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The Complete Pelviperineology March 2009 Issue in PDF format. [PDF]
Pdf
[2.2 Mb] The Complete Pelviperineology March 2009 Issue in PDF format. [PDF]
Pdf Editorial Editorial
This
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]
Full Text Pdf
This
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] Full Text Pdf 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.
Over
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]
Full Text Pdf
Over
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] Full Text Pdf Case
Report Cure of childhood urgency incontinence with a midurethral sling
by P. Petros
Miss “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]
Full
Text Pdf
Miss “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] Full
Text Pdf Original
Article Retropubic
urethrolysis and tape sectioning for obstruction following incontinence
surgery. Long-term results by
J. R. Maroto et al.
Standard
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]
Full
Text Pdf
Standard
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] Full
Text Pdf CommentComplex pelvic problems - a multidisciplinary perspective
by M. Soligo
“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]
Full
Text Pdf
“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] Full
Text Pdf Review articleImpact of urinary incontinence on quality of lifeby S. Charalambous et al.
Urinary
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]
Full
Text Pdf
Urinary
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] Full
Text Pdf Original
article The
prebiotic effects of a new mixture of soluble fermentable fibres in
the treatment of chronic constipation by L. Amodio et al.
Chronic
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]
Full
Text Pdf
Chronic
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] Full
Text Pdf Original
article The
assessment of normal female urethral vascularity with Color Doppler
endovaginal ultrasonography: preliminary reportby A. P.
Wieczorek et al.
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]
Full
Text Pdf
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] Full
Text Pdf Conference 11th
aavis annual scientifc meeting International Pelviperineology Conference [420
kb]
Conference
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]
Pdf
[420
kb]Conference
Brochure. IPFDS -
ICOPF -
USANZ -
AAVIS11th aavis annual scientifc meeting International Pelviperineology Conference.
Noosa Sheraton Resort and Spa July 30 – August 1 2009
Noosa, Sunshine Coast, Australia [PDF]
Pdf Pelvic
Floor Digest June
2009 Issue Pelvic Floor Digest [307
kb]
This
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]
Pdf
[307
kb]This
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] Pdf