Komplikationsmanagement im Internet Marketing

Background

New patients come more and more often over the internet; therefore internet marketing plays an increasingly important role.

Question

How can physicians build an effective internet marketing strategy and avoid complications?

Method

Selection and authorization of a reputable agency.

Results

New customer acquisition through high visibility in the internet, at the same time increasing the image and awareness.

Conclusions

In the overall “marketing mix” internet marketing has become indispensable to physicians who want to be successful. Those who are well positioned in Google are well known by their target audience and thus receive a higher response.

     

Trends in internet search activity,media coverage,and patient-centered health information after the FDA safety communications on surgical mesh for pelvic organ prolapse

Introduction

In July 2011, the US Food and Drug Administration (FDA) issued a safety communication regarding serious complications associated with surgical mesh for pelvic organ prolapse, prompting increased media and public attention. This study sought to analyze internet search activity and news article volume after this FDA warning and to evaluate the quality of websites providing patient-centered information.

Methods

Google Trends? was utilized to evaluate search engine trends for the term “pelvic organ prolapse” and associated terms between 1 January 2004 and 31 December 2014. Google News? was utilized to quantify the number of news articles annually under the term “pelvic organ prolapse.” The search results for the term “pelvic organ prolapse” were assessed for quality using the Health On the Net Foundation (HON) certification.

Results

There was a significant increase in search activity from 37.42 in 2010 to 57.75 in 2011, at the time of the FDA communication (p?=?0.021). No other annual interval had a statistically significant increase in search activity. The single highest monthly search activity, given the value of 100, was August 2011, immediately following the July 2011 notification, with the next highest value being 98 in July 2011. Linear regression analysis of news articles per year since the FDA communication revealed r²?=?0.88, with a coefficient of 186. Quality assessment demonstrated that 42 % of websites were HON-certified, with .gov sites providing the highest quality information.

Conclusions

Although the 2011 FDA safety communication on surgical mesh was associated with increased public and media attention, the quality of relevant health information on the internet remains of poor quality. Future quality assurance measures may be critical in enabling patients to play active roles in their own healthcare.

     

Female urinary incontinence health information quality on the Internet: a multilingual evaluation

Introduction and hypothesis

The quality of Internet information on female urinary incontinence is considered variable. No comprehensive analysis exists to support this. We compared the quality of current Internet information for common layperson terminology on female urinary incontinence across four Western languages and a comparative analysis of website sponsors.

Methods

World Health Organization Health on the Net (HON) principles may be applied to websites using an automated toolbar function. We used the Google search engine; 10,200 websites were identified using keywords related to female urinary incontinence and treatments in English, French, German and Spanish. The first 150 websites in each language had HON principles examined, whilst a further analysis of site sponsorship was undertaken.

Results

The total number of websites for each term is variable. “Female sling surgery” had the most websites with approximately 18 million, whereas “colposuspension” had the least with only 159,890 websites. Regardless of language, very few female urinary incontinence websites were HON accredited (p?<?0.0001). Linguistically, French (18 %) and English (16 %) had the greatest percentage of HON-accredited sites. Tertiles (thirds) of the first 150 websites returned the higher percentage of HON-accredited websites (p?<?0.0001). Websites were largely sponsored by physicians/surgeons.

Conclusions

The lack of validation of most female urinary incontinence websites should be appreciated by clinicians. Additionally, discrepancies exist in the quality and number of websites across conditions, languages and also between medical and alternative terms. Clinicians should participate in and encourage the development of informative, ethical and reliable health websites on the Internet and direct patients to them.

     

Is the robotic approach feasible for repair of iatrogenic injuries of the lower ureter?

Objectives

To analyze the robotic approach as treatment of iatrogenic ureteral injuries.

Methods

Medical records were reviewed for patients undergoing robotic-assisted laparoscopic ureteral reimplantation at the University of Missouri from 2009 to 2014. Patient charts were analyzed for demographics, prior abdominal surgeries, circumstances of injury, outcomes, and other relevant information.

