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The Journal of Urology Jun 2018We studied correlations between sonographic and urodynamic findings after suburethral sling surgery.
PURPOSE
We studied correlations between sonographic and urodynamic findings after suburethral sling surgery.
MATERIALS AND METHODS
This retrospective study was done in 141 women who underwent multichannel urodynamic testing and translabial 4-dimensional ultrasound after suburethral sling surgery between 2006 and 2016. We determined the sling-pubis gap, ie the distance between the sling and the inferior posterior margin of the pubic symphysis, during the Valsalva maneuver and the urethral motion profile. The latter was assessed by calculating the mobility vectors of 6 equidistant points along the length of the urethra from the bladder neck to the external urethral meatus against the dorsocaudal margin of the pubic symphysis during the Valsalva maneuver. Correlations were determined between the sling-pubis gap and the mobility vectors, and between these measures and urodynamic data.
RESULTS
Median followup in the 126 women with complete data was 36 months. Significant correlations were found between the sling-pubis gap and the mid urethral mobility vectors (all p <0.02). The sling-pubis gap and the mid urethral mobility vectors negatively correlated with detrusor pressure at maximum flow (p = 0.037 and 0.004, respectively). Urodynamic stress incontinence was more likely in women with a greater sling-pubis gap (p = 0.003).
CONCLUSIONS
The tighter the sling on ultrasound, the less likely is urodynamic stress incontinence and the higher the detrusor pressure during voiding.
Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Middle Aged; Pelvic Organ Prolapse; Postoperative Complications; Retrospective Studies; Suburethral Slings; Treatment Outcome; Ultrasonography; Urethra; Urinary Incontinence, Stress; Urodynamics; Urologic Surgical Procedures
PubMed: 29288123
DOI: 10.1016/j.juro.2017.12.046 -
Journal of Forensic Sciences Jan 2022Suchey-Brooks method has been studied many times with varying reports of accuracy and reliability. A systematic review and meta-analyses were utilized to quantitatively... (Meta-Analysis)
Meta-Analysis
Suchey-Brooks method has been studied many times with varying reports of accuracy and reliability. A systematic review and meta-analyses were utilized to quantitatively determine the accuracy and reliability of the Suchey-Brooks (S-B) method. A systematic search of PubMed and EBSCO health and medical databases was performed. Meta-analyses were performed to quantify the relationship between actual known age at death and the S-B method using Spearman's Rho and Pearson's r for (1) combined males and females estimates, (2) male-only estimates, and (3) female-only estimates. Overall correlation coefficient using Cohen's kappa, Spearman's Rho, and Pearson's r was also calculated to determine the interrater and intrarater reliability using the S-B method. Eighteen studies classified as moderate-to-high methodological quality met the inclusion criteria. The sample sizes were different for the combined male and female (n = 2620), male-only (n = 2602), and female-only (n = 1431) meta-analyses. The effect size of the age at death meta-analyses was large and significant for combined males and females (Spearman's Rho = 0.62; Pearson's r = 0.65), male-only (Spearman's Rho = 0.77; Pearson's r = 0.75), and female-only (Spearman's Rho = 0.71; Pearson's r = 0.71). The overall correlation coefficients of the interrater (Kappa = 0.76; Spearman's Rho = 0.73; Pearson's r = 0.80) and intrarater (Kappa = 0.81; Spearman's Rho = 0.91; Pearson's r = 0.83) reliability meta-analyses were large and significant. A significant degree of heterogeneity was present in all meta-analyses, with minimal evidence of publication bias. The meta-analyses results suggest the S-B method is highly reliable with a moderate-to-high degree of accuracy. Our results also identified sample size and accuracy differences between male and female individuals.
