oalib
Search Results: 1 - 10 of 100 matches for " "
All listed articles are free for downloading (OA Articles)
Page 1 /100
Display every page Item
Outcomes following mid-urethral sling placement in patients with intrinsic sphincteric deficiency: comparison of Sparc and Monarc slings
Rapp, David E.;Govier, Fred E.;Kobashi, Kathleen C.;
International braz j urol , 2009, DOI: 10.1590/S1677-55382009000100011
Abstract: purpose: the treatment of patients with intrinsic sphincteric deficiency (isd) remains difficult. it is theorized that differing vectors of support provided by retropubic versus transobturator mid-urethral sling routes may affect outcomes. we sought to compare outcomes of patients undergoing sparc versus monarc sling types in patients with valsalva leak point pressures (vlpps) below 60 cm h2o. materials and methods: a retrospective review of female patients with stress urinary incontinence undergoing sparc? (n = 97) or monarc? (n = 39) placement following urodynamic diagnosis of isd was performed, with minimum 12-month follow-up required. outcomes were assessed using a questionnaire comprising validated incontinence questionnaires (udi-6, iiq-7) and additional items addressing satisfaction. results: success rates of 76% and 77% were observed in the sparc (mean follow-up 36 months) and monarc (mean follow-up 32 months) cohorts, respectively (p > 0.05). superior udi scores were demonstrated in the monarc cohort (3.8 vs. 5.3, p = 0.04)), in contrast to similar iiq scores across both groups (3.7 vs. 3.1, p > 0.05). a deterioration in success rates was seen in both cohorts with more extended follow-up and with lower vlpps. however, this finding was limited by low patient numbers in these cohorts. a complication rate of 7% and 3% was noted in sparc and monarc cohorts (p > 0.05). conclusions: we observed no significant differences in subjective outcomes when comparing patients undergoing sparc versus monarc sling placement in the treatment of sui with vlpp < 60 cm h2o. a deterioration in continence rates was seen with extended follow-up. these data may be affected by low patient numbers and related study power, in particular with more extended follow-up.
Laparoendoscopic single-site transvesical removal of mid-urethral polypropylene sling eroded into the bladder  [cached]
Marek Roslan,Marcin Markuszewski,Artur Gibas,Wojciech Piaskowski
Videosurgery and Other Miniinvasive Techniques , 2011,
Abstract: Complications of mid-urethral sling procedure such as erosion into the bladder are not very common. However, whenthey occur, removal of the tape may be necessary. To date, this complication has usually been managed by retropubicexploration or operative cystoscopy, which can often be associated with disproportionate morbidity or even failure. Wepresent 2 cases of a laparoendoscopic single-site surgery (LESS) approach for removal of polypropylene tape erodedinto the bladder. We report two female patients aged 41 years and 47 years who underwent treatment with this noveltechnique. A TriPort single-site access system was placed through the apex of the bladder under cystoscopic control.Carbon dioxide was used for insufflations of the bladder. A combination of straight and articulating laparoscopic instrumentswas used to dissect and completely remove the foreign body. Both patients were managed adequately in themanner presented above. The length of the skin incision was 20 mm. Time of intervention was 35 min and 40 min.No blood loss or complications occurred. A Foley 18 F catheter was left for seven days and the patients were dischargedon the 1st postoperative day. The follow-up period (4 months and 7 months) showed no events related to the method.Removal of foreign bodies of the bladder through a single transvesical laparoscopic port is technically feasible. This procedureoffers excellent visualization inside the bladder, especially near the bladder neck where polypropylene tapesoften reside, and provides patients with a minimally invasive approach through a single small incision.
