Tension-free Vaginal Tape

Many different surgical techniques have been introduced for the treatment of female stress urinary incontinence (SUI). They not only differ with regard to success, but they also have different complication rates. TVT is a relative new minimally invasive procedure and is based on the concept of mid urethral support. The aims of the studies presented in this thesis were to assess: 1 the anatomical complications, its frequency and the influence of risk factors. 2 the pre- and intraoperative factors influencing the success of the TVT. 3 the long-term outcome of TVT in women in whom the TVT procedure was their first incontinence surgery. 4 the outcome after a follow-up of three years of TVT in women with previous incontinence or prolapse surgery. 5 the long-term outcome of TVT on urge incontinence and other forms of irritative bladder symptoms. 6 the outcome with a follow-up of three years of the TVT procedure in women with concomitant pelvic surgery. 7 the prevalence of immediate postoperative and long-term voiding difficulties (VD) after TVT. Between March 2000 and September 2001 women with an indication for a TVT procedure were asked to participate in this study. This was a long term ((3 years follow-up of all patients), multicenter prospective cohort study with 41 hospitals and 54 gynaecologists and urologists participating. RESULTS The original database comprised data from 809 women. 1 TVT is a relative safe procedure, concomitant pelvic surgery can be safely performed. Several risk factors for complications were identified. 2 General anaesthesia and inexperience of the surgeon with the TVT procedure seemed to have a negative effect on the result. Therefore, we believe that the TVT should only be performed by experienced surgeons. 3 This is the largest study which used validated disease specific health-related quality of life (HRQoL) questionnaires to asses the long term outcome of the TVT procedure. This study shows a long-term improvement of the quality of life after a TVT. 4 TVT is a valuable tool for women with recurrent stress urinary incontinence, prior prolapse surgery or both. Therefore, we think the TVT should be recommended for the treatment of recurrent stress urinary incontinence in women with previous incontinence and/or prolapse surgery. 5 This study reports the long term outcome of symptoms of frequency, nocturia, urge incontinence, overactive bladder (OAB), irritative symptoms. These symptoms are often prevalent prior to TVT and often resolve afterwards. Urge incontinence and OAB wet symptoms developed in 11% and 3% respectively and gave less improvement on the quality of life scores. Over all most symptoms resolved significantly more than they developed after TVT, resulting in a better quality of life after TVT. 6 TVT is effective for women without and with concomitant prolapse surgery, after 2 years a difference in UDI & IIQ scores could be identified. 7 Quality of life after TVT is only in part negatively influenced by the existence of VD and women who develop VD, are still significantly improved compared to their preoperative condition. Furthermore in most women the clinical course of developing urinary retention after TVT is mild

The effectiveness of the sacrospinous hysteropexy for the primary treatment of uterovaginal prolapse

The objective of this study was to assess the effectiveness of sacrospinous ligament fixation of the uterus as a primary treatment of uterovaginal prolapse. In this observational study, 133 women underwent a sacrospinous hysteropexy. Data were obtained from their medical records, and standardized questionnaires about urogenital symptoms and quality of life were used. All women were invited for gynecological examination, using the Pelvic Organ Prolapse Quantification score. Ninety-nine women responded by returning the questionnaire (mean age, 59.2 and follow-up time, 22.5 months); 60 of these women underwent gynecologic examination. Eighty-four percent of women were highly satisfied about the outcome of the procedure. Serious complications were rare. The recurrence rate of descensus uteri that needed surgical treatment was 2.3%. The recurrence of cystoceles after surgery was 35%, but there were no differences in urogenital symptoms between women with or without a cystocele

The effectiveness of the sacrospinous hysteropexy for the primary treatment of uterovaginal prolapse

The objective of this study was to assess the effectiveness of sacrospinous ligament fixation of the uterus as a primary treatment of uterovaginal prolapse. In this observational study, 133 women underwent a sacrospinous hysteropexy. Data were obtained from their medical records, and standardized questionnaires about urogenital symptoms and quality of life were used. All women were invited for gynecological examination, using the Pelvic Organ Prolapse Quantification score. Ninety-nine women responded by returning the questionnaire (mean age, 59.2 and follow-up time, 22.5 months); 60 of these women underwent gynecologic examination. Eighty-four percent of women were highly satisfied about the outcome of the procedure. Serious complications were rare. The recurrence rate of descensus uteri that needed surgical treatment was 2.3%. The recurrence of cystoceles after surgery was 35%, but there were no differences in urogenital symptoms between women with or without a cystocele

Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial.

