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European Journal of Medical Research Mar 2024Enterocystoplasty is the most commonly used treatment for bladder reconstruction. However, it has some major complications. In this study, we systematically reviewed the... (Review)
Review
Enterocystoplasty is the most commonly used treatment for bladder reconstruction. However, it has some major complications. In this study, we systematically reviewed the alternative techniques for enterocystoplasty using different scaffolds. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library, and a total of 10 studies were included in this study. Five different scaffolds were evaluated, including small intestinal submucosa (SIS), biodegradable scaffolds seeded with autologous bladder muscle and urothelial cells, dura mater, human cadaveric bladder acellular matrix graft, and bovine pericardium. The overall results revealed that bladder reconstruction using regenerative medicine is an excellent alternative method to enterocystoplasty regarding the improvement of bladder capacity, bladder compliance, and maximum detrusor pressure; however, more large-scale studies are required.
Topics: Humans; Animals; Cattle; Regenerative Medicine; Urinary Bladder; Urologic Surgical Procedures; Muscles; Plastic Surgery Procedures
PubMed: 38475865
DOI: 10.1186/s40001-024-01757-z -
Child's Nervous System : ChNS :... Jan 2013Positioned anatomically between the spinal epidural space and the intramedullary compartment, the spinal subdural space remains the least common area of localized... (Review)
Review
INTRODUCTION
Positioned anatomically between the spinal epidural space and the intramedullary compartment, the spinal subdural space remains the least common area of localized infection in the central nervous system. Infectious processes of the subdural spinal space include subdural spinal empyema, subdural spinal abscess, infected spinal subdural cyst, and infectious spinal subdural cyst. To date, there has been no systematic review of these entities in children, with the cumulative knowledge of the pathophysiologic, microbiologic, and demographic characteristics of these infections relegated solely to few small series and case reports.
METHODS
A series of 11 recent cases culled from the collaboration of international authors are presented. In addition, an exhaustive MEDLINE search and manual review of the international literature was performed, identifying a total of 73 cases of spinal subdural infections in patients under the age of 21. Data of interest include the age, sex, signs, and symptoms at presentation, spinal location of infection, presence of spinal dysraphism, and other comorbidities, offending organism, treatment, outcome, and follow-up.
RESULTS
Patients ages ranged from 4 weeks to 20 years (mean, 6.5 years). Males outnumbered females by a ratio of 2:1. Over half (53 %) of spinal subdural infections in children were associated with spinal dysraphism or other congenital abnormalities of the spine. The commonest organism to infect the spinal subdural space in children is mycobacterium tuberculosis and the thoracic spinal region was most commonly infected.
CONCLUSIONS
The disease is usually treated surgically, although a more expectant approach consisting of antibiotics and observation has also been proposed.
Topics: Adolescent; Adult; Africa; Child; Child, Preschool; Female; Humans; Infant; International Cooperation; MEDLINE; Male; Meningitis; Spinal Cord; Spinal Cord Diseases; Subdural Space; Young Adult
PubMed: 23053357
DOI: 10.1007/s00381-012-1916-4 -
Neurosurgical Focus May 2012Spinal arteriovenous malformations (AVMs) are classified into types according to anatomical characteristics: dural arteriovenous fistulas (AVFs), intramedullary AVMs,... (Review)
Review
OBJECT
Spinal arteriovenous malformations (AVMs) are classified into types according to anatomical characteristics: dural arteriovenous fistulas (AVFs), intramedullary AVMs, perimedullary AVFs, and extradural AVFs. Spinal extradural AVFs are much rarer than other types of spinal AVMs, and the available literature on this clinical entity has been based only on case reports or small case series. To investigate the clinical characteristics of patients with spinal extradural AVFs, the authors systematically reviewed the associated literature in the MRI era.
METHODS
The PubMed database was searched for all relevant English-language case reports and case series published from 1990 to 2011. The clinical differences between Type A with and Type B without intradural venous drainage were statistically compared, especially regarding clinical features and angiographic and MRI findings.
