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Resection rectopexy--laparoscopic neuromapping reveals neurogenic pathways to the lower segment of the rectum: preliminary results.

PURPOSE: Nerve sparing in functional pelvic floor surgery is strongly recommended as intraoperative damage to the autonomic nerves may predispose to persistent or worsened anorectal and urogenital function. The aim of this study was to investigate the intraoperative neural topography above the pelvic floor in patients undergoing laparoscopic resection rectopexy in combination with electrophysiologic neuromapping. METHODS: Ten consecutive female patients underwent laparoscopic resection rectopexy for rectal prolapse. Intraoperative identification of pelvic autonomic nerves was carried out with

Constipation: a potential cause of pelvic floor damage?

BACKGROUND: Pelvic floor damage is a major clinical problem usually attributed to obstetric injury. We speculated that constipation may also be an aetiological and preventable factor resulting from repeated stress on the perineum over many years, and this study aimed to test this hypothesis. METHODS: A total of 600 women attending a gynaecological clinic were assessed using a structured questionnaire gathering data on pelvic floor damage, constipation and obstetric trauma. Complete data were available on 596 subjects. KEY RESULTS: The prevalence of pelvic floor damage was 10% (61/596). In th

Prevention of complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice.

The objective of the study was to provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning adverse events related to surgical procedures involving the use of prosthetic meshes. French and English-language articles from Medline, PubMed, and the Cochrane Database were searched, using key words (mesh; pelvic organ prolapse; cystocele; rectocele; uterine prolapse; complications; adverse event; sacral colpopexy; extrusion; infection). As with any surgery, recommendations include perioperative smoking cess…

[Prevention of the complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice - literature review].

OBJECTIVE: To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning the adverse events related to surgical procedures involving the use of prosthetic meshes. MATERIALS AND METHODS: French and English-language articles from Medline, PubMed, and the Cochrane Database were searched, using key words (mesh ; pelvic organ prolapse ; cystocele ; rectocele ; uterine prolapse ; complications ; adverse event ; sacral colpopexy ; extrusion ; infection...). RESULTS: As with any surgery, it is recomme…

[Synthetic suburethral sling in the treatment of stress urinary incontinence in women].

UNLABELLED: Since the marketing and success of the TVT technique, other products have been released onto the suburethral sling market. These … intestinal or vascular injury, but the urethra, vagina or even the bladder (in the case of lateral cystocele) can be damaged by this incision. INSTRUMENTS: Ease of use is an essential feature. Uretex Sup comprises ancillary instruments and a technique requiring multiple manipulations. Sparc tape cannot be easily dissociated from the ancillary instruments …

Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology.

PURPOSE: Standard diagnostic proctologic procedures in the assessment of pelvic floor disorders include clinical evaluation and endoscopy. P … fecography of the pelvic floor, 12 patients with descending perineum, 10 rectoceles (10 females), 6 cystoceles (6 females), 4 enteroceles (4 females), 8 intussusceptions (5 females), and a dyskinetic puborectalis muscle in 3 males were detected. In 11 females and 3 males multifocal disorders were found, involving more than one compartment in females, wherea …

MR-defecography in obstructed defecation syndrome (ODS): technique, diagnostic criteria and grading.

BACKGROUND: The aim of this study was to evaluate the use of a magnetic resonance (MR)-based classification system of obstructive defecation … endopelvic fascia; Grade 4 = combined defects of two or three pelvic floor compartments, including cystocele, hysterocele, enlarged urogenital hiatus, fascial tears enterocele or peritoneocele; Grade 5 = changes after failed surgical repair abscess/sinus tracts, rectal pockets, anastomotic strictures, small uncompliant rectum, kinking and/or lateral shift …

Dynamic half Fourier acquisition, single shot turbo spin-echo magnetic resonance imaging for evaluating the female pelvis.

PURPOSE: We assessed the merit of dynamic half Fourier acquisition, single shot turbo spin-echo sequence T2-weighted magnetic resonance imag … iteria the sensitivity, specificity and positive predictive value of MRI were 100%, 83% and 97% for cystocele; 100%, 75% and 94% for urethrocele; 100%, 54% and 33% for vaginal vault prolapse; 83%, 100% and 100% for uterine prolapse; 87%, 80% and 91% for enterocele; and 76%, 50% and 96% for rectocele. CONCLUSIONS: Dynamic half Fourier acquisition, single sh …

Magnetic resonance imaging in evaluating functional disorders of female pelvic floor.

PURPOSE: To evaluate the diagnostic capabilities of MRI in the study of functional diseases of the female pelvic floor. MATERIALS AND METHO … al hypermobility syndrome: 22 cases; isolated abnormalities of the anterior compartment: 8 cases of cystocele (low grade: 2, middle grade: 2, severe: 4); isolated abnormalities of the middle compartment: 6 cases of hysterocele (low grade: 2, middle grade: 4); isolated abnormalities of the posterior compartment: 5 cases of low-grade rectocele; 2 cases of ent …

Safety of Trans Vaginal Mesh procedure: retrospective study of 684 patients.

AIM: To study peri-surgical complications after cure of genital prolapse by vaginal route using interposition of synthetic prostheses Gyneme … ed in 50.3% of cases, cervix amputation in 1.5%, and cure of SUI in 40.9%. 15.8% were treated for a cystocele only. 14.8% had only a rectocele +/- elytrocele and 69.4% had a prolapse touching both compartments, anterior and posterior. In peri-surgical complications, (2%) were five bladder wounds (0.7%), one rectal wound (0.15%) and seven hemorrhages greater …

Pelvic Floor Reconstruction Using Mesh Versus Campbell Uterosacral Ligament Suspension: 2-Year Clinical Outcome.

