The Experts below are selected from a list of 13152 Experts worldwide ranked by ideXlab platform
Enrique Guiloff - One of the best experts on this subject based on the ideXlab platform.
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colpoperineoplasty in women with a sensation of a wide vagina
Acta Obstetricia et Gynecologica Scandinavica, 2006Co-Authors: Jack S Pardo, V Sola, Enrique Guiloff, Paolo Ricci, Odette K FreundlichAbstract:Background. In women complaining of a wide vagina and decreased sexual satisfaction we performed colporrhaphy – including perineoplasty in most cases. Methods. Between November 2003 and October 2004, a total of 53 patients were selected for operation at the Urogynecology and Vaginal Surgery Unit, Las Condes Clinic, Chile. The patients were requested to assess the results of Surgery in terms of experienced Vaginal tightening and regained or enhanced sexual satisfaction. Results. Six months after Surgery, 94% experienced a tighter vagina and said they were able to achieve orgasm. Expectations were fulfilled in 74%, partially fulfilled in 21%, and not met in 5%. Only two patients (4%) regretted Surgery, and two patients had minor surgical complications. Conclusion. In a selected group of women with acquired sensation of a wide vagina, colporrhaphy seems to improve symptoms and enhance sexual gratification in a majority of the women. A controlled trial with a longer follow-up is needed for a proper evaluation.
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tension free monofilament macropore polypropylene mesh gynemesh ps in female genital prolapse repair
International Braz J Urol, 2006Co-Authors: V Sola, J Pardo, P Ricci, Enrique GuiloffAbstract:OBJECTIVES: To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transVaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% of patients, with a pursuit between 1 and 8 months. DISCUSSION: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transVaginal route with tension free technique seems to be a safe and effective Surgery procedure.
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tension free monofilament macropore polypropylene mesh gynemesh ps in female genital prolapse repair
International Braz J Urol, 2006Co-Authors: V Sola, J Pardo, P Ricci, Enrique GuiloffAbstract:ABSTRACTObjectives: To review intraoperative and postoperative complications associated to the correction of cystocele and recto-cele with polypropylene mesh macropore monofilament (Gynemesh PS) using transVaginal free tension technique.Materials and Methods: Prospective study of patients that have been submitted to correction of cystocele and/or rectocelebetween November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and ObstetricsDepartment, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitantmeshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correctionof urinary incontinence by TVT-O technique.Results: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did notobserve hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% ofpatients, with a pursuit between 1 and 8 months.Discussion: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/orrectocele, by transVaginal route with tension free technique seems to be a safe and effective Surgery procedure.Key words: cystocele, rectocele, polypropylene marlexInt Braz J Urol. 2006; 32: 410-5
Matthew D Barber - One of the best experts on this subject based on the ideXlab platform.
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perioperative behavioral therapy and pelvic muscle strengthening do not enhance quality of life after pelvic Surgery secondary report of a randomized controlled trial
Physical Therapy, 2017Co-Authors: Alison C Weidner, Matthew D Barber, Lauren Klein Warren, Alayne D Markland, David D Rahn, Yvonne Hsu, Elizabeth R Mueller, Sharon Jakuswaldman, Keisha Y Dyer, Marie G GantzAbstract:Background There is significant need for trials evaluating the long-term effectiveness of a rigorous program of perioperative behavioral therapy with pelvic floor muscle training (BPMT) in women undergoing transVaginal reconstructive Surgery for prolapse. Objective The purpose of this study was to evaluate the effect of perioperative BPMT on health-related quality of life (HRQOL) and sexual function following Vaginal Surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Design This study is a secondary report of a 2 × 2 factorial randomized controlled trial. Setting This study was a multicenter trial. Participants Participants were adult women with stage 2-4 POP and SUI. Intervention Perioperative BPMT versus usual care and sacrospinous ligament fixation (SSLF) versus uterosacral ligament suspension (ULS) were provided. Measurements Participants undergoing transVaginal Surgery (SSLF or ULS for POP and a midurethral sling for SUI) received usual care or five perioperative BPMT visits. The primary outcome was change in body image and in Pelvic Floor Impact Questionnaire (PFIQ) short-form subscale, 36-item Short-Form Health Survey (SF-36), Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire short form (PISQ-12), Patient Global Impression of Improvement (PGII), and Brink scores. Results The 374 participants were randomized to BPMT (n = 186) and usual care (n = 188). Outcomes were available for 137 (74%) of BPMT participants and 146 (78%) of the usual care participants at 24 months. There were no statistically significant differences between groups in PFIQ, SF-36, PGII, PISQ-12, or body image scale measures. Limitations The clinicians providing BPMT had variable expertise. Findings might not apply to Vaginal prolapse procedures without slings or abdominal apical prolapse procedures. Conclusions Perioperative BPMT performed as an adjunct to Vaginal Surgery for POP and SUI provided no additional improvement in QOL or sexual function compared with usual care.
