This document discusses female urinary incontinence and the use of surgical mesh. It notes that several governments and regulatory agencies have placed restrictions on transvaginal mesh due to inadequate evidence of long-term safety and efficacy. Alternatives to mesh for treating incontinence mentioned include pelvic floor exercises, retropubic suspensions, and laparoscopic sacrocolpopexy. The document also discusses a non-surgical treatment called BTL Emsella that uses electromagnetic therapy to stimulate pelvic floor muscles. Pilot studies on Emsella show improvements in incontinence based on pad tests and questionnaires. An ongoing study is further evaluating its efficacy and safety.
1) The study examined the effect of tempeh extract in promoting callus growth in patients with femoral fractures over 16 days.
2) 28 subjects with femoral fractures were divided into two groups - 14 received 50ml tempeh extract daily and 14 did not receive the extract.
3) Analysis found the group receiving tempeh extract had higher rates of positive callus growth (39.3%) compared to the control group (14.3%), indicating tempeh extract significantly promotes fracture healing.
This study aimed to determine if the drug Flomax (tamsulosin) could reduce rates of postoperative urinary retention (POUR) in male neurosurgery patients undergoing spine surgery. 95 patients were randomized to receive either Flomax or a placebo for 2 days before and after surgery. The overall rate of POUR was similar between the two groups, with 36% in the Flomax group and 28% in the placebo group developing POUR. Foley catheters were reinserted in similar rates between groups as well. The study found that Flomax did not provide significant benefits in reducing POUR for these patients.
Research article no needle no suture vmmcDeepak Kabbur
This study evaluated a new single-visit adult male circumcision technique called Unicirc that uses a disposable plastic instrument and tissue adhesive. In a trial of 110 men across 3 sites in South Africa, the procedure took a median of 9 minutes with minimal blood loss and pain. There was a 6.3% rate of moderate complications like bleeding and infection but no serious adverse events. Nearly all wounds were fully healed by 4 weeks with high patient satisfaction and excellent cosmetic results, demonstrating the potential for this technique to safely scale up circumcision programs with one visit and without injections.
How to Build Muscle with Red Light Therapy | BodybuildingMarkSloan21
If you want to pack on 10 to 20 pounds of muscle but don’t want to have to go through the trouble or pain of injecting yourself with testosterone and other anabolic steroids, then this presentation is for you. This presentation is also for you if you’re a professional bodybuilder who is looking for a secret weapon that will give you the edge over your competition.
In this presentation we’re going to find out if red light therapy can help you build bigger muscles and the body you want - whether it’s to help you win that upcoming bodybuilding competition or to boost your confidence and overall health.
For the show notes visit:
https://endalldisease.com/episode15
All of my videos, podcasts and articles are and will always be free. If you enjoyed this video and want to support my work, you can do so by donating, buying one of my bestselling books or red light therapy devices below.
Check out our red light therapy store:
https://endalldisease.com/store
Read my books:
https://endalldisease.com/books
Donate :
►Paypal:
https://www.paypal.me/endalldisease
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGESTLifecare Centre
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGEST
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
This study retrospectively analyzed 65 cases of unusual ectopic pregnancies out of 1000 total ectopic pregnancy cases over a 10-year period. The study found that ovarian pregnancies were associated with intrauterine device placement and pelvic inflammatory diseases. Extratubal ectopic pregnancies like those in the ovaries, cervix, and abdomen presented more serious symptoms and had higher misdiagnosis rates than tubal pregnancies. Most unusual ectopic pregnancies required surgery for treatment, though some early cervical and corneal pregnancies were treated with conservative methods like mifepristone and methotrexate or curettage.
1) The study examined the effect of tempeh extract in promoting callus growth in patients with femoral fractures over 16 days.
2) 28 subjects with femoral fractures were divided into two groups - 14 received 50ml tempeh extract daily and 14 did not receive the extract.
