Publications by authors named "Eckhard Petri"

21 Publications

  • Page 1 of 1

Laparoscopic approach to pelvic organ prolapse - the way to go or a blind alley?

Wideochir Inne Tech Maloinwazyjne 2019 Dec 15;14(4):469-475. Epub 2019 Oct 15.

Department of Gynecology and Obstetrics, University of Warmia and Mazury, Olsztyn, Poland.

Pelvic organ prolapse represents a relatively frequent diagnosis that requires attention due to its detrimental effect on quality of life. Not surprisingly, it is one of the commonest indications for surgery in premenopausal and postmenopausal women, often requiring a complex multidisciplinary approach. Traditional vaginal procedures are being gradually replaced by laparoscopic techniques, offering anticipated benefits in reduced recurrence and complication rates, while respecting the trend towards uterus sparing if desirable. Recently, questions about the safety of alloplastic materials used in pelvic organ prolapse surgery were raised, leading to official restrictions in their use, particularly for transvaginal application. As a result, laparoscopic procedures might appear slightly favored but caution must be taken to assure proper technique of mesh placement while maintaining high awareness of possible long-term mesh-related complications that require close surveillance. Therefore, adequate education and training becomes even more important to achieve optimal results and to avoid possible serious medico-legal charges.
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http://dx.doi.org/10.5114/wiitm.2019.88749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939204PMC
December 2019

An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction.

Int Urogynecol J 2018 May 26;29(5):647-666. Epub 2018 Mar 26.

St Vincents Hospital, University of New South Wales, Sydney, NSW, Australia.

Introduction And Hypothesis: The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report.

Methods: This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction.

Results: A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible.

Conclusions: A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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http://dx.doi.org/10.1007/s00192-018-3603-9DOI Listing
May 2018

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction.

Neurourol Urodyn 2018 04 14;37(4):1220-1240. Epub 2018 Feb 14.

University of New South Wales, St Vincents Hospital, Sydney, New South Wales, Australia.

Aims: The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report.

Methods: This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction.

Results: A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible.

Conclusion: A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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http://dx.doi.org/10.1002/nau.23508DOI Listing
April 2018

Evaluation and surgery for stress urinary incontinence: A FIGO working group report.

Neurourol Urodyn 2017 02 7;36(2):518-528. Epub 2016 Mar 7.

Department of Obstetrics and Gynaecology, St George's University Hospital NHS Foundation Trust, London, United Kingdom.

Aims: To review available evidence regarding evaluation and treatment of stress urinary incontinence (SUI) and provide recommendations for management of urinary incontinence under specific conditions determined by the International Federation of Gynecology and Obstetrics (FIGO) Working Group.

Methods: The FIGO Working Group discussed the management of SUI during meetings and assessed the evidence. The search of evidence was performed using MEDLINE and Cochrane databases as well as additional searches from societies and major organizations for additional guidelines and recommendations and hand searches from bibliographies. Initial searches from 1985 to December 31, 2012 extended until July 15, 2015. After review, recommendations are made based on levels of evidence according to the recommendations from Oxford EBM Center.

Results: Initial evaluation of SUI consists of history and physical examination; cough stress test, evaluation for urinary tract infections (UTI), assessment of urethral mobility, and post-void residual volumes (LOE 5). Urodynamic studies are not necessary to evaluate patients with uncomplicated SUI (LOE 1a). Conservative treatment should be tried prior to surgery and more importantly in areas of low resources (LOE 5). Midurethral slings (MUS), pubovaginal (traditional suburethral) slings (PVS), and Burch colposuspension are effective in treating SUI (LOE 1a). Patients with SUI with ISD or UUI appear to have lower cure rates than patients without (LOE 2-4). There are limited data on surgical outcomes under limited resources (LOE 5).

Conclusions: MUS, PVS, and Burch colposuspension are effective treatments for SUI. Evidence for recommendations to treat patients in underserved low resource areas is lacking. Neurourol. Urodynam. 36:518-528, 2017. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/nau.22960DOI Listing
February 2017

Standardized modified colposuspension--mid-term results of prospective studies in one centre.

Ann Agric Environ Med 2015 ;22(2):293-6

Clinic of Operative and Oncologic Gynaecology, 1 st Department of Obstetrics and Gynaecology, Medical University, Łódź, Poland.

Introduction: Burch colposuspension is still estimated as a 'gold standard' by the Cochrane Collaboration Group in the treatment of operative stress urinary incontinence (SUI) Some urogynecologists agree with this statement, some argue that Burch colposuspension should no longer be used.

Objective: The aim of this study was to evaluate mid-term effects and patient's satisfaction with standardized modified colposuspension performed in one centre.

