Search PubMed⌕ Search

Biomedical subjects

Evan R Eisenberg

Publications and source records attributed to Evan R Eisenberg.

6 recordsLinked to original sources
PubMed2007

Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction.

AIMS: A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point fixation is also reviewed. METHODS: After proper vaginal dissection, a specially fashioned "H" shaped polypropylene mesh is positioned and fixed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior fixation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t-test, with Sigma Stat(R). RESULTS: Seventy-six patients (79%) were available with a mean follow-up time of 30.7 +/- 1.7 months and mean age of 69.3 +/- 11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, defined as an occasional leak. For those with preoperative incontinence (n = 36), average pad use per day decreased significantly from 2.1 +/- 0.4 to 0.8 +/- 0.2 (P < 0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9 +/- 0.3 on a scale of 1 (least satisfied) to 10 (most satisfied). CONCLUSIONS: Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and efficacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable.

Aged↗
PubMed2004

Long-term treatment outcomes of CoreTherm microwave feedback thermotherapy.

The gold standard for definitive management of symptomatic benign prostatic hypertrophy is transurethral resection of the prostate (TURP). Despite its efficacy, TURP has significant morbidity/mortality concerns such as hemorrhage and transurethral resection syndrome. This is especially worrisome for the medically high-risk patient, but the high rates of retrograde ejaculation found with TURP also pose a problem for young patients. A minimally invasive, outpatient alternative to TURP that has long-term efficacy, low morbidity/mortality, and provides a cost-effective advantage is in high demand. This review article discusses microwave thermotherapy as such an option and reports the long-term experience with the CoreTherm (CoreTherm Operations AB, Sweden) device.

Diathermy↗
PubMed2004

Short-term outcome analysis of total pelvic reconstruction with mesh: the vaginal approach.

PURPOSE: We describe our experience with transvaginal total pelvic reconstruction using a mesh with 4-point fixation for patients with genitourinary prolapse with or without stress urinary incontinence. MATERIALS AND METHODS: A total of 29 consecutive patients who underwent sacrospinous fixation using mesh material since March 1999 for genitourinary prolapse were analyzed retrospectively. In all patients defect specific repair was done, including hysterectomy (in 13). For isolated vault prolapse a rectangular mesh was interposed between the peritoneum and vaginal vault, with each corner anchored to the sacrospinous ligament using a suture-capturing device. For vault prolapse associated with anterior vaginal wall prolapse an "H" shaped, 1-piece sling was used to support both entities. Additionally, posterior and perineal repairs were done through separate incisions if needed. RESULTS: Of the 29 patients 19 (65.5%), 7 (26.92%) and 11 (39.29%) had associated symptoms of stress urinary incontinence, urgency and frequency, respectively, and 79.31% had associated anterior and 44.8% had associated posterior prolapse. Average operative time was 175.6 minutes, blood loss was 340 cc and hospital stay was 2.46 days. Early adverse events following the procedure were perineal pain, vaginal discharge and irritative voiding symptoms. At 6 month followup (mean 25.14 months) mild constipation and dyspareunia were encountered in a small subset of patients. Two patients (6.89%) have genital prolapse recurrence and none has reported erosion or nonhealing to date. CONCLUSIONS: Transvaginal technique of 4-point vaginal vault fixation using mesh is a safe and effective procedure at 2 years.

Aged↗
PubMed2003

Etiology: where does prostatitis stop and interstitial cystitis begin?

Male chronic pelvic pain syndrome (MCPPS) and interstitial cystitis (IC) patients show striking similarities in clinical presentation, diagnostic evaluation, purported pathogenesis, and even response to therapy. This makes the distinction between them very difficult. This review aims to show just how easy it is for the clinician to miss the features of IC in the MCPPS patient (and conversely). Misdiagnosis can result in the rejection of various potentially helpful therapies while accurate early diagnosis will lead to appropriate therapies and a better quality of life for the patient.

Chronic Disease↗
PubMed2003

Broad based tension-free synthetic sling for stress urinary incontinence: 5-year outcome.

PURPOSE: The use of nonabsorbable synthetic material has been questioned due to reports of erosion and infection. We present the 5-year followup outcome of stress urinary incontinence (SUI) treated using polypropylene mesh as a pubovaginal sling. MATERIALS AND METHODS: A retrospective analysis was performed of 58 consecutive patients who underwent pubovaginal sling procedures using polypropylene mesh since April 1996 for types II and III SUI at our institution. The technique included a single midline anterior vaginal wall incision with full-thickness flaps. Broad based polypropylene mesh was used to support the vesicourethral junction entering the retropubic space through the endopelvic fascia and bone anchors were used for fixation. Patient satisfaction was evaluated during followup office visits and/or telephone interview by an individual not involved in any surgeries. All procedure failures were evaluated by urodynamics. RESULTS: Of the 58 patients 49 were available for analysis. Average followup was 59.34 months (range 29 to 77). Of the 49 patients 40 (81.63%) were dry and 2 (4.08%) improved (1 pad daily). De novo urgency and urgency related incontinence was reported in 1 case each. Three patients (8.16%) had recurrent SUI, while prolonged retention developed with subsequent urethrolysis required in 2 (4.08%). None of the patients have experienced infection, nonhealing or erosion of the synthetic slings to date. CONCLUSIONS: In our experience polypropylene mesh used as a broad based tension-free sling was successful for treating all types of SUI. In our opinion technique and case selection have a bearing on outcomes.

Female↗