Anna Rosamilia

Victoria University Melbourne, Melbourne, Victoria, Australia

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Publications (73)171.42 Total impact

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    ABSTRACT: Use of synthetic clinical meshes in pelvic organ prolapse (POP) repair can lead to poor mechanical compliance in vivo, as a result of a foreign body reaction leading to excessive scar tissue formation. Seeding mesh with mesenchymal stem cells (MSCs) prior to implantation may reduce the foreign body reaction and lead to improved biomechanical properties of the mesh/tissue complex. This study investigates the influence of seeding human endometrial mesenchymal stem cells (eMSCs) on novel gelatin coated polyamide scaffolds, to identify differences in scaffold/tissue biomechanical properties and new tissue growth following up to 90 days implantation, in a subcutaneous rat model of wound repair. Scaffolds were subcutaneously implanted, either with or without eMSCs, in immunocompromised rats and following 7, 30, 60 and 90 days were removed and assessed for their biomechanical properties using uniaxial tensile testing. Following 7, 30 and 90 days implantation scaffolds were assessed for tissue ingrowth and organisation using histological staining and scanning electron microscopy. The eMSCs were associated with altered collagen growth and organisation around the mesh filaments of the scaffold, affecting the physiologically relevant tensile properties of the scaffold/tissue complex, in the toe region of the load-elongation curve. Scaffolds seeded with eMSCs were significantly less stiff on initial stretching than scaffolds implanted without eMSCs. Collagen growth and organisation were enhanced in the long-term in eMSC seeded scaffolds, with improved fascicle formation and crimp configuration. Results suggest that neo-tissue formation and remodelling may be enhanced through seeding scaffolds with eMSCs.
    Acta Biomaterialia. 11/2014;
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    ABSTRACT: The aim of this study was to assess the impact of the surgical removal of a large pelvic mass on preexisting lower urinary tract symptoms (LUTS) and function.
    International Urogynecology Journal 07/2014; · 2.17 Impact Factor
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    ABSTRACT: Does post-menopausal endometrium contain mesenchymal stem/stromal cells (MSC) that have adult stem cell properties and can be prospectively isolated from a biopsy?
    Human reproduction (Oxford, England). 06/2014;
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    ABSTRACT: Mesh reinforcement is considered an effective method for anterior compartment prolapse repair. Two common methods of mesh reinforcement involve either transobturator fixation (eg Perigee™) or lateral and apical anchoring (eg Anterior Elevate™). The aim of this study was to assess subjective and objective outcomes after Anterior Elevate and Perigee mesh kit surgery. This was a surgical audit of patients after anterior colporrhaphy (AC) with mesh reinforcement, undertaken at three tertiary urogynaecological centres. All patients were assessed for prolapse recurrence, which was defined as either (i) symptoms of prolapse (vaginal lump/dragging), (ii) ICS POPQ ≥ Stage 2, or (iii) bladder descent ≥10 mm below the symphysis pubis on transperineal ultrasound. Mesh co-ordinates and organ descent on Valsalva were determined relative to the inferior symphyseal margin. Two hundred and twenty-nine patients with anterior compartment mesh (138 Perigee, 91 Elevate) were assessed at a median follow-up of 1.09 years (IQR 0.65-2.01). On assessment, 24% (n = 55) had symptoms of prolapse recurrence, 46% (n = 106) had a clinical recurrence, and 41% (n = 95) a recurrent cystocele sonographically. All objective results favoured the Perigee group. The superiority of the Perigee kit remained highly significant (P < 0.0001 for all clinical and ultrasound measures of prolapse recurrence) on multivariate analysis. This retrospective analysis suggests that apical anchoring such as Anterior Elevate mesh system does not necessarily confer an advantage over the original transobturator mesh fixation technique for anterior compartment reconstruction.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 02/2014; · 1.30 Impact Factor
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    ABSTRACT: Data on female sexual function after prolapse surgery are conflicting. The aim of the study was to evaluate the change in sexual function and vaginal symptoms using patient reported outcomes following prolapse surgery in addition to the anatomical stage. Prospective observational study of women undergoing pelvic organ prolapse (POP) surgery. The validated International Consultation on Incontinence modular Questionnaire-Vaginal Symptoms (ICIQ-VS) questionnaire was completed preoperatively, 6 and 12 months postoperatively. Ninety-three women participated in the study with 83 (89%) returning the 6 months questionnaire and 80 (86%) the 12 months questionnaire. Twenty-four healthy women without prolapse were included as a control group. The mean vaginal- and sexual-symptom score both improved with a significant decrease at 6 months and 12 months after surgery (P < 0.001, P < 0.05, respectively). The POP-Q scores of each compartment also improved significantly after 6 and 12 months (P < 0.001) with 75% reaching anatomical success. There was no correlation between anatomical success and subjective ICIQ-VS outcomes. The vaginal and sexual matters score had a lesser reduction in women who had additional levator plication sutures during posterior vaginal repair compared to those without. Women with levator plication also showed a significant increase in postoperative dyspareunia. Surgical intervention for POP improved the vaginal and sexual matters scores at 6 and 12 months postoperatively. Levator plication additionally to posterior vaginal repair is associated with an increase in postoperative dyspareunia rates and with decreased sexual function. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.
