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M Y Bongers

Publications and source records attributed to M Y Bongers.

16 recordsLinked to original sources
PubMed2007

Does urodynamic investigation improve outcome in patients undergoing prolapse surgery?

AIMS: Without solid evidence, it has been advocated to perform urodynamic investigation in all patients scheduled for prolapse surgery. If urodynamic investigations were to be valuable in the diagnostic work-up, patients with normal and abnormal findings would have different treatment results. Our policy to never combine prolapse surgery and stress-incontinence surgery allowed us to study whether incontinence after surgery can be predicted from urodynamic investigation results. METHODS: A retrospective study was performed in consecutive patients undergoing vaginal prolapse surgery (anterior colporraphy and/or posterior colporraphy, and/or vaginal hysterectomy) between 2002 and 2004. All patients underwent pre-operative urodynamic investigation, including filling cystometry, urethral pressure profile measurement, and free flow cystometry. Data were collected from the files about medical history, findings at pelvic examination, findings at urodynamic investigation and presence of stress- and/or urge-incontinence after surgery. RESULTS: We studied 76 patients, of whom 5 (7%) patients reported stress-incontinence and 5 (7%) patients reported urge-incontinence after surgery. Findings at urodynamic investigation could not predict the presence of stress- or urge-incontinence after surgery. Likelihood ratios (LR) of prior presence of urge and stress-incontinence for the presence of post-operative urge- and stress-incontinence were 4.5 and 1.2, respectively. Of all findings at urodynamic investigation, only negative transmission during cough test was associated with presence of stress-incontinence (LR = 1.5). CONCLUSIONS: The prevalence of incontinence after prolapse surgery is low. None of the investigated parameters of the urodynamic investigation tests was associated with the presence of urinary incontinence after surgery.

Aged↗
PubMed2003

[Transvaginal contrast sonography of the uterus in the diagnosis of abnormal uterine blood loss: less hysteroscopies needed].

OBJECTIVE: To determine the value of transvaginal saline-infusion sonography of the uterus in patients with abnormal uterine blood loss in terms of avoiding hysteroscopy. DESIGN: Prospective. METHOD: According to the protocol, transvaginal saline-infusion sonography was carried out on all consecutive patients with abnormal uterine blood loss (post-menopausal patients with an endometrial thickness of > or = 5 mm and all pre-menopausal patients with menorrhagia or metrorrhagia) in the St. Joseph hospital in Veldhoven, the Netherlands, during the period 1999-2001. If sonography did not provide an image suitable for assessment, or if intracavitary (pedunculated) lesions such as polyps or myomas were suspected, a planned therapeutic hysteroscopy was carried out. Patients indicated their perception of pain on a visual analogue scale. RESULTS: Saline-infusion sonography of the uterus was performed in 457 patients (age: 40-69 years). In 32 patients (7%) it did not result in a representative image. In 138 (32%) of the remaining 425 patients, a pedunculated lesion was suspected. In 262 (59%) of the 457 patients, diagnostic efforts were restricted to ultrasonic examination. This was combined with endometrial aspiration in 161 (61%) of these patients. In total, hysteroscopy was carried out in 195 of the 457 patients (43%). There were no complications. Pain was scored as 'none-little' by 292 patients (64%), 'moderate' by 76 (17%) and 'a great deal' by 48 (10%) patients. CONCLUSION: Saline-infusion sonography of the uterus is a safe diagnostic method in patients with abnormal uterine blood loss, which, in more than half the cases, can replace less well-tolerated diagnostic procedures.

Adult↗
PubMed2003

Cost-effectiveness of transvaginal sonography and saline infused sonography in the evaluation of menorrhagia.

