Complications of Tension-Free Vaginal Tape Surgery: A Multi-Institutional Review

Tension-free vaginal tape for primary genuine stress incontinence: a two-centre follow-up study

– The purpose of this paper is to present a model for supporting and increasing teachers’ reflection process. , – The model is grounded in two concepts from variation theory: critical aspects and dimensions of variation. Those concepts are related to the concepts of reflection in-, on- and for-action. Analysis of data allows for determination of what kind of reflection is used in teachers’ professional development (PD) and the teachers’ perceptions of the relevance and usefulness of the PD. , – The results show that, using the concepts of critical aspects and dimensions of variation, teachers practiced reflection in-, on- and for-action in a non-dualistic way. , – The preliminary results confirm that the teachers change their behaviours, through reflection processes, if they have the opportunity to focus on the object of learning and to use research results found in mathematics education in order to open up dimensions of variation in the identified critical aspects. , – The design of algebra modules, according to concepts from variation theory and the reflection process, is the main result of this study. The model used in creating the modules has the potential for supporting and increasing teachers’ reflection process. , – A conceptual model of work practice evolution is proposed. The model is conceived as an intermediary between models of reflection, action at work and models of organisational teaching in the classroom. It considers work practices as evolving through confrontations between critical aspects, action in context, reflections in-, on- and for-action. The author advocate that the use of the presented methodology is not only inevitable but also vital to improve teachers’ PD.

/pdf/reflection-and-the-object-of-learning-1zuxl39jh8.pdf

Reflection and the object of learning

Introduction Pelvic organ prolapse is a multifactorial disease. Aim was to evaluate the effect of the whole surgical correction of pelvic floor on hydronephrosis due to severe prolapse. Patients and methods A retrospective case study on 250 patients presenting with severe uterovaginal prolapse was carried out. Results Hydronephrosis was found in 32/234 (13.7 %). All patients underwent hysterectomy, vaginal apex axial suspension, posterior and anterior repair, vaginally. Prepubic TICT (Tension free Incontinence Cystocoele Treatment) was done in 38 cases (3 with hydronephrosis). Of the 32/234 (13.7 %) patients with hydronephrosis, 18/32 (56.25%) had complete resolution of hydronephrosis after treatment, 14/32 (43.75%) had a reduction of calico-pyelic dilatation, among them 8 patients had a second degree and 6 a first degree of hydronephrosis. Conclusions Vaginal-hysterectomy, axial apex suspension, anterior and posterior repair resulted in either complete resolution or improvement of hydronephrosis. Prepubic TICT did not interfere on mechanical obstruction and maintained postoperative continence in the event of occult Stress Urinary Incontinence (SUI).

/pdf/hydronephrosis-and-utero-vaginal-prolapse-in-postmenopausal-32mfk8ki8g.pdf

Hydronephrosis and utero-vaginal prolapse in postmenopausal women: management and treatment

Neoplastic sigmoid-uterine fistula is an extremely rare condition because the uterus is a thick and muscular organ. A 74-year-old woman was admitted to the First Aid Station suffering from abdominal pain and foul smelling vaginal discharge. Gynaecological examination showed fecal drainage from the cervical orifice, while the uterus was regular in size but very firm and painful. Ovaries and fallopian tubes were not palpable owing to abdominal tenderness. Ultrasounds reveled inhomogeneous thickening of uterine cavity, without detecting fistula. Contrast Medium CT (CMCT) showed Douglas' recto-uterine pouch occluded. The sigmoid wall was very thin exception a site where a fistula was suspected. At the surgery severe adhesions of the sigma-rectum with the posterior uterine wall were observed. After adhesiolysis, 18 cm colon-sigma-rectum was removed. Total hysterectomy with salpingooophorectomy was performed. Lymphadenectomy ended the procedure. Anatomical specimen confirmed sigmoid-uterine fistula. At histology a mildly differentiated adenocarcinoma of sigma-rectum was shown. Postoperative course was uneventful. Such a case of neoplastic sigmoiduterine fistula has not been reported so far.

Neoplastic sigmoid-uterine fistula. An exceptional complication of large intestine cancer.

