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1.
J Gynecol Obstet Hum Reprod ; 51(1): 102234, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34571197

ABSTRACT

Native tissue cystocele repair has been the cornerstone of prolapse surgery, especially since the learned societies warned clinicians and patients about serious mesh related complications and recommend a vaginal route without prosthesis in first intention. Surgical techniques mainly consist in anterior colporraphy, vaginal patch plastron and para vaginal repair. However, in case of vaginal patch plastron, the vagina left in contact with the bladder is a material of much better quality than colporraphy alone. The multiplication of native tissues, generating post-operative fibrosis, associated with anchorage on a strong ligamentous structure, allows to expect better outcomes compared to anterior colporraphy. Indeed, vaginal plastron corrects median cystoceles with a vaginal strip as well as lateral cystoceles thanks to bilateral paravaginal suspension. Thereby, vaginal patch plastron appears to be a good compromise between the 3 autologous techniques with median and paralateral repair We aimed to describe the surgical technique of the vaginal patch plastron for vaginal native tissue repair for cystocele.


Subject(s)
Cystocele/surgery , Prosthesis Implantation/instrumentation , Surgical Mesh/standards , Adult , Cystocele/complications , Female , Humans , Middle Aged , Pelvic Organ Prolapse/surgery , Prosthesis Implantation/methods , Prosthesis Implantation/trends
3.
Bone Joint J ; 103-B(3): 430-439, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33641410

ABSTRACT

Upper limb amputations, ranging from transhumeral to partial hand, can be devastating for patients, their families, and society. Modern paradigm shifts have focused on reconstructive options after upper extremity limb loss, rather than considering the amputation an ablative procedure. Surgical advancements such as targeted muscle reinnervation and regenerative peripheral nerve interface, in combination with technological development of modern prosthetics, have expanded options for patients after amputation. In the near future, advances such as osseointegration, implantable myoelectric sensors, and implantable nerve cuffs may become more widely used and may expand the options for prosthetic integration, myoelectric signal detection, and restoration of sensation. This review summarizes the current advancements in surgical techniques and prosthetics for upper limb amputees. Cite this article: Bone Joint J 2021;103-B(3):430-439.


Subject(s)
Amputees/rehabilitation , Artificial Limbs/trends , Prosthesis Design/trends , Prosthesis Implantation/trends , Upper Extremity/surgery , Amputation, Surgical , Amputation Stumps/innervation , Humans , Osseointegration , Sensation , Upper Extremity/innervation
4.
Europace ; 23(3): 456-463, 2021 03 08.
Article in English | MEDLINE | ID: mdl-33595062

ABSTRACT

AIMS: During the COVID-19 pandemic, concern regarding its effect on the management of non-communicable diseases has been raised. However, there are no data on the impact on cardiac implantable electronic devices (CIED) implantation rates. We aimed to determine the impact of SARS-CoV2 on the monthly incidence rates and type of pacemaker (PM) and implantable cardiac defibrillator (ICD) implantations in Catalonia before and after the declaration of the state of alarm in Spain on 14 March 2020. METHODS AND RESULTS: Data on new CIED implantations for 2017-20 were prospectively collected by nine hospitals in Catalonia. A mixed model with random intercepts corrected for time was used to estimate the change in monthly CIED implantations. Compared to the pre-COVID-19 period, an absolute decrease of 56.5% was observed (54.7% in PM and 63.7% in ICD) in CIED implantation rates. Total CIED implantations for 2017-19 and January and February 2020 was 250/month (>195 PM and >55 ICD), decreasing to 207 (161 PM and 46 ICD) in March and 131 (108 PM and 23 ICD) in April 2020. In April 2020, there was a significant fall of 185.25 CIED implantations compared to 2018 [95% confidence interval (CI) 129.6-240.9; P < 0.001] and of 188 CIED compared to 2019 (95% CI 132.3-243.7; P < 0.001). No significant differences in the type of PM or ICD were observed, nor in the indication for primary or secondary prevention. CONCLUSIONS: During the first wave of the COVID-19 pandemic, a substantial decrease in CIED implantations was observed in Catalonia. Our findings call for measures to avoid long-term social impact.


Subject(s)
COVID-19 , Defibrillators, Implantable/trends , Pacemaker, Artificial/trends , Practice Patterns, Physicians'/trends , Prosthesis Implantation/trends , Humans , Patient Safety , Prospective Studies , Prosthesis Implantation/instrumentation , Spain , Time Factors
5.
J Vasc Surg Venous Lymphat Disord ; 9(5): 1093-1098, 2021 09.
Article in English | MEDLINE | ID: mdl-33482377

ABSTRACT

In response to the pandemic, an abrupt pivot of Vascular Quality Initiative physician members away from standard clinical practice to a restrictive phase of emergent and urgent vascular procedures occurred. The Society for Vascular Surgery Patient Safety Organization queried both data managers and physicians in May 2020. Approximately three-fourths (74%) of physicians adopted restrictive operating policies for urgent and emergent cases only, whereas one-half proceeded with "time sensitive" elective cases as urgent. Data manager case entry was negatively affected by both low case volumes and staffing due to reassignment or furlough. Venous registry volumes were reduced fivefold in the first quarter of 2020 compared with a similar period in 2019. The consequences of delaying vascular procedures for ambulatory venous practice remain unknown with increased morbidity likely. Challenges to determine venous thromboembolism mortality impact exist given difficulty in verifying "in home and extended care facility" deaths. Further ramifications of a pandemic shutdown will likely be amplified if postponement of elective vascular care extends beyond a short window of time. It will be important to monitor disease progression and case severity as a result of policy shifts adopted locally in response to pandemic surges.


