Microfat and Nanofat Grafting in Genital Rejuvenation

2020 ◽  
Author(s):  
Sophie Menkes ◽  
Mounia SidAhmed-Mezi ◽  
Jean Paul Meningaud ◽  
Laurent Benadiba ◽  
Guy Magalon ◽  
...  
Keyword(s):  
Health Index ◽  
Inclusion Criteria ◽  
Effective Technique ◽  
Level Of Evidence ◽  
Genitourinary Syndrome Of Menopause ◽  
Sexual Distress ◽  
Perimenopausal Women ◽  
Vaginal Health ◽  
Genitourinary Syndrome

Abstract Background Genitourinary syndrome of menopause (GSM) is a major problem in many post- or perimenopausal women. Lipofilling has long been considered to be an effective technique for restoring volume, but the discovery of its trophic proprieties has made it the most widely utilized method in regenerative medicine. Objectives The authors aimed to assess the safety and efficacy of microfat and nanofat grafting for vulvovaginal rejuvenation. Methods Women with GSM who met the inclusion criteria were enrolled. Women received microfat in the labia majora and nanofat in the vagina; follow-up was conducted 1, 3, 6, 12, and 18 months. The vaginal health index (VHI) and Female Sexual Distress (FSD) were utilized to assess improvement in vulvovaginal atrophy, orgasm, and sexual desire posttreatment. Results Fifty women were included; their average age was 53 years (range, 45-63 years). The VHI score significantly increased at 1 and 3 months after treatment (P < 0.0001). Moreover, the average FSD score showed a significant improvement at 1 and 3 months posttreatment. This score stabilized from 6 to 12 months but showed further improvement at 18 months. At 6 months posttreatment, for both scales, data pertaining to 80% of patients appeared normalized. There was a particular benefit noted for dryness and dyspareunia. At 18 months, the results remained stable for all of patients. No major side effects were observed. Conclusions There are now many ways to rejuvenate the intimate sphere, but microfat and nanofat grafting seem to offer good results with an autologous procedure. Their utilization appears promising for genital rejuvenation. Level of Evidence: 4

scholarly journals A hüvelyi CO2-lézer-kezelés rövid távú hatásai a menopausalis genitourinalis szindróma tüneteire

2019 ◽  
Vol 160 (41) ◽  
pp. 1617-1622
Author(s):  
Bence Kozma ◽  
Róbert Póka ◽  
Attila Sipos ◽  
Nándor Ács ◽  
Péter Takács
Keyword(s):  
Postmenopausal Women ◽  
Statistical Significance ◽  
Health Index ◽  
Analog Scale ◽  
Vas Score ◽  
Vaginal Health ◽  
The University ◽  
Genitourinary Syndrome ◽  
First Session

Abstract: Introduction: Genitourinary syndrome of menopause (GSM) affects up to 40–57% of postmenopausal women. Intravaginal microablative fractional CO2 laser is a new proposal for the management of GSM, although the evidence of safety and efficacy of the procedure appears to be insufficient. Aim: The aim of the study was to assess the efficacy of fractional CO2 laser for the treatment of GSM at the Department of Obstetrics and Gynecology of the University of Debrecen. Method: Postmenopausal women with symptoms of GSM underwent three sessions of microablative fractional rejuvenation CO2 laser therapy at 4–6 weeks intervals. Vaginal health index (VHI) scores were completed before each treatment and at 6 weeks follow-up as an objective measurement and visual analog scale was used to assess subjective complaints. Statistical analysis included Student’s paired two-sampling t-test for the measure of statistical significance using the standard cutoff for significance p<0.05. Results: 51 women participated (mean age 57.0 ± 9.9 y). Average VHI score was 14.0 ± 4.9 before treatment, 15.0 ± 4.7 after the first session, 18.2 ± 4.6 after the second treatment and 19.5 ± 4.9 at follow-up. The improvement of VHI score was statistically significant between all sessions. Average VAS score was 15.6 ± 14.1 before treatment, 9.0 ± 10.8 after the first session, 5.9 ± 9.2 after the second treatment and 3.4 ± 7.5 at follow-up. The improvement of VAS score was statistically also significant between all sessions. Conclusions: Our study suggests that the fractional CO2 laser is an effective and safe treatment of symptoms associated with GSM. Orv Hetil. 2019; 160(41): 1617–1622.

