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Howard B. Goldman - One of the best experts on this subject based on the ideXlab platform.
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Transvaginal Sling excision: tips and tricks
International Urogynecology Journal, 2017Co-Authors: Marisa M. Clifton, Howard B. GoldmanAbstract:Introduction and hypothesis Complications of synthetic midurethral Sling surgery include bladder outlet obstruction, mesh extrusion, and vaginal pain. A treatment of these complications is Transvaginal mesh removal. The objectives of this video are to present cases of complications after Sling placement and describe techniques to help with successful Sling removal. Methods Three patients are presented in this video. One experienced urinary hesitancy and was found to have bladder outlet obstruction on urodynamic study. The second patient presented to the clinic with diminished force of stream and significant dyspareunia. The last patient presented with mesh extrusion. After discussion of management options, all three patients wished to pursue Transvaginal Sling excision. Results All patients had successful removal of a portion of their synthetic midurethral Sling. This video presents techniques to aide with dissection, mesh excision and prevention of further mesh complications. These include using an individualized surgical technique based on patient presentation and surgeon expertise, planning surgical incisions based on where mesh can be identified or palpated, using a cystoscope sheath or urethral dilator to identify any bladder outlet obstruction, and using a knife blade to identify mesh from surrounding tissue. Conclusions Sling excision can be successfully performed with careful surgical technique and dissection.
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Removal of obstructing synthetic Sling from a urethra: English and Spanish version
International Urogynecology Journal, 2016Co-Authors: Javier Pizarro-berdichevsky, Michelle P. Goldman, Howard B. GoldmanAbstract:Introduction and hypothesis Urethral perforations after synthetic midurethral Sling (MUS) placement are uncommon. Transvaginal removal is an option. The objective of this English and Spanish video is to demonstrate removal of an MUS that had perforated the urethra and the concomitant urethral reconstruction. Methods A 66-year-old woman with a history of an anterior and posterior colporrhaphy and a retropubic MUS 12 years earlier presented with difficulty voiding, recurrent urinary tract infections, and mild stress incontinence (SUI). Physical examination revealed tenderness on the anterior vaginal wall (AVW) without mesh extrusion. Cystourethroscopy showed urethral perforation, distal to the bladder neck and urodynamics demonstrated an obstructive pattern. The patient wished to undergo Transvaginal Sling removal and reconstruction. Results The mesh was deep in the AVW perforating the urethra and the vaginal portion was completely removed. The video demonstrates several tips on how to remove a perforating MUS and subsequent urethral reconstruction. Ten months postoperatively the force of stream returned to normal, with no further UTIs, no evidence of fistula, and rare SUI. Conclusions Urethral perforation with an MUS can be successfully treated with removal of any mesh in proximity to the urethra and urethral reconstruction via a completely Transvaginal approach.
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Transvaginal Sling excision: tips and tricks.
International Urogynecology Journal, 2016Co-Authors: Marisa M. Clifton, Howard B. GoldmanAbstract:Introduction and hypothesis Complications of synthetic midurethral Sling surgery include bladder outlet obstruction, mesh extrusion, and vaginal pain. A treatment of these complications is Transvaginal mesh removal. The objectives of this video are to present cases of complications after Sling placement and describe techniques to help with successful Sling removal.
Hann-chorng Kuo - One of the best experts on this subject based on the ideXlab platform.
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Long-term outcomes of anti-incontinence surgery and subsequent Transvaginal Sling incision for urethral obstruction
International Urogynecology Journal, 2019Co-Authors: Hann-chorng KuoAbstract:Introduction and hypothesis The suburethral Sling procedure has been widely used as the first-line treatment for stress urinary incontinence (SUI) in women. Although the success rate is high, difficult urination and urine retention can occur in a small portion of patients. A Transvaginal Sling incision can solve this problem but recurrent SUI may occur. This study investigated the long-term outcomes of women who underwent the pubovaginal Sling (PVS) procedure and subsequent Transvaginal Sling incision for urethral obstruction. Methods We retrospectively reviewed the voiding conditions of women who underwent Transvaginal Sling incision owing to bladder outlet obstruction after the PVS procedure over the past two decades. Urodynamic study was performed before and after each operation. The patients’ Global Impression of Improvement (PGI-I) and quality of life index (QoL-I) due to urinary symptoms were used for outcome evaluation. Results Among 405 women who underwent PVS procedure, 14 (3.5%) underwent subsequent Transvaginal Sling incision. The main symptoms were severe dysuria, followed by urinary retention or severe wound discomfort. The average interval between the two operations was 147.6 ± 353.6 days (range 3~1,344). The mean follow-up time after Sling incision was 91.1 ± 50.7 months. At follow-up, 12 patients (85.7%) could maintain urinary continence whereas 2 had urgency incontinence. Ten patients (71.4%) were satisfied with their quality of life postoperatively. Conclusions Transvaginal Sling incision is effective for urethral obstruction after PVS procedure. Voiding dysfunction after PVS could be resolved via Sling incision. Most patients could maintain urinary continence and reported good satisfaction.
