Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 24
Filter
1.
Article in English | MEDLINE | ID: mdl-38803102

ABSTRACT

OBJECTIVE: To investigate whether women undergoing their first vaginal delivery after a previous cesarean section (secundiparous) are at increased risk for obstetric anal sphincter injury (OASI) compared with primiparous women. METHODS: A retrospective cohort study of 85 428 women who delivered vaginally over a 10-year period in a single tertiary medical center. Incidence of OASI, risk factors, and clinical characteristics were compared between primiparous women who delivered vaginally and secundiparous women who underwent their first vaginal birth after cesarean section (VBAC). A multivariable logistic regression analysis was used to study the association between VBAC and OASI. RESULTS: Overall, 36 250 primiparous and 1602 secundiparous women were enrolled, 309 of whom had OASI. The rates of OASI were similar among secundiparous women who had VBAC and primiparous women who underwent vaginal delivery (15 [0.94%] vs 294 [0.81%], P = 0.58). The proportions of third- and fourth-degree tears were also similar among secundiparous and primiparous women who experienced OASI (87% vs 91.5%, and 13% vs 8.5%, respectively, P = 0.68). Furthermore, the rates of OASI were similar in both study groups, although secundiparous women who underwent VBAC had higher rates of birth weights exceeding 3500 g (414 [25.8%] vs 8284 [22.8%], P = 0.016), and higher rates of vacuum-assisted deliveries (338 [21%] vs 6224 [17.2%], P < 0.001). A multivariate logistic regression analysis failed to establish a statistically significant association between VBAC and OASI (odds ratio 0.672, 95% confidence interval 0.281-1.61, P = 0.37). CONCLUSIONS: No increased risk for OASI was found in secundiparous women who underwent VBAC compared with primiparous women at their first vaginal birth.

2.
Int J Gynaecol Obstet ; 163(2): 667-671, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37338053

ABSTRACT

OBJECTIVE: The EnPlace® device is a novel minimally invasive tool allowing transvaginal sacrospinous ligament (SSL) fixation of apical pelvic organ prolapse (POP). The study aimed to investigate the safety and short-term efficacy of the EnPlace® SSL fixation for significant apical POP repair. METHODS: A retrospective cohort study of 123 consecutive patients (mean age 64.4 ± 11.1 years) with stage III or IV apical POP who underwent SSL fixation by the EnPlace® device. Safety and 6-month outcome results were analyzed and compared between 91 (74%) patients with uterine prolapse versus 32 (26%) patients with vaginal vault prolapse. RESULTS: There were no intraoperative or early postoperative complications. The mean (± standard deviation) duration of surgery was 30 ± 6.9 min and mean blood loss was 30.5 ± 18.5 mL. The average position of point C by POP-Quantification measurements before surgery and at 6 months postoperatively was 4.5 ± 2.8 cm and -3.1 ± 3.3 cm, respectively. Of 91 patients with preoperative uterine prolapse, eight (8.8%) patients developed a recurrent uterine prolapse within 6 months postoperatively. Of 32 patients with preoperative vault prolapse, two patients (6.3%) had recurrent vault prolapse. CONCLUSION: Short-term outcome results of EnPlace® SSL fixation suggest that it is a safe and effective minimally invasive transvaginal procedure for significant apical POP repair.


Subject(s)
Ligaments , Pelvic Organ Prolapse , Uterine Prolapse , Aged , Female , Humans , Middle Aged , Gynecologic Surgical Procedures/methods , Ligaments/surgery , Pelvic Organ Prolapse/surgery , Retrospective Studies , Treatment Outcome , Uterine Prolapse/surgery
3.
J Clin Med ; 12(3)2023 Jan 29.
Article in English | MEDLINE | ID: mdl-36769692

