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- Altman, Daniel, et al.
(författare)
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A generic health-related quality of life instrument for assessing pelvic organ prolapse surgery : correlation with condition-specific outcome measures
- 2018
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 29:8, s. 1093-1099
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: The aim of this study was to investigate the use of a generic and globally accessible instrument for assessing health-related quality of life (HR-QoL) in pelvic organ prolapse (POP) surgery.Methods: In a prospective multicenter setting, 207 women underwent surgery for apical prolapse [stage ae2, Pelvic Organ Prolapse Quantificcation (POP-Q) system] with or without anterior wall defect. Demographic and surgical characteristics were collected before surgery. Results of the 15-dimensional (15D) instrument and condition-specific pelvic floor symptoms as assessed using the Pelvic Floor Distress Inventory questionnaire (PFDI-20), including its subscales Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Colorectal-Anal Distress Inventory-8 (CRADI-8), and Urinary Distress Inventory-6 (UDI-6), were assessed preoperatively and 2 months and 1 year after surgery.Results: HR-QoL as estimated by 15D was improved 1 year after surgery (p < 0.001). Prolapse-related 15D profile-index measures (excretion, discomfort, sexual activity, distress, and mobility) were significantly improved after surgery (p < 0.05-0.001). Significant inverse associations were detected between increased 15D scores and a decrease in PFDI-20 and subscale scores (p < 0.001), indicating improvements on both instruments.Conclusions: Generic HR-QoL as estimated by 15D improved significantly after apical POP surgery and correlated with improvements of condition-specific outcome measures. These results suggest that a comprehensive evaluation of global HR-QoL is valid in assessing pelvic reconstructive surgery and may provide novel and important insights into previously understudied areas, such as cost-utility and cost-effectiveness analysis after urogynecological surgery.
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| 2. |
- Falconer, Christian, et al.
(författare)
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Long-term outcomes of pelvic organ prolapse repair using a mesh-capturing device when comparing single- versus multicenter use
- 2021
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Ingår i: Archives of Gynecology and Obstetrics. - : Springer. - 0932-0067 .- 1432-0711. ; 303:1, s. 135-142
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this study was to compare long-term effects of high-volume surgery at a single-center to multicenter use when using a mesh-capturing device for pelvic organ prolapse (POP) repair. Methods Five years after surgery 101 (88%) at the single center were compared with 164 (81.2%) in the multicenter trial. Outcome measurements included clinical examination, prolapse-specific symptom questionnaires [Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire-short form (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)] and pain estimation by VAS (0-10). Results Optimal apical segment outcome was 95% in the single- compared to 83.3% in the multicenter study (p < 0.001). POP recurrence in the anterior and posterior walls (POP-Q, Ba and Bp >= 0) was more common at the multicenter as compared to the single center [(19.8% vs 5.4%) and (26% vs 2.7%), (p < 0.001)]. Reoperations for POP and mesh-related complications were more frequent in the multicenter study [31/202 (15.3%) vs 7/116 (6.1%),p < 0.001]. Total PFDI-20, PFIQ-7 and PISQ-12 scores were comparable between the cohorts. There were no significant differences in overall pain scores in-between the cohorts during follow-up. At the single center, 1/81 patients (1.2%) had VAS 7/10, i.e. severe pain, as compared to 3/131 (2.3%) in the multicenter study (p = 0.277). Conclusions Despite the high objective and subjective long-term effectiveness of the procedure in both regular use, and at a high-volume center, centralizing the use of a standardized capturing-device guided transvaginal mesh for POP repair reduced secondary interventions by more than half.
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| 3. |
- Morcos, Edward, et al.
(författare)
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Association between surgical volumes and real-world healthcare cost when using a mesh capturing device for pelvic organ prolapse : a 5-years comparison between single- versus multicenter use
- 2021
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Ingår i: International Urogynecology Journal. - : Springer Science+Business Media B.V.. - 0937-3462 .- 1433-3023. ; 32:11, s. 3007-3015
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: The aim of this study was to evaluate whether high surgical volume at a single center was associated with lower healthcare costs compared to lower surgical volume in a multicenter setting.Methods: All patients had symptomatic and anatomical apical prolapse (POP-Q ≥ stage II) with or without cystocele and were operated on by a standard surgical procedure using the Uphold mesh. Data on time of resource use in terms of surgery time, hospital stay and re-interventions across 5 years were compared between the single center (97 patients) and multicenter (173 patients, at 24 clinics). Unit costs for surgical time, inpatient and outpatient visits were extracted from the single-center hospital’s operation analysis program and prime production cost. Total costs were estimated for primary surgery and during 5-year follow-up.Results: Costs for primary surgery were comparable between the single and the multicenter ($13,561 ± 2688 and $13,867 ± 1177, P = 0.29). Follow-up costs 5 years after primary surgery were 2.8 times higher at the multicenter than single center ($3262 vs. $1149, P < 0.001). Mean cost per patient over 5 years was significantly lower at the single than multicenter [$14,710 (CI: 14,168–15,252) vs. $17,128 (CI: 16,952–17,305), P < 0.001)].Conclusions: Using a mesh kit for apical pelvic organ prolapse in a high surgical volume center was associated with reduced healthcare costs compared with a lower volume multiple-site setting. The cost reduction at the high surgical volume center increased over time because of lower surgical and medical re-intervention rates for postoperative complications and recurrence.
