C. Skala

Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period

Please cite this paper as: Albrich S, Laterza R, Skala C, Salvatore S, Koelbl H, Naumann G. Impact of mode of delivery on levator morphology: a prospective observational study with three‐dimensional ultrasound early in the postpartum period. BJOG 2012;119:51–61.

Mesh complications following prolapse surgery: management and outcome

OBJECTIVE This is a description of complications following prolapse surgery with the use of alloplastic materials, the management and outcome. STUDY DESIGN 54 women have been referred to Mainz, urogynecology referral center due to complications following mesh-augmented prolapse surgery. RESULTS The complaints who lead to the admission are expressed by the new terminology and standardized classification for complications arising directly from the insertion of prostheses and grafts in female pelvic floor surgery [1]. Pain (66.7%), mesh erosion (55.6%) and vaginal discharge (48.1%) were the most frequent complaints. Revision was performed after a median time of 27.2 months post mesh implantation. Nine patients underwent limited excision of the mesh, 49 had a vaginal revision with wide mesh removal and 10 had a laparotomy with wide mesh removal. After 3 months 48 patients had a follow-up, 25 could have been relieved from their complaints. CONCLUSION Although the incidence is low, complications after prolapse repair with mesh use are difficult to prevent, affect quality of life and often require a new surgical intervention, which should be performed by an experienced and competent surgeon.

The effect of genital and lower urinary tract symptoms on steroid receptor expression in women with genital prolapse.

Introduction and hypothesisThis study evaluates the expression of estrogen receptor (ER) isoforms alpha (α) and beta (β) and progesterone receptor (PR) in vaginal and periurethral tissue in women with genital prolapse in relation to genital and lower urinary tract symptoms (LUTS).MethodsForty-seven postmenopausal women without systemic estrogen therapy underwent pelvic organ prolapse quantification and urodynamic assessment. LUTS were evaluated by CATI questionnaire. Biopsies from vaginal and periurethral tissue were obtained during prolapse surgery. The steroid receptor gene expression was measured by RT-PCR.ResultsThe expression of PR in periurethral and ER β in vaginal tissue varied with prolapse extent. Nulliparous women showed a significantly higher expression of PR in periurethral tissue. Women with a positive stress test and those with overactive bladder symptoms showed a significantly lower amount of PR in vaginal tissue.ConclusionChanges in PR expression in vaginal or periurethral tissue might be a marker of structural and endocrine changes.

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.

Isolation of fibroblasts for coating of meshes for reconstructive surgery: differences between mesh types

AIMS An extensive colonization of surgical meshes with autologous fibroblasts may reduce complications. Therefore, we aimed to establish a technique that allows isolation and propagation of fibroblasts from vaginal biopsies. Using these cells we tested the applicability of several clinically applied meshes for fibroblast coating. MATERIALS & METHODS Fibroblasts were isolated from vaginal tissue after digestion with collagenase. Characterization was performed by immunostaining for cytokeratin 5, 6 and 14, smooth muscle actin and vimentin. A semiquantitative technique was applied to determine the degree of mesh coating 5 h and 5 weeks after seeding of fibroblasts. Seven meshes of different mesh types have been tested. RESULTS Cells with a fibroblast-like morphology have been isolated from vaginal tissue and could be propagated for at least 12 passages, resulting in a total number of 1.2 x 10(7) cells. Immunostaining showed that cells were positive for the mesenchymal cell marker vimentin and negative for smooth muscle actin, as well as the epithelial cell markers cytokeratin 5, 6 and 14, supporting their classification as fibroblasts. Clear differences in fibroblast colonization between the seven tested mesh types have been observed. Polypropylene mesh Obtape showed an acceptable covering with fibroblasts. The best coating was obtained for xenograft-based meshes, but under cell-culture conditions the mesh showed signs of decomposition. CONCLUSION We have established a technique that allows isolation and propagation of vaginal fibroblasts. The result of vaginal fibroblast colonization of allograft-based meshes strongly depends on the mesh type, whereby the best coating could be achieved for a polypropylene mesh.

