Publications by authors named "Alice Cola"

32 Publications

Transvaginal primary layered repair of postsurgical urethrovaginal fistula.

Int Urogynecol J 2021 May 5. Epub 2021 May 5.

ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy.

Introduction And Hypothesis: Urethrovaginal fistula (UVF) is a rare disorder, which implies the presence of an abnormal communication between the urethra and the vagina.

Methods: Surgical repair options include transurethral, transabdominal and transvaginal procedures, either with or without tissue interposition. The vaginal route is considered a safe and effective option to correct UVF. This video is aimed to present a case of direct transvaginal layered repair of urethrovaginal fistula, without the use of tissue interposition. The featured patient is a 66-year-old woman who developed a symptomatic UVF after a complicated laparoscopic hysterectomy for endometrial cancer 3 years before. Cystoscopy demonstrated the presence of a 7 mm urethral orifice a few millimeters caudal from the bladder neck. After proper informed consent, the patient was admitted to transvaginal primary layered repair, according to the technique demonstrated in the video. The featured procedure was completed in 60 min and blood loss was < 100 ml. No surgical complications were observed.

Results: The procedure was successful in restoring the anatomy and relieving the symptoms.

Conclusion: Transvaginal layered repair without tissue interposition represents a safe and effective procedure for the surgical management of postsurgical urethrovaginal fistula.
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http://dx.doi.org/10.1007/s00192-021-04819-6DOI Listing
May 2021

Detrusor underactivity prevalence and risk factors according to different definitions in women attending urogynecology clinic.

Int Urogynecol J 2021 Apr 30. Epub 2021 Apr 30.

ASST Monza, Ospedale San Gerardo, Monza, Italy.

Introduction And Hypothesis: There is still no consensus on definitions of detrusor underactivity; therefore, it is difficult to estimate the prevalence. The primary objective of the study was to evaluate the prevalence of detrusor underactivity in a cohort of patients with pelvic floor disorders according to different proposed urodynamics definitions. The secondary objectives were to estimate the association between detrusor underactivity and symptoms, anatomy and urodynamic findings and to build predictive models.

Methods: Patients who performed urodynamic evaluation for pelvic floor disorders between 2008 and 2016 were retrospectively analyzed. Detrusor underactivity was evaluated according to Schafer's detrusor factor, Abrams' bladder contractility index and Jeong cut-offs. The degree of concordance between each method was measured with Cohen's kappa, and differences were tested using Student's t test, Wilcoxon test and Pearson's chi-squared test.

Results: The prevalence of detrusor underactivity among a cohort of 2092 women, concerning the three urodynamic definitions, was 33.7%, 37.0% and 4.1%, respectively. Age, menopausal status, voiding/bulging symptoms, anterior and central prolapse, first desire to void and positive postvoid residual were directly related to detrusor underactivity. Conversely, stress urinary incontinence, detrusor pressures during voiding and maximum flow were inversely associated. Final models for detrusor underactivity resulted in poor accuracy for all considered definitions.

Conclusions: The prevalence of detrusor underactivity varies depending on the definition considered. Although several clinical variables resulted as independent predictors of detrusor underactivity, instrumental evaluation still plays a key role in the diagnosis.
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http://dx.doi.org/10.1007/s00192-021-04796-wDOI Listing
April 2021

Clinical and urodynamic predictors of Q-tip test urethral hypermobility.

Minerva Obstet Gynecol 2021 Apr 20. Epub 2021 Apr 20.

Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy.

Background: Urodinamics and Q-tip test represent diagnostic tools for the assessment of stress urinary incontinence. The aim of the present study is to investigate the possibility to predict the Q-tip test urethral hypermobility on the basis of clinical and urodynamic parameters.

Methods: We analyzed all women performed urodynamics between 2008 and 2016 presenting urodynamic stress urinary incontinence. Symptoms were collected by the Incontinence Questionnaire-Short Form questionnaire.

Results: A total of 501 women presented urodynamic stress incontinence, of which 270 had urethral hypermobility, according to the Q-tip test. Patients with urethral hypermobility were younger (p<0.0001) and presented a more advanced anterior compartment descensus according to the POP-Q system (Aa point p=0.0155; Ba point p=0.0374), a higher detrusor pressure at maximum flow (p=0.0075) and maximum flow rate compared to controls.