Topics: Age Determination by Skeleton; Female; Humans; Male; Pubic Symphysis; Reproducibility of Results
PubMed: 34617597
DOI: 10.1111/1556-4029.14911 -
Injury 2015During spontaneous vaginal delivery, pubic symphyseal widening is normal. Common changes are reversible after complication-free birth. However, cases of peripartum... (Review)
Review
BACKGROUND
During spontaneous vaginal delivery, pubic symphyseal widening is normal. Common changes are reversible after complication-free birth. However, cases of peripartum symphysis separation are rare. There is no consensus in the literature on how to treat pregnancy-related pubic symphysis separation.
METHODS
This review used a literature-based search (PubMed, 1900-2013) and analysis of 2 own case reports. Studies with conclusions regarding management were particularly considered.
RESULTS
Characteristic symptoms, suprapubic pain and tenderness radiating to the posterior pelvic girdle or lower back, may be noted 48 h after delivery. Pain on movement, especially walking or climbing stairs, is often present. Conservative treatments, such as a pelvic brace with physiotherapy and local interventions such as infiltration, are successful in most cases. Symptom reduction within 6 weeks is the most common outcome, but can take up to 6 months in some cases. Surgical intervention is needed in cases of persistent separation. Anterior plate fixation is offered as a well-known and safe procedure. Minimally invasive SI joint screw fixation is required in cases of combined posterior pelvic girdle lesions.
SUMMARY
Postpartum symphyseal rupture can be indicated with the rare occurrence of pelvic pain post-delivery, with sciatica or lumbago and decreased mobility. The diagnosis is made on clinical findings, as well as radiographs of the pelvic girdle. Conservative treatment with a pelvic brace is the gold standard in pre- and postpartum cases of symphysis dysfunction.
Topics: Adult; Bone Screws; Delivery, Obstetric; Female; Fracture Fixation, Internal; Humans; Infant, Newborn; Obstetric Labor Complications; Peripartum Period; Pregnancy; Pubic Symphysis; Pubic Symphysis Diastasis; Risk Factors; Treatment Outcome
PubMed: 25816704
DOI: 10.1016/j.injury.2015.02.030 -
Orthopaedic Journal of Sports Medicine Feb 2022The cleft sign (CS) and bone marrow edema (BME) are considered magnetic resonance imaging (MRI) findings signifying a pubic pathology, which is associated with groin...
BACKGROUND
The cleft sign (CS) and bone marrow edema (BME) are considered magnetic resonance imaging (MRI) findings signifying a pubic pathology, which is associated with groin pain; however, their relationship with bony morphology related to femoroacetabular impingement (FAI) has not been established.
PURPOSE
To investigate the prevalence of CS and BME in symptomatic patients with acetabular labral tears and assess their possible association with bone morphology and sport-specific activities.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
This study enrolled 418 patients (469 hips) undergoing hip arthroscopic surgery for labral tears. Also included were patients with labral tears in the setting of either hip dysplasia or borderline hip dysplasia who were undergoing endoscopic shelf acetabuloplasty combined with hip arthroscopic labral repair, cam osteoplasty, and capsular plication. All patients were screened for superior CS (SCS), inferior CS (ICS), and BME of the ipsilateral side of the pubis using 3-T MRI. We measured the following angles: lateral center edge (LCE), Sharp, Tönnis, vertical-central-anterior, and alpha. Then, we evaluated the relationship between patient characteristics and abnormal findings on MRI scans (preoperatively vs 1 year postoperatively).
RESULTS
An overall 397 hips were included: 200 in men and 197 in women (mean ± SD age, 35.3 ± 16.0 years). There were hips in 214 athletes (53.9%) and hips in 183 nonathletes (46.1%). MRI findings revealed SCS, ICS, and BME in 18 (4.5%), 13 (3.3%), and 34 hips (8.6%), respectively. Abnormal MRI findings at the pubis were seen more often in athletes than nonathletes (23.8% vs 3.3%), and contact sports athletes had the most frequent abnormalities. There was no SCS in patients with an LCE angle <22°. SCS was more frequently seen in those who had an alpha angle ≥71°. More than 60% of abnormal findings at the pubis diminished after arthroscopic surgery that included FAI correction and labral repair.