    Neurourology and Urodynamics 02/2014; · 2.67 Impact Factor
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    ABSTRACT: To undertake a comprehensive analysis of the biochemical tissue composition and passive biomechanical properties of ovine vagina and relate this to the histo-architecture at different reproductive stages as part of the establishment of a large preclinical animal model for evaluating regenerative medicine approaches for surgical treatment of pelvic organ prolapse. Vaginal tissue was collected from virgin (n = 3), parous (n = 6) and pregnant sheep (n = 6; mean gestation; 132 d; term = 145 d). Tissue histology was analyzed using H+E and Masson's Trichrome staining. Biochemical analysis of the extracellular matrix proteins used a hydroxyproline assay to quantify total collagen, SDS PAGE to measure collagen III/I+III ratios, dimethylmethylene blue to quantify glycosaminoglycans and amino acid analysis to quantify elastin. Uniaxial tensiometry was used to determine the Young's modulus, maximum stress and strain, and permanent strain following cyclic loading. Vaginal tissue of virgin sheep had the lowest total collagen content and permanent strain. Parous tissue had the highest total collagen and lowest elastin content with concomitant high maximum stress. In contrast, pregnant sheep had the highest elastin and lowest collagen contents, and thickest smooth muscle layer, which was associated with low maximum stress and poor dimensional recovery following repetitive loading. Pregnant ovine vagina was the most extensible, but the weakest tissue, whereas parous and virgin tissues were strong and elastic. Pregnancy had the greatest impact on tissue composition and biomechanical properties, compatible with significant tissue remodeling as demonstrated in other species. Biochemical changes in tissue protein composition coincide with these altered biomechanical properties.
    PLoS ONE 01/2014; 9(4):e93172. · 3.53 Impact Factor
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    ABSTRACT: There are increasing numbers of reports describing human vaginal tissue composition in women with and without pelvic organ prolapse with conflicting results. The aim of this study was to compare ovine and human posterior vaginal tissue in terms of histological and biochemical tissue composition and to assess passive biomechanical properties of ovine vagina to further characterise this animal model for pelvic organ prolapse research.
    PLoS ONE 01/2014; 9(8):e104972. · 3.53 Impact Factor
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    ABSTRACT: To determine if abobotulinumtoxin A (AboBTXA) is an effective treatment for interstitial cystitis/bladder pain syndrome (IC/BPS). We performed a double-blind study of 54 women with severe, refractory IC from three referral centres whom we randomly allocated to treatment with hydrodistension + injection of normal saline or to hydrodistension + injection with AboBTXA. The O'Leary-Sant questionnaire consists of problem (OLS-PI) and symptom (OLS-PI) index scores, and bladder diary data were compared between AboBTXA and control patients at baseline and at 3 months of follow-up. Measurements were made beyond 3 months, but no further randomised comparison was possible due to the ability of nonresponsive patients in either group to have AboBTXA treatment. Complete data were available in 50 patients, and in both groups, OLS questionnaires showed improvement at 3 months. Only the OLS-PI was improved in the AboBTXA group (p = 0.04). At 3 months, no difference was found in either OLS-SI or total OLS score. Twelve patients had urinary tract infection (UTI) treated during the follow-up period, which confounded results. In the 38 patients without UTI, there was improvement in total OLS score (p = 0.02), OLS-PI (0.08), and OLS-SI (p = 0.008) for the AboBTXA group at 3 months. Only five AboBTXA compared with two control patients had a 50 % reduction in OLS score. For chronic refractory IC/BPS patients, AboBTXA was associated with no overall improvement in total OLS score, although significant benefit was noted in a small number of patients. The absence of posttreatment UTI was associated with a better response to AboBTXA.