Subject(s)
COVID-19 , Practice Patterns, Physicians'/trends , Prosthesis Implantation/trends , Surgeons/trends , Varicose Veins/therapy , Vascular Surgical Procedures/trends , Vena Cava Filters/trends , Venous Thromboembolism/therapy , Elective Surgical Procedures/trends , Health Care Surveys , Humans , Prosthesis Implantation/adverse effects , Prosthesis Implantation/instrumentation , Registries , Time Factors , Treatment Outcome , Varicose Veins/diagnostic imaging , Vascular Surgical Procedures/adverse effects , Venous Thromboembolism/diagnostic imaging , Workload
6.
Prosthet Orthot Int ; 44(6): 384-401, 2020 Dec.
Article in English | MEDLINE | ID: mdl-33164655

ABSTRACT

The human-prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International, has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human-prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.


Subject(s)
Artificial Limbs/trends , Prosthesis Design/trends , Prosthesis Fitting/trends , Prosthesis Implantation/trends , Forecasting , Humans , Lower Extremity , Osseointegration
7.
Clin J Am Soc Nephrol ; 15(11): 1622-1630, 2020 11 06.
Article in English | MEDLINE | ID: mdl-32967922

ABSTRACT

BACKGROUND AND OBJECTIVES: Patients on dialysis are at high risk of complications related to implantable cardioverter defibrillator (ICD) implantation; use of subcutaneous ICDs may be preferred over transvenous devices due to lower risk of bloodstream infection and interference with vascular access sites. We evaluated trends in use and in-hospital outcomes of subcutaneous compared with transvenous ICDs among patients on dialysis in the United States. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Retrospective analysis of ICD implants from 2012 to 2018 among patients on dialysis reported to the National Cardiovascular Data Registry ICD Registry, a nationally representative US ICD Registry. We examined overall trends in subcutaneous ICD adoption as a proportion of all eligible ICD implants among patients on dialysis and then compared in-hospital outcomes between eligible subcutaneous ICD and transvenous ICD recipients using inverse probability of treatment weighting. RESULTS: Of the 23,136 total ICD implants in patients on dialysis during the study period, 3195 (14%) were subcutaneous ICDs. Among eligible first-time ICD recipients on dialysis, the proportion of subcutaneous ICDs used increased yearly from 10% in 2012 to 69% in 2018. In propensity score-weighted analysis of 3327 patients, compared with transvenous ICDs, patients on dialysis receiving subcutaneous ICDs had a higher rate of in-hospital cardiac arrest (2% versus 0.4%, P=0.002), but there was no significant difference in total in-hospital complications (2% versus 1%, P=0.08), all-cause death, or length of hospital stay. CONCLUSIONS: The utilization of subcutaneous ICDs among US patients on dialysis has been steadily increasing. The overall risk of short-term complications is low and comparable with transvenous ICDs, but higher risks of in-hospital cardiac arrest merits closer monitoring and further investigation. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_09_23_CJN07920520.mp3.


Subject(s)
Defibrillators, Implantable/statistics & numerical data , Prosthesis Implantation/methods , Prosthesis Implantation/trends , Renal Dialysis/statistics & numerical data , Defibrillators, Implantable/adverse effects , Female , Heart Arrest/epidemiology , Hospital Mortality , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prosthesis Implantation/adverse effects , Registries , Renal Dialysis/adverse effects , Retrospective Studies , Time Factors , United States/epidemiology
8.
Spine (Phila Pa 1976) ; 45(15): 1024-1029, 2020 Aug 01.
Article in English | MEDLINE | ID: mdl-32675601

ABSTRACT

STUDY DESIGN: Retrospective analysis using data from RCTs. OBJECTIVE: This study aimed to report on the incidence of radiological adjacent segment degeneration (ASD) in patients with cervical radiculopathy due to a herniated disc that were randomized to receive cervical arthroplasty or arthrodesis. SUMMARY OF BACKGROUND DATA: Cervical disc prostheses were introduced to prevent ASD in the postsurgical follow-up. However, it is still a controversial issue. METHODS: Two hundred fifty-three patients were included in two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF), or without intervertebral cage (ACD) for one-level disc herniation. Neutral lateral radiographs were obtained preoperatively, at 1- and 2-year follow-up after surgery. Radiological ASD was evaluated on X-ray and defined by a decrease in disc height and the presence of anterior osteophyte formation on both the superior and the inferior level in relation to the target level. RESULTS: Radiological ASD was present in 34% of patients at baseline and increased to 59% at 2-year follow-up in the arthrodesis groups (ACD and ACDF combined), and to 56% in the arthroplasty group. Progression of radiological ASD was present in 29% of patients in the arthrodesis group and in 31% of patients in the arthroplasty group for 2-year follow-up. CONCLUSIONS: Radiological ASD occurs in a similar manner in patients who were subjected to arthrodesis in cervical radiculopathy and in patients who received arthroplasty to maintain motion. Current data tend to indicate that the advantage of cervical prosthesis in preventing radiological ASD is absent. LEVEL OF EVIDENCE: 2.


