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Lewis Chan, Vincent Tse
PURPOSE: The mid-urethral synthetic sling (MUS) procedure has become the standard of care for treatment of female stress urinary incontinence. However, a small number of patients will have complications following MUS including failure, obstructive voiding, sling erosion, or chronic pain. This paper discusses the role of 2D and 3D ultrasound imaging in the evaluation of the female patient with complications following placement of a synthetic mid-urethral sling. RESULTS: The MUS is easily visualized as an echogenic structure on ultrasound and can be imaged by transperineal, transvaginal and introital approaches...
March 12, 2018: World Journal of Urology
Ruiyang Jiang, Steven Wolf, Muhammad H Alkazemi, Gina-Maria Pomann, J Todd Purves, John S Wiener, Jonathan C Routh
INTRODUCTION: The surgical comorbidity assessment is important for patient risk stratification, counseling, and research. In adults, risk assessment indices, such as the Charlson Co-morbidity Score (CCS) or Van Walraven Index (VWI), are well established. In pediatrics, however, risk assessment indices are scarce. Recently, a pediatric-specific risk assessment index, the Rhee index, was developed to discriminate mortality for pediatric general surgery patients. Currently, there is no validated risk assessment tool in pediatric urology...
February 26, 2018: Journal of Pediatric Urology
Julia Geynisman-Tan, Bhumy Dave-Heliker, Katarzyna Bochenska, Sarah Collins, Christina Lewicky-Gaupp, Margaret Mueller, Kimberly Kenton
OBJECTIVE: The objective of this study was to describe the expected duration of self-catheterization in women discharged home performing intermittent self-catheterization (ISC) after retropubic midurethral sling (RMUS). METHODS: We conducted a retrospective cohort analysis of women who underwent an isolated RMUS by 3 providers between 2009 and 2014 at a single institution. A 300 mL retrograde-fill voiding trial (VT) was performed before discharge. Those who failed their VT (postvoid residual [PVR] >1/3 total bladder volume [TBV]) and could perform ISC are included in this analysis...
March 5, 2018: Female Pelvic Medicine & Reconstructive Surgery
Myong Kim, Daehun Choi, Jun Hyuk Hong, Choung-Soo Kim, Hanjong Ahn, Myung-Soo Choo
OBJECTIVES: To investigate the clinical and urodynamic parameters affecting the treatment outcomes of post-prostatectomy incontinence (PPI) surgery. PATIENTS AND METHODS: We reviewed the patients with PPI who received an artificial urinary sphincter (AUS) or adjustable male sling (MS) from 2001 to 2016. RESULTS: A total of 103 patients (AUS, 53; adjustable MS, 50) with a mean age of 69.9 (±5.6, standard deviation) years were analyzed. The mean number of pads used daily was 4...
March 5, 2018: Neurourology and Urodynamics
Mauricio Plata, Daniela Robledo, Alejandra Bravo-Balado, Juan Carlos Castaño, Catalina Osorio, Milton Salazar, Juan Guillermo Velásquez, Carlos Gustavo Trujillo, Juan Ignacio Caicedo, Juan Guillermo Cataño
INTRODUCTION AND HYPOTHESIS: We report our experience with the Remeex system™ in women with recurrent stress urinary incontinence (SUI) or intrinsic sphincter deficiency (ISD). METHODS: A multicenter retrospective study was conducted in women who underwent an adjustable sling procedure between 2011 and 2016. We used urodynamic studies (UDS) preoperatively and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and cough stress test (CST) pre- and postoperatively...
March 3, 2018: International Urogynecology Journal
Emilio Sacco, Carlo Gandi, Luigi Vaccarella, Salvatore Recupero, Marco Racioppi, Francesco Pinto, Angelo Totaro, Nazario Foschi, Giuseppe Palermo, Francesco Pierconti, Pierfrancesco Bassi
OBJECTIVE: To evaluate prospectively midterm outcomes of a new titanium-coated fixed polypropylene sling for male stress urinary incontinence. MATERIALS AND METHODS: From 01/2013 to 06/2016, 44 consecutive patients with incontinence caused by radical prostatectomy (39) or TURP (5) underwent transobturator two-arm titanium-coated sling (TiLOOP Male® ) implantation with an inside-out, single-incision technique, leaving the bulbourethral muscle in place. Patients have been assessed postoperatively with uroflowmetry, pad count, ICIQ-SF, IIQ-7, PGI-I, OABq, IPSS, satisfaction (yes/no)...
