Biomedical subjects

Ronen Gold

Publications and source records attributed to Ronen Gold.

6 recordsLinked to original sources

PubMed2005

Tension-free vaginal tape in the elderly: is it a safe procedure?

OBJECTIVES: To analyze the safety and efficacy of tension-free vaginal tape (TVT) surgery in elderly versus younger women with stress urinary incontinence (SUI). METHODS: A total of 157 consecutive elderly women, aged 70 years and older, and 303 younger women (mean age, 74.8 and 57.2 years, respectively) who underwent TVT for urodynamically-confirmed SUI were prospectively enrolled. Concomitant genitourinary prolapse repair was performed in 84% of the elderly and 67% of the younger women. The main outcome measures were perioperative morbidity, postoperative SUI, persistent or de novo urge incontinence, and voiding dysfunction. RESULTS: The incidence of TVT-related morbidity was similar in both groups, except for significantly fewer cases of bladder perforation among elderly women (1.3% versus 4.9%, P <0.05). However, some age-related morbidity was noted among the elderly women: 2 cases of pulmonary embolism, 2 cases of cardiac arrhythmia, 1 case of severe pneumonia, and 1 case of deep vein thrombosis. The outcome analysis was restricted to 123 elderly and 208 younger women with follow-up of at least 12 months (mean, 30 +/- 12 months; range, 12 to 67 months). The incidence of persistent postoperative SUI and persistent urge incontinence was similar in both age groups. However, de novo urge incontinence was significantly more common among elderly women (18% versus 4%, P <0.05). Two elderly and three younger women had postoperative pressure-flow studies suggestive of bladder outlet obstruction. CONCLUSIONS: Tension-free vaginal tape surgery in elderly women is associated with good outcome results; however, the risk of postoperative de novo urge incontinence, as well as age-related morbidity, is increased.

Adult↗

PubMed2004

Surgical complications and medium-term outcome results of tension-free vaginal tape: a prospective study of 313 consecutive patients.

OBJECTIVE: A prospective study was undertaken to examine the incidence of surgical complications and medium-term outcomes of tension-free vaginal tape (TVT) surgery in a large, heterogeneous group of stress-incontinent women. METHODS: Surgery was tailored according to preoperative clinical and urodynamic findings: stress-incontinent women underwent TVT surgery, whereas those with concomitant urogenital prolapse underwent combined TVT and prolapse repair. Post-operatively the patients were scheduled for evaluation at 1, 3, 6, and 12 months, and annually thereafter. All underwent urodynamics at 3 months post-operatively. RESULTS: Three hundred and thirteen consecutive patients were prospectively studied. The mean follow-up period was 21.4 +/- 13.5 months. Sixteen (5.1%) cases of intravesical passage of the prolene tape occurred in our series, two of which were diagnosed at 3 and 15 months post-operatively. Eight (2.5%) patients had post-operative voiding difficulties, necessitating catheterization for more than 7 days. However, transvaginal excision of the tape was required in one case only. Vaginal erosion of the tape was diagnosed in four (1.3%) patients, all of whom were successfully treated by local excision of the eroded tape. Outcome analysis was restricted to 241 consecutive patients with at least 12 months of follow-up. Subjectively, 16 (6.6%) patients had persistent mild stress urinary incontinence, although urodynamics revealed asymptomatic sphincteric incontinence in 17 (7%) other patients. De-novo urge incontinence developed post-operatively in 20 (8.3%) patients. CONCLUSIONS: The TVT procedure is associated with good medium-term cure rates, however, it is not free of troublesome complications and the patients should be informed accordingly. Only well-trained surgeons, familiar with pelvic anatomy, surgical alternatives, and endoscopic techniques should perform the operation.

Aged↗

PubMed2004

Cesarean section: does it really prevent the development of postpartum stress urinary incontinence? A prospective study of 363 women one year after their first delivery.

AIMS: Stress urinary incontinence (SUI) in young women is usually the result of pelvic floor injury during vaginal delivery. Whether cesarean section delivery may prevent such injury is questionable. We undertook a prospective study to compare the prevalence of SUI among primiparae 1 year after spontaneous vaginal delivery versus elective cesarean section, or cesarean section performed for obstructed labor. METHODS: Three hundred and sixty-three consecutive primiparae were recruited immediately after delivery and were followed for 1 year. Women were asked upon recruitment whether they had ever experienced SUI before pregnancy. Those who had SUI before pregnancy were excluded. Thus, only cases of de novo childbirth-associated SUI were analyzed. Patients were divided into three subgroups according to the mode of delivery: spontaneous vaginal delivery (n = 145), elective cesarean section (n = 118), and cesarean section performed for obstructed labor (n = 100). Patients who underwent elective cesarean section were not given a trial of labor. Cesarean sections for obstructed labor were performed at a mean cervical dilatation of 8.7 +/- 1.6 cm and arrest of 184 +/- 24 min. Prevalence, frequency, and severity of postpartum SUI, as well as demographic and obstetric parameters, were analyzed in each subgroup. RESULTS: The three subgroups were comparable with respect to maternal age, weight, and height. Prevalence of postpartum SUI was similar after spontaneous vaginal delivery (10.3%) and cesarean section performed for obstructed labor (12%). However, SUI was significantly less common following elective cesarean section with no trial of labor (3.4%, P < 0.05). Approximately half of the symptomatic patients in each subgroup reported either moderate or severe symptoms, however, only 15-18% expressed their desire for further evaluation. CONCLUSIONS: Prevalence of postpartum SUI is similar following spontaneous vaginal delivery and cesarean section performed for obstructed labor. It is quite possible that pelvic floor injury in such cases is already too extensive to be prevented by surgical intervention. Conversely, elective cesarean section, with no trial of labor, was found to be associated with a significantly lower prevalence of postpartum SUI. Whether the prevention of pelvic floor injury should be an indication for elective cesarean section is yet to be established.