Subject(s)
Arthroplasty/trends , Cervical Vertebrae/surgery , Diskectomy/trends , Intervertebral Disc Degeneration , Intervertebral Disc Displacement/surgery , Prosthesis Implantation/trends , Adult , Arthroplasty/adverse effects , Cervical Vertebrae/diagnostic imaging , Diskectomy/adverse effects , Double-Blind Method , Female , Follow-Up Studies , Humans , Intervertebral Disc Degeneration/diagnostic imaging , Intervertebral Disc Degeneration/prevention & control , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/prevention & control , Male , Middle Aged , Prospective Studies , Prosthesis Implantation/adverse effects , Retrospective Studies
9.
Spine (Phila Pa 1976) ; 45(19): 1329-1334, 2020 Oct 01.
Article in English | MEDLINE | ID: mdl-32576776

ABSTRACT

STUDY DESIGN: Retrospective analysis using data from randomized clinical trials. OBJECTIVE: To compare the occurrence of heterotopic ossification (HO) between two cervical disc prostheses. Clinical outcome and range of motion (ROM) were also evaluated. SUMMARY OF BACKGROUND DATA: Cervical arthroplasty was reported to be able to maintain the segmental ROM. However, controversy exists since the difference of the occurrence of HO concerning cervical prosthesis is still huge. METHODS: Patients who underwent anterior cervical discectomy with arthroplasty for a cervical radiculopathy due to a herniated disc from the The Netherlands Cervical Kinematics (NECK) trial (activC; metal endplates with a polyethylene inlay and a keel for primary stability) and the PROCON trial (Bryan; metal-on-polymer with titanium coated endplates without a keel) were analyzed for HO at 12 and 24 months postoperatively. HO was scored according to the McAfee-Mehren classification. Segmental ROM was defined by a custom developed image analysis tool, and global cervical ROM was measured by Cobb's angle. Clinical outcome was evaluated by means of the neck disability index (NDI) as well as physical-component summary (PCS) and mental-component summary (MCS). RESULTS: At 2-year follow-up, the occurrence of HO was 68% in patients treated with the activC prosthesis (severe HO 55%), which was comparable with 85% (P = 0.12) in patients with the Bryan disc (severe HO 44%; P = 0.43). The HO progression was similar between groups. Clinically, the patients had comparable NDI, PCS, and MCS at 2-year follow-up, and comparable improvement of clinical outcomes. The global ROM in the Bryan group (56.4 ±â€Š10.8°) was significantly higher than in the activC group (49.5 ±â€Š14.0, P = 0.044) at 2-year follow-up. CONCLUSION: In comparison of two cervical disc prostheses the development of HO is independent on their architecture. Although global ROM was higher in the Bryan prosthesis group, this difference was not deemed clinically important, particularly because the clinical condition of patients with and without severe HO was comparable. LEVEL OF EVIDENCE: 2.


Subject(s)
Arthroplasty/trends , Bone-Anchored Prosthesis/trends , Cervical Vertebrae/diagnostic imaging , Diskectomy/trends , Ossification, Heterotopic/diagnostic imaging , Prosthesis Implantation/trends , Adult , Arthroplasty/adverse effects , Bone-Anchored Prosthesis/adverse effects , Cervical Vertebrae/surgery , Diskectomy/instrumentation , Double-Blind Method , Female , Humans , Intervertebral Disc Degeneration/diagnostic imaging , Intervertebral Disc Degeneration/epidemiology , Intervertebral Disc Degeneration/surgery , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/epidemiology , Intervertebral Disc Displacement/surgery , Male , Middle Aged , Netherlands/epidemiology , Ossification, Heterotopic/epidemiology , Prosthesis Implantation/adverse effects , Retrospective Studies , Treatment Outcome
10.
Circ Heart Fail ; 13(4): e006544, 2020 04.
Article in English | MEDLINE | ID: mdl-32233662