scholarly journals Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic

2021 ◽  
Vol 3 ◽  
Author(s):  
Ayane Cristine Alves Sarmento ◽  
Ana Paula Ferreira Costa ◽  
Pedro Vieira-Baptista ◽  
Paulo César Giraldo ◽  
José Eleutério ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Recurrent Urinary Tract Infection ◽  
Signs And Symptoms ◽  
Health Index ◽  
Genitourinary Syndrome Of Menopause ◽  
Vaginal Health ◽  
Maturation Index ◽  
Genitourinary Syndrome ◽  
Lower Urinary

Genitourinary syndrome of menopause (GSM) is a term used to define a compilation of signs and symptoms arising from decreased estrogenic stimulation of the vulvovaginal and lower urinary tract. Among 27–84% of women in postmenopausal are affected for symptoms of GSM, and these can unquestionably impair health, sexual function, consequently the quality of life of these women. The main signs and symptoms of GSM include, among others, burning, irritation, vulvovaginal dryness, dyspareunia, urinary symptoms of urgency, dysuria, or recurrent urinary tract infection. The diagnosis can be made through anamnesis, questionnaires, physical exams, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be complemented by using the Vaginal Health Index (VHI), Vaginal Maturation Index (VMI), or vaginal pH measurement. The acknowledgment of this condition by health professionals is crucial for its identification and proper management and exclusion of other conditions that make a differential diagnosis with it.

scholarly journals Failed Latarjet procedure: a systematic review of surgery revision options

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Matteo Buda ◽  
Riccardo D’Ambrosi ◽  
Enrico Bellato ◽  
Davide Blonna ◽  
Alessandro Cappellari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Recurrent Instability ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Abstract Background Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. Methods A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords “failed”, “failure”, “revision”, “Latarjet”, “shoulder stabilization” and “shoulder instability” to identify articles published in English that deal with failed Latarjet procedures. Results A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16–54 years) were reviewed at an average follow-up of 51.5 months (range: 24–208 months). Conclusions Eden–Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090—www.crd.york.ac.uk/prospero/

scholarly journals Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair

2019 ◽  
Vol 08 (05) ◽  
pp. 403-407 ◽  
Author(s):  
Eric J. Sarkissian ◽  
Matthew B. Burn ◽  
Jeffrey Yao
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Triangular Fibrocartilage Complex ◽  
Study Cohort ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Triangular Fibrocartilage ◽  
Suture Device

Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results. Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs. Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient. Results Eleven patients (mean age, 36 years; range, 20–64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3–10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention. Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears. Level of Evidence This is a Level IV, therapeutic study.

The K-Wire Fixation Technique for Endoscopic Brow Lift: A Long-Term Follow-Up

2019 ◽  
Vol 40 (10) ◽  
pp. 1051-1060 ◽  
Author(s):  
Paul E Chasan ◽  
Adam T Hauch
Keyword(s):  
Fixation Technique ◽  
Effective Technique ◽  
Level Of Evidence ◽  
Brow Lift ◽  
Wire Fixation ◽  
Aesthetic Results ◽  
Long Term Follow Up ◽  
Endoscopic Brow Lift

Abstract Background Many techniques have been presented for fixation during endoscopic brow lift, but no singular technique has become dominant. Objectives The authors described a technique for fixation for endoscopic brow lift that is inexpensive, easy to use, and versatile and has minimal morbidity. Methods The charts of 284 patients who underwent the K-wire fixation technique between December 1996 and September 2018 were reviewed. This technique employs a transcutaneous K-wire to hold the brow in position until tissue adhesion creates a lasting elevation of the brow. Results A total of 284 patients underwent K-wire fixation for endoscopic brow lifting. Two patients had hematomas and 5 patients (1.8%) required a second unilateral brow lift procedure. Long-term elevation of the brow was maintained in all patients. Conclusions K-wire fixation for endoscopic brow lift is a simple, safe, and effective technique for fixation during endoscopic brow lifting that provides long-term aesthetic results. Level of Evidence: 4