    International Urogynecology Journal 11/2013; · 2.17 Impact Factor
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    ABSTRACT: Background Pelvic organ prolapse is defined as the descent of one or more of the pelvic structures into the vagina and includes uterine, vaginal vault, and anterior or posterior vaginal wall prolapse. The treatment of pelvic organ prolapse may include implantation of a synthetic mesh. However, the long-term benefit of mesh surgery is controversial due to complications such as mesh exposure or pain. The aim of this study was to use a tissue engineering approach to assess the in vivo biological and biomechanical behaviour of a new gelatin/polyamide mesh, seeded with a novel source of mesenchymal stem cells in a subcutaneous rat model of wound repair. Methods W5C5-enriched human endometrial mesenchymal stem cells were seeded onto meshes (gelatin coated polyamide knit) at 100,000 cells/ cm2. Meshes, with or without cells were subcutaneously implanted dorsally in immunocompromised rats for 7, 30, 60 and 90 days. Flow cytometry was used to detect DiO labelled cells after explantation. Immunohistochemical assessment of foreign body reaction and tissue integration were conducted. Total collagen and the levels of collagens type III and type I, were determined. Uniaxial tensiometry was performed on explanted meshes, originally seeded with and without cells, at days 7 and 90. Results Implanted meshes were well tolerated, with labelled cells detected on the mesh up to 14 days post-implantation. Meshes with seeded cells promoted significantly more neovascularisation at 7 days (p< 0.05) and attracted fewer macrophages at 90 days (p<0.05). Similarly, leukocyte infiltration was significantly lower in the cell-seeded meshes at 90 days (p<0.05). Meshes with cells were generally less stiff (more extensible) than those without cells, after 7 and 90 days implantation. Conclusion The tissue engineering approach used in this study significantly reduced the number of inflammatory cells around the implanted mesh and promoted neovascularisation. Seeding with endometrial mesenchymal stem cells (eMSC) exerts an anti-inflammatory effect and promotes wound repair with new tissue growth and minimal fibrosis, and produces mesh with greater extensibility. Cell seeding onto polyamide/ gelatin mesh improves mesh biocompatibility and may be an alternative option for future treatment of pelvic organ prolapse.
    Tissue Engineering Part A 10/2013; · 4.64 Impact Factor
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    ABSTRACT: Surgical revision of a tape inserted for urinary stress incontinence may be indicated for pain, or tape exposure or extrusion. This study assesses the clinical outcomes of revision surgery. A retrospective review of 47 consecutive women who underwent surgical revision for the indications of pain, tape exposure or tape extrusion. Forty-seven women underwent revision. 29 women (62 %) had initial tape placement at another institution. Mean interval between placement and revision was 30 months. 39 women (83 %) had an identifiable tape exposure or extrusion with or without pain, while 8 women (17 %) presented with pain alone. 11 (23 %) of the tapes were infected clinically and histologically at revision, 10 of the 11 (90 %) being of a multifilament type. In 23 (49 %) cases, the revision aimed to completely remove the tape. Partial excision 24 (51 %) was reserved for localised exposures or extrusions where infection was not suspected. A concomitant continence procedure was performed in 9(19 %) at the time of tape revision. None of these 9 women has experienced recurrent stress urinary incontinence (SUI) compared with 11 out of 38 women (29 %) requiring further stress incontinence surgery when no continence procedure was performed (Fisher's exact p = 0.092). Eight out of 47 underwent revision surgery for pain with no identifiable exposure or extrusion; pain subsequently resolved in all 8 women. Excision is an effective treatment for tape exposure and pain whether infection is present or not. Tapes of a multifilament type are strongly associated with infection. When infection is present, complete sling removal is necessary. A concomitant procedure to prevent recurrent SUI should be considered if tape excision is planned and infection is not suspected.
