scholarly journals Hüvelyi hálóműtétek gyakorlata az amerikai korlátozó figyelmeztetés után. Merjem, vagy ne merjem?

2018 ◽  
Vol 159 (10) ◽  
pp. 397-404 ◽  
Author(s):  
Zoltán Fekete ◽  
Szilvia Körösi ◽  
Gábor Németh
Keyword(s):  
The Elderly ◽  
Pelvic Organ ◽  
Vaginal Mesh ◽  
Referral Centre ◽  
Tertiary Referral Centre ◽  
Mesh Surgery ◽  
Operative Complications ◽  
Short And Long Term

Abstract: Introduction: The prevalence of pelvic organ prolapse (POP) with aging is escalating alarmingly, and now becoming a growing epidemic among the elderly. Synthetic transvaginal mesh (TVM) has been employed with increasing popularity in the treatment of POP until the end of the last decade. After the U.S. Drug and Food Administration (FDA) warnings in the years 2008 and 2011, the number of vaginal mesh operations has decreased dramatically. Aim: The aim of the study was to evaluate and compare the anti-POP effectivity, the anti-stress incontinence (anti-SUI) efficacy, and the late (36 months) post-operative complications of the anterior vaginoplasty and the TVM operations. Method: We analysed the clinical data from 120 patients with stage II–III anterior prolapse and concomitant SUI who had undergone surgery at a tertiary referral centre in Hungary between January 2013 and January 2014. Sixty patients underwent Kelly–Stoeckel vaginoplasty and the other 60 cases had TVM operation. The surgical complications were classified using the Clavien–Dindo (CD) classification system. Results: The anti-POP (91.6% vs. 63.3%; p<0.001) and the anti-SUI efficacy (90% vs. 55%, p<0.001) were significantly higher in the TVM group than in the vaginoplasty group, while the overall extrusion rate was found 8.3% after a 3-year follow-up. The Clavien–Dindo score (CD) proved that the early post-operative complication profile was similar among the TVM patients as compared to the vaginoplasty group (p = 0.405). Conclusion: Vaginal mesh surgery represents an effective procedure for prolapse and concomitant SUI with a decreased risk of short- and long-term complications. Orv Hetil. 2018; 159(10): 397–404.

scholarly journals Long-term outcomes of transvaginal mesh surgery for pelvic organ prolapse: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaojuan Wang ◽  
Yisong Chen ◽  
Changdong Hu ◽  
Keqin Hua
Keyword(s):  
Pelvic Organ Prolapse ◽  
Patient Characteristics ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Recurrence Rates ◽  
Kaplan Meier ◽  
Mesh Surgery ◽  
Patient Global Impression

Abstract Background The objective of this study was to evaluate the overall outcomes and complications of transvaginal mesh (TVM) placement for the management of pelvic organ prolapse (POP) with different meshes with a greater than 10-years of follow-up. Methods We performed a retrospective review of patients with POP who underwent prolapse repair surgery with placement of transvaginal mesh (Prolift kit or self-cut Gynemesh) between January 2005 and December 2010. Baseline of patient characteristics were collected from the patients’ medical records. During follow-up, the anatomical outcomes were evaluated using the POP Quantification system, and the Patient Global Impression of Improvement (PGI-I) was used to assess the response of a condition to therapy. Overall postoperative satisfaction was assessed by the following question: “What is your overall postoperative satisfaction, on a scale from 0 to 10?”. Relapse-free survival was analyzed using Kaplan–Meier curves. Results In total, 134 patients were included. With a median 12-year (range 10–15) follow-up, 52 patients (38.8%) underwent TVM surgery with Prolift, and Gynemesh was used 82 (61.2%). 91% patients felt that POP symptom improved based on the PGI-I scores, and most satisfied after operation. The recurrence rates of anterior, apical and posterior compartment prolapse were 5.2%, 5.2%, and 2.2%, respectively. No significant differences in POP recurrence, mesh-associated complications and urinary incontinence were noted between TVM surgery with Prolift versus Gynemesh. Conclusions Treatment of POP by TVM surgery exhibited long-term effectiveness with acceptable morbidity. The outcomes of the mesh kit were the same as those for self-cutmesh.

Long-term observation on postoperative recurrence and complications of transvaginal mesh surgery for pelvic organ prolapse

2021 ◽  
Author(s):  
Junfang Yang ◽  
Kun Zhang ◽  
Jinsong Han ◽  
Yiting Wang ◽  
Ying Yao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pelvic Organ Prolapse ◽  
Protective Factor ◽  
Pelvic Organ ◽  
Vaginal Mesh ◽  
Transvaginal Mesh ◽  
Mesh Exposure ◽  
Mesh Surgery ◽  
Post Menopause

Objective: This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery. Design：This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019. Methods: The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis. Results: A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9±5.1 vs. 63.4±5.8 years old), years of post-menopause (17.5±6.3 vs. 13.3±6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (P<0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (P<0.05). Furthermore, 6.7% of sexually active patients reported do novo dyspareunia. Limitation: The investigators could only record the subjective recurrence of patients, thus there is a lack of objective recurrence data. Conclusion: Age, years of post-menopause and previous hysterectomy are risk factors for subjective recurrence of transvaginal mesh surgery; however，concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.

