Anna Rosamilia

Monash University (Australia), Melbourne, Victoria, Australia

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Publications (82)196.39 Total impact

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    ABSTRACT: http://www.ics.org/Abstracts/Publish/241/000426.pdf
    No preview · Conference Paper · Oct 2015
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    Natharnia Young · Joseph Lee · Anna Rosamilia
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    ABSTRACT: Objective: To evaluate lower urinary tract outcomes of eligible women who declined randomization to MiniArc(®) versus Monarc™ (MiniMo) RCT. To explore reasons why eligible women declined participation. Study design: The medical records of 44 women who declined randomization to MiniMo were reviewed. Women had a phone questionnaire at a mean of 2.4 years after surgery (range 1.3-3.9) and asked to document their symptoms at 6 and 12 months after operation, if they had not attended previously. Objective cure was defined as a negative cough stress test. Subjective cure was defined as patient reporting no leak on cough, sneeze or exercise. Outcomes of patients who declined were compared with those who participated in the MiniMo RCT. Women were asked to outline their reasons for declining participation in the MiniMo RCT. Results: Baseline characteristics were similar except for BMI, which was higher in the declined group compared to the randomized group. Subjective cure at 6 months (79% vs. 94%, p=0.01) and 12 months was significantly lower in the declined group (58% vs. 93%, p<0.001). The commonest reason for declining participation in this study was the requirement for additional follow up. Conclusions: Results of RCTs may be overstated compared to standard clinical care as seen in this study.
    Full-text · Article · Oct 2015 · European journal of obstetrics, gynecology, and reproductive biology
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    ABSTRACT: Background: Pelvic organ prolapse (POP) is a multi-factorial disease that manifests as the herniation of the pelvic organs into the vagina. Surgical methods for prolapse repair involve the use of a synthetic polypropylene mesh. The use of this mesh has led to significantly higher anatomical success rates compared to native tissue repairs and, therefore, despite recent warnings by the FDA regarding the use of vaginal mesh, the number of POP mesh surgeries has increased over the last few years. However, mesh implantation is associated with higher post-surgery complications, including pain and erosion, with higher consecutive rates of reoperation when placed vaginally. Little is known on how the mechanical properties of the implanted mesh itself change in vivo. It is assumed that the mechanical properties of these meshes remain unchanged, with any differences in mechanical properties of the formed mesh-tissue complex attributed to the attached tissue alone. It is likely that any changes in mesh mechanical properties that do occur in vivo will impact on the biomechanical properties of the formed mesh-tissue complex. Objectives: To assess changes in the multi-axial mechanical properties of synthetic clinical prolapse meshes implanted abdominally for up to 90 days, using a rat model. To assess the biomechanical properties of the formed mesh-tissue complex following implantation. Study design: Three non-degradable polypropylene clinical synthetic mesh types for prolapse repair (Gynemesh® PS, Polyform Lite™, and Restorelle®) and a partially-degradable polypropylene/polyglecaprone mesh (UltraPro™) were mechanically assessed before and after implantation (n=5/ mesh type) in Sprague Dawley rats for 30 (Gynemesh PS, Polyform Lite, and Restorelle) and 90 (UltraPro and Polyform Lite) days. Stiffness and permanent extension following cyclic loading, and breaking load, of the pre-implanted mesh types, explanted mesh-tissue complexes, and explanted meshes were assessed using a multi-axial (ball-burst) method. Results: The four clinical meshes varied from each other in weight, thickness, porosity, and pore size and showed significant differences in stiffness and breaking load before implantation. Following 30 days implantation, the mechanical properties of some mesh types altered, with significant decreases in mesh stiffness and breaking load, and increased permanent extension. After 90 days these changes were more obvious, with significant decreases in stiffness and breaking load, and increased permanent extension. Similar biomechanical properties of formed mesh-tissue complexes were observed for mesh types of different pre-implant stiffness and structure after 90 days implantation. Conclusion: This is the first study to report on intrinsic changes in the mechanical properties of implanted meshes and how these changes impact on the estimated tissue contribution of the formed mesh-tissue complex. Decreased mesh stiffness, strength, and increased permanent extension following 90 days implantation increase the biomechanical contribution of the attached tissue of the formed mesh-tissue complex more than previously thought. This needs to be considered when using meshes for prolapse repair.
    No preview · Article · Sep 2015 · American journal of obstetrics and gynecology
  • Meirav Braverman · natharnia young · Joseph Lee · Anna Rosamilia
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    ABSTRACT: BACKGROUND: Apical prolapse post hysterectomy is a challenging problem in pelvic floor surgery. Systematic review showed transvaginal mesh kits use gives high anatomical results in restoring apical prolapse.(1) Maher et al, showed laparoscopic sacrocolpopexy had a higher satisfaction rate and objective success rate than a total vaginal mesh with lower perioperative morbidity and reoperation rate (2), but it takes longer to perform and has a significant learning curve.