Postoperative Visual Outcome: Sling procedure with prolene sutures in children with simple congenital ptosis

Objective: To assess the visual outcome after sling procedure using prolene sutures in children with simple congenital ptosis. Methods: A descriptive case series study was performed in the Department of Ophthalmology of Jinnah Post Graduate Medical Centre, for a duration of six months in which 20 patients aged 3-10 years were selected with either unilateral or bilateral congenital ptosis. They were thoroughly examined and visual acuity and degree of ptosis were measured pre-operatively. Frontalis sling surgery was performed using prolene sutures on all patients after which their visual acuity and degree of ptosis were measured once again after three months post-operatively. Data were analyzed using SPSS version 20.0. For qualitative variables, frequency and percentages were calculated. Mean and Standard deviation was commutated for the quantitative variable. Results: The mean age of the patients was 8.15±1.75. 11 (55%) male and 9 (45%) female participants were included in the study. Visual acuity improved in all the patients with all the patients attaining a visual acuity of 6/6 (n=12, 60%), 6/9 (n=7, 35%), and 6/12 (n=1, 5%). The degree of ptosis post-operatively was not found in any patient either. Conclusion: Sling procedure helped in eliminating ptosis and improved visual acuity in patients with simple congenital ptosis. doi: https://doi.org/10.12669/pjms.38.1.4359 How to cite this:Shamim N, Hayat N, Cheema A. Postoperative Visual Outcome: Sling procedure with prolene sutures in children with simple congenital ptosis. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4359 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A new titanium-covered transobturator tape for surgical treatment of stress urinary incontinence

Introduction and hypothesis To assess the long-term satisfaction, cure rate and safety of a new titanium-covered transobturator tape compared to polypropylene tape for the treatment of stress urinary incontinence (SUI). Methods A prospective study was conducted with 151 patients. Seventy patients underwent transobturator sling surgery with titanium tape from 2011 to 2019, and a historical control group (CG) of 81 patients was treated with a noncoated tape and underwent incontinence surgery from 1999 to 2009. We compared patient-reported outcome measures (PROMs) with the incontinence outcome questionnaire (IOQ). Results The median follow-up was 2½ years in both groups. Based on responses to the IOQ, a statistically significantly shorter time of recovery (IOQ 15: 21.3 ± 26.4 [TG], 40.2 ± 38.5 [CG], p = 0.02), improvement of sex life (IOQ 13: 34.1 ± 29.4 [TG] vs. 65.3 ± 35.6 [CG], p = 0.01) and less voiding dysfunction (IOQ 19: 30.9 ± 28.1 [CG], 9.3 ± 18.6 [TG], p = 0.01) were observed in the TG. Objectively, no postoperative urinary retention was observed in the TG, but four cases were described in the CG. Ten patients needed a reoperation for SUI in the CG compared to three in the TG (p = 0.03). Conclusion The titanium-covered transobturator sling had superior recovery time, improved sexual function and reduced reoperation rate compared to a historical polypropylene group.

Narrow Vagina as a Predictor of Obstructive Voiding Dysfunction after Transobturator Sling Surgery

<b><i>Background:</i></b> Voiding dysfunction (VD) is a potential complication after female midurethral sling operations. <b><i>Objectives:</i></b> Our goal was to assess the rate of obstructive VD after ­transobturator tension-free tape (TOT) procedures and to find perioperative risk factors (RFs) predicting postoperative voiding problems. <b><i>Methods:</i></b> We have retrospectively evaluated the perioperative data of 397 women who underwent TOT operations. Significant post-void residual (PVR) (&#x3e;50 mL) was considered as the primary (objective) end point of the study, the voiding difficulty as the secondary (subjective) 1. First univariate analysis and then multivariate logistic regression were performed, with a 5% significance level. <b><i>Results:</i></b> Significant PVR was present in 51 (12.8%) women; catheterization was needed in 21 (5.3%) and reoperation in 3 (0.8%) cases. Seventy women (17.6%) experienced postoperative voiding difficulty. Narrow vagina (&#x3c;2 cm), older age &#x3e;70 years, and preoperative voiding difficulty were independent RFs for significant PVR (odds ratio: 5.07, 2.14, 5.38, respectively, <i>p</i> &#x3c; 0.05). Preoperative overactive bladder syndrome and previous pelvic organ prolapse surgery were considered independent RFs for postoperative voiding difficulty. <b><i>Conclusions:</i></b> Older age, narrow vagina, or preoperative voiding difficulty increases the chance for significant postoperative PVR. These patients should be chosen and counseled appropriately.

Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

Introduction and hypothesis The aims were to review the literature from the last two decades and analyze treatment efficacy and findings of the studies on colpocleisis. Methods A systematic search was conducted within the MEDLINE/PubMed and ClinicalTrials.gov databases, using the following keywords: pelvic organ prolapse (POP), colpocleisis, obliterative, and LeFort. All English full-text prospective and retrospective observational and interventional studies were included. Anatomical and subjective success, surgical techniques, concomitant procedures, complication rates, anesthesia methods, and decision regret were analyzed. Results A total of 237 papers were identified and 49 met the inclusion criteria. Mean patient age was 69.0 ± 8.0 to 84 ± 3.1. Over 90.2% of patients undergoing colpocleisis were diagnosed with POP stage ≥ 3. The follow-up ranged from 30 days to a median of 5 years. Anatomical success, defined as POP-Q stage ≤ 1 and no prolapse beyond the hymen, was achieved in 62.5 to 100% and 87.5 to 100% of all patients respectively. Subjective success ranged from 88% to 100%. Regret over the loss of coital ability ranged from 0% in many studies to 12.9%, general decision regret from 0% to 13.8%. After concomitant midurethral sling surgery, 86.8% to 94% of all patients were continent, with a 0–14% sling revision rate due to urinary retention. Urinary tract infection was the most common postoperative complication (4.3 to 9% confirmed with urine culture, 34.7% based on symptom definition). Bowel (0 to 2.7%) and urinary tract (0 to 9.1%) injuries were the consequences of concomitant procedures. The mortality rates were up to 1.3%. Conclusions Colpocleisis is a heterogeneous procedure, characterized by high subjective and objective success, low coital ability regret, and a low risk of complications.