3) Analysis found the group receiving tempeh extract had higher rates of positive callus growth (39.3%) compared to the control group (14.3%), indicating tempeh extract significantly promotes fracture healing.
This study aimed to determine if the drug Flomax (tamsulosin) could reduce rates of postoperative urinary retention (POUR) in male neurosurgery patients undergoing spine surgery. 95 patients were randomized to receive either Flomax or a placebo for 2 days before and after surgery. The overall rate of POUR was similar between the two groups, with 36% in the Flomax group and 28% in the placebo group developing POUR. Foley catheters were reinserted in similar rates between groups as well. The study found that Flomax did not provide significant benefits in reducing POUR for these patients.
Research article no needle no suture vmmcDeepak Kabbur
This study evaluated a new single-visit adult male circumcision technique called Unicirc that uses a disposable plastic instrument and tissue adhesive. In a trial of 110 men across 3 sites in South Africa, the procedure took a median of 9 minutes with minimal blood loss and pain. There was a 6.3% rate of moderate complications like bleeding and infection but no serious adverse events. Nearly all wounds were fully healed by 4 weeks with high patient satisfaction and excellent cosmetic results, demonstrating the potential for this technique to safely scale up circumcision programs with one visit and without injections.
How to Build Muscle with Red Light Therapy | BodybuildingMarkSloan21
If you want to pack on 10 to 20 pounds of muscle but don’t want to have to go through the trouble or pain of injecting yourself with testosterone and other anabolic steroids, then this presentation is for you. This presentation is also for you if you’re a professional bodybuilder who is looking for a secret weapon that will give you the edge over your competition.
In this presentation we’re going to find out if red light therapy can help you build bigger muscles and the body you want - whether it’s to help you win that upcoming bodybuilding competition or to boost your confidence and overall health.
For the show notes visit:
https://endalldisease.com/episode15
All of my videos, podcasts and articles are and will always be free. If you enjoyed this video and want to support my work, you can do so by donating, buying one of my bestselling books or red light therapy devices below.
Check out our red light therapy store:
https://endalldisease.com/store
Read my books:
https://endalldisease.com/books
Donate :
►Paypal:
https://www.paypal.me/endalldisease
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGESTLifecare Centre
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGEST
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
This study retrospectively analyzed 65 cases of unusual ectopic pregnancies out of 1000 total ectopic pregnancy cases over a 10-year period. The study found that ovarian pregnancies were associated with intrauterine device placement and pelvic inflammatory diseases. Extratubal ectopic pregnancies like those in the ovaries, cervix, and abdomen presented more serious symptoms and had higher misdiagnosis rates than tubal pregnancies. Most unusual ectopic pregnancies required surgery for treatment, though some early cervical and corneal pregnancies were treated with conservative methods like mifepristone and methotrexate or curettage.
This study examined outcomes of female genital plastic surgery procedures performed by 12 physicians across the United States. The procedures studied were labiaplasty, reduction of the clitoral hood, vaginoplasty, and perineoplasty. Data was collected from 258 patients who underwent a total of 341 procedures. Overall, 91.6% of patients reported being satisfied with their surgical outcomes at follow-ups between 6-42 months post-surgery. Significant improvements in sexual functioning were reported for both patients and their partners. Complication rates were deemed acceptable. The study aimed to provide objective data on these procedures and found high patient satisfaction and enhancement of sexual function and quality of life.
Pelvic floor dysfunction can cause symptoms like incontinence and organ prolapse. Risk factors include age, pregnancy, obesity, and smoking. Evaluation involves examination, testing like anorectal manometry, and imaging. Treatment options range from lifestyle changes and medications to biofeedback, surgery, and sacral nerve stimulation. Prevention focuses on exercises during and after pregnancy. Future research aims to better understand causes and most effective therapies.
This document discusses several studies on urological injuries and conditions:
1. A study of 25 female patients with urethral and bladder neck injuries from pelvic fractures, finding many required surgical repair and long-term urinary and sexual dysfunction for some.