ABSTRACT

BACKGROUND: The Affordable Care Act (ACA) has been associated with increased heart transplant listings among blacks, who are disproportionately uninsured. It is unclear whether the ACA is also associated with increased ventricular assist device implantation in blacks. METHODS: Using Healthcare Cost and Utilization Project Data State Inpatient Databases from 19 states and Washington DC, we analyzed 1157 patients from early-adopter states (ACA Medicaid expansion by January 2014) and 785 patients from nonadopter states (no implementation from 2013 to 2014). Piecewise Poisson regression with a discontinuity was used to estimate change in census-adjusted rates of ventricular assist device implants by race and ACA adopter status 1 year before and after January 2014. RESULTS: Following the ACA Medicaid expansion, the proportional change in rate increased significantly among blacks from early adopter (1.40 [95% CI, 1.12-1.75], pre 0.57/100 000 to post-ACA 0.80/100 000) but not nonadopter states (1.25 [95% CI, 0.98-1.58], pre 0.40/100 000 to post-ACA 0.50/100 000). However, the early and nonadopter changes in implantation rates were not statistically different from each other (P=0.50). There were no immediate changes in whites in either state group following the ACA Medicaid expansion (early adopter, 1.12 [95% CI, 0.98-1.29], pre 0.27/100 000 to post-ACA 0.30/100 000; nonadopter, 0.98 [95% CI, 0.82-1.16], pre 0.27/100 000 to post-ACA 0.26/100 000). CONCLUSIONS: Among eligible states participating in Healthcare Cost and Utilization Project Data State Inpatient Databases, the ACA was not associated with immediate changes in ventricular assist device implantation rates by race. Although a significant increase in implantation rate was observed among blacks from early-adopter states, the change was not statistically different from the change seen in nonadopter states.


Subject(s)
Black or African American , Healthcare Disparities/trends , Heart Failure/therapy , Heart-Assist Devices/trends , Medicaid/trends , Outcome and Process Assessment, Health Care/trends , Patient Protection and Affordable Care Act/trends , Prosthesis Implantation/trends , White People , Adult , Aged , Databases, Factual , Eligibility Determination/trends , Female , Heart Failure/diagnosis , Heart Failure/epidemiology , Heart Failure/physiopathology , Humans , Male , Middle Aged , Practice Patterns, Physicians'/trends , Prosthesis Implantation/adverse effects , Prosthesis Implantation/instrumentation , Time Factors , Treatment Outcome , United States/epidemiology , Ventricular Function , Young Adult
11.
Open Heart ; 7(1): e001214, 2020.
Article in English | MEDLINE | ID: mdl-32201591

ABSTRACT

Objectives: To describe the contemporary trends in the use of mechanical circulatory support (MCS) in patients with acute myocardial infarction and cardiogenic shock (AMICS). To evaluate survival benefit with early application of intra-aortic balloon pump (IABP) or Impella CP. Methods: A cohort study of all consecutive patients with AMICS undergoing percutaneous coronary intervention (PCI) <24 hours of symptom onset (early PCI) in southeastern Denmark from 2010 to 2017. A matched case-control study comparing 30-day mortality between patients receiving early-IABP or early-Impella CP and their respective control group. Controls were matched on age, left ventricular ejection fraction, arterial lactate, estimated glomerular filtration rate and cardiac arrest before PCI. Early-IABP/Impella CP was defined as applied before PCI if shock developed pre-PCI, or immediately after PCI if shock developed during PCI. Results: 903 patients with AMICS undergoing early PCI were identified. Use of MCS decreased from 50% in 2010 to 25% in 2017, p for trend of <0.001. The IABP was abandoned in 2012 and replaced mostly by Impella CP. Patients receiving MCS in 2013-2017 had more compromised haemodynamics compared with patients receiving MCS in 2010-2012. 40 patients received early IABP, and 40 patients received early Impella CP. Only the group receiving early Impella CP was associated with lower 30-day mortality compared with their matched control group (30-day mortality 40% vs 77.5%, plog-rank of<0.001). Conclusion: Use of MCS decreased by 50% from 2010 to 2017. Patients receiving MCS had more compromised haemodynamics in recent years. Early application of Impella CP was associated with reduced 30-day mortality compared with a matched control group.


Subject(s)
Heart-Assist Devices/trends , Intra-Aortic Balloon Pumping/trends , Myocardial Infarction/therapy , Percutaneous Coronary Intervention/trends , Practice Patterns, Physicians'/trends , Prosthesis Implantation/trends , Shock, Cardiogenic/therapy , Aged , Diffusion of Innovation , Female , Humans , Intra-Aortic Balloon Pumping/adverse effects , Intra-Aortic Balloon Pumping/mortality , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Myocardial Infarction/physiopathology , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Prosthesis Design/trends , Prosthesis Implantation/adverse effects , Prosthesis Implantation/instrumentation , Prosthesis Implantation/mortality , Recovery of Function , Registries , Retrospective Studies , Risk Factors , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/mortality , Shock, Cardiogenic/physiopathology , Stroke Volume , Time Factors , Treatment Outcome , Ventricular Function, Left
12.
Trends Cardiovasc Med ; 30(4): 223-229, 2020 05.
Article in English | MEDLINE | ID: mdl-31201005