ABSTRACT

(1) Background: Obstetric anal sphincter injuries (OASI) may complicate vaginal deliveries. The aim of the present study was to explore the incidence and clinical characteristics of OASI among Asian women living in a Western country compared to local Caucasian women. (2) Methods: A retrospective cohort study of 380 women diagnosed with OASI, following singleton vaginal deliveries, during a 10-year period (January 2011 to December 2020). Exclusion criteria: age < 18 years, stillbirth, and breech presentation. Demographic, clinical, and obstetrical data were obtained, and a comparison between Asian and Caucasian women was performed. (3) Results: There were 35 cases of OASI among 997 women of Asian ethnicity compared to 345 cases of OASI among 86,250 Caucasian women (3.5% vs. 0.4%, respectively, p < 0.001). Asian women endured a significantly higher rate of fourth-degree OASI (17.1%) even though they bore smaller newborns (3318 g vs. 3501 g, p = 0.004), and birth weights rarely exceeded 3800 g (2.8% vs. 25.8%, p < 0.001). Asian ethnicity was also associated with a significantly higher risk for blood transfusion following OASI and a lower tendency for postpartum follow up. (4) Conclusions: Immigrant women of Asian ethnicity had a nine-fold higher rate of OASI, much higher than previously reported. Furthermore, Asian women had higher rates of fourth-degree OASI.

4.
J Clin Med ; 11(23)2022 Nov 26.
Article in English | MEDLINE | ID: mdl-36498565

ABSTRACT

BACKGROUND: Obstetric anal sphincter injuries (OASIS) might be associated with long-term urinary and anorectal morbidities. The aim of the study was to investigate the risk factors and clinical implications of OASIS associated with vacuum-assisted deliveries versus normal vaginal deliveries. METHODS: A series of 413 consecutive OASIS cases were retrospectively analyzed. A comparison was made between OASIS cases diagnosed following vacuum-assisted deliveries versus OASIS cases diagnosed following normal vaginal deliveries. Multivariable analysis was used to study the association between vacuum-assisted deliveries and superficial (3A and 3B) versus deep (3C and 4) perineal tears. RESULTS: The study population comprised 88,123 singleton vaginal deliveries. Diagnosis of OASIS was made in 413 women (0.47% of the total cohort), 379 (91.8%) of whom had third-degree tears and 34 (8.2%) of whom had fourth-degree tears. Among the 7410 vacuum-assisted deliveries, 102 (1.37%) had OASIS, whereas, among the 80,713 normal vaginal deliveries, only 311 (0.39%) had OASIS. In a multivariate analysis, only vacuum-assisted delivery was found to be associated with a significant risk of deeper (3C or 4) perineal tears (OR = 1.72; 95% CI 1.02-2.91; p = 0.043). CONCLUSIONS: Vacuum-assisted instrumental intervention is a significant risk factor for OASIS and especially for deeper tears, independent of other maternal and obstetric risk factors.

5.
J Obstet Gynaecol ; 42(5): 1419-1423, 2022 Jul.
Article in English | MEDLINE | ID: mdl-34985379

ABSTRACT

We conducted a study to assess the efficacy and outcome results of Manchester operation for women with symptomatic elongation of uterine cervix between 2010 and 2020. Forty-five women were enrolled. Mean age was 54.2 ± 10.5 years, 57.5% were premenopausal. Mean follow up was 4.53 years. Most patients were pleased from the surgery: 29 (76.3%) very pleased and three (7.9%) quite pleased. There were four cases of late postoperative complications: hematometra, pyometra, vesicovaginal fistula and small bowel evisceration through the posterior vaginal fornix. All four cases required surgical interventions with complete recovery. Manchester operation is an effective procedure for symptomatic elongation of uterine cervix. The surgery is short, minimal blood loss and without significant intraoperative complications. However, it is not free of late postoperative complications and it is therefore important that the surgery will be carried out with a strict technique and by skilled surgeons who are capable to manage unique postoperative complications.Impact StatementWhat is already known on this subject? Elongation of the uterine cervix is a condition that has not been sufficiently studied. Up-to-date data regarding the efficacy and safety of the Manchester operation for patients with cervical elongation and normal pelvic support are scarce, as most previously published studies included mainly patients with uterine prolapse.What do the results of this study add? The present study presents the efficacy, complications and clinical outcomes of Manchester operation for women with elongation of the uterine cervix. Our results show that Manchester operation is safe, effective method for symptomatic uterine cervix elongation.What are the implications of these findings for clinical practice and/or further research? This suggests Manchester operation is an effective procedure for symptomatic uterine cervix elongation should be implemented more widely. It must be carried out with a strict technique by skilled surgeons capable to manage unique postoperative complications.