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Long-term outcomes of anti-incontinence surgery and subsequent Transvaginal Sling incision for urethral obstruction.
International Urogynecology Journal, 2018Co-Authors: Hann-chorng KuoAbstract:The suburethral Sling procedure has been widely used as the first-line treatment for stress urinary incontinence (SUI) in women. Although the success rate is high, difficult urination and urine retention can occur in a small portion of patients. A Transvaginal Sling incision can solve this problem but recurrent SUI may occur. This study investigated the long-term outcomes of women who underwent the pubovaginal Sling (PVS) procedure and subsequent Transvaginal Sling incision for urethral obstruction. We retrospectively reviewed the voiding conditions of women who underwent Transvaginal Sling incision owing to bladder outlet obstruction after the PVS procedure over the past two decades. Urodynamic study was performed before and after each operation. The patients’ Global Impression of Improvement (PGI-I) and quality of life index (QoL-I) due to urinary symptoms were used for outcome evaluation. Among 405 women who underwent PVS procedure, 14 (3.5%) underwent subsequent Transvaginal Sling incision. The main symptoms were severe dysuria, followed by urinary retention or severe wound discomfort. The average interval between the two operations was 147.6 ± 353.6 days (range 3~1,344). The mean follow-up time after Sling incision was 91.1 ± 50.7 months. At follow-up, 12 patients (85.7%) could maintain urinary continence whereas 2 had urgency incontinence. Ten patients (71.4%) were satisfied with their quality of life postoperatively. Transvaginal Sling incision is effective for urethral obstruction after PVS procedure. Voiding dysfunction after PVS could be resolved via Sling incision. Most patients could maintain urinary continence and reported good satisfaction.
Peter K. Sand - One of the best experts on this subject based on the ideXlab platform.
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Predictors of persistent detrusor overactivity after Transvaginal Sling procedures
American Journal of Obstetrics and Gynecology, 2008Co-Authors: Tondalaya Gamble, Jennifer L. Beaumont, Roger P. Goldberg, Sylvia M. Botros, Jay James R. Miller, Oyinlolu O. Adeyanju, Peter K. SandAbstract:Objective Determine predictors of persistent postoperative detrusor overactivity and urge urinary incontinence after Sling procedures for stress urinary incontinence Study Design Three hundred five women with mixed urinary incontinence underwent Sling procedures for stress urinary incontinence. Risk factors for persistent detrusor overactivity and urge urinary incontinence were examined using logistic regression models. Results Women (31.5%) who had postoperative resolution of detrusor overactivity. Transobturator Slings had the lowest rate of persistent detrusor overactivity (53%), followed by retropubic (SPARC = 66%; TVT=64%) and bladder neck Slings (86%). Predictors for persistent detrusor overactivity included age (odds ratio [OR], 1.38; P = .001), prior hysterectomy (OR, 1.95; P = .012), paravaginal repair (OR, 0.46; P = .015), nocturia (OR, 1.91; P = .013), maximum cystometric capacity (OR, 0.79; P P = .006), urethral closure pressure (OR, 0.83; P P = .014). Persistent urge urinary incontinence was predicted by Sling type ( P Conclusion When treating women with mixed urinary incontinence, age, nocturia, maximum cystometric capacity, and choice of Sling procedure impact persistence of detrusor overactivity and urge urinary incontinence.