ABSTRACT

Early generation left ventricular assist devices (LVAD) for treatment of refractory heart failure attempted to mimic the pulsatility of a native heart and were bulky and less durable due to valves within the inflow and outflow pathways. The next disruption came with the introduction of continuous flow pumps characterized by a low-pulse pressure circulation. Since the mechanism of action did not involve displacement of blood, these pumps were much smaller and less noisy in part due to fewer moving parts. Such devices include the HeartMate II axial-flow pathway pump which is implanted thoraco-abdominally and the HVAD, a centrifugal-flow pathway pump which is smaller and is implanted entirely within the thoracic cavity and uses a combination of hydrodynamic and magnetic levitation of the internal rotor. These pumps improved survival compared with the early generation LVADs and in a trial, the HVAD demonstrated non-inferiority compared with the HeartMate II but with an increase in ischemic and hemorrhagic strokes. The HeartMate 3 LVAD is an intrapericardial centrifugal-flow pathway pump with a full magnetically levitated, frictionless rotor with a fixed intrinsic pulse. In a randomized trial, the HeartMate 3 "hybrid" pump was associated with near-elimination of pump thrombosis, a reduction in strokes of any type or severity and lower mucosal bleeding rates. Despite improvements in hemocompatibility, right heart failure and infections contribute to significant morbidity, and devices designed to be internally contained with a wireless power source and physiological flow characteristics are still required despite great strides in the field.


Subject(s)
Heart Failure/therapy , Heart-Assist Devices/trends , Magnetics/trends , Prosthesis Implantation/trends , Ventricular Function, Left , Animals , Diffusion of Innovation , Heart Failure/diagnosis , Heart Failure/physiopathology , Humans , Prosthesis Design/trends , Prosthesis Implantation/adverse effects , Prosthesis Implantation/instrumentation , Recovery of Function , Risk Factors , Treatment Outcome
13.
Asian J Androl ; 22(1): 70-75, 2020.
Article in English | MEDLINE | ID: mdl-31571642

ABSTRACT

Since their popularization, genitourinary prosthetics have remained a gold-standard therapy for the treatment of erectile dysfunction and stress urinary incontinence and in cases of testicular loss or dysfunction. They have also represented an area of significant innovation, which has contributed to excellent long-term outcomes. Given this history, the objective of the current review was to provide a 5-10-year outlook on anticipated trends and developments in the field of genitourinary prosthetics. To accomplish this objective, a PubMed and patent search was performed of topics relating to penile and testicular prostheses and urinary sphincters. In regard to penile prostheses, findings demonstrated several new concepts including temperature-sensitive alloys, automated pumps, devices designed specifically for neophalluses, and improved malleable designs. With artificial urinary sphincters, new concepts include the ability to add or remove fluid from an existing system, two-piece systems, and new mechanisms to occlude the urethra. For testicular prosthetics, future implementations may not only better replicate the feel of a biological testicle but also add endocrinological functions. Beyond device innovation, the future of prosthetics is also one of expanding geographic boundaries, which necessitates variable cost modeling and regulatory considerations. Surgical trends are also changing, with a greater emphasis on nonnarcotic, postoperative pain control, outpatient surgeries, and adjunctive techniques to lengthen the penis and address concomitant stress incontinence, among others. Concomitant with device and surgical changes, future considerations also include a greater need for education and training, particularly given the rapid expansion of sexual medicine into developing nations.


Subject(s)
Penile Prosthesis/trends , Prosthesis Design/trends , Prosthesis Implantation/trends , Urinary Sphincter, Artificial/trends , Urologic Surgical Procedures, Male/trends , Erectile Dysfunction/surgery , Humans , Male , Penile Implantation , Penile Prosthesis/economics , Prostheses and Implants/economics , Prostheses and Implants/trends , Testicular Diseases/surgery , Urinary Incontinence, Stress/surgery , Urinary Sphincter, Artificial/economics
14.
Asian Journal of Andrology ; (6): 70-75, 2020.
Article in English | WPRIM (Western Pacific) | ID: wpr-1009771

ABSTRACT

Since their popularization, genitourinary prosthetics have remained a gold-standard therapy for the treatment of erectile dysfunction and stress urinary incontinence and in cases of testicular loss or dysfunction. They have also represented an area of significant innovation, which has contributed to excellent long-term outcomes. Given this history, the objective of the current review was to provide a 5-10-year outlook on anticipated trends and developments in the field of genitourinary prosthetics. To accomplish this objective, a PubMed and patent search was performed of topics relating to penile and testicular prostheses and urinary sphincters. In regard to penile prostheses, findings demonstrated several new concepts including temperature-sensitive alloys, automated pumps, devices designed specifically for neophalluses, and improved malleable designs. With artificial urinary sphincters, new concepts include the ability to add or remove fluid from an existing system, two-piece systems, and new mechanisms to occlude the urethra. For testicular prosthetics, future implementations may not only better replicate the feel of a biological testicle but also add endocrinological functions. Beyond device innovation, the future of prosthetics is also one of expanding geographic boundaries, which necessitates variable cost modeling and regulatory considerations. Surgical trends are also changing, with a greater emphasis on nonnarcotic, postoperative pain control, outpatient surgeries, and adjunctive techniques to lengthen the penis and address concomitant stress incontinence, among others. Concomitant with device and surgical changes, future considerations also include a greater need for education and training, particularly given the rapid expansion of sexual medicine into developing nations.


