Full Text Available The aim of this study was to compare the clinical outcomes of anti-incontinence surgeries employing the transobturator sling and single-incision sling (SIS. Our hypothesis is that the outcome of the SIS is not inferior to the obturator sling. This retrospective study reviewed the medical records of patients who underwent anti-incontinence surgery with the transobturator sling or SIS from July 2005 to November 2014. Patients who underwent concomitant pelvic organ reconstruction with an artificial mesh were excluded. Assessments included preoperative and postoperative urodynamic examinations, perioperative complications, and postoperative urogenital symptoms. A total of 122 women were recruited according to the inclusion and exclusion criteria. Among them, 68 patients underwent transobturator sling procedures while 54 patients underwent SIS procedures. The subjective failure rate of the transobturator sling and SIS were 10.2% and 18.5%, respectively (p = 0.292. The objective failure rate, defined as a pad test showing more than 2 g of urine, was 10.2% for the transobturator sling and 12.9% for the SIS (p = 0.777. SIS resulted in less blood loss, operative time, length of hospital stay, and transient voiding dysfunction after the operation. No major complication occurred after either surgical intervention. In conclusion, SIS and transobturator slings might have similar efficacy, safety, and effects on new-onset urogenital symptoms.
D. D. Shkarupa
Full Text Available Introduction. The optimal tension of suburethral tape is an important component of effectiveness and safety of the surgery. By now, there is no common standardized guidance on the tensioning of the sling. There is a limited number of publications, devoted to adjustable systems with the ability to correct tape tension in postoperative period. To evaluate the effectiveness of this method, the long-term results of postoperative adjustment of the sling are necessary.Aim. To evaluate the results of complicated stress urinary incontinence (SUI surgical treatment using a transobturator adjustable sling Urosling (Lintex.Materials and methods. The study included 89 women with complicated SUI. All patients underwent the transobturator adjustable midurethral tape placement. The tension adjustment was performed during 3 days after surgery. Postoperative evaluation included vaginal examination, cough stress test, 1-h Pad-test, uroflowmetry, bladder ultrasound and post-void residual (PVR urine measurement, validated questionnaires (UDI-6, UIQ-7, ICIQ-SF, PICQ-12 and visual analogue scale (VAS.Results. Mean operative time was 15.74±7.49 min. The tension adjustment was performed in 45.0% (40/89 patients the next day after surgery. On the second day tension re-adjustment was required in 14,6% (13/89 patients. In 3.4% (3/89 women the tension was also tuned on the 3 day. The loosening of the sling was needed in 13.5% (12/89 patients. After adjustment, all patients were continent without any signs of bladder outlet obstruction (BOO. Mean follow-up was 14.3±2.1 months. The objective cure rate was 92.9%. There was no statistically significant difference in the urodynamic parameters. Assessment of patient satisfaction showed that 95.2% (80/84 of the patients were «very» or «very» satisfied.Conclusion. The adjustable transobturator suburethral tape Urosling allows to achieve high effectiveness of treatment in female patients with complicated SUI and to reduce the
King, A B; Tenggardjaja, C; Goldman, H B
Transobturator slings have higher rates of de novo neurologic symptoms than retropubic slings, most commonly related to the thigh. Cases refractory to conservative management may require removal of the thigh portion of the sling. In this series we prospectively examine the effect of thigh dissection with mesh removal on refractory thigh pain. All thigh dissections for refractory neurologic symptoms after transobturator sling placement were followed prospectively from October 2012 to October 2015. Patients were assessed preoperatively, with a pain score using a visual analog scale, and postoperatively with a global response assessment. A total of 12 thigh dissections were performed from October 2012 to October 2015 in 8 patients. Mean (±SD) time from original mesh placement to presentation was 2.7 (±1.5) years. Average preoperative pain score was 7.9 (±1.7) out of 10, with pain in the thigh in all patients. Seven cases involved unilateral thigh dissection and 1 had concomitant bilateral thigh dissection. Five patients underwent concurrent transvaginal excision. On postoperative evaluation the average global response rating was 1.6, with 1 defined as very much better and 2 defined as much better. Of the 8 patients 3 went on to have the contralateral side done with an average global response rating of 1.3 (±0.6). One patient underwent further treatment for stress urinary incontinence with placement of a retropubic mid urethral sling. Our prospective series supports the use of thigh dissection in patients with refractory neurologic symptoms after transobturator sling placement. The procedure can be performed safely with positive outcomes for the patient. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Andrea Lopes Salzedas Tanuri
Full Text Available OBJETIVO: Comparar resultados das técnicas de "sling" retropúbico e transobturador para o tratamento de mulheres com incontinência urinária de esforço (IUE. MÉTODOS: Foram randomizadas 30 pacientes, sendo que 20 se submeteram ao sling retropúbico e 10 ao transobturador. As pacientes foram avaliadas antes e após o tratamento com um, seis e 12 meses, por meio de história clínica, exame físico, questionário de qualidade de vida ("King's Health Questionnaire", teste do absorvente e avaliação urodinâmica. Os grupos foram homogêneos no pré-operatório. RESULTADOS: Houve melhora significante na avaliação da qualidade de vida em ambos os grupos após a terapêutica, sem diferença entre os grupos. Houve diminuição no peso do absorvente para os dois grupos. As taxas de cura pela avaliação urodinâmica em 12 meses foram de 84,2% para o grupo transobturador e 88,8% para o retropúbico. Da mesma forma, a cura subjetiva foi de 85% e 88,8%, respectivamente. Não observamos diferenças entre os grupos consoante as complicações. CONCLUSÃO: As cirurgias deste sling, pelas vias retropúbica e transobturadora, foram eficazes para o tratamento de mulheres com IUE, no seguimento de 12 meses. Observamos elevada taxa de cura e melhora da qualidade de vida com baixos índices de complicações.OBJECTIVE: The aim of this study was to compare results of retropubic and transobturator sling for surgical treatment of female stress urinary incontinence (SUI. METHODS: Thirty randomized patients with SUI were divided in two groups, twenty who underwent the transobturator sling and ten the retropubic sling procedure. .Patients were assessed before and after one, six and twelve months of treatment by clinical history, physical examination, quality of life questionnaire (King's Health Questionnaire, pad test and urodynamic parameters. At preoperative both groups were homogenous. RESULTS: One year after surgery, incontinence and quality of life
Full Text Available ABSTRACTPurpose:To compare transobturator midurethral sling (TOS and single-incision sling procedures in terms of their effects on urinary incontinence and the quality of life in overweight (BMI ≥25-29.9 kg/m2 female patients using the International Consultation on Incontinence Questionnaire scoring form (ICIQ-SF and Quality of Life of Persons with Urinary Incontinence scoring form (I-QOL.Materials and Methods:In this prospective trial, the patients were divided into two groups consecutively; first 20 overweight female patients underwent the TOS (Unitape T®,Promedon, Cordoba, Argentina procedure and the subsequent 20 consecutive overweight female patients underwent the single-incision sling [TVT-secur (Ethicon Inc., Sommerville, USA] procedure. Age, urinary incontinence period, parity and daily pads usage were recorded. No usage of pads was defined as subjective cure rate postoperatively. Before the operation and 6. month after the surgery, the patients completed the ICIQ-SF and I-QOL.Results:There was no significant difference between the two groups in terms of mean age, duration of incontinence, parity, and BMI (p>0.05. ICIQ-SF and I-QOL revealed that the patients in the TOS group showed significantly better improvement (76.20% versus 64.10%, p=0.001, 81.31% versus 69.28%, p=0.001, respectively. In addition, subjective cure rates were found higher in TOS group (75% versus 55%, p=0.190.Conclusions:The existing data is showed that incontinence symptoms and the quality of life have higher improvement in overweight female patients who underwent the TOS procedure. It is likely that the TOS procedure may provide stronger urethral support and better contributes to continence in this group of patients.
Seklehner, Stephan; Laudano, Melissa A; Te, Alexis E; Kaplan, Steven A; Chughtai, Bilal; Lee, Richard K
To compare the cost-effectiveness (CE) of retropubic midurethral sling (RMS) versus transobturator midurethral sling (TMS) for the treatment of female stress urinary incontinence (SUI). A Markov chain decision model was created to simulate treatment of SUI with RMS versus TMS. Costing data were obtained from the Medicare RBRVS. Data regarding the efficacy and complications associated with RMS versus TMS was compiled from a literature review of 21 randomized RCTs with a minimum of 12 months follow-up, as were corresponding utilities for different continence states. Deterministic and probabilistic estimates of cost-effectiveness (CE) for each procedure were calculated and compared, and sensitivity analyses were performed. In the base-case deterministic analysis, the efficacy of RMS was 6.275 versus 6.272 QALYs for TMS. QALYs represent a measure of disease burden accounting for both quantity and quality of life lived and are used to assess the monetary value of a medical intervention. The average cost for treatment with RMS however was higher at $9,579 versus $9,017 with TMS. TMS was therefore overall more cost-effective than RMS (CE = $1,438/QALY vs. $1,527/QALY). Sensitivity analysis demonstrated that physician and sling characteristics such as device cost, surgeon fee, efficacy of treatment, operative time, and duration of hospitalization could all affect the relative CE of the therapies. Our study demonstrated that TMS was more cost-effective than RMS as a treatment for female SUI. The efficacy of the two treatments could be affected by physician and sling characteristic factors. © 2013 Wiley Periodicals, Inc.
Full Text Available Chailee F Moss,1 Lynn A Damitz,2 Richard H Gracely,3 Alice C Mintz,3 Denniz A Zolnoun,2–4 A Lee Dellon5 1Department of Obstetrics and Gynecology, Ohio State University School of Medicine, Columbus, OH, USA; 2Department of Surgery, University of North Carolina at Chapel Hill, NC, USA; 3Department of Endodontics, University of North Carolina at Chapel Hill, NC, USA; 4Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; 5Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA Introduction: Transobturator slings can be successfully used to treat stress urinary incontinence and improve quality of life through a minimally invasive vaginal approach. Persistent postoperative pain can occur and pose diagnostic and therapeutic dilemmas. Following a sling procedure, a patient complained of pinching clitoral and perineal pain. Her symptoms of localized clitoral pinching and pain became generalized over the ensuing years, eventually encompassing the entire left vulvovaginal region.Aim: The aim of this study was to highlight the clinical utility of conventional pain management techniques used for the evaluation and management of patients with postoperative pain following pelvic surgery. Methods: We described a prototypical patient with persistent pain in and around the clitoral region complicating the clinical course of an otherwise successful sling procedure. We specifically discussed the utility of bedside sensory assessment techniques and selective nerve blocks in the evaluation and management of this prototypical patient. Results: Neurosensory assessments and a selective nerve block enabled us to trace the source of the patient’s pain to nerve entrapment along the dorsal nerve of the clitoris. We then utilized a nerve stimulator-guided hydrodissection technique to release the scar contracture Conclusion: This case
Lau, Hui-Hsuan; Su, Tsung-Hsien; Huang, Wen-Chu; Hsieh, Ching-Hung; Su, Chin-Hui; Chang, Rhu-Chu
The transobturator suburethral sling is a common surgical treatment for stress urinary incontinence (SUI). In patients with incontinence after trocar-guided transvaginal mesh repair (Prolift), data on outcome remain limited. In the present study, we hypothesized that transobturator tape in such cases is assumed to be as effective as surgery alone. This was a prospective analysis of outcomes of transobturator slings in women who had undergone transvaginal mesh repair and in those who underwent sling surgery alone (controls). Objective cure was defined as the absence of urinary leakage during the stress test at filling cystometry and a negative cough test during pelvic examination. The success rates were evaluated 3-6 months postoperatively. One hundred women were recruited for the study. Compared to the control group, women after transvaginal mesh repair had a significantly lower objective success rate (62 vs 86%, p = 0.005) and poorer bladder neck mobility (0.5 ± 0.8 vs 1.1 ± 0.5 cm, p = 0.001). The transobturator sling has lower objective success rate in women after transvaginal mesh that may be due to decreased bladder neck mobility. Patients with post-mesh repair SUI who opt for sling surgery should be informed of these less satisfactory outcomes during preoperative counseling.
Chang Hee Kim
Full Text Available Purpose: Despite reports of persistent stress urinary incontinence (SUI in patients after the midurethral sling (MUS procedure, there is no widely accepted definition or cause of the condition. In many cases, the mesh implanted in the previous MUS procedure has been found to have migrated proximally. The aim of this study was to evaluate the efficacy of the modified distal urethral polypropylene sling, or canal transobturator tape (TOT, procedure for persistent SUI after a conventional MUS procedure on the assumption that persistent SUI after MUS is due to the location of the sling. Methods: From January 2008 to April 2012, 31 female patients who underwent the canal TOT procedure presented with incontinence or lower urinary tract symptoms (LUTS were included in this study. We identified patients who had been operated on by use of the conventional MUS procedure at other medical facilities, whose Valsalva leak pressure point was less than 120 cm-H2O by urodynamic study, and who were also diagnosed with persistent SUI. If vaginal or urethral mesh exposure was concomitant with persistent SUI, the mesh was removed completely or in part. Surgical procedures for canal TOT were identical to the original TOT procedures, except in the number and location of the vaginal incisions. Incontinence Impact Questionnaire-Short Form (IIQ-7 and Urogenital Distress Inventory-Short Form (UDI-6 scores were assessed preoperatively and at 3 months postoperatively. Results: There were no intraoperative or postoperative complications. Twenty-eight patients (90.3% showed improvement in incontinence or other LUTS. Postoperative scores of the IIQ-7 (0.65±0.48 and UDI-6 (3.48±2.28 were significantly improved compared with preoperative scores (1.26±0.58 and 7.52±4.30, respectively; P<0.05. Conclusions: Improper sling location is one of the major causes of persistent SUI after the conventional MUS procedure. Our results demonstrate that canal TOT may be an alternative
Houwert, R. Marijn; Venema, Pieter L.; Aquarius, Annelies E.; Bruinse, Hein W.; Roovers, Jan Paul W. R.; Vervest, Harry A. M.
OBJECTIVE: The aim of our study was to identify and compare risk factors for failure of retropubic and transobturator procedures. STUDY DESIGN: This was a retrospective cohort study. Women with predominant stress urinary incontinence who underwent a retropubic (n = 214) or transobturator tape
Nazura Bt Karim
Full Text Available Minimally invasive suburethral slings, namely the retropubic suburethral sling or the tension-free vaginal tape (TVT, has become the mainstay for surgical management of moderate to severe stress urinary incontinence (SUI taking over the place of Burch's colposuspension after its introduction in the 1990s. Following the introduction of retropubic sling procedures are the transobturator (TVT-O procedures and the mini-sling procedures. This review attempts to summarize the current trend of midurethral sling (MUS procedures in the management of SUI.
Ryan M Krlin
Full Text Available The advent of the mid-urethral sling (MUS 15 years ago has drastically changed the surgical management of stress urinary incontinence (SUI. Both retropubic and transobturator MUS can be placed in the ambulatory setting with excellent results. The tension-free vaginal tape (TVT sling has the most robust and long-term data, but more recent literature suggests that the transobturator tape sling may offer comparable efficacy in appropriately selected patients. Single incision sling (SIS is the newest addition to the MUS group and was developed in an attempt to minimize morbidity and create an anti-incontinence procedure that could be performed in the office. The efficacy of SIS remains unknown as the current literature regarding SIS lacks long-term results and comparative trials. The suprapubic arc sling appears to have equally effective outcomes in at least the short-term when compared with TVT. Although evolution of the SIS has led to a less invasive procedure with decreased post-op pain and reduced recovery time, durability of efficacy could be the endpoint we are sacrificing. Until longer-term data and more quality comparison trials are available, tailoring one′s choice of MUS to the individual patient and her unique clinical parameters remains the best option.
Full Text Available Abstract Backround The transobturator tape procedure (TOT is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions. Methods It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris®, Obtape®, TVT-O®. Follow-up information was available for 225 (96.6% women. Results There were few per operative complications. Forty-eight women (21.3% reported late complications including de novo or worsening of preexisting urgencies (10.2%, perineal pain (2.2%, de novo dyspareunia (9%, and vaginal erosion (7.6%. The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris®, Obtape® and TVT-O® respectively (P = 0.001. The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4% compared to women who did not (78.4% (RR 0.14, 95% CI 0.05-0.38, P Conclusion Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.
Shaw, Jonathan S; Jeppson, Peter C; Rardin, Charles R
Groin pain following a transobturator (TO) midurethral sling is not uncommon and can be difficult to manage. We sought to determine if decreasing the mesh burden in the groin would decrease pain. The primary objective was to compare the incidence of post-operative groin pain following placement of full-length TVT-Obturator versus the shorter TVT-Abbrevo. Secondarily, we aimed to compare the efficacy between both devices 6 months after surgery. This is a retrospective cohort study of all women who underwent a TO midurethral sling by the division of urogynecology at one institution between 1 January 2007 and 31 October 2013. Charts were reviewed and the incidence of post-operative groin pain in the two groups dichotomized as present or absent and compared using a Chi-squared test. Validated questionnaire scores of the groups were compared using t tests. There were 125 patients who received a TVT-Obturator and 100 patients who received a TVT-Abbrevo. No differences in demographic data were present between the groups. Twelve patients (9.6 %) in the TVT-Obturator group and 1 patient (1 %) in the TVT-Abbrevo group experienced bothersome groin pain (P value = 0.007). The complete pre- and 6-month post-operative ISI, UDI-6 and PFIQ-7 scores were available for 76 (61 %), 47 (38 %), and 45 (36 %) patients following TVT-Obturator and 57 (57 %), 30 (30 %), and 28 (28 %) following TVT-Abbrevo treatment. At 6 months the mean improvement in questionnaire scores for the TVT-Obturator and TVT-Abbrevo groups were as follows: 5.0 and 5.1 for ISI (P value = 0.9), 8.3 and 7.9 for UDI-6 (P value = 0.8), and 4.8 and 6.1 for PFIQ-7 (P value = 0.4). Use of TVT-Abbrevo reduces post-operative groin pain compared with the full-length TVT-Obturator, without any reduction in efficacy.
Full Text Available OBJECTIVE: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI. MATERIALS AND METHODS: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT or transobturator tape (TOT. They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6 and the impact of incontinence on quality of life (IIQ-7 questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS. Preoperative VLPP was correlated with primary and secondary outcome variables. RESULTS: Mean follow-ups were 32 + 12 months (range 12-55 for TVT and 31 + 15 months (range 12-61 for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5% patients showed a VLPP > 60 cm H2O and 50 (34.5% patients had a VLPP 60 cm H2O and 72% for those with VLPP 60 cm H2O (82 % vs. 68.9% p of 60 cm H2O, preoperative VLPP was not linked to outcome after TVT or TOT procedures.
Full Text Available Objective: To report the objective outcome, subjective measurement of incontinence-related quality of life (QoL for female urodynamic stress incontinence (USI after transobturator sling surgery (TVT-O and to evaluate the effects of surgical failure and complications on QoL. Materials and methods: We analyzed the data from women who underwent TVT-O for USI and completed two validated QoL questionnaires, the Urogenital Distress Inventory (UDI-6 and Incontinence Impact Questionnaire (IIQ-7 preoperatively and at least 12 months postoperatively. We evaluated the subjective results of QoL questionnaires, objective results and compare the effect of QoL on those with surgical failure and complications after TVT-O surgery. Results: A total of 78 women were followed for a median of 13.5 months (range 12–15 months after surgery. Within this group, 75 (96% were considered subjectively cured or improved after TVT-O. There were significant improvements in the IIQ-7 and total UDI-6 scores postoperatively, as well as in the UDI-6 subscales for urge, stress and voiding dysfunction symptoms. Even the 18 women with objective urodynamic failure had significant improvement in QoL scores. For those with surgical related complications, the QoL scores were also significantly improved. Conclusions: TVT-O for USI resulted in improvement of incontinence-related QoL including urgency, stress, and voiding dysfunction symptoms. Surgical failure and complications didn't impair postoperative QoL. Keywords: Complication, Quality of life, Stress urinary incontinence, Transobturator tape, Urodynamic stress incontinence
Chang, Chia-Pei; Chang, Wen-Hsun; Hsu, Yen-Mei; Chen, Yi-Jen; Wen, Kuo-Chang; Chao, Kuan-Chong; Yen, Ming-Shyen; Horng, Huann-Cheng; Wang, Peng-Hui
To investigate the effectiveness and safety of a new single-incision mini-sling (SIMS)-Ajust-compared with the standard transobturator midurethral sling (SMUS)-Align-for the treatment of female stress urinary incontinence (SUI). A retrospective cohort study was conducted between January 1, 2010 and August 31, 2012. Women with SUI who underwent either SMUS-Align or SIMS-Ajust were recruited. The primary outcomes included operation time, estimated operative blood loss, postoperative pain, and complications. The secondary outcomes included subjective and objective success, defined as an International Consultation on Incontinence Questionnaire (ICIQ) score of 0 or improvement as felt by the patient and a long-term complication, such as dyspareunia and mesh erosion after 6 months and 12 months of follow-up. A total of 136 patients were enrolled, including 76 receiving SMUS-Align and 60 receiving SIMS-Ajust. Baseline characteristics of the patients in both groups were similar, without a statistically significant difference. Primary outcomes between both groups were similar, except that women treated with SIMS-Ajust had statistically significantly shorter operation time (p = 0.003), less intent to treat (p < 0.05), and earlier postoperative discharge (p = 0.001) than women treated with SMUS-Align. Secondary outcomes were similar without a significant difference between the two groups (93% vs. 88% success rate in each group). Our results showed that SIMS-Ajust was not inferior to SMUS-Align with respect to success rate, and might have a slight advantage in early discharge. A long-term follow-up or prospective study is needed to confirm the above findings. Copyright © 2015. Published by Elsevier B.V.
Reynolds, W Stuart; Kit, Laura Chang; Kaufman, Melissa R; Karram, Mickey; Bales, Gregory T; Dmochowski, Roger R
Groin pain after transobturator synthetic mesh placement can be recalcitrant to conservative therapy and ultimately requires surgical excision. We describe our experiences with and technique of obturator foramen dissection for mesh excision. The records of 8 patients treated from 2005 to 2010, were reviewed. Obturator dissection was performed via a lateral groin incision over the inferior pubic ramus at the level of the obturator foramen, typically in conjunction with orthopedic surgery. Five patients had transobturator mid urethral sling surgery for stress urinary incontinence, 2 had mid urethral sling and trocar based anterior vaginal wall mesh kits with transobturator passage of mesh arms for stress urinary incontinence and pelvic organ prolapse, and 1 had an anterior vaginal wall mesh kit for pelvic organ prolapse. Patients had 0 to 2 prior transvaginal mesh excisions before obturator surgery. All patients presented with intractable pain in the area of the obturator foramen and/or medial groin for which conservative treatment measures had failed. Six patients underwent concurrent vaginal and obturator dissection and 2 underwent obturator dissection alone. In all cases residual mesh (3 to 11 cm) was identified and excised from the obturator foramen. Mesh was closely associated to or traversing the adductor longus muscle and tendon with significant fibrous reaction in all cases. Postoperatively 5 patients were cured of pain and/or infection, and 3 reported no or some improvement at a mean followup of 6 months (range 1 to 12). Our experience suggests that surgical excision of residual mesh can alleviate many of the symptoms in many patients. In all cases mesh remnants were identified and removed, and typically involved neuromuscular structures adjacent to the obturator foramen. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Transversal incision of the vagina favors the remaining of the tape in the middle-third urethra compared to longitudinal incision during transobturator sling procedures for stress urinary incontinence.
Pirtea, L; Sas, I; Ilina, Razvan; Grigoraș, D; Mazilu, O
To describe a new type of incision of the vagina during transobturator sling procedure and to evaluate by ultrasound the tape position at 3, 6 and 12 months after surgery. We conducted a prospective study including 51 patients with urinary stress incontinence who underwent sling procedure using the transversal vaginal incision. Tape position was evaluated by ultrasound at 3, 6 and 12 months after surgery and expressed as a percentage of the urethral length (the proximal third of the urethral length 0-39 %, the middle third 40-60 %, and the distal third 60-100 %). Informed consent was obtained from all patients prior to their inclusion in the study. All procedures have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and were approved by the Institutional Review Board and Ethical Committee of "Victor Babeş" University of Medicine and Pharmacy Timisoara before the beginning of the study (no 7/17.04.2012). At 3 months after surgery, 3.92 % of the slings were located in the proximal third of the urethra, 88.23 % in the middle third of the urethra and 7.84 % in the distal third. At 6 and 12 months after surgery we obtained similar results: 9.81 % of the slings were located in the proximal third of the urethra, 82.35 % in the middle third and 7.84 % in the distal third of the urethra. The transversal incision of the vagina offers a minimal dissection along the long axis of the urethra favoring the remaining of the tape in the middle third of the urethra.
Martinez Franco, Eva; Amat Tardiu, Lluís
This study compared transobturator tension-free vaginal tape (TVT-O®) and Contasure-Needleless (C-NDL®) at long-term follow-up . Non-inferiority, prospective, single-centre , quasi-randomised trial started in September 2006 and finished in April 2011 to compare C-NDL® with transobturator vaginal tape (TVT-O®) mesh in the treatment of stress urinary incontinence (SUI) . Epidemiological information, intraoperative and postoperative complications, subjective estimates of blood loss and pain levels were recorded. We also analysed the postoperative stress test, the subjective impression of improvement using the Sandvik Severity Index and the quality of life during follow-up using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) . Two hundred and fifty-seven women with primary SUI were scheduled to receive TVT-O® or C-NDL® and were followed up at least 3 years after the procedure . One hundred and eleven women in the C-NDL® group (84.7%) had a negative stress test, compared with 54 women (88.9%) in the TVT-O® group (p = 0.0065 for the non-inferiority test). The postoperative Sandvik Severity Index was 0 or better than the preoperative score in 90.7% of patients in the C-NDL® group and 95.4% of patients in the TVT-O® group (p = 0.0022). The complication rate was similar in both groups. There were significant differences (p = 0.02) in postoperative pain within the TVT-O® group. The degree of satisfaction was not statistically significant between the two groups. The outcomes for the C-NDL® group were similar to those of the TVT-O® group, adding the concept of "single incision tape" to the tension-free sling option.
Gaber, Mohamed E; Borg, Tamer; Samour, Hazem; Nawara, Mai; Reda, Ahmed
The aim of this study was to compare the outcome of two single-incision mini-slings (the Contasure-Needleless [C-NDL] and the endopelvic free anchorage) with the standard midurethral transobturator tension-free vaginal tape (TVT-O) procedure. A double blind randomized controlled study was conducted at Ain Shams University Maternity Hospital from August 2014 until July 2015. A total of 209 patients were randomized into three groups. The first group underwent the TVT-O procedure, the second group underwent the endopelvic free anchorage procedure and the third group underwent the C-NDL procedure. Patients were followed up for 12 months in terms of subjective cure, objective cure, and complications rate. After 12 months of follow-up, there were no differences among the three groups in terms of objective cure rate, subjective cure rate, patient satisfaction, or incidence of complications (de novo urge, hemorrhage, infection, and mesh erosion). The C-NDL was associated with a shorter operative time (P < 0.001) and less blood loss (P = 0.021) than the standard TVT-O. The new single-incision mini-slings showed similar efficacy and patient acceptance to that of the standard TVT-O for up to 12 months postoperatively with no difference in the complications rate. The C-NDL is associated with shorter operative time and less blood loss. © 2016 Japan Society of Obstetrics and Gynecology.
Kim, Tae-Hee; Lee, Hae-Hyeog; Kim, Jun-Mo
We report on a patient who underwent total vaginal hysterectomy for urinary incontinence 8 years previously with a sling operation using transobturator tape (TOT). She was admitted to our hospital after complaints of vaginal discharge, foul odor, and bleeding, left thigh pain, and edema. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a fistula tract from the vagina or urethra with remnant sling tape. We removed the remnant tape using intraoperative ultrasonography. This case exemplifies the rare occurrence of a vaginal fistula extending to the obturator, adductor, and pectineus muscles combined with myositis after TOT placement. It is important that urogynecologists recognize that TOT procedures may result in complications accompanied by common recurrent vaginal symptoms, such as vaginal odor and spotting, which can be identified by MRI or CT.
Hinoul, Piet; Vervest, Harry A. M.; den Boon, Jan; Venema, Pieter L.; Lakeman, Marielle M.; Milani, Alfredo L.; Roovers, Jan-Paul W. R.
Mid urethral sling procedures have become the surgical treatment of choice for female stress urinary incontinence. Innovative modifications of mid urethral sling procedures were recently introduced with the claim of offering similar efficacy and decreased morbidity. We compared the efficacy and
Canel, Virginie; Thubert, Thibault; Wigniolle, Ingrid; Fernandez, Hervé; Deffieux, Xavier
Placement of a transobturator midurethral sling (MUS) is the standard surgical treatment for stress urinary incontinence. Most recent MUS procedures have been poorly evaluated. We compared the results using a "new" device expected to reduce postoperative pain, the TVT ABBREVO® system (TVT-Abb), with those using the TVT™ obturator system (TVT-O). This was a retrospective study comparing the use of the TVT-Abb (in 50 patients) and the TVT-O (in 50 patients). The main outcomes were the amount of postoperative pain, the success rate (no reported urinary leakage and negative cough test) with both MUS procedures, and the prevalence of complications. The mean follow-up time was 12 months. The preoperative characteristics of the two groups were comparable. There was less postoperative pain (VAS, 0 to 100) in the TVT-Abb group than in the TVT-O group (12.2 vs. 24.4, p TVT-Abb group and the TVT-O group (8 % vs. 12 %, p = 0.74). The prevalences of perioperative and postoperative complications (bladder/urethral injury, haemorrhage) in the two groups were equal. The success rates were similar at 12 months after surgery (88 % vs. 78 %, p = 0.29). The success rates with TVT-Abb and TVT-O were equal at 12 months after surgery, but there was less immediate postoperative pain with TVT-Abb.
Altan, Mesut; Asi, Tariq; Bilen, Cenk Yucel; Ergen, Ali
To present the long-term results in patients with urinary incontinence who were treated with adjustable perineal male sling. An adjustable male sling procedure was performed in 45 patients with a mean age of 67.6 ± 7.8 years who had urinary incontinence. The mean period between primary prostatic surgery and the sling procedure was 36.7 months. The difference between the classical sling and the adjustable one is a 10 cm tissue expander between the 2 layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via this port, in case of recurrence or persistence of incontinence. Mean follow-up was 48 ± 29 months. Average operative time was 101.1 ± 25.5 minutes (45-150). Median daily pad use in these patients decreased from 8(2-12) to 1(0-10) (P dry rate was higher in patients with nonsevere incontinence compared to the others with severe incontinence (57.9% vs 23.1%, P = .029). Nevertheless, there was no significant difference in the case of total success rate (78.9% vs 57.7%, respectively; P = .135). Age was significantly greater in both complete dry group (71.1 ± 4.8 vs 65.4 ± 8.7) and total success group (70.1 ± 5.2 vs 62.4 ± 5.2) (P = .017 and P < .001, respectively). Adjustable male sling is an acceptable procedure with low complication rates especially in patients with mild and moderate incontinence. At the same time, this procedure may be offered to patients with previous incontinence surgery. Copyright © 2017 Elsevier Inc. All rights reserved.
Houwert, R. Marijn; Roovers, Jan Paul W. R.; Venema, Pieter L.; Bruinse, Hein W.; Dijkgraaf, Marcel G. W.; Vervest, Harry A. M.
OBJECTIVE: We sought to determine and compare surgical therapeutic indices (STIs) of the retropubic tension-free vaginal tape (TVT) and 2 kinds of transobturator tape (TOT), Monarc (American Medical Systems, Minneapolis, MN), and tension-free vaginal tape obturator. STUDY DESIGN: This was a
Selçuk, İlker; Boyraz, Gökhan; Tuncer, Selçuk
The risk of stress urinary incontinence (SUI) is tremendously increasing in adult females. Midurethral slings (MUS) are the preferred way of treatment for SUI. Transobturator tape (TOT) and transvaginal tape (TVT) operations are the types of MUS procedures and they can be performed with high success rates. Dyspareunia, pain, mesh exposure and vaginal erosion, infection and voiding dysfunction are all possible complications of synthetic slings. Mesh exposure and erosion is the greatest reason ...
Zimmern, Philippe E; Gormley, E Ann; Stoddard, Anne M; Lukacz, Emily S; Sirls, Larry; Brubaker, Linda; Norton, Peggy; Oliphant, Sallie S; Wilson, Tracey
To examine treatment options selected for recurrent stress urinary incontinence (rSUI) in follow-up after Burch, autologous fascial and synthetic midurethral sling (MUS) procedures. We performed a secondary analysis of the SISTER and ToMUS trials of participants who underwent primary stress urinary incontinence (SUI) treatment (without prior SUI surgery or concomitant procedures). Using Kaplan-Meier analysis, retreatment-free survival rates by initial surgical procedure were compared. Mean MESA (Medical Epidemiologic and Social Aspects of Aging) stress index was also compared between those retreated for rSUI compared to those not retreated. Half of the women in the SISTEr trial met inclusion criteria for this analysis (329/655, 174 Burch and 155 fascial sling), as did 444/597 (74%) of subjects in ToMUS (221 transobturator midurethral sling (TMUS), and 223 retropubic midurethral sling (RMUS). Types of surgical retreatment included autologous fascial sling (19), synthetic sling (1), and bulking agent (18). Five-year retreatment free survival rates (and standard errors) were 87% (3%), 96% (2%), 97% (1%), and 99% (0.7%) for Burch, autologous fascial sling, TMUS, and RMUS groups respectively (P < 0.0001). For all index surgery groups, the mean MESA stress index at last visit prior to retreatment for those retreated (n = 23) was significantly higher than mean MESA stress index at last visit for those not retreated (n = 645) (P < 0.0001). In these cohorts, 6% of women after standard anti-incontinence procedures were retreated within 5 years, mostly with injection therapy or autologous fascial sling. Not all women with rSUI chose surgical retreatment. © 2015 Wiley Periodicals, Inc.
Schellart, René P.; Zwolsman, Sandra E.; Lucot, Jean-Philippe; de Ridder, Dirk J. M. K.; Dijkgraaf, Marcel G. W.; Roovers, Jan-Paul W. R.
Midurethral sling procedures are the first surgical option in women undergoing surgery for stress urinary incontinence (SUI). Single-incision midurethral-slings (SIMS) were designed to provide similar efficacy to traditional midurethral slings but with reduced morbidity. In this international trial
M.S. El Badry
Mar 25, 2016 ... procedure for the treatment of male urinary incontinence. It has the advantage of ... However, a lack of postoperative adjustment and the risk of dis- location of the ... of male SUI due to different etiological factors. Subjects and ...
Alwaal, Amjad; Harris, Catherine R; Awad, Mohannad A; Allen, Isabel E; Breyer, Benjamin N
Male stress urinary incontinence (SUI) can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male SUI. Our objective is to evaluate 30-day complications in patients undergoing male slings and AUS placement from a national multicenter database. Data from the American College of Surgeons National Surgical Quality of Improvement Program for 2008-2013 were used to identify patients who underwent male slings and AUS implantation. Trained coders abstracted complication data from the patient record independent of the surgical team. We compared 30-day postoperative complications for male slings and AUS. We examined the relationship between patient factors and complication rates for each procedure type. Overall, 1205 incontinence surgeries in men were identified: 597 male sling placements and 608 AUS implantations. Male sling placement had a lower 30-day postoperative complication rate compared to AUS (2.8 vs. 5.1 %, p = 0.046). Compared to AUS, male sling was associated with fewer urinary tract infections (0.3 vs. 2.0 %, p = 0.020) and return trips to the operating room (1.0 vs. 3.0 %, p < 0.001). Patients with higher BMI were more likely to have a complication, while age, race and Charlson comorbidity index were not associated with higher or lower complication rates. Complications rates for both male sling and AUS are low. Male sling is associated with a lower rate of complications than AUS. These findings allow for better patient perioperative counseling regarding 30-day perioperative complications.
Kim, Sea Young; Park, Jong Yeon; Kim, Han Kwon; Park, Chang Hoo; Kim, Sung Jin; Sung, Gi Teck; Park, Chang Myon
Purpose Tension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique. Materials and Methods A total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2...
Full Text Available Purpose To report our intermediate experience in treating patients with severe incontinence using an adjustable perineal male sling with a tissue expander. Materials and Methods An adjustable male sling procedure was performed on 21 patients with severe incontinence. The underlying etiology of urinary incontinence was radical prostatectomy in 13 patients, open prostatectomy in 5 patients and transurethral prostate resection in 3 patients. The difference between the classical and the adjustable sling is that in the latter there is a 25 mL tissue expander between the two layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via an inflation port, in case of recurrence or persistence of incontinence. Results The mean age of the patients was 66.2±7.3 (50-79 years and mean pad usage was 6.4±0.6 per day. The mean follow-up time was 40.1±23.2 (6-74 months. The balloon was postoperatively inflated on average with 11.6±5.7 (5-25 mL. After the mean 40.1 months of follow-up, 16 of the 21 patients (76.2% were dry (11 patients, 0 pads; 5 patients using safety pads, 3 patients (14% had mild and 2 (9.8% had moderate degree post-prostatectomy urinary incontinence (PPI. The average maximum urine flow rate of the patients was 15.6±4.7 (10-31 mL/s. No residual urine was found. In 2 patients, all parts of the device were removed due to infection and discomfort, and in 3 patients only the inflation component was removed due to local scrotal infection. Conclusions Our results show that using an adjustable perineal male sling with a tissue expander seems to be an efficient, and safe surgical treatment option in patients with PPI.
Kim, Sea Young; Park, Jong Yeon; Kim, Han Kwon; Park, Chang Hoo; Kim, Sung Jin; Sung, Gi Teck; Park, Chang Myon
Tension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique. A total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2005 and August 2009. All patients succeeded in follow-ups, among which 8 patients (mean age: 50.5 years) presented with vaginal exposure of the mesh. A vaginal mucosal covering technique was performed under local anesthesia after administration of antibiotics and vaginal wound dressings for 3-4 days. Seven of the 8 patients complained of persistent vaginal discharge postoperatively. Two of the 8 patients complained of dyspareunia of their male partners. The one remaining patient was otherwise asymptomatic, but mesh erosion was discovered at the routine follow-up visit. Six of the 8 patients showed complete mucosal covering of the mesh after the operation (mean follow-up period: 16 moths). Vaginal mucosal erosion recurred in 2 patients, and the mesh was then partially removed. One patient had recurrent stress urinary incontinence. Vaginal mucosal covering as a sling preservation with continued patient continence may be a feasible and effective option for the treatment of vaginal exposure of mesh after TOT tape procedures.
Miklos, John R; Moore, Robert D; Chinthakanan, Orawee
To show a technique of retropubic tension-free vaginal tape (TVT) removal using both a transvaginal and laparoscopic approach in the treatment of a rare condition, obturator neuralgia. A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and postoperative results using video, pictures, and medical illustrations (education video). TVT retropubic slings have become the gold standard for the treatment of stress urine incontinence over the last decade. Despite high cure rates, the TVT is not without potential complications. Typical complications include urine retention, incomplete bladder emptying, frequency, urgency, urethral erosion, vaginal extrusion, vaginal pain, and dyspareunia. The most common complication for sling removal/revision is chronic pain. The TVT obturator neuralgia is a rare and specific type of chronic pain that is normally associated with transobturator tape slings. The purpose of this video is to present an extremely rare complication of TVT retropubic slings, present symptoms and signs of obturator nerve compression, show the normal and the actual position of this patient's TVT sling, describe the laparoscopic removal of the TVT sling, and present the postoperative course and resolution of the patient's pain. The patient signed a release for her video to be used for educational and teaching purposes. A combined transvaginal and laparoscopic approach in a patient with lower abdominal, levator, and obturator-type pain after a TVT retropubic procedure. In patients suffering from obturator neuralgia after a retropubic sling, surgeons should include the sling as a potential causative factor in the differential diagnosis. Surgeons should consider removing the sling based on the patient's symptoms. If the patient suffers from only vaginal pain and dyspareunia, then the surgeon should consider only the removal of the vaginal portion of the sling. In patients with obturator neuralgia, retropubic, and/or lower abdominal
Full Text Available Introduction: Transobturator tapes (TOT are frequently used in the management of female stress urinary incontinence (SUI. We evaluated the effect of TOT on sexual function in Indian women with stress urinary incontinence. Materials and Methods: 34 sexually active women (mean age 42.38 years with SUI were evaluated before TOT placement for sexual function using the NSF-9 sexual scoring system questionnaire. The evaluation was repeated at the 3 rd , 6 th and 12 th months post surgery and then yearly. Results: There was significant improvement in scores in all domains of sexual function post-surgery. The frequency improved in 24 (70.5% patients, lubricacy improved in 12 (57.1% patients, orgasm improved in 21 (67.1% patients, pain improved in 14 (70% patients and, in leaking patients, sexual satisfaction improved in 85.7% while in non-leaking patients improvement was seen in 40%. Sexual relation was not satisfactory in 26 (76.4% of the patients before surgery; of them, 21 (80% patients had improved sexual satisfaction after surgery. De novo urgency and dyspareunia developed in one and two patients, respectively. Conclusions: The TOT procedure has no significant negative impact on sexual function and it significantly improves female sexual function and overall sexual satisfaction in majority of the patients with SUI.
Ferro, Matteo; Bottero, Danilo; D'Elia, Carolina; Matei, Deliu Victor; Cioffi, Antonio; Cozzi, Gabriele; Serino, Alessandro; Cordima, Giovanni; Bianchi, Roberto; Incarbone, Piero Giacomo; Brescia, Antonio; Musi, Gennaro; Fusco, Ferdinando; Detti, Serena; Mirone, Vincenzo; de Cobelli, Ottavio
To evaluate the efficacy and safety of the Virtue ® male sling (Coloplast, Humlebaek, Denmark) in a cohort of patients affected by post-prostatectomy stress urinary incontinence (SUI). All 29 consecutive patients treated with a Virtue male sling at our Institution between July 2012 and October 2013 were included in the present prospective, non-randomized study. Patients were evaluated preoperatively and at 1, 3, 6, 12, 24 and 36 months after surgery using a 24-h pad weight test, the International Consultation on Incontinence short-form questionnaire (ICIQ-SF), Urinary Symptom Profile (USP) questionnaire, a bladder diary, uroflowmetry and the Patient Global Impression of Improvement (PGI-I) and Patient Global Impression of Severity questionnaires. The mean patient age was 65.5 years. A total of 72.4% of patients had preoperative mild incontinence (1-2 pads/day), while nine patients used 3-5 pads/day. There were a total of 17 complications, which occurred in 29 patients (58.6%); all were Clavien-Dindo grade I. At 12-month follow-up patients showed a significant improvement in 24-h pad test (128.6 vs 2.5 g), number of pads per day (2 vs 0), ICIQ-SF score (14.3 vs 0.9) and USP score for SUI (4 vs 0), and outcomes remained stable at 36 months. At last follow-up, the median score on the PGI-I questionnaire was 1 (very much better). The Virtue male sling is an effective treatment option for low to moderate post-prostatectomy incontinence. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.
Full Text Available Objectives: To analyze the short and long term results of tapes of different materials used to treat stress urinary incontinence (SUI. A secondary objective was to evaluate the ability to adjust the tape after implantation. Materials and methods: Retrospective chart review of 355 patients with SUI operated between March 2003 and October 2011. Eight different types of transobturator tapes were used: Gynecare TVT-O®, Monarc®, SAFYRE®, Contasure KIM®, I-Stop®, DynaMesh®, Aris® Bandellete and Swing-band®. Results and complications were recorded. Results: The mean age at operation was 61 years. Correction of SUI was achieved in 87.88% of cases. The best results were obtained with Contasure KIM® (98.26 % continence. The tape was well tolerated and was elastic enough to be able to be adjusted 48-72 hours after implantation without deformation. Slings with macropores and over lock stiches on the superior and inferior borders presented the lower rates of postoperative urinary retention, pain, perior postoperative bleeding and urinary tract infections. Conclusions: Transobturator tension free tapes require a short operation time and have a low complication rate. The possibility of adjustment in the early postoperative period increases the success rate and reduces complications. Knotless meshes with macropores and over lock stiches appear to be better balanced, are quite resistant to stretching and deformation when readjusted after implantation and present a low infection rate.
Aniuliene, Rosita; Aniulis, Povilas; Skaudickas, Darijus
The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.
M.S. El Badry
Conclusions: Our early experience demonstrated that the ATOMS system may be a safe and effective procedure for the treatment of male urinary incontinence. It has the advantage of being feasible any time after an operation when necessary. However, long-term follow-up on a large number of cases is required to ensure its long-term efficacy and safety.
Angleitner-Flotzinger, Johannes; Aigmueller, Thomas
The TVT-Secur was introduced in 2006 as a less invasive alternative to retropubic and transobturator suburethral slings. This retrospective cohort study evaluated objective and subjective results in a series of 158 consecutive patients as well as complications and the reoperation rate after TVT-Secur procedure. Between November 2006 and June 2010 a total of 158 patients underwent a TVT-Secur procedure at a single institution. All patients underwent preoperative urodynamic testing. All patients were invited for follow-up including physical examination, urodynamic studies and subjective evaluation. A total of 96 patients (61%) were available for follow-up with a mean follow-up of 29.8 months (range 5-50, median 30). At follow-up, eight (8%) of 96 patients had reoperations for stress incontinence. There were no reoperations for bleeding/hematoma, tape erosions or obstructed micturition and there were no tape erosions or exposures. 29 patients (30%) had a negative cough stress test and 44 patients (46%) subjectively considered themselves "cured". Nine of 43 patients (21%) without urgency symptoms preoperatively developed de novo urgency; 24 of 35 patients (69%) with preoperative urgency complaints were free of urgency symptoms. At 2.4 years, the TVT-Secur appears to have a low adverse events profile but inferior results compared with traditional midurethral slings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Xu, Yue-Min; Zhang, Xin-Ru; Xie, Hong; Song, Lu-Jie; Feng, Chao; Fei, Xiao-Fang
Male urinary incontinence is relatively common complication of radical prostatectomy and of posterior urethroplasty following traumatic pelvic fracture. Here, we investigate the use of pedicled rectus abdominis muscle and fascia flap sling of the bulbar urethra for treatment for male-acquired urinary incontinence. Ten patients with acquired urinary incontinence were included in the study. Urinary incontinence was secondary to TURP in three patients and was secondary to posterior urethroplasty performed following traumatic pelvic fracture in seven patients. Pedicled rectus abdominalis muscle and fascial flaps, approximately 2.5 cm wide and 15 cm long, were isolated. The flaps were inserted into a perineal incision through a subcutaneous tunnel. The free end of the flap was sectioned to form two muscle strips, each 3 cm in length, and inserted into the space between bulbar urethra and corpus cavernosa. After adequate sling tension had been achieved, the two strips of muscle were anastomosed around the bulbar urethra using a 2-zero polyglactin suture. The patients were followed up for between 12 and 82 months (mean 42.8 months). Complete continence was achieved with good voiding in seven of the 10 patients. In other three patients achieved good voiding following catheter removal, but incontinence was only moderately improved. A pedicled rectus muscle fascial sling of the bulbar urethra is an effective and safe treatment for male patients with mild to moderate acquired urinary incontinence, but it may not be suitable for severe incontinence or for patients with weak rectus abdominalis muscles.
Tincello, Douglas G; Botha, Theunis; Grier, Douglas; Jones, Peter; Subramanian, Dhinagar; Urquhart, Colin; Kirkemo, Aaron; Khandwala, Salil
We examined the clinical effectiveness of a single incision sling in women with stress urinary incontinence and obtained comparative perioperative and postoperative data on retropubic and transobturator slings. Women who underwent a cough stress test were treated with surgery using a single incision, retropubic or obturator sling (Gynecare® TVT SECUR™, TVT™ or TVT Obturator System, respectively) with the choice of sling based on surgeon preference. Objective cure was assessed by the standing cough stress test at 1 year. Subjective outcomes were assessed by the Incontinence Quality of Life Questionnaire and EQ-5D™. Perioperative data and return to normal activity were recorded. Of the 1,398 women who underwent surgery there were postoperative data on 1,334, including 32.8%, 17.8% and 49.4% who received a tension free vaginal tape, obturator tension free vaginal tape and SECUR, respectively. After obturator tension free vaginal tape surgery fewer women had a positive cough stress test than after TVT and SECUR surgery (4 of 110 or 3.6% vs 24 of 187 or 12.8% and 59 of 374 or 15.8%, respectively). Incontinence Quality of Life Questionnaire effect size was 1.87, 1.42 and 1.56, respectively, indicating a large treatment effect. Using our Incontinence Quality of Life Questionnaire response definition 85.4%, 79.0% and 85.2% of the TVT, TVT outside-in obturator system and SECUR cohorts, respectively, were treatment responders (p = 0.11).The SECUR cohort had the shortest operative time, the lowest proportion of women who required an overnight stay and the most women who underwent surgery under local anesthesia. Median time to return to employment, housework, sex life and hobbies was most rapid for SECUR. This registry demonstrates the high effectiveness of all 3 approaches. The single incision sling appeared to have objective and subjective efficacy similar to that of the retropubic sling and it can be performed under local anesthesia in an office environment
Henderson, C. S. [Washington River Protection Solutions, Richland, WA (United States); Mackey, Thomas C. [Washington River Protection Solutions, Richland, WA (United States)
The information and evaluations provided in this report were compiled to address the recurring problem of synthetic sling failure. As safety is the number one priority in all work aspects, a solution must be devised to prevent accidents from occurring. A total of thirteen cases regarding synthetic sling failure were evaluated in order to determine their causes, effects, and preventative measures. From the collected data, it was found that all cases in which the synthetic sling contacted the edge of its load resulted in sling failure. It is required that adequate synthetic sling protection devices be used to protect slings in any lift where the sling comes in direct contact with the edge or corner of its load. However, there are no consensus codes or standards stating the type, material, or purpose of the type of protective device used to protect the sling from being cut. Numerous industry standards and codes provide vague descriptions on how to protect synthetic slings. Without a clear, concise statement of how to protect synthetic slings, it is common for inadequate materials and sling protection devices to be used in an attempt to meet the intent of these requirements. The use of an inadequate sling protection device is the main cause of synthetic sling failure in all researched cases. Commercial sling protection devices come in many shapes and sizes, and have a variety of names, as well as advertised uses. 'Abrasion pads' and 'wear protectors' are two different names for products with the same intended purpose. There is no distinguishable way to determine the extent of sling protection which these devices will provide, or what specific scenarios they are made for. This creates room for error in a field where error is unacceptable. This report provides a recommended action for hoisting and rigging activities which require synthetic slings to contact a load, as well as recommended changes to industry standards which will benefit overall
Resultados del cabestrillo suburetral transobturatriz con cinta de polipropileno para el tratamiento quirúrgico de la incontinencia de orina de esfuerzo Results obtained with the trans-obturation subureteral sling procedure with polypropylen3 strip for surgical treatment of stress urinary incontinence
Radamés Isaac Adefna Pérez
Full Text Available Introducción: la incontinencia urinaria de esfuerzo constituye un problema frecuente en el sexo femenino, con una prevalencia de un 30 %. Aunque no es letal, provoca un impacto importante en las esferas psíquica, social y económica para las que la padecen. Objetivo: demostrar la posibilidad de realizar la técnica de cabestrillo suburetral transobturatriz con medios propios sin afectar la continencia ni seguridad de la paciente. Métodos: se realizó un estudio descriptivo y prospectivo para evaluar las principales variables demográficas y el impacto en la calidad de vida y continencia mediante la escala Cuestionario de Calidad de Vida para Pacientes con Incontinencia Urinaria, Forma corta. Resultados: fueron intervenidas 36 pacientes con un seguimiento de 12 meses. La edad promedio es de 51,2 años, con predominio de las de edades posmenopáusicas y multíparas. Todas presentaban incontinencia de esfuerzo genuina o mixta. Se comprobó una mejoría significativa del puntaje preoperatorio con el posoperatorio. El porcentaje de éxitos al año fue de un 86,1 %. La principal complicación fue la erosión de prótesis e infecciones urinarias. Conclusiones: la realización del cabestrillo suburetral con prótesis por vía transobturatriz es una opción real y factible de ser realizada en nuestro país en pacientes con incontinencia urinaria de esfuerzo o mixta, pues logra una continencia similar a otras técnicas, con una morbilidad menor y un ahorro económico significativo.Introduction: the stress urinary incontinence is a frequent problem in the female sex with a prevalence of 30 %. Although is not lethal it to provokes a significant impact on the psychic, social and economic spheres for those suffering this disease. Objective: to demonstrate the chance of performing the trans-obturation subureteral sling procedure with own means without involve the continence and the safety of patient. Methods: a prospective and descriptive study was
Full Text Available Introduction. Stress urinary incontinence is an involuntary leakage of urine on a sudden increase of intra-abdominal pressure by physical activity, exercise, coughing, sneezing or laughing. Objective. To assess symptoms, functional and anatomical status of voiding function, complications and short term success of a novel procedure, tension-free vaginal tape obturator technique (TVT-O in the treatment of stress urinary incontinence. Methods. A prospective study was performed on 40 female patients who underwent the TVT-O suburethral sling at the Urology Department of the Health Centre in Prokuplje and Urology Hospital in Niš between May 2009 and February 2010. The mean patients’ age was 58 years (range 34-84 years. Preoperative evaluation included a detailed history and gynaecologic examination including urodynamic testing and voiding studies.UDI-6 and UIQ-7 score testing was performed before, and six months after surgery. All patients who demonstrated stress urinary incontinence with a Q-tip test-angle during maximal straining were included into the study. Postoperatively, outcomes evaluation included voiding function, anatomical parameters, complications, as well as subjective success rates. Results. In 30 patients surgery was performed under spinal and in ten under general anaesthesia. The average intraoperative blood loss during the TVT-O was minimal (<50 ml. There were no vascular, bladder, bowel, and neurological injuries. Thirty-eight patients (95% were discharged voiding satisfactorily. There was a statistically significant difference in symptoms between UDI-6 and UIQ-7 before and after surgery. Conclusion. Initial experience with TVT-O suburethral sling is promising. The TVT-O differs from retropubic procedures by resulting in lower postoperative morbidity, intraoperative and postoperative complications.
Objectives: Urinary incontinence in patients with neurological disease is a major health problem. A modified rectus fascial sling has been assessed in incontinent male patients. Patients and Methods: Fourteen adult male patients with total incontinence due to neurogenic or post-traumatic and etiology were included in this ...
Ammendrup, Astrid Cecilie; Sørensen, Helle Christina; Sander, Pia
(TVT) was the preferred sling in 2006. A total of 20 (47%) UI surgeons used only TVT, seven (17%) only transobturator slings (TOS) and 15 (36%) both TVT and TOS. Only 11 (24%) performed > 25 TVT per year and 11 (27%) performed > 25 TOS per year. In all, UI surgeons had experience with ten different...
Clifton, Marisa M; Goldman, Howard B
Complications of synthetic midurethral sling surgery include bladder outlet obstruction, mesh extrusion, and vaginal pain. A treatment of these complications is transvaginal mesh removal. The objectives of this video are to present cases of complications after sling placement and describe techniques to help with successful sling removal. Three patients are presented in this video. One experienced urinary hesitancy and was found to have bladder outlet obstruction on urodynamic study. The second patient presented to the clinic with diminished force of stream and significant dyspareunia. The last patient presented with mesh extrusion. After discussion of management options, all three patients wished to pursue transvaginal sling excision. All patients had successful removal of a portion of their synthetic midurethral sling. This video presents techniques to aide with dissection, mesh excision and prevention of further mesh complications. These include using an individualized surgical technique based on patient presentation and surgeon expertise, planning surgical incisions based on where mesh can be identified or palpated, using a cystoscope sheath or urethral dilator to identify any bladder outlet obstruction, and using a knife blade to identify mesh from surrounding tissue. Sling excision can be successfully performed with careful surgical technique and dissection.
Stracke, Jenny; Bert, Bettina; Fink, Heidrun; Böhner, Jörg
The 3Rs - Replacement, Reduction and Refinement - have become increasingly important in designing animal experiments. The Pavlov sling is thought to be a non-invasive method to restrain dogs for examinations. The aim of our study was to investigate whether laboratory Beagle dogs that had been trained to tolerate restraint by a Pavlov sling are stressed by this procedure and, furthermore, to analyze their behavior during this period. Five male and five female Beagle dogs were used, each three years of age. Animals were restrained in the Pavlov sling for 30 min on six days with an interval of at least two days. The following behaviors were recorded every minute for each session: postures of body, head, and ears, as well as state of eyes, tail, legs, and mouth. Additionally, the animals were observed for the occurrence of particular stress signs, including body shaking, sweating of the paws, increased saliva production, piloerection, blinking of eyes, snout licking, yawning, and panting. As an indicator for stress, salivary cortisol levels were measured before, during, and after each session. Our results show that for most behavioral parameters, e.g., body, leg, head, tail, and ear posture, the frequency of changes between different behavior patterns, as well as cortisol concentration, were not influenced by restraint in the Pavlov sling. Therefore, the Pavlov sling does not seem to be perceived as a stressful situation by the Beagle dogs. Our study demonstrates that under certain conditions the use of the Pavlov sling in trained dogs can substitute for more ordinary methods of immobilization, e.g., the use of narcotics.
Hwang, Eugene; Shin, Ju Hyun; Lim, Jae Sung; Song, Ki Hak; Sul, Chong Koo; Na, Yong Gil
This study aims to identify independent risk factors for treatment failure of tension-free vaginal tape TVT-Secur (TVT-S) compared to that of the well-established transobturator tape. Of a total of 175 consecutive patients with urodynamically confirmed stress urinary incontinence (SUI) identified between July 2007 and March 2010, 89 patients underwent TVT-S, and 86 underwent TOT. Cure was defined using the Urogenital Distress Inventory as no urinary leakage during physical activity, coughing, or sneezing as reported by patients during a telephone survey. To identify predictors of treatment failure, multivariable logistic regression models were used, and odds ratios (ORs) were calculated using variables identified during univariate analysis. There were more patients with cystocele ≥ grade 2 in the TVT-S group (p = 0.031); otherwise the groups were well matched. After a median follow-up of 32 months (range, 12-44 months), the overall cure rate was 80.6%; it was 70.8% for those treated with TVT-S and 90.7% for those treated with TOT (p = 0.001). In a multivariate model, previous incontinence surgery (OR 27.1, p = 0.005) and a cystocele ≥ grade 2 (OR 3.0, p = 0.020) were independent risk factors influencing the outcome of TVT-S procedures. For the TOT procedures, detrusor overactivity was an independent risk factor in a multivariate model (OR 8.6, p = 0.033). TVT-S could be performed for selected patients, but conventional TOT procedures are still superior to the novel TVT-S device.
Full Text Available Christina P Moldovan,1 Michelle E Marinone,2 Andrea Staack3 1Department of Psychology, Loma Linda University, Loma Linda, California, United States of America; 2School of Medicine, Loma Linda University, Loma Linda, California, United States of America; 3Department of Urology, Loma Linda University Medical Center, Loma Linda, California, United States of America Abstract: Stress urinary incontinence is a common, disabling, and costly medical problem that affects approximately 50% of women with urinary incontinence. Suburethral retropubic slings have been developed as a minimally invasive and effective surgical option, and they have been used as a first-line treatment for stress urinary incontinence since 1995. However, complications including vaginal extrusion, erosion, pain, bleeding, infections, lower urinary tract symptoms, urinary retention, and incontinence have been reported with use of the slings. Several companies manufacture sling kits, and the sling kits vary with regard to the composition of the mesh and introducer needle. The aim of this review was to determine which sling kit was most effective for patients, had minimal reported side effects, and was best accepted by patients and surgeons. In a review of the literature, it was found that a total of 38 studies were published between 1995 and 2014 that reported on eight tension-free retropubic sling kits: SPARC, RetroArc, Align, Advantage, Lynx, Desara, Supris, and Gynecare TVT. The Gynecare TVT was the most cited sling kit; the second most cited was the SPARC. This review provides a summary of the studies that have examined positive and negative outcomes of the retropubic tension-free suburethral sling procedure using various sling kits. Overall, the results of the literature review indicated that data from comparisons of the available sling kits are insufficient to make an evidenced-based recommendation. Therefore, the decision regarding which sling kit is appropriate to use in
Friedl, Alexander; Schneeweiss, Jenifer; Stangl, Kathrin; Mühlstädt, Sandra; Zachoval, Roman; Hruby, Stephan; Gründler, Therese; Kivaranovic, Danijel; Fornara, Paolo; Lusuardi, Lukas; Brössner, Clemens
To investigate the efficacy and safety of the Adjustable Transobturator Male System (ATOMS) in men with stress urinary incontinence after transurethral resection of the prostate (TURP). From a large international prospectively administrated ATOMS register, we identified 49 patients with an ATOMS device as a result of persistent stress urinary incontinence after TURP. For evaluation, the men were divided into standard transurethral resection of the prostate (sTURP) and palliative transurethral resection of the prostate (pTURP) in radiated patients. Baseline and follow-up measurements included continence parameters, urodynamics, quality-of-life surveys (Patient Global Impression-Improvement and International Consultation on Incontinence Questionnaire-Short Form), and pain ratings. The dry rate (0-1 security pad/vs 10%, P = .0171) and infection was the most common side effect (50%) observed. Neither intraoperative nor Clavien-Dindo 4 and 5 adverse events were recorded. In sTURP and pTURP, the median daily pad count and the pad test improved significantly (all P <.001), and quality-of-life parameters shifted to a high satisfaction level (P <.001 and P = .001). Urodynamics remained unchanged and postoperative pain was not an issue. The ATOMS device shows promising treatment outcomes in patients after TURP and a similar efficacy as in postprostatectomy incontinence. There is no difference in continence outcome between sTURP and pTURP; however, a higher removal rate was found after pTURP, which may be important for patient counseling. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available Mid urethral sling is the standard in SUI treatment. Nevertheless, the risk of reoperation reaches 9%. There is no consensus as to the best treatment option for complications. A question is raised: what is the optimal way to achieve the best result in patients after primary failure? The aim of the study was to evaluate the outcomes of repeat MUS surgery in patients after excision of the sling with recurrent SUI. We compared its effectiveness with uncomplicated cases treated with TVT. 27 patients who underwent the repeated MUS and 50 consecutive patients after primary TVT were enrolled in the study. After 6 months, we have found that 24 (88.46% patients from repeat sling group and 48 (96% patients after primary sling were dry (1-hour pad test, 2 g or less. The difference between groups was not significant. We showed statistically significant improvement of quality of life in both groups. In conclusion, we showed that repeated sling after MUS excision is almost as effective as primary MUS. We postulate that sling excision and repeated MUS may be the best option for persistent SUI and/or complications after MUS procedures. Further multicenter observations are ongoing as to provide results on bigger group of cases.