(3) Previous randomized controlled trials compared abdominal sacrocolpopexy to vaginal sacrospinous colpopexy and showed no statistically significant difference between the approaches in regard to prolapse symptoms, but more subjective failure in the vaginal group. (4,5) There is little data comparing laparoscopic sacrocolpopexy with vaginal mesh devices which do not traverse the transobturator foramen. This trial compared the efficacy and morbidity of laparoscopic sacrocolpopexy and Anterior Elevate ® vaginal mesh kit. OBJECTIVE: The aim of this study was to evaluate subjective and objective cure and surgery related complications following laparoscopic abdominal sacrocolpopexy and Anterior Elevate ® mesh. Methods: The design was a prospective cohort trial with an intended follow-up of 2 years. The current follow-up represents the first 6 months. Women with symptomatic apical prolapse post hysterectomy were eligible. Exclusion criteria were BMI >35, women who had ≥ 5 laparotomies, previous sacrocolpopexy and synthetic mesh used for pelvic organ prolapse (POP) in the past. Subjects were allocated to Anterior Elevate ® procedure performed as per manufacturer instructions or laparoscopic sacrocolpopexy. Concomitant continence and posterior vaginal or paravaginal surgery was performed if necessary. Baseline and follow-up assessments included a pelvic examination, Patient Global Impression of Severity (PGI -S) questionnaire, Pelvic Floor Distress Inventory – Short Form 20 (PFDI20) questionnaire, Pelvic Floor Impact Questionnaire – Short Form 7 (PFIQ7) and Pelvic organ prolapse / Urinary incontinence Sexual Questionnaire (PISQ12). Primary outcome was incidence of apical POP> stage 2. Secondary outcomes were incidence of overall POP>stage 2 and an improvement on the Patient Global Impression of Improvement (PGI-I) questionnaire or improvement in relation to baseline questionnaires. Differences between the groups on dichotomous variables were Fisher's exact test; paired t-test was used to compare parametric and Mann Whitney rank test for non-parametric variables. Power calculations were based on one sided α of 0.05 with a 20% difference in primary outcome and an assumption of 10% recurrence rate for laparoscopic sacrocolpopexy with attrition rate of 15%, led to a sample size of 116 subjects. RESULTS: The trial had institutional ethics approval and commenced in December 2011. This trial was prematurely ceased due to very slow recruitment. Factors contributing to this included the FDA notification of vaginal mesh and the introduction of robotic sacrocolpopexy. Twenty women were allocated to Anterior Elevate ® and 17 to sacrocolpopexy (30% of sample size in almost 3 years). Sixteen women from the Anterior Elevate® group and 15 women from the sacrocolpopexy group have completed 6 month follow-up. No significant difference was found between the groups in baseline characteristics (table 1). However, the baseline POP-Q evaluation points Aa and Ba had significantly greater descent in the Anterior Elevate ® group in comparison to the sacrocolpopexy group (p=0.03) whereas the reverse was the case for the posterior wall (p<0.03). There was no significant difference in point C and total vaginal length (TVL) between the groups. The objective cure rate was 100% for apical prolapse, cystocele and rectocele (stage II or less) in both groups. Overall POP (stage II or less) was 100% following both procedures. No significant difference was found between the two groups in regard to the post-operative questionnaire scores, except for the PFDI20, which was significantly higher in the sacrocolpopexy group (p= 0.04) mainly due to the higher scores of the Craig-8 bowel component. Analysis of the questionnaire scores pre and post-operatively, demonstrated significant improvement (p< 0.009) in PFDI-20 score in both groups following surgery. There was significant difference (p= 0.004) in the PFIQ7 score post-operatively only in the sacrocolpopexy group. There was improvement in the PISQ12 scores before and after surgery in both groups which did not reach significance. The median PGI-I score was 1 (= very much better) in both groups. After 6 months follow up there were no mesh complications or repeat surgery. Only one patient from the sacrocolpopexy group had surgical complication (cystotomy which was recognized intra-operative and repaired with no further implication). CONCLUSIONS: At 6-months follow-up, results of comparison between Anterior Elevate ® and sacrocolpopexy were similar in respect to overall cure rate and no significant difference in surgical complications. The study was ceased prematurely due to very slow recruitment.
    No preview · Conference Paper · Aug 2015
  • Natharnia Young · Joseph Lee · Anna Rosamilia
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    ABSTRACT: Introduction: Mid-urethral slings are the gold standard for management of stress incontinence. The newest generation of the mid-urethral sling is the single-incision-sling. These are thought to reduce complications, including bladder, vascular injury and groin pain; with a shorter hospital stay and less postoperative pain. A recent Cochrane review demonstrated that TVT-Secur had inferior results to retropubic and trans-obturator slings and has subsequently been withdrawn. Evidence was insufficient to reveal a difference in incontinence rates with other single-incision slings [1]. In a review of literature only two small studies were found on the Solyx sling. [2,3] Objective: To evaluate short-term patient outcomes from Solyx and MiniArc from a single surgeon’s early experience. Methods: The records of women who were the first cohort to undergo Solyx and MiniArc single incision slings from one surgeon were retrospectively reviewed. Ethics was obtained; baseline demographics recorded, urodynamic assessment and results from the bladder section of the Australian female pelvic floor questionnaire collected pre-operatively and at 6 month review. Objective cure was defined as negative cough stress test with a comfortably full bladder and Subjective cure was defined, as patient reported cure or marked improvement in leaking with cough or exercise. Both slings were inserted as per manufacturers instructions and tensioned to snug. Statistical analysis was performed using Graphpad Prism. Continuous data was analyzed using t-test for parametric and Mann-whitney U for non-parametric data. Categorical data was analyzed using chi-square. Results: Twenty-four women had MiniArc and 21 had Solyx implanted for urodynamic stress incontinence. Baseline demographics demonstrated no significant difference between groups; median stress incontinence episodes were daily in both groups and no significant difference in baseline urinary frequency, nocturia, urgency and UUI, impact and bother (Table 1). At 6 months there was excellent objective and subjective cure with no significant difference (Table 2). Two early failures were seen in the Solyx group both receiving a retropubic sling within 6 months for ongoing stress incontinence. One woman who had MiniArc reported no improvement and had a positive cough stress test and later had a retropubic