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- Chapple, C. R., et al.
(författare)
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Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence
- 2017
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Ingår i: European Urology. - : Elsevier BV. - 0302-2838. ; 72:3, s. 424-431
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Tidskriftsartikel (refereegranskat)abstract
- Context: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). Objective: A consensus review of existing data based on published meta-analyses and reviews. Evidence acquisition: This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations. Evidence synthesis: Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae. Conclusions: When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres. Patient summary: Synthetic slings can be safely used in the surgical treatment of stress incontinence in both male and female patients. Patients need to be aware of the alternative therapy and potential risks and complications of this therapy. Synthetic mesh for treating prolapse should be used only in complex cases with recurrent prolapse in specialist referral centres.
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- Altés Arlandis, Alberto, 1978-, et al.
(författare)
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Habitability, the scale of sustainability
- 2009
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Ingår i: CISBAT 2009 Renewables in changing climate. - Lausanne : École polytechnique fédérale de Lausanne. ; , s. 409-414
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Konferensbidrag (refereegranskat)abstract
- This paper will explore an alternative to so-called „sustainable‟ models and strategies currently applied in the field of building, architecture and urbanism. In front of irrational resource consumption and an ever-growing waste generation or other problems, seemingly inherent to the current industrial productive model and now transferred to the production of space, the most critical and concerned sectors within these disciplines keep on applying scale-segregated sustainable solutions, i.e. working and intervening at the scale of the single built unit, or at that of the urban model.Instead, the paper will explain ongoing research related to the possibilities of generating another model based in the concept of “global habitability”, that would allow the application of those and other new solutions and mechanisms at all scales in a much more holistic approach to the implementation of sustainability: working transversally and simultaneously, from the room to the city.If current strategies aim at an increase in efficiency exclusively based in the reduction of resource consumption and waste generation, the new model would propose a redefinition of the other term intervening, namely utility. The very subject of sustainability is changed here through this redefinition; no more space but activity, no more the object but the process.Utility and use within architecture can be identified with habitability, here understood as the achievement of adequate social and environmental conditions in order to satisfy the socially acknowledged basic needs of people. Two different factors would determine such idea of utility: on the one hand the conditions of matter‟, as an expression of requirements related to space, resource flows and equipment needed to develop an activity; and on the other hand, the conditions of „orgware‟ or „privacy‟, another term that would include synergy – as the relation between the level of individuality and the level of collectivity - and management, as a combination of time, control and legislation.The main aim of the paper will be thus to present this reformulation of the idea of „habitability‟ as the only effective strategy towards an implementation of sustainability in the field of building. A systemic intervention, re-thinking the utility of architecture from the smallest spatial unit (the room) and extending its scale to that of the urban services (i.e. providers of any need that can‟t be fulfilled within the dwelling), allows achieving the maximum efficiency in terms of resource consumption; whereas social focus, incorporating individual, collective and organizational demands, allows the strategy to take roots in society expanding, thus, the likelihood of its success.
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