Subject(s)
Gynecologic Surgical Procedures , Uterine Cervical Neoplasms , Adult , Female , Gynecologic Surgical Procedures/methods , Humans , Middle Aged , Neoplasm Recurrence, Local , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Treatment Outcome
6.
J Am Geriatr Soc ; 69(9): 2518-2523, 2021 09.
Article in English | MEDLINE | ID: mdl-33979457

ABSTRACT

OBJECTIVES: To present a flexible protocol of vaginal pessaries for older women with significant pelvic organ prolapse (POP). DESIGN: A prospective cohort study of 140 consecutive older women (aged ≥65 years) with significant POP treated with individually fitted vaginal pessaries. After initial insertion, each patient was invited for a first evaluation after 1 month and subsequent follow-ups at increasing intervals of 1 month. During each examination, the pessary was removed and the vagina was inspected for infection, bleeding, or erosions. All patients were advised to use a vaginal estrogen cream twice a week. SETTING: The study was conducted during 2020 in the urogynecology clinic of a tertiary medical center. PARTICIPANTS: The study cohort included 140 consecutive older women with significant and symptomatic POP treated with vaginal pessaries. MAIN OUTCOME: Primary outcomes included time intervals between follow-up visits, pessary-associated complications, need to change the pessary, need to remove the pessary temporarily, and whether the patients eventually underwent POP surgery. RESULTS: The mean age of the patients at the time of pessary fitting was 76.7 ± 9.2 years (range 65-100 years). Mean interval between follow-up examinations was 3.3 ± 1.1 months (range 1-6 months). Most patients (83.6%) used a ring pessary with support, but only a small number of patients were able to maintain the pessary by themselves. Of the 140 patients, five (3.6%) patients only eventually underwent POP surgery, and in 11 (7.9%) patients, the vaginal pessary had to be removed for 2-4 weeks because of significant vaginal discharge or superficial erosions. Additionally, 12 (8.6%) patients developed stress urinary incontinence following pessary insertion. CONCLUSIONS: Customized management with vaginal pessary for symptomatic POP in older women is effective and safe, and is a suitable therapeutic alternative for older women who are unable or unwilling to undergo reconstructive pelvic surgery.


Subject(s)
Pelvic Organ Prolapse/surgery , Pessaries , Aged , Aged, 80 and over , Clinical Protocols , Equipment Design , Female , Humans , Prospective Studies , Vagina
9.
Urology ; 140: 34-37, 2020 06.
Article in English | MEDLINE | ID: mdl-32194090

ABSTRACT

OBJECTIVE: To assess the effect of a sharp increase in estrogen levels on overactive bladder (OAB) symptoms among women undergoing ovulation induction. METHODS: 100 consecutive women (mean age 36.9 ± 5.2 years) who underwent IVF treatments, were prospectively enrolled. Three validated questionnaires on urinary urgency, urinary incontinence, and lower urinary tract symptoms were used to evaluate patient's OAB symptoms before ovulation induction (low estradiol level) and prior to ovum pickup (peak estradiol level). RESULTS: Of the 100 women, 49 reported OAB symptoms prior to ovulation induction (mean USIQ severity score 33) and 51 women were asymptomatic. Of the 49 symptomatic women, 44 (90%) remained symptomatic (mean USIQ severity score 34) and 5 women became asymptomatic through ovulation induction. Of the 51 asymptomatic women, 24 (47%) developed de novo OAB symptoms, while 27 women (53%) remained asymptomatic through ovulation induction. The mean peak estradiol level was significantly higher among women who remained asymptomatic in comparison to women with de novo OAB symptoms (2069 versus 1372 pg/ml; respectively). Moreover, in most (63%) women who remained asymptomatic, peak estradiol levels were higher than 1500 pg/ml, whereas in most (67%) women who became symptomatic, peak estradiol levels were lower than 1500 pg/ml. CONCLUSION: A higher estradiol level appears to have a protective effect against the development of OAB symptoms during ovulation induction. Further, in most (63%) women who remained asymptomatic, peak estradiol levels were higher than 1500 pg/ml. This finding may suggest a threshold for estradiol activity in the lower urinary tract.