2. A study of 8 girls with pelvic fracture urethral strictures, finding 1-stage repair and substitution urethroplasty had 100% success rates and advocating early cystostomy drainage and deferred reconstruction when needed.
3. An editorial comment on female urethral injuries from pelvic fractures, noting they require high suspicion to diagnose and advocating early repair of urethral and vaginal injuries to
Laparoscopic ovarian drilling : Not too much Not too littleMahmoud zakherah
Laparoscopic ovarian drilling (LOD) is a second-line treatment for infertility in polycystic ovary syndrome (PCOS) patients who do not respond to clomiphene citrate. Adjusting the number of punctures and thermal dose based on individual ovarian volume improves outcomes and reduces risks of damage to ovarian reserve compared to fixed dosing protocols. While LOD improves ovulation and pregnancy rates, it is not a first-line or permanent treatment, and repeated drilling is not recommended. Oral and gonadotropin therapies are preferable first-line options before considering LOD or in vitro fertilization.
IVF is stressful and expensive and there is a continued need to improve outcome using all information technology available to improve outcomes , meet expectations and review management.
Hysteroscopic endometrial resection in the management of abnormal uterine ble...Dr. Aisha M Elbareg
This document summarizes a study that investigated the efficacy of hysteroscopic endometrial resection (HER) in treating abnormal uterine bleeding (AUB) among Libyan women. The study found that HER was an effective treatment, achieving a 92.8% success rate in reducing symptoms after 2 years of follow up among the 70 women who completed the study. Younger age (<40 years), thicker endometrium (>7mm), larger uterine size, and the presence of fibroids were found to be factors associated with treatment failure. The study concludes that HER is an effective procedure for AUB, especially in women over age 40 without an enlarged uterus or fibroids.
This document summarizes three clinical studies on IVF outcomes for women with PCOS:
1. A study comparing fresh versus frozen-thawed embryo transfer, finding higher clinical pregnancy and live birth rates with fresh transfers.
2. An analysis of over 4,000 IVF cycles from SART, finding no significant difference in outcomes between IVF and ICSI for couples with PCOS and normal sperm.
3. A study examining the impact of metformin on outcomes in overweight/obese PCOS women, with conflicting previous results noted.
This document discusses emerging treatments for endometriosis. It begins by outlining the limitations of current treatments, such as being suppressive rather than curative, interfering with fertility, and having limited effectiveness for certain disease phenotypes. The document then examines the criteria for an ideal endometriosis medication and evaluates several emerging hormonal and non-hormonal treatments. These include gonadotropin-releasing hormone antagonists, selective progesterone receptor modulators, aromatase inhibitors, immunomodulators, and other agents. For many of the treatments, human and animal studies are summarized that demonstrate reductions in pain, lesion size, or other beneficial outcomes for endometriosis.
This study compared obstetric and neonatal outcomes between 76 women who conceived using donated oocytes, 150 women who conceived spontaneously, and 63 women who conceived using non-donor IVF. The study found that women who conceived using donated oocytes had higher rates of hypertensive disorders during pregnancy, cesarean delivery, induction of labor, postpartum hemorrhage, and preterm birth compared to spontaneously conceiving women. Similar trends were observed when comparing women who conceived using donated oocytes to those using non-donor IVF, though some differences were not statistically significant. However, mean birth weight and length of term infants were similar between groups, and rates of congenital malformations did not differ.
This document discusses adolescent endometriosis (AE), noting that it is a common condition with many unanswered questions. AE can involve lesions of all stages of severity, from minimal to severe. While some reports have found only early stage lesions in AE, more recent studies show a significant portion have advanced stage disease. AE seems to have a progressive natural course. Risk factors include early menarche, family history, and mullerian anomalies. Common symptoms are pain, which is often resistant to medical therapy, and pelvic masses seen on ultrasound. Laparoscopy is the gold standard for diagnosis but often shows atypical lesions. Treatment involves medications, with surgery as an option for persistent or severe cases. Recurrence is a
This document discusses several studies and guidelines related to fertility treatments. It provides recommendations on:
- Performing hysteroscopic procedures before IVF to improve outcomes for patients with failed ART cycles.