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quality of life and sexual function 2 years after Vaginal Surgery for prolapse
Obstetrics & Gynecology, 2016Co-Authors: Emily S Lukacz, Matthew D Barber, Alison C Weidner, Lauren Klein Warren, Holly E Richter, Linda Brubaker, Peggy Norton, John N Nguyen, Marie G GantzAbstract:OBJECTIVE:To longitudinally assess the effect of native tissue Vaginal apical prolapse repair with anti-incontinence Surgery on quality of life, sexual function, and body image between uterosacral and sacrospinous suspensions.METHODS:A planned secondary analysis was performed on 374 women enrolled i
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complication and reoperation rates after apical Vaginal prolapse surgical repair a systematic review
Obstetrics & Gynecology, 2009Co-Authors: Gouri B Diwadkar, Matthew D Barber, Benjamin Feiner, Christopher G Maher, Eric J JelovsekAbstract:OBJECTIVE: To compare postoperative complication and reoperation rates for surgical procedures correcting apical Vaginal prolapse. DATA SOURCES: Eligible studies were selected through an electronic literature search covering January 1985 to January 2008 using PubMed, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews and Effects. METHODS OF STUDY SELECTION: Only clinical trials and observational studies addressing apical prolapse repair and recurrence or complication rates were included. The search was restricted to original articles published in English with 50 or more participants and a follow-up period of 3 months or longer. Oral platform and poster presentations from the American Urogynecological Society, the Society for Gynecologic Surgeons, the International Urogynecological Association, and the International Continence Society from January 2005 to December 2007 were hand searched to determine whether they were eligible for inclusion. TABULATION, INTEGRATION, AND RESULTS: Procedures were separated into three groups: traditional Vaginal Surgery, sacral colpopexy, and Vaginal mesh kits. Complications were classified using the Dindo grading system. Weighted averages were calculated for each Dindo grade, complication, and reoperation. Dindo grade IIIa (433/3,425 women) and IIIb (245/3,425) rates were highest in the mesh kit group owing to higher rates of mesh erosion (198/3,425) and fistulae (8/3,425). Reoperation rates for prolapse recurrence were highest in the traditional Vaginal Surgery group (308/7,827). The total reoperation rate was greatest in the mesh kit group (291/3, 425, 8.5%). CONCLUSION: The rate of complications requiring reoperation and the total reoperation rate was highest for Vaginal mesh kits despite a lower reoperation rate for prolapse recurrence and shorter overall follow-up.
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perioperative complications in obese women vs normal weight women who undergo Vaginal Surgery
American Journal of Obstetrics and Gynecology, 2007Co-Authors: Chi Chiung Grace Chen, Marie Fidela R Paraiso, Mark D Walters, Sarah A Collins, Allison K Rodgers, Matthew D BarberAbstract:Objective The purpose of this study was to compare the incidence of perioperative complications in obese and normal-weight patients who undergo Vaginal urogynecologic Surgery. Study Design A retrospective cohort analysis was conducted for obese patients (body mass index, ≥30 kg/m 2 ) who underwent Vaginal Surgery and who were matched with patients with normal body mass indices (>18.5 kg/m 2 but 2 ) by surgical procedures. Demographic information, comorbidities, and perioperative (≤6 weeks) complications were documented. Logistic regression analysis was used to compare the incidence of perioperative complications and to adjust for baseline differences. Results Seven hundred forty-two patients underwent Vaginal Surgery during the study period; 235 women were considered to have obese body mass indices. We matched 194 of these patients with normal-weight control subjects. There was no statistical difference in the proportion of subjects who had at least 1 perioperative complication (20% [obese] vs 15% [nonobese]). However, obese subjects were more likely to have an operative site infection (adjusted odds ratio, 5.5; [95% CI, 1.7-24.7]; P = .01). Conclusion The overall perioperative complication rate in obese and nonobese women is low, with obesity as an independent risk factor for the development of operative site infections.