RESULTS
Forty-five cases of spinal extradural AVFs were found. Type A spinal extradural AVFs were diagnosed in patients with a significantly older age (mean 63.5 years) as compared with Type B AVFs (mean 34.3 years, p < 0.0001). Most cases of Type A spinal extradural AVFs exhibited a diffuse high signal intensity of the spinal cord on T2-weighted MR images and no mass effect (p < 0.0001), and they commonly occurred in the thoracolumbar and lumbar regions (p < 0.0001). On the other hand, cases of Type B lesions exhibited a normal signal intensity of the cord with severe mass effect due to an enlarged extradural venous plexus, and they commonly occurred in the cervical and upper thoracic regions (p < 0.0001), frequently in patients with neurofibromatosis Type 1 (p = 0.049). Because Type B AVFs consisted of high-flow, multiple complex anastomoses between arteries and the epidural venous plexus, patients with these lesions tended to undergo multisession treatments, and the rate of partial AVF occlusion was significantly higher than for Type A AVFs (p = 0.018), although there was no difference in symptom outcomes between the 2 groups.
CONCLUSIONS
To the best of the authors' knowledge, a comparative analysis of the clinical differences in patients with extradural AVFs with or without intradural venous drainage has yet to be described in the literature. They concluded that in the diagnosis of spinal extradural AVF, evaluation of intradural venous drainage is important because the cause of myelopathy determines the treatment goals.
Topics: Aged; Arteriovenous Malformations; Databases, Bibliographic; Drainage; Dura Mater; Embolization, Therapeutic; Female; Humans; Male; Middle Aged; Spinal Cord
PubMed: 22537134
DOI: 10.3171/2012.2.FOCUS1216 -
Journal of Neurology, Neurosurgery, and... Oct 2019Although surgical resection is associated with a complete cure in most cases of spinal dural arteriovenous fistulas (SDAVF), there has been an increasing trend towards... (Comparative Study)
Comparative Study Meta-Analysis
Although surgical resection is associated with a complete cure in most cases of spinal dural arteriovenous fistulas (SDAVF), there has been an increasing trend towards embolisation. We performed a systematic review and meta-analysis comparing surgical resection with endovascular treatment in terms of success of treatment, rate of recurrence and complications. A literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation Working Group system. Surgical outcomes such as initial treatment failure, late recurrence, neurological improvement and complications were compared between the two approaches. We included 57 studies with 2029 patients, of which 32 studies with 1341 patients directly compared surgery (n=590) and embolisation (n=751). Surgery was found to be associated with significantly lower odds of initial treatment failure (OR: 0.15, 95% CI 0.09 to 0.24, I 0%, p<0.001) and late recurrence (OR 0.18, 95% CI 0.09 to 0.39, I 0%, p<0.001). The odds of neurological improvement following surgery were also significantly higher compared with embolisation alone (OR: 2.73, CI:1.67 to 4.48, I :49.5%, p<0.001). No difference in complication rates was observed between the two approaches (OR 1.78, 95% CI 0.97 to 3.26, I 0%, p=0.063). Onyx was associated with significantly higher odds of initial failure/late recurrence as compared with n-butyl 2-cyanoacrylate (OR: 3.87, CI: 1.73 to 8.68, I :0%, p<0.001). Surgery may be associated with superior outcomes for SDAVFs in comparison to endovascular occlusion. Newer embolisation agents like Onyx have not conferred a significant improvement in occlusion rate.
Topics: Central Nervous System Vascular Malformations; Dura Mater; Embolization, Therapeutic; Enbucrilate; Endovascular Procedures; Humans; Ligation; Neurosurgical Procedures; Spinal Cord; Tissue Adhesives; Treatment Outcome
PubMed: 31142659
DOI: 10.1136/jnnp-2019-320648 -
Biointerphases Aug 2019In this systematic review, the authors explored the surface aspects of various titanium (Ti) or Ti alloy medical implants, examining the interface formed between the...
