Publications by authors named "Matteo Frigerio"

64 Publications

Systematic review and meta-analysis on the impact of the levonorgestrel-releasing intrauterine system in reducing risk of ovarian cancer.

Int J Gynaecol Obstet 2021 May 9. Epub 2021 May 9.

Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.

Background: Ovarian carcinoma (OC) is one of the most widespread tumors in the world and is characterized by low survival rates.

Objective: To determine whether the levonorgestrel-releasing intrauterine system (LNG-IUS) can prevent OC.

Search Strategy: The literature until December 2020 were systematically reviewed according to the PRISMA Statement for Reporting Systematic Reviews (PROSPERO: CRD42019137957).

Selection Criteria: Studies assessing the impact of LNG-IUS on the risk of OC were included.

Data Collection And Analysis: Data were extracted independently by two authors to ensure accuracy and consistency.

Main Results: A total of 34 323 records were obtained, of which three satisfied the inclusion criteria. In total, 1687 events of OC in a population of 20 461 311 person-years were considered. Data pooling revealed that the use of LNG-IUS did not confer a lower risk of OC relative to the never-use of LNG-IUS, with an estimated odds ratio of 0.66 (95% confidence interval 0.41-1.08; I = 84%; P = 0.002).

Conclusion: The meta-analysis did not demonstrate a preventive role of LNG-IUS on OC. However, it was carried out on a few papers, and a definitive conclusion on the topic still cannot be drawn. Further studies are indicated in the future to define the impact of LNG-IUS on OC. The meta-analysis carried out on three papers did not demonstrate a preventive role of the levonorgestrel-releasing intrauterine device on ovarian cancer.
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http://dx.doi.org/10.1002/ijgo.13737DOI Listing
May 2021

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

Inability to walk and persistent thigh pain after transobturator tape procedure for stress urinary incontinence: surgical management.

Int Urogynecol J 2021 May 3;32(5):1317-1319. Epub 2021 Mar 3.

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

Introduction And Hypothesis: Groin pain after transobturator tape is often a self-limiting situation, but can occasionally persist and be associated with serious neurological sequelae. The video is aimed at presenting the surgical management of persistent groin pain and inability to walk after transobturator sling placement and subsequent partial removal.

Methods: The featured patient is a 31-year-old woman unable to walk after transobturator sling implantation 2 years before. She reported left thigh pain immediately after surgery that was not responsive to postoperative medication. Six months later, suburethral portion excision was performed but no pain relief was obtained. She was unable to walk, and needed a wheelchair. Electromyography showed axonal injury of the left obturator nerve. After providing proper informed consent, the patient was admitted for combined transvaginal and transcutaneous transobturator tape arm removal.

Results: The featured procedure was completed in 120 min and blood loss was <100 ml. No surgical complications were observed. The patient is currently doing left leg rehabilitation, has regained the ability to walk with the aid of a crutch, and the need for chronic pain control medication is greatly reduced.

Conclusion: This represents a valid surgical approach for the late management of this mesh-related complication.
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http://dx.doi.org/10.1007/s00192-020-04666-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927782PMC
May 2021

Telephone interview in urogynecology in the era of COVID-19 pandemic

J Turk Ger Gynecol Assoc 2021 02 28;22(1):8-11. Epub 2021 Jan 28.

Department of Gynecology, ASST Monza, San Gerardo Hospital, Monza, Italy

Objective: During the Coronavirus disease-2019 (COVID-19) pandemic deferable access, including non-urgent outpatient visits, have been suspended. In our practice non-urgent routine visits for pelvic floor symptom assessment were discontinued and rescheduled, and telephone interview was performed. The aim was to evaluate patients’ satisfaction for this alternative approach.

Material And Methods: Telephone interviews were conducted using a validated questionnaire to investigate pelvic floor symptoms. Patients were also asked if they had other symptoms or disorders, to identify patients who may need urgent hospital evaluation. At the end of the phone call, patients were asked to score their satisfaction with the telephone interview by grading their response to three questions from 0 (minimum) to 10 (maximum). The questions were: 1) “Was the telephone interview useful to check your state of health?”; 2) “Was the telephone interview an adequate healthcare tool in consideration of COVID-19 outbreak?”; 3) “Could the telephone interview replace the conventional visit?”.

