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Biomedical subjects

Peter L Dwyer

Publications and source records attributed to Peter L Dwyer.

13 recordsLinked to original sources
PubMed2006

Congenital urogenital anomalies that are associated with the persistence of Gartner's duct: a review.

The embryogenesis and management of congenital urogenital anomalies that are associated with ureteric ectopia and the persistence of Gartner's duct are discussed. Ureteric ectopia with Gartner's duct cyst is caused by the failure of separation of the ureteric bud from the mesonephric duct, which leads to persistence of Gartner's duct, frequently with cystic dilation. Abnormal development of the ureter subsequently causes maldevelopment or absence of the ipsilateral kidney. The diagnosis and treatment of 2 adult women with congenital urethrovaginal fistula that was associated with unilateral single ectopic ureter, renal agenesis, and Gartner's duct anomaly are presented. Surgical repair of the urethrovaginal fistulae and removal of the Gartner's duct and cyst was performed transvaginally.

Abnormalities, Multiple↗
PubMed2006

Evolution of biological and synthetic grafts in reconstructive pelvic surgery.

Surgery is an evolving science in the attempt to make surgical procedures more effective, safer, and less invasive. Recurrence and subsequent re-operation for stress incontinence and prolapse has been reported to be necessary in one of three patients, so there is a need for improvement [1]. In reconstructive pelvic surgery (RPS), the use of biological and synthetic grafts for the transabdominal and transvaginal treatment of pelvic organ prolapse (POP) or stress urinary incontinence (SI) has improved long-term support and function after surgery. However, the potential benefits of using grafts need to be carefully balanced against the risks of using materials foreign to the patient's body. Pelvic organ prolapse develops secondary to defective endopelvic fascial and muscular support. The levator ani provides resting tonic muscular support for all three pelvic compartments. Once neuromuscular damage occurs, extra strain is placed on the connective tissue supports, which may also subsequently fail. To date, there is no surgery that adequately addresses the issue of neuromuscular damage of the pelvic floor musculature. In conventional POP surgery, defective support is repaired by suturing of the patient's own connective tissue, fascia, or ligaments. The rationale for the use of grafts is to reinforce and strengthen pelvic organ repairs similar to the use of grafts to strengthen abdominal hernia repair.

Biocompatible Materials↗
PubMed2005

Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings.

OBJECTIVES: The objective of the study is to clarify potential risks to the dorsal nerve of the clitoris (DNC) and obturator canal using different minimally invasive slings. STUDY DESIGN: Ten embalmed hemipelves were dissected to demonstrate the course of the DNC and the obturator canal. On each cadaver, tension-free vaginal tape (TVT), transobturator in-out (TVT-O) and transobturator out-in (Monarc) procedures were performed. Distances between the DNC and the obturator canal to the different devices were measured. RESULTS: The DNC passes beneath the pubic bone at a distance of 14.3 +/- 4.7 mm of the midline. The distances of the different devices to the DNC were similar. The distance to the obturator canal was significantly different, with TVT being the furthest (40.1 +/- 3.7 mm) and TVT-O the closest (19.3 +/- 3.1 mm; p < 0.0001). CONCLUSION: Given the course of the DNC along the medial aspect of the ischiopubic ramus, the out-in technique may be safer. The in-out technique is the closest to the obturator canal.

Cadaver↗
PubMed2005

Sexual function and pelvic floor disorders.

Sexual wellbeing is an important aspect of women's health. Female sexual dysfunction is multifactorial and involves physical, social and psychological dimensions. Dysfunction may result from lack of sexual desire, sexual pain or arousal, and orgasmic problems. Sexual dysfunction is common and increases with age and pelvic floor disorders such as urinary incontinence and pelvic organ prolapse. Surgical treatment of pelvic floor disorders has been poorly studied but has the potential to improve sexual satisfaction or to cause sexual difficulties. New instruments such as condition-specific sexual questionnaires have recently been developed and will help us to better evaluate the results of incontinence and prolapse surgery on sexual function.

Female↗
PubMed2005

Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh.

