Pelvic Prolapse - Evaluating The Effects Of Pelvic Floor Reconstruction On The Outcomes Of Slings

ORLANDO, FL ( UroToday. com ) - Two different groups evaluated effects of pelvic floor reconstruction on the outcomes of slings. While UCLA group showed no evidence of any effect of posterior repair on slings outcomes ( Abstract #1300 ) , work from Virginia Mason in Seattle suggested a possible protective effect of anterior repair on sling results ( Abstract #1299 ) . Clearly, a randomized study involving patients with similar demographics and degrees of prolapse and incontinence would be necessary to demonstrate this with certainty.

A multicenter trial evaluating safety and short term efficacy of the Perigee system was presented by Doctor Karny Jacoby ( Abstract #1301 ) . 8 U. S. sites implanted 108 patients with type I polypropylene mesh for anterior compartment repair and reported a 93% success rate ( defined as anterior compartment POP-Q of Stage 0 or 1 ) in 57 patients who had 12 month follow up. Mean blood loss was < 70cc, intraoperative complication rate was low ( one bladder perforation and one hematoma requiring transfusion ) , 8. 3% experienced vaginal extrusion, and 10 patients ( 9. 2% ) underwent device-related revision due to vaginal extrusion, pain, recurrent or persistent prolapse, and bladder perforation.

Dr. Joseph Costa presented an overview of incidence and management of graft complications following synthetic graft reinforcement of prolapse repair experienced at his institution in 240 patients over a four year period, 132 of whom underwent anterior repair alone, 31 of whom underwent anterior-posterior repairs, and 77 of whom underwent isolated posterior repairs ( Abstract #1303 ) . While overall success rate of the repairs was reported to be 96. 7%, 10% ( 24 ) experienced graft exposure in vagina, with 11 ( 4. 6% of the group ) requiring excision which occurred between 0. 5 and 11 months postoperatively. Major complications related to mesh included bleeding requiring reoperation, rectovaginal fistula, and urinary retention requiring suprapubic cystostomy. Patients who were sexually active were more likely to require excision, but many patients who weren't sexually active were managed successfully with observation.

A topic of frequent discussion is whether or not an anti-incontinence procedure should be performed at the time of repair of large prolapse. To address this question, Doctor Victor Nitti's group from New York retrospectively reviewed the charts of patients who underwent transvaginal repair of POP-Q Stage 3 or 4 prolapse and examined impact of their urodynamic protocol on the postoperative stress incontinence ( SUI ) and obstruction rates in this cohort of patients ( Abstract #1304 ) . Of 55 patients who denied SUI, 24 had no urodynamic or occult SUI and didn't receive a sling. 2 ( 8. 3% ) subsequently required a sling.

31 of those who denied SUI symptoms demonstrated SUI and underwent a sling. 3 ( 9. 7% ) required intervention for obstruction and one for SUI. Of the 50 patients who described preoperative SUI, 10 didn't demonstrate objective SUI and didn't undergo a sling. 3 ( 30% ) required subsequent sling placement. 40 confirmed urodynamic or occult SUI and received a sling. Of these, 3 ( 7. 5% ) required intervention for obstruction. The group concluded that risk of requiring intervention for obstruction in patients receiving a sling without demonstrable SUI is equivalent to risk of requiring intervention for SUI if no sling is placed in a patient who has no symptoms of or demonstrable SUI. However, in those patients who report clinical SUI, irrespective of whether SUI is demonstrated, intervention for SUI is recommended.

ABST #1299: Effect of Concurrent Cystocele Repair on Outcomes Following Transvaginal Cadaveric Fascia Lata Urethral Sling Placement, by David E. Rapp, MD, et al.

ABST #1300: The Effect of Posterior Compartment Repair on Outcome of Sub-Urethral Sling, by Christian O. Twiss, MD, et al.

