PubMed Health⌕ Search

Biomedical subjects

Mickey M Karram

Publications and source records attributed to Mickey M Karram.

At least 19 recordsLinked to original sources
PubMed2006

Effects of sacral neuromodulation on female sexual function.

The aim of this prospective study was to determine if sacral neuromodulation has an effect on the patient's subsequent sexual function. Sexually active patients that underwent an Interstim Sacroneuromodulator implantation (Medtronic, Minneapolis, MN) for control of bladder symptoms were enrolled. A Female Sexual Function Index (FSFI) was completed before surgery and at a mean of 5.7 months postoperatively. Eleven subjects proceeded to permanent implantation, seven of these were sexually active before and after placement. Three subjects (43%) felt the device impacted on their sexual function in a positive way (1) by decreasing urgency and (2) by increasing desire. Overall sexual frequency increased significantly after the surgery (p=0.047). There were also significant increases in the FSFI total (p=0.002), and domain scores for desire (p=0.004), lubrication (p=0.005), orgasm (p=0.043), satisfaction (p=0.007), and pain (p=0.015). There was no correlation between patient report of urinary symptom improvement and FSFI scores. In conclusion, sacral neuromodulation may improve sexual frequency and sexual function scores in subjects with urgency frequency and urge incontinence.

Adult↗
PubMed2006

Sexual function in patients presenting to a urogynecology practice.

The purpose of this study was to evaluate sexual function in women referred to a urogynecology practice. All new patients were mailed an optional female sexual function index (FSFI) in conjunction with their history forms; other sexual function information was obtained during the physician interview. Over 6 months, four hundred fifty new patients were enrolled. Of these, 243 (54%) were not sexually active. Reasons listed for sexual inactivity included partner problems/no partner (32%), low desire (14%), prolapse (10%), and pain (10%). There were several differences between sexually active and non-sexually active participants; however, after a multivariate analysis, only age, marital status, and stage/grade 1-2 of prolapse remained significant. One hundred nine sexually active patients completed the FSFI; the majority was sexually active two to four times per month. Female sexual dysfunction was noted in 70 (64%) patients. Lowest scores were noted for the domain of desire, followed by arousal, orgasm, lubrication, satisfaction, and pain. Reduced frequency of intercourse was the only factor significantly associated with dysfunction. Ninety-four percent were not embarrassed by the survey. Overall, sexual inactivity is common in patients presenting for urogynecologic care. Those that are sexually active report low rates of sexual activity and high rates of sexual dysfunction. Most sexually active patients will accept a sexual function questionnaire as part of their routine assessment.

Adult↗
PubMed2006

Uterosacral ligament vault suspension: five-year outcomes.

OBJECTIVE: To evaluate the five-year anatomic and functional outcomes of the high uterosacral vaginal vault suspension. METHODS: One hundred ten patients with advanced symptomatic uterovaginal or posthysterectomy prolapse treated between January 1997 and January 2000 were identified and 72 (65%) consented to participate in this study. Anatomic outcomes were obtained by Pelvic Organ Prolapse Quantification. Functional results were obtained subjectively and with quality-of-life questionnaires, including the short-form Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI), and Female Sexual Function Index. RESULTS: The mean follow-up period was 5.1 years (range 3.5-7.5 years). Vaginal hysterectomy (37.5%), anterior colporrhaphy (58.3%), posterior colporrhaphy (87.5%), and suburethral slings (31.9%) were performed as indicated. Surgical failure (symptomatic recurrent prolapse of stage 2 or greater in one or more segments) was 11 of 72 (15.3%). Two patients (2.8%) had recurrence of apical prolapse of stage 2 or greater. For those sexually active preoperatively and postoperatively (n=34), mean postoperative Female Sexual Function Index scores for arousal, lubrication, orgasm, satisfaction, and pain were normal, whereas the desire score was abnormal (mean= 3.2). However, 94% (n=29) were currently satisfied with their sexual activity. Postoperative IIQ/UDI scores were significantly improved in all three domains (irritative, P= .01; obstructive, P<.001; stress, P=.03) and overall (IIQ-7, P<.001; UDI, P<.001) compared with preoperatively. Bowel dysfunction occurred 33.3% preoperatively compared with 27.8% postoperatively (P=.24). CONCLUSION: Uterosacral ligament vaginal vault fixation seems to be a durable procedure for vaginal repair of enterocele and vaginal vault prolapse. Lower urinary tract, bowel, and sexual function may be maintained or improved.