In this systematic review, the authors explored the surface aspects of various titanium (Ti) or Ti alloy medical implants, examining the interface formed between the implant and surrounding nonkeratinized soft tissues (periosteum, muscles, tendons, fat, cicatrix, or dura mater). A comprehensive search undertaken in July 2019 used strict keywords in relevant electronic databases to identify relevant studies. Based on the authors' inclusion criteria (restricted to in vivo studies), 19 of 651 publications qualified, all pertaining to animal models. The syrcle's risk of bias tool for animal studies was applied at study level. Given the broad nature of the reported results and the many different parameters measured, the articles under scrutiny were assigned to five research subgroups according to their surface modification types: mechanical surface modifications, oxidative processes (e.g., acid etching, anodization, microarc oxidation), sol-gel derived titania (TiO) coatings, biofunctionalized surfaces, and a subgroup for other modifications. The primary outcome was a liquid space at the interface (e.g., seroma formation) that was reported in six studies. Machining Ti implants to a roughness between R = 0.5 and 1.0 μm was shown to induce soft-tissue adhesion. Smoother surfaces, with the exception of acid polished and anodized Ti (R = 0.2 μm), prevented soft-tissue adhesion. A fibroblast growth factor 2 apatite composite coating promoted soft-tissue attachment via Sharpey-like fibers. In theory, this implant-soft tissue interface could be nearly perfect.
Topics: Alloys; Coated Materials, Biocompatible; Materials Testing; Prostheses and Implants; Surface Properties; Titanium
PubMed: 31419910
DOI: 10.1116/1.5113607 -
The Cochrane Database of Systematic... Jan 2011Traditional suburethral slings are surgical operations used to treat women with symptoms of stress urinary incontinence. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Traditional suburethral slings are surgical operations used to treat women with symptoms of stress urinary incontinence.
OBJECTIVES
To determine the effects of traditional suburethral slings on stress or mixed incontinence in comparison with other management options.
SEARCH STRATEGY
We searched the Cochrane Incontinence Group Specialised Register (searched 3 June 2010) and the reference lists of relevant articles.
SELECTION CRITERIA
Randomised or quasi-randomised trials that included traditional suburethral slings for the treatment of stress or mixed urinary incontinence.
DATA COLLECTION AND ANALYSIS
At least three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, a summary statistic was calculated: a relative risk for dichotomous data and a weighted mean difference for continuous data.
MAIN RESULTS
Twenty six trials involving 2284 women were included. The quality of evidence was moderate for most trials and there was generally short follow-up ranging from 6-24 months.One medium sized trial compared traditional suburethral sling operations with oxybutynin in the treatment of mixed urinary incontinence patients. Surgery appeared to be more effective than drugs in treating patient-reported incontinence (n = 75, Risk Ratio (RR) 0.18, 95% Confidence Interval (CI) 0.08 to 0.43).One trial found that traditional slings were more effective than transurethral injectable treatment (RR for clinician-assessed incontinence within a year 0.21; 95% CI 0.09 to 0.21), and also cheaper on average cost.Seven trials compared slings with open abdominal retropubic colposuspension. Patient-reported incontinence was lower with the slings after one year (RR 0.75; 95% CI 0.62 to 0.90), but not when assessed by clinicians. Colposuspension, however, was associated with fewer peri-operative complications, shorter duration of use of indwelling catheter and less long term voiding dysfunction. One study showed there was a 20% lower risk of bladder perforation with the sling procedure but a 50% increase in urinary tract infection with the sling procedure compared with colposuspension. Fewer women developed prolapse after slings (compared with after colposuspension) in two small trials but this did not reach statistical significance.Twelve trials addressed the comparison between traditional sling operations and minimally invasive sling operations.These seemed to be equally effective in the short term (RR for incontinence within first year 0.97; 95% CI 0.78 to 1.20) but minimally invasive slings had a shorter operating time, fewer peri-operative complications (other than bladder perforation) and some evidence of less post-operative voiding dysfunction and detrusor symptoms.Six trials compared one type of traditional sling with another. Materials included porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia. Patient-reported improvement rates within the first year favoured the traditional autologous material rectus fascia over other biological materials (RR 0.45; 95% CI 0.21 to 0.98). There were more complications with the use of non-absorbable Goretex in one trial.Data for comparison of bladder neck needle suspension with suburethral slings were inconclusive because they came from a single trial with a small specialised population.No trials compared traditional suburethral slings with anterior repair, laparoscopic retropubic colposuspension or artificial sphincters. Most trials did not distinguish between women having surgery for primary or recurrent incontinence when reporting patient characteristics.For most of the comparisons, clinically important differences could not be ruled out.