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histopathologic changes of porcine dermis xenografts for Transvaginal suburethral Slings
American Journal of Obstetrics and Gynecology, 2005Co-Authors: Sanjay Gandhi, Roger P. Goldberg, Yoram Abramov, Sylvia M. Botros, Lena M Kubba, Thomas A Victor, Peter K. SandAbstract:Objective The purpose of this study was to examine the histopathologic changes of HMDI (Hexamethylene di-isocyanate) cross-linked porcine dermis grafts used for suburethral Sling surgery. Study design Twelve patients underwent reoperation with graft removal for urinary retention or recurrent stress urinary incontinence after Transvaginal Sling surgery. Tissue specimens were available for pathologic evaluation in 7 patients. Graft specimens underwent histologic preparation including hematoxylin and eosin staining. A single pathologist reviewed the slides blinded to clinical outcomes. Results Histopathologic analyses revealed only limited collagen remodeling, and evidence of a foreign body type reaction was present in some specimens. In cases of recurrent stress incontinence, implants appeared to be completely replaced by dense fibroconnective tissue and moderate neovascularization without evidence of inflammation or graft remnants. Conclusion HMDI cross-linked porcine dermal collagen implants result in variable tissue reactions that may have unpredictable clinical outcomes in different patients, raising questions about the overall tolerability and efficacy of these grafts in pelvic reconstructive surgery.
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Foley versus intermittent self-catheterization after Transvaginal Sling surgery: which works best?
Urology, 2004Co-Authors: Sanjay Gandhi, Jennifer L. Beaumont, Roger P. Goldberg, Christina Kwon, Yoram Abramov, Peter K. SandAbstract:Abstract Objectives To determine whether the duration of catheter use differed between subjects using clean intermittent self-catheterization and those using continuous Foley catheterization after Transvaginal Sling surgery. Methods We performed a retrospective analysis of postoperative bladder drainage in 167 consecutive women undergoing Transvaginal suburethral Sling placement for stress urinary incontinence. The primary outcome measure was the duration of catheter use. Normal voiding was defined as a voided volume equal to twice the residual volume and a residual volume of less than 100 mL for 24 hours. The groups were compared for differences in demographic, preoperative, and postoperative variables using univariate and multivariate analyses. The potential confounding effects of age, concomitant procedures, Sling material, preoperative Valsalva voiding, and voiding pressures were investigated using general linear models. Results A total of 122 subjects used clean intermittent self-catheterization and 45 had Foley catheter drainage. No differences were found between the groups in terms of concomitant procedures performed and preoperative diagnoses. The median duration of catheter use was 12 days (range 1 to 120) for women using clean intermittent self-catheterization versus 8 days (range 1 to 120) for those using Foley catheter drainage ( P = 0.026). This difference was not influenced by age, concomitant procedures, Sling material, preoperative Valsalva voiding, or preoperative voiding pressures according to the multivariate analyses. Conclusions Although many advocate bladder retraining for postoperative bladder rehabilitation, continuous bladder drainage may result in quicker recovery of normal voiding after Sling procedures.
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Transvaginal bladder neck suspension to Cooper’s ligament
Current Urology Reports, 2001Co-Authors: Sumana Koduri, Peter K. SandAbstract:Numerous surgeries have been proposed for the treatment of genuine stress incontinence, with the goals to improve functional outcome and decrease complications and their associated morbidity. Two new, minimally invasive procedures, Transvaginal retropubic urethropexy and Transvaginal Cooper’s ligament Sling, are reviewed in this article. These procedures provide a completely Transvaginal approach, without the use of abdominal incisions or bone anchors. The anterior point of suspension is Cooper’s ligament. The Transvaginal retropubic urethropexy is used for the treatment of genuine stress incontinence with urethral hyper-mobility, and the Transvaginal Sling also may be used in the presence of intrinsic sphincteric deficiency. The procedures are described and the recent outcomes discussed.
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Transvaginal bladder neck suspension to Cooper's ligament.
Current Urology Reports, 2001Co-Authors: Sumana Koduri, Peter K. SandAbstract:Numerous surgeries have been proposed for the treatment of genuine stress incontinence, with the goals to improve functional outcome and decrease complications and their associated morbidity. Two new, minimally invasive procedures, Transvaginal retropubic urethropexy and Transvaginal Cooper’s ligament Sling, are reviewed in this article. These procedures provide a completely Transvaginal approach, without the use of abdominal incisions or bone anchors. The anterior point of suspension is Cooper’s ligament. The Transvaginal retropubic urethropexy is used for the treatment of genuine stress incontinence with urethral hyper-mobility, and the Transvaginal Sling also may be used in the presence of intrinsic sphincteric deficiency. The procedures are described and the recent outcomes discussed.
Eric S. Rovner - One of the best experts on this subject based on the ideXlab platform.
