Browsing by Subject "Uterine Prolapse"
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Item Comparisons of Anterior Vaginal Wall Indentation Parameters in Age-Matched Control and Prolapse Patients Using an Operator Independent Artificial Finger(2018-01-23) Wang, Connie; Abraham, Michael R.; Abrego, Christopher E.; Shiakolas, Panos S.; Zimmern, Philippe E.GOAL: To compare reaction forces of the human anterior vaginal wall in control (C) and prolapsed (P) women in response to pressure applied at different angles of indentation through an automated artificial finger equipped with a distal sensor. METHODS: Following IRB approval, a tripod-mounted, artificial finger equipped with a calibrated, piezoresistive sensor at its tip and automated by NI LabView 2015 software for motion control via an actuator was used to create anterior vaginal wall deformations at 10, 15 and 20 degree angles. Age-matched women in the C and P groups were compared. All measurements were performed in the supine position in the operating room, with patients under general anesthesia prior to the start of the operation and after the bladder was drained. Each deformation included a 1 second upwards indentation, a 1 second maintenance "hold", and a 1 second return of the fingertip to the baseline. Measurements were done in triplicate with a 3 second interval between each deformation sequence. Real-time voltages, equivalent to reaction forces sensed by the sensor during each indentation, were modeled as function of motion profiles and analyzed in Excel. The motion profile of each indentation was used to calculate baseline voltage, amplitude change over the 1 second interval of upwards indentation, and slope of the upwards indentation curve in its median 0.5 second range. RESULTS: Five women of similar age group (mean 64, 51-73) were studied in each group. A significant difference was observed between all degrees of indentation in baseline voltage in P and C groups (p<0.05). At 10 and 20 degrees of indentation, there was a significant difference in amplitude change between P and C groups, while there was a significant difference in slope of indentation at 15 degrees between P and C groups. CONCLUSION: The biomechanical properties of the human anterior vaginal wall can be objectively determined by a new device resembling the human finger. This mounted, free-standing artificial finger can apply a predictable and reproducible deformation to the anterior vaginal wall to compare the indentation properties of vaginal tissue in prolapsed and non-prolapsed conditions.Item High Midline Levator Myorrhaphy for Vaginal Vault Prolapse: Long-Term Results(2016-01-19) Wu, Yuefeng (Rose); Christie, Alana; Alhalabi, Feras; Zimmern, Philippe E.INTRODUCTION AND OBJECTIVE: To review long-term outcomes following a vaginal native tissue repair (High Midline Levator Myorrhaphy, HMLM) in women with symptomatic vault prolapse.1, 2 METHODS: Following IRB-approval, a prospectively maintained database of women who underwent HMLM for symptomatic vault prolapse (VP) alone or associated with other POP was reviewed for demographic data, history of prior POP, physical examination, hospital stay length, and long-term outcomes. Patients with <6 months follow up and no retrievable operative notes were excluded. Data was reviewed by a third party investigator not involved in patient care. Failure was defined as same compartment POP ≥ stage 2 or POP reoperation. Descriptive statistics and Kaplan-Meier curves were obtained. RESULTS: Between 1996 and 2014, 94 women who underwent HMLM were studied. Mean follow-up time was 7.7 (0.6-18.4) years, mean age was 69.6 (36-91), and 89% were Caucasian. Patients were grouped by POP indications: VP (6), vault and anterior (26), vault and posterior (35), and all 3 compartments (27) (Table 1). No intra-operative complications were reported. Ten (11%) early complications (<30 days) were noted (Clavien I/II). Sixty-seven (71%) women were cured of VP. Ten women (11%) had failure in a non-apical compartment and 17 (18%) had apical failure. Reoperation rate was 14% (13/94) and 5% (5/94) for vault and non-vault recurrences, respectively. VP recurrence-free probability between women with ≤ 2 versus 3 POP compartments was statistically significant (p = 0.0128). CONCLUSIONS: At a mean follow-up of 7-8 years, HMLM was successful in two thirds of women. Best outcome was noted in women with VP and one associated compartment prolapse. REFERENCES: 1. Lemack, G. E., et al. Urology, 56: 50, 2000. 2. Natale, F. et al. J Urol, 180: 2047, 2008