March 1, 2018: Urology
Ziyad M Binsalamah, Charles D Fraser, Carlos M Mery
Pulmonary artery slings and vascular rings are very rare congenital anomalies. It is even rarer to have both anomalies in the same setting. We present a case of a toddler who was diagnosed with a left pulmonary artery sling and a vascular ring as part of the screening process for the VACTERL association - co-occurrence of vertebral, anorectal, cardiac, tracheoesophageal, renal, and limb malformations. He underwent a successful surgical repair via median sternotomy and on cardiopulmonary bypass with an uneventful postoperative course...
March 1, 2018: Cardiology in the Young
David Sheyn, C Emi Bretschneider, Dana Canfield, Mary Duarte, Jeffrey M Mangel, Sangeeta T Mahajan
OBJECTIVE: Trainee involvement in surgical procedures has been associated with longer surgical times and increased rates of certain complications. There has been limited study of the impact trainee involvement has on outcomes in urogynecologic surgery. We sought to determine the impact of resident and fellow involvement in pelvic reconstructive surgeries on 30-day complication rates. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, patients who underwent pelvic floor surgery were identified between 2010 and 2015...
February 27, 2018: Female Pelvic Medicine & Reconstructive Surgery
Marcella G Willis-Gray, Katherine E Husk, Taylor J Brueseke, Jennifer M Wu, Alexis A Dieter
OBJECTIVES: Our primary objective was to evaluate age as a predictor of postanesthesia care unit (PACU) opioid administration in women undergoing reconstructive pelvic surgery. Our secondary objective was to identify additional predictors of PACU opioid administration. METHODS: We conducted a retrospective cohort study of women undergoing outpatient urogynecologic surgery for pelvic organ prolapse and/or stress urinary incontinence between September 2015 to October 2016 at 1 academic medical center...
February 27, 2018: Female Pelvic Medicine & Reconstructive Surgery
Amy Farkas, Michael Steiner, Henry Giles, Kristen Miller
Pulmonary sling is the anatomic variant defined by the aberrant origin of the left pulmonary artery from the right pulmonary artery. This patient presented with a mimic of pulmonary sling as a result of an extremely rare condition, arterial tortuosity syndrome (ATS). The patient was first diagnosed with pulmonary sling on prenatal echocardiogram performed by cardiology. Computed tomography angiography of the chest obtained at birth to evaluate respiratory depression demonstrated ATS. The early detection of ATS has been demonstrated to improve patient outcome...
February 2018: Radiology Case Reports
Xuelei Li, Xu Li, David Saul, Zhen Zhao
We report on 2 different types of left pulmonary artery sling (LPAS), types IA and IIB, diagnosed by fetal magnetic resonance imaging (MRI). We suggest that fetal MRI is an effective tool for accurately diagnosing LPAS and helping guide its perinatal management. Fetal MRI is relatively unaffected by the conditions that limit visualization by echocardiography. When prenatal ultrasound detects either a possible anomalous origin of the left pulmonary artery or a tracheobronchial anomaly, fetal MRI may provide additional information to confirm the LPAS diagnosis and classify its type...
December 2017: Radiology Case Reports
Abigail Shatkin-Margolis, Catrina C Crisp, Christopher Morrison, Rachel N Pauls
OBJECTIVES: An ability to anticipate individuals at increased risk of postoperative pain would improve coordination of care and patient satisfaction. We sought to describe predictive factors of postoperative pain following vaginal reconstructive surgery. METHODS: This institutional review board-approved, retrospective study used previously collected data from research performed at 1 center from 2009 to 2015. Eligible trials enrolled subjects undergoing vaginal reconstructive surgery for pelvic organ prolapse...
March 2018: Female Pelvic Medicine & Reconstructive Surgery
Omar Felipe Dueñas-Garcia, Tania Sierra, Danielle Taylor, Katherine Leung, Cynthia D Hall, Michael K Flynn
OBJECTIVE: To determine the effect of preoperative oral phenazopyridine on postoperative voiding dysfunction in women undergoing a retropubic midurethral sling. METHODS: A single-institution randomized clinical trial was performed from September 2015 to March 2017, comparing 200 mg of oral phenazopyridine versus no phenazopyridine in patients undergoing a retropubic midurethral sling under general anesthesia with no concomitant procedures. A power calculation indicated that we required at least 40 subjects per arm...
March 2018: Female Pelvic Medicine & Reconstructive Surgery
Alex Fuselier, Jordan Hanberry, J Margaret Lovin, Alex Gomelsky
PURPOSE OF REVIEW: Obesity is highly prevalent and is associated with stress urinary incontinence (SUI). The purposes of this review are to assess the pathophysiology of SUI in the obese female and review the outcomes of weight loss and anti-incontinence surgery in this population. RECENT FINDINGS: While increased intra-abdominal pressure appears to be the common pathophysiologic link between obesity and SUI, neurogenic and metabolic pathways have been proposed...