Material And Methods: Modified colposuspension was performed after standardization by 2 trained gynaecologists in 354 women. Data collected from 227 women were added to the final analysis of mid-term results. Average time from the operation to mid-term visit was 19 months (range 9-36 months).

Results: At mid-term visit, 86.3% of patients were cured. There was no case of post-void urine residual over 100 ml. Pain near the operated region was reported by 1 woman from agricultural region. No one reported negative impact of modified colposuspension on sexual activity or dyspareunia.

Conclusions: Modified colposuspension according to the E. Petri technique seems to be an operation that is safe and well-tolerated by women with preoperative stress urinary incontinence and paravaginal defect without urodynamic signs of ISD in mid-term observation.
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http://dx.doi.org/10.5604/12321966.1152082DOI Listing
April 2016

Overactive bladder and its effects on sexual dysfunction among women.

Acta Obstet Gynecol Scand 2013 Oct;92(10):1202-7

Department of Obstetrics and Gynecology, Faculty of Medicine, Ege University, Bornova, Turkey.

Objective: To evaluate the relation between overactive bladder (OAB) and sexual dysfunction in sexually active nurses without stress urinary incontinence and pelvic organ prolapse.

Design: Prospective, observational study.

Setting: Tertiary care center.

Population: 200 nurses, under 49 years of age.

Method: Data were obtained with Turkish language-validated questionnaires between January 2011 and June 2011. OAB was diagnosed using the Overactive Bladder Awareness Tool (OAB AT).

Main Outcome Measures: Scores on the Overactive Bladder Symptom and Health-related Quality of Life Questionnaire Short Form (OABq-SF), the Health-related Quality of Life Questionnaire Short Form (HRQOL), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form (PISQ-12).

Results: Of the 127 enrolled volunteers, 51 were diagnosed with OAB. The mean age of the participants was 37.8 ± 7.3 years. After controlling for age, body mass index, and parity, OAB did not significantly affect PISQ-12 scores, but significantly worsened OABq-SF scores. No strong correlation was noted between the parts of the OABq-SF and the domains of the PISQ-12.

Conclusion: OAB is a common problem among sexually active young women and significantly affects their quality of life. However, OAB-related sexual dysfunction plays a limited role among sexually active nurses.
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http://dx.doi.org/10.1111/aogs.12203DOI Listing
October 2013

Complications of synthetic slings used in female stress urinary incontinence and applicability of the new IUGA-ICS classification.

Eur J Obstet Gynecol Reprod Biol 2012 Dec 1;165(2):347-51. Epub 2012 Sep 1.

Division of Urogynecology, Department of Obstetrics and Gynecology, University of Greifswald, Greifswald, Germany.

Objectives: To analyze different complications of synthetic suburethral slings, and to apply the new "IUGA-ICS classification of complications directly related to the insertion of prosthesis (meshes, implants, tapes) and grafts in female pelvic floor surgery" to the list of complications, check its applicability, and give suggestions regarding possible improvements.

Study Design: This study is an analysis of complications of synthetic suburethral slings. Data on type of complication, time interval between the insertion of the prosthesis and the onset of symptoms of complication, type and nature of prosthesis, and management process were documented. Additional descriptions of the sling position in relation to lower urinary tract, shrinkage or prominence of the prosthesis, and intra-operative nature of the prosthetic material were collected for analysis.

Results: From the year 2003 to 2010, 376 women with complications of synthetic suburethral slings were managed surgically and the data were analyzed. Overactive bladder (OAB) at 54%, lower urinary tract obstruction (48%), vaginal exposure (19%), and pain (14%) were the most frequent complications. Infection, fistulae, urinary tract penetration, and groin/thigh pain were other complications. The new IUGA-ICS classification could be applied to most of the types of complications, a notable exception being de novo development of overactive bladder. Also category 4B of IUGA-ICS classifications encompasses a wide clinical variety of complications and may need reconsideration.

Conclusion: De novo OAB seems to be the commonest complication of synthetic suburethral slings, followed by obstruction, vaginal exposure, and long term pain. The new IUGA-ICS classification on complications has good general applicability; some minor changes may be useful in the future.
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http://dx.doi.org/10.1016/j.ejogrb.2012.08.011DOI Listing
December 2012

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related to native tissue female pelvic floor surgery.

Int Urogynecol J 2012 May 12;23(5):515-26. Epub 2012 Apr 12.

University of New South Wales, Sydney, NSW, Australia.

Introduction And Hypothesis: A terminology and standardized classification has yet to be developed for those complications related to native tissue female pelvic floor surgery.