无张力尿道中段悬吊术治疗女性混合性尿失禁的疗效分析
Analysis of outcomes of tension-free mid-urethral sling procedure in women with mixed urinary incontinence
 [PDF]

张维宇,张晓鹏,胡浩,陈京文,刘献辉,许克新
- , 2017, DOI: 10.3969/j.issn.1671-167X.2017.04.016
Abstract: 关键词: 压力性尿失禁, 急迫性尿失禁, 无张力尿道中段悬吊术, 治疗结果
Key words: Stress urinary incontinence, Urge urinary incontinence, Tension-free mid-urethral sling procedure, Treatment outcome
The Miniarc? sling system in the treatment of female stress urinary incontinence
Gauruder-Burmester, Annett;Popken, Gralf;
International braz j urol , 2009, DOI: 10.1590/S1677-55382009000300010
Abstract: aims: to assess the technical feasibility of a new mini-invasive sling procedure (miniarc?) and present short-term results in the treatment of female urinary incontinence. material and methods: a total of 97 women with mixed or stress urinary incontinence (sui) were treated by placement of the new single-incision sling. pelvic organ prolapse was graded using the pop-q system (pelvic organ prolapse quantification system). preoperative workup included urodynamic evaluation, cough stress test and introital ultrasound. postoperatively, introital ultrasound was performed to determine residual urine and check tape position. quality of life was measured using king's health questionnaire. a voiding diary and pad count served to verify the patients' subjective complaints. results: the miniarc? single-incision sling procedure was the initial intervention in 37 (38.2%) patients and the second intervention in 60 (61.7%) patients with recurrent incontinence. the cough stress test was negative in 79 (83.1%) women 6 weeks after the sling procedure and in 74 (77.8%) at 12 months. de novo urge occurred in 32 (36.8%) women. quality of life was significantly improved at 12-month follow-up in 65 (69.1%) patients (p < 0.001). the number of pads decreased significantly from 2.2 to 0.6 (p < 0.001) after the procedure. one patient developed an hematoma and bladder perforation occurred in another. conclusions: our short-term clinical results suggest that the miniarc? is a safe and effective minimally invasive sling procedure for treating female sui. randomized comparative controlled trials and long-term results are still required to define the role of the new sling system in comparison to established mid-urethral tape techniques for treating incontinence.
Longitudinal urethral sling with prepubic and retropubic fixation for male urinary incontinence
Schaal, Carlos H.;Costa, Renato P.;Sala, Fernando C.;Vanni, André P.;Cortez, José P.;
International braz j urol , 2004, DOI: 10.1590/S1677-55382004000400007
Abstract: objective: description and early results of a new urethral sling technique for treatment of postprostatectomy urinary incontinence, which combines efficacy, low cost and technical simplicity. materials and methods: from may 2003 to april 2004, 30 patients with moderate or total urinary incontinence, following radical prostatectomy or endoscopic resection of the prostate, underwent the new technique. the technique is based on the placement of a longitudinal-shaped sling in the bulbar urethra, measuring 4 cm in length by 1.8 cm in width, made of dacron or polypropylene mesh, fixed by 4 sutures on each side, with 2 sutures passed with stamey-pereira needle by retropubic approach and 2 by prepubic approach, which are then tied over the pubis. pressure control was determined by interrupting the loss of infused water through a suprapubic cystostomy 60 cm from the pubis level. results: pre-operative assessment excluded vesical instability, urethral stenosis and urinary infection. suprapubic cystostomy was removed when the patient was able to satisfactorily void with urinary residue lower than 100 ml, which occurred in 29 of the 30 cases. in 2 cases, there was infection of the prosthesis, requiring its removal. in 3 cases, there was the need to adjust the sling (increasing the tension), due to failure of the urinary continence. overall, 20 of 30 (66.7%) operated patients became totally continent, and did not require any kind of pads. four of 30 (13.3%) patients achieved partial improvement, requiring 1 to 2 pads daily and 6 of 30 (20%) patients had minimal or no improvement. there was no case of urethral erosion. conclusion: this new sling technique has shown highly encouraging preliminary results. its major advantage over other surgical techniques for treatment of moderate or severe stress urinary incontinence is the simplicity for its execution and low cost. a long-term assessment, addressing maintenance of continence, detrusor function and preservation of the upper urina
Surgical technique using AdVance? Sling placement in the treatment of post-prostatectomy urinary incontinence
Rapp, David E.;Reynolds, W. Stuart;Lucioni, Alvaro;Bales, Gregory T.;
International braz j urol , 2007, DOI: 10.1590/S1677-55382007000200015
Abstract: objectives: to describe and illustrate a new minimally invasive approach to the treatment of male stress urinary incontinence following prostatectomy. surgical technique: our initial experience consisted of four patients treated with the advance sling for post-prostatectomy urinary incontinence. sling placement involves the following steps: 1. urethral dissection and mobilization, 2. identification of surgical landmarks, 3. placement of needle passers through the obturator foramen, 4. mesh advancement, 5. mesh tensioning and fixation, 6. incision closure. comments: based on our initial experience, we believe that the advance male sling system may be a safe technique for the treatment of male stress urinary incontinence. this technique is easy to perform and may offer a reproducible, transobturator approach. further patient accrual is ongoing to assess the safety and reproducibility of this technique. also, additional study will focus on efficacy standards and complication rates.
