba was the leading edge of prolapse in 83.9% of cases. The position of Ba strongly correlated with that of the vaginal apex (Spearman ρ = 0.769, p <0.001). Overall ...
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The Predictive Value of a Cystocele for Concomitant Vaginal Apical Prolapse
The Journal of Urology, 2012Co-Authors: Christopher S. Elliott, Judy Yeh, Craig V. Comiter, Bertha Chen, Eric R. SokolAbstract:Purpose: Recent studies showing a correlation between descent of the anterior and apical vaginal compartments suggest that Cystoceles may recur if associated apical prolapse is not corrected. However, to date the anatomical relationship of apical prolapse with respect to Cystocele has been incompletely reported. We present the predictive value of a Cystocele for clinically significant vaginal apical prolapse.Materials and Methods: We retrospectively reviewed the records of all new patient visits to a urogynecology clinic in a 30-month period. Women with a point Ba value of −1 or greater (stage 2 Cystocele and above) were included in analysis. Predictive values of clinically significant apical prolapse, defined as point C −3 or greater, were calculated and stratified by Cystocele stage.Results: A total of 385 women were included in study. Point Ba was the leading edge of prolapse in 83.9% of cases. The position of Ba strongly correlated with that of the vaginal apex (Spearman ρ = 0.769, p
Salvatore Lopez - One of the best experts on this subject based on the ideXlab platform.
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anterior colporrhaphy plus inside out tension free vaginal tape for associated stress urinary incontinence and Cystocele 10 year follow up results
Neurourology and Urodynamics, 2018Co-Authors: Roberto Montera, Andrea Miranda, Francesco Plotti, Corrado Terranova, Daniela Luvero, Stella Capriglione, Giuseppe Scaletta, Marzio Angelo Zullo, Maurizio Buscarini, Salvatore LopezAbstract:Aims We report the success rate and complications rate of combined ultralateral anterior Colporrhaphy plus Tension-free Vaginal Tape (TVT-O) in a long-term (10 year) follow-up prospective survey. Methods Patients previously treated for associated stress urinary incontinence (SUI) and Cystocele were subjected to annual follow-up for 10 year with a complete urogynecologic evaluation. Furthermore, an urodynamic assessment and a quality of life questionnaire (ICIQ-UI SF) were recorded at the 5th and 10th year of follow up. Results Fifty patients treated between June 2004 and May 2006 were included in the analysis. Five patients did not return to 5-yr follow-up: two patients developed a median tape erosion and three patients withdraw. At 10-yr follow-up two more patients withdraw for a total of seven patients lost to follow-up. After 10 years patients objectively cured from Cystocele were 41 (95%) while patients objectively cured from SUI were 39 (91%). At 10th year follow-up 38 patients (89%) result cured from both SUI and Cystocele, 3 (7%) patients result cured only from prolapse, 1 (2%) patient only from SUI, and 1 (2%) patient result objectively failed for both SUI and Cystocele. The ICIQ-UI SF scores at 10th year follow-up was 6.2 ± 3.7. The late complication rate at 10th year follow-up was 32% (OAB symptoms 20%; Mixed incontinence 2%; Bladder outlet obstruction 0%; Dyspareunia 6%; Chronic pelvic pain 0%; Vaginal tape erosion 4%; Detrusor hyperactivity 0%). Conclusions The combined procedures shown proved to be an effective and safe procedure to treat concomitant SUI and Cystocele.
Michel Cosson - One of the best experts on this subject based on the ideXlab platform.
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Cystocele and functional anatomy of the pelvic floor: review and update of the various theories
International Urogynecology Journal, 2016Co-Authors: Géry Lamblin, Michel Cosson, Emmanuel Delorme, Chrystèle RubodAbstract:Introduction and hypothesis We updated anatomic theories of pelvic organ support to determine pathophysiology in various forms of Cystocele. Methods PubMed/MEDLINE, ScienceDirect, Cochrane Library, and Web of Science databases were searched using the terms pelvic floor, Cystocele, anatomy, connective tissue, endopelvic fascia, and pelvic mobility. We retrieved 612 articles, of which 61 matched our topic and thus were selected. Anatomic structures of bladder support and their roles in Cystocele onset were determined on the international anatomic classification; the various anatomic theories of pelvic organ support were reviewed and a synthesis was made of theories of Cystocele pathophysiology. Results Anterior vaginal support structures comprise pubocervical fascia, tendinous arcs, endopelvic fascia, and levator ani muscle. DeLancey’s theory was based on anatomic models and, later, magnetic resonance imaging (MRI), establishing a three-level anatomopathologic definition of prolapse. Petros’s integral theory demonstrated interdependence between pelvic organ support systems, linking ligament–fascia lesions, and clinical expression. Apical Cystocele is induced by failure of the pubocervical fascia and insertion of its cervical ring; lower Cystocele is induced by pubocervical fascia (medial Cystocele) or endopelvic fascia failure at its arcus tendineus fasciae pelvis attachment (lateral Cystocele). Conclusions Improved anatomic knowledge of vaginal wall support mechanisms will improve understanding of Cystocele pathophysiology, diagnosis of the various types, and surgical techniques. The two most relevant theories, DeLancey’s and Petros’s, are complementary, enriching knowledge of pelvic functional anatomy, but differ in mechanism. Three-dimensional digital models could integrate and assess the mechanical properties of each anatomic structure.
