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Biomedical subjects

A S Arunkalaivanan

Publications and source records attributed to A S Arunkalaivanan.

13 recordsLinked to original sources
PubMed2005

Surgical management of stress urinary incontinence: a questionnaire based survey.

OBJECTIVES: To determine the trends in the surgical management of urinary stress incontinence amongst members of the International Urogynaecology Association (IUGA). DESIGN: Postal Questionnaire Survey. METHODS: 530 members of the International Urogynaecology association were sent a postal questionnaire regarding their practice in the surgical management of urinary stress incontinence. We also collected data on the demographic profile of members and the preferred primary and secondary continence procedures. OUTCOME: Consensus in the surgical management of urinary stress incontinence amongst members of the IUGA. RESULTS: Five hundred and thirty questionnaires were sent to IUGA members worldwide. Two hundred and seventeen questionnaires were received of which fifteen were from physiotherapists, so were excluded from our analysis. The overall response rate was 41%, and the useable response rate was 38%. Of the total results analysed (two hundred and two), one hundred and twelve (54%) were from teaching hospital, sixty-two (31%) were from district general hospitals and twenty-eight (14%) were from members in private practice. The preferred primary continence procedure was Tension Free Vaginal Tape (TVT) in one hundred and thirty four (68%) respondents. The preferred secondary continence procedure was colposuspension or Trans obturator tape in twenty-six respondents each (13%). CONCLUSIONS: Almost all respondents (97.1%) were skilled at performing either TVT or colposuspension, which have been identified as the preferred methods of surgical management by the NICE (National Institute of Clinical Excellence, UK). Although colposuspension has been identified as the gold standard surgical procedure in the management of stress incontinence, 16% of respondents were not performing colposuspension. There appears to be little evidence base to the surgical techniques in the management of stress urinary continence.

Adult↗
PubMed2004

Vesicocervical fistula--a rare complication secondary to caesarean section.

We report a case of vesicocervical fistula secondary to caesarean section. This is a rare complication of caesarean section, which was not recognised intraoperatively. Diagnosis was made clinically, radiologically and endoscopically during the post-operative period. Conservative management with indwelling catheterisation for 3 weeks failed. Hence the fistula was repaired surgically by an abdominal approach.

Adult↗
PubMed2004

Does posture affect cystometric parameters and diagnoses?

The objective of this study was to investigate the effect of lying and sitting positions on urodynamic parameters and diagnoses. This prospective study was carried out on 96 women with urinary incontinence who underwent urodynamic assessment. Cystometry was performed both in the lying and sitting positions. For filling cystometry, we infused normal saline at a rate of 50 ml/min. All the results were entered on the urodynamic database and were analysed using Minitab software release 13.30. Mean age was 49 (20-84) years. Sixty-four (67%) women complained of mixed incontinence, 16 (17%) of urgency alone, eight (8%) of stress incontinence and eight (8%) of urgency and urge incontinence. Two (2%) showed stress incontinence by lying cystometry, and 53 (55%) by sitting cystometry. During lying nine (9%) demonstrated detrusor overactivity, while 53 (55%) demonstrated detrusor overactivity in sitting position. No case of mixed incontinence was diagnosed by lying cystometry but 17 (18%) cases were detected by sitting cystometry. This study explains the higher detection rate of stress incontinence, detrusor overactivity and mixed incontinence by cystometry in sitting position. Therefore, we recommend that sitting posture is preferred over lying position for performing cystometry.

Adult↗
PubMed2004

Pelvicol pubovaginal sling versus tension-free vaginal tape for treatment of urodynamic stress incontinence: a prospective randomized three-year follow-up study.

OBJECTIVES: The aim of this study was to compare the long-term success rates, complication rates and patient satisfaction rates for Pelvicol pubovaginal sling (Bard) versus TVT (Gynecare) in surgical treatment of urodynamic stress incontinence (USI) in women. DESIGN: Prospective randomized cohort trial. SETTING: District General Hospital, South West of England. METHODS: One hundred and forty-two women with urodynamic stress incontinence were randomized to either surgical procedure (Pelvicol = 74, TVT = 68) with median follow-up of 36 month. A postal questionnaire was sent to all women and the response rate was excellent at approximately 90% in both groups. RESULTS: Cure of incontinence, as identified by a quality of life improvement >90%, and/or patient-determined continent status as dry, were comparable in both groups. When the cure rates were adjusted assuming the non-respondents as failures the figures were almost identical (p > 0.05). Preoperative continence pad usage was similar for both groups. Overall, a postoperative significant decrease in pad score was noted in both groups (p = 0.01) but there was no significant difference between the groups (p > 0.05). Statistical analysis failed to detect significant differences between both groups as regards complication rates such as frequency, nocturia, de-novo urgency or dyspareunia. CONCLUSION: Pelvicol sling is a safe procedure in the surgical management of USI with similar success rate and patient satisfaction rate to TVT up to three years of follow-up.

Adult↗
PubMed2004

Longitudinal study of Pelvicol pubovaginal slings using magnetic resonance imaging.

The mechanism of urinary continence is complicated and is poorly understood. One current opinion is that there is an absence or weakness of the endopelvic fascial supports of the urethra. Pubovaginal slings are rapidly becoming the surgical procedure of choice in the management of urodynamic stress incontinence but their method of action is unclear. This study using magnetic resonance imaging shows how a pubovaginal sling can restore the normal anatomy and continence and adds to the global understanding of this condition.