Intraoperative maximal urethral closing pressure measurement: a new technique of tape tension adjustment in transobturator sling surgery?
Kang, Myung Beum;Kim, Hyeong Gon;Paick, Sung Hyun;Lho, Yong Soo;Park, Hyoung Keun;
International braz j urol , 2011, DOI: 10.1590/S1677-55382011000600011
Abstract: purpose: tape tension adjustment is an essential procedure in mid-urethral sling surgery. the goal of this study was to determine if intraoperative maximal urethral closing pressure (mucp) elevation could be used as a reference value for adequate tape tension adjustment and predict transobturator (tot) sling surgery outcome. materials and methods: a prospective study was performed using mucp measurements just before tape insertion and just after tension adjustment during surgery. clinical data including preoperative urodynamic results were collected. the cure rate was determined by questionnaire. patients were divided into two groups. the mucp elevation group included patients with a mucp elevation of more than 10 cmh2o before tape insertion; the others were regarded as the non-elevation group. the cure rate and pre- and postoperative clinical variables were compared between the two groups. results: a total of 48 patients had tot surgery. the mucp elevation group (n=19) and the non-elevation group (n=29) were similar with regard to patient characteristics and the preoperative parameters including age, mixed incontinence prevalence, q-tip angle, peak flow rate, mucp and the valsalva leak point pressure (vlpp). the mean follow-up period was nine months. the cure rate was significantly higher in the group with mucp elevation than in the non-elevation group (84% vs. 52%, p=0.02). there was no significant difference in the mean postoperative peak flow rate between the two groups and there was no retention episode. conclusions: mucp elevation of more than 10 cmh2o just after tape insertion was a prognostic factor.
Arc-to-arc mini-sling 1999: a critical analysis of concept and technology
Palma, Paulo;
International braz j urol , 2011, DOI: 10.1590/S1677-55382011000200012
Abstract: purpose: the aim of this study was to critically review the arc-to-arc mini-sling (palma's technique) a less invasive mid-urethral sling using bovine pericardium as the sling material. materials and methods: the arc-to-arc mini-sling, using bovine pericardium, was the first published report of a mini-sling, in 1999. the technique was identical to the "tension-free tape" operation, midline incision and dissection of the urethra. the atfp (white line) was identified by blunt dissection, and the mini-sling was sutured to the tendinous arc on both sides with 2 polypropylene 00 sutures. results: the initial results were encouraging, with 9/10 patients cured at the 6 weeks post-operative visit. however, infection and extrusion of the mini-sling resulted in sling extrusion and removal, with 5 patients remaining cured at 12 months. conclusion: the arc-to-arc mini-sling was a good concept, but failed because of the poor technology available at that time. further research using new materials and better technology has led to new and safer alternatives for the management of stress urinary incontinence.
