Abstract:

Sacral colpopexy is often chosen as a reliable approach that effectively resolves vaginal vault prolapse. Advancements in minimally invasive technology, robotic and laparoscopic surgery, have helped facilitate surgical dissection and operation when performing this procedure. An increased presacral thickness can potentially present a surgical challenge when operating in the presacral space. We hypothesize that there is a correlation between body mass index and presacral thickness. Computed Tomography (CT) images of 241 patients were reviewed in this retrospective study. The presacral thickness was measured by taking the cross sectional distance from the sacral promontory to the upper aspect of the iliac arteries. The corresponding demographic information of age, body mass index (BMI), and comorbidities were evaluated using univariate analysis, linear regression, and multiple regression analysis. The mean age was 56.6 years, and BMI was 27.6. The mean presacral thickness measurement based on the CT scan was 21.08 mm. Univariate linear regression models demonstrated a positive correlation between presacral thickness and BMI and a negative correlation with age. When adjusting for both age and BMI on multivariate analysis, a positive correlation with hypertension was found. The surgeon should be aware of this potential change in anatomy when operating in the presacral space.

Authors:

Anubhav Agrawal, MD, Fellow in Female Pelvic Medicine and Reconstructive Surgery, University of Louisville, Louisville, Kentucky, Aly Abayazeed, MD, Radiology Resident, University of Louisville, Louisville, Kentucky, Sean Lamar Francis, MD, FACOG, FPMRS, Associate Professor of Obstetrics and Gynecology, University of Louisville, Louisville Kentucky, Jocelyn Tolentino, MD, Obstetrics/Gynecology Resident, State University of New York Downstate Medical Center, Brooklyn, New York, Donald R. Ostergard, MD, FACOG, Professor of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California, Albert Seow, MD, FACR, Associate Professor of Radiology, University of Louisville, Louisville, Kentucky, Eric Van Bogaert, MD, Radiology Resident, University of Louisville, Louisville, Kentucky, Timothy Rose, BS, Computed Tomography Supervisor, Department of Radiology, University of Louisville, Louisville, Kentucky, Nicolette Elizabeth Deveneau, MD, FACOG, Fellow in Female Pelvic Medicine and, Reconstructive Surgery, University of Louisville, Louisville, Kentucky, Ali Azadi, MD, MSc, FACOG, FPRMS, Assistant Professor of Obstetrics and Gynecology, University of Louisville, Norton Women’s Specialist, Louisville, Kentucky

For Direct IP Access please click this link

Abstract:

Polypropylene mesh has been shown to shrink up to 50%; however, little is known about other changes that may occur while it is implanted. It is unclear whether such changes have clinical impact; nonetheless, knowledge of such can ultimately affect the technique of implantation and may affect outcomes. The objective of this study was to evaluate surgically explanted mesh after two years implantation for evidence of change in morphology using scanning electron microscopy (SEM). Secondly, we describe a novel technique for quantifying such changes with intentions for future validation. SEM imaging was conducted and mesh changes were visualized. SEM images revealed deep surface cracks both transverse and longitudinal, flaking and peeling of fibers, as well as fibrosis. Microstructural quantification of cracks was also completed. The fraction of transverse cracked area to whole surface area was 24.2%. Average crack length range was 0.58 to 71.46 µm and average crack thickness range was 0.99 to 25.46 µm. Polypropylene mesh is subject to structural changes after surgical implantation. It is important to investigate how these processes impact clinical outcomes. Validated techniques of quantifying such changes can prove useful in future research and aid in development of the ideal graft.

Authors:

Ali Azadi, MD, MSc, Assistant Professor, Norton Women's Specialists – Urogynecology, Norton Health Care, Louisville, Kentucky, Sourav S. Patnaik, PhD, Research Assistant, Department of Biological Engineering, Mississippi State University, Mississippi State, Mississippi, Jacek B. Jasinski, PhD, Research Scientist, Conn Center for Renewable Energy Research, University of Louisville, Louisville, Kentucky, Sean L. Francis, MD, Associate Professor, Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Louisville, Kentucky, Zhenmin Lei, PhD, Associate Professor, Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Louisville, Kentucky, Jun Liao, PhD, Associate Professor, Department of Biological Engineering, Mississippi State University, Mississippi State, Mississippi, Nicolette E. Deveneau, MD, Fellow of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Louisville, Kentucky, Donald R. Ostergard, MD, Professor-in-Residence, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California Los Angeles School of Medicine – Harbor, Torrance, California

For Direct IP Access please click this link

Abstract:

The aim of this study is to introduce a new, safe, tension-free vaginal tape (TVT) trocar. Twenty-eight women with stress urinary incontinence who underwent a TVT procedure with a new trocar during a 6-month period were prospectively enrolled in this study. All the operations were performed by the same surgeon who developed the trocar. The trocar has two buttons, which make the tip of the device sharp or blunt. Median age of the study population was 52 years (range, 30–76 years), median number of vaginal deliveries was 3 (range, 1–10). And 57.1% of women were at menopause. Median body mass index was 30.0 kg/m² (range, 23.8–35.2 kg/m²). Preoperative median Valsalva leak point pressure was 78 cmH2O (range, 50–94 cmH2O), while the median maximum urethral closure pressure was 50 cmH2O (range, 14–74 cmH2O). Concomitant prolapse surgery was present in 23 women (82.1%). At the 6-month postoperative visit, objective and subjective cure rates were 89.3% for each. No serious intraopeartive or postoperative complication such as bladder, intestine, or major vessel injury occured. Only 3 women (10.7%) needed blood transfusion, and 2 women (7.1%) had postoperative voiding difficulty. Due to the modifiable tip, this new sling trocar seems safer than the conventional trocars. But large studies are necessary to prove this assumption.

Authors:

Orhan Seyfi Aksakal, MD, Associate Professor, Director of Urogynecology, Mahmut Kuntay Kokanali, MD, Gynecologist, Sabri Cavkaytar, MD, Gynecologist, Melike Doganay, MD, Associate Professor, Chief of Gynecology, Department of Gynecology, Ankara Dr Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey

For Direct IP Access please click this link