OBJECTIVES: To assess the cost-effectiveness of transvaginal sonography (TVS) and saline infused sonography (SIS) in the diagnostic work-up of women with menorrhagia. METHODS: We performed a decision analysis in which we compared the percentage of patients treated successfully and cost of six strategies for the evaluation of menorrhagia: (0) hormonal treatment, (I) treatment of all patients with balloon ablation, (II) TVS and therapeutic hysteroscopy, (III) TVS, SIS and therapeutic hysteroscopy, (IV) SIS and therapeutic hysteroscopy, and (V) diagnostic hysteroscopy and therapeutic hysteroscopy. Hormonal treatment was considered to be the reference strategy to which the five strategies were compared. Data were obtained from the published literature. In order to evaluate the robustness of our results, we performed extensive sensitivity analyses, in which we varied sensitivity and specificity of TVS and hysteroscopy, the prevalence of intracavitary abnormalities, as well as costs of TVS and SIS. RESULTS: We found that the strategy starting with SIS (IV) and the strategy with diagnostic hysteroscopy (V) revealed the highest number of patients treated successfully for menorrhagia. In terms of cost-effectiveness, SIS for all patients was superior over immediate diagnostic hysteroscopy for all patients. Strategies starting with TVS were less effective than the strategy starting with SIS. CONCLUSIONS: We recommend SIS as the procedure of first choice in the work-up for women with menorrhagia.

Catheter Ablation↗
PubMed2002

Prognostic factors for the success of thermal balloon ablation in the treatment of menorrhagia.

OBJECTIVE: To identify predictive factors that will ensure successful menorrhagia treatment using hot fluid balloon endometrial ablation. METHODS: This is a prospective study on patients referred for menorrhagia and treated with hot fluid thermal balloon ablation. Potential prognostic factors for assessing the success of treatment were recorded. Success was defined as patient satisfaction and no subsequent hysterectomy at 2-year follow-up. RESULTS: A total of 130 women were included in the final analysis. The cumulative rate of patients undergoing a hysterectomy after 2 years was 12%. After 2 years, 81% of the remaining patients were satisfied with the results of the treatment. Predictive factors for adverse outcome were a retroverted uterus (hazard rate ratio 3.3, 95% confidence interval [CI] 1.2, 8.6), pretreatment endometrial thickness of at least 4 mm (hazard rate ratio 3.6, 95% CI 1.3, 11), and the duration of menstruation (hazard rate ratio 1.2, 95% CI 1.0, 1.3, per day in excess of 9 days). The risk of an adverse outcome declined steadily with increasing age (hazard rate ratio 0.86, 95% CI 0.77, 0.96 per year over 42 years of age). Uterine depth and dysmenorrhea were not predictive factors, which significantly affected outcome. CONCLUSION: Young age, retroverted uterus, endometrial thickness of at least 4 mm, and prolonged duration of menstruation were associated with an increased risk of treatment failure. Uterine depth and dysmenorrhea had limited impact on the effectiveness of balloon ablation.

Adult↗
PubMed2000

Is balloon ablation as effective as endometrial electroresection in the treatment of menorrhagia?

BACKGROUND: Hot-fluid balloon therapy is a recently introduced, relatively simple endometrial ablation procedure for menorrhagia. Because it is thought to be safer than other ablation procedures, it would be superior to other types of ablation if it is equally effective. The purpose of the present study was therefore to compare the safety and effectiveness of balloon ablation and transcervical resection of the endometrium (TCRE) for the treatment of menorrhagia. PATIENTS AND METHODS: We performed a prospective cohort study comparing TCRE and hot-fluid balloon ablation in consecutive patients suffering from menorrhagia and not responding to medical treatment. Between 1992 and 1994, all patients had TCRE, whereas from 1995 onward, all patients had balloon therapy. Outcome measures were surgical reintervention, menstrual pattern, and patient satisfaction. Assuming a 9% reintervention rate after TCRE, a series of 150 patients was required to show balloon ablation to be equally effective. RESULTS: Of the 152 patients who were included, 75 underwent TCRE and 77 had balloon ablation. The procedure had to be abandoned in 13 patients in the TCRE group (17%) and in 8 patients in the balloon ablation group (10%). In the TCRE group, four patients underwent a second resection, whereas hysterectomy was performed in 15 patients (3-year cumulative reintervention rate 26%). In the balloon-ablation group, there were no reresections, whereas hysterectomy was performed in 9 patients (3-year cumulative reintervention rate 13%) (log-rank test P = 0.11). The relative risk for any reintervention was 0.36 (95% confidence interval 0.05-2.5). At 3 months' follow-up the duration of menstruation was significantly shorter after TCRE than after balloon ablation, but at 6, 12, and 24 months, the duration of menstruation in the two groups appeared to be equal. No difference in patient satisfaction could be detected between the two groups, but there appeared to be a statistically significant decline in patient satisfaction over time for both therapies. This decline was stronger after TCRE than after balloon ablation. CONCLUSIONS: Because endometrial ablation with a hot-fluid balloon seems to be as effective as endometrial resection, with a lower complication rate, balloon ablation might become the procedure of choice for endometrial ablation.

