Primary evaluation of patients suspected of having interstitial cystitis (IC).
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Cystitis, Interstitial↗
Biomedical subjects
M Cervigni
Publications and source records attributed to M Cervigni.
The use of synthetics in the treatment of pelvic organ prolapse.
Despite an improved understanding of pelvic anatomy and organ function and advances in surgical techniques, long-term success rates in pelvic surgery are still variable (3-59%), but can reach up to 92% in the case of associated procedures. The major causes of recurrent pelvic prolapse after corrective surgery are related to patient factors, such as poor tissues, impaired healing processes and chronic pathological increases in intra-abdominal pressure. Other causes of failure are, however, probably related to surgical techniques: the use of weak or insufficient sutures, or suboptimal performance of the surgery. In line with progress in the surgical correction of abdominal hernias, the use of synthetic mesh in pelvic reconstructive surgery also seems to guarantee its reliability, especially when autologous tissue is of poor quality or insufficient quantity. Moreover, the use of artificial mesh may simplify a surgical procedure, reducing operative time and the need for additional techniques. This review evaluates the main properties of synthetic biomaterials, their complications and the most common procedures involved in the use of synthetic mesh: the abdominal sacral colpopexy and transvaginal cystocele repair.
Biocompatible Materials↗
Surgical treatment of stress urinary incontinence.
The treatment of stress urinary incontinence (SUI) is one of more controversial aspects of pelvic floor surgery. The indications for the surgical approach are related to the international classification as: Type 1 and Type 2 (Anatomical Incontinence), and Type 3 urinary incontinence (Intrinsic Sphincteric Dysfunction). The procedure of choice for Type 1 and Type 2 is Bladder Neck Suspension (BNS) that create a strong hammock against which the urethra can be compressed with sudden changes of abdominal pressure. Type 3 has to be treated by coaptation or compression of the deficient sphinteric unit (slings or injections). The mean cure rate after Marshall-Marchetti-Krantz is 77%, that of the Burch is 81%, and that of the Needle Suspension is 79%. Laparoscopy, Bone Anchors BNS and Tension-Free Vaginal Tape represent a promising option to the traditional techniques. The contribution of minimal invasive surgery consisting in: short recovery or possibility of day surgery, reduced trauma and pain, and success rate similar to the conventional techniques, is changing the SUI treatment.
Female↗
Detection of human papillomavirus type 16 DNA sequences in paraffin-embedded tissues from the female urinary tract.
We investigated the presence of human papillomavirus-related DNA sequences (HPV 6, 11, 16 and 18) in 33 formalin-fixed paraffin-embedded biopsies from the urinary tract of female patients with recurrent and persistent urethritis and cystitis, using the polymerase chain reaction (PCR). The samples for PCR reaction were selected among tissues examined for histological diagnosis on the basis of the presence of microscopic changes consistent with HPV infection. Sequences homologous to HPV 6, 11 and 18 genome were not found, while HPV 16-related DNA sequences were identified in 25/33 lesions with histopathological diagnosis of metaplasia (1 from the urethra, 23 from the trigone and 1 from the bladder). The results suggest that the spread of HPV in the female urinary tract may not be uncommon and point to the need for further research on the possible pathogenic role in recurrent female disturbances.
Cystitis↗
[Endoscopic treatment of sphincter insufficiency with autologous fat injection].
A total of 11 women with stress urinary incontinence related to intrinsic sphinteric incontinence (type 3) underwent periurethral injection of autogolous fat. The fat was harvested from the abdominal wall by special liposuction unit including: a special syringe for plastic surgery provided with 6 straight needles 12-20 Gauge connected to a vaum extractor for the liposuction; a 14 Gauge straight needle for lipofilling periurethrally and then a cystoscope with a 0 degree and 70 degree lenses. The fat is injected at 3 and 9 o'clock position and the mean quantity was 15,5 ml. The exact localization of the injected area was endoscopically detected before, and afterwards with an ultrasound transrectal probe. Follow up results were assessed clinically and by urodinamic and ultrasound evaluation at 3, 6 and every six months following. A follow up was ranged from 9 to 36 months (mean 22.6). Of the 11 women, 6 (54.5%) were cured, 2 (18.2%) pats. Were improved and in 3 woman (27.3%) no change occurred. The Urodynamic parameters didn't show any statistical significant change except for Functional Urethral Length (p < 02) and Flow Time (p < 04) that increased in cured patient. The ultrasound evaluation showed an hyperecogenic aspect in all patients; and al the urethral wall was hyperecognic in 1 woman. The resorption average time was 8 months, and 8 pats (72.7%) showed a partial resorption after 22 months. 3 patients should have been reinjected, 2 of them were cured and in the last one an improvement was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Adipose Tissue↗
[Echographic diagnosis and treatment of urethral instability].