sling implanted. All three patients had an increased BMI of 28, 30 and 33. There were no bladder perforations and no mesh exposures. There was one vaginal sulcus perforation in MiniArc recognized and managed intra-operatively. In the Solyx group one patient initially had high PVR, this was managed conservatively and spontaneously resolved. Conclusion: Early objective cure appears equal in the MiniArc and Solyx single incision slings. Patient reported incontinence episodes was significantly lower in the Solyx slings; further long-term and large randomized controlled trials are required to ensure equal efficacy with standard mid-urethral slings. References: [1] Nambiar A, Cody JD, Jeffery ST. Single-incision sling operations for urinary incontinence in women. Cochrane Database of systematic Reviews 2014, Issue 6 [2] Serels, S, Douso, M, Short, G. Preliminary findings with the Solyx single-incision sling system in female stress urinary incontinence. Int Urogynecol J (2010) 21:557-561 [3] Serels S, Douso M. Long term follow up of the solyx single incision sling in the treatment of female stress urinary incontinence. Open Journal of Urology, 2014, 4, 13-17
    No preview · Conference Paper · Jun 2015
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    ABSTRACT: to evaluate objective and subjective outcomes of MiniArc and Monarc midurethral sling (MUS) in women with stress incontinence at 12 months STUDY DESIGN: 225 women were randomized to receive MiniArc or Monarc. Women with intrinsic sphincter deficiency, previous MUS or untreated detrusor overactivity were excluded. Objective cure was defined as negative cough stress test (CST) with a comfortably full bladder. Subjective cure was defined as no report of leakage with coughing or exercise on questionnaire. Validated questionnaires, together with urodynamic and clinical cough stress test were used to evaluate objective and subjective outcomes following surgery. Participants and clinicians were not masked to treatment allocation. Outcomes were compared with exact binomial tests (e.g. Fischer's Exact test for dichotomous data) for categorical data and Student t tests or exact versions of Wilcoxon tests for numerical data as appropriate. There was no statistically significant difference in the subjective (92.2% vs 94.2%, p=0.78; difference 2.0%, 95%CI[-2.7%, +6.7%]) or objective (94.4% vs 96.7%, p=0.50; difference 2.3%, 95%CI[-1.5%, +6.1%]) cure rates between MiniArc and Monarc at 12m respectively, with a significant improvement in overactive bladder outcomes and incontinence impact from baseline in both arms. MiniArc outcomes are not inferior to Monarc MUS outcomes at 12 months follow up in women without intrinsic sphincter deficiency. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jan 2015 · American Journal of Obstetrics and Gynecology
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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.
    Full-text · Article · Nov 2014 · Acta Biomaterialia
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    ABSTRACT: Objective 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. Study Design Vaginal tissue was collected from ovariectomised sheep (n = 6) and from postmenopausal women (n = 7) from the proximal, middle and distal thirds. Tissue histology was analyzed using Masson's Trichrome staining; total collagen was quantified by hydroxyproline assays, collagen III/I+III ratios by delayed reduction SDS PAGE, glycosaminoglycans by dimethylmethylene blue assay, and elastic tissue associated proteins (ETAP) by amino acid analysis. Young's modulus, maximum stress/strain, and permanent strain following cyclic loading were determined in ovine vagina. Results Both sheep and human vaginal tissue showed comparable tissue composition. Ovine vaginal tissue showed significantly higher total collagen and glycosaminoglycan values (p<0.05) nearest the cervix. No significant differences were found along the length of the human vagina for collagen, GAG or ETAP content. The proximal region was the stiffest (Young's modulus, p<0.05), strongest (maximum stress, p<0.05) compared to distal region, and most elastic (permanent strain). Conclusion Sheep tissue composition and mechanical properties showed regional differences along the postmenopausal vaginal wall not apparent in human vagina, although the absolute content of proteins were similar. Knowledge of this baseline variation in the composition and mechanical properties of the vaginal wall will assist future studies using sheep as a model for vaginal surgery.
    Full-text · Article · Aug 2014 · PLoS ONE
  • Kristina Cvach · Peter Dwyer · Anna Rosamilia · Yik Lim · Lore Schierlitz
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    ABSTRACT: Introduction and hypothesis: 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. Methods: This was a prospective study of planned surgical management of women with a large pelvic mass (uterine or ovarian mass ≥ 7 cm on pelvic ultrasound) who also reported bothersome LUTS (urinary frequency, urgency, incontinence and/or voiding dysfunction). Assessment included structured history and examination, completion of the short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), a 3-day bladder diary and multi-channel urodynamics (UDS) at baseline and 3 months postoperatively. The primary outcome was a reduction in the total mean scores of the UDI-6 and IIQ-7. Secondary outcomes were a change in bladder diary and UDS parameters. Univariate analysis and paired t test were used in the statistical analysis. Results: Twenty-nine women underwent surgical management of a pelvic mass. The most common preoperative urinary symptom was urinary urgency. Two women had overt urinary retention that resolved completely postoperatively. All women completed pre- and postoperative UDI-6 and IIQ-7. The UDI-6 and IIQ-7 demonstrated a highly significant reduction in the mean total scores of 66%, signifying symptom and quality of life improvement. Bladder diary parameters showed significant reductions in daytime urinary frequency and stress incontinence episodes. Maximum and average voided volumes increased by a mean of 60 ml. Only 14 women underwent postoperative UDS. Conclusions: This study provides evidence that the majority of LUTS present preoperatively improve significantly or resolve completely following removal of a ≥ 7-cm pelvic mass.
    No preview · Article · Jul 2014 · International Urogynecology Journal
  • J. Lee · A. Rosamilia · P. Dwyer · Y. N. Lim · D. Ulrich