Adult↗
PubMed1999

How concordant are the estimated rates of natural conception and in-vitro fertilization/embryo transfer success?

Knowledge of the chance to conceive for the subfertile couple is important in the process of counselling and clinical decision making. There are no data available on the reproducibility of the clinician's ability to assess the chance to conceive, both after expectant management or treatment with in-vitro fertilization and embryo transfer (IVF-embryo transfer). We evaluated this reproducibility by means of a set of case histories presented to a panel of gynaecologists and endocrinologists. A poor reproducibility would indicate a strong need for the use of prognostic models. In 1995, 57 gynaecologists and 32 reproductive endocrinologists were asked to appraise the 1 year spontaneous conception chance as well as the cumulative success rate of three cycles for IVF-embryo transfer of four couples with different medical histories. The clinical and laboratory data of these couples were presented as case histories. The difference between the estimated spontaneous pregnancy chances and the success rate of IVF-embryo transfer was also calculated. Calculation of intra-class correlation coefficients, which can be considered as measures of the reproducibility, demonstrated a substantial reproducibility of the assessment of spontaneous conception chances, but a slight to fair reproducibility of the assessment of IVF-embryo transfer success rates. We conclude that the use of reliable prognostic models for IVF-embryo transfer in the management of subfertility is warranted.

Adult↗
PubMed1998

The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis.

OBJECTIVE: To assess the diagnostic performance of serum CA-125 measurement in the detection of endometriosis. DESIGN: Meta-analysis. SETTING AND PATIENT(S): Twenty-three studies comparing serum CA-125 levels and laparoscopically confirmed endometriosis. INTERVENTION(S): Serum CA-125 measurement and laparoscopy. MAIN OUTCOME MEASURE(S): Sensitivity and specificity of serum CA-125 measurement in the diagnosis of endometriosis with laparoscopy as the reference standard. RESULT(S): The estimated summary receiver operating characteristic curves showed that the performance of serum CA-125 measurement in the diagnosis of endometriosis grade I/IV is limited, whereas its performance in the diagnosis of endometriosis grade III/IV is better. CONCLUSION(S): Despite its limited diagnostic performance, we believe that the routine use of serum CA-125 measurement in patients with infertility might be justified. In contrast to laparoscopy, serum CA-125 measurement is an inexpensive test that is not a burden for the patient. It could identify a subgroup of patients who are more likely to benefit from early laparoscopy. Studies reporting on the mutual dependence between serum CA-125 measurement and data from the history and physical examination are needed.

CA-125 Antigen↗
PubMed1996

The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnormalities.