Results

Nine patients met inclusion criteria. The average age was 44.6. Patients had an average of 4.3 abdominal surgeries. Injury occurred during hysterectomy (open, laparoscopic, or vaginal) in eight patients (88.9 %), five cases were laparoscopic, two utilized robotic assistance, and one injury occurred during uterosacral vault suspension. All cases were related to gynecological procedures. On average, ureteral injury was detected 17.2 days after the initial surgery and repaired 62.3 days after initial operation. The average surgical repair time was 295.9 min (range 168–498) with an average blood loss of 77.2 mL (range 20–150). Four patients required a psoas hitch, with one receiving both a psoas hitch and a Boari flap. Postoperatively, patients had an average hospital stay of 2.7 days. One patient had ileus for greater than 3 days, and another was readmitted within 30 days for pain control and antiemetics following stent removal. One patient underwent open reimplantation 3 years after original surgery for development of ureteral stricture. At follow-up, all patients had returned to baseline renal function.

Conclusions

Robotic approach is feasible and a safe option for distal iatrogenic ureteral injuries occurring during gynecological procedures. Prior abdominal surgery or delayed repair does not preclude a robotic approach.

     

Use of XenX™, the latest ureteric occlusion device with guide wire utility: results from a prospective multicentric comparative study

Purpose

This is a prospective multicentric comparative study evaluating the performance of XenX—a new dual-purpose device for the prevention of stone fragments migration during ureteroscopic lithotripsy (URS).

Methods

Between March 2014 and January 2015, 41 patients undertaking URS + XenX were matched with 41 patients undergoing standard URS. Patients included had unilateral ureteric stone(s) of 0.5–1.5 cm in maximum size. Demographics, complication rates and surgical outcomes were recorded for comparison. A Likert-like 5-grade scoring system was used for surgeons’ evaluation of XenX properties. Cost analysis was performed by comparing weighted mean costs of the relevant procedures.

Results

Patients’ characteristics between the two groups were comparable. Lasering time was longer for XenX group (13.59 vs. 5.17 min; p = 0.0001) whilst use of basket and need of JJ stent insertion was more frequent in control group (19.5 vs. 97.6 %; p = 0.0001 and 22 vs. 35 %; p = 0.001, respectively). Intra-operative SFR was significantly higher for XenX group (100 vs. 85.4 %; p = 0.0001), but not at 4-week follow-up, after ancillary procedures were needed in 17.1 % of the control group. Surgeons’ evaluations for XenX were suboptimal for “Ease of Basketing” (2/5) and “Advancement of double J stent” (3/5). The use of XenX increased costs of procedures, but spared the costs associated to ancillary procedures and stent removals.

Conclusions

XenX confirmed to be a safe and effective device especially for the treatment of upper ureteric tract stones; moreover, XenX may reduce the risk for the need of auxiliary procedures and for the insertion of a JJ stent.

     

The Quality of Online Resources Available to Patients Interested in Knee Biologic Therapies Is Poor

Background

As the use of biologic therapies for the management of knee pathology continues to expand, it is more likely that patients will turn to the Internet to gather information on this topic. Given the lack of scientific consensus on the use of biologics, care providers must understand what information is available online.

Questions/Purposes

The purpose of this study was to evaluate the quality of websites that patients may use to educate themselves on knee biologics.

Methods

Websites were identified using search terms relevant to multiple biologic therapies available for knee pathology. Websites were scored based on an author-derived grading rubric, with a total of 25 possible points relating to the role of knee biologics in the diagnosis, evaluation, and treatment of knee pathology. Websites were categorized based on the source (e.g., physician-operated website vs. industry-related website). Reading level was assessed with the Flesch-Kincaid readability test.

Results

The initial search yielded 375 results, with 96 websites meeting final inclusion criteria. Mean website score was poor, at 6.01 of the 25 possible points (24.0%). Physician websites were the most common, with 60% of the articles identified. Industry-related websites scored the lowest (mean, 3.2?±?0.97) while hospital-related websites scored the highest (mean, 8.3?±?2.93). Overall, websites published from hospitals or orthopedic professional societies had significantly higher scores than other websites. The search term “knee PRP” yielded higher-quality results than “knee platelet rich plasma.” Similarly, “knee BMAC” led to better results than “knee bone marrow aspirate concentrate.” The average reading level was 11.4.