Results: Fifty-three patients were evaluated. All patients showed great satisfaction with telephone interview (Q1 median: 10, IQ range: 10-10) and were similarly positive in response to the second question (Q2 median: 10, IQ range: 10-10). Although fewer patients felt that telephone interview could replace conventional clinic visits most remained positive (Q3 median: 7; IQ range: 6-8).

Conclusion: This simple experience showed that phone interviews with validated questionnaires are appreciated and effective to safely perform interview of selected urogynecologic patients.
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http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944235PMC
February 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

Obstetric outcomes after uterus-sparing surgery for uterine prolapse: A systematic review and meta-analysis.

Eur J Obstet Gynecol Reprod Biol 2021 Jan 20;256:333-338. Epub 2020 Nov 20.

ASST Monza, San Gerardo Hospital, Monza, Italy.

Up-to-date there are no guidelines about uterus-sparing prolapse repair procedures for women desiring childbearing. This systematic review and meta-analysis aims to evaluate obstetrical outcomes after uterus-sparing apical prolapse repair in terms of pregnancy rate, obstetrical adverse outcomes and delivery mode according to the type of procedure. To identify potentially eligible studies, we searched PubMed, Scopus, Cochrane Library and ISI Web of Science (up to April 15, 2020). Case reports, reviews, letters to Editor, book chapters, guidelines, Cochrane reviews, and expert opinions were excluded. Twenty-four studies met inclusion criteria and were incorporated into the final assessment, which included 1518 surgical procedures. In total 151 patients got pregnant after prolapse surgical repair, for a resulting pregnancy raw rate of 9.9 %. Overall, adverse obstetric outcomes resulted low, rating 4.6 %. Manchester procedure resulted associated with the highest risk of adverse obstetrical outcomes and preterm premature rupture of membranes (p < 0.0001). After exclusion of Manchester procedure, sacrohysteropexy was found to be associated with higher risk of obstetrical adverse outcomes compared to native-tissue procedures (p = 0.04). Native-tissue surgery might represent the most cautious option for women wishing for pregnancy.
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http://dx.doi.org/10.1016/j.ejogrb.2020.11.054DOI Listing
January 2021

Urodynamic predictors of de novo overactive bladder after single-incision sling.

Int J Gynaecol Obstet 2021 Jun 16;153(3):412-416. Epub 2020 Dec 16.

ASST Monza, San Gerardo Hospital, Monza, Italy.

Objective: To identify urodynamic predictors for de novo overactive bladder (OAB) after single-incision sling implantation.

Methods: This retrospective study analyzed women with pure, urodynamically proven stress urinary incontinence, without OAB, between 2008 and 2015, in a university hospital. De novo OAB was investigated during clinical interviews.

Results: A total of 192 patients were analyzed; 21 patients with de novo OAB were considered as group A while 171 control patients formed group B. Univariate analysis demonstrated that patients with de novo OAB have the first desire to void at a lower bladder volume (124 mL versus 160 mL, P = 0.0052), smaller maximum cystometric capacity (357 mL versus 406 mL, P = 0.0061), lower maximum flow (17 mL/s versus 23 mL/s, P = 0.0006), and higher bladder outlet obstruction index (BOOI; -11 versus -23, P = 0.0022) compared with controls. According to multivariate analysis, maximum cystometric capacity (parameter estimate [PE] =0.008, P = 0.04) and BOOI (PE = -0.029, P = 0.01) were independent urodynamic predictors of de novo OAB. The final model showed good predictive accuracy (area under the curve =0.81).

Conclusion: The present study identified maximum cystometric capacity and BOOI as independent predictors of de novo overactive bladder after single-incision sling implantation. Therefore, preoperative urodynamics may be useful to improve preoperative counseling and to tailor surgical treatment.
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http://dx.doi.org/10.1002/ijgo.13503DOI Listing
June 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

Single-incision slings for the treatment of stress urinary incontinence: efficacy and adverse effects at 10-year follow-up.

Int Urogynecol J 2021 Jan 9;32(1):187-191. Epub 2020 Sep 9.

