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Radiologie (Heidelberg, Germany) Nov 2023Pelvic organ prolapse is a common condition in women, for which both conservative and surgical interventions are available. Knowledge of the different surgical... (Review)
Review
CLINICAL/METHODICAL ISSUE
Pelvic organ prolapse is a common condition in women, for which both conservative and surgical interventions are available. Knowledge of the different surgical procedures and the materials used is essential for adequate radiological diagnosis after prolapse surgery in order to differentiate potential complications from normal postoperative changes.
STANDARD RADIOLOGICAL METHODS
In the immediate postoperative period, computed tomography (CT) is often the modality of choice for evaluating acute complications such as bleeding or organ injuries. Magnetic resonance imaging (MRI) provides excellent soft tissue contrast and is therefore generally preferred for assessing subacute and chronic complications.
METHODICAL INNOVATIONS
Innovative techniques such as dynamic MRI protocols can improve the radiological assessment after prolapse surgery by enabling the evaluation of organ mobility.
PERFORMANCE
Radiological standard procedures such as computed tomography (CT) and MRI provide detailed and reliable information about the postoperative site and potential complications following prolapse surgery.
ACHIEVEMENTS
Radiological imaging plays an important role in the evaluation of patients after prolapse surgery, particularly when complications are suspected. Accurate radiological diagnosis can guide further appropriate therapeutic measures.
Topics: Humans; Female; Pelvic Organ Prolapse; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 37698652
DOI: 10.1007/s00117-023-01203-x -
Frontiers in Surgery 2024
PubMed: 38375410
DOI: 10.3389/fsurg.2024.1363416 -
Obstetrics & Gynecology Science Nov 2023This review aimed to summarize the complications and surgical outcomes of robot-assisted sacrocolpopexy. Nineteen original articles on 1,440 robotic sacrocolpopexies...
This review aimed to summarize the complications and surgical outcomes of robot-assisted sacrocolpopexy. Nineteen original articles on 1,440 robotic sacrocolpopexies were reviewed, and three systematic reviews and meta-analyses were summarized in terms of intraoperative, perioperative, postoperative, and/or surgical outcomes. Robotic sacrocolpopexy has demonstrated low overall complication rates and favorable surgical outcomes. Nevertheless, long-term follow-up outcomes regarding objective and/or subjective prolapse recurrence, reoperation rates, and mesh-related complications remain unclear. Further research is required to demonstrate whether the robotic approach for sacrocolpopexy is feasible or can become the modality of choice in the future when performing sacrocolpopexy.
PubMed: 37461208
DOI: 10.5468/ogs.23073 -
International Urogynecology Journal Aug 2023The objective was to demonstrate the surgical procedure of laparoscopic mesh removal after sacrocolpopexy to aid clinicians facing mesh complications.
INTRODUCTION AND HYPOTHESIS
The objective was to demonstrate the surgical procedure of laparoscopic mesh removal after sacrocolpopexy to aid clinicians facing mesh complications.
METHODS
Video footage shows the laparoscopic management of mesh failure and mesh erosion after sacrocolpopexy with narrated video sequences of two patients.
RESULTS
Laparoscopic sacrocolpopexy represents the gold standard in advanced prolapse repair. Mesh complications occur infrequently but infections, failure of prolapse repair and mesh erosions necessitate mesh removal and repeat sacrocolpopexy if applicable. The video deals with two women referred to our tertiary referral urogynecology unit in the University Women's Hospital of Bern, Switzerland, after laparoscopic sacrocolpopexies that were carried out in remote hospitals. Both patients were asymptomatic more than 1 year after surgery.
CONCLUSIONS
Complete mesh removal after sacrocolpopexy and repeat prolapse surgery can be challenging but is feasible and is aimed at improving patients' complaints and symptoms.
Topics: Female; Humans; Gynecologic Surgical Procedures; Laparoscopy; Pelvic Organ Prolapse; Surgical Mesh; Treatment Outcome; Uterine Prolapse; Vagina
PubMed: 36897370
DOI: 10.1007/s00192-023-05494-5 -
Biomedical Papers of the Medical... Dec 2023The aim of this retrospective study was to try to find correlations between different diagnoses established by clinical examination, anorectal manometry and...
AIMS
The aim of this retrospective study was to try to find correlations between different diagnoses established by clinical examination, anorectal manometry and MRI-defecography and, the association with psychiatric disorders.
METHODS
44 patients (median age 53.81 years) presenting with intestinal motility disorders and who underwent clinical, biological and psychiatric examination, dynamic defecographic-MRI (resting, squeezing, straining, defecation and evacuation phases), anorectal manometry, colonoscopy. MRI was performed using the 1,5 T.
