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Cadaveric Assessment of Synthetic Mid-Urethral Sling Placement
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51
S21
fact that they may be placed or tensioned differently, or anchored to different muscles. To evaluate which sling placement was tensioned most correctly and was most likely at the mid-urethra. Design: We placed an obturator, retropubic, and a single incision sling in three different fresh cadavers. Afterwards, 30 physicians were allowed to visually inspect the cadavers without being aware of how the slings were placed. Each physician completed a questionnaire asking what type of sling was placed, if the sling was the right tension, and if it was located at the mid-urethra. Setting: N/A Patients: N/A Intervention: Each cadaver had all possible skin incisions made. The tension for the obturator and retropubic slings were set using a 12 Hagar dilator as a spacer. The tension of the single incision sling was set so that the sling lay against the urethra such that pillowing of the periurethral tissues were observed through the pores of the sling. Measurements and Main Results: The physicians were composed of 5 urologists, 7 urogynecologist, and 18 general gynecologists. The average number of slings performed per year by each physician was 53. The findings are summarized in the table below: Cadaveric Mid-Urethral Sling Placement Results
Measurements and Main Results: Twenty eight Wistar rats, with abdominal hernia, were repaired with synthetic meshes, either non absorbable (Polypropylene (PP), n 5 14), and absorbable (poly (lacticacid)94 (PLA94), n 5 14), using a validated incisionnal abdominal hernia model. Fourteen meshes were infected intraoperatively (n 5 7 PLA94 meshes and n 5 7 PP meshes) with 10e6 CFU Escherichia coli, versus 14 non infected meshes (n 5 7 PLA94 meshes and n 5 7 PP meshes) (control groups). Explantations were performed at day 30. Contaction was evaluated by a reproducible numerical analysis of mesh area and completed by a bacteriological and histological analysis. Non infected synthetic meshes were less likely to contract than infected meshes, for both non absorbable (5% versus 21.56%, p ! .05) and absorbable meshes (2.4% versus 10.98% p ! .05). Shrinkage was less detected on PLA94 versus PP meshes when infected (10.98% versus 21.56%, p ! .05). Both bacteriological and histological studies were consistent with the numerical analysis.
% Who correctly identified sling % Who thought tension was just right % Who thought sling was at mid-urethra
Retropubic Sling
Obturator Sling
Single Incision Sling
40%
43%
23%
33%
47%
73%
50%
67%
83%
Physicians were least likely to be able to identify a single incision sling placement. The single incision sling whose tension was not set with a spacer was felt to have the most appropriate tension and was felt to most likely represent a mid-urethral placement. Conclusion: This study showed that after placement of a mid-urethral synthetic sling it is hard to tell how the sling was placed. This study also showed that most physicians felt that the sling that was tensioned the best and most likely at the mid-urethra was the single incision sling.
69
Plenary Session 5dUrogynecology (2:37 PM d 2:47 PM)
A Randomized Controlled Trial of Anterior Colporraphy and PerigeeÔ as Primary Surgical Correction of Symptomatic Cystocele Thys SD,1 Ridder D,3 Deprest J,3 Roovers JP.2 1Gynecology, Maxima Medical Center, Veldhoven, Noord Brabant, The Netherlands; 2 Gynecology, AMC, The Netherlands; 3University Hospital ‘‘Gasthuisberg’’, Belgium
Conclusion: The link between infection and contraction was established in our animal model, using polypropylene and PLA94. Absorbable meshes or meshes with anti bacterial properties should be less exposed to infection and contraction. 68
Plenary Session 5dUrogynecology (2:26 PM d 2:36 PM)
Cadaveric Assessment of Synthetic Mid-Urethral Sling Placement Serels S. Bladder Control Center of Norwalk, Norwalk, CT Study Objective: To prove that mid-urethral synthetic slings are visually the same against the urethra at the end of a procedure regardless of the
Study Objective: We randomly compared the morbidity and effectivity of anterior colporraphy and PerigeeÔ as primary surgical correction of symptomatic cystocele. Design: A randomized controlled trial was performed of anterior colporraphy versus PerigeeÔ to correct primary cystocele stage 2 or more (ICS). The procedure was combined with a sacrospinous ligament fixation or vaginal hysterectomy in case of co-existing level 1 defect, with a midurethral sling in case of co-existing stress incontinence. We compared anatomical and functional outcome, morbidity and reinterventions for pelvic floor dysfunction in the first year after surgery. We considered the prolapse domain score of the UDI as primary outcome measurement. Setting: Academic Medical Center, Amsterdam and University Hospital ‘‘Gasthuisberg’’, Leuven. Patients visited the hospital at 6 weeks, 6 and 12 months after surgery. POP-Q staging was performed and urogenital distress inventory (UDI) and defecation distress inventory (DDI) was completed. Pain scores (VAS) were registered during the first 6 weeks after surgery.