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Cystocele and functional anatomy of the pelvic floor: review and update of the various theories
International Urogynecology Journal, 2016Co-Authors: Géry Lamblin, Michel Cosson, Emmanuel Delorme, Chrystèle RubodAbstract:Introduction and hypothesis We updated anatomic theories of pelvic organ support to determine pathophysiology in various forms of Cystocele. Methods PubMed/MEDLINE, ScienceDirect, Cochrane Library, and Web of Science databases were searched using the terms pelvic floor, Cystocele, anatomy, connective tissue, endopelvic fascia, and pelvic mobility. We retrieved 612 articles, of which 61 matched our topic and thus were selected. Anatomic structures of bladder support and their roles in Cystocele onset were determined on the international anatomic classification; the various anatomic theories of pelvic organ support were reviewed and a synthesis was made of theories of Cystocele pathophysiology. Results Anterior vaginal support structures comprise pubocervical fascia, tendinous arcs, endopelvic fascia, and levator ani muscle. DeLancey’s theory was based on anatomic models and, later, magnetic resonance imaging (MRI), establishing a three-level anatomopathologic definition of prolapse. Petros’s integral theory demonstrated interdependence between pelvic organ support systems, linking ligament–fascia lesions, and clinical expression. Apical Cystocele is induced by failure of the pubocervical fascia and insertion of its cervical ring; lower Cystocele is induced by pubocervical fascia (medial Cystocele) or endopelvic fascia failure at its arcus tendineus fasciae pelvis attachment (lateral Cystocele). Conclusions Improved anatomic knowledge of vaginal wall support mechanisms will improve understanding of Cystocele pathophysiology, diagnosis of the various types, and surgical techniques. The two most relevant theories, DeLancey’s and Petros’s, are complementary, enriching knowledge of pelvic functional anatomy, but differ in mechanism. Three-dimensional digital models could integrate and assess the mechanical properties of each anatomic structure.
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Cure of Cystocele with vaginal patch
Progres En Urologie, 2001Co-Authors: Michel Cosson, Pierre Collinet, B Occelli, Fabrice Narducci, Gilles CrepinAbstract:But : Decrire une technique originale de cure de Cystocele par voie vaginale. L'intervention associe une suspension par six points aux arcs tendineux du fascia pelvien d'une prothese de tissu vaginal de 6 a 8 cm de long sur 4 cm de large environ, laissee au contact de la Cystocele. Le plastron vaginal est alors enfoui sous la suture de la colporraphie anterieure. En fonction de la necessite on associera une spinofixation, une hysterectomie, une myorraphie des elevateurs ou une cure d'incontinence urinaire. Materiel et Methodes : Etude retrospective de 47 patientes operees d'une cure de prolapsus par voie vaginale entre octobre 1997 et juin 1998. Toutes les patientes presentaient un prolapsus exteriorise avec Cystocele de grade III, associee a une incontinence urinaire dans 38,3% des cas et a une hysterocele ou un prolapsus du fond vaginal dans 87% des cas. L'âge moyen etait de 69 ans. Dans deux cas une conservation uterine a ete preferee mais chez les 45 autres patientes une hysterectomie etait realisee avec une spinofixation selon Richter chez 44 d'entre elles. Dans tous les cas une myorraphie des elevateurs etait associee. Resultats : Le recul moyen a ete de 16,4 mois avec des extremes de 6 a 26 mois chez 46 patientes. 93% des patientes sont considerees comme gueries de leur Cystocele, une patiente presentait une Cystocele de grade I asymptomatique et deux patientes presentaient un echec avec recidive d'une Cystocele de grade II. Conclusion : La technique que nous presentons est un traitement curatif de la Cystocele de grade III chez la femme menopausee associee a une spinofixation selon Richter, et previent le risque de Cystocele decrit en cas de traitement d'un prolapsus par voie basse avec spinofixation isolee (10 a 20%). Les resultats a court terme sont encourageants meme s'ils demandent a etre confirmes par un suivi a 5 ans et plus.