Conclusion

Many online resources are available for patients seeking information about knee biologic therapies, but the quality of websites identified was very poor. Patients should be counseled that the information available online for knee biologic therapy is unreliable. Surgeons should play an increased role in providing resources to patients and educating them on biologic options.

     

Computer-assisted total knee arthroplasty marketing and patient education: an evaluation of quality,content and accuracy of related websites

Background

The internet is increasingly being used as a resource for health-related information by the general public. We sought to establish the authorship, content and accuracy of the information available online regarding computer-assisted total knee arthroplasty (CA-TKA).

Methods

One hundred fifty search results from three leading search engines available online (Google, Yahoo!, Bing) from ten different countries worldwide were reviewed.

Results

While private physicians/groups authored 50.7 % of the websites, only 17.3 % were authored by a hospital/university. As compared to traditional TKA, 59.3 % of the websites claimed that navigated TKA offers better longevity, 46.6 % claimed accelerated recovery and 26 % claimed fewer complications. Only 11.3 % mentioned the prolonged operating room time required, and only 15.3 % noted the current lack of long-term evidence in support of this technology.

Conclusions

Patients seeking information regarding CA-TKA through the major search engines are likely to encounter websites presenting a narrow, unscientific, viewpoint of the present technology, putting emphasis on unsubstantiated benefits while disregarding potential drawbacks.

Level of evidence

Survey of Materials—Internet.

     

A randomized controlled trial comparing alpha blocker (tamsulosin) and anticholinergic (solifenacin) in treatment of ureteral stent-related symptoms

Purpose

To compare the effectiveness of tamsulosin and solifenacin in relieving ureteral stents related symptoms.

Patients and methods

A randomized controlled trial was conducted between January 2013 and July 2014. Inclusion criteria were patients aged 20–50 years who underwent temporary unilateral ureteral stent for drainage of calcular upper tract obstruction or after ureteroscopic lithotripsy. Patients with history of lower urinary tract symptoms before stent placement, stents that were fixed after open or laparoscopic procedures, and those who developed complications related to the primary procedure were not included. Eligible patients were randomly assigned to 1 of 3 groups using computer-generated random tables. Patients in group 1 received placebo, patients in group 2 received tamsulosin 0.4 mg once daily, and those in group 3 received solifenacin 5 mg once daily. Ureteral Stent Symptom Questionnaire (USSQ) was answered by all patients 1–2 weeks after stent placement. The primary outcome was the comparison of total score of USSQ between all groups.

Results

The study included 131 patients. All baseline characteristics (age, sex, side, indication, length, and duration of stent) were comparable for all groups. Total USSQ score was 61 in solifenacin group, 76 in tamsulosin group, and 83 in control group (P < 0.001). The total USSQ scores and all domains, except sexual index, were significantly better in solifenacin than in tamsulosin group (P < 0.05).

Conclusion

The use of tamsulosin alone or solifenacin alone in patients with ureteral stents can improve the quality of life by decreasing ureteral stent-related symptoms. Solifenacin was better than tamsulosin.

ClinicalTrial.gov Identifier

NCT01880619.

     

Effect of twelve-month physical exercise program on patients with osteoporotic vertebral fractures: a randomized,controlled trial

Summary

We performed a randomized clinical trial to evaluate the effect of a 12-month physical exercise program on quality of life, balance, and functional mobility in postmenopausal women with osteoporotic vertebral fractures. All three outcomes improved in the intervention group and were better than in the controls.

Introduction

Th aim of this study was to evaluate the effectiveness of a structured physical exercise intervention on quality of life, functional mobility, and balance in patients with osteoporotic vertebral fractures and back pain.