    International Urogynecology Journal 09/2013; 25:235-239. · 2.17 Impact Factor
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    ABSTRACT: To define types of support failure after anterior compartment mesh implantation and to investigate any association with predictors of recurrence. This is a retrospective study on patients ≥3 months after anterior mesh. All patients underwent a standardised interview, clinical examination using the ICS POP-Q and 3D/4D translabial ultrasound (US). Mesh 'failure' was defined as recurrence of anterior/central compartment prolapse on US. Failures were classified as anterior, global and apical. Their association with hiatal area on Valsalva and levator avulsion was tested. 301 patients were seen. 5 were excluded because of missing data, leaving 296. Mean follow-up was 1.8 years (0.3-5.6). Mean age was 65 years (32-88). 139 had a Perigee(TM) (47%), 66 an Anterior Prolift(TM) (22%) and 91 an Anterior Elevate(TM) (31%). Recurrent symptoms (lump/drag) were reported in 65 (22%), a recurrent cystocele was noted in 128 clinically (43%) and in 105 on US (35%). Avulsion was diagnosed in 117 (39.5%) patients. Mean hiatal area on Valsalva was 33.3 cm(2) (range 14.1-60). Mesh failure was diagnosed in 112 (38%). It was a global failure in 81 (27%), apical failure in 23 (8%) and anterior failure in 8 (3%). Apical and global failures were significantly associated with hiatal area. This remained true after controlling for potential confounders. Anterior/ central compartment prolpase recurrence was noted in 38% of patients on average 1.8 years after anterior compartment mesh. Global and apical failures constituted 92% of all mesh failures and both types of failure were significantly associated with hiatal area on Valsalva.
    Ultrasound in Obstetrics and Gynecology 07/2013; 42:699-704. · 3.56 Impact Factor
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    ABSTRACT: We set out to determine if insertion of a retropubic tension-free vaginal tape (TVT) sling at the time of pelvic organ prolapse surgery improves continence outcomes in women with pre-operative occult stress incontinence (OSI) or asymptomatic urodynamic stress incontinence (USI). We conducted a randomised controlled study of prolapse surgery with or without a TVT midurethral sling. The pre- and post-operative assessment at 6 months included history, physical examination and urodynamic testing. Quality of life (QOL) and treatment success was assessed with the UDI-6 SF, IIQ-7 SF and a numerical success score. The primary outcome was symptomatic stress urinary incontinence (SUI) requiring continence surgery (TVT) at 6 months. Long-term follow-up continued to a minimum of 24 months. Secondary outcomes were quality of life parameters. Eighty women received prolapse surgery alone (n = 43) or prolapse surgery with concurrent TVT (n = 37). Six months following prolapse surgery 3 out of 43 (7 %) patients in the no TVT group requested sling surgery compared with 0 out of 37 (0 %) in the TVT group (ARR 7 % [95 %CI: 3 to 19 %], p = 0.11). After 24 months there was one further participant in the no TVT group who received a TVT for treatment of SUI compared with none in the TVT group (4 out of 43, 9.3 % versus 0 out of 37; ARR 9.3 % [95 %CI: -1 to 22 %], p = 0.06). Both groups showed improvement in QOL difference scores for within-group analysis, without difference between groups. These results support a policy that routine insertion of a sling in women with OSI at the time of prolapse repair is questionable and should be subject to shared decision-making between clinician and patient.
    International Urogynecology Journal 06/2013; · 2.17 Impact Factor
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    ABSTRACT: Clinical meshes used in pelvic organ prolapse (POP) repair are predominantly manufactured from monofilament polypropylene (PP). Complications from the use of these meshes in transvaginal kits, including mesh exposure and pain, have prompted two public health notifications by the FDA. The aim of this study was to compare several clinical PP POP meshes to new fabricated POP meshes, knitted from alternative polymers, for their mechanical properties using standard and clinically relevant multi-axial testing methods. Five new meshes were warp knitted to different architectures and weights from polyamide and polyetheretherketone monofilaments. A composite mesh of a polyamide mesh incorporating a gelatin layer was also fabricated to enable the potential delivery of cells on these meshes. Meshes were assessed for their structural characteristics and mechanical properties, using uniaxial stiffness, permanent strain, bending rigidity and multi-axial burst strength methods. Results were compared to three clinical urogynaecological polypropylene meshes: Polyform®, Gynemesh(TM)PS, and IntePro®. New fabricated meshes were uniaxially less stiff (less than 0.24N/mm and 1.20N/mm in toe and linear regions, respectively) than the Gynemesh (0.48N/mm and 2.08N/mm in toe and linear regions, respectively) and IntePro (0.57N/mm in toe region) clinical meshes, with the gelatin coated PA mesh exhibiting lower permanent strain than Polyform clinical mesh (8.1% vs. 23.5%). New meshes had lower burst stiffness than Polyform (less than 16.9N/mm for new meshes and 26.6N/mm for Polyform). Within the new mesh prototypes, the PA meshes, either uncoated (4.7-5.7μNm) or with gelatin coating (16.7μNm) possessed lower bending rigidity than both Polyform and Gynemesh (46.2μNm and 36.4μNm, respectively). The new fabricated mesh designs were of similar architecture, but with some improved mechanical properties, compared to clinical POP meshes. Multi-axial analysis of new and clinical mesh designs provides greater discriminatory power in analysing mesh mechanical properties for clinical applications.