Adult↗

PubMed2004

Tension-free vaginal tape (TVT) for the treatment of occult stress urinary incontinence in women undergoing prolapse repair: a prospective study of 100 consecutive cases.

AIMS: Clinically continent women with genitourinary prolapse and occult stress urinary incontinence (SUI) are considered to be at high risk of developing symptomatic SUI once the prolapse is repaired. We studied the efficacy and safety of tension-free vaginal tape (TVT) procedure in preventing postoperative SUI in these women. METHODS: One hundred consecutive women (mean age 66.7 +/- 9.9 years) with significant genitourinary prolapse and occult SUI were prospectively enrolled. Preoperatively, none of the women complained of SUI. However, all had urodynamically-confirmed occult SUI, revealed by repositioning of the prolapse. Surgical intervention was comprised of transvaginal prolapse repair and prophylactic TVT procedure. Main outcome end points included operative morbidity, postoperative SUI, persistent or de novo urge incontinence, and voiding dysfunction. RESULTS: The mean follow-up period was 27 months (range: 12-52 months). There was only one case of technique-related bladder perforation with no adverse outcome. Two other patients had postoperative urinary retention necessitating catheterization for more than 7 days, none of whom required any surgical intervention. Vaginal erosion of the tape was diagnosed in three patients, all of whom were successfully treated by excision of the eroded tape. Two (2%) patients developed urodynamically-confirmed SUI within 1 year postoperatively. However, postoperative urodynamics revealed asymptomatic sphincteric incontinence in 15 (15%) other patients. Thirteen (72%) of 18 patients with preoperative urge incontinence had postoperative persistent urge incontinence. De novo urge incontinence developed postoperatively in 8 (8%) patients. CONCLUSIONS: TVT procedure is effective and safe in patients with occult SUI undergoing prolapse repair. Long-term durability of this procedure is yet to be established.

Aged↗

PubMed2004

Early postpartum voiding dysfunction: incidence and correlation with obstetric parameters.

OBJECTIVE: To investigate the incidence and obstetric risk factors in early postpartum voiding dysfunction. STUDY DESIGN: Two hundred seventy-seven consecutive women in the early postpartum period were prospectively enrolled. Evaluation included history, physical examination, urinary questionnaire and non-invasive uroflowmetry measurements. Patients were interviewed regarding the presence and severity of voiding symptoms and were categorized into symptomatic versus asymptomatic subgroups. Obstetric parameters were compared in symptomatic versus asymptomatic patients as well as in cases of decreased (< 15 mL/sec) versus normal maximum urinary flow rates. RESULTS: One hundred twenty-five women (45% of the study population) hadearly postpartum voiding difficulties. Symptoms were significantly more common after vacuum extraction (38%) than spontaneous vaginal delivery (27%) or cesarean section (15%). The second stage of labor was significantly prolonged in symptomatic versus asymptomatic patients (62+/-52 versus 47+/-48 minutes). Voided volume, maximum and average flow rates and continuous flow pattern were significantly decreased in symptomatic versus asymptomatic patients. Twenty-eight patients (10%) demonstrated decreased (<15 mL/sec) maximum flow rates. The first stage of labor was significantly prolonged in these patients (9.7+/-5.8 versus 6.4+/-3.9 hours). Twenty-five patients (13%) gave birth to a neonate weighing > or =3,800 g. Maximum flow rates among these women were significantly decreased as compared to women with smaller infants (25.6+/-11 versus 32.9+/-19.2 mL/sec, respectively). CONCLUSION: Approximately 50% of patients complained of voiding difficulties in the immediate postpartum period. Main risk factors were prolonged first and second stages of labor, vacuum extraction and birth weight > or = 3,800 g. Long-term follow-up is needed to determine the significance of this clinically common entity.

Adult↗

PubMed2004

[Pregnancy, labor and delivery: the pelvic floor injury].

The association between pregnancy, labor and delivery, and pelvic floor injury is well known. Pregnancy itself may be associated with some injury, but the main damage occurs during vaginal delivery. It is well documented that vaginal delivery may cause denervation of the pelvic floor as well as direct injury to muscles and connective tissue. These injuries may lead to the development of stress urinary incontinence, anal incontinence, voiding difficulties, and/or urogenital prolapse. Previous studies showed correlation between various obstetric risk factors and the development of these symptoms, however, there is no consensus regarding the relative contribution of the different parameters. Moreover, the apparently protective effect of cesarean section is questionable. Further studies are required to define obstetric risk factors as well as patients at increased risk. These factors should be taken into consideration in modern obstetric practice.

Delivery, Obstetric↗