Anterior-apical Transvaginal Mesh (Calistar-S) for Treatment of Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year.

INTRODUCTION AND HYPOTHESIS: Calistar-S is a single-incision synthetic mesh kit that addresses apical and anterior compartment prolapse. The aims of this study were to evaluate the short-term objective and subjective outcomes at the 1-year follow-up. The secondary objectives were to evaluate quality of life and lower urinary tract symptoms (LUTS) outcomes, as well as surgical complications. METHODS: Records of 108 patients with symptomatic advanced pelvic organ prolapse (stages III and IV) who underwent prolapse surgery using the Calistar-S system from June 2018 to August 2022 were reviewed. The primary outcome was the objective cure of anterior and apical prolapse < stage 1, and the subjective cure was the negative response to questions 2 and 3 of the Pelvic Organ Prolapse Distress Inventory-6. Secondary outcomes measured quality of life, the presence of lower urinary tract symptoms, and complications. RESULTS: A total of 101 patients were evaluated. The overall objective cure rate is 97% and the subjective cure rate is 92.1%. Good outcomes were seen in all three compartments. Secondary outcomes show significant improvement in all validated questionnaires. Persistence and de novo urinary incontinence were 15.2% and 18.2% post-operatively. There is one case of bladder injury and one case of vaginal mesh exposure. CONCLUSIONS: The Calistar-S System is a safe and efficient method for treating advanced-stage POP. We observed good anatomical results and subjective relief with a minimal complication rate. LUTS have also been positively affected, showing a high success rate. Additional studies are needed to establish the long-term efficacy of this system.

The association between ABO blood groups and gestational diabetes mellitus: a retrospective population-based cohort study.

OBJECTIVE: There is a lot of evidence that connects blood type to several diseases, including the development of diabetes mellitus type 2. The evidence for an association between ABO blood groups and the possibility of developing gestational diabetes mellitus (GDM) is scant and inconclusive. We aimed to examine the link between ABO blood group types and GDM by the use of a large population-based cohort of pregnant women. STUDY DESIGN: A retrospective population-based cohort study was conducted using data collected from January 2013 to December 2017 from the Emek Medical Center, Afula, Israel. All pregnant women who underwent the two-step screening and diagnosed with GDM and delivered at >24 weeks were included. Women who had pre-gestational diabetes or whose pregnancies were terminated were excluded. The odds ratio (OR) were obtained through binary logistic regression analysis and the corresponding 95% confidence interval (CI) by the use of both the univariable and multivariable analysis. RESULTS: Of all 16,067 women included in the study cohort, 1712 (10.7%) had GDM. The incidence of GDM was 11.0%, 10.8%, 10.6%, and 8.8% in blood group A, B, O, and AB, respectively. After adjusting for maternal age, parity, and number of fetuses, AB blood group was associated with reduced risk for developing GDM compared to the other blood groups (p = .038; adjusted OR: 0.79; 95% CI: 0.64-0.99). There was no difference in Rhesus factor between GDM and controls. CONCLUSIONS: Women with AB blood group have a lower risk for developing GDM compared to other blood group types.

Effectiveness of antimicrobial prophylaxis at 30 versus 60 min before cesarean delivery.

This study aimed to examine the effect of antibiotic prophylaxis (AP) given within 30 compared to 30-60 min before skin incision on the incidence of infectious morbidity after cesarean delivery (CD). A retrospective cohort study was conducted at a single institution on data between 2014 and 2018. Women who delivered by CD were divided into two groups according to AP timing before skin incision: group 1 within 30 min, and group 2 from 30 to 60 min. The primary outcome was the incidence of any infectious morbidity. Overall, 2989 women were eligible: 2791 in group 1 and 198 in group 2. The primary composite outcome occurred in 125 women (4.48%) in group 1 and 8 women (4.04%) in group 2 (OR, 1.11; 95% CI 0.54-2.31; P = 0.77). The rate of surgical site infection only, was 1.08% in group 1 and 0.51% in group 2 (OR, 2.13; 95% CI 0.29-15.70; P = 0.72). The incidence was comparable between the groups in a separate sub-analysis restricted to laboring CDs and obese women. The rate of infectious morbidity was similar among women who received AP within 30 min and from 30 to 60 min before skin incision.