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The vaginal patch plastron for vaginal cure of Cystocele. Preliminary results for 47 patients.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2001Co-Authors: Michel Cosson, Pierre Collinet, B Occelli, Fabrice Narducci, Gilles CrepinAbstract:Abstract Objective: We describe a new surgical technique (the vaginal plastron) for the treatment of Cystocele by the vaginal route. The technique is based on bladder support by a vaginal strip (6–8 cm in length and 4 cm in width), isolated from the anterior colpocele, left attached to the bladder, associated with a suspension of this strip by its fixation to the tendinous arch of the pelvic fascia by six lateral sutures (three on each side of the plastron). The vaginal plastron is then covered by tucking it under the anterior colporraphy. Study design: We evaluated the short-term functional and anatomical results of the first 47 patients to have undergone this treatment between October 1997 and June 1998. The average age of the patients was 69 years. Cystoceles were associated with urinary stress incontinence in 38.3% of cases, with hysterocele or prolapse of the vaginal dome in 87.2% of cases, with an elytrocele in 19.1% of cases and a rectocele in 70.2% of cases. Of the 45 patients having had a hysterectomy combined with the vaginal plastron or in their past history, 44 (99.77%) had a Richter sacro-spino-fixation and 17 (38%) had a Campbell procedure combined with the vaginal plastron. All patients underwent a posterior perineorraphy with myorraphy of the elevators. Results: Average follow-up was 16.4 months with extremes of 6–26 months and concerned 46 patients (one patient was unavailable). Ninety-three percent of the Cystoceles were considered treated. One case of imperfect anatomical outcome was noted (persistence of stage 1 Cystocele in one patient) together with two other cases of failure of the treatment of Cystocele (relapse to stage 2 Cystocele). Conclusion: Proposed as a curative treatment of Cystocele and combined with the Richter fixation, the plastron provides a surgical solution to the problem of Cystocele relapse arising after vaginal treatment of prolapse by sacro-spino-fixation alone (10–20% according to Richter). Short-term results are encouraging, however, medium- to long-term results (36–60 months) are necessary in order confirm the usefulness of this surgical technique.
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The vaginal plastron for cure of Cystocele
Journal De Gynecologie Obstetrique Et Biologie De La Reproduction, 2000Co-Authors: Pierre Collinet, Michel Cosson, Crépin GAbstract:Nous decrivons une nouvelle technique chirurgicale de cure de Cystocele par voie vaginale : le plastron vaginal. Cette technique, mise au point par le Pr Crepin, a pour principe un soutenement vesical par lambeau vaginal rectangulaire, isole a partir de la colpocele anterieure, laisse accole a la vessie et associe a une suspension de ce lambeau par fixation de celui-ci a l'arc tendineux du fascia pelvien par six points lateraux (3 de chaque cote du plastron). Propose comme traitement curatif des Cystoceles et associe au Richter, le plastron est une solution chirurgicale au probleme des recidives de Cystocele survenant apres traitement vaginal des prolapsus par sacro-spino-fixation seule (10 a 20 % selon Richter).
Christopher S. Elliott - One of the best experts on this subject based on the ideXlab platform.
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does the degree of Cystocele predict de novo stress urinary incontinence after prolapse repair further analysis of the colpopexy and urinary reduction efforts trial
Female pelvic medicine & reconstructive surgery, 2017Co-Authors: Michael T Davenport, Eric R. Sokol, Craig V. Comiter, Christopher S. ElliottAbstract:INTRODUCTION Cystoceles may cause urethral obstruction by altering the vesicourethral angle. Restoration of normal anatomy after pelvic organ prolapse (POP) repair can relieve this obstruction but may unmask stress urinary incontinence (SUI). The association between the severity of Cystocele and developing de novo SUI after prolapse repair, however, is poorly understood. We hypothesized that, in women undergoing prolapse repair, increasing degrees of bladder prolapse would be associated with increasing rates of postoperative de novo SUI. MATERIALS AND METHODS We performed a secondary analysis of the Colpopexy and Urinary Reduction Efforts (CARE) trial data. Using the control arm (women undergoing prolapse repair without a prophylactic SUI procedure), we identified de novo SUI using a composite definition based on original trial criteria. We performed logistic regression to evaluate the relationship between the degree of Cystocele and the development of new SUI. RESULTS Of the 164 women who underwent abdominal sacrocolpopexy alone, 54% developed de novo postoperative SUI. Stratifying by the degree of anterior prolapse (point Ba), we found a linear increase in the rate of SUI with worsening preoperative Cystocele. The incidence of de novo SUI based on the POP Quantification stage of anterior prolapse was 41.3%, 52.5%, and 66.1%, for stage 2, early stage 3, and advanced stage 3 or stage 4, respectively. Point Ba was found to be significantly associated with de novo SUI on both univariate (odds ratio = 1.17, P = 0.015) and multivariate analysis (odds ratio = 1.16, P = 0.04). CONCLUSIONS The incidence of de novo SUI after prolapse repair directly correlates to the degree of Cystocele on preoperative examination. This simple yet novel relationship should further guide discussions about potential postoperative incontinence.