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| 4. |
- Morcos, Edward R I
(författare)
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Formation and role of nitric oxide in host defense reactions in the urinary bladder
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Nitric oxide (NO) is an important biological mediator and cell signaling molecule. It is also involved in several host defense reactions. NO is formed in vivo from L-arginine by the enzyme NO synthase (NOS). However, it can also be formed non-enzymatically from acidified nitrite. The main aim of this thesis was to investigate the formation of NO and its role in host defense in the urinary bladder with focus on intravesical instillation of bacillus Calmette-Guérin (BCG) in the treatment of bladder cancer. Furthermore, to establish a method for measurement of NO oxidation products (nitrite and nitrate) in human urine by capillary electrophoresis (CE). T24 and MBT-2 bladder cancer cells showed both calcium-dependent and calcium-independent NOS activity whereas in cultured normal human urothelial cells (NHU) only calcium-dependent NOS activity was detected. BCG and cytokines induced calcium-independent NOS activity in bladder cancer cells and NHU cells. Cytokine treatment inhibited the growth of bladder cancer cells partly via induction of calcium-independent NOS activity. In agreement, exogenously administered NO inhibited the growth of bladder cancer cells. On the other hand, the NO substrate L-arginine showed a dose-dependent proliferative effect on bladder cancer cells. In line with the in vitro findings, bladder tumor biopsies showed both calcium-dependent and calcium-independent NOS activities whereas only calcium-dependent NOS activity was detected in bladder mucosal biopsies. BCG treatment induced calcium-dependent and calcium-independent NOS activity in bladder mucosal biopsies. In patients treated with BCG, bladder NO concentrations were markedly increased after the first instillation and over a six month treatment course. NO formation from nitrite containing acidified urine was hugely increased and addition of ascorbic acid augmented the NO formation. Nitrite addition to acidified urine inhibited the growth of E. coli and T24 bladder cancer cells. These results may explain a bacteriostatic effect of ascorbic acid in the treatment of urinary tract infection and may be of importance in the treatment of bladder cancer. A sensitive, simple and rapid technique was developed for measurement of nitrite and nitrate in human urine and cell culture medium by CE using UV detection. The method allows detection of basal nitrite and nitrate concentrations in urine avoiding interference of urine sample matrices and pH with detection. This is of importance to elucidate the role of NO in the urinary tract. In summary, the results indicate that BCG induces long-term local formation of NO in the urinary bladder via induction of NOS activity in urothelial cells. The induction of NOS is likely mediated by endogenous cytokine production following BCG treatment. Endogenous NO formation following NOS induction may inhibit the growth of bladder cancer cells. Non-enzymatically formed NO or other nitrogen oxides from nitrite containing acidified urine may have a role in host defense reactions in the urinary bladder.
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| 5. |
- Poutakidis, Georgios, et al.
(författare)
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Ultrasound evaluation of anterior transvaginal mesh for pelvic organ prolapse : correlation to 5-year clinical outcomes
- 2022
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Ingår i: International Urogynecology Journal. - : Springer London. - 0937-3462 .- 1433-3023. ; 33:7, s. 1907-1915
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis Vaginal prolapse mesh may effectively restore vaginal anatomy. The aim of this study was to investigate how the in vivo mesh position correlates to clinical outcomes. Methods Seventy-one women operated on using Uphold mesh for apical pelvic organ prolapse (POP-Q, C >= stage II) were examined 5 years after surgery by introital-perineal 2D ultrasound in a midsagittal plane at rest and Valsalva. The horizontal line and pubis symphysis were considered the reference for all measures. Ultrasound measures were statistically compared to clinical outcomes: POP-Q, Pelvic Floor Distress Inventory (PFDI-20) and subscales [Pelvic Organ Distress Inventory (PODI-6), and Urinary Distress Inventory (UDI-6)] and the VAS scale for pain. Results Original mesh length was preserved by 86% and correlated to improved pain as estimated by VAS scale (r 0.321). Valsalva was associated with a lowering of the superior and inferior mesh margins by 7.3 and 6.1 mm, respectively (p < 0.001) but a reduction of total mesh length by only 1 mm (30.2 +/- 5.2 to 29.2 +/- 4.7 mm, p < 0.001). Mobility of the anterior vaginal wall (bladder neck and midurethra) at Valsalva was parallel to downward movement of the mesh inferior margin (r 0.346 and 0.314) but inversely correlated to total UDI-6 (r - 0.254 and - 0.263). Mobility of the midurethra was inversely correlated to bladder emptying (PFDI-20 Question 19, r - 0.245). Conclusions Five years after surgery, preserved original length of the mesh with apical support was correlated to improved anatomical and patient-reported outcomes. Mesh support to the vaginal apex was associated with improved bladder emptying and total urinary distress outcomes but not stress urinary incontinence.
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