    Journal of the mechanical behavior of biomedical materials. 04/2013; 23C:53-61.
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    Vincent Letouzey, Joseph K-S Lee, Anna Rosamilia
    International Urogynecology Journal 03/2013; 24:703-705. · 2.17 Impact Factor
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    ABSTRACT: INTRODUCTION AND HYPOTHESIS: De novo urgency has a negative impact on women after midurethral sling (MUS). We aimed to identify risk factors for de novo urgency (dU) and urgency urinary incontinence (dUUI) following MUS, using multivariate analysis. METHODS: We investigated 358 consecutive women with only stress urinary incontinence (SUI) [or urodynamic stress incontinence (USI)] and 598 women with both SUI (or USI) and urgency (but not UUI) who underwent MUS with a mean follow-up of 50 months. Women who developed dU or dUUI at long-term follow-up were compared to those who did not. RESULTS: dU occurred in 27.7 % (99/358) and dUUI occurred in 13.7 % (82/598) of women at long-term follow-up after midurethral sling. Intrinsic sphincter deficiency {odds ratio (OR) dU 3.94 [95 % confidence interval (CI) 1.50-10.38]; OR dUUI 2.5 (1.31-4.80)}, previous stress incontinence surgery [sling: OR dU 3.69 (1.45-9.37); colposuspension: OR dUUI 2.5 (1.23-5.07)], previous prolapse surgery [OR dU 2.45 (1.18-5.10)], preexisting detrusor overactivity [OR dU 1.99 (1.15-3.48); OR dUUI 1.85 (1.31-2.60)] increased the risk, whereas performing concomitant apical prolapse surgery [OR dU 0.5 (0.41-0.81); OR dUUI 0.29 (0.087-0.97)] significantly decreased the risk. Women are more likely to not recommend surgery when they experienced dU (18.2 vs 0.8 %, p < 0.0001) or dUUI (20.7 vs 2.1 %, p < 0.0001). CONCLUSIONS: Urodynamic parameters, history of prior incontinence or prolapse surgery and concomitant apical prolapse operation were important predictors of dU or dUUI following MUS.