Methods

Seventy-eight postmenopausal women with vertebral fractures were randomized into an exercise group (n?=?40) and a control group (n?=?38). The mean age was 69.2?±?7.7 years. All women had at least one osteoporotic vertebral fracture and suffered from chronic back pain. Patients with a history of vertebral and non-vertebral fracture within the past 6 months were excluded. The 40-min exercise program was conducted twice weekly for 1 year. Participants in the control group were instructed to continue their usual daily activities. Participants were assessed at baseline and at 12 months using the Quality of Life Questionnaire (QUALEFFO-41). Balance was measured with the Balance Master® System NeuroCom® and functional mobility was measured with the “timed up and go” test and “sit-to-stand” test.

Results

Total QUALEFFO-41 score after 12 months was significantly better in the exercise group (44.2?±?7.5) compared to the control group (56.6?±?9.4), p?<?0.0001. Quality of life improved in domains: “Pain”, “Physical function: Jobs around the house”, “Physical function: Mobility”, “Social function”, “General health perception” in the exercise group as compared to the control group. After 12 months, balance as assessed by “Tandem Walk and Sway” became significantly better in the exercise group as compared to the control group (p?=?0.02). A significant improvement in the “timed up and go” test (p?=?0.02) and the “sit-to-stand” test (p?=?0.01) was shown in the exercise group compared to the control group.

Conclusions

This is the first 12 month-randomized clinical trial of exercise in osteoporotic women with a vertebral fracture that demonstrates improvement of three key outcome measures: quality of life, functional mobility, and balance.

     

Role of Percutaneous Glue Treatment After Persisting Leak After Laparoscopic Sleeve Gastrectomy

Background

Over the years, many treatment modes have been attempted for gastrocutaneous fistula (GCF) after laparoscopic sleeve gastrectomy (LSG). Minimally invasive techniques for GCF treatment include stent placement and radiological percutaneous glue treatment (GT).

Material and Method

Ten patients underwent a radiological acrylate mixed with contrast medium GT combined or not with other treatment strategies such as relaparoscopy, ultrasound, or computerized tomography scan (CT scan)-guided drain and endoscopic stent placement.

Results

Ten patients (mean age 47.1 years, range 64–29) were treated by percutaneous injection of glue after LSG leak. Body mass index (BMI) was 42.2 kg/m²?±?6.7 at the time of LSG surgery. Mean time between LSG and leak diagnosis was 12 days (range 4–31 days). GT was only effective when performed after endoscopic stent placement (80 % resolution). With this regimen, five patients required a laparoscopic Roux limb placement. All fistulas eventually healed a mean of 75 days (range 29–293 days) after GCF diagnosis.

Conclusions

Percutaneous glue treatment alone does not seem to provide adequate results. Stenting previous to the glue treatment allows for better results.

     

Obstetric fistula in Niger: 6-month postoperative follow-up of 384 patients from the Danja Fistula Center

Introduction and hypothesis

The impoverished West African country of Niger has high rates of obstetric fistula. We report a 6-month postoperative follow-up of 384 patients from the Danja Fistula Center and assess factors associated with operative success or failure.

Methods

The medical records of 384 women who had completed a 6-month follow-up after fistula surgery were reviewed. Cases were categorized as “easy,” “of intermediate complexity,” or “difficult” based on a preoperative points system. Data were analyzed using simple chi-squared statistics and logistic regression.

Results

The patients were predominantly of Hausa ethnicity (73%), married young (average 15.9 years), had teenage first pregnancies (average first delivery 16.9 years), and experienced prolonged labor (average 2.3 days) with poor outcomes (89% stillbirth rate). The average parity was four. Patients commonly developed their fistula during their first delivery (43.5%), but over half sustained a fistula during a subsequent delivery (56.5%). Prior fistula surgery elsewhere (average 1.75 operations) was common. The overall surgical success (“closed and dry”) was 54%. When the 134 primary operations were analyzed separately, the overall success rate was 80%. Increasing success was seen with decreasing surgical difficulty: 92% success for “easy” cases, 68% for “intermediate” cases, and 57% success for “difficult” cases. Success decreased with increasing numbers of previous attempts at surgical repair.