S21
fact that they may be placed or tensioned differently, or anchored to different muscles. To evaluate which sling placement was tensioned most correctly and was most likely at the mid-urethra. Design: We placed an obturator, retropubic, and a single incision sling in three different fresh cadavers. Afterwards, 30 physicians were allowed to visually inspect the cadavers without being aware of how the slings were placed. Each physician completed a questionnaire asking what type of sling was placed, if the sling was the right tension, and if it was located at the mid-urethra. Setting: N/A Patients: N/A Intervention: Each cadaver had all possible skin incisions made. The tension for the obturator and retropubic slings were set using a 12 Hagar dilator as a spacer. The tension of the single incision sling was set so that the sling lay against the urethra such that pillowing of the periurethral tissues were observed through the pores of the sling. Measurements and Main Results: The physicians were composed of 5 urologists, 7 urogynecologist, and 18 general gynecologists. The average number of slings performed per year by each physician was 53. The findings are summarized in the table below: Cadaveric Mid-Urethral Sling Placement Results
Measurements and Main Results: Twenty eight Wistar rats, with abdominal hernia, were repaired with synthetic meshes, either non absorbable (Polypropylene (PP), n 5 14), and absorbable (poly (lacticacid)94 (PLA94), n 5 14), using a validated incisionnal abdominal hernia model. Fourteen meshes were infected intraoperatively (n 5 7 PLA94 meshes and n 5 7 PP meshes) with 10e6 CFU Escherichia coli, versus 14 non infected meshes (n 5 7 PLA94 meshes and n 5 7 PP meshes) (control groups). Explantations were performed at day 30. Contaction was evaluated by a reproducible numerical analysis of mesh area and completed by a bacteriological and histological analysis. Non infected synthetic meshes were less likely to contract than infected meshes, for both non absorbable (5% versus 21.56%, p ! .05) and absorbable meshes (2.4% versus 10.98% p ! .05). Shrinkage was less detected on PLA94 versus PP meshes when infected (10.98% versus 21.56%, p ! .05). Both bacteriological and histological studies were consistent with the numerical analysis.
% Who correctly identified sling % Who thought tension was just right % Who thought sling was at mid-urethra
Retropubic Sling
Obturator Sling
Single Incision Sling
40%
43%
23%
33%
47%
73%
50%
67%
83%
Physicians were least likely to be able to identify a single incision sling placement. The single incision sling whose tension was not set with a spacer was felt to have the most appropriate tension and was felt to most likely represent a mid-urethral placement. Conclusion: This study showed that after placement of a mid-urethral synthetic sling it is hard to tell how the sling was placed. This study also showed that most physicians felt that the sling that was tensioned the best and most likely at the mid-urethra was the single incision sling.
69
Plenary Session 5dUrogynecology (2:37 PM d 2:47 PM)
A Randomized Controlled Trial of Anterior Colporraphy and PerigeeÔ as Primary Surgical Correction of Symptomatic Cystocele Thys SD,1 Ridder D,3 Deprest J,3 Roovers JP.2 1Gynecology, Maxima Medical Center, Veldhoven, Noord Brabant, The Netherlands; 2 Gynecology, AMC, The Netherlands; 3University Hospital ‘‘Gasthuisberg’’, Belgium
Conclusion: The link between infection and contraction was established in our animal model, using polypropylene and PLA94. Absorbable meshes or meshes with anti bacterial properties should be less exposed to infection and contraction. 68
Plenary Session 5dUrogynecology (2:26 PM d 2:36 PM)
Cadaveric Assessment of Synthetic Mid-Urethral Sling Placement Serels S. Bladder Control Center of Norwalk, Norwalk, CT Study Objective: To prove that mid-urethral synthetic slings are visually the same against the urethra at the end of a procedure regardless of the
Study Objective: We randomly compared the morbidity and effectivity of anterior colporraphy and PerigeeÔ as primary surgical correction of symptomatic cystocele. Design: A randomized controlled trial was performed of anterior colporraphy versus PerigeeÔ to correct primary cystocele stage 2 or more (ICS). The procedure was combined with a sacrospinous ligament fixation or vaginal hysterectomy in case of co-existing level 1 defect, with a midurethral sling in case of co-existing stress incontinence. We compared anatomical and functional outcome, morbidity and reinterventions for pelvic floor dysfunction in the first year after surgery. We considered the prolapse domain score of the UDI as primary outcome measurement. Setting: Academic Medical Center, Amsterdam and University Hospital ‘‘Gasthuisberg’’, Leuven. Patients visited the hospital at 6 weeks, 6 and 12 months after surgery. POP-Q staging was performed and urogenital distress inventory (UDI) and defecation distress inventory (DDI) was completed. Pain scores (VAS) were registered during the first 6 weeks after surgery.