Attachment of Primary Vaginal Fibroblasts to Absorbable and Nonabsorbable Implant Materials Coated With Platelet-Rich Plasma: Potential Application in Pelvic Organ Prolapse Surgery.

OBJECTIVES: Pelvic organ prolapse (POP) is a common condition in women. The lifetime risk of undergoing surgery to correct POP is 11%, with 30% recurrence rate. Various types of vaginal implants, absorbable and nonabsorbable, that have been introduced in pelvic floor reconstructive surgeries have numerous serious adverse effects. Platelet-rich plasma (PRP) is an autologous product that accelerates tissue healing and regeneration. We hypothesized that autologous PRP will promote human vaginal fibroblast (HVF) attachment to vaginal implants and increase their healing potential. METHODS: Vaginal tissue biopsies were collected from postmenopausal patients with POP (n = 10) and asymptomatic control subjects (n = 4) during vaginal hysterectomy or repair. Primary cells were isolated and characterized by immunocytochemistry. Cell attachment and proliferation were compared between POP HVFs and control HVFs (n = 4/group). Twelve weeks after the surgery, blood samples were collected from 6 POP patients to obtain autologous PRP. Two meshes, absorbable (Vicryl) and nonabsorbable (Restorelle), were coated in PRP or control media; autologous POP HVFs (n = 6) were seeded on meshes for 2 hours. Cells attached to the meshes were fixed, stained with DAPI (4,6-diamidino-2-phenylindole dihydrochloride), and counted. RESULTS: Pelvic organ prolapse HVFs were similar to control HVFs in attachment to different matrix substrates and in proliferation rate. Attachment of POP HVFs to both meshes was significantly increased after coating with PRP versus Dulbecco modified Eagle medium (Vicryl: 9875 vs. 1006 cells/cm, Restorelle: 3724 vs. 649 cells/cm; P < 0.001 for both). CONCLUSIONS: In vitro, primary POP HVFs show better attachment to implant materials when treated with PRP, which may lead to reduced mesh-related complications in vivo, indicating its great potential for urogynecologic surgeries.

Outcome of the laparoscopic two-team sling procedure, tension-free vaginal tape insertion, and transobturator tape insertion in women with recurrent stress urinary incontinence.

OBJECTIVE: Although the surgical treatment of primary stress urinary incontinence (SUI) has been well studied, the optimal treatment of persistent or recurrent SUI represents a significant challenge to the surgeon, and there are limited relevant published data. The aim of this study was to document outcome data for various surgical techniques used at our centre for the treatment of recurrent SUI, and to assess the immediate and long-term complications associated with these procedures. METHODS: This retrospective study assessed the outcome of the laparoscopic two-team sling procedure, tension-free vaginal tape (TVT) insertion, and transobturator tape (TOT) insertion in the treatment of recurrent SUI in women. Data collected included patient demographics, urodynamic data, postoperative subjective cure and objective cure (negative cough stress test), and intraoperative and postoperative complications. RESULTS: Forty-six women with recurrent SUI were included in the study: 24 had had laparoscopic two-team sling procedures, 15 had had TVT insertion, and 7 had had TOT insertion. For each procedure, objective cure rates were 91.7%, 73.3%, and 85.7%, respectively, and subjective cure rates were 79.2%, 60%, and 57.1% respectively. In the laparoscopic two-team sling group, one woman developed an infected hematoma and one required surgery for a small bowel obstruction. CONCLUSION: The laparoscopic two-team sling procedure or TVT or TOT insertion may be used in experienced hands for surgical management of patients with recurrent stress urinary incontinence. We found no statistically significant differences in outcomes between the three groups, possibly because of the small sample size. Larger sample size and longer follow-up within prospective randomized trials are warranted to identify any possible differences.

Objectif : Bien que la prise en charge chirurgicale de l'incontinence urinaire à l'effort primaire (IUE) ait été bien étudiée, la prise en charge optimale de l'IUE persistante ou récurrente constitue un défi considérable pour le chirurgien et les données publiées pertinentes sont limitées. Cette étude avait pour but de documenter les données quant aux issues de diverses techniques chirurgicales utilisées dans notre centre pour la prise en charge de l'IUE récurrente, ainsi que d'évaluer les complications immédiates et à long terme étant associées à ces interventions. Méthodes : Cette étude rétrospective a évalué l'issue de l'intervention laparoscopique de fronde à deux équipes, de l'insertion d'une bandelette vaginale sans tension (TVT) et de l'insertion d'une bandelette transobturatrice (TOT) dans la prise en charge de l'IUE récurrente chez des femmes. Parmi les données recueillies, on trouvait les caractéristiques démographiques des patientes, les données urodynamiques, la guérison postopératoire subjective et la guérison objective (test à la toux négatif), ainsi que les complications peropératoires et postopératoires. Résultats : Quarante-six femmes présentant une IUE récurrente ont été admises à l'étude : 24 d'entre elles ont subi une intervention laparoscopique de fronde à deux équipes, 15 ont subi une insertion de TVT et 7 ont subi une insertion de TOT. Les taux de guérison objective ont été de 91,7 %, de 73,3 % et de 85,7 %, respectivement, tandis que les taux de guérison subjective ont été de 79,2 %, de 60 % et de 57,1 %, respectivement. Au sein du groupe « intervention laparoscopique de fronde à deux équipes ¼, une des participantes en est venue à présenter un hématome infecté, tandis qu'une autre a nécessité une chirurgie en raison d'une occlusion de l'intestin grêle. Conclusion : L'intervention laparoscopique de fronde à deux équipes ou l'insertion d'une TVT ou d'une TOT peuvent être utilisées par des praticiens expérimentés pour assurer la prise en charge chirurgicale des patientes qui présentent une incontinence urinaire à l'effort récurrente. Nous n'avons constaté aucune différence significative sur le plan statistique en matière d'issues entre ces trois groupes, et ce, peut-être en raison de la faible envergure de l'échantillon. La tenue d'essais randomisés prospectifs comptant des échantillons de plus grande envergure et des suivis prolongés s'avère justifiée aux fins de l'identification de toute différence possible.

Caso clínico: utilidad de la tomografía computada en la detección de cuerpos extraños del tracto digestivo / Case report: utility of computed tomography in the detection of foreign bodies of aerodigestive tract

We present the case of a 35 years old female patient with an impacted fish bone in the upper aerodigestive tract. In the initial assessment with physical examination, simple radiology study and fiberoptic endoscopy the fish bone couldn’t be found, so a Computed tomographic (C.T.) study was performed showing a foreign body image in the right pyriform sinus. A direct laryngoscopy is performed removing successfully the fish bone. A bibliographic revision showed that C.T. has a sensibility of 100 percent and a specificity of 97 percent in the recognition of aerodigestive foreign body, while simple radiology has a sensibility of 15,9 percent and specificity of 99,5 percent, due mainly because of the variable degree of calcification of the patient’s laryngeal cartilages and the characteristics of the consumed fish (sweet or salad water origin, size of the fish, bone or cartilaginous fish, and depth of habitat).