Subject(s)
Estrogens/blood , Ovulation Induction , Urinary Bladder, Overactive/blood , Adult , Asymptomatic Diseases/epidemiology , Body Mass Index , Estradiol/blood , Female , Fertilization in Vitro , Health Surveys , Humans , Lower Urinary Tract Symptoms/blood , Middle Aged , Ovulation Induction/methods , Prospective Studies , Severity of Illness Index , Urinary Bladder, Overactive/diagnosis , Urinary Bladder, Overactive/epidemiology , Urinary Incontinence, Urge/blood , Young Adult
10.
J Womens Health (Larchmt) ; 20(10): 1525-8, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21819253

ABSTRACT

PURPOSE: To assess the 5-year efficacy of the inside-out transobturator tension-free vaginal tape (TVT-O) for the treatment of stress urinary incontinence (SUI) and to explore possible predictors for long-term failure. METHODS: Sixty-five consecutive patients who underwent TVT-O were prospectively enrolled. Patients who required concomitant anterior or apical pelvic organ prolapse repair or both and those with urodynamic occult SUI were excluded. Postoperatively, patients were scheduled for evaluation at 1, 3, 6, and 12 months and annually thereafter. Surgical failure was defined as positive stress test, daily episodes of SUI, and negative global satisfaction. Preoperative and interim clinical and urodynamic predictors for long-term failure were analyzed from a computerized database. RESULTS: Sixty-one patients (mean age at surgery 56.6±10.2 years) completed 5 years of follow-up. Of these, 11 (18%) patients were classified as surgical failure, 5 (8%) as improved, and 45 (74%) as cured. Any SUI (100% vs. 10%, p=0.001), daily SUI (100% vs. 0%, p=0.001), overactive bladder (OAB) (100% vs. 48%, p=0.001), and the use of antimuscarinic drugs (64% vs. 26%, p=0.03) were found to be significantly more common among failure cases. Preoperative detrusor overactivity (odds ratio [OR] 7.6, 95% confidence interval [CI] 1.7-32.9), interim 1-year OAB (OR 20.5, 95% CI 1.9-215.4), and interim 1-year SUI (OR 26.4, 95% CI 1.5-475.2) were found to be significant independent risk factors for long-term surgical failure. CONCLUSIONS: An 18% rate of surgical failure was observed 5 years after TVT-O. Larger studies with longer follow-up periods may facilitate the identification of risk factors for failure and, thus, enable better preoperative consultation.


Subject(s)
Outcome Assessment, Health Care , Suburethral Slings/standards , Aged , Female , Humans , Israel , Middle Aged , Prospective Studies , Risk Factors , Urinary Incontinence, Stress/therapy
11.
J Minim Invasive Gynecol ; 18(6): 726-9, 2011.
Article in English | MEDLINE | ID: mdl-21855420

ABSTRACT

STUDY OBJECTIVE: To assess the 10-year subjective outcome of use of retropubic tension-free vaginal tape (TVT). DESIGN: Structured telephone interview (Canadian Task Force classification II-3). SETTING: Universitiy-affiliated tertiary medical center. PATIENTS: Sixty consecutive women with urodynamically confirmed stress urinary incontinence (SUI) who underwent retropubic TVT surgery during 2000. At surgery, their mean (SD) age was 62.4 (9.3) years, and parity was 2.9 (1.3). INTERVENTIONS: Retropubic TVT, with 10-year subjective outcome questionaire. MEASUREMENTS AND MAIN RESULTS: Of the 60 patients, 52 (87%) were available for 10-year follow-up. Preoperatively, all patients reported substantial SUI, and 28 (54%) also had concomitant urge urinary incontinence (UUI). At 10 years postoperatively, 34 women (65%) considered their condition cured, 6 (12%) believed it was improved, and 12 (23%) thought surgery had failed. Eleven women (21%) reported SUI, 22 (42%) had UUI (de novo UUI in 9), and 8 (15%) had recurrent urinary tract infections. Two women (4%) underwent repeated TVT. Of the various perioperative variables, only postoperative impaired bladder emptying was a statistically independent risk factor for long-term failure (odds ratio, 6.4; 95% confidence interval, 1.3-30.1). CONCLUSIONS: Ten-year subjective outcome of retropubic TVT are less favorable than previously reported. Early postoperative impaired bladder emptying is the most significant risk factor for long-term failure.


