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Yan-feng Song - One of the best experts on this subject based on the ideXlab platform.

  • Study on modified Prolift for pelvic floor reconstruction in the prevention of stress urinary incontinence
    Zhonghua fu chan ke za zhi, 2012
    Co-Authors: Fengmei Wang, Huijuan Huang, Yan-feng Song
    Abstract:

    Objective To evaluate the safety and efficacy of modified Prolift pelvic floor reconstruction with improving the placement of Prolift-A in treatment of severe pelvic floor dysfunction and stress urinary incontinence (SUI).Methods From July 2008 to September 2010,170 cases with severe pelvic organ prolapse(POP) treated by modified Prolift pelvic floor reconstruction surgery in Fuzhou General Hospital were enrolled in this study.The Prolift-A was laid tension-free under the mid-urethra with the position of Prolift-A displaced from the neck of bladder to the mid-urethra.No concomitant tension-free urethra suspender via vagina was performed.Primary outcomes were assessed with POP quantitation ( POPQ) system to evaluate the postoperative anatomical replacement stage.Secondary outcome measure were:urogenital distress inventory 6 ( UDI-6),the incontinence impact questionnaire 7 ( IIQ-7 ) and the pelvic floor incontinence questionnaire 7 (PFIQ-7) to evaluate the impact on life quality at the follow-up of 1,6,12 months.Results At 6 and 12 months after surgery,168 cases and 163 cases were followed up.The anatomical cure rates were 98.8％ (166/168) at 6 months and 97.5％ (159/163) at 12 months,respectively.One case with bladder Injury and 1 case with Rectum Injury were observed.Five cases with recurrence were observed,including 2 cases with anterior vagina prolapse,2 cases with uterine prolapse and 1 case with posterior vagina prolapse.Meanwhile,3 cases with hematoma and 7 cases with mesh erosion were observed.Quality of life of all patients were improved significantly by UDI-6,IIQ-7 and PFIQ-7 scoring system evaluation.Among 79 POP patients with SUI,the cure rate of SUI was 93.7％ (74/79).Of 5 cases with symptomatic SUI,2 cases were needed surgical intervention.Twenty-three cases were found with minimal SUI symptoms and subjective satisfaction without objective influence on quality of life.Seven patients presented dysuria after surgery,5 cases recovered urination with 10 days,1 case recovered with 1 months,and 1 case with 6 months by bladder drainage.Eleven cases with discomfort urination and 3 cases with slow urination were found.Conclusions The modified Prolift pelvic reconstructive surgery was safe and efficacy intervention in treatment of POP and prevention of SUI. Key words: Pelvic organ prolapse;  Urinary incontinence, stress;  Gynecologic surgicalprocedures;  Pelvic floor

C.h. Sun - One of the best experts on this subject based on the ideXlab platform.

  • Isolation of Uterosacral Ligament (USL): A Safe and Effective Way for Laparoscopic Usl Hysteropexy / Colpopexy
    Journal of Minimally Invasive Gynecology, 2020
    Co-Authors: C.h. Sun
    Abstract:

    Study Objective Because of the potential complications from artificialmesh, native tissue repair has regained its popularity during pelvic floor reconstruction surgery. Uterosacral ligament (USL) is the most important structures for level I support. However, the attenuated or broken USL in pelvic organ prolapse (POP) patients makes it difficult to get enough strong tissue for durable pelvic support, which result in the high recurrence rate after USL suspension for uterus or vagina cuff. Besides, the close anatomical relationship between USL and other important retroperitoneal structures (ureter, vessels, nerves) and Rectum may sometimes limit the accessibility and suture bite during USL colpopexy/hysteropexy. In this video, we will demonstrate the important anatomical structures near the USL, and the technique to isolate it, that will make USL suspension safe and effective. Design Video clips from different patients were collected and edited. Setting single hospital, single surgeon. Patients or Participants Video clips from young patient with minimal endometriosis as normal control (demonstrate transperitoneal view), video clips from patients undergoing nerve-sparing radical hysterectomy as teaching model for detailed retroperitoneal structures, and video clips from patients undergoing USL hysteropexy were collected and edited. Interventions Ureter was identified transperitoneally first. Peritoneal window was developed between ureter and USL, entering the Okabayashi pararectal space. All the retroperitoneal structures (including ureter, uterine artery and vein, hypogastric nerve and pelvic plexus) were lateralized. Perirectal space and rectovaginal space were opened, dissecting the Rectum away from the USL. Measurements and Main Results After USL isolation, USL suspension can be performed with maximal durability (big bite) and safety (minimal risk of ureter kinking, nerve Injury, or Rectum Injury). Conclusion Isolation of uterosacral ligament (USL) is a safe and effective way for laparoscopic USL hysteropexy / colpopexy.

