Browsing by Subject "Vagina"
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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 Cost Analysis of the Anterior Vaginal Wall Suspension Procedure to the Repair of Stress Urinary Incontinence with Early Grade Anterior Compartment Prolapse(2015-01-26) Rawlings, Tanner; Zimmern, Philippe E.INTRODUCTION: To evaluate the contemporary cost of the Anterior Vaginal Wall Suspension (AVWS) procedure to correct SUI with early grade compartment prolapsed. METHODS: The cost of AVWS for women undergoing AVWS alone (with no associated procedure) was analyzed from a prospective long-term database. Costing data was obtained from a tertiary care institution for operating room expenses, medical and surgical supplies, pharmacy, anesthesia supplies, and room and bed. Professional fees for the AVWS procedure were obtained from the Medicare Fee for Service Schedule. Costs for 2012 were adjusted by 3% to match 2013 costs. Due to non-normality in the data, the non-parametric Wilcoxon Rank Sum test was used to test for differences in cost by fiscal year or payer type. The Student t-test was used to ensure this population was a representative sample by testing for differences between the patients in this sample compared to the remainder of the patients that have undergone AVWS without concomitant surgery at our institution RESULTS: For 2012 - 2013, 34 of 48 women met inclusion criteria. One charity case was excluded, and others had concomitant procedures like hysterectomy. With the 3% inflation adjustment for 2012, the mean total cost was $3681 ± $764, with a median cost of $3664. Anesthesia, operating room, and room and bed costs differed significantly from 2012 to 2013. Only pharmacy cost differed between payer mix and Medicare. The sample analyzed had a shorter mean surgery time (69.6 min) compared to the overall AVWS population (86 min).). This cost data compares favorably to the average cost reported in contemporary U.S. literature for Tension free vaginal tape (TVT)( $8082 - 9579), transobturator tape (TOT) ($9017), and BC ($9320 - $105450) CONCLUSION: The AVWS mean total cost was $3681, with an increase in cost from 2012 to 2013 related to anesthesia, operating room, and room and bed costs, a figure much lower than most reported costs for comparable anti-incontinence procedures.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, 2008Item [UT Southwestern Medical Center News](2010-08-19) Morales, Katherine