CONCLUSION
In patients with labral tears, CS and BME were seen more frequently in athletes versus nonathletes, especially contact athletes with FAI-related bony abnormalities. More than 60% of abnormal MRI pubis findings resolved after arthroscopic treatment of FAI.
PubMed: 35141338
DOI: 10.1177/23259671211068477 -
Journal of Forensic Sciences Jul 2016This research assessed whether parity has a differential effect on age indicators of the pelvis. The data were collected from the William M. Bass Donated Skeletal...
This research assessed whether parity has a differential effect on age indicators of the pelvis. The data were collected from the William M. Bass Donated Skeletal Collection. Age indicators of the pubic symphysis and auricular surface were assessed using the Todd, Suchey-Brooks, Lovejoy et al., and Buckberry and Chamberlain scoring systems. A transition analysis was conducted, and scoring systems of the pubic symphysis showed the parous female group transitioning between eight and 14 years earlier than the nulliparous female and male groups, and 1 and 7 years earlier using the auricular surface methods. A likelihood ratio test produced significantly different results between parous and nulliparous females using the pubic symphysis (p < 0.01) but not the auricular surface (p > 0.05). Although parous females were inaccurately assessed more often than nulliparous females, no correction of methods is necessary at this time as current standards take parity into account by utilizing a lumped female sample.
Topics: Adolescent; Adult; Age Determination by Skeleton; Female; Forensic Anthropology; Humans; Male; Middle Aged; Parity; Pelvis; Pubic Symphysis; Young Adult
PubMed: 27364285
DOI: 10.1111/1556-4029.13085 -
Journal of Orthopaedic Trauma Apr 2021Examine factors associated with fixation failure in patients treated with superior intramedullary ramus screws.
OBJECTIVE
Examine factors associated with fixation failure in patients treated with superior intramedullary ramus screws.
DESIGN
Retrospective.
SETTING
Single, Level 1 trauma center.
PATIENTS
Unstable pelvic ring fractures amenable fixation that included superior intramedullary ramus screws.
INTERVENTION
Percutaneously inserted intramedullary superior ramus screw fixation of superior pubic ramus (SPR) fractures.
MAIN OUTCOME MEASUREMENTS
Loss of reduction (LOR) of the SPR fracture defined as >2 mm displacement on pelvic radiographs at any time point in follow-up.
RESULTS
Two hundred eighty-five fractures in 211 patients (age 44, 95% confidence interval 40.8%-46.4%, 59.3% women, 55.1% retrograde screws) were included in the analysis. 14 (4.9%) of fractures had LOR. Patients were significantly more likely to have LOR as age increased (P = 0.01), body mass index (BMI) increased (P = 0.01), and if they were women (P < 0.01). There was a significantly decreased LOR (P < 0.01) as fractures moved further from the pubis symphysis. Retrograde screws were significantly (P < 0.01) more likely to have LOR. In SPR fractures treated with retrograde screws, failure was significantly associated with increasing BMI (P = 0.02), the presence of an inferior ramus fracture (P = 0.02), and trended toward significance with increasing age (P = 0.06), and decreased distance from the symphysis (P = 0.07).
CONCLUSIONS
Superior ramus screws are associated with a low failure rate (4.9%), which is lower than previously reported. Retrograde screw insertion, distance from the symphysis, increasing age, increasing BMI, decreased distance from the symphysis, and ipsilateral inferior ramus fractures were predictors of failure. In these patients, alternative modalities should be considered, although low rates of failure can still be expected.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Adult; Bone Screws; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Middle Aged; Pelvic Bones; Pubic Bone; Retrospective Studies
PubMed: 33727521
DOI: 10.1097/BOT.0000000000001973 -
The Cochrane Database of Systematic... Sep 2015Symphysis fundal height (SFH) measurement is commonly practiced primarily to detect fetal intrauterine growth restriction (IUGR). Undiagnosed IUGR may lead to fetal... (Review)
Review
BACKGROUND
Symphysis fundal height (SFH) measurement is commonly practiced primarily to detect fetal intrauterine growth restriction (IUGR). Undiagnosed IUGR may lead to fetal death as well as increase perinatal mortality and morbidity.