Conclusions

These data provide further evidence that clinical outcomes are better when primary fistula repair is performed by expert surgeons in specialist centers with the support of trained fistula nurses.

     

Improvement of Postoperative Pain Control Processes and Outcomes in Veterans of a Surgical Intensive Care Unit

Background

Postoperative pain remains undertreated in critically ill patients. We hypothesized that the adequacy of pain control in our Surgical Intensive Care Unit (SICU) was above the reported average of 71 % in the literature and that the introduction of the critical care pain observation tool (CPOT) could improve it. We used a Lean Six Sigma methodology to improve our processes and quantify our improvement.

Patients and methods

We retrospectively review 713 consecutive veterans admitted to our SICU. Between December 2014 and February 2015, postoperative pain was assessed every 2 h and rated “acceptable,” “unacceptable,” or “unable to assess”. Between March 2015 and October 2015, postoperative pain was assessed with CPOT. Concurrently, we implemented a postoperative pain education program and documented this activity in the electronic medical record.

Results

The baseline adequacy of pain control was 78 %, which improved to 99 % after the introduction of CPOT. We concurrently achieved a 100 % median documentation of postoperative pain education in the electronic medical record. The introduction of CPOT improved the process σ from 2.3 to 3.8. The process of documenting pain education achieved a process σ of 3.1.

Conclusions

The proportion of veterans with acceptable pain control in our SICU is higher than that reported in the literature and the application of a Six Sigma methodology that involved the introduction of the CPOT has allowed us to improve the perception of pain control and comply with the newest regulatory directives.

     

The use of adjuncts to reduce seroma in open incisional hernia repair: a systematic review

Background

Seroma formation remains a common complication after an incisional hernia repair. The use of surgical drains is widespread, but evidence for their use and other adjuncts is limited. Our aim was to perform a systematic review of the literature on techniques used to reduce the incidence of post-operative seroma formation.

Methods

A systematic search of PubMed and Embase databases was conducted using terms including “incisional hernia” and “seroma”. All studies on adults undergoing open incisional hernia repair with at least one intervention designed to reduce seroma formation were included.

Results

Of the 1093 studies identified, 9 met the inclusion criteria. Medical talc: one cohort study of 74 patients undergoing talc application following pre-peritoneal mesh placement found a significantly decreased rate of seroma formation of 20.8 versus 2.7% (p < 0.001), but a retrospective study including 21 patients with onlay mesh found an increased rate of 76% seroma formation from 9.5% (p = 0.001). Fibrin glue: one comparative study including 60 patients found a reduction in seroma formation from 53 to 10% (p = 0.003), whereas a retrospective study of 250 patients found no difference (11 vs. 4.9% p = 0.07). Negative pressure wound therapy: four retrospective studies including a total of 358 patients found no difference in seroma outcome. Others: one randomised study of 42 patients undergoing either suction drainage or “quilting” sutures found no difference in seroma formation.

Conclusions

There is currently insufficient quality evidence to recommend any of the investigated methods, some of which incur significant additional cost.

     

Versorgung und Outcome von Patienten mit Schädel-Hirn-Trauma

Background

The article describes the objectives and methods of a study initiated by the working group (AG) on neurotrauma of the Employers Liability Insurance Association (BG) hospitals and supported by a grant from the German Statutory Accident Insurance (DGUV) entitled “A prospective study on epidemiology and outcome of patients with traumatic brain injury (TBI) in BG hospitals (ProSHT)”, reg.-nr. DRKS00010525.

Objectives

The aim of the main part of this study (TBI registry) is the documentation of treatment and outcome of patients after TBI treated in one of the participating BG hospitals. In an additional subproject (mild TBI), risk factors for a negative course after mild TBI are assessed by additional examinations.