T. Kratt - One of the best experts on this subject based on the ideXlab platform.

  • Gene expression analysis in chronic postradiation proctopathy
    International Journal of Colorectal Disease, 2012
    Co-Authors: F. Traub, S. Schleicher, A. Kirschniak, D. Zieker, S. Kupka, M. Weinmann, A. Königsrainer, T. Kratt
    Abstract:

    Purpose Radiotherapy is one of the important treatment modalities for tumors of pelvic organs. The fixed location of the Rectum and its anatomic relationship with other pelvic organs makes it prone to radiation Injury resulting in chronic radiation proctopathy in 5% to 20% of patients. Endothelial dysfunction has been associated with a number of pathophysiological processes. Endothelial cells synthesize and release various factors that regulate angiogenesis, inflammatory responses, hemostasis, as well as vascular tone and permeability. Methods Rectum tissue samples from 20 patients with established chronic radiation proctopathy were analysed for the expression of genes related to oxidative stress, tissue hypoxia, angiogenesis, and inflammation [endoglin (ENG), activin receptor-like kinase 1 (ALK1), platelet endothelial cell adhesion molecule 1 (PECAM), vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2), hypoxia-inducible factor 1 (HIF-1), and interleukin-1 beta (IL-1β)]. Results Overexpression of HIF-1, VEGF, FGF2, and IL-1β was detected in affected tissue. For the first time, a significant suppression of activin receptor-like kinase 1 and ENG could be revealed. Conclusion The data provided here allow further insight into the pathogenesis of radiation-induced Rectum Injury. Radiation-induced damage is not confined to a single event but involves complex signaling between different pathways, enhancing and maintaining the processes that lead to mucosal damage. The results indicate that postradiation tissue hypoxia is critical for fibrosis, which involves changes in the expression of profibrotic and angiogenic factors in rectal tissue.

  • Gene expression analysis in chronic postradiation proctopathy
    International journal of colorectal disease, 2011
    Co-Authors: F. Traub, S. Schleicher, A. Kirschniak, D. Zieker, S. Kupka, M. Weinmann, A. Königsrainer, T. Kratt
    Abstract:

    Radiotherapy is one of the important treatment modalities for tumors of pelvic organs. The fixed location of the Rectum and its anatomic relationship with other pelvic organs makes it prone to radiation Injury resulting in chronic radiation proctopathy in 5% to 20% of patients. Endothelial dysfunction has been associated with a number of pathophysiological processes. Endothelial cells synthesize and release various factors that regulate angiogenesis, inflammatory responses, hemostasis, as well as vascular tone and permeability. Rectum tissue samples from 20 patients with established chronic radiation proctopathy were analysed for the expression of genes related to oxidative stress, tissue hypoxia, angiogenesis, and inflammation [endoglin (ENG), activin receptor-like kinase 1 (ALK1), platelet endothelial cell adhesion molecule 1 (PECAM), vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2), hypoxia-inducible factor 1 (HIF-1), and interleukin-1 beta (IL-1β)]. Overexpression of HIF-1, VEGF, FGF2, and IL-1β was detected in affected tissue. For the first time, a significant suppression of activin receptor-like kinase 1 and ENG could be revealed. The data provided here allow further insight into the pathogenesis of radiation-induced Rectum Injury. Radiation-induced damage is not confined to a single event but involves complex signaling between different pathways, enhancing and maintaining the processes that lead to mucosal damage. The results indicate that postradiation tissue hypoxia is critical for fibrosis, which involves changes in the expression of profibrotic and angiogenic factors in rectal tissue.