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MP75-19 STRESS URINARY INCONTINENCE OUTCOMES FOLLOWING Transvaginal Sling INCISION
The Journal of Urology, 2014Co-Authors: Lara S. Maclachlan, Justin D. Ellett, Kelly Johnson, Gini Ikwuezunma, Michelle Koski, Ross Rames, Ahmed El-zawahry, Eric S. RovnerAbstract:INTRODUCTION AND OBJECTIVES: Mid-urethral Slings (MUS) have been commonly used in the operative management of stress urinary incontinence (SUI). Unfortunately, many women suffer from complications following MUS surgery that may necessitate a subsequent surgery such as a Transvaginal Sling incision (TVSI). The objective of this study is to assess the SUI outcomes following TVSI. METHODS: A retrospective review of patients who underwent TVSI from 2007 to 2013 was conducted. Indications for the surgery included bladder outlet obstruction (BOO), pelvic pain, dyspareunia, Transvaginal exposure of mesh and erosion of mesh into the urinary tract. SUI at baseline and at 3 months follow-up was assessed. SUI was defined as any patient-reported symptoms of SUI, or demonstration of SUI on physical exam, or urodynamic examination. RESULTS: A total of 167 patients underwent TVSI with the most common indication being BOO (67.7%). Of the entire cohort, 88/167 (52.7%) had no SUI at baseline and following TVSI 26.1% of these patients had SUI at 3 months follow-up. Of the 113 patients with BOO at presentation, 67 (59.3%) patients had no SUI at baseline and 16/67 (23.9%) patients had SUI at 3 months follow-up. 17/39 (43.6%) patients with Transvaginal mesh exposure had no SUI at baseline and 23.5% of these patients had SUI following TVSI. Of the 23 patients with mesh erosion into the urinary tract, 11 (47.8%) patients had no SUI at baseline and 6/11 (54.5%) patients had SUI at 3 months. Of the 66 patients with pelvic pain, 10/30 (33.3%) patients had SUI following TVSI who did not have SUI at baseline. Of the 78 patients with dyspareunia, 10/34 (29.4%) who did not have SUI at baseline had SUI following TVSI. There were 46 patients with SUI and BOO at baseline and following TVSI, 21 patients (45.7%) continued to have SUI at 3 months. Of the 33 patients with SUI and no BOO at baseline, concomitant Slings were done on 5 patients at the time of TVSI (2 MUS and 3 autologous pubovaginal Slings (aPVS). One patient with concomitant MUS had SUI at 3 months and no patient with a concomitant aPVS had SUI at 3 months. 19 patients have undergone subsequent SUI surgery or bulking injection (11 aPVS, 3 MUS, 2 bladder neck closures, and 3 bulking agents). CONCLUSIONS: For patients who do not have SUI at baseline, recurrent SUI following TVSI is not commonly seen. However, for those patients with mesh erosion into the urinary tract or SUI at presentation, recurrent/persistent SUI is seen in over 50% of patients. This knowledge can be used in counseling patients who undergo TVSI.
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Predicting for postoperative incontinence following Sling incision
International Urogynecology Journal, 2011Co-Authors: Timothy Yoost, Ross Rames, Brett Lebed, Robin Bhavsar, Eric S. RovnerAbstract:Introduction and hypothesis Our objective was to assess preoperative risk factors for developing recurrent stress urinary incontinence (SUI) following Transvaginal Sling incision (TVSI) for bladder outlet obstruction (BOO). Methods We identified 101 women who underwent TVSI and/or removal of a midurethral Sling. Thirty-nine underwent TVSI for clinical and videourodynamic demonstrable BOO. Eighteen of 39 women demonstrated preoperative clinical SUI and urodynamic BOO. A comparative analysis was performed specifically looking at several clinical factors and the risk of the occurrence of postoperative SUI. Results Mean age, number of prior surgeries, parity, and pre- and postoperative PVRs did not predict for postoperative SUI. Nine of 18 (50%) of women with SUI and BOO preoperatively vs. only 2/21 (10%) of women with BOO alone developed postoperative SUI. This difference in the incidence of postoperative SUI was statistically significant ( p
Gary E Leach - One of the best experts on this subject based on the ideXlab platform.
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Transvaginal surgery in the octogenarian using cadaveric fascia for pelvic prolapse and stress incontinence: minimal one-year results compared to younger patients.