Material and methods

In the main part of the study, treatment was documented by standard assessment forms (including inital treatment, acute inpatient treatment and rehabilitation) and outcome was assessed by standardized telephone interviews 3 and 12 months after trauma. In the subproject, additional neurological, neuropsychological and magnetic resonance imaging (MRI) examinations were performed in the first 4 weeks after trauma and after 3 and 12 months.

Results

The study is still ongoing, and definitive results are not yet available.

Conclusion

It is expected that the results will substantially contribute to improvement of treatment of TBI patients.

     

Microendoscopic discectomy versus open discectomy for lumbar disc herniation: a meta-analysis

Purpose

To compare the outcomes of microendoscopic discectomy and open discectomy for patients with lumbar disc herniation.

Methods

An extensive search of studies was performed in PubMed, Medline, Embase, Cochrane library and Google Scholar. The following outcome measures were extracted: visual analogue scale (VAS), Oswestry disability index (ODI), complication, operation time, blood loss and length of hospital stay. Data analysis was conducted with RevMan 5.0.

Results

Five randomized controlled trials involving 501 patients were included in this meta-analysis. The pooled analysis showed that there was no significant difference in the VAS, ODI or complication between the two groups. However, compared with the open discectomy, the microendoscopic discectomy was associated with less blood loss [WMD = ?151.01 (?288.22, ?13.80), P = 0.03], shorter length of hospital stay [WMD = ?69.33 (?110.39, ?28.28), P = 0.0009], and longer operation time [WMD = 18.80 (7.83, 29.76), P = 0.0008].

Conclusions

Microendoscopic discectomy, which requires a demanding learning curve, may be a safe and effective alternative to conventional open discectomy for patients with lumbar disc herniation.

     

Kidney Autotransplantation: Between the Past and the Future

Purpose of Review

The practice of kidney autotransplantation (KAT) has become an increasingly favorable approach in the treatment of certain renovascular, ureteral, and malignant pathologies. Current KAT literature describes conventional open procedures, which are associated with substantial risks. We sought to compare previously reported outcomes, evaluate common surgical indications, and assess associated risks and benefits of current KAT methods. A thorough evaluation and review of the literature was performed with the keywords “autologous transplantation” and “kidney.”

Recent Findings

Early outcomes of robotic KAT are encouraging and have been associated with fewer complications and shorter hospital stay, but require robotic technique proficiency.

Summary

KAT is an important method to manage selected complex urological pathologies. Robotic KAT is promising. Nevertheless, future studies should utilize larger patient cohorts to better assess the risks and benefits of KAT and to further validate this approach.

     

Identification of physical and psychosocial problems associated with diabetic nephropathy using the International Classification of Functioning,Disability and Health Core Set for Diabetes Mellitus

Background

We previously demonstrated validation of the Comprehensive International Classification of Functioning, Disability and Health Core Set for Diabetes Mellitus (ICF-CS for DM) in patients with diabetic nephropathy (DMN). The objective of the present study was to identify differences in experience of physical and psychosocial problems between DMN patients with and without hemodialysis (HD), and diabetes patients without nephropathy using the ICF-CS for DM.

Methods

A total of 302 diabetes outpatients (men, 68 %; mean age, 62 years) were interviewed using four components of the ICF-CS for DM including “Body functions”, “Body structures”, “Activities and participation”, and “Environmental factors”.

Results

The mean number of categories in which difficulty was experienced in the four components was significantly greater in DMN patients with HD followed by DMN patients without HD, and diabetes patients without nephropathy (23.9 vs. 18.0 vs. 13.1, respectively). Multivariate logistic regression models revealed that, compared with diabetes patients without nephropathy, diabetes patients with nephropathy were more likely to have difficulty with physical problems and social activities and participation. Among DMN patients, dialysis patients were found to have larger numbers of problems, and face difficulty with employment status after adjusting for sex, age, type, and duration of diabetes.

Conclusion

The results of this study using the ICF-CS for DM identified the areas for improvement among physical and psychosocial problems in DMN patients with and without HD in contrast to diabetes patients without nephropathy.

