| 1. |
- Ankardal, Maud, 1957, et al.
(författare)
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A randomised trial comparing open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence
- 2004
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Ingår i: Bjog. - : Wiley. - 1470-0328. ; 111:9, s. 974-81
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence. DESIGN: Multicentre, prospective randomised trial. SETTING: Departments of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Goteborg, Boras County Hospital and Orebro University Hospital, Sweden. POPULATION: Women with genuine stress urinary incontinence or mixed incontinence with a predominantly stress component were included, and were randomised to either open colposuspension (n= 120) or laparoscopic colposuspension (n= 120). METHODS: Women were randomised to open colposuspension with sutures or laparoscopic colposuspension with polypropylene mesh and staples. Anaesthesia/operation time, blood loss, complications and other related surgical parameters were compared. MAIN OUTCOME MEASURES: Objective and subjective cure rates from 48-hour frequency-volume chart, a 48-hour pad test and a subjective assessment of the woman's incontinence and quality of life performed one year after surgery. RESULTS: Objective and subjective cure rates were higher after open compared with laparoscopic colposuspension (P < 0.001). Quality of life was improved following surgery in both groups (P < 0.0001) and the improvement was significantly greater in the open colposuspension group (P < 0.05) with regard to physical activity. Performing an open colposuspension was less time consuming (P < 0.0001), resulted in more blood loss (P < 0.0001), longer catheterisation time (P < 0.01), greater risk of urinary retention (P < 0.01) and a longer hospital stay (P < 0.0001) compared with performing a laparoscopic colposuspension. The rate of serious complications was low in both groups. CONCLUSION: Open colposuspension had a higher objective and subjective cure rate one year after surgery but with a greater blood loss, greater risk of urinary retention and a longer hospital stay than laparoscopic colposuspension.
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| 2. |
- Ankardal, Maud, 1957, et al.
(författare)
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A three-armed randomized trial comparing open Burch colposuspension using sutures with laparoscopic colposuspension using sutures and laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence
- 2005
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Ingår i: Acta Obstet Gynecol Scand. - : Wiley. - 0001-6349. ; 84:8, s. 773-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare open Burch colposuspension using sutures (OC) with laparoscopic colposuspension using sutures (LCS) and laparoscopic colposuspension using mesh and staples (LCM) in women with stress urinary incontinence. DESIGN: Prospective randomized trial. Setting: Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Goteborg, Sweden. POPULATION: Women with genuine stress urinary incontinence or mixed incontinence with a predominantly stress component attending the Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Goteborg, Sweden. METHODS: The women were assessed objectively using a 48-h frequency-volume chart, a 48-h pad test and a standardized stress test. Subjectively, the women were assessed by a questionnaire including influence on quality of life. The women were randomized to OC using sutures (n = 79), LCS (n = 53) or LCM (n = 79). Anaesthesia/operation time, blood loss, complications and other related surgical parameters were compared. Main outcome measures. Objective and subjective cure rate. RESULTS: Objective cure rates 1 year after surgery were significantly higher in the OC and LCS groups compared to the LCM group analyzed by a standardized stress test. Subjective findings were in concordance with the objective results. Performing an OC was less time consuming than performing a LCS and resulted in more blood loss compared to the two laparoscopic techniques. Patients in the LCM group had a shorter duration of catheter use and hospital stay. CONCLUSION: The use of sutures, irrespective of whether the surgical approach was laparoscopic or open surgery, was superior to the laparoscopic mesh and staple technique.
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| 3. |
- Ankardal, Maud, 1957, et al.
(författare)
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Comparison of health care costs for open burch colposuspension, laparoscopic colposuspension and tension-free vaginal tape in the treatment of female urinary incontinence
- 2007
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Ingår i: Neurourol Urodyn.
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To compare direct health care costs of treatment for stress urinary incontinence in Sweden with four different procedures: (i) open Burch colposuspension (OBC); (ii) laparoscopic colposuspension with sutures (LCS); (iii) laparoscopic colposuspension with mesh and staples (LCM), and (iv) Tension-free Vaginal Tape (TVT). MATERIAL AND METHODS: A model was constructed representing a hospital with standardized surgical equipment, staff and average unit costs in 2003 Euros. The time used for anesthesia and surgery was calculated. Clinical data was collected from three different sources, a multicenter, randomized, prospective study comparing OBC with LCM with 1 year follow-up, a three-armed, prospective study where women were randomized to either OBC, LCM, or LCS with 1 year follow-up and a descriptive study reporting results of TVT with 5 year follow-up. Data collected from the studies and hospital cost data were put into the model to create the different cost elements. RESULTS: The total cost per individual, showed a lower cost for TVT compared to the other alternatives. The direct costs for a TVT, euro1,366 were only 56% of the costs for an OBC, euro2,431 (P < 0.001) and 59% of the costs for a LCS, euro2,310 (P < 0.001). CONCLUSIONS: When using a model and comparing health care costs for surgical treatment of female stress urinary incontinence in Sweden, the TVT procedure generated a lower direct cost than both open and laparoscopic colposuspension. Neurourol. Urodynam. (c) 2007 Wiley-Liss, Inc.