OBJECTIVE: To evaluate the diagnostic accuracy of transvaginal ultrasonography for endometrial abnormalities in women with abnormal uterine bleeding. METHODS: In a prospective study, 136 consecutive patients underwent transvaginal ultrasonography, hysteroscopy, and endometrial sampling through suction curettage or directed biopsy. The ultrasonographic findings were evaluated on the basis of the final diagnosis established by hysteroscopy and histologic examination. Receiver operating characteristic curve analysis and likelihood ratios were used. Likelihood ratios algebraically combine sensitivity and specificity to describe more than the independent values themselves, specifically the change in odds favoring disease given a particular test result. RESULTS: In 21 of the 136 patients, hysteroscopy detected polyps or submucous myomas, which curettage failed to detect. In 67 premenopausal women, ultrasonography demonstrated a sensitivity in diagnosing endometrial abnormalities of 88% and a specificity of 68%, using a cutoff point of 5 mm of single-layer endometrial thickness. The positive likelihood ratio was 2.8 (95% confidence interval [CI] 1.66-4.55) and negative likelihood ratio 0.18 (95% CI 0.07-0.46). In 69 postmenopausal women, using a cutoff point of 3 mm, the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 97%, 74%, 3.7 (95% CI 2.18-6.38), and 0.04 (95% CI 0.01-0.28) respectively. CONCLUSIONS: Transvaginal ultrasonography is an excellent first-step diagnostic method of excluding the endometrial abnormalities in women with postmenopausal bleeding but is of limited use in premenopausal women with irregular bleeding. Ultrasonography may reduce the number of invasive endometrial investigations by approximately 40%.

Adult↗
PubMed1995

Endometrial electrosurgical resection by hysteroscopy in 32 menorrhagic patients: endometrial preparation with a GnRH agonist may have some effect on results.

Our objective was to evaluate the effect of endometrial thinning by GnRH agonists on the results of hysteroscopic endometrial electrosurgical resection. In a prospective study, 32 women were treated with the GnRH agonist goserelin (Zoladex) before hysteroscopic endometrial resection. Endometrial thickness was measured before and after GnRH-a therapy by ultrasound. Short-term results in diminished vaginal blood loss and patient satisfaction were registered. The mean endometrial thickness (ET) before GnRH-a is 3.7 mm and after GnRH-a is 1.9 mm. In 24 cases, ET was reduced by a mean of 2.6 mm, in 1 case, no change was seen, and in 7 cases, ET increased by a mean 1.1 mm. The mean thickness rate (TR = ET before and after GnRH) is 2.7 (range 0.3-11). Fluid resorption during hysteroscopic surgery does not relate to ET or TR. Although the ET after GnRH-a therapy is not related to success or failure of the endometrial resection, there is some evidence that the TR is, probably expressing a more active state of the endometrium. Endometrial thinning by GnRH-a may have an effect on the results of hysteroscopic endometrial resection. In light of the present study and the literature, there seems to be no justification for abandoning preparation of the endometrium before hysteroscopic surgery.

Adult↗
PubMed1993

[Ultrasonographic diagnosis of endometrial disorders: correlation with the histological results in 112 patients].

The diagnosis of endometrial lesions hitherto was mainly made on the basis of histological examination. The objective of this study was the assessment of the diagnostic accuracy of transvaginal ultrasound investigation by comparison with the usual histological investigation, which implies painful endometrial sampling. 112 perimenopausal women with irregular vaginal blood loss were examined by transvaginal ultrasound. Shortly afterwards endometrial sampling was performed by means of aspiration, conventional curettage or hysteroscopically guided biopsies. The group of 112 patients included 11 women who had previously received hormone substitution therapy (10%). The other patients (without previous hormone substitution therapy) were divided into a premenopausal group (n = 47) and a postmenopausal group (n = 54). In case of an endometrial thickness (single layer) of less than 3 mm in postmenopausal patients, no (pre)malignant lesions were found. In the pre- and postmenopausal group, using this cut-off-level two of the five endometrial hyperplasias were ultrasonographically missed. All fourteen endometrial carcinomas in 112 patients were ultrasonographically detected by an endometrial thickness > or = 4 mm. In the postmenopausal group specificity was 73% (16/22) using a cut-off-level of 3 mm, in the premenopausal patients it was only 36% (11/31). Regular echo-density or a clear alignment between endo- and myometrium hardly had any value in the diagnosis of (pre)malignant lesions of the endometrium. If our patients with an endometrial thickness of less than 3 mm would not have had an endometrial curettage, 38 of 112 (34%) endometrial samplings might have been avoided. According to our view, transvaginal endometrial examination can be of distinct value in the detection of (pre)malignant endometrium.

Biopsy, Needle↗