Conclusions: Age, Aa POP-Q point and detrusor pressure at maximum flow were found to be independent predictors of Q-tip test urethral hypermobility. However, the final model can not be used as an effective predictor of the Q-tip test result.
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http://dx.doi.org/10.23736/S2724-606X.21.04766-3DOI Listing
April 2021

Hydrouretonephrosis caused by uterine prolapse after gellhorn pessary displacement.

Eur J Obstet Gynecol Reprod Biol 2021 Feb 10;257:150-151. Epub 2020 Dec 10.

ASST Monza, San Gerardo University Hospital, Monza, Italy.

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http://dx.doi.org/10.1016/j.ejogrb.2020.12.008DOI Listing
February 2021

Postpartum urinary retention: Absolute risk prediction model.

Low Urin Tract Symptoms 2021 Apr 28;13(2):257-263. Epub 2020 Oct 28.

University Milano-Bicocca, Monza and Brianza Mother and Child Foundation, San Gerardo Hospital, Monza, Italy.

Objectives: To evaluate the incidence and assess clinical factors that can predict the occurrence of postpartum urinary retention (PPUR). PPUR is a puerperal condition defined as the inability to void over 6 hours after birth or after catheter removal in case of cesarean section, requiring catheterization. Lack of prompt diagnosis of this condition may lead to severe sequelae, including infection, chronic voiding difficulties, and renal failure.

Methods: This retrospective cohort study analyzed all deliveries from January 2011 to December 2017 in a single Italian university hospital. We used multivariate logistic regression to develop a predictive score for PPUR.

Results: By multivariate logistic regression, our analysis shows as minor (odds ratio [OR] < 2) risk factors for PPUR: non-Caucasian ethnicity (OR = 1.46, CI = 1.05-2.03), nulliparity (OR = 1.47, CI = 1.01-2.14), body mass index (BMI) at the end of the pregnancy <30 kg/m (OR = 1.54, CI = 1.10-2.17). On the other hand, epidural analgesia (OR = 3.93, CI = 2.96-5.22), meconium-stained amniotic fluid (OR = 2.07, CI = 1.54-2.77), nonoperative vaginal birth vs cesarean section (OR = 6.25, CI = 2.16-18.13), vacuum extraction vs cesarean section (OR = 8.80, CI = 2.86-27.01), pushing stage ≥60 minutes (OR = 3.00,CI = 2.26-3.97), and perineal tear (OR = 2.87, CI = 1.86-4.43) proved to be major (OR > 2) risk factors for PPUR. Using our final model (area under curve = 0.84), we created a nomogram for PPUR absolute risk calculation. Specifically, a 116-point cutoff might be used to identify high-risk patients who deserve more intensive micturition monitoring.

Conclusions: Our study identified non-Caucasian ethnicity, nulliparity, and a BMI <30 kg/m at the end of the pregnancy as minor and epidural analgesia, meconium-stained amniotic fluid, vaginal nonoperative birth, vacuum extraction, pushing stage ≥60 minutes, and perineal tear as major independent risk factors for PPUR.
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http://dx.doi.org/10.1111/luts.12362DOI Listing
April 2021

Italian validation of the German Pelvic Floor Questionnaire for pregnant and postpartum women.

Eur J Obstet Gynecol Reprod Biol 2020 May 19;248:133-136. Epub 2020 Mar 19.

Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy.

Objective: The only available validated questionnaire for pelvic floor disorders in pregnant and postpartum women is in German. The aim of this study was to translate and validate the German Pelvic Floor Questionnaire for pregnant and postpartum women into Italian.

Study Design: The questionnaire was translated into Italian by standardized procedural steps. The final version of the questionnaire was submitted to women in the third trimester of pregnancy or within 6 weeks post partum. Construct validity was tested using the Wilcoxon test, and internal consistency was tested using Cronbach's alpha. Test-retest reliability was measured with Cohen's kappa and intraclass correlation coefficient.

Results: Fifty women answered the questionnaire. Construct validity was demonstrated, as the questionnaire discriminated significantly between patients with and without symptoms for four domains of pelvic floor disorders. Internal consistency was satisfactory (0.62-0.93). Cohen's kappa values for test-retest reliability were between 0.46 (moderate agreement) and 1.00 (complete agreement). Intraclass correlation coefficients ranged between 0.93 and 0.96, indicating very satisfactory overall agreement for each functional domain.