    No preview · Article · Jul 2014 · International Urogynecology Journal
  • J. Alvarez · L. Schierlitz · P. Dwyer · A. Rosamilia · C. Murray · J. Lee

    No preview · Article · Jul 2014 · International Urogynecology Journal
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    D Ulrich · K S Tan · J Deane · K Schwab · A Cheong · A Rosamilia · C E Gargett
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    ABSTRACT: STUDY QUESTION Does post-menopausal endometrium contain mesenchymal stem/stromal cells (MSC) that have adult stem cell properties and can be prospectively isolated from a biopsy? SUMMARY ANSWER Perivascular W5C5+ cells isolated from post-menopausal endometrial biopsies displayed characteristic MSC properties of clonogenicity, multipotency and surface phenotype irrespective of whether the women were or were not pre-treated with estrogen to regenerate the endometrium. WHAT IS KNOWN ALREADY Recently MSCs have been identified in human premenopausal endometrium, and can be prospectively isolated using a single marker, W5C5/SUSD2. STUDY DESIGN, SIZE, DURATION Endometrial tissue of both the functional and basal layers, from 17 premenopausal (pre-MP) women, 19 post-menopausal (post-MP) women without hormonal treatment and 15 post-menopausal women on estrogen replacement therapy (post-MP+ E2), was collected through a prospective phase IV clinical trial over 2 years. PARTICIPANTS/MATERIALS, SETTING, METHODS Post-menopausal women
    Full-text · Article · Jun 2014 · Human Reproduction
  • D Ulrich · KS Tan · K Schwab · A Cheong · A Rosamilia · CE Gargett