Subject(s)
Humans , Male , Erectile Dysfunction/surgery , Penile Implantation , Penile Prosthesis/trends , Prostheses and Implants/trends , Prosthesis Design/trends , Prosthesis Implantation/trends , Testicular Diseases/surgery , Urinary Incontinence, Stress/surgery , Urinary Sphincter, Artificial/trends , Urologic Surgical Procedures, Male/trends
15.
J Orthop Surg Res ; 14(1): 350, 2019 Nov 08.
Article in English | MEDLINE | ID: mdl-31703710

ABSTRACT

BACKGROUND: The incidence of intertrochanteric hip fracture is expected to increase as the global population ages. It is one of the most important causes of mortality and morbidities in the geriatric population. The incidence of reverse oblique and transverse intertrochanteric (AO/OTA 31-A3) fractures is relatively low; however, the incidence of implant failure in AO/OTA 31-A3 fractures is relatively high compared with that in AO/OTA 31-A1 and A2 fractures. To date, the risk factors for implant failure in AO/OTA 31-A3 fractures treated with proximal femoral nail antirotation (PFNA) have remained ambiguous. The purpose of this study was to identify the predictive factors of implant failure in AO/OTA 31-A3 fractures treated with PFNA. METHODS: The data of all patients who underwent surgery for trochanteric fractures at our institution between January 2006 and February 2018 were retrospectively reviewed. All AO/OTA 31-A3 fractures treated with PFNA were included. Logistic regression analysis of potential predictors of implant failure was performed. Potential predictors included age, sex, body mass index, fracture type, reduction method, status of posteromedial support and lateral femoral wall, reduction quality, tip-apex distance and position of the helical blade in the femoral head. RESULTS: One hundred four (9.3%) patients with AO/OTA 31-A3 fractures were identified. Forty-five patients with AO/OTA 31-A3 fractures treated with PFNA were suitable for our study. Overall, implant failure occurred in six (13.3%) of forty-five patients. Multivariate analysis identified poor reduction quality (OR, 28.70; 95% CI, 1.91-431.88; p = 0.015) and loss of posteromedial support (OR, 18.98; 95% CI, 1.40-257.08; p = 0.027) as factors associated with implant failure. CONCLUSIONS: Poor reduction quality and loss of posteromedial support are predictors of implant failure in reverse oblique and transverse intertrochanteric fractures treated with PFNA.


Subject(s)
Bone Nails/adverse effects , Femur/surgery , Hip Fractures/surgery , Prosthesis Failure/adverse effects , Prosthesis Implantation/adverse effects , Rotation , Adult , Aged , Aged, 80 and over , Bone Nails/trends , Female , Femur/diagnostic imaging , Hip Fractures/diagnostic imaging , Humans , Male , Middle Aged , Prosthesis Failure/trends , Prosthesis Implantation/trends , Retrospective Studies , Risk Factors , Young Adult
16.
J Orthop Surg Res ; 14(1): 346, 2019 Nov 07.
Article in English | MEDLINE | ID: mdl-31699134

ABSTRACT

BACKGROUND: Osteosarcoma is the most common primary malignant bone tumor in adults and is usually located in the long bones. Standard treatment consists of perioperative chemotherapy and radical surgical resection. Limb-sparing surgery using a variety of reconstructive techniques remains the gold standard. METHODS: In our study, we retrospectively analyzed 90 adult patients operated at our institution between 2000 and 2017 for extremity osteosarcoma that underwent limb-sparing reconstruction with the megaprosthesis. Sixty-one patients underwent resection and reconstruction of the distal femur, 9 patients-proximal femur, 7 patients-proximal tibia, 5 patients-total femoral resection and reconstruction, 5 patients-proximal humeral resection, and 3 patients-other types of resection with endoprosthetic reconstruction. The median follow-up time was 41 months, median overall survival was 86 months (3-225 months), and progression-free survival was 81 months (1-86 months). Functional assessment was made on 48 out of 56 living patients, after endoprosthetic reconstruction. The assessment was made according to MSTS functional scale. RESULTS: In 14 cases (15%), the endoprosthesis had to be explanted, or amputation was performed for local recurrence or septic complication. Due to a mechanical failure of the implant, we had to perform a revision in 5 patients (5%). Eighteen out of 74 patients with endoprosthesis died of the disease. The median MSTS score was 84% (53-100%), and the best result of 85% was achieved in patients after distal femoral resection with endoprosthetic reconstruction. CONCLUSION: Careful planning of the treatment of patients with extremity osteosarcoma that is performed at the referral centers gives the possibility of long-term survival with a good and excellent functional result.