Unstable urethra as defined by the International Continence Society is the condition where loss of urine is caused solely by a fall in urethral pressure. But the condition is rare and therefore the term Urethral Pressure Variations (UPV) is better used. The UPV are caused by activity of smooth and striated muscles. Frequently is associated with Genuine Stress Incontinence or Detrsor Instability that can make worse urinary loss. An urogynecologic work-up can reveal the presence of UPV by Urodynamic and ultrasound evaluations. The Urethral Pressure monitoring reveals the fast or slow intraluminal pressure fall between 10 to 20 cm H2O or more. The ultrasound examination carried out by a linear vaginal probe (5 MHz) can observe the contraction of the "prepubic muscle" (anterior pubo-urethral ligament + bulbo-spongious muscle) as a preliminary phase of urethral pressure fall. The prepubic muscle located from clitoris to the external meatus exert a force on the anterior and distal part of the urethra during the intraluminal pressure falls. With the section of this structure (muscle + ligament) we treated 9 patients diagnosed as having UPV with concomitant irritative urologic symptoms. Out of 9 women with a follow-up ranged from 1 to 23 months (mean 9,5), 5 patients (56%) were cured, 2 (22%) of them were improved, in the last 2 (22%) patients no change was observed. The complications were minimal only a vestibulo-vaginal increased sensitivity, and one case of dyspareunia.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Analysis of the prognostic factors of endometrial carcinoma. A retrospective study of 144 patients.
One hundred and fourty-four patients with endometrial carcinoma who had undergone surgery as primary treatment were retrospectively studied from January 1980 to September 1990 for the purpose of correlating the survival rate with known or presumed prognostic factors. The patients averaged 63.1 years of age (range 32-88 years); 106 were classified as having Stage I disease, 10 Stage II, 16 Stage III and 2 Stage IV. Histology confirmed pure adenocarcinomas in 77%, adenosquamous carcinoma in 3.5%, clear cell carcinomas in 2.5% and serous papillary in 17%. Surgical treatment consisted of extrafasial hysterectomy with pelvic lymphadenectomy up to the aortic bifurcation in 69 patients (48%), Wertheim's hysterectomy in 10 (7%), simple or vaginal hysterectomy in the remaining 65 patients (45%). Five-year survival rate in all the case series was 74.3% whereas for patients with Stage I carcinoma it was 79.9%. Different prognostic factors were correlated in a multivariate analysis with the outcome of the disease. Myometrial invasion presented a mortality ODDS RATIO (OR) of 3.18 (95% CI 1.25-8.06), for histologic grade OR 4.33 (95% CI 1.74-10.74) and for stage (2-3 vs 1) OR of 2.73 (95% CI 1.09-6.83) demonstrating a high significance, whereas pregnancy, excess body weight, age and histotype were not considered as relevant factors for prognosis. For age we found mortality OR 2.54 (95% CI 0.75-8.59) for women greater than 55y.
Adenocarcinoma↗
Acute urethral obstruction due to condylomata acuminata.
Urethral obstruction is a rare disease in women, and even more uncommon is the occurrence of acute urethral obstruction due to condylomata. This case report describes the course of one such case, unique for its progressive clinical evolution, the primary involvement of the lower urinary tract in the absence of either an obvious primary site or a history of sexual intercourse for more than 15 years, and its successful treatment with cryotherapy.
Aged↗
The Studer ileal neo-bladder: anatomical and functional characteristics.
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Adult↗
Transvaginal bladder neck suspension: a safer method.
A new modification of transvaginal technique of bladder neck suspension is described. Its main merit is its safety. The ligature-carrying needles are inserted from below rather than above. It virtually eliminates bladder injury. Our experience with 29 cases and a follow-up of six to thirty months shows that this technique is as successful as other similar procedures in controlling genuine stress incontinence.
Adult↗