Urogynecology

Commentary to: Prospective comparative study on the effects of lidocaine on urodynamic and sensory parameters in bladder-pain syndrome

Commentary on: "Does spinal anesthesia lead to postoperative urinary retention in same day urogynecology surgery: a retrospective review"

Treatment of subacute rectosigmoid obstruction secondary to uterosacral ligament suspension

The transition from resident to consultant

A live porcine model for robotic sacrocolpopexy training Abstract Introduction and hypothesis Robotic sacrocolpopexy is an effective and durable technique for pelvic organ prolapse repair. However, the learning curve for this procedure has underscored the need for an effective surgical training module. Given the cost, infection risk, poor tissue compliance, and scarcity of human cadavers, the live porcine model represents a realistic, available, and cost-effective alternative. This article describes a live porcine model for teaching robotic sacrocolpopexy to determine whether it teaches key aspects of live human robotic sacrocolpopexy to the learner. Methods This robotic sacrocolpopexy model was created using the Da Vinci Xi or Si robotic system on domestic pigs under general anesthesia. The main steps of the model include: (1) creating the porcine "cervix" and (2) performing robotic sacrocolpopexy. The model was evaluated with a survey given to 18 board-certified surgeons who attended the training course between December 2016 and April 2018. Results All of the participants reported improvements in their economy of motion, tissue handling ability, suturing efficiency, and overall performance of robotic sacrocolpopexy. Furthermore, a majority of participants were likely to incorporate aspects of the model into their practice (88.8%) and recommend the model to colleagues (94.2%). Conclusions The porcine model provides a feasible tool for teaching robotic sacrocolpopexy to physicians.

Impairment of urethral coitus due to mid-urethral sling in a woman with vaginal agenesis

Resident simulation training improves operative time of the retropubic midurethral sling procedure for stress incontinence Abstract Introduction and hypothesis Our aim was to assess whether immediate preoperative resident simulation training decreases operative time and improves resident proficiency when performing a retropubic midurethral sling (MUS) procedure. Methods This prospective cohort study took place over 8 months at the Icahn School of Medicine, New York, USA. During the first 4 months, all retropubic MUS procedures were performed by residents who underwent immediate preoperative simulation training. The cases completed during the following 4 months were performed by residents who had not received preoperative simulation training. During the 8-month period, residents completed self-assessment questionnaires upon completion of the surgery and attendings evaluated the residents using the Objective Structured Assessment of Technical Skills (OSATS) global rating scale. Operative time between the two periods were compared using two-sample Student's t test. Comparative analysis between groups was performed based on the OSATS scores using the Wilcoxon rank-sum nonparametric test. Results There were 22 cases in the simulation group (SG) and 20 in the no simulation group (NSG). SG mean operative time was 12.6 min and NSG mean operative time was 14.6 min (p = 0.12). The SG mean OSATS score was 30.4 versus NSG of 27.8 (p < 0.001). Conclusions This study demonstrates that preoperative simulation significantly improves operative performance of the retropubic MUS procedure among residents and also improves their confidence in the operating room. There was a decrease in mean operative time of 2 min in the SG, but the difference was not statistically significant. This data is consistent in demonstrating improved surgical performance and resident confidence with simulation training.

Total vaginal length: Does it matter for assessing uterine prolapse? Abstract Introduction and hypothesis Using the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) system, uterine prolapse staging requires measurement of total vaginal length (TVL). The aim of this study was to determine whether TVT is a confounder of the relationship between uterine descent and POP symptoms. Methods This is a retrospective study on 721 patients seen in a tertiary urogynaecological unit. All patients had undergone a standardised, in-house, physician-led questionnaire and digital POP-Q examination. Patients with a history of hysterectomy or with a dominant prolapse in the anterior ± posterior compartment were excluded from analysis, leaving 393 complete data sets for analysis. Association between prolapse symptoms (lump/drag) and station of cervix (i.e. C) were tested. Age, body mass index (BMI), menospausal status and vaginal parity were tested as potential confounders. Variables that were significant on binary logistic regression (P < 0.05) were included in a model for receiver operting characteristic (ROC) statistical analysis. This was repeated after adding TVL to the model. Likelihood ratio test was performed to compare models. Results On binary logistic regression, prolapse symptoms were significantly associated with C, menopausal status and TVL (all P < 0.03). ROC analysis yielded an area under the curve (AUC) of 0.75 with menopausal status and C in the model. Adding TVL yielded an AUC of 0.773. The difference is statistically significant on the likelihood ratio test (P < 0.001). Conclusions Adding TVL improved the performance of cervical station in predicting prolapse symptoms, validating the practice of using TVL in staging uterine prolapse.

A multipurpose uterine/vaginal manipulator for laparoscopic urogynecologic procedures Abstract Introduction and hypothesis The use of an appropriate uterine manipulator is key to various laparoscopic gynecologic procedures. Adequate uterine manipulation is important for total or supracervical laparoscopic hysterectomies, laparoscopic sacrocolpopexy as well as laparoscopic repair of vaginal vault prolapse. While several uterine manipulators are available to choose from, their use may be specific to certain procedures and their cost may vary as well. Methods This video aims to provide an introduction to a multipurpose, reusable uterine/vaginal manipulator that can be used for laparoscopic supracervical hysterectomy, laparoscopic sacrocolpopexy, laparoscopic hysteropexy as well as laparoscopic repair of vaginal vault prolapse. Results The video highlights the user-friendly, easy-to-clean, reusable, multipurpose uterine/vaginal manipulator. Conclusions The manipulator is designed for an efficient combination of laparoscopic urogynecologic procedures and supracervical hysterectomy.

National BSUG audit of stress urinary incontinence surgery in England Abstract Introduction and hypothesis The aim of the British Society of Urogynaecology (BSUG) 2013 audit for stress urinary incontinence (SUI) surgery was to conduct a national clinical audit looking at the intra- and postoperative complications and provide outcomes for these procedures. This audit was supported by the Healthcare Quality Improvement Partnership (HQIP) and National Health Service (NHS) England. Methods Data were collected for all continence procedures performed in 2013 through the BSUG database. All clinicians in England performing SUI surgery were invited to submit data to a central database. Outcomes data for the different continence procedures were collected and included intraoperative and postoperative complications and the change in continence scores at postoperative follow-up Changing trends in stress incontinence surgery were also assessed. Results We recorded 4993 urinary incontinence procedures from 177 consultants at 110 centres in England: 94.6% were midurethral slings; 86.7% (4331) were submitted by BSUG members with the remaining 13.3% submitted by non-BSUG members. Postoperative follow-up data were available for 3983 (80%) patients: 92.3% (3676) were very much better/much better postoperatively, and 4806 (96.3%) proceeded with no reported complications. There were 187 cases (3.7%) in which a perioperative complication was recorded. Pain persisting >30 days was reported in 1.9% of all patients. Conclusions Surgery for SUI has good outcomes in the short term. Midurethral synthetic slings have been shown to be safe and effective as a treatment option, with >90% being very much/much better at their postoperative follow-up.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com