The objective of this study was to identify the risk factors associated with the occurrence of mesh erosion (ME) during the first 6 post-operative months in patients having undergone transvaginal repair of pelvic organ prolapse (POP) with Atrium or Vypro II mesh. We retrospectively reviewed the records of 198 consecutive patients who underwent vaginal reconstructive surgery reinforced either by Atrium or Vypro II mesh between February 1999 and July 2003. Univariable and multivariable logistic regression was performed to assess associations between measured covariates and ME. Fourteen patients [7.1%, 95% confidence interval (CI): 3.9-11.6] developed vaginal ME. We found that, in the Vypro II mesh patients, the surgeon experienced in the technique had less erosions than less experienced surgeons (2.9 vs 15.6%, p=0.02). There was no statistically significant difference between the monofilament polypropylene (Atrium) and the composite polypropylene/polyglactin 910 (Vypro II) mesh (7.2 vs 6.9%, p=0.41) when adjusted for surgeon experience and patient age. There was no association between mesh type (Atrium or Vypro II) and vaginal ME following transvaginal repair of POP. Surgeon experience and patient age were associated with ME.

Female↗
PubMed2005

Pubovaginal sling versus transurethral Macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial.

OBJECTIVE: To compare the pubovaginal sling and transurethral Macroplastique in the treatment of female stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD). DESIGN: A prospective randomised controlled trial comparing two surgical treatments for SUI and ISD. SETTING: Tertiary referral urogynaecology unit in Australia. POPULATION: Women with SUI and ISD who were suitable for either surgical technique. METHODS: Forty-five women with SUI and ISD were randomly allocated the pubovaginal sling (n = 22) or transurethral Macroplastique (n = 23). Subjective and objective success rates, patient satisfaction and cost measurements at six months and one year following surgery were the primary outcome measures. A telephone questionnaire survey was performed at a mean follow up period of 62 months (43-71). MAIN OUTCOME MEASURE: Comparison of success rates, complications and costs. RESULTS: The symptomatic and patient satisfaction success rates were similar following the sling and Macroplastique with the objective success rate being significantly greater (P < 0.001) following the sling (81%vs 9%). Macroplastique had significantly lower morbidity but was more expensive than the sling (P < 0.001). Response rate at 62 months follow up was 60% in both groups with the sling group reporting better continence success (69%vs 21%) and satisfaction rates (69%vs 29%, P = 0.057). CONCLUSIONS: The pubovaginal sling was more effective and economical than transurethral Macroplastique for the treatment of SUI and ISD. However, transurethral Macroplastique remains an appropriate treatment in selected cases of SUI and ISD.

Adult↗
PubMed2004

Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study.

OBJECTIVE: The purpose of this study was to compare the abdominal sacral colpopexy and vaginal sacrospinous colpopexy in the treatment of vaginal vault prolapse. STUDY DESIGN: Ninety-five women with vaginal vault prolapse were allocated randomly to sacral colpopexy (47 women) or sacrospinous colpopexy (48 women). Primary outcome measurements include subjective, objective, and patient-determined success rates. Secondary outcomes include the impact on bowel, bladder, and sexual function, cost, and quality of life. RESULTS: Two years after the operation (range, 6-60 months), the subjective success rate was 94% in the abdominal and 91% in the vaginal group (P=.19). The objective success rate was 76% in the abdominal group and 69% in the vaginal group (P=.48). The abdominal approach was associated with a longer operating time, a slower return to activities of daily living, and a greater cost than the sacrospinous colpopexy (P<.01). Both surgeries significantly improved the patient's quality of life (P<.05). CONCLUSION: Abdominal sacral colpopexy and vaginal sacrospinous colpopexy are both highly effective in the treatment of vaginal vault prolapse.

Abdomen↗
PubMed2004

Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh.

