Chasta Bacsu

Meshology: a fast-growing field involving mesh and/or tape removal procedures and their outcomes

Stress urinary incontinence and pelvic organ prolapse are two of the commonest conditions affecting women today. It is associated with significant compromise to quality of life. Through the years, there has been an evolution of technique and graft material to augment repairs for durability. Transvaginal placements of synthetic mid-urethral slings and vaginal meshes have largely superseded traditional tissue repairs in the current era because of presumed efficacy and ease of implant with device ‘kits’. The use of synthetic material has generated novel complications, including mesh extrusion, pelvic and vaginal pain and mesh contraction. In this review, our aim is to discuss the management and outcomes associated with mesh removal. In addition, we will briefly review the safety communications issued by the US FDA on transvaginal mesh placement and a new classification system for complications arising from the use of synthetic graft endorsed by both the International Continence Society and International Urogynecological Association.

Long-term outcomes of autologous pubovaginal fascia slings: Is there a difference between primary and secondary slings?

To report our long‐term pubovaginal slings (PVS) outcomes between primary (PVS1) and secondary (PVS2) autologous fascia PVS, with the hypothesis that outcomes in PVS1 will be better than in PVS2.

Durability of collagen injection for stress urinary incontinence in women proven by transvaginal 3-dimensional ultrasound.

Objective The aim of this study is to evaluate the durability of collagen injection (CI) using serial 3-dimensional (3D) transvaginal ultrasound (US) in women with sufficient improvement of stress urinary incontinence (SUI) symptoms not requiring additional treatment. Methods After the institutional review board approval, a retrospective review of prospectively followed patients who underwent CI was conducted. Eligible patients received 3 or less consecutive CI for SUI with no reinjection afterward during the follow-up period and had a minimum follow-up of 1 year from the last CI. Serial 3D US was obtained for collagen volume and configuration at baseline (6–8 weeks postoperatively) and approximately every 12 months thereafter as clinically indicated. Results Of 191 eligible patients from 1/99 to 6/11, 67 (35%) met the inclusion criteria. The mean age was 67 years (42–90 years) with mean follow-up from the time of last CI at 43 months (12–149 months). A total of 283 three-dimensional US were performed, with the mean of 4 (2–11) per patient. The mean number of injections was 1.4 (1–3) with a mean injected volume at 5.8 mL (2–18 mL). The volume retention rate compared with the baseline volume was 84% (12%-100%), with a decrease in mean collagen volumes between the baseline and last follow-up visit (3.2 vs 2.7 mL; P = 0.008). Collagen volume decreased by a mean of 0.11 mL for each year past the final injection (P = 0.0015) by mixed-effect model analysis. Conclusions Although believed to be nondurable, CI was found to be objectively stable over time by transvaginal 3D US in a subset of women with durably improved SUI symptoms.

Influence of rectal gel volume on defecation during dynamic pelvic floor magnetic resonance imaging

PURPOSE To evaluate effects of altering rectal contrast volume on defecatory effort during magnetic resonance defecography (MRD). METHODS We assessed defecation qualitatively and quantitatively as a function of rectal distention (group A: 180 cc, n=31; group B: 120 cc, n=31). Quantitative evaluation comprised measuring rectal area on midline sagittal images pre- and post-defecation. RESULTS Resting rectal area was significantly higher for group A than for group B (35.2 vs. 28.3 cm(2), P<.0001). Post-defecation rectal area and change in area (pre- to post-defecation) were not significantly different. Subjective evaluation showed no significant difference. CONCLUSION Decreasing rectal gel volume from 180 to 120 cc did not compromise defecation performance during MRD.

Quality of life after suprapubic catheter placement in patients with neurogenic bladder conditions

To evaluate quality of life in patients with neurogenic bladder (NGB) conditions who have elected to undergo suprapubic catheterization (SPC), as well as assess adverse events (AEs) related to the procedure.

Anterior Vaginal Wall Suspension Procedure for Stress Urinary Incontinence Associated with Variable Degrees of Anterior Compartment Prolapse

Stress urinary incontinence is for the most part due to a sudden descent of the urethra pulled open by a dropping vagina which has lost its lateral attachment support during straining efforts. The goal of this procedure is to restore back this vaginal support, thus stabilizing the vaginal plate underneath the urethra and bladder base to prevent this rapid downward process with efforts. Inspired by the Raz bladder neck suspension, this anterior vaginal wall suspension procedure has been part of our practice for several decades. Long-term data is now available, attesting to its durability, safety and efficacy. It is also a very versatile procedure which can be performed along with other vaginal repair procedures, uterine preservation, or autologous fascial sling.

Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal

To determine outcomes after removal of two synthetic mid‐urethral slings (MUS) at a tertiary care center.

Bladder Emptying: Contractility

Bladder contractility is a measure of detrusor muscle contractile strength and it can be affected by a variety of factors. In this chapter, conditions such as detrusor underactivity, acontractile detrusor, detrusor hyperactivity and impaired contractility, and other abnormal forms of detrusor function will be discussed extensively with urodynamics tracings demonstrating each clinical scenario. Other factors that can affect bladder contractility, such as the bladder outlet, will also be reviewed in this chapter underscoring the importance of understanding the relationship between bladder contractility and outlet resistance. A properly performed urodynamic study is a powerful tool in better understanding disorders of bladder contractility.

Complications of treatment of urinary incontinence and pelvic organ prolapse

Summary This review aims to provide an overview of complications associated with surgical treatment for urinary incontinence and pelvic organ prolapse relating to synthetic mesh, as well as review the new International Urogynecologic Association (IUGA)/ International Continence Society (ICS) classification of complications for insertion of prosthesis or grafts in female pelvic floor surgery and the recent Food and Drug Administration (FDA) notifications.

Complicaciones del tratamiento de incontinencia urinaria y prolapso de la pelvis

Resumen Este articulo tiene como objetivo proporcionar una vision general de las complicaciones asociadas al tratamiento quirurgico por incontinencia urinaria y prolapso pelvico relacionado con el uso de mallas quirurgicas. Asimismo, otro de sus objetivos es revisar la nueva clasificacion de complicaciones relacionadas con la insercion de protesis o injertos en la cirugia de piso pelvico femenino otorgada por la Asociacion Uroginecologica Internacional (IUGA, por su sigla en ingles) / Sociedad de Continencia Internacional (ICS, por su sigla en ingles) y por las recientes notificaciones proporcionadas por la Administracion de Medicamentos y Alimentacion (FDA, por su sigla en ingles).