Conclusions: The Italian version of the German Pelvic Floor Questionnaire for pregnant and postpartum women is reliable, valid and consistent.
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http://dx.doi.org/10.1016/j.ejogrb.2020.03.032DOI Listing
May 2020

Surgical treatment of complete uterovaginal prolapse and concomitant vaginal cancer: a video case report.

Int Urogynecol J 2020 08 3;31(8):1703-1705. Epub 2020 Mar 3.

ASST Monza, Ospedale San Gerardo, Monza, Italy.

Introduction And Hypothesis: The concurrence of vaginal cancer with irreducible uterine prolapse is rare. Reports about the management of vaginal cancer and concomitant irreducible prolapse are scanty in the literature, and there is no consensus on optimal treatment. In this video case report, we show surgical management of vaginal cancer and concomitant stage IV uterovaginal prolapse.

Methods: The featured video shows surgical management of vaginal cancer and concomitant stage IV uterovaginal prolapse through anterior colpectomy and retrograde hysterectomy en bloc plus transvaginal levator ani plication as a non-obliterative native-tissue technique for apical support.

Results: Final examination revealed good apical support and vaginal "habitability" preservation. The patient underwent five sessions of intracavity brachytherapy for a total of 20 Gy as adjuvant therapy.

Conclusion: Surgical management of vaginal cancer and concomitant stage IV uterovaginal prolapse was successfully achieved without complications. Transvaginal levator ani plication can provide a versatile non-obliterative native-tissue technique for apical support, allowing subsequent adjuvant brachytherapy.
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http://dx.doi.org/10.1007/s00192-020-04263-yDOI Listing
August 2020

Surgical excision of paraurethral cyst.

Int Braz J Urol 2020 Mar-Apr;46(2):298-299

Department Ginecologia Chirurgica, San Gerardo Hospital, Monza, Italy.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2018.0761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025852PMC
May 2020

Transvaginal uterosacral ligament hysteropexy versus hysterectomy plus uterosacral ligament suspension: a matched cohort study.

Int Urogynecol J 2020 09 17;31(9):1867-1872. Epub 2019 Dec 17.

Department of Obstetrics and Gynaecology, San Gerardo Hospital, ASST Monza, Monza, Italy.

Introduction And Hypothesis: Uterine-sparing procedures are associated with shorter operative time, less blood loss and faster return to activities. Moreover, they are attractive for patients seeking to preserve fertility or concerned about the change of their corporeal image and sexuality after hysterectomy. This study aimed to compare outcomes of transvaginal uterosacral hysteropexy with transvaginal hysterectomy plus uterosacral suspension.

Methods: This retrospective study compared all patients who underwent uterosacral hysteropexy for symptomatic prolapse at our institute to matched control patients who underwent hysterectomy plus uterosacral ligament suspension. Anatomic recurrence was defined as postoperative prolapse stage ≥ II or reoperation for prolapse. Subjective recurrence was defined as the presence of bulging symptoms. PGI-I score was used to evaluate the patients' satisfaction.

Results: One hundred four patients (52 for each group) were analyzed. Mean follow-up was 35 months. Hysteropexy was associated with shorter operative time and less bleeding compared with hysterectomy (p < 0.0001), without differences in complication rates. Moreover, overall anatomic and subjective cure rate and patient satisfaction were similar between groups. However, hysteropexy was found to be associated with a significantly higher central recurrence rate (21.2% versus 1.9%, p = 0.002), mostly related to cervical elongation, and subsequently a higher reoperation rate (13.5% versus 1.9%, p = 0.04). A 42.9% pregnancy rate in patients still desiring childbirth was found.

Conclusions: Transvaginal uterosacral hysteropexy resulted in similar objective and subjective cure rates, and patient satisfaction, without differences in complication rates, compared with vaginal hysterectomy. However, postoperative cervical elongation may lead to higher central recurrence rates and need for reoperation.
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http://dx.doi.org/10.1007/s00192-019-04206-2DOI Listing
September 2020

Surgical management of dyspareunia after laparoscopic lateral suspension for pelvic organ prolapse.

Eur J Obstet Gynecol Reprod Biol 2020 Jan 1;244:205. Epub 2019 Nov 1.