Kim, Hyeong Gon; Park, Hyoung Keun; Paick, Sung Hyun; Choi, Woo Suk
The aim of this study was to compare the two types of mid-urethral slings for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD). This retrospective study included patients who underwent tension-free vaginal tape (TVT) procedure or transobturator tape (TOT) procedure by a single surgeon for SUI with ISD, defined as Valsalva leak point pressure (VLPP) TVT and 52 patients received TOT. Age, underlying diseases, Stamey grade, cystocele grade, and presence of urge incontinence were not significantly different between the two groups. Urodynamic parameters including maximal urethral closing pressure, detrusor overactivity, VLPP, urethral hypermobility (Q-tip ≥ 30°), were also comparable between the two groups. Success rate was significantly higher in the TVT group than in the TOT group (95.2% vs. 82.7%, p = 0.009). On multivariate analysis, only TOT surgery (OR = 3.922, 95%CI = 1.223-12.582, p = 0.022) was a risk factor for failure following surgical treatment. TVT is more effective than TOT in treatment of female SUI with ISD.
Full Text Available Objectives: To assess the efficacy of midurethral bulbo-cavernous muscle sling (BCMS in the treatment of genu-ine stress incontinence in women. Methods: A prospective study comprising 25 women was carried out at the Govt. Kasturba Gandhi Hospital, Chennai. The women whose age was in the range of 30-65 years had GSI as proved by urodynamic evaluation. The bulbocavernous muscle sling implies the approximation of both the bulbocavernous muscles around the midurethra with prolene sutures. The procedure is done under regional anaesthesia. Results: These patients were followed up for 2 years. Eighteen (72% women reported complete cure, 4 (16% were significantly improved and in 3 the surgery failed. Conclusions: The bulbocavernous muscle sling is a promising new procedure for genuine stress incontinence. There is no need for intraoperative cystoscopy and the chances of bladder injury are nonexistent. Larger sample with long term follow up and randomized controlled trials comparing it with the other surgical techniques may prove its true efficacy.
... arm sling is a device intended for medical purposes to immobilize the arm, by means of a fabric band... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Arm sling. 890.3640 Section 890.3640 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES...
Full Text Available Shieh-Ling Bang, Mohammed Belal Department of Urology, Queen Elizabeth Hospital, Birmingham, UK Abstract: Stress urinary incontinence (SUI is an under-diagnosed problem affecting up to 50% of women worldwide. SUI is a source of psychological distress to the individual and also imposes a financial burden to the individual and the health care system. The role of surgery in the treatment in SUI has evolved steadily in the last two decades. The synthetic mid-urethral sling and its different insertion methods have gained widespread popularity and are now the most frequently used surgical interventions for women with SUI in Europe. As the use of synthetic slings becomes more widespread, an increasing number of complications are being reported. With the recent concerns surrounding the use of synthetic transvaginal meshes in organ prolapse surgery, synthetic slings have been put under further scrutiny. It is imperative for health care providers to be aware of the current issues associated with synthetic slings and the alternative surgical options available. Traditional autologous pubovaginal slings (PVS have re-emerged as a viable alternative to synthetic slings in light of the issues with synthetic slings. The re-adoption of autologous PVS has however, been slow due to the technical difficulty of the surgery and perceived higher morbidity rates. In this article, we will discuss the various aspects of autologous PVS and its indications as an alternative to synthetic slings. We will also touch on the current evidence and controversies for synthetic mesh slings. Keywords: autologous pubovaginal sling, stress urinary incontinence, synthetic sling, erosions
Friedl, Alexander; Mühlstädt, Sandra; Zachoval, Roman; Giammò, Alessandro; Kivaranovic, Danijel; Rom, Maximilian; Fornara, Paolo; Brössner, Clemens
To evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS ® , Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting. In all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (ATOMS devices are still functioning; 56 (20%) were removed, the most common reason being local titanium intolerance (41%) and leak/dysfunction (30%). The operating time and continence outcome varied between port generations. In this regard the latest port generation (silicone-covered scrotal port) was superior to its predecessors. Primary implantation (P = 0.002), good physical health (P = 0.001), and no history of radiotherapy (P ATOMS device is safe and shows high treatment efficacy and patient satisfaction in the largest cohort study to date. The latest generation, with its pre-attached silicone-covered scrotal port, is superior to its predecessors. Significantly better results were achieved with primary implantation and in those without a history of radiotherapy. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.
Full Text Available Background. Use of alloplastic mesh implantates allow a new urogynecologycal surgical techniques achieve a marked improvement in pelvic organ static and pelvic floor function with minimally invasive needle transvaginal intervention like an anterior transobturator mesh (ATOM and a posterior ischiorectal mesh (PIRM procedures. Methods. In three years, between April 2006 and May 2009, we performed one hundred and eightyfour operative corrections of female pelvic organ prolapse (POP and pelvic floor dysfunction (PFD with mesh implantates. The eighty-three patients with surgical procedure TVT-O or Monarc as solo intervention indicated by stress urinary incontinence without POP, are not included in this number. In 97 % of mesh operations, Gynemesh 10 × 15 cm was used. For correction of anterior vaginal prolapse with ATOM procedure, Gynemesh was individually trimmed in mesh with 6 free arms for tension-free transobturator application and tension-free apical collar. IVS (Intravaginal sling 04 Tunneller (Tyco needle system was used for transobturator application of 6 arms through 4 dermal incisions (2 on right and 2 on left. Minimal anterior median colpotomy was made in two separate parts. For correction of posterior vaginal prolapse with PIRM procedure Gynemesh was trimmed in mesh with 4 free arms and tension-free collar. Two ischiorectal long arms for tension-free application through fossa ischiorectale – right and left, and two short arms for perineal body also on both sides. IVS 02 Tunneller (Tyco needle system was used for tension-free application of 4 arms through 4 dermal incisions (2 on right and 2 on left in PIRM. Results. All 184 procedures were performed relatively safely. In 9 cases of ATOM we had perforation of bladder, in 5 by application of anterior needle, in 3 by application of posterior needle and in one case with pincette when collar was inserted in lateral vesico – vaginal space. In 2 cases of PIRM we had perforation of rectum
Sohn, Min Kyun; Jee, Sung Ju; Hwang, Pyoungsik; Jeon, Yumi
Objective To investigate the effects of a shoulder sling on balance in patients with hemiplegia. Methods Twenty-seven hemiplegic stroke patients (right 13, left 14) were enrolled in this study. The subjects' movement in their centers of gravity (COGs) during their static and dynamic balance tests was measured with their eyes open in each sling condition-without a sling, with Bobath's axillary support (Bobath sling), and with a simple arm sling. The percent times in quadrant, overall, anterior/posterior, and medial/lateral stability indexes were measured using a posturography platform (Biodex Balance System SD). Functional balance was evaluated using the Berg Balance Scale and the Trunk Impairment Scale. All balance tests were performed with each sling in random order. Results The COGs of right hemiplegic stroke patients and all hemiplegic stroke patients shifted to, respectively, the right and posterior quadrants during the static balance test without a sling (pBobath or the simple arm sling. There was no significant improvement in any stability index during either the static or the dynamic balance tests in any sling condition. Conclusion The right and posterior deviations of the hemiplegic stroke patients' COGs were maintained during the application of the shoulder slings, and there were no significant effects of the shoulder slings on the patients' balance in the standing still position. PMID:26798614
R B Nerli
Full Text Available Background: The tension-free vaginal tape (TVT procedure is based on the integral theory that the midurethra has an important role in the continence mechanism. Transobturator vaginal tape (TOT is the same in concept as TVT but it differs from TVT in that, rather than passing through the retropubic space, sling materials are drawn through the obturator foramina. We prospectively compared TVT with TOT with respect to operation-related morbidity and surgical outcomes at a minimum follow up of 12 months. Materials and Methods: A total of 36 women with stress urinary incontinence (SUI were alternatively assigned to the TVT group (18 or the TOT group. Preoperative evaluation included urodynamic study and I-QOL questionnaire. One year after operation the surgical result, patient satisfaction, incontinence quality-of-life questionnaire, long-term complications, and uroflowmetry were evaluated in both groups. Results: The patient characteristics in both the TVT and TOT group were similar. Mean operating time was significantly shorter in the TOT group likened to the TVT group. Conclusions: Both the TVT and TOT procedures are minimally invasive and similar in operation-related morbidity. TOT appears to be as effective as TVT, and safer than TVT for the surgical treatment of SUI in women at 12 months follow-up.
Melanie Christofferson, DO
Conclusion: Clitoral pain symptoms following placement of a retropubic midurethral sling should be evaluated and promptly addressed, given the potential negative impact on the patient's sexual function. Christofferson M, Barnard J, and Montoya TI. Clitoral pain following retropubic midurethral sling placement. Sex Med 2015;3:346–348.
Heesakkers, J.P.F.A.; Vierhout, M.E.
Complications occurred in two women of 45 and 54 years of age who were treated with tension-free midurethral sling procedures. The first woman was treated with transobturator tape due to stress incontinence and an overactive bladder. The procedure resulted in a worsening of the overactive bladder.
Giri, Subhasis K
PURPOSE: The aim was to characterize different types of slings such as autologous rectus fascia (ARF), porcine dermis (PD) and tension-free vaginal tape (TVT) in the early postoperative period with regard to its visibility and location by using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Between October 2003 and June 2007, total of 60 patients underwent MRI after a sling procedure. Thirty-six patients had ARF slings. Twelve patients had a PD sling and 12 had a TVT. All patients had pelvic MRI 6-8 hr postoperatively. Six patients in the ARF sling group had both preoperative and postoperative images at 6 hr and 3 months. MRI images were analyzed with regard to visibility and location. All data were collected prospectively. RESULTS: ARF slings were clearly visible in both T1W and T2W images. ARF appeared as low signal intensity area with surrounding high signal intensity due to fat attached to the rectus fascia in the MRI images obtained 6 hr after the procedure. Although the fatty component of the sling was diminished but was still visible on MRI scan 3 months postoperatively. On the other hand PD and TVT sling materials were not visible by MRI. Most of the ARF slings were located just below the bladder neck. CONCLUSIONS: The ARF sling is easily identifiable on MRI in the early postoperative period primarily because of the fat attached to the autologous rectus fascia. However, depiction of the PD and TVT slings in the early postoperative period is very poor.
Acar, Merve; Karatas, Gulcin Kaymak
The aim of this study was to investigate the effect of an arm sling on balance in patients with, hemiplegia following a stroke. Twenty-six patients with hemiplegia (11 men, 15 women) who had, shoulder subluxation were enrolled in the study. Balance was evaluated by the Berg Balance Scale, the, Functional Reach test, and a static balance index which was measured by the Kinesthetic Ability, Trainer 3000. Balance tests were performed twice, with arm sling and without arm sling use. Results of, this study show that the Berg Balance Scores and static balance index ameliorated with arm sling use (p=0.005 and p=0.004, respectively). Likewise, the Functional Reach test was better when performed with an arm sling (p=0.039). In conclusion, arm slings have a beneficial effect on balance in patients, with hemiplegia. An arm sling may be applied for its possible beneficial effect on balance especially in, the early phases of stroke rehabilitation while the upper extremity is still flaccid and arm swing is, reduced. Copyright © 2010 Elsevier B.V. All rights reserved.
Govier, F E; Kobashi, K C; Kuznetsov, D D; Comiter, C; Jones, P; Dakil, S E; James, R
To report a premarket multicenter trial to test the feasibility of a transvaginal silicone-coated polyester synthetic mesh sling in women with anatomic incontinence. Fifty-one patients in four centers underwent transvaginal placement of a silicone-coated polyester synthetic mesh sling (American Medical Systems) during an 8-month period. Of the 51 patients, 31 were part of a prospective institutional review board-approved feasibility trial in three centers funded by American Medical Systems (group 1) and 20 underwent implantation by a single surgeon and their data were retrospectively reviewed (group 2). The studies were done concomitantly, and all slings were fixed transvaginally with bone anchors. All patients in group 1 were followed up at 4 weeks, 6 months, and 1 year (as applicable) with repeat questionnaires, physical examinations, and pad tests. In group 1, 20 patients completed 6 months of follow-up. Ten patients (32%) required a second surgical procedure at an average of 183 days (range 68 to 343) postoperatively. Eight patients (26%) had vaginal extrusion of the mesh, one (3%) required sling lysis, and one (3%) required sling removal because of infection. In group 2, 8 patients (40%) underwent sling removal for vaginal extrusion at a mean of 160 days (range 83 to 214). Transvaginally placed silicone-coated mesh slings used for the treatment of urinary incontinence demonstrated an unacceptably high vaginal extrusion rate in this study. Once identified, this study was immediately terminated, and this product was not marketed for this application in the United States.
Elliott, Jason E; Maslow, Ken D
Bowel perforation is a rare complication of mid-urethral sling procedures and is usually reported shortly after the surgery. We report a remotely discovered asymptomatic bowel injury found at the time of subsequent surgery. The patient with a history of several prior pelvic surgeries underwent an uneventful retropubic mid-urethral sling placement. Five years later, during an abdominal sacrocolpopexy procedure, mesh from the mid-urethral sling was found perforating the wall of the cecum and fixating it to the right pelvic sidewall. Cecal wedge resection was performed to excise the sling mesh. Asymptomatic bowel perforation by mid-urethral sling mesh has not been previously reported. Pelvic and abdominal surgeons should be aware of the possibility of finding this injury in patients with prior sling surgeries.
Full Text Available Objective: Predictive factors that could affect the cure and complication rates of midurethral slings (MUS in the treatment of stress urinary incontinence (SUI were investigated. Materials and Methods: A total of 594 women (outside-in transobturator in 285, inside-out transobturator in 91, and retropubic in 218 with SUI and who had undergone MUS were evaluated. The median age was 53.9 (27-82 years. Univariate analyses were done using chi-square test, Student’s t-test and the Mann-Whitney U test. Multivariate analyses were done using logistic regression analysis to determine predictive factors affecting cure and complication rates. Results: The mean follow-up time was 48 months. The subjective cure rate was 84% and complication rate was 11.2%. On univariate and multivariate analyses, the cure rate was found to be increased in younger patients [odds ratio (OR: 0.97, 95% confidence interval (CI: 0.95-0.99, p=0.038] and in patients with pure SUI (OR: 2.17, 95% CI: 1.31-3.60, p=0.002. The type of surgery was the only statistically significant parameter affecting the complication rate, which was significantly higher in retropubic MUS procedure (OR: 6.28, 95% CI: 3.51-11.22, p<0.001. Conclusion: MUS is an effective and safe surgical procedure in the treatment of SUI. In this study, age and type of incontinence were the only significant predictive factors affecting the cure rate. Our study suggests that retropubic approach could be considered a risk factor for complication after MUS.
Full Text Available PURPOSE: The aim of this study was to critically review the Arc-to-Arc mini-sling (Palma's technique a less invasive mid-urethral sling using bovine pericardium as the sling material. MATERIALS AND METHODS: The Arc-to-Arc mini-sling, using bovine pericardium, was the first published report of a mini-sling, in 1999. The technique was identical to the "tension-free tape" operation, midline incision and dissection of the urethra. The ATFP (white line was identified by blunt dissection, and the mini-sling was sutured to the tendinous arc on both sides with 2 polypropylene 00 sutures. RESULTS: The initial results were encouraging, with 9/10 patients cured at the 6 weeks post-operative visit. However, infection and extrusion of the mini-sling resulted in sling extrusion and removal, with 5 patients remaining cured at 12 months. CONCLUSION: The Arc-to-Arc mini-sling was a good concept, but failed because of the poor technology available at that time. Further research using new materials and better technology has led to new and safer alternatives for the management of stress urinary incontinence.
Full Text Available Objectives. To examine what changes are caused in the activity of the vastus medialis oblique (VMO and vastus lateralis (VL at the time of sling-based exercises in patients with patellofemoral pain syndrome (PFPS and compare the muscular activations in patients with PFPS among the sling-based exercises. Methods. This was a cross-over study. Sling-based open and closed kinetic knee extension and hip adduction exercises were designed for PFPS, and electromyography was applied to record maximal voluntary contraction during the exercises. The VMO and VL activations and VMO : VL ratios for the three exercises were analyzed and compared. Results. Thirty male (age = 21.19 ± 0.68 y and 30 female (age = 21.12 ± 0.74 y patients with PFPS were recruited. VMO activations during the sling-based open and closed kinetic knee extension exercises were significantly higher (P=0.04 and P=0.001 than those during hip adduction exercises and VMO : VL ratio for the sling-based closed kinetic knee extension and hip adduction exercises approximated to 1. Conclusions. The sling-based closed kinetic knee extension exercise produced the highest VMO activation. It also had an appropriate VMO : VL ratio similar to sling-based hip adduction exercise and had beneficial effects on PFPS.
Constable, Lynda; Cotterill, Nikki; Cooper, David; Glazener, Cathryn; Drake, Marcus J; Forrest, Mark; Harding, Chris; Kilonzo, Mary; MacLennan, Graeme; McCormack, Kirsty; McDonald, Alison; Mundy, Anthony; Norrie, John; Pickard, Robert; Ramsay, Craig; Smith, Rebecca; Wileman, Samantha; Abrams, Paul
Stress urinary incontinence (SUI) is a frequent adverse effect for men undergoing prostate surgery. A large proportion (around 8% after radical prostatectomy and 2% after transurethral resection of prostate (TURP)) are left with severe disabling incontinence which adversely effects their quality of life and many are reliant on containment measures such as pads (27% and 6% respectively). Surgery is currently the only option for active management of the problem. The overwhelming majority of surgeries for persistent bothersome SUI involve artificial urinary sphincter (AUS) insertion. However, this is expensive, and necessitates manipulation of a pump to enable voiding. More recently, an alternative to AUS has been developed - a synthetic sling for men which elevates the urethra, thus treating SUI. This is thought, by some, to be less invasive, more acceptable and less expensive than AUS but clear evidence for this is lacking. The MASTER trial aims to determine whether the male synthetic sling is non-inferior to implantation of the AUS for men who have SUI after prostate surgery (for cancer or benign disease), judged primarily on clinical effectiveness but also considering relative harms and cost-effectiveness. Men with urodynamic stress incontinence (USI) after prostate surgery, for whom surgery is judged appropriate, are the target population. We aim to recruit men from secondary care urological centres in the UK NHS who carry out surgery for post-prostatectomy incontinence. Outcomes will be assessed by participant-completed questionnaires and 3-day urinary bladder diaries at baseline, 6, 12 and 24 months. The 24-h urinary pad test will be used at baseline as an objective assessment of urine loss. Clinical data will be completed at the time of surgery to provide details of the operative procedures, complications and resource use in hospital. At 12 months, men will also have a clinical review to evaluate the results of surgery (including another 24-h pad test) and to
Full Text Available Background: The purpose of our study was to assess the applicability of a specially designed functional sling for the correction of shoulder joint position in the early phase of neurorehabilitation. Patients and methods: Study included patients hospitalized at the Clinical Department of Neurosurgery of the University Medical Centre in Ljubljana, who suffered from severe paresis or paralysis of the upper limb. All patients included in the research were given a specially designed functional sling with the possibility of individual adjustments. By the help of a manipulated scale (transfer with respect to needed assistance we assessed how much help the patients using the sling needed in every-day activities; special attention was given to the evaluation of patients’ ability to stand up from and sit down in a wheelchair. Results: The research included 15 patients. During the rehabilitation programme, which included a specially designed functional sling, seven patients progressed by a grade on a scale (transfer with respect to needed assistance, seven patients progressed by two grades and one patient was bedridden. The average VAS value for shoulder pain without a functional sling was 5.3. With the use of a functional sling, the average VAS value was 2.3. Conclusion: The research has shown that the sling for shoulder joint position correction in early neurorehabilitation phase plays an important role as a device that enables patients more self-dependence in movement, especially when sitting down in and rising up from a wheel-chair. The process of learning how to use the sling was somewhat more difficult because of sensation disorder as well as cognitive and communication difficulties. An additional drawback was short usage time, because the patients were using the sling during hospitalization period only.
Zhang, Yan; Jiang, Min; Tong, Xiao-Wen; Fan, Bo-Zhen; Li, Huai-Fang; Chen, Xin-Liang
To compare the safety and efficacy of an inexpensive-modified transobturator vaginal tape procedure with the transobturator tension-free vaginal tape (TVT-O) procedure for the surgical treatment of female stress urinary incontinence (SUI). Patients with SUI were randomly allocated to either the test group receiving the inexpensive-modified transobturator vaginal tape procedure or the control group receiving the GYNECARE TVT-O procedure. Treatment outcomes and Quality-of-life scores were recorded and analyzed between two groups. A total of 156 patients were enrolled in this trial. Eighty patients underwent the modified transobturator vaginal tape procedure. Among them 75(93.8%) were cured and 5(6.2%) were improved. The rest of the 76 patients underwent the GYNECARE TVT-O procedure with a 92% (70 of 76) cure rate and an 8% (6 of 76) improvement rate. No inefficient or aggravated cases occurred in both groups. The success rates between groups had no significant statistic difference (p > 0.05). The operative time, blood loss, hospital stay, and medical cost were significantly lower in the test group (p < 0.01); the increases in Quality-of-life scores were comparable between groups. The modified transobturator vaginal tape procedure is an efficacious and economic surgical treatment for female SUI. Copyright © 2011. Published by Elsevier B.V.
Kdous, Moez; Zhioua, Fethi
Objectives To evaluate the long-term efficacy and safety of transobturator four-arm mesh for treating cystoceles. Patients and methods In this prospective study, 105 patients had a cystocele corrected between January 2004 and December 2008. All patients had a symptomatic cystocele of stage ?2 according to the Baden?Walker halfway stratification. We used only the transobturator four-arm mesh kit (Surgimesh?, Aspide Medical, France). All surgical procedures were carried out by the same experien...
... this page: //medlineplus.gov/ency/article/007376.htm Urinary incontinence - vaginal sling procedures To use the sharing features ... are types of surgeries that help control stress urinary incontinence . This is urine leakage that happens when you ...
Full Text Available INTRODUCTION AND OBJECTIVES: The mini sling concept for stress urinary incontinence is an anatomical approach that involves placing a midurethral low-tension tape anchored to the obturator internus muscles bilaterally. They overcome the blind passage of long needles and all the related complications. There are many different devices available and because these are outpatient procedures, primary fixation plays an important role in the outcome. The objective is to evaluate the primary fixation of the various devices of attachment of the commercially available mini-slings through biomechanical tests. MATERIALS AND METHODS: A total of 45 Wistar rats were divided in 3 groups of 15 rats each. They underwent 5 subcutaneous implantation of different mini slings and one polipropilene mesh (control, as follows: TVT-Secur® (Gynecare, USA, Type 1 polypropylene mesh (control; Ophira Mini Sling System® (Promedon, Argentina, Tissue Fixation System® (TFS PTY, Australia, Zipper Sling® and "T device" (Prosurg, USA. The abdominal wall was removed on bloc at different times after implant for biomechanical evaluation, which consisted in application of unidirectional force to the extremity of the fixation system or mesh, until it was completely removed from the tissue using a tension meter (Nexygen 3.0 Universal Testing Machine - LLOYD Instruments. The force was measured in Newtons (N. RESULTS: There was significant difference in the resistance to extraction among the different fixation systems. At 7 days the Ophira Mini Sling System® presented the best fixation and "T dispositive" the worst. CONCLUSION: Ophira mini sling System® presented the best primary fixation at 7º, 14º and 30º days. The impact of this feature in the clinical setting needs to be verified.
Rudnicki, Martin; von Bothmer-Ostling, Katarina; Holstad, Anja
INTRODUCTION: The primary aim was to compare the objective and subjective outcomes and short-term complication rates of an adjustable single-incision mini-sling (SIMS) versus standard mid-urethral slings (SMUS). The secondary aim was reporting pain perception and complications at one-year follow......-up. MATERIAL AND METHODS: The study was designed as a multicenter prospective randomized trial where women were included by eight centers in Denmark, Norway and Sweden. The trial was registered at ClinicalTrials. gov: NCT01754558. A total of 305 women less than 60 years old with verified stress urinary...... incontinence were included. All women were randomized to SIMS (Ajust(®) ; N=155) or SMUS (TVT, TVT-O or TOT; N=150) and were evaluated by stress test and bladder diary before and after surgery and symptoms related to incontinence using ICIQ-SF, PISQ-12 and PGI-S and PGI-I. Objective cure was defined...
Healey, David; Ron, Nitin; Hromada, Andrew; Chhabra, Manoj
Pulmonary artery sling is a very rare cause of pediatric respiratory distress. The estimated prevalence of the disease was first determined by Yu et al. in 2008 as 59 per million school-aged children. Associated symptoms are cough, wheezing, and feeding difficulty, all of which are common in routine outpatient pediatric clinical encounters. We report a case of a premature male neonate twin who was admitted to the neonatal intensive care unit with respiratory distress and pneumothorax. His presentation, as well as the etiology of his pulmonary disease, was felt to be consistent with those of numerous other premature infants. Akin to this was his delayed discharge on account of his slow progress with oral feeding. Parents gave a history of tachypnea and feeding difficulty to his doctors. He presented twice to the emergency room in respiratory distress. At 4 months of age, while in hospital for a pulmonary infection, he had an echocardiogram that revealed a pulmonary artery sling. We review the literature on this vascular anomaly, discuss its diagnosis and management, and critique the clinical thinking that determined this child's course from the perspective of availability heuristics.
Esquinas, C; Arance, I; Pamplona, J; Moraga, A; Dorado, J F; Angulo, J C
Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both pATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively. Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
... reduces the risk of opening a closed injury. First Aid Care for all wounds before applying a splint or sling. If you can see bone in the injured site, call your local emergency number (such as 911) or local hospital for ...
Lee, Dominic; Bacsu, Chasta; Dillon, Benjamin; Zimmern, Philippe E
To determine outcomes after removal of two synthetic mid-urethral slings (MUS) at a tertiary care center. Following IRB approval, a retrospective chart review of non-neurogenic, symptomatic women requiring re-operation after ≥2 MUS was performed. Data reviewed by a third party included: demographics, prior anti-incontinence surgery, complications, pelvic/urinary symptoms, subsequent investigations, surgical repair and outcomes (including UDI-6/IIQ-7 questionnaires) at a minimum 6 months follow-up. Cure was defined as being continent, no dyspareunia, and no additional surgical therapy. Between 2007 and 2014, 21 women met the inclusion criteria. Mean age was 57 years (range: 40-82) and mean follow-up was 30.2 months (range: 6-78). The majority of patients presented with one or more symptoms of voiding dysfunction (95%), urinary incontinence (86%), irritative voiding symptoms (62%), dyspareunia (57%), recurrent urinary tract infections (UTIs) (29%), vaginal extrusion (20%) and erosion involving the urinary tract (5%). Patients had a mean of 2 prior anti-incontinence procedures (range 2-3). Over two-thirds had a combination of retropubic and transobturator MUS. Mean number of pre-operative investigations was 3.5 (1-6) including voiding cystourethrogram, cystoscopy and urodynamics. Two patients had complete remission, 14 partial remission, and five failed. Mean postoperative total UDI-6 and IIQ-7 scores at last clinic visit were 10 (range: 0-16/SD 4.1) and 11 (range: 0-28/SD 10.3), respectively. The management of women with suboptimal outcomes following two synthetic MUS from transvaginal excision results in modest symptomatic improvement but low permanent complete remission and frequent need for additional therapies. © 2017 John Wiley & Sons Australia, Ltd.
Lu, Zxy-Yann Jane; Lin, Wan-Shiuan
Healthcare providers recognize the important role played by attachment theory in explaining the close relationship between mental health and social behavior in mothers and their children. This paper uses attachment theory in a socio-cultural context to ascertain the mechanism by which baby slings/carriers, a new technology, produced and reproduced the scientific motherhood. It further applies a social history of technology perspective to understand how baby carriers and attachment theory are socially constructed and historically contingent on three major transformations. These transformations include the use of attachment theory-based baby carriers to further scientific motherhood; the use of baby slings/carriers to further the medicalization of breastfeeding and enhance mother-infant attachment; and the use of baby slings/carriers to transform woman's identities by integrating scientific motherhood, independence and fashion. Implications for nursing clinical policy are suggested.
Rodrigues, Claudinei A; Bianchi-Ferraro, Ana Maria H M; Zucchi, Eliana Viana Monteiro; Sartori, Marair G F; Girão, Manoel J B C; Jarmy-Di Bella, Zsuzsanna I K
Objective Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of mid-urethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results. Methods A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVT-O), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student t -test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons. Results Differences among the groups were found in the mean angle of the tape arms (TVT = 119.94°, TVT-O = 141.93°, TVT-S = 121.06°; p TVT = 1.65 cm, TVT-O = 1.93 cm, TVT-S = 1.95 cm; p = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8%; p = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4%; p = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVT-S = 89.2%; p = 0.001), with a more distal location associated with obesity (distal: 66.7% obese; mid-urethra: 34% obese; p = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT
Al Taweel Waleed
Full Text Available Aim: To evaluate the effectiveness of transobturator vaginal tape (TOT in the treatment of female stress urinary incontinence (SUI and to analyze functional results and quality of life after12 months follow up. Materials and Methods : All women with SUI who underwent TOT procedure from outside to inside under general or regional anesthesia from December 2004 to January 2007 were included in the study. All must have had a minimal follow up of one year. The patients were prospectively evaluated with history including pads use/day, physical examination - pelvic examination, urinalysis, urogenital distress inventory (UDI-6, and analog global satisfaction scale - and urodynamic studies - filling cystometry, pressure-flow studies, and Valsalva leak point pressure. Results: Sixty two consecutive patients who fulfilled the inclusion criteria underwent TOT procedure by one surgeon. The mean age was 52 ± 9 years (range, 34-70 years and minimal follow up was one year (12-24 months. The mean operative time was 17 ± 4 minutes (15-31 with average amount of bleeding 62 ± 22 cc. We found objectively 89% cure or improvement rate after one year. Conclusion: The out-in transobturator approach is a very effective treatment of SUI with low morbidity and high success rate. However, longer follow up in larger populations should assess the long-term reliability of this attractive procedure.
..., rated capacity, and reach of the sling. The information, supplied by the manufacturer, is typically...] Slings; Extension of the Office of Management and Budget's (OMB) Approval of Information Collection... handling. Paragraph (e) of the Standard covers alloy steel chain slings. Paragraph (e)(1) requires that...
Freilich, Drew A; Rovner, Eric S
To describe a technique for removal of intraurethral mesh with minimal disruption of the periurethral anatomy. Through a midline transvaginal approach the sling is located lateral to the urethra and divided. The medial portion of the divided sling is carefully dissected back to its entrance laterally into the urethral lumen. A stay suture is placed on the dissected sling. The sling is located on the contralateral side and likewise divided and dissected back to the urethral lumen. The completely dissected sling is pulled through such that the holding stitch is through and through the urethral lumen, allowing easy localization of the urethral defect on lateral walls of the urethra. These defects are closed with an absorbable suture and the vaginal incision is closed. Three patients have undergone a transvaginal removal of their intraurethral mesh using the described technique. At a mean follow-up of 6.0 months, there were no intraoperative or postoperative complications. All patients were obstructed preoperatively and all developed stress urinary incontinence postoperatively requiring 0-1 pads per day. Current approaches to the surgical repair of chronic intraurethral mesh have significant limitations that are minimized by the described technique. This anatomic removal of mesh from the urethra has several advantages including no disruption of the ventral wall of the urethra, complete removal of foreign body from the urethra, and simplified localization of the urethral wall defect to allow for anatomic closure. Copyright © 2015 Elsevier Inc. All rights reserved.
Hinoul, Piet; Vanormelingen, Linda; Roovers, Jan-Paul; de Jonge, Eric; Smajda, Stéfan
An experimental surgical study on human cadavers was undertaken to assess variability in the trajectory followed by the needle during application of the inside-out transobturator tape suspension (TVT-O) technique. The TVT-O surgical procedures were performed on six fresh female cadavers according to
Surgical management of lower urinary mesh perforation after mid-urethral polypropylene mesh sling: mesh excision, urinary tract reconstruction and concomitant pubovaginal sling with autologous rectus fascia.
Shah, Ketul; Nikolavsky, Dmitriy; Gilsdorf, Daniel; Flynn, Brian J
We present our management of lower urinary tract (LUT) mesh perforation after mid-urethral polypropylene mesh sling using a novel combination of surgical techniques including total or near total mesh excision, urinary tract reconstruction, and concomitant pubovaginal sling with autologous rectus fascia in a single operation. We retrospectively reviewed the medical records of 189 patients undergoing transvaginal removal of polypropylene mesh from the lower urinary tract or vagina. The focus of this study is 21 patients with LUT mesh perforation after mid-urethral polypropylene mesh sling. We excluded patients with LUT mesh perforation from prolapse kits (n = 4) or sutures (n = 11), or mesh that was removed because of isolated vaginal wall exposure without concomitant LUT perforation (n = 164). Twenty-one patients underwent surgical removal of mesh through a transvaginal approach or combined transvaginal/abdominal approaches. The location of the perforation was the urethra in 14 and the bladder in 7. The mean follow-up was 22 months. There were no major intraoperative complications. All patients had complete resolution of the mesh complication and the primary symptom. Of the patients with urethral perforation, continence was achieved in 10 out of 14 (71.5 %). Of the patients with bladder perforation, continence was achieved in all 7. Total or near total removal of lower urinary tract (LUT) mesh perforation after mid-urethral polypropylene mesh sling can completely resolve LUT mesh perforation in a single operation. A concomitant pubovaginal sling can be safely performed in efforts to treat existing SUI or avoid future surgery for SUI.
Foss Hansen, Margrethe; Lose, Gunnar; Kesmodel, Ulrik Schiøler
INTRODUCTION AND HYPOTHESIS: The objective was to describe the choice of subsequent surgery after failure of synthetic midurethral slings (MUS) based on a nationwide background population. METHODS: We used the Danish National Patient Registry to identify women who had undergone first-time synthetic...
Full Text Available PURPOSE: This prospective study was performed to achieve visualization of the reestablishment of anatomy after reconstructive surgery in the different pelvic compartments with non-absorbable radiopaque meshes, providing valuable anatomic information for surgeons implanting meshes. MATERIALS AND METHODS: A total of 30 female patients with stress urinary incontinence (SUI, anterior and posterior vaginal wall prolapse, or both underwent surgical repair using radiopaque meshes after written informed consent. Patients with SUI underwent five different surgeries. Patients with anterior vaginal prolapse underwent a procedure using a combined pre-pubic and transobturator mesh, and those with posterior vaginal prolapse underwent posterior slingplasty. Three-dimensional reconstruction using helical CT was performed four weeks postoperatively. RESULTS: In all cases, the mesh was clearly visualized. Transobturator slings were shown at the midurethra, and the anchoring tails perforated the obturator foramen at the safety region. Mini-slings were in the proper place, and computed angiography revealed that the anchoring system was away from the obturator vessels. In patients undergoing procedure for anterior vaginal prolapse, both pre-pubic armpit and obturator slings were clearly seen and the mesh was in the proper position, supporting the bladder base and occluding the distal part of the urogenital hiatus. Transcoccygeal sacropexy revealed indirectly a well-supported "neo rectovaginal fascia" and the anchoring tails at the level of ischial spines. CONCLUSION: Three-dimensional helical tomography images of the female pelvis using radiopaque meshes have a potential role in improving our understanding of pelvic floor reconstructive surgeries. These radiopaque meshes might be the basis of a new investigative methodology.
Full Text Available Midurethral placement of tension-free vaginal tapes with a transvaginal route for stress urinary incontinence achieves higher and better long-term success rates than the transobturator route. Bladder perforations are reported more in transvaginal tape (TVT but incidences of vaginal erosions, extrusion, and groin pain are exceedingly more in TOT groups. There is no clear evidence that transobturator tape (TOT is associated with less post-operative voiding problems than TVT. Major complications such as bowel injuries and significant vascular injuries with TVT are rare. TVT has been found to be superior to TOT and preferable in technically demanding conditions such as prior anti-incontinence operation failures, obese women, and very elevated and scarred lateral cul-de sac. TVT is always preferred in severe grades of stress urinary incontinence and with patients of intrinsic sphincter deficiency (ISD with little or no urethral mobility.
Manso, M; Alexandre, B; Antunes-Lopes, T; Martins-da-Silva, C; Cruz, F
Urinary incontinence (UI) is a complication of radical prostatectomy (RP) and transurethral resection of the prostate (TURP). The gold-standard treatment is the artificial urinary sphincter, however, new treatments have been investigated. To examine the outcome of an adjustable transobturator male system (ATOMS ® ) in men with UI after prostatic surgery in a low to medium volume continence center. Twenty-five men with UI were implanted with ATOMS ® system between 2012 and 2014. The most common indication was UI after RP (92%), followed by UI after TURP (8%). Eleven patients (44%) had received adjuvant external beam radiotherapy (RT). Patients were considered to be 'dry' if they stopped wearing pads or needed just one protective pad per day; and improved if the daily number of pads used decreased by at least half. The Incontinence Quality of Life questionnaire (ICIQ-SF) was used, adding a verbal question about the satisfaction of the patient considering the outcome. After a mean follow-up of 21.56 months, 64% were dry and 8% revealed a significant improvement. The success of the procedure was negatively correlated with the severity of the previous UI and with previous treatment with RT. Concerning patients satisfaction, 84% of the patients would repeat the procedure. ATOMS ® offers good rates of cure and improvement of UI after prostatic surgery with a reasonable rate of minor complications. The results of this study, performed in a low to medium volume continence center, are comparable to the results achieved in high volume continence centers. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
Cluver, Catherine Anne; Hofmeyr, G Justus
The purpose of this study was to report on all cases in which posterior axilla sling traction (PAST) has been used to deliver cases of intractable shoulder dystocia and to describe a new method of shoulder rotation with the sling. A record of all published and known cases was collected that included information on preliminary obstetric techniques that were used and how the PAST technique was performed. Maternal outcomes that included maternal injury and length of hospital stay and fetal outcomes, which included birthweight, Apgar scores, nerve injuries, fractures, hospital stay, and outcome, were documented. We have recorded 19 cases where PAST has been used. In 5 cases, the babies had died in utero. Ten were assisted deliveries. PAST was successful in 18 cases. In one case, it was partially successful because it enabled delivery of the posterior shoulder with digital axillary traction. The most commonly used material was suction tubing. Once the posterior shoulder was delivered, the shoulder dystocia was resolved in all cases. Time from insertion to delivery was dystocia fail. Advantages are that it is easy to use (even by someone who has not seen it used previously), that the sling material is readily available, and that it is inserted quickly with 2 fingers. This is the first report of its use to rotate the posterior shoulder to the anterior position for delivery. Copyright © 2015 Elsevier Inc. All rights reserved.
McCoy, Olugbemisola; Vaughan, Taylor; Nickles, S Walker; Ashley, Matt; MacLachlan, Lara S; Ginsberg, David; Rovner, Eric
We reviewed the outcomes of the autologous fascial pubovaginal sling as a salvage procedure for recurrent stress incontinence after intervention for polypropylene mesh erosion/exposure and/or bladder outlet obstruction in patients treated with prior transvaginal synthetic mesh for stress urinary incontinence. In a review of surgical databases at 2 institutions between January 2007 and June 2013 we identified 46 patients who underwent autologous fascial pubovaginal sling following removal of transvaginal synthetic mesh in simultaneous or staged fashion. This cohort of patients was evaluated for outcomes, including subjective and objective success, change in quality of life and complications between those who underwent staged vs concomitant synthetic mesh removal with autologous fascial pubovaginal sling placement. All 46 patients had received at least 1 prior mesh sling for incontinence and 8 (17%) had received prior transvaginal polypropylene mesh for pelvic organ prolapse repair. A total of 30 patients underwent concomitant mesh incision with or without partial excision and autologous sling placement while 16 underwent staged autologous sling placement. Mean followup was 16 months. Of the patients 22% required a mean of 1.8 subsequent interventions an average of 6.5 months after autologous sling placement with no difference in median quality of life at final followup. At last followup 42 of 46 patients (91%) and 35 of 46 (76%) had achieved objective and subjective success, respectively. There was no difference in subjective success between patients treated with a staged vs a concomitant approach (69% vs 80%, p = 0.48). Autologous fascial pubovaginal sling placement after synthetic mesh removal can be performed successfully in patients with stress urinary incontinence as a single or staged procedure. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Zyczynski, Halina M.; Sirls, Larry T.; Greer, W. Jerod; Rahn, David D.; Casiano, Elizabeth; Norton, Peggy; Kim, Hae-Young; Brubaker, Linda
OBJECTIVE The purpose of this study was to report the frequency of abnormal cystoscopy at incontinence surgery and to identify risk factors and sequelae of injury. STUDY DESIGN Findings of cystoscopy were collected prospectively in 3 multicenter surgical trials. Clinical, demographic, and procedure characteristics and surgeon experience were analyzed for association with iatrogenic injury and noninjury abnormalities. Impact of abnormalities on continence outcomes and adverse events during 12 months after the procedure were assessed. RESULTS Abnormal findings in the bladder or urethra were identified in 95 of 1830 women (5.2%). Most injuries (75.8%) were iatrogenic. Lower urinary tract (LUT) injury was most common at retropubic urethropexy and retropubic midurethral sling procedures (MUS; 6.4% each), followed by autologous pubovaginal sling procedures (1.7%) and transobturator MUS (0.4%). Increasing age (56.9 vs 51.9 years; P = .04), vaginal deliveries (3.2 vs 2.6; P = .04), and blood loss (393 vs 218 mL; P=.01) were associated with LUT injury during retropubic urethropexy; however, only age (62.9 vs 51.4 years; P = .02) and smoking history (P = .04) were associated for pubovaginal sling procedures. No factors correlated with increased risk of injury at retropubic and transobturator MUS. Notably, previous incontinence surgery, concomitant procedures, anesthesia type, and trainee participation did not increase LUT injury frequency. Although discharge with an indwelling catheter was more common after trocar perforation compared with the noninjury group (55.6% vs 18.5%; P urinary tract infections, or urge urinary incontinence. CONCLUSION Universal cystoscopy at incontinence surgery detects abnormalities in 1 in 20 women. Urinary trocar perforations that are addressed intraoperatively have no long-term adverse sequelae. PMID:24380742
Goulet, Charles; Rogowski, Isabelle
Context: Tennis playing generates specific adaptations, particularly at the dominant shoulder. It remains to be established whether shoulder strength balance can be restored by sling-based training for adolescent recreational tennis players. Objective: We added a sling-based exercise for shoulder external rotators to investigate its effects on external rotator muscle strength, on internal rotator muscle strength, on glenohumeral range of motion and on tennis serve performance. Design: Test-retest design. Setting: Tennis training sports facilities. Participants: Twelve adolescent male players volunteered to participate in this study (age: 13.3 ± 0.5 years; height: 1.64 ± 0.07 cm, mass: 51.7 ± 5.8 kg, International Tennis Number: 8). Intervention: The procedure spanned 10 weeks. For the first five weeks, players performed their regular training (RT) twice a week. For the last five weeks, a sling-based exercise (SE) for strengthening the shoulder external rotator muscles was added to their regular training. Main Outcome Measures: Maximal isometric strength of shoulder external and internal rotator muscles and glenohumeral range of motion in external and internal rotation were assessed in both shoulders. Serve performance was also evaluated by accuracy and post-impact ball velocity, using a radar gun. Results: No change was found in any measurement after the RT period. Significant increases in external (~+5%; pexternal/internal strength ratio (~+4%; pexternal rotator muscles appears effective in restoring strength balance at the dominant shoulder, and may prevent adolescent tennis players from sustaining degenerative shoulder problems which could later impair their performance of daily and work-related tasks.
Amy Farkas, MD
Full Text Available Pulmonary sling is the anatomic variant defined by the aberrant origin of the left pulmonary artery from the right pulmonary artery. This patient presented with a mimic of pulmonary sling as a result of an extremely rare condition, arterial tortuosity syndrome (ATS. The patient was first diagnosed with pulmonary sling on prenatal echocardiogram performed by cardiology. Computed tomography angiography of the chest obtained at birth to evaluate respiratory depression demonstrated ATS. The early detection of ATS has been demonstrated to improve patient outcome. This case provides an overview of the typical imaging features of ATS to aid radiologists in making this uncommon diagnosis.
Houwert, R. Marijn; Venema, Pieter L.; Aquarius, Annelies E.; Bruinse, Hein W.; Kil, Paul J. M.; Vervest, Harry A. M.
OBJECTIVE: The aim of this study was to evaluate the value of urodynamic investigation in the preoperative workup of midurethral sling surgery and to identify risk factors for failure after 3 different midurethral sling procedures. STUDY DESIGN: Retrospective cohort study. 437 women who underwent a
Alwaal, Amjad; Al-Sayyad, Ahmad J
Erectile dysfunction is a prevalent disease affecting over 50% of men between the ages of 40 and 70 years. Penile prosthesis represents the end of the line treatment when other less invasive therapies fail or are contraindicated. Male stress urinary incontinence can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male stress incontinence. No data exist on the utilization of penile prosthesis or male incontinence surgical treatment in Saudi Arabia. Generally, urological prosthetic surgery is performed either in private hospitals or in government hospitals. Our aim was to assess the trend of penile prosthesis and male incontinence device utilization in Saudi Arabia. We utilized sales' data of penile prosthetics, male slings, and AUS from the only two companies selling these devices in Saudi Arabia (AMS ® and Coloplast ® ), from January 2013 to December 2016. There were 2599 penile prosthesis implantation procedures done in the study period, with 67% of them performed in private institutions. There was a progressively increased use of penile prosthetics which nearly doubled from 2013 to 2016. The main type of prosthesis utilized was the semirigid type 70% versus 11% of the 2-piece inflatable and 17% of the 3-piece inflatable device. Only 10 slings and 31 AUS were inserted during the same study period. There is an increased utilization of penile prosthetics in Saudi Arabia. The private sector performs the majority of penile prosthesis procedures, and most of them are of the semirigid type. The governmental sector is more likely to perform inflatable penile prosthesis and male incontinence device procedures. Male incontinence prosthetics' use is very limited in Saudi Arabia.
Limberger, Leo Francisco; Faria, Fernanda Pacheco; Campos, Luciana Silveira; Anzolch, Karin Marise Jaeger; Fornari, Alexandre
Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (pCost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (pcost of the synthetic sling was considered. Copyright® by the International Brazilian Journal of Urology.
Yamada, Brian S; Govier, Fred E; Stefanovic, Ksenija B; Kobashi, Kathleen C
The transobturator tape method is a newer surgical technique for the treatment of stress urinary incontinence. Limited data exist related to complications with this approach or the types of mesh products used. We report our experience with vaginal erosions associated with the Mentor ObTape and American Medical Systems Monarc transobturator slings. Beginning in December 2003 selected female patients with anatomic urinary incontinence were prospectively followed after placement of the Mentor ObTape. Beginning in January 2004 we also began using the American Medical Systems Monarc in similar patients. Patients were admitted overnight after surgery, discharged on oral antibiotics, and seen in the clinic at 6 weeks postoperatively. A total of 67 patients have undergone placement of the Mentor ObTape and 9 of those patients (13.4%) have had vaginal extrusions of the sling. Eight patients reported a history of persistent vaginal discharge. One patient presented initially to an outside facility with a left thigh abscess tracking to the left inguinal incision site. Each patient was taken back to the operating room for mesh removal. A total of 56 patients have undergone placement of the AMS Monarc and none have had any vaginal erosions. Our high rate of vaginal extrusion using the ObTape has led us to discontinue the use of this product in our institution. Continued followup of all of these patients will be of critical importance.
Foss Hansen, Margrethe; Lose, Gunnar; Kesmodel, Ulrik Schiøler
for urinary incontinence (retropubic midurethral tape, transobturator tape, urethral injection therapy, Burch colposuspension, pubovaginal slings, and miscellaneous operations). Cox proportional hazard models were used to estimate the hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for factors......BACKGROUND: The synthetic midurethral slings were introduced in the 1990s and were rapidly replaced the Burch colposuspension as the gold standard treatment for urinary incontinence. It has been reported that the retropubic midurethral tape has an objective and subjective cure rate of 85% at 5...... years of follow-up, but the rate of reoperation after retropubic midurethral tape at the long-term follow-up is less well described. The existing literature specifies an overall lifetime rate of reoperation of about 8-9% after an initial operation for urinary incontinence. There are, however...
Purnima Rajkarnikar Sthapit
Full Text Available Introduction: To evaluate the cosmetic results and recurrence of unilateral frontalis sling surgery using a silicone rod compared with autogenous fascia lata in cases of simple congenital ptosis. Methods: This is a retrospective comparative study of 59 patients who underwent a frontalis sling operation for congenital ptosis. Patients were divided into two groups according to the sling material used; an autogeneous fascia lata (fl group (n = 24 and a silicone rod group (sl (n = 35. Cosmetic results and recurrence rates were compared between these 2 groups. The cosmetic results of the frontalis sling operation were assessed as good, fair, or poor based on the difference between the Margin Reflex Distance of both eyelids and graded as good if the difference in two eyes was ≤1mm and poor if it was 2mm or more. Recurrence was defined as the conversion of the cosmetic result from good or fair to poor category. Results: At postoperative day seven and 30, MRD of both the groups were good but on three months follow-up MRD of silicon rod group dropped, however it was not statistically significant .Lid contour was good in both the groups, however, lid symmetry was poor in two cases of fascia lata at three months follow-up. Repeat surgery for poor outcome was done in 8.6% of cases in silicon rod and 8.3% of fascia lata group. Conclusions: The frontalis sling operation using either a silicone rod or autogenous fascia lata showed equally good cosmetic results and lower recurrence rate at three months follow up. Keywords: congenital ptosis; fascia lata; frontalis sling surgery; margin reflex distance; silicone rod.
Comparing effectiveness of combined transobturator tension-free vaginal mesh (Perigee) and transobturator tension-free vaginal tape (TVT-O) versus anterior colporrhaphy and TVT-O for associated cystocele and urodynamic stress incontinence.
Lau, Hei-Yu; Twu, Nae-Fang; Chen, Yi-Jen; Horng, Huann-Cheng; Juang, Chi-Mou; Chao, Kuan-Chong
To evaluate the efficacy and safety of transobturator tension-free vaginal mesh (Perigee) and concomitant transobturator tension-free vaginal tape (TVT-O) for treating cystocele with urodynamic stress incontinence (UDSI). A retrospective study of 115 patients with symptomatic stages 2-3 cystocele and UDSI who were treated with a Perigee system (Group I, n=68) plus TVT-O procedure or traditional anterior colporrhaphy (Group II, n=47) plus TVT-O procedure. All patients were followed up for more than one year. Objective and subjective symptoms were evaluated at one year postoperatively. Statistical analysis was performed using SPSS software. The objective cure rates for cystocele at one year were significantly higher in Group I than in Group II (98.5% and 86.9%, P=0.018), respectively. The cure rates for UDSI in the two groups were 91.0% vs. 91.3% (P=1.000). Symptomatic improvement of frequency was better in Group I than Group II (87.7% vs. 70.0%, P=0.030). There were no significant differences with regard to intraoperative and postoperative complications between the two groups. The combination of the Perigee system and TVT-O offers a safe and effective treatment for cystocele with UDSI and may be performed as first-line treatment. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Devereux, D.F.; Thompson, D.; Sandhaus, L.; Sweeney, W.; Haas, A.
Patients with malignant tumors of the pelvis who cannot be cured surgically often are treated with radiation after surgery. A devastating side effect of this treatment is radiation-associated small bowel injury (RASBI). The purpose of this study was to test the hypothesis that removal of the small bowel from the radiation field would protect it against RASBI. Twenty cebus monkeys underwent low anterior resection. In 10 animals an absorbable polyglycolic acid (PGA) mesh was sewn circumferentially around the interior of the abdominal cavity as a supporting apron, which prevented the small bowel's descent into the pelvis. The other 10 monkeys did not receive the mesh. All animals received 2000 rads by linear acceleration in a single dose. Twenty-four-hour stool fat, serum vitamin B12, and other serum values were obtained during the study. Animals were sacrificed after 1, 2, 3, 6, and 12 months, and the small bowel and rectum were examined histologically in a blind manner. Two monkeys who did not undergo surgery, or exposure to radiation served as controls. At all sacrifice periods, the animals with PGA mesh slings demonstrated normal small bowel function and histologic structure. Animals without mesh slings had abnormal stool and blood values at 1 month, and by 2 months all had died of small bowel necrosis. The animals that received the slings had no evidence of infection or obstruction, and by 6 months all evidence of the mesh was gone. Support of the small bowel out of the pelvis by an absorbable PGA mesh sling protects against RASBI and is without apparent complications
Shukla, Anirudh; Dudeja, Vivek
To study effect of orbital sling on post operative vision in cases of maxillary carcinoma undergoing total maxillectomy. All patients with the principal procedure of "total maxillectomy" for histopathologically proven cases of carcinoma maxilla in department of otorhinolaryngology and head-neck surgery, N.S.C.B. medical college, Jabalapur, Madhya Pradesh, India from July 2011 to October 2013 were included. Out of the 20 patients irrespective of whether orbital sling was created or not, maximum number of patients 8 (40 %) showed a 3 step improvement, and maximum improvement seen was up to five steps. Out of the 14 patients in which orbital sling was created maximum number of patients 7 (50 %) showed a 3 step improvement, and maximum improvement seen was up to five steps. Out of the 6 patients in whom orbital sling was not created maximum number of patients 3 (50 %) showed a 2 step improvement, and maximum improvement seen was up to three steps. Infraorbital repair with the help of sling results in better improvement of vision as compared to those in whom sling was not or could not be made with no significant difference on eye movements.
Sling de aponeurose e com faixa sintética sem tensão para o tratamento cirúrgico da incontinência urinária de esforço feminina Pubovaginal sling and tension-free vaginal tape for surgical treatment of stress urinary incontinence in women
João Paulo Sartori
Full Text Available OBJETIVO: comparar as cirurgias de sling de aponeurose e TVT (do inglês tension-free vaginal tape para correção da incontinência urinária de esforço (IUE quanto às taxas de cura subjetiva e objetiva, à mobilidade do colo vesical ao ultra-som, à variação do teste do absorvente, às alterações urodinâmicas e à incidência de complicações. MÉTODOS: foram selecionadas 80 pacientes com IUE. Destas, 61 foram operadas pela técnica de TVT e 19 por sling de aponeurose do reto abdominal. As médias de idade, índice de massa corpórea e paridade foram 50,1 anos, 29,7 kg/m² e 4,5 partos (mediana=3 para as pacientes com sling de aponeurose e de 51,7 anos, 28,1 kg/m² e 4,1 partos (mediana=3 para aquelas com TVT. Todas se submeteram a anamnese, exame físico, ultra-sonografia do colo vesical, teste do absorvente e estudo urodinâmico no pré-operatório e após, pelo menos, seis meses depois da cirurgia. Após 15 ou 19 meses e depois de cerca de quatro a cinco anos, foram novamente entrevistadas quanto aos resultados da cirurgia. RESULTADOS: quanto à avaliação subjetiva, após seis meses, julgaram-se curadas 96,7% das mulheres com TVT e 89,5% das com sling. Porém, após 15 a 19 meses, o Grupo TVT manteve a mesma taxa de cura subjetiva, enquanto que no Grupo Sling houve redução para 77,8%. Houve diminuição significativa da mobilidade do colo vesical, similar em ambos os grupos, e melhora no teste do absorvente. No final do estudo urodinâmico, foram classificadas como cura objetiva 93,4% das mulheres do Grupo TVT e 78,9% daquelas do Grupo Sling. O tempo médio de sondagem vesical foi maior no Grupo Sling. Observou-se retenção urinária em 42,1% dos casos de sling e em 9,8% de TVT. As taxas de cura tardia foram 90% para TVT e 55,6% para sling. CONCLUSÕES: a cirurgia de TVT propiciou melhor taxa de cura subjetiva após 15 ou 19 meses, porém, a taxa de cura objetiva foi igual em ambas as técnicas neste tempo. Entre as complica
Kim, Gye-Yeop; Kin, Se-Hun
[Purpose] The purpose of this study was to examine the effect of lumbar stability exercises on chronic low back pain by using sling exercise and push-ups. [Subjects] Thirty adult subjects with chronic back pain participated, with 10 adults being assigned to each of 3 exercise groups: general physical therapy (PT), lumbar stability using sling exercises (Sling Ex), and sling exercise plus push-ups (Sling Ex+PU). Each group trained for 30 minutes 3 times a week for 6 weeks. The Oswestry Disability Index (ODI), surface electromyographic (sEMG) activity of the lumbar muscles, and cross-sectional area of the multifidus muscle on computed tomography (CT) were evaluated before and at 2, 4, and 6 weeks of therapy. [Results] A significant decrease in ODI was seen in all therapy groups, and this change was greater in the Sling Ex and Sling Ex+PU groups than in the PT group. No changes in sEMG activity were noted in the PT group, whereas significant increases in the sEMG activities of all lumbar muscles were found in the other 2 groups. The increases in the sEMG activities of the rectus abdominis and internal and external oblique muscles of the abdomen were greater in the Sling Ex+PU group than in the other 2 groups. [Conclusion] These findings demonstrate that Sling Ex+PU, similar to normal lumbar stabilization exercise, is effective in activating and improving the function of the lumbar muscles. These results suggest that Sling Ex+PU has a positive impact on stabilization of the lumbar region.
Calcagni, Giulio; Bonnet, Damien; Sidi, Daniel; Brunelle, Francis; Vouhe, Pascal; Ou, Phalla
We report a 10-month-old infant who presented with tetralogy of Fallot and respiratory disease in whom the suspicion of a ring-sling complex was confirmed by high-resolution CT. CT demonstrated the typical association of left pulmonary artery sling and the ''chicken trachea'' resulting from complete cartilaginous rings of the trachea. (orig.)
Calcagni, Giulio; Bonnet, Damien; Sidi, Daniel [University Paris Descartes, Department of Paediatric Cardiology, Hopital Necker-Enfants Malades, AP-HP, Paris (France); Brunelle, Francis [University Paris Descartes, Department of Paediatric Radiology, Hopital Necker-Enfants Malades, AP-HP, Paris Cedex 15 (France); Vouhe, Pascal [University Paris Descartes, Department of Paediatric Cardiovascular Surgery, Hopital Necker-Enfants Malades, AP-HP, Paris (France); Ou, Phalla [University Paris Descartes, Department of Paediatric Cardiology, Hopital Necker-Enfants Malades, AP-HP, Paris (France); University Paris Descartes, Department of Paediatric Radiology, Hopital Necker-Enfants Malades, AP-HP, Paris Cedex 15 (France)
We report a 10-month-old infant who presented with tetralogy of Fallot and respiratory disease in whom the suspicion of a ring-sling complex was confirmed by high-resolution CT. CT demonstrated the typical association of left pulmonary artery sling and the ''chicken trachea'' resulting from complete cartilaginous rings of the trachea. (orig.)
Stress urinary incontinence (SUI) is the most observed type of urinary incontinence and is defined as the loss of urine following a rise in abdominal pressure. The TVT (Tension-free Vaginal Tape), a mid-urethral sling (MUS), was introduced in 1996 and soon became the gold standard in the surgical
Doganay, Melike; Cavkaytar, Sabri; Kokanali, Mahmut Kuntay; Ozer, Irfan; Aksakal, Orhan Seyfi; Erkaya, Salim
To identify the potential risk factors for urinary tract infections following midurethral sling procedures. 556 women who underwent midurethral sling procedure due to stress urinary incontinence over a four-year period were reviewed in this retrospective study. Of the study population, 280 women underwent TVT procedures and 276 women underwent TOT procedures. Patients were evaluated at 4-8 weeks postoperatively and were investigated for the occurrence of a urinary tract infection. Patients who experienced urinary tract infection were defined as cases, and patients who didn't were defined as controls. All data were collected from medical records. Multivariate logistic regression model was used to identify the risk factors for urinary tract infection. Of 556 women, 58 (10.4%) were defined as cases while 498 (89.6%) were controls. The mean age of women in cases (57.8±12.9years) was significantly greater than in controls (51.8±11.2years) (purinary tract infection, concomitant vaginal hysterectomy and cystocele repair, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml were more common in cases than in controls. However, in multivariate regression analysis model presence of preoperative urinary tract infection [OR (95% CI)=0.1 (0.1-0.7); p=0.013], TVT procedure [OR (95% CI)=8.4 (3.1-22.3); p=0.000] and postoperative postvoiding residual bladder volume ≥100ml [OR (95% CI)=4.6 (1.1-19.2); p=0.036] were significant independent risk factors for urinary tract infection following midurethral slings CONCLUSION: Urinary tract infection after midurethral sling procedures is a relatively common complication. The presence of preoperative urinary tract infection, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml may increase the risk of this complication. Identification of these factors could help surgeons to minimize this complicationby developing effective strategies. Copyright © 2017. Published by Elsevier B.V.
