Hannah Krause

Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial

Objective  To compare vaginal repair augmented by mesh with traditional colporrhaphy for the treatment of pelvic organ prolapse.

Biocompatible properties of surgical mesh using an animal model

Aim:  To study the biocompatibility of surgical meshes for use in pelvic reconstructive surgery using an animal model.

Mental health screening in women with genital tract fistulae.

There is little information regarding the mental health status of women with genital tract fistulae in developing countries. The aim of this prospective observational study was to screen women at Dhaka Medical College Hospital, Bangladesh (December 2003 to June 2004), and Addis Ababa Fistula Hospital, Ethiopia (June to July 2004), with genital tract fistula for mental health dysfunction. Women presenting to the above institutions were screened using the General Health Questionnaire (GHQ‐28) prior to fistula surgery. As the women were illiterate, the questionnaire was completed with the assistance of a medical officer, nurse or interpreter. The female staff members acted as controls. Sixty‐eight women with fistulae and 28 controls completed the GHQ‐28. Sixty‐six of the 68 women with fistulae screened positive to probable mental health dysfunction compared with 9 of the 28 controls. We conclude that women with genital tract fistula are at high risk of mental health dysfunction. If the high rates of positive screening are confirmed on psychiatric evaluation, then the management of women with genital tract fistulas must include routine psychological/psychiatric assessment and treatment.

Is levator avulsion a predictor of cystocele recurrence following anterior vaginal mesh placement

Levator avulsion has been shown to be a predictor of cystocele recurrence following anterior colporrhaphy. The aim of this study was to determine if levator avulsion is a risk factor for prolapse recurrence following anterior colporrhaphy with mesh.

SHORT COMMUNICATION: Mental health screening in women with genital tract fistulae

There is little information regarding the mental health status of women with genital tract fistulae in developing countries. The aim of this prospective observational study was to screen women at Dhaka Medical College Hospital, Bangladesh (December 2003 to June 2004), and Addis Ababa Fistula Hospital, Ethiopia (June to July 2004), with genital tract fistula for mental health dysfunction. Women presenting to the above institutions were screened using the General Health Questionnaire (GHQ‐28) prior to fistula surgery. As the women were illiterate, the questionnaire was completed with the assistance of a medical officer, nurse or interpreter. The female staff members acted as controls. Sixty‐eight women with fistulae and 28 controls completed the GHQ‐28. Sixty‐six of the 68 women with fistulae screened positive to probable mental health dysfunction compared with 9 of the 28 controls. We conclude that women with genital tract fistula are at high risk of mental health dysfunction. If the high rates of positive screening are confirmed on psychiatric evaluation, then the management of women with genital tract fistulas must include routine psychological/psychiatric assessment and treatment.

Biomechanical properties of raw meshes used in pelvic floor reconstruction

Female urinary incontinence and pelvic organ prolapse are common conditions. The aim of this study was to assess the biomechanical properties of raw meshes commonly used in pelvic floor surgery, particularly the effects of cyclical loading on these meshes. The material properties of nine different types of surgical meshes were examined using uniaxial tensile tests. The strength and extensibility of the mesh designs differed considerably. Most mesh types exhibited curvilinear loading curves. Cyclical loading of mesh samples produced significant permanent deformation in all mesh designs. This non-recoverable extension ranged from about 8.5% to 19% strain. Hysteresis also varied considerably between materials from 30% to 85%. All mesh groups tested for their biomechanical properties displayed differences in results for failure load, stiffness, non-recoverable extension and hysteresis.

Abdominal sacral colpopexy: an independent prospective long‐term follow‐up study

Aims:  The aim of the study was to provide a long‐term follow up of subjective and objective outcomes following sacral colpopexy.

Sheep and rabbit genital tracts and abdominal wall as an implantation model for the study of surgical mesh.

Aim:  In order to evaluate the biocompatible and biomechanical properties of surgical mesh, suitable animal models are required. This paper assesses the sheep and rabbit genital tracts as potential models for direct vaginal implantation of mesh for use in pelvic floor surgery.

Biomechanical properties of graft materials employed for pelvic floor reconstructive surgeries.

Purpose of review Numerous biomaterials are currently used to augment pelvic organ prolapse reconstructive surgeries. Understanding the biomechanical properties of the raw and implanted graft materials may lead to improvements in biomaterial design and development. This summary aims to review recent assessments and advances in the understanding of vaginal tissues and synthetic graft materials profiles. Recent findings Numerous meshes have been assessed and compared for various biomechanical properties. There is now an emphasis on more relevant mechanical tests rather than only comparing loads at failure. Development of tests at physiological loads is important in achieving relevance of biomechanical data. Comparisons of partly absorbable with nonabsorbable meshes both preimplantation and postimplantation, have shown no difference in biomechanical properties, thus promoting the use of less permanent components in meshes. Potential factors contributing to mesh exposure are presented. Summary Biomechanical testing of synthetic graft materials is moving towards achieving data relevant to physiological loads and clinical conditions. Modeling research is required to understand these physiological loads, and create relevant measurements which can then be used when biomechanically assessing both raw and implanted grafts.

A descriptive study on the efficacy and complications of the Capio (Boston Scientific) suturing device for sacrospinous ligament fixation

Sacrospinous colpopexy is an effective vaginal apical support operation. Due to morbidity associated with traditional approaches which require wide dissection, slim‐line suture delivery devices have been introduced in the hope of reducing morbidity without compromise to outcomes.