AUTHORS' CONCLUSIONS
Traditional slings seem to be as effective as minimally invasive slings, but had higher rates of adverse effects. This should be interpreted with some caution however, as the quality of evidence for the studies was variable, follow-up short and populations small, particularly for identifying complication rates. Tradional sling procedures appeared to confer a similar cure rate in comparison to open retropubic colposuspension, but the long term adverse event profile is still unclear. Reliable evidence to clarify whether or not traditional suburethral slings may be better or worse than other surgical or conservative management options is lacking.
Topics: Adult; Female; Humans; Polytetrafluoroethylene; Randomized Controlled Trials as Topic; Suburethral Slings; Urinary Incontinence; Urinary Incontinence, Stress
PubMed: 21249648
DOI: 10.1002/14651858.CD001754.pub3 -
World Neurosurgery Jun 2020Surgical management of high-grade spondylolisthesis is controversial. Both reduction and in situ fusion are available options, but it remains unclear which approach... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Surgical management of high-grade spondylolisthesis is controversial. Both reduction and in situ fusion are available options, but it remains unclear which approach provides better outcomes. We conducted a systematic review and meta-analysis of studies reporting outcomes following reduction or in situ fusion for adult high-grade spondylolisthesis.
METHODS
PubMed, Embase, Web of Science, and Cochrane databases were last searched on June 24, 2019. We identified 1236 studies after excluding duplicates. After screening, 15 studies were included in the meta-analysis. Random-effects models were used to pool effect estimates.
RESULTS
A total of 188 patients were analyzed. Compared with reduction, in situ fusion had a higher mean estimated blood loss (584 mL vs. 451 mL) and a clinically higher incidence of neurologic (48% vs. 15%), pseudarthrosis (13% vs. 8%), and infectious (20% vs. 10%) complications; however, these differences were not statistically significant. Reduction was associated with a clinically higher incidence of overall complications (32% vs. 25%) and dural tears (22% vs. 7%). Reduction provided better pain relief (mean difference [MD] = 5.24 vs. 4.77) and greater change in pelvic tilt (MD = 5.33 vs. 2.60); however, these differences were not statistically significant. Patients who underwent reduction had significantly greater decline in Oswestry Disability Index scores (MD = 55.7 vs. 11.5; P < 0.01) and greater change in slip angle (MD = 25.0 vs. 11.4; P = 0.01).
CONCLUSIONS
In management of adult high-grade spondylolisthesis, both approaches appeared to be safe and effective. Reduction appeared to offer better disability relief and spinopelvic parameter correction than in situ fusion.
Topics: Adult; Blood Loss, Surgical; Bone Screws; Decompression, Surgical; Dura Mater; Humans; Neurosurgical Procedures; Postoperative Complications; Pseudarthrosis; Severity of Illness Index; Spinal Fusion; Spondylolisthesis; Treatment Outcome
PubMed: 32179186
DOI: 10.1016/j.wneu.2020.03.030 -
The Cochrane Database of Systematic... 2001Suburethral slings are surgical operations used to treat women with urinary incontinence. They were originally designed for recurrent stress incontinence, but have also... (Review)
Review
BACKGROUND
Suburethral slings are surgical operations used to treat women with urinary incontinence. They were originally designed for recurrent stress incontinence, but have also been used recently for primary cases.