Matuszewski, Marcin; Michajłowski, Jerzy; Krajka, Kazimierz
Introduction Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during physical exertion, sneezing, coughing, laughing, or other activities that put pressure on the bladder. In some cases, recurrent or persistent SUI after sling operations may be caused by too loose placement of the sling. In the current study, we describe our method of shortening of the sling as a second-line treatment of tension-free vaginal tape (TVT) failure. Materials and methods Four women, aged 46-61, after initial TVT operation were treated for persistent SUI. The severity of SUI was estimated by: physical examinations, cough tests, 24-h pad tests, and King's Health Questionnaire. The shortening procedure, based on excising the fragment of tape and suturing it back, was performed in all patients. Results All cases achieved a good result, which was defined as restoration of full continence. No complications occurred. The 12-month follow-up showed no side-effects. The postoperative control tests: the cough and 24-h pad tests were negative in all women. The general health perceptions increased after the shortening procedure by a mean value 44.25%. The incontinence impact decreased by a mean value 44.6%. In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively). The negative emotions connected with SUI significantly decreased after the second procedure. Conclusions The operative shortening of the implanted sling is a simple, cheap, and effective method of second-line treatment in cases of TVT failure and may be offered to the majority of patients with insufficient urethral support after the first procedure. PMID:24578885
Collis, George N; TerKonda, Sarvam P; Waldorf, James C; Perdikis, Galen
Acellular dermal matrix (ADM) slings in breast reconstruction are increasingly used but are not yet validated. This study compares immediate, expander-based breast reconstruction with and without the use of inferolateral ADM slings. There were 63 patients (106 breasts) in the ADM group and 42 patients (68 breasts) in the control group. Initial intraoperative fill volumes were significantly greater in the ADM group, median 69% full (250 mL) versus 50% full (180 mL; P < 0.001). However, the number of days to complete expansion between the 2 groups was similar. One less office visit was required to complete the fills in the ADM group (P < 0.01). Drains were removed 3 days later in the ADM group (P < 0.01). Overall complication rate was greater in the ADM group (18.9% vs. 7.4%, P < 0.05), with a slightly higher percentage of expanders requiring removal due to infection in the ADM group (5.7% vs. 4.4%, P = NS). This study suggests inferolateral ADM slings in expander-based breast reconstruction allow for significantly increased initial fill volumes and may offer an aesthetic advantage; however, its use is costly and increases complications.
Park, Yoo Jun; Kim, Duk Yoon
Transobturator approaches to midurethral sling surgery are one of the most commonly performed operations for female stress urinary incontinence throughout the world. However, very few results of randomized clinical trials of transobturator midurethral sling surgery (MONARC vs. TVT-O) for the treatment of female urinary incontinence have been reported. In this study, we compared the 3-year follow-up cure rates of these two procedures. From July 2006 to June 2008, 74 patients who had undergone MONARC (35 patients) or TVT-O (39 patients) were included in the study and were analyzed prospectively. The mean follow-up duration of both groups was 39.2 months. Preoperative and postoperative evaluations included physical examination, uroflowmetry and postvoid residual measurement, involuntary urine loss with physical activity, and urinary symptoms. Cure of female urinary incontinence was defined as patient report of no loss of urine upon physical activity. The patients' satisfaction after treatment was rated as very satisfied, satisfied, equivocal, and unsatisfied. Very satisfied and satisfied were considered as the satisfied rate. There were no significant differences in preoperative patient characteristics, postoperative complications, or success rate between the two groups. The cure rate of the MONARC and TVT-O groups was 85.7% and 84.6%, respectively. The patient satisfaction (very satisfied, satisfied) rate of the MONARC and TVT-O groups was 82.8% and 82.1%, respectively. The MONARC and TVT-O procedures were equally efficient for the treatment of female urinary incontinence, with maintenance of high cure rates for 3 years. Longer follow-up is needed to confirm these results.
Jung, Bok Ki; Yun, In Sik; Lee, Won Jai; Lew, Dae Hyun; Choi, Eun Chang; Lee, Dong Won
Reconstruction after total maxillectomy with extensive orbital floor defects poses a significant challenge for the reconstruction. The aim of this study is to present the outcomes of orbital floor reconstruction using tensor fascia lata slings after total maxillectomy and to compare these results to orbital floor reconstruction using alloplastic implants. This was a retrospective analysis of 19 consecutive patients who underwent tumor resection with orbital floor removal for malignancies. Reconstructions were performed using either tensor fascia lata slings (Group A) or alloplastic implants (Group B). The early and late postoperative outcomes such as wound infection, plate exposure, ectropion, diplopia, and enophthalmos, were analyzed and compared between the two groups. Patients in group A had significantly less wound complication than in group B (p < 0.05). In group A, there were no early or late wound complications after the operation. However, in group B, five patients had infection, the plate was exposed in eight of fourteen patients, and three patients had enophthalmos. Eight patients in group B underwent reoperation to correct their complications. Reconstruction of the orbital floor with a tensor fascia lata sling offers reliable support to the globe and prevents the ophthalmic complications associated with loss of orbital support. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Sukanda Bin Jaili
Conclusion: Repeated vaginal reconstructive surgery may jeopardize a primary mesh or sling, and pose a high risk of mesh erosion, which may be delayed for several years. Removal of the mesh erosion and bladder repair are feasible pervaginally with good outcome.
Su Jin Kim
Full Text Available Purpose We studied the influence of preoperative bladder outlet obstruction (BOO on postoperative continence rates and patient satisfaction after the midurethral sling procedure. Methods A total of 159 women who underwent the midurethral sling procedure were evaluated. Using the Blaivas-Groutz nomogram, we assigned the patients were assigned to Group I (n=37, no obstruction, Group II (n=89, mild obstruction, or Group III (n=33, moderate to severe obstruction. Continence rates, patient satisfaction, urinary sensation scale and uroflowmetry were evaluated postoperatively. Results There were no significant differences in continence rates, satisfaction, or postoperative maximal flow rate between the 3 groups. Postoperative urgency was improved after surgery in Groups I and II (P<0.05 but not in Group III. Conclusions BOO does not seem to be a risk factor for failure after the midurethral sling procedure. However, BOO may be considered as a potential factor for persistent storage symptoms after the midurethral sling.
Full Text Available Aim: To evaluate the cure rates and complications of midurethral slings performed by residents under an experienced surgeon supervision. Material and Method: Between January 2013 and January 2014, one hundred forty-one midurethral slings performed in the urogynecology clinic of Ankara Zekai Tahir Burak Women%u2019s Health Research and Education Hospital were reviewed.Age, parity,body mass index,menopausal status, grade 2 preoperative pelvic organ prolapsus,concomitant vaginal surgery and intraoperative (bladder and bowel perforations,bleeding,vaginal laceration and early postoperative (urinary retention etc.complications were recorded.All women were re-examined at postoperative 6 th month and symptoms were questioned. The patients were classified as %u2018%u2019cured%u2019%u2019 if the stress test was negative , %u2018%u2019partially cured%u2019%u2019 if continence frequency decreased but still continued and %u2018%u2019unsatisfied%u2019%u2019 if there was no change in symptoms. Both TVT and TOT groups were compared in case of complications and cure rates. Results: Among 141 patients who had undergone midurethral sling due to urinary stress incontinence,50(35.5% were TOT , 91(64.5% were TVT. In the TVT group, 3 (3.3% patients had bleeding which requires transfusion and 5(5.5% patients had bladder perforations. But in the TOT group,there was no bladder perforation and bleeding that requires transfusion. In the early postoperative period, urinary retention was encountered in 7(14.0% patients in TOT group and in 17(18.7% patients in TVT group. There was no statistically significant difference between the groups in case of complications. At postoperative 6th month, in the TOT group 76% of patients were cured,18% were partially cured and 6% were unsatisfied. In the TVT group, 83.5% of patients were cured, 12.1% were partially cured and 4.4% were unsatisfied and there was no significant difference in cure rates between the groups. Discussion: The
Tammaa, Ayman; Aigmüller, Thomas; Hanzal, Engelbert; Umek, Wolfgang; Kropshofer, Stephan; Lang, Peter F J; Ralph, George; Riss, Paul; Koelle, Dieter; Jundt, Katharina; Tamussino, Karl; Bjelic-Radisic, Vesna
To compare outcomes of the retropubic versus the transobturator tension-free vaginal tape (TVT vs TVT-O) at 5 years. A total of 569 women undergoing surgery for primary stress incontinence were randomized to receive a retropubic or a transobturator tensionfree vaginal tape (TVT or TVT-O). Follow-up at 5 years included clinical examination, urodynamic studies and quality of life. The primary outcome measure was continence defined as a negative cough stress test at a volume of 300 mL. Secondary outcomes included urodynamic parameters, complications and quality of life.ClinicalTrials.gov (NCT 0041454). Three hundred and thirty-one patients (59%) were evaluated at 5 years (277 were seen, examined and completed questionnaires; 54 only completed questionnaires). No significant differences were seen in rates of a negative cough stress test (83% vs 76%, respectively), urodynamic parameters and complications. Quality-of-life improved significantly in both groups, without significant differences between the groups. Erosion rates were 5.2% and 4.5%, and reoperation rates were 4.1% and 3.2% respectively. At 5 years, subjective and objective results after TVT and TVT-O are stable and similar, without statistical significant differences between the procedures. Major long-term problems appear rare. © 2017 Wiley Periodicals, Inc.
Almassi, Nima; Goldman, Howard B
Since the introduction of the tension-free vaginal tape, the surgical management of female stress urinary incontinence has undergone a dramatic shift toward synthetic midurethral slings (MUSs). The evolution of the MUS has led to the development of the single incision mini sling (SIMS), a minimally invasive procedure that can be performed under local anesthesia. Complications arising after SIMS placement parallel those of the traditional MUS, including pelvic pain, dyspareunia, and mesh erosion. The patient in this case presented with persistent pelvic pain due to a retained SIMS anchor after having previously undergone SIMS placement and subsequent transvaginal exploration with mesh removal. We report the use of intraoperative ultrasound for identification and removal of the retained SIMS anchor.
Jonathan A. Eandi
Full Text Available OBJECTIVE: To evaluate our experience with tension-free transvaginal tape (TVT placement for the management of stress urinary incontinence (SUI in women who had previously undergone a failed midurethral synthetic sling (MUS procedure. MATERIALS AND METHODS: Ten women underwent retropubic TVT insertion for continued or recurrent SUI following a prior MUS procedure. No attempt was made to remove the previously placed sling at the time of surgery. A retrospective chart review was performed to obtain perioperative and follow-up patient information. Post-operatively, each patient completed a mailed incontinence questionnaire to assess self-reported urinary continence outcomes. RESULTS: All 10 women were available for follow-up at a mean period of 16 months (range 6 to 33. Four of the 10 patients achieved complete continence, and another three patients reported significantly improved continence and quality of life. Three women stated that their continence did not improve. CONCLUSIONS: TVT placement may be a viable option for the management of women with persistent or recurrent SUI following an initial MUS procedure.
Ghandi, Yazdan; Shafiee, Akbar; Sharifi, Mehrazad; Bolandnazar, Najmeh Sadat
The VACTERL association, co-occurrence of vertebral, anorectal, cardiac, tracheoesophageal, genitourinary, and limb malformations, is a rare congenital anomaly. Several cardiac anomalies have been reported as a part of the VACTERL association, particularly ventricular and atrial septal defects. Pulmonary artery sling is a rare congenital abnormality in which the left pulmonary artery arises from the right pulmonary artery. This anomaly is not frequently observed in the VACTERL association and has been rarely reported. A 20-month-old girl was admitted to our hospital due to pneumonia in the right lung, which had pulmonary artery sling as a part of the VACTERL association. Barium meal X-ray showed pressure effects on the esophagus, and computed tomography angiography revealed pulmonary artery sling. Pneumonia management was done. However, the parents of our patient refused to give consent for the surgical correction of this vascular anomaly. Three months after discharge from the hospital, the patient was visited, at which time the parents again refused surgery and treatment for their daughter despite our recommendations.
Kdous, Moez; Zhioua, Fethi
To evaluate the long-term efficacy and safety of transobturator four-arm mesh for treating cystoceles. In this prospective study, 105 patients had a cystocele corrected between January 2004 and December 2008. All patients had a symptomatic cystocele of stage ⩾2 according to the Baden-Walker halfway stratification. We used only the transobturator four-arm mesh kit (Surgimesh®, Aspide Medical, France). All surgical procedures were carried out by the same experienced surgeon. The patients' characteristics and surgical variables were recorded prospectively. The anatomical outcome, as measured by a physical examination and postoperative stratification of prolapse, and functional outcome, as assessed by a questionnaire derived from the French equivalents of the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire and the Pelvic Organ Prolapse-Urinary Incontinence-Sexual Questionnaire, were considered as the primary outcome measures. Peri- and postoperative complications constituted the secondary outcome measures. At 36 months after surgery the anatomical success rate (stage 0 or 1) was 93%. On a functional level, all the scores of quality of life and sexuality were improved. The overall satisfaction score (visual analogue scale) was 71.4%. There were no perioperative adverse events. Mesh erosion was reported in 7.6% and mesh retraction in 5.7% of the patients. If the guidelines and precautions are followed, vaginal prosthetic surgery for genitourinary prolapse has shown long-term benefits. It provides excellent results both anatomically and functionally. However, complications are not negligible and some are specific to prosthetic surgery.
Ramesh C Gupta
Full Text Available Aim : To evaluate the efficacy of modified temporalis muscle transfer (TMT by silicone sling for the management of paralytic lagophthalmos. Settings and Design: Prospective interventional study. Materials and Methods : Ten patients of lagophthalmos due to facial palsy underwent modified TMT using silicone sling. The patients were followed-up for a period of 3 months. Palpebral aperture in primary gaze and during eye closure were assessed both pre- and postoperatively along with problems associated with lagophthalmos like exposure keratopathy and lacrimation. Statistical Analysis : Paired t-test was applied to measure the statistical outcome. Results : Eight patients achieved full correction of lagophthalmos with no lid gap on closing the eye. The mean (standard deviation (SD lid gap on eye closure was 7.7 (0.86 mm preoperatively, 0.5 (0.47 mm at 1 st postoperative day, and 0.7 (0.75 mm at 3 rd month. There was a reduction in mean lid gap on eye closure of 7 mm at 3 months (P < 0.0001 which is highly significant. The mean (SD vertical interpalpebral distance during primary gaze was 12.05 (1.12 mm preoperatively, 10 (0.94 mm at 1 st postoperative day, and 10.35 (1.08 mm at 3 rd month. There was a reduction in mean vertical inter palpebral distance of 1.7 mm at 3 months (P = 0.001 which is significant. Exposure keratitis decreased in five out of six patients at 3 months. Conclusion : Modified TMT by silicone sling is a useful procedure with lesser morbidity and good outcomes for the treatment of paralytic lagophthalmos due to long standing facial palsy.
Punjani, Nahid; Winick-Ng, Jennifer; Welk, Blayne
To determine if postoperative urinary retention and urinary tract infections (UTIs) were predictors of future mesh complications requiring surgical intervention after midurethral sling (MUS). Administrative data in Ontario, Canada, between 2002 and 2013 were used to identify all women who underwent a mesh-based MUS. The primary outcome was revision of the transvaginal mesh sling (including mesh removal/erosion/fistula, or urethrolysis). Two potential risk factors were analyzed: postoperative retention (within 30 days of procedure) and number of postoperative emergency room visits or hospital admissions for UTI symptoms. A total of 59,556 women had a MUS, of which 1598 (2.7%) required revision surgery. Of the 2025 women who presented to the emergency room or were admitted to hospital for postoperative retention, 212 (10.5%) required operative mesh revision. Of the 11,747 patients who had at least one postoperative UTI, 366 (3.1%) patients required operative mesh revision. In adjusted analysis, postoperative retention was significantly predictive of future reoperation (hazard ratio [HR] 3.46, 95% confidence interval [CI] 2.97-4.02), and this difference persisted when urethrolysis was excluded as a reason for sling revision (HR 3.08, 95% CI 2.62-3.63). Similarly, in adjusted analysis, each additional postoperative hospital visit for UTI symptoms increased the risk for surgical intervention for mesh complications (HR 1.74, 95% CI 1.61-1.87). Postoperative urinary retention and hospital presentation for UTI symptoms are associated with an increased risk of reoperation for MUS complications. These patients should be followed and investigated for mesh complications when appropriate. Copyright © 2016 Elsevier Inc. All rights reserved.
Ammendrup, Astrid Cecilie; Jørgensen, Anette; Sander, Pia
OBJECTIVE: To perform a national survey on self-reported cure, satisfaction and complications four years after mid-urethral sling (MUS) for urinary stress incontinence in Danish women operated in 2001. DESIGN: A postal questionnaire survey. POPULATION: All Danish women who received an MUS operation...
Weltz, Vibeke; Guldberg, Rikke; Larsen, Michael D.
Introduction and hypothesis: The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery. Methods: Data were retrieved from the national Danish Urogynaecological Database, including women...... was defined as any new surgical procedure for stress urinary incontinence performed within the study period. Results: During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence...
Ali Feyzullah Sahin
Full Text Available Surgical treatment of female stress urinary incontinence (SUI has become very pop- ular after respectable success with minimal invasive surgeries. This is the first report of long term vaginocutaneous fistula (VCF plus inguinal abcess after tension-free vaginal tape (TVT. A 67 year-old woman with vaginal discharge lasting more than 3 years complained with a painful swelling in the left inguinal area for the last three months. She had a medical history of TVT sling procedure for SUI six years ago. She had no history of pelvic surgery, cancer treatment or pelvic irradiation before or after TVT sling. No urethrovaginal or vesicovaginal fistula was found in physical examination and cystocopy. MRI showed a vaginocutenaous fistula and inguinal abcess. This case highlights the need for a high index of suspicion for VCF after TVT.
Gahlawat, Sumit; Goel, Hemant; Khattar, Nikhil
Congenital short patulous urethra is a rare entity and may be associated with developmental anomalies of mullerian ducts or urogenital sinus. We report the management of two cases of congenital short patulous urethra with stress urinary incontinence (SUI). Both the patients presented with SUI; one was diagnosed with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome and the other had uterus didelphys with longitudinally septated vagina. Both patients were successfully managed by excisional tapering of the urethra and pubovaginal sling placement. SUI with congenital short patulous urethra can be managed with excisional tapering of urethra and pubovaginal sling placement.
Sergent, F; Gay-Crosier, G; Resch, B; Pons, J-C; Marpeau, L
To evaluate complications and functional outcomes at 1 year and more of a modified Tension-free Vaginal Tape (TVT) technique from that of classic TVT. Retrospective study comparing the two techniques. For the modified TVT technique, a peri-urethrovesical hydrodissection was performed. An 18-gauge hollow needle, in which a thread was introduced, was used as an ancillary for the placement of the sling. The sling was secured to the thread and then positioned with it. Bladder filling objectified perforations. An absorbable suture around the sling allowed its descent if necessary. One hundred and eighteen procedures were performed (54 classic TVT and 64 modified TVT). For the standard TVT and the modified TVT, the vesico-urethral perforation rates were respectively 7.4% and 1.5% (PTVT versus 88.2% and 90% for the modified TVT (NS). The dissatisfaction rate was lower for the modified TVT (PTVT, it is possible to reduce its complications while maintaining its efficacy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Hogewoning, Cornelis R C; Elzevier, Henk W; Pelger, Rob C M; Bekker, Milou D; DeRuiter, Marco C
One of the methods to treat post radical prostatectomy stress urinary incontinence is the AdVance (American Medical Systems, Minnetonka, MN, USA) male sling procedure. During this procedure, the somatic innervation of the penis may be at risk for injury. Six AdVance procedures were performed in six donated bodies at the Anatomy and Embryology Department of the Leiden University Medical Centre. The pelves were dissected and the shortest distance between the sling and the dorsal nerve of the penis (DNP) was documented. The aim of this study was to describe the anatomical relation between the AdVance male sling and penile nerves based on the dissection of six adult male pelves. The AdVance male sling procedure was conducted in six donated male bodies. After placement, the pelves were dissected and the shortest distance between sling and the DNP was documented. The main outcome measure was the distance between the AdVance male sling and the DNP. The mean distance of the sling to the DNP was 4.1 mm and was found situated directly next to the nerve (distance 0 mm) in 4 out of 12 (33%) hemipelves. The distance of the sling to the obturator neurovascular bundle was 30 mm or more in all six bodies. Damage to the DNP caused by the AdVance male sling procedure appears to be an extremely rare complication, which has not been described in current literature. The proximity of the AdVance to the DNP could, however, pose a risk that should be taken into consideration by physicians and patients when opting for surgery. © 2015 International Society for Sexual Medicine.
Pizarro-Berdichevsky, Javier; Goldman, Michelle P; Goldman, Howard B
Urethral perforations after synthetic midurethral sling (MUS) placement are uncommon. Transvaginal removal is an option. The objective of this English and Spanish video is to demonstrate removal of an MUS that had perforated the urethra and the concomitant urethral reconstruction. A 66-year-old woman with a history of an anterior and posterior colporrhaphy and a retropubic MUS 12 years earlier presented with difficulty voiding, recurrent urinary tract infections, and mild stress incontinence (SUI). Physical examination revealed tenderness on the anterior vaginal wall (AVW) without mesh extrusion. Cystourethroscopy showed urethral perforation, distal to the bladder neck and urodynamics demonstrated an obstructive pattern. The patient wished to undergo transvaginal sling removal and reconstruction. The mesh was deep in the AVW perforating the urethra and the vaginal portion was completely removed. The video demonstrates several tips on how to remove a perforating MUS and subsequent urethral reconstruction. Ten months postoperatively the force of stream returned to normal, with no further UTIs, no evidence of fistula, and rare SUI. Urethral perforation with an MUS can be successfully treated with removal of any mesh in proximity to the urethra and urethral reconstruction via a completely transvaginal approach.
Full Text Available ... Hospital, Norfolk, VA, 3/25/2009) Urinary Incontinence Advanced Procedures in Male Incontinence: The Male Sling (Kaiser ... Hospital, Greenville, SC, 04/10/2013) Urinary Incontinence Advanced Procedures in Male Incontinence: The Male Sling (Kaiser ...
Miklos, John R; Chinthakanan, Orawee; Moore, Robert D; Karp, Deborah R; Nogueiras, Gladys M; Davila, G Willy
Synthetic mesh utilized to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can often result in postoperative complications. The objectives of this study were to determine: 1) the most common indications for mesh removal; 2) the incidences of the removal of specific mesh procedures (such as suburethral sling [SUS], transvaginal mesh [TVM], or sacrocolpopexy); and 3) the idences and types of surgical complications associated with mesh removal. This was a retrospective study. Design Classification: Canadian Task Force II-3. Three tertiary referral centers in the United States. We examined data from all patients at the three centers who underwent surgical removal of synthetic materials from previous SUS, TVM, and sacrocolpopexy procedures for mesh-related complications from 2011 to 2013. Patients underwent vaginal, intra-abdominal, and inguinal mesh revisions by cutting, partial removal, or total removal of the mesh for mesh-related complications. Overall, 445 patients with complications underwent mesh removal laparoscopically, via groin dissection and/or transvaginally. There were a total of 506 mesh products removed. Of these, 56.5% were slings and 43.5% were for pelvic organ prolapse (POP). Synthetic mesh removed from patients included: transvaginal mesh (TVM) anterior for anterior vaginal prolapse, TVM posterior for posterior vaginal prolapse, sacrocolpopexy mesh, and suburethral slings (SUS) for stress urinary incontinence. Synthetic SUS removed included: retropubic (RPS), transobturator (TOT), and single-incision slings (SIS). TOT was the most common type of sling removed. Patients with a sling who only complained of vaginal pain with or without intercourse underwent a vaginal approach for surgical revision/removal of the sling (86.6%). Patients with an RPS with lower abdominal/suprapubic pain and vaginal pain underwent a vaginal and laparoscopic approach for sling removal (18.4%). Patients with a TOT sling who complained of vaginal and
Fukuda, Hironobu; Imataka, George; Drago, Fabrizio; Maeda, Kosaku; Yoshihara, Shigemi
We report a case of a 10-year-old female patient who survived ring-sling complex without surgery. The patient had congenital wheezing from the neonatal period and was treated after a tentative diagnosis of infantile asthma. The patient suffered from allergy and was hospitalized several times due to severe wheezing, and when she was 22 months old, she was diagnosed with ring-sling complex. We used a segmental 4 mm internal diameter of the trachea for 3-dimensional computed tomography (3D-CT). ...
Full Text Available ... Norfolk General Hospital, Norfolk, VA, 3/25/2009) Urinary Incontinence Advanced Procedures in Male Incontinence: The Male Sling ( ... St. Francis Hospital, Greenville, SC, 04/10/2013) Urinary Incontinence Advanced Procedures in Male Incontinence: The Male Sling ( ...
Weltz, V; Guldberg, R; Lose, G
INTRODUCTION AND HYPOTHESIS: Obesity is associated with an increased prevalence of female stress urinary incontinence (SUI). Mid-urethral polypropylene sling is considered the surgical gold standard for treatment of SUI. We reviewed the current literature on efficacy at 1 year (or more......) and perioperative safety of synthetic mid-urethral sling procedures for SUI in obese women. METHODS: A systematic search of PubMed, Embase and the Cochrane databases was performed using the MeSH terms "Stress urinary incontinence", "Overweight", "Obesity" and "Surgery". We included 13 full-text papers published...... from January 1995 to May 2014. We defined two groups of women: non-obese (BMI below 30 kg/m(2)) and obese (BMI above 30 kg/m(2)). Data regarding subjective and objective cure and selected perioperative complications were pooled and compared. RESULTS: The pooled data from the 13 studies showed that 76...
Hampel, C; Gillitzer, R; Wiesner, C; Thüroff, J W
Nowadays, male stress urinary incontinence is rare and almost always of iatrogenic origin (radiotherapy, pelvic surgery). However, the prognosis of urinary incontinence following surgery is good and can be improved by pelvic floor muscle exercises in combination with biofeedback systems. For the remaining patient cohort with persistent urinary incontinence, several established surgical treatment options are available. Suburothelial injections of bulking agents can easily be performed in an ambulatory setting. However, regardless of the material used, long-term results are disappointing. Moreover, the residual urethral function deteriorates due to cicatrization of the suburothelial plexus with consequent loss of urethral elasticity. The fascial sling procedure in males has to be performed in preoperated areas and is as technically demanding for the surgeon as it is burdening for the patient. Alloplastic material is not used, thus minimizing risks for arrosion or infection. Since the sling tension can neither be standardized nor postoperatively readjusted, the risk of overcorrection is considerable and the success of the procedure is heavily dependent on the surgeon's experience. Despite wear and high revision rates, the technically mature artificial sphincter produces excellent continence results and has become the gold standard in the therapy of male stress urinary incontinence. The circumferential and continuous urethral compression by the cuff is highly effective, but at the price of an almost inevitable urethral atrophy. To overcome this problem, various surgical techniques have been developed (tandem cuff, cuff downsizing, transcorporal cuff placement). However, the expensive artificial sphincter is not a nostrum for every incontinent man, since it requires certain minimal cognitive and manual capabilities. Therefore, the search for less demanding treatment alternatives seems to be necessary, even if one has to accept lower continence rates.
Full Text Available Female, 57 year-old patient, reported having undergone surgery for correction of urinary incontinence due to sphincteric insufficiency with the implantation of a synthetic pubovaginal sling 14 months earlier. Though she did not present urine loss any longer, approximately 60 days following the surgical procedure she started to report dysuria, pollakiuria and dyspareunia. Attempts of a conservative solution were ineffective. The appearance of a vaginal infra-urethral granuloma and the exteriorization of the synthetic material led to its removal.
Huang, Kuan-Hui; Chuang, Fei-Chi; Fu, Hung-Chun; Kung, Fu-Tsai
The aim of this study was to evaluate the efficacy and safety of polypropylene mesh for uterine preservation during pelvic reconstruction in patients with severe uterine prolapse. The study included 67 women with severe uterine prolapse (pelvic organ prolapse quantification stage III/IV) who received transvaginal mesh reconstruction with uterine preservation. Surgery combined with a transobturator membrane sling procedure (tension-free vaginal tape-transobturator route) was performed in 54 patients. Among them, 18 had urodynamic stress incontinence, 30 had occult stress urinary incontinence, and six had mixed urinary incontinence. Objective assessments were carried out with the pelvic organ prolapse quantification staging system, urodynamic examination, and 1-h pad test. Evaluation of urinary and prolapse symptoms comprised the subjective assessment. The mean follow-up interval was 19.6 months (12-40 months). The objective cure rate for the treatment of uterine prolapse was 89.5%, and the objective cure rate for the treatment of urinary incontinence was more than 90%. Uterine preservation in pelvic reconstruction is technically feasible and the subjective and objective assessments imply that uterine preservation in pelvic reconstruction is an alternative option for indicated patients. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.
Walsh, Colin A
• Synthetic mid-urethral slings (MUSs) are considered the first choice surgical procedure for stress urinary incontinence. Recent publications have raised concerns about the efficacy of third generation single-incision mini-slings. The present paper is a systematic review of studies reporting 12-month outcomes after the TVT-Secur (TVT-S) procedure. • Pubmed/Medline online databases, abstracts from recent International Continence Society and International Urogynecological Association annual scientific meetings and the Clinicaltrials.gov and Controlled-trials.com online trial registries were searched for English-language articles containing the terms 'TVT-Secur', 'TVT Secur' or 'mini-sling'. The primary outcomes were objective and subjective cure rates at 12 months. Secondary outcomes included peri-operative (vaginal perforation, urinary retention, urinary tract infection [UTI]) and postoperative (mesh exposure, de novo overactive bladder (OAB), dyspareunia and return to theatre) complication rates. • Among 1178 women undergoing the TVT-S procedure, from 10 studies, both objective and subjective cure rate at 12 months was 76%, with objective cure significantly higher in women undergoing the 'U-type' approach. Vaginal perforation was a complication in 1.5% of cases, with a 2.4% incidence of mesh exposure in the first year. The incidence of de novo OAB symptoms was 10%. Rates of urinary retention (2.3%), UTI (4.4%), dyspareunia (1%) and return to theatre for complications (0.8%) were low. In the first year after a TVT-S procedure 5% of women required repeat continence surgery. • Longer-term studies and randomized comparisons with more established MUSs are required before TVT-S should be routinely used in the surgical treatment of stress urinary incontinence. © 2011 THE AUTHOR. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.
Heidari, Mohammad; Khorramabadi, Manoochehr Shams
To evaluate the utility and efficacy of bulbar urethera sling in the management of sphincter insufficiency that usually occurs after prostate surgery or posterior urethral injuries and may lead to moderate to severe stress incontinence. A total of 30 patients underwent sling surgery with rectus fascia in a four-year period at the Shohadaye Ashayer Teaching Hospital in Iran. Urinary incontinence occurred in 8 patients after open prostatectomy, in 12 patients after prostatectomy through urethra, in 8 patients after radical prostatectomy. For the purpose of the study, 2 patients in whom incontinence occurred after pelvic fracture were excluded. The 28 patients were followed up for a one-year period after the operation. All patients had incontinence from one to six years. After hospitalisation, an 18 gauge Foley's catheter was introduced in the urethra in every patient. The perineum was incised longitudinally, and the bulbar urethra was freed and a 2x7 cm span of rectus fascia was separated and placed under the bulbar urethra. Treatment was defined as use of one or no pad per day and recovery, as a reduction of at least 50% in the number of the used pads after sling operation. After operation, all patients suffering from moderate to severe stress incontinence were treated with 0-1 pad per day. Four patients were unable to urinate; in 2 patients the sling was modified and loosened, and in two others dilatation resolved their problems. Bulbar urethra sling can be carried out in moderate to severe urinary incontinence treatment in any hospital at a modest cost with satisfactory results.
Romero Hoyuela, A; Reina Alcaina, L; Izquierdo Morejon, E; Rosino Sanchez, A; Carrillo George, C; Rivero Guerra, A; Barcelo Bayonas, I; Pardo Martinez, A; Muñoz Guillermo, V; Pietricica, B; Fernandez Aparicio, T; Hita Villaplana, G; Miñana Lopez, B
To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance ® and AdvanceXP ® slings. The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVance ® and AdVanceXP ® sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of≥1.5cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24h; moderate was defined as 3-5 absorbers/24h; and severe was defined as more than 5 absorbers/24h. Healing was defined as the total absence of using pads; improvement was defined as a reduction>50% in the number of pads; and failure was defined as a reduction<50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation≥1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P<.001) compared with the preoperative score. The Advance ® and AdvanceXP ® system are effective over time in terms of urinary continence and patient satisfaction. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
Houwert, R. Marijn; Venema, Pieter L.; Aquarius, Annelies E.; Bruinse, Hein W.; Kil, Paul J. M.; Vervest, Harry A. M.
Urodynamic investigation (UDI) is routinely performed before midurethral sling surgery (MUS) for female stress urinary incontinence to detect factors that may adversely affect the surgical outcome or confirm the diagnosis. A recent review, however, concluded that there was insufficient evidence to
Full Text Available Objective. It is to assess the feasibility, effectiveness, and safety of transobturator tension-free vaginal mesh (Prolift and concomitant tension-free vaginal tape-obturator (TVT-O system as a treatment of female anterior vaginal wall prolapse associated with stress urinary incontinence (SUI. Patients and Methods. Between December 2006 and July 2007, 20 patients with anterior genital prolapse and voiding dysfunction were treated with the transobturator tension-free vaginal mesh (Prolift and concomitant tension-free vaginal tape-obturator (TVT-O. Sixteen patients had stress urinary incontinence and 4 patients were considered at risk for development of de novo stress incontinence after the prolapse is repaired. All patients underwent a complete urodynamic assessment. All the patients underwent pelvic examination 4Ã¢Â€Â“6 weeks after the operation, and anatomical and functional outcomes were recorded. Results. Twenty cystocoeles were repaired: 6 grade II, 12 grade III, and 2 grade IV. There were no vessel or bladder injuries. Eighteen patients had optimal anatomic results and 2 patients had persistent asymptomatic stage I prolapse. Conclusion. These preliminary results suggest that Prolift system offers a safe and effective treatment for female anterior vaginal wall prolapse. However, a long-term followup is necessary in order to support the good result maintenance.
Richard, Patrick; Gagnon, Louis-Olivier; Tu, Le Mai
Introduction: The TVT-Secur, a single incision sling, was introduced in 2006. It is implanted using either the “hammock” or the “U-method” technique. With the latter, the sling is tightened to create a “pillowing effect” on the urethra until a negative stress test is obtained. Short-term results seem promising. However, no study has ever reported on the voiding pattern 12 months after its implantation. Our objective was to assess whether the “U-method” technique creates an obstructive voiding pattern on pressure-flow study (PFS) 12 months after the surgery. Methods: In this retrospective study, we reviewed the charts of 33 women who underwent the “U-method” TVT-Secur. Patients were evaluated before and 12 months postoperatively with regard to different urodynamic studies (UDS). The incontinence status was also assessed 12 months after surgery. Results: At 12 months after the operation, 12.5% (4/32) of the patients reported an improvement of their stress urinary incontinence, while 78.1% (25/32) reported being cured from it. The objective cure rate was 63% (19/30). One patient had a suspected bladder outlet obstruction (BOO) based on PFS. Maximal flow rate (Qmax) was significantly lower 12 months after surgery (26.0 mL/s [range: 19.0–36.5] vs. 21.5 mL/s [range: 16.0–32.3]). However, median voided volume was lower on the postoperative uroflowmetry (446 mL [range: 348–605] vs. 320 mL [range: 243–502]). Furthermore, none of the patients complained of voiding symptoms after surgery. Conclusions: Although one patient had findings compatible with BOO, none complained of voiding symptoms. TVT-Secur may result in a lower Qmax. However, this finding may be due to a lower voiding volume on the postoperative UDS. PMID:22511425
Full Text Available Naidu Vinuthinee,1,2 Anuar Azreen-Redzal,1 Jaafar Juanarita,1 Embong Zunaina2 1Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia; 2Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia Abstract: We report a rare case of sling shot injury that presented with a gunshot-like wound with preseptal cellulitis, in a toddler. An 11-month-old Malay child presented with a gunshot-like wound over the forehead following sling shot injury. On examination, he had a deep circular laceration wound over the forehead, measuring 2.0 cm in diameter, with minimal bleeding. There was no obvious foreign body seen inside the wound and no palpable foreign body surrounding the wound. The gunshot-like wound was associated with left preseptal cellulitis. A skull X-ray showed a white opaque foreign body in the left frontal bone. Computed tomography (CT scan of orbit and brain revealed a left comminuted fracture of the left orbital roof, and left frontal brain contusion with prelesional edema. Wound exploration was performed and revealed a 0.5 cm unshattered marble embedded in the left frontal bone. The marble and bone fragments were removed. The left preseptal cellulitis responded well to intravenous antibiotic and topical antibiotic. Keywords: preseptal cellulitis, orbital roof fracture, pediatric trauma
Mengerink, Bianca B.; van Leijsen, Sanne A. L.; Vierhout, Mark E.; IntHout, Joanna; Mol, Ben W. J.; Milani, Alfredo L.; Roovers, Jan-Paul W. R.; van Eijndhoven, Hugo W. F.; van der Vaart, Carl H.; van Gestel, Iris; Hartog, Francis E.; Heesakkers, John F. A.; Kluivers, Kirsten B.
Introduction: Stress urinary incontinence has a negative impact on sexual function. Aim: To assess the effect of midurethral sling surgery on sexual activity and function in women with stress urinary incontinence. Methods: This is a secondary analysis of the Value of Urodynamics Prior to Stress
Full Text Available ... Springs, Coral Springs, FL, 3/31/2014) Erectile Dysfunction Simultaneous Inflatable Penile Prosthesis (IPP) and Male Sling ... Springs, Coral Springs, FL, 3/31/2014) Erectile Dysfunction Simultaneous Inflatable Penile Prosthesis (IPP) and Male Sling ...
Gałczyński, Krzysztof; Futyma, Konrad; Bar, Krzysztof; Rechberger, Tomasz
Sling operations have been performed for over 15 years. In recent years these operations have become the gold standard in the treatment of stress urinary incontinence (SUI) due to their efficacy safety and low invasiveness. Approximately 4% of women will undergo a surgery for SUI in the course of their life. As with any surgical intervention, there may be some technical problems, as well as intra- and postoperative complications, the most common of which is bladder injury Other complications encountered during mid-urethral slings procedures include bleeding (retropubic or vaginal hematomas), urethral perforation, urinary tract infections, postoperative vaginal or urethral erosions, bowel perforation, chronic pelvic pain, wound infection, nerve injury transient and persistent voiding dysfunction such as de novo urgency incomplete bladder emptying or urinary retention. Below we present a case of a patient with diagnosed vesicovaginal fistula after sling operation (TVT-tension-free vaginal tape). Upon admission the patient reported dysuria, persistent urinary leakage and abnormal, abundant vaginal discharge. Case report and review of literature concerning surgical treatment of stress urinary incontinence and its complications. Analysis of medical documentation of the patient treated at the Second Department of Gynecology Medical University of Lublin. Review of abstracts or papers in the Medline database related to surgical treatment of urinary incontinence and its complications. Bladder perforation is one of the most common complications of the retropubic approach for MUS placement. The presence of mesh within the bladder may arise from direct bladder perforation or from subsequent erosion of the sling. Such lesions do not cause any serious health consequences for patients on condition they are detected intraoperatively and appropriately repaired, but when unrecognized, they results in the development of considerable symptoms and negatively influence the quality of
Nicole Szell, DO
Szell N, Komisaruk B, Goldstein SW, et al. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence. Sex Med 2017;5:e84–e93.
Magnus, Charlene R A; Barss, Trevor S; Lanovaz, Joel L; Farthing, Jonathan P
The purpose of this study was to apply cross-education during 4 wk of unilateral limb immobilization using a shoulder sling and swathe to investigate the effects on muscle strength, muscle size, and muscle activation. Twenty-five right-handed participants were assigned to one of three groups as follows: the Immob + Train group wore a sling and swathe and strength trained (n = 8), the Immob group wore a sling and swathe and did not strength train (n = 8), and the Control group received no treatment (n = 9). Immobilization was applied to the nondominant (left) arm. Strength training consisted of maximal isometric elbow flexion and extension of the dominant (right) arm 3 days/wk. Torque (dynamometer), muscle thickness (ultrasound), maximal voluntary activation (interpolated twitch), and electromyography (EMG) were measured. The change in right biceps and triceps brachii muscle thickness [7.0 ± 1.9 and 7.1 ± 2.2% (SE), respectively] was greater for Immob + Train than Immob (0.4 ± 1.2 and -1.9 ± 1.7%) and Control (0.8 ± 0.5 and 0.0 ± 1.1%, P effect on maximal voluntary activation or EMG. The cross-education effect on the immobilized limb was greater after elbow extension training. This study suggests that strength training the nonimmobilized limb benefits the immobilized limb for muscle size and strength.
Full Text Available Background: The aim of this study was to assess the efficacy and safety of a new minimally-invasive surgical procedure using trans-obturator Tape (TOT to treat female stress urinary incontinence.Methods: This clinical trial study was performed from 2003 to 2004 in the Gynecology Department of Imam Hospital, Vali-e-Asr, Tehran, Iran. A total of 35 women with stress urinary incontinence underwent the TOT procedure. All patients underwent pre-operative clinical examination, cough-stress test (full bladder, uroflowmetry and post-voiding residual volume assessment. Results: The mean age of patients was 50 years, ranging from 26 to 74 years, with an average urinary stress incontinence duration of six years. The mean time of follow-up was 14 months (at 1, 6, 12 and 24 months and the average duration of surgery was about 20 minutes. The perioperative complication rate was 9% with no vascular, nerve or bowel injuries. The rate of hemorrhagic side effects (spontaneously-absorbed hematoma and blood loss not requiring blood transfusion was 2.9%. Post-operative urinary retention and vaginal erosion occurred in one case each; the former was treated by intermittent self-catheterization. In total, 91.4% of patients were completely cured and 8.6% were improved without failure of treatment. Conclusions: The present study confirms the results obtained by Delorme and coworkers, and allows us to consider TOT as a safe, minimally invasive and efficient short-term surgical technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair. Following this study, a randomized control trial is recommended to compare TOT with the gold standard surgery for women with urinary incontinence.
Mazloomdoost, Donna; Pauls, Rachel N; Hennen, Erin N; Yeung, Jennifer Y; Smith, Benjamin C; Kleeman, Steven D; Crisp, Catrina C
Midurethral slings are commonly used to treat stress urinary incontinence. Pain control, however, may be a concern. Liposomal bupivacaine is a local anesthetic with slow release over 72 hours, demonstrated to lower pain scores and decrease narcotic use postoperatively. The purpose of this study was to examine the impact of liposomal bupivacaine on pain scores and narcotic consumption following retropubic midurethral sling placement. This randomized, placebo-controlled trial enrolled women undergoing retropubic midurethral sling procedures with or without concomitant anterior or urethrocele repair. Subjects were allocated to receive liposomal bupivacaine (intervention) or normal saline placebo injected into the trocar paths and vaginal incision at the conclusion of the procedure. At the time of drug administration, surgeons became unblinded, but did not collect outcome data. Participants remained blinded to treatment. Surgical procedures and perioperative care were standardized. The primary outcome was the visual analog scale pain score 4 hours after discharge home. Secondary outcomes included narcotic consumption, time to first bowel movement, and pain scores collected in the mornings and evenings until postoperative day 6. The morning pain item assessed "current level of pain"; the evening items queried "current level of pain," "most intense pain today," "average pain today with activity," and "average pain today with rest." Likert scales were used to measure satisfaction with pain control at 1- and 2-week postoperative intervals. Sample size calculation deemed 52 subjects per arm necessary to detect a mean difference of 10 mm on a 100-mm visual analog scale. To account for 10% drop out, 114 participants were needed. One hundred fourteen women were enrolled. After 5 exclusions, 109 cases were analyzed: 54 women received intervention, and 55 women received placebo. Mean participant age was 52 years, and mean body mass index was 30.4 kg/m 2 . Surgical and
Larouche, Maryse; Geoffrion, Roxana; Lazare, Darren; Clancy, Aisling; Lee, Terry; Koenig, Nicole A; Cundiff, Geoffrey W; Stothers, Lynn
Scant literature exists about the quality of urogynecological content on social media. Our objective was to measure the accuracy and comprehensiveness of YouTube videos related to mid-urethral sling (MUS) procedures. YouTube was searched using the terms "mid-urethral sling," "vaginal tape," "TVT," "TOT," "TVT surgery," and "TOT surgery." Duplicates and videos with less than 1,000 views were excluded. We developed a standardized questionnaire for this project, assessing each video's target audience, main purpose, relevance, informed consent elements, surgical steps, and bias. The primary outcome was the presence of all elements of informed consent. Inter-rater reliability (IRR) was calculated using the Fleiss' kappa statistic. Descriptive statistics were also obtained. Five reviewers each rated 56 videos. Mean IRR was moderate (Fleiss' kappa 0.58 ± 0.24). Video content was classified as physician educational material (67.9 %), patient information (16.1 %), advertisement (10.7 %), lawsuit recruitment (1.8 %), and unclear (3.6 %). MUS was the primary topic for 82.1 % of the videos. The remainder discussed other types of anti-incontinence procedures or prolapse surgery. None of the videos mentioned all four elements of informed consent. Of 32 videos demonstrating surgical technique, none showed the complete list of pre-determined surgical steps. The mean number of listed steps was 7.6/16. Only four videos mentioned at least one post-operative patient instruction. A marketing element was shown in 26.8 % of videos. Patient information about MUS on YouTube is lacking and often biased. Physicians and students viewing YouTube videos for educational purposes should be cognizant of the variability in the surgical steps demonstrated.
Genevois, Cyril; Berthier, Philippe; Guidou, Vincent; Muller, Franck; Thiebault, Boris; Rogowski, Isabelle
In women's handball, the large numbers of throws and passes make the shoulder region vulnerable to overuse injuries. Repetitive throwing motions generate imbalance between shoulder internal- and external-rotator muscles. It has not yet been established whether sling-based training can improve shoulder external-rotator muscle strength. This study investigated the effectiveness of a 6-wk strengthening program in improving shoulder functional profile in elite female high school handball players. Crossover study. National elite handball training center. 25 elite female high school handball players. The program, completed twice per week for 6 wk, included sling-based strengthening exercises using a suspension trainer for external rotation with scapular retraction and scapular retraction alone. Maximal shoulder external- and internal-rotation strength, shoulder external- and internal-rotation range of motion (ROM), and maximal throwing velocity were assessed preintervention and postintervention for dominant and nondominant sides. After sling training, external- and internal-rotation strength increased significantly for both sides (P ≤ .001, and P = .004, respectively), with the result that there was no significant change in external- and internal-rotation strength ratios for either the dominant or the nondominant shoulder. No significant differences were observed for external-rotation ROM, while internal-rotation ROM decreased moderately, in particular in the dominant shoulder (P = .005). Maximal throwing velocity remained constant for the dominant arm, whereas a significant increase was found for the nondominant arm (P = .017). This 6-wk strengthening program was effective in improving shoulder external-rotator muscle strength but resulted in a decrease in the ROM in shoulder internal rotation, while throwing velocity remained stable. Adding a stretching program to this type of sling-based training program might help avoid potential detrimental effects on shoulder ROM.
William Luis de Oliveira
Full Text Available Os autores deste trabalho procuram mostrar os benefícios para a mulher com incontinência urinária, através da correção da mesma pela técnica do Sling pubovaginal. Estudaram-se clínica e cirurgicamente, 60 pacientes, relatando a técnica, os métodos e os resultados obtidos. Concluiu-se que houve melhora acentuada da incontinência urinária (I.U.E. com o uso desta técnica, em relação às técnicas convencionais.
Töz, Emrah; Sahin, Cağdaş; Apaydin, Nesin; Ozcan, Aykut; Taner, Cüneyt E
The Burch colposuspension, which was regarded as the gold standard treatment for stress urinary incontinence for several years, has been replaced by minimally invasive sling devices. Although these procedures are simple and minimally invasive, they are associated with complications such as infection, mesh erosion, chronic pain, and de novo detrusor overactivity, which may necessitate surgical resection or tape removal. The aim of the study was to assess urinary function outcomes including continence, after partial resection of suburethral tapes. Patients were admitted for resection of tape due to extrusion/exposure, between 2011 and 2014. Patients were evaluated with physical examination, transvaginal ultrasound, cough stress test, 24-hour bladder diary, Incontinence Impact Questionnairre-7 form and Urogenital Distress Inventory-6 form. Minimum follow-up time was 2 months after treatment of the tape complication (mean 20, range 2 to 38). Recurrence of incontinence after partial tape resection was observed in 9% (3/32) cases. In two patients due to stress urinary incontinence recurrence repeat anti-incontinence surgery was necessary. Although one patient had suffered from incontinence after resection of tape, she did not desire operation. The results of this study indicated that preservation of the anti-incontinence effects of slings might not be dependent on the intactness of the sling. Recurrence of incontinence after partial tape resection is uncommon and in the majority of cases this stress incontinence is minimally and does not require repeat operation.
Tran, M G B; Yip, J; Uveili, K; Biers, S M; Thiruchelvam, N
Patient reported outcome measures (PROMs) were used to evaluate outcomes of the artificial urinary sphincter (AUS) and the AdVance™ (American Medical Systems, Minnetonka, MN, US) male sling system (AVMS) for the symptomatic management of male stress urinary incontinence. All male patients with stress urinary incontinence referred to our specialist clinic over a two-year period completed the ICIQ-UI SF (International Consultation on Incontinence Questionnaire on Urinary Incontinence Short Form) and the ICIQ-MLUTS LF (International Consultation on Incontinence Questionnaire on Male Lower Urinary Tract Symptoms Long Form) at consultation as well as at subsequent follow-up appointments. The Wilcoxon signed-rank test for non-parametric paired data was used for pre and postoperative comparisons. The chi-squared test was used for categorical variables. Thirty-seven patients (forty surgical cases) completed a preoperative and at least one follow-up questionnaire. There was a statistically significant improvement in PROMs postoperatively, regardless of mode of surgery (p25) had greater improvement with an AUS than with the AVMS (p<0.01). This prospective study shows that completion and collection of PROMs as part of routine clinical practice is achievable and useful in the assessment of male stress incontinence surgery. PROMs are important instruments to assess effectiveness of healthcare intervention and they are useful adjuncts in surgical studies.
Mooyaart, E.L.; Boomsma, J.H.B.; Postmus, P.E.; Formanek, G.A.
Two new adult patients with aberrant origin of the left pulmonary artery from the right pulmonary artery - pulmonary artery sling - are described, totalling the published adult cases to eight. Differentiation from a mediastinal mass closely mimicking this vascular anomaly is discussed. For the definitive diagnosis, digital subtraction angiography was applied for the first time. The clearest demonstration of the anatomy is in 20-25 0 RPO and 20-25 0 sitting position. The aberrant left pulmonary artery in adults is asymptomatic.
Full Text Available ABSTRACT Purpose To determine whether there is a difference in sexual function after modified and classical TOT procedures. Materials and Methods Of the 80 sexually active women with SUI, 36 underwent an original outside-in TOT as described by Delorme, and 44 underwent modified TOT procedure, between 2011 and 2015. The severity of incontinence and sexual function were evaluated using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF and Female Sexual Function Index (FSFI questionnaires preoperatively and 3 months after surgery. Results The postoperative ICIQ-SF score was significantly lower than the preoperative ICIQ-SF score in both groups (p=0.004 for modified TOT and p=0.002 for classical TOT. There was no significant difference in the ICIQ-SF score reduction between the two groups (14.1±2.1 vs. 14.4±1.9; p=0.892. Complication rates according to the Clavien-Dindo classification were also similar in both groups. In both groups, difference between preoperative and postoperative FSFI scores revealed a statistically significant improvement in all domains. Comparison of postoperative 3-month FSFI scores of modified and classical TOT groups showed statistically significant differences in arousal, lubrication and orgasm domains. Desire, satisfaction, pain and total FSFI scores did not differ significantly between two groups. Conclusion The modified TOT technique is a simple, reliable and minimal invasive procedure. The cure rate of incontinence and complication rates are the same as those of the classical TOT technique. However, due to the positive effects of minimal tissue damage on sexual arousal and orgasmic function, modified TOT has an advantage over the classical TOT.
van der Ploeg, J Marinus; Rengerink, Katrien Oude; van der Steen, Annemarie; van Leeuwen, Jules H Schagen; van der Vaart, C Huub; Roovers, Jan-Paul W R
INTRODUCTION AND HYPOTHESIS: We compared pelvic organ prolapse (POP) repair with and without midurethral sling (MUS) in women with occult stress urinary incontinence (SUI). METHODS: This was a randomized trial conducted by a consortium of 13 teaching hospitals assessing a parallel cohort of
Jones, Trahern W; Seckeler, Michael D
Three-dimensional (3D) printing is a manufacturing method by which an object is created in an additive process, and can be used with medical imaging data to generate accurate physical reproductions of organs and tissues for a variety of applications. We hypothesized that using 3D printed models of congenital cardiovascular lesions to supplement an educational lecture would improve learners' scores on a board-style examination. Patients with normal and abnormal aortic arches were selected and anonymized to generate 3D printed models. A cohort of pediatric and combined pediatric/emergency medicine residents were then randomized to intervention and control groups. Each participant was given a subjective survey and an objective board-style pretest. Each group received the same 20-minutes lecture on vascular rings and slings. During the intervention group's lecture, 3D printed physical models of each lesion were distributed for inspection. After each lecture, both groups completed the same subjective survey and objective board-style test to assess their comfort with and postlecture knowledge of vascular rings. There were no differences in the basic demographics of the two groups. After the lectures, both groups' subjective comfort levels increased. Both groups' scores on the objective test improved, but the intervention group scored higher on the posttest. This study demonstrated a measurable gain in knowledge about vascular rings and pulmonary artery slings with the addition of 3D printed models of the defects. Future applications of this teaching modality could extend to other congenital cardiac lesions and different learners. © 2017 Wiley Periodicals, Inc.
van der Ploeg, J. Marinus; Oude Rengerink, Katrien; van der Steen, Annemarie; van Leeuwen, Jules H. Schagen; van der Vaart, C. Huub; Roovers, Jan-Paul W. R.
We compared pelvic organ prolapse (POP) repair with and without midurethral sling (MUS) in women with occult stress urinary incontinence (SUI). This was a randomized trial conducted by a consortium of 13 teaching hospitals assessing a parallel cohort of continent women with symptomatic stage II or
van der Ploeg, J M; Oude Rengerink, K; van der Steen, A; van Leeuwen, J H S; Stekelenburg, J; Bongers, M Y; Weemhoff, M; Mol, B W; van der Vaart, C H; Roovers, J-P W R
OBJECTIVE: To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. DESIGN: Multi-centre randomised trial. SETTING: Fourteen teaching hospitals in the Netherlands. POPULATION: Women with symptomatic stage two or greater pelvic organ prolapse (POP),
The SIMS trial: adjustable anchored single-incision mini-slings versus standard tension-free midurethral slings in the surgical management of female stress urinary incontinence. A study protocol for a pragmatic, multicentre, non-inferiority randomised controlled trial.
Abdel-Fattah, Mohamed; MacLennan, Graeme; Kilonzo, Mary; Assassa, R Phil; McCormick, Kirsty; Davidson, Tracey; McDonald, Alison; N'Dow, James; Wardle, Judith; Norrie, John
Single-incision mini-slings (SIMS) represent the third generation of midurethral slings. They have been developed with the aim of offering a true ambulatory procedure for treatment of female stress urinary incontinence (SUI) with reduced morbidity and earlier recovery while maintaining similar efficacy to standard midurethral slings (SMUS). The aim of this study is to determine the clinical and cost-effectiveness of adjustable anchored SIMS compared with tension-free SMUS in the surgical management of female SUI, with 3-year follow-up. A pragmatic, multicentre, non-inferiority randomised controlled trial. The primary outcome measure is the patient-reported success rate measured by the Patient Global Impression of Improvement at 12 months. The primary economic outcome will be incremental cost per quality-adjusted life year gained at 12 months. The secondary outcomes measures include adverse events, objective success rates, impact on other lower urinary tract symptoms, health-related quality of life profile and sexual function, and reoperation rates for SUI. Secondary economic outcomes include National Health Service and patient primary and secondary care resource use and costs, incremental cost-effectiveness and incremental net benefit. The statistical analysis of the primary outcome will be by intention-to-treat and also a per-protocol analysis. Results will be displayed as estimates and 95% CIs. CIs around observed differences will then be compared with the prespecified non-inferiority margin. Secondary outcomes will be analysed similarly. The North of Scotland Research Ethics Committee has approved this study (13/NS/0143). The dissemination plans include HTA monograph, presentation at international scientific meetings and publications in high-impact, open-access journals. The results will be included in the updates of the National Institute for Health and Care Excellence and the European Association of Urology guidelines; these two specific guidelines directly
Full Text Available ABSTRACT Introduction The prevalence of urinary incontinence is increasing. Two major risk factors are overweight and age. We present objective and subjective cure rates of elderly and overweight patients treated with an adjustable single-incision sling system (AJUST™, C.R. BARD, Inc.. Materials and Methods Between 04/2009 and 02/2012 we treated 100 female patients with the single incision sling. Patients were retrospectively evaluated by Stamey degree of incontinence, cough test, pad use, and overall satisfaction. The primary outcomes of the study were objective and subjective cure rates, secondary outcomes were the safety profile of the sling and complications. Results The overall success rate in this population was 84.6% with a mean follow-up of 9.3 months. The average usage of pads per day decreased from 4.9 to 1.6 and was significantly lower in patients with a BMI <30 (p=0.004. Postoperative residual SUI was also lower in patients with a BMI <30 (p=0.006. Postoperative satisfaction was better in patients with a lower BMI, but this difference did not reach a level of significance (p=0.055. There were no complications such as bleeding, bladder injury, or tape infection. Conclusions In elderly and obese patients a considerable success rate is achievable with this quick and minimal invasive procedure. However, the success rate shows a clear trend in favor of a lower body-mass-index. The cut-off point has been identified at a BMI of 30. The AJUST™ system can be regarded as safe and beneficial for elderly and obese patients.
van der Ploeg, J. M.; Oude Rengerink, K.; van der Steen, A.; van Leeuwen, J. H. S.; Stekelenburg, J.; Bongers, M. Y.; Weemhoff, M.; Mol, B. W.; van der Vaart, C. H.; Roovers, J.-P. W. R.; Bergmans, Martin G.; Bongers, Marlies Y.; Dekker, Karin S.; van Gestel, Iris; Kluivers, Kirsten B.; Milani, A. L. Fred; van der Ploeg, J. Marinus; Oude Rengerink, Katrien; Schagen van Leeuwen, Jules H.; Schram, Aaltje J.; van der Steen, Annemarie; Stekelenburg, Jelle; van der Vaart, C. Huub; Weemhoff, Mirjam; Weis-Potters, Annemarie E.; Wijma, Jac
To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. Multi-centre randomised trial. Fourteen teaching hospitals in the Netherlands. Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress
van der Ploeg, J. M.; Rengerink, K. Oude; van der Steen, A.; van Leeuwen, J. H. S.; Stekelenburg, J.; Bongers, M. Y.; Weemhoff, M.; Mol, B. W.; van der Vaart, C. H.; Roovers, J-P W. R.
ObjectiveTo compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. DesignMulti-centre randomised trial. SettingFourteen teaching hospitals in the Netherlands. PopulationWomen with symptomatic stage two or greater pelvic organ prolapse (POP), and
Gibson, W; Wagg, A
To examine the trends in surgical treatment of stress urinary incontinence (SUI) in older women since the introduction of the mid-urethral sling. Analysis of data from Hospital Episode Statistics (HES) between 2000 and 2012. All surgical procedures for SUI in the National Health Service (NHS) in England. Retrospective cohort analysis of Hospital Episode Statistics for England from 2000 to 2012. Number of invasive, less invasive, and urethral bulking procedures performed in women in three age groups. There was a 90% fall in the number of invasive surgical treatments for SUI and a four-fold increase in the number of mid-urethral slings over this time. The total number of surgical procedures for SUI increased from 8458 to 13 219. However, the rise in the number of procedures in women aged over 75 was more modest-a three-fold increase from a low start of 187-and these women now make up a smaller proportion of all women receiving a mid-urethral sling (MUS). Despite the development and wide availability of a less invasive, safe and effective operation for stress urinary incontinence in older women, they do not appear to have benefitted. The reasons for this require prospective investigation. © 2015 Royal College of Obstetricians and Gynaecologists.
Brennand, Erin A; Kim-Fine, Shunaha
The goal of this trial is to compare two techniques for tensioning retropubic midurethral slings: a Mayo scissor between the tape and urethra vs. a Babcock clamp creating a measured loop underneath the urethra. The primary outcome is a composite of abnormal bladder function at 12 months post surgery. Abnormal bladder function is defined as bothersome stress incontinence or worsening over active bladder symptoms, a positive cough stress test, re-treatment of stress urinary incontinence, post-operative urinary retention requiring either catheterization beyond 6 weeks or surgical intervention. Secondary outcomes include the duration of post operative urinary retention, quality of life scores, and physical examination. This article describes the rationale and design of this clinical trial, which will be of interest to those who care for patient with pelvic floor disorders such as stress urinary incontinence.