Aged↗
PubMed2005

The efficacy of the tension-free vaginal tape in the treatment of five subtypes of stress urinary incontinence.

PURPOSE: To determine the efficacy of tension-free vaginal tape (TVT) for the treatment of five sub-types of stress urinary incontinence (SUI). MATERIALS AND METHODS: A retrospective review was performed from November 1998 to November 2001 on all patients with SUI who underwent a TVT procedure either alone or with other reconstructive pelvic procedures. The patients were subdivided into five categories. Intrinsic sphincter deficiency (ISD) was defined by a maximum urethral closure pressure < 20 cm H2O or a mean Valsalva leak point pressure < 60 cm H2O above baseline. Urethral hypermobility (UH) was defined by a straining Q-tip angle greater than 30 degrees from the horizontal. Cure was defined as the subjective resolution of SUI without the development of voiding dysfunction or de novo urge incontinence. Improvement was defined as the subjective improvement of SUI without complete resolution or the subjective resolution of SUI occurring with the development of prolonged voiding dysfunction lasting greater than 6 weeks or de novo urge incontinence. Failure was defined as the subjective lack of improvement of SUI, the need for an additional procedure to correct SUI or the need for revision or takedown of the TVT for persistent voiding dysfunction or mesh erosion. RESULTS: The cure, improvement and failure rates for each of the following groups are respectively as follows: group 1 (+UH, -ISD) (n = 121): 101 (83.5%), 13 (10.7%), 7 (5.8%); group 2 (-UH, +ISD) (n = 22): 17 (77.3%), 3 (13.6%), 2 (9.1%); group 3 (+UH, +ISD) (n = 32): 26 (81.3%), 4 (12.5%), 2 (6.2%); group 4 (-UH, -ISD) (n = 25): 21 (84.0%), 3 (12.0%), 1 (4.0%); group 5 (occult SUI) (n = 67): 57 (85.1%), 10 (14.9%), 0 (0%). CONCLUSION: This study shows that the TVT is effective in treating all five sub-types of SUI.

Aged↗
PubMed2005

Practice patterns of physician members of the American Urogynecologic Society regarding female sexual dysfunction: results of a national survey.

The purpose of the study was to evaluate practice patterns of members of the American Urogynecologic Society (AUGS) with respect to female sexual dysfunction (FSD). A brief self-administered survey of 20 questions was mailed to 966 physician members of the AUGS in the United States of America and Canada; 471 surveys were returned (49% response rate). The majority of responders see urogynecology (19%) or urogynecology and general gynecology patients (43%). Sixty-eight percent of physicians were familiar with questionnaires to assess FSD; however, only 13% said they use these for screening purposes. Most said they believed screening for FSD was somewhat (47%) or very important (42%). Despite having these beliefs, only 22% of the responding physicians stated they always screen for FSD, while 55% do so most of the time and 23% admitted they never or rarely screen. Similar results were obtained regarding screening following urogynecologic surgery. Several barriers to screening for FSD existed, the most common being lack of time. The majority of respondents (69%) underestimated the prevalence of FSD in their patient population. Finally, although more than half of responders had received post-residency training in urogynecology (59%), 50% of them stated the training with respect to FSD was unsatisfactory, while only 10% were satisfied. Overall, many urogynecologists do not consistently screen for FSD, underestimate its prevalence, and feel they received unsatisfactory training.

Attitude of Health Personnel↗
PubMed2005

Is previous cesarean section a risk for incidental cystotomy at the time of hysterectomy? A case-controlled study.