INTRODUCTION AND HYPOTHESIS: The present study is aimed at comparing the clinical outcome and patient satisfaction between transvaginal modi … inclusion criteria: 78 patients underwent MPFR-mesh, whereas 97 patients had C-USLS. With regard to cystocele, in the MPFR-mesh group, 68 (87.2%) had stage III, 10 (12.8%) had stage IV, and in the C-USLS group, 76 (78.4%) had stage III, 1 (1.0%) had stage IV; a significant difference was noted (p < 0.05). No differences were observed among women who underwe …

Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system.

INTRODUCTION AND HYPOTHESIS: In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the fema … erative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococc …

Treating anterior vaginal wall prolapse with polypropylene mesh via the transoburator route minimizing the complications with the use of preventing measures. A prospective study with 2-year follow-up.

AIM: Our objectives were to evaluate the efficacy of the Perigee™ transoburator (TOT) mesh kit (American Medical Systems [AMS]-Minnetonka, M … o incontinence and both were treated with a TOT sling (monarc AMS) procedure three months after the cystocele repair. Three cases (6.0%) reported pain vaginal pain postoperatively and again our treatment of choice was vaginal estrogen cream for 4 weeks with the addition of antinflammatories for 10 days and their symptoms resolved. CONCLUSIONS: The treatmen …

Risk factors for mesh complications after trocar guided transvaginal mesh kit repair of anterior vaginal wall prolapse.

AIMS: To identify risk factors for mesh exposures after anterior pelvic organ prolapse repair using a standardized trocar guided polypropylene mesh kit. METHODS: A secondary risk analysis combining patients from two prospective multicenter studies. Main outcome was clinical host-vs-implant reactions one year after surgery using a macroscopic inflammatory scale. RESULTS: 353 patients were included in the study. Mean age at surgery was 65.3 (± 9.6 SD) years and surgery was performed as a primary procedure in 224/353 (63.5%) patients. Mesh exposures, of which the majority were mild-moderate, oc

Acute myoclonus following spinal anaesthesia.

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Laparoscopic ventral rectopexy for obstructed defecation syndrome.

INTRODUCTION: Obstructed defecation remains a serious syndrome. Several procedures have been applied to treat it. A concomitant enterocele excludes some of these procedures, because of potential threat of damaging the bowel. The aim of this study was to assess the outcome of patients who underwent laparoscopic nerve sparing ventral rectopexy for obstructed defecation syndrome with concomitant enterocele. METHODS: Seventeen patients were included. Data about clinical history, physical examination and a defecogram were collected. All patients underwent a laparoscopic ventral rectopexy. Complica

Preventive posterior mesh placement during laparoscopic double sacrocolpopexy for anterior urogenital prolapse: Anatomical and functional outcomes from a 20-year single center experience.

INTRODUCTION: Genital prolapse is a common and disabling functional condition in women, affecting nearly one-third of women over 70years of … ndo ≥3) were observed during follow-up. Regarding the anterior compartment, 65% (27/41) had grade 1 cystocele and 25% (10/41) had grade 2 according to Baden-Walker (BW). Overall, 85% reported satisfaction with the procedure, particularly regarding the correction of their initial urogenital prolapse and the resolution of pelvic heaviness. CONCLUSION: Our st …

[Morphologic structure and immunohistochemical analysis of vaginal wall in women with pelvic organ prolapse].

AIM: to study a correlation between clinical stage of pelvic organ prolapse (POP), a histological structure and results of immunohistochemical study of the vaginal wall were evaluated. MATERIALS AND METHODS: A total of 60 peri- and postmenopausal women (average age 61.9+/-8.4 years) with POP of stage II-IV, according to the POP-Q classification, or with stress urinary incontinence and cystocele of stage I-II, who undergone to surgical treatment, were included in the study. During a procedure, a biopsy from the anterior vaginal wall was taken. Depending on the stage of POP, patients was divide…

Obesity definition, diagnosis, bias, standard operating procedures (SOPs), and telehealth: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022.

BackgroundThe Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding definition, diagnosis, bias, standard operating procedures (SOPs) and telehealth is intended to provide clinicians an overview of obesity medicine and provide basic organizational tools towards establishing, directing, managing, and maintaining an obesity medical practice.MethodsThis CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by Obesity Medicine Association leadership.ResultsOMA has defined obesity as: "A chronic, progressive, relapsing, and

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… Table 9 • Hypoandrogenemia • Urinary stress incontinence • Hyperestrogenemia • Infertility • Erectile dysfunction • Buried or hidden penis • Low sperm count • Psychological barriers to sexual behavior • Pelvic organ prolapse (e.g., cystocele, rectocele) • Benign prostatic hypertrophy with urinary hesitancy … of genitourinary complications for men. [ [120] , [121] , [122] ]. • Hypoandrogenemia | • Urinary stress incontinence • Hyperestrogenemia | • Infertility • Erectile dysfunction | • Buried or hidden penis • Low sperm count | • Psychological barriers to sexual behavior • Pelvic organ prolapse (e.g., cystocele …

Risk factor analysis and predictive model for the alleviation of postpartum stress urinary incontinence: a retrospective cohort study.

BACKGROUND: Postpartum stress urinary incontinence (SUI) can substantially affect women's daily functioning, psychosocial well-being, and re … alysis showed that older age, higher BMI, gestational diabetes mellitus, parity >=2, perineal tear, cystocele, uterine prolapse, rectocele, and levator ani hiatus defect were associated with higher odds of persistent SUI. Cesarean delivery and greater postpartum BMI loss were associated with lower odds of persistent SUI. The nomogram demonstrated good discr …