Female↗
PubMed2003

Questionnaire-based survey on obstetricians and gynaecologists' attitudes towards the surgical management of urinary incontinence in women during their childbearing years.

OBJECTIVE: To determine the appropriate surgical management of incontinence in women who desire to maintain their childbearing capacity. DESIGN: Questionnaire-based survey. METHOD: A postal questionnaire was sent to 251 (every fourth) consultant obstetricians and gynaecologists in the UK practising in both district general hospitals (n=156) and teaching hospitals (n=95). MAIN OUTCOME MEASURES: Clinical consensus in the management of incontinence in women who are interested in childbearing. RESULTS: One hundred and thirty two (53%) consultants responded of which 22 (17%) were not involved in managing this group of women and were therefore excluded from analysis. Thirty-nine (36%) of the replies were from teaching hospital, 71 (65%) were from district general hospitals. Eighty-six (78%) consultants are prepared to perform a continence procedure on women who had not completed their families. One hundred (91%) would offer caesarean section to those continent pregnant women following their continence surgery. (Fisher's exact test' P=0.038). Interestingly, 67 (60.9%) of respondents still perform caesarean section to the pregnant women even if they are incontinent. CONCLUSIONS: The majority of UK consultants would perform a continence procedure in women who wish to maintain their childbearing capacity. Colposuspension is the favoured surgical procedure. If women are continent following surgery, most prefer them to be delivered by caesarean section.

Adult↗
PubMed2003

The accuracy of Bladderscan in intrapartum care.

This study was carried out to ascertain whether the Bladderscan machine is accurate in the measurement of bladder volume of women in labor. This would help avoid unnecessary intervention for a significant number of women who have small bladder volumes. Fifty women had a Bladderscan measurement during labor which was compared with an immediately obtained catheter volume. The overall correlation was weak (r = 0.593) but was influenced by the absence or presence of amniotic fluid. In women with ruptured membranes the relationship between Bladderscan volume and catheter-obtained volume was good (r = 0.851), but poor if the membranes were intact (r = 0.128). The Bladderscan may have a role in measuring bladder volume in women in labor and may therefore reduce the frequency of unnecessary catheterization, with the inherent increased incidence of urinary tract infection.

Adult↗
PubMed2003

Randomized trial of porcine dermal sling (Pelvicol implant) vs. tension-free vaginal tape (TVT) in the surgical treatment of stress incontinence: a questionnaire-based study.

The objective of this study was to compare porcine dermal sling (Pelvicol implant, Bard) with tension-free vaginal tape (TVT) in the surgical treatment of stress incontinence. One hundred and forty-two women with genuine stress incontinence (GSI) were randomly assigned to either Pelvicol implant pubovaginal sling (n=74) or TVT (n=68). They were followed up at a minimum of 6 months (range 6-24 months), with a median follow-up of 12 months. The majority (n=109) of procedures were carried out in a day surgery unit. The median operation time was 35 minutes (range 15-60) in the TVT group and 30 minutes (range 20-80) in the Pelvicol implant group; 81% of the TVT group and 77% of the Pelvicol implant group were able to void urine within 24 hours, and had insignificant residual bladder volumes. The prevalence of postoperative symptomatic voiding dysfunction was 3.4% after TVT and 1.4% after Pelvicol implant. Nine percent of the TVT group developed de novo urge incontinence and 6% of the Pelvicol implant group had de novo urge incontinence 6 months after the procedure. Postoperative evaluation was done at the outpatient department, and a postal questionnaire was also completed to determine subjective continence status. The patient-determined cure rate was 85% in the TVT group and 89% in the Pelvicol implant group. The Pelvicol implant sling had a comparable patient- determined success rate with TVT and should be considered in the surgical treatment of women with genuine stress incontinence.

Animals↗
PubMed2002

Post-colposuspension syndrome following a tension-free vaginal tape procedure.

A 51-year-old nurse underwent an uneventful TVT procedure. Two weeks postoperatively she developed intractable suprapubic pain directly over the iliopectineal ligaments consistent with a "post-colposuspension syndrome". This failed to respond to conservative therapy and she subsequently underwent exploration of the retropubic space. The TVT sling was found to be densely adherent to the iliopectineal ligaments, from which it was dissected free and then divided, leaving the part where it passes through the endopelvic fascia intact. The pain resolved immediately and the woman remained continent. This diagnosis should be considered in a woman presenting with groin pain following a sling procedure.

Broad Ligament↗
PubMed2002

The use of porcine dermal implant in a minimally invasive pubovaginal sling procedure for genuine stress incontinence.

OBJECTIVE: To assess the outcome of a suburethral sling using a porcine dermal implant (Pelvicoltrade mark, Bard Urology, UK) in the surgical management of urinary stress incontinence. PATIENTS AND METHODS: Forty women with urodynamically confirmed genuine stress incontinence were recruited into the study and followed up at 6 weeks and at least 6 months (mean 12 months, range 6-18). The sling was inserted using a minimal-access technique, which allowed 23 women to be operated as day-cases. Outcome measures included continence rates, voiding dysfunction, satisfaction scores and whether the patients would recommend the operation to a friend or relative. RESULTS: The cure rate was 85%, with sustained benefit; a further 10% of the women were improved by surgery. Voiding dysfunction rates were low and satisfaction scores high. Most women would undergo the procedure again if they became incontinent in the future and would recommend the procedure to a friend or relative. CONCLUSION: A minimal access pubovaginal sling using Pelvicoltrade mark is effective in treating stress incontinence. The complication rate is low and the procedure can be performed as a day-case with no loss of efficacy.

Adult↗