OBJECTIVES
The objective of this review is to compare SFH measurement with serial ultrasound measurement of fetal parameters or clinical palpation to detect abnormal fetal growth (IUGR and large-for-gestational age), and improving perinatal outcome.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 July 2015) and reference lists of retrieved articles.
SELECTION CRITERIA
Randomised controlled trials including quasi-randomised and cluster-randomised trials involving pregnant women with singleton fetuses at 20 weeks' gestation and above comparing tape measurement of SFH with serial ultrasound measurement of fetal parameters or clinical palpation using anatomical landmarks.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
MAIN RESULTS
One trial involving 1639 women was included. It compared SFH measurement with clinical abdominal palpation.There was no difference in the two reported primary outcomes of incidence of small-for-gestational age (risk ratio (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.90, low quality evidence) or perinatal death.(RR 1.25, 95% CI 0.38 to 4.07; participants = 1639, low quality evidence). There were no data on the neonatal detection of large-for-gestational age (variously defined by authors). There was no difference in the reported secondary outcomes of neonatal hypoglycaemia, admission to neonatal nursery, admission to the neonatal nursery for IUGR (low quality evidence), induction of labour and caesarean section (very low quality evidence). The trial did not address the other outcomes specified in the 'Summary of findings' table (intrauterine death; neurodevelopmental outcome in childhood). GRADEpro software was used to assess the quality of evidence, downgrading of evidence was based on including a small single study with unclear risk of bias and a wide confidence interval crossing the line of no effect.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine whether SFH measurement is effective in detecting IUGR. We cannot therefore recommended any change of current practice. Further trials are needed.
Topics: Abdomen; Female; Fetal Growth Retardation; Humans; Palpation; Pregnancy; Pubic Symphysis; Randomized Controlled Trials as Topic; Ultrasonography, Prenatal; Uterus
PubMed: 26346107
DOI: 10.1002/14651858.CD008136.pub3 -
OTA International : the Open Access... Dec 2022To compare the stability of screw fixation with that of plate fixation for symphyseal injuries in a vertically unstable pelvic injury (AO/Tile 61-C1) associated with...
To compare the stability of screw fixation with that of plate fixation for symphyseal injuries in a vertically unstable pelvic injury (AO/Tile 61-C1) associated with complete disruption of the sacroiliac joint and the pubic symphysis. Eight fourth-generation composite pelvis models with sacroiliac and pubic symphyseal disruption (Sawbones, Vashon Island, WA) underwent biomechanical testing simulating static single-leg stance. Four were fixed anteriorly with a symphyseal screw, and 4 with a symphyseal plate. All had single transsacral screw fixation posteriorly. Displacement and rotation were monitored at both sacroiliac joint and pubic symphysis. There was no significant difference between the 2 groups for mean maximum force generated. There was no significant difference in net displacement at both sacroiliac joint and pubic symphysis. There was significantly less rotation but more displacement in the screw group in the -axis. The screw group showed increased stiffness compared with the plate group. This is the first biomechanical study to compare screw versus plate symphyseal fixation in a Tile C model. Our biomechanical model using anterior and posterior fixation demonstrates that symphyseal screws may be a viable alternative to classically described symphyseal plating.
PubMed: 36569108
DOI: 10.1097/OI9.0000000000000215 -
Archives of Orthopaedic and Trauma... Apr 2023Open reduction and internal fixation with plates is the most widespread surgery in traumatic pubic symphysis diastasis. However, implant failure or recurrent diastasis...