Urology, 2004Co-Authors: Jeffrey M. Carey, Gary E LeachAbstract:Abstract Objectives To evaluate prospectively our Transvaginal surgery experience in octogenarian women and compare the results with those in younger patients. As our population has aged, the treatment of incontinence and prolapse in women older than 80 years, known as octogenarians, has become a significant clinical issue. Methods To date, our prospective database includes 455 women who have undergone Transvaginal Sling surgery using nonfrozen cadaveric fascia lata with or without concurrent prolapse repair. Of these, 51 (11%) were at least 80 years old at surgery. Complete follow-up was defined as pelvic examination findings, validated questionnaire responses (incontinence and quality of life), and SEAPI (Stress, Emptying, Anatomy, Protection, and Instability) score. The outcomes analysis was focused on the 31 octogenarian women with a minimum of 1 year of complete follow-up and compared their data with the data of 234 younger women with an identical minimal follow-up time. Results The mean octogenarian age was 83 years (maximal age 93). The mean octogenarian questionnaire and examination follow-up was administered at 21.4 months and 17.5 months, respectively. Of the 31 octogenarians, 17 (55%) reported continence improvement of greater than 70%, and 28 (90%) had no symptomatic recurrent prolapse. Compared with younger patients, no statistically significant difference in outcome parameters was identified. The rates of persistent urgency and urgency in dissatisfied patients were greater in octogenarian women, but did not reach statistical significance. Statistically significant improvement in the octogenarian quality-of-life measures was demonstrated. No perioperative complications occurred. Conclusions Transvaginal incontinence and/or prolapse surgery may be safely performed in octogenarian women, with resultant improvement in quality-of-life measures. Although outcomes after Transvaginal surgery were comparable between octogenarian and younger women, persistent urgency may predict dissatisfaction in the octogenarian population.
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Osseous complications after Transvaginal bone anchor fixation in female pelvic reconstructive surgery: Report from single largest prospective series and literature review
Urology, 2004Co-Authors: Robert W. Frederick, Jeffrey M. Carey, Gary E LeachAbstract:Abstract Objectives To report, from our prospective database and review of published studies (including primary reported patient series and case reports for osseous complications after Transvaginal bone anchor fixation in female pelvic reconstructive surgery), our results and those from previously reported patient series to determine the incidence of osteitis pubis and osteomyelitis. Methods A total of 440 patients from our database of cadaveric Transvaginal Sling (n = 127) and cadaveric prolapse repair with Sling (n = 313) procedures had at least 3 months of examination follow-up and were included in this report. We found 15 primary reported patient series involving Transvaginal bone anchor fixation in published studies, for a total of 788 patients. The combined patient population of 1228 was assessed for the incidence of osteitis pubis and osteomyelitis. Results Of our 440 patients included in this study, 2 developed osteitis pubis (0.45%), and none had osteomyelitis (0%). In the published studies we reviewed, no case of osteitis pubis and 1 case of osteomyelitis (1 of 788, 0.13%) were reported. One additional case of osteomyelitis with Transvaginal bone anchor fixation was reported. The combined incidence of osteitis pubis was 2 (0.16%) of 1228, and the combined incidence of osteomyelitis was 1 (0.08%) of 1228. Conclusions In procedures using Transvaginal bone anchor fixation in female pelvic reconstructive surgery, the combined incidence, from our experience and that reported in published studies, of osteitis pubis and osteomyelitis was 2 (0.16%) and 1 (0.08%) of 1228, respectively. The infectious osseous complication rate associated with Transvaginal pubic bone anchor fixation appears to be less than that previously reported for suprapubic bone anchor placement. In our experience, when using careful surgical technique and proper prophylactic precautions, infectious osseous complications have not been encountered.
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Continued Multicenter Followup of Cadaveric Prolapse Repair With Sling.
The Journal of Urology, 2002Co-Authors: Kathleen C Kobashi, Gary E Leach, Joanna Chon, Fred E. GovierAbstract:ABSTRACTPurpose: Since our initial description of the technique of combining a Transvaginal Sling with a cystocele repair using solvent dehydrated cadaveric fascia lata and bone anchors we have continued to follow our outcomes closely to determine long-term results. We present the updated, multicenter results of the cadaveric prolapse repair with Sling.Materials and Methods: A total of 172 patients 35 to 90 years old (mean age 62.1) have undergone cadaveric prolapse repair with Sling with a mean followup of 12.4 months (range 6 to 28). Of these patients 132 (76.7%) completed followup. Repair was performed for grade 2 cystoceles in 73 cases, grade 3 cystoceles in 43 and grade 4 cystoceles in 16. Followup included physical examination (degree of pelvic prolapse), SEAPI scores, complications, patient reported continence, perceived improvement and satisfaction. The latter 2 parameters were obtained using a validated questionnaire.Results: Of the 132 patients 15 (11.4%) had grade 1 and 2 (1.5%) had grade 2 cys...