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a prospective assessment of overactive bladder symptoms in a cohort of elderly women who underwent transVaginal Surgery for advanced pelvic organ prolapse
American Journal of Obstetrics and Gynecology, 2007Co-Authors: Raymond T Foster, Matthew D Barber, Mark D Walters, Alison C Weidner, Marie Fidela R Parasio, Cindy L AmundsenAbstract:Objective The objective of this study was to evaluate the impact of transVaginal prolapse Surgery on overactive bladder symptoms in elderly women. Study Design Women (≥65 years old) with stage III or IV prolapse who enrolled in a prospective study that compared Vaginal reconstructive Surgery (n = 39) to obliterative Surgery (n = 26) and who underwent preoperative urodynamics are the subjects of this study. The women completed the Pelvic Floor Distress Inventory at baseline and again 6 months and 12 months after Surgery. Postoperative changes in symptoms of urinary urgency, frequency, and urge urinary incontinence were assessed. The association between a baseline urodynamic diagnosis of detrusor overactivity and pre- and postoperative overactive bladder symptoms was also determined. Results Data were analyzed from 65 subjects with a mean age of 75.3 years (range, 65.5-87.0 years). Detrusor overactivity was documented in 25% of subjects. There was no difference in the proportion of baseline urge incontinence ( P = .38), urinary frequency ( P = .53), or urgency ( P = .76) in comparing women with and without detrusor overactivity. Surgery resulted in a significant reduction of urgency and frequency symptoms 6 months after Surgery and a similar significant reduction in urgency and urge incontinence at 1 year after Surgery. Overall, a clinically and statistically significant improvement in the irritative subscale of the Pelvic Floor Distress Inventory was noted at 6 months (18.3%; P P P = .48). Likewise, there was no difference in postoperative symptom reduction (urgency, frequency, or urge incontinence) between women who received reconstructive Surgery vs women who had obliterative Surgery ( P = .84). Conclusion Vaginal Surgery for stage III or IV pelvic organ prolapse significantly reduces overactive bladder symptoms in elderly women. In our cohort, symptom reduction was unrelated to the type of Vaginal Surgery (obliterative vs reconstructive) or the inclusion of a procedure to treat stress incontinence. Furthermore, preoperative urodynamic findings did not correlate with the presence or absence of overactive bladder symptoms.
V Sola - One of the best experts on this subject based on the ideXlab platform.
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colpoperineoplasty in women with a sensation of a wide vagina
Acta Obstetricia et Gynecologica Scandinavica, 2006Co-Authors: Jack S Pardo, V Sola, Enrique Guiloff, Paolo Ricci, Odette K FreundlichAbstract:Background. In women complaining of a wide vagina and decreased sexual satisfaction we performed colporrhaphy – including perineoplasty in most cases. Methods. Between November 2003 and October 2004, a total of 53 patients were selected for operation at the Urogynecology and Vaginal Surgery Unit, Las Condes Clinic, Chile. The patients were requested to assess the results of Surgery in terms of experienced Vaginal tightening and regained or enhanced sexual satisfaction. Results. Six months after Surgery, 94% experienced a tighter vagina and said they were able to achieve orgasm. Expectations were fulfilled in 74%, partially fulfilled in 21%, and not met in 5%. Only two patients (4%) regretted Surgery, and two patients had minor surgical complications. Conclusion. In a selected group of women with acquired sensation of a wide vagina, colporrhaphy seems to improve symptoms and enhance sexual gratification in a majority of the women. A controlled trial with a longer follow-up is needed for a proper evaluation.
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tension free monofilament macropore polypropylene mesh gynemesh ps in female genital prolapse repair
International Braz J Urol, 2006Co-Authors: V Sola, J Pardo, P Ricci, Enrique GuiloffAbstract:OBJECTIVES: To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transVaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% of patients, with a pursuit between 1 and 8 months. DISCUSSION: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transVaginal route with tension free technique seems to be a safe and effective Surgery procedure.