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| 4. |
- Ankardal, Maud, 1957
(författare)
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Evaluation of surgical methods for treatment of female stress urinary incontinence
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: Paper I & II: To compare the subjective and objective results of open Burch colposuspension and laparoscopic colposuspension using sutures or mesh and staples in randomised trials. Paper III: To assess the short and long term results of the Tension-free Vaginal Tape (TVT)-procedure in a large observational study and to identify factors predictive of successful outcome. Paper IV: To compare direct health care costs for incontinence surgery in Sweden using four different surgical procedures and to relate health care costs to subjective cure thus creating a simple cost effectiveness ratio. Patients and methods: Papers I & II: Women with stress urinary incontinence (SUI) or mixed urinary incontinence (MUI) with a predominant stress component were included. Paper I: Multicenter Randomised Controlled Trial comparing open Burch colposuspension (n = 120) to laparoscopic colposuspension with mesh and staples (n = 120). Paper II: Three-armed Randomised Trial comparing open Burch colposuspension (n = 79), laparoscopic colposuspension using sutures (n = 53) and laparoscopic colposuspension using mesh and staples (n = 79). Papers I & II Evaluation one year after surgery included subjective cure, quality of life assessed by a visual analogue scale, leakage in a 48-hour pad-test and in Paper II a standardised stress test. Paper III: Prospective observational trial of 707 consecutive women with SUI (n = 396) or MUI (n = 311) treated with the TVT-procedure. Subjective cure after 1, 2 and 5 years was evaluated by a postal questionnaire. A sub-sample of 59 women was objectively evaluated 5 years after surgery. Factors influencing the cure rate were analysed using a stepwise multiple regression analysis. Paper IV: A model was constructed representing a hospital with standardised surgical equipment, staff and average unit costs in 2003 value. Clinical data collected from the studies in Paper I, II and III and hospital cost data were put into the model to create the different cost elements. Results: Paper I & II: Objective cure 1 year after surgery was higher after open colposuspension and laparoscopic suspension using sutures compared to laparoscopic colposuspension using mesh and staples. Subjective findings were in concordance with the objective results. Performing an open colposuspension was less time consuming than performing a laparoscopic colposuspension but resulted in more blood loss than both the laparoscopic methods. Patients in the laparoscopic colposuspension group using mesh and staples had a shorter duration of catheter use and hospital stay. Paper III: Subjective cure rate was 83% after 1 year and 73% after 5 years. Objective cure rate was 83% in the subgroup after 5 years. In patients with MUI the cure rate was lower than in patients with SUI (after 5 years 55% vs 81%). Type of incontinence was the only independent variable found to influence surgical outcome. Paper IV: The total cost per individual, showed a lower cost for TVT compared to the other three methods. The direct costs for a TVT were only 56% of the costs for an open colposuspension and 59% of the costs for a laparoscopic colposuspension using sutures. The TVT procedure was more cost-effective, in costs per subjectively cured patient, compared to all other three methods. Conclusions: Open colposuspension had a higher objective and subjective cure rate 1 year after surgery, but with a greater blood loss, greater risk of urinary retention and a longer hospital stay than laparoscopic colposuspension using mesh and staples. The use of sutures, irrespective of whether the surgical approach was laparoscopic or open surgery, was superior to the laparoscopic mesh and staples technique. The TVT-procedure, performed in over 700 women at a single unit, was found to be safe and efficient. Type of incontinence was the only independent variable found to predict for outcome of surgery. When using an economic model and comparing health care costs for surgical treatment of female stress urinary incontinence in Sweden, the TVT-procedure generated a lower direct cost and cost per subjectively cured patient.
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| 5. |
- Ankardal, Maud, 1957, et al.