AUSL Romagna, Infermi Hospital, Rimini, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.ejogrb.2019.10.044DOI Listing
January 2020

Transvaginal hysteropexy to levator myorrhaphy: A novel technique for uterine preservation.

Int J Gynaecol Obstet 2020 01 16;148(1):125-126. Epub 2019 Oct 16.

ASST Monza, Ospedale San Gerardo, University of Milano-Bicocca, Monza, Italy.

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http://dx.doi.org/10.1002/ijgo.12989DOI Listing
January 2020

Long-term outcomes and five-year recurrence-free survival curves after native-tissue prolapse repair.

Int J Gynaecol Obstet 2019 Nov 22;147(2):238-245. Epub 2019 Aug 22.

School of Medicine, University Milano-Bicocca, Milan, Italy.

Objective: To evaluate the long-term objective and subjective outcomes to build recurrence-free survival curves after mesh-free uterosacral ligament suspension and to evaluate the long-term impact of prognostic factors on outcome measures.

Methods: A retrospective study analyzed 5-year follow-up after repair of primary prolapse through high uterosacral ligament suspension. Bulging symptoms and post-operative prolapse stage II or above were considered subjective and objective recurrences, respectively. The cumulative proportion of relapse-free patients in time was analyzed by Kaplan-Meier curves.

Results: A total of 353 women were analyzed. Five-year recurrence rates were 15.0% for objective recurrence, 13.0% for subjective recurrence, and 4.0% for the combined objective and subjective recurrences. Premenopausal status was shown to be a risk factor for anatomic (P=0.022), symptomatic (P=0.001), and combined (P=0.047) recurrence. Conversely, anterior repair was shown to be a protective factor for symptomatic (P=0.012) and combined (P=0.002) recurrence. Most of the recurrences occurred within 2 years after surgery.

Conclusion: Long-term outcomes after high uterosacral ligament suspension were satisfactory. Premenopausal status and lack of anterior repair represented risk factors for recurrence in the long term.
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http://dx.doi.org/10.1002/ijgo.12938DOI Listing
November 2019

Single-incision sling for stress urinary incontinence: A video tutorial.

Eur J Obstet Gynecol Reprod Biol 2019 Jun 24;237:216-217. Epub 2019 Apr 24.

ASST Monza, San Gerardo Hospital, Monza, Italy.

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http://dx.doi.org/10.1016/j.ejogrb.2019.04.037DOI Listing
June 2019

Prolapse mesh complication: large stone on vaginal mesh extruded in the bladder.

Eur J Obstet Gynecol Reprod Biol 2019 Apr 20;235:131-132. Epub 2019 Feb 20.

AUSL Romagna, Ospedale Infermi Rimini, Italy; Università degli Studi di Milano-Bicocca, Italy.

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http://dx.doi.org/10.1016/j.ejogrb.2019.02.012DOI Listing
April 2019

Pelvic organ prolapse and voiding function before and after surgery.

Minerva Ginecol 2019 Jun 6;71(3):253-256. Epub 2019 Feb 6.

ASST Monza, San Gerardo Hospital, Monza, Italy.

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http://dx.doi.org/10.23736/S0026-4784.19.04313-2DOI Listing
June 2019

Risk factors for persistent, de novo and overall overactive bladder syndrome after surgical prolapse repair.

Eur J Obstet Gynecol Reprod Biol 2019 Feb 26;233:141-145. Epub 2018 Dec 26.

ASST Monza, Ospedale San Gerardo, Monza, Italy.

Objective: Overactive bladder (OAB) symptoms are frequently associated with pelvic organ prolapse (POP) and both postoperative improvement and de novo onset of OAB symptoms have been described. The aim of the study is to identify risk factors for persistent, de novo and overall postoperative OAB after POP repair.

Study Design: This was a retrospective study including patients who underwent primary POP surgery. Medical interview, urogenital examination and urodynamics were performed preoperatively; patients were examined one and six months after surgery and then yearly.

Results: 518 patients were included. 36.1% of women preoperatively complained of OAB symptoms while detrusor overactivity was found in 20.5%. The rate of persistent and de novo OAB after surgery were respectively 14.1% and 13.5%. Multivariate analysis found age, BMI, preoperative OAB, sling placement and postoperative SUI as independent risk factors for overall OAB after surgery. Moreover, preoperative OAB and postoperative constipations were associated with OAB persistence after surgery. Finally, age, sling placement, postoperative SUI and voiding symptoms were independently associated with de novo OAB.