Transvaginal mesh surgery for pelvic organ prolapse does not affect sexual function at long term follow up

2019 ◽  
Vol 18 (9) ◽  
pp. e3177
Author(s):  
S. Serni ◽  
S. Morselli ◽  
P. Verrienti ◽  
M. Di Camillo ◽  
L. Gemma ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Sexual Function ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Mesh Surgery ◽  
Long Term Follow Up

scholarly journals P017 COMPLEX ABDOMINAL WALL RECONSTRUCTION IN ELDERLY PATIENTS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Joaquin Munoz-Rodriguez ◽  
Javier López Monclús ◽  
Carlos San Miguel ◽  
Luis Blázquez Hernando ◽  
Alvaro Robin Valle de Lersundi ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Surgical Site Infections ◽  
The Elderly ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Preperitoneal Approach ◽  
Short And Long Term

Abstract Aim Our study aims to analyze and evaluate the results obtained in patients older than 80 years old who underwent complex abdominal wall reconstruction (CAWR) in a multicenter abdominal wall unit using different surgical approaches. Material and Methods Patients were identified from a prospective maintained multicenter database. Demographic characteristics, incisional hernias’ (IH) characteristics, as well as postoperative outcomes, including short and long-term complications have been analyzed. Results 21 patients were identified. The mean age was 82.5 (+/- 2.4) years old . There were 10 (47.6%) midline IH, 5 (23.8%) lateral IH, 4 (19%) synchronous midline and lateral IHs, and 2 (9.6%) parastomal hernias (PH). 9 (42.8%) Madrid TAR modification technique, 5 (23.8%) Rives-Stoppa, 3 (14.3%) lateral preperitoneal approaches, 1 (4.8%) midline preperitoneal approach and 1 (4.8%) anterior component separation were performed. In patients with PH, a modification of the Pauli technique (4.8%), and a unilateral TAR with a keyhole repair associated (4.8%) were performed. There were 7 (33,3) surgical site occurrences (SSO), 1 (4.8%) seroma, 3 (14.3%) hematomas and 3 (14.3%) surgical site infections. Only 3 (14.3%) SSO required procedural intervention. During a mean follow-up of 20.6 (+/- 15.9) months, 1 (4.8%) hernia recurrence was diagnosed. No cases of postoperative bulging were recorded. There were also no cases of chronic pain in the sample. During follow-up, 3 patients died from surgery unrelated causes. Conclusions CAWR in the elderly patient, after an adequate preoperatively selection of patients, presented acceptable short- and long-term results, despite the advanced population age.

Transvaginal mesh surgery for pelvic organ prolapse does not affect sexual function at long term follow up

2019 ◽  
Vol 240 ◽  
pp. 282-287
Author(s):  
Simone Morselli ◽  
Vincenzo Li Marzi ◽  
Pierangelo Verrienti ◽  
Maurizio Serati ◽  
Matteo Di Camillo ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Sexual Function ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Mesh Surgery ◽  
Long Term Follow Up

scholarly journals 87 Epidemiology Study of Elderly Patients with Acute Myeloid Leukaemia at a Haematological Tertiary Referral Centre

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv18-iv27
Author(s):  
Raymond D K Yeak ◽  
Yee Yee Yap ◽  
Sen Mui Tan ◽  
Tee Chuan Ong ◽  
Jerome T C Tan ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Myeloid Leukemia ◽  
The Elderly ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Elderly Aml ◽  
Acute Myeloid

Abstract Introduction Acute Myeloid Leukemia (AML) is a rare disease with a high incidence in the elderly. Our aim is to report the incidence of elderly patients with AML at a haematological tertiary referral centre. Method We have collected data from 2007 till 2017 from the main Malaysian haematological tertiary referral centre involving all the 1225 AML patients. Out of those, 182 elderly patients aged 65 and above with AML were examined. The patients had at least 2 years follow-up. Results The elderly represented 14.9% of the 1225 patients who presented with acute myeloid leukemia to the centre. There were 182 elderly patients with AML which were subdivided to the unspecified AML of 154 patients, 1 patient with M1, 4 patients with M2, 6 patients with M3, 5 patients with M4, 8 patients with M5, 2 patients with M6 and 2 patients with M7. There were 109 males and 73 females. The majority of the patients were Chinese (n=85) representing 46.7% of the patients, followed by the Malay (n=76), Indian (n=19) and lastly others (n=2). The average age at diagnosis was 71 years. There were 136 deaths and the mortality rate was 74.7%. The average age of the patients who had passed away (n=136) was 71.4 years. The average age of the patients who are still living (n=42) was 76.5 years. Conclusion The incidence of elderly AML is increasing. The younger patients with AML are known to have better survival rate in comparison to the elderly. More research is needed to explore the reasons for the higher mortality in the elderly and the ways to improve the outcome of this elderly population as our lifespan increases and Malaysia heads towards an ageing nation.