Guerrero, K L; Emery, S J; Wareham, K; Ismail, S; Watkins, A; Lucas, M G
To compare TVT(TM) , Pelvicol(TM) and autologous fascial slings (AFSs). A multicentre randomised control trial. Four units in the UK. Women requiring primary surgery for stress urinary incontinence (SUI). A total of 201 women with urodynamically proven stress incontinence were randomised into three groups and assessed at baseline, 6 weeks, 6 months and 1 year. The primary outcome was patient-reported improvement rates. Secondary outcomes included operative complications/time, intermittent self-catheterisation (ISC) and re-operation rates. The quality-of-life tools used were the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) and EuroQoL. Fifty women had a Pelvicol(TM) sling, 79 had AFSs and 72 had TVT(TM). At 6 months the Pelvicol(TM) arm had poorer improvement rates (73%) than TVT(TM) (92%)/AFS (95%); P=0.003. At 1 year only 61% of the Pelvicol(TM) slings remained as improved, versus 93% of TVTs and 90% of AFSs (PTVT(TM) (55%)/AFS (48%) (P=0.001) at 1 year; hence, the Pelvicol(TM) arm was suspended following interim analysis. There is no difference in the success rates between TVT(TM) and AFS. One in five women in the Pelvicol(TM) arm had further surgery for SUI by 1 year, but none required further surgery in the other arms. AFS took longer to do (54 minutes versus 35 minutes for TVT(TM) /36 minutes for Pelvicol(TM) ) and had higher ISC rates (9.9 versus 0% Pelvicol(TM) /TVT(TM) 1.5%). Hospital stay was shortest for TVT(TM) (2 days). Most BFLUTS domains showed improvement in all three arms. The improvement for women in the Pelvicol(TM) arm, however, was less than for women in the other arms in several key domains. Pelvicol(TM) cannot be recommended for the management of SUI. TVT(TM) does not have greater efficacy than AFS, but does utilise fewer resources. © 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.
Fukuda, Hironobu; Imataka, George; Drago, Fabrizio; Maeda, Kosaku; Yoshihara, Shigemi
We report a case of a 10-year-old female patient who survived ring-sling complex without surgery. The patient had congenital wheezing from the neonatal period and was treated after a tentative diagnosis of infantile asthma. The patient suffered from allergy and was hospitalized several times due to severe wheezing, and when she was 22 months old, she was diagnosed with ring-sling complex. We used a segmental 4 mm internal diameter of the trachea for 3-dimensional computed tomography (3D-CT). Bronchial asthma is considered an exacerbating factor in infantile period and frequently required treatment with bronchodilator. After the age of 10, the patient had recurrent breathing difficulties during physical activity and during night time, and this condition was assessed to be related to the pressure from the blood vessel on the ring. We repeated the 3D-CT evaluation later and discovered that the internal diameter of the trachea had grown to 5 mm. Eventually, patient's breathing difficulties disappeared after the treatment of bronchial asthma and restriction of physical activities. Our patient remained in stable condition without undergoing any surgical procedures even after she passed the age of 10.
Full Text Available INTRODUCTION: Mid Urethral Slings is the main stay of therapy in the management of stress urinary incontinence in the female, w e evaluated the effect of TVT on sexual function in women who are from the rural backward districts of Rayalaseema districts of Andhra Pradesh. MATERIALS & METHODS: 30 Women with a mean age of 44 yrs with SUI were evaluated before TVT procedure and then every 3months for 1yr for sexual health using NSF - 9 questionnaire . RESULTS: The sexual function in all the domains including desire, frequency ar ousal , orgasm remained the same as before surgery in more than 80% pts. The satisfaction rate was better in pts who were leaking during sex before surgery in six out of ten patients. CONCLUSIONS: TVT surgery does not have any significant impact on sexual function Sexual function is not an important issue for the female beyond the age of 40 yrs in the perimenopau s e/ post menopause period
Deffieux, Xavier; Daher, Nagib; Mansoor, Aslam; Debodinance, Philippe; Muhlstein, Joël; Fernandez, Hervé
The purpose of this study is to compare the retropubic tension-free vaginal tape (TVT) procedure with the inside-out transobturator approach (TVT-O). Multicenter randomized controlled trial. One hundred forty-nine patients were randomly allocated to either TVT (n = 75) or TVT-O (n = 74). Interview, medical examination, pain scores, success rates, and quality of life assessment were recorded pre-operatively, and 2, 6, 12, and 24 months post-operatively. One hundred forty-nine patients underwent surgery, and 132 completed a 24-month follow-up. Bladder injury rate was 5% (4/75) in the TVT group and 2% (2/74) in the TVT-O group (p = 0.68). There was no significant difference between the two groups, concerning overall cure rate and the patients' satisfaction rate at 24 months follow-up. The range of mean pain scores was significantly higher after the TVT-O procedure post-operatively but not at 24 months follow-up. TVT and TVT-O procedures both have an outcome associated with an increase in quality of life with no significant differences in satisfaction rates at 2 years follow-up.
Naumann, Gert; Steetskamp, Joscha; Meyer, Mira; Laterza, Rosa; Skala, Christine; Albrich, Stefan; Koelbl, Heinz
The objective of this prospective cohort study was to compare effectiveness, morbidity, quality of life (QoL) and sexual function in women treated with tension-free vaginal tape (TVT) versus single-incision sling (SIS) in the treatment of female stress urinary incontinence (SUI). Retropubic TVT sling or SIS was implanted in local anesthesia and patients were followed post-operatively for 6 months. Evaluation was performed to assess post-operative rate of continence, complications, changes in sexual function and patient reported quality of life. Female sexual function was evaluated before and after sling procedure using Female Sexual Function Index (FSFI) in sexually active patients. From January 2009 to December 2011, 150 patients were enrolled and underwent a procedure to implant the retropubic TVT (n = 75) or the MiniArc(®) and Ajust(®) SIS (n = 75). Overall, 93.3 % of the patients who successfully received SIS demonstrated total restoration (84 %) or improvement of continence (9.3 %) at the 6 month post-operative study visit. In TVT group we found 88 % total continence and 6.7 % improvement, respectively. Improvements were seen in the QoL scores related to global bladder feeling (89.3 %) in SIS group and 96 % for TVT. Post-operative FSFI score improves significantly and were comparable in both groups (SIS pre-operative 24.30 ± 4.56 to 27.22 ± 4.66 (P TVT 24.63 ± 6.62 to 28.47 ± 4.41, respectively). The SIS procedure appears to be as effective in improving incontinence-related quality of life and sexual function as the TVT through 6 months of post-operative follow-up. No differences in complications and sexual function were demonstrated between the groups.
Full Text Available Objective: This study compared the Tension-free vaginal tape (TVT and Transobturator tape (TOT procedures for surgical treatment of stress urinary incontinence in women.Materials and methods: This prospective non randomized clinical trial was conducted in Vali-e-asr hospital from March 2001 to March 2005. A total of 71 patients with clinical and urodynamic diagnosis of Stress urinary incontinence (SUI were enrolled in the study. Patients were divided into two groups and underwent TVT or TOT procedures. Mean operation time, cure rate, post operative urinary retention, bleeding and infection were compared between two groups. SPSS software was used for statistical analysis. Chi square and fisher exact test calculated the effects of the nominal variables. Mean difference of quantitative variables were compared by student's T- test. P ≤0.05 was considered statistically significant. Results: There was no significant difference in mean time of operation and peri-operative complications among groups. Urinary retention was 13.8% (n=5 in the TVT group versus 2.8% (n=1 in TOT group (NS. The rates of cure (91.6% vs 91.4%, improvement (5.6% vs 8.6% and failure (2.8% vs 0 were similar for the TVT and TOT groups. The rate of hemorrhagic complications was 5.5% in TVT and 2.8% in TOT group (NS.Conclusion: TOT appears to be equally efficient to TVT for surgical treatment of stress urinary incontinence after 30 months follow-up.
The Health and Safety Executive (HSE) initiated studies to (a) identify reasons why hooks snag on various objects and (b) into the unsolicited discharge or shedding of slings/pennants from non-loaded hooks during offshore operations with cranes. In practical testing, both Single Point Hooks and Load Closing Hooks were used. The author of the report has assumed the reader is familiar with the offshore environment and with the terminology associated with lifting equipment. The tests were recorded on video which is available from the HSE. The report includes various safety recommendations.
McCoy, Allen H.
Helicopter external air transportation plays an important role in today's world. For both military and civilian helicopters, external sling load operations offer an efficient and expedient method of handling heavy, oversized cargo. With the ability to reach areas otherwise inaccessible by ground transportation, helicopter external load operations are conducted in industries such as logging, construction, and fire fighting, as well as in support of military tactical transport missions. Historically, helicopter and load combinations have been qualified through flight testing, requiring considerable time and cost. With advancements in simulation and flight test techniques there is potential to substantially reduce costs and increase the safety of helicopter sling load certification. Validated simulation tools make possible accurate prediction of operational flight characteristics before initial flight tests. Real time analysis of test data improves the safety and efficiency of the testing programs. To advance these concepts, the U.S. Army and NASA, in cooperation with the Israeli Air Force and Technion, under a Memorandum of Agreement, seek to develop and validate a numerical model of the UH-60 with sling load and demonstrate a method of near real time flight test analysis. This thesis presents results from flight tests of a U.S. Army Black Hawk helicopter with various external loads. Tests were conducted as the U.S. first phase of this MOA task. The primary load was a container express box (CONEX) which contained a compact instrumentation package. The flights covered the airspeed range from hover to 70 knots. Primary maneuvers were pitch and roll frequency sweeps, steps, and doublets. Results of the test determined the effect of the suspended load on both the aircraft's handling qualities and its control system's stability margins. Included were calculations of the stability characteristics of the load's pendular motion. Utilizing CIFER(R) software, a method for near
Full Text Available ... Merriam, KS, 05/04/2012) Colorectal Cancer Laparoscopic Right Colectomy ... Incontinence Advanced Procedures in Male Incontinence: The Male Sling (Kaiser Permanente San Diego ...
Jeong, Moo Youl; Kim, Su Jin; Kim, Hyo Sin; Koh, Jun Sung; Kim, Joon Chul
The tension-free vaginal tape SECUR® (TVT-S) is a new, minimally invasive sling procedure for treating female stress urinary incontinence (SUI). However, results of comparisons of the TVT-S with the transobturator tape (TOT) sling are lacking. Therefore, we investigated outcome and satisfaction of the TVT-S procedure compared with the TOT procedure. We included 64 patients with SUI who underwent the TVT-S (n=31) or TOT (MONARC®, n=33) procedure and were followed up for more than 1 year. The preoperative evaluation included history taking, pelvic examination, consecutive 3-day voiding diary, and urodynamic study including Valsalva leak point pressure. Postoperatively, continence status and subjective patient satisfaction were evaluated. Cure was defined as the absence of any episodes of involuntary urine leakage during stressful activities and a stress cough test. The TVT-S group (71.0%) showed a slightly lower cure rate than did the MONARC group (84.8%); however, there was no significant difference between the 2 groups (p=0.179). Nine of the patients who underwent the TVT-S showed incontinence postoperatively. Among them, the H approach was used in 7 patients and the U approach was done in 2 patients. Following TVT-S and MONARC, the patients' reported satisfaction was 80.6% and 78.8%, respectively. Patient satisfaction did not differ significantly between the two groups (p=0.854). Our results showed that the TVT-S and MONARC procedures may be comparable in terms of cure rate and patient satisfaction after more than 1 year of follow-up.
Bianchi-Ferraro, Ana Maria H M; Jarmy-DiBella, Zsuzsanna I K; de Aquino Castro, Rodrigo; Bortolini, Maria Augusta T; Sartori, Marair G F; Girão, Manoel J B C
The aim was to compare the efficacy and safety of single-incision sling TVT-Secur (TVT-S) and transobturator midurethral sling (TVT-O) for the treatment of stress urinary incontinence (SUI) over 2 years' follow-up. This is a randomized controlled trial in which women with SUI were randomly assigned to have either TVT-O (n = 56) or TVT-S (n = 66). Exclusion criteria included: voiding dysfunction, detrusor overactivity, and pelvic organ prolapse beyond the hymen. The primary outcomes were objective and subjective cure rates at a follow-up visit at 24 months, defined as a negative stress test and pad test as well as absence of self-reported SUI symptoms. Secondary endpoints included quality of life assessment using the King's Health Questionnaire (KHQ), and complication and reoperation rates. Analysis was performed using intention to treat, and statistical significance was fixed at 5% (p TVT-S and TVT-O groups were 77.3% and 83.6%, while subjective cure rates were 75.7% and 80.3% respectively, with no statistically significant differences between the techniques. There was a significant improvement in all KHQ domains in both groups (p TVT-O, while the long-term one was tape exposure observed in 5.3% of TVT-O and in 7.5% of TVT-S cases. The efficacy of the TVT-S was similar to that of the TVT-O after 2 years' assessment. This cohort will continue to be followed in order to maintain commitment to contributing data on long-term results.
Przydacz, Mikolaj; Adli, Oussama El Yazami; Mahfouz, Wally; Loutochin, Oleg; Bégin, Louis R; Corcos, Jacques
To evaluate the impact of design features of the synthetic mid-urethral slings on tissue integrity and inflammatory responses. In total 30 female Sprague-Dawley rats were implanted with type I monofilamentous, macroporous polypropylene meshes: Gynecare TVT-Obturator tape ® (Ethicon Inc., Johnson & Johnson, Somerville, NJ, USA) and I-STOP ® (CL Medical Inc., Lyon, France). All animal groups were sacrificed at set time intervals - 6 weeks, 3 months, 6 months, 9 months and 12 months - and the abdominal wall was harvested with mesh strips for histological evaluation. All mesh strips appeared to be well incorporated into the abdominal wall, and no signs of shrinkage was noticed. All specimens showed a thin/delicate, loose, fibrous interface between the synthetic graft plate and abdominal wall, along with mild inflammatory reactions from 6 weeks to 12 months. Both mesh brands induced comparable, minimal foreign body reactions and integrated well into the host tissues despite differences in architectural features. TVT-O ® and I-STOP ® evoked similar low-grade inflammatory responses up to 12 months in this animal model. Structural differences and architectural features of polypropylene slings used in this study have had no impact on tissue integrity and inflammatory responses.
Zhou, Quan; Song, Yan-feng; Chen, Jie; Qiu, Lin-lin; Yuan, Xiao-dong
To assess the current evidence of effectiveness and safety of Single-incision mini-slings (TVT-S) versus transobturator tension-free vaginal tapes (TVT-O/TOT) in the management of female stress urinary incontinence (SUI). Literature searches were conducted for all randomized controlled trials (RCTs) comparing TVT-S and TVT-O/TOT from CNKI, CBM, VIP, MEDLINE, OVID, FMJS and Cochrane Library between November 1996 and November 2011. The Revman 5.1.0 software was used for Meta-analysis according to Cochrane system evaluation method. A total of 1545 females in 7 RCTs were included. Meta-analysis showed that no statistical differences existed in the rate of postoperative voiding dysfunction and dyspareunia between TVT-S and TVT-O/TOT (P > 0.05). But the rate of objective cure, re-operation, inner thigh and groin pain and de novo urgency were statistically significant (P TVT-O/TOT, TVT-S procedure is associated with less postoperative inner thigh and groin pain, but a lower objective cure rate and relatively higher rates of de novo urgency and re-operation.
Zhang, Xiaolong; Lu, Yongxian; Shen, Wenjie; Liu, Jingxia; Ge, Jing; Liu, Xin; Zhao, Ying; Niu, Ke; Zhang, Yinghui; Wang, Wenying; Qiu, Chengli
To evaluate the clinical outcome of anti-incontinence sling in the treatment of occult stress urinary incontinence (OSUI) during reductive surgery for advanced pelvic organ prolapse (POP). From Jun. 2003 to Dec. 2012, 78 patients with OSUI underwent reductive surgery for advanced POP such as high uterosacral ligament suspension, sacrospinous ligament suspension and sacral colpopexy in the First Affiliated Hospital, General Hospital of People's Liberation Army. Among them, 41 patients received reductive surgery alone was enrolled in non-concomitant anti-incontinence group and the other 37 patients who underwent same surgery with tension-free vaginal tape (TVT) or tension-free vaginal tape-obturator technique (TVT-O) was in anti-incontinence group. The patient's demography, objective and subjective outcomes, as well as complications and injures were compared between the two groups. The pelvic organ prolapse quantitation (POP-Q) was used to evaluate the objective outcomes of POP. Urinary distress inventory (UDI-6) and incontinence impact questionnaire short form (IIQ-7) were used to evaluate the subjective outcomes of stress urinary incontinence (SUI). Compared with the non-concomitant anti-incontinence group, the objective outcomes of reductive surgery exhibited no significant differences (100%, 78/78), and only the operation time of anti-incontinence group slightly increased 16 minutes. The occurrence rate of postoperative SUI was 12% (5/41), 15% (6/41), 17% (7/41) respectively after the operation at 2-month, 6-month and 12-month follow up in the non-concomitant anti-incontinence group; and the occurrence rate of the anti-incontinence group was 3% (1/37), 3% (1/37), 3% (1/37); but none of patients in the two groups require further surgery for stress urinary incontinence. Mean score of UDI-6 and IIQ-7 in all the patients decreased significantly after operation at 2-month, 6-month and 12-month follow up (all P statistic difference between the two groups (P > 0.05). It
Zhong, Yu-Min M.; Zhu, Ming; Sun, Ai-Min M.; Wang, Qian [Shanghai Jiao Tong University School of Medicine, Department of Radiology, Shanghai Children' s Medical Center, Shanghai (China); Jaffe, Richard B. [Primary Children' s Medical Center, Department of Medical Imaging, Salt Lake City, UT (United States); Gao, Wei [Shanghai Jiao Tong University School of Medicine, Department of Cardiology, Shanghai Children' s Medical Center, Shanghai (China)
The left pulmonary artery sling (LPAS) is a rare vascular anomaly where the left pulmonary artery arises from the right pulmonary artery, passes over the right bronchus, and goes posteriorly between the trachea and esophagus. The LPAS is frequently associated with cardiac and non-cardiac defects including tracheobronchial abnormalities. To evaluate the utility of multislice CT (MSCT) and helical CT (HCT) in diagnosing and defining the tracheobronchial anomaly and anatomic relationships between the trachea and aberrant left pulmonary artery. MSCT or HCT was performed in 27 children to determine the tracheobronchial anatomy and identify tracheobronchial stenosis. Eighteen children underwent surgery. According to the Wells  classification of LPAS, which includes two main types and two subtypes, there were eight cases of type 1A, five cases of type 1B, six cases of type 2A and eight cases of type 2B in this group. Twenty-four of the 27 children had substantial tracheobronchial stenosis. Four died before surgery; the 18 had reanastomosis of the left pulmonary artery. Five children also had tracheoplasty; three died after surgery. CT, especially MSCT, is an ideal modality for simultaneously identifying aberrant left pulmonary artery and any associated tracheobronchial anomaly. The Wells classification is useful for operative planning. (orig.)
Huser, Martin; Belkov, Ivan A; Janku, Petr; Sedlakova, Katerina
To analyze the available clinical evidence on the continued effectiveness of midurethral sling (MUS) surgery for stress urinary incontinence (SUI) in women who become pregnant and undergo delivery, and then to determine the optimal mode of delivery for such women. An online search was carried out to retrieve the available evidence regarding the risk of SUI recurrence during pregnancy and after delivery following a successful MUS treatment. Appropriate keywords were used to identify all relevant reports published from 1996 through 2011. Basic patient characteristics, mode of delivery, and presence of SUI during pregnancy and the postpartum were analyzed. No more than 36 relevant cases were found. The overall urinary continence rates were 91.7% during pregnancy and 80.6% during the postpartum. Most (58.3%) of the women were delivered vaginally. The evidence indicates that the risk of SUI recurrence is not significantly different after a vaginal or a cesarean delivery. In women successfully treated with a MUS, pregnancy care and delivery mode therefore need to be considered case by case, according to factors other than the risk of recurrence. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Full Text Available ... Medical Center, Winston-Salem, NC, 2/28/2014) Male Reproductive System Circumcision Circumcision (Broward Health Coral Springs, ... Erectile Dysfunction Simultaneous Inflatable Penile Prosthesis (IPP) and Male Sling Placement: Aiding in a Faster Return to ...
Male stress urinary incontinence (SUI) remains a debilitating condition that adversely impacts all domains of quality of life and is associated with significant social stigma and health economic burden. The incidence of post-prostatectomy urinary incontinence (PPI) depends on the definition of urinary incontinence and the length of patient follow up. In patients with persistent PPI following failure of conservative measures, surgical treatment is recommended although there is no published guideline on when surgery should be performed, and what the best surgical option is. Male slings (MS) can be divided into adjustable or non-adjustable types, and offers an attractive option for patients who wish to avoid mechanical handling during urinary voiding. Published intermediate data supports good safety and efficacy rate in men with mild to moderate degree of SUI. The AMS 800 artificial urinary sphincter (AUS) remains the standard of treatment for complete continence and has the longest efficacy and safety records. Other AUS-like devices are designed to address current AMS 800 limitations but themselves are fraught with their own issues.
Full Text Available Objective: To propose possible success-driven solutions for problem and complication rates encountered with the ATOMS sling system, based on first-hand experience; and to provide possible actual alternative scenarios for the treatment of male . Patients and methods: During the defined period (between 4/2010 and 04/2014, 36 patients received ATOMS system implants at our clinic. We collected pre- and post-operative evaluation data using the International Consultation on Incontinence Questionnaire Short Form (ICIQ SF. As an expansion of the questionnaire, we added questions about post-operative perineal pain, the general satisfaction with the results of the intervention and willingness to recommend the operation to a best friend. Results: Our data shows a relatively high explantation rate, but a surprisingly high patient satisfaction rate. Explantation was required mainly due to late onset infections or other symptomatic factors. Compared to other studies early onset infections were rare. Conclusion: A non-invasive, uncomplicated adjustable system to alleviate male stress urinary incontinence remains a challenge. Although there are various systems available for the treatment of male stress urinary incontinence, it seems that despite the advantages of the ATOMS system, an artificial sphincter system may pose more advantages based on our experience, understanding and knowledge of its well-documented long-term solutions and problems.
A multicentre prospective randomised study of single-incision mini-sling (Ajust®) versus tension-free vaginal tape-obturator (TVT-O™) in the management of female stress urinary incontinence: pain profile and short-term outcomes.
Mostafa, Alyaa; Agur, Wael; Abdel-All, Mohamed; Guerrero, Karen; Lim, Chi; Allam, Mohamed; Yousef, Mohamed; N'Dow, James; Abdel-fattah, Mohamed
To compare the postoperative pain profile, peri-operative details, and short-term patient-reported and objective success rates of single-incision mini-slings (SIMS) versus standard mid-urethral slings (SMUS). In a multicentre prospective randomised trial in six UK centres in the period between October 2009 and October 2010, 137 women were randomised to either adjustable SIMS (Ajust®, C. R. Bard Inc., NJ, USA), performed under local anaesthesia as an opt-out policy (n=69), or SMUS (TVT-O™, Ethicon Inc., Somerville, USA) performed under general anaesthesia (n=68). Randomisation was done through number-allocation software and using telephone randomisation. Postoperative pain profile (primary outcome) was assessed on a ten-point visual analogue scale at fixed time-points. Pre- and post operatively (4-6 months) women completed symptom severity, urgency perception scale (UPS), quality of life and sexual function questionnaires. In addition, women completed a Patient Global Impression of Improvement Questionnaire and underwent a cough stress test at 4-6 months follow up. Sample size calculation was performed and data were analysed using SPSS 18. Descriptive analyses are given and between-group comparisons were performed using chi-square, Fischer exact test and Mann-Whitney test as appropriate. Significance level was set at 5%. Women in the SIMS Ajust® group had a significantly lower postoperative pain profile up to 4 weeks (p=TVT-O™ groups respectively. There was a trend towards higher rates of de novo urgency or worsening of pre-existing urgency in the SIMS Ajust® group (21.7% versus 8.8%) but this did not reach statistical significance (p=0.063). Women in the SIMS Ajust® group had shorter hospital stay (median (IQR) 3.65 (2.49, 4.96)) compared to (4.42 (3.16, 5.56)) the TVT-O™ group 95% CI (-0.026, 1.326), with significantly earlier return to normal activities (p=0.025) and to work (p=0.006). The adjustable single-incision mini-sling (Ajust®) is associated
Yao, Zong; Wang, Wei-ping; Jiang, Yan; Chen, Shi-hai
Korean Sewol is successfully lifted up with the strand jack system based on twin barges. During the salvage operation, two barges and Sewol encounter offshore environmental conditions of wave, current and wind. It is inevitable that the relative motions among the three bodies are coupled with the sling tensions, which may cause big dynamic loads for the lifting system. During the project engineering phase and the site operation, it is necessary to build up a simulation model that can precisely generate the coupled responses in order to define a suitable weather window and monitor risks for the salvage operation. A special method for calculating multibody coupled responses is introduced into Sewol salvage project. Each body's hydrodynamic force and moment in multibody configuration is calculated in the way that one body is treated as freely moving in space, while other bodies are set as fixed globally. The hydrodynamic force and moment are then applied into a numerical simulation model with some calibration coefficients being inserted. These coefficients are calibrated with the model test results. The simulation model built up this way can predict coupled responses with the similar accuracy as the model test and full scale measurement, and particularly generate multibody shielding effects. Site measured responses and the responses only resulted from from the simulation keep project management simultaneously to judge risks of each salvage stage, which are important for success of Sewol salvage.
Full Text Available ... Medical Center, Winston-Salem, NC, 2/28/2014) Male Reproductive System Circumcision Circumcision (Broward Health Coral Springs, Coral Springs, FL, 3/31/2014) Erectile Dysfunction Simultaneous Inflatable Penile Prosthesis (IPP) and Male Sling Placement: Aiding in a Faster Return to ...
Chen, Lianghua; Chen, Junqi; Peng, Qiyuan; Chen, Jingjie; Zou, Yucong; Liu, Gang
This study aims to evaluate the effect of sling exercise training (SET) on balance in patients with stroke. PubMed, Cochrane Library, Ovid LWW, CBM, CNKI, WanFang, and VIP databases were searched for randomized controlled trials of the effect of SET on balance in patients with stroke. The study design and participants were subjected to metrological analysis. Berg balance Scale (BBS), Barthel index score (BI), and Fugl-Meyer Assessment (FMA) were used as independent parameters for evaluating balance function, activities of daily living(ADL) and motor function after stroke respectively, and were subjected to meta-analysis by RevMan5.3 software. Nine studies with 460 participants were analyzed. Results of meta-analysis showed that the SET treatment combined with conventional rehabilitation was superior to conventional rehabilitation treatments, with increased degrees of BBS (WMD = 3.81, 95% CI [0.15, 7.48], P = 0.04), BI (WMD = 12.98, 95% CI [8.39, 17.56], P risk of bias. Therefore, more multi-center and large-sampled randomized controlled trials are needed to confirm its clinical applications.
Kasyan, George; Gvozdev, Michail; Sosnowski, Roman
Introduction This study summarized our experience in the treatment of 1,081 women with stress urinary incontinence (SUI) using mid-urethral slings. Material and methods The study included 1,081 operated patients. Pure SUI was diagnosed in 77.80% (841) of the patients; another 18.68% (202) had mixed symptoms. The remaining 3.52% (38) suffered from recurrent SUI. Group 1 included the SUI patients treated with TVT. Group 2 – SUI managed with TVT-O. In Group 3, mixed urinary incontinent (MUI) patients were treated with TVT-O. Results Retropubic TVT was used in 273 patients (25.25%) and TVT-O in 740 (68.45%). Other slings were used in 68 patients (6.3%). Mean follow-up for the groups was 50.1, 31.1, and 32.6 months respectively. For objective evaluation of cure rate we used the cough stress test. Subjective efficacy was studied via a visual analog scale. The complication rate in each group of the patients was used as a secondary end point. A negative cough test was found in 85.58% of patients in Group 1. For the TVT-O group, the objective cure rate was 84.36%. Intra-operative complications for TVT and TVT-O were not related to age, BMI, or parity. Bladder perforation and pelvic hematoma developed more frequently in the TVT group. There is a higher risk of vaginal perforation for TVT-O. The objective and subjective cure rates for MUI patients were 86.15% and 87.69% respectively. Conclusions TVT and TVT-O are equally effective and safe methods of treatment for women suffering from SUI and MUI. PMID:24578904
Full Text Available Emrah Töz, Aykut Özcan, Nesin Apaydin, İbrahim Uyar, Betül Kocakaya, Gülin Okay Department of Gynecology and Obstetrics, Tepecik Education and Research Hospital, İzmir, Turkey Objectives: We performed constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy, and investigated the intraoperative complications, and short-term outcomes of these constricting procedures in patients aged 75 years or older.Methods: We searched our hospital database for cases, between January 2011 and January 2014, of women aged over 75 years who underwent surgery for pelvic organ prolapse of stage 2 or higher, via vaginal hysterectomy, constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy, with or without treatment of urinary incontinence. All volunteers were evaluated via pelvic examination using the pelvic organ prolapse quantification system, the modified Decision Regret Scale–Pelvic Floor Disorders form, the Satisfaction Decision Scale–Pelvic Floor Disorders form, and the Pelvic Floor Distress Inventory form.Results: Fifty-four patients were included in the study. The mean follow-up time was 24.4 months after constricting surgery (range: 8–44 months. There were four cases (7% of de novo urge incontinence (the symptoms resolved upon prescription of anticholinergic medication. Two patients developed de novo stress urinary incontinence after the procedure and were treated via transobturator sling surgery using Safyre T® polypropylene monofilament slings. No anatomical or subjective recurrence of prolapse was noted during the follow-up period. No patient required additional surgery for recurrence of prolapse.Conclusion: Constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy is a feasible, safe, and effective surgical option in elderly patients at low anesthesiological risk. The decision
Goel, Ruchi; Sanoria, Abhilasha; Kumar, Sushil; Arya, Deepanjali; Nagpal, Smriti; Rathie, Neha
The study aims to compare the effectiveness and complications of transconjunctival retractor plication (TRP) with lateral tarsal strip (LTS) and the polypropylene sling (PS) surgery for treatment of involutional lower lid ectropion. A prospective randomised pilot study was conducted on 30 eyes of 30 patients suffering from epiphora having horizontal eyelid laxity >6mm and age >50 years at a tertiary care centre from December 2014 to March 2015. They were randomly divided into two equal groups for TRP with LTS (group A) and PS (group B). Success was defined as relief in epiphora and lid laxity ≤4mm at 12 months post operatively. There were 19 male and 11 female patients with age ranging from 55-80 years. The mean grade of ectropion was 2.80±1.32 in group A and 2.87±1.60 in group B. The preoperative horizontal laxity increased with the grade of ectropion (p <0.001) while medial canthal laxity was variable. The average surgical time per procedure in group A was 66 minutes and in group B was 24 minutes. Group A had a success rate of 93.33%, while group B had a success rate of 87%. Post-operative complications occurred in 2 eyes in group B only. Both LTS with TRP and PS are effective in the management of involutional ectropion. LTS with TRP though more invasive has higher success rates and a lower incidence of complications as compared to PS. However, PS is an easy to perform out- patient procedure that is faster and better tolerated in old patients.
Hazewinkel, Menke H.; Hinoul, Piet; Roovers, Jan-Paul
Groin pain after a tension-free vaginal tape-obturator (TVT-O) procedure can occur but mostly disappears within 4 weeks. Persistent groin pain is extremely rare and there is a paucity of literature on how to diagnose and manage this adverse event. We present two cases with severe persistent groin
problem. A modified rectus fascial sling has been assessed in incontinent male ... in urine leakage. ... intravesical storage pressures, patients with ... laboratory tests, cystourethroscopy in order ... patients, anticolinergic drugs were added.
Kitagawa, Yasuhide; Narimoto, Kazutaka; Urata, Satoko; Kawaguchi, Shohei; Kuribayashi, Masato; Namiki, Mikio
We noninvasively compared urinary flow in both pre- and post-transobturator tape (TOT) procedures in stress urinary incontinence (SUI) patients using previously reported corrected flow-age nomograms in healthy women. This retrospective cohort study included patients who underwent a successful TOT procedure to treat SUI. Non-instrumented uroflowmetry was performed before and 3 months after surgery. Corrected maximum flow rate (cQmax) and average flow rate (cQave) were calculated using Qmax/√voided volume (VV) and Qave/√VV respectively. The ratio of corrected flow to age-adjusted corrected flow in healthy women was calculated in each patient. Each parameter was compared against pre-TOT and 3-months post-TOT values. Sixty-two patients were eligible for study inclusion. All urinary flow parameters were significantly higher pre-TOT than at 3 months post-TOT. The number of patients with cQmax and cQave over mean flow-age nomogram, compared with healthy women, before the TOT procedure decreased 3 months post-TOT; however, in many patients, cQmax and cQave were higher than in the corrected flow-age nomogram post-TOT. No significant difference in the ratio of cQmax to age-adjusted cQmax between pre- and post-TOT in the normal urinary flow group was observed, but significantly decreased in the high urinary flow group 3 months after TOT. Urinary flow rates were higher in SUI patients compared with age-matched controls and successful TOT procedures normalized urinary flows in patients with high urinary flow. A simple evaluation of urinary flow using a corrected flow-age nomogram may be clinically useful in SUI patients.
Arterial oxygen tension and pulmonary ventilation in horses placed in the Anderson Sling suspension system after a period of lateral recumbency and anaesthetised with constant rate infusions of romifidine and ketamine.
François, I; Lalèyê, F-X; Micat, M; Benredouane, K; Portier, K
Some controversy exists over whether or not horses' recovery and cardiopulmonary function are affected by suspension in slings. To measure arterial oxygen tension and pulmonary ventilation in anaesthetised horses placed in a standing position in an Anderson Sling (AS) after a period of right lateral recumbency (RLR). Randomised crossover experimental study. Six Standardbred horses were anaesthetised twice. Catheters were inserted into the right jugular vein and the left carotid artery. After premedication with romifidine, anaesthesia was induced with diazepam and ketamine. Following 50 min in RLR, horses were maintained in either RLR or AS for an additional 60 min through to recovery. Anaesthesia was maintained i.v. with a constant rate infusion of romifidine and ketamine. Heart rate, respiratory rate, mean arterial pressure, expiratory tidal volume, minute volumes and end tidal CO2 were monitored continuously. Venous and arterial bloods were sampled for lactate concentration, creatine kinase activity and blood gas analysis before premedication, after induction, every 20 min for 100 min, as soon as the horse was standing (TR), and 24 h later. The data were averaged within 2 anaesthetic periods: P1, 0-20 min; and P2, 40-100 min. During P2, horses in the RLR group had lower arterial oxygen tension (P = 0.001), higher alveolar-arterial oxygen tension gradient (P = 0.005), higher respiratory rate (P = 0.04) and higher minute volumes (P = 0.04) than horses in the AS group. Arterial CO2 tension and mean arterial pressure increased in the AS group during P2 (P = 0.01 and 0.02 respectively). The recoveries were judged better in the AS group than in the RLR group (P = 0.01). During TR, lactate were higher in the RLR group than in the AS group (P = 0.007). Creatine kinase activities were higher in the AS group at 24 h vs. TR (P = 0.02). Anderson Sling suspension after a period of recumbency improves cardiopulmonary function and recovery quality in horses and
Stavros, Charalambous; Ioannis, Vouros; Vasileios, Sakalis I; Gkotsi, Anastasia Ch; Georgios, Salpiggidis; Papathanasiou, Athanasios; Rombis, Vasileios
Although mid-urethral slings (MUS), have been extensively used for the treatment of female stress urinary incontinence (SUI), no published data exists for the efficiency and the complications of these methods in large patient series. This is a retrospective analysis on patients who underwent MUS surgery since 1999. 531 patients were studied and the results of preoperative assessment, perioperative, early postoperatively and each follow up were registered. Patients were classified in three groups according to the MUS used. Efficacy of each method was evaluated in terms of early postoperative course, late complications and patient's symptoms improvement based questioners, pad test, uroflowmetry, filling cystometry and ultrasonography. Evaluation took place at 7th and 30th postoperative day, 3rd and 12th month and then annually. Each patient was characterized as cured, improved or failed. Trans Obturator (TO) group prevailed in efficiency with no significant differences between trans obturator route with inside-out (TVT-O) and outside-in (TOT). Success rate at 30th month evaluation, was higher in the TO group than in Tension-free Vaginal Tape (TVT) or Single-Incision Mini Slings (SIMS) group (93.4% vs 89.5%, 93.4% vs. 91.7%). None TVT patient required reoperation for remaining/reoccurring SUI, while 1.04% of TO group and 5.48% of SIMS group did. Patients of TVT group underwent reoperation for tape related complications in 2.25%, while 2.07% of TO group and none of SIMS group did. The potential limitation of the study is its retrospective character. Even though TO tapes and SIMS seem more efficient than TVT, they carry a risk of SUI re-occurrence that must be weighted towards the risk of potential complications after TVT.
Oliveira, Rui; Botelho, Francisco; Silva, Pedro; Resende, Alexandre; Silva, Carlos; Dinis, Paulo; Cruz, Francisco
Contemporary surgical treatment of female stress urinary incontinence (SUI) includes retropubic and transobturator (TO) midurethral slings (MUS). Case series of single-incision slings (SIS) have shown similar outcomes with lower morbidity. Our aim was to assess the cure rates, complications, and quality-of-life impact of one standard TO MUS and two SIS. Ninety consecutive patients with clinically and urodynamically proven SUI were enrolled in an exploratory randomised phase 2 trial. Patients with previous SUI surgery, major pelvic organ prolapse, mixed incontinence, or detrusor overactivity were excluded. Patients were treated randomly with TVT-O, TVT-Secur, or Mini-Arc. Postoperative visits were scheduled at 6 and 12 mo. The King's Health Questionnaire (KHQ) was repeated at 6 mo. Cure was defined as the absence of urine leakage, no pad use, and a negative cough test at 12 mo. Pain and other complications were also investigated. Cure rate was 83% after TVT-O, 67% after TVT-Secur, and 87% after Mini-Arc. Improvement was found in 10%, 13%, and 7% of the patients, respectively. Failures were 7% after TVT-O and Mini-Arc and 20% after TVT-Secur. TVT-O and Mini-Arc improved at least 15 points in >80% of the patients in six KHQ domains, whereas TVT-Secur could only achieve improvement in three of the nine domains. The pain score was lower in the Mini-Arc group. Complications were more numerous after TVT-O. This study has the limitations inherent in a phase 2 trial with a follow-up limited to 12 mo. Mini-Arc offers cure and improvement rates similar to TVT-O, whereas TVT-Secur may yield an inferior outcome. These findings recommend the urgent launch of large randomised phase 3 studies comparing conventional MUS with SIS, with Mini-Arc the advised option. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
BACKGROUND: Radiotherapy has a significant role in the management of pelvic malignancies. However, the small intestine represents the main dose limiting organ. Invasive and non-invasive mechanical methods have been described to displace bowel out of the radiation field. We herein report a case series of laparoscopic placement of an absorbable pelvic sling in patients requiring pelvic radiotherapy. METHODS: Six patients were referred to our minimally invasive unit. Four patients required radical radiotherapy for localised prostate cancer, one was scheduled for salvage localised radiotherapy for post-prostatectomy PSA progression and one patient required adjuvant radiotherapy post-cystoprostatectomy for bladder carcinoma. All patients had excessive small intestine within the radiation fields despite the use of non-invasive displacement methods. RESULTS: All patients underwent laparoscopic mesh placement, allowing for an elevation of small bowel from the pelvis. The presence of an ileal conduit or previous surgery did not prevent mesh placement. Post-operative planning radiotherapy CT scans confirmed displacement of the small intestine allowing all patients to receive safely the planned radiotherapy in terms of both volume and radiation schedule. CONCLUSION: Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. This procedure is also feasible in those that have undergone previous major abdominal surgery.
Al Taweel W
Full Text Available Waleed Al Taweel, Raouf SeyamDepartment of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi ArabiaAbstract: Neurogenic bladder dysfunction due to spinal cord injury poses a significant threat to the well-being of patients. Incontinence, renal impairment, urinary tract infection, stones, and poor quality of life are some complications of this condition. The majority of patients will require management to ensure low pressure reservoir function of the bladder, complete emptying, and dryness. Management typically begins with anticholinergic medications and clean intermittent catheterization. Patients who fail this treatment because of inefficacy or intolerability are candidates for a spectrum of more invasive procedures. Endoscopic managements to relieve the bladder outlet resistance include sphincterotomy, botulinum toxin injection, and stent insertion. In contrast, patients with incompetent sphincters are candidates for transobturator tape insertion, sling surgery, or artificial sphincter implantation. Coordinated bladder emptying is possible with neuromodulation in selected patients. Bladder augmentation, usually with an intestinal segment, and urinary diversion are the last resort. Tissue engineering is promising in experimental settings; however, its role in clinical bladder management is still evolving. In this review, we summarize the current literature pertaining to the pathology and management of neurogenic bladder dysfunction in patients with spinal cord injury.Keywords: neurogenic bladder, spinal cord injury, urodynamics, intestine, intermittent catheterization
Roumeguère, Thierry; Quackels, Th; Bollens, R; de Groote, A; Zlotta, A; Bossche, M Vanden; Schulman, C
The aim of this study was to evaluate the effectiveness of a new minimally invasive surgical procedure, the Trans-obturator Vaginal Tape (TOT) in the treatment of female urodynamic stress incontinence (USI) and to analyse functional results and quality of life after one year of follow up. 120 consecutive women with stress urinary incontinence underwent the procedure since February 2002 under general or loco-regional anesthesia. Minimum follow up was one year (range 12-30 months). Mean age was 58 years (range 31-86). 70% of the patients had pure USI. 5 patients were previously operated for USI. In 10 cases, concomitant repair of pelvic floor defects was mandatory. Collection of the data included operative time, pre- and post-operative complications. Patients were post-operatively assessed at one week, one month and one year. A validated urinary incontinence-specific measure of Quality of Life (QoL) questionnaire (Contilife) was sent and completed 12 months after surgery. The mean operative time was 12 min (range 6-30) with a catheterisation time of 0,9 day (range 0-2). No severe bleeding was observed. There were 13 minor lateral tears of the vagina without any sequelae. Three perforations of the urethra and one of the bladder occurred during the learning phase. In two cases a re-intervention was necessary for tape removal when the injury was not recognised during the procedure. Two transient urinary retention needed a supra pubic catheter and tape release. Eleven women presented transient voiding outflow obstruction. After one month, 93% patients were cured with no pad and a negative cough test with a full bladder. Uroflowmetry did not show any significant changes between pre- and post-operative time in all the population. De novo urgency occurred only in 2.5% and persistent dysuria (Qmax 120 cc) in 4%. 80% of patients were completely dry after one year and 12% were greatly improved. According to the pre-operative maximal urethral closure pressure, continence rate
Hontanilla, Bernardo; Marre, Diego
This study aims to analyse the efficacy of static techniques, namely gold weight implant and tendon sling, in the reanimation of the paralytic eyelid. Upper eyelid rehabilitation in terms of excursion and blinking velocity is performed using the automatic motion capture system, FACIAL CLIMA. Seventy-four patients underwent a total of 101 procedures including 58 upper eyelid gold weight implants and 43 lower eyelid tendon suspension with 27 patients undergoing both procedures. The presence of lagophtalmos, eye dryness, corneal ulcer, epiphora and lower lid ptosis/ectropion was assessed preoperatively. The Wilcoxon signed-rank test was used to compare preoperative versus postoperative measurements of upper eyelid excursion and blinking velocity determined with FACIAL CLIMA. Significance was set at p CLIMA revealed significant improvement of eyelid excursion and velocity of blinking (p CLIMA system is a reliable method to quantify upper eyelid excursion and blinking velocity and to detect the exact position of the lower eyelid. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Background In this study, by comparing TVT surgery and TOT surgery for stress urinary incontinence in women, the characteristics and learning curves of both operative methods were studied. Methods A total of 83 women with stress urinary incontinence treated with tension-free vaginal tape (TVT) (n = 38) or transobturator tape (TOT) (n = 45) at Saiseikai Central Hospital between April 2004 and September 2009 were included. We compare the outcomes and learning curves between TVT surgery and TOT surgery. In statistical analysis, Student's t test, Fisher's exact test, and Mann-Whitney's U test were used. Results The surgical durations were 37.4 ± 15.7 minutes with TVT surgery and 31.0 ± 8.3 minutes with TOT surgery. A longer period of time was required for TVT surgery (p = 0.025). The residual urine at post-operative day 1 was higher in TVT surgery (25.9 ± 44.2 ml) than in TOT surgery (10.6 ± 19.2 ml) (p = 0.0452). The surgical duration of TVT surgery was shortened after the operator had performed 15 operations (p = 0.019). Conclusions In comparison of TVT surgery and TOT surgery, the surgical duration of TVT surgery was longer and the residual urine of TVT surgery was higher at post-operative day 1. Surgical experience could shorten the duration of TVT surgery. PMID:21726448
Full Text Available Abstract Background In this study, by comparing TVT surgery and TOT surgery for stress urinary incontinence in women, the characteristics and learning curves of both operative methods were studied. Methods A total of 83 women with stress urinary incontinence treated with tension-free vaginal tape (TVT (n = 38 or transobturator tape (TOT (n = 45 at Saiseikai Central Hospital between April 2004 and September 2009 were included. We compare the outcomes and learning curves between TVT surgery and TOT surgery. In statistical analysis, Student's t test, Fisher's exact test, and Mann-Whitney's U test were used. Results The surgical durations were 37.4 ± 15.7 minutes with TVT surgery and 31.0 ± 8.3 minutes with TOT surgery. A longer period of time was required for TVT surgery (p = 0.025. The residual urine at post-operative day 1 was higher in TVT surgery (25.9 ± 44.2 ml than in TOT surgery (10.6 ± 19.2 ml (p = 0.0452. The surgical duration of TVT surgery was shortened after the operator had performed 15 operations (p = 0.019. Conclusions In comparison of TVT surgery and TOT surgery, the surgical duration of TVT surgery was longer and the residual urine of TVT surgery was higher at post-operative day 1. Surgical experience could shorten the duration of TVT surgery.
Full Text Available Purpose We compared the effectiveness of the retropubic tension-free vaginal tape (TVT and the transobturator inside-out tape (TVT-O in treating symptoms of overactive bladder (OAB in women with stress urinary incontinence (SUI. Methods Women with urodynamic SUI and OAB (mean urgency episodes ≥1 and frequency ≥8/24 hours on a 3-day voiding diary were assigned to the TVT or TVT-O group. Preoperative measures were based on a urodynamic study, 3-day voiding diary, the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTSSF, and the urgency perception scale (UPS. At 12 postoperative months, the 3-day voiding diary, symptoms questionnaire, patient satisfaction, and standing stress test were assessed. The primary endpoint was change in the number of urgency episodes/24 hours from baseline to 12 months. Results In this group of 132 women, 42 received TVT and 90 received TVT-O. The mean urgency episodes/24 hours decreased from 6.3±5.5 to 1.6±3.2 in the TVT group and from 5.1±4.4 to 1.8±3.0 in the TVT-O group. The mean percent change was significantly greater after TVT than after TVT-O (73% vs. 60%, P=0.049. All subscales of BFLUTSSF and UPS were significantly improved using either method, with significantly greater improvement seen in the quality of life (QoL domain after TVT (P=0.002. There were no significant differences in the cure and satisfaction rates between the two groups. Conclusions Intervention with the TVT or the TVT-O significantly improved symptoms of OAB in women with SUI and OAB. Urgency and QoL significantly improved after TVT compared with that after TVT-O.
Han, Ji-Yeon; Choo, Myung-Soo; Lee, Young-Suk; Seo, Ju Tae; Kim, Jang Hwan; Kim, Young Ho
Purpose We compared the effectiveness of the retropubic tension-free vaginal tape (TVT) and the transobturator inside-out tape (TVT-O) in treating symptoms of overactive bladder (OAB) in women with stress urinary incontinence (SUI). Methods Women with urodynamic SUI and OAB (mean urgency episodes ≥1 and frequency ≥8/24 hours on a 3-day voiding diary) were assigned to the TVT or TVT-O group. Preoperative measures were based on a urodynamic study, 3-day voiding diary, the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTSSF), and the urgency perception scale (UPS). At 12 postoperative months, the 3-day voiding diary, symptoms questionnaire, patient satisfaction, and standing stress test were assessed. The primary endpoint was change in the number of urgency episodes/24 hours from baseline to 12 months. Results In this group of 132 women, 42 received TVT and 90 received TVT-O. The mean urgency episodes/24 hours decreased from 6.3±5.5 to 1.6±3.2 in the TVT group and from 5.1±4.4 to 1.8±3.0 in the TVT-O group. The mean percent change was significantly greater after TVT than after TVT-O (73% vs. 60%, P=0.049). All subscales of BFLUTSSF and UPS were significantly improved using either method, with significantly greater improvement seen in the quality of life (QoL) domain after TVT (P=0.002). There were no significant differences in the cure and satisfaction rates between the two groups. Conclusions Intervention with the TVT or the TVT-O significantly improved symptoms of OAB in women with SUI and OAB. Urgency and QoL significantly improved after TVT compared with that after TVT-O. PMID:24143294
Lorenzo Gómez, María F; Collazos Robles, Rafael E; Virseda Rodríguez, Álvaro J; García Cenador, María B; Mirón Canelo, José A; Padilla Fernández, Bárbara
Stress urinary incontinence (SUI) and recurrent urinary tract infections (RUTIs) are highly prevalent diseases. Our purpose was to investigate the relationship between RUTIs and surgical correction of SUI with transobturator suburethral tape (TOT) and to describe the benefit gained from a sublingual polibacterial preparation on RUTIs developed after TOT. A retrospective study was performed on 420 women who underwent TOT surgery due to SUI between April 2003 and October 2011. Group A: patients without urinary tract infections (UTIs) before TOT (n = 294). Group B: patients with UTIs before TOT (n = 126). age, personal history, number of UTIs/month prior to and after surgery, appearance of urgent urinary incontinence (UUI) with or without UTIs, response to International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and Short Form 36 (SF-36) questionnaires. Group A: 85% dry; 5% UUI; 4% de novo UTIs with good response to antibiotics over 6 days. No RUTIs during the follow-up period, 2% with sporadic UTIs. Group B: 47.61% RUTIs; 52.39% sporadic UTIs; greater incidence of diabetes mellitus (p < 0.0025) and smoking (p < 0.0031) than group A. After TOT: 79.36% dry; 10% RUTIs. After treatment with antibiotics for 6 days and bacterial preparation for 3 months, 82% of patients did not have a UTI anymore. Postoperative cystourethrogram revealed 38% of nondiagnosed cystoceles before TOT. No patient had a postvoiding volume greater than 100 cm(3) after TOT. Improvement of ICIQ-SF (p < 0.001) and SF-36 (p < 0.0004) in both groups. After eliminating bias associated with the tape, the technique and the surgeon's skills, SUI correction may decrease the number of UTIs and improve the quality of life. UTIs disappeared in 82% of patients with RUTIs after TOT.
Full Text Available Introduction: Stress urinary incontinence is a highly debilitating condition, with an important impact over the quality of life. When the conservative treatment fails, the surgical treatment is a viable solution. Minimally invasive sling procedures have become the gold standard of surgical management for stress urinary incontinence (SUI in women. Material and methods: The study was conducted on 68 patients with stress urinary incontinence, 52 have undergone the retropubic tension-free vaginal tape and 16 patients were operated using the transobturator tape procedure. All the patients were evaluated before the operation and the indication of the surgical treatment was established on the basis of physical examination (all the patients had positive cough test, abdominal ultrasound (to determine postvoid residual urine volume, urinalysis and urine culture (the majority of the patients have had before the operation recurrent urinary tract infections. Results: The satisfaction was similar in both groups of patients, with an average satisfaction rate of 91% for TVT and 86% for the patients who have undergone TOT procedure. The patients were in a proportion of 78,9% at menopause, with an average number of natural births of 1.9 and a mean BMI of 28.2. Regarding the surgical duration, this has varied between 20 and 40 minutes, being higher in the TVT cases (up to 5-7 minutes longer than TOT, because cystoscopy was performed during the operation to verify if the bladder was perforated or not. The urethral catheter was removed immediately after the operation in the case of the TOT procedure and in the day after the operation for the patients who have undergone TVT procedures (all of these patients associated genital prolapse. The hospitalization time was 3 days. We haven’t encountered significant intraoperative and postoperative complications. Conclusions: The TOT and TVT procedures have proven to be highly effective and safe methods in the treatment of
Thubert, Thibault; Canel, Virginie; Vinchant, Marie; Wigniolle, Ingrid; Fernandez, Hervé; Deffieux, Xavier
Although placement of a retropubic mid-urethral slings (MUS) is one of the gold standard surgical treatments for stress urinary incontinence, new devices are poorly evaluated before marketing. We compared TVT-EXACT™ (TVT-E), a new device expected to reduce bladder injuries, with the historically described bottom-to-top TVT™ (TVT). This retrospective study compared TVT-E (n=49) and TVT (n=49). The main outcomes were the prevalence of complications (bladder injuries, immediate postoperative pain, perioperative complications, etc.) and the short-term success rate (no reported urinary leakage and negative cough test) of both MUSs. Minimum follow-up was 12 months. The characteristics of the two groups were comparable. The prevalence of bladder injury for TVT-E and TVT was 8% and 6%, respectively (p=1). The intensity of immediate postoperative pain (VAS/100) was lower following TVT-E than after TVT (8.0 vs. 15.9, p=0.01). The first post-void residual was increased in the TVT-E group (153.9 vs. 78.9mL, p=0.045), and there were more postoperative bladder outlet obstruction (BOO) symptoms in the TVT-E group (24% vs. 6%, p=0.02). However, there was no difference when considering only de novo BOO (14% vs. 4%, p=0.16). The prevalence of peri- and post-operative complications was equal in the two groups. The success rate was similar at 12 months of follow-up (80 vs. 82%, p=1). The prevalence of bladder injury was unchanged with TVT-EXACT™ compared with TVT™, but post-operative pain was decreased. The success rate of both retropubic MUSs was similar at 12 months of follow-up. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Mahmoud Ahmed Elsamkary,1 Maged Maher Salib Roshdy1,2 1Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 2Pediatric Ophthalmology Department, Al Watany Eye Hospital, Cairo, Egypt Purpose: To study the effect of autogenous fascia lata sling (AFLS versus Gore-Tex suspension (GTS regarding the functional and aesthetic outcomes in patients with bilateral congenital ptosis. Patients and methods: A prospective comparative randomized single-center study enrolled 110 patients with bilateral congenital ptosis. One group (n=55 underwent AFLS and the second group (n=55 underwent GTS. Exclusion criteria were good levator function, absent Bell’s phenomenon, and abnormal ocular motility. Follow-up period was 2 years. Functional outcome was measured from digital photos by analysis of upper eyelid margin position relative to the superior limbus and classified as very good (<3 mm, good (3–5 mm, poor (>5 mm, and recurrent. Aesthetic outcome was assessed in terms of lid contour, symmetry of eyelid height, and lid crease presence. Complications were also reported. Results: Failure rate (recurrence and complications was less in AFLS (P=0.035. Symmetrical lid height and good contour were more frequently attained by AFLS (P=0.007 and 0.047, respectively. However, the frequency of very good, good, poor, recurrence, lagopthalmos, ectropion, infection, and formed lid crease individually showed no statistically significant difference (P=0.252, 0.482, 1, 0.489, 0.438, 1, 0.618, and 0.506, respectively. Conclusion: AFLS is a better choice in surgery for patients with bilateral congenital ptosis because it has fewer complications and a lesser recurrence rate than GTS. Keywords: ptosis surgery, surgical outcomes, ptosis recurrence, lagophthalmos
Elshatanoufy, Solafa; Matthews, Alexandra; Yousif, Mairy; Jamil, Marcus; Gutta, Sravanthi; Gill, Harmanjit; Galvin, Shelley L; Luck, Ali M
The aim of our study was to assess midurethral sling (MUS) failure rate in the morbidly obese (body mass index [BMI] ≥40 kg/m) population as compared with normal-weight individuals. Our secondary objective was to assess the difference in complication rates. This is a retrospective cohort study. We included all patients who underwent a synthetic MUS procedure from January 1, 2008, to December 31, 2015, in our health system. Failure was defined as reported stress urinary incontinence symptoms or treatment for stress urinary incontinence. Variables collected were BMI; smoking status; comorbidities; perioperative (≤24 hours), short-term (≤30 days), and long-term (>30 days) complications; and follow-up time. Statistics include analysis of variance, χ test, logistic regression, Kaplan-Meier method, and Cox regression. There were 431 patients included in our analysis. Forty-nine patients were in class 3 with a BMI mean of 44.9 ± 5.07 kg/m. Median follow-up time was 52 months (range, 6-119 months). Class 3 obesity (BMI ≥40 kg/m) was the only group that had an increased risk of failure when compared with the normal-weight group (P = 0.03; odds ratio, 2.47; 95% confidence interval, 1.09-5.59). Obesity was not a significant predictor of perioperative, short-term, or long-term postoperative complications (P = 0.19, P = 0.28, and P = 0.089, respectively) after controlling for other comorbidities. Patients in the class 3 obesity group who are treated with an MUS are 2 times as likely to fail when compared with those in the normal-weight category on long-term follow-up with similar low complication rates.
John T. Stoffel
Full Text Available OBJECTIVE: Our purpose was to determine if women with mixed urinary incontinence (MUI and urodynamic detrusor overactivity (DO have less improvement in urinary symptoms after pubovaginal sling surgery (PVS, compared to MUI without DO. MATERIALS AND METHODS: Women with preoperative MUI symptoms prior to PVS were identified through retrospective review. DO was defined as a symptomatic 5 cm H20 detrusor pressure or greater rise during urodynamics. MUI patients with and without DO before PVS were divided into Groups A and B, respectively. All patients had returned a completed Urogenital Distress Inventory 6 (UDI-6 questionnaire and a 3-day diary of pad usage before surgery and at each postoperative visit. Study endpoints included change in total UDI-6 score, and change in number of pad use/day after PVS. RESULTS: 73 patients were identified, 31 in Group A and 42 in Group B. Mean follow-up after PVS was 15 and 16 months, respectively (p = 0.59. Preoperative total UDI-6 scores were 11.8 and 12.7 (p = 0.30 for Group A and B. Mean changes in total UDI-6 after PVS were - 8.0 and - 10.2 (p = 0.030, respectively. After PVS, both groups reported similar mean reduction in pad/day usage from preoperative baseline (-2.57 vs. --2.49, p = 0.83. There were no differences between the groups when comparing demographic, urodynamic, or operative data. CONCLUSION: MUI patients had improved continence and quality of life after PVS. However, MUI patients with DO had less improvement in UDI-6 scores after PVS, despite a similar reduction to pad use/day.
Casteleijn, Fenne M; Zwolsman, Sandra E; Kowalik, Claudia R; Roovers, Jan-Paul P W R
The aim of this study was to identify all treatment decision factors that determined the preference for peri-urethral bulk injection therapy (PBI) or mid-urethral sling (MUS) surgery in patients with primary stress urinary incontinence (SUI). Second, we explored what patients expect from treatment for SUI and whether patients would consider PBI as a primary treatment option. In a qualitative design, 20 semi-structured, face-to-face interviews were conducted in women with primary SUI. Exclusion criteria were: previous PBI or MUS surgery; predominating urgency. Interviews were guided by three open-ended questions and a topic list. PBI treatment and MUS surgery were described in detail, and the efficacy was stated as 70% and 90%, respectively. Data saturation was reached when no new treatment decision factors were identified in three consecutive interviews. Interviews were audiotaped and fully transcribed. Thematic analysis by a coding process was done independently by two researchers. Sixteen procedural, personal, professional, social and external treatment decision factors were identified. Regarding expectations about treatment for SUI, women believed 'becoming dry' was wishful thinking. The majority of patients accepted a small degree of persistent urinary incontinence after treatment. Regardless of their treatment preference, patients indicated that women should be informed about PBI as a primary treatment option. Patients with primary SUI are open to PBI as an alternative treatment option even with lower cure rates compared with MUS surgery performed under general or spinal anesthesia. Patients indicated that women with primary SUI seeking treatment should be informed about PBI as a treatment option.
Full Text Available Post-prostatectomy incontinence (PPI is a common and significant issue that can affect the quality of life in men who are undergoing treatment for prostate cancer. While some patients opt for conservative management of their incontinence, many elect to undergo surgical treatment as a result of the significant impact to quality of life. The most commonly employed surgical techniques to address PPI are placement of a male sling or artificial urinary sphincter (AUS. Currently, the AUS continues to serve as the gold standard for management, with robust data concerning longitudinal outcomes available. However, in recent years, the various methods to place the male sling have emerged as viable, less complex alternatives that avoid the need for pump manipulation. In the present review, we discuss these main surgical treatment modalities for PPI, and focus on the selection criteria that may influence appropriate operative stratification of PPI patients. Indeed, an individualised, comprehensive assessment of baseline urinary function, age, radiation, prior surgeries, functional status, and other comorbidities must be considered in the context of shared decision-making between the treatment provider and the patient in determining the optimal approach to managing PPI.
Weintraub, Adi Y; Reuven, Yonatan; Paz-Levy, Dorit; Yohay, Zehava; Idan, Inbal; Elharar, Debi; Glinter, Hannah; Tzur, Tamar; Yohay, David
To investigate the prevalence and risk factors of urinary tract infection (UTI) one year following sub-midurethral sling (SMUS) incontinence surgery in a university affiliated medical center in southern Israel. A retrospective cohort study was conducted to identify and characterize patients who suffered UTI within a year following SMUS surgery. The study population comprised of all patients who underwent a SMUS surgery between the years 2014 and 2015. Demographic and clinical data were retrieved from the patients' medical records, and a comparison between patients with and without a positive urine culture was performed. During the study period, there were 178 SMUS surgeries. Urine culture positive UTI was noted in 21% (38 patients) within the first year following surgery. The mean age and BMI of patients complicated with UTI was 64.8 and 29.1, respectively. The most common pathogen found in urine culture was E. coli that accounted for 55% of all UTIs. When comparing patients with and without UTI, no significant difference was noted in the pre- and intra-operative characteristics. However, duration of hospitalization and readmissions in the first year following surgery, were significantly associated with the risk of UTI (p < 0.026 and p < 0.003, respectively). Approximately one in every five women undergoing a SMUS operation in our population will suffer from UTI within a year from surgery. A significant association was found between the duration of hospitalization and readmissions in the first postoperative year and suffering from UTI. Copyright © 2018 Elsevier B.V. All rights reserved.