- Cabergoline reducing OHSS risk with IVF without compromising pregnancy rates.
- AFC and AMH being better predictors of ovarian response than FSH.
- No need for FSH doses over 300IU to increase pregnancy rates.
- Laparoscopic approach for ectopic pregnancy being less costly than open surgery, though open has lower persistent trophoblast rates. Medical treatment is also an option.
A 33-year old female presented with abdominal pain, dysuria, and fever. Ultrasound and X-ray revealed a bladder calculus formed around an intrauterine contraceptive device (IUCD) that had migrated from the uterus into the bladder. Such IUCD migration is a rare but known complication, and the device must be removed to prevent further complications like stone formation. Cystoscopy confirmed the presence of the IUCD within the bladder, which was then removed surgically.
Trauma and urologic reconstruction network of surgeons - MMC and BNCXjeremybmyers
This document summarizes the use of mitomycin C (MMC) for recurrent bladder neck contractures. It describes the author's experience treating 55 patients with transurethral incision and MMC injection, finding a 58% initial success rate and 75% success after a second treatment. It also reviews literature on deep incision alone, finding similar success rates. Complications from MMC included bladder pain, ulceration, and osteitis pubis in 3 patients. The optimal timing of artificial urinary sphincter placement after treatment is unknown.
Introduction: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn,
research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1
rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl.
This document summarizes a study that evaluated the effects of various maternal, fetal, and technical factors on the accuracy of sonographic fetal weight estimation (SFWE). The study analyzed over 9,000 SFWEs performed within a week of delivery. It found that several maternal factors, including higher weight, height, BMI, older age, diabetes, and multiparity were associated with underestimation of fetal weight. Fetal factors like male sex were also linked to underestimation, while breech presentation slightly improved accuracy. Experience level of the sonographer had little effect. Overall, the models assessed explained less than 10% of errors, suggesting most inaccuracy comes from limitations of SFWE formulas themselves.
Journal club 1 (Management of CGCG using subcutaneous Denosumab therapy )Anish Kamat
- The patient was diagnosed with central giant cell granuloma in the right mandible based on an incisional biopsy. Laboratory tests showed normal calcium, alkaline phosphatase, phosphorus, and parathyroid hormone levels.
- According to a treatment protocol, the patient received subcutaneous injections of denosumab 120 mg monthly for 6 months, with additional loading doses on days 8 and 15 of the first month, along with daily calcium and vitamin D supplements.
- After 6 and 18 months of denosumab therapy, CT scans showed reduction in tumor size. Reduction was also seen 1 year after cessation of therapy, indicating the treatment was effective for the central giant cell granuloma.
This document discusses single-incision slings (SIS) for treating stress urinary incontinence. It provides pros and cons of SIS and summarizes various studies on the Minisling procedure. The studies found success rates of 85-95% in curing incontinence with SIS at 12-24 months follow up. Complication rates were low. SIS provide benefits of reduced bleeding risk, pain, and recovery time compared to standard mid-urethral slings. However, the document notes the learning curve is still developing for SIS procedures. In summary, the document reviews clinical studies demonstrating that single-incision slings effectively treat incontinence with low complication rates.
This study examined outcomes of female genital plastic surgery procedures performed by 12 physicians across the United States. The procedures studied were labiaplasty, reduction of the clitoral hood, vaginoplasty, and perineoplasty. Data was collected from 258 patients who underwent a total of 341 procedures. Overall, 91.6% of patients reported being satisfied with their surgical outcomes at follow-ups between 6-42 months post-surgery. Significant improvements in sexual functioning were reported for both patients and their partners. Complication rates were deemed acceptable. The study aimed to provide objective data on these procedures and found high patient satisfaction and enhancement of sexual function and quality of life.