Conclusion: Preoperative OAB symptoms are associated with OAB persistence after POP surgery, while age and sling placement correlate with de novo OAB. Finally, increased BMI is related to postoperative OAB.
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http://dx.doi.org/10.1016/j.ejogrb.2018.12.024DOI Listing
February 2019

Efficacy of needle retractor device in single-incision slings for treatment of stress urinary incontinence.

Minerva Ginecol 2018 Dec 26;70(6):724-728. Epub 2018 Sep 26.

ASST Monza, San Gerardo Hospital, Monza, Italy.

Background: Single-incision slings demonstrated overall similar effectiveness and less pain and recovery time compared to standard tapes. Efficacy rates vary widely among different commercial kits and may be affected by device characteristics. The aim was to evaluate the impact needle removal device of single-incision sling on objective, subjective and functional outcomes.

Methods: This was a retrospective study. Single-incision sling without needle removal device (Group A) were compared to same single-incision sling with needle removal device (Group B) in terms of complications, objective, subjective and functional outcomes.

Results: A total of 191 patients were analyzed: 51 in group A and 140 in group B. Estimated blood loss, operative time and overall complications were not different. No bladder perforation or other intraoperative complications were observed. At 12-month follow-up visit, objective cure rate was similar irrespective of the presence of the needle retractor lever (Group A: 84.3%, Group B: 87.1%; P=0.61). Subjective outcomes evaluated as International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, ICIQ-SF score improvement and Patient Global Impression of Improvement score were similar between groups. De-novo onset of overactive bladder syndrome resulted more frequent in Group A (Group A: 19.6%, Group: B 7.9%; P=0.02) while voiding symptoms were reported without differences between groups.

Conclusions: The current study showed that the presence of a needle retractor device to avoid unintentional tip displacement for single-incision sling had no impact on objective and subjective postoperative continence. However, a reduced rate of de-novo overactive bladder syndrome was observed after implantation of single-incision sling with needle retractor.
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http://dx.doi.org/10.23736/S0026-4784.18.04207-7DOI Listing
December 2018

Transvaginal native-tissue repair of enterocele.

Int Urogynecol J 2018 Nov 22;29(11):1705-1707. Epub 2018 Jun 22.

ASST Monza, San Gerardo Hospital, Monza, Italy.

Introduction And Hypothesis: Enterocele repair represents a challenge for pelvic surgeons. Surgical management implies enterocele sac removal. Subsequently, hernial port closure and adequate suspension may be achieved with Shull uterosacral ligament suspension (ULS).

Methods: A 55-year-old woman with symptomatic stage 3 enterocele was admitted for transvaginal uterosacral ligaments suspension according to the described technique.

Results: Surgical procedure was successfully achieved without complications. Final examination revealed excellent pelvic supports and preservation of vaginal length. This step-by-step video tutorial may represent an important tool to improve surgical know-how.

Conclusions: Transvaginal uterosacral ligaments suspension provides a safe and effective technique for enterocele repair without the use of prosthetic materials. Identifying uterosacral ligaments, proper suture placement, and reapproximation of pubocervical and rectovaginal fascias with closure of the hernial port are the key points to achieve surgical success.
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http://dx.doi.org/10.1007/s00192-018-3686-3DOI Listing
November 2018

Gluteo-vaginal fistula after prolapse mesh surgery.

Eur J Obstet Gynecol Reprod Biol 2018 06 30;225:266-267. Epub 2018 Apr 30.

ASST Monza, Ospedale San Gerardo, Monza, Italy.

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http://dx.doi.org/10.1016/j.ejogrb.2018.04.035DOI Listing
June 2018

Outcomes of Transvaginal High Uterosacral Ligaments Suspension: Over 500-Patient Single-Center Study.

Female Pelvic Med Reconstr Surg 2018 May/Jun;24(3):203-206

Background: Uterosacral ligament (USL) suspension is a safe and effective procedure in terms of anatomical, functional, and subjective outcomes for primary surgical treatment of prolapse.

Objectives: There has been a renewed interest toward native tissue prolapse repair by vaginal route because of low cost and lack of mesh-related complications. Uterosacral ligaments are considered safe, effective, and durable as suspending structures for primary surgical repair of the apical compartment. Our aim was to evaluate complications, anatomical, functional and subjective outcomes of high USL suspension for primary prolapse repair.