Effect of Syndesmotic Implant Removal on Dorsiflexion

2019 ◽  
Vol 40 (5) ◽  
pp. 499-505 ◽  
Author(s):  
Jorge Briceno ◽  
Timilien Wusu ◽  
Philip Kaiser ◽  
Patrick Cronin ◽  
Alyssa Leblanc ◽  
...  
Keyword(s):  
Final Analysis ◽  
Ankle Dorsiflexion ◽  
Implant Removal ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Level Ii ◽  
Significant Difference ◽  
Before And After ◽  
The Mean

Background: There is limited evidence that syndesmotic implant removal (SIR) is beneficial. However, many surgeons advocate removal based on studies suggesting improved motion. Methodologic difficulties make the validity and applicability of previous works questionable. The purpose of this study was to examine the effect of ankle dorsiflexion after SIR using radiographically measured motion before and after screw removal utilizing a standardized load. Methods: All patients undergoing isolated SIR were candidates for inclusion. Dorsiflexion was measured radiographically: (1) immediately before implant removal intraoperatively, (2) immediately after removal intraoperatively, and (3) 3 months after removal. A standardized torque force was applied to the ankle and a perfect lateral radiograph of the ankle was obtained. Four reviewers independently measured dorsiflexion on randomized, deidentified images. A total of 29 patients met inclusion criteria. All syndesmotic injuries were associated with rotational ankle fractures. There were 11 men (38%) and 18 women (62%). The mean, and standard deviation, age was 50.3 ± 16.9 years (range 19-80). Results: The mean ankle dorsiflexion pre-operatively, post-operatively, and at a 3-month follow-up was 13.7 ± 6.6 degrees, 13.3 ± 7.3 degrees and 11.8 ± 11.3 degrees, respectively ( P = .466). For subsequent analysis, 5 patients were excluded because of the potential confounding effect of retained suture button devices. Analysis of the remaining 24 patients (and final analysis of 21 patients who had complete 3-month follow-up) demonstrated similar results with no statistically significant difference in ankle dorsiflexion at all 3 time points. Conclusion: Removal of syndesmotic screws may not improve ankle dorsiflexion motion and should not be used as the sole indication for screw removal. Level of Evidence: Level II, prospective cohort study.

Tibiotalocalcaneal Arthrodesis Using a Novel Retrograde Intramedullary Nail

2019 ◽  
Vol 13 (6) ◽  
pp. 463-469
Author(s):  
John R. Steele ◽  
Alexander L. Lazarides ◽  
James K. DeOrio
Keyword(s):  
High Risk ◽  
Intramedullary Nail ◽  
Weight Bearing ◽  
Bone Defects ◽  
Inclusion Criteria ◽  
Union Rate ◽  
Level Of Evidence ◽  
Retrograde Intramedullary Nail ◽  
Favorable Safety

Background. Tibiotalocalcaneal (TTC) arthrodesis is a common treatment option for complex hindfoot pathology. Overall union rates range from 50% to 86% but can be even lower in certain populations. A novel retrograde intramedullary nail has recently been developed. The purpose of this study was to report fusion rates, time to weight-bearing, and complications with the use of the A3 Fusion Nail. Methods. All patients 18 years or older who underwent TTC arthrodesis with an A3 Fusion Nail at a single institution from 2010 to 2015 with a minimum 3-month follow-up were included in this study. Rates of successful fusion, time to union, time to weight-bearing, and complications were evaluated. A total of 20 patients with an average age of 58.1 years and an average follow-up of 12.5 months met inclusion criteria. Results. Successful TTC arthrodesis was achieved in 14 of 20 patients (70%) overall. Average time to union was 8.1 months, and average time to weight-bearing was 6.8 weeks. Of 20 patients, 17 (85%) required femoral head allograft for bulk bone defects, and the union rate in this subset of patients was 76.5%. The rates of revision surgery (10%) and complications were low. Conclusion. The A3 Fusion Nail demonstrated a favorable safety profile and achieved TTC arthrodesis at a rate consistent with historical data despite being used in a patient population at high risk for nonunion. In patients with bulk bone defects at high risk for nonunion, the A3 Fusion Nail demonstrated superior rates of fusion (76.5%) to those reported in the literature (50%). Level of Evidence: Level III: Retrospective cohort study