Pelvic floor dysfunction can cause symptoms like incontinence and organ prolapse. Risk factors include age, pregnancy, obesity, and smoking. Evaluation involves examination, testing like anorectal manometry, and imaging. Treatment options range from lifestyle changes and medications to biofeedback, surgery, and sacral nerve stimulation. Prevention focuses on exercises during and after pregnancy. Future research aims to better understand causes and most effective therapies.
This document discusses several studies on urological injuries and conditions:
1. A study of 25 female patients with urethral and bladder neck injuries from pelvic fractures, finding many required surgical repair and long-term urinary and sexual dysfunction for some.
2. A study of 8 girls with pelvic fracture urethral strictures, finding 1-stage repair and substitution urethroplasty had 100% success rates and advocating early cystostomy drainage and deferred reconstruction when needed.
3. An editorial comment on female urethral injuries from pelvic fractures, noting they require high suspicion to diagnose and advocating early repair of urethral and vaginal injuries to
Laparoscopic ovarian drilling : Not too much Not too littleMahmoud zakherah
Laparoscopic ovarian drilling (LOD) is a second-line treatment for infertility in polycystic ovary syndrome (PCOS) patients who do not respond to clomiphene citrate. Adjusting the number of punctures and thermal dose based on individual ovarian volume improves outcomes and reduces risks of damage to ovarian reserve compared to fixed dosing protocols. While LOD improves ovulation and pregnancy rates, it is not a first-line or permanent treatment, and repeated drilling is not recommended. Oral and gonadotropin therapies are preferable first-line options before considering LOD or in vitro fertilization.
IVF is stressful and expensive and there is a continued need to improve outcome using all information technology available to improve outcomes , meet expectations and review management.
Hysteroscopic endometrial resection in the management of abnormal uterine ble...Dr. Aisha M Elbareg
This document summarizes a study that investigated the efficacy of hysteroscopic endometrial resection (HER) in treating abnormal uterine bleeding (AUB) among Libyan women. The study found that HER was an effective treatment, achieving a 92.8% success rate in reducing symptoms after 2 years of follow up among the 70 women who completed the study. Younger age (<40 years), thicker endometrium (>7mm), larger uterine size, and the presence of fibroids were found to be factors associated with treatment failure. The study concludes that HER is an effective procedure for AUB, especially in women over age 40 without an enlarged uterus or fibroids.
This document summarizes three clinical studies on IVF outcomes for women with PCOS:
1. A study comparing fresh versus frozen-thawed embryo transfer, finding higher clinical pregnancy and live birth rates with fresh transfers.
2. An analysis of over 4,000 IVF cycles from SART, finding no significant difference in outcomes between IVF and ICSI for couples with PCOS and normal sperm.
3. A study examining the impact of metformin on outcomes in overweight/obese PCOS women, with conflicting previous results noted.
This document discusses emerging treatments for endometriosis. It begins by outlining the limitations of current treatments, such as being suppressive rather than curative, interfering with fertility, and having limited effectiveness for certain disease phenotypes. The document then examines the criteria for an ideal endometriosis medication and evaluates several emerging hormonal and non-hormonal treatments. These include gonadotropin-releasing hormone antagonists, selective progesterone receptor modulators, aromatase inhibitors, immunomodulators, and other agents. For many of the treatments, human and animal studies are summarized that demonstrate reductions in pain, lesion size, or other beneficial outcomes for endometriosis.
This study compared obstetric and neonatal outcomes between 76 women who conceived using donated oocytes, 150 women who conceived spontaneously, and 63 women who conceived using non-donor IVF. The study found that women who conceived using donated oocytes had higher rates of hypertensive disorders during pregnancy, cesarean delivery, induction of labor, postpartum hemorrhage, and preterm birth compared to spontaneously conceiving women. Similar trends were observed when comparing women who conceived using donated oocytes to those using non-donor IVF, though some differences were not statistically significant. However, mean birth weight and length of term infants were similar between groups, and rates of congenital malformations did not differ.
