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Fulltext The transobturator outside in suburethral sling insertion procedure

Balakrishnan SS, Dass AK, Tan YL

Indian J Urol, 2015 Apr-Jun;31(2):160-1.
PMID: 25878424 DOI: 10.4103/0970-1591.154223

This video describes the transobturator outside in suburethral sling surgical procedure for the indication of urodynamic stress urinary incontinence. A total of 170 cases were performed from January 2007 till December 2013. The average follow up was from 6 months till 7 years. The cure rate was 90%. There were no recurrences in our series. There was one patient with tape exposure after 3 years which required excision.
Fulltext Lower urinary tract dysfunction resulting from a 10-year retained intravesical absorbable suture from a uterine myomectomy

Tan YL, Lo TS, Khanuengkitkong S, Dass AK

Taiwan J Obstet Gynecol, 2013 Sep;52(3):435-6.
PMID: 24075389 DOI: 10.1016/j.tjog.2013.01.027
Assessment of collagen-coated anterior mesh through morphology and clinical outcomes in pelvic reconstructive surgery for pelvic organ prolapse

Lo TS, Tan YL, Khanuengkitkong S, Dass AK, Cortes EF, Wu PY

J Minim Invasive Gynecol, 2014 Sep-Oct;21(5):753-61.
PMID: 24607796 DOI: 10.1016/j.jmig.2014.02.013

STUDY OBJECTIVE: To assess the morphologic features of anterior armed transobturator collagen-coated polypropylene mesh and its clinical outcomes in pelvic reconstructive surgery to treat pelvic organ prolapse.
DESIGN: Evidence obtained from several timed series with intervention (Canadian Task Force classification II-3).
SETTING: Chang Gung Memorial Hospital, Taoyuan, Taiwan, China.
PATIENTS: Between April 2010 and October 2012, 70 patients underwent surgery to treat symptomatic pelvic organ prolapse, stage III/IV according to the POP-Q (Pelvic Organ Quantification System).
INTERVENTION: Anterior armed transobturator collagen-coated mesh.
MEASUREMENT AND MAIN RESULTS: Morphologic findings and clinical outcome were measured. Morphologic features were assessed via 2-dimensional introital ultrasonography and Doppler studies. Clinical outcome was measured via subjective and objective outcome. Objective outcome was assessed via the 9-point site-specific staging method of the International Continence Society Pelvic Organ Prolapse Quantification before the operation and at 1-year postoperative follow-up. Subjective outcome was based on 4 validated questionnaires: the 6-item UDI-6 (Urogenital Distress Inventory), the 7-item IIQ-7 (Incontinence Impact Questionnaire), the 6-item POPDI-6 (Pelvic Organ Prolapse Distress Inventory 6), and the 12-item PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), at baseline and at 12 months after the operation. Data were obtained for 65 patients who underwent the combined surgery and were able to comply with follow-up for >1 year. Ultrasound studies reveal that mesh length tends to shorten and decrease in thickness over the 1-year follow-up. Vagina thickness also was reduced. Neovascularization through the mesh was observed in <8.5% of patients in the first month and at 1 year, and was evident in approximately 83%. The mesh exposure rate was 6.4%. The recorded objective cure was 90.8% (59 of 65 patients), and subjective cure was 89.2% (58 of 65 patients) at mean (SD) follow-up of 19.40 (10.98) months. At 2 years, UDI-6, IIQ-7, and POPDI-6 scores were all significantly decreased (p < .001), whereas the PISQ-12 score was significantly increased (p = .01).
CONCLUSIONS: Ultrasound features suggest that the degeneration of collagen barrier may be longer than expected and that integration of collagen-coated mesh could occur up to 1 year. A substantially good clinical outcome was noted.
KEYWORDS: Anterior vaginal mesh; Collagen-coated mesh; Morphology; Outcome; Pelvic organ prolapse
Rectovaginal fistula: Twenty years of rectovaginal repair

Lo TS, Huang YH, Dass AK, Karim N, Uy-Patrimonio MC

J Obstet Gynaecol Res, 2016 Oct;42(10):1361-1368.
PMID: 27354199 DOI: 10.1111/jog.13066

AIM: To identify the favorable factors in rectovaginal fistula (RVF) management.
METHODS: After Institutional Review Board approval (99-0793B), we retrospectively studied all patients diagnosed, treated and followed up with RVF at Chang Gung Memorial Hospital, Taiwan between January 1990 and December 2009. All female patients with International Classification of Diseases RVF were included. We reviewed demographic data, socioeconomic status, clinical presentation, comorbidities, method of treatment, duration of hospitalization and clinical outcome at 12 months postoperatively.
RESULTS: A total of 397 patients were included in the study. Fifty-six patients (14.1%) had conservative treatment and 341 patients (85.9%) underwent surgical intervention. A total of 125 patients underwent simple repair while 216 patients underwent reconstruction. Three hundred and forty-four patients (86.7%) had improved outcome at 12-month follow up. Age (P = 0.003), education level (P = 0.033), ability to pay insurance (P < 0.001), and choice of treatment (P < 0.0001) were identified as significant favorable factors. An etiological factor associated with favorable outcome was RVF from obstetric complication, while that resulting from malignancy had a less favorable outcome.
CONCLUSIONS: Age, education level and ability to pay insurance significantly affect 12-month outcome of RVF. Surgery is the preferred option, while medical treatment should be used only for small rectovaginal fistulas or for patients not suitable for surgery and anesthesia. More support and assistance should be offered to those patients with unfavorable factors, such as old age, low education level and inability to afford insurance. All RVF secondary to obstetrical injury had a 100% favorable outcome compared with those secondary to surgery or malignancy. Women with suspected RVF should receive prompt and extensive evaluation to ensure immediate effective management and prevention of further serious complications.