Methods: Data of patients who underwent vaginal hysterectomy followed by high USL suspension for pelvic organ prolapse were retrospectively analyzed. Operative data, as well as complications, were recorded. Anatomical recurrence was defined as descent of any compartment stage II or greater according to the Pelvic Organ Prolapse Quantification system. Functional outcomes focused on urinary, bowel, and sexual dysfunctions. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, Wexner, and Patient Global Impression of Improvement questionnaires were collected.

Results: Data of 533 women were analyzed. Mean follow-up was 32 (SD, 19) months (dropout rate, 2.6%). Most frequent complication was ureteral kinking (2.6%). Total recurrence rate was 13.7%, with anterior compartment being the most frequent (9.4%), whereas reoperation for symptomatic prolapse recurrence was required in only 1% of patients. Improvement of urinary incontinence, voiding dysfunction, constipation, and dyspareunia was observed. Overall subjective satisfaction was high (Patient Global Impression of Improvement score, 1.3), ranging from "much improved" to "very much improved."

Conclusions: Uterosacral ligament suspension is a safe and effective procedure in primary surgical treatment of pelvic organ prolapse. Anatomical, functional, and subjective outcomes were very satisfactory, and reoperation rate for recurrence was only 1%.
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http://dx.doi.org/10.1097/01.spv.0000533751.41539.5bDOI Listing
February 2019

Management of unrecognized bladder perforation following suburethral tape procedure.

Int J Gynaecol Obstet 2018 07 14;142(1):118-119. Epub 2018 Apr 14.

San Gerardo Hospital, Monza, Italy.

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http://dx.doi.org/10.1002/ijgo.12493DOI Listing
July 2018

Quality of life in women with advanced pelvic organ prolapse treated with Gellhorn pessary.

Minerva Ginecol 2018 08 13;70(4):490-492. Epub 2018 Feb 13.

ASST Monza, San Gerardo Hospital, Monza, Italy.

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http://dx.doi.org/10.23736/S0026-4784.18.04199-0DOI Listing
August 2018

Detrusor underactivity in pelvic organ prolapse.

Int Urogynecol J 2018 08 21;29(8):1111-1116. Epub 2017 Dec 21.

ASST Monza, Ospedale San Gerardo, U.O. Ginecologia, Via Pergolesi, 33, 20900, Monza, MB, Italy.

Introduction And Hypothesis: The association between pelvic organ prolapse (POP) and detrusor underactivity (DU) is not well defined. The primary outcome of this study was to evaluate the prevalence of DU in a cohort of patients with POP and its association with symptoms, anatomy. and urodynamic findings. The secondary outcome was to evaluate the evolution of lower urinary tract symptoms after POP repair between DU and non-DU patients.

Methods: Consecutive patients who underwent preoperative urodynamic tests were retrospectively analyzed. Detrusor underactivity was evaluated by the Bladder Contractility Index (BCI = pDetQmax + Qmax × 5) proposed by Abrams. A BCI < 100 was considered indicative of an underactive bladder. Patients with underactive bladder were considered group A, whereas the remaining patients were classified as group B.

Results: A total of 518 patients were studied. According to BCI, detrusor underactivity was identified in 212 (40.9%) patients (group A). Group A showed higher rates of voiding symptoms (59.4% vs 36.3%, p < 0.0001) and positive (>100 ml) postvoid residual (29.7% vs 9.8%, p < 0.0001). Conversely, they displayed lower rates of urge incontinence (15.1% vs 23.2%, p = 0.02) and detrusor overactivity (15.6% vs 23.9%, p = 0.02). Preoperative Pelvic Organ Prolapse Quantification (POP-Q) demonstrated greater Aa (+1.1 ± 1.5 vs +0.9 ± 1.5, p = 0.03) and Ba (+1.4 ± 1.7 vs +1.2 ± 1.7, p = 0.04) points values in patients in group A. After POP surgery, postoperative voiding symptoms were similar in the two groups (16% vs 15.7%, p = 0.91).

