Novel repair of tension-free midurethral sling erosion into the urethra

Severe urinary tract injury is a relatively uncommon occurrence after the placement of a tension-free vaginal tape sling. Bladder perforation is the most common urinary tract injury, but bladder drainage for a few days is usually the only intervention that is required. Urethral erosions of synthetic sling tapes are much rarer, but can result in more significant sequelae such as voiding dysfunction or fistula formation. A 50-year-old woman had an erosion of a synthetic, tension-free midurethral sling through the urethra. She underwent resection of the sling with closure of the urethral defect. The internal urethral sphincter was used during the primary repair to cover the defect because of periurethral scarring and fibrosis. This technique may reduce the risk of subsequent fistula formation, and may be a less invasive alternative to the use of a Martius interposition flap.     

Complications of sling surgery among female Medicare beneficiaries

OBJECTIVE: To analyze Medicare claims data to determine short-term complications after sling surgery among female beneficiaries aged 65 years and over. METHODS: We analyzed the 1999-2001 Medicare Public Use Files provided by the Centers for Medicare and Medicaid Services on a 5% national random sample of beneficiaries. Women undergoing sling procedures between January 1, 1999, and July 31, 2000, (the index period) were identified by Physicians Current Procedural Terminology Coding System (4th edition) and tracked for 12 months. Main outcome measures were complications as identified by International Classification of Diseases (9th revision) (ICD-9) diagnosis codes and Current Procedural Terminology procedure codes in the first postoperative year. RESULTS: A total of 1,356 sling procedures were performed during the index period. In the 3 months after the procedure, 12.5% of women developed surgical or urologic complications, and 33.6% were diagnosed with urinary tract infections. Within 1 year of the procedure, 6.9% of subjects had a new diagnosis of outlet obstruction, and 8.0% underwent treatments to manage outlet obstruction. There was a high incidence of new diagnoses of urge incontinence (15.2%) and treatment of pelvic prolapse (23.2%). Both cystoscopy and urodynamic testing, which may serve as indicators of possible complications, were performed frequently during the first year after surgery (32.4% and 30.5%, respectively). Patient race, age, and comorbidity each had a significant influence on outcomes. CONCLUSION: Complication rates within 1 year after sling surgery among Medicare beneficiaries were found to be higher than those reported in the clinical literature. The high rates of postoperative urinary tract infections, prolapse, and outlet obstruction suggest the need for quality improvement measures in the management of women with incontinence and pelvic prolapse. LEVEL OF EVIDENCE: III.     

阔筋膜悬吊术用于治疗女性压力性尿失禁

目的探讨自体阔筋膜吊带行尿道悬吊术治疗女性压力性尿失禁的疗效和安全性。方法对13例压力性尿失禁伴子宫脱垂及阴道前后壁膨出的患者,取自体大腿外侧阔筋膜条作为吊带,经下腹阴道联合切口,行尿道近端悬吊术,同时行阴式全子宫切除及阴道前后壁修补术,平均随访30个月。结果13例患者均获得治愈,无阴道出血、感染、排斥反应等并发症发生。5例患者在术后出现轻度、暂时性排尿困难,1个月内症状消失。结论自体阔筋膜吊带行尿道悬吊术是治疗女性压力性尿失禁的安全有效术式。     

Changes in sexual function and quality of life after single-incision mid-urethral sling for treatment of female stress urinary incontinence

Objectives

To evaluate the effectiveness and assess the changes in sexual function and quality of life after placement of a single-incision sling for the treatment of female stress urinary incontinence.

Study design

A prospective study of women diagnosed with stress urinary incontinence. The single-incision sling was implanted and patients were followed postoperatively for 6 months. The postoperative rate of continence, complications, changes in sexual function, and patient-reported quality of life were evaluated. Female Sexual Function in sexually active patients was evaluated before and after the single-incision sling procedure using the Female Sexual Function Index. From January 2009 to November 2011, 73 patients were enrolled and underwent the procedure to implant the MiniArc^® or Ajust^® single-incision sling.

