An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction

There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report.This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper.A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible.A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research

The Use of Prosthetic Stents in Tracheobronchial, Gastrointestinal, and Genitourinary Diseases

The concept of using a stent to maintain patency of a lumen is not new. As early as 1969, stents were being investigated in the peripheral arterial system as a means of preventing restenosis after dilatation by balloon angioplasty (Dotter, 1969). Since then, numerous reports have demonstrated the use of stents in both the peripheral and coronary artery systems (Maass et al., 1982; Dotter et al., 1983; Wright et al., 1985; Palmaz et al., 1987). Concomitant with the investigation of expandable endovascular metal prosthesis has been the development of prosthetic devices for management of tracheobronchial, gastrointestinal, and genitourinary diseases. We will review the use of endoscopically placed prosthetic devices in the management of diseases affecting these systems

Urology

УЧЕБНО-МЕТОДИЧЕСКИЕ ПОСОБИЯУРОЛОГИЯУРОЛОГИЧЕСКИЕ БОЛЕЗН

2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery

Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs

Poważne powikłanie u osób z uszkodzonym rdzeniem kręgowym: neurogeniczna dysfunkcja pęcherza moczowego

The complications of neurogenic bladder which follows spinal cord injury include urinary infections, sepsis, hydronephrosis, urinary tract stones, structural deterioration of bladder and bladder cancers. If the care and treatment intended to prevent these complications are not performed, the quality of life and environmental and social compliance of the patient are declined, and it can result with serious mortality and morbidity. Therefore, rehabilitation of neurogenic bladder should begin immediately after the injury in individuals with spinal cord injury, the patient and his family should be informed and educated adequately and the patient should be followed up for a lifetime. With proper management, urinary continence can be safely achieved and renal deterioration can be effectively prevented. (JNNN 2015;4(1):35–39)Powikłania neurogenicznej dysfunkcji pęcherza moczowego będącej następstwem urazów rdzenia kręgowego to zakażenia dróg moczowych, sepsa, wodonercze, kamica układu moczowego, pogorszenie strukturalne oraz nowotwory pęcherza moczowego. Brak opieki i leczenia mającego na celu uniknięcie powyższych komplikacji powoduje, że jakość życia oraz warunki środowiskowe i społeczne pogarszają się, co prowadzi do poważnych stanów chorobowych, a nawet śmierci. Rehabilitacja pęcherza z dysfunkcją neurogeniczną u osób z uszkodzonym rdzeniem kręgowym musi zacząć się zaraz po urazie. Pacjent oraz jego rodzina powinni zostać poinformowani i odpowiednio przeszkoleni. Pacjent powinien być monitorowany przez całe jego życie. Dzięki odpowiedniej opiece można nie tylko uniknąć pogorszenia czynności nerek, ale również bezpiecznie osiągnąć kontynencję. (PNN 2015;4(1):35–39

2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery

Bladder injury; Urinary injury management; Urinary injury preventionLesió de la bufeta; Maneig de lesions urinàries; Prevenció de lesions urinàriesLesión de la vejiga; Manejo de lesiones urinarias; Prevención de lesiones urinariasIatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs

Female Urethral Reconstruction

Female urethral strictures are rare; thus, the literature describing stricture management in women is sparse. Although urethral dilation continues to be performed at a high frequency in women despite lack of proven efficacy, this procedure is used for a variety of voiding complaints other than stricture. Hence, the long-term utility of dilation and urethrotomy for urethral stricture in women is unknown. This review describes the various urethroplasty techniques used in the management of female urethral stricture. Although grafts using a dorsal approach have been shown to be feasible in women, ventral flap techniques offer good long-term outcomes with minimal morbidity. Acute and delayed management of pelvic fracture–associated urethral distraction defects in women is also described. Unlike in men, immediate urethroplasty in women should be performed once the patient is hemodynamically stable

A prospective study on outcome of Tension Free Trans Obturator Tape for Female Stress Urinary Incontinence

INTRODUCTION: Stress Urinary Incontinence is defined as the involuntary loss of urine from the urethra during physical activities that increase the intra abdominal pressure in the absence of detrusor activity. It is the major proportion of cause of urinary incontinence. SUI can develop through two mechanisms; hyper mobility - significant displacement of the urethra and bladder neck during exertion and intrinsic sphincter deficiency (ISD). These two conditions can coexist in women. As stated by the American Urologic Association consensus statement in 2001, there are only 2 procedures that are proven to have effective long-term cure rates for the treatment of stress urinary incontinence (SUI). These procedures are the abdominal Burch Colposuspension and the sling procedure that is completed vaginally. However, in the past, the sling procedure was far from standardized. There have been multiple different descriptions using different materials for the sling (fascia from the patient, cadaveric fascia or dermis from humans or animals, synthetics, etc), different anchoring points, and different methods to adjust the tension of the sling. In many cases patients had to undergo general anesthesia, were in the hospital for several days, required a catheter to drain the bladder and many patients suffered high rates of voiding dysfunction following these slings. AIM OF STUDY: 1. To study the efficacy of TOT in Stress Urinary Incontinence. 2. To analyse immediate and late complications. 3. Compare the results. MATERIALS AND METHODS: All female patients with SUI who underwent TOT procedure from September 2007 to March 2009 were included .The study was prospective study, conducted in Department of Urology, GRH and KMCH. Total number of patients included in this study were 60. All patients were evaluated with history including bladder diary pre operative. International Consulation on continence Questionnaire and Urogenital Distress Inventory. physical examination including pelvic examination, urinalysis, urodynamic studies. RESULTS: 50 patients under spinal anaesthesia 10 patients under IV Sedation. The mean operative time was 12 min (6–30) in cases of isolated SUI treatment. The catheterisation time was 0.9 day (0–2). No significant blood loss occurred in any cases. At one month, 93% of patients (56/60) were cured and 3.5% (2/60) of persistent voiding dysfunction with de novo urgency or urge incontinence who needed simple follow up. Perineal pain was observed in 1 patient (2.5%) – Lasted for 3 months. Post operative leg pain in 4 patients (7%) - Lasted for 2 to 6 months. No vaginal erosion was observed at this point. No perioperative complications noted. 2 urinary retention after removal of the catheter on post-operative day 1, one for 15 days and the other one not recovered, patient advised splitting of the tape under mid urethra..Patient was not willing, hence self catheterisation was taught. Two lower urinary tract infections were observed in the immediate post-operative period. At one year, 48 of 60 patients (80%) were clinically cured from their stress incontinence and an additional 12% were also improved. CONCLUSION: Trans obturator tape is a simple, effective and safe procedure for the treatment of female stress urinary incontinence confirmed after 1 year of follow-up. • It offers increased safety. • The post-operative morbidities associated with this technique are minimal and manageable. • Evaluation of the results after a longer follow-up period is needed. • The learning curve is simple and easy