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tension free monofilament macropore polypropylene mesh gynemesh ps in female genital prolapse repair
International Braz J Urol, 2006Co-Authors: V Sola, J Pardo, P Ricci, Enrique GuiloffAbstract:ABSTRACTObjectives: To review intraoperative and postoperative complications associated to the correction of cystocele and recto-cele with polypropylene mesh macropore monofilament (Gynemesh PS) using transVaginal free tension technique.Materials and Methods: Prospective study of patients that have been submitted to correction of cystocele and/or rectocelebetween November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and ObstetricsDepartment, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitantmeshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correctionof urinary incontinence by TVT-O technique.Results: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did notobserve hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% ofpatients, with a pursuit between 1 and 8 months.Discussion: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/orrectocele, by transVaginal route with tension free technique seems to be a safe and effective Surgery procedure.Key words: cystocele, rectocele, polypropylene marlexInt Braz J Urol. 2006; 32: 410-5
Renaud De Tayrac - One of the best experts on this subject based on the ideXlab platform.
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is polypropylene mesh material fundamentally safe for use as a reconstructive material in Vaginal Surgery ici rs 2019
Neurourology and Urodynamics, 2020Co-Authors: Eric S Rovner, Renaud De Tayrac, Ruth Kirschnerhermanns, Nikolaus Veitrubin, Ralf AndingAbstract:Polypropylene (PP) mesh has been used as a primary or adjuvant material for Vaginal reconstruction for both stress urinary incontinence (SUI) and pelvic organ prolapse (POP) for decades. Whether polypropylene is the optimal material for such indications has been called into question by clinicians, regulatory agencies and the public in several countries around the world. This paper is a report of presentations and subsequent discussion at the annual International Consultation on Incontinence Research Society (ICI-RS) Meeting in June 2019 in Bristol, UK on the proposal "Is polypropylene mesh material fundamentally safe for use as a reconstructive material in Vaginal Surgery?" in which several of the salient issues were presented and discussed.
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in vitro degradation and in vivo biocompatibility of poly lactic acid mesh for soft tissue reinforcement in Vaginal Surgery
Journal of Biomedical Materials Research Part B, 2008Co-Authors: Renaud De Tayrac, Samir Chentouf, Henri Garreau, Christian Braud, Isabelle Guiraud, Philippe Boudeville, Michel VertAbstract:This study was aimed at evaluating the in vitro degradation, the in vivo biocompatibility and at comparing the effects of two methods of sterilization on poly(L-lactic acid) (PLA(94)) resorbable mesh. The mesh was manufactured to be used as surgical soft tissue reinforcement in the Vaginal area. Samples of 100 mg of PLA(94) mesh (10 x 10 mm(2)) were immersed in isoosmolar 0.13M, pH 7.4 phosphate buffer solution at 37 degrees C, during 12 months. The hydrolytic degradation up to 12 months after immersion was monitored by measuring weight loss, mesh area changes, and by various analytical techniques namely Differential scanning calorimetry (DSC), capillary zone electrophoresis (CZE), size exclusion chromatography (SEC), and environmental scanning electron microscopy (ESEM). Specimens of nonsterilized, ethylene-oxide (ETO) sterilized, and gamma-ray sterilized PLA(94) mesh were compared. Fifteen samples were implanted in an incisional hernia Wistar rat model. Histopathology was performed up to 90 days after implantation to evaluate the inflammatory response and the collagen deposition. Although the decrease of molecular weight due to polymer chain scissions started 6 weeks after in vitro immersion, water-soluble degradation products and decrease of tensile strength appeared after 8 months only. Analyses showed also that ETO sterilization did not affect the degradation of the PLA(94) mesh. In contrast, gamma-ray sterilization increased very much the sensitivity of the mesh to the hydrolytic degradation. In vivo, the PLA(94) mesh exhibited good biocompatibility over the investigated time period.
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collagen coated vs noncoated low weight polypropylene meshes in a sheep model for Vaginal Surgery a pilot study
International Urogynecology Journal, 2007Co-Authors: Renaud De Tayrac, Antoine Alves, Michel TherinAbstract:The aims of this study were dual. First, to evaluate the feasibility of a sheep model as an animal model for Vaginal Surgery with meshes. Second, to compare host response to two low-weight polypropylene (PP) meshes, a noncoated (Soft Prolene™, Gynecare, Ethicon) and a coated mesh with an absorbable hydrophilic film (Ugytex™, Sofradim). Thirty-six 20×20 mm polypropylene meshes (18 coated and 18 noncoated) were surgically implanted by the Vaginal route in 12 adult ewes. Meshes were implanted in the anterior (n=12) and the posterior Vaginal compartments (n=24). Animals were killed 1 (n=6) and 12 (n=6) weeks after Surgery. Postimplantation evaluation included macroscopical examination, histological and immunohistochemical analysis and histomorphometrical measures of the distance between the meshes and the Vaginal epithelium. The experimental procedure was feasible in all cases. Vaginal erosions were observed twice as frequently with the noncoated-PP meshes (6/18, 33.3%) as with the coated-PP meshes (3/18, 16.7%), even if that difference was not significant (p=0.4). However, no differences were observed between the two meshes in terms of shrinkage, tissue ingrowth, inflammatory response, and position of the mesh in the Vaginal wall. The mechanism involved in the reduction of Vaginal erosion could be due to the lesser adhesion of the coated mesh on the Vaginal wound during the early postoperative period.