Methods: This report on the terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many external referees. A process of rounds of internal and external review took place with decision making by collective opinion (consensus).

Results: A terminology and classification of complications related to native tissue female pelvic floor surgery has been developed, with the classification based on category (C), time (T), and site (S) classes and divisions that should encompass all conceivable scenarios for describing operative complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids ( www.icsoffice.org/ntcomplication ).

Conclusions: A consensus-based terminology and classification report for complications in native tissue female pelvic floor surgery has been produced. It is aimed at being a significant aid to clinical practice and particularly to research.
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http://dx.doi.org/10.1007/s00192-011-1659-xDOI Listing
May 2012

International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related to native tissue female pelvic floor surgery.

Neurourol Urodyn 2012 Apr;31(4):406-14

University of New South Wales, Sydney, New South Wales, Australia.

Introduction And Hypothesis: A terminology and standardized classification has yet to be developed for those complications related to native tissue female pelvic floor surgery.

Methods: This report on the terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many external referees. A process of rounds of internal and external review took place with decision-making by collective opinion (consensus).

Results: A terminology and classification of complications related to native tissue female pelvic floor surgery has been developed, with the classification based on category (C), time (T), and site (S) classes and divisions, that should encompass all conceivable scenarios for describing operative complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, color charts, and online aids (www.icsoffice.org/ntcomplication).

Conclusions: A consensus-based terminology and classification report for complications in native tissue female pelvic floor surgery has been produced. It is aimed at being a significant aid to clinical practice and particularly to research.
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http://dx.doi.org/10.1002/nau.22199DOI Listing
April 2012

Preface: gynecologic urology.

World J Urol 2012 Aug 5;30(4):427. Epub 2012 Jan 5.

University of Greifswald, Greifswald, Germany.

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http://dx.doi.org/10.1007/s00345-011-0814-9DOI Listing
August 2012

Failures and complications in pelvic floor surgery.

World J Urol 2012 Aug 9;30(4):487-94. Epub 2011 Dec 9.

Consultant Gynecologist and Urogynecologist, ESIC Medical College, Rajajinagar, Bangalore, India.

Objectives: To review current literature on the failures of different surgical approaches in pelvic floor surgery, in particular the use of alloplastic materials, and to analyze complications related to them.

Methods: A Medline search was performed to retrieve English language literature (from the year 1995 to 2011) on the success rates, failures, and complications profiles of pelvic floor surgery. Search terms used are "pelvic organ prolapse," "stress urinary incontinence," "complications," "vaginal mesh," "mid-urethral slings," and "colposuspension." The review includes surgical techniques for the correction of pelvic organ prolapse and stress urinary incontinence. Failure rates and complications in different studies are compiled and analyzed.

Results: Use of synthetic materials in pelvic organ prolapse surgery has reduced surgical failures but it is associated with an increased risk of complications compared to traditional surgical repairs. Synthetic mid-urethral slings for stress urinary incontinence seem to have good success rates over long term, but they have unique complication profile including de novo development of overactive bladder, voiding dysfunction, sling exposures, dyspareunia, and long-term pain. However, some of these complications seem to be related to wrong surgical indications and improper surgical techniques, although some complications may be directly related to the use of synthetic material itself.

Conclusion: Use of synthetic materials in pelvic floor surgery has definitely reduced surgical failures, but at the same time, it is associated with an increased risk of complications (some of which are unique to synthetic materials) compared to traditional surgical repairs.
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http://dx.doi.org/10.1007/s00345-011-0808-7DOI Listing
August 2012

My mentors in urogynecology.

Authors:
Eckhard Petri

Int Urogynecol J 2012 Jun 21;23(6):657-60. Epub 2011 Oct 21.

Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany.

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http://dx.doi.org/10.1007/s00192-011-1571-4DOI Listing
June 2012

Comparison of late complications of retropubic and transobturator slings in stress urinary incontinence.

Int Urogynecol J 2012 Mar 16;23(3):321-5. Epub 2011 Aug 16.

Division of Urogynecology, Department of Obstetrics and Gynecology, University of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany.

Introduction And Hypothesis: To compare the late complication profiles between retropubic and transobturator slings used for stress urinary incontinence was the objective of the study.

Methods: Between the years 2003 and 2010, 338 complications of midurethral slings were surgically managed in a tertiary referral center. For the purpose of study, we excluded slings that had materials other than monofilament polypropylene, patients with previous anti-incontinence surgeries, and patients who were suspected of having a neurologic bladder condition. This is a prospective and retrospective study of the complications of midurethral slings. The characteristics of complications in retropubic and transobturator routes were compared and analyzed.