Conclusions: Our study showed a 40.9% prevalence of DU in POP patients. DU was associated with the presence of voiding symptoms and positive PVR. Moreover, cystocele showed to be more severe in DU group. After surgical repair of POP, voiding symptoms of DU patients became equal to non-DU ones, suggesting that obstruction removal might recover DU in these patients.
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http://dx.doi.org/10.1007/s00192-017-3532-zDOI Listing
August 2018

Transvaginal levator myorrhaphy for posthysterectomy vaginal vault prolapse repair.

Int Urogynecol J 2018 Jun 14;29(6):913-915. Epub 2017 Dec 14.

ASST Monza, Ospedale San Gerardo, Monza, Italy.

Introduction And Hypothesis: Posthysterectomy vaginal vault prolapse repair represents a surgical challenge. Surgical management can be successfully achieved with native-tissue repair through levator myorrhaphy. Despite low morbidity, levator myorrhaphy is not a common procedure. The aim of the video is to provide anatomic views and surgical steps necessary to achieve a successful transvaginal levator myorrhaphy for vaginal vault prolapse repair.

Methods: A 72-year-old woman with symptomatic stage IV vaginal vault prolapse was admitted for transvaginal levator myorrhaphy according to the described technique.

Results: Surgical repair was successfully achieved without complications. The final examination revealed good apical support and preservation of vaginal length. This step-by-step video tutorial may represent an important tool to improve surgical know how.

Conclusions: Transvaginal levator myorrhaphy provides an alternative technique for apical support without using prosthetic materials. This technique can be indicated when abdominal approach or synthetic device are not recommended or when peritoneum opening may be challenging. However, due to its possible constricting effect, it should be reserved to sexually inactive patients.
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http://dx.doi.org/10.1007/s00192-017-3526-xDOI Listing
June 2018

Repair of a vesicouterine fistula following cesarean section.

Int Urogynecol J 2018 02 16;29(2):309-311. Epub 2017 Nov 16.

Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy.

Introduction And Hypothesis: Vesicouterine fistula is a rare complication of cesarean section. The aim of this video is to present a case report and to provide a tutorial on the surgical technique of delayed transvaginal repair of a high vesicouterine fistula that developed after cesarean section with manual removal of a morbidly adherent placenta.

Methods: A 43-year-old woman was referred to our unit for continuous urinary leakage 3 months after undergoing a cesarean section with manual removal of a morbidly adherent placenta. A vesicouterine fistula starting from the posterior bladder wall was identified. The surgical repair consisted of a transvaginal layered repair as shown in the video.

Results: No surgical complications were observed postoperatively. Two months after surgery the fistula had not recurred and the patient reported no urinary leakage.

Conclusions: Transvaginal layered primary repair of vesicouterine fistula was shown to be a safe and effective procedure for restoring continence. The vaginal route can be particularly attractive for urogynecological surgeons.
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http://dx.doi.org/10.1007/s00192-017-3506-1DOI Listing
February 2018

Risk factors for recurrence after hysterectomy plus native-tissue repair as primary treatment for genital prolapse.

Int Urogynecol J 2018 Jan 16;29(1):145-151. Epub 2017 Aug 16.

ASST Monza, U.O. Ginecologia, Ospedale San Gerardo, Via Pergolesi, 33 - 20900, Monza, MB, Italy.

Introduction And Hypothesis: Identification of risk factors for pelvic organ prolapse (POP) recurrence is crucial to provide adequate preoperative counselling and tailor surgical treatment. The aim of this retrospective study was to identify risk factors for recurrence in a large series of patients with POP treated with primary transvaginal native-tissue repair involving high uterosacral ligament suspension.

Methods: Postoperative descent of POP-Q stage 2 or higher in any compartment was considered as recurrence. Global recurrence (GR) was defined as any recurrence in any compartment irrespective of the surgical procedures performed during primary prolapse surgery. True recurrence (TR) was defined as recurrence in a compartment repaired during primary prolapse surgery.

Results: Of a total of 533 eligible women, 519 were available for follow-up. Univariate analysis showed that age ≤50 years, premenopausal status, obesity (BMI >30 kg/m), history of severe macrosomia (>4,500 g), preoperative POP stage 3 or higher and absence of anterior repair at the time of POP surgery were risk factors for GR. Multivariate analysis confirmed lack of posterior repair (odds ratio, OR, 1.8), severe macrosomia (OR 2.7), premenopausal status (OR 3.9), obesity (OR 2.2) and preoperative stage 3 or higher (OR  2.6) as risk factors for GR. Univariate analysis showed that premenopausal status and preoperative POP stage 3 or higher were risk factors for TR. Multivariate analysis confirmed premenopausal status (OR 4.0) and preoperative stage 3 or higher (OR 4.5) as risk factors for TR.

