Farzeen Firoozi

Robotic-assisted sacrocolpopexy for pelvic organ prolapse.

The demand for surgical correction of pelvic organ prolapse is expected to grow as the aging population remains active and focused on quality of life. Definitive correction of pelvic organ prolapse can be accomplished through both vaginal and abdominal approaches. This article provides a contemporary reference source that specifically addresses the historical framework, diagnostic algorithm, and therapeutic options for the treatment of female pelvic organ prolapse. Particular emphasis is placed on the role and technique of abdominal-based reconstruction using robotic technology and the evolving controversy regarding the use of synthetic vaginal mesh.

Pure transvaginal excision of mesh erosion involving the bladder.

Introduction and hypothesisWe present a pure transvaginal approach to the removal of eroded mesh involving the bladder secondary to placement of transvaginal mesh for management of pelvic organ prolapse (POP) using a mesh kit.MethodsAlthough technically challenging, we demonstrate the feasibility of a purely transvaginal approach, avoiding a potentially more morbid transabdominal approach.ResultsThe video presents the surgical technique of pure transvaginal excision of mesh erosion involving the bladder after mesh placement using a prolapse kit was performed.ConclusionsThis video shows that purely transvaginal removal of mesh erosion involving the bladder can be done safely and is feasible.

BPH and Pelvic Organ Prolapse in Patients with Neurogenic Bladder

The successful management of many diseases that result in neurogenic bladder has allowed patients who were previously only cared for by Pediatric Urologists to live well into adulthood. In the past, patients with myelomeningocele and neurogenic bladder rarely used to live into their third decade. It is now not uncommon for these patients to live significantly longer lives [1]. With this increased longevity comes the myriad of adult Urologic conditions that these patients are now beginning to face, including benign prostatic hyperplasia (BPH) and pelvic organ prolapse (POP). While BPH and POP are common urologic conditions in the general adult population, they present a unique challenge for patients with neurogenic bladder, and relatively little is known about the effects of these disorders in this patient population. This chapter aims to focus on the presentation and management of patients with neurogenic bladder who develop BPH or POP in their adult lives.

Mesh Prolapse Repair

The lifetime risk of requiring pelvic surgery for vaginal prolapse or incontinence for a woman in the United States is 11 %, with a risk for reoperation of 29 %. Traditional vaginal repairs for prolapse using only the patient’s native tissues have had reported rates of recurrence ranging from 10 to 50 % depending on the compartment repaired. In the last 10 years, there have been advancements in pelvic floor reconstructive surgery to create repairs that are reproducible with improved subjective and objective outcomes.

Female Stress Urinary Incontinence

Most cases of female stress urinary incontinence (SUI) can be diagnosed following a positive cough or stress test in which urine is seen leaking from the urethral meatus. However, for more complicated cases, urodynamics can be a useful tool to help with diagnosis as well as to guide further management for patients with stress urinary incontinence. In this chapter, we will describe complicated cases of SUI and the specific components of urodynamic testing that should be performed prior to treatment selection.

Male Stress Urinary Incontinence

Male stress urinary incontinence (SUI) is an infrequently encountered clinical entity in general urological practice. It is most commonly encountered in men undergoing surgery for benign or malignant prostatic disease. Men with traumatic injury to the posterior urethra, neurogenic disorders, and unresolved urological conditions from infancy represent a minority of patients presenting with SUI. The diagnosis of male SUI is clinical; however, the use of urodynamics (UDS) may aid in the evaluation of this condition. In addition to establishing the storage and functional capabilities of the bladder, it may help identify concomitant male voiding dysfunction. Both the International Continence Society (ICS) and the American Urological Association (AUA) state UDS may be performed when considering invasive treatment of stress incontinence.

Surgical Management of Stress Urinary Incontinence

Stress urinary incontinence (SUI) has a reported prevalence between 12.8 and 46 %. There is no doubt that SUI has been shown to negatively impact the everyday quality of life (QOL) of the women who suffer from this dysfunction. The economic burden for the treatment of urinary incontinence has been estimated to be approximately 19 billion annually in the United States. Risk factors for the development of SUI include age, obesity, previous pelvic surgery, and childbirth. Surgical management of SUI is the standard of care once conservative options, such as behavioral modification, pelvic floor exercises, fluids modification, and scheduled voiding, have been exhausted. The surgical options have evolved over the last few decades to include the Burch colposuspension, periurethral bulking agents, pubovaginal slings, and the newest multitude of approaches for midurethral synthetic slings. The synthetic slings include retropubic, transobturator, and the newest additions which include the so-called single-incision slings. The aims of this chapter include the evaluation and management of SUI and review each of the surgical techniques currently available to pelvic floor surgeons.

Transvaginal Mesh Complications

The lifetime risk of requiring pelvic surgery for vaginal prolapse or incontinence for a woman in the United States is 11%, with a risk for reoperation of 29% [1]. Traditional vaginal repairs for prolapse using only the patient’s native tissues have had reported rates of recurrence ranging from 10 to 50% depending on the compartment repaired [2]. In the last 10 years, there have been advancements in pelvic floor reconstructive surgery to create repairs that are reproducible with improved subjective and objective outcomes.

Transvaginal Mesh for Prolapse Repair: What is All the Controversy About?

The use of synthetic mesh for the management of pelvic organ prolapse has been embroiled in a contentious debate over the past decade, with only more partisanship among physicians strictly against its use versus those pelvic surgeons who believe it to be a useful tool in their armamentarium. At the heart of the controversy lies the concern, by its detractors, for complications related to mesh use outweighing the as yet not rigorously tested benefit of augmenting repairs with mesh. This article discusses, in detail, the current literature supporting the use of mesh in the management of pelvic organ prolapse repair. The rising concern for complications, both simple and complex, will be addressed. This review aims to narrow the divide between physicians and to address their discordant beliefs by objectively reporting the most up-to-date data on biologic and synthetic mesh use in pelvic organ prolapse repair.

SINGLE-PORT TRANSVESICAL EXCISION OF FOREIGN BODY

Hypothesis / aims of study Managing foreign bodies of the bladder can be technically challenging. Often times, these foreign bodies are a result of trocar passage through the bladder during midurethral sling and prolapse procedures. Attempts at cystoscopic removal of mesh from midurethral slings may leave residual mesh within the detrusor, which may cause future stone formation, infections or irritable voiding symptoms. Traditionally, removal involves opening the bladder, removing the mesh under direct vision, and placement of a suprapubic tube.