Results: Two hundred eighty cases with midurethral sling complications were suitable for analysis. Of these, retropubic slings constituted 210 and transobturator 70. The time interval between the insertion of tape and onset of complications was similar in both groups. Within the two groups, obstructive symptoms were seen more frequently in the retropubic tapes group. Compared to the retropubic tapes group, the transobturator group had more number of complications related to persistent pain (10% tension-free vaginal tapes vs. 32% transobturator tapes), dyspareunia (3% vs. 18%), and tape-related infections (4% vs. 18%). There were no significant differences among the complication rates pertaining to de novo overactive bladder (49% vs. 44%), obstructive symptoms (48% vs. 30%), and contraction of sling material (5% vs. 8%).

Conclusions: Obstructive complications were seen more commonly in the retropubic tapes compared to the transobturator tapes. Transobturator tapes were more frequently associated with persistent pain, dyspareunia, and tape-related infections as compared to retropubic tapes.
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http://dx.doi.org/10.1007/s00192-011-1535-8DOI Listing
March 2012

Partner dyspareunia--a report of six cases.

Int Urogynecol J 2012 Jan 29;23(1):127-9. Epub 2011 Jul 29.

Division of Urogynecology, Department of Obstetrics and Gynecology, University of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany.

One of the rarely cited complications of the use of alloplastic materials in pelvic floor surgery is dyspareunia of the partner caused by prominence or vaginal exposure of the sling material. Even though this entity is real and an important problem, it is rarely reported in literature. We report six cases of partner dyspareunia, in which there were two incidences of partner penile injury, occurring as a complication of synthetic midurethral sling surgery. There were three tension-free vaginal tapes, two transobturator tapes and one anterior intravaginal sling in the series. Time interval between tape insertion and the presentation of complications ranged from 3 to 48 months. Vaginal exposure was seen in five of the six cases and in one patient prominence of sling material without exposure was noted. Recognizing partner dyspareunia as an important complication of the vaginal use of alloplastic prosthesis is not only important in preoperative counseling of patients but also to avoid legal implications.
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http://dx.doi.org/10.1007/s00192-011-1498-9DOI Listing
January 2012

Sacrospinous vaginal fixation--current status.

Acta Obstet Gynecol Scand 2011 May 16;90(5):429-36. Epub 2011 Mar 16.

Division of Urogynecology, Department of Obstetrics and Gynecology, University of Greifswald, Germany.

There has been a trend towards increased use of synthetic meshes and abdominal procedures with decreased use of sacrospinous fixation (SSF). A Medline search was performed for the MeSH terms 'sacrospinous ligament', 'sacrospinous fixation', 'sacrospinous ligament suspension' and 'sacrospinous colpopexy'. Published papers from 1996-2010 were selected for analysis. Outcome measures were assessed in terms of efficacy, complications and quality of life after sacrospinous vaginal fixation. Studies on bilateral SSF and fixing uterus to the sacrospinous ligament, use of concomitant anti-incontinence procedures along with SSF were not included in this review. Sacrospinous vaginal fixation provides good long-term objective and subjective outcomes and improves quality of life of women with pelvic organ prolapse. Further, complication rates of SSF are comparable to abdominal sacrocolpopexy and are much less than transvaginal mesh procedures and SSF is a cost-effective procedure. SSF is a time-tested surgical procedure with a reduction in surgical extent and has a definite place in modern pelvic reconstructive surgery.
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http://dx.doi.org/10.1111/j.1600-0412.2011.01084.xDOI Listing
May 2011

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery.

Neurourol Urodyn 2011 Jan;30(1):2-12

University of New South Wales, Sydney, NSW, Australia.

Introduction And Hypothesis: A terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological (grafts) materials in female pelvic floor surgery.

Methods: This report on the above terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many expert external referees. An extensive process of 11 rounds of internal and external review took place with exhaustive examination of each aspect of the terminology and classification. Decision-making was by collective opinion (consensus).

Results: A terminology and classification of complications related directly to the insertion of prostheses and grafts in female pelvic floor surgery has been developed, with the classification based on category (C), time (T) and site (S) classes and divisions, that should encompass all conceivable scenarios for describing insertion complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids (www.icsoffice.org/complication).

Conclusion: A consensus-based terminology and classification report for prosthesis and grafts complications in female pelvic floor surgery has been produced, aimed at being a significant aid to clinical practice and research.
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http://dx.doi.org/10.1002/nau.21036DOI Listing
January 2011

An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery.

Int Urogynecol J 2011 Jan;22(1):3-15

University of New South Wales, Sydney, N.S.W., Australia.