Alison C Weidner - One of the best experts on this subject based on the ideXlab platform.
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perioperative behavioral therapy and pelvic muscle strengthening do not enhance quality of life after pelvic Surgery secondary report of a randomized controlled trial
Physical Therapy, 2017Co-Authors: Alison C Weidner, Matthew D Barber, Lauren Klein Warren, Alayne D Markland, David D Rahn, Yvonne Hsu, Elizabeth R Mueller, Sharon Jakuswaldman, Keisha Y Dyer, Marie G GantzAbstract:Background There is significant need for trials evaluating the long-term effectiveness of a rigorous program of perioperative behavioral therapy with pelvic floor muscle training (BPMT) in women undergoing transVaginal reconstructive Surgery for prolapse. Objective The purpose of this study was to evaluate the effect of perioperative BPMT on health-related quality of life (HRQOL) and sexual function following Vaginal Surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Design This study is a secondary report of a 2 × 2 factorial randomized controlled trial. Setting This study was a multicenter trial. Participants Participants were adult women with stage 2-4 POP and SUI. Intervention Perioperative BPMT versus usual care and sacrospinous ligament fixation (SSLF) versus uterosacral ligament suspension (ULS) were provided. Measurements Participants undergoing transVaginal Surgery (SSLF or ULS for POP and a midurethral sling for SUI) received usual care or five perioperative BPMT visits. The primary outcome was change in body image and in Pelvic Floor Impact Questionnaire (PFIQ) short-form subscale, 36-item Short-Form Health Survey (SF-36), Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire short form (PISQ-12), Patient Global Impression of Improvement (PGII), and Brink scores. Results The 374 participants were randomized to BPMT (n = 186) and usual care (n = 188). Outcomes were available for 137 (74%) of BPMT participants and 146 (78%) of the usual care participants at 24 months. There were no statistically significant differences between groups in PFIQ, SF-36, PGII, PISQ-12, or body image scale measures. Limitations The clinicians providing BPMT had variable expertise. Findings might not apply to Vaginal prolapse procedures without slings or abdominal apical prolapse procedures. Conclusions Perioperative BPMT performed as an adjunct to Vaginal Surgery for POP and SUI provided no additional improvement in QOL or sexual function compared with usual care.
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quality of life and sexual function 2 years after Vaginal Surgery for prolapse
Obstetrics & Gynecology, 2016Co-Authors: Emily S Lukacz, Matthew D Barber, Alison C Weidner, Lauren Klein Warren, Holly E Richter, Linda Brubaker, Peggy Norton, John N Nguyen, Marie G GantzAbstract:OBJECTIVE:To longitudinally assess the effect of native tissue Vaginal apical prolapse repair with anti-incontinence Surgery on quality of life, sexual function, and body image between uterosacral and sacrospinous suspensions.METHODS:A planned secondary analysis was performed on 374 women enrolled i
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a randomized controlled trial evaluating 2 techniques of postoperative bladder testing after transVaginal Surgery
American Journal of Obstetrics and Gynecology, 2007Co-Authors: Raymond T Foster, Alison C Weidner, Kristy M Borawski, Mary M T South, George D Webster, Cindy L AmundsenAbstract:Objective The purpose of this pilot study was to compare the efficacy of 2 techniques for evaluating bladder function after transVaginal Surgery. Study Design Subjects scheduled for transVaginal, outpatient Surgery were consecutively enrolled and randomized to backfill-assisted voiding trial or a trial of spontaneous voiding after Surgery. Results Sixty subjects were enrolled. The mean time in the perioperative anesthesia care unit for the backfill group was 199.5 minutes vs 226.6 minutes in the spontaneous voiding group ( P = .08). Subjects randomized to backfill were more likely to adequately empty their bladders and be discharged home without catheter drainage than subjects in the spontaneous voiding group (61.5% vs 32.1%, respectively, P = .02). Multiple logistic regression further demonstrated that the backfill-assisted technique predicted successful bladder emptying after Vaginal Surgery ( P = .02). Conclusion Women undergoing transVaginal outpatient Surgery are more likely to empty their bladder effectively before discharge if they are evaluated with a backfill-assisted voiding trial.