Zhang Jion - One of the best experts on this subject based on the ideXlab platform.

  • Clinical analysis of the TVT-O treatment of female stress urinary incontinence
    Clinical Medicine, 2015
    Co-Authors: Zhang Jion
    Abstract:

    Objective To investigate the clinical efficacy of tapeobturator tension-free vaginal tape( TVT-O) treatment on female stress urinary incontinence( FSUI). Methods The clinical data of 38 female patients with stress urinary incontinence treated by TVT-O were analyzed retrospectively. The 1 month,6 months maximum flow rates were followed up and residual urine was measured by B ultrasoud. Using ICI-Q-SF score,the clinical effect and safety of TVT-O surgery was evaluated. Results All of the patients had successful operation. The surgical success rate was 100%,the average operative time was( 16 ± 4) min,blood loss was( 10 ±3) ml,postoperative catheterization time was 2-5 d,averaged 2. 9 d,the average length of hospital stay was 3-6 d,averaged 4. 2 d. The Qmax of flow rate had no downward trend( P 0. 05),and there was no increase in residual urine( P 0. 05).ICI-Q-SF score was significantly improved( P 0. 01). Only one case had postoperative dysuria after one week of pull out the catheter,after bladder training,physical therapy and other symptoms improved with conservative treatment,and the remaining patients had satisfactory urinary results. All patients had varying degrees of incision bleeding,no bladder,urethra,Rectum Injury,there was no retropubic hematoma formation,no implant rejection,infection or other complications. Conclusion The clinical efficacy of TVT-O on FSUI is good and safe,especially in patients with severe FSUI,symptom improvement is remarkable.

Paweł Kukołowicz - One of the best experts on this subject based on the ideXlab platform.

  • [I125] Modern radiotherapy of localized prostrate cancer
    Physica Medica, 2018
    Co-Authors: Paweł Kukołowicz
    Abstract:

    Purpose Radiotherapy is the effective way of treatment of localized cancer. Clinical evidence of dependence of treatment outcome on the total dose has been proofed by several randomized trials. Today safe delivery of very high dose to prostate is possible thanks to achievements in modern methods of dose delivery. Methods This presentation is based on a search and review of the literature and on the experience of our center. The main question was how to deliver the Effective Biological Dose > 190 Gy ( α / β  = 1.5 Gy) with external beam radiotherapy safely. Results The accurate delineation of the CTV should be supported by MRI images. Multi-parametric MRI is well established for detection of dominant prostatic lesion in order to escalate the dose delivered to this region. The PTV–CTV margin applied in our center is 7 mm, however the margin as small as 3 mm is also used. High precision of prostate irradiation requires daily verification of prostate position with fiducial markers inserted into the prostate. Also intrafraction verification of prostate position is applied. To diminish the probability of Rectum Injury perirectal spacing between the prostate and Rectum is recommended. If spacers are used the probability of late Rectum Injury (Grade ≥ 2) is 1%. The best irradiation technique is VMAT technique, because the treatment time of irradiation is the shortest one what reduces the probability of prostate movement. The low α / β has established a strong basis for hypofractionation of prostate cancer. In our center the mild hypofractionation with 2.6 fraction dose in 27 fractions is used (BED = 192 Gy). From our experience the good cooperation with the patient plays a key role in the treatment. We recommend to spend enough time for explanation of treatment procedure. A patient should be convinced to strive for a reproducible Rectum and bladder filling. Conclusions The modern, safe and effective external radiotherapy of prostate cancer with photon beams is possible but requires: very careful preparation of patients for treatment and precise, image-guided irradiation. The only unresolved problem is bladder protection. This problem will be also addressed in this presentation.