ASST Santi Paolo e Carlo, Ospedale San Paolo, via Antonio di Rudini, Milan, Italy.

Introduction And Hypothesis: Single-incision slings are not considered a first-choice surgical treatment owing to a lack of data about long-term outcomes. We aimed to assess the long-term results of urinary incontinence treatment after single-incision sling implantation at 10 years' follow-up and to investigate possible deterioration over time.

Methods: This retrospective study analyzed women with subjective and urodynamically proven stress urinary incontinence who underwent single-incision sling procedure. The objective cure rate was assessed with a 300-ml stress test. The subjective cure rate was determined by the Patient Global Impression of Improvement (PGI-I) questionnaire. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire scores and self-answered patient-satisfaction scales were collected to assess symptom severity. Findings were compared with short-term outcomes in the same patients, available through our previous database, in order to detect possible outcome deterioration over time.

Results: The records of 60 patients were analyzed. Nine patients (15%) were lost to follow-up. A total of 51 patients completed the evaluation, with a mean follow-up of 10.3 ± 0.7 years. Objective and subjective cure resulted 86.3% and 88.2% respectively. Mean PGI-I scores and ICIQ-SF were 1.5 ± 1.0 and 3.2 ± 4.8 respectively. Patients' satisfaction scored 8.6 ± 2.6 out of 10. No long-term complications occurred. Comparison of short-term (2.6 ± 1.4 years after surgery) and long-term follow-up did not show a significant deterioration of outcome over time.

Conclusions: Single-incision slings were shown to be a procedure with a great efficacy and safety profile at very long-term follow-up. Cure rates and functional outcomes did not show any deterioration over time compared with short-term results.
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http://dx.doi.org/10.1007/s00192-020-04499-8DOI Listing
January 2021

Update in fertility-sparing native-tissue procedures for pelvic organ prolapse.

Int Urogynecol J 2020 Nov 18;31(11):2225-2231. Epub 2020 Aug 18.

San Gerardo University Hospital, Via Pergolesi 33, 20900, Monza, Italy.

Uterine-sparing prolapse surgery has been gaining back popularity with clinicians and patients. Although both prosthetic and native-tissue surgery procedures are described, the latter is progressively regaining a central role in pelvic reconstructive surgery, owing to a lack of mesh-related complications. Available native-tissue procedures have different advantages and pitfalls, as well as different evidence profiles. Most of them offer anatomical and subjective outcomes comparable with those of hysterectomy-based procedures. Moreover, native-tissue procedures in young women desiring childbearing allow to avoid synthetic material implantation, which may lead to potentially serious complications during pregnancy. As a consequence, we do think that offering a reconstructive native-tissue procedure for uterine preservation (with the exception of the Manchester procedure) is the safest option in women wishing for pregnancy. Sacrospinous ligament hysteropexy and high uterosacral ligament hysteropexy may be considered first-line options in consideration of the higher level of evidence and lack of adverse obstetrical outcomes.
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http://dx.doi.org/10.1007/s00192-020-04474-3DOI Listing
November 2020

Pelvic floor ultrasonography for the evaluation of the rectum-vaginal septum before and after prolapse native-tissue repair.

Minerva Ginecol 2020 12 3;72(6):426-428. Epub 2020 Aug 3.

Unit of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy -

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http://dx.doi.org/10.23736/S0026-4784.20.04620-1DOI Listing
December 2020

Female Genital Hair-Thread Tourniquet Syndrome: A Case Report and Literature Systematic Review.

J Pediatr Adolesc Gynecol 2021 Feb 18;34(1):65-70. Epub 2020 Jul 18.

Department of Gynecology, ASST Monza, San Gerardo University Hospital, Monza, Italy.