OBJECTIVES
To determine the effects of suburethral slings on stress or mixed urinary incontinence in comparison with other management options.
SEARCH STRATEGY
We searched the Cochrane Incontinence Group's trials register, The UK National Research Register (Issue 1, 2001) and the reference lists of relevant articles. We hand searched the proceedings of the Brazilian Congress of Urology from 1991 to 1999, inclusive. Date of most recent search: March 2001.
SELECTION CRITERIA
Randomised or quasi-randomised trials that included suburethral slings for the treatment of urinary incontinence.
DATA COLLECTION AND ANALYSIS
Both reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, a summary statistic was calculated: a relative risk for dichotomous data and a weighted mean difference for continuous data.
MAIN RESULTS
Seven trials were identified including 682 women - 457 treated with suburethral slings and 225 with other procedures. Four compared suburethral slings with open abdominal retropubic suspensions (Burch/Marshall-Marchetti-Krantz) and one compared suburethral slings with needle suspension (Stamey). In the two last trials, different types of suburethral sling were compared with each other. Six types of slings were included (Teflon, polytetrafluoroethylene, prolene used for tension free vaginal tape (TVT), porcine dermis, lyophilized dura mater and rectus fascia). There were no comparisons of suburethral sling with anterior repair, laparoscopic retropubic suspension, peri-urethral injections, artificial sphincters or conservative management. In respect of short-term cure, overall rates are similar (RR 0.93; 95% CI 0.68 to 1.27) in comparison to open abdominal retropubic suspension. This mainly reflects the results of one larger trial on TVT. However, for long term results, data are too few to give a reliable estimate. Data were too few to address whether other types of suburethral slings were as effective as open abdominal retropubic suspension or needle suspension. There were no detectable differences in terms of voiding dysfunction, urge incontinence or detrusor instability between suburethral slings and abdominal or needle suspensions, but the data were few and the confidence intervals wide. About one in 11 had a complication during TVT, most commonly bladder perforation, but none had serious consequences. In the small trial which compared autologous (rectus fascia) with synthetic (Goretex) slings, 11/32 vs 2/16 women were not cured after a year (RR 0.36, 95% CI 0.09 to 1.45) which is not statistically significant but fewer women with autologous slings had complications (0/32 vs 5/16; RR 21.35, 95% CI 1.25 to 363.78). Two women in the Goretex group had late sling erosion of the urethra requiring removal of the Goretex, although their incontinence remained cured.
REVIEWER'S CONCLUSIONS
Preliminary results from a larger trial provide reassuring evidence about the performance of the less invasive TVT sling procedure. Cure rates after TVT were similar to those following open abdominal retropubic suspension, but with confidence intervals of around 10% absolute difference. About one in 11 women had a complication during TVT, most commonly bladder perforation, but none had serious consequences. Long term results are awaited. The data were too few to address whether other types of suburethral slings were as effective as open abdominal retropubic suspension or needle suspension. There was limited evidence from one small trial that slings made of Goretex had more complications than slings made of rectus fascia. The broader effects of suburethral slings could not be established since trials did not include appropriate outcome measures such as general health status, health economics, pad testing, third party analysis and time to return to normal activity level. Evidence that suburethral slings may be better or worse than other surgical or conservative management is lacking because no trials addressed these comparisons.
Topics: Female; Humans; Polytetrafluoroethylene; Randomized Controlled Trials as Topic; Urethra; Urinary Incontinence; Urologic Surgical Procedures
PubMed: 11686996
DOI: 10.1002/14651858.CD001754 -
Acta Neurochirurgica Jan 2021Surgery for symptomatic Chiari type I malformation (CM-I) patients include posterior fossa decompression (PFD) involving craniectomy with or without dural opening, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgery for symptomatic Chiari type I malformation (CM-I) patients include posterior fossa decompression (PFD) involving craniectomy with or without dural opening, and posterior fossa decompression with duraplasty (PFDD). This review aims to examine the evidence to aid surgical decision-making.