The Authors describe the techniques they perform of prepubic, retropubic and transobturator mini-invasive anti-incontinence surgical procedures and point-out some technical details. The state of art and the results of these three main surgical procedure are compared and discussed. Data from the Literature have been reviewed in order to evaluate the efficacy of the techniques. A Medline search has been performed, and 65 relevant articles from 1996 to 2012 were selected. Literature showed similar cure rates among retropubic (71,4-91%), trans-oburator (77,3-95%) and prepubic (81-87,2%) anti-incontinence procedures. Cystoscopy was considered necessary in the retropubic, optional in transobturator and in the prepubic techniques. Intra-operative cough stress test was believed useful only in the retropubic and prepubic procedures. Obstruction symptoms prevailed in the retropubic, were rare in the transobturator and missing in the prepubic technique. Erosion rate was very low and similar for all the three techniques. Intra-operative vascular and perforating risks prevailed in the retropubic technique, due to the danger present in the retropubic space, whereas late infective complications overcame in the transobturator procedure. Severe complications in the prepubic procedure were not reported, but the procedure is performed only in few centers.

Mini-invasive tension-free surgery for female urinary incontinence.

A specific application of two psychological measures on pelvic organ prolapse patients

Background. ll fibroma uterino (leiomioma) rappresenta la più comune forma di patologia benigna del tratto genitale femminile. I fibromi possono causare infertilità e sono caratterizzati da una sintomatologia piuttosto variegata. L’isterectomia, che prevede l’ablazione totale dell’utero, è un intervento demolitorio di notevole impatto fisico e psichico sul corpo e sulla persona. Lo scopo del presente lavoro è quello di capire in che modo l’isterectomia possa influire significativamente sulla condizione psicofisica della donna. metodo. La ricerca si è avvalsa dell’uso di due importanti strumenti per la misurazione dei tratti di personalità e per la rilevazione di eventuali problemi psicologici e di sintomi psicopatologici: il MCMI-III (millon Clinical multiaxial inventory) e la SCL-90-R (Symptom Checklist 90 r). Il campione della ricerca è formato da 200 soggetti di sesso femminile a cui è stato diagnosticato il fibroma uterino, di cui 100 sono donne che sono state sottoposte a miomectomia; le altre 100 hanno invece subìto l’intervento di isterectomia per la medesima patologia. risultati. La ricerca ha evidenziato che, per quanto riguarda le donne di età compresa tra i 46 e i 55 anni, non vi è alcuna differenza significativa, in merito alle scale dei due test utilizzati, tra chi ha conservato l’utero asportando solo il fibroma uterino e chi si è sottoposta ad intervento di isterectomia. L’analisi della varianza (ANOVA) ha rilevato, invece, differenze significative per quanto riguarda le donne di età compresa tra i 35 e i 45 anni. Conclusioni. I risultati supportano la tesi secondo cui non esiste una vera e propria sindrome “post-isterectomia”. Per quanto l’ablazione dell’utero si configuri come un intervento dal forte impatto psicofisico, la sintomatologia depressiva, le lamentele somatiche multiple o il disagio dal punto di vista sessuale palesati dalle donne subito dopo l’operazione sarebbero riconducibili ad eventuali condizioni Summary: The impact of hysterectomy as uterine fibroid therapy on personality traits and psychological symptoms of patients.

The impact of hysterectomy as uterine fibroid therapy on personality traits and psychological symptoms of patients

Objectives To compare mini-sling and traditional tension-free operations for female stress urinary incontinence. Study design A systematic review of articles in the Literature published between 2002 and 2012, was conducted. A Pubmed search was performed. Primary outcomes were subjective and objective cure rates at 12 months comparing the three single-incision mini-slings techniques (TVT-Secur, MiniArc and Monarc systems) with the standard midurethral sling procedure TOT (Transobturator Vaginal Tape). Secondary outcomes included peri-operative (vaginal and/or bladder perforation, urine retention, urinary tract infection, bleeding, pain) and post-operative (mesh exposure, de novo urgency, and dyspareunia) complications. Results In term of objective cure rate at 12 month after surgery, it is evident that TOT at first, and MiniArc are the most effective procedures. The incidence of post-operative urgency and UTI was lower in TOT technique, while vaginal perforation was described in equal frequency both in TOT and in MiniArc procedures. The advantages of the three above described mini-invasive techniques seem to consist into lower cases of urinary retention, pain and bleeding. Furthermore, bladder perforation and bleeding are not described in the Literature for TVT-Secur and Monarc systems. Conclusions Some single-incision slings look promising and as effective as conventional sub-urethral slings at short term evaluation. However, at this moment a clear statement in favor of the widespread use of single-incision slings cannot be made. More studies must define the efficacy of these techniques.

Comparison between three mini-sling surgical procedures and the traditional transobturator vaginal tape technique for female stress urinary incontinence.

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Mini-invasive tension-free surgery for female urinary incontinence.

A specific application of two psychological measures on pelvic organ prolapse patients

The impact of hysterectomy as uterine fibroid therapy on personality traits and psychological symptoms of patients

Comparison between three mini-sling surgical procedures and the traditional transobturator vaginal tape technique for female stress urinary incontinence.