RESULTS
MRI-defecography revealed the following changes: anismus (16), rectocele (12), pelvic floor dysfunction (6), peritoneocele (2), cervical-cystic-ptosis (1), rectal prolapse (6), and in 1 case the examination was normal. Hypertonic anal sphincter (16) and lack of defecation reflex (12) at anorectal manometry correlated with anismus in all patients at MRI-defecography. Lack of inhibitor anal reflex (6) was associated with rectocele (4), cervix-cysto-ptosis (1) and peritoneocele (2). Anxiety (11), depression (6) and anxiety-depressive disorders (10) were found in 27/44, somatization disorders in 9/44 and no psychiatric changes in 8/44 cases.
CONCLUSION
As multiparous women are at risk for outlet obstruction constipation, MRI-defecography is suggested in this category. There is good correlation between diagnosis using anorectal manometry and MRI-defecography in patients with terminal constipation and anismus. Lower defecation dysfunction is often associated with psychiatric disorders.
Topics: Humans; Female; Middle Aged; Defecation; Rectocele; Defecography; Retrospective Studies; Constipation; Magnetic Resonance Imaging
PubMed: 35582728
DOI: 10.5507/bp.2022.023 -
Cureus Sep 2023Horner's syndrome (HS) is a rare complication of thyroidectomy caused by damage to the oculosympathetic nerves. This article reports the case of a 29-year-old woman...
Horner's syndrome (HS) is a rare complication of thyroidectomy caused by damage to the oculosympathetic nerves. This article reports the case of a 29-year-old woman referred to the clinic with a newly diagnosed papillary thyroid carcinoma (PTC). Ultrasound studies were concerning for multiple thyroid nodules and an enlarged lymph node, confirmed by a computed tomography (CT) scan. Cytology results of fine needle aspiration (FNA) diagnostic for PTC showed tumors in the thyroid tissue and lymph node. The patient underwent a thyroidectomy and woke up with right-sided ptosis and miosis. Clinical follow-up revealed subjective ipsilateral anhidrosis. She also developed a low parathyroid hormone level and dysphonia, albeit they resolved after months. The patient still exhibits HS eight months after surgery. This paper reviews the literature and attempts to establish the most probable causal factor while providing implications for surgical teams to minimize HS occurrence in future thyroid surgeries.
PubMed: 37876407
DOI: 10.7759/cureus.45825 -
Frontiers in Public Health 2023To determine whether the different pelvic floor disorders are associated with changes in perceived quality of life (QoL), globally and in its sub-dimensions. (Observational Study)
Observational Study
OBJECTIVE
To determine whether the different pelvic floor disorders are associated with changes in perceived quality of life (QoL), globally and in its sub-dimensions.
METHODS
An observational study was conducted with women in Spain between 2021 and 2022. Information was collected using a self-developed questionnaire on sociodemographic data, employment, history and health status, lifestyle and habits, obstetric history, and health problems. The SF-12 questionnaire was used to assess quality of life. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor problems, and includes the POPDI-6 subscales for prolapse, CRADI- 8 for colorectal symptoms, and UDI-6 for urinary symptoms. Crude (MD) and adjusted mean differences (aMD) were estimated with their respective 95% confidence intervals (CI).
RESULTS
Thousand four hundred and forty six women participated in the study with a mean age of 44.27 (SD = 14.68). A statistical association was observed between all the pelvic floor disorders and QoL, overall and in all its dimensions ( <.001), in the bivariable analysis. The lowest scores were observed in the emotional component. After adjusting for confounding factors, the pelvic floor disorders in general (aMD -0.21, 95% CI: -0.23 to -0.20), the impact of uterine prolapse symptoms (aMD -0.20, 95% CI: -0.27 to -0.12), the colorectal-anal symptoms (aMD -0.15, 95% CI: -0.22 to -0.09), and urinary symptoms (aMD -0.07, 95% CI: -0.13 to -0.03) was negatively associated on the score on the SF-12 questionnaire ( <.05).
CONCLUSIONS
Women who have a pelvic floor dysfunction, symptoms of pelvic organ prolapse, colorectal-anal symptoms, or urinary symptoms, have a worse perceived quality of life in all dimensions. Prolapse symptoms have the biggest impact, and the emotional component of QoL is the most affected sub-domains.
Topics: Pregnancy; Female; Humans; Adult; Pelvic Floor Disorders; Quality of Life; Pelvic Organ Prolapse; Uterine Prolapse; Colorectal Neoplasms
PubMed: 37942254
DOI: 10.3389/fpubh.2023.1180907