This document discusses adolescent endometriosis (AE), noting that it is a common condition with many unanswered questions. AE can involve lesions of all stages of severity, from minimal to severe. While some reports have found only early stage lesions in AE, more recent studies show a significant portion have advanced stage disease. AE seems to have a progressive natural course. Risk factors include early menarche, family history, and mullerian anomalies. Common symptoms are pain, which is often resistant to medical therapy, and pelvic masses seen on ultrasound. Laparoscopy is the gold standard for diagnosis but often shows atypical lesions. Treatment involves medications, with surgery as an option for persistent or severe cases. Recurrence is a
This document discusses several studies and guidelines related to fertility treatments. It provides recommendations on:
- Performing hysteroscopic procedures before IVF to improve outcomes for patients with failed ART cycles.
- Cabergoline reducing OHSS risk with IVF without compromising pregnancy rates.
- AFC and AMH being better predictors of ovarian response than FSH.
- No need for FSH doses over 300IU to increase pregnancy rates.
- Laparoscopic approach for ectopic pregnancy being less costly than open surgery, though open has lower persistent trophoblast rates. Medical treatment is also an option.
A 33-year old female presented with abdominal pain, dysuria, and fever. Ultrasound and X-ray revealed a bladder calculus formed around an intrauterine contraceptive device (IUCD) that had migrated from the uterus into the bladder. Such IUCD migration is a rare but known complication, and the device must be removed to prevent further complications like stone formation. Cystoscopy confirmed the presence of the IUCD within the bladder, which was then removed surgically.
Trauma and urologic reconstruction network of surgeons - MMC and BNCXjeremybmyers
This document summarizes the use of mitomycin C (MMC) for recurrent bladder neck contractures. It describes the author's experience treating 55 patients with transurethral incision and MMC injection, finding a 58% initial success rate and 75% success after a second treatment. It also reviews literature on deep incision alone, finding similar success rates. Complications from MMC included bladder pain, ulceration, and osteitis pubis in 3 patients. The optimal timing of artificial urinary sphincter placement after treatment is unknown.
Introduction: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn,
research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1
rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl.
This document summarizes a study that evaluated the effects of various maternal, fetal, and technical factors on the accuracy of sonographic fetal weight estimation (SFWE). The study analyzed over 9,000 SFWEs performed within a week of delivery. It found that several maternal factors, including higher weight, height, BMI, older age, diabetes, and multiparity were associated with underestimation of fetal weight. Fetal factors like male sex were also linked to underestimation, while breech presentation slightly improved accuracy. Experience level of the sonographer had little effect. Overall, the models assessed explained less than 10% of errors, suggesting most inaccuracy comes from limitations of SFWE formulas themselves.
Journal club 1 (Management of CGCG using subcutaneous Denosumab therapy )Anish Kamat
- The patient was diagnosed with central giant cell granuloma in the right mandible based on an incisional biopsy. Laboratory tests showed normal calcium, alkaline phosphatase, phosphorus, and parathyroid hormone levels.
- According to a treatment protocol, the patient received subcutaneous injections of denosumab 120 mg monthly for 6 months, with additional loading doses on days 8 and 15 of the first month, along with daily calcium and vitamin D supplements.
- After 6 and 18 months of denosumab therapy, CT scans showed reduction in tumor size. Reduction was also seen 1 year after cessation of therapy, indicating the treatment was effective for the central giant cell granuloma.