Results

Overall, 93.2% of the patients who successfully received a single-incision sling demonstrated total restoration of continence (83.6%) or improved continence (9.6%) at the 6-month postoperative visit. Improvements were seen in the quality of life scores related to global bladder feeling (87.7%) and the Female Sexual Function Index (preoperative score 23.86 ± 5.67 vs postoperative score 27.25 ± 4.66 [P < 0.0001]).

Conclusion

Single-incision sling treatment for stress urinary incontinence led to improvements in continence and sexual function at 6 months of postoperative follow-up.     

Quality of life after mid-urethra polypropylene tape sling surgery (IVS, TVT) in female stress urinary incontinence

INTRODUCTION: Urinary incontinence exerts a huge influence on women's quality of life in regard to hygienic problems. The great progress in female stress urinary incontinence (SUI) surgery was introduction of mid-urethra polypropylene sling procedures, which are characterized by very high efficacy, safety and minimal invasiveness. The aim of our study was to assess if functioning of lower urinary tract after minimum 1 year from TVT or IVS procedure has an impact on women's quality of life. MATERIALS AND METHODS: Analysis was done by means of King's quality of life questionnaire in Polish version from 1993. One hundred and sixty patients operated because of SUI in II-nd Department of Gynecology in Lublin in years: 1999-2001 were assessed. The mean time relapsed from surgery was 19 +/- 6 months. Eighty women were operated by TVT method (monofilament tape) and eighty by IVS method (multifilament tape. Statistical analysis was done by means of STATISTICA program, version 6. To estimate patient's quality of life according to King's questionnaire the mode value (Mo) and the frequency of mode value (fr Mo) were used in respective questions. The results in both groups were compared by Mann-Whitney test. RESULTS: Most of patients assessed the general health condition as good (fr Mo = 25; 36.9%). In TVT group Mo value indicated good health condition (fr Mo = 30; 37.5%), whereas in IVS group general health condition was estimated most commonly as satisfactory (fr Mo = 33; 41.25%). In respect to incontinence impact on life in TVT group 37.5% of patients (fr Mo = 30) reported some influence, while in IVS group 50% of women (fr Mo = 40) reported no influence (p = 0.16). Moreover, analysis revealed that in both groups the functioning of lower urinary tract does not influence their normal functioning, social contacts, physical activity, personal life, emotions or sleep. CONCLUSION: After modern incontinence surgery (TVT, IVS methods) the majority of patients reported that current bladder symptoms have no negative impact on their quality of life.     

Increased frequency of female partner chromosomal abnormalities in patients with high-order implantation failure after in vitro fertilization

OBJECTIVE: To find the type and frequency of chromosomal abnormalities in a selected group of high-order implantation failure (> or =6 IVF trials and > or =15 transferred embryos) and to evaluate its impact on pregnancy outcome.DESIGN: A retrospective study.SETTING: In vitro fertilization (IVF) unit in a university affiliated hospital.PATIENT(S): Sixty-five couples with high-order implantation failure in IVF and embryo transfer.INTERVENTION(S): In vitro fertilization/embryo transfer (ET), work-up for implantation failure, cytogenetic analysis of the couple.MAIN OUTCOME MEASURE(S): We studied the type and frequency of chromosomal changes, quality of embryos, cumulative pregnancy rates, and pregnancy outcome.RESULT(S): The mean number of treatment cycles per patient, before karyotyping was 7.8 +/- 2.4 (range: 6 to 16 cycles). The mean cumulative number of all transferred embryos per patient was 25.7 +/- 10.3 (range: 9 to 65 embryos). Chromosomal abnormalities were found in 10 of 65 (15.4%) cases: translocations in six, mosaicism in two, and inversion or deletion in another two. The morphologic characteristics of the transferred embryos and the cumulative pregnancy rates were similar in patients with implantation failure with and without chromosomal changes. Three of the 16 patients with abnormal karyotype delivered and three miscarried within a follow-up period of 1 year.CONCLUSION(S): A high frequency of chromosomal aberrations was found in a selected group of high-order implantation failures, a similar frequency to recurrent miscarriages. Karyotyping is recommended as part of the work-up for repeated implantation failure in assisted reproduction. Treatment options include further IVF trials, preimplantation genetic diagnosis, or oocyte donation, tailored according to the type of chromosomal change. An international registry should be considered to assist in counseling these patients.     