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A new technique for cystocele repair and Transvaginal Sling: the cadaveric prolapse repair and Sling (CAPS).
Urology, 2000Co-Authors: Kathleen C Kobashi, Sharron L Mee, Gary E LeachAbstract:A new technique using cadaveric fascia lata for the simultaneous repair of a cystocele and placement of a pubovaginal Sling by means of a Transvaginal approach is described, and our early results are reported. We refer to this as the cadaveric prolapse repair with Sling (CaPS). Fifty patients, ages 37 to 90 years, underwent a new technique for simultaneous cystocele repair and Transvaginal pubovaginal Sling using a single piece of cadaveric fascia. Maximum follow-up was 6 months (range 1 to 6). A 6 x 8 cm segment of cadaveric fascia lata is placed Transvaginally to repair the defect through which the bladder herniates into the vagina and to provide Sling support at the bladder neck/proximal urethra. The Sling is anchored to the pubic bone with Transvaginal bone anchors. The remainder of the fascia is then secured to the medial edge of the levator muscles/pubocervical fascia bilaterally and at the vaginal cuff or cervix with absorbable sutures to reduce the cystocele. Patients are being evaluated with preoperative and postoperative stress, emptying, anatomy, protection, instability (SEAPI) scores as well as with grading of the prolapse based on a 3-grade anatomic classification system. Presenting symptoms have included stress urinary incontinence (SUI) in 13 (26%), urge incontinence in 4 (8%), mixed incontinence in 6 (12%), and pelvic prolapse in 20 (40%). These symptoms are not mutually exclusive; some patients presented with a combination of symptoms. The mean SEAPI scores were 5.51 preoperatively and 0.63 postoperatively, representing a significant improvement (P
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a new technique for cystocele repair and Transvaginal Sling the cadaveric prolapse repair and Sling caps
Urology, 2000Co-Authors: Kathleen C Kobashi, Sharron L Mee, Gary E LeachAbstract:A new technique using cadaveric fascia lata for the simultaneous repair of a cystocele and placement of a pubovaginal Sling by means of a Transvaginal approach is described, and our early results are reported. We refer to this as the cadaveric prolapse repair with Sling (CaPS). Fifty patients, ages 37 to 90 years, underwent a new technique for simultaneous cystocele repair and Transvaginal pubovaginal Sling using a single piece of cadaveric fascia. Maximum follow-up was 6 months (range 1 to 6). A 6 x 8 cm segment of cadaveric fascia lata is placed Transvaginally to repair the defect through which the bladder herniates into the vagina and to provide Sling support at the bladder neck/proximal urethra. The Sling is anchored to the pubic bone with Transvaginal bone anchors. The remainder of the fascia is then secured to the medial edge of the levator muscles/pubocervical fascia bilaterally and at the vaginal cuff or cervix with absorbable sutures to reduce the cystocele. Patients are being evaluated with preoperative and postoperative stress, emptying, anatomy, protection, instability (SEAPI) scores as well as with grading of the prolapse based on a 3-grade anatomic classification system. Presenting symptoms have included stress urinary incontinence (SUI) in 13 (26%), urge incontinence in 4 (8%), mixed incontinence in 6 (12%), and pelvic prolapse in 20 (40%). These symptoms are not mutually exclusive; some patients presented with a combination of symptoms. The mean SEAPI scores were 5.51 preoperatively and 0.63 postoperatively, representing a significant improvement (P <0.001). Of the 40 patients whose prolapse was quantified, 1 patient (2.5%) had a minimal cystocele, 16 (40.0%) had moderate cystoceles, and 23 (57.5%) had large cystoceles. After the CaPS, 36 (72%) were completely dry, 3 (6%) had persistent SUI, 1 (2%) had de novo urinary incontinence (UI), 3 (6%) had persistent UI, and 1 (2%) had mixed incontinence. No patient had permanent urinary retention. Transvaginal placement of cadaveric fascia for concomitant Sling and cystocele repair provides material of excellent strength for the repair without relying on the inherently weak tissues in the patient with pelvic prolapse. Thus far, the early results with CaPS are extremely encouraging. Long-term follow-up is underway to evaluate the efficacy of this procedure.