(författare)
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Short- and long-term results of the tension-free vaginal tape procedure in the treatment of female urinary incontinence
- 2006
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Ingår i: Acta Obstet Gynecol Scand. - : Wiley. - 0001-6349. ; 85:8, s. 986-92
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim was to describe the short- and long-term results of treatment for urinary incontinence (UI) in women using the tension-free vaginal tape (TVT) procedure at a single unit and to identify factors predictive of successful outcome. MATERIAL AND METHODS: Consecutive female patients (n = 707) treated for UI with the TVT procedure at Karlstad Hospital from November 1996 to June 2004 were included. After a standardized preoperative evaluation, the women were classified as having either stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). The results of surgery were evaluated after 1, 2, and 5 years, by means of a postal questionnaire. An objective evaluation was performed after 5 years in a subsample of the first patients included (n = 59). Factors influencing the cure rate were analyzed using multiple regression analysis. RESULTS: The subjective cure rate was 83% after 1 year and 73% after 5 years. The objective cure rate was 83% in the subgroup after 5 years. Surgical time was 30+/-9 min (mean+/-SD). The rate of bladder perforations was 1.7%. In patients with MUI the cure rate was lower than in patients with SUI (after 5 years 54.9% versus 81.0%). Type of incontinence was the only independent variable found to influence surgical outcome. CONCLUSIONS: The TVT procedure, performed in over 700 women at a single gynecological unit, was found to be a safe and efficient surgical procedure. Type of incontinence was the only independent variable found to predict for outcome of surgery.
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| 6. |
- Bohlin, Katja Stenstrom, et al.
(författare)
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Factors influencing the outcome of surgery for pelvic organ prolapse
- 2018
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Ingår i: International Urogynecology Journal. - : Springer London. - 0937-3462 .- 1433-3023. ; 29:1, s. 81-89
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Tidskriftsartikel (refereegranskat)abstract
- Pelvic organ prolapse (POP) surgery is a common gynecological procedure. Our aim was to assess the influence of obesity and other risk factors on the outcome of anterior and posterior colporrhaphy with and without mesh. Data were retrieved from the Swedish National Register for Gynecological Surgery on 18,554 women undergoing primary and repeat POP surgery without concomitant urinary incontinence (UI) surgery between 2006 and 2015. Multivariate logistic regression analyses were used to identify independent risk factors for a sensation of a vaginal bulge, de novo UI, and residual UI 1 year after surgery. The overall subjective cure rate 1 year after surgery was 80% (with mesh 86.4% vs 77.3% without mesh, p < 0.001). The complication rate was low, but was more frequent in repeat surgery that were mainly mesh related. The use of mesh was also associated with more frequent de novo UI, but patient satisfaction and cure rates were higher compared with surgery without mesh. Preoperative sensation of a vaginal bulge, severe postoperative complications, anterior colporrhaphy, prior hysterectomy, postoperative infections, local anesthesia, and body mass index (BMI) 30 were risk factors for sensation of a vaginal bulge 1 year postsurgery. Obesity had no effect on complication rates but was associated increased urinary incontinence (UI) after primary surgery. Obesity had no influence on cure or voiding status in women undergoing repeat surgery. Obesity had an impact on the sensation of a vaginal bulge and the presence of UI after primary surgery but not on complications.
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| 7. |
- Bohlin, Katja S., et al.
(författare)
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Influence of the modifiable life-style factors body mass index and smoking on the outcome of hysterectomy
- 2016
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 95:1, s. 65-73
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThe aim of this study was to study the impact of body mass index (BMI) and smoking on the outcome of hysterectomy and whether effects of these factors vary between abdominal, laparoscopic and vaginal hysterectomy.Material and methodsPre-, per- and postoperative (8 weeks) data were retrieved from the Swedish National Register for Gynecological Surgery on 28 537 hysterectomies performed because of a benign indication between 2004 and 2013. Multivariable logistic regression analyses were used to identify independent factors affecting the rate of complications, presented as adjusted odds ratios (adjOR) with 95% confidence intervals (CI).ResultsOverweight and obesity had the strongest impact on complications in the abdominal hysterectomy group. In women with a BMI 30 an increased adjOR could be seen for bleeding >1000 mL (2.90; 95% CI 2.23-3.77), peroperative complications (1.54; 95% CI 1.26-1.88), operation time >120 min (2.67; 95% CI 2.33-3.03), postoperative complications (1.21; 95% CI 1.08-1.34) and postoperative infections (1.73; 95% CI 1.50-1.99). With vaginal hysterectomy, the effect of BMI 30 could be seen in relation to excessive bleeding >500 mL (1.63; 95% CI 1.22-2.17) and operative time >120 min (2.00; 95% CI 1.60-2.50). With laparoscopic hysterectomy (LH), a BMI 30 had a higher adjOR for prolonged surgery (1.71; 95% CI 1.30-2.26). Smokers had an increased risk of postoperative infection in the abdominal hysterectomy (1.23; 95% CI 1.07-1.40) and vaginal hysterectomy groups (1.21; 95% CI 1.02-1.43) but not in the LH group.ConclusionsBody mass index and smoking had a negative effect with all hysterectomy approaches but to a lesser extent in vaginal and laparoscopic hysterectomies. This should be taken into consideration in advance of surgery to improve outcome.
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| 8. |
- Stenström Bohlin, Katja, et al.