Success of endoscopic prostatic surgery in patients with DUA: a prospective observational and analytic study

2021 ◽  
pp. 205141582199360
Author(s):  
Bonny Shah ◽  
Rajeev Chaudhari ◽  
Aman Gupta ◽  
Priyank Shah
Keyword(s):  
Urine Volume ◽  
Outlet Obstruction ◽  
Reduced Form ◽  
P Value ◽  
Clean Intermittent Catheterization ◽  
Detrusor Underactivity ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Acontractile Detrusor

Introduction: Detrusor underactivity (DUA) is a highly prevalent and poorly understood disease in urology practice. Conservative treatment in the form of clean intermittent catheterization (CIC) and pharmacotherapy are in use for DUA without good results. Endoscopic prostate surgery was initially considered ineffective in such patients. But a recent series of retrospective studies showed promising results of surgery in DUA. Therefore, we conducted this prospective study to evaluate success of endoscopic prostatic surgery in a patient with DUA. Materials and methods: This is prospective observational study of 50 patients, satisfying the inclusion criteria, at Ruby Hall Clinic, Pune, conducted between March 2017 and March 2019. Inclusion criteria are that the patients are male, aged > 50 years; urodynamically diagnosed with DUA; a bladder contractility index < 90 with associated bladder outlet obstruction index (BOOI) between 20–40 (equivocal) or > 40 (obstruction), who presented with lower urinary tract symptoms and poor flow ( Qmax < 10 ml/s in a voided volume of >150 ml. Patients were excluded from the study if they had DUA due to neurological causes or spinal trauma, an acontractile detrusor, and were < 50 years. Results: The follow-up period for each patient was 12 months. The mean international prostate specific score reduced from 24.82 ± 2.74 preoperatively to 4.4 ± 1.85 postoperatively. Mean quality of life score reduced from 4.06 ± 0.68 to 0.82 ± 0.62. Mean Qmax increased from 6.26 ±1.46 ml/s to 12.22 ±1.6 ml/s. Mean post-void residual urine volume reduced form 241.9 ±74.9 to 77.3 ±20.75. All of these were statistically significant with a p value < 0.00001. Conclusion: Transurethral resection of the prostate (monopolar/laser) to reduce BOO should be considered as an alternative, viable treatment option in men with DUA. Preoperative counselling and postoperative follow-up are crucial in the management of such patients. Level of evidence:

Open surgery versus nonoperative treatments for paediatric trigger thumb: a systematic review

2014 ◽  
Vol 39 (7) ◽  
pp. 719-726 ◽  
Author(s):  
S. Farr ◽  
F. Grill ◽  
R. Ganger ◽  
W. Girsch
Keyword(s):  
Systematic Review ◽  
Open Surgery ◽  
Nonoperative Treatment ◽  
Joint Motion ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Trigger Thumb ◽  
The Mean ◽  
Results Of Surgery

The purpose of this systematic review was to determine the outcome of interphalangeal (IP) joint motion in children undergoing open surgical release, splinting, and passive exercising therapy for the treatment of paediatric trigger thumb. We conducted an online literature search of seven major databases. Only studies with a mean follow-up of at least 12 months were considered for inclusion. Seventeen retrospective studies and one prospective study met all the inclusion criteria. They reported on the results of surgery (634 children, 759 thumbs), splinting (115 children, 138 thumbs), and passive exercising (89 children, 108 thumbs). The mean follow-up periods were 59 (surgery), 23 (splinting), and 76 months (exercising), respectively. Full IP joint motion without residual triggering was achieved in 95% of all children undergoing surgery, in 67% of children treated with continuous splinting, and 55% after passive exercising. Based on the low level of evidence available, it seems that open surgery resulted in more reliable and rapid outcomes compared with nonoperative treatment.

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