0000000000207950
AUTHOR
Stefan Albrich
Detection of Subpubic Tumor Causing Bladder Outlet Obstruction by 3D Perineal Ultrasound
This case report shows that 3D perineal ultrasound can be superior to clinical examination and routine 2D perineal ultrasound in the detection of an unusual subpubic tumor. A 73-year-old female patient was referred to our urogynecological outpatient unit complaining of over-active bladder symptoms and voiding dysfunction for 3 years. Gynecological examination found no signs of pelvic organ prolapse or abnormality in the vaginal cavity. Routine 2D perineal ultrasound showed substantial residual urine (ca. 300 ml on catheter) and limited bladder neck mobility, but no signs of pelvic organ prolapse. Use of standardized 3D perineal ultrasound revealed a 24 × 26 × 32 mm spherical, hypoechoic tum…
Changes in sexual function and quality of life after single-incision mid-urethral sling for treatment of female stress urinary incontinence.
Abstract Objectives To evaluate the effectiveness and assess the changes in sexual function and quality of life after placement of a single-incision sling for the treatment of female stress urinary incontinence. Study design A prospective study of women diagnosed with stress urinary incontinence. The single-incision sling was implanted and patients were followed postoperatively for 6 months. The postoperative rate of continence, complications, changes in sexual function, and patient-reported quality of life were evaluated. Female Sexual Function in sexually active patients was evaluated before and after the single-incision sling procedure using the Female Sexual Function Index. From January…
Isolation of fibroblasts for coating of meshes for reconstructive surgery: differences between mesh types.
Aims: An extensive colonization of surgical meshes with autologous fibroblasts may reduce complications. Therefore, we aimed to establish a technique that allows isolation and propagation of fibroblasts from vaginal biopsies. Using these cells we tested the applicability of several clinically applied meshes for fibroblast coating. Materials & methods: Fibroblasts were isolated from vaginal tissue after digestion with collagenase. Characterization was performed by immunostaining for cytokeratin 5, 6 and 14, smooth muscle actin and vimentin. A semiquantitative technique was applied to determine the degree of mesh coating 5 h and 5 weeks after seeding of fibroblasts. Seven meshes of diffe…
Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period
Please cite this paper as: Albrich S, Laterza R, Skala C, Salvatore S, Koelbl H, Naumann G. Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period. BJOG 2012;119:51–61. Objective To evaluate morphology and integrity of the levator ani muscle (LAM) with three-dimensional ultrasound early in the postpartum period. Design Prospective cross-sectional observational study. Setting University hospital in Germany. Population Women after vaginal delivery and caesarean section with no previous vaginal delivery. Methods Three-dimensional perineal ultrasound was performed between 48 and 72 hours postpartu…
Prevalence of Levator Ani Defects in Urogynecological Patients
Introduction: Defects of the levator ani muscle complex could represent a pathophysiological link between vaginal birth trauma and urogynecological symptoms many years later. The aim of our study was to determine the prevalence of levator ani muscle defects using 3D or 4D ultrasound and palpation in urogynecological patients. Material and Methods: Urogynecological patients were retrospectively investigated using 3D or 4D ultrasound. Clinical examination consisted of palpation and 3D or 4D imaging of the levator ani muscle. Results: A total of 319 women were included in the analysis. Mean age was 64.9 years, average parity was 2.1. Stress incontinence was present in 50.8 %, overactive bladde…
Measurement of subpubic arch angle by three-dimensional transperineal ultrasound and impact on vaginal delivery
Objectives To assess whether antepartum measurement of the subpubic arch angle (SPAA) as a parameter of the bony pelvic outlet can predict vaginal delivery. Methods Between January 2007 and June 2011, 625 nulliparous women with a singleton pregnancy were recruited from the antenatal clinic to be interviewed and have a four-dimensional transperineal ultrasound examination. Ultrasound examinations were performed between 34 and 36 weeks of gestation. Volume ultrasound data were saved for offline analysis, blinded against all other data. The SPAA was measured in the axial plane and logistic regression analysis was used to examine the association between SPAA and outcomes of vaginal delivery vs …
The effect of hormonal status on the expression of estrogen and progesterone receptor in vaginal wall and periurethral tissue in urogynecological patients
Abstract Objective Our objective was to study the expression of estrogen receptor (ER) isoforms ER alpha (α) and ER beta (β) and of progesterone receptor (PR) in the vaginal wall and in periurethral tissue of women who underwent urogynecological surgical treatment with reference to estrogen status. Study design The study included 89 patients undergoing vaginal surgery for urogynecological conditions. Patients’ history and clinical data including estrogen status and body mass index (BMI) were evaluated. Biopsies from the vaginal wall and from periurethral tissue were obtained during surgery. The expression of ER α and β and of PR in vaginal wall and periurethral tissue was measured by RT-PCR…
Mesh complications following prolapse surgery: management and outcome.
