Full Issue June 2009 Complete Issue read_pdf [2.2 Mb]

June 2009 Complete Issue
The Complete Pelviperineology March 2009 Issue in PDF format
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Editorial Editorial

Cover pelviperineologyThis issue of Pelviperineology will be the last one printed before the 2nd Joint International Pelviperineology Conference at the end of July. The Organising Committee and the Executives of the Australian Association of Vaginal and Incontinence Surgeons as well as the International Collaboration of the Pelvic Floor and the International Pelvic Floor Dysfunction Society invite you to attend the 2nd International Pelviperineology Congress at Noosa on the Sunshine Coast of Australia between July 30th and August 1st 2009. This conference aims to continue the momentum of an outstanding meeting in Padua and Venice in 2008. Yet again we aim to help clinicians who aspire to a multidisciplinary approach in the management of pelvic problems take the first step to widen their horizons by communicating with their peers and colleagues from other specialties. [More]

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Original Article Recto Anal Repair (RAR): a viable new treatment option forhigh-grade hemorrhoids. One year results of a prospective study by U. Satzinger et al.

Recto Anal Repair (RAROver the last decade, several novel treatment options have been developed for high-grade hemorrhoids with the intention of minimising the drawbacks of what is considered today to be the gold-standard, the conventional hemorrhoidectomy. Two of these new methods are HAL (Hemorrhoidal Artery Ligation) and stapled hemorroidopexy. Both techniques have shown potential benefits for high-grade hemorrhoids, particularly with regard to the perioperative parameters and at least partially also with respect to long-term results. However, both also have drawbacks still requiring improvement. The stapled hemorrhoidopexy has a much higher re-prolapse rate than the gold standard, and the resolution of hemorrhoidal symptoms is lower. In addition, severe complications after stapled hemorrhoidopexy are known and have also been reported in literature. The increased re-prolapse rate for high-grade hemorrhoids is also shared by the HAL method. However this shortcoming has more recently been addressed by the advent of RAR, a technique which is an extension of the HAL method. [More]

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Case Report Cure of childhood urgency incontinence with a midurethral sling by P. Petros

childhood urgency incontinenceMiss “X”, a 21 year old nullipara had a major incontinence problem, since childhood which had failed to respond to any treatment including a “bladder stretch” at 8 years of age. Her main complaint was history of severe incontinence, wetting with urgency, with use of 3-4 menstrual pads per day. Urinary 24 hour diary confirmed this was a severe problem: 11 entries of urgency with micurition, with 5 recorded episodes of involuntary wetting. She also gave a history of stress incontinence, nocturia x1 per night. She was objectively assessed with a self-administered questionnaire, diary, pad tests, urodynamics, ultrasound, and “simulated operation”. There was no urine loss with 10 coughs in the upright position with a bladder volume of 155 ml. 24 hour pad loss was 90.4 gm. Rotation and a bladder base descent of 17.7 mm was measured on straining during transperineal ultrasound. There was no funnelling or urine loss even with repeated coughing or straining. Overactive bladder was diagnosed on urodynamics testing. Residual urine (catheter) was 2 ml. A “simulated operation”, was performed to test the diagnosis of congenital pubourethral ligament defect: the patient was examined with a bladder sufficiently full to provoke urgency in the supine position. Unilateral digital pressure at midurethra relieved the sensation of urgency 100%. [More]

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Original Article Retropubic urethrolysis and tape sectioning for obstruction following incontinence surgery. Long-term results by J. R. Maroto et al.

Retropubic urethrolysisStandard surgery for urinary incontinence can cause urinary dysfunction along with storage or voiding symptoms, or both simultaneously, in 2-24% of cases.Tension-free vaginal tape (TVT), introduced by Ulmsten in 1995, has not eliminated these complications. In addition, the procedure occasionally causes further urinary dysfunction with similar characteristics occurring in up to 26% of cases and necessitating tape sectioning in 4-6% of cases. Although there are less data on surgical outcome with the transobturator tape technique, complications do not seem to be eliminated completely with this technique either. Satisfactory results have been published for both urethrolysis and the sectioning of suburethral tape. However, there is a clear lack of long-term results, above all those obtained via quality of life questionnaires. The objective of this study is to evaluate the long-term results in patients who underwent two types of urethrolysis: retropubic urethrolysis and section of TVT tape. Furthermore, we aim to examine the factors that could influence the results. [More]

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CommentComplex pelvic problems - a multidisciplinary perspective by M. Soligo