Waltregny, David; de Leval, Jean
Tension-free suburethral tapes have revolutionized the surgical treatment of female stress urinary incontinence (SUI). These tapes are inserted by way of a retropubic or transobturator route. The inside-out tension-free vaginal tape transobturator approach, or TVT-Obturator system (TVT-O, Ethicon Women's Health and Urology, Somerville, NJ), was developed ten years ago with the aim of minimizing the risk of urinary tract injuries associated with retropubic and outside-in transobturator tapes while reproducibly ensuring minimal tissue dissection. Cadaveric studies have shown that the anatomical trajectory of the TVT-O tape is strictly perineal and courses away from neighboring obturator and pudendal neurovascular structures. Several meta-analyses have shown similar SUI cure rates after retropubic and transobturator tape procedures. Yet, the transobturator route may be associated with less voiding dysfunction, blood loss, bladder perforation, and shorter operating time. The original TVT-O procedure was modified with the aim of reducing the incidence of postoperative groin pain as well as the rather theoretical risk of obturator nerve injury. This modified procedure, named TVT-ABBREVO (Ethicon Women's Health and Urology, Somerville, NJ), utilizes a shortened, 12-cm-long polypropylene tape. In addition, perforation of the obturator membrane with the scissors and guide is avoided in order to reduce the depth of lateral dissection, and consequently, to maximize securing of the tape within the obturator muscular/aponeurotic structures. In a comparative anatomical study, it was indeed observed that the shorter tape traversed less muscular structures (with no or only a minimal amount of tape lying in the adductor muscles) than its original counterpart, while still consistently anchoring in the obturator membrane at a similarly safe distance from the obturator canal. In a single-center randomized clinical trial, after a 3-year minimum follow-up, the modified TVT-O procedure
Wei, John; Nygaard, Ingrid; Richter, Holly; Brown, Morton; Barber, Matthew; Xiao Xu; Kenton, Kimberly; Nager, Charles; Schaffer, Joseph; Visco, Anthony; Weber, Anne
The primary aims of this trial are to determine whether the use of a concomitant prophylactic anti-incontinence procedure may prevent stress urinary incontinence symptom development in women undergoing vaginal prolapse surgery and to evaluate the cost-effectiveness of this prophylactic approach. To present the rationale and design of a randomized controlled surgical trial (RCT), the Outcomes following vaginal Prolapse repair and mid Urethral Sling (OPUS) Trial highlighting the challenges in the design and implementation. The challenges of implementing this surgical trial combined with a cost-effectiveness study and patient preference group are discussed including the study design, ethical issues regarding use of sham incision, maintaining the masking of study staff, and pragmatic difficulties encountered in the collection of cost data. The trial is conducted by the NICHD-funded Pelvic Floor Disorders Network. The ongoing OPUS trial started enrollment in May 2007 with a planned accrual of 350. The use of sham incision was generally well accepted but the collection of cost data using conventional billing forms was found to potentially unmask key study personnel. This necessitated changes in the study forms and planned timing for collection of cost data. To date, the enrollment to the patient preference group has been lower than the limit established by the protocol suggesting a willingness on the part of women to participate in the randomization. Given the invasive nature of surgical intervention trials, potential participants may be reluctant to accept random assignment, potentially impacting generalizability. Findings from the OPUS trial will provide important information that will help surgeons to better counsel women on the benefits and risks of concomitant prophylactic anti-incontinence procedure at the time of vaginal surgery for prolapse. The implementation of the OPUS trial has necessitated that investigators consider ethical issues up front, remain flexible
Hota, Lekha S; Hanaway, Katherine; Hacker, Michele R; Disciullo, Anthony; Elkadry, Eman; Dramitinos, Patricia; Shapiro, Alexander; Ferzandi, Tanaz; Rosenblatt, Peter L
This study aimed to compare TVT-Secur (TVT-S) and TVT-Obturator (TVT-O) suburethral slings for treatment of stress urinary incontinence (SUI). This was a single-center, nonblinded, randomized trial of women with SUI who were randomized to TVT-S or TVT-O from May 2007 to April 2009. The primary outcome, SUI on cough stress test (CST), and quality-of-life and symptom questionnaires (Pelvic Floor Distress Inventory [PFDI-20] and Pelvic Floor Impact Questionnaire [PFIQ-7]) were assessed at 12 weeks and 1 year. Forty-three women were randomized to TVT-S and 44 to TVT-O. There were no differences in median baseline PFDI-20 and PFIQ-7. Twenty-two (52.4%) of 42 participants randomized to TVT-S had a positive CST result at evaluation after 12 weeks or 1 year, whereas 4 (9.1%) of the 44 in the TVT-O group had a positive CST result. The intent-to-treat analysis showed that the risk of a positive CST result was 6 times higher after TVT-S than TVT-O (risk ratio, 6.0; 95% confidence interval [CI], 2.3-16.0). Among women not lost to follow-up, the risk ratio for a positive CST result after TVT-S compared with TVT-O was 17.9 (95% CI, 2.5-128.0) at 12 weeks and 3.5 (95% CI, 1.1-11.0) at 1 year. Both TVT-S and TVT-O resulted in improved quality of life and symptoms at 12 weeks. There was no difference between the groups for PFDI-20 (P = 0.40) or PFIQ-7 (P = 0.43). A similar pattern was seen at 1 year (P = 0.85 and P = 0.36). The TVT-S seems to have a higher risk of positive postoperative CST result; however, the procedures result in similar improvements in quality of life and symptoms.
Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence.
Chapple, Christopher R; Cruz, Francisco; Deffieux, Xavier; Milani, Alfredo L; Arlandis, Salvador; Artibani, Walter; Bauer, Ricarda M; Burkhard, Fiona; Cardozo, Linda; Castro-Diaz, David; Cornu, Jean Nicolas; Deprest, Jan; Gunnemann, Alfons; Gyhagen, Maria; Heesakkers, John; Koelbl, Heinz; MacNeil, Sheila; Naumann, Gert; Roovers, Jan-Paul W R; Salvatore, Stefano; Sievert, Karl-Dietrich; Tarcan, Tufan; Van der Aa, Frank; Montorsi, Francesco; Wirth, Manfred; Abdel-Fattah, Mohamed
Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). A consensus review of existing data based on published meta-analyses and reviews. This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations. Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae. When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres. Synthetic slings can be safely used
Lane, S M; Dickinson, A W; Tregenza, T; House, C M
Traditional views of sexual selection assumed that male-male competition and female mate choice work in harmony, selecting upon the same traits in the same direction. However, we now know that this is not always the case and that these two mechanisms often impose conflicting selection on male sexual traits. Cuticular hydrocarbons (CHCs) have been shown to be linked to both social dominance and male attractiveness in several insect species. However, although several studies have estimated the strength and form of sexual selection imposed on male CHCs by female mate choice, none have established whether these chemical traits are also subject to sexual selection via male-male competition. Using a multivariate selection analysis, we estimate and compare sexual selection exerted by male-male competition and female mate choice on male CHC composition in the broad-horned flour beetle Gnatocerus cornutus. We show that male-male competition exerts strong linear selection on both overall CHC abundance and body size in males, while female mate choice exerts a mixture of linear and nonlinear selection, targeting not just the overall amount of CHCs expressed but the relative abundance of specific hydrocarbons as well. We discuss the potential implications of this antagonistic selection with regard to male reproductive success. © 2016 The Authors. Journal of Evolutionary Biology published by John Wiley & Sons Ltd on behalf of European Society for Evolutionary Biology.
Chow, Alexander K; Sherer, Benjamin A; Yura, Emily; Kielb, Stephanie; Kocjancic, Ervin; Eggener, Scott; Turk, Thomas; Park, Sangtae; Psutka, Sarah; Abern, Michael; Latchamsetty, Kalyan C; Coogan, Christopher L
To evaluate the Urological resident's attitude and experience with surgical simulation in residency education using a multi-institutional, multi-modality model. Residents from 6 area urology training programs rotated through simulation stations in 4 consecutive sessions from 2014 to 2017. Workshops included GreenLight photovaporization of the prostate, ureteroscopic stone extraction, laparoscopic peg transfer, 3-dimensional laparoscopy rope pass, transobturator sling placement, intravesical injection, high definition video system trainer, vasectomy, and Urolift. Faculty members provided teaching assistance, objective scoring, and verbal feedback. Participants completed a nonvalidated questionnaire evaluating utility of the workshop and soliciting suggestions for improvement. Sixty-three of 75 participants (84%) (postgraduate years 1-6) completed the exit questionnaire. Median rating of exercise usefulness on a scale of 1-10 ranged from 7.5 to 9. On a scale of 0-10, cumulative median scores of the course remained high over 4 years: time limit per station (9; interquartile range [IQR] 2), faculty instruction (9, IQR 2), ease of use (9, IQR 2), face validity (8, IQR 3), and overall course (9, IQR 2). On multivariate analysis, there was no difference in rating of domains between postgraduate years. Sixty-seven percent (42/63) believe that simulation training should be a requirement of Urology residency. Ninety-seven percent (63/65) viewed the laboratory as beneficial to their education. This workshop model is a valuable training experience for residents. Most participants believe that surgical simulation is beneficial and should be a requirement for Urology residency. High ratings of usefulness for each exercise demonstrated excellent face validity provided by the course. Copyright © 2017 Elsevier Inc. All rights reserved.
Cornu, Jean-Nicolas; Sèbe, Philippe; Peyrat, Laurence; Ciofu, Calin; Cussenot, Olivier; Haab, Francois
TVT-Secur has been described as a new minimally invasive sling for women's stress urinary incontinence (SUI) management, showing promising results in short-term studies. Our goal was to evaluate the outcome of this procedure after a midterm follow-up. A prospective evaluation involved 45 consecutive patients presenting SUI associated with urethral hypermobility. Fourteen patients preoperatively reported overactive bladder (OAB) symptoms, but none had objective detrusor overactivity. Eight patients had low maximal urethral closure pressure (MUCP). Four patients had pelvic organ prolapse (POP). Patients with POP were treated under general anesthesia by Prolift and TVT-Secur procedure. The 41 other patients received TVT-Secur under local anesthesia on an outpatient basis. All interventions were made by the same surgeon. Postoperative assessment included pad count, bladder diary, clinical examination with stress test, evaluation of satisfaction with the Patient Global Impression of Improvement (PGI-I) scale, and evaluation of side effects. Patients were classified as cured if they used no pads, had no leakage, and had a PGI-I score 50% and PGI-I score TVT or transobturator tape during follow-up. Age, MUCP, or OAB were not associated with failure. Side effects were limited to five cases of de novo OAB and three cases of urinary tract infection. This work is limited by the absence of a comparison group. Our experience shows that despite its good short-term efficacy, TVT-Secur is associated with a high recurrence rate of SUI. Therefore, TVT-Secur does not seem appropriate for SUI first-line management in women. Copyright 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Full Text Available While the ultimate consequences of social bonds start to be better understood, the proximate behavioural mechanisms underlying the formation and maintenance of these close affiliative relationships have received less attention. We investigated the possible function of male-infant-male interactions (MIMIs in male-male social bonding processes by analysing about 9000h of focal animal observations collected on two groups of wild Assamese macaques. In support of an agonistic buffering function of MIMIs, after engaging in a MIMI upon approach, subordinates stayed longer in close proximity of a dominant male. Overall, the frequency of MIMIs increased the stronger the affiliative relationship between two males, suggesting that MIMIs like grooming function in relationship maintenance. We did not find support for a role of MIMIs in bond formation as the frequency of MIMIs did not affect the time a male dyad spent in proximity in the consecutive year. Our results contribute to the general debate on behaviours influencing social dynamics in group living mammals.
Kowalik, Casey G; Cohn, Joshua A; Kakos, Andrea; Lang, Patrick; Reynolds, W Stuart; Kaufman, Melissa R; Karram, Mickey M; Dmochowski, Roger R
Urethral injury resulting from transvaginal mesh slings is a rare complication with an estimated incidence of surgical management and functional outcomes of women presenting with urethral mesh perforation following midurethral sling (MUS) placement. This was a retrospective multicenter review of women who from January 2011 to March 2016 at two institutions underwent mesh sling excision for urethral perforation with Female Pelvic Medicine and Reconstructive Surgery fellowship-trained surgeons. Data comprising preoperative symptoms, operative details, and postoperative outcomes were collected by telephone (n 13) or based on their last follow-up appointment. Nineteen women underwent transvaginal sling excision for urethral mesh perforation. Eight (42%) patients had undergone previous sling revision surgery. Sixty percent of women had resolution of their pelvic pain postoperatively. At follow-up, 92% reported urinary incontinence (UI), and three had undergone five additional procedures for vaginal prolapse mesh exposure (n 1), incontinence (onabotulinum toxin injection n 1, rectus fascia autologous sling n 1), prolapse (colpopexy n 1), and pain (trigger-point injection n 1). Patient global impression of improvement data was available for 13 patients, of whom seven (54%) rated their postoperative condition as Very much better or Much better. The management of urethral mesh perforation is complex. Most women reported resolution of their pelvic pain and a high rate of satisfaction with their postoperative condition despite high rates of incontinence.
Full Text Available Abstract Background The outcome of male-male competition can be predicted from the relative fighting qualities of the opponents, which often depend on their age. In insects, freshly emerged and still sexually inactive males are morphologically indistinct from older, sexually active males. These young inactive males may thus be easy targets for older males if they cannot conceal themselves from their attacks. The ant Cardiocondyla obscurior is characterised by lethal fighting between wingless (“ergatoid” males. Here, we analyse for how long young males are defenceless after eclosion, and how early adult males can detect the presence of rival males. Results We found that old ergatoid males consistently won fights against ergatoid males younger than two days. Old males did not differentiate between different types of unpigmented pupae several days before emergence, but had more frequent contact to ready-to-eclose pupae of female sexuals and winged males than of workers and ergatoid males. In rare cases, old ergatoid males displayed alleviated biting of pigmented ergatoid male pupae shortly before adult eclosion, as well as copulation attempts to dark pupae of female sexuals and winged males. Ergatoid male behaviour may be promoted by a closer similarity of the chemical profile of ready-to-eclose pupae to the profile of adults than that of young pupae several days prior to emergence. Conclusion Young ergatoid males of C. obscurior would benefit greatly by hiding their identity from older, resident males, as they are highly vulnerable during the first two days of their adult lives. In contrast to the winged males of the same species, which are able to prevent ergatoid male attacks by chemical female mimicry, young ergatoids do not seem to be able to produce a protective chemical profile. Conflicts in male-male competition between ergatoid males of different age thus seem to be resolved in favour of the older males. This might represent selection
Full Text Available Abstract Introduction Closing the pelvic peritoneum to prevent the small bowel dropping into the pelvis after surgery for locally recurrent rectal cancer is important to prevent adhesions deep in the pelvis or complications of adjuvant radiotherapy. Achieving this could be difficult because sufficient native tissue is unavailable; we report on the use of small intestine submucosa extra-cellular matrix mesh in the obliteration of the pelvic brim. Case presentation We describe two cases in which submucosa extra-cellular matrix mesh was used to obliterate the pelvic brim following resection of a recurrent rectal tumour; the first patient, a 78-year-old Caucasian man, presented with small bowel obstruction caused by adhesions to a recurrent rectal tumour. The second patient, an 84-year-old Caucasian woman, presented with vaginal discharge caused by an entero-vaginal fistula due to a recurrent rectal tumour. Conclusion We report on the use of submucosa extra-cellular matrix mesh as a pelvic sling in cases where primary closure of the pelvic peritoneum is unfeasible. Its use had no infective complications and added minimal morbidity to the postoperative period. This is an original case report that would be of interest to general and colorectal surgeons.
Xiang, Zuo-Fu; Yang, Bang-He; Yu, Yang; Yao, Hui; Grueter, Cyril C; Garber, Paul A; Li, Ming
Group-level male-male co-operation, which has been documented in several primate and non-primate societies, may be mutualistically advantageous to the participants when confronted with threats such as takeovers and cuckoldry by external males. Co-operation among members of distinct social units-while universal among humans-is extremely rare in non-human primates. We present the first observations of collective action or co-operation among males of different one-male units (OMU) in a multi-level society of Rhinopithecus roxellana. A total of 59 instances of male co-operation were recorded. Male co-operation included coordinated chasing, joint vigilance, and patrolling behavior directed at lone adult males trying to enter an OMU. Male co-operation was significantly more frequent during the mating season when the risk of incursions and extra-group paternity was higher. Paternity of infants born in the subsequent birth season and kin relationships among resident males were identified using microsatellite genotype. All infants were sired by OMU males, which we interpret as possible evidence for their success at thwarting mating attempts by satellite males. OMU males were principally unrelated suggesting that male co-operation is best understood in terms of the mutual direct benefits individuals obtain through collective action. Our findings lend support to the bachelor threat hypothesis in which the cooperative behavior of several individuals is more effective than the lone action of a single individual in providing mate defense. Our research has implications for understanding male bonding, higher-level collective action, and the evolution of social co-operation in human societies. © 2013 Wiley Periodicals, Inc.
Dietz, Jill; Lundgren, P; Veeramani, A; O'Rourke, C; Bernard, S; Djohan, R; Larson, J; Isakov, R; Yetman, R
Skin-sparing mastectomy and prosthetic reconstruction can be complicated by poor surgical outcomes in large-breasted, obese women. This article describes a single surgeon's experience comparing conventional skin-sparing mastectomy (SSM) and skin-reduction mastectomy using an autologous vascularized inferior dermal/cutaneous sling (autoderm). From July 2007 to May 2012, patients undergoing skin-sparing mastectomy were evaluated for surgical outcomes. After July 2009, the surgeon performed skin-reduction mastectomies with autoderm (SRM-AD) on all patients with macromastia or grade 3-4 ptosis. Remaining patients in this time period (SSM-cont) underwent conventional skin-sparing mastectomies while all previous patients (historical) also underwent skin-sparing mastectomies (SSM-hist). A predictive model was used to compare the large historical patients (who would have had reduction mastectomy if available) with the smaller historical patients to evaluate the effect of the procedure. Body mass index (BMI) and specimen weight were higher in both the SRM group and large historical group. The hazard ratio for having skin-reduction mastectomy was 0.53 (P = 0.51) compared with the historical group. There was a total of 16 complications for the whole study. Smoking was the only significant risk factor. This study shows that mastectomy with prosthetic reconstruction using a skin-reduction technique with autoderm can be done safely with a low complication rate and improved cosmetic outcomes in the traditionally "at-risk" group of women with high BMI and large ptotic breasts.
Meschia, Michele; Bertozzi, Rosanna; Pifarotti, Paola; Baccichet, Roberto; Bernasconi, Francesco; Guercio, Elso; Magatti, Fabio; Minini, Gianfranco
The aim of this study was to compare the morbidity and short-term efficacy of retro-pubic (TVT) and inside-out trans-obturator (TVT-O) sub-urethral sling in the treatment of stress urinary incontinence. This was a prospective multi-centre randomised trial; 231 women with primary stress urinary incontinence were randomised to TVT (114) or TVT-O (117). The International Consultation on Incontinence-Short Form (ICIQ-SF), Women Irritative Prostate Symptoms Score (W-IPSS) and Patient Global Impression of Severity (PGI-S) questionnaires were used to evaluate the impact of incontinence and voiding dysfunction on QoL and to measure the patient's perception of incontinence severity. The primary and secondary outcome measures were rates of success and complications. The SPSS software was used for data analysis. The TVT-O procedure was associated with significantly shorter operation time and with a more extensive use of general anaesthesia when compared with TVT. There were 5 (4%) bladder perforations in the TVT group compared with none in the TVT-O group. Rates of early post-operative urinary retention and voiding difficulty were similar for both groups and no difference was found in the average hospital stay. Six patients (5%) in the TVT-O group complained of thigh pain in the post-operative course. The median follow-up time was 6 months. Two hundred eighteen patients were available for the analysis of outcomes. Subjective and objective cure rates were 92% and 92% in the TVT group and 87% and 89% in the TVT-O group. The ICIQ-SF questionnaire symptoms score showed a highly statistical decrease in both groups, the W-IPSS on the contrary was unchanged. Our data show that both procedures were equally effective in the short-term for the treatment of stress urinary incontinence with a highly significant improvement in incontinence-related QoL.
Bech, Lenette; Sander, Pia; Lose, Gunnar
recovery. As opposed to the macroporous types (e.g. tension-free vaginal tape), the microporous structure of the IVS-sling causes a higher rate of erosion and infection. Complete sling removal is important in case of IVS-complications. The monitoring of complications related to new medical devices......This report presents a case of vaginal erosion and bilateral suprabupic abscesses five years after insertion of an intravaginal slingplasty (IVS) midurethral incontinence sling in a 53-year-old female patient. Partial removal was insufficient. After complete removal, the patient achieved full...
Chae, Ji Y; Bae, Jae H; Lee, Jeong G; Park, Hong S; Moon, Du G; Oh, Mi M
To evaluate the effects of preoperative low maximal flow rate (Qmax) on voiding trials after the midurethral sling (MUS) procedure in women with stress urinary incontinence (SUI). One hundred and sixty-eight women who underwent MUS procedure were enrolled. Preoperative free uroflowmetry was performed and patients were divided by Qmax. Low Qmax was defined as a Qmax under 15 mL/sec with voided volume at least 150 mL. Surgical results, failure of voiding trial, and postoperative uroflowmetry parameters were compared between the groups. Failure of voiding trial was defined by a PVR more than 100 mL on postoperative uroflowmetry. At the discharge day, there were 42 cases showing failure of voiding trial and 33 cases requiring CIC, but only one patient showed failure of voiding trial at 12 months postoperatively. Overall, 48 patients had preoperative low Qmax. Low Qmax group showed lower Qmax in all of postoperative uroflowmetry, but there were no significant differences in the rate of postoperative voiding trial failure or CIC. The low Qmax group was then divided into two groups according to the preoperative detrusor pressure at Qmax over and under 20 cmH 2 O in pressure flow study. Comparing the two groups, no significant differences were observed in the cure rate, voiding trial failure or CIC. Our results suggest that women with preoperative low Qmax experienced no definite unfavorable voiding problem from the MUS procedure compared to those with normal voiding function. MUS procedure may be regarded as a safe and successful procedure in SUI women with low Qmax. © 2017 John Wiley & Sons Australia, Ltd.
van der Ploeg, J Marinus; Oude Rengerink, Katrien; van der Steen, Annemarie; van Leeuwen, Jules H Schagen; van der Vaart, C Huub; Roovers, Jan-Paul W R
We compared pelvic organ prolapse (POP) repair with and without midurethral sling (MUS) in women with occult stress urinary incontinence (SUI). This was a randomized trial conducted by a consortium of 13 teaching hospitals assessing a parallel cohort of continent women with symptomatic stage II or greater POP. Women with occult SUI were randomly assigned to vaginal prolapse repair with or without MUS. Women without occult SUI received POP surgery. Main outcomes were the absence of SUI at the 12-month follow-up based on the Urogenital Distress Inventory and the need for additional treatment for SUI. We evaluated 231 women, of whom 91 randomized as follows: 43 to POP surgery with and 47 without MUS. A greater number of women in the MUS group reported absence of SUI [86 % vs. 48 %; relative risk (RR) 1.79; 95 % confidence interval (CI) 1.29-2.48]. No women in the MUS group received additional treatment for postoperative SUI; six (13 %) in the control group had a secondary MUS. Women with occult SUI reported more urinary symptoms after POP surgery and more often underwent treatment for postoperative SUI than women without occult SUI. Women with occult SUI had a higher risk of reporting SUI after POP surgery compared with women without occult SUI. Adding a MUS to POP surgery reduced the risk of postoperative SUI and the need for its treatment in women with occult SUI. Of women with occult SUI undergoing POP-only surgery, 13 % needed additional MUS. We found no differences in global impression of improvement and quality of life.
Svensson P Andreas
Full Text Available Abstract Background Male sexual displays play an important role in sexual selection by affecting reproductive success. However, for such displays to be useful for female mate choice, courtship should vary more among than within individual males. In this regard, a potentially important source of within male variation is adjustment of male courtship effort in response to female traits. Accordingly, we set out to dissect sources of variation in male courtship effort in a fish, the desert goby (Chlamydogobius eremius. We did so by designing an experiment that allowed simultaneous estimation of within and between male variation in courtship, while also assessing the importance of the males and females as sources of courtship variation. Results Although males adjusted their courtship depending on the identity of the female (a potentially important source of within-male variation, among-male differences were considerably greater. In addition, male courtship effort towards a pair of females was highly repeatable over a short time frame. Conclusion Despite the plasticity in male courtship effort, courtship displays had the potential to reliably convey information about the male to mate-searching females. Our experiment therefore underscores the importance of addressing the different sources contributing to variation in the expression of sexually-selected traits.
Bech, Lenette Tove; Sander, Pia; Lose, Gunnar
recovery. As opposed to the macroporous types (e.g. tension-free vaginal tape), the microporous structure of the IVS-sling causes a higher rate of erosion and infection. Complete sling removal is important in case of IVS-complications. The monitoring of complications related to new medical devices...
Clare C. Rittschof
Across a variety of animal taxa, the outcome of male--male contests depends on male body size; winners are usually the larger males or the males with bigger weapons. However, high male density can either increase or reverse large-male advantage because density changes the frequency and intensity of male--male interactions. In the golden orb-web spider Nephila clavipes, large males have a competitive advantage in male--male contests. However, this species shows more than 2-fold variation in ma...
... defective or deteriorated slings, thereby reducing their risk of death or serious injury caused by sling.... In addition, notwithstanding any other provisions of law, no person shall generally be subject to penalty for failing to comply with a collection of information if the collection of information does not...
A. A. Lebedev
Full Text Available Сonsidered question of reducing oscillations of cargo on helicopter external sling to improve the safety and efficiency of flight operations during the conduct of urgent aerial works. Offered practical recommendations of piloting a helicopter and effective maneuvers to eliminate oscillations of cargo on external sling.
Ginsberg, Terrie B
It should be recognized that sexuality in the aging male is of such import that a complete sexual history must be performed. By taking a complete sexual history, facts can be obtained that will allow for appropriate focus relating to a holistic evaluation and will enable us to dispel antiquated sexual myths pertaining to the aging male. If initiated by the history taker, questions concerning sexuality may be discussed more comfortably by the patient. Erectile dysfunction, male sexual response cycle, testosterone, sexually transmitted diseases, human immunodeficiency virus, long-term illness, along with religion and culture are explored in this article with the aim of improving one's knowledge base, self reflection, and awareness of the importance of male sexuality. A complete understanding and appreciation of the aging male's medical history, surgical history, social history, and emotional history as well as his sexual, cultural, and religious concepts will allow the health care provider to better analyze information, and to recommend and provide appropriate advice and treatment to the aging male patient. Copyright 2010 Elsevier Inc. All rights reserved.
Yoon, Seong-Deok; Sung, Dong-Hun; Park, Gi Duck
[Purpose] The effects of core training using slings and Togus on the improvement of posture control in Taekwondo club students, that is, balance ability, were investigated. To that end, changes in the Taekwondo players' balance ability resulting from active core training for eight weeks were examined through fitness and foot pressure. [Subjects] The present study was conducted with 13 male Taekwondo players of K University in Deagu, South Korea. Once the experiment process was explained, consent was obtained from those who participated voluntarily. [Methods] Air cushions (Germany), Jumpers (Germany), and Aero-Steps (Germany) were used as lumbar stabilization exercise tools. As a method of training proprioceptive senses by stimulating somatesthesia in standing postures, the subjects performed balance squats, supine pelvic lifts, and push-up plus exercise using slings while standing on an Aero-Step and performed hip extension parallel squats (Wall Gym Ball), and standing press-ups on a Togu using their own weight. The subjects performed four sets of these isometric exercises while maintaining an exercise time per set at 30 seconds in each session and repeated this session three times per week. [Result] Left grip strength significantly increased and number of sit-ups, which indicates muscle endurance, also significantly increased after the eight weeks exercise compared with before the exercise. The values measured during the sit and reach test, which indicate flexibility, also significantly increase after the eight weeks of exercise compared with before the exercise but only in the left foot. [Conclusion] The result of present study suggest that active core exercise using Slings and Togus can be applied as a very effective exercise program for enhancing balance, which is an important physical factor for Taekwondo club students.
..., shall consist of one continuous piece without knot or splice. (c) Natural fiber rope. (1) The employer... consist of at least six tucks, three on each side of the centerline. (d) Synthetic rope. (1) The employer... slings. (1) Slings and nets or other combinations of more than one piece of synthetic webbing assembled...
... wire rope used in hoisting or lowering, or in bulling cargo, shall consist of one continuous piece... splices shall consist of at least three full tucks. Short splices shall consist of at least six full tucks... slings. (1) Slings and nets or other combinations of more than one piece of synthetic webbing assembled...
Martín, José; López, Pilar
Scent-marked substrates may inform conspecifics on the characteristics of territorial males. Scent-marks of male Carpetan rock lizards (Iberolacerta cyreni) affect space use of females, which by selecting an area may increase the probability of mating with the male that has scent-marked that area. However, males do not hold exclusive territories, and scent-marks of different individual males are often together. This may provide complex information from multiple sources on the social structure. Here, we examined female preference in response to scent marks of various males and combinations in a laboratory experiment. Females preferred areas scent-marked by territorial old males against those scent-marked by young satellite-sneaker males. This reflected the known preference of females for mating with old males. In a second experiment, females preferred areas scent-marked by two males to areas of similar size marked by a single male. This may increase the probability of obtaining multiple copulations with different males, which may favour sperm competition and cryptic female choice, or may be a way to avoid infertile males. Finally, when we experimentally over-marked the scent-marks of an old male with scent-marks of a young male, females did not avoid, nor prefer, the over-marked area, suggesting that the quality of the old male may override the presence of a satellite male. We suggest that, irrespective of the causes underlying why a female selects a scent-marked area, this strategy may affect her reproductive success, which may have the same evolutionary consequences that "direct" mate choice decisions of other animals. Copyright © 2013 Elsevier B.V. All rights reserved.
Frederico Teixeira Brandt
Full Text Available Objective: To describe the relevance of transvulvar ultrasound in the assessment of anatomical differences induced by the lata fascia sling (LFS and tension-free vaginal tape (TVT procedures. Materials and Methods: Forty women with stress urinary incontinence (SUI, aged 30 to 60 years, have been treated with either LFS (20 patients or TVT (20 patients. The transvulvar ultrasound of the urethrovesical junction (UVJ and proximal urethra (PU has been used as the main investigational tool both pre- and post-operatively. The studied parameters were the vertical (VUVJD and horizontal (HUVJD UVJ distances, the pubourethral distance (PUD and the PU length. Results: The VUVJD did not vary significantly after the LFS surgery (P=0.10. The PUD became shorter (P=0.001 and the HUVJD became shorter only at rest (P=0.03 after the correction by LFS. The TVT procedure has led to shortening of the VUVJ displacement (P=0.0005 and of the PU length (P=0.02. Conclusions: The transvulvar ultrasound was of utmost importance in the demonstration that both the LFS and TVT surgical procedures elongate the PU, even though the LFS technique does it more efficiently. The LFS technique focus more on shortening the PUD and the TVT procedure focus more on the correction of the vertical UVJ displacement.
Robinson, Eric; Hogenkamp, Pleunie S
Obesity is now common and this may have altered visual perceptions of what constitutes a 'normal' and therefore healthy weight. The present study examined cross-cultural differences in male and female participants' ability to visually identify the weight status of photographed Caucasian males. Five hundred and fifty three male and female young adults from the US (high obesity prevalence), UK and Sweden (lower obesity prevalence) participated in an online study. Participants judged the weight status of a series of photographed healthy weight, overweight and obese (class I) Caucasian males and rated the extent to which they believed each male should consider losing weight. There was a strong tendency for both male and female participants to underestimate the weight status of the photographed overweight and obese males. Photographed males were frequently perceived as being of healthier weight than they actually were. Some modest cross-cultural differences were also observed; US participants were worse at recognising obesity than UK participants (p cross-cultural differences were observed for perceptions or attitudes towards the photographed healthy weight or overweight males. The weight status of overweight and obese (class I) Caucasian males is underestimated when judged by males and females using visual information alone. This study provides initial evidence of modest cross-cultural differences in attitudes toward, and the ability to recognise, obesity in Caucasian males.
Chen, Bin; Liu, He; Ren, Jing; Guo, Aike
In Drosophila, dopamine plays important roles in many biological processes as a neuromodulator. Previous studies showed that dopamine level could affect fly courtship behaviors. Disturbed dopamine level leads to abnormal courtship behavior in two different ways. Dopamine up-regulation induces male-male courtship behavior, while down-regulation of dopamine level results in increased sexual attractiveness of males towards other male flies. Until now, the identity of the dopamine receptor involved in this abnormal male-male courtship behavior remains unknown. Here we used genetic approaches to investigate the role of dopamine receptors in fly courtship behavior. We found that a dopamine D1-like receptor, DopR, was involved in fly courtship behavior. DopR mutant male flies display male-male courtship behavior. This behavior is mainly due to the male's increased propensity to court other males. Expression of functional DopR successfully rescued this mutant phenotype. Knock-down of D2-like receptor D2R and another D1-like receptor, DAMB, did not induce male-male courtship behavior, indicating the receptor-type specificity of this phenomenon. Our findings provide insight into a possible link between dopamine level disturbance and the induced male-male courtship behavior. Copyright © 2012 Elsevier Inc. All rights reserved.
Sores - male genitals; Ulcers - male genitals ... A common cause of male genital sores are infections that are spread through sexual contact, such as: Genital herpes (small, painful blisters filled with clear ...
Dandolu, Vani; Akiyama, Megumi; Allenback, Gayle; Pathak, Prathamesh
Our objective was to quantitate the extent of complications and failure rate for apical prolapse repair with transvaginal mesh (TVM) use versus sacrocolpopexy over a minimum of 2 years of follow-up. Truven CCAE and Medicare Supplemental databases 2008-2013 were used for analysis. Patients with apical prolapse repair via transvaginal mesh (TVMR), abdominal sacrocolpopexy (ASCP), laparoscopic sacrocolpopexy (LSCP), or native tissue repair (NTR) and continuously enrolled for years were in the study cohort. Surgical failures were identified by reoperation for any prolapse or subsequent use of pessary. SAS® 9.3 was used for analysis. Mesh removal/revision was reported highest in TVMR (5.1 %), followed by LSCP (1.7 %) and ASCP (1.2 %). In those with concomitant sling, combined rates for mesh/sling revision were high, at 9.0 % in TVMR + sling, 5.6 % in ASCP + sling, and 4.5 % LSCP + sling. Sling-alone cases reported a 3.5 % revision rate. Pelvic pain (16.4-22.7 %) and dyspareunia (5.6-7.5 %) were high in all three approaches for apical prolapse repairs. Reoperation for apical prolapse was more common for TVMR (2.9 %) compared with NTR (2.3 %) [odds ratio (OR) 1.27; confidence interval (CI) 1.1-1.47; p 0.002]. Both ASCP and LSCP were superior to NTR (ASCP 1.5 %, OR 0.63, CI 0.46-0.86; p 0.003) and LSCP 1.8 % (OR 0.79, CI 0.62-1.01; p 0.07). Overall prolapse recurrence, as indicated by any compartment surgery for prolapse and/or pessary use, was also noted highest in TVMR (5.9 % OR 1.23, CI 1.11-1.36; p mesh is used for repair, mesh revision is highest with TVMR and lowest with ASCP.
Alopecia in men; Baldness - male; Hair loss in men; Androgenetic alopecia ... Male pattern baldness is related to your genes and male sex hormones. It usually follows a pattern of receding hairline and ...
Gomes, Suzanne; Civetta, Alberto
Hybrid male sterility is a common barrier to gene flow between species. Previous studies have posited a link between misregulation of spermatogenesis genes in interspecies hybrids and sterility. However, in the absence of fully fertile control hybrids, it is impossible to differentiate between misregulation associated with sterility vs. fast male gene regulatory evolution. Here, we differentiate between these two possibilities using a D. pseudoobscura species pair that experiences unidirectional hybrid sterility. We identify genes uniquely misexpressed in sterile hybrid male reproductive tracts via RNA-seq. The sterile male hybrids had more misregulated and more over or under expressed genes relative to parental species than the fertile male hybrids. Proteases were the only gene ontology class overrepresented among uniquely misexpressed genes, with four located within a previously identified hybrid male sterility locus. This result highlights the potential role of a previously unexplored class of genes in interspecific hybrid male sterility and speciation.
Full Text Available Abstract Background Male breast cancer is a comparatively rare disease, and simultaneous bilateral male breast cancer is considered to be an extremely rare event. Risk factors are said to be genetic factors and hormonal abnormalities due to obesity or testicular diseases. Case presentation The patient was a 47-year-old Japanese male. His family had no history of female breast cancer. This patient also had hypospadias and hormonal examination indicated the presence of primary testicular potential hypogonadism, and these hormonal abnormalities seemed to be present since childhood or the fetal period. The bilateral breast cancer developed in this man at a comparatively young age, and histopathological studies of multiple sections showed that there was almost no normal epithelial cell in the ducts, while the ducts were almost completely filled with breast cancer cells. Conclusion It is thought that male breast cancer is caused by an imbalance between estrogen and testosterone. We cannot rule out the possibility that the breast cancer developed due to the effect of the slight elevation of estrogen over a long period of time, but the actual causative factors in this patient were unable to be definitively identified. In the future, we hope to further elucidate the causes of male breast cancer.
Hubka, P.; Naňka, O.; Martan, A.; Švabík, K.; Zvárová, Jana; Mašata, J.
Roč. 284, č. 4 (2011), s. 901-905 ISSN 0932-0067 Institutional research plan: CEZ:AV0Z10300504 Keywords : Anatomy * Female stress urinary incontinence * Surgical complications * Tension-free vaginal tape transobturator Subject RIV: FK - Gynaecology, Childbirth Impact factor: 1.277, year: 2011
Amory, John K
Although female contraceptives are very effective at preventing unintended pregnancy, some women can not use them because of health conditions or side-effects, leaving some couples without effective contraceptive options. In addition, many men wish to take active responsibility for family planning. Thus, there is a great need for male contraceptives to prevent unintended pregnancies, of which 80-90 million occur annually. At present, effective male contraceptive options are condoms and vasectomy, which are not ideal for all men. Therefore, efforts are under way to develop novel male contraceptives. This paper briefly reviews the advantages and disadvantages of condoms and vasectomies and then discusses the research directed toward development of novel methods of male contraception. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Liu, Tong; Dartevelle, Laurence; Yuan, Chunyan; Wei, Hongping; Wang, Ying; Ferveur, Jean-François; Guo, Aike
Dopamine is an important neuromodulator in animals and its roles in mammalian sexual behavior are extensively studied. Drosophila as a useful model system is widely used in many fields of biological studies. It has been reported that dopamine reduction can affect female receptivity in Drosophila and leave male-female courtship behavior unaffected. Here, we used genetic and pharmacological approaches to decrease the dopamine level in dopaminergic cells in Drosophila, and investigated the consequence of this manipulation on male homosexual courtship behavior. We find that reduction of dopamine level can induce Drosophila male-male courtship behavior, and that this behavior is mainly due to the increased male attractiveness or decreased aversiveness towards other males, but not to their enhanced propensity to court other males. Chemical signal input probably plays a crucial role in the male-male courtship induced by the courtees with reduction of dopamine. Our finding provides insight into the relationship between the dopamine reduction and male-male courtship behavior, and hints dopamine level is important for controlling Drosophila courtship behavior.
Surgical management of stress urinary incontinence in women: safety, effectiveness and cost-utility of trans-obturator tape (TOT versus tension-free vaginal tape (TVT five years after a randomized surgical trial
Full Text Available Abstract Background We recently completed a randomized clinical trial of two minimally invasive surgical procedures for stress urinary incontinence, the retropubic tension-free vaginal tape (TVT versus the trans-obturator tape (TOT procedure. At one year postoperatively, we were concerned to find that a significant number of women had tape that was palpable when a vaginal examination was undertaken. Because the risk factors for adverse outcomes of tape surgery are not clearly understood, we are unable to say whether palpable tapes will lead to vaginal erosions or whether they merge into vaginal tissue. We do not know whether patients go on to have further adverse consequences of surgery, leading to additional cost to patients and healthcare system. Our current study is a 5 year follow-up of the women who took part in our original trial. Methods/Design All 199 women who participated in our original trial will be contacted and invited to take part in the follow-up study. Consenting women will attend a clinic visit where they will have a physical examination to identify vaginal erosion or other serious adverse outcomes of surgery, undertake a standardized pad test for urinary incontinence, and complete several health-related quality of life questionnaires (15D, UDI-6, IIQ-7. Analyses will compare the outcomes for women in the TOT versus TVT groups. The cost-effectiveness of TOT versus TVT over the 5 years after surgery, will be assessed with the use of disease-specific health service administrative data and an objective health outcome measure. A cost-utility analysis may also be undertaken, based on economic modeling, data from the clinical trial and inputs obtained from published literature. Discussion This study is needed now, because TOT and TVT are among the most frequently conducted surgical procedures for stress urinary incontinence in Canada. Because stress urinary incontinence is so common, the impact of selecting an approach that causes
Surgical management of stress urinary incontinence in women: safety, effectiveness and cost-utility of trans-obturator tape (TOT) versus tension-free vaginal tape (TVT) five years after a randomized surgical trial
Background We recently completed a randomized clinical trial of two minimally invasive surgical procedures for stress urinary incontinence, the retropubic tension-free vaginal tape (TVT) versus the trans-obturator tape (TOT) procedure. At one year postoperatively, we were concerned to find that a significant number of women had tape that was palpable when a vaginal examination was undertaken. Because the risk factors for adverse outcomes of tape surgery are not clearly understood, we are unable to say whether palpable tapes will lead to vaginal erosions or whether they merge into vaginal tissue. We do not know whether patients go on to have further adverse consequences of surgery, leading to additional cost to patients and healthcare system. Our current study is a 5 year follow-up of the women who took part in our original trial. Methods/Design All 199 women who participated in our original trial will be contacted and invited to take part in the follow-up study. Consenting women will attend a clinic visit where they will have a physical examination to identify vaginal erosion or other serious adverse outcomes of surgery, undertake a standardized pad test for urinary incontinence, and complete several health-related quality of life questionnaires (15D, UDI-6, IIQ-7). Analyses will compare the outcomes for women in the TOT versus TVT groups. The cost-effectiveness of TOT versus TVT over the 5 years after surgery, will be assessed with the use of disease-specific health service administrative data and an objective health outcome measure. A cost-utility analysis may also be undertaken, based on economic modeling, data from the clinical trial and inputs obtained from published literature. Discussion This study is needed now, because TOT and TVT are among the most frequently conducted surgical procedures for stress urinary incontinence in Canada. Because stress urinary incontinence is so common, the impact of selecting an approach that causes more adverse events, or is
... hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes. Defects of tubules that transport sperm. Many ... syndrome — in which a male is born with two X chromosomes and one ...
Weir, Laura K; Kindsvater, Holly K; Young, Kyle A; Reynolds, John D
Large male body size is typically favored by directional sexual selection through competition for mates. However, alternative male life-history phenotypes, such as "sneakers," should decrease the strength of sexual selection acting on body size of large "fighter" males. We tested this prediction with salmon species; in southern populations, where sneakers are common, fighter males should be smaller than in northern populations, where sneakers are rare, leading to geographical clines in sexual size dimorphism (SSD). Consistent with our prediction, fighter male body size and SSD (fighter male∶female size) increase with latitude in species with sneaker males (Atlantic salmon Salmo salar and masu salmon Oncorhynchus masou) but not in species without sneakers (chum salmon Oncorhynchus keta and pink salmon Oncorhynchus gorbuscha). This is the first evidence that sneaker males affect SSD across populations and species, and it suggests that alternative male mating strategies may shape the evolution of body size.
Rinne, Kirsi; Kainulainen, Sakari; Aukee, Sinikka; Heinonen, Seppo; Nilsson, Carl G
To study changes in mid-urethral function with dynamic MRI in stress urinary incontinent women undergoing either tension-free vaginal tape (TVT) or TVT-obturator sling operations. Prospective clinical study. University hospital. Forty-two parous women with stress urinary incontinence recruited to dynamic magnetic resonance imaging before and after mid-urethral sling surgery. Control group of 16 healthy women. Dynamic magnetic resonance imaging at rest, during pelvic floor muscle contraction, coughing and voiding with a bladder volume of 200-300 ml. X- and Y- coordinates were used to determine the location of the mid-urethra during these activities. Changes in mid-urethral position after TVT and TVT-obturator operations during the different activities. Postoperatively the women could elevate their mid-urethra by pelvic floor muscle contraction significantly higher than before the operation (pTVT and the TVT-O mid-urethral slings, we could not see any differences in the movement patterns. Mid-urethral slings support the mid-urethra and restrict downward movement during different activities. Movement patterns are similar after TVT and TVT-O operations. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.
Oral Tradition of Male-Male: Death Anthem Ciacia: Sosiological Studies and an Effort to Pass It On to the next Generation. Male-Male is lyrics sung upon the death of a member of the society who is considered a perfect person. This oral tradition shows the society appreciation towards the person through the expression of sadness, longing, partience and praises. Male-Male serves various functions; both private functions (the singer and host, and societal function (the guests. For th singer and the host, this tradition serves as consolation, caring towards other members, dissemination of social values and religion, prestige, and passing on a tradition. For the society, Male-Male functions as a self remainder of death, strengthening faith, increasing empathy and solidarity. Efforts to guarantee the continuity of this tradition by the next generation are required. Formal effortcan be made through schools, and the informal ones can be made through the strengthening of tradition bodies. Keywords: Oral tradition, Male-Male, Sociology, and Passing the tradition
Kumpula, Esa; Ekstrand, Per
Forensic psychiatric care is largely populated by men--as patients, caregivers, and nurses. Previous research has not focused on the meaning of gender in this context. The aim of this study is to analyse male nurses' experiences of working with male caregivers and attending to male patients in forensic psychiatric care. Data were collected through interviews with six male nurses. The results consist of five themes. Protection and defence are key aspects of care and male caregivers gain status and authority through their physical strength. This could hamper caring and provide male caregivers with a superior position in the department.
Full Text Available The article describes the movement of natural parenting and its confrontational ideology. The authors sought to provide a general understanding of the movement natural parenting and describe its confrontational ideology. Speaking in terms of sociology, sling parents form the imagined community and this particular ideology is the focus of the presents study. The hypothesis of the study lies in the assumption that discourse analysis of natural parenting is to discover traits of propaganda discourse. The subject of the analyzed discourse is set critically in relation to the modern practice of consumption, declares the personal position free from stereotypes and willingness to confront the dictatorial influence of consumer values on the style of parenting. The subject is prone to reflection and the generation of ideological texts. Despite the fact that natural parenting has positioned itself as anti-consumer-orientated, it creates a consumer niche of the “right” products for children. Being against some commodities, natural parenting creates demand for the other ones. Sling clothing for Moms (sling jackets, accessories and the like become the accompanying sling commodities. Natural parenting has positioned itself as focused on the child’s needs. The traditional educational discourse is marked as providing the convenience for a mother who does not love her child. Many of the arguments of the sling discourse are based on fear to fail to meet a child’s needs (or to cause harm to his\\her health, to threaten his\\her life, which relates it with the mainstream advertising discourse.
Chen, Heidi Wen-Chu; Guess, Marsha K; Connell, Kathleen A; Bercik, Richard S
Synthetic meshes have been used extensively to augment surgical management of pelvic organ prolapses. Posterior intravaginal sling (IVS) is a technique used for correcting vaginal vault/apical prolapse, posterior vaginal prolapse or rectocele. There are limited data on long-term safety of this procedure. In a subanalysis of the IVS tapes from the SUSPEND trial performed secondary to the large number of patients with complications of suburethral sling erosions after IVS, it was noted that the sling erosion tended to have a delayed presentation secondary to poor incorporation of the mesh. A 48-year-old woman with cystocele, uterine prolapse and rectocele had undergone total vaginal hysterectomy, mesh-augmented anterior repair, posterior colporrhaphy and posterior intravaginal slingplasty (IVS) in July 2005. Thirty months after the surgery, she presented with gradual symptoms of copious vaginal discharge for several weeks followed by constant right buttock pain and swelling. Examination was notable for intact mesh with no signs of erosion and a 3-cm induration deep within the right buttock. Computed tomography suggested a pelvic abscess. Magnetic resonance imaging confirmed a right ischiorectal fossa abscess and a vaginal fistula. The patient underwent sling excision, right ischiorectal fossa exploration and vaginal fistula repair. A fistulous tract was found to extend along the intact sling from the vaginal epithelium toward the right ischiorectal fossa. At 2 months' followup, there were no recurrences or other complications. This is the first report of a delayed complication of an ischiorectal abscess associated with an ischiorectal-vaginal fistula that presented 30 months after the placement of a posterior IVS.
van der Ploeg, J M; Oude Rengerink, K; van der Steen, A; van Leeuwen, J H S; Stekelenburg, J; Bongers, M Y; Weemhoff, M; Mol, B W; van der Vaart, C H; Roovers, J-P W R
To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. Multi-centre randomised trial. Fourteen teaching hospitals in the Netherlands. Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress urinary incontinence (SUI) without prolapse reduction. Women were randomly assigned to undergo vaginal prolapse repair with or without MUS. Analysis was according to intention to treat. The primary outcome at 12 months' follow-up was the absence of urinary incontinence (UI) assessed with the Urogenital Distress Inventory and treatment for SUI or overactive bladder. Secondary outcomes included complications. One hundred and thirty-four women were analysed at 12 months' follow-up (63 in MUS and 71 in control group). More women in the MUS group reported the absence of UI and SUI; respectively 62% versus 30% UI (relative risk [RR] 2.09; 95% confidence interval [CI] 1.39-3.15) and 78% versus 39% SUI (RR 1.97; 95% CI 1.44-2.71). Fewer women underwent treatment for postoperative SUI in the MUS group (10% versus 37%; RR 0.26; 95% CI 0.11-0.59). In the control group, 12 women (17%) underwent MUS after prolapse surgery versus none in the MUS group. Severe complications were more common in the MUS group, but the difference was not statistically significant (16% versus 6%; RR 2.82; 95% CI 0.93-8.54). Women with prolapse and co-existing SUI are less likely to have SUI after transvaginal prolapse repair with MUS compared with prolapse repair only. However, only 17% of the women undergoing POP surgery needed additional MUS. A well-informed decision balancing risks and benefits of both strategies should be tailored to individual women. © 2015 Royal College of Obstetricians and Gynaecologists.
Hernandez-Jimenez, Armando; Rios-Cardenas, Oscar
There is extensive morphological variation of male genitalia across animals with internal fertilization, even among closely related species. Most studies attempting to explain this extraordinary diversity have focused on processes that occur post-copula (e.g. sperm competition, cryptic female choice). Only a few studies have focused on the pre-copula process of female preference. In addition, the extent to which this variation could be associated with the use of different reproductive tactics has yet to be explored. Here, we show that female preference for male genitalia length in two livebearing fishes depends on the type of reproductive tactic of the males being evaluated as well as the body condition of the female. In a species where all males coax females to acquire matings (courters), females preferred males with short genitalia. In a species with genetically influenced alternative reproductive tactics (courter males that only court and produce courter sons, sneaker males that use the coercive tactic of sneak chase and produce sneaker sons), female preference depended on an interaction between male tactic and female condition: females in good condition preferred courter males with short genitalia, and sneaker males with long genitalia. Our results suggest that female preference for male traits favourable to their sons may be an important factor contributing to the diversification of male genitalia. Despite the contrasting selection for genitalia length that our female preference tests suggest, we found no significant differences in genitalia length between coaxing (courters) and coercive (sneakers) males. Our study represents a starting point to more clearly understand the role of alternative reproductive tactics and variation in female mate preference in the evolution of male genitalia. © 2017 The Author(s).
Hudepohl, Adam D.; Parrott, Dominic J.; Zeichner, Amos
The present study compared effects of erotic and non-erotic depictions of male-male intimacy on the experience of anger in heterosexual men. Data came from three independent laboratory studies designed to elicit anger in response to erotic or non-erotic depictions of male-male and male-female intimacy. All participants completed a measure of sexual prejudice and anger was assessed before and after viewing the erotic or non-erotic video. Among high-prejudiced men, viewing erotic and non-erotic...
Male baldness is very common. Its effect on individuals is extremely variable, and in some people it will have a significant adverse effect on their quality of life. The objectives of this article are to help general practitioners (GPs) be aware of potential health problems related to male baldness, to have an approach to assessing hair loss and to be aware of treatment options. Male baldness is, most often, a normal occurrence, but it may have significant effects on a man's health. It may also be a pointer to other potential health issues. The GP is in the ideal position to conduct an initial evaluation, consider other health issues and advise on treatment options.
Milinski, Manfred; Bakker, Theo C. M.
AN important problem in evolutionary biology since the time of Darwin has been to understand why females preferentially mate with males handicapped by secondary sexual ornaments1-3. One hypothesis of sexual selection theory is that these ornaments reliably reveal the male's condition4-6, which can be affected for example by parasites4,7-13. Here we show that in the three-spined stickleback (Gasterosteus aculeatus) the intensity of male red breeding coloration positively correlates with physical condition. Gravid females base their active mate choice on the intensity of the male's red coloration. Choice experiments under green light prevent the use of red colour cues by females, and males that were previously preferred are now chosen no more than randomly, although the courtship behaviour of the males remains unchanged. Parasitieation causes a deterioration in the males' condition and a decrease in the intensity of their red coloration. Tests under both lighting conditions reveal that the females recognize the formerly parasitized males by the lower intensity of their breeding coloration. Female sticklebacks possibly select a male with a good capacity for paternal care14 but if there is additive genetic variation for parasite resistance, then they might also select for resistance genes, as proposed by Hamilton and Zuk4.
Fang, Gu; Dixson, Alan F; Qi, Xiao-Guang; Li, Bao-Guo
An all-male band of golden snub-nosed monkeys (Rhinopithecus roxellana) was observed for 3 months in the Qinling Mountains of China, in order to collect data on the frequencies and contextual significance of male-male mounting behaviour. Mounts occurred in a variety of affiliative, dominance-related and sexual contexts, which differed depending upon the ages of the males involved. Mounting behaviour in this group was mainly initiated by adults. Juveniles mounted each other in affiliative contexts (during play and prior to grooming). Adult males mounted subadult and juvenile partners in a greater variety of sociosexual contexts (dominance/rank-related interactions; reconciliation following agonistic encounters, and sometimes as a prelude to receiving grooming). However, subadults and juveniles were never observed to mount adults. In one dyad, involving an adult male and a subadult partner, mounting was more frequent and prolonged, and included bouts of deep pelvic thrusting. Two mounts resulted in anal intromissions and, in 1 case, the subadult partner exhibited seminal emission. Given that the study took place during the annual mating peak period of R. roxellana, it is possible that this unusual male-male sexual activity was related to the absence of mating opportunities for those adults that were excluded from 1-male units. © 2018 S. Karger AG, Basel.
Hudepohl, Adam D; Parrott, Dominic J; Zeichner, Amos
The present study compared effects of erotic and non-erotic depictions of male-male intimacy on the experience of anger in heterosexual men. Data came from three independent laboratory studies designed to elicit anger in response to erotic or non-erotic depictions of male-male and male-female intimacy. All participants completed a measure of sexual prejudice and anger was assessed before and after viewing the erotic or non-erotic video. Among high-prejudiced men, viewing erotic and non-erotic intimate behavior between two men elicited significant increases in anger relative to viewing comparable behavior between a male-female dyad. In contrast, among low-prejudiced men, viewing erotic, but not non-erotic, intimate behavior between two men elicited significant increases in anger relative to viewing comparable behavior between a male-female dyad. Implications for understanding heterosexual men's anger, and aggression, toward gay men were discussed.
Hudepohl, Adam D.; Parrott, Dominic J.; Zeichner, Amos
The present study compared effects of erotic and non-erotic depictions of male-male intimacy on the experience of anger in heterosexual men. Data came from three independent laboratory studies designed to elicit anger in response to erotic or non-erotic depictions of male-male and male-female intimacy. All participants completed a measure of sexual prejudice and anger was assessed before and after viewing the erotic or non-erotic video. Among high-prejudiced men, viewing erotic and non-erotic intimate behavior between two men elicited significant increases in anger relative to viewing comparable behavior between a male-female dyad. In contrast, among low-prejudiced men, viewing erotic, but not non-erotic, intimate behavior between two men elicited significant increases in anger relative to viewing comparable behavior between a male-female dyad. Implications for understanding heterosexual men's anger, and aggression, toward gay men were discussed. PMID:20818528
Möller-Leimkühler, Anne Maria; Yücel, Mete
Scientific evidence for a male-typed depression ("male depression") is still limited, but mainly supports this concept with respect to single externalizing symptoms or symptom clusters. In particular, studies on non-clinical populations including males and females are lacking. The present study aims at assessing general well-being, the risk and the symptoms of male depression dependent on biological sex and gender-role orientation on instrumental (masculine) and expressive (feminine) personality traits in an unselected community sample of males and females. Students (518 males, 500 females) of the Ludwig-Maximilians-University of Munich, Germany, were asked to participate in a "stress study" and complete the following self-report questionnaires: the WHO-5 Well-being Index [Bech, P., 1998. Quality of Life in the Psychiatric Patient. Mosby-Wolfe, London], the Gotland Scale for Male Depression [Walinder, J., Rutz, W., 2001. Male depression and suicide. International Clinical Psychopharmacology 16 (suppl 2), 21-24] and the German Extended Personal Attribute Questionnaire [Runge, T.E., Frey, D., Gollwitzer, P.M., et al., 1981. Masculine (instrumental) and feminine (expressive) traits. A comparison between students in the United States and West Germany. Journal of Cross-Cultural Psychology 12, 142-162]. General well-being of the students was significantly lower compared to population norms. Contrary to expectations, female students had a greater risk of male depression than male students (28.9% vs. 22.4%; p<0.05). Overall, prototypic depressive symptoms as well as externalizing symptoms were more pronounced in females. In the subgroup of those at risk for male depression, biological sex and kind of symptoms were unrelated. Principal component analyses revealed a similar symptom structure for males and females. Low scores on masculinity/instrumentality significantly predicted higher risk of male depression, independent of biological sex. The study sample is not
Lefkowich, Maya; Oliffe, John L; Hurd Clarke, Laura; Hannan-Leith, Madeline
The pressure on boys and men to engage in extensive body practices (e.g., closely monitored eating and exercise habits) and achieve ideal male bodies has grown significantly over the past 20 years. Central to the depiction of ideal male bodies and body practices are both the pursuit and achievement of lean and well-defined muscles. The labels "pitches," "purchases," and "performativities" were inductively derived from the literature, and used to describe the multifaceted connections between masculinities, muscularity, and idealized male body practices. "Pitches" distil how popular culture posture norms of masculinity, and manly bodies and behaviors attainable and necessary. "Purchases" refer to men's diverse buy-in to dominant discourses about acceptable male bodies and practices. "Performativities" chronicle how men embody and navigate gender norms as they evaluate their own bodies, behaviors, and eating habits and those of their peers. Based on findings from the current scoping review, future research could benefit from fully linking masculinities with the drive for muscularity to address health and social risks associated with the pursuit of the idealized male body. In highlighting the plurality of masculinities and the complexity of men's diverse identities, health care providers can better reach and support men. Focusing on, and celebrating, a wider range of male bodies could help recenter dominant discourses about how and whose bodies and experiences are idealized. The current scoping review article offers an overview of how masculinities and muscularity have been linked to male body practices, and recommendations to advance this emergent field.
Luo, Hao; Liang, Xu; Chen, Jian; Yang, Xiao-bo; Jiang, Jun-jun; Deng, Wei; Zou, Yun-feng; Wei, Bo; Zhang, Zhi-yong; Liu, Zhi-hao; Liang, Hao
To investigate the acceptability of male circumcision among male miners in Baise, Guangxi, China. A questionnaire-based survey on the willingness to be circumcised (WTC) and its influential factors were conducted among Guangxi male miners recruited by random cluster sampling. Of 569 subjects who were surveyed, 143 (25.13%) expressed their willingness to be circumcised. Univariate analysis showed that marital status, education level, and the awareness of the hazards of phimosis and redundant prepuce and reasons for circumcision were significantly different between WTC group and the non-WTC group (all Pminers WTC. Male miners in this area have low WTC. Education on the basic knowledge of acquired immunodeficiency syndrome and circumcision may help promote the application of circumcision.
Noguera, José C.; Metcalfe, Neil B.; Monaghan, Pat
Poor early-life nutrition could reduce adult reproductive success by negatively affecting traits linked to sexual attractiveness such as song complexity. If so, this might favor strategic mate choice, allowing males with less complex songs to tailor their mating tactics to maximize the reproductive benefits. However, this possibility has been ignored in theoretical and empirical studies. By manipulating the micronutrient content of the diet (e.g., low or high) during the postnatal period of male zebra finches, we show for the first time (1) that males reared on a poor (low) micronutrient diet had less complex songs as adults; (2) that these males, in contrast to the high micronutrient diet group, were more selective in their mating strategies, discriminating against those females most likely to reduce their clutch size when paired with males having less complex songs; and (3) that by following different mating strategies, males reared on the contrasting diets obtained similar reproductive benefits. These results suggest that early-life dietary conditions can induce multiple and long-lasting effects on male and female reproductive traits. Moreover, the results seem to reflect a previously unreported case of adaptive plasticity in mate choice in response to a nutritionally mediated reduction in sexual attractiveness.
Macia, Laura; Ruiz, Hector Camilo; Boyzo, Roberto; Documet, Patricia Isabel
Little documentation exists about male community health workers (promotores) networks. The experiences of promotores can provide input on how to attract, train, supervise and maintain male promotores in CHW programs. We present the experience and perspectives of promotores who participated in a male promotores network assisting Latino immigrant men in an emerging Latino community. All promotores in this community-based participatory study received payment for work 10 hours a week. We conducte...