ABST #1301: Multi-Center Trial Evaluating Intra-Operative Safety and 6 and 12-Month Efficacy of Perigee System, by Robert D. Moore, MD, et al.

ABST #1303: Incidence and Management of Graft Complications in Patients with History of Synthetic Mesh Repair for Pelvic Organ Prolapse, by Joseph A. Costa, MD, and Steve E. Goldwasser, MD

ABST #1304: Managing the Urethra at Time of Transvaginal Pelvic Organ Prolapse Repair: A Urodynamic Approach, by Katie N. Ballert, MD, et al.

Presented at the Annual Meeting of American Urological Association ( AUA ) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday. com Contributing Editor Kathleen C. Kobashi, MD

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The Eurosearchengine - your medicine guide

What you have to know buying Zyrtec.

Zyrtec: uses

Zyrtec is an antihistamine which provides relief of seasonal and perennial allergy symptoms such as watery eyes, runny nose ( rhinitis ) , itching eyes, and sneezing. It's also used for hives.

Zyrtec: how to use

Take Zyrtec by mouth once a day; or use as directed by your doctor. Zyrtec may be taken with or without food.

Don't increase your dose or take this more often than directed.

Don't take Zyrtec for several days before allergy testing since test results can be affected.

Inform your doctor if your condition persists or worsens.

Zyrtec: side effects

Drowsiness, fatigue and dry mouth may occur while use Zyrtec. In children, stomach pain and vomiting may occur while use Zyrtec. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed Zyrtec because he or she has judged that the benefit to we is greater than risk of side effects. Many people using Zyrtec don't have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur:

A serious allergic reaction to Zyrtec is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include:

This is not a complete list of possible side effects. If we notice other effects not listed above, contact your doctor or pharmacist.

Zyrtec: precautions

Before taking Zyrtec, tell your doctor or pharmacist if you're allergic to it; or to hydroxyzine; or if we have any other allergies.

Before using Zyrtec, tell your doctor or pharmacist your medical history, especially of:

Zyrtec may make we drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcoholic beverages.

Caution is advised when using Zyrtec in elderly because they may be more sensitive to effects of drug, especially the drowsiness effect.

Zyrtec should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.

Zyrtec passes into breast milk. Breast-feeding is not recommended while using Zyrtec.

Zyrtec: interactions

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring we for them. Do not start, stop, or change the dosage of any medicine before checking with them first.

Before using Zyrtec, tell your doctor or pharmacist of all prescription and nonprescription products you may use, especially of drugs that cause drowsiness such as:

Check the labels on all your medicines ( e. g. , cough-and-cold products ) because they may contain drowsiness-causing ingredients. Ask your pharmacist about the safe use of those products.

This document does not contain all possible interactions. Therefore, before using Zyrtec, tell your doctor or pharmacist of all the products we use. Keep a list of all your medications with you, and share list with your doctor and pharmacist.

Zyrtec: overdose

If overdose of Zyrtec is suspected, contact your local poison control center or emergency room immediately. US residents can call US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: severe drowsiness. In children, symptoms may include initial restlessness and irritability followed by drowsiness.

Zyrtec: notes

Don't share Zyrtec with others.

Zyrtec: missed dose

If we miss a dose Zyrtec, use it as soon as we remember. If it is near time of the next dose, skip the missed dose and resume your usual dosing schedule. Don't double dose of Zyrtec to catch up.

Zyrtec: storage

Store Zyrtec at room temperature between 68-77 degrees F ( 20-25 degrees C ) away from light and moisture. Brief storage between 59-86 degrees F ( 15-30 degrees C ) is permitted. Or store in refrigerator between 36-46 degrees F ( 2-8 degrees C ) . Don't store Zyrtec in bathroom. Keep all medicines away from children and pets.

Properly discard Zyrtec when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Quality cheap Zyrtec

Recent Generic Drug Approvals. Each year, FDA approves scores of new generic drugs that help consumers save money. Here are some of the most significant generic approvals of the past year.

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