scholarly journals Vaginal mesh surgery is efficient to treat pelvic organ prolapse grade 3 in elderly women

2019 ◽  
Vol 4 (4) ◽  
pp. 38-46
Author(s):  
O. S. Korotkevich ◽  
V. G. Mozes ◽  
I. A. Eizenakh ◽  
A. V. Soloviev ◽  
V. V. Vlasova
Keyword(s):  
Surgical Treatment ◽  
Pelvic Organ Prolapse ◽  
Outcome Measure ◽  
Elderly Women ◽  
Pelvic Organ ◽  
Vaginal Mesh ◽  
Mesh Surgery ◽  
Grade 3

Aim. To evaluate the surgical treatment of pelvic organ prolapse grade 3 in elderly women.Materials and Methods. We consecutively recruited 86 elderly women (60 to 75 years old) suffering from pelvic organ prolapse grade 3. Out of them, 56 patients underwent vaginal mesh surgery while 30 refused surgical treatment. After 1 year, we assessed stress urinary incontinence using a cough test and Valsalva maneuver. Pain intensity was measured using the Numeric Rating Scale whereas quality of life was assessed by Pelvic Floor Disability Index (PDFI-20). The primary outcome measure was the prevalence of pelvic organ prolapse symptoms while the secondary outcome measure was the frequency of stress urinary incontinence and low quality of life upon 1 year of follow-up.Results. After 1 year of follow-up, patients who received a surgical treatment were characterized by a statistically significant decrease in both frequency and intensity of complaints and symptoms of pelvic organ prolapse. Pelvic Organ Prolapse Distress Inventory score was 8.3 (4.2-12.5) and 79.2 (79.2-100) in patients with or without surgical treatment respectively. Similar results were showed using Colorectal-Anal Distress Inventory score (6.2 (3.1-6.2) and 68.8 (62.5-71.9) and Urinary Distress Inventory score (8.3 (4.2-8.3) and 83.3 (79.2-87.5), in treated and untreated individuals, respectively. Total Pelvic Floor Disability Index score was 22.8 (11.5-27.0) in women who underwent a vaginal mesh surgery and 227.2 (226.1251.0) in those who did not. All indicated differences were statistically significant.Conclusions. Vaginal mesh surgery is efficient for the treatment of pelvic organ prolapse grade 3 in elderly women.

scholarly journals Premorbid frailty predicts short and long term outcomes of reperfusion treatment in acute stroke

2021 ◽  
Author(s):  
Andrea Pilotto ◽  
cora brass ◽  
klaus fassbender ◽  
fatma merzou ◽  
andrea morotti ◽  
...  
Keyword(s):  
Acute Treatment ◽  
The Elderly ◽  
Neurological Recovery ◽  
Long Term Outcomes ◽  
Stroke Outcomes ◽  
Frailty Status ◽  
Short And Long Term ◽  
One Year

Background: Frailty is the most important short and long term predictor of disability in the elderly and thus might influence the clinical outcome of acute treatment of stroke. Objective: to evaluate whether frailty predicts short- and long term all-cause mortality and neurological recovery in elderly patients who underwent reperfusion acute treatment of stroke. Methods: the study included consecutive patients older than 65 years who underwent reperfusion treatment in a single stroke Unit from 2015 to 2016. Predictors of stroke outcomes were assessed including demographics, baseline NIHSS, time to needle, treatment and medical complications. Premorbid Frailty was assessed with a comprehensive geriatric assessment (CGA) including functional, nutritional, cognitive, social and comorbidities status. At three and twelve months, all-cause death and clinical recovery (using modified Ranking scale, mRS) were evaluated. Results: One-hundred and two patients who underwent acute reperfusion treatment for stroke entered the study (mean age 77.5, 65- 94 years). Frailty was diagnosed in 32 out of 70 patients and associated with older age (p=0.001) but no differences in baseline NIHSS score, vascular risk profile or treatment management strategy. Frailty status was associated with worse improvement at 24 hours and higher in-hospital mortality. At follow-up, frail patients showed poorer survival at 3 (25% vs 3%, p=0.008) and 12 (38% vs 7%, p=0.001) months. Frailty was the best predictor of neurological recovery at one year follow-up (mRS 3.2 + 1.9 vs 1.9 + 1.9). Discussion: frailty is an important predictor of efficacy of acute treatment of stroke beyond classical predictors of stroke outcomes. Larger longitudinal studies are thus warranted in order to evaluate the risk-benefit of reperfusion treatment in the growing elderly frail population.

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