(författare)
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Factors influencing the incidence and remission of urinary incontinence after hysterectomy
- 2017
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 0002-9378 .- 1097-6868. ; 216:1, s. 53.e1-53.e9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Studies on the influence of body mass index, smoking, and mode of delivery on the occurrence of urinary incontinence after hysterectomy are required to provide women with information about how these factors influence continence after a hysterectomy.OBJECTIVE: The aim was to assess the impact of lifestyle factors such as body mass index, smoking, and delivery mode (vaginal/cesarean) on the incidence and remission of urinary incontinence after hysterectomy.STUDY DESIGN: This was a cohort study based on pre-, per-, and postoperative (1 year) data retrieved from the Swedish National Register for Gynecological Surgery on 16,182 hysterectomies performed because of a benign indication between 2006 and 2013. Multivariable logistic regression analyses were used to identify independent risk factors for de novo urinary incontinence and postoperative remission of urinary incontinence, presented as adjusted odds ratios with 95% confidence intervals.RESULTS: De novo urinary incontinence was reported by 8.5%, remission of urinary incontinence by 13.3%, and residual urinary incontinence by 16.1% after the hysterectomy. A body mass index ≥30 kg/m(2) (odds ratio, 1.63, 95% confidence interval, 1.37-1.94), having undergone a vaginal delivery (odds ratio, 1.40, 95% confidence interval, 1.14-1.86), the presence of daily urge without incontinence prior to surgery (odds ratio, 1.77, 95% confidence interval, 1.47-2.13), and a uterine weight <500 g (odds ratio, 2.46, 95% confidence interval, 1.96-3.09) were associated with an increased risk of de novo urinary incontinence. A uterine weight >300 g (odds ratio, 1.98, 95% confidence interval, 1.69-2.33), body mass index <25 kg/m(2) (odds ratio, 1.22, 95% confidence interval, 1.01-1.47), prolapse (odds ratio, 2.25, 95% confidence interval, 1.60-3.18), or fibroids (odds ratio, 1.33, 95% confidence interval, 1.09-1.62) as indication for surgery and the absence of daily urge without incontinence preoperatively (odds ratio, 1.51, 95% confidence interval, 1.29-1.76) were associated with an increased remission of urinary incontinence. Vaginal compared with abdominal hysterectomy was associated with a decreased remission of urinary incontinence (odds ratio, 0.70, 95% confidence interval, 0.57-0.87). There was no effect of of age or smoking or a difference between total and subtotal hysterectomy with regard to de novo urinary incontinence or remission of urinary incontinence after the hysterectomy. Residual urinary incontinence and de novo urinary incontinence significantly reduced satisfaction with surgery 1 year postoperatively compared with women without urinary incontinence.CONCLUSION: Vaginal delivery, obesity, and daily urge symptoms without incontinence prior to surgery increased de novo urinary incontinence and had a negative influence on the rate of remission of urinary incontinence after hysterectomy, which in turn influenced patients' satisfaction with surgery.
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| 9. |
- Stenström Bohlin, Katja, et al.
(författare)
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The influence of the modifiable life-style factors body mass index and smoking on the outcome of mid-urethral sling procedures for female urinary incontinence
- 2015
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 26:3, s. 343-351
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: The aim of this observational study was to investigate the influence of body mass index (BMI) smoking and age on the cure rate, rate of complications and patient satisfaction with mid-urethral sling (MUS) procedures.Methods: Pre-, peri- and postoperative (8 weeks and 1 year) data were retrieved from the Swedish National Register for Gynecological Surgery of MUS procedures (retropubic procedures, n = 4,539; transobturator procedures, n =1,769) performed between January 2006 and December 2011. Multiple logistic regression analyses were performed between the outcome variables and BMI and smoking, presented as adjusted odds ratios (adjOR) with 95 % confidence interval (CI).Results: Subjective 1-year cure rate was 87.4 % for all MUS procedures (88.3 % with the retropubic technique and 85.2 % with the transobturator technique (p = 0.002). Preoperative daily urinary leakage and urgency were more common with increasing BMI, but surgery reduced symptoms in all BMI groups. Lower cure rate was seen in women with a BMI >30 (0.49; CI 0.33–0.73), in diabetics (0.50; CI 0.35–0.74) and women aged > 80 years (0.18; CI 0.06–0.51). Perioperative complications were more common in the retropubic group (4.7 % vs 2.3 % in the transobturator group, p=0.001) and in women with BMI < 25. Smoking did not influence any of the outcome variables.Conclusions: The overall 1-year cure rate for MUS procedures was 87 %, but was negatively influenced by BMI >30, diabetes and age > 80 years. Perioperative complications were more common with the retropubic procedure than with the transobturator technique, and in women with a BMI < 25. Smoking did not impact on any of the studied outcome variables.
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