Full Issue December 2010 Complete Issue read_pdf [3.4 Mb]


The Complete Pelviperineology December 2010 Issue
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New High Resolution Pelviperineology
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AAVIS Editorial Editorial

Cover pelviperineologyLe Meridien Hotel in Vienna, Austria was the venue for the latest AAVIS Annual Scientific Meeting and International Pelviperineology Conference, held on September 19th-21st 2010. The meeting was a tremendous success with a high quality scientific program and wonderful opportunity for fellowship and social interaction. The full scientific content of the meeting can now be viewed via webcast which is available through the AAVIS website at www.aavis.org. [More]

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Original Article Tethered vagina syndrome: cure of severe involuntary urinary loss by skin graft to the bladder neck area of vaginaby Klaus Goeschen, Andrei Müller-FunoGea, Peter Petros

tethered vagina syndromeThe ‘tethered vagina syndrome’ is a iatrogenic, but as yet, not well recognized, condition. It is caused by scar-induced tightness in the middle zone of the vagina. It was described by Petros & Ulmsten in 1990, and again in 1993. It is not defined as a separate entity by the International Continence Society. This problem is somewhat similar to ‘motor detrusor instability’, and may arise in patients with multiple previous operations in the bladder neck area of vagina. The classical symptom is commencement of uncontrolled urine leakage as soon as the patient’s foot touches the floor, indeed, often commencing as the patient rolls over to get out of bed in the morning. The patient does not complain of bedwetting during the night. [More]

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Original Article Arc to Arc minisling 1999: a critical analysis of concept and technologyby Paulo Palma

arc minislingThe understanding of stress urinary incontinence (SUI) pathophysiology has consistently improved over the past decade, and has resulted in the development of many surgical techniques. Based on the Integral Theory, Petros and Ulmsten proposed the tension-free vaginal tape (TVT). According to this theory a midurethral tape can stabilize the urethra during straining without modifying the urethral mobility. Despite the good cure rate reported for TVT, major complications as injuries to bowel and major blood vessels have been described. [More]

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Original Articlet Two year outcome data on efficacy and quality of life following mesh augmented vaginal reconstruction by Adam S. Holzberg, Peter S. Finamore, Krystal Hunter, Ricardo Caraballo, Karolynn T. Echols

Sagittal SectionA woman has an 11% lifetime risk for pelvic organ prolapse and a third of patients who undergo corrective surgery have repeat procedures. Methods of repair vary greatly and there is limited evidence to help guide surgeons to determine which techniques have better outcomes. The high rates of failure with traditional colporrhaphy have led to the use of graft materials to augment pelvic floor reconstruction. This has led to the debate as to what graft material is best? To help answer this question one has to look at both objective outcomes as identified by the surgeon as well as patient perception regarding success of the surgery and improvement in their quality of life. Our study presented here evaluates the objective, subjective and quality of life outcomes for a single surgeon’s use of synthetic mesh over an eighteen month period for the correction of pelvic organ prolapse. [More]

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Original ArticleCommon genitourinary fistulae at a referral hospital in Saudi Arabiaby Ahmed H. Al-badr, Ola Y. Malabary, Abdullah N. Al-Jasser, Valerie A. Zimmerman

QOL auditsGenitourinary fistulae can be classified anatomically, etiologically, or by surgical size. It is generally accepted that surgical fistulae occur after unrecognized incision in urinary structures, pressure necrosis, devascularization, or a combination of these mechanisms. Obstetric fistulae occur because of damage during the course of prolonged labor, instrumentation during delivery, or as consequences of cesarean section (CS). Historically, most vesicovaginal fistulae (VVF) were the result of birth trauma; accordingly, they remain the major urinary fistulae and the most common cause of urinary incontinence in many underdeveloped nations. [More]

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GuidelinesDiagnosis and management of adult female stress urinary incontinence. Summary of the guidelines for clinical practice from the French College of Gynaecologist and Obstetricians (CNGOF) by Gregory Triopon, Renaud de Tayrac, Pierre Mares

Filshie clip migrationTubal occlusion with Filshie clips is one of the preferred methods of female sterilization. It has a low failure rate when correctly applied. Complications of this method of sterilization can be divided mainly into two groups: early (peri-operative) and late complications. Early complications include mortality (1-2/100,000 procedures, mainly as a complication of general anaesthesia), visceral injury (bowel, urinary bladder and uterus), vascular injury and unintended laparotomy (1-2%). Procedure failure (occurrence of pregnancy including ectopic pregnancy) is the main late complication of this procedure. Migration of Filshie Clips is also a late complication; it is usually asymptomatic and does not result in serious morbidity. It should be kept in mind that in rare instances it can cause significant symptoms and morbidity. [More]

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Original ArticleDevelopment of a third generation surgical technique for mesh repair for pelvic organ prolapse using a lightweight monofilament polypropylene mesh. A preliminary report of efficacy and safetyby Bruce Farnsworth

Duplex ureter damagedAs a result of audit and evaluation of existing techniques of pelvic reconstruction over 10 years (1997-2007), a third generation technique of prolapse repair with mesh has evolved into a standardized technique. Other mesh techniques have been associated with a high success rate and good functional results but erosion rates associated with defective healing have been reported at 5-10% and higher in the first three months after surgery using a number of commercially available mesh kits and slings. Reports of the significant advantages of light weight wide pore monofilament meshes in hernia and other surgery led to the adoption of this material. [More]

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FocusThe neuropelveology: a new speciality in medicine?by Marc Possover

neuropelveologyThe pelvis contains not only different organs such as the bladder, rectum or genital organs, but also pelvic nerves. After the central nervous system and spinal cord, no other part of the body contains so many and such important nerves: pelvic nerves are not only involved in sexuality, voiding and storage pelvic organs and locomotion but also in the transport of all sensitive information’s generated in the lower limbs and pelvis to the central nervous system. Pelvic nerves damages lead therefore to pelvic visceral dysfunctions, problems with locomotion and different kinds of pain. unfortunately no specialty deals electively with the pathologies of the pelvic nerves and plexuses! [More]

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