女性盆底微创吊带手术的临床解剖学研究

目的 探讨3种盆底微创吊带手术的正确通路,并评价其安全性.方法 2005年9月-2006年2月,应用血管颜料灌注的方法在5具新鲜尸体上依次进行经耻骨后途径阴道无张力吊带(TVT)手术、经闭孔途径TVT(TVT-O)手术以及经阴道后路悬吊带(P-IVS)手术穿刺,穿刺后以4%甲醛防腐处理,随后进行手术通路解剖,并测量穿刺针至相关血管、神经、脏器和骨边缘的最短距离.结果 所有穿刺均未产生副损伤,'rVT穿刺针距耻骨血管、膀胱壁、髂外血管及闭孔血管的平均最短距离分别为0.6.0.6,4.2及4.3 cm,穿刺针侧偏或轴向旋转可能产生副损伤;由内向外的TVT-O穿刺未进入耻骨后间隙,距闭孔血管神经束的平均最短距离为2.6 cm,穿刺点深入尿道外口内平均2.2 cm可能进入盆腔,翼状挡板与尿道轴夹角小至平均35°时可能损伤闭孔血管神经束;P-IVS助推器针距直肠浆膜的平均最短距离为0.5 cm,不易损伤阴部内血管神经.结论 TVT穿刺针经耻骨后间隙有副损伤可能;TVT-O由内向外穿刺通路稳定,不经过耻骨后间隙;P-IVS钝头穿刺针以及术中向对侧推开直肠降低了损伤风险.     

Male partner involvement and assistance in female condom use

Objective To investigate how males assist their partners in using the female condom.

Methods A multi-site, randomized, cross-over trial was conducted to test the performance and acceptability of the Reality® female condom compared to a prototype similar in design and appearance but made of synthetic latex (FC2). In this study women were asked about male partner assistance in FC use.

Results Partner assistance in FC use was similar across FC type. Of the women who returned for the first follow-up visit (n = 233), just over a third (35.2%) reported that the male partner assisted in the insertion compared to 26.4% of the 201 women who returned for the second visit. In most cases where the partner assisted, the device was inserted using the inner ring, as recommended in the instructions for use. A small number (6%) mentioned that partners assisted in removal.

Conclusion Men have a role to play in the use of the female condom and are willing to assist their partners in using it.     

Insertion of a sub-urethral sling through the obturating membrane for treatment of female urinary incontinence

OBJECTIVE: The use of a TVT device has been for a few years the operation most often performed to treat female urinary incontinence. One of the most frequent complications of this surgery is bladder perforation. MATERIAL AND METHODS: To prevent this complication we use the way initially suggested by Delorme, in which the two ends of the sling were passed through the obturating membrane and the muscles which cover it, by circumventing the ischiopubic bone with Emmet needle introduced from outside to inside. RESULTS: No bladder perforation was noted among the first 71 operated patients. For the first 68 patients re-examined 6 to 12 weeks after the surgery, two patients had improved and 64 were totally cured. CONCLUSION: The effectiveness of this method is the same as that of the traditional method.     