February 22, 2018: Current Urology Reports
Sunday Lengmang, Steven Shephard, Avisek Datta, Svjetlana Lozo, Carolyn V Kirschner
INTRODUCTION AND HYPOTHESIS: For decades, the pubovesical (PV) sling has been in the armamentarium of the fistula surgeon for treating persistent urinary incontinence after successful fistula closure. We report our early experience with slings, and then also introduce a new "tight" PV sling technique for management of post-fistula urethral leak. Our hypothesis is that performance of tight slings might result in improved continence for women with persistent urinary incontinence after obstetric fistula closure...
February 21, 2018: International Urogynecology Journal
Alessandro Mirra, Micaël David Klopfenstein Bregger, Olivier Louis Levionnois
A 15-year-old Selle Francais gelding was presented to the equine referral hospital for treatment of a left guttural pouch mycosis previously diagnosed. After induction, the horse was shortly hoisted by all four feet, moved on a padded surgical table, and positioned in right lateral recumbency. In order to reduce the risk of bleeding during surgical manipulation of the carotid and maxillary arteries, a mean arterial pressure between 60 and 70 mmHg was targeted. After surgery, the horse was moved in a padded recovery box keeping the same lateral recumbency...
2018: Frontiers in Veterinary Science
Lynda Constable, Nikki Cotterill, David Cooper, Cathryn Glazener, Marcus J Drake, Mark Forrest, Chris Harding, Mary Kilonzo, Graeme MacLennan, Kirsty McCormack, Alison McDonald, Anthony Mundy, John Norrie, Robert Pickard, Craig Ramsay, Rebecca Smith, Samantha Wileman, Paul Abrams
BACKGROUND: Stress urinary incontinence (SUI) is a frequent adverse effect for men undergoing prostate surgery. A large proportion (around 8% after radical prostatectomy and 2% after transurethral resection of prostate (TURP)) are left with severe disabling incontinence which adversely effects their quality of life and many are reliant on containment measures such as pads (27% and 6% respectively). Surgery is currently the only option for active management of the problem. The overwhelming majority of surgeries for persistent bothersome SUI involve artificial urinary sphincter (AUS) insertion...
February 21, 2018: Trials
Erika J Wasenda, Anna C Kirby, Emily S Lukacz, Charles W Nager
AIMS: Traditional technology to characterize urethral pressure changes during dynamic conditions is limited by slow response times or artifact-inducing withdrawal maneuvers. The 8F high-resolution manometry (HRM) catheter (ManoScan™ ESO, Covidien) has advantages of fast response times and the ability to measure urethral pressures along the urethral length without withdrawal. Our objective was to determine static and dynamic maximum urethral closure pressures (MUCPs) and resting functional urethral length (FUL) in women using HRM before and after transurethral bulking and compare results to other women who underwent midurethral sling (MUS)...
February 21, 2018: Neurourology and Urodynamics
Connie Wang, Alana L Christie, Philippe E Zimmern
INTRODUCTION: To study the evolution of type of presenting symptoms after mid-urethral sling (MUS) placement relative to the interval between placement and subsequent synthetic sling removal (SSR) for complication(s). METHODS: An IRB-approved, prospectively maintained database of women who underwent SSR was retrospectively reviewed for demographics, interval between MUS placement and SSR, history of chronic pain syndromes and recurrent urinary tract infections (RUTI), anti-incontinence and prolapse repairs, and MUS-related symptoms at presentation, including storage dysfunction, voiding dysfunction, RUTI, vaginal pain, non-vaginal pain, mesh exposure, and urinary incontinence (UI)...
February 21, 2018: Neurourology and Urodynamics
Mehmet Akif Cakmak, Hakan Cinal, Ensar Zafer Barin, Muhammed Sedat Sakat, Harun Karaduman, Onder Tan
Free flaps based on static slings principles cannot provide esthetic and functional outcomes at a desired level in total or close to total lip loss. Therefore, dynamic methods have become a current issue in recent years and especially the idea of functional gracilis free muscle flap has been suggested. In this study, we present a case of a successful total lower lip repair with this flap.In a 78-year-old female patient who was diagnosed with squamous cell carcinoma involving the entire lower lip, bilateral modified radical neck dissection and full-thickness total resection with 1 cm surgical margin so as to include both commissures of the tumor were performed and then a free gracilis muscle flap was transferred from the same side...
February 14, 2018: Journal of Craniofacial Surgery
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