Pubovaginal sling in the treatment of stress urinary incontinence for urethral hypermobility and intrinsic sphincteric deficiency
Silva-Filho, Agnaldo L.;Triginelli, Sérgio A.;Noviello, Maurício B.;Santos-Filho, Admário S.;Pires, Cleidismar R.;Cunha-Melo, J. Renan;
International braz j urol , 2003, DOI: 10.1590/S1677-55382003000600012
Abstract: purpose: this study was undertaken to evaluate the use of pubovaginal sling for the treatment of female stress urinary incontinence in patients with intrinsic sphincteric deficiency and patients with urethral hypermobility. materials and methods: sixty-two patients aging 22 to 73 years-old (mean = 49.6) with a median parity of 4.1 (range 0 - 14) who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence from august/1999 to august/2002 were prospectively analyzed. objective pre and postoperative urodynamic evaluation was performed in all cases. the patients were divided into 2 groups: thirty-nine patients (62.9%) with urethral hypermobility (valsalva leak point pressure equal or superior to 60 cm of h2o) and twenty-three patients (37.1%) with intrinsic sphincteric insufficiency (valsalva leak point pressure below 60 cm of h2o). results: the average follow-up period was 24.8 months, ranging from 3 to 38 months. three patients (4.8%) had detrusor overactivity before the operation, and 36 patients (58.1%) had voiding dysfunction before surgery. the postoperative objective cure rate was 88.7% for stress urinary incontinence. the study also showed that 32.2% of the patients had voiding dysfunction and 11.3% had detrusor overactivity. the mean hospital stay was 3.1 days (range 2 - 4). no difference in the above parameters was noticed between patients with intrinsic sphincteric deficiency and those with urethral hypermobility. conclusion: construction of a pubovaginal sling is an effective technique for the relief of severe stress urinary incontinence, for both patients with urethral hipermobility and with intrinsic sphincteric deficiency, having a cure rate of 88.7%. the high frequency of postoperative voiding urgency was not related to the detrusor overactivity as evaluated by urodynamic studies.
Pubovaginal sling in the treatment of stress urinary incontinence for urethral hypermobility and intrinsic sphincteric deficiency  [cached]
Silva-Filho Agnaldo L.,Triginelli Sérgio A.,Noviello Maurício B.,Santos-Filho Admário S.
International braz j urol , 2003,
Abstract: PURPOSE: This study was undertaken to evaluate the use of pubovaginal sling for the treatment of female stress urinary incontinence in patients with intrinsic sphincteric deficiency and patients with urethral hypermobility. MATERIALS AND METHODS: Sixty-two patients aging 22 to 73 years-old (mean = 49.6) with a median parity of 4.1 (range 0 - 14) who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence from August/1999 to August/2002 were prospectively analyzed. Objective pre and postoperative urodynamic evaluation was performed in all cases. The patients were divided into 2 groups: thirty-nine patients (62.9%) with urethral hypermobility (Valsalva leak point pressure equal or superior to 60 cm of H2O) and twenty-three patients (37.1%) with intrinsic sphincteric insufficiency (Valsalva leak point pressure below 60 cm of H2O). RESULTS: The average follow-up period was 24.8 months, ranging from 3 to 38 months. Three patients (4.8%) had detrusor overactivity before the operation, and 36 patients (58.1%) had voiding dysfunction before surgery. The postoperative objective cure rate was 88.7% for stress urinary incontinence. The study also showed that 32.2% of the patients had voiding dysfunction and 11.3% had detrusor overactivity. The mean hospital stay was 3.1 days (range 2 - 4). No difference in the above parameters was noticed between patients with intrinsic sphincteric deficiency and those with urethral hypermobility. CONCLUSION: Construction of a pubovaginal sling is an effective technique for the relief of severe stress urinary incontinence, for both patients with urethral hipermobility and with intrinsic sphincteric deficiency, having a cure rate of 88.7%. The high frequency of postoperative voiding urgency was not related to the detrusor overactivity as evaluated by urodynamic studies.
Page 1 /100
Display every page Item


Home
Copyright © 2008-2017 Open Access Library. All rights reserved.