Objectives Pain is a recognized complication of mid-urethral slings (MUS), which may lead to suburethral sling removal (SSR) alone, or to a more extensive removal approach. We report on the outcomes of women who required an SSR or an additional secondary MUS arm removal for pain only. Methods After Institutional Review Board (IRB) approval, the charts of nonneurogenic women who underwent SSR for pain only were reviewed. Demographic information, MUS type, self-reported pain resolution, and preoperative and postoperative questionnaires, including Urogenital Distress Inventory-Short form question 6 (UDI-6 Q6) scores, were collected for the SSR (group 1) and secondary removal (group 2) groups. Results Of 52 women who underwent SSR for pain only between 2005 and 2018, 16 (31%) required a secondary procedure to remove the extension arms due to persistent pain after SSR. All women in group 2 experienced pain immediately after SSR (UDI-6 Q6 score of 2 to 3). Patients whose pain improved after SSR presented at a median 61 months after MUS whereas those in group 2 underwent SSR at median 34 months after MUS. Median duration of follow-up in group 2, after the secondary procedure, was 34 months. Over one half of those in group 2 (54%) noticed pain cure/improvement. Seven were left with persistent pain. Conclusions In women who underwent SSR for pain only, 67% reported pain resolution. An additional procedure to remove the extension arms of the mesh was performed in one third of women for persistent pain after SSR.
INTRODUCTION AND OBJECTIVES: Antimuscarinic are the current pharmacological mainstay for overactive bladder (OAB). However, adverse events resulting from antimuscarinics are inevitable in some patients. Discontinuation rates of 70% to 90% within the first year of therapy have been reported for various OAB medications, because the therapy did not produce the treatment bene?t expected. Mirabegron, which acts as a subtype of relaxation of detrusor, appeared on the Japanese market in 2011, and it provides a new treatment option for OAB. Currently, there are few published studies on the long-term persistence with drug therapy among OAB patients. The purposes of this study were to evaluate OAB pharmacotherapy adherence.METHODS: Patients 18 years of age or older who received an OAB diagnosis and OAB medication prescription for one ß3-adrenoceptor and six antimuscarinics were identified from April 2013 to August 2016. The study cohort consisted of 1,917 OAB patients in Aichi Medical University Hospital. Medication status such as persistence, switching, adherence and the reasons for discontinuation were examined. Persistence was measured by the length of continuous medication with OAB drugs. Time to discontinuation was defined as the number of days between the first dispense date and the expected end date of the last refill. The cumulative incidence of medication persistence was estimated using Kaplan-Meier method. Patients who remained on treatment until the end of the follow-up were regarded as censored data, and the length of follow-up period was assigned as the time of persistence. The proportion of persistence was compared according to each drug using the log-rank test.RESULTS: The mean patient age and time of persistence were 72.0 years and 323.9 days, and the following drugs were prescribed to OAB patients for 245 of imidafenacin, 24 of oxybutynin, 747 of solifenacin, 17 of tolterodine, 67 of fesoterodine, 100 of propiverine hydrochloride, and 723 of mirabegron. The 1-year persistence rate of each drug were 31.6%, 17.4%, 35.9%, 12.5%, 21.9%, 36.5% and 41.7%, respectively. The median of time to discontinuation were 184 days, 112 days, 196 days, 182 days, 77 days, 189 days and 231 days, respectively. Patients taking mirabegron demonstrated statistically significantly greater adherence than those taking antimuscarinics in both sexes.CONCLUSIONS: Mirabegron was associated with higher levels of persistence and adherence than antimuscarinics in our large and long term cohort.
Introduction We report on the management of intraoperative vaginal cuff perforation during robotic‐assisted mesh recto‐sacrocolpopexy for vaginal vault prolapse with defecatory dysfunction. Case presentation A 75‐year‐old woman with vaginal bulge and constipation was to undergo a joint robotic mesh recto‐sacrocolpopexy. Intraoperatively, mesh was secured to the left posterior vaginal wall following dissection. Prior to contralateral suture placement, the vaginal cuff split open and exposed an end‐to‐end anastomotic sizer previously inserted in the vagina. Due to subsequent mesh erosion risk, we proceeded with vaginotomy closure with running and interrupted absorbable sutures, removal of mesh, direct suture rectopexy to the promontory, and enterocele defect correction by reapproximating the right and left wings of the peritoneum flaps over the rectum with running sutures. Patient reported satisfactory outcomes after 2 years. Conclusion We reviewed our experience with vaginal cuff perforation during robotic‐assisted mesh recto‐sacrocolpopexy prompting enterocele repair and rectopexy without mesh.
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