Subject(s)
Patient Satisfaction , Suburethral Slings , Urinary Incontinence, Stress/surgery , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Middle Aged , Prospective Studies , Risk Factors , Treatment Outcome , Urinary Incontinence, Urge/surgery , Urodynamics
12.
Neurourol Urodyn ; 30(1): 83-6, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20860036

ABSTRACT

AIMS: To evaluate the prevalence and obstetric risk factors of protracted postpartum urinary retention, beyond the third postpartum day. METHODS: Thirty thousand seven hundred fifty-seven consecutive women delivered in Lis maternity hospital during June 2006 to June 2009. The term "protracted postpartum urinary retention" was defined as the absence of adequate voiding beyond the third postpartum day. Study group comprised 55 women who developed protracted postpartum urinary retention. Control group comprised 110 women, matched by age and parity, who delivered at the same day but did not develop urinary retention. RESULTS: Fifty-five (0.18%) women (41 primipara, 14 multipara) developed protracted postpartum urinary retention. On multivariate logistic regression analysis, only duration of the second stage of labor and vacuum deliveries was found to be significant independent risk factors. Thirty-six (65%) women achieved normal voiding within 4-14 days postpartum, and 19 (35%) others within 15-28 days. Higher postvoid residual urinary volume at 72 hr after delivery was associated with increased risk for late recovery. Forty-eight (87%) patients were available for 3-39 months follow-up. Of these, five (10.4%) had stress urinary incontinence, and four (8.3%) had overactive bladder symptoms. Three (6.3%) others had subjective voiding difficulties; however, urodynamic evaluation failed to reveal any voiding phase abnormalities. CONCLUSIONS: Protracted postpartum urinary retention is uncommon in modern obstetric practice. The duration of the second stage of labor and vacuum deliveries were found to be significant independent risk factors. With early diagnosis and timely intervention, complete resolution is expected within 28 days postpartum with no extraordinary long-term consequences.


Subject(s)
Urinary Bladder, Overactive/epidemiology , Urinary Incontinence, Stress/epidemiology , Urinary Retention/epidemiology , Urination , Early Diagnosis , Female , Follow-Up Studies , Humans , Israel/epidemiology , Logistic Models , Multivariate Analysis , Postpartum Period , Pregnancy , Prevalence , Risk Factors , Time Factors , Urinary Bladder, Overactive/etiology , Urinary Incontinence, Stress/etiology , Urinary Retention/complications
13.
Neurourol Urodyn ; 30(3): 380-3, 2011 Mar.
Article in English | MEDLINE | ID: mdl-20665549

ABSTRACT

OBJECTIVES: To analyze the safety and efficacy of the trans-obturator tension-free vaginal tape (TVT-O) in elderly versus younger stress-incontinent women. METHODS: Ninety-seven consecutive elderly, aged 70 and older, and 256 younger women (mean age 75 and 55 years, respectively) who underwent TVT-O for urodynamically confirmed stress urinary incontinence (SUI) were prospectively enrolled. Concomitant pelvic organ prolapse (POP) repair was performed in 90% of the elderly and 70% of the younger women. The surgical procedures, as well as all pre- and postoperative clinical and urodynamic evaluation, were performed in one university-affiliated medical center. Main outcome measures were operative complications, early and late postoperative morbidity, postoperative urodynamically confirmed SUI (symptomatic, or asymptomatic), persistent, or de novo overactive bladder (OAB) and bladder outlet obstruction (BOO). RESULTS: Mean follow-up of the patients was 30 ± 17 months (range 3-58 months). Early and late postoperative morbidity was similar in both groups, except for significantly more cases of postoperative recurrent UTI's among elderly women (13.7% vs. 6.2%). The incidence of persistent urodynamically confirmed overt SUI was similar in both age groups (5%). However, asymptomatic urodynamic SUI was significantly more common among elderly patients (19% vs. 3.7%, P<0.05). The incidence of persistent OAB was similar in elderly and younger patients (68% and 62%, respectively), while de novo OAB was significantly more common in elderly patients (11.9% vs. 4.7%, P<0.05). CONCLUSIONS: TVT-O is safe and efficient for both elderly and younger stress-incontinent women. However, elderly patients are in increased risk for postoperative recurrent UTI's as well as de novo OAB.


