Biomedical subjects

Lance H Betson

Publications and source records attributed to Lance H Betson.

4 recordsLinked to original sources

PubMed2006

Dyspareunia and chronic pelvic pain after polypropylene mesh augmentation for transvaginal repair of anterior vaginal wall prolapse.

Synthetic mesh augmentations for pelvic floor reconstructive surgeries are increasing in usage and popularity. Many studies are focusing on the anatomical success rates of transvaginal anterior compartment repairs with synthetic mesh, with minimal attention on its postoperative complications. We present a case report on a 59-year-old postmenopausal woman who underwent an anterior repair with 6x4-cm polypropylene mesh. Postoperatively, she developed severe dyspareunia and debilitating chronic pelvic pain. The patient failed conservative medical therapy and now requests complete removal of the synthetic mesh.

Cystocele↗

PubMed2005

A review of laparoscopic uterine suspension procedures for uterine preservation.

PURPOSE OF REVIEW: The most appropriate surgical approach for uterine preservation still remains the subject of ongoing controversy. Uterine suspension procedures can be performed abdominally, vaginally, or laparoscopically. This article focuses on the three different laparoscopic approaches of uterine suspension for uterine preservation: suspension to the round ligaments; suspension to the uterosacral ligaments; and suspension to the anterior ligament of the sacral promontory. This article reviews the published studies in the literature, analyzes the results, discusses the differences, and compares the different laparoscopic techniques. RECENT FINDINGS: A review of the literature reveals a paucity of research studies and publications on laparoscopic uterine suspension procedures. All the published studies are small, retrospective case series or case studies. Laparoscopic ventrosuspension using the round ligaments for uterine prolapse has a reported success rate of less than 50%. The ventrosuspension procedure has a very limited role and should not be employed. In comparison, laparoscopic uterine suspension procedures have a reported success rate ranging between 81 and 100%. The newest surgical technique is the laparoscopic sacral colpohysteropexy and there is only one reported case series on this procedure. The reported success rate for the sacral colpohysteropexy is 100%. SUMMARY: The first surgical option for uterine preservation is uterine suspension to the uterosacral ligaments. If the uterosacral ligaments cannot be identified or the uterosacral ligaments are weak and unusable, then laparoscopic sacral colpohysteropexy is a reliable second option. Uterine suspension to the round ligaments has an unacceptably high failure rate and is not an effective, durable alternative.

Adult↗

PubMed2005

Reevaluating occult incontinence.

PURPOSE OF REVIEW: Occult incontinence is a controversial subject without significant exposure in the literature. Conventionally, it has been assumed to be a marker for increased risk of postoperative stress urinary incontinence (POSUI) after repair of pelvic organ prolapse. The controversy surrounds the performance of prophylactic incontinence procedures based on this assumption. Until 2004 no article in the English language had been published demonstrating an association between occult incontinence and increased risk of stress urinary incontinence after repair of severe pelvic organ prolapse in previously continent women. We will explore the evidence regarding occult incontinence, review the data on intervention trials, and address questions that remain. RECENT FINDINGS: The limited evidence suggests 11-22% of continent patients with severe pelvic organ prolapse will develop POSUI. New evidence suggests that patients with occult incontinence are at substantially more risk. Since anti-incontinence procedures in patients with occult incontinence reduces the incidence of POSUI (to 0-15%), there appears to be some benefit from screening and intervention. Most studies on the subject are small and limited by their design. Results differ regarding whether a negative stress test can be used to rule out the risk of POSUI. SUMMARY: Minimal existing evidence in the English language suggests that patients with occult incontinence are at increased risk of POSUI. Outcomes in occult incontinence patients undergoing repair of pelvic organ prolapse need systematic study. Until there is adequate solid evidence on the predictive values of our screening test, we cannot counsel patients regarding our ability to prevent POSUI or protect them from unnecessary procedures.

Female↗

PubMed2003

Intrinsic urethral sphincteric deficiency: critical analysis of various diagnostic modalities.

PURPOSE OF REVIEW: The proper diagnosis of intrinsic urethral sphincteric deficiency among women with urinary incontinence carries important implications for determining the most effective medical or surgical therapy. Numerous diagnostic tests have been described attempting to make an accurate and comprehensive assessment of urethral function, but all suffer from a lack of standardization or inconsistently quoted reference values. This paper will review the literature on the positive aspects and limitations of commonly employed procedures to diagnose intrinsic urethral sphincteric deficiency. RECENT FINDINGS: Specific urodynamic studies, including the 'active' valsalva leak-point pressure and the 'static' urethral pressure profile are commonly used to determine urethral competence. However, these tests measure specific aspects of the continence mechanism under different clinical conditions, which limits the direct comparison between them. More complex techniques such as Doppler ultrasound, video-urodynamics and both static and dynamic magnetic resonance imaging are attempting to validate the urodynamic findings for urethral function. This approach may encourage the standardization of these procedures and parameters for diagnosing intrinsic urethral sphincteric deficiency. SUMMARY: A single definitive test for the diagnosis of intrinsic urethral sphincteric deficiency does not exist. Instead, multiple tests should be employed to reach a consensus for the diagnosis. This should include a complete voiding history, simple office examinations, and advanced studies such as urethrocystoscopy, urodynamics and possibly radiological evaluations. Understanding the limitations and variabilities of their equipment and the specific studies utilized should enable practitioners to standardize the approach for determining the extent of urethral dysfunction.

Diagnostic Techniques, Urological↗