    International Urogynecology Journal 01/2013; 24:47-54. · 2.17 Impact Factor
  • Young N, Rosamilia A, Lee J
    International Urogynecology Journal 01/2013; 24(suppl1):S115-S116. · 2.17 Impact Factor
  • International Urogynecology Journal 01/2013; 24(Suppl 1):S108-S109. · 2.17 Impact Factor
  • Fay Lin Chao, Peter Dwyer, Anna Rosamilia
    International Urogynecology Journal 10/2012; · 2.17 Impact Factor
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    ABSTRACT: We have previously identified and purified multipotent mesenchymal stromal cell (MSC)-like cells in the highly regenerative endometrial lining of the human uterus (eMSC) as CD140b(+)CD146(+) cells. Due to ease of accessibility with minimal morbidity via biopsy, we are proposing to use eMSC in cell-based therapies; however, culture conditions compliant with Good Manufacturing Practice have not been established for eMSC. The aim of this study was to optimize serum-free and xeno-free culture conditions for expansion of eMSC for potential clinical use. Real-time cell assessment (Xcelligence) and MTS viability assays were used to measure attachment and proliferation of freshly isolated, flow cytometry-sorted CD140b(+)CD146(+) eMSC cultured in several commercially available and in-house serum-free and xeno-free media in combination with five attachment matrices (fibronectin, collagen, gelatin, laminin, and Cell Start-XF(®)). Comparisons were made with a standard serum-containing medium, DMEM/F-12/10% fetal bovine serum. Under all conditions examined, eMSC attachment and proliferation was greatest using a fibronectin matrix, with Lonza TP-SF(®) and our in-house DMEM/SF/FGF2/EGF serum-free xeno-product-containing medium similar to serum-containing medium. Hypoxia increased eMSC proliferation in the DMEM/SF/FGF2/EGF serum-free medium. Culture of eMSC for 7 days on a fibronectin matrix in DMEM/SF/FGF2/EGF serum-free media in 5% O(2) maintained greater numbers of undifferentiated eMSC expressing CD140b, CD146, and W5C5 compared to culture under similar conditions in Lonza TP-SF medium. However, the percentage of cells expressing typical MSC phenotypic markers, CD29, CD44, CD73, and CD105, were similar for both media. EMSC showed greater expansion in 2D compared to 3D culture on fibronectin-coated microbeads using the optimized DMEM/SF/FGF2/EGF medium in 5% O(2). In the optimized 2D culture conditions, eMSC retained CFU activity, multipotency, and MSC surface phenotype, representing the first steps in their preparation for potential clinical use.
    Tissue Engineering Part C Methods 06/2012; · 4.64 Impact Factor
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    ABSTRACT: To determine the functional outcomes after synthetic sling revision surgery performed for voiding dysfunction. A retrospective review of 63 women who underwent surgical revision of a synthetic sling (SS) over an 11 year period between 2000 and 2010 inclusive, for the treatment of voiding dysfunction. Voiding dysfunction was defined as a persistently raised post-void residual of >150 ml. Patient review included demographics, a comprehensive medical history, all surgical reports and a detailed proforma with details of lower urinary tract symptoms, physical findings and bladder diaries. Variables were compared between methods of sling revision using the Fisher exact test (Freeman-Halton extension) with a 2 by 3 contingency table. Statistical significance is defined as P ≤ 0.05. Sixty-three women underwent SS revision for voiding dysfunction with an overall success rate of 87%. Three types of surgical revision were performed; simple SS division (46/63, 73%), partial excision of SS material (13/63, 21%) and either division or excision but with a concomitant procedure to prevent recurrent SUI (4/63, 6%). Persistent voiding dysfunction following revision in each of the three groups was 5/46 (10.9%), 1/13 (7.7%) and 2/4 (50%) respectively (P=0.09). Subsequent surgery for recurrent SUI in each of the groups was 1/46 (2.2%), 3/13 (23.1%) and 0/4 (0%) respectively (P=0.04). Surgical revision of a SS is an effective treatment for postoperative voiding dysfunction. Both simple division and partial excision of the SS are successful, but simple division carries a lower risk of recurrent SUI. A concomitant SUI procedure at the time of revision may prevent recurrence but may increase the risk of persistent voiding dysfunction.
    European journal of obstetrics, gynecology, and reproductive biology 05/2012; 163(1):113-6. · 1.97 Impact Factor

Publication Stats

549 Citations
171.42 Total Impact Points

Institutions

  • 2014
    • Victoria University Melbourne
      Melbourne, Victoria, Australia
  • 2009–2014
    • Monash University (Australia)
      • • Department of Obstetrics and Gynaecology
      • • Monash Medical Centre
      Melbourne, Victoria, Australia
  • 2013
    • The Commonwealth Scientific and Industrial Research Organisation
      • Division of Materials Science and Engineering
      Canberra, Australian Capital Territory, Australia
  • 2012
    • Medical University of Graz
      Gratz, Styria, Austria
  • 2011
    • Assaf Harofeh Medical Center
      Ayun Kara, Central District, Israel
  • 2010
    • University of Melbourne
      Melbourne, Victoria, Australia
  • 1997–2010
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
    • Royal Women's Hospital in Victoria
      Melbourne, Victoria, Australia
  • 1997–2002
    • Royal Hospital for Women
      Sydney, New South Wales, Australia
  • 1999–2001
    • Prince Henry's Institute
      Melbourne, Victoria, Australia