Factors involved in prolapse recurrence one year after anterior vaginal repair.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to identify which factors are associated with anatomic and symptomatic prolapse recurrence in the anterior compartment 1 year after traditional anterior vaginal repair. Our study hypothesis was that major defects in pelvic floor support structures before surgery are associated with higher recurrence rates. METHODS: This was a prospective multicenter study including women with symptomatic anterior compartment prolapse who underwent primary vaginal surgery. Prolapse examination was performed using the Pelvic Organ Prolapse Quantification (POP-Q) system, prolapse symptoms were described using the Pelvic Floor Distress Inventory short form (PFDI-20), and levator ani avulsion and hiatal area were identified by translabial 3D ultrasonography. RESULTS: During the inclusion period, 455 patients were recruited and 442 (97.1%) attended the 1-year follow-up. In three cases, ultrasound data were not available, and the remaining 439 formed the study group. Anatomic and symptomatic recurrence rates were 45.1% and 6.8%, respectively. Levator avulsion increased the risk of anatomic (OR: 1.96) and symptomatic (OR: 2.60) recurrence; abnormal distensibility of the levator hiatal area increased the risk of anatomic (OR: 2.51) and symptomatic (OR: 2.43) recurrence; advanced prolapse increased the risk of anatomic recurrence: POP-Q stage 3 (OR: 2.34) and POP-Q stage 4 (OR: 5.47). CONCLUSIONS: Major defects in pelvic floor support structures before surgery are associated with higher recurrence rates 1 year after native tissue vaginal repair. Advanced stage of prolapse increases the risk of anatomic recurrence, while levator avulsion and abnormal distensibility of the levator hiatus area increase the risk of both anatomic and symptomatic recurrence.

Efficacy of a Fibrin Sealant (Tissucol Duo) for the Preventionof Lymphocele after Laparoscopic Pelvic Lymphadenectomy:A Randomized Controlled Trial.

STUDY OBJECTIVE: To assess the efficacy of Tissucol Duo (Baxter AG, Vienna, Austria) fibrin sealant in decreasing the incidence of lymphocele (LC) after pelvic laparoscopic lymph node dissection using harmonic shears. DESIGN: Randomized controlled trial (Canadian Task Force classification level I). SETTING: Tertiary referral and educational center. PATIENTS: Seventy-four patients randomized to the use of sealant per hemipelvis. INTERVENTION: Fibrin sealant. MEASUREMENTS AND MAIN RESULTS: After bilateral pelvic lymphadenectomy a fibrin sealant was used in 1 hemipelvis but not the other, applied in 41 patients (55.4%) to the left and 33 patients (44.6%) to the right hemipelvis. The primary outcome was the incidence of LC after surgery in symptomatic and asymptomatic patients. Imaging (ultrasound, computed tomography, and magnetic resonance) was performed to detect LC at 3, 6, and 12 months after surgery. Overall, 26 patients (35.1%) developed LC, and 4 were symptomatic (5.4%). Allowing patients to serve as their own treatment group and control, the hemipelvis treated with Tissucol Duo corresponding to the treatment group and that not treated to the control group, LCs were found in 17 (23%) and 14 (19%) cases, respectively, but the difference was not significant. The mean initial LC maximum diameter was 27.1 mm (standard deviaiotn, 35.2), and LCs tended to decrease in size during the first year to a mean of 8.7 mm. CONCLUSION: Application of Tissucol Duo fibrin sealant after laparoscopic pelvic lymphadenectomy using ultrasonic shears does not decrease the occurrence of symptomatic or asymptomatic LC.

Attachment and posttraumatic growth after breast cancer: A dyadic approach.

