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Biomedical subjects

Michelle M Fynes

Publications and source records attributed to Michelle M Fynes.

6 recordsLinked to original sources
PubMed2005

Female urethral diverticula.

Urethral diverticula are frequently under-diagnosed. The pathogenesis of this condition is poorly understood, and these lesions represent a spectrum of disorders ranging from isolated suburethral cysts to herniation of the urethral lining into the vaginal mucosa. Women with this disorder frequently complain of a host of symptoms referable to the lower urinary and genital tracts. Accurate diagnosis is based on history and clinical evaluation. Perineal ultrasound and MRI are often helpful. Repeated courses of antibiotics and urethral dilatation often fail to resolve the problem, and definitive intervention usually requires surgical excision to provide relief. This chapter describes the current management of this condition, and it heralds a re-look at the patho-aetiology in view of recent MRI findings of symptomatic non-communicating microcystic lesions.

Diverticulum↗
PubMed2004

The tension-free vaginal tape in older women.

OBJECTIVE: To evaluate peri-operative morbidity, continence outcome and patient satisfaction in older women (>/=65 years) compared with younger women undergoing tension-free vaginal tape. DESIGN: Case controlled study. SETTING: Tertiary Urogynaecology Unit. SAMPLE: Women undergoing tension-free vaginal tape for urodynamic stress incontinence between July 1999 and July 2002 were included. Those with detrusor overactivity, voiding difficulty at urodynamics or requiring concomitant prolapse surgery were excluded. METHODS: Older women were case matched to a younger cohort for BMI, parity, mode of anaesthesia and whether it was a primary or secondary continence procedure. MAIN OUTCOME MEASURES: Operative morbidity and continence outcome were assessed at six weeks. After a minimum six months follow up, patient satisfaction and continence outcome were assessed using the Genitourinary Treatment Satisfaction Score (GUTSS). RESULTS: The median hospital stay was one day and overall urinary tract infection rate was similar in both groups. Post-operative voiding difficulty rates were 3% in older versus 15% in younger women (P= 0.09). At six weeks, 65% of older versus 79% of younger women were dry (P= 0.2). At a median of 12 months, 15 (45%) of older versus 24 (73%) of younger women had no urinary symptoms (P= 0.05). Median GUTSS scores for satisfaction with continence outcome were lower for older 90% compared with 100% in younger women (P= 0.003). CONCLUSIONS: Tension-free vaginal tape is an effective continence intervention in older women but has a lower continence satisfaction rate compared with younger women.

Adult↗
PubMed2002

Stress urinary incontinence after delayed primary closure of genitourinary fistula: a technique for surgical management.

OBJECTIVES: Our purpose was to evaluate the anatomic pathology of severe incontinence after fistula closure and assess a surgical technique for correction of this problem. STUDY DESIGN: Twenty-two women with severe urinary incontinence after fistula closure were recruited, and clinical and urodynamic assessment was performed. A technique combining retropubic urethrolysis, pubovaginal sling, and omental graft was performed in women with genuine stress incontinence (GSI), and continence outcome was assessed at 4 weeks and 14 months. RESULTS: On urodynamic assessment, 9 (41%) had severe GSI with normal compliance, 3 (14%) GSI and poor compliance, 9 (41%) GSI and detrusor instability, and 1 (4%) voiding dysfunction with overflow incontinence. Nine women (41%) with pure GSI underwent continence surgery. Continence outcomes were 78% at 4 weeks and 67% at 14 months. CONCLUSION: The anatomic pathology of GSI after fistula surgery is complex. The surgical technique described is promising with low morbidity and improved continence rates at 4 weeks and 14 months compared with previous techniques.

Adolescent↗
PubMed2002

The role of synthetic and biological prostheses in reconstructive pelvic floor surgery.

PURPOSE OF REVIEW: Uterovaginal prolapse and urinary incontinence are common problems whose pathogenesis remains unclear. As life expectancy increases, significantly greater numbers of women will present with pelvic floor prolapse and incontinence requiring surgical intervention. Currently, the lifetime risk of undergoing prolapse or continence surgery in the USA is one in 11, and up to 30% of patients will require repeat prolapse and 10% repeat continence surgery. In an attempt to improve surgical outcomes and to preserve vaginal capacity and coital function, a number of synthetic and biological prostheses have been developed. This review aims to look at the controversies that exist as the 'ideal' prosthetic material is developed. RECENT FINDINGS: The recent literature has reflected the increasing interest in the use of biological prostheses (Allograft/Xenograft) and synthetic absorbable meshes. There has been a focus on the risk factors for erosion seen with the use of synthetic non-absorbable material and a review of techniques for the reduction and management of this complication. The advent of mesh placement in minimally invasive continence surgery (tension-free vaginal tape, intravaginal sling, and Supra Public ARC) is now seeing surgical success to 5 years, but the reporting of complications remains inconsistent. SUMMARY: The use of prosthetics in pelvic floor and continence surgery is an evolving field. Further randomized controlled trials are required to evaluate the role of both biological and synthetic prostheses in reconstructive surgery, to determine which type of prosthesis is most suitable for specific procedures. Prosthetic reinforcement should not be used to replace good surgical techniques.

Bioprosthesis↗