INTRODUCTION
Open reduction and internal fixation with plates is the most widespread surgery in traumatic pubic symphysis diastasis. However, implant failure or recurrent diastasis was commonly observed during follow-up. The aim of our study was to evaluate the radiologic findings and clinical outcomes.
MATERIALS AND METHODS
Sixty-five patients with traumatic pubic symphysis diastasis treated with plating between 2008 and 2019 were retrospectively reviewed. The exclusion criteria were a history of malignancy and age under 20 years. Radiographic outcomes were determined by radiograph findings, including pubic symphysis distance (PSD) and implant failure. Clinical outcomes were assessed according to the Majeed score at the final follow-up.
RESULTS
Twenty-eight patients were finally included. Nine patients (32%) experienced implant failure, including four (14%) with screw loosening and five (18%) with plate breakage. Only one patient underwent revision surgery. Postoperatively, a significant increase in PSD was observed at 3 months and 6 months. Postoperative PSD was not significantly different between patients with single plating and double plating, but it was significantly greater in the implant-failure group than in the non-failure group. The Majeed score was similar between patients with single plating and double plating or between the implant-failure group and the non-failure group. Body mass index, number of plates, age, and initial injured PSD were not significantly different between the implant-failure group and the non-failure group. Only a significant male predominance was observed in the implant-failure group.
CONCLUSION
A gradual increase in the symphysis distance and a high possibility of implant failure may be the distinguishing features of traumatic pubic symphysis diastasis fixation. The postoperative symphyseal distance achieved stability after 6 months, even after implant failure. Radiographic outcomes, such as increased symphysis distance, screw loosening, and plate breakage, did not affect clinical functional outcomes.
Topics: Female; Humans; Male; Young Adult; Adult; Pubic Symphysis Diastasis; Retrospective Studies; Fracture Fixation, Internal; Pubic Symphysis; Bone Plates
PubMed: 35278092
DOI: 10.1007/s00402-022-04411-7 -
Journal of Orthopaedic Trauma Jun 2021The iliopectineal fascia (IPF) serves as an important anatomical compass during the ilioinguinal and anterior intrapelvic approaches. The purpose of this investigation...
OBJECTIVES
The iliopectineal fascia (IPF) serves as an important anatomical compass during the ilioinguinal and anterior intrapelvic approaches. The purpose of this investigation is to qualitatively and quantitatively describe the IPF by cadaveric dissection.
METHODS
Dissections were performed on 7 paired fresh-frozen cadaveric pelvic specimens. Measurements were made with surgical rulers to determine attachments of the IPF relative to surrounding anatomy.
RESULTS
The IPF is the thickened anterior portion of the iliopsoas fascia, attached superolaterally at the iliac crest for a mean insertion distance of 2.5 cm (range, 2.0-3.0 cm), immediately posterior to the origin of the inguinal ligament. Inferomedially, the IPF attaches to a bony ridge along the apex of the iliopectineal eminence, between the pelvic brim posteriorly and the anterior wall of the acetabulum anteriorly (mean distance, 4.3 cm; range, 3.1-5.6 cm). The attachment at the iliopectineal eminence is 7.8 cm (range, 6.0-10.0 cm) from the pubic symphysis, measured curvilinearly along the brim. The mean length of the IPF between its superolateral and inferomedial attachments is 9.2 cm (range, 8.0-11.8 cm). Anterolaterally, the IPF is the site of attachment of the internal oblique and transversus abdominis. Posteriorly, the IPF continues as the iliopsoas fascia.
CONCLUSIONS
The authors have sought clarity and reconciliation of the myriad terms and descriptions of the IPF and its surrounding anatomy. We recommend a thorough understanding of this anatomy to enable safe and effective surgery via the ilioinguinal and anterior intrapelvic approaches to the acetabulum.
Topics: Acetabulum; Cadaver; Fascia; Humans; Pelvis; Pubic Symphysis
PubMed: 33093295
DOI: 10.1097/BOT.0000000000001995