Subject(s)
Suburethral Slings , Urinary Incontinence, Stress/surgery , Urologic Surgical Procedures/instrumentation , Academic Medical Centers , Adult , Age Factors , Aged , Aged, 80 and over , Chi-Square Distribution , Female , Humans , Israel , Middle Aged , Prospective Studies , Prosthesis Design , Recurrence , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Urinary Bladder/physiopathology , Urinary Bladder, Overactive/etiology , Urinary Incontinence, Stress/physiopathology , Urodynamics , Urologic Surgical Procedures/adverse effects
14.
Am J Obstet Gynecol ; 204(4): 347.e1-4, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21183150

ABSTRACT

OBJECTIVE: We sought to assess the modern prevalence and risk factors for third- and fourth-degree perineal tears. STUDY DESIGN: The study population comprised 38,252 women who delivered in one medical center, from January 2005 through December 2009, and met the following inclusion criteria: singleton pregnancy, vertex presentation, and vaginal delivery. Of these, 96 women (0.25%) sustained third- or fourth-degree perineal tears. Maternal and obstetric variables were compared between women with vs without severe perineal tears. RESULTS: Five variables were found to be statistically significant independent risk factors: Asian ethnicity (odds ratio [OR], 8.9; 95% confidence interval [CI], 4.2-18.9), primiparity (OR, 2.4; 95% CI, 1.5-3.7), persistent occipito posterior (OR, 2.1; 95% CI, 1-4.5), vacuum delivery (OR, 2.7; 95% CI, 1.6-4.6), and heavier birthweight (OR, 1.001; 95% CI, 1-1.001). CONCLUSION: Severe perineal tears are uncommon in modern obstetric practice. Significant risk factors are Asian ethnicity, primiparity, persistent occipito posterior, vacuum delivery, and heavier birthweight.


Subject(s)
Delivery, Obstetric/adverse effects , Lacerations/epidemiology , Perineum/injuries , Adult , Asian People/statistics & numerical data , Birth Weight , Female , Humans , Infant, Newborn , Injury Severity Score , Labor Presentation , Lacerations/classification , Lacerations/etiology , Multivariate Analysis , Parity , Pregnancy , Prevalence , Risk Factors , Vacuum Extraction, Obstetrical/adverse effects
15.
Urology ; 76(6): 1358-61, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20974490

ABSTRACT

OBJECTIVES: To assess the safety and effectiveness of the "inside-out" transobturator tension-free vaginal tape procedure for the management of occult stress urinary incontinence (SUI) in clinically continent women undergoing prolapse repair. METHODS: A total of 117 consecutive continent women (mean age and parity 66.8 ± 9.9 years and 3.2 ± 1.5, respectively) with significant pelvic organ prolapse and urodynamically confirmed occult SUI were enrolled in the present study. Surgical intervention included transvaginal prolapse repair and concomitant prophylactic transobturator tension-free vaginal tape. The main outcome measures were procedure-related complications, early and late postoperative morbidity, postoperative urodynamic SUI, persistent or de novo overactive bladder, and bladder outlet obstruction. RESULTS: No cases of significant blood loss, hematoma formation, or bladder injury occurred. Of the 117 patients, 6 (5.1%) had immediate postoperative voiding difficulties necessitating catheterization for >2 days. Late postoperative morbidity was assessed in 110 patients with ≥3 months of follow-up (mean 27.2 ± 17.7). Of these 110 patients, 7 (6.4%) had protracted postoperative thigh pain with spontaneous resolution within 1-3 months, and 7 (6.4%) had developed recurrent urinary tract infections. No cases of vaginal erosion developed. The functional outcome analysis was restricted to 92 patients with ≥12 months of follow-up (mean 31 ± 16). Of the 92 patients, 13 (14%) were found to have urodynamic SUI. However only 2 patients (2.2%) were symptomatic for a subjective and objective cure rate of 97.8% and 86%, respectively. Of the 34 patients who had had overactive bladder preoperatively, 22 (64.7%) had persisting symptoms postoperatively. An additional 4 patients (6.9%) had developed de novo overactive bladder symptoms, and 1 patient had bladder outlet obstruction. CONCLUSIONS: The prophylactic transobturator tension-free vaginal tape procedure is both effective and safe in patients with occult SUI undergoing prolapse repair.


Subject(s)
Pelvic Organ Prolapse/surgery , Postoperative Complications/surgery , Suburethral Slings , Urinary Incontinence, Stress/surgery , Aged , Female , Follow-Up Studies , Humans , Middle Aged , Pain/etiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/therapy , Recurrence , Retrospective Studies , Risk , Treatment Outcome , Urinary Bladder Neck Obstruction/etiology , Urinary Bladder, Overactive/etiology , Urinary Bladder, Overactive/surgery , Urinary Catheterization , Urinary Incontinence, Stress/etiology , Urinary Tract Infections/epidemiology , Urodynamics
16.
J Reprod Med ; 52(7): 616-8, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17847759

