Joseph B. Abdelmalak

BONE ANCHOR INFECTIONS IN FEMALE PELVIC RECONSTRUCTIVE PROCEDURES: A LITERATURE REVIEW OF SERIES AND CASE REPORTS

PURPOSE We determined the reported prevalence of infectious osseous complications due to the use of bone anchors for suture fixation in female pelvic reconstructive procedures. In addition, the type and method of bone anchors as well as the reported pathogens associated with osseous infections were reviewed. MATERIALS AND METHODS Primary reported series of female pelvic reconstructive procedures involving bone anchor suture fixation referenced in Index Medicus from January 1990 to July 2000 were extracted using the MEDLINE bibliographic database on English language articles involving humans. All case reports of infectious osseous complications due to bone anchor use in female reconstructive procedures were also reviewed during this period. RESULTS Since the inception of bone anchor suture fixation for female pelvic reconstructive procedures 10 years ago, the overall prevalence of related infectious complications has been 6 cases in 1,018 procedures (0.6%). This type of adverse event developed between followup weeks 1 and 24. The prevalence of suprapubic bone anchors has been 6 cases in 698 procedures (0.86%). For transvaginal bone anchor procedures no infectious cases have been reported in the combined series of 314 procedures and the same is true for 1 reported case of sacral bone anchor placement in 6 procedures. No statistical difference was noted in regard to the prevalence of infection in procedures involving suprapubic bone anchors and transvaginal bone anchor combined with sacral bone anchor placement (Fishers exact test p = 0.19). The organisms reported in case reports suggest a coliform, skin or hematogenous source for contamination of the bone anchor site. CONCLUSIONS An infectious bone anchor complication in female pelvic reconstructive procedures is an uncommon event with a reported prevalence of 0.6%. Currently there is no evidence of differences in the prevalence of osseous complications after transvaginal versus suprapubic bone anchor fixation. Preoperative broad-spectrum antibiotics are recommended to decrease the potential of infectious bone anchor complications.

Case reportUrethral erosion of tension-free vaginal tape

Tension-free vaginal tape (TVT) is gaining popularity as a treatment of choice for women with stress urinary incontinence. It is a minimally invasive procedure with reported short operative and postoperative hospitalization times and low complication rates. We describe urethral erosion of a TVT sling material in a 55-year-old woman who presented with immediate postoperative urinary retention. The sling material was surgically removed and the urethral defect repaired, with the patient continent at the 3-month follow-up visit. A mid-urethral synthetic sling such as the TVT can erode into the urethra.

Porcine small intestinal submucosa as a percutaneous mid‐urethral sling: 2‐year results

To report the 2‐year follow‐up results on patients treated with a novel minimally invasive outpatient procedure for placing a mid‐urethral sling, using porcine small intestinal submucosa (SIS).

Novel technique for combined repair of postirradiation vesicovaginal fistula and augmentation ileocystoplasty

Concomitant vesicovaginal fistula and significant bladder contracture after radiation is an uncommon but complex urologic problem. We describe a surgical technique to address both issues and present our preliminary clinical data.

Surgical Management of the Overactive Bladder: Evacuation Disorders

For evolving strategies to effectively address the growing number of refractory cases of OAB, they must have widespread, practical application that translates therapeutic effectiveness to the patient as defined by clinical efficacy, tolerability, and persistence. Although many options seem limited in scope or complex in application, most are inspirational to specialists seeking optimal outcomes for people with refractory and complex conditions. The available strategies outlined above are a reflection of our current understanding of the pathophysiology of OAB and attendant refractory conditions. The promise for future successful strategies lies not only in the successful translation of our basic science knowledge of the OAB to date, but advancement of our basic and clinical science research of refractory conditions for the future.

Laparoscopic Augmentation Cystoplasty With or Without Continent Stoma Formation

Purpose: We report our techniques and outcomes for laparoscopic enterocystoplasty using various bowel segments. Method: A total of 17 patients with reduced bladder capacities due to neurogenic causes underwent laparoscopic augmentation enterocystoplasty with or without continent stoma formation. The bladder was mobilized and opened in the transverse direction for direct anastomosis with the appropriate bowel segment. All the steps were performed intracorporeally except for preparation of the bowel segment and establishment of the bowel continuity. Results: Blood loss was minimal, and there were no major postoperative complications. Conclusion: We conclude that laparoscopic enterocystoplasty is safe and effective and appears to be a first-line alternative to open enterocystoplasty approaches.

Bladder Augmentation With or Without Urinary Diversion

Augmentation cystoplasty (AC) is used as a reconstructive technique for creating a compliant, large-capacity urinary storage unit to protect the upper urinary tract and can provide urinary continence when more conservative management fails. The standard enterocystoplasty involves anastomosing an adequate-sized, well-vascularized patch of bowel with the urinary bladder. This procedure is classically performed through an open laparotomy incision utilizing various segments of the gastrointestinal system: stomach, ileum, cecum, and ascending and sigmoid colon. However, no intestinal segment is a perfect physiological substitute for a native bladder, and all have the potential for a variety of complications, including urinary tract infection, stone formation, small bowel obstruction, metabolic complications, fistula formation, and, rarely, malignancy transformation. The choice of the bowel segment is based on the primary clinical requirements of the patient and the secondary preference of the surgeons. Recently, the laparoscopic approach to bladder augmentation as outlined has become the primary approach for procedures of augmentation enterocystoplasty. As demonstrated below, the technical steps in performing a laparoscopic bladder augmentation are designed to emulate its open surgical counterpart in every aspect, producing similar functional results with an improved recovery.

Urinary Tract Infections in Adults

Urinary tract infection (UTI) is a common health problem affecting millions of people each year. They are the most common nosocomial infections and are second in seriousness only to respiratory infections. UTIs account for more than 7 million physician visits every year in the United States alone (1). They are the most common bacterial infection found in the elderly and the most frequent source of bacteremia (2,3). The incidence ratio of UTIs in middle-aged women to men is 30:1. However, during later decades of life, the incidence of infection in women to men decrease. Women are especially prone to UTIs for reasons that are poorly understood. One factor may be that a woman’s urethra is short, allowing bacteria quick access to the bladder. Also, a woman’s urethral opening is near sources of bacteria from the anus and vagina. For many women, sexual intercourse seems to trigger an infection, although the reasons for this linkage are unclear (4). In men, prostatitis syndromes account for about 25% of office visits for genitourinary tract infections (5). Five percent of these men have bacterial prostatitis, 64% have nonbacterial prostatitis, and 31% suffer from pelviperineal pain syndrome (6).

Management of Female Urinary Incontinence

Urinary incontinence (UI) is generally defined as the involuntary loss of urine from the bladder through the urethral meatus. More than 13 million people in the United States—male and female, young and old—experience incontinence. UI is the second-leading cause of institutionalization of the elderly in the United States (1), and the cost of managing this condition was approx

Sling may hasten return of continence after radical prostatectomy.

16 billion in 1994 (2). UI is often temporary and always results from an underlying medical condition. Women experience incontinence two times more often than men do, most likely as a result of pregnancy, childbirth, menopause, and the structure of the female urinary tract. Additionally, older women experience incontinence more frequently than younger women. Despite one’s age, incontinence is treatable and often curable.