Biomedical subjects

Curt R Powell

Publications and source records attributed to Curt R Powell.

3 recordsLinked to original sources

PubMed2005

Suburethral sling materials: best outcome with autologous tissue.

OBJECTIVE: This study was undertaken to assess the outcome of suburethral slings by type of sling material. STUDY DESIGN: A retrospective review of women who underwent a suburethral sling between January 1997 and January 2003 with autograft, allograft or xenograft materials. Objective failure was defined as urinary leakage with cough stress testing at any time after 3 months, postoperatively. Objective cure was defined as no leakage with a standing cough stress test with at least 200 mL bladder volume at a minimum of 12 months postoperatively. Data were analyzed using Student t, Wilcoxon rank sum, and Kaplan-Meier survival tests. RESULTS: A total of 241 women were included in this study: 78 received autograft, 80 received allograft, and 83 received xenograft. Objective failure was 36% and 46% for allograft and xenograft, respectively compared with 13% for autograft (P < .001). CONCLUSION: Autograft has a significantly higher cure rate when used for suburethral slings.

Adult↗

PubMed2004

Predictive value of prolapse symptoms: a large database study.

We sought to describe the relationship between patient symptoms and pelvic organ prolapse (POP) and report the sensitivity, specificity, and positive and negative predictive value of these POP symptoms. Two urologists and four urogynecologists developed a standardized pelvic floor questionnaire based on face validation for use at three female pelvic floor disorder clinics. Specific questions related to prolapse included questions on urinary splinting, digital assistance for defecation, and a bulge per vagina. Prolapse was assessed with the standardized Pelvic Organ Prolapse Quantitative (POP-Q) terminology. The analysis included 1912 women. Urinary splinting was uncommon (< 10%) when Ba < 0, but ranged between 23 and 36% for stage III and IV Ba prolapse. Digital assistance was equally common in stage II Bp prolapse (21-38%) and stage III-IV Bp prolapse (26-29%). Only 6-11% of women with stage 0 or I POP reported symptoms of bulge, but with stage II it increased to 77%. Urinary splinting is 97% specific for anterior prolapse. The report of a bulge has an 81% positive predictive value and a 76% negative predictive value. Very few patients without anterior prolapse will report urinary splinting. Digital assistance for fecal evacuation is no more common with massive posterior prolapse than with moderate posterior prolapse. Patient report of a bulge is a valuable screening tool for POP and should prompt a careful exam.

Adolescent↗

PubMed2004

Anterior vaginal wall hammock with fascia lata for the correction of stage 2 or greater anterior vaginal compartment relaxation.

PURPOSE: We determined the efficacy of the anterior vaginal wall hammock (AVWH) using fascia lata for the correction of anterior vaginal compartment relaxation. MATERIALS AND METHODS: A total of 58 patients with stage 2 or greater anterior vaginal compartment relaxation underwent an AVWH procedure with autologous or allograft fascia lata from June 1998 to March 2001. Patients were evaluated preoperatively with a history and pelvic organ prolapse quantitative examination. Postoperatively patients were evaluated at 6 weeks, 6 months and yearly thereafter with pelvic organ prolapse quantitative staging of the anterior, middle and posterior compartments. Objective cure was defined as stage 0 or 1 relaxation. Subjective cure was defined as no symptoms of pelvic pressure or a vaginal bulge. RESULTS: Of the 69 (89%) patients who underwent surgery 58 were available for followup. Median age of the population was 61.9 years and median followup was 24.7 months (range 12 to 57). There were 11 objective failures (19%) in the anterior compartment, of which 1 (2%) was symptomatic. Two patients (4%) had enteroceles that required surgical correction. Of the patients 16 (28%) had new onset or worsening stage 2 posterior relaxation at a median of 15.2 months postoperatively, including 7 (12%) who were symptomatic and underwent subsequent repair. CONCLUSION: The AVWH procedure with fascia lata is safe and effective for correcting stage 2 or greater anterior compartment relaxation. The whole pelvic floor must be evaluated and repaired to minimize the progression of prolapse of the middle and posterior compartments.

Adult↗