ABSTRACT

OBJECTIVE: To analyze the incidence, possible risk factors, preoperative morbidity and outcome results in tension-free vaginal tape (TVT) cases complicated by lower urinary tract injury in a large, heterogeneous, consecutive group of women. STUDY DESIGN: Four hundred sixty consecutive women who underwent TVT surgery for correction of urodynamically proven stress urinary incontinence were enrolled prospectively. All the procedures were performed at 1 center by 3 experienced surgeons. RESULTS: In this series, 3.9% cases of lower urinary tract injury occurred. Most of the injuries occurred during the learning curve. TVT-related urinary tract injury was not associated with increased perioperative morbidity. The cure rates were similar with and without injury. De novo urge and persistent urge incontinence were slightly more common in patients with bladder perforation. CONCLUSION: Lower urinary tract injury during the TVT procedure is directly related to the inexperience of the surgeon. However, TVT-related lower urinary tract injury does not appear to affect medium-term outcome results.


Subject(s)
Gynecologic Surgical Procedures/adverse effects , Suburethral Slings , Urinary Bladder/injuries , Urinary Incontinence, Stress/surgery , Urologic Surgical Procedures/adverse effects , Aged , Clinical Competence , Female , Follow-Up Studies , Gynecologic Surgical Procedures/statistics & numerical data , Humans , Incidence , Israel/epidemiology , Medical Errors/adverse effects , Medical Errors/statistics & numerical data , Middle Aged , Minimally Invasive Surgical Procedures/adverse effects , Prospective Studies , Urinary Bladder/surgery , Urologic Surgical Procedures/statistics & numerical data
17.
Neurourol Urodyn ; 26(6): 779-82, 2007.
Article in English | MEDLINE | ID: mdl-17335051

ABSTRACT

AIMS: First delivery at an older age is not an uncommon event in modern obstetric practice. The present study was undertaken to compare the prevalence of postpartum stress urinary incontinence (SUI) according to maternal age and mode of delivery. METHODS: Fifty two consecutive elderly primiparae (mean age 40.0 +/- 1.8) who underwent spontaneous vaginal delivery, 42 consecutive elderly primiparae (mean age 40.7 +/- 3.6) who underwent elective cesarean section, and 92 consecutive young primiparae (mean age 26.2 +/- 2.5) who underwent spontaneous vaginal delivery were interviewed 1-2 years postpartum about the symptom of SUI. Women who had SUI before pregnancy were not enrolled. Obstetric data were collected from computerized hospital records. RESULTS: The prevalence of SUI 1-2 years after spontaneous vaginal delivery was significantly higher in elderly compared with younger primiparae (38.5% vs. 9.8%, respectively). Elderly primiparae who underwent elective cesarean section had a significantly lower prevalence of postpartum SUI than those delivered vaginally (16.7% vs. 38.5%, respectively). Further comparison of stress-incontinent versus continent elderly primiparae failed to reveal significant demographic or obstetric differences, except for increased prevalence of SUI during pregnancy among incontinent patients (45% vs. 19%, respectively). CONCLUSIONS: First vaginal delivery at an older age carries an increased risk for postpartum SUI. Stress-incontinent women also had higher prevalence of SUI during pregnancy. This finding implies that the pathophysiologic process of SUI begins during pregnancy, prior to active labor and delivery. Nonetheless, elective cesarean section in these women has a protective effect and lowers the risk of developing postpartum SUI.


Subject(s)
Delivery, Obstetric/adverse effects , Urinary Incontinence, Stress/epidemiology , Adult , Age Factors , Female , Humans , Maternal Age , Pregnancy , Prevalence , Risk Factors
18.
Harefuah ; 144(7): 502-5, 525, 2005 Jul.
Article in Hebrew | MEDLINE | ID: mdl-16082904

ABSTRACT

Vaginal delivery is one of the main causes of anal incontinence. While previously postpartum anal incontinence was attributed to neurological damage to the pelvic floor and the rectal sphincter, today we know that mechanical injury plays an important role, especially when symptoms start soon after delivery. Risk factors for postpartum fecal incontinence are: forceps delivery, nulliparity, birth weight over 4 kilograms and persistent occiput posterior presentation of the fetal head. Anal incontinence developed in 42% of women who had posterolateral episiotomy. Therefore, the main focus of the treating physician should be on prevention by avoiding birth trauma followed by early recognition and skilful correction.