Complex pelvic problems“I think that any system, whatever it might be, is complex by its own nature” as Edgar Morin states in his comments on the modern philosophical concept of “Complex Thinking”. The Pelvic Floor (PF) as a system doesn’t escape this general rule. This is true for every component – urological, gynaecological, colorectal – of the PF and moreover is it true for the whole system. It is a common experience for clinicians dedicated to PF disorders to deal quite frequently with complex conditions whose actual understanding is extremely limited. As an example we could consider the topic of the use of prosthetic material in pelvic floor reconstructive surgery: in 2008 three literature Reviews have covered this subject all substantially confirming the statement of 2005 IUGA roundtable: “With a few exceptions, the current expansion of graft utilization in pelvic reconstructive surgery is not a product of evidence-based medicine”. [More]

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Review articleImpact of urinary incontinence on quality of lifeby S. Charalambous et al.

urinary incontinence on quality of lifeUrinary incontinence is frequently associated with a negative impact of quality of life of the patient. It is not really a disease, but rather a symptom, as a result of either a bladder or sphincter disorder. Urinary incontinence is defined by the International Continence Society (ICS) as “involuntary loss of urine”. The symptomatology of incontinence may be subdivided into three categories: a) stress urinary incontinence, which is caused by “the involuntary loss by effort, exercise, sneeze or cough”, b) urge incontinence, which is the “involuntary loss of urine accompanied by or following a sudden compelling desire to void which is difficult to defer”, and c) mixed urinary incontinence, which is defined as “the involuntary urine loss accompanied by urgency and present by effort, exercise, sneeze or cough”. Women are more prone to the condition than men. This is because the incidence for each type of urinary incontinence in females ranges between 10% and 58% while incidence in men is estimated to be between 3% and 11% depending on the population checked and the definition used for incontinence. [More]

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Original article The prebiotic effects of a new mixture of soluble fermentable fibres in the treatment of chronic constipation by L. Amodio et al.

prebiotic effectsChronic constipation is a multifactorial polysymptomatic disorder very common in the western population. Though constipation is a widespread condition, its real prevalence and incidence are difficult to quantify because of the definition itself, which varies among physicians and laypersons, and because only a small part of people who perceive they have constipation seek health care. Chronic constipation has become a significant health problem, especially in the female population. It is associated with impairment of quality of life and high levels of psychological distress. A recent systematic review estimates the prevalence of constipation in Europe to be 17.1% (median value 16.6%) and epidemiologic studies based on householder surveys in North America suggest a prevalence of 15% to 20% especially in people over 65 years old with a ten year cumulative incidence estimated at 17.4%. These prevalence rates were calculated using the Rome II criteria. However for self-reported constipation the prevalence rises up to 29.5% with approximately 1/3 of subjects dissatisfied with their bowel function. [More]

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Original article The assessment of normal female urethral vascularity with Color Doppler endovaginal ultrasonography: preliminary reportby A. P. Wieczorek et al.

normal female urethral vascularity The female urethra has very complex anatomy and function which are still not fully understood. Vascularity is one of the major factors contributing to maintaining the normal function of urethra. The usefulness of color-doppler as well as of spectral analysis of blood flow within the urethral vessels have been already described in the literature. From these reports it is known that a number of various elements, such as age, parity, body mass index, estrogen/gestagen profile, menopause, hormone replacement therapy can influence the appearance of Doppler flow spectrum in urethral vessels. However, the research describing the number and the distribution of urethral blood vessels is scarce. It is known from anatomy that the female urethra is supplied by 3 different vessel networks manifested by 3 major vascular levels – proximal (intramural), middle (midurethra) and distal. The aim of the study was a comparison of intensity of the vascularity of urethra at 3 levels in its sagittal plane (intramural, midurethra and distal part), and in its axial plane at the level of midurethra (rhabdosphincter vs. the inner part of urethra) in premenopausal, nulliparous, continent patients. [More]

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Conference 11th aavis annual scientifc meeting International Pelviperineology Conference read_pdf [420 kb]

pelvic floor digestConference Brochure. IPFDS - ICOPF - USANZ - AAVIS
11th aavis annual scientifc meeting International Pelviperineology Conference.
Noosa Sheraton Resort and Spa July 30 – August 1 2009
Noosa, Sunshine Coast, Australia  [PDF]

Pelvic Floor Digest June 2009 Issue Pelvic Floor Digest read_pdf [307 kb]

pelvic floor digestThis section presents a small sample of the Pelvic Floor Digest (September 2009), an online publication (www.pelvicfloordigest.org) that reproduces titles and abstracts from over 200 journals. The goal is to increase interest in all the compartments of the pelvic floor and to develop an interdisciplinary culture in the reader. [PDF]