     

Achievement of trifecta in minimally invasive partial nephrectomy correlates with functional preservation of operated kidney: a multi-institutional assessment using MAG3 renal scan

Purpose

To validate and compare the values of “MIC” and “trifecta” as predictors of operated kidney functional preservation in a multi-institutional cohort of patients undergoing minimally invasive PN.

Methods

We retrospectively reviewed records of consecutive cases of minimally invasive PN performed for cT1 renal masses in 4 centers from 2009 to 2013. Inclusion criteria consisted of availability of a renal scan obtained within 2 weeks prior to surgery and follow-up renal scan 3–6 months after the surgery. The primary endpoint of the study was to compare the degree of ipsilateral renal function preservation assessed by MAG3 renal scan in relation to achievement of MIC and trifecta.

Results

Total of 351 patients met our inclusion criteria. The rates of trifecta achievement for cT1a and cT1b tumors were 78.9 and 60.6 %, respectively. The rate of MIC achievement for cT1a tumors and cT1b tumors was 60.3 and 31.7 %, respectively. On multivariable linear regression model, only the degree of tumor complexity assessed by R.E.N.A.L nephrometry score [coefficient B ?1.8 (?2.7, ?0.9); p < 0.0001] and the achievement of trifecta [coefficient B 6.1 (2.4,9.8); p = 0.014] or MIC (coefficient B 7.2 (3.8,0.6); p < 0.0001) were significant clinical factors predicting ipsilateral split function preservation.

Conclusions

Achievement of both MIC and “trifecta” is associated with higher proportion of split renal function preservation for cT1 tumors after minimally invasive PN. Thus, these outcome measures can be regarded not only as markers of surgical quality, but also as reliable surrogates for predicting functional outcome in the operated kidney.

     

Endoscopic Management of Ureteral Strictures: an Update

Purpose of Review

This review focuses on the role of endoscopic treatment of ureteral stricture disease (USD) in the era of minimally invasive surgery.

Recent Findings

There is a relative paucity of recent literature regarding the endoscopic treatment of USD. Laser endopyelotomy and balloon dilation are associated with good outcomes in treatment-naïve patients with short (<?2 cm), non-ischemic, benign ureteral strictures with a functional renal unit. If stricture recurs, repetitive dilation and laser endopyleotomy is not recommended, as success rates are low in this scenario. Patients with low-complexity ureteroenteric strictures and transplant strictures may benefit from endoscopic treatment options, although formal reconstruction offers higher rates of success.

Summary

Formal ureteral reconstruction remains the gold-standard treatment for ureteral stricture disease as it is associated with higher rates of complete resolution. However, in carefully selected patients, endoscopic treatment modalities provide a low-cost, low-morbidity alternative.

     

Laparoscopic hysteropexy: 10 years’ experience

Introduction and hypothesis

Uterine prolapse is common and has traditionally been treated by vaginal hysterectomy. Increasingly, women are seeking uterine-preserving alternatives. Laparoscopic hysteropexy offers resuspension of the uterus using polypropylene mesh. We report on 10 years’ experience with this technique.

Methods

All hysteropexy procedures in our unit since 2006 were reviewed. Primary outcome was safety of hysteropexy, as assessed by intraoperative and major postoperative complications. Secondary outcomes were measures of feasibility, including operating time, length of stay, conversion to alternative procedures, change in point C, patient satisfaction, and repeat apical prolapse surgery.

Results

Data were available for 507 women. Complications were rare (1.8%) with no evidence of any mesh exposure. Mean operating time was 62.5 min and median length of stay 2 nights. In 17 patients (3.4%), hysteropexy was abandoned. There was a mean change in point C of 7.9 cm and 93.8% of patients felt that their prolapse was “very much” or “much” better. Of these women, 2.8% have had repeat apical surgery.

Conclusions

To our knowledge, this is the largest series to date, describing 10 years’ experience with laparoscopic hysteropexy. The surgical technique appears to be safe, with low complication rates, which supports the choice of appropriately selected women to opt for uterine preservation surgery as an alternative to hysterectomy for the management of uterine prolapse.