BACKGROUND: Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence, return to normal activities and work after surgery is hampered, leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption. OBJECTIVE: With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures, leading to accelerated recovery and to a reduction in costs in comparison to usual care. METHODS: This is a multicenter randomized, single-blinded, controlled trial. At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication will be included. Patients will be randomized to an intervention or control group. The intervention group will have access to an innovative, perioperative eHealth care program. This intervention program consists of a website, mobile phone app, and activity tracker. It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery. The control group will receive usual care and will have access to a nonintervention (standard) website consisting of the digital information brochure about the surgical procedure being performed. Patients are asked to complete questionnaires at 5 moments during the first 6 months after surgery. The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning item bank version 1.2. Secondary outcomes include social participation, self-rated health, duration of return to work, physical activity, length of recovery, pain intensity, and patient satisfaction. In addition, an economic evaluation alongside this randomized controlled trial will be performed from the societal and health care perspective. All statistical analyses will be conducted according to the intention-to-treat principle. RESULTS: The enrollment of patients started in September 2015. The follow-up period will be completed in February 2017. Data cleaning and analyses have not begun as of the time this article was submitted. CONCLUSIONS: We hypothesize that patients receiving the intervention program will resume their normal activities sooner than patients in the control group and costs will be lower

Electronic Health Program to Empower Patients in Returning to Normal Activities After General Surgical and Gynecological Procedures: Intervention Mapping as a Useful Method for Further Development

Contains fulltext : 215610.pdf (publisher's version ) (Open Access)BACKGROUND: Support for guiding and monitoring postoperative recovery and resumption of activities is usually not provided to patients after discharge from the hospital. Therefore, a perioperative electronic health (eHealth) intervention ("ikherstel" intervention or "I recover" intervention) was developed to empower gynecological patients during the perioperative period. This eHealth intervention requires a need for further development for patients who will undergo various types of general surgical and gynecological procedures. OBJECTIVE: This study aimed to further develop the "ikherstel" eHealth intervention using Intervention Mapping (IM) to fit a broader patient population. METHODS: The IM protocol was used to guide further development of the "ikherstel" intervention. First, patients' needs were identified using (1) the information of a process evaluation of the earlier performed "ikherstel" study, (2) a review of the literature, (3) a survey study, and (4) focus group discussions (FGDs) among stakeholders. Next, program outcomes and change objectives were defined. Third, behavior change theories and practical tools were selected for the intervention program. Finally, an implementation and evaluation plan was developed. RESULTS: The outcome for an eHealth intervention tool for patients recovering from abdominal general surgical and gynecological procedures was redefined as "achieving earlier recovery including return to normal activities and work." The Attitude-Social Influence-Self-Efficacy model was used as a theoretical framework to transform personal and external determinants into change objectives of personal behavior. The knowledge gathered by needs assessment and using the theoretical framework in the preparatory steps of the IM protocol resulted in additional tools. A mobile app, an activity tracker, and an electronic consultation (eConsult) will be incorporated in the further developed eHealth intervention. This intervention will be evaluated in a multicenter, single-blinded randomized controlled trial with 18 departments in 11 participating hospitals in the Netherlands. CONCLUSIONS: The intervention is extended to patients undergoing general surgical procedures and for malignant indications. New intervention tools such as a mobile app, an activity tracker, and an eConsult were developed. TRIAL REGISTRATION: Netherlands Trial Registry NTR5686; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5686