Conclusions: This study confirmed preoperative stage 3 or higher as a risk factor for prolapse recurrence. The study also identified additional risk factors for surgical failure including lack of posterior repair, severe macrosomia, premenopausal status and obesity.
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http://dx.doi.org/10.1007/s00192-017-3448-7DOI Listing
January 2018

Outcomes of Transvaginal High Uterosacral Ligaments Suspension: Over 500-Patient Single-Center Study.

Female Pelvic Med Reconstr Surg 2018 Jan/Feb;24(1):39-42

Background: Uterosacral ligament (USL) suspension is a safe and effective procedure in terms of anatomical, functional, and subjective outcomes for primary surgical treatment of prolapse.

Objectives: There has been a renewed interest toward native tissue prolapse repair by vaginal route because of low cost and lack of mesh-related complications. Uterosacral ligaments are considered safe, effective, and durable as suspending structures for primary surgical repair of the apical compartment. Our aim was to evaluate complications, anatomical, functional and subjective outcomes of high USL suspension for primary prolapse repair.

Methods: Data of patients who underwent vaginal hysterectomy followed by high USL suspension for pelvic organ prolapse were retrospectively analyzed. Operative data, as well as complications, were recorded. Anatomical recurrence was defined as descent of any compartment stage II or greater according to the Pelvic Organ Prolapse Quantification system. Functional outcomes focused on urinary, bowel, and sexual dysfunctions. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, Wexner, and Patient Global Impression of Improvement questionnaires were collected.

Results: Data of 533 women were analyzed. Mean follow-up was 32 (SD, 19) months (dropout rate, 2.6%). Most frequent complication was ureteral kinking (2.6%). Total recurrence rate was 13.7%, with anterior compartment being the most frequent (9.4%), whereas reoperation for symptomatic prolapse recurrence was required in only 1% of patients. Improvement of urinary incontinence, voiding dysfunction, constipation, and dyspareunia was observed. Overall subjective satisfaction was high (Patient Global Impression of Improvement score, 1.3), ranging from "much improved" to "very much improved."

Conclusions: Uterosacral ligament suspension is a safe and effective procedure in primary surgical treatment of pelvic organ prolapse. Anatomical, functional, and subjective outcomes were very satisfactory, and reoperation rate for recurrence was only 1%.
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http://dx.doi.org/10.1097/SPV.0000000000000403DOI Listing
August 2018

Transvaginal uterosacral ligament hysteropexy: a retrospective feasibility study.

Int Urogynecol J 2017 Jan 19;28(1):73-76. Epub 2016 May 19.

Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy.

Introduction And Hypothesis: Uterine-sparing procedures could be attractive in patients concerned about preservation of fertility and change in corporeal image and sexuality. Transvaginal uterosacral hysteropexy can provide an alternative mesh-free technique for uterine suspension. This study aimed to evaluate the feasibility of transvaginal uterine suspension to uterosacral ligaments in terms of operative data, complications, midterm efficacy, and patient satisfaction.

Materials And Methods: This retrospective study analyzed the first 20 cases of transvaginal hysteropexy through bilateral high uterosacral ligaments (modified Shull technique) performed in our Institution.

Results: Mean follow-up was 33.2 months. The procedure was performed in 84 ± 19 min ,and blood loss was 228 ± 139 ml. Three mild complications (15 %) were observed. Recurrence [Pelvic Organ Prolapse Quantification system (POP-Q) stage ≥ II was observed in five patients (25 %), and three of them (15 %) required reintervention. Mean Patient Global Impression of Improvement score was "much improved." Two woman (40 %) who had not fulfilled their childbearing desire obtained a pregnancy. Both underwent elective caesarean section at term.

Conclusions: Transvaginal uterosacral hysteropexy appears a feasible mesh-free technique for apical support. This procedure can be indicated in women with the desire of preserving fertility or who prefer a uterine-sparing surgical option.
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http://dx.doi.org/10.1007/s00192-016-3036-2DOI Listing
January 2017