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the predictive value of a Cystocele for concomitant vaginal apical prolapse
The Journal of Urology, 2013Co-Authors: Christopher S. Elliott, Judy Yeh, Craig V. Comiter, Bertha Chen, Eric R. SokolAbstract:Purpose: Recent studies showing a correlation between descent of the anterior and apical vaginal compartments suggest that Cystoceles may recur if associated apical prolapse is not corrected. However, to date the anatomical relationship of apical prolapse with respect to Cystocele has been incompletely reported. We present the predictive value of a Cystocele for clinically significant vaginal apical prolapse.Materials and Methods: We retrospectively reviewed the records of all new patient visits to a urogynecology clinic in a 30-month period. Women with a point Ba value of −1 or greater (stage 2 Cystocele and above) were included in analysis. Predictive values of clinically significant apical prolapse, defined as point C −3 or greater, were calculated and stratified by Cystocele stage.Results: A total of 385 women were included in study. Point Ba was the leading edge of prolapse in 83.9% of cases. The position of Ba strongly correlated with that of the vaginal apex (Spearman ρ = 0.769, p <0.001). Overall ...
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The Predictive Value of a Cystocele for Concomitant Vaginal Apical Prolapse
The Journal of Urology, 2012Co-Authors: Christopher S. Elliott, Judy Yeh, Craig V. Comiter, Bertha Chen, Eric R. SokolAbstract:Purpose: Recent studies showing a correlation between descent of the anterior and apical vaginal compartments suggest that Cystoceles may recur if associated apical prolapse is not corrected. However, to date the anatomical relationship of apical prolapse with respect to Cystocele has been incompletely reported. We present the predictive value of a Cystocele for clinically significant vaginal apical prolapse.Materials and Methods: We retrospectively reviewed the records of all new patient visits to a urogynecology clinic in a 30-month period. Women with a point Ba value of −1 or greater (stage 2 Cystocele and above) were included in analysis. Predictive values of clinically significant apical prolapse, defined as point C −3 or greater, were calculated and stratified by Cystocele stage.Results: A total of 385 women were included in study. Point Ba was the leading edge of prolapse in 83.9% of cases. The position of Ba strongly correlated with that of the vaginal apex (Spearman ρ = 0.769, p
Roberto Montera - One of the best experts on this subject based on the ideXlab platform.
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anterior colporrhaphy plus inside out tension free vaginal tape for associated stress urinary incontinence and Cystocele 10 year follow up results
Neurourology and Urodynamics, 2018Co-Authors: Roberto Montera, Andrea Miranda, Francesco Plotti, Corrado Terranova, Daniela Luvero, Stella Capriglione, Giuseppe Scaletta, Marzio Angelo Zullo, Maurizio Buscarini, Salvatore LopezAbstract:Aims We report the success rate and complications rate of combined ultralateral anterior Colporrhaphy plus Tension-free Vaginal Tape (TVT-O) in a long-term (10 year) follow-up prospective survey. Methods Patients previously treated for associated stress urinary incontinence (SUI) and Cystocele were subjected to annual follow-up for 10 year with a complete urogynecologic evaluation. Furthermore, an urodynamic assessment and a quality of life questionnaire (ICIQ-UI SF) were recorded at the 5th and 10th year of follow up. Results Fifty patients treated between June 2004 and May 2006 were included in the analysis. Five patients did not return to 5-yr follow-up: two patients developed a median tape erosion and three patients withdraw. At 10-yr follow-up two more patients withdraw for a total of seven patients lost to follow-up. After 10 years patients objectively cured from Cystocele were 41 (95%) while patients objectively cured from SUI were 39 (91%). At 10th year follow-up 38 patients (89%) result cured from both SUI and Cystocele, 3 (7%) patients result cured only from prolapse, 1 (2%) patient only from SUI, and 1 (2%) patient result objectively failed for both SUI and Cystocele. The ICIQ-UI SF scores at 10th year follow-up was 6.2 ± 3.7. The late complication rate at 10th year follow-up was 32% (OAB symptoms 20%; Mixed incontinence 2%; Bladder outlet obstruction 0%; Dyspareunia 6%; Chronic pelvic pain 0%; Vaginal tape erosion 4%; Detrusor hyperactivity 0%). Conclusions The combined procedures shown proved to be an effective and safe procedure to treat concomitant SUI and Cystocele.