    No preview · Article · Jun 2014 · Geburtshilfe und Frauenheilkunde
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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.
    Full-text · Article · Apr 2014 · PLoS ONE
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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.
    Full-text · Article · Feb 2014 · Australian and New Zealand Journal of Obstetrics and Gynaecology
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    Daniela Ulrich · Peter Dwyer · Anna Rosamilia · Yik Lim · Joseph Lee
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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.
    Full-text · Article · Jan 2014 · Neurourology and Urodynamics
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    K L Shek · V Wong · J Lee · A Rosamilia · A J Rane · H Krause · J Goh · H P Dietz
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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.
    Full-text · Article · Dec 2013 · Ultrasound in Obstetrics and Gynecology
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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.
    No preview · Article · Nov 2013 · International Urogynecology Journal
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    ABSTRACT: Background: Pelvic organ prolapse (POP) 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 POP 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 (TE) approach to assess the in vivo biological and biomechanical behavior 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 (eMSC) 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 labeled 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 labeled cells detected on the mesh up to 14 days postimplantation. Meshes with cells promoted significantly more neovascularization 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 than those without cells, after 7 and 90 days implantation. Conclusion: The TE approach used in this study significantly reduced the number of inflammatory cells around the implanted mesh and promoted neovascularization. Seeding with 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 POP.
    Full-text · Article · Oct 2013 · Tissue Engineering Part A
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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.
    Full-text · Article · Sep 2013 · International Urogynecology Journal

Publication Stats

956 Citations
196.39 Total Impact Points

Institutions

  • 2009-2015
    • Monash University (Australia)
      • • Department of Obstetrics and Gynaecology
      • • Monash Medical Centre
      Melbourne, Victoria, Australia
    • University of Vic
      Vic, Catalonia, Spain
  • 2014
    • Monash Health
      Melbourne, Victoria, Australia
  • 1997-2013
    • Royal Melbourne Hospital
      • Department of Radiology
      Melbourne, Victoria, Australia
  • 2009-2010
    • University of Melbourne
      Melbourne, Victoria, Australia
  • 1997-2002
    • Royal Hospital for Women
      Sydney, New South Wales, Australia
  • 2001
    • Prince Henry's Institute
      Melbourne, Victoria, Australia