Kurinji Kannan

Prospective study of the Perigee system for the management of cystocoeles – Medium-term follow up

Objectives:  The Perigee transobturator cystocoele repair system (AMS) was designed and first used in Townsville, Australia. This prospective study evaluates the efficacy and safety of this device for the management of cystocoeles.

Thyroid function and pregnancy: before, during and beyond.

Thyroid disturbances are common in women during the reproductive years of their lives. Autoimmunity and altered iodine status together account for a high proportion of the abnormalities. Autoimmune thyroid disease is present in around 4% of young females, and up to 15% are at risk because they are thyroid antibody-positive. There is a strong relationship between thyroid immunity on the one hand and infertility, miscarriage, and thyroid disturbances in pregnancy and postpartum on the other hand. Suboptimal iodine status affects a large proportion of the worlds population, and pregnancy further depletes iodine stores. There is controversy surrounding the degree to which iodine should be supplemented and the duration of supplementation. Recent studies have helped to clarify the relationship between maternal thyroid status and neuropsychological development of the child. The role of other environmental factors including smoking and selenium status is also now recognised. Universal screening for thyroid hormone abnormalities is not routinely recommended at present. However, measurement of thyroid function and autoantibodies should certainly be considered in those who are at high risk of thyroid disease and in those whose pregnancy is otherwise high risk. The practicing clinician needs to be aware of the thyroid changes which accompany pregnancy.

Maternal urological problems in pregnancy.

Urological conditions in pregnancy represent a major diagnostic and therapeutic challenge. During pregnancy the urinary tract undergoes some anatomical and physiological changes that may result in many symptoms and pathological conditions affecting both the mother and fetus. With prompt evaluation and expeditious treatment, the prognosis is good. Fear of causing harm is unfounded. This article describes urological problems in pregnancy, specifically infection, calculus, renal failure, renal tumour, lower urinary tract symptoms and trauma and their management.

Sling distress: a subanalysis of the IVS tapes from the SUSPEND trial

Aim:  To study the incidence of erosions and tape infections following the use of intravaginal slingplasty (IVS) treatment for stress urinary incontinence after the SUSPEND trial period of 30 months. This subanalysis was carried out because of concerns regarding high percentage of delayed sling erosions and infections during follow up of the patients who participated in the trial.

Prospective study of the Perigee™ system for treatment of cystocele – our five‐year experience

Objectives:  The Perigee™ transobturator cystocoele repair system (AMS) was designed and first used in Townsville, Australia. In this study, we are reporting our five‐year experience with the Perigee™ system in the management of cystocoele stage III and above.

Prospective evaluation of the safety and efficacy of the Apogee™ system for treatment of vault prolapse

Summary This is a prospective study evaluating the efficacy and safety of the Apogee™ vault repair system in the management of vault prolapse. All patients who underwent this procedure between October 2004 and December 2005 in Townsville, Australia are included in the study. Preoperative and postoperative clinical assessments were done using the pelvic organ prolapse quantification (POPQ) system and patients were followed up at 6 weeks, 12 weeks, 6 months, 12 months and then biannually. Of the 35 patients operated, there were no intraoperative complications and only one patient (2.8%) had a recurrence of vault prolapse at 12 months. Nine patients (25%) had mesh exposure treated successfully with outpatient trimming and oestrogen. This medium term study shows that the Apogee procedure is safe with minimal complications for the management of vault prolapse.

The sacrospinous ligament: Conveniently effective or effectively convenient?

Summary The sacrospinous ligament has been used for over 50 years as a convenient structure for treating vaginal vault and more recently, uterine prolapse. The procedure has evolved over the years and its efficacy has been hotly debated with invariable comparisons made to abdominal sacral colpopexy. Mesh surgery has introduced a newer dimension to the debate. This review is an attempt to clarify the anatomy, reflect on various techniques and offer a critique on the current ‘status’ of the sacrospinous ligament.

Pelvic haematoma following Miniarc surgery – A case report

[Extract]The transobturator approach for midurethral sling placement in the treatment of stress urinary incontinence was introduced in 2001. Traditional transobturator sling procedures like TVT-O, Monarc, involve blind passage of instruments through obturator foramen, adductor muscles etc. This carries a finite risk of neurovascular injuries and postoperative groin pain. The newer generation of micro invasive slings such as the Miniarc may minimise these risks by avoiding needle passages through the obturator foramen and muscles. We report a case of postoperative pelvic haematoma, developed after a Miniarc operation.

Recurrent non-absorbable suture erosion into the bladder after a Pereyra bladder neck suspension.

Delayed migration of sutures into the bladder after colposuspension procedures have been well documented in the literature. Biyani and Upsdell (1998) published a case report of late migration of the suture occurring 7 years after a Stamey endoscopic bladder neck suspension. Mandikandan et al. (2004) presented a case of intravesical foreign body granuloma post-Burch colposuspension. There are other reports of similar complications after bladder or pelvic surgery for incontinence. Most patients presented with lower urinary tract infection-like symptoms. The suture erosion and calculi formation were diagnosed by endoscopic assessment of the bladder. However, recurrent suture erosion case reports over a period of time are rare. Literature search revealed only one particular case report by Cardozo (1997) describing recurrent suture erosion following a Stamey-type endoscopic bladder neck suspension. This patient presented over a period of 2 years following the procedure. We are presenting here a case of recurrent suture erosion over even a longer period of time, 3 years and 8 years after a Pereyra bladder neck suspension procedure.