"Hair-thread tourniquet syndrome" (HTTS) describes the condition in which fibers of hair or thread wrap around an appendage (ie, toes, fingers, genital structures, tongue, uvula, and neck), eventually causing ischemia and tissue necrosis. To date, few cases of female genitalia HTTS have been described. We report a case of female genitalia HTTS in a 5-year-old girl and report the state of the art by systematically reviewing all existing evidence about female genital HTTS. A total of 29 studies, describing a total of 34 patients, were identified. The presence of a hair-thread wrapping genitalia should be suspected in prepubertal girls complaining of genital pain associated with vulvar/vaginal swelling, wide-based gait, and voiding symptoms. Genital examination disclosing an extremely tender, swollen, and erythematous lesion on the clitoris or labia minora encircled by a hair confirms the diagnosis. The aim of the management is to remove the hair-thread in the shortest time possible, with the use of forceps, scissors, or scalpels, and this is often performed under sedation/anesthesia because of the patient's pain reaction. When the hair-thread is difficult to find or when the lesion is necrotic, excision of the lesion itself can be the only option. Complications include partial or total amputation because of tissue necrosis and recurrence.
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http://dx.doi.org/10.1016/j.jpag.2020.07.007DOI Listing
February 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 management of bladder erosion and pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse.

Int Urogynecol J 2020 04 5;31(4):843-845. Epub 2020 Mar 5.

ASST Monza, San Gerardo Hospital, Monza, Italy.

Introduction And Hypothesis: Mesh-augmented lateral suspension for prolapse repair seems to be associated with few complications. However, mesh-related complications can negatively affect the quality of life and may be challenging to manage. This video is aimed at presenting the surgical management of a case of severe pelvic pain and dyspareunia after lateral laparoscopic suspension associated with mesh erosion in the bladder.

Methods: A 46-year-old woman was referred to our Unit for severe pelvic pain and inability to have sexual intercourses since undergoing a uterus-sparing laparoscopic lateral suspension procedure for genital prolapse 2 years before in another hospital. Moreover, she reported bladder pain and recurrent urinary tract infections. Cystoscopy showed mesh erosion in the bladder. She was admitted to laparoscopic hysterectomy plus subtotal mesh excision and bladder reconstruction (video).

Results: No surgical complications were observed. The postoperative course was uneventful. At the current follow-up, the patient reported complete resolution of her symptoms.

Conclusion: The featured video shows laparoscopic subtotal mesh excision, concomitant hysterectomy and bladder repair for pelvic pain, dyspareunia and bladder erosion after lateral suspension. This video may be useful in providing anatomical views and surgical steps necessary for achieving successful surgical management of this mesh-related complication.
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http://dx.doi.org/10.1007/s00192-020-04261-0DOI Listing
April 2020

Locally-advanced vaginal cancer with complete utero-vaginal prolapse.

Int J Gynecol Cancer 2020 05 5;30(5):705-708. Epub 2020 Mar 5.

Department of Radiotherapy, San Gerardo Hospital, Monza, Italy.

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http://dx.doi.org/10.1136/ijgc-2020-001326DOI 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

Long-term effects of episiotomy on urinary incontinence and pelvic organ prolapse: a systematic review.

Arch Gynecol Obstet 2019 02 18;299(2):317-325. Epub 2018 Dec 18.

Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel.

Purpose: To focus attention on the long-term effects of episiotomy on urinary incontinence and pelvic organ prolapse.

Methods: A systematic review was conducted including only studies with mean follow-up ≥ 5 years. We searched using combinations of the following keywords and text words: "episiotomy", "perineal laceration", "perineal tear", "perineal damage" and "long term", "long term outcomes", "prolapse", "pelvic organ prolapse", "pelvic floor", "pelvic floor dysfunction", "urinary incontinence", "hysterocele", "cystocele" and "rectocele".

Results: The electronic database search provided a total of 6154 results. After exclusions, 24 studies were included yielding the following results: (1) episiotomy might be detrimental with respect to urinary incontinence symptoms; (2) the relationship between episiotomy and anti-incontinence surgery is not clear; (3) episiotomy does not seem to negatively influence genital prolapse development and might even be protective with respect to prolapse severity and prevalence; (4) episiotomy does not seem to affect genital prolapse surgery rate.

Conclusions: We did not find evidence for a long-term beneficial effect of episiotomy in the prevention of urinary incontinence symptoms and anti-incontinence surgery. Episiotomy does not seem to negatively influence genital prolapse development and might even be protective with respect to prolapse severity and prevalence without affecting surgery rates.
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http://dx.doi.org/10.1007/s00404-018-5009-9DOI Listing
February 2019