OBJECTIVE: The purpose of this study was to determine if previous cesarean section is an independent risk factor for incidental cystotomy at the time of hysterectomy. STUDY DESIGN: This is a case-controlled study that evaluated all cases of incidental cystotomy at the time of hysterectomy between January 1998 and December 2001. Five thousand and ninety-two hysterectomies were performed in the time period mentioned above, and 51 cases of incidental cystotomy were identified. Each case of incidental cystotomy was then matched to 3 controls with similar patient characteristics, medical histories, and surgical histories, as well as the absence of incidental cystotomy at the time of hysterectomy. RESULTS: Overall, 5092 hysterectomies were performed during the study period (total abdominal hysterectomy [TAH] 3140 [61.7%], total vaginal hysterectomy [TVH] 1519 [29.8%], laparoscopically-assisted vaginal hysterectomy [LAVH] 433 [8.5%]). Fifty-one cases of incidental cystotomy were identified (TAH: 24 [47.1%], TVH: 19 [37.3%], LAVH: 8 [15.7%]). The overall incidence of cystotomy was 1.0%. When considering TAH, there were 24/3141 (0.76%) cases of incidental cystotomy, with 8 (33%) of these patients with a history of previous cesarean section. During TVH, we encountered 19/1519 (1.3%) cases of incidental cystotomy, with 4 (21%) of these women having undergone a previous cesarean. Finally, during LAVH, there were 8/433 (1.8%) cases of incidental cystotomy. Five (62.5%) of these patients had a previous history of cesarean section. In comparison, 19/72 (26.4%) TAH controls had a previous history of cesarean. Four out of 57 (7.0%) TVH controls had a history of cesarean section. Finally, 2/24 (8.3%) LAVH controls had a history of previous cesarean. CONCLUSION: Previous cesarean section is indeed a significant risk factor for damage to the lower urinary tract at the time of hysterectomy (odds ratio [OR] 2.04; 95%CI 1.2-3.5). When analyzed separately, the OR of incidental cystotomy at the time of TAH, TVH, and LAVH in a woman with a history of previous cesarean was 1.26, 3.00, and 7.50, respectively. Only the value for LAVH was statistically significant (P = .005; 95%CI 1.8-31.4).

Adult↗
PubMed2005

Rectoceles and the anatomy of the posteriorvaginal wall: revisited.

OBJECTIVE: The purpose of this study was to histologically evaluate the posterior aspect of the pelvis, specifically, the relationship between the perineum, posterior vagina, anterior rectum, and all other intervening tissue. STUDY DESIGN: The perineum, posterior vaginal wall, and upper part of the rectum were removed en bloc from 4 fresh cadavers without pelvic prolapse. Length of the specimens ranged from 6 to 7.9 cm and width 3 to 4 cm. Seven to 26 serial sections were taken from each cadaver. Sections were stained with hematoxylin and eosin (H&E), Masson trichrome, and Verhoeff Von Gieson elastic stain. RESULTS: All 4 specimens showed dense connective tissue and no plane of cleavage for 3 to 3.5 cm proximally from the posterior forchette. Proximal to this, all 4 specimens showed space between the muscular wall of the vagina and the muscular wall of the rectum, which was composed of adipose tissue with discontinuous bands of fibrous tissue or loose areolar tissue. This appears to be a natural line of cleavage. Histologically, no evidence of fascia or a rectovaginal septum was identified. CONCLUSION: Histologically, there is no evidence of a distinct fascial layer between the posterior vaginal wall and anterior wall of the rectum. Clinically, it is the splitting of the adventitia and fibromuscular layers of the vagina that are used in defect-specific rectocele repairs to support the anterior rectal wall.

Fascia↗
PubMed2005

Scientific basis for use of grafts during vaginal reconstructive procedures.

PURPOSE OF REVIEW: The use of graft material and mesh in the setting of pelvic organ prolapse surgery has gained increasing popularity and attention in spite of lack of scientific evidence to support their use. The objective of this review is to discuss available synthetic and biologic graft materials, review operative techniques, and evaluate the anatomic and functional results of published data on graft augmented prolapse repairs and antiincontinence procedures. RECENT FINDINGS: Natural biologic graft materials (such as fascia lata) have been used to augment prolapse surgery and have a theoretical advantage of causing less erosions; however, a renewed interest in the employment of synthetic mesh in the anterior and posterior segments has increased, partly due to the need to find improved materials with less inconsistent material strength. The insertion of 'tension-free' meshes for anterior and posterior vaginal wall prolapse may be promising, but studies with longer follow-up are necessary to determine their true efficacy and safety profile. SUMMARY: The recent introduction of newer graft materials and minimally invasive surgical techniques for pelvic organ prolapse repair and stress incontinence has rapidly grown, despite the relative lack of evidence-based information to document their long-term efficacy and safety. Their current use must take into account the risk-benefit profile and be individualized for each surgical candidate. The ultimate goal is to correct both the anatomic and functional derangements seen in this patient population, while improving quality of life.

Biocompatible Materials↗
PubMed2005

Female sexual dysfunction: principles of diagnosis and therapy.

Female sexual dysfunction is a common health problem, affecting approximately 43% of women. Female sexual dysfunction is defined as disorders of libido, arousal, orgasm, and sexual pain that lead to personal distress or interpersonal difficulties. It is frequently multifactorial in etiology, with physiological and psychologic roots. Approaching female sexual dysfunction involves an open discussion with the patient, followed by a thorough physical examination and laboratory testing. Therapy consists of patient and partner education, behavior modification, and may include individualized pharmacotherapy. Ultimately, as awareness and research in the field grows, it is hoped that a better understanding of the physiology and pharmacology of the female sexual response will be achieved.