OBJECTIVE: To determine the efficacy and safety of a new technique using Atrium polypropylene mesh (Atrium, Hudson, New Hampshire, USA) as an overlay graft for repair of large or recurrent anterior and posterior compartment prolapse. DESIGN: A retrospective review of women who had vaginal prolapse surgery with Atrium mesh reinforcement. SETTING: Tertiary referral urogynaecology unit in Australia. POPULATION: Forty-seven women where mesh was placed under the bladder base with lateral extensions onto the pelvic sidewall, 33 women where a Y-shaped mesh was placed from the sacrospinous ligaments to the perineal body and 17 women who had mesh placement in both compartments. METHODS: Women were assessed by site-specific vaginal examination pre-operatively and post-operatively at six weeks, six months and two years. MAIN OUTCOME MEASURES: All complications. Rate of recurrent prolapse assessed by the Baden-Walker halfway classification system. RESULTS: Mean follow up was 29 months (range 6 to 52). Four of 64 women with anterior mesh placement (6%) developed a grade 2 asymptomatic cystocele. Five women (5%) required further surgery for recurrent prolapse at a non-mesh site. Erosion occurred in nine women (9%). Three healed after intravaginal oestrogen cream, five after excision of exposed mesh and vaginal closure and one woman also had surgical closure of a rectovaginal fistula. The risk of mesh erosion decreased over the study period. Urinary, coital and bowel symptoms were significantly improved following surgery. CONCLUSIONS: This technique shows promise in correcting pelvic organ prolapse. Vaginal mesh erosion is the most common complication and is related to surgical experience.

Adult↗
PubMed2002

Recurrent urinary tract infection in the female.

PURPOSE OF REVIEW: Recurrent urinary tract infection is a common problem and can affect women of all ages, particularly the elderly and pregnant women. Obstetricians and gynaecologists need to have up-to-date knowledge of the diagnosis, pathophysiology and management of this condition. RECENT FINDINGS: The diagnosis of urinary tract infection is made on the basis of symptoms and bacteriuria of more than 103 bacteria per ml. Host and bacterial virulence factors are important in the pathogenesis of recurrent urinary tract infections. General host factors predisposing to recurrent infection are genetic factors, ageing, the menopause, urogenital dysfunction, sexual behaviour, and previous pelvic surgery. Urinary tract infection is common in pregnancy, and recent studies have suggested an association with mental retardation and developmental delay. Women with recurrent urinary tract infection in pregnancy should be considered for long-term antibiotic prophylaxis. Intravaginal oestrogens and cranberry juice have been found to be effective for prevention, although more research is required. Women with recurrent urinary tract infection should have at least a 3-day course of trimethoprim or cotrimoxazole, or a 5-day course of beta-lactams or nitrofurantoin, with perhaps a 10-day course in the elderly. Women with frequent urinary tract infection (more than three episodes per year) should be offered prophylactic antibiotics, which can be patient-initiated, postcoital, or long-term low-dose therapy. In the future, vaccines against specific uropathogenic bacteria may be useful in urinary tract infection prophylaxis. SUMMARY: More research is required, by all medical disciplines, on various aspects of urinary tract infection.

Aging↗
PubMedDate not supplied

Anatomy of the pudendal nerve and its terminal branches: a cadaver study.

BACKGROUND: This study documents the anatomy of the pudendal nerve, which has a major role in maintaining faecal continence. Unexpected faecal incontinence can develop following perineal surgery even when the anal sphincters are not damaged. In addition, injury to the pudendal nerve might be encountered during pelvic procedures such as a sacrospinous colpopexy. METHODS: An anatomical study on 28 cadavers was conducted to examine the course of the pudendal nerve and its branches in the perineum. RESULTS: In five of the 28 cadavers dissected (four male, one female), a nerve plexus was found within the ischiorectal fossa in close proximity to the anal sphincters. The plexus received contributions from interconnecting branches of the inferior rectal and perineal nerves to innervate the external anal sphincter. In 11 of the 28 cadavers (five female, six male) an additional nerve arose from the medial aspect of the pudendal nerve at the level of the sacrotuberous and sacrospinous ligaments. This nerve continued distally and gave several branches to the perineum and the levator ani muscle. CONCLUSION: A sound knowledge of the anatomical variations of the pudendal nerve and its branches is essential for all surgeons operating in the perineal region.

Aged↗