Comparación entre el uso de malla de prolene y cinta de mersilene en la sacrohisteropexia abdominal para el prolapso apical: ensayo clínico aleatorizado / Abdominal sacro-hysteropexy using proline mesh versus mersilene tape in apical prolapse: A randomized clinical trial

Contexto La preservación uterina se requiere cada vez más en el tratamiento quirúrgico del prolapso de órganos pélvicos. El uso de la malla de prolene puede tener efectos adversos en la reparación quirúrgica del prolapso. Objetivo Comparar el uso de malla de polipropileno y cinta de mersilene en la sacrohisteropexia abdominal para el tratamiento de prolapso apical en estadio ii o superior. Diseño del estudio Este ECA se realizó en el departamento de Obstetricia y Ginecología (hospitales universitarios de Menoufia y Ain Shams, Egipto). La población elegible incluyó a mujeres a las que se había planificado una sacrohisteropexia por prolapso uterino≥estadio 2, asignadas a 2 grupos: grupo de malla (n=38), sometidas a sacrohisteropexia con malla de polipropileno; y grupo de cinta (n=38), tratadas mediante sacrohisteropexia sacra con cinta de mersilene. Resultados Hubo diferencias estadísticamente significativas entre el grupo tratado con cinta y el grupo tratado con malla en cuanto a la duración de la histeropexia: 50,4min en el grupo de cinta vs. 90,6min en el grupo de malla (p<0,001), y en cuanto a la necesidad de analgésicos en el postoperatorio: 14 en el grupo de cinta vs. 27 en el de malla (p<0,005). La estancia hospitalaria media fue de 2,8 días en el grupo de cinta vs. 5,2 días en el grupo de malla (p<0,001). Conclusiones EL uso de cinta de mersilene en la sacrohisteropexia es una alternativa segura a la malla de poliprolileno, con una eficacia comparable y menos complicaciones. El procedimiento con cinta es más fácil, ya que requiere una zona de disección menor para la fijación sacra, por lo que la incidencia de lesiones es más baja (AU)

Background Uterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. Objective Compare between using polyproline mesh and mersilene tape in abdominal sacrohysteropexy repairing apical prolapse stage ?? or more. Study design This RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned sacrohysteropexy for uterine prolapse≥stage 2 assigned to 2 groups: Mesh group (n=38), underwent sacrohysteropexy with polyproline mesh, and tape group (n=38), underwent sacrohysteropexy using mersilene tape. Results High statistically significant difference between tape group and mesh group concerning hysteropexy time was 50.4minute in tape group vs 90.6minute in mesh group (P<.001), need for post operative analgesia was 14 in tape group vs 27 in mesh group (P<.005). The mean hospital stay was 2.8 days in tape group vs 5.2days mesh group (P<.001). Conclusions Using mersilene tape in sacrohysteropexy is a safe alternative to polyproline mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence (AU)

Abdominal Sacrohysteropexy using Proline mesh versus Mersilene tape in apical prolapse: A randomized clinical trial.

IMPORTANCE: uterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. OBJECTIVE: compare between using Polyproline mesh and Mersilene tape in abdominal Sacrohysteropexy repairing apical prolapse stage ӀӀ or more. STUDY DESIGN: This RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned Sacrohysteropexy for uterine prolapse ≥ stage 2 assigned to two groups: Mesh group (n = 38), underwent Sacrohysteropexy with polyproline mesh, and Tape group (n = 38), underwent Sacrohysteropexy using Mersilene tape. RESULTS: High statistically significant difference between TAPE group and MESH group concerning hysteropexy time was 50.4 min in TAPE group vs 90.6 min in MESH group (p < 0.001), need for post operative analgesia was14 in TAPE group vs 27 in MESH group (p < 0.005). The mean hospital stay was 2.8 days in TAPE group vs 5.2days in MESH group (p < 0.001). CONCLUSIONS: Using Mersilene tape in Sacrohysteropexy is a safe alternative to Polyproline Mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.

Three-dimensional sonohysterography may replace hysteroscopy for women with perimenopausal bleeding.

OBJECTIVE: To investigate whether three-dimensional saline-infusion transvaginal sonohysterography can replace hysteroscopy in the detection of intrauterine lesions in women with perimenopausal bleeding. MATERIALS AND METHODS: This study was carried out at the Department of Obstetrics and Gynecology, Menofyia University Hospital in Egypt. Fifty women who presented with perimenopausal bleeding and fulfilled the inclusion criteria were recruited for the study. Three-dimensional sonohysterography was performed followed by hysteroscopy for all women. Results were tabulated and statistically analyzed. The accuracy of both techniques was calculated in terms of sensitivity, specificity, positive and negative predictive values. RESULTS: The mean age of women enrolled was 47.5 ± 5.61 years and the mean body mass index was 28.13 ± 2.91 kg/m(2). Three-dimensional sonohysterography detected no abnormality in 26 women but hysteroscopy only detected 24 with no abnormality. Compared to hysteroscopy, three-dimensional sonohysterography has sensitivities of 100% and 92% in the detection of endometrial polyps and submucous fibroids, respectively. The specificity of sonohysterography for both lesions was 100%. The sensitivity and specificity for other lesions exceeded 95%. CONCLUSIONS: Three-dimensional sonohysterosonography may be considered as an effective alternative to hysteroscopy in the assessment of the uterine cavity for any woman with perimenopausal bleeding.

Comparison of alendronate and raloxifene in postmenopausal women with osteoporosis.

OBJECTIVES: To compare the efficacy and tolerability of raloxifene (RLX) 60 mg daily and alendronate (ALN) 70 mg once weekly, either alone or in combination, on bone mineral density (BMD), bone turnover, and lipid metabolism in postmenopausal women with osteoporosis. METHODS: Of the 135 women enrolled, 98 completed this 12-month, randomized, clinical study (35 in the RLX group, 31 in the ALN group, and 32 in the combination group). Measurements were taken of the BMD of the lumbar spine, femoral neck and total hip, urinary N-telopeptide (NTx) of type I collagen corrected for creatinine, serum bone-specific alkaline phosphatase (BSAP), and the lipid profile. All adverse effects were recorded. RESULTS: At 12 months, the BMD of the lumbar spine, femoral neck, and total hip significantly increased from baseline in all treatment groups. However, the increase in BMD in the combination group was significantly greater than those in the RLX and ALN groups (p < 0.0001). The reductions in both urinary NTx and serum BSAP in the combination and ALN groups were significantly greater than those in the RLX group (p < 0.0001). There were significant reductions in the serum total cholesterol and low density lipoprotein cholesterol and a significant increase in the serum high density lipoprotein cholesterol in the RLX and combination groups but not in the ALN group at 12 months. There were no significant differences in the incidence of adverse effects. CONCLUSIONS: Treatment of postmenopausal women with osteoporosis with RLX and ALN, alone and in combination, significantly increased the BMD of the lumbar spine, femoral neck and total hip and reduced markers of bone turnover. However, the effects of combined therapy were more pronounced than those of either monotherapy. On the other hand, RLX had some beneficial effects on lipid metabolism. Both medications, alone or in combination, had similar tolerability and safety profiles.