This document discusses single-incision slings (SIS) for treating stress urinary incontinence. It provides pros and cons of SIS and summarizes various studies on the Minisling procedure. The studies found success rates of 85-95% in curing incontinence with SIS at 12-24 months follow up. Complication rates were low. SIS provide benefits of reduced bleeding risk, pain, and recovery time compared to standard mid-urethral slings. However, the document notes the learning curve is still developing for SIS procedures. In summary, the document reviews clinical studies demonstrating that single-incision slings effectively treat incontinence with low complication rates.
ECO10 - Measuring the true pathway of innovation in the NHSInnovation Agency
The document discusses the introduction and clinical evidence for the UroLift system, a minimally invasive treatment for benign prostatic hyperplasia (BPH). It summarizes the clinical trials demonstrating UroLift's rapid and durable relief of BPH symptoms with minimal side effects. It also outlines UroLift's journey to approval and reimbursement in the UK, including a positive NICE recommendation and being granted an Innovation Technology Tariff to facilitate adoption in the NHS. UroLift is positioned as a cost-effective alternative to traditional BPH surgeries that allows for quicker recovery and preservation of sexual function.
Long term-quality-life-tension-free-vaginal-tape-obturator-procedure-women-st...dynajolly
Introduction:
Stress urinary incontinence represents a common but strongly underestimated health problem that affects women of all ages and severely downgrades their health related quality of life. The transobturator vaginal tape (TVT-O) approach offers long term success rates, while minimizing complications. In this study, we examined quality of life of patients suffering by stress urinary incontinence and investigated whether TVT-O procedure offers considerable benefits in patient’s quality of life after 5 years of placement.
Methods and results:
Women with confirmed urodynamic stress urinary incontinence that underwent TVT-O procedure were included in this prospective study. Patient’s quality of life was evaluated by using the Greek version of SF-36 preoperatively and 60 months postoperatively. The outcomes demonstrated that incontinence had significant adverse effect in patient’s quality of life. However, TVT-O procedure offers a safe and efficient treatment, substantially improving both physical and mental dimension of women’s health related quality of life (P>0.05).
Discussion:
Stress urinary incontinence strongly impairs women’s health related quality of life, limiting their physical activities, social function and causing emotionally imbalance. Insertion of tension free vaginal tape reverses symptoms and significantly improves all health indicators associated with patient’s health related quality of life. In our study, we demonstrate that minimal invasive surgery, by using TVT-O procedure is highly effective, in long term, in improving quality of life of women with stress urinary incontinence.
Nursing and Health care Journal attracts high quality manuscripts with rapid peer review process related to all the aspects of Health care Researches. Journal accepts leading forefront original research papers, review manuscripts, case reports and commentary in the field. Nursing and Health Care journal offers a stage in Health care Research and related subjects.
This document summarizes developments in direct visual internal urethrotomy (DVIU) for treating urethral strictures. It discusses techniques for DVIU, factors that influence outcomes, and the long-term efficacy of DVIU. While initial studies reported high success rates of around 80%, more recent long-term studies have found much lower success rates of only around 8-30%. Recurrence rates are higher for longer strictures, greater spongiofibrosis, distal strictures, and when DVIU is repeated for recurrent strictures. Overall, DVIU has relatively poor long-term outcomes for treating urethral strictures.
This document proposes a standardized definition for a successful urethral reconstruction procedure based on both anatomic and functional outcomes. Anatomical success is defined as the ability to traverse the reconstructed urethra during cystoscopy without force. Functional success is defined as improved voiding symptoms and quality of life without new sexual or pain issues, based on patient-reported outcomes. Both should be routinely reported. Follow-up should utilize uroflowmetry and questionnaires to detect recurrence while minimizing invasive testing. This standardized approach allows for more accurate comparison of reconstruction techniques and outcomes.
This study compared the effects of the modified Furlow palatoplasty technique versus the two-flap palatoplasty technique on ear function and hearing outcomes in 72 cleft palate patients over one year. The results found that at three months post-operation, the modified Furlow group had significantly lower middle ear effusion and acute otitis media rates compared to the two-flap group. However, the differences between groups were not statistically significant at other follow-up periods of one month, six months, and one year.