OBJECTIVE: Cancer poses unique challenges for the couple relationship. From a relational perspective, successful adaptation may be less dependent on the circumstances of being the "patient" or the "caregiver" than on how couples successfully integrate cancer into their relationship. In this article, we study posttraumatic growth through attachment theory, which provides a useful framework to explore the role of intimate processes dyadically. METHOD: The sample comprised 84 heterosexual married and cohabitating couples. Women were in adjuvant treatment for breast cancer or in the posttreatment phase. Both members of the couple completed measures of attachment and posttraumatic growth. Path models were used to examine associations between the constructs through the application of the actor-partner interdependent model. Moreover, time since diagnosis was examined within the actor-partner interdependent model as a possible moderator affecting the attachment-posttraumatic growth associations. RESULTS: Partners' attachment security was an important predictor of individual posttraumatic growth for both members of the couple, while individuals' own attachment security was not associated with their posttraumatic growth for either member of the couple. The partner's effects were equal across gender. Additionally, time since breast cancer diagnosis did not affect the pattern of results. CONCLUSION: Findings support the assessment of the couple dyadically and corroborate an attachment approach of the couple as an interdependent unit. Implications of the study for interventions assisting couples in oncological setting are discussed.

Experiencing an Intimate Partner's Breast Cancer: Attachment, Caregiving, and Burden in Men.

OBJECTIVE: This study examined interrelationships among adult attachment orientations, caregiving, and caregiver burden in men of female partners with breast cancer, and tested whether caregiving patterns mediated associations between men's attachment orientations and their self-reported caregiver burden. METHOD: The participants were 124 male partners of women with breast cancer. These participants completed assessments related to attachment, caregiving, and caregiver burden. Path models examined the associations between constructs and tested mediational effects. RESULTS: Findings demonstrated significant associations between men's adult attachment orientations and their experience of caregiver burden. In addition, the maintenance of proximity in caregiving completely mediated the respective associations of attachment security and attachment avoidance to caregiver health problems, on one hand, and to the caregiver's self-esteem (e.g., another indicator for caregiver burden), on the other. Moreover, we found a direct effect of attachment avoidance on health problems. CONCLUSIONS: This study highlighted the importance of addressing adult attachment dispositions and caregiving to understanding the relational processes implicated in caregiver burden. The results support the conclusion that men's adult attachment orientations and caregiving patterns toward their female partners with breast cancer are relevant contributors to men's perceptions of caregiver burden.

Attachment, emotion regulation, and adaptation to breast cancer: assessment of a mediational hypothesis.

OBJECTIVES: This study examines the links between attachment, adaptation to breast cancer, and the mediating role played by emotional regulation processes. METHODS: Participants were 127 women with breast cancer recruited in two public hospitals of Porto and at the Portuguese Cancer League. Women completed measures of attachment, quality of life, and emotion regulation. Path models were used to examine the associations between the constructs and to test the mediational hypotheses. RESULTS: Significant associations were found between attachment and adaptation. Dimensions of emotion regulation totally or partially mediated the associations between attachment and adaptation outcomes. Attachment security effects on interpersonal relations were totally mediated by communicating emotions. Also, attachment anxiety effect on physical well-being was totally mediated by rumination. Attachment avoidance effects on psychological outcomes were totally mediated by emotional control and partially mediated by communicating emotions for the case of interpersonal relations. CONCLUSIONS: This study highlights the importance of addressing emotional regulation jointly with attachment to deepen the comprehension of the relational processes implicated in adaptation to breast cancer. Results supported a mediational hypothesis, presenting emotional regulation processes as relevant dimensions for the understanding of attachment associations with adaptation to breast cancer.

Identity in university students: the role of parental and romantic attachment.

In this study with 236 Portuguese university students, we examined two competing models for understanding identity. In the first model, the direct independent effects of parental and romantic attachment on identity were tested. The second model examined the mediating role of romantic attachment representations in the link between parental attachment and identity. The participants completed measures of parental and romantic attachment at the beginning of the freshman year (Wave 1), and a measure of identity development 18 months later (Wave 2). Structural equation modeling for the independent model indicated that identity is exclusively predicted by romantic attachment at this life stage, and not by parental attachment. Regarding the second model, our mediational hypothesis was supported, since the association between parental attachment and identity was totally mediated by romantic attachment representations. Both models presented adequate indices of adjustment, and provided a complementary understanding of the differential role that romantic relations play in contributing to explaining identity development.