Introduction And Hypothesis: a terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological (grafts) materials in female pelvic floor surgery.

Methods: this report on the above terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many expert external referees. An extensive process of 11 rounds of internal and external review took place with exhaustive examination of each aspect of the terminology and classification. Decision-making was by collective opinion (consensus).

Results: a terminology and classification of complications related directly to the insertion of prostheses and grafts in female pelvic floor surgery has been developed, with the classification based on category (C), time (T) and site (S) classes and divisions, that should encompass all conceivable scenarios for describing insertion complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids ( www.icsoffice.org/complication ).

Conclusions: a consensus-based terminology and classification report for prosthess and grafts complications in female pelvic floor surgery has been produced, aimed at being a significant aid to clinical practice and research.
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http://dx.doi.org/10.1007/s00192-010-1324-9DOI Listing
January 2011

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.

Neurourol Urodyn 2010 ;29(1):4-20

University of New South Wales, Sydney, New South Wales, Australia.

Introduction: Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report.

Methods: This report combines the input of members of the Standardization and Terminology Committees of two international organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus).

Results: A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible.

Conclusion: A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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http://dx.doi.org/10.1002/nau.20798DOI Listing
March 2010

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.

Int Urogynecol J 2010 Jan 25;21(1):5-26. Epub 2009 Nov 25.

St Vincent's Clinic, Suite 904, 438 Victoria Street, Darlinghurst, Sydney, 2010, NSW, Australia.

Introduction And Hypothesis: Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report.

Methods: This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus).

Results: A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible.

Conclusions: A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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http://dx.doi.org/10.1007/s00192-009-0976-9DOI Listing
January 2010

Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system.

Int Urogynecol J Pelvic Floor Dysfunct 2006 Nov 6;17(6):615-20. Epub 2006 Apr 6.

Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Ste 634, P.O. Box 250619, Charleston, SC 29425, USA.

Our objective was to determine the inter-examiner agreement of a simplified pelvic organ prolapse quantification (POPQ) exam and to assess its correlation with the standard POPQ exam. This study consists of two parts; both were performed in a prospective, randomized, blinded fashion on women presenting with complaints attributed to pelvic organ support defects. The first study was done to determine the inter-examiner reliability of a simplified POPQ exam. The simplified POPQ exam is based on the POPQ with similar ordinal staging but with only four points measured instead of nine. Forty-eight women underwent exams by five different investigators. The order of exams was randomized and the examiners were blinded to the results of each other's findings. The results of these two exams were compared using weighted kappa statistics. The second part of the study was done to determine the inter-system agreement between the simplified vs standard POPQ exam. A group of 49 women were examined by four different investigators: one using the simplified and the other using standard POPQ exams. The order of the exams was randomized and the examiners were blinded to the results of each other's exam. Kendall's tau-b statistics were used to determine the inter-system agreement. For the inter-examiner reliability of the POPQ exam, the average age was 60+/-13 years. The weighted kappa statistics for the inter-examiner reliability of the simplified prolapse classification system were 0.86 for the overall stage, 0.89 and 0.86 for the anterior and posterior vaginal walls, respectively, 0.82 for the apex/cuff, and 0.72 for the cervix. All demonstrate significant agreement. For the inter-system association between the simplified POPQ and standard POPQ, the average age was 61+/-15 year. The Kendall's tau-b value for overall stage was 0.90, 0.83, and 0.87 for the anterior and posterior walls respectively, and 0.78 for the cuff/apex and 0.98 for the cervix. There is good inter-examiner agreement of a simplified POPQ classification system and it appears to have good inter-system association with the POPQ.
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http://dx.doi.org/10.1007/s00192-006-0076-zDOI Listing
November 2006

Reasons for and treatment of surgical complications with alloplastic slings.

Int Urogynecol J Pelvic Floor Dysfunct 2006 Jan 18;17(1):3-13. Epub 2005 Jun 18.

Department of Obstetrics and Gynecology, Helios-Clinics Schwerin, University of Rostock, Wismarsche Str. 397, 19049, Schwerin, Germany.

Suburethral slings with tension-free vaginal tapes have become a popular treatment for stress urinary incontinence. Case reports on singleton complications are numerous and of clinical interest. Four European centers for urogynecology report on 328 surgical reinterventions after tension-free slings. Poor surgical technique is the most frequent cause of problems (45%), followed by incorrect indication (38%). The most frequent symptom is functional or anatomical outlet obstruction; perforation or penetration and defect healing are rare, but, apparently more frequent than described in studies or follow-up series previously.
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http://dx.doi.org/10.1007/s00192-005-1331-4DOI Listing
January 2006
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