Alshahrani, Saad; McGill, John; Agarwal, Ashok
The prostate gland plays an important role in male reproduction. Inflammation of the prostate gland (prostatitis) is a common health problem affecting many young and middle aged men. Prostatitis is considered a correctable cause of male infertility, but the pathophysiology and appropriate treatment options of prostatitis in male infertility remain unclear. This literature review will focus on current data regarding prostatitis and its impact on male infertility. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Benjamin D Charlton
Full Text Available Although the use of formant frequencies in nonhuman animal vocal communication systems has received considerable recent interest, only a few studies have examined the importance of these acoustic cues to body size during intra-sexual competition between males. Here we used playback experiments to present free-ranging male koalas with re-synthesised bellow vocalisations in which the formants were shifted to simulate either a large or a small adult male. We found that male looking responses did not differ according to the size variant condition played back. In contrast, male koalas produced longer bellows and spent more time bellowing when they were presented with playbacks simulating larger rivals. In addition, males were significantly slower to respond to this class of playback stimuli than they were to bellows simulating small males. Our results indicate that male koalas invest more effort into their vocal responses when they are presented with bellows that have lower formants indicative of larger rivals, but also show that males are slower to engage in vocal exchanges with larger males that represent more dangerous rivals. By demonstrating that male koalas use formants to assess rivals during the breeding season we have provided evidence that male-male competition constitutes an important selection pressure for broadcasting and attending to size-related formant information in this species. Further empirical studies should investigate the extent to which the use of formants during intra-sexual competition is widespread throughout mammals.
... male; CIC - male Images Catheterization References Davis JE, Silverman MA. Urologic procedures. In: Roberts JR, ed. Roberts ... provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial ...
Sung Yong Cho
Full Text Available PurposeNationwide database regarding stress urinary incontinence (SUI is important for evaluating treatment patterns for SUI and for establishing appropriate national policies regarding SUI management. The purpose of this present study was to investigate surgical treatment patterns for women with SUI and analyze the current status of SUI management in Korea by using a nationwide database.MethodsData used for investigating the surgical trends and changes in Korea were retrieved from the Health Insurance Review & Assessment Service from 2008 to 2011.ResultsThe number of surgical cases of SUI decreased continuously from 2008 to 2011. The proportion of transvaginal surgery using a midurethral sling increased continuously. Sling procedures were most commonly performed for women in their 40s followed by women in their 50s. Transvaginal surgery using a single sling or a readjustable sling was performed from 5.6% to 6.1%, which showed no significant change in the number of surgical cases.ConclusionsThere is a growing need for an appropriate national welfare policy and budget to care for aged and super-aged women in Korea. The early detection and intervention of silent SUI should be actively considered as an important preventive strategy to improve the quality of life in younger women.
Mathew, Vivek; Bantwal, Ganapathi
Contraception is an accepted route for the control of population explosion in the world. Traditionally hormonal contraceptive methods have focused on women. Male contraception by means of hormonal and non hormonal methods is an attractive alternative. Hormonal methods of contraception using testosterone have shown good results. Non hormonal reversible methods of male contraception like reversible inhibition of sperm under guidanceare very promising. In this article we have reviewed the curren...
Young, Brent; Conti, David V; Dean, Matthew D
In a variety of taxa, males deploy alternative reproductive tactics to secure fertilizations. In many species, small "sneaker" males attempt to steal fertilizations while avoiding encounters with larger, more aggressive, dominant males. Sneaker males usually face a number of disadvantages, including reduced access to females and the higher likelihood that upon ejaculation, their sperm face competition from other males. Nevertheless, sneaker males represent an evolutionarily stable strategy under a wide range of conditions. Game theory suggests that sneaker males compensate for these disadvantages by investing disproportionately in spermatogenesis, by producing more sperm per unit body mass (the "fair raffle") and/or by producing higher quality sperm (the "loaded raffle"). Here, we test these models by competing sperm from sneaker "jack" males against sperm from dominant "hooknose" males in Chinook salmon. Using two complementary approaches, we reject the fair raffle in favor of the loaded raffle and estimate that jack males were ∼1.35 times as likely as hooknose males to fertilize eggs under controlled competitive conditions. Interestingly, the direction and magnitude of this skew in paternity shifted according to individual female egg donors, suggesting cryptic female choice could moderate the outcomes of sperm competition in this externally fertilizing species.
Full Text Available Voluntary medical male circumcision is an integral part of the South African government's response to the HIV and AIDS epidemic. Following circumcision, it is recommended that patients abstain from sexual activity for six weeks, as sex may increase the risk of female-to-male HIV transmission and prolong the healing period. This paper investigates the resumption of sexual activity during the healing period among a cohort of school-going males in the KwaZulu-Natal province of South Africa. The analysis for this paper compares two groups of sexually active school-going males: the first group reported having sex during the healing period (n = 40 and the second group (n = 98 reported no sex during the healing period (mean age: 17.7, SD: 1.7.The results show that 29% (n = 40 of young males (mean age: 17.9, SD: 1.8 who were previously sexually active, resumed sexual activity during the healing period, had on average two partners and used condoms inconsistently. In addition, those males that engage in sexual activity during the healing period were less inclined to practice safe sex in the future (AOR = 0.055, p = 0.002 than the group of males who reported no sex during the healing period. These findings suggest that a significant proportion of young males may currently and in the future, subject themselves to high levels of risk for contracting HIV post circumcision. Education, as part of a VMMC campaign, must emphasize the high risk of HIV transmission for both the males their partners during the healing period.
Kelly, Natasha B; Alonzo, Suzanne H
Existing theory predicts that male signalling can be an unreliable indicator of paternal care, but assumes that males with high levels of mating success can have high current reproductive success, without providing any parental care. As a result, this theory does not hold for the many species where offspring survival depends on male parental care. We modelled male allocation of resources between advertisement and care for species with male care where males vary in quality, and the effect of care and advertisement on male fitness is multiplicative rather than additive. Our model predicts that males will allocate proportionally more of their resources to whichever trait (advertisement or paternal care) is more fitness limiting. In contrast to previous theory, we find that male advertisement is always a reliable indicator of paternal care and male phenotypic quality (e.g. males with higher levels of advertisement never allocate less to care than males with lower levels of advertisement). Our model shows that the predicted pattern of male allocation and the reliability of male signalling depend very strongly on whether paternal care is assumed to be necessary for offspring survival and how male care affects offspring survival and male fitness.
Boer, T.A. de; Heesakkers, J.P.F.A.
*Urinary incontinence in males is gaining increasingly more attention. *Male urinary incontinence can be classified as storage incontinence due to overactive bladder syndrome or stress incontinence due to urethral sphincter dysfunction. *Most patients benefit from the currently available treatment
Lautrup, Marianne D; Thorup, Signe S; Jensen, Vibeke
OBJECTIVE: Describe prognostic parameters of Danish male breast cancer patients (MBCP) diagnosed from 1980-2009. Determine all-cause mortality compared to the general male population and analyze survival/mortality compared with Danish female breast cancer patients (FBCP) in the same period...
Svensson, O; Kvarnemo, C
Both natural selection and sexual selection may act on nest-building. We tested experimentally how different regimes of egg-predation and male-male competition influence nest-building before mating, using the marine fish sand goby, Pomatoschistus minutus. Males with sneaker males present built the smallest nest-openings, smaller than males held alone or with Pomatoschistus microps males (which may predate eggs and compete over nest-sites but not compete over fertilizations). Males with visual access to other nest-building males tended also to build smaller openings than males held alone or with P. microps. Males with egg-predators present built nests with openings not differing significantly from any other treatment. Our results indicate that the small nest-openings found in the sneaker male treatment are sexually selected through protection against sneaking or by female choice. Across treatments, time span before a male started to build his nest also explained variation in nest-opening width; males starting late built larger nest-openings.
Joo, Young Min; Choe, Jin Ho
Purpose We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR® and CureMesh®, and assessed the 1-year surgical outcomes. Materials and Methods Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient's perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. Results The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. Conclusions Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures. PMID:20495697
Faria, Luiz R R; Soares, Elaine Della Giustina; Carmo, Eduardo do; Oliveira, Paulo Murilo Castro de
Insects in the order Hymenoptera (bees, wasps and ants) present an haplodiploid system of sexual determination in which fertilized eggs become females and unfertilized eggs males. Under single locus complementary sex-determination (sl-CSD) system, the sex of a specimen depends on the alleles at a single locus: when diploid, an individual will be a female if heterozygous and male if homozygous. Significant diploid male (DM) production may drive a population to an extinction scenario called "diploid male vortex". We aimed at studying the dynamics of populations of a sl-CSD organism under several combinations of two parameters: male flight abilities and number of sexual alleles. In these simulations, we evaluated the frequency of DM and a genetic diversity measure over 10,000 generations. The number of sexual alleles varied from 10 to 100 and, at each generation, a male offspring might fly to another random site within a varying radius R. Two main results emerge from our simulations: (i) the number of DM depends more on male flight radius than on the number of alleles; (ii) in large geographic regions, the effect of males flight radius on the allelic diversity turns out much less pronounced than in small regions. In other words, small regions where inbreeding normally appears recover genetic diversity due to large flight radii. These results may be particularly relevant when considering the population dynamics of species with increasingly limited dispersal ability (e.g., forest-dependent species of euglossine bees in fragmented landscapes).
Watanabe, M; Maekawa, K
This study examined whether dominant migratory males (adopting fighter tactics) of the masu salmon Oncorhynchus masou would more aggressively attack large mature male parr (adopting sneaker tactics) as large mature male parr are expected to have the potential to cause a greater decrease in fertilization success. The frequency of aggressive behaviour was not related to the body size of males, and it increased with the frequency of interactions with mature male parr. The fertilization success of mature male parr was much lower than migratory males, and no relationship was observed between fertilization success and aggressive behaviour. The low fertilization success of mature male parr, despite infrequent aggressive behaviour by migratory males, indicates that there might be little benefit for migratory males to attack mature male parr more aggressively according to their body size.
Jensen, Christian Fuglesang S.; Østergren, Peter; Dupree, James M.
The link between varicoceles and male infertility has been a matter of debate for more than half a century. Varicocele is considered the most common correctable cause of male infertility, but some men with varicoceles are able to father children, even without intervention. In addition, improvements...... if the male partner has a clinically palpable varicocele and affected semen parameters....
Wålinder, J; Rutzt, W
Based on the experiences of the Gotland Study that education of general practitioners about depressive illness resulted in a statistically significant reduction in the number of female suicides, leaving the rate of male suicides almost unaffected, we propose the concept of a male depressive syndrome. This syndrome comprises a low stress tolerance, an acting-out behavior, a low impulse control, substance abuse and a hereditary loading of depressive illness, alcoholism and suicide. This notion is supported by data from The Amish study as well as the concept of van Praag of a stress-precipitated, cortisol-induced, serotonin-related and anxiety-driven depressive illness most often seen in males. In order to identify depressed males, the Gotland Male Depression Scale has been developed. Some preliminary data using the scale in a group of alcohol-dependant patients are presented.
Keesom, Sarah M; Finton, Caitlyn J; Sell, Gabrielle L; Hurley, Laura M
Early-life social isolation has profound effects on adult social competence. This is often expressed as increased aggression or inappropriate displays of courtship-related behaviors. The social incompetence exhibited by isolated animals could be in part due to an altered ability to participate in communicatory exchanges. House mice (Mus musculus) present an excellent model for exploring this idea, because social isolation has a well-established influence on their social behavior, and mice engage in communication via multiple sensory modalities. Here, we tested the prediction that social isolation during early life would influence ultrasonic vocalizations (USVs) emitted by adult male mice during same-sex social encounters. Starting at three weeks of age, male mice were housed individually or in social groups of four males for five weeks, after which they were placed in one of three types of paired social encounters. Pair types consisted of: two individually housed males, two socially housed males, or an individually housed and a socially housed male ("mixed" pairs). Vocal behavior (USVs) and non-vocal behaviors were recorded from these 15-minute social interactions. Pairs of mice consisting of at least one individually housed male emitted more and longer USVs, with a greater proportional use of USVs containing frequency jumps and 50-kHz components. Individually housed males in the mixed social pairs exhibited increased levels of mounting behavior towards the socially housed males. Mounting in these pairs was positively correlated with increased number and duration of USVs as well as increased proportional use of spectrally more complex USVs. These findings demonstrate that USVs are part of the suite of social behaviors influenced by early-life social isolation, and suggest that altered vocal communication following isolation reflects reduced social competence.
Tomkins, Patrick; Saaristo, Minna; Bertram, Michael G; Tomkins, Raymond B; Allinson, Mayumi; Wong, Bob B M
Despite a growing literature highlighting the potential impact of human-induced environmental change on mechanisms of sexual selection, relatively little is known about the effects of chemical pollutants on male-male competition. One class of environmental pollutant likely to impact male competitive interactions is the endocrine-disrupting chemicals (EDCs), a large and heterogeneous group of chemical contaminants with the potential to influence morphology, physiology and behaviour at minute concentrations. One EDC of increasing concern is the synthetic, androgenic steroid 17β-trenbolone, which is used globally to promote growth in beef cattle. Although 17β-trenbolone has been found to cause severe morphological and behavioural abnormalities in fish, its potential impact on male-male competition has yet to be investigated. To address this, we exposed wild male guppies (Poecilia reticulata) to an environmentally realistic concentration of 17β-trenbolone (average measured concentration: 8 ng/L) for 21 days using a flow-through system. We found that, in the presence of a competitor, 17β-trenbolone-exposed males carried out more frequent aggressive behaviours towards rival males than did unexposed males, as well as performing less courting behaviour and more sneak (i.e., coercive) mating attempts towards females. Considering that, by influencing mating outcomes, male-male competition has important consequences for population dynamics and broader evolutionary processes, this study highlights the need for greater understanding of the potential impact of EDCs on the mechanisms of sexual selection. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
... Breast & Gynecologic Cancers Breast Cancer Screening Research Male Breast Cancer Treatment (PDQ®)–Patient Version General Information about Male Breast Cancer Go to Health Professional Version Key Points Male ...
Cho, Yong Seok; Kang, Mi Jin; Bae, Kyung Eun; Lee, Jin Hae; Lee, Han Bee; Kim, Jae Hyung; Jeong, Myeong Ja; Kang, Tae Kyung
Aberrant origins of the pulmonary artery are rare anomalies, but are being reported several times in the world literature. Among them, pulmonary artery sling is the most well known anomaly, which is the left pulmonary artery arising from the right pulmonary artery. In case of pulmonary artery sling, the left pulmonary artery causes compression of the trachea and esophagus while it courses in between. In this case, we describe a case on incidentally found aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery without any compressions of the esophagus or trachea. In the world literature, aberrant origins of the left pulmonary artery without pulmonary artery sling was reported at one time, but currently, this is the first case of aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery.
Cho, Yong Seok; Kang, Mi Jin; Bae, Kyung Eun; Lee, Jin Hae; Lee, Han Bee; Kim, Jae Hyung; Jeong, Myeong Ja; Kang, Tae Kyung [Sanggye Paik Hospital, Inje University College of Medicine, Seoul, (Korea, Republic of)
Aberrant origins of the pulmonary artery are rare anomalies, but are being reported several times in the world literature. Among them, pulmonary artery sling is the most well known anomaly, which is the left pulmonary artery arising from the right pulmonary artery. In case of pulmonary artery sling, the left pulmonary artery causes compression of the trachea and esophagus while it courses in between. In this case, we describe a case on incidentally found aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery without any compressions of the esophagus or trachea. In the world literature, aberrant origins of the left pulmonary artery without pulmonary artery sling was reported at one time, but currently, this is the first case of aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery.
Dorman, Emily; Bishai, David
The biological basis for male contraception was established decades ago, but despite promising breakthroughs and the financial burden men increasingly bear due to better enforcement of child support policies, no viable alternative to the condom has been brought to market. Men who wish to control their fertility must rely on female compliance with contraceptives, barrier methods, vasectomy or abstinence. Over the last 10 years, the pharmaceutical industry has abandoned most of its investment in the field, leaving only nonprofit organisations and public entities pursuing male contraception. Leading explanations are uncertain forecasts of market demand pitted against the need for critical investments to demonstrate the safety of existing candidate products. This paper explores the developments and challenges in male contraception research. We produce preliminary estimates of potential market size for a safe and effective male contraceptive based on available data to estimate the potential market for a novel male method.
Full Text Available This study investigated possible differences using the same stretch-shortening exercise (SSE protocol on generally accepted monitoring markers (dependent variables: changes in creatine kinase, muscle soreness, and voluntary and electrically evoked torque in males across three lifespan stages (childhood versus adulthood versus old age. The protocol consisted of 100 intermittent (30 s interval between jumps drop jumps to determine the repeated bout effect (RBE (first and second bouts performed at a 2-week interval. The results showed that indirect symptoms of exercise-induced muscle damage after SSE were more expressed in adult males than in boys and elderly males, suggesting that the muscles of boys and elderly males are more resistant to exercise-induced damage than those of adult males. RBE was more pronounced in adult males than in boys and elderly males, suggesting that the muscles of boys and elderly males are less adaptive to exercise-induced muscle damage than those of adult males.
Howell, Paul I.; Knols, Bart G. J.
Before sterile mass-reared mosquitoes are released in an attempt to control local populations, many facets of male mating biology need to be elucidated. Large knowledge gaps exist in how both sexes meet in space and time, the correlation of male size and mating success and in which arenas matings
... Twitter Pinterest Email Print How effective is male contraception? Not all contraceptive methods are appropriate for all ... is best for them. For men, methods of contraception include male condoms and sterilization (vasectomy). Male condoms. ...
Schröder, Guido; Knauerhase, Andreas; Willenberg, Holger S; Kundt, Guenther; Wendig, Detlef; Schober, Hans-Christof
A fracture is a clinical manifestation of osteoporosis and is one of the main causes of functional limitations and chronic pain in patients with osteoporosis. Muscle and coordination training are recommended to the patients as general measures. We inquired whether sling training is better than traditional physiotherapy in relieving pain and improving abilities of daily living. Fifty patients with osteoporosis were divided into two groups. Group A performed conventional physiotherapy, while Group B performed sling training exercises. Data were collected before and after the intervention and after 3 months. The registered parameters were stamina, posture, and pain. Posture, torques, and the associated strength of spinal muscles were studied in a biomechanical model in order to estimate the forces acting on the spine. Furthermore, the factors that exerted a positive impact on the success of therapy were registered. Forty-four patients (88%) completed the study. Positive effects of the training were noted in both groups, but significantly better effects were observed in the group that performed sling training. A reduction of pain independent of the number of fractures, significantly reduced torques, and reduced muscle strength were registered. Specific training programs helped to increase muscle strength and straightening the back thereby reducing the force needed on a permanent basis and decreasing torque in the spine. Sling training was more effective in that than traditional physiotherapy.
Poli, Federica; Locatello, Lisa; Rasotto, Maria B
The most common adaptation to sperm competition in males is represented by an increase in the sperm number and/or quality released at mating, to raise their probability of egg fertilization. However, rapidly mounting evidence highlights that seminal fluid may directly influence the competitive fertilization success of a male by affecting either own and/or rival sperm performances. In the black goby, Gobius niger , an external fertilizer with guard-sneaker mating tactics and high sperm competition level, sneaker males' ejaculates contain less seminal fluid and more sperm, that are also of better quality, than those of territorial males. However, territorial males, gain a higher paternity success inside natural nests. Here, we ask whether the seminal fluid can contribute to territorial males' reproductive success by enhancing their sperm performances and/or by decreasing those of sneaker males. Using sperm and seminal fluid manipulation and in vitro fertilization tests, we found that own seminal fluid influences the velocity and fertilization ability of sperm only in territorial males, making them as faster as those of sneakers and with similar fertilization rate. Moreover, both sneaker and territorial males' sperm remain unaffected by the seminal fluid of rival males. Thus, black goby males respond to the different level of sperm competition faced by differently allocating in sperm and non-sperm components of the ejaculate, with sneakers primarily investing in sperm of intrinsic high quality and territorial males relying on the effect of seminal fluid to increase the lower intrinsic quality of their sperm. © 2018. Published by The Company of Biologists Ltd.
Young, Brent; Conti, David V; Dean, Matthew D
In a variety of taxa, males deploy alternative reproductive tactics to secure fertilizations. In many species, small “sneaker” males attempt to steal fertilizations while avoiding encounters with larger, more aggressive, dominant males. Sneaker males usually face a number of disadvantages, including reduced access to females and the higher likelihood that upon ejaculation, their sperm face competition from other males. Nevertheless, sneaker males represent an evolutionarily stable strategy un...
Clancy, Lisa M; Cooper, Amy L; Griffith, Gareth W; Santer, Roger D
Same-sex sexual behaviour occurs across diverse animal taxa, but adaptive explanations can be difficult to determine. Here we investigate male-male mounting (MMM) behaviour in female-deprived desert locust males infected with the entomopathogenic fungus Metarhizium acridum. Over a four-week period, infected locusts performed more MMM behaviours than healthy controls. Among infected locusts, the probability of MMM, and the duration of time spent MMM, significantly increased with the mounting locust's proximity to death. In experimental trials, infected locusts were also significantly more likely than controls to attempt to mount healthy males. Therefore, we demonstrate that MMM is more frequent among infected than healthy male locusts, and propose that this may be explained by terminal reproductive effort and a lowered mate acceptance threshold in infected males. However, during experimental trials mounting attempts were more likely to be successful if the mounted locusts were experimentally manipulated to have a reduced capacity to escape. Thus, reduced escape capability resulting from infection may also contribute to the higher frequency of MMM among infected male locusts. Our data demonstrate that pathogen infection can affect same-sex sexual behaviour, and suggest that the impact of such behaviours on host and pathogen fitness will be a novel focus for future research.
Full Text Available Infertility by definition, is not to get pregnant within one year of regular sexual relationship without protection, affects 15-20% of reproductive age couples. Approximately 30% of infertility cases are male originated. Male infertility is caused by endocrine-related genetic defects affecting urogenital system function. These defects adversely affect subsequent spermatogenesis, sexual function, fertility, early embryonic stage of sexual maturation. Autosomal and gonosomal, numerical and structural chromosome abnormalities and related syndromes rank at the top causes of male infertility. Similar chromosome abnormalities are detected in male infertility and as the rate of these abnormalities increase, it was found to reduce sperm count especially in azospermic and oligozoospermic men. [Archives Medical Review Journal 2011; 20(4.000: 230-245
Sato, Y.; Egas, M.; Sabelis, M.W.; Mochizuki, A.
Theory predicts that when individuals live in groups or colonies, male-male aggression peaks at intermediate levels of local average relatedness. Assuming that aggression is costly and directed toward nonrelatives and that competition for reproduction acts within the colony, benefits of aggressive
Kelly, Natasha B.; Alonzo, Suzanne H.
Existing theory predicts that male signalling can be an unreliable indicator of paternal care, but assumes that males with high levels of mating success can have high current reproductive success, without providing any parental care. As a result, this theory does not hold for the many species where offspring survival depends on male parental care. We modelled male allocation of resources between advertisement and care for species with male care where males vary in quality, and the effect of c...
Young, Brent; Conti, David V; Dean, Matthew D
In a variety of taxa, males deploy alternative reproductive tactics to secure fertilizations. In many species, small “sneaker” males attempt to steal fertilizations while avoiding encounters with larger, more aggressive, dominant males. Sneaker males usually face a number of disadvantages, including reduced access to females and the higher likelihood that upon ejaculation, their sperm face competition from other males. Nevertheless, sneaker males represent an evolutionarily stable strategy under a wide range of conditions. Game theory suggests that sneaker males compensate for these disadvantages by investing disproportionately in spermatogenesis, by producing more sperm per unit body mass (the “fair raffle”) and/or by producing higher quality sperm (the “loaded raffle”). Here, we test these models by competing sperm from sneaker “jack” males against sperm from dominant “hooknose” males in Chinook salmon. Using two complementary approaches, we reject the fair raffle in favor of the loaded raffle and estimate that jack males were ∼1.35 times as likely as hooknose males to fertilize eggs under controlled competitive conditions. Interestingly, the direction and magnitude of this skew in paternity shifted according to individual female egg donors, suggesting cryptic female choice could moderate the outcomes of sperm competition in this externally fertilizing species. PMID:24455130
Estimates of Atlantic cod Gadus morhua reproductive success, determined using experimental spawning groups and genetic paternity assignment of offspring, showed that within-group variance in male size correlated positively with the degree of male mating skew, predicting a decrease in male reprodu...
Dubuc, Constance; Coyne, Sean P; Maestripieri, Dario
The adaptive function of male masturbation is still poorly understood, despite its high prevalence in humans and other animals. In non-human primates, male masturbation is most frequent among anthropoid monkeys and apes living in multimale-multifemale groups with a promiscuous mating system. In these species, male masturbation may be a non-functional by-product of high sexual arousal or be adaptive by providing advantages in terms of sperm competition or by decreasing the risk of sexually transmitted infections. We investigated the possible functional significance of male masturbation using behavioral data collected on 21 free-ranging male rhesus macaques ( Macaca mulatta ) at the peak of the mating season. We found some evidence that masturbation is linked to low mating opportunities: regardless of rank, males were most likely to be observed masturbating on days in which they were not observed mating, and lower-ranking males mated less and tended to masturbate more frequently than higher-ranking males. These results echo the findings obtained for two other species of macaques, but contrast those obtained in red colobus monkeys ( Procolobus badius ) and Cape ground squirrels ( Xerus inauris ). Interestingly, however, male masturbation events ended with ejaculation in only 15% of the observed masturbation time, suggesting that new hypotheses are needed to explain masturbation in this species. More studies are needed to establish whether male masturbation is adaptive and whether it serves similar or different functions in different sexually promiscuous species.
Male pattern baldness is a sex-linked characteristic that is passed from mother to child. A man can more accurately predict his chances of developing male pattern baldness by observing his mother's father than by looking ...
Kubo, Ryohei; Harano, Ken-ichi; Ono, Masato
To explore the role of the volatiles emitted from male labial gland (LG) of the bumblebee Bombus ardens ardens, we investigated the responses of virgin queens and males to volatiles using a gas chromatography-electroantennographic detector (GC-EAD) system and Y-tube olfactometer. GC-EAD analysis revealed that citronellol, the main compound detected in the male LG, caused clear electrophysiological responses in the antennae of B. a. ardens virgin queens and males although two minor compounds elicited antennal responses when applied in a high concentration. Behavioral tests using a Y-tube olfactometer showed that queens and males were significantly attracted to both LG extracts and citronellol more than to the solvent alone. This is the first study to demonstrate that citronellol as a major compound of male scent-marking pheromone in B. a. ardens functions as a sex attractant for queens. The results also suggest that this compound has another function as a trail marker used by males.
A survey is given of two different types of genetically controlled male sterility in higher plants. 'Functional' male sterility is due to the action of mutated genes causing a misdifferentiation of the growing points in different specific ways. Under the influence of the genes of this group either the stamens or the archespore tissues are not differentiated. In other mutants functionable male germ cells are produced but cannot be used for fertilizing the egg cells because the anthers remain closed or anthers and stigma become spatially separated from each other. Other genes of the group are responsible for the transformation of stamens into carpels, i.e. for a change of the hermaphrodite flower into a unisexually female one. A second type of male sterility is due to the action of ms genes influencing the course of micro-sporogenesis directly. They cause the breakdown of this process in a specific meiotic stage characteristic for each gene of the group. This breakdown is introduced by the degeneration of PMCs, microspores, or pollen grains preventing the production of male germ cells. The female sex organs remain uninfluenced. (author)
Jiguet, Frédéric; Bretagnolle, Vincent
In their choice of mates, females may use alternative tactics, including a comparative assessment of males in a population, using one or several relative preference criteria. Traits involved in female choice should presumably be variable between, but not within males, thus potentially providing reliable cues of male identity and quality for prospecting females. In lekking species, sexual selection is usually intense, and females can freely choose mates. Studying the Little Bustard Tetrax tetrax, a bird with an exploded lek mating system, we first identified male phenotypic traits that showed higher among, than within variation (plumage pattern, display rates and call structure). Among those and other traits (ornaments and their symmetry, body condition, lek spatial organization and territory quality), we identified phenotypic traits that correlated with male attractiveness toward females. At least four phenotypic male traits were correlated with female attraction, i.e. body condition, lek attendance, ornamental symmetry and display rates. Traits related to the initial female attraction on male territory seem to differ from traits related to the decision of females to stay in the territory of attractive males. Copyright © 2014 Elsevier B.V. All rights reserved.
Full Text Available Experimental evidence suggests that females would prefer males with better cognitive abilities as mates. However, little is known about the traits reflecting enhanced cognitive skills on which females might base their mate-choice decisions. In particular, it has been suggested that male foraging performance could be used as an indicator of cognitive capacity, but convincing evidence for this hypothesis is still lacking. In the present study, we investigated whether female zebra finches (Taeniopygia guttata modify their mating preferences after having observed the performance of males on a problem-solving task. Specifically, we measured the females’ preferences between two males once before and once after an observation period, during which their initially preferred male was incapable of solving the task contrary to their initially less-preferred male. We also conducted a control treatment to test whether the shift in female preferences was attributable to differences between the two stimulus males in their foraging efficiency. Finally, we assessed each bird’s performance in a color associative task to check whether females can discriminate among males based on their learning speed. We found that females significantly increased their preference toward the most efficient male in both treatments. Yet, there was no difference between the two treatments and we found no evidence that females assess male cognitive ability indirectly via morphological traits. Thus, our results suggest that females would not use the males’ problem-solving performance as an indicator of general cognitive ability to gain indirect fitness benefits (i.e., good genes but rather to assess their foraging efficiency and gain direct benefits.
Full Text Available Introduction: Despite a recent focus on intimate partner violence (IPV among men who have sex with men (MSM, the male-male couple is largely absent from the IPV literature. Specifically, research on dyadic factors shaping IPV in male-male couples is lacking.Methods: We took a subsample of 403 gay/bisexual men with main partners from a 2011 survey of approximately 1,000 gay and bisexual men from Atlanta. Logistic regression models of recent (,12 month experience and perpetration of physical and sexual IPV examined dyadic factors, including racial differences, age differences, and social network characteristics of couples as key covariates shaping the reporting of IPV.Results: Findings indicate that men were more likely to report perpetration of physical violence if they were a different race to their main partner, whereas main partner age was associated with decreased reporting of physical violence. Having social networks that contained more gay friends was associated with significant reductions in the reporting of IPV, whereas having social networks comprised of sex partners or closeted gay friends was associated with increased reporting of IPV victimization and perpetration.Conclusion: The results point to several unique factors shaping the reporting of IPV within male-male couples and highlight the need for intervention efforts and prevention programs that focus on male couples, a group largely absent from both research and prevention efforts. [West J Emerg Med. 2013;14(4:316–323.
O'Connor, T E; Cooney, T
We report the rare case of an oesophageal foreign body which lodged above the site of oesophageal compression by a double aortic arch. Case report and a review of the literature surrounding the classification, embryology, diagnosis and management of vascular rings and slings. An eight-month-old male infant presented with symptoms of tracheal compression following ingestion of an oesophageal foreign body. Following removal of the oesophageal foreign body, the infant's symptoms improved initially. However, subsequent recurrence of respiratory symptoms lead to a repeat bronchoscopy and the diagnosis of a coexisting double aortic arch, causing tracheal and oesophageal compression. To our knowledge, this is only the second reported case of a double aortic arch being diagnosed in a patient following removal of an oesophageal foreign body.
Vivian C. Nanagas MD, MSc
Full Text Available Objective. To determine male vaccination rates with quadrivalent human papillomavirus vaccine (HPV4 before and after the October 2011 national recommendation to routinely immunize adolescent males. Methods. We reviewed HPV4 dose 1 (HPV4-1 uptake in 292 adolescent males in our urban clinic prior to national recommendations and followed-up for HPV4 series completion rates. After national recommendation, 248 urban clinic and 247 suburban clinic males were reviewed for HPV4-1 uptake. Factors associated with HPV4-1 refusal were determined with multiple logistic regression. Results. Of the initial 292 males, 78% received HPV4-1 and 38% received the 3-dose series. After recommendation, HPV4-1 uptake was 59% and 7% in urban and suburban clinics, respectively. Variables associated with HPV4-1 uptake/refusal included time period, race, type of insurance, and receipt of concurrent vaccines. Conclusions. HPV4-1 vaccination rates in our urban clinic were high before and after routine HPV vaccine recommendations for adolescent males. Our vaccination rates were much higher than in a suburban practice.
Gomes, Suzanne; Civetta, Alberto
Hybrid male sterility is a common barrier to gene flow between species. Previous studies have posited a link between misregulation of spermatogenesis genes in interspecies hybrids and sterility. However, in the absence of fully fertile control hybrids, it is impossible to differentiate between misregulation associated with sterility vs. fast male gene regulatory evolution. Here, we differentiate between these two possibilities using a D. pseudoobscura species pair that experiences unidirectio...
Xia, Dong-Po; Li, Jin-Hua; Garber, Paul A; Matheson, Megan D; Sun, Bing-Hua; Zhu, Yong
In several primate species, adult males are reported to compete for access to reproductive partners as well as forming affiliative and cohesive social bonds based on the exchange of goods or services. We hypothesized that among a broad set of fitness-maximizing strategies, grooming can be used by individual adult males to enhance social relationships through reciprocity and/or through the interchange of grooming for a different but equivalent good or service. We used focal animal sampling and continuously recorded dyadic grooming and agonistic interactions to test a series of predictions regarding male social interactions in a free-ranging group of Tibetan macaques (Macaca thibetana) at Huangshan, China. During the non-mating season or between males of similar rank throughout the year, grooming effort given was matched by grooming effort received. However, lower ranking males groomed higher ranking males at a greater rate and/or for a longer duration during both the mating and non-mating periods. We found that higher ranking males directed less aggression towards males with whom they formed a frequent grooming partnership, indicating that grooming received was interchanged for increased social tolerance. These data suggest that individual male Tibetan macaques employ alternative social strategies associated with grooming reciprocity or interchange depending on dominance rank and rates of aggression, and highlight the importance of both biological markets and grooming reciprocity as behavioral mechanisms used by resident adult males to form and maintain affiliative social bonds. © 2013 Wiley Periodicals, Inc.
Golom, Frank D; Mohr, Jonathan J
Despite the recent proliferation of lesbian, gay, and bisexual (LGB) thematic content in U.S. media, there have been relatively few empirical investigations examining its impact on heterosexuals' attitudes toward LGB individuals. This study examined the effect of one type of content, male-male homoerotic imagery, on male and female heterosexuals' attitudes toward, stereotypes about, and affective reactions to gay men. One hundred ninety-eight undergraduate students were assigned to either a male-male or male-female erotica condition, and their corresponding attitudes toward gay men were assessed. Results revealed that the effect of erotic imagery (male-male vs. male-female) on participants' stereotype and affect scores differed for men and women at varying levels of sexual anxiety. The implications of these findings are discussed in light of the literature on exposure to erotic imagery and attitudes toward gay men. In particular, the study highlights the need for additional research that acknowledges within-gender heterogeneity with respect to antigay attitude valence, extremity, and function.
Civetta, Alberto; Gaudreau, Chelsea
The biological concept of species stresses the importance of understanding what mechanisms maintain species reproductively isolated from each other. Often such mechanisms are divided into premating and postmating, with the latest being the result of either prezygotic or postzygotic isolation barriers. Drosophila willistoni quechua and Drosophila willistoni willistoni are two subspecies that experience reproductive isolation. When a D. w. quechua female is crossed with a D. w. willistoni male, the hybrid males (F1QW) are unable to father progeny; however, the reciprocal cross produces fertile hybrids. Thus, the mechanism of isolation is unidirectional hybrid male sterility. However, the sterile F1QW males contain large amounts of motile sperm. Here we explore whether pre-copulatory or post-copulatory pre-zygotic mechanisms serve as major deterrents in the ability of F1QW males to father progeny. Comparisons of parental and hybrid males copulation durations showed no significant reduction in copulation duration of F1QW males. Interrupted copulations of the parental species confirmed that sperm transfer occurs before the minimum copulation duration registered for F1QW males. However, we found that when females mate with F1QW males, sperm is not present inside the female storage organs and that the lack of sperm in storage is due to failure to transfer sperm rather than spillage or active sperm dumping by females. Sterility of F1QW hybrid males is primarily driven by their inability to transfer sperm during copulation.
Tobias, Martha L.; Corke, Anna; Korsh, Jeremy; Yin, David; Kelley, Darcy B.
Male Xenopus laevis frogs produce underwater advertisement calls that attract gravid females and suppress calling by male competitors. Here we explore whether groups of males establish vocal ranks and whether auditory cues alone suffice for vocal suppression. Tests of male–male pairs within assigned groups reveal linear vocal dominance relations, in which each male has a defined rank. Both the duration over which males interact, as well as the number of competitive opportunities, affect linea...
Finkel, Madelon Lubin; Finkel, David J.
The contraceptive utilization of a sample of sexually active, urban, high school males (Black, Hispanic, and White) was examined by anonymous questionnaire. Contraceptive use was haphazard, but White males tended to be more effective contraceptors than the other two groups. Reasons for nonuse were also studied. (Author/SJL)
Prophylactics; Rubbers; Male condoms; Contraceptive - condom; Contraception - condom; Barrier method - condom ... your health care provider or pharmacy about emergency contraception ("morning-after pills"). PROBLEMS WITH CONDOM USE Some ...
Elkonin, L A; Gerashchenkov, G A; Domanina, I V; Rozhnova, N A
Heritable phenotypic alterations occurring during plant ontogenesis under the influence of environmental factors are among the most intriguing genetic phenomena. It was found that male-sterile sorghum hybrids in the 9E cytoplasm from the F1 and F2 generations, which were obtained by crossing CMS lines with different fertile lines grown in field conditions, were transferred to greenhouse produce fertile tillers. Lines created by the self-pollination of revertant tillers exhibit complete male fertility upon cultivation under various environments (in the field, Tdry plot,(y) Tirrigated plot(y)). In a number of test-crosses of revertants to CMS lines in the 9E cytoplasm, restoration of male fertility in F1 hybrids was found, indicating that revertants possess functional fertility-restoring genes. A high positive correlation was found between the fertility level of the test-cross hybrids and the hydrothermal coefficient (the ratio of the sum of precipitation to the sum of temperatures) during the booting stage and pollen maturation (r = 0.75...0.91; Pmale fertility are due to up-regulation of fertility-restoring genes by a high level of water availability. Comparative MSAP-analysis of DNA of male-sterile and male-fertile test-cross hybrids using HpaII/MspI restrictases and primers to polygalacturonase gene ADPG2, which is required for cell separation during reproductive development, and gene MYB46, the transcription factor regulating secondary wall biosynthesis, revealed differences in the number and the length of amplified fragments. Changes in the methylation of these genes in conditions of drought stress are apparently the reason for male sterility of sorghum hybrids in the 9E cytoplasm. These data demonstrate that methylation of nuclear genes in sterility-inducing cytoplasm may be one of mechanisms causing the CMS phenomenon.
Matushita, J.P.K.; Andrade, L.G. de; Carregal, E.; Marimatsu, R.I.; Matushita, J.S.
Roentgenographic examination of the male breast is an important aspect of the continued, intensive investigation of the radiologic morphology of the normal and diseased breast conducted in 17 cases examined at the Instituto Nacional do Cancer - RJ. It is purpose of this report to present the Roentgen appearance of various lesions of the male breast as they have been found in our practice and also to stress some of the difficulties in the differential diagnosis of these lesions. (author) [pt
Annicchiarico Iseda, Ivan Darío; Universidad Nacional de Colombia
In this paper, empirical and theoretical reports which question the causes of male homosexuality are examined. According to these reports, male homosexuality differs from female homosexuality in some respects. Additionally, evidence favouring the consideration of male homosexuality as a biological condition is shown: there are brain differences between gay men and heterosexual men, there are genetic and perinatal factors associated to male homosexuality, there are cognitive and behavioral dif...
Omura, Mitsuo; Akihama, Tomoya
A tentative plan was proposed for chestnuts based on their pollination system, male sterility and restoration. The studies on the male sterility of 1,063 cultivars and clones suggested that there were three types of male sterility. The first type (S-1) was characterized by antherless florets. In the second type (S-2), the catkins fell before anthesis, and the third type (S-3) appeared to develop normally in gross floral morphology, but the pollen grains were abnormal in shape and did not have germinating power. In an interspecific hybrid clone CS which belonged to S-1, fertility was restored in an open pollinated progeny. The use of CS and CSO-3 with its restored fertility, permitted the planning of breeding the chestnut hybrid cultivars propagated by seeds. The inbred clones with either male sterility or restorer genes are first bred mainly by back crossing with parents with favorable pollen. The clones are selected individually for early bearing, wasp and disease resistance, and restoration. Then, the hybrid seedling lines between male sterile and restorer inbreds are evaluated for homogenity in nut characters and tree habits. Next, the hybrid seedling lines selected will be examined for crop yield, vigor and cross compatibility. The superior seedling lines are finally selected, and the parental inbreds are grafted to be propagated for seed production orchards. (Kaihara, S.)
Macia, Laura; Ruiz, Hector Camilo; Boyzo, Roberto; Documet, Patricia Isabel
Little documentation exists about male community health workers (promotores) networks. The experiences of promotores can provide input on how to attract, train, supervise and maintain male promotores in CHW programs. We present the experience and perspectives of promotores who participated in a male promotores network assisting Latino immigrant men in an emerging Latino community. All promotores in this community-based participatory study received payment for work 10 hours a week. We conducted qualitative interviews with all promotores starting the program, after 5 and 13 months. Three main themes emerged: 1) Men decided to become promotores to help others, yet appreciated being paid. 2) Promotores' learning experience was ongoing and was facilitated by a cooperative dynamic among them. Learning how to listen was crucial for promotores 3) Promotores experienced difficulty separating their personal lives form their role as a promotor We conclude that paying promotores facilitates the fulfillment of their drive to serve the community. Enhancing listening abilities needs to be part of promotores' training curricula. Finally, it is advisable to build a project with many opportunities for promotores and project staff to share professional and non-professional time and discuss their challenges. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: email@example.com.
Levine, S B
Adolescent and adult cross-dressing or "transvestism" is the most common antecedent behavioral pattern among those who request sex reassignment surgery. Transvestites are actually a diverse group of men who differ in their gender identities, orientation, and intention. They do, however, have in common a soothing image of themselves as women. Because of this, whether cross-dressing occurs among masculine or feminine males or heterosexuals, homosexuals, bisexuals, or asexuals, or among those with paraphilia, the behavior should be considered the expression of their consciously felt femininity. The confusing differences among cross-dressing males may be explained by their diversity along three dimensions: 1) the ambition for heterosexual intercourse; 2) the natural history of their sexual arousal to female clothing; 3) their current capacity to integrate their masculine and feminine strivings into separate compartments. When cross-dressers give up all vestiges of male gender role behaviors and successfully live and work full time as women, the appropriate descriptive term for them becomes "transsexual."
Cacheiro, N.L.A.; Cornett, C.V.
Genetic male sterility results primarily from certain types of balanced reciprocal translocations, and, more rarely, from certain numerical sex-chromosome anomalies. Sterile male offspring sired following exposure of male meiotic or postmeiotic stages to radiation or chemical mutagens are not uncommon and are predominantly carriers of balanced translocations. The chromosome breakpoints of these translocations are generally located near the ends of autosomes or anywhere in the sex chromosomes. Sterile offspring from mutagen-treated spermatogonial stem cells, on the other hand, are not only rare but most of them have no readily detectable chromosomal anomalies. Those that have are either carriers of balanced translocations, or are sex-chromosome trisomics or mosaics (XYY, XXY, XY//XYY, XO//XY, etc.). The nature of the exchange in spermatogonia-derived sterile translocations is not clear and awaits detailed study. In addition, the data base is not yet sufficient for determining the role of induced nondisjunction in the production of genetic male sterility. Accordingly, they have an ongoing project that attempts to study associations between the nature of genetic fertility impairments and the detailed chromosomal genotype, and between chromosomal causes of sterility and the nature of mutagenic treatments that produce them
Chang, Zhenyi; Chen, Zhufeng; Wang, Na; Xie, Gang; Lu, Jiawei; Yan, Wei; Zhou, Junli; Tang, Xiaoyan; Deng, Xing Wang
Nuclear male sterility is common in flowering plants, but its application in hybrid breeding and seed production is limited because of the inability to propagate a pure male sterile line for commercial hybrid seed production. Here, we characterized a rice nuclear gene essential for sporophytic male fertility and constructed a male sterility system that can propagate the pure male sterile seeds on a large scale. This system is fundamentally advantageous over the current cytoplasmic male steril...
Yang, Congwen; Lin, Ying; Shen, Guanwang; Chen, Enxiang; Wang, Yanxia; Luo, Juan; Zhang, Haiyan; Xing, Runmiao; Xia, Qingyou
Female qualities in males are common in vertebrates but have not been extensively reported in insects. Vitellogenin (Vg) is highly expressed in the female fat body and is generally required for the formation of yolk proteins in the insect egg. Vg upregulation is generally regarded as a female quality in female oviparous animals. In this study, we found that Bombyx mori Vg (BmVg) is especially highly expressed in the female pupa. Downregulation of the BmVg gene in the female pupa by RNA interference (RNAi) interfered with egg formation and embryonic development, showing the importance of BmVg in these processes. So, we used BmVg as a biomarker for female qualities in the silkworm. Hematoxylin-eosin staining and immunofluorescence histochemistry showed that ovary transplants induced BmVg synthesis in the male pupa fat body. Ovaries transplanted into male silkworms produced only a few eggs with deformed yolk granules. These results suggested that the amount of BmVg in the male silkworm was insufficient for eggs to undergo complete embryonic development. After 17-beta-estradiol was used to treat male pupae and male pupal fat bodies, BmVg was upregulated in vivo and in vitro. These findings indicated that the male silkworm has innate female qualities that were induced by a transplanted ovary and 17β-estradiol. However, in silkworms, female qualities in males are not as complete as in females. Copyright © 2014 Elsevier Inc. All rights reserved.
Shi, Hyejin; Sohn, Sungmin; Wang, SungHo; Park, Sungrock; Lee, SangKi; Kim, Song Yi; Jeong, Sun Young; Kim, Changhwan
Congenital cardiovascular anomalies, such as dextrocardia, persistent left superior vena cava (SVC), and pulmonary artery (PA) sling, are rare disorders. These congenital anomalies can occur alone, or coincide with other congenital malformations. In the majority of cases, congenital anomalies are detected early in life by certain signs and symptoms. A 56-year-old man with no previous medical history was admitted due to recurrent wide QRS complex tachycardia with hemodynamic collapse. A chest radiograph showed dextrocardia. After synchronized cardioversion, an electrocardiogram revealed Wolff-Parkinson-White (WPW) syndrome. Persistent left SVC, PA sling, and right tracheal bronchus were also detected by a chest computed tomography (CT) scan. He was diagnosed with paroxysmal supraventricular tachycardia (PSVT) associated with WPW syndrome, and underwent radiofrequency ablation. We reported the first case of situs solitus dextrocardia coexisting with persistent left SVC, PA sling and right tracheal bronchus presented with WPW and PSVT in a middle-aged adult. In patients with a cardiovascular anomaly, clinicians should consider thorough evaluation of possibly combined cardiovascular and airway malformations and cardiac dysrhythmia. © 2017 The Korean Academy of Medical Sciences.
Different types of cranes, hoists, chain pulley blocks are the most commonly used material handling equipment in industry along with attachments like chains, wire rope slings, d-shackles, etc. These equipment are used at work for transferring loads from one place to another and attachments are used for anchoring, fixing or supporting the load. Selection of the correct equipment, identification of the equipment planning of material handling operation, examination/testing of the equipment, education and training of the persons engaged in operation of the material handling equipment can reduce the risks to safety of people in workplace. Different safety systems like boom angle indicator, overload tripping device, limit switches, etc. should be available in the cranes for their safe use. Safety requirement for safe operation of material handling equipment with emphasis on different cranes and attachments particularly wire rope slings and chain slings have been brought out in this paper. An attempt has also been made to bring out common nature of deficiencies observed during regulatory inspection carried out by AERB. (author)
Bajaj, Vijay Kumar; Gupta, Radhey S
Male contraceptive development in the present scenario is most viable aspect of research due to uncontrolled population growth in the world. In this respect investigators are busy to find out a safe male contraceptive drug. Researchers have started their finding for a suitable drug from natural sources because these are safe and easily acceptable for common man, most of natural sources are plants and their products. In this review 137 plants and their effects on reproduction and reproductive physiology are summarized. Some of them have intense effect on male reproductive system and do not produce any side effects. Reproductive toxicological studies are also important aspects of these kinds of researches, so it is important that drugs are safe and widely acceptable. An ideal male contraceptive can influence semen, testes, hormone level, accessory reproductive organs and general physiology of animals and produced some alterations. Many plants in this review are showing antifertility as well as antispermatogenic effects, so these may be used for further study for contraceptives development but it is important to find out the mechanism of reaction and further laboratory and clinical research on some plants are needed for final male contraceptive drug development. In conclusion this review will help for finding suitable plant products for male contraceptive clinical and laboratory studies.
... to have a baby? If treatment doesn’t work, what are our other options? Resources National Institute of Child Health and Human Development, What Causes Male Infertility? Last Updated: May 30, 2017 This ...
Full Text Available Male mating investment can strongly influence fitness gained from a mating. Yet, male mating investment often changes with age. Life history theory predicts that mating investment should increase with age, and males should become less discriminatory about their mate as they age. Understanding age-dependent changes in male behavior and their effects on fitness is important for understanding how selection acts in age-structured populations. Although the independent effects of male or female age have been studied in many species, how these interact to influence male mating investment and fitness is less well understood. We mated Drosophila pseudoobscura males of five different age classes (4-, 8-, 11-, 15-, 19-day old to either young (4-day or old (11-day females, and measured copulation duration and early post-mating fecundity. Along with their independent effects, we found a strong interaction between the effects of male and female ages on male mating investment and fitness from individual matings. Male mating investment increased with male age, but this increase was more prominent in matings with young females. Male D. pseudoobscura made smaller investments when mating with old females. The level of such discrimination based on female age, however, also changed with male age. Intermediate aged males were most discriminatory, while the youngest and the oldest males did not discriminate between females of different ages. We also found that larger male mating investments resulted in higher fitness payoffs. Our results show that male and female ages interact to form a complex pattern of age-specific male mating investment and fitness.
de Souza, André Rodrigues; Alberto Mourão Júnior, Carlos; do Nascimento, Fabio Santos; Lino-Neto, José
Sexually selected signals are common in many animals, though little reported in social insects. We investigated the occurrence of male visual signals mediating the dominance relationships among males and female choice of sexual partner in the paper wasp Polistes simillimus. Males have three conspicuous, variable and sexually dimorphic traits: black pigmentation on the head, a pair of yellow abdominal spots and body size differences. By conducting behavioral assays, we found that none of the three visual traits are associated with male-male dominance relationship. However, males with higher proportion of black facial pigmentation and bigger yellow abdominal spots are more likely chosen as sexual partners. Also, after experimentally manipulating the proportion of black pigment on males' face, we found that females may evaluate male facial coloration during the choice of a sexual partner. Thus, the black pigmentation on P. simillimus male's head appears to play a role as a sexually selected visual signal. We suggest that sexual selection is a common force in Polistes and we highlight the importance of this group as a model for the study of visual communication in insects.
Bonde, Jens P E
To highlight and discuss the new evidence on occupational and environmental risk to male reproductive function.......To highlight and discuss the new evidence on occupational and environmental risk to male reproductive function....
... the hormone that plays a key role in masculine growth and development during puberty — or has an ... Adulthood In adult males, hypogonadism may alter certain masculine physical characteristics and impair normal reproductive function. Signs ...
Rick, Ingolf P.; Bakker, Theo C. M.
Animal colour signals serve important functions in intraspecific interactions, including species recognition, mate choice and agonistic behaviour. An increasing interest concerns ultraviolet (UV) wavelengths, for instance studies on the effect of UV in mating decisions. More recently, some studies also established that UV signals affect intrasexual interactions. We studied the role of UV during aggressive encounters between male three-spined sticklebacks ( Gasterosteus aculeatus), a species in which UV has an effect on female and male mate choice and shoaling behaviour. To that aim, we compared the aggressive response of a territorial male to male intruders, either seen in UV-including (UV+) or UV-lacking (UV-) conditions. Our prediction was that, if UV wavelengths are used in male-male competition, a territorial male should show less competitive behaviour towards an intruder representing a lower threat, i.e. the one presented without UV light. Male sticklebacks showed significantly lower levels of aggression towards male opponents lacking an UV component to their coloration than male opponents possessing this colour component. Discrimination was not influenced by a difference in brightness between the UV+ and UV- stimuli. Finally, we present some reflectance-spectrophotometrical data of two skin regions (cheek and abdomen) of the experimental males and analysed relationships between colorimetric variables, body variables and behaviour. Our study emphasises that UV visual cues are of importance in different communicational tasks in the three-spined stickleback.
Mills, Martin; Martino, Wayne; Lingard, Bob
Frequent calls for more male teachers are being made in English-speaking countries. Many of these calls are based upon the fact that the teaching profession has become (even more) 'feminized' and the presumption that this has had negative effects for the education of boys. The employment of more male teachers is sometimes suggested as a way to…
Zargham, Mahtab; Alizadeh, Farshid; Tadayyon, Farhad; Khorrami, Mohammad-Hatef; Nouri-Mahdavi, Kia; Gharaati, Mohammad Reza; Izadpanahi, Mohammad Hossein; Yazdani, Mohammad; Mazdak, Hamid
Background: The aim of this study is to evaluate the outcome of an innovative, minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse (AVWP). Materials and Methods: Fifty-six women with stress urinary incontinence (SUI) or mixed urinary incontinence and AVWP were randomly assigned into two groups: In Group A (26 patients), anterior colporrhaphy (Kelly placation) and sling placement using a strip of anterior vaginal wall were performed, and in Group B (30 patients), transvaginal mesh correction of AVWP and tension-free vaginal tape (TVT) insertion (retropubic – craniocaudal route) using polypropylene mesh were carried out. The patients were followed-up for over 18 months and were assessed objectively using a 48 h frequency-volume chart, a 48 h pad test and a standardized stress test. Related surgical complications and outcomes were recorded and compared. Results: Surgical cure rates for Group A and Group B at the first (3 days) and last (18 months) post-operative visits were 62% and 84%; and 54%, and 72%, respectively (P = 0.09 and 0.31). Complications occurred in 9 patients (44%) of Group B, but only 3 patients (12%) in Group A. Conclusion: Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates. Although, the surgical success rate of this technique is lower than T-Sling, larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery. PMID:24516492
Full Text Available Background: The aim of this study is to evaluate the outcome of an innovative, minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse (AVWP. Materials and Methods : Fifty-six women with stress urinary incontinence (SUI or mixed urinary incontinence and AVWP were randomly assigned into two groups: In Group A (26 patients, anterior colporrhaphy (Kelly placation and sling placement using a strip of anterior vaginal wall were performed, and in Group B (30 patients, transvaginal mesh correction of AVWP and tension-free vaginal tape (TVT insertion (retropubic - craniocaudal route using polypropylene mesh were carried out. The patients were followed-up for over 18 months and were assessed objectively using a 48 h frequency-volume chart, a 48 h pad test and a standardized stress test. Related surgical complications and outcomes were recorded and compared. Results: Surgical cure rates for Group A and Group B at the first (3 days and last (18 months post-operative visits were 62% and 84%; and 54%, and 72%, respectively (P = 0.09 and 0.31. Complications occurred in 9 patients (44% of Group B, but only 3 patients (12% in Group A. Conclusion: Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates. Although, the surgical success rate of this technique is lower than T-Sling, larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery.
Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications.
Rac, Goran; Younger, Austin; Clemens, James Q; Kobashi, Kathleen; Khan, Aqsa; Nitti, Victor; Jacobs, Ilana; Lemack, Gary E; Brown, Elizabeth T; Dmochowski, Roger; MacLachlan, Lara; Mourtzinos, Arthur; Ginsberg, David; Koski, Michelle; Rames, Ross; Rovner, Eric S
To investigate the possible effects of the Food and Drug Administration (FDA) Public Health Notifications in 2008 and 2011 regarding surgical trends in transvaginal mesh (TVM) placement for stress urinary incontinence (SUI) and related mesh revision surgery in Female Pelvic Medicine & Reconstructive Surgery (FPMRS) practice in tertiary care academic medical centers in the United States. Surgical volume for procedures performed primarily by FPMRS surgeons at eight academic institutions across the US was collected using Current Procedural Terminology (CPT) codes for stress urinary incontinence repair and revision surgeries from 2007 to 2013. SAS statistical software was used to assess for trends in the data. There was a decrease in the use of synthetic mesh sling for the treatment of SUI at academic tertiary care centers over the past 7 years; however, this was not statistically significant. While the total number of surgical interventions for SUI remained stable, there was an increase in the utilization of autologous fascia pubovaginal slings (AFPVS). The number of mesh sling revision surgeries, including urethrolysis and removal or revision of slings, increased almost three-fold at these centers. These observed trends suggest a possible effect of the FDA Public Health Notifications regarding TVM on surgical practice for SUI in academic centers, even though they did not specifically warn against the use of synthetic mesh for this indication. Indications for surgery, complications, and outcomes were not evaluated during this retrospective study. However, such data may provide alternative insights into reasons for the observed trends. Neurourol. Urodynam. 36:1155-1160, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Nolen, Zachary J; Allen, Pablo E; Miller, Christine W
In animal contests, resource value (the quality of a given resource) and resource holding potential (a male's absolute fighting ability) are two important factors determining the level of engagement and outcome of contests. Few studies have tested these factors simultaneously. Here, we investigated whether natural, seasonal differences in cactus phenology (fruit quality) influence interactions between males in the leaf-footed cactus bug, Narnia femorata (Hemiptera: Coreidae). We also considered whether males were more likely to interact when they were similar in size, as predicted by theory. Finally, we examined if male size relative to the size of an opponent predicted competitive success. We found that males have more interactions on cactus with high value ripe fruit, as we predicted. Further, we found that males that were closer in size were more likely to interact, and larger males were more likely to become dominant. Copyright © 2017 Elsevier B.V. All rights reserved.
André Rodrigues de Souza
Full Text Available Sexually selected signals are common in many animals, though little reported in social insects. We investigated the occurrence of male visual signals mediating the dominance relationships among males and female choice of sexual partner in the paper wasp Polistes simillimus. Males have three conspicuous, variable and sexually dimorphic traits: black pigmentation on the head, a pair of yellow abdominal spots and body size differences. By conducting behavioral assays, we found that none of the three visual traits are associated with male-male dominance relationship. However, males with higher proportion of black facial pigmentation and bigger yellow abdominal spots are more likely chosen as sexual partners. Also, after experimentally manipulating the proportion of black pigment on males' face, we found that females may evaluate male facial coloration during the choice of a sexual partner. Thus, the black pigmentation on P. simillimus male's head appears to play a role as a sexually selected visual signal. We suggest that sexual selection is a common force in Polistes and we highlight the importance of this group as a model for the study of visual communication in insects.
Klinken, A.S. van
In some Christian circles in Africa, male headship is a defining notion of masculinity. The central question in this article is how discourses on masculinity that affirm male headship can be understood. A review of recent scholarship on masculinities and religion shows that male headship is often
Hotchkins, Bryan K.
Background/Context: High school educational environments find Black males experience systemic racial microaggressions in the form of discipline policies, academic tracking and hegemonic curriculum (Allen, Scott, & Lewis, 2013). Black males in high school are more likely than their White male peers to have high school truancies and be viewed as…
Full Text Available Kochin (2002:8 makes the following interesting observation regarding the life of the main character, David Lurie, in Coetzee’s novel, “Disgrace” (1999, and his observation will be explored in detail when analysing the novel, and in particular the presentation of masculinities: “Lurie has no relationship of depth with men. His one effort is with Isaacs, Melanie’s father, and seems to be more of a quest for the sources of Melanie’s beauty than the expression of a desire for friendship with a man.” The focus of my investigation is on male-male relationships and the way in which they impact on the other characters in the novel. What contribution does the novel make to the debate on masculinity within the context of South African literary studies?
Lyu, Nan; Servedio, Maria R; Lloyd, Huw; Sun, Yue-Hua
An increasing number of empirical studies in animals have demonstrated male mate choice. However, little is known about the evolution of postpairing male choice, specifically which occurs by differential allocation of male parental care in response to female signals. We use a population genetic model to examine whether such postpairing male mate choice can evolve when males face a trade-off between parental care and extra-pair copulations (EPCs). Specifically, we assume that males allocate more effort to providing parental care when mated to preferred (signaling) females, but they are then unable to allocate additional effort to seek EPCs. We find that both male preference and female signaling can evolve in this situation, under certain conditions. First, this evolution requires a relatively large difference in parental investment between males mated to preferred versus nonpreferred females. Second, whether male choice and female signaling alleles become fixed in a population versus cycle in their frequencies depends on the additional fecundity benefits from EPCs that are gained by choosy males. Third, less costly female signals enable both signaling and choice alleles to evolve under more relaxed conditions. Our results also provide a new insight into the evolution of sexual conflict over parental care. © 2017 The Author(s). Evolution published by Wiley Periodicals, Inc. on behalf of The Society for the Study of Evolution.
Saour, G.; Makee, H.