男性精液携带阴道加德纳菌对配偶的影响

目的:进一步了解男性生殖道感染阴道加德纳菌(Gv)与配偶之间的互感率。方法:取男性精液携带Gv者的配偶阴道分泌物进行Gv套式PCR法检测。结果:随机抽取102例男性精液携带Gv者的配偶中,共检出Gv阳性者89例,阳性率为87.3%。结论:Gv是性接触传播的病原生物之一。     

The phenomenology of meditation for female survivors of intimate partner violence

An existential-phenomenological methodology was utilized to investigate the experience of meditation for female survivors of intimate partner violence. Six coresearchers were taught a form of concentrative meditation and were asked to meditate daily and to attend a weekly group meditation for 6 weeks. Semistructured interviews were utilized to gather the data. The essence of the experience that was revealed was the emergence of a centered awareness that is distinctly different from the usual mode of being in the world. Findings suggest the value of meditation as an intervention strategy with survivors and demonstrate the need for further research in this area.     

Factors affecting transient urinary retention after transobturator tape mid-urethral sling surgery for female patients with stress urinary incontinence: a single center experience

Objective

To identify the incidence and potential risk factors affecting postoperative transient urinary retention (TR) with transobturator tape (TOT) mid-urethral sling surgery for female patients with stress urinary incontinence (SUI).

Study design

We reviewed the medical records of 305 patients with SUI who underwent the TOT procedure. Postoperative TR was defined as follows: (1) patients had still voiding difficulty after removing the Foley catheter postoperatively and (2) straining pattern of postoperative voiding with the post-void residual urine volume (PVR) larger than 100 mL during 1st or 2nd trial of self-voiding and (3) these voiding problems are resolved within 48 h without any special treatment. The Foley catheter was removed routinely on the first postoperative day. Age, previous pelvic surgery history, co-existence of cystocele, number of vaginal deliveries and all urodynamic parameters were analyzed and compared between the TR group and control group.

Results

The incidence of TR was 9.5%. Comparative analysis revealed concomitant prolapse surgery including anterior and posterior repair, Valsalva leak point pressure and preoperative PVR. In multivariate analysis, preoperative PVR proved to be a potential risk factor for TR.

Conclusion

TR was not a rare postoperative complication after TOT procedures. Potential risk factors for transient retention include preoperative PVR.     

Quality of life impairment during the female menopausal transition is related to personal and partner factors

Objective.?To assess the female quality of life (QoL) during the menopausal transition and determine factors (personal and partner) related to its impairment. The frequency of menopausal symptoms was also assessed.

Methods.?In this cross-sectional study, healthy women aged 40–59 years were asked to fill out the Menopause Rating Scale (MRS) and a questionnaire assessing personal and partner demographic data.

Results.?During the study period, a total of 409 women were surveyed. Mean age was 47 ± 5.3 years (median 46). Mean educational level was 13.2 ± 4.1 years (median 14), with 28.1% having 12 or less years of schooling; premenopausal (42.1%), perimenopausal (24.4%) and postmenopausal (33.5%). At the time of the survey, 9.8% were receiving hormonal therapy (HT) for the menopause, 1.5% were on psychotropic drugs and 1.2% on alternative treatments for the menopausal. Regarding partner profile, 10.3% had erectile dysfunction, 11.2% had precocious ejaculation and 7.3% had abused alcohol. Mean total MRS score was 9.1 ± 6.4 (median 9); for the somatic subscale, 4 ± 2.7; the psychological subscale, 3 ± 2.8 and the urogenital subscale, 2.1 ± 2.5. Of the surveyed women, 50.6% presented a total MRS scoring of 9 or more (moderate to severe intensity). The four most frequently found symptoms of those composing the MRS were hot flushes (68.9%), sleeping problems (68.4%), depressive mood (55.2%) and irritability (51.6%). After adjusting for confounding factors, logistic regression analysis determined that female age, menopause and partner precocious ejaculation increased the risk for presenting higher total MRS scores (impaired female QoL) whereas HT use, church assistance and partner faithfulness decreased this risk.

Conclusions.?A high rate of middle-aged women in this series presented impaired QoL associated to female age and hormonal status and additionally to partner's health and sexual behavior.