Androgens↗
PubMed2004

Paravaginal defects: prevalence and accuracy of preoperative detection.

The objective of this study was to determine the prevalence of paravaginal defects and to report the correlation between diagnosing a paravaginal defect preoperatively and observing the presence of one intraoperatively. This was a prospective study in which 77 patients with at least stage 2 prolapse of the anterior vaginal wall who desired surgical correction of their prolapse were assessed pre- and intraoperatively for the detection of a paravaginal defect. In order to differentiate a midline or central defect from a paravaginal defect, an index finger or ring forceps was placed vaginally toward each ischial spine separately. If the prolapse became reduced, the patient was clinically diagnosed with a paravaginal defect on that side. The intraoperative visualization or palpation of the pubocervical fascia detached from the arcus tendineus fasciae pelvis was used as the gold standard in diagnosing a paravaginal defect. The overall prevalence of a paravaginal defect in patients with at least stage 2 prolapse of the anterior vaginal wall was 37.7%. The sensitivities for detecting a left, right and bilateral paravaginal defect were 47.6, 40.0 and 23.5%, respectively, while the specificities for each side were 71.4, 67.3, and 80.0%, respectively. The overall prevalence of a paravaginal defect in patients with anterior vaginal wall prolapse is low. The standard clinical evaluation used to preoperatively detect a paravaginal defect in our hands is a poor predictor for the actual presence of a paravaginal defect.

Female↗
PubMed2004

Effects of a full bladder and patient positioning on pelvic organ prolapse assessment.

OBJECTIVE: To evaluate the effect of bladder filling and patient position on the degree of pelvic organ prolapse (of the maximally prolapsed segment). METHODS: Fifty consecutive patients with symptomatic pelvic organ prolapse were evaluated between February 2003 and August 2003. Patients were examined in the supine lithotomy and standing position at maximal bladder capacity and then in the supine lithotomy and standing position with an empty bladder. The International Continence Society's Pelvic Organ Prolapse Quantification system was used. RESULTS: The mean descent of prolapse beyond the hymen was 0.39 cm in the full/supine setting, 1.3 cm, full/standing, 1.9 cm, empty/supine, and 2.7 cm, empty/standing. All mean paired differences in the six examination pairs (empty/standing compared with empty/supine, full/standing compared with full/supine, full/standing compared with empty/standing, full/supine compared with empty/supine, full/standing compared with empty/supine, and full/supine compared with empty/standing) were statistically significantly different. The largest mean paired difference was noted in the full/supine compared with empty/standing pair (-2.3, 95% confidence interval -2.8 to -1.8, P <.001). Age and parity were not associated with differences in measurements taken in the different examination conditions. Using a linear regression model to control for body mass index, maximal bladder capacity, and Pelvic Organ Prolapse Quantification system stage, it was found that the values were still statistically significant. Full/supine compared with empty/standing pairs were significantly more likely to be upstaged by 1 stage (P <.001), or by 2 stages (P =.049), but not by 3 stages (P =.061). CONCLUSION: Unless a patient is examined in the standing position with an empty bladder, the full extent of the prolapse may not be appreciated.

Female↗
PubMed2004

Laparoscopic Burch colposuspension versus tension-free vaginal tape: a randomized trial.

OBJECTIVE: To compare the laparoscopic Burch colposuspension with the tension-free vaginal tape procedure (TVT) for efficacy. METHODS: Seventy-two women from 2 institutions were randomized: 36 to laparoscopic Burch colposuspension and 36 to TVT. Multichannel urodynamic tests were performed preoperatively and 1 year after surgery. A research nurse administered the Urogenital Distress Inventory, Incontinence Impact Questionnaire, and pelvic examinations using the pelvic organ prolapse quantification system preoperatively, and at 6 months, 1 year, and 2 years after surgery. Voiding diaries were collected at 1 and 2 years. Primary outcome was objective cure, which was defined as no evidence of urinary leakage during postoperative urodynamic studies. Secondary outcomes included subjective continence, perioperative and postoperative data, and quality of life. RESULTS: Thirty-three laparoscopic Burch colposuspension and 33 TVT patients were analyzed with a mean follow-up of 20.6 +/- 8 months (range 12-43). Mean operative time was significantly greater in the laparoscopic Burch colposuspension group compared with the TVT group, 132 versus 79 minutes, respectively (P = .003). Multichannel urodynamic studies in 32 laparoscopic Burch colposuspension and 31 TVT patients showed a higher rate of urodynamic stress incontinence at 1 year in the laparoscopic Burch colposuspension group, 18.8% versus 3.2% (P = .056). There was a significant improvement in the number of incontinent episodes per week and in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores in both groups at 1 and 2 years after surgery (P < .001). However, postoperative subjective symptoms of incontinence (stress, urge, and any urinary incontinence) were reported significantly more often in the laparoscopic Burch colposuspension group than in the TVT group (P < .04 for each category). CONCLUSION: The TVT procedure results in greater objective and subjective cure rates for urodynamic stress incontinence than does laparoscopic Burch colposuspension.