Subject(s)
Puerperal Disorders/physiopathology , Urinary Incontinence/etiology , Birth Weight , Delivery, Obstetric/methods , Female , Humans , Parity , Pregnancy , Risk Factors
19.
Urology ; 65(3): 479-82, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15780359

ABSTRACT

OBJECTIVES: To analyze the safety and efficacy of tension-free vaginal tape (TVT) surgery in elderly versus younger women with stress urinary incontinence (SUI). METHODS: A total of 157 consecutive elderly women, aged 70 years and older, and 303 younger women (mean age, 74.8 and 57.2 years, respectively) who underwent TVT for urodynamically-confirmed SUI were prospectively enrolled. Concomitant genitourinary prolapse repair was performed in 84% of the elderly and 67% of the younger women. The main outcome measures were perioperative morbidity, postoperative SUI, persistent or de novo urge incontinence, and voiding dysfunction. RESULTS: The incidence of TVT-related morbidity was similar in both groups, except for significantly fewer cases of bladder perforation among elderly women (1.3% versus 4.9%, P <0.05). However, some age-related morbidity was noted among the elderly women: 2 cases of pulmonary embolism, 2 cases of cardiac arrhythmia, 1 case of severe pneumonia, and 1 case of deep vein thrombosis. The outcome analysis was restricted to 123 elderly and 208 younger women with follow-up of at least 12 months (mean, 30 +/- 12 months; range, 12 to 67 months). The incidence of persistent postoperative SUI and persistent urge incontinence was similar in both age groups. However, de novo urge incontinence was significantly more common among elderly women (18% versus 4%, P <0.05). Two elderly and three younger women had postoperative pressure-flow studies suggestive of bladder outlet obstruction. CONCLUSIONS: Tension-free vaginal tape surgery in elderly women is associated with good outcome results; however, the risk of postoperative de novo urge incontinence, as well as age-related morbidity, is increased.


Subject(s)
Prostheses and Implants/adverse effects , Urinary Incontinence, Stress/surgery , Adult , Age Factors , Aged , Female , Humans , Middle Aged , Prospective Studies , Urologic Surgical Procedures/adverse effects
20.
Neurourol Urodyn ; 23(7): 632-5, 2004.
Article in English | MEDLINE | ID: mdl-15382184

ABSTRACT

AIMS: Clinically continent women with genitourinary prolapse and occult stress urinary incontinence (SUI) are considered to be at high risk of developing symptomatic SUI once the prolapse is repaired. We studied the efficacy and safety of tension-free vaginal tape (TVT) procedure in preventing postoperative SUI in these women. METHODS: One hundred consecutive women (mean age 66.7 +/- 9.9 years) with significant genitourinary prolapse and occult SUI were prospectively enrolled. Preoperatively, none of the women complained of SUI. However, all had urodynamically-confirmed occult SUI, revealed by repositioning of the prolapse. Surgical intervention was comprised of transvaginal prolapse repair and prophylactic TVT procedure. Main outcome end points included operative morbidity, postoperative SUI, persistent or de novo urge incontinence, and voiding dysfunction. RESULTS: The mean follow-up period was 27 months (range: 12-52 months). There was only one case of technique-related bladder perforation with no adverse outcome. Two other patients had postoperative urinary retention necessitating catheterization for more than 7 days, none of whom required any surgical intervention. Vaginal erosion of the tape was diagnosed in three patients, all of whom were successfully treated by excision of the eroded tape. Two (2%) patients developed urodynamically-confirmed SUI within 1 year postoperatively. However, postoperative urodynamics revealed asymptomatic sphincteric incontinence in 15 (15%) other patients. Thirteen (72%) of 18 patients with preoperative urge incontinence had postoperative persistent urge incontinence. De novo urge incontinence developed postoperatively in 8 (8%) patients. CONCLUSIONS: TVT procedure is effective and safe in patients with occult SUI undergoing prolapse repair. Long-term durability of this procedure is yet to be established.


Subject(s)
Gynecologic Surgical Procedures , Urinary Incontinence, Stress/prevention & control , Uterine Prolapse/surgery , Aged , Bandages , Female , Follow-Up Studies , Humans , Length of Stay , Postoperative Complications/epidemiology , Prospective Studies , Treatment Outcome , Urinary Bladder Diseases/complications , Urodynamics , Uterine Prolapse/diagnosis
SELECTION OF CITATIONS
SEARCH DETAIL
...