Subject(s)
Bone Neoplasms/surgery , Limb Salvage/trends , Osteosarcoma/surgery , Plastic Surgery Procedures/trends , Prosthesis Implantation/trends , Recovery of Function/physiology , Adult , Aged , Bone Neoplasms/diagnostic imaging , Female , Follow-Up Studies , Humans , Limb Salvage/methods , Male , Middle Aged , Osteosarcoma/diagnostic imaging , Prosthesis Implantation/methods , Plastic Surgery Procedures/methods , Retrospective Studies , Treatment Outcome , Young Adult
17.
JAMA Netw Open ; 2(10): e1913553, 2019 10 02.
Article in English | MEDLINE | ID: mdl-31626314

ABSTRACT

Importance: Defibrillation testing (DFT) is performed during implantable cardioverter-defibrillator (ICD) implantation to assess the capacity of the device to detect and terminate ventricular arrhythmias. However, DFT can result in complications and omission of its use has been shown to be safe. Objective: To describe temporal trends and variation in the use of DFT in contemporary practice in the United States. Design, Setting, and Participants: This multicenter cross-sectional study used data from the National Cardiovascular Data Registry ICD Registry. A total of 499 211 patients from 1794 different facilities undergoing first-time ICD implantation from April 2010 to December 2015 were included. Data analysis was performed from May 20, 2015, to August 15, 2019. Exposure: Defibrillation testing was assessed using the National Cardiovascular Data Registry ICD Registry. Main Outcomes and Measures: Defibrillation testing rates and median odds ratios (MORs) were assessed over time. The MOR represents the odds that a randomly selected patient receiving testing at a hospital with high testing rates would be tested compared with if he or she had received care at a hospital with low testing rates. Results: Of the 499 211 patients from 1794 different facilities included in this analysis, the mean (SD) age of the population was 65.5 (13.4) years and 356 681 patients (71.4%) were men. The use of DFT declined from 71.6% in the first calendar quarter of 2010 to 36.4% in the fourth quarter of 2015 (P < .001). Patients undergoing DFT were more likely than those without testing to have ischemic heart disease (170 569 [58.1%] vs 116 295 [56.6%]), ventricular tachycardia (91 500 [31.2%] vs 58 949 [28.7%]), and less advanced heart failure (New York Heart Association class I and II, 153 188 [52.2%] vs 91 215 [44.4%]) (P < .001 for all). The MOR for the use of defibrillation testing was 3.78 (95% CI, 3.54-4.03) in 2010, increasing to 6.05 (95% CI, 5.61-6.52) in 2015, indicating that by 2015 a randomly selected patient receiving testing at a hospital with high testing rates would have a 6-fold higher odds of being tested than if they had received care at a hospital with low testing rates. Conclusions and Relevance: Defibrillation testing at the time of ICD placement in the United States may have declined over time; however, institutional variation in its use appears to be marked and increased. This variability in the reduced use of defibrillation testing could reflect differences in individual or institutional cultures of practice.


Subject(s)
Defibrillators, Implantable , Electric Countershock/instrumentation , Hospitals/statistics & numerical data , Prosthesis Implantation/statistics & numerical data , Aged , Cross-Sectional Studies , Female , Heart Failure/therapy , Humans , Male , Middle Aged , Myocardial Ischemia/therapy , Prosthesis Implantation/methods , Prosthesis Implantation/trends , Registries , Tachycardia, Ventricular/therapy , Time Factors
18.
Circ Heart Fail ; 12(9): e006082, 2019 09.
Article in English | MEDLINE | ID: mdl-31514517

ABSTRACT

BACKGROUND: Women comprise approximately one-third of the advanced heart failure population but may receive fewer advanced heart failure therapies including left ventricular assist devices (LVADs). During the early pulsatile-flow device era, women had higher post-LVAD mortality and increased complications. However, knowledge about these differences in the continuous-flow device era is limited. Therefore, we sought to explore temporal trends in LVAD utilization and post-LVAD mortality by sex. METHODS AND RESULTS: Patients with LVAD implantation from 2004 to 2016 were identified using the Nationwide Inpatient Sample. Trends in LVAD utilization and post-LVAD inpatient mortality were compared by sex and device era. Although LVADs are being increasingly utilized for patients with advanced systolic heart failure, women continue to represent a smaller proportion of LVAD recipients-25.8% in 2004 to 21.9% in 2016 (P for trend, 0.91). Women had increased inpatient mortality after LVAD implantation compared with men in the pulsatile-flow era (46.9% versus 31.1%, P<0.0001) but not in the continuous-flow era (13.3% versus 12.1%, P=0.27; P for interaction=0.0002). Inpatient mortality decreased for both sexes over time after LVAD, with a sharp fall in 2008 to 2009. Female sex was independently associated with increased post-LVAD inpatient mortality beyond adjustment for demographics and risk factors during the pulsatile-flow era (odds ratio, 2.13; 95% CI, 1.45-3.10; P<0.0001) but not during the continuous-flow era (1.18; 0.93-1.48; P=0.16). CONCLUSIONS: Although utilization of LVAD therapy increased over time for both sexes, LVAD implantation remains stably lower in women, which may suggest a potential underutilization of this potentially life-saving therapy. Prospective studies are needed to confirm these findings.