Newly emerged adult males (0-18 h) potato tuber moth (PTM) phthorimaea operculella (Zeller) (Lepidoptera: Gelechiidae) were irradiated with various doses of gamma irradiation ranging from 5 to 45 krad. Sterility in order of 91% was induced when males were irradiated with a dose of 45 Krad. Longevity of male PTM was not affected by the application of irradiation, while mating ability and frequency of mating of the males irradiated with 25, 35 and 45 Krad were decreased. The mean number of eggs laid by females mated with males irradiated at 35 and 45 Krad was lower than the control. When males PTM were irradiated with high doses their competitiveness values were reduced, while the competitiveness was increased when the sex ratio of irradiated males to normal males was increased, specially with ration 1 : 10 : 1 (Normal male: Irradiated males: Normal female). Application of 15 Krad dose permitted, the ability to obtain a desired level of male sterility with acceptable reduction in its competitiveness. The inherited sterility phenomena in partially sterile males irradiated with 10-15 and 20 Krad was studied. Sterility in F1 progeny was higher than that in their irradiated male parents. The sex ratio of F1 progeny was distorted in favour of the males. (author). 24 refs., 5 figs
Saour, G; Makee, H [Atomic Energy Commission, Damascus (Syrian Arab Republic). Dept. of Radiation Agriculture
Newly emerged adult males (0-18 h) potato tuber moth (PTM) phthorimaea operculella (Zeller) (Lepidoptera: Gelechiidae) were irradiated with various doses of gamma irradiation ranging from 5 to 45 krad. Sterility in order of 91% was induced when males were irradiated with a dose of 45 Krad. Longevity of male PTM was not affected by the application of irradiation, while mating ability and frequency of mating of the males irradiated with 25, 35 and 45 Krad were decreased. The mean number of eggs laid by females mated with males irradiated at 35 and 45 Krad was lower than the control. When males PTM were irradiated with high doses their competitiveness values were reduced, while the competitiveness was increased when the sex ratio of irradiated males to normal males was increased, specially with ration 1 : 10 : 1 (Normal male: Irradiated males: Normal female). Application of 15 Krad dose permitted, the ability to obtain a desired level of male sterility with acceptable reduction in its competitiveness. The inherited sterility phenomena in partially sterile males irradiated with 10-15 and 20 Krad was studied. Sterility in F1 progeny was higher than that in their irradiated male parents. The sex ratio of F1 progeny was distorted in favour of the males. (author). 24 refs., 5 figs.
Espinosa, E; Josa, A; Gil, L; González, N
In this study, the annual cycle of the gonadal steroids testosterone (T), 11-ketotestosterone (11-KT), 17β-oestradiol (E2) and 17α, 20β-dihydroxy-4-pregnen-3-one (DHP) was determined using radioimmunoassay and then compared, for XY males (n=35) and sex-reversed XX males (n=27) rainbow trout, to establish possible endocrinology differences. Both in XY males and sex-reversed XX males, significant correlation was shown between body weight and T (r=0.5046 and 0.34078, respectively; psex-reversed XX males were similar and showed an intense seasonal variation. The highest levels for T and 11-KT were detected from December to April with a peak in January (51.67 ± 5.11 and 61.95 ± 4.25 ng/ml, for XY males and 57.1 ± 5.82 and 59.27 ± 4.84 ng/ml, respectively, for XX males). In addition, there was a positive correlation (psex-reversed XX males (r=0.6019). Concentrations of DHP in XY males also showed seasonal variation with a peak in February (25.18 ± 12.99 ng/ml). However, DHP levels in sex-reversed XX males were undetectable (sex-reversed XX males were similar to those observed in XY males. The only difference in the annual gonadal steroid cycle between XY and sex-reversed XX males was in the DHP profile. © 2009 Blackwell Verlag GmbH.
MacPhail, Catherine; Scott, John; Minichiello, Victor
Technological change, particularly the growth of the Internet and smart phones, has increased the visibility of male escorts, expanded their client base and diversified the range of venues in which male sex work can take place. Specifically, the Internet has relocated some forms of male sex work away from the street and thereby increased market reach, visibility and access and the scope of sex work advertising. Using the online profiles of 257 male sex workers drawn from six of the largest websites advertising male sexual services in Australia, the role of the Internet in facilitating the normalisation of male sex work is discussed. Specifically we examine how engagement with the sex industry has been reconstituted in term of better informed consumer-seller decisions for both clients and sex workers. Rather than being seen as a 'deviant' activity, understood in terms of pathology or criminal activity, male sex work is increasingly presented as an everyday commodity in the market place. In this context, the management of risks associated with sex work has shifted from formalised social control to more informal practices conducted among online communities of clients and sex workers. We discuss the implications for health, legal and welfare responses within an empowerment paradigm.
Rohner, Patrick T; Blanckenhorn, Wolf U; Puniamoorthy, Nalini
Sexual size dimorphism (SSD) arises when the net effects of natural and sexual selection on body size differ between the sexes. Quantitative SSD variation between taxa is common, but directional intraspecific SSD reversals are rare. We combined micro- and macroevolutionary approaches to study geographic SSD variation in closely related black scavenger flies. Common garden experiments revealed stark intra- and interspecific variation: Sepsis biflexuosa is monomorphic across the Holarctic, while S. cynipsea (only in Europe) consistently exhibits female-biased SSD. Interestingly, S. neocynipsea displays contrasting SSD in Europe (females larger) and North America (males larger), a pattern opposite to the geographic reversal in SSD of S. punctum documented in a previous study. In accordance with the differential equilibrium model for the evolution of SSD, the intensity of sexual selection on male size varied between continents (weaker in Europe), whereas fecundity selection on female body size did not. Subsequent comparative analyses of 49 taxa documented at least six independent origins of male-biased SSD in Sepsidae, which is likely caused by sexual selection on male size and mediated by bimaturism. Therefore, reversals in SSD and the associated changes in larval development might be much more common and rapid and less constrained than currently assumed. © 2016 The Author(s). Evolution © 2016 The Society for the Study of Evolution.
Armstrong, Gregory; Jorm, Anthony F; Samson, Luke; Joubert, Lynette; Singh, Shalini; Kermode, Michelle
HIV among people who inject drugs (PWID) is a major public health challenge in India. This paper examines PWID in Delhi who also have male-to-male sex with a focus on overlapping HIV risk behaviours and the psychosocial correlates of a history of male-to-male anal sex. We analysed data collected in April-May of 2012 from a community-based sample of 420 male PWID in Delhi obtained using time location sampling. One third (37%) of the men reported a history of anal sex with men, among whom just 16% used a condom at last anal sex. Almost all (93%) participants who had a history of anal sex with men also had sex with women. Chi-square tests revealed that a history of anal sex with men was associated with a higher number of female sexual partners and sharing of needles and syringes. Additionally, unprotected sex at last sex with a male partner was significantly associated with unprotected sex at last sex with regular and paid female partners. Multivariate binary logistic regression revealed that the psychosocial correlates of a history of anal sex with other men were: being aged 18-24 (OR = 2.4, p = 0.014), illiteracy (OR = 1.9, p = 0.033), having never been married (OR = 2.6, p = 0.007), a main source of income of crime/begging (OR = 3.1, p = 0.019), a duration of injecting drug use greater than 20 years (OR = 3.4, p = 0.035) and suicidal ideation (OR = 1.7, p = 0.048). Male-to-male sex was associated with psychosocial vulnerability, including a longer history of injecting drug use, suicidal ideation and socio-economic disadvantage. Given the extent of overlapping HIV risk behaviours, HIV programs for PWID would benefit from a strong focus on prevention of sexual HIV transmission, especially among male injectors who also have sex with other men. Copyright © 2014 Elsevier B.V. All rights reserved.
Wang, Christina; Swerdloff, Ronald S.
Purpose of review Condoms and vasectomy are male controlled family planning methods but suffer from limitations in compliance (condoms) and limited reversibility (vasectomy); thus many couples desire other options. Hormonal male contraceptive methods have undergone extensive clinical trials in healthy men and shown to be efficacious, reversible and appear to be safe. Recent Findings The success rate of male hormonal contraception using injectable testosterone alone is high and comparable to methods for women. Addition of progestins to androgens improved the rate of suppression of spermatogenesis. Supported by government or non-government organizations, current studies aim to find the best combination of testosterone and progestins for effective spermatogenesis suppression and to explore other delivery methods for these hormones. Translation of these advances to widespread use in the developed world will need the manufacturing and marketing skills of the pharmaceutical industry. Availability of male contraceptives to the developing world may require commitments of governmental and non-governmental agencies. In a time when imbalance of basic resources and population needs are obvious, this may prove to be a very wise investment. Summary Male hormonal contraception is efficacious, reversible and safe for the target population of younger men in stable relationships. Suppression of spermatogenesis is achieved with a combination of an androgen and a progestin. Partnership with industry will accelerate the marketing of a male hormonal contraceptive. Research is ongoing on selective androgen and progesterone receptor modulators that suppress spermatogenesis, minimize potential adverse events while retaining the androgenic actions. PMID:20808223
Tinggaard, Jeanette; Mieritz, Mikkel Grunnet; Sørensen, Kaspar
To describe available markers of male puberty, discuss associations between adiposity and pubertal timing and to review recent evidence of a possible secular trend in male pubertal timing.......To describe available markers of male puberty, discuss associations between adiposity and pubertal timing and to review recent evidence of a possible secular trend in male pubertal timing....
Full Text Available Abstract Background Among invertebrates, specific pheromones elicit inherent (fixed behavioural responses to coordinate social behaviours such as sexual recognition and attraction. By contrast, the much more complex social odours of mammals provide a broad range of information about the individual owner and stimulate individual-specific responses that are modulated by learning. How do mammals use such odours to coordinate important social interactions such as sexual attraction while allowing for individual-specific choice? We hypothesized that male mouse urine contains a specific pheromonal component that invokes inherent sexual attraction to the scent and which also stimulates female memory and conditions sexual attraction to the airborne odours of an individual scent owner associated with this pheromone. Results Using wild-stock house mice to ensure natural responses that generalize across individual genomes, we identify a single atypical male-specific major urinary protein (MUP of mass 18893Da that invokes a female's inherent sexual attraction to male compared to female urinary scent. Attraction to this protein pheromone, which we named darcin, was as strong as the attraction to intact male urine. Importantly, contact with darcin also stimulated a strong learned attraction to the associated airborne urinary odour of an individual male, such that, subsequently, females were attracted to the airborne scent of that specific individual but not to that of other males. Conclusions This involatile protein is a mammalian male sex pheromone that stimulates a flexible response to individual-specific odours through associative learning and memory, allowing female sexual attraction to be inherent but selective towards particular males. This 'darcin effect' offers a new system to investigate the neural basis of individual-specific memories in the brain and give new insights into the regulation of behaviour in complex social mammals. See associated
Roberts, Sarah A; Simpson, Deborah M; Armstrong, Stuart D; Davidson, Amanda J; Robertson, Duncan H; McLean, Lynn; Beynon, Robert J; Hurst, Jane L
Among invertebrates, specific pheromones elicit inherent (fixed) behavioural responses to coordinate social behaviours such as sexual recognition and attraction. By contrast, the much more complex social odours of mammals provide a broad range of information about the individual owner and stimulate individual-specific responses that are modulated by learning. How do mammals use such odours to coordinate important social interactions such as sexual attraction while allowing for individual-specific choice? We hypothesized that male mouse urine contains a specific pheromonal component that invokes inherent sexual attraction to the scent and which also stimulates female memory and conditions sexual attraction to the airborne odours of an individual scent owner associated with this pheromone. Using wild-stock house mice to ensure natural responses that generalize across individual genomes, we identify a single atypical male-specific major urinary protein (MUP) of mass 18893Da that invokes a female's inherent sexual attraction to male compared to female urinary scent. Attraction to this protein pheromone, which we named darcin, was as strong as the attraction to intact male urine. Importantly, contact with darcin also stimulated a strong learned attraction to the associated airborne urinary odour of an individual male, such that, subsequently, females were attracted to the airborne scent of that specific individual but not to that of other males. This involatile protein is a mammalian male sex pheromone that stimulates a flexible response to individual-specific odours through associative learning and memory, allowing female sexual attraction to be inherent but selective towards particular males. This 'darcin effect' offers a new system to investigate the neural basis of individual-specific memories in the brain and give new insights into the regulation of behaviour in complex social mammals.See associated Commentary http://www.biomedcentral.com/1741-7007/8/71.
Calvo, M V; Groba, H F; Martínez, G; Sellanes, C; Rossini, C; González, A
The bronze bug, Thaumastocoris peregrinus Carpintero & Dellape (Heteroptera: Thaumastocoridae), is an exotic emerging pest in Eucalyptus commercial forests in South America, Africa and southern Europe. Information on the chemical communication system and reproductive ecology of this insect is scant, and it may be relevant for designing management strategies for eucalypt plantations. Adults and nymphs usually aggregate in the field, possibly by means of chemical signals. Males emit large amounts of 3-methyl-2-butenyl butyrate, which attracts conspecific adult males but not females. The ecological role of this putative male aggregation pheromone remains unknown. Here, we report olfactometer bioassays showing that late-instar male nymphs are also attracted to synthetic 3-methyl-2-butenyl butyrate and to adult male volatile extracts, which contain this compound as the major component. As previously shown for adult females, nymphs that moulted into females were not attracted to either volatile stimulus. The intra-gender attraction of nymphs and adults may be related to the exploitation of food resources, or as a reproductive strategy for newly emerged males. Further studies on the reproductive behaviour and mating system of T. peregrinus will contribute to understanding the ecological significance of male-male, adult-nymph attraction, as well as the practical applications that may result from these findings.
Shapouri, Soheil; Nejati, Vahid; Eftekhar Ardebili, Mehrdad
Researchers have been investigating similarities of and differences between homosexuals and heterosexuals for past few decades. Several studies have shown that in the particular domain (e.g., spatial ability), male homosexuals would resemble female heterosexuals better than male heterosexuals. Executive function, however, has received more attention than social cognition in this line of research. This study focuses on theory of mind and empathy as two important components of social cognition in male homosexuals (N=14), male heterosexuals (N=15) and female heterosexuals (N=14). Applying Reading the Mind in the Eyes test and the Empathy Quotient, no significant difference between groups was identified. This study suggests that similarities of male homosexuals and female heterosexuals may be confined to executive function and not extended to some social cognition abilities like theory of mind or empathy.
Full Text Available Male reproduction is governed by the classical hypothalamo-hypophyseal testicular axis: Hypothalamic gonadotropin releasing hormone (GnRH, pituitary luteinizing hormone (LH and follicle stimulating hormone (FSH and the gonadal steroid, principally, testosterone. Thyroid hormones have been shown to exert a modulatory influence on this axis and consequently the sexual and spermatogenic function of man. This review will examine the modulatory influence of thyroid hormones on male reproduction.
Marcos TOKUDA; Jean P. BOUBLI; Patrícia IZAR; Karen B. STRIER
Analyses of spatial relationships and social interactions provide insights into the social structure of animal societies and the ways in which social preferences among and between dyads affect higher order social relationships.In this paper we describe the patterns of spatial associations and social interactions among adult male northern muriquis in order to evaluate the dynamics of their social networks above the dyadic levels.Systematic observations were made on the 17 adult males present in a multi-male/multi-female group from April 2004 through February 2005,and in July 2005.Analyses of their spatial relationships identified two distinct male cliques; some adult males (called "N" males) were more connected to the females and immatures than other adult males ("MU" males),which were more connected to one another.Affiliative interactions were significantly higher among dyads belonging to the same clique than to different cliques.Although frequencies of dyadic agonistic interactions were similarly low among individuals within and between cliques,MU males appeared to be subordinate to N males.Nonetheless,there were no significant differences in the copulation rates estimated for MU males and N males.Mutual benefits of cooperation between MU and N cliques in intergroup encounters might explain their ongoing associations in the same mixed-sex group [Current Zoology 58 (2):342-352,2012].
Roth, Mara Y; Amory, John K
Nearly half of all pregnancies worldwide are unplanned, despite numerous contraceptive options available. No new contraceptive method has been developed for men since the invention of condom. Nevertheless, more than 25% of contraception worldwide relies on male methods. Therefore, novel effective methods of male contraception are of interest. Herein we review the physiologic basis for both male hormonal and nonhormonal methods of contraception. We review the history of male hormonal contraception development, current hormonal agents in development, as well as the potential risks and benefits of male hormonal contraception options for men. Nonhormonal methods reviewed will include both pharmacological and mechanical approaches in development, with specific focus on methods which inhibit the testicular retinoic acid synthesis and action. Multiple hormonal and nonhormonal methods of male contraception are in the drug development pathway, with the hope that a reversible, reliable, safe method of male contraception will be available to couples in the not too distant future. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Singh, Babu; Keaney, Terrence; Rossi, Anthony M
Men are increasingly turning to dermatologists and plastic surgeons to request procedures that correct or enhance physical features. With the advent of this emerging new patient population, alterations in preexisting aesthetic techniques, gender-specific uses of existing devices and overall approaches need to be revisited and adapted to obtain results that are suitable for the male patient. Recently, body contouring has become one of the most sought out procedures by men. Although the majority of clinical studies involving body contouring esthetics are performed with female patients, gains from such studies can be extrapolated to men. Body contouring can be broadly classified as non-invasive or invasive, depending on the modality used. Non-invasive contouring is most frequently performed with devices that target subcutaneous adipose with focused electrical or thermal energy, including low-level laser, cryolipolysis, ultrasonography, and radiofrequency. Invasive body contouring modalities useful for male body contouring include liposuction, pectoral and abdominal wall etching, jawline fillers, synthetic deoxycholic acid injections, and solid silicone implants. The purpose of this review is to bring attention to the unique aspects, strategies, and modalities used in aesthetic body contouring for the male patient.
Full Text Available The aim of hormonal male contraception is to prevent unintended pregnancies by suppressing spermatogenesis. Hormonal male contraception is based on the principle that exogenous administration of androgens and other hormones such as progestins suppress circulating gonadotropin concentrations, decreasing testicular Leydig cell and Sertoli cell activity and spermatogenesis. In order to achieve more complete suppression of circulating gonadotropins and spermatogenesis, a progestin has been added testosterone to the most recent efficacy trials of hormonal male contraceptives. This review focusses on the potential effects of male hormonal contraceptives on cardiovascular risk factors, lipids and body composition, mainly in the target group of younger to middle-aged men. Present data suggest that hormonal male contraception can be reasonably regarded as safe in terms of cardiovascular risk. However, as all trials have been relatively short (< 3 years, a final statement regarding the cardiovascular safety of hormonal male contraception, especially in long-term use, cannot be made. Older men with at high risk of cardiovascular event might not be good candidates for hormonal male contraception. The potential adverse effects of hormonal contraceptives on cardiovascular risk appear to depend greatly on the choice of the progestin in regimens for hormonal male contraceptives. In the development of prospective hormonal male contraception, data on longer-term cardiovascular safety will be essential.
Luo, Gangming; Houston, Vern L; Mussman, Martin; Garbarini, Maryanne; Beattie, Aaron C; Thongpop, Chaiya
Morphological and geometric differences between male and female feet can be the decisive factor of whether well-fitting, functional, and comfortable footwear is available for both men and women. Optical scans, plaster wrap casts, and a set of manual measurements from the right feet of 51 female participants, aged 20 to 59 years (32 +/- 10.2 years), and 39 male participants, aged 22 to 71 years (47.1 +/- 12.1 years), were taken to determine which parameters were the most significant in characterizing pedal geometry and which had the largest difference between male and female feet. Analysis showed that the heel-to-ball length (ball length) of the male participants' feet (181.5 mm) was significantly longer, on average, than that of the female participants' feet (165.0 mm). The width of the male paticipants' feet at the ball, instep, and heel regions, as well as the ball circumference, normalized by the ball length, were all significantly larger on average, than the female test participants' feet. However, toe region, instep, and medial and lateral malleoli heights were larger, on average, for the female participants than for the male. The results show that female feet differ in size and shape from male feet and are not algebraically scaled, smaller versions of male feet, as is often assumed. The study shows that the average male participants' feet are longer than that of the female participants' feet, while the female feet are relatively narrower but higher than those of the male participants.
One of the hottest growing segments of the romance genre is male-on-male (M/M) romance--gay romantic fiction mostly written and read by straight women. Featuring traditional romance conventions, including mistaken identities, star-crossed lovers, and happy endings, these stories show both physical and emotional intimacy between men. M/M builds on…
Morrell, Stephen; Page, Andrew N; Taylor, Richard J
Since the late 1990s there has been a sharp downward trend in Australian young male suicide. It is possible that a major government youth suicide prevention initiative, the National Youth Suicide Prevention Strategy (NYSPS), implemented during 1995-1999 may have influenced the decline. In this article, we examine time trends in age- and means-specific male and female Australian suicide rates in relation to unemployment rates and the NYSPS. Based on Australian suicide data over the period 1966-2003, we assess secular changes in the 20-24 year male suicide to total (crude) male suicide rate ratio in relation to the NYSPS, using interrupted time series analysis (ARIMA), since this was previously found to be significantly associated with the 20-24 year male unemployment to total employment ratio. Results show that a dramatic reduction in Australian young male (aged 20-34 years) suicide has occurred since 1997-1998, declining from approximately 40 per 100,000 in 1997-1998 to approximately 20 per 100,000 in 2003. Most of the decline is due to a decrease in suicide by hanging and to a lesser extent from motor vehicle carbon monoxide and other gases. Further, the previously established strong secular association (lasting over 3 decades from 1966) between the rate ratio of 20-24 year male suicide to total (crude) male suicide, and the rate ratio of 20-24 year male unemployment to total unemployment, appears to have been disrupted. ARIMA modelling of the suicide ratio against the initiative indicates a highly significant statistical association between the NYSPS and the suicide ratio reduction but not between the NYSPS and the unemployment indicator trend, suggesting a break in the link between young male suicide and unemployment. The recent sudden turnaround in Australian young male suicide trends and its extent appears to preclude explanations centring on slow-moving social indices traditionally associated with suicide, or on possible cohort effects. This sudden decrease
Marcos TOKUDA, Jean P. BOUBLI, Patrícia IZAR, Karen B. STRIER
Full Text Available Analyses of spatial relationships and social interactions provide insights into the social structure of animal societies and the ways in which social preferences among and between dyads affect higher order social relationships. In this paper we describe the patterns of spatial associations and social interactions among adult male northern muriquis in order to evaluate the dynamics of their social networks above the dyadic levels. Systematic observations were made on the 17 adult males present in a multi-male/multi-female group from April 2004 through February 2005, and in July 2005. Analyses of their spatial relationships identified two distinct male cliques; some adult males (called “N” males were more connected to the females and immatures than other adult males (“MU” males, which were more connected to one another. Affiliative interactions were significantly higher among dyads belonging to the same clique than to different cliques. Although frequencies of dyadic agonistic interactions were similarly low among individuals within and between cliques, MU males appeared to be subordinate to N males. Nonetheless, there were no significant differences in the copulation rates estimated for MU males and N males. Mutual benefits of cooperation between MU and N cliques in intergroup encounters might explain their ongoing associations in the same mixed-sex group [Current Zoology 58 (2: 342-352, 2012].
The sterile insect technique (SIT is increasingly used to control pest insect populations. The success of SIT control programs depends on the ability to release sterile males and on the capacity of sterile males to compete with wild males to inseminate wild females. In this study, we evaluated the mating performance of Schistocerca gregaria (Försk. males irradiated with 4 Gray. We compared reproductive traits, such as duration of precopulation time, mating duration, quantity of sperm stored by females after copulation, number of females mated successively and postmating competition of irradiated males with non-irradiated males. Irradiated males were able to mate but the resulting number of offspring was dramatically reduced compared to the average number of offspring observed during a regular mating. During a single copulation, irradiated males transferred fewer sperm than regular males but, theoretically, this quantity is enough to fertilize all the eggs produced by a female during its reproductive life. Irradiated males also had the ability to remove sperm from a previous mating with unirraditated males. This new information on the mating strategies helps explain the post-copulation guarding behaviour of S. gregaria.
Full Text Available Many animals produce elaborated sexual signals to attract mates, among them are common chemical sexual signals (pheromones with an attracting function. Lizards produce chemical secretions for scent marking that may have a role in sexual selection. In the laboratory, female rock lizards (Iberolacerta cyreni prefer the scent of males with more ergosterol in their femoral secretions. However, it is not known whether the scent-marks of male rock lizards may actually attract females to male territories in the field.In the field, we added ergosterol to rocks inside the territories of male lizards, and found that this manipulation resulted in increased relative densities of females in these territories. Furthermore, a higher number of females were observed associated to males in manipulated plots, which probably increased mating opportunities for males in these areas.These and previous laboratory results suggest that female rock lizards may select to settle in home ranges based on the characteristics of scent-marks from conspecific males. Therefore, male rock lizards might attract more females and obtain more matings by increasing the proportion of ergosterol when scent-marking their territories. However, previous studies suggest that the allocation of ergosterol to secretions may be costly and only high quality males could afford it, thus, allowing the evolution of scent-marks as an honest sexual display.
Martín, José; López, Pilar
Background Many animals produce elaborated sexual signals to attract mates, among them are common chemical sexual signals (pheromones) with an attracting function. Lizards produce chemical secretions for scent marking that may have a role in sexual selection. In the laboratory, female rock lizards (Iberolacerta cyreni) prefer the scent of males with more ergosterol in their femoral secretions. However, it is not known whether the scent-marks of male rock lizards may actually attract females to male territories in the field. Methodology/Principal Findings In the field, we added ergosterol to rocks inside the territories of male lizards, and found that this manipulation resulted in increased relative densities of females in these territories. Furthermore, a higher number of females were observed associated to males in manipulated plots, which probably increased mating opportunities for males in these areas. Conclusions/Significance These and previous laboratory results suggest that female rock lizards may select to settle in home ranges based on the characteristics of scent-marks from conspecific males. Therefore, male rock lizards might attract more females and obtain more matings by increasing the proportion of ergosterol when scent-marking their territories. However, previous studies suggest that the allocation of ergosterol to secretions may be costly and only high quality males could afford it, thus, allowing the evolution of scent-marks as an honest sexual display. PMID:22253895
Jeffrey S McKinnon
Full Text Available Studies of mating preferences and pre-mating reproductive isolation have often focused on females, but the potential importance of male preferences is increasingly appreciated. We investigated male behavior in the context of reproductive isolation between divergent anadromous and stream-resident populations of threespine stickleback, Gasterosteus aculeatus, using size-manipulated females of both ecotypes. Specifically, we asked if male courtship preferences are present, and if they are based on relative body size, non-size aspects of ecotype, or other traits. Because male behaviors were correlated with each other, we conducted a principal components analysis on the correlations and ran subsequent analyses on the principal components. The two male ecotypes differed in overall behavioral frequencies, with stream-resident males exhibiting consistently more vigorous and positive courtship than anadromous males, and an otherwise aggressive behavior playing a more positive role in anadromous than stream-resident courtship. We observed more vigorous courtship toward smaller females by (relatively small stream-resident males and the reverse pattern for (relatively large anadromous males. Thus size-assortative male courtship preferences may contribute to reproductive isolation in this system, although preferences are far from absolute. We found little indication of males responding preferentially to females of their own ecotype independent of body size.
Scott, Kathryn P.
Describes how the traditional, agressive male role has been reinforced by social studies textbooks. The author recommends that teachers teach about new roles for males by presenting images of males in caring, nurturing, and expressive roles. (AM)
Hallmayer, J.; Spiker, D.; Lotspeich, L. [Stanford Univ., CA (United States)] [and others
Despite strong genetic influences in autism, the true mode of inheritance remains unknown. Sex differences in autism have been described in both singleton and multiplex families: boys outnumber girls by 3 or 4 to 1, and so a sex-linked mode of transmission must also be considered. The key characteristic of X-linkage is that all sons of affected men are unaffected (no male-to-male transmission). In the present study, which is part of an ongoing linkage project in autism, we describe 77 multiplex autism families, 11 of who are affected cousin or half-sibling families. By using these families, it is possible to trace the path of genetic transmission and observe whether the hypothesis of X-linkage is tenable. Of 11 extended pedigrees from 77 multiplex families, six show male-to-male transmission; in these families, X-linkage can be excluded as the genetic basis for their autism. The data from the other five families are compatible with either an autosomal or an X-linked mode of transmission. The key point to emerge, then, is that autism cannot be exclusively an X-linked disorder; there must be an autosomal mode of transmission at least in some families. Thus we must consider the alternative hypotheses that autism is either entirely autosomal, or it is genetically heterogeneous, involving at least one autosomal locus with gender-specific expression, as well as a possible locus on the X-chromosome. 28 refs., 1 fig.
Muller, Martin N
Considerable evidence suggests that the steroid hormone testosterone mediates major life-history trade-offs in vertebrates, promoting mating effort at the expense of parenting effort or survival. Observations from a range of wild primates support the "Challenge Hypothesis," which posits that variation in male testosterone is more closely associated with aggressive mating competition than with reproductive physiology. In both seasonally and non-seasonally breeding species, males increase testosterone production primarily when competing for fecund females. In species where males compete to maintain long-term access to females, testosterone increases when males are threatened with losing access to females, rather than during mating periods. And when male status is linked to mating success, and dependent on aggression, high-ranking males normally maintain higher testosterone levels than subordinates, particularly when dominance hierarchies are unstable. Trade-offs between parenting effort and mating effort appear to be weak in most primates, because direct investment in the form of infant transport and provisioning is rare. Instead, infant protection is the primary form of paternal investment in the order. Testosterone does not inhibit this form of investment, which relies on male aggression. Testosterone has a wide range of effects in primates that plausibly function to support male competitive behavior. These include psychological effects related to dominance striving, analgesic effects, and effects on the development and maintenance of the armaments and adornments that males employ in mating competition. Copyright © 2016 Elsevier Inc. All rights reserved.
El Harroudi, T; Tijami, F; El Otmany, A; Jalil, A
Breast cancer occurring in the mammary gland of men is infrequent. It accounts for 0.8% of all breast cancers, which is less than one per cent of all newly diagnosed male cancers and 0.2% of male cancer deaths. However, Paget disease of the male nipple is extremely rare. We report a single case of Paget disease with infiltrative ductal carcinoma of the breast in a 61-year-old man.
Riparbelli, Maria Giovanna; Callaini, Giuliano
The orientation of the mitotic spindle plays a central role in specifying stem cell-renewal by enabling interaction of the daughter cells with external cues: the daughter cell closest to the hub region is instructed to self-renew, whereas the distal one starts to differentiate. Here, we have analyzed male gametogenesis in DSas-4 Drosophila mutants and we have reported that spindle alignment and asymmetric divisions are properly executed in male germline stem cells that lack centrioles. Spermatogonial divisions also correctly proceed in the absence of centrioles, giving rise to cysts of 16 primary spermatocytes. By contrast, abnormal meiotic spindles assemble in primary spermatocytes. These results point to different requirements for centrioles during male gametogenesis of Drosophila. Spindle formation during germ cell mitosis may be successfully supported by an acentrosomal pathway that is inadequate to warrant the proper execution of meiosis. Copyright © 2010 Elsevier Inc. All rights reserved.
Pedersen, A. S.; Berg, Lise Charlotte; Almstrup, Kristian
Tortoiseshell coat color is normally restricted to female cats due to X-linkage of the gene that encodes the orange coat color. Tortoiseshell male cats do, however, occur at a low frequency among tortoiseshell cats because of chromosome aberrations similar to the Klinefelter syndrome in man...... tissue from a tortoiseshell male cat referred to us. Chromosome analysis using RBA-banding consistently revealed a 39,XXY karyotype. Histological examinations of testis biopsies from this cat showed degeneration of the tubules, hyperplasia of the interstitial tissue, and complete loss of germ cells....... Immunostaining using anti-vimentin and anti-VASA (DDX4) showed that only Sertoli cells and no germ cells were observed in the testicular tubules. As no sign of spermatogenesis was detected, we conclude that this is a classic case of a sterile, male tortoiseshell cat with a 39,XXY chromosome complement. © 2013 S...
Stinson, David W.
This article shows how equity research in mathematics education can be decentered by reporting the "voices" of mathematically successful African American male students as they recount their experiences with school mathematics, illustrating, in essence, how they negotiated the White male math myth. Using post-structural theory, the…
Szentirmai, [No Value; Komdeur, J; Szekely, T; Szentirmai, István
Why do females increase parental effort when caring for the offspring of attractive males? First, attractive males may be poor fathers so that their females are compelled to increase their own contribution in order to fledge some young (the partner-compensation hypothesis). Second, females mated to
Zhang Lingbi; Rong Tingzhao; Zhang Caibo; Sichuan Agricultural Univ., Ya'an; Zhu Yingguo; Cao Moju; Sichuan Agricultural Univ., Ya'an; Wuhan Univ., Wuhan
The contents of soluble sugar, starch, protein and free praline in anthers were analyzed and compared between male fertilizable and male sterile induced by space flight at different developmental stages. The results showed that all contents were lower in male sterile anthers than in fertilisable ones. With anther developing, the contents of soluble starch, protein and free proline increased obviously in male fertilizable anthers, but not in sterile ones. (authors)
Yang, Grace S; Huesmann, L Rowell; Bushman, Brad J
Previous research has shown that violent video games can increase aggression in players immediately after they play. The present research examines the effects of one subtle cue within violent video games that might moderate these effects-whether the avatar is male or female. One common stereotype is that males are more aggressive than females. Thus, playing a violent video game as a male avatar, compared to a female avatar, should be more likely to prime aggressive thoughts and inclinations in players and lead to more aggressive behavior afterwards. Male and female university students (N = 242) were randomly assigned to play a violent video game as a male or female avatar. After gameplay, participants gave an ostensible partner who hated spicy food hot sauce to eat. The amount of hot sauce given was used to measure aggression. Consistent with priming theory, results showed that both male and female participants who played a violent game as a male avatar behaved more aggressively afterwards than those who played as female avatar. The priming effects of the male avatar were somewhat stronger for male participants than for female participants, suggesting that male participants identified more with the male avatar than did the female participants. These results are particularly noteworthy because they are consistent with another recent experiment showing that playing a violent game as an avatar with a different stereotypically aggressive attribute (black skin color) stimulates more aggression than playing as an avatar without the stereotypically aggressive attribute (Yang et al., 2014, Social Psychological and Personality Science). © 2014 Wiley Periodicals, Inc.
Miklos, John R; Chinthakanan, Orawee; Moore, Robert D; Mitchell, Gretchen K; Favors, Sheena; Karp, Deborah R; Northington, Gina M; Nogueiras, Gladys M; Davila, G Willy
The objective was to report patterns of sling and transvaginal mesh-related complications using the IUGA/ICS classification of prosthesis-related complications. This was a retrospective chart review of all patients who underwent surgical removal of sling, transvaginal mesh, and sacrocolpopexy for mesh-related complications from 2011 to 2013 at three tertiary referral centers. The International Urogynecological Association (IUGA)/International Continence Society (ICS) classification system was utilized. We identified 445 patients with mesh complications, 506 pieces of synthetic mesh were removed, and 587 prostheses-related complications were classified. 3.7 % of patients had viscus organ penetration or vaginal exposure as their presenting chief complaint and 59.7 % were classified as not having any vaginal epithelial separation or category 1. The most common category was spontaneous pain (1Be: 32.5 %) followed by dyspareunia (1Bc: 14.7 %). The sling group was 20 % more likely to have pain compared with the pelvic organ prolapse (POP) mesh group (OR 1.2, 95 % CI 0.8-1.6). The most commonly affected site (S2) was away from the suture line (49 %). Compared with the sling group, the POP group had a higher rate of mesh exposure, which mostly occurred at the suture line area. The majority of patients presented with mesh-related complications more than 1 year post-insertion (T4; average 3.68 ± 2.47 years). Surgeons should be aware that patients with vaginal mesh complications routinely exhibit complications more than 1 year after the implantation with pain as the most common presenting symptom.
Cavkaytar, Sabri; Kokanalı, Mahmut Kuntay; Guzel, Ali Irfan; Ozer, Irfan; Aksakal, Orhan Seyfi; Doganay, Melike
To compare the change of urethral mobility after midurethral sling procedures in stress urinary incontinence with hypermobile urethra and assess these findings with surgical outcomes. 141 women who agreed to undergo midurethral sling operations due to stress urinary incontinence with hypermobile urethra were enrolled in this non-randomized prospective observational study. Preoperatively, urethral mobility was measured by Q tip test. All women were asked to complete Urogenital Distress Inventory Short Form (UDI-6) and Incontinence Impact Questionnaire Short Form (IIQ-7) to assess the quality of life. Six months postoperatively, Q tip test and quality of life assessment were repeated. The primary surgical outcomes were classified as cure, improvement and failure. Transient urinary obstruction, de novo urgency, voiding dysfunction were secondary surgical outcomes. Of 141 women, 50 (35. 5%) women underwent TOT, 91 (64.5%) underwent TVT. In both TOT and TVT groups, postoperative Q tip test values, IIQ-7 and UDI-6 scores were statistically reduced when compared with preoperative values. Postoperative Q tip test value in TVT group was significantly smaller than in TOT group [25°(15-45°) and 20° (15-45°), respectively]. When we compared the Q-tip test value, IIQ-7 and UDI-6 scores changes, there were no statistically significant changes between the groups. Postoperative urethral mobility was more frequent in TOT group than in TVT group (40% vs 23.1%, respectively). Postoperative primary and secondary outcomes were similar in both groups. Although midurethral slings decrease the urethtal hypermobility, postoperative mobility status of urethra does not effect surgical outcomes of midurethral slings in women with preoperative urethral hypermobility. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Chang, Zhenyi; Chen, Zhufeng; Wang, Na; Xie, Gang; Lu, Jiawei; Yan, Wei; Zhou, Junli; Tang, Xiaoyan; Deng, Xing Wang
The breeding and large-scale adoption of hybrid seeds is an important achievement in agriculture. Rice hybrid seed production uses cytoplasmic male sterile lines or photoperiod/thermo-sensitive genic male sterile lines (PTGMS) as female parent. Cytoplasmic male sterile lines are propagated via cross-pollination by corresponding maintainer lines, whereas PTGMS lines are propagated via self-pollination under environmental conditions restoring male fertility. Despite huge successes, both systems have their intrinsic drawbacks. Here, we constructed a rice male sterility system using a nuclear gene named Oryza sativa No Pollen 1 (OsNP1). OsNP1 encodes a putative glucose-methanol-choline oxidoreductase regulating tapetum degeneration and pollen exine formation; it is specifically expressed in the tapetum and miscrospores. The osnp1 mutant plant displays normal vegetative growth but complete male sterility insensitive to environmental conditions. OsNP1 was coupled with an α-amylase gene to devitalize transgenic pollen and the red fluorescence protein (DsRed) gene to mark transgenic seed and transformed into the osnp1 mutant. Self-pollination of the transgenic plant carrying a single hemizygous transgene produced nontransgenic male sterile and transgenic fertile seeds in 1:1 ratio that can be sorted out based on the red fluorescence coded by DsRed Cross-pollination of the fertile transgenic plants to the nontransgenic male sterile plants propagated the male sterile seeds of high purity. The male sterile line was crossed with ∼1,200 individual rice germplasms available. Approximately 85% of the F1s outperformed their parents in per plant yield, and 10% out-yielded the best local cultivars, indicating that the technology is promising in hybrid rice breeding and production.
Dominic A Edward
Full Text Available Male mate choice has been reported in the fruit fly, Drosophila melanogaster, even though males of this species were previously thought to maximise their fitness by mating with all available females. To understand the evolution of male mate choice it is important to understand variation in male mating preferences. Two studies, using different stock populations and different methods, have reported contrasting patterns of variation in male mate choice in D. melanogaster. Two possible explanations are that there are evolved differences in each stock population or that the methods used to measure choice could have biased the results. We investigated these hypotheses here by repeating the methods used in one study in which variable male mate choice was found, using the stock population from the other study in which choice was not variable. The results showed a significant resource-independent male preference for less fecund, smaller females, which contrasts with previous observations of male mate choice. This indicates that different selection pressures between populations have resulted in evolved differences in the expression of male mate choice. It also reveals phenotypic plasticity in male mate choice in response to cues encountered in each choice environment. The results highlight the importance of variation in male mate choice, and of identifying mechanisms in order to understand the evolution of mate choice under varying ecological conditions.
One explanation for the cost to mating for females caused by damaging male mating behavior is that this causes the females to adaptively modify their subsequent life histories in a way that also increases male fitness. This might occur because the reduction in residual reproductive value of the
van der Hulst, R.G.M.; Meirmans, P.G.; van Tienderen, P.H.; van Damme, J.M.M.
Male-sterility was found in diploid dandelions from two widely separated populations from France, and its inheritance was analysed by crossing a diploid male-sterile dandelion to diploid sexuals and triploid apomicts. Nuclear genetic variation, found in full-sib families, segregated for male
Yang, Taehong; Yang, Cindy F; Chizari, M Delara; Maheswaranathan, Niru; Burke, Kenneth J; Borius, Maxim; Inoue, Sayaka; Chiang, Michael C; Bender, Kevin J; Ganguli, Surya; Shah, Nirao M
How environmental and physiological signals interact to influence neural circuits underlying developmentally programmed social interactions such as male territorial aggression is poorly understood. We have tested the influence of sensory cues, social context, and sex hormones on progesterone receptor (PR)-expressing neurons in the ventromedial hypothalamus (VMH) that are critical for male territorial aggression. We find that these neurons can drive aggressive displays in solitary males independent of pheromonal input, gonadal hormones, opponents, or social context. By contrast, these neurons cannot elicit aggression in socially housed males that intrude in another male's territory unless their pheromone-sensing is disabled. This modulation of aggression cannot be accounted for by linear integration of environmental and physiological signals. Together, our studies suggest that fundamentally non-linear computations enable social context to exert a dominant influence on developmentally hard-wired hypothalamus-mediated male territorial aggression. Copyright © 2017 Elsevier Inc. All rights reserved.
Clifton, Marisa M; Goldman, Howard B
In the developed world, urethrovaginal fistulas are most the likely the result of iatrogenic injury. These fistulas are quite rare. Proper surgical repair requires careful dissection and tension-free closure. The objective of this video is to demonstrate the identification and surgical correction of an urethrovaginal fistula. The case presented is of a 59-year-old woman with a history of pelvic organ prolapse and symptomatic stress urinary incontinence who underwent vaginal hysterectomy, anterior colporrhaphy, posterior colporrhaphy, and synthetic sling placement. Postoperatively, she developed a mesh extrusion and underwent sling excision. After removal of her synthetic sling, she began to experience continuous urinary incontinence. Physical examination and cystourethroscopy demonstrated an urethrovaginal fistula at the midurethra. Options were discussed and the patient wished to undergo transvaginal fistula repair. The urethrovaginal fistula was intubated with a Foley catheter. The fistula tract was isolated and removed. The urethra was then closed with multiple tension-free layers. This video demonstrates several techniques for identifying and subsequently repairing an urethrovaginal fistula. Additionally, it demonstrates the importance of tension-free closure. Urethrovaginal fistulas are rare. They should be repaired with careful dissection and tension-free closure.
Plavcan, J Michael
Sexual size dimorphism is generally associated with sexual selection via agonistic male competition in nonhuman primates. These primate models play an important role in understanding the origins and evolution of human behavior. Human size dimorphism is often hypothesized to be associated with high rates of male violence and polygyny. This raises the question of whether human dimorphism and patterns of male violence are inherited from a common ancestor with chimpanzees or are uniquely derived. Here I review patterns of, and causal models for, dimorphism in humans and other primates. While dimorphism in primates is associated with agonistic male mate competition, a variety of factors can affect male and female size, and thereby dimorphism. The causes of human sexual size dimorphism are uncertain, and could involve several non-mutually-exclusive mechanisms, such as mate competition, resource competition, intergroup violence, and female choice. A phylogenetic reconstruction of the evolution of dimorphism, including fossil hominins, indicates that the modern human condition is derived. This suggests that at least some behavioral similarities with Pan associated with dimorphism may have arisen independently, and not directly from a common ancestor.
William F N Chan
Full Text Available In humans, naturally acquired microchimerism has been observed in many tissues and organs. Fetal microchimerism, however, has not been investigated in the human brain. Microchimerism of fetal as well as maternal origin has recently been reported in the mouse brain. In this study, we quantified male DNA in the human female brain as a marker for microchimerism of fetal origin (i.e. acquisition of male DNA by a woman while bearing a male fetus. Targeting the Y-chromosome-specific DYS14 gene, we performed real-time quantitative PCR in autopsied brain from women without clinical or pathologic evidence of neurologic disease (n=26, or women who had Alzheimer's disease (n=33. We report that 63% of the females (37 of 59 tested harbored male microchimerism in the brain. Male microchimerism was present in multiple brain regions. Results also suggested lower prevalence (p=0.03 and concentration (p=0.06 of male microchimerism in the brains of women with Alzheimer's disease than the brains of women without neurologic disease. In conclusion, male microchimerism is frequent and widely distributed in the human female brain.
Full Text Available Objective: To examine the potential effects of lifestyle factors on male reproductive health. Evidence of a global decline in human sperm quality over recent decades has been accumulating. Environmental, occupational, and modifiable lifestyle factors may contribute to this decline. This review focuses on key lifestyle factors that are associated with male infertility such as smoking cigarettes, alcohol intake, use of illicit drugs, obesity, psychological stress, advanced paternal age, dietary practices, and coffee consumption. Other factors such as testicular heat stress, intense cycling training, lack of sleep and exposure to electromagnetic radiation from mobile phone use are briefly discussed. Materials and method: A comprehensive literature search was performed to identify and synthesise all relevant information, mainly from within the last decade, on the major lifestyle factors associated with male infertility and semen quality. Database searches were limited to reports published in English only. A manual search of bibliographies of the reports retrieved was conducted to identify additional relevant articles. Results: In all, 1012 articles were identified from the database search and after reviewing the titles and abstract of the reports, 104 articles met the inclusion criteria. Of these, 30 reports were excluded as the full-text could not be retrieved and the abstract did not have relevant data. The remaining 74 reports were reviewed for data on association between a particular lifestyle factor and male infertility and were included in the present review. Conclusion: The major lifestyle factors discussed in the present review are amongst the multiple potential risk factors that could impair male fertility. However, their negative impact may well be mostly overcome by behaviour modification and better lifestyle choices. Greater awareness and recognition of the possible impact of these lifestyle factors are important amongst couples seeking
Armitage, S.; Boomsma, J.; Baer, Boris
1. In haplodiploid social insects where males are haploid and females are diploid, inbreeding depression is expressed as the production of diploid males when homozygosity at the sex-determining locus results in the production of diploid individuals with a male phenotype. Diploid males are often a...
Umbers, Kate D. L.; Tatarnic, Nikolai J.; Holwell, Gregory I.; Herberstein, Marie E.
Contests among individuals over mating opportunities are common across diverse taxa, yet physical conflict is relatively rare. Due to the potentially fatal consequences of physical fighting, most animals employ mechanisms of conflict resolution involving signalling and ritualistic assessment. Here we provide the first evidence of ubiquitous escalated fighting in grasshoppers. The chameleon grasshopper (Kosciuscola tristis) is an Australian alpine specialist, in which males engage in highly aggressive combat over ovipositing females. We describe discrete agonistic behaviours including mandible flaring, mounting, grappling, kicking and biting, and their use depending on the individual’s role as challenger or defender. We show that male role predicts damage, with challengers being more heavily damaged than males defending females (defenders). Challengers also possess wider mandibles than defenders, but are similar in other metrics of body size. Our data suggest that fights escalate between males matched in body size and that mandibles are used as weapons in this species. This system represents an exciting opportunity for future research into the evolution of costly fighting behaviour in an otherwise placid group. PMID:23166725
Kate D L Umbers
Full Text Available Contests among individuals over mating opportunities are common across diverse taxa, yet physical conflict is relatively rare. Due to the potentially fatal consequences of physical fighting, most animals employ mechanisms of conflict resolution involving signalling and ritualistic assessment. Here we provide the first evidence of ubiquitous escalated fighting in grasshoppers. The chameleon grasshopper (Kosciuscola tristis is an Australian alpine specialist, in which males engage in highly aggressive combat over ovipositing females. We describe discrete agonistic behaviours including mandible flaring, mounting, grappling, kicking and biting, and their use depending on the individual's role as challenger or defender. We show that male role predicts damage, with challengers being more heavily damaged than males defending females (defenders. Challengers also possess wider mandibles than defenders, but are similar in other metrics of body size. Our data suggest that fights escalate between males matched in body size and that mandibles are used as weapons in this species. This system represents an exciting opportunity for future research into the evolution of costly fighting behaviour in an otherwise placid group.
Lee, Courtland C.
This series of five interrelated modules is an update and revision of "Saving the Native Son: Empowerment Strategies for Young Black Males (1996)." It offers specific strategies for empowering young African American males to help them achieve optimal educational and social success. Empowerment is a developmental process by which people who are…
Full Text Available Background: Polyscias fruticosa is used widely as food, disease remedy and as an ornamental across Afro-Asian countries. For instance, P. fruticosa is used traditionally as an anti-asthma, anti-tussive, and a muco-suppressant herbal remedy for asthmatics in Ghana. Although many studies have investigated the pharmacological basis of the ethnobotanical uses of P. fruticosa, however, its effect on the reproductive system remains completely unknown. Aim of study: This study assessed effects of Polyscias fruticosa leaf extract (PFE on male fertility and toxicity in adult male Wistar rats. Materials and methods: after crude preparation of PFE, it was subjected to qualitative phytochemical, thin layer chromatography (TLC and gas chromatography mass spectrometry (GC-MS analyses. Effect of PFE was assessed on male fertility and toxicity by using healthy adult male Wistar rats. Rats were randomly assigned to: normal saline (5 ml/kg po, n = 5, Clomiphene Citrate (50 mg/kg po; n = 5 and PFE (100, 200 and 500 mg/kg po; n = 5 respectively groups and treated for 21 days. On day 22 rats were sacrificed and male fertility parameters (left testis weight, relative testis weight, caudal epididymal weight, caudal epididymal sperm count, sperm motility, sperm morphology and assessment of male sex hormones and testicular histology were assessed. Results: There were no significant changes in bodyweight, weight of left testis, weights of right and left caudal epididymides between treatments groups (PFE and clomiphene citrate and control. Caudal epididymal sperm count increased in PFE (100 and 500 mg/kg-treated rats relative to control. Sperm motility relatively increased in PFE-treated rats compared to control. Sperm abnormality decreased in PFE-treated rats; especially in PFE (100 mg/kg group compared to control. Serum testosterone levels decreased inversely with serum luteinizing hormone (LH levels in PFE-treated rats compared to control. There were minimal
Diaz, A M
In late 1997, PROFAMILIA began a study of the role of male sexual and reproductive rights as part of the construction of new masculine identities. The work was approached from the disciplines of law and sociology. Patriarchy, as a system of domination, permeated most cultures, giving men a position of power in relation to women and leading to a series of violent and self-destructive male behaviors. The patriarchal system imposed aggressive, promiscuous, risky, and irresponsible behaviors on men, which created a climate for sexual abuse, unwanted pregnancy, propagation of sexually transmitted diseases, and violence against women. Changes in female roles have created the need for changes in male roles. The most visible sexual and reproductive needs of men were studied through literature reviews and semistructured questionnaires with PROFAMILIA clients. Among the needs identified were a new type of male participation in family and domestic life, a new content for male sexual freedom, greater participation of men in reproductive decisions and in raising their children, and new ways of relating to others and sharing feelings and emotions. The need to avoid behaviors that put health at risk was also identified. A review of the evolution of existing sexual and reproductive rights and of the documents that constitute their ethical and juridical framework led to the conclusion that the construction of new rights specifically for men is not necessary, or juridically possible, in the current historical context.
Andrea Camperio Ciani
Full Text Available Several lines of evidence indicate the existence of genetic factors influencing male homosexuality and bisexuality. In spite of its relatively low frequency, the stable permanence in all human populations of this apparently detrimental trait constitutes a puzzling 'Darwinian paradox'. Furthermore, several studies have pointed out relevant asymmetries in the distribution of both male homosexuality and of female fecundity in the parental lines of homosexual vs. heterosexual males. A number of hypotheses have attempted to give an evolutionary explanation for the long-standing persistence of this trait, and for its asymmetric distribution in family lines; however a satisfactory understanding of the population genetics of male homosexuality is lacking at present. We perform a systematic mathematical analysis of the propagation and equilibrium of the putative genetic factors for male homosexuality in the population, based on the selection equation for one or two diallelic loci and Bayesian statistics for pedigree investigation. We show that only the two-locus genetic model with at least one locus on the X chromosome, and in which gene expression is sexually antagonistic (increasing female fitness but decreasing male fitness, accounts for all known empirical data. Our results help clarify the basic evolutionary dynamics of male homosexuality, establishing this as a clearly ascertained sexually antagonistic human trait.
There are many examples of male mate choice for female traits that tend to be associated with high fertility. I develop quantitative genetic models of a female trait and a male preference to show when such a male preference can evolve. I find that a disagreement between the fertility maximum and the viability maximum of the female trait is necessary for directional male preference (preference for extreme female trait values) to evolve. Moreover, when there is a shortage of available male partners or variance in male nongenetic quality, strong male preference can evolve. Furthermore, I also show that males evolve to exhibit a stronger preference for females that are more feminine (less resemblance to males) than the average female when there is a sexual dimorphism caused by fertility selection which acts only on females.
Miyamoto, Toshinobu; Tsujimura, Akira; Miyagawa, Yasushi; Koh, Eitetsu; Namiki, Mikio; Sengoku, Kazuo
Infertility is one of the most serious social problems facing advanced nations. In general, approximate half of all cases of infertility are caused by factors related to the male partner. To date, various treatments have been developed for male infertility and are steadily producing results. However, there is no effective treatment for patients with nonobstructive azoospermia, in which there is an absence of mature sperm in the testes. Although evidence suggests that many patients with male infertility have a genetic predisposition to the condition, the cause has not been elucidated in the vast majority of cases. This paper discusses the environmental factors considered likely to be involved in male infertility and the genes that have been clearly shown to be involved in male infertility in humans, including our recent findings.
Full Text Available Infertility is one of the most serious social problems facing advanced nations. In general, approximate half of all cases of infertility are caused by factors related to the male partner. To date, various treatments have been developed for male infertility and are steadily producing results. However, there is no effective treatment for patients with nonobstructive azoospermia, in which there is an absence of mature sperm in the testes. Although evidence suggests that many patients with male infertility have a genetic predisposition to the condition, the cause has not been elucidated in the vast majority of cases. This paper discusses the environmental factors considered likely to be involved in male infertility and the genes that have been clearly shown to be involved in male infertility in humans, including our recent findings.
Full Text Available We present the case of a boy with a clinical diagnosis of Goltz syndrome (focal dermal hypoplasia, a rare genodermatosis characterized by widespread dysplasia of mesodermal and ectodermal tissues. A 9-year-old male patient with Goltz syndrome presented with typical skin lesions along with progressive dimness of vision and mental retardation since birth. It is inherited in an X-linked dominant fashion and is normally lethal in male patients, and so very few male patients, like the index case, have been reported.
Smith Mark EF
Full Text Available Abstract Background Neurofibroma of the male breast outside of neurofibromatosis is extremely rare with only one previous case having been reported. Case presentation A 48 year old male patient with a neurofibroma in the breast presenting with gynaecomastia is reported. Clinical and mammogram findings with fine needle aspiration cytology and full histology are presented. Conclusion To our knowledge this is only the second case of a neurofibroma in a male breast in the English literature and the first report to include the mammographic findings.
Heinze, Jürgen; Künholz, S.; Schilder, K.; Hölldobler, B.
Ergatoid males of the ant, Cardiocondyla nuda, attack and frequently kill young males during or shortly after eclosion. Smaller colonies therefore contain typically only one adult male, which may inseminate all alate queens which are reared in the colony over a few weeks. In larger colonies, several males may be present, however, fighting among adult males was not observed. We discuss the significance of male fighting behavior in ants.
Jones, Bryan A; Watson, Neil V
Masculinization of the developing rodent brain critically depends on the process of aromatization of circulating testosterone (T) to its estrogenic metabolite 17beta-estradiol, which subsequently interacts with estrogen receptors to permanently masculinize the brain. However, it remains unclear what role other androgenic mechanisms may play in the process of masculinization. A novel way of examining this is through the study of male rats that express the tfm mutation of the androgen receptor (AR) gene; such males are fully androgen insensitive and manifest a female phenotype due to a failure of AR-mediated masculinization of peripheral structures. Because tfm-affected males develop secretory testes and have near-normal T titers during development, aromatization would be expected to proceed normally, and brain mechanisms may be developmentally masculinized despite the feminized periphery. We compared tfm-affected males (X(tfm)Y) with normal males and females in the Morris Water Maze, a task in which males typically perform better than females. Performance of tfm-affected males was intermediate between that of normal males and females. While an overall male superiority was found in the task, the X(tfm)Y group reached male-typical escape latencies faster than females. Furthermore, in the X(tfm)Y group, the granule cell layer of the dentate gyrus was significantly larger than in females. These results support the suggestion that that AR mediated mechanisms contribute to the masculinization of spatial behaviours and hippocampal morphology, and this may be independent of estrogenic processes.
Carrier, J M
Some aspects of the mestizoized urban culture in Mexico are linked to male homosexuality in support of the theory that cultural factors play an important role in the kind of life styles and sex practices of males involved in homosexual behavior. The following factors are considered relevant: the sharp dichotomization of gender roles, dual categorization of females as good or bad, separate social networks maintained by males before and after marriage, proportion of unmarried males, and distribution of income. One result of the sharp dichotomization of male and female gender roles is the widely held belief that effeminate males generally prefer to play the female role rather than the male. Effeminacy and homosexuality are also linked by the belief that as a result of this role preference effeminate males are sexually interested only in masculine males with whom they play the passive sex role. The participation of masculine males in homosexual encounters is related in part to a relatively high level of sexual awareness in combination with the lack of stigmatization of the insertor sex role and in part to the restraints placed on alternative sexual outlets by available income and/or marital status. Males involved in homosexual behavior in Mexico operate in a sociocultural environment which gives rise to expectations that they should play either the insertee or insertor sex role but not both and that they should obtain ultimate sexual satisfaction with anal intercourse rather than fellatio. In spite of cultural imperatives, however, individual preferences stemming from other variables such as personality needs, sexual gratification, desires of wanted partners, and amount of involvement may override the imperatives with resulting variations in sexual behavior patterns.
Joshua D Ring
Full Text Available Male factor contributes to 50%-60% of overall infertility but is solely responsible in only 20% of couples. Although most male factor infertility is ascertained from an abnormal semen analysis, other male factors can be contributory especially if the sample returns normal. Male infertility can be due to identifiable hormonal or anatomical etiologies that may be reversible or irreversible. This manuscript will highlight existing guidelines and our recommendations for hormone evaluation for male infertility and empiric therapies including multivitamins, estrogen receptor modulators (clomiphene, estrogen conversion blockers (anastrozole, and hormone replacement.
Chotirmall, S H
Infertility rates among males with cystic fibrosis (CF) approximate 97%. No information is currently available within Ireland determining an understanding of fertility issues and the best methods of information provision to this specialized group. This study aimed to determine understanding and preferred approaches to information provision on fertility issues to Irish CF males. A Descriptive Study utilizing prospective coded questionnaires was mailed to a male CF cohort (n=50). Sections included demographics, fertility knowledge & investigation. Response rate was 16\\/50 (32%). All were aware that CF affected their fertility. More than two-thirds (n=11) were able to provide explanations whilst only one-third (n=5) provided the correct explanation. Significant numbers stated thoughts of marriage and a future family. Half have discussed fertility with a healthcare professional (HCP). Mean age of discussion was 21.9 years. One third preferred an earlier discussion. The commonest first source for information was written material which was also the preferred source. Three-quarters requested further information preferring again, written material. Significant gaps in sex education of Irish CF males exist. Discussion should be initiated by HCPs and centre-directed written material devised to address deficiencies.
Aleshia L. Fremgen; Christopher P. Hansen; Mark A. Rumble; R. Scott Gamo; Joshua J. Millspaugh
It is unlikely all male sage-grouse are detected during lek counts, which could complicate the use of lek counts as an index to population abundance. Understanding factors that influence detection probabilities will allow managers to more accurately estimate the number of males present on leks. We fitted 410 males with global positioning system and very high...
Puebla, C.; Sainz, J.M.; Pujala, M.; Villavieja, J.L.
To review the specific radiological signs of male breast pathology observed in our center over the past five years, as well as the pertinent medical literature. A retrospective study was carried out of the 47 mammographic studies performed in 41 men. Oblique mediolateral and craniocaudal views were employed. The distribution of different types of male breast pathology among our patients was as follows: gynecomastia was detected in 30 cases (73.1%), pseudogynectomastia in 4 (9.7%), carcinoma in 3(7.3%), abscess in 2 (4.9%), lipoma in 1 (2.5%) and epidermoid cyst in the remaining patient (2.5%). The results obtained agree with those reported in the literature reviewed. The most significant findings were the low incidence of carcinoma and the high rate of gynecomastia. (Author) 26 refs
L P Deodbar
Full Text Available Semen examination with special reference to semen analysis and culture for Ureaplasma urealyticum was carried out in 50 male infertile patients in the age group of 25 to 40 years, attending a private infertility clinic. Isolation of Ureaplasma urealyticum in 14 (28% patients and the abnormalities in count and motility of spermatozoa suggest that ureaplasmas may play a role in human male infertility.
Inke van der SLUIJS, Peter D. DIJKSTRA, Charlotte M. LINDEYER et al.
Full Text Available Both inter- and intrasexual selection have been implicated in the origin and maintenance of species-rich taxa with diverse sexual traits. Simultaneous disruptive selection by female mate choice and male-male competition can, in theory, lead to speciation without geographical isolation if both act on the same male trait. Female mate choice can generate discontinuities in gene flow, while male-male competition can generate negative frequency-dependent selection stabilizing the male trait polymorphism. Speciation may be facilitated when mating preference and/or aggression bias are physically linked to the trait they operate on. We tested for genetic associations among female mating preference, male aggression bias and male coloration in the Lake Victoria cichlid Pundamilia. We crossed females from a phenotypically variable population with males from both extreme ends of the phenotype distribution in the same population (blue or red. Male offspring of a red sire were significantly redder than males of a blue sire, indicating that intra-population variation in male coloration is heritable. We tested mating preferences of female offspring and aggression biases of male offspring using binary choice tests. There was no evidence for associations at the family level between female mating preferences and coloration of sires, but dam identity had a significant effect on female mate preference. Sons of the red sire directed significantly more aggression to red than blue males, whereas sons of the blue sire did not show any bias. There was a positive correlation among individuals between male aggression bias and body coloration, possibly due to pleiotropy or physical linkage, which could facilitate the maintenance of color polymorphism [Current Zoology 59 (2: 221-229, 2013].