Patient goals after incontinence procedures: does the single-incision sling satisfy them?

OBJECTIVE This study was undertaken to describe short-term postoperative achievement of subjective preoperative goals for single-incision MiniArc slings, in comparison with tension-free vaginal tape (TVT). METHOD Patients submitted to mid-urethral sling (TVT and MiniArc) procedures for stress urinary incontinence (SUI) in two centers were included in this prospective study. Before surgery, the patients completed a preoperative open-ended questionnaire, in which they described their personal outcomes goals for SUI surgery and the degree of severity of their symptoms. At the first postoperative check, they were asked to assess the degree to which their goals had been met and the degree of postoperative incontinence symptoms; their grade of satisfaction was evaluated with IIQ-7, UDI-6 and a 0-10 visual analog scale. RESULTS One hundred and eight patients (TVT n=51, MiniArc n=57) were included in this study. Incontinence symptom relief and improvement of quality of life were the most commonly described preoperative goals. Six to eight weeks after surgery, 47 patients (92.1%) after TVT and 53 (92.9%) women after single-incision slings were objectively cured (P=1). After surgery, more than 90% of the patients in both groups achieved their preoperative goals. Symptom scores improved significantly and were comparable in both groups. CONCLUSION Our results show that self-reported achievement of preoperative goals of patients submitted to single-incision slings are comparable at the first follow-up with patients who have undergone the classic mid-urethral sling.

Complications following the use of alloplastic materials in urogynecological surgery

STUDY DESIGN 118 patients, who were admitted from 2005 to 2008 to our department due to complications following mesh implantation, were included in a retrospective survey. We investigated patient symptoms, findings and subsequent patient management. There was a re-evaluation of symptoms in a follow-up eight weeks after the revision procedure. Data from our urogynecological file archive were used. RESULTS The main complaints were de novo urgency, pain and recurrent urinary tract infections. The main findings were mesh erosion and infections including abscess formations and osteomyelitis. Before being admitted to our department, 42 patients (35.6%) had already undergone at least one intervention. Surgery to overcome complications was performed in our unit after an average time of 27 months. In most cases, mesh removal was necessary. CONCLUSIONS Surgeons need to be aware of potential mesh complications, which should be managed in referral centres as soon as symptoms arise and should be documented in registers. There is a need for more prospective randomised studies on complications arising from surgery.

Krieg der Bänder

The number of incontinence surgeries has drastically increased for female stress urinary incontinence requiring treatment. On the one hand, public perception of the problem has become widespread, increasingly removing the stigma of the condition, and on the other hand, newer surgical techniques and materials have been continually developed in the last 15 years. The use of tension-free vaginal slings for the treatment of stress incontinence is associated with high continence rates and minimal side effects and has meanwhile become the gold standard in the management of incontinence.

Krieg der Bänder@@@“War of the slings”: Wann mache ich was und welches Konzept hat Bestand?@@@When do I do what and which concept will endure?

The number of incontinence surgeries has drastically increased for female stress urinary incontinence requiring treatment. On the one hand, public perception of the problem has become widespread, increasingly removing the stigma of the condition, and on the other hand, newer surgical techniques and materials have been continually developed in the last 15 years. The use of tension-free vaginal slings for the treatment of stress incontinence is associated with high continence rates and minimal side effects and has meanwhile become the gold standard in the management of incontinence.

["War of the slings": when do I do what and which concept will endure?].

The number of incontinence surgeries has drastically increased for female stress urinary incontinence requiring treatment. On the one hand, public perception of the problem has become widespread, increasingly removing the stigma of the condition, and on the other hand, newer surgical techniques and materials have been continually developed in the last 15 years. The use of tension-free vaginal slings for the treatment of stress incontinence is associated with high continence rates and minimal side effects and has meanwhile become the gold standard in the management of incontinence.