Return to sports after chronic anterior exertional compartment syndrome of the leg: Conservative treatment versus surgery.

AIM: To evaluate whether surgical treatment for anterior chronic exertional compartment syndrome (CECS) of the lower leg will lead to full athletic activity recovery compared to conservative treatment. METHODS: Patients diagnosed with anterior CECS of the leg were offered surgical treatment, as surgery considered today to be the mainstay of treatment. Patients unwilling to be treated surgically were treated conservatively. They were followed up, assessing both groups for pain, functional status, and the Tegner sports activity score with comparisons at diagnosis and following treatment. RESULTS: Forty-three patients were treated for CECS (31; 72.1% with surgery and 12; 27.9% conservatively) with a mean follow-up of 28.15 (4.16-54.09) months. Reported pain improved at follow-up by 1.59 (0-6) points and by 4.27 ± (0-10) points in the conservatively and the surgically treated patient groups, respectively ( p = 0.014) with a mean change in the Tegner score of 0.09 (-5 to 5) and 3.22 (-4 to 7), respectively ( p = 0.009). Three patients in the conservatively treated group (25% of 12) and 24 patients in the operated group (77.4% of 31) reported full resumption of their pre-diagnosis activity level ( p = 0.001). CONCLUSION: This study supports surgery as the treatment of choice for anterior CECS of the leg with differential benefit for fasciotomy in terms of pain and return to pre-diagnosis athletic activity.

The occurrence and severity of intra-abdominal adhesions in cases of pregnancies complicated by placenta accreta: A case control study.

OBJECTIVE: To examine the occurrence of intra-abdominal adhesions (IAA) among women with placenta accreta (PA). STUDY DESIGN: Case control study conducted at a single teaching hospital on data from January 2004 to December 2016. The cases included women who underwent a cesarean hysterectomy due to PA and had a pathological confirmation of accretion. The controls were matched for delivery date and number of cesarean deliveries (CDs) at a ratio of 1:4. IAA were categorized as "none", "filmy", or "dense". The outcome measures were rate of IAA. In order to detect a 25% difference in overall IAA between the groups, with alpha of 0.05 and 80% power, a sample size of 165 women was needed. RESULTS: Overall, 165 women (33 and 132 in the case and control groups, respectively) were included. Except for maternal age, there were no statistically significant differences between the groups in demographic and obstetric variables. Overall IAA rate was 30.3% and 47.7% in the case and control groups, respectively (RR: 0.64; 95% CI: 0.37-1.10, p = 0.04). Rate of dense adhesions was 15.2% and 32.6% in the case and control groups, respectively (RR: 0.47, 95% CI: 0.20-1.08; p = 0.03). After adjustment for maternal age, there was a significantly lower rate of overall IAA (RR = 0.39; 95% CI: 0.17-0.93; p = 0.02) and dense adhesions (RR = 0.30; 95% CI: 0.11-0.87; p = 0.02) among the cases. CONCLUSION: The incidence and severity of IAA following CDs are low, among women who develop PA.

[Chronic exertional compartment syndrome].

Chronic exertional compartment syndrome is an uncommon phenomenon first reported in the mid 50's. This condition is characterized by sharp pain during physical activity, causing reduction in activity frequency or intensity and even abstention. This syndrome is caused by elevation of the intra-compartmental pressure which leads to decreased tissue perfusion, thus ischemic damage to the tissue ensues. Chronic exertional syndrome is usually related to repetitive physical activity, usually in young people and athletes. The physical activity performed by the patient causes a rise in intra-compartmental pressure and thereby causes pain. The patient discontinues the activity and the pain subsides within minutes of rest. Chronic exertional syndrome is reported to occur in the thigh, shoulder, arm, hand, foot and gluteal region, but most commonly in the leg, especially the anterior compartment. The diagnosis of chronic exertional syndrome is primarily based on patients' medical history, supported by intramuscular pressure measurement of the specific compartment involved. Treatment of chronic exertional syndrome, especially the anterior and lateral compartment of the leg is mainly by surgery i.e. fasciotomy. If the patient is reluctant to undergo a surgical procedure, the conservative treatment is based on abstention from the offending activity, changing footwear or using arch support. However, the conservative approach is not as successful as surgical treatment.