Subject(s)
Health Services Misuse/trends , Heart Failure/surgery , Heart-Assist Devices/trends , Hospital Mortality/trends , Prosthesis Implantation/statistics & numerical data , Adult , Aged , Databases, Factual , Female , Health Services Misuse/statistics & numerical data , Heart Failure/epidemiology , Heart Failure/mortality , Heart-Assist Devices/statistics & numerical data , Humans , Male , Middle Aged , Prosthesis Implantation/mortality , Prosthesis Implantation/trends , Sex Factors , United States/epidemiology
19.
World Neurosurg ; 130: e251-e258, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31207376

ABSTRACT

OBJECTIVE: To investigate the characteristics of materials used as prostheses for microvascular decompression surgery (MVDs) in Japan and their possible adverse events (AEs) to determine preferable materials for MVDs. METHODS: A questionnaire was sent to all members of the Japanese Society for MVDs, and answers were obtained from 59 institutions. RESULTS: Among a total of 2789 MVDs, 1088 operations for trigeminal neuralgia, 1670 for hemifacial spasm, and 31 others, including 117 reoperations, were performed between April 2011 and March 2014. Nonabsorbable material was used in 96.5% of MVDs, including polytetrafluoroethylene (PTFE) (80.5%), polyurethane (11.9%), expanded PTFE (2.1%), and silk thread (1.47%). The use of absorbable materials, including fibrin glue (87.5%), cellulose (13.5%), gelatin (4,77%), and collagen (1.76%), was reported. The major combinations were PTFE with fibrin glue (58.7%) followed by PTFE alone (7.60%). Eighty-eight AEs in 85 (3.2%) cases were reported among 2672 first operations. AEs included 51 central nervous system dysfunctions, 15 wound infections/dehiscence, and 10 others, which were presumed to be related to the intraoperative procedure. Among relatively high-, moderate-, and low-volume centers, there were no significant differences in the frequency of AEs (P = 0.077). Tissue-prosthesis adhesion and/or granuloma formation were reported in 13 cases of 117 reoperations. The incidence of adhesion-related recurrence was 11.1% of all reoperations. CONCLUSIONS: The number of AEs was quite low in this survey, and intradural use of any prosthesis reported in this paper might be justified; however, further development of easily handled and less-adhesive prosthesis materials is awaited.


Subject(s)
Blood Vessel Prosthesis , Microvascular Decompression Surgery/instrumentation , Prosthesis Implantation/instrumentation , Societies, Medical , Surveys and Questionnaires , Blood Vessel Prosthesis/trends , Humans , Japan , Microvascular Decompression Surgery/trends , Prosthesis Implantation/trends , Societies, Medical/trends
20.
J Orthop Surg Res ; 14(1): 160, 2019 May 28.
Article in English | MEDLINE | ID: mdl-31138246

ABSTRACT

PURPOSE: The relationship between upper or lower adjacent segments (UAS/LAS) and the cervical spine parameters was not clear yet. So, the purpose was to analyze range of motion (ROM), lordosis (LOR), and intervertebral disc height (IDH) of UAS and LAS before and after total cervical disc replacement (TDR) and to explore the influencing factors of cervical spine radiological parameters on adjacent segments. METHODS: A single-center retrospective study was performed on patients completing 10-year follow-up undergone TDR. As the primary outcomes, radiological parameters included UAS-ROM/LAS-ROM, UAS-LOR/LAS-LOR, and UAS-IDH/LAS-IDH. The secondary outcomes were ROM and LOR of C2-C7 and surgical levels, IDH of surgical segments, prosthesis migration, subsidence, heterotopic ossification (HO), and adjacent segment degeneration (ASD), which were measured on X-ray. RESULTS: UAS-ROM and LAS-ROM remained stable in follow-up periods. There was no significance on UAS-LOR or LAS-LOR between pre- and post- operation, so was UAS-IDH or LAS-IDH. UAS-ROM was larger in the segments with ASD (P < 0.001), the same to LAS-ROM (P < 0.001), and UAS-LOR was larger in segments with ASD (P = 0.02). UAS-ROM was positively correlated with C2-C7 ROM and LOR (both P < 0.001). UAS-LOR was correlated with operated-segmental LOR while LAS-LOR were in correlation with surgical segment ROM. The influencing factors of UAS-ROM were the surgical segment ROM and C2-C7 LOR. The influencing factors of UAS-LOR and LAS-LOR were LAS-ROM and UAS-ROM, respectively. The influencing factors of UAS-IDH were LAS-IDH, surgical segment IDH, and HO while that of LAS-IDH were UAS-IDH and surgical segment IDH. CONCLUSIONS: TDR has only a little effect on the adjacent segments. There is an interaction between UAS and LAS. The maintenance on surgical segments ROM and reconstruction of IDH will benefit to adjacent segments.


Subject(s)
Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Intervertebral Disc/diagnostic imaging , Intervertebral Disc/surgery , Prosthesis Implantation/methods , Total Disc Replacement/methods , Adult , Female , Follow-Up Studies , Humans , Intervertebral Disc Degeneration/diagnostic imaging , Intervertebral Disc Degeneration/surgery , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/surgery , Male , Middle Aged , Postoperative Care/methods , Postoperative Care/trends , Prosthesis Implantation/trends , Retrospective Studies , Total Disc Replacement/trends
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