Aneta Zwierzchowska

Vaginal excision of the sub-urethral sling: analysis of indications, safety and outcome

Introduction Sling techniques are the method of choice in stress urinary incontinence management, despite the high rates of complications leading sometimes to the necessity of re-operation, and the tape transection and resection are of the greatest importance. The study was aimed at analyzing the indications, technique and effects of transvaginal tape excision. Material and methods A retrospective study including 100 patients who underwent surgical removal of the sub-urethral sling in Evangelisches Krankenhaus Hagen-Haspe was conducted. The analyzed measures were: sling type, onset of symptoms, rates of particular complications, safety and outcome of the operative procedure. Results Most complications occurred in the first 2 years after surgery. The most common indications for re-operation were: overactive bladder (OAB) (64%), persistent stress urinary incontinence (SUI) (59%), pain (40%), urinary retention (40%), and erosion (29%). Some of the complications co-existed (i.e. vaginal erosion with postoperative pain, infections with urinary retention). During the procedure 1 bladder was injured and 1 patient had a hematoma. In women with OAB, 24-hour frequency decreased from 13.3 to 8.5 (p < 0.001), the mean voiding volume increased from 131.7 to 216.4 ml (p < 0.001), and nocturia increased from 3.28 to 1.19 (p < 0.001). Intensity of urgency decreased from 8.78 to 0.92 in the 10-point visual score (p < 0.001). Pain and urinary retention resolved in 39 out of 40 patients (p < 0.0001). The rate of SUI increased from 59% to 83% (p < 0.001). Conclusions Sling removal is safe and associated with a minimal rate of complications. Removing the tape causes resolution of most of the complications, but SUI recurs or worsens.

Are complications of stress urinary incontinence surgery procedures associated with the position of the sling

To evaluate whether the sling position is associated with particular types of complications in patients undergoing suburethral sling placement for stress urinary incontinence.

Does the suburethral sling change its location

To ascertain whether a phenomenon of sling migration exists after suburethral sling placement, whether this might be responsible for suboptimal sling location and persistent incontinence, and whether a link exists between sling dislocation or migration and risk factors, such as obesity or age.

Demographic features of female urethra length

To determine cohort urethral length, identify epidemiological factors influencing the parameter and to establish the percentage of cases with clinically relevant outsized urethras.

Recurrent miscarriage is associated with increased ghrelin mRNA expression in the endometrium- a case-control study

Ghrelin has been found to be expressed in the human endometrium. Emerging evidence links ghrelin and its receptor with the reproductive system. Certain associations between ghrelin and angiogenesis have also been established. The aim of this small case-control study was to quantify and compare the expression of mRNA encoding ghrelin, ghrelin receptor (GHS-R), vascular endothelial growth factor A (VEGF A) and its receptors (VEGFR1-3) in the endometrium of women with recurrent miscarriage compared to parous controls. Correlations between the expression of particular genes were also investigated. Endometrial samples were obtained during the secretory phase of the menstrual cycle from 15 women with a history of recurrent miscarriage (first trimester pregnancy loss without a known cause) and 10 healthy parous controls. Ghrelin, GHS-R, VEGF A and VEGFR1-3 mRNA expression was analyzed by quantitative RT-PCR. The expression of mRNA for ghrelin and VEGF A was significantly higher in the study group than the control group. In the control group, the expression of ghrelin mRNA was positively correlated with the expression of VEGF A and VEGFR1 mRNA. In the study group, no such associations were observed. These results show that the expression of mRNA for ghrelin and VEGF A may be increased in the endometrium of women with recurrent miscarriage thus suggesting that ghrelin may play a role in the pathogenesis of recurrent miscarriage.

Quality of life assessment in women after cervicosacropexy with polypropylene mesh for pelvic organ prolapse: a preliminary study.

Aim of the study Aim of the study was to assess the changes in the subjective perception of quality of life in patients who underwent abdominal cervicosacropexy for pelvic organ prolapse. Material and methods Forty patients with diagnosed pelvic organ prolapse (Pelvic Organ Prolapse – Quantification [POPQ] stage IV or IIIC) underwent abdominal supracervical hysterectomy and cervicosacropexy. The questionnaire concerning the quality of life was filled in before and 6 months after the surgery. Results In all patients, an accurate prolapse correction was achieved. In 42% of patients, stress urinary incontinence (SUI) was diagnosed prior to surgery, while after the surgery in 38.24% (p > 0.05). In 50% of women, symptoms of overactive bladder (OAB) occurred pre-surgery. These symptoms were reported by 17.65% of patients postoperatively (p < 0.05). Urinary retention was observed in 32.36% before and in 2.5% after the surgery (p < 0.05). The average score of the quality of sexual life was 5.75 (SD 2.52, 95% CI: 4.41-7.1) before and increased to 7.93 (SD 1.77, 95% CI: 6.9-8.95) after the procedure (p < 0.05). The mean score of the overall quality of life in relation to POP before and after the procedure was 2.77 (SD 2.39, 95% CI: 1.87-8.64) and 9.03 (SD 1.08, 95% CI: 8.66-9.43), respectively (p < 0.001). Conclusions These results show a highly significant improvement of the quality of life in patients who underwent abdominal cervicosacropexy for POP. The change in quality of their sexual life, reduced OAB and urinary retention rates, as well as improvement of the esthetic self-perception may have contributed to this positive effect.