Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve...Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve-sparing Burch-Sling method represents a surgical advancement through the use of a nerve-sparing sling to treat genuine stress urinary incontinence. The procedure involves retropubic urethropexy using the FDA-approved Burch-Sling device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction to the mid-urethra toward Cooper’s ligament above the base of the bladder. Then, the anterior vaginal wall and fascia are used as an endogenous suburethral sling without dissection. Two hundred twenty cases were included in this study;two hundred patients underwent the outpatient nerve-sparing sling method, and the other twenty underwent the novel abdominal Burch method. There were no major complications. The follow-up duration ranged from 6 months to eight years. All procedures were performed at the U.S. Women’s Institute at a 400-bed hospital in Fountain Valley, CA.展开更多
Background and aims: Adhesions can cause important morbidity including abdominal and pelvic pain, intestinal obstructions, and infertility. When adhesions are formed, there is no efficient method, nowadays, to resolve...Background and aims: Adhesions can cause important morbidity including abdominal and pelvic pain, intestinal obstructions, and infertility. When adhesions are formed, there is no efficient method, nowadays, to resolve them, thus the reduction of their prevalence relies on the prevention. Profiling high risk patients for abdominal and pelvic adhesions (APA) is an important step to this prevention. The risk factors of adhesions in our institution, the association between APA, leiomyomas and skin scar anomaly (SSA) were investigated. Methods: A cross-sectional study was conducted from March 1st to June 30th 2013 including patients who underwent laparotomy or laparoscopy. Patients’ characteristics, presence of a SSA and leiomyomas, as related to adhesions, were analyzed. Student’s t, Pearson’s Khi-square, Fisher’s Exact, Mann-Whitney tests and logistic regression were used. P values < 0.05 were considered statistically significant. Results: The frequency of adhesions was 41.74%. Patients had a mean age of 32.69 ± 8.94 years. Those with a previous abdominal surgery (PAS), SSA and leiomyomas had respectively 12 times [OR: 11.98, CI95 (4.63 - 30.97)], 3 times [OR: 2.79, CI95 (1.16 - 6.71) and 2.5 times [(OR: 2.49, CI95 (1.07 - 5.78)] more adhesions. In logistic regression, a PAS and leiomyomas remained associated significantly to adhesions with p = 0.000 and p = 0.037 respectively. Conclusion: In peritoneal adhesions, leiomyomas and SSA are other factors that may allow a cautious selection of high risk patients who must benefit from particular attention during surgery. Further well designed studies are necessary to investigate the accurate clinical relation among those three conditions.展开更多
文摘Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve-sparing Burch-Sling method represents a surgical advancement through the use of a nerve-sparing sling to treat genuine stress urinary incontinence. The procedure involves retropubic urethropexy using the FDA-approved Burch-Sling device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction to the mid-urethra toward Cooper’s ligament above the base of the bladder. Then, the anterior vaginal wall and fascia are used as an endogenous suburethral sling without dissection. Two hundred twenty cases were included in this study;two hundred patients underwent the outpatient nerve-sparing sling method, and the other twenty underwent the novel abdominal Burch method. There were no major complications. The follow-up duration ranged from 6 months to eight years. All procedures were performed at the U.S. Women’s Institute at a 400-bed hospital in Fountain Valley, CA.
文摘Background and aims: Adhesions can cause important morbidity including abdominal and pelvic pain, intestinal obstructions, and infertility. When adhesions are formed, there is no efficient method, nowadays, to resolve them, thus the reduction of their prevalence relies on the prevention. Profiling high risk patients for abdominal and pelvic adhesions (APA) is an important step to this prevention. The risk factors of adhesions in our institution, the association between APA, leiomyomas and skin scar anomaly (SSA) were investigated. Methods: A cross-sectional study was conducted from March 1st to June 30th 2013 including patients who underwent laparotomy or laparoscopy. Patients’ characteristics, presence of a SSA and leiomyomas, as related to adhesions, were analyzed. Student’s t, Pearson’s Khi-square, Fisher’s Exact, Mann-Whitney tests and logistic regression were used. P values < 0.05 were considered statistically significant. Results: The frequency of adhesions was 41.74%. Patients had a mean age of 32.69 ± 8.94 years. Those with a previous abdominal surgery (PAS), SSA and leiomyomas had respectively 12 times [OR: 11.98, CI95 (4.63 - 30.97)], 3 times [OR: 2.79, CI95 (1.16 - 6.71) and 2.5 times [(OR: 2.49, CI95 (1.07 - 5.78)] more adhesions. In logistic regression, a PAS and leiomyomas remained associated significantly to adhesions with p = 0.000 and p = 0.037 respectively. Conclusion: In peritoneal adhesions, leiomyomas and SSA are other factors that may allow a cautious selection of high risk patients who must benefit from particular attention during surgery. Further well designed studies are necessary to investigate the accurate clinical relation among those three conditions.