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a prospective assessment of overactive bladder symptoms in a cohort of elderly women who underwent transVaginal Surgery for advanced pelvic organ prolapse
American Journal of Obstetrics and Gynecology, 2007Co-Authors: Raymond T Foster, Matthew D Barber, Mark D Walters, Alison C Weidner, Marie Fidela R Parasio, Cindy L AmundsenAbstract:Objective The objective of this study was to evaluate the impact of transVaginal prolapse Surgery on overactive bladder symptoms in elderly women. Study Design Women (≥65 years old) with stage III or IV prolapse who enrolled in a prospective study that compared Vaginal reconstructive Surgery (n = 39) to obliterative Surgery (n = 26) and who underwent preoperative urodynamics are the subjects of this study. The women completed the Pelvic Floor Distress Inventory at baseline and again 6 months and 12 months after Surgery. Postoperative changes in symptoms of urinary urgency, frequency, and urge urinary incontinence were assessed. The association between a baseline urodynamic diagnosis of detrusor overactivity and pre- and postoperative overactive bladder symptoms was also determined. Results Data were analyzed from 65 subjects with a mean age of 75.3 years (range, 65.5-87.0 years). Detrusor overactivity was documented in 25% of subjects. There was no difference in the proportion of baseline urge incontinence ( P = .38), urinary frequency ( P = .53), or urgency ( P = .76) in comparing women with and without detrusor overactivity. Surgery resulted in a significant reduction of urgency and frequency symptoms 6 months after Surgery and a similar significant reduction in urgency and urge incontinence at 1 year after Surgery. Overall, a clinically and statistically significant improvement in the irritative subscale of the Pelvic Floor Distress Inventory was noted at 6 months (18.3%; P P P = .48). Likewise, there was no difference in postoperative symptom reduction (urgency, frequency, or urge incontinence) between women who received reconstructive Surgery vs women who had obliterative Surgery ( P = .84). Conclusion Vaginal Surgery for stage III or IV pelvic organ prolapse significantly reduces overactive bladder symptoms in elderly women. In our cohort, symptom reduction was unrelated to the type of Vaginal Surgery (obliterative vs reconstructive) or the inclusion of a procedure to treat stress incontinence. Furthermore, preoperative urodynamic findings did not correlate with the presence or absence of overactive bladder symptoms.
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quality of life after Surgery for genital prolapse in elderly women obliterative and reconstructive Surgery
International Urogynecology Journal, 2007Co-Authors: Matthew D Barber, Marie Fidela R Paraiso, Cindy L Amundsen, Alison C Weidner, Audrey A Romero, Mark D WaltersAbstract:The objective of this study was to determine if obliterative and reconstructive Vaginal Surgery for advanced pelvic organ prolapse improve quality of life in elderly women. Women age 65 years or older with stage 3 or 4 pelvic organ prolapse who desired surgical correction were prospectively enrolled. The subjects underwent either obliterative or reconstructive Vaginal Surgery based on their personal preference and sexual expectations. The subjects received a pelvic organ prolapse quantitation examination and completed the pelvic floor distress inventory (PFDI), the pelvic floor impact questionnaire (PFIQ), the SF-36, and the Beck depression inventory preoperatively, 6 and 12 months after Surgery. Seventy-nine subjects were enrolled, 70 of whom completed follow-up: 30 in the obliterative group and 40 in the reconstructive group. Both groups demonstrated significant improvements in the pelvic organ prolapse, urinary, and colorectal scales of the PFDI and PFIQ 6 and 12 months after Surgery with no differences between the two treatment groups. In addition, there were significant and clinically important improvements noted in the bodily pain, vitality, social functioning, role–emotional, and mental health summary scales of the SF-36 in both groups after Surgery, with no significant difference between groups. In appropriately selected elderly women, both obliterative and reconstructive Vaginal Surgery for advanced pelvic organ prolapse significantly improved health-related quality of life.