METHODS
A medical database search was expanded to include article references to identify all relevant published case series. Animal studies, editorials, letters, and review articles were excluded. A systemic review and meta-analysis were performed to assess clinical and radiological improvement, complications, and reoperation rates.
RESULTS
Seventeen articles, containing data on 3618 paediatric and adult participants, met the inclusion criteria. In the group, 5 papers included patients that had the dura left open. PFDD is associated with better clinical outcomes (RR 1.24, 95% CI, 1.07 to 1.44; P = 0.004), but has a higher complication rate (RR 4.51, 95% CI, 2.01 to 10.11; P = 0.0003). In adults, clinical outcomes differences did not reach statistical significance (P = 0.07) but re-operation rates were higher with PFD (RR 0.17, 95% CI 0.03 to 0.86; P = 0.03), whilst in children re-operation rates were no different (RR 0.97, 95% CI 0.41 to 2.30; P = 0.94). Patients with a syrinx did better with PFDD (P = 0.02). No significant differences were observed concerning radiological improvement.
CONCLUSIONS
In the absence of hydrocephalus and craniocervical region instability, PFDD provides better clinical outcomes but with higher risk. The use of PFD may be justified in some cases in children, and in the absence of a syrinx. To help with future outcome assessments in patients with a CM-I, standardization of clinical and radiological grading systems are required.
TRIAL REGISTRATION
not required.
Topics: Adolescent; Adult; Arnold-Chiari Malformation; Child; Child, Preschool; Craniotomy; Decompression, Surgical; Dura Mater; Female; Humans; Male; Middle Aged; Postoperative Complications; Reoperation
PubMed: 32577895
DOI: 10.1007/s00701-020-04403-9 -
World Neurosurgery May 2021Incidental or intentional durotomy in spine surgery is associated with a risk of cerebrospinal fluid (CSF) leakage and reoperation. Several strategies have been...
BACKGROUND
Incidental or intentional durotomy in spine surgery is associated with a risk of cerebrospinal fluid (CSF) leakage and reoperation. Several strategies have been introduced, but the incomplete closure is still relatively frequent and troublesome. In this study, we review current evidence on spinal dural repair strategies and evaluate their efficacy.
METHODS
PubMed, Web of Science, and Scopus were used to search primary studies about the repair of the spinal dura with different techniques. Of 265 articles found, 11 studies, which specified repair techniques and postoperative outcomes, were included for qualitative and quantitative analysis. The primary outcomes were CSF leakage and postoperative infection.
RESULTS
The outcomes of different dural repair techniques were available in 776 cases. Pooled analysis of 11 studies demonstrated that the most commonly used technique was a combination of primary closure, patch or graft, and sealant (22.7%, 176/776). A combination of primary closure and patch or graft resulted in the lowest rate of CSF leakage (5.5%, 7/128). In this study, sealants as an adjunct to primary closure (13.7%, 18/131) did not significantly reduce the rate of CSF leakage compared with primary closure alone (17.6%, 18/102). The rates of infection and postoperative neurologic deficit were similar regardless of the repair techniques.
CONCLUSIONS
Although the use of sealants has become prevalent, available sealants as an adjunct to primary closure did not reduce the rate of CSF leakage compared with primary closure. The combination of primary closure and patches or grafts could be effective in decreasing postoperative CSF leakage.
Topics: Cerebrospinal Fluid Leak; Dura Mater; Humans; Neurosurgical Procedures; Postoperative Complications; Reoperation; Spinal Diseases; Spine; Tissue Adhesives; Tissue Transplantation; Treatment Outcome
PubMed: 33640528
DOI: 10.1016/j.wneu.2021.02.079