Friedl, Alexander; Bauer, Wilhelm; Rom, Maximilian; Kivaranovic, Danijel; Lüftenegger, Werner; Brössner, Clemens
To investigate erectile function and sexuality before/after implantation of the ATOMS device including continence outcome, pain perception and co-morbidities. We collected data from 34 patients (2010-2014) who were provided with an ATOMS implant due to mild or moderate stress urinary incontinence (SUI) after radical prostatectomy (RPE), transurethral resection (TURP) or radiotherapy. Previous failed implants were no contraindication. Sexuality was evaluated with the International Index of Erectile Function (IIEF-5). The Visual Analog Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used to analyse pain perception. Results regarding continence, influence of co-morbidities and drug intake were interpreted. IIEF-5 score increased 6 months after ATOMS implantation with a mean difference of 2.18 (Cl: 1.22, 3.14), p < 0,001). Non-sexually active patients had the greatest benefit. However, 50% of patients achieved a mean IIEF-5 of 10.1 and 38% of patients reported a new onset of sexual activity at follow up (mean IIEF-5 score of 12.9). This is in accordance with reduced SUI and absence of persistent pain syndrome. Overall success rate regarding 24h pad-use was 88% (no pad rate 38%). Previous failed implants did not influence results but diabetes, obesity and drug intake (beta-blockers, antidepressants) led to poorer outcomes. Sexuality and erectile function improves significantly 6 months after ATOMS implantation. We postulate that reduced SUI (also during sexual activity) and absence of chronic pain are the improving factors. ATOMS should be offered to men with mild to moderate SUI who are interested in regaining their erectile function and sexual activity.
Goñi, Beatriz; Matsuda, Muneo; Tobari, Yoshiko N
With few exceptions, spontaneous crossing over does not normally occur in male Drosophila. Drosophila ananassae males show considerable amounts of crossing over. In wild males of D. ananassae from Asian (2008) and Brazilian populations (1986 and 2007) variable frequencies of meiotic crossing over, estimated from chiasmata counts, suggested the existence of factors controlling male crossing over in these populations. To corroborate for such prediction, we present data on spontaneous recombination in F1 males of D. ananassae heterozygous for chromosomes of the same Brazilian populations (1986) and marker chromosomes using three testers stocks. Mean recombination value was low, although high variability existed between individual frequencies. Recombination frequencies between lines in each tester stock were not significantly different, excepting when the 3ple-px and 3ple-cy testers were compared (p recombination in chromosomes 2 and 3 in F1 males tested with e(65) se; bri ru was not related, suggesting they are under independent genetic control. Our data are consistent with proposed genetic factors controlling male crossing over in the tester stocks and to the presence of enhancers and suppressors of male crossing over segregating in the Brazilian populations (1986).
Durairajanayagam, Damayanthi; Agarwal, Ashok; Ong, Chloe; Prashast, Pallavi
Excessive amounts of reactive oxygen species (ROS) cause a state of oxidative stress, which result in sperm membrane lipid peroxidation, DNA damage and apoptosis, leading to decreased sperm viability and motility. Elevated levels of ROS are a major cause of idiopathic male factor infertility, which is an increasingly common problem today. Lycopene, the most potent singlet oxygen quencher of all carotenoids, is a possible treatment option for male infertility because of its antioxidant properties. By reacting with and neutralizing free radicals, lycopene could reduce the incidence of oxidative stress and thus, lessen the damage that would otherwise be inflicted on spermatozoa. It is postulated that lycopene may have other beneficial effects via nonoxidative mechanisms in the testis, such as gap junction communication, modulation of gene expression, regulation of the cell cycle and immunoenhancement. Various lycopene supplementation studies conducted on both humans and animals have shown promising results in alleviating male infertility—lipid peroxidation and DNA damage were decreased, while sperm count and viability, and general immunity were increased. Improvement of these parameters indicates a reduction in oxidative stress, and thus the spermatozoa is less vulnerable to oxidative damage, which increases the chances of a normal sperm fertilizing the egg. Human trials have reported improvement in sperm parameters and pregnancy rates with supplementation of 4–8 mg of lycopene daily for 3–12 months. However, further detailed and extensive research is still required to determine the dosage and the usefulness of lycopene as a treatment for male infertility. PMID:24675655
Page, Stephanie T.; Amory, John K.; Bremner, William J.
Despite significant advances in contraceptive options for women over the last 50 yr, world population continues to grow rapidly. Scientists and activists alike point to the devastating environmental impacts that population pressures have caused, including global warming from the developed world and hunger and disease in less developed areas. Moreover, almost half of all pregnancies are still unwanted or unplanned. Clearly, there is a need for expanded, reversible, contraceptive options. Multicultural surveys demonstrate the willingness of men to participate in contraception and their female partners to trust them to do so. Notwithstanding their paucity of options, male methods including vasectomy and condoms account for almost one third of contraceptive use in the United States and other countries. Recent international clinical research efforts have demonstrated high efficacy rates (90–95%) for hormonally based male contraceptives. Current barriers to expanded use include limited delivery methods and perceived regulatory obstacles, which stymie introduction to the marketplace. However, advances in oral and injectable androgen delivery are cause for optimism that these hurdles may be overcome. Nonhormonal methods, such as compounds that target sperm motility, are attractive in their theoretical promise of specificity for the reproductive tract. Gene and protein array technologies continue to identify potential targets for this approach. Such nonhormonal agents will likely reach clinical trials in the near future. Great strides have been made in understanding male reproductive physiology; the combined efforts of scientists, clinicians, industry and governmental funding agencies could make an effective, reversible, male contraceptive an option for family planning over the next decade. PMID:18436704
Bruce E. Byers; Michael E. Akresh; David I. King; W. Koenig
To determine if the songs of male prairie warblers could potentially reveal to female listeners information about the quality of singers, we compared various aspects of prairie warbler song structure and performance to attributes that might reflect a male singer's potential to enhance the fitness of his mate. We found that all the tested male attributesâarrival...
Procter, D S; Moore, A J; Miller, C W
Sexual selection arises from social interactions, and if social environments vary so too should sexual selection. For example, male-male competition often occurs either in the presence or in the absence of females, and such changes in the social environment could affect the form and strength of sexual selection. Here we examine how the presence of a female influences selection arising from male-male competition in a leaf-footed cactus bug, Narnia femorata, which has a resource defence mating system. Males compete for territories on cacti because females lay eggs on the cactus plants. Females are not always present when this competition first occurs; however, the presence or absence of the female matters. We found that both the form and strength of selection on male traits, those traits that influenced success in intrasexual competition, depended on the social context. When a female was not present, male size and the area of the sexually dimorphic hind legs was only marginally important to winning a contest. However, males with larger overall size and leg area were more likely to win in the presence of a female. There was also positive quadratic selection on these traits when a female was present with both the largest and the smallest males winning. The implication is unexpected alternative strategies when females are present. Our results support the notion that sexual selection should be studied under all relevant social contexts. © 2012 The Authors. Journal of Evolutionary Biology © 2012 European Society For Evolutionary Biology.
Brown, Anthony L.
Drawing from ethnographic data, this paper explores how African American male teachers working with African American male students performed their pedagogy. This paper highlights how teachers' understanding of African American males social and educational needs shaped their pedagogical performance. Interestingly however, teachers' performance was…
Intense intolerance among males is considered to be an important mechanism maintaining the uni-male organization traditionally attributed to socially monogamous gibbons. Long-term field work, however, has revealed the existence of stable, socially polyandrous groups in at least two populations, raising questions about the mechanism that allows two adult males to co-reside in the same group. I collected 21 months of behavioral data on 7 two-male groups of wild siamangs (Symphalangus syndactylus) in southern Sumatra (Indonesia) to test the hypothesis that dominance relationships regulate the interactions of adult male siamangs and ultimately facilitate multi-male social groups. A dominant male could clearly be identified in each dyad, based on a consistent direction of agonistic interactions, displacements and the maintenance of an advantageous position in the canopy. Males identified as dominant enjoyed greater social access to the resident female and monopolized copulations. These results suggest that gibbons possess the psycho-social flexibility to regulate intra-sexual aggression and live in multi-male social units under certain social conditions. I discuss the effects that relatedness between males and female choice have in determining this grouping pattern, and the role of male intolerance in the maintenance of primate mating systems. © 2015 Wiley Periodicals, Inc.
Kelly, N B; Alonzo, S H
Recent theory predicted that male advertisement will reliably signal investment in paternal care in species where offspring survival requires paternal care and males allocate resources between advertisement and care. However, the predicted relationship between care and advertisement depended on the marginal gains from investment in current reproductive traits. Life history theory suggests that these fitness gains are also subject to a trade-off between current and future reproduction. Here, we investigate whether male signalling remains a reliable indicator of parental care when males allocate resources between current advertisement, paternal care and survival to future reproduction. We find that advertisement is predicted to remain a reliable signal of male care but that advertisement may cease to reliably indicate male quality because low-quality males are predicted to invest in current reproduction, whereas higher-quality males are able to invest in both current reproduction and survival to future reproduction. © 2010 The Authors. Journal Compilation © 2010 European Society For Evolutionary Biology.
Wade, C.E.; Bossone, C.A.; Hannon, J.P.; Hunt, M.M.; Rodkey, W.G.
We investigated the effect of physical restraint on cardiovascular function and plasma hormone levels in 20 to 25 kg conscious Duroc pigs. Pigs were placed in a Pavlov sling or remained in a portable holding cage. Blood pressure and heart rate were monitored and blood samples taken at 0, 2.5, 5, 10, 30, 60, 120 and 240 min. Placement into the sling increased heart rate from 106 ''+ or -'' 3 to 151 ''+ or -'' 13 beats/min and mean arterial pressure rose from 95 ''+ or -'' 2 to 115 ''+ or -'' 2 mm Hg. Both heart rate and blood pressure returned to basal values within 10 min. Hematocrit was increased from 26 ''+ or -'' 1 to 32 ''+ or -'' 1%. Heart rate, blood pressure and hematocrit were not changed in caged animals. Plasma norepinephrine increased from 179 ''+ or -'' 32 to 461 ''+ or -'' 52 pg/ml returning to basal values within 10 min. Epinephrine showed a similar trend rising from 69 ''+ or -'' 10 to 337 ''+ or -'' 53 pg/ml. Plasma renin activity increased after 5 min in the sling and remained increased from a basal level of 1.0 ''+ or -'' 0.2 to 2.8 ''+ or -'' 0.5 ng AI/ml/hr at four hr. Plasma cortisol (4.5 ''+ or -'' 0.6 to 8.2 ''+ or -'' 1.5 microg/dl), ACTH (45 ''+ or -'' 9 to 169 ''+ or -'' pg/ml) and aldosterone (3.5 ''+ or -'' 0.4 to 11.2 ''+ or -'' 1.1 ng/dl) rose over the four hr period. Pigs in cages showed no change in plasma hormones. Placement of an untrained pig into a sling raises heart rate, blood pressure and hematocrit and produces increases in plasma concentrations of epinephrine, ACTH, cortisol and aldosterone
Hemendra N Shah
Full Text Available We reviewed the incidence, predisposing factors, presentation and management of complications related to the use of synthetic mesh in the management of stress urinary incontinence and pelvic organ prolapse repair. Immediate complications, such as bleeding, hematoma, injury to adjacent organs during placement of mesh and complication of voiding dysfunction are not discussed in this review, since they are primarily related to technique. A PubMed search of related articles published in English was done from April 2008 to March 2011. Key words used were urinary incontinence, mesh, complications, midurethral sling, anterior prolapse, anterior vaginal repair, pelvic organ prolapse, transvaginal mesh, vault prolapse, midurethral slings, female stress urinary incontinence, mesh erosion, vaginal mesh complications, and posterior vaginal wall prolapse. Since there were very few articles dealing with the management of mesh-related complications in the period covered in the search we extended the search from January 2005 onwards. Articles were selected to fit the scope of the topic. In addition, landmark publications and Manufacturer and User Facility Device Experience (MAUDE data (FDA website were included on the present topic. A total of 170 articles were identified. The use of synthetic mesh in sub-urethral sling procedures is now considered the standard for the surgical management of stress urinary incontinence. Synthetic mesh is being increasingly used in the management of pelvic organ prolapse. While the incidence of extrusion and erosion with mid-urethral sling is low, the extrusion rate in prolapse repair is somewhat higher and the use in posterior compartment remains controversial. When used through the abdominal approach the extrusion and erosion rates are lower. The management of mesh complication is an individualized approach. The choice of the technique should be based on the type of mesh complication, location of the extrusion and/or erosion
Shah, Hemendra N.; Badlani, Gopal H.
We reviewed the incidence, predisposing factors, presentation and management of complications related to the use of synthetic mesh in the management of stress urinary incontinence and pelvic organ prolapse repair. Immediate complications, such as bleeding, hematoma, injury to adjacent organs during placement of mesh and complication of voiding dysfunction are not discussed in this review, since they are primarily related to technique. A PubMed search of related articles published in English was done from April 2008 to March 2011. Key words used were urinary incontinence, mesh, complications, midurethral sling, anterior prolapse, anterior vaginal repair, pelvic organ prolapse, transvaginal mesh, vault prolapse, midurethral slings, female stress urinary incontinence, mesh erosion, vaginal mesh complications, and posterior vaginal wall prolapse. Since there were very few articles dealing with the management of mesh-related complications in the period covered in the search we extended the search from January 2005 onwards. Articles were selected to fit the scope of the topic. In addition, landmark publications and Manufacturer and User Facility Device Experience (MAUDE) data (FDA website) were included on the present topic. A total of 170 articles were identified. The use of synthetic mesh in sub-urethral sling procedures is now considered the standard for the surgical management of stress urinary incontinence. Synthetic mesh is being increasingly used in the management of pelvic organ prolapse. While the incidence of extrusion and erosion with mid-urethral sling is low, the extrusion rate in prolapse repair is somewhat higher and the use in posterior compartment remains controversial. When used through the abdominal approach the extrusion and erosion rates are lower. The management of mesh complication is an individualized approach. The choice of the technique should be based on the type of mesh complication, location of the extrusion and/or erosion, its magnitude
Kristin L Dunkle
Full Text Available In sub-Saharan Africa the population prevalence of men who have sex with men (MSM is unknown, as is the population prevalence of male-on-male sexual violence, and whether male-on-male sexual violence may relate to HIV risk. This paper describes lifetime prevalence of consensual male-male sexual behavior and male-on-male sexual violence (victimization and perpetration in two South African provinces, socio-demographic factors associated with these experiences, and associations with HIV serostatus.In a cross-sectional study conducted in 2008, men aged 18-49 y from randomly selected households in the Eastern Cape and KwaZulu-Natal provinces provided anonymous survey data and dried blood spots for HIV serostatus assessment. Interviews were completed in 1,737 of 2,298 (75.6% of enumerated and eligible households. From these households, 1,705 men (97.1% provided data on lifetime history of same-sex experiences, and 1,220 (70.2% also provided dried blood spots for HIV testing. 5.4% (n = 92 of participants reported a lifetime history of any consensual sexual activity with another man; 9.6% (n = 164 reported any sexual victimization by a man, and 3.0% (n = 51 reported perpetrating sexual violence against another man. 85.0% (n = 79 of men with a history of consensual sex with men reported having a current female partner, and 27.7% (n = 26 reported having a current male partner. Of the latter, 80.6% (n = 21/26 also reported having a female partner. Men reporting a history of consensual male-male sexual behavior are more likely to have been a victim of male-on-male sexual violence (adjusted odds ratio [aOR] = 7.24; 95% CI 4.26-12.3, and to have perpetrated sexual violence against another man (aOR = 3.10; 95% CI 1.22-7.90. Men reporting consensual oral/anal sex with a man were more likely to be HIV+ than men with no such history (aOR = 3.11; 95% CI 1.24-7.80. Men who had raped a man were more likely to be HIV+ than non
Godt, Jannik; Kristensen, Kai; Poulsen, Carsten Stig
made in-home by consumers, thus bringing the analysis out of the laboratory and into the market place. The vast majority of the population of uncastrated male pigs have low concentrations of skatole and androstenone. The cutlets that were evaluated in this study were selected from uncastrated male pigs...... on a number of castrated male pigs and gilts. No difference was found in the way the odour components affected the eating quality determined by men and women. A total of 5.4% of the consumers in the study reacted negatively in their evaluation of the eating quality of the cutlets selected for the study......Former studies of the unpleasant odour of meat from certain uncastrated male pigs have been based mainly on evaluations made by trained sensory panellists. This study analyses the effect of the two dominating male pig odour components, skatole and androstenone, on the evaluation of eating quality...
Poulsen, Carsten Stig; Godt, J.; Kristensen, K.
Former studies of the unpleasant odour of meat from certain uncastrated male pigs have been based mainly on evaluations made by trained sensory panellists. This study analyses the effect of the two dominating male pig odour components, skatole and androstenone, on the evaluation of eating quality...... made in-home by consumers, thus bringing the analysis out of the laboratory and into the market place. The vast majority of the population of uncastrated male pigs have low concentrations of skatole and androstenone. The cutlets that were evaluated in this study were selected from uncastrated male pigs...... on a number of castrated male pigs and gilts. No difference was found in the way the odour components affected the eating quality determined by men and women. A total of 5.4% of the consumers in the study reacted negatively in their evaluation of the eating quality of the cutlets selected for the study...
Vinay Singh Chauhan
Full Text Available Male genital self-mutilation (GSM is a rare but serious phenomenon. Some of the risk factors for this act are the presence of religious delusions, command hallucinations, low self-esteem, and feelings of guilt associated with sexual offences. Other risk factors include failures in the male role, problems in the early developmental period, such as experiencing difficulties in male identification and persistence of incestuous desires, depression, and having a history of GSM. The eponym Klingsor Syndrome, which involves the presence of religious delusions, is proposed for GSM. Psychiatric case reports of male GSM in the literature are rare and mostly anecdotal.
Roth, Mara Y.; Page, Stephanie T.; Bremner, William J.
Despite numerous contraceptive options available to women, approximately half of all pregnancies in the United States and worldwide are unplanned. Women and men support the development of reversible male contraception strategies, but none have been brought to market. Herein we review the physiologic basis for male hormonal contraception, the history of male hormonal contraception development, currents agents in development, as well as the potential risks and benefits of male hormonal contrace...
Pande, Kalpana; Raghuvanshi, S.S.
Single and combined treatment of γ-rays and 0.25 per cent EMS were tried on Vigna radiata variety K851. A male sterile mutant was isolated in M 2 generation. Experiments indicated male sterility to be recessive and monogenic in nature. 6 figures. (author)
Nguyen, Thanh Manh; Bressac, Christophe; Chevrier, Claude
In insects, reproductive success and survival are affected by temperature. Reproduction is more sensitive than other physiological traits. While the effects of heat stress on females are well known, the effects on males are less clear. Hymenopteran parasitoids are valuable for studying the consequences of heat stress on male reproduction. In these species, through arrhenotoquous parthenogenesis, the sex ratio of the offspring is directly dependent on the sperm stock acquired by females during copulation. In the lab, heat temperature treatments (32-44°C) were applied for 3 days in the pupal stage of Anisopteromalus calandrae males, and development was completed at 30°C. Three different effects were observed depending on the temperature: mortality above 42°C, sterility of emerging males at 40°C, and sub-fertility at 38°C. This sub-fertility is characterized by a dramatic decrease in male sperm supplies, of up to 7% compared to control males. In the course of ageing, the sperm stock of sub-fertile males increases but never reaches the level of control males. Survival was significantly higher in control (30°C) males than those treated at 38°C. Male mating ability was similar whatever the treatment (control and 38°C), but females mated with 38°C-treated males stored 100 times less sperm on average than those mated with control males. The offspring sex ratio of females mated with 38°C-treated males was strongly male biased. The physiological mechanisms are as yet unknown. The relationship between temperature, sperm stock and sex ratio should be taken into account in the management of parasitoids for integrated pest management. Copyright © 2012 Elsevier Ltd. All rights reserved.
Meijer, Mathias; Thygesen, Lau Caspar; Green, Anders
A potential link has been suggested between dispensed finasteride and increased risk of male breast cancer (MBC). Due to the rare occurrence of MBC, it remains to be established if such a relationship exists. The purpose of this study was to combine nationwide registers in four countries to assess...... the potential association between dispensed finasteride and MBC. A cohort of all males with dispensed finasteride in Denmark, Finland, Norway, and Sweden (1,365,088 person years) was followed up for up to 15 years for breast cancer, and compared to a cohort of males unexposed to finasteride. Individual...
Park, Jin Ho; Bonthius, Paul J; Tsai, Houng-Wei; Bekiranov, Stefan; Rissman, Emilie F
Sexual behavior is variable between individuals, ranging from celibacy to sexual addictions. Within normal populations of individual men, ranging from young to middle aged, testosterone levels do not correlate with libido. To study the genetic mechanisms that contribute to individual differences in male sexual behavior, we used hybrid B6D2F1 male mice, which are a cross between two common inbred strains (C57BL/6J and DBA/2J). Unlike most laboratory rodent species in which male sexual behavior is highly dependent upon gonadal steroids, sexual behavior in a large proportion of these hybrid male mice after castration is independent of gonadal steroid hormones and their receptors; thus, we have the ability to discover novel genes involved in this behavior. Gene expression arrays, validation of gene candidates, and transgenic mice that overexpress one of the genes of interest were used to reveal genes involved in maintenance of male sexual behavior. Several genes related to neuroprotection and neurodegeneration were differentially expressed in the hypothalamus of males that continued to mate after castration. Male mice overexpressing the human form of one of these candidate genes, amyloid beta precursor protein (APP), displayed enhanced sexual behavior before castration and maintained sexual activity for a longer duration after castration compared with controls. Our results reveal a novel and unexpected relationship between APP and male sexual behavior. We speculate that declining APP during normal aging in males may contribute to the loss of sexual function.
Li Yingde; Feng Xiangyun; Zhao Yingzhong
The dry seeds of the high yielding cultivar, Yuzhi-4, were irradiated with 300, 500 and 700 Gy of 60 Co- gamma rays. 3277 M 1 plants were harvested separately as single plants and also in bulk, by doses. In M 2 , the single plant seeds were grown in progeny rows and the bulked seeds were grown as bulks. 25 male sterile plants were screened from M 2 . 10 of the 25 male sterile plants were from the progenies of the single plant seeds and 15 were from the progenies of the bulked seeds. In further genetic research of the 25 male sterile plants in M 3 and M 4 , 6 separate genic male sterile (GMS) lines were identified. Their male sterility was stable and was controlled by a pair of alleles, male fertility being dominant to sterility. (author)
... With the Male Reproductive System Print en español Sistema reproductor masculino Reproduction All living things reproduce. Reproduction — ... of Use Notice of Nondiscrimination Visit the Nemours Web site. Note: All information on KidsHealth® is for ...
Nikolay V. Dimitro v
Full Text Available The management of male breast cancer is still under discussion due to lack of information from prospective, randomized clinical trials and low incidence of this disease. Current management is based largely on extrapolation from data related to treatment of female breast cancer. Over the last two decades, several review articles have discussed mainly retrospective and anecdotal data related to hormonal and chemotherapy treatment modalities. In this review, we present the most recent information and future considerations related to the management of male breast cancer. In addition to the conventional treatment options we will discuss the possible role of targeted therapy. Establishing a national or global registry for male breast cancer will provide more precise information about the natural history of the disease and will facilitate the design and execution of prospective, randomized multicenter clinical trials.
Kotrschal, Kurt; Schöberl, Iris; Bauer, Barbara; Thibeaut, Anne-Marie; Wedl, Manuela
In the paper we investigate how owner personality, attitude and gender influence dog behavior, dyadic practical functionality and the level of dog salivary cortisol. In three meetings, 12 female and 10 male owners of male dogs answered questionnaires including the Neo-FFI human personality inventory. Their dyadic behavior was video-taped in a number of test situations, and saliva samples were collected. Owners who scored highly in neuroticism (Neo-FFI dimension one) viewed their dogs as social supporters and spent much time with them. Their dogs had low baseline cortisol levels, but such dyads were less successful in the operational task. Owners who scored highly in extroversion (Neo-FFI dimension two) appreciated shared activities with their dogs which had relatively high baseline cortisol values. Dogs that had female owners were less sociable-active (dog personality axis 1) than dogs that had male owners. Therefore, it appears that owner gender and personality influences dyadic interaction style, dog behavior and dyadic practical functionality.
Hames, Raymond; Garfield, Zachary; Garfield, Melissa
The cross-cultural ethnographic literature has traditionally used the label male "homosexuality" to describe sexual relationships between biological males without considering whether or not the concept encompasses primary sexual attraction to adult males. Although male androphilia seems to be found in all national populations, its universal existence in tribal populations has been questioned. Our goal is to review previous cross-cultural classifications and surveys of male same sex behavior to present a system that does justice to its varied expressions, especially as it is informed by contemporary sexuality research. Previous comparative research does not effectively distinguish male same sex behavior from male androphilia. Using the standard cross-cultural sample (SCCS) as a sampling frame and the ethnographic sources in the human relations area files and elsewhere, we present distributional data on various forms of male same sex behavior. The SCCS is useful because it is designed to be representative of all historically known social formations and the sample is designed to reduce similarities as a consequence of common descent or historical origin as well as reduce the probability of diffusion of sociocultural practices from one culture to another. Our results show that male same sex behavior as well as male androphilia is much more common than previously estimated in the SCCS. With our findings, we make an argument that male androphilia is a context-dependent cross-cultural universal.
Emily A Hornett
Full Text Available Male-killing bacteria are widespread in arthropods, and can profoundly alter the reproductive biology of their host species. Here we detail the first case of complete suppression of a male killer. The nymphalid butterfly Hypolimnas bolina is infected with a strain of the bacterium Wolbachia, wBol1, which kills male host embryos in Polynesian populations, but does not do so in many areas of Southeast Asia, where both males and female adults are naturally infected, and wBol1-infected females produce a 1:1 sex ratio. We demonstrate that absence of male killing by wBol1 is associated with dominant zygotic suppression of the action of the male killer. Simulations demonstrate host suppressors of male-killer action can spread very rapidly, and historical data indicating the presence of male killing in Southeast Asia in the very recent past suggests suppressor spread has been a very recent occurrence. Thus, male killer/host interactions are much more dynamic than previously recognised, with rapid and dramatic loss of the phenotype. Our results also indicate that suppression can render male killers completely quiescent, leading to the conclusion that some species that do not currently express a male killer may have done so in the past, and thus that more species have had their biology affected by these parasites than previously believed.
Full Text Available This article discusses the diagnosis of Androgenic Deficiency of the Aging Male (ADAM and the controversies and disputes over it, based on the re-medicalization of sexuality. The analysis is based on interviews with urologists and endocrinologists, and the different approaches of these two medical specialties elucidate divergent conceptions of body and sexuality present in the biomedical knowledge, and the struggle for hegemony in the scientific field. By comparing the meanings attributed to ADAM and to another male sexual dysfunction, the Erectile Dysfunction (ED, we intend to reflect about the difficulties inherent in the biological reduction of sexuality and the reiteration of gender norms in the medical discourse concerning the male body and sexuality.
Cheng, C Yan; Mruk, Dolores D
The world's population is nearing 6.8 billion, and we are in need of a male contraceptive that is safe, effective, reversible and affordable. Hormonal approaches, which employ different formulations of testosterone administered in combination with other hormones, have shown considerable promise in clinical trials, and they are currently at the forefront of research and development. However, the long-term effects of using hormones throughout a male's reproductive life for contraception are unknown, and it may take decades before this information becomes available. Because of this, many investigators are aiming to bring a nonhormonal male contraceptive to the consumer market. Indeed, there are several distinct but feasible avenues in which fertility can be regulated without affecting the hypothalamus-pituitary-testis axis. In this review, we discuss several approaches for fertility control involving the testis that one day may lead to the development of a nonhormonal male contraceptive. Copyright © 2010 Elsevier Inc. All rights reserved.
Nya-Ngatchou, Jean-Jacques; Amory, John K
A non-hormonal male contraceptive is a contraceptive that does not involve the administration of hormones or hormone blockers. This review will focus on the use of lonidamine derivatives and inhibitors of retinoic acid biosynthesis and function as approaches to male non-hormonal contraception. Two current lonidamine derivatives, adjudin and H2-gamendazole, are in development as male contraceptives. These potent anti-spermatogenic compounds impair the integrity of the apical ectoplasmic specialization, resulting in premature spermiation and infertility. Another approach to male contraceptive development is the inhibition of retinoic acid in the testes, as retinoic acid signaling is necessary for spermatogenesis. The administration of the retinoic acid receptor antagonist BMS-189453 reversibly inhibits spermatogenesis in mice. Similarly, oral dosing of WIN 18,446, which inhibits testicular retinoic acid biosynthesis, effectively contracepts rabbits. Hopefully, one of these approaches to non-hormonal male contraception will prove to be safe and effective in future clinical trials. Copyright © 2013 Elsevier Inc. All rights reserved.
Martin, J D; Hauck, A E
An 83-year-old man with an endometrioma of the lower abdominal wall has been reported. This occurred following the administration of 25 mg of TACE for a period of about 10 years for what was thought to be carcinoma of the prostate. A second transurethral resection done by Dr. R. C. Thompson proved to be adenocarcinoma. Subsequent to this he was continued on TACE. A review of the more commonly accepted theories of the development of endometriosis in the female has been presented. It is pointed out that the separation between the male and female urogenital systems occurs in the embryo between the eighth week and the fourth month. There is always a possibility for remnants of the opposite sex to remain in individuals. No such was seen in the case which is herein reported. Normal phenotype male was demonstrated in the chromosomal evaluation. A review of the literature on endometriosis in the male reveals several cases which have occurred; the origin of which is though to be from the prostatic utricle which is a remnant of the uterus existing in the male. After a prolonged course the patient reported was followed until he died in 1979. There was no recurrence of the abdominal wall mass but persistent low grade carcinoma of the prostate remained. The terminal process was related to cardiovascular disease and not carcinoma of the prostate. There was delay in publication of this unusual case. The original plan was to await final confirmation of the exact pathologic nature of this condition; unfortunately this was never done since a postmortem examination was not performed.(ABSTRACT TRUNCATED AT 250 WORDS)
Pines, Mathew; Saunders, Julian; Swedell, Larissa
The nested one-male units (OMUs) of the hamadryas baboon are part of a complex social system in which "leader" males achieve near exclusive mating access by forcibly herding females into permanent consortships. Within this multi-level social system (troops, bands, clans and OMUs) are two types of prereproductive males--the follower and solitary male--whose different trajectories converge on the leader role. Here we compare OMU formation strategies of followers, who associate with a particular OMU and may have social access to females, with those of solitary males, who move freely within the band and do not associate regularly with OMUs. Data were derived from 42 OMU formations (16 by followers and 26 by solitary males) occurring over 8 years in a hamadryas baboon band at the Filoha site in Ethiopia. "Initial units" (IUs) with sexually immature females (IU strategy) were formed by 44% of followers and 46% of solitary males. The remaining followers took over mature females when their leader was deposed (challenge strategy) or disappeared (opportunistic strategy), or via a seemingly peaceful transfer (inheritance strategy). Solitary males took over mature females from other clans and bands, but mainly from old, injured or vanished leaders within their clan (via both the challenge and opportunistic strategies). Former followers of an OMU were more successful at taking over females from those OMUs than any other category of male. Despite this advantage enjoyed by ex-follower leaders, ex-solitary leaders were equally capable of increasing their OMU size at a comparable rate in their first 2 years as a leader. These results demonstrate the potential for males to employ both multiple roles (follower vs. solitary male) and multiple routes (IU, inheritance, challenge, opportunistic) to acquire females and become a leader male in a mating system characterized by female defense polygyny in a competitive arena. © 2011 Wiley-Liss, Inc.
Like the lecture this chapter begins with an overview of male reproductive biology and transitions into male reproductive toxicology. It ends with a brief discussion of the strengths and weaknesses in male reproductive toxicology and epidemiology today. This chapter is highly il...
Hou, Z.; Tang, N.
Male sterility is an important approach in utilization of heterosis in marigold (Tagetes erecta L.). Study on the mechanism of male sterility is very important, especially in mining of fertility-related genes. Three suppression subtractive hybridization (SSH) cDNA libraries were constructed between male fertile and male sterile flower buds of marigold. Out of 1920 clones, five hundred and six positive clones were verified by dot-blot hybridization. Two hundred and eighty-six non-redundant ESTs were obtained of which, one hundred and ninety-two ESTs corresponding to proteins with known functions. Through GO function annotation, fifteen candidate genes that may have a function in male sterility were identified. These genes involved in hormone pathways and cell cycles as well as encoded transcription factors and protein kinases. Further more, five of them were verified by quantitative real-time PCR, they were CDKB2;1 functioned in cell division, AMS involved in anther wall tapetum development, LAP3 played a role in pollen exine formation, ACOS5 and CYP703A2 involved in sporopollenin biosynthetic process. This is the first study that constructing cDNA libraries containing differentially expressed gene pools associate with male fertility using SSH strategy, and provides a first step to understand the mechanism of male reproductive development in marigold. (author)
Full Text Available Reproductive dysfunction and malignancies related to the male gender represent a serious health concern, whose incidence has significantly risen over the past years. Prior to treatment, testicular or prostate cancer patients often display poor semen characteristics similar to subfertile or infertile patients. This fact is underscored by cases where the malignancy is often diagnosed in males who undergo a general fertility screening. This review aims to examine the associations between male infertility and reproductive cancers focusing on common etiologies and biological mechanisms underlining these pathologies. Furthermore, we discuss compelling epidemiological data hypothesizing that male reproductive failure may act as a precursor of future andrological malignancies, including testicular or prostate cancer, thus providing a stimulus for a more specific research in male reproductive health and emphasizing the importance of this relation for physicians taking care of male patients with a reproductive disease.
Borges, Edson; Zanetti, Bianca Ferrarini; Braga, Daniela Paes de Almeida Ferreira; Setti, Amanda Souza; Figueira, Rita de Cássia Sávio; Nardi, Aguinaldo César; Iaconelli, Assumpto
To evaluate the effect of male factor infertility on intracytoplasmic sperm injection (ICSI) outcomes compared with a control group presenting isolated tubal factor. This retrospective study included 743 couples undergoing ICSI as a result of isolated male factor and a control group consisting of 179 couples undergoing ICSI as a result of isolated tubal factor, performed in a private university- -affiliated in vitro fertilization center, between January/2010 and December/2016. Patients were divided into two groups according to maternal age: women ≤35 years old and >35 years old. The effects of infertility causes on laboratorial and clinical ICSI outcomes were evaluated using Student's t-test and (2 test. No differences in controlled ovarian stimulation outcomes were observed between male factor cycles and tubal factor cycles in the two age groups. Implantation (male factor 35.5% vs. tubal factor 32.0%, p=0.340), pregnancy (male factor 46.9% vs. tubal factor 40.9%, p=0.184) and miscarriage (male factor 10.3% vs. tubal factor 10.6%, p=0.572) rates were similar between the infertility groups, irrespective of female age. Considering maternal age, the cancelation rate was higher in older women (>35 years old) undergoing ICSI as a result of male factor infertility (17.4% vs. 8.9%, p=0.013). Our results showed that there is no difference in the outcomes of pregnancy between couples with male or tubal factor infertility, which indicates that ICSI surpasses the worse specific outcomes associated with male factor.
Selam Yekta Sendul
Full Text Available Purpose. To evaluate of functional and cosmetic effectiveness of lower eyelid sling technique with fascia lata graft in patients with lagophthalmos due to facial paralysis. Material and Method. Ten patients with a mean age of 55.1±19.77 years who underwent lower eyelid sling surgery with a fascia lata graft between September 2011 and January 2014 were included in this prospective study. Preoperatively and postoperatively patients were evaluated in terms of corneal epithelial defects, Schirmer’s test, and tear break-up time (TBUT. Cosmetically, vertical eyelid aperture, margin reflex distances 1 and 2 (MRD1 and MRD2 and scleral show were evaluated preoperatively and postoperatively. Results. One patient had facial paralysis on the right side whereas the other 9 patients had facial paralysis on the left side. Preoperatively, 3 patients were detected with corneal ulcer, whereas 7 patients were detected with persistent corneal epithelial defects localized in the lower half of the cornea. In the 3 patients with preoperative corneal ulcer, the ulcer recovered with corneal opacity, whereas in the 7 patients with punctate epitheliopathy, postoperative corneal transparency was obtained. Discussion. Lower eyelid sling technique with fascia lata graft is an effective technique for the repositioning of the lower eyelid and preventing the corneal complications.
The production of hybrid-onion seed is dependent on cytoplasmic-genic male sterility (CMS) systems. For the most commonly used CMS, male-sterile (S) cytoplasm interacts with a dominant allele at one nuclear male-fertility restoration locus (Ms) to condition male fertility. We are using proteomics ...
Jun 15, 2011 ... male sterility; AFLP, amplified fragment length polymorphism;. DDRT-PCR, differential ... production of hybrid seed (Bino, 1985). ... percentage of male-sterile plants in an ideal male-sterile .... and presence or absence of pollen, the flower buds were ..... Diurnal changes of photosynthetic and physiological.
Sawamura, Kyoichi; Roote, John; Wu, Chung-I; Yamamoto, Masa-Toshi
Recent genetic analyses of closely related species of Drosophila have indicated that hybrid male sterility is the consequence of highly complex synergistic effects among multiple genes, both conspecific and heterospecific. On the contrary, much evidence suggests the presence of major genes causing hybrid female sterility and inviability in the less-related species, D. melanogaster and D. simulans. Does this contrast reflect the genetic distance between species? Or, generally, is the genetic basis of hybrid male sterility more complex than that of hybrid female sterility and inviability? To clarify this point, the D. simulans introgression of the cytological region 34D-36A to the D. melanogaster genome, which causes recessive male sterility, was dissected by recombination, deficiency, and complementation mapping. The 450-kb region between two genes, Suppressor of Hairless and snail, exhibited a strong effect on the sterility. Males are (semi-)sterile if this region of the introgression is made homozygous or hemizygous. But no genes in the region singly cause the sterility; this region has at least two genes, which in combination result in male sterility. Further, the males are less fertile when heterozygous with a larger introgression, which suggests that dominant modifiers enhance the effects of recessive genes of male sterility. Such an epistatic view, even in the less-related species, suggests that the genetic complexity is special to hybrid male sterility.
Full Text Available Systemic lupus erythematous (SLE is a systemic autoimmune disease that tends to occur in early adult life. The peak age of onset of the first symptom or sign in females is about 38 years and later in men, at about 44 years. Females outnumber men in this illness in a ratio of about 8 : 1. Cutaneous lesions in male have not been properly investigated and some studies in male with SLE have shown that the illness may present with atypical skin lesions. A case of SLE in a 20 year male who developed sudden onset of haemorrhagic vesiculobullous butterfly rash is described.
Dickinson, Thad E.
Discussion of library profession stereotypes focuses on academic male librarians. Topics include the position of the early academic librarians and the environment in which they worked; the beginnings of reference service; women in academic libraries; men in a feminized profession; and current images of male librarians in motion pictures and…
Monroe, M J; Amundsen, T; Utne-Palm, A C; Mobley, K B
Genetic parentage analyses reveal considerable diversity in alternative reproductive behaviours (e.g. sneaking) in many taxa. However, little is known about whether these behaviours vary seasonally and between populations. Here, we investigate seasonal variation in male reproductive behaviours in a population of two-spotted gobies (Gobiusculus flavescens) in Norway. Male two-spotted gobies guard nests, attract females and care for fertilized eggs. We collected clutches and nest-guarding males early and late in the breeding season in artificial nests and used microsatellite markers to reconstruct parentage from a subset of offspring from each nest. We hypothesized that mating, reproductive success and sneaking should be more prevalent early in the breeding season when competition for mates among males is predicted to be higher. However, parentage analyses revealed similar values of mating, reproductive success and high frequencies of successful sneaking early (30% of nests) and late (27% of nests) in the season. We also found that multiple females with eggs in the same nest were fertilized by one or more sneaker males, indicating that some males in this population engage in a satellite strategy. We contrast our results to previous work that demonstrates low levels of cuckoldry in a population in Sweden. Our results demonstrate marked stability in both the genetic mating system and male alternative reproductive tactics over the breeding season. However, sneaking rates may vary geographically within a species, likely due to local selection influencing ecological factors encountered at different locations. © 2016 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2016 European Society For Evolutionary Biology.
To examine the potential effects of lifestyle factors on male reproductive health. Evidence of a global decline in human sperm quality over recent decades has been accumulating. Environmental, occupational, and modifiable lifestyle factors may contribute to this decline. This review focuses on key lifestyle factors that are associated with male infertility such as smoking cigarettes, alcohol intake, use of illicit drugs, obesity, psychological stress, advanced paternal age, dietary practices, and coffee consumption. Other factors such as testicular heat stress, intense cycling training, lack of sleep and exposure to electromagnetic radiation from mobile phone use are briefly discussed. A comprehensive literature search was performed to identify and synthesise all relevant information, mainly from within the last decade, on the major lifestyle factors associated with male infertility and semen quality. Database searches were limited to reports published in English only. A manual search of bibliographies of the reports retrieved was conducted to identify additional relevant articles. In all, 1012 articles were identified from the database search and after reviewing the titles and abstract of the reports, 104 articles met the inclusion criteria. Of these, 30 reports were excluded as the full-text could not be retrieved and the abstract did not have relevant data. The remaining 74 reports were reviewed for data on association between a particular lifestyle factor and male infertility and were included in the present review. The major lifestyle factors discussed in the present review are amongst the multiple potential risk factors that could impair male fertility. However, their negative impact may well be mostly overcome by behaviour modification and better lifestyle choices. Greater awareness and recognition of the possible impact of these lifestyle factors are important amongst couples seeking conception.
Mikkelsen, Alice Toft; Madsen, Svend Aage; Humaidan, Peter
To explore and to identify the possible need for psychological communicative support in men undergoing fertility treatment. Male infertility affects many aspects of a man's life and may cause a life crisis. Although infertility treatment is now commonplace in men, they often feel remote and disconnected from the treatment process. A descriptive survey. A questionnaire with structured and open-ended questions was completed by 210 Danish men undergoing fertility treatment. The questionnaire covered three issues: individual perception of male infertility, gender equality issues, and communication with health professionals in the clinic. Data were collected during 2008. Of the participants, 28% believed that their reduced sperm quality affected their perception of masculinity. 46% stated that equal involvement between partners was a very important element of the treatment; however, 63% said that the health professionals communicated primarily with their female partner. Finally, 62% found that there was a need for a deeper dialogue with the nurses concerning male infertility and 72% lacked information about the psychological consequences of male infertility. In general, participants wanted a more open and balanced dialogue about infertility treatment and the role of the male partner during this process. Infertile men want health professionals to view them on equal terms with their partner. When treating the infertile man, there is a further need to develop more inclusive communication skills. © 2012 Blackwell Publishing Ltd.
Full Text Available Rice is one of the most important model crop plants whose heterosis has been well exploited in commercial hybrid seed production via a variety of types of male sterile lines. Hybrid rice cultivation area is steadily expanding around the world, especially in Southern Asia. Characterization of genes and proteins related to male sterility aims to understand how and why the male sterility occurs, and which proteins are the key players for microspores abortion. Recently, a series of genes and proteins related to cytoplasmic male sterility, photoperiod sensitive male sterility, self-incompatibility and other types of microspores deterioration have been characterized through genetics or proteomics. Especially the latter, offers us a powerful and high throughput approach to discern the novel proteins involving in male-sterile pathways which may help us to breed artificial male-sterile system. This represents an alternative tool to meet the critical challenge of further development of hybrid rice. In this paper, we reviewed the recent developments in our understanding of male sterility in rice hybrid production across gene, protein and integrated network levels, and also, present a perspective on the engineering of male sterile lines for hybrid rice production.
This article presents research undertaken among male teachers and it explores their perceptions and experiences of working in early years contexts. It examines prevalent, contrary discourses and their impact on the construction of male teachers' identities. Public discourses in relation to male teachers reveal contradictions ...
Zare, Elham; Simbar, Masoumeh; Shahhosseini, Zohreh; Alavi Majd, Hamid
Health in the adolescence period guarantees the next generation's health. The assessment of health needs is the first stage for the implementation of health promotion interventions. This study aimed to assess the priorities of male adolescent's health needs in Tehran, Iran, in year 2015. This cross-sectional correlational study was conducted with 1,200 male adolescents aged between 13 and 18 years. Single male adolescents studying in public guidance and high schools in Tehran, Iran, in year 2015 were chosen using a random multistage sampling method. Data were collected using the male adolescent health need assessment scale. The data were analyzed using descriptive and inferential statistics. It was found that while the lowest score was for the domain of sexual health, other domains had average or higher than average scores. More attention should be paid to the sexual health needs of male adolescents. Policy makers need to design strategies that help meet the health needs of male adolescents.
Lähteenmäki, P M; Arola, M; Suominen, J
Twenty-five male patients were investigated to elucidate the correlation of semen parameters and other related parameters in the assessment of spermatogenesis after childhood cancer treatment.......Twenty-five male patients were investigated to elucidate the correlation of semen parameters and other related parameters in the assessment of spermatogenesis after childhood cancer treatment....
Kohl, Andreas Pagh; Andresen, Kristoffer; Rosenberg, Jacob
OBJECTIVE:: To determine whether patients who receive an inguinal hernia repair father the same number of children as the background population. BACKGROUND:: Although the effect of inguinal hernia repair on male fertility has previously been investigated through indirect measures, no previous...... studies have evaluated the final measure of male fertility, which is the number of children fathered by patients. METHODS:: Prospectively collected data on 32,621 male patients between the ages of 18 and 55 years who received 1 or more inguinal hernia repairs during the years 1998 to 2012 were found in 5...... hernia repair using Lichtenstein technique or laparoscopic approach did not father fewer children than expected. Thus, inguinal hernia repair using Lichtenstein or laparoscopic approach did not impair male fertility....
Given the lack of information concerning the role of Chlamydia trachomatis in male infertility, it has become imperative to analyse the quality of semen of male with seroevidence of antibody to Chlamydia trachomatis infection. A total of 156 male patients attending the Human Reproduction Research Programme/Invitro ...
Roth, M Y; Page, S T; Bremner, W J
Despite numerous contraceptive options available to women, approximately half of all pregnancies in the United States and worldwide are unplanned. Women and men support the development of reversible male contraception strategies, but none have been brought to market. Herein we review the physiologic basis for male hormonal contraception, the history of male hormonal contraception development, currents agents in development as well as the potential risks and benefits of male hormonal contraception for men. © 2015 American Society of Andrology and European Academy of Andrology.
Dong, Yu-Hang; Wei, Jin-Hua; Li, Zhen
Estrogen receptors (ERs), including two sub-types ERα and ERβ, belong to the steroid hormone superfamily of nuclear receptors. ERα distributes in the male reproductive system and plays a crucial role in the regulation of male reproduction through estrogen-dependent and -independent ways. In this article, we mainly reviewed the molecular structure, mode of action and location of ERα in the male reproductive system, and explored the mechanism of ERα in regulating the male reproductive system by analyzing different animal models of disrupted ERα.
Marty, Pascal R; Hodges, Keith; Agil, Muhammad; Engelhardt, Antje
In species with a high male reproductive skew, competition between males for the top dominant position is high and escalated fights are common between competitors. As a consequence, challenges incur potentially high costs. Selection should favor males who time an alpha male challenge to maximize chances of a successful outcome minimizing costs. Despite the importance of alpha male replacements for individual males, we know little about the timing of challenges and the condition of the challenger. We investigated the timing and process of alpha male replacements in a species living in multi-male groups with high male reproductive skew, the crested macaque. We studied four wild groups over 6 years in the Tangkoko Reserve, North Sulawesi, Indonesia, during which 16 alpha male replacements occurred. Although unusual for cercopithecines, male crested macaques delayed their natal dispersal until they attained maximum body mass and therefore fighting ability whereupon they emigrated and challenged the alpha male in another group. Accordingly, all observed alpha male replacements were from outside males. Ours is the first report of such a pattern in a primate species living in multi-male groups. Although the majority of alpha male replacements occurred through direct male-male challenges, many also took place opportunistically (i.e., after the alpha male had already been injured or had left the group). Furthermore, alpha male tenures were very short (averaging ca. 12 months). We hypothesize that this unusual pattern of alpha male replacements in crested macaques is related to the species-specific combination of high male reproductive skew with a large number of males per group. Am. J. Primatol. 79:e22448, 2017. © 2015 The Authors. American Journal of Primatology Published by Wiley Periodicals, Inc. © 2015 The Authors. American Journal of Primatology Published by Wiley Periodicals, Inc.
St. Louis, Kenneth O.
Purpose: The study investigated the extent to which differences existed between public attitudes of males versus females. Method: One hundred adults, 50 males and 50 females, were chosen at random from each of 50 study samples comprising a total of 3371 respondents in a database archive who had completed the "Public Opinion Survey of Human…
Budenberg, W J; Ndiege, I O; Karago, F W
Females of the banana weevil,Cosmopolites sordidus, were attracted to and made longer visits to live conspecific males, trapped volatiles from males, and dissected male hindguts in a still-air olfactometer. Male weevils were attracted to volatiles trapped from males and made longer visits to live males and volatiles from males. Live females, collected volatiles from females and female hindguts, elicited small or no behavioral responses from either sex. Electroantennogram (EAG) responses from both male and female antennae were elicited by collected volatiles from males and by dichloromethane extracts of male hindguts and bodies but not by surface washes of males. No significant EAG responses were given to equivalent material from females. It is therefore suggested that male banana weevils release an aggregation pheromone via their hindgut.
Kotani, Masato; Katagiri, Fumihiko; Hirai, Tsuyoshi; Kagawa, Jiro
The hypothalamic hormone kisspeptin (metastin) regulates human reproduction by modulating gonadotropin-releasing hormone (GnRH) secretion. Kisspeptin is detected in peripheral blood, although GnRH is not. In this study, we measured plasma kisspeptin levels in four male cases with hypogonadism and seven normal male controls using enzyme immunoassay (EIA) to elucidate the clinical implications of kisspeptin levels in male hypogonadism. The results showed a variety of plasma kisspeptin levels: 6.0 fmol/mL in a male with isolated hypogonadotropic hypogonadism (IHH), 43.2 fmol/mL in a male with Kallmann's syndrome, 40.7 fmol/mL in a male with azoospermia, 323.2 fmol/mL in a male with hypergonadotropic hypogonadism, and 12.3 ± 2.5 fmol/mL (mean ± SD) in seven normal controls. Except for the case with IHH, the plasma kisspetin levels were elevated in the three cases with Kallmann's syndrome, azoospermia, and hypergonadotropic hypogonadism. The reason why the three cases had high values was their lesions were downstream of the kisspeptin neuron in the hypothalamic-pituitary-gonadal axis, suggesting that elevated kisspeptin levels were implicated in hypothalamic kisspeptin secretion under decreased negative feedback of gonadal steroids. The result that the plasma kisspeptin levels were decreased by gonadotropin therapy in the case with Kallmann's syndrome supported this hypothesis. In conclusion, to measure plasma kisspeptin levels could be useful for better understanding of male hypogonadism.
Appelbaum, A H; Evans, G F; Levy, K R; Amirkhan, R H; Schumpert, T D
Various male breast diseases have characteristic mammographic appearances that can be correlated with their pathologic diagnoses. Male breast cancer is usually subareolar and eccentric to the nipple. Margins of the lesions are more frequently well defined, and calcifications are rarer and coarser than those occurring in female breast cancer. Gynecomastia usually appears as a fan-shaped density emanating from the nipple, gradually blending into surrounding fat. It may have prominent extensions into surrounding fat and, in some cases, an appearance similar to that of a heterogeneously dense female breast. Although there are characteristic mammographic features that allow breast cancer in men to be recognized, there is substantial overlap between these features and the mammographic appearance of benign nodular lesions. The mammographic appearance of gynecomastia is not similar to that of male breast cancer, but in rare cases, it can mask malignancy. Gynecomastia can be mimicked by chronic inflammation. All mammographically lucent lesions of the male breast appear to be benign, similar to such lesions in the female breast.
Full Text Available The underlying assumption in popular and scientific publications on sex differences in the brain is that human brains can take one of two forms male or female, and that the differences between these two forms underlie differences between men and women in personality, cognition, emotion and behavior. Documented sex differences in brain structure are typically taken to support this dimorphic view of the brain. However, neuroanatomical data reveal that sex interacts with other factors in utero and throughout life to determine the structure of the brain, and that because these interactions are complex, the result is a multi-morphic, rather than a dimorphic, brain. More specifically, here I argue that human brains are composed of an ever-changing heterogeneous mosaic of male and female brain characteristics (rather than being all male or all female that cannot be aligned on a continuum between a male brain and a female brain. I further suggest that sex differences in the direction of change in the brain mosaic following specific environmental events lead to sex differences in neuropsychiatric disorders.
Full Text Available Introduction & Objective: Soybean (Soja hispida Moench is a member of Fabaceae family. It is a species of legume native to East Asia. Soy contains significant amount of all the essential amino acids for humans therefore, is a good source of protein .Soy has an important role in the improvement and treatment of some cancers such as colon, prostate, and breast. The aim of this study was to investigate the effect of soybeans on reproductive system in male mice. Materials & Methods: This experimental study was conducted at Isfahan Payam e Noor University in 2009. In this research, 32 male mice were randomly grouped into four experimental groups. The control group was fed with soy-free basic diet. The experimental groups 1, 2, and 3 were fed with a diet containing 20%, 30% and 50% soy diet respectively.At the end of 9 weeks of treatment, blood samples were collected and serum levels of testosterone, LH and FSH were measured. The collected data was analyzed with SPSS software using one way ANOVA with Dunnett's post test and Duncan test. Results : In the experimental group which received 20% soy diet, the level of testosterone had a meaningful decrease in comparison with the control group (P<0.05, but in the experimental group which received a 50% soy diet, the level of testosterone had a meaningful increase (P<0.05 .The LH level in 30% and 50% groups had a meaningful increase but no significant differences were observed in FSH level & weight of testicles (P<0.05.The number of sperms in all of the treatment regimes had a meaningful decrease (P0.05 Conclusion: Results of this research indicated that the 20, 30, and 50 percent soy diet had a negative effect on the male reproductive system in mice.
Morán, P; Labbé, L; Garcia de Leaniz, C
Juvenile sex ratios are often assumed to be equal for many species with genetic sex determination, but this has rarely been tested in fish embryos due to their small size and absence of sex-specific markers. We artificially crossed three populations of brown trout and used a recently developed genetic marker for sexing the offspring of both pure and hybrid crosses. Sex ratios (SR = proportion of males) varied widely one month after hatching ranging from 0.15 to 0.90 (mean = 0.39 ± 0.03). Families with high survival tended to produce balanced or male-biased sex ratios, but SR was significantly female-biased when survival was low, suggesting that males sustain higher mortality during development. No difference in SR was found between pure and hybrid families, but the existence of sire × dam interactions suggests that genetic incompatibility may play a role in determining sex ratios. Our findings have implications for animal breeding and conservation because skewed sex ratios will tend to reduce effective population size and bias selection estimates. © 2016 The Authors.
Villavaso, E.J.; McGovern, W.L.; Wagner, T.L.; Willers, J.L.
This study examines the relative importance of age at the time of irradiation on attractiveness, mating ability, sperm transfer, prior mating, and longevity as factors of competitiveness in sterile male boll weevil, Anthonomus grandis grandis Boheman. The amount of sperm transferred by irradiated males appeared to be the most important factor in competitiveness. More sperm was transferred by virgin males irradiated on day 5 than by virgin males irradiated on day 2, and males irradiated on day 5 had greater impact on egg hatch than those irradiated on day 2. The amount of sperm in spermathecae of females mated to virgin mates irradiated on day 5 was indistinguishable from that in females mated to virgin control males. Mating ability of males of all treatments was similar. Comparable numbers of boll weevils were captured in traps baited with males irradiated at 2 or 5 d during the first 4-5 d after irradiation, but thereafter, generally more weevils were captured in traps baited with males irradiated at 2 d or with control males. Attractiveness of males irradiated at 2 d was generally comparable to that of control males. More than 91% of irradiated males individually caged on cotton, Gossypium hirsutum L., plants lived for 10 d in the field, and 40% lived for 14 d; all individually caged control males lived 14 d. When released into cotton fields, however, the numbers of both irradiated and control males declined sharply over 14 d. Thus, the potential for an effective 2-wk life span in the field suggested by the caged study did not appear to apply to laboratory-reared weevils released into cotton fields
Futagami, Hiroko; Sakuma, Yasuo; Kondo, Yasuhiko
Copulatory behavior has been reported to raise the pain threshold in male rats. In this study, we examined the effect of copulatory behavior with or without ejaculation on pain threshold measured by electrical shock via an electrode attached to the tail. It was demonstrated that ejaculation is not necessary to raise the pain threshold in male rats. In addition, we examined whether oxytocin, a hypothalamic neuropeptide, was involved in copulation-induced hypoalgesia. Sexually experienced males were subjected to stereotaxic implantation of a guide cannula targeting the lateral ventricle. After the recovery period, half of the males were intracerebroventricularly treated with an oxytocin antagonist (OTA, 100ng d(CH2)51,Tyr(Me)2,Thr4, Orn8,Tyr-NH29]-vasotocin/1μL saline) and the remaining half were administered saline without anesthesia. Fifteen minutes later, half of each group were given sexual behavior with receptive females. We found no effect of OTA on sexual activity. Immediately after ejaculation, pain threshold was measured. While raised pain threshold was observed after sexual behavior in saline-treated males, no change in pain threshold was found in OTA-treated males even after copulation. The results suggest that central oxytocin mediates copulation-induced hypoalgesia in male rats. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Male-mediated developmental toxicity has been of concern for many years. The public became aware of male-mediated developmental toxicity in the early 1990s when it was reported that men working at Sellafield might be causing leukemia in their children. Human and animal studies have contributed to our current understanding of male-mediated effects. Animal studies in the 1980s and 1990s suggested that genetic damage after radiation and chemical exposure might be transmitted to offspring. With the increasing understanding that there is histone retention and modification, protamine incorporation into the chromatin and DNA methylation in mature sperm and that spermatozoal RNA transcripts can play important roles in the epigenetic state of sperm, heritable studies began to be viewed differently. Recent reports using molecular approaches have demonstrated that DNA damage can be transmitted to babies from smoking fathers, and expanded simple tandem repeats minisatellite mutations were found in the germline of fathers who were exposed to radiation from the Chernobyl nuclear power plant disaster. In epidemiological studies, it is possible to clarify whether damage is transmitted to the sons after exposure of the fathers. Paternally transmitted damage to the offspring is now recognized as a complex issue with genetic as well as epigenetic components.
Zheng, Da-Jiang; Foley, Lauren; Rehman, Asad; Ophir, Alexander G.
Single males might benefit from knowing the identity of neighbouring males when establishing and defending boundaries. Similarly, males should discriminate between individual females if this leads to more reproductive opportunities. Contextual social cues may alter the value of learning identity. Knowing the identity of competitors that intrude into an animal’s territory may be more salient than knowing the identity of individuals on whose territory an animal is trespassing. Hence, social and environmental context could affect social recognition in many ways. Here we test social recognition of socially monogamous single male prairie voles, Microtus ochrogaster. In experiment 1 we tested recognition of male or female conspecifics and found that males discriminated between different males but not between different females. In experiment 2 we asked whether recognition of males is influenced when males are tested in their own cage (familiar), in a clean cage (neutral) or in the home cage of another male (unfamiliar). Although focal males discriminated between male conspecifics in all three contexts, individual variation in recognition was lower when males were tested in their home cage (in the presence of familiar social cues) compared to when the context lacked social cues (neutral). Experiment 1 indicates that selective pressures may have operated to enhance male territorial behaviour and indiscriminate mate selection. Experiment 2 suggests that the presence of a conspecific cue heightens social recognition and that home-field advantages might extend to social cognition. Taken together, our results indicate social recognition depends on the social and possibly territorial context. PMID:24273328
Ubuka, Takayoshi; Tsutsui, Kazuyoshi
It is thought that estrogen (neuroestrogen) synthesized by the action of aromatase in the brain from testosterone activates male socio-sexual behaviors, such as aggression and sexual behavior in birds. We recently found that gonadotropin-inhibitory hormone (GnIH), a hypothalamic neuropeptide, inhibits socio-sexual behaviors of male quail by directly activating aromatase and increasing neuroestrogen synthesis in the preoptic area (POA). The POA is thought to be the most critical site of aromatization and neuroestrogen action for the regulation of socio-sexual behavior of male birds. We concluded that GnIH inhibits socio-sexual behaviors of male quail by increasing neuroestrogen concentration beyond its optimal concentration in the brain for expression of socio-sexual behavior. On the other hand, it has been reported that dopamine and glutamate, which stimulate male socio-sexual behavior in birds and mammals, inhibit the activity of aromatase in the POA. Multiple studies also report that the activity of aromatase or neuroestrogen is negatively correlated with changes in male socio-sexual behavior in fish, birds, and mammals including humans. Here, we review previous studies that investigated the role of neuroestrogen in the regulation of male socio-sexual behavior and reconsider the hypothesis that neuroestrogen activates male socio-sexual behavior in vertebrates. It is considered that basal concentration of neuroestrogen is required for the maintenance of male socio-sexual behavior but higher concentration of neuroestrogen may inhibit male socio-sexual behavior.
Yun Seok Jung
Full Text Available Various postoperative complications have been reported after the use of tension-free vaginal tapes (TVT. The transobturator approach was introduced to minimize the potential complications. The next generation of recently introduced T