Adult↗
PubMed2004

Prevalence of persistent and de novo overactive bladder symptoms after the tension-free vaginal tape.

OBJECTIVE: The purpose of this study was to assess 1) the proportion of de novo urge incontinence and overactive bladder symptoms after a tension-free vaginal tape (TVT), and 2) the natural history of preoperative urge incontinence and overactive bladder symptoms after a TVT. METHODS: A chart review was performed on all patients who underwent a TVT without concomitant procedures from November 1998 to November 2002. Preoperative and postoperative stress and mixed urinary incontinence symptoms as well as overactive bladder symptoms were assessed subjectively, as was the use of anticholinergics to treat overactive bladder symptoms. Two preoperative and postoperative validated quality-of-life questionnaires, the Incontinence Impact Questionnaire (IIQ-7) and Urinary Distress Inventory (UDI-6), were also compared. RESULTS: Ninety-eight patients were included in the study. Postoperatively, de novo urge incontinence symptoms developed in 9.1%, de novo overactive bladder symptoms developed in 4.3%, and 8.7% started taking anticholinergics for the first time. After a TVT, the urge component resolved in 63.1% of those with preoperative symptoms of mixed incontinence, overactive bladder symptoms resolved in 57.3% of those with preoperative overactive bladder symptoms, and 57.7% of those who used anticholinergics preoperatively no longer needed to do so. There was also a statistically significant improvement in comparing the preoperative and postoperative IIQ-7 and UDI-6 scores. CONCLUSION: The proportion of patients in whom de novo overactive bladder or urge incontinence symptoms developed postoperatively is low, and approximately 57% of patients with preoperative overactive bladder symptoms can expect resolution of these symptoms after a TVT.

Aged↗
PubMed2003

Urethral erosion of a tension-free vaginal tape.

BACKGROUND: Urethral dilation has been recommended to treat voiding dysfunction that may occur after placement of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence. We report on a case of urethral erosion by the tape secondary to repetitive urethral dilations after surgery. CASE: A urethral erosion by the tape was diagnosed by cystoscopy after three urethral dilations failed to resolve postoperative voiding dysfunction 8 weeks after the initial procedure. A partial tape revision with repair of the urethrotomy was performed, with resolution of the subject's voiding dysfunction. CONCLUSION: This report describes a potential complication of a recommended treatment for voiding dysfunction after placement of TVT.

Adult↗
PubMed2003

Management of iatrogenic vaginal constriction.

OBJECTIVE: To prospectively assess the outcomes of four approaches to the surgical management of iatrogenic vaginal constriction. METHODS: A prospective study was initiated to evaluate all women who presented to our practice with the complaint of apareunia or dyspareunia secondary to postoperative vaginal constriction. All participants were initially offered and failed a trial of manual dilation. Between 1997 and 2002, 20 women underwent one of four surgical procedures: Z-plasty, vaginal incision of constriction ring, vaginal advancement, or placement of free skin graft. All 20 participants have been followed postoperatively, including assessment of dyspareunia and postoperative vaginal length and caliber. RESULTS: Three patients underwent Z-plasty, eight had incision of vaginal ring or ridge, eight had vaginal advancement, and one underwent placement of a free skin graft. Mean follow-up was 17 months (range, 3-32 months). Subjective cure was defined as resumption of pain-free vaginal intercourse. Objective cure was defined by findings on physical examination. The overall subjective and objective cure rates were 75% and 85%, respectively. CONCLUSION: The appropriate surgical procedure depends on the site and extent of the vaginal constriction, the state of the surrounding tissue, and the overall length and caliber of the vagina.

Adult↗