Abstract Objective This is a description of complications following prolapse surgery with the use of alloplastic materials, the management and outcome. Study design 54 women have been referred to Mainz, urogynecology referral center due to complications following mesh-augmented prolapse surgery. Results The complaints who lead to the admission are expressed by the new terminology and standardized classification for complications arising directly from the insertion of prostheses and grafts in female pelvic floor surgery [1] . Pain (66.7%), mesh erosion (55.6%) and vaginal discharge (48.1%) were the most frequent complaints. Revision was performed after a median time of 27.2 months post mesh …
Die Messung des infrapubischen Winkels in der 3-D-Perineal-Sonografie und seine Beziehung zu geburtshilflichen Parametern
Ziel: Die 3-D-Sonografie bietet einige Vorteile gegenuber der 2-D-Sonografie in der Urogynakologie. Neben den Weichteil-Strukturen ermoglicht die Darstellung der axialen Ebene die Identifikation des Levators und der Symphyse. Ziel dieser Arbeit war es, eine genaue Messung des infrapubischen Winkels sowie des Symphysenspalts durch Rotations-Anpassung zu beschreiben und die Inter-Observer-Variabilitat zu bestimmen. Zusatzlich wurden die Korrelationen des infrapubischen Winkels mit dem Auftreten von Levator-Defekten und der Dauer der Austreibungsperiode untersucht. Material und Methoden: Am 2. bis 3. Tag postpartal nach Vaginalgeburt wurde eine 3-D-Sonografie durchgefuhrt. Die Auswertung erfol…
Quality of life and adjuvant tamoxifen treatment in breast cancer patients
About two-thirds of all breast cancer patients are treated with adjuvant hormonal therapy. Side effects of tamoxifen and their effects on physical, emotional and social functioning have been shown to impair the quality of life. Aim of this paper was to evaluate the side effects and level of influence on the physical, emotional and social functioning caused by tamoxifen treatment. For assessment of quality of life an own questionnaire was designed. Between January 2001 and December 2003, 136 women with breast cancer and adjuvant tamoxifen therapy were included in this study. Data of side effects, physical and mental health and patients' self-evaluation identified detrimental effects on patie…
Complications following the use of alloplastic materials in urogynecological surgery
Abstract Study design 118 patients, who were admitted from 2005 to 2008 to our department due to complications following mesh implantation, were included in a retrospective survey. We investigated patient symptoms, findings and subsequent patient management. There was a re-evaluation of symptoms in a follow-up eight weeks after the revision procedure. Data from our urogynecological file archive were used. Results The main complaints were de novo urgency, pain and recurrent urinary tract infections. The main findings were mesh erosion and infections including abscess formations and osteomyelitis. Before being admitted to our department, 42 patients (35.6%) had already undergone at least one …
Patient goals after incontinence procedures: does the single-incision sling satisfy them?
Abstract Objective This study was undertaken to describe short-term postoperative achievement of subjective preoperative goals for single-incision MiniArc slings, in comparison with tension-free vaginal tape (TVT). Method Patients submitted to mid-urethral sling (TVT and MiniArc) procedures for stress urinary incontinence (SUI) in two centers were included in this prospective study. Before surgery, the patients completed a preoperative open-ended questionnaire, in which they described their personal outcomes goals for SUI surgery and the degree of severity of their symptoms. At the first postoperative check, they were asked to assess the degree to which their goals had been met and the degr…