Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh

Contains fulltext : 96379.pdf (publisher's version ) (Closed access)INTRODUCTION AND HYPOTHESIS: The objective of this study is to evaluate the complications and anatomical and functional outcomes of the surgical treatment of mesh-related complications. METHODS: A retrospective cohort study of patients who underwent complete or partial mesh excision to treat complications after prior mesh-augmented pelvic floor reconstructive surgery was conducted. RESULTS: Seventy-three patients underwent 30 complete and 51 partial mesh excisions. Intraoperative complications occurred in 4 cases, postoperative complications in 13. Symptom relief was achieved in 92% of patients. Recurrence of pelvic organ prolapse (POP) occurred in 29% of complete and 5% of partial excisions of mesh used in POP surgery. De novo stress urinary incontinence (SUI) occurred in 36% of patients who underwent excision of a suburethral sling. CONCLUSIONS: Mesh excision relieves mesh-related complications effectively, although with a substantial risk of serious complications and recurrence of POP or SUI. More complex excisions should be performed in skilled centers

Appearance of the levator ani muscle subdivisions in magnetic resonance images.

OBJECTIVE: Identify and describe the separate appearance of 5 levator ani muscle subdivisions seen in axial, coronal, and sagittal magnetic resonance imaging (MRI) scan planes. METHODS: Magnetic resonance scans of 80 nulliparous women with normal pelvic support were evaluated. Characteristic features of each Terminologia Anatomica–listed levator ani component were determined for each scan plane. Muscle component visibility was based on pre-established criteria in axial, coronal, and sagittal scan planes: 1) clear and consistently visible separation or 2) different origin or insertion. Visibility of each of the levator ani subdivisions in each scan plane was assessed in 25 nulliparous women. RESULTS: In the axial plane, the puborectal muscle can be seen lateral to the pubovisceral muscle and decussating dorsal to the rectum. The course of the puboperineal muscle near the perineal body is visualized in the axial plane. The coronal view is perpendicular to the fiber direction of the puborectal and pubovisceral muscles and shows them as “clusters” of muscle on either side of the vagina. The sagittal plane consistently demonstrates the puborectal muscle passing dorsal to the rectum to form a sling that can consistently be seen as a “bump.” This plane is also parallel to the pubovisceral muscle fiber direction and shows the puboperineal muscle. CONCLUSION: The subdivisions of the levator ani muscle are visible in MRI scans, each with distinct morphology and characteristic features

Vaginal birth and de novo stress incontinence:relative contributions of urethral dysfunction and mobility

BACKGROUND: Vaginal birth increases the chance a woman will develop stress incontinence. This study evaluates the relative contributions of urethral mobility and urethral function to stress incontinence. METHODS: This is a case-control study with group matching. Eighty primiparous women with self-reported new stress incontinence 9–12 months postpartum were compared to 80 primiparous continent controls to identify impairments specific to stress incontinence. Eighty nulliparous continent controls were evaluated as a comparison group to allow us to determine birth-related changes not associated with stress incontinence. Urethral function was measured with urethral profilometry, and vesical neck mobility was assessed with ultrasound and Q-tip test. Urethral sphincter anatomy and mobility were evaluated using MRI. The association between urethral closure pressure, vesical neck movement, and incontinence were explored using logistic regression. RESULTS: Urethral closure pressure in primiparous incontinent women (62.9 +/− 25.2 s.d. cm H(2)0) was lower than in primiparous continent women (83.0 +/− 21.0, p<0.001; effect size d= 0.91) who were similar to nulliparous women (90.3 +/− 25.0, p=0.09). Vesical neck movement measured during cough with ultrasound was the mobility parameter most associated with stress incontinence; 15.6 +/− 6.2 mm in incontinent women versus 10.9 +/− 6.2 in primiparous continent women (p < 0.0001, d = 0.75) or nulliparas (9.9 +/− 5.0, p=0.33). Logistic regression disclosed the two-variable model (max-rescaled R(2) =0.37, p < 0.0001) was more strongly associated with stress incontinence than either single variable models, urethral closure pressure (R(2) = 0.25, p <0.0001) or vesical neck movement (R(2) = 0.16 p < 0.0001). CONCLUSIONS: Lower maximal urethral closure pressure is the parameter most associated with de novo stress incontinence after first vaginal birth followed by vesical neck mobility

Rectal obstruction after a vaginal posterior compartment polypropylene mesh fixed to the sacrospinous ligaments

Item does not contain fulltextWe present a case in which a polypropylene mesh was placed over the posterior vaginal wall and was fixed to the sacrospinous ligaments on both sides. Postoperative a rectal obstruction developed which was only resolved after splitting the entire mesh in the midline. It is hypothesised that the obstruction was due to the fixation of the mesh with irresolvable suture material to the sacrospinous ligaments acting as a hinge on which the bowel folded

A Chinese multi-modal neuroimaging data release for increasing diversity of human brain mapping

The big-data use is becoming a standard practice in the neuroimaging field through data-sharing initiatives. It is important for the community to realize that such open science effort must protect personal, especially facial information when raw neuroimaging data are shared. An ideal tool for the face anonymization should not disturb subsequent brain tissue extraction and further morphological measurements. Using the high-resolution head images from magnetic resonance imaging (MRI) of 215 healthy Chinese, we discovered and validated a template effect on the face anonymization. Improved facial anonymization was achieved when the Chinese head templates but not the Western templates were applied to obscure the faces of Chinese brain images. This finding has critical implications for international brain imaging data-sharing. To facilitate the further investigation of potential culturerelated impacts on and increase diversity of data-sharing for the human brain mapping, we released the 215 Chinese multi-modal MRI data into a database for imaging Chinese young brains, namely'I See your Brains (ISYB)', to the public via the Science Data Bank (https://doi.org/10.11922/sciencedb.00740)

Comparison of muscle fiber directions between different levator ani muscle subdivisions: in vivo MRI measurements in women

INTRODUCTION AND HYPOTHESIS This study describes a technique to quantify muscle fascicle directions in the levator ani (LA) and tests the null hypothesis that the in vivo fascicle directions for each LA subdivision subtend the same parasagittal angle relative to a horizontal reference axis. METHODS Visible muscle fascicle direction in the each of the three LA muscle subdivisions, the pubovisceral (PVM; synonymous with pubococcygeal), puborectal (PRM), and iliococcygeal (ICM) muscles, as well as the external anal sphincter (EAS), were measured on 3-T sagittal MRI images in a convenience sample of 14 healthy women in whom muscle fascicles were visible. Mean ± standard deviation (SD) angle values relative to the horizontal were calculated for each muscle subdivision. Repeated measures ANOVA and post-hoc paired t tests were used to compare muscle groups. RESULTS Pubovisceral muscle fiber inclination was 41 ± 8.0°, PRM was -19 ± 10.1°, ICM was 33 ± 8.8°, and EAS was -43 ± 6.4°. These fascicle directions were statistically different (p < 0.001). Pairwise comparisons among levator subdivisions showed angle differences of 60° between PVM and PRM, and 52° between ICM and PRM. An 84° difference existed between PVM and EAS. The smallest angle difference between levator divisions was between PVM and ICM 8°. The difference between PRM and EAS was 24°. All pairwise comparisons were significant (p < 0.001). CONCLUSIONS The null hypothesis that muscle fascicle inclinations are similar in the three subdivisions of the levator ani and the external anal sphincter was rejected. The largest difference in levator subdivision inclination, 60°, was found between the PVM and PRM