This document discusses stress urinary incontinence (SUI) and various treatment options. It begins by outlining some myths about SUI, noting that it is not simply a natural part of aging and can be treated. Conservative management options for SUI are discussed such as lifestyle changes and pelvic floor exercises. Surgical options for urodynamic stress incontinence (USI) are then summarized, including traditional approaches like Burch colposuspension as well as modern mid-urethral sling (MUS) procedures. Complications, outcomes, and long-term results are compared for different surgical techniques. Guidance from regulatory bodies on the appropriate use of MUS is also presented.
L’indagine urodinamica prima della chirurgia per IUS - PROGLUP2010
(1) A recent Cochrane review found that while urodynamic tests changed clinical decision making, there was no clear evidence it resulted in better patient outcomes. However, the review had limitations as it only included two small studies.
(2) A study of 523 women found that omitting urodynamics was not inferior to including it for preoperative evaluation of stress urinary incontinence. However, the study groups were imbalanced and subgroups like those with voiding dysfunction were not fully analyzed.
(3) Urodynamics can identify underlying conditions like detrusor overactivity that may not require surgery. Avoiding unnecessary surgeries through urodynamics could save costs when evaluating large numbers of patients
L’indagine urodinamica prima della chirurgia per IUS PROGLUP2010
(1) A recent Cochrane review found that while urodynamic tests changed clinical decision making, there was no clear evidence it led to better patient outcomes. However, the review had limitations as it only included two small studies.
(2) Urodynamic evaluation can identify underlying conditions like detrusor overactivity that may not require surgery. Avoiding unnecessary surgeries through urodynamics could save significant costs.
(3) Urodynamic tests can provide parameters to predict surgical success or complications and guide surgical technique selection, such as using retropubic slings for stress urinary incontinence patients with intrinsic sphincter deficiency.
Cosmetic and asthetic gynaecology by Dr Narendra MalhotraNARENDRA C MALHOTRA
This document provides a summary of the qualifications and accomplishments of Prof. Narendra Malhotra. It lists his positions including being a professor, vice president of various medical organizations, editor of medical publications, and director of multiple hospitals and medical centers. It also outlines his areas of medical specialization including obstetrics, gynecology, infertility, and genetics. The document notes he has over 50 published papers, 200 presentations, and has received several awards for his contributions to the field of medicine.
Top Five Problems You Have with Ovulation Induction and How to Solve ThemSandro Esteves
The document discusses the top five problems with ovulation induction and how to solve them. It addresses whether protocols need to be individualized, how long clomiphene citrate should be used, the advantages of recombinant versus urinary gonadotropins, the advantages of recombinant versus urinary hCG, and whether LH supplementation is needed. It provides evidence-based recommendations including that protocols should be tailored based on biomarkers and individual factors, clomiphene citrate is usually first-line for up to 3 cycles, and recombinant gonadotropins yield higher pregnancy rates than clomiphene without increased risks.
Clinical Improvement after ESSURE® devices removal, a systematic reviewFrançois PARANT
Removal of Essure® in symptomatic patients improve symptoms and quality-of-life in majority of cases. The physiological mechanisms underlying Essure®-attributed-symptoms remains unknown, but are probably related to release of metallic elements. Managing the few proportion of patients with no improvement remain a challenge.
Endometrioma and how it affects IVF outcome : modified procedure with encoura...Mohamed Walaa El Deeb
1) Endometriomas are common in women with endometriosis and infertility, affecting up to 50% of subfertile women. Surgical removal carries risks of reducing ovarian reserve.
2) A meta-analysis found no significant difference in ovarian response or pregnancy rates between surgery vs no treatment prior to IVF. However, large endometriomas over 4cm may interfere with oocyte retrieval.
3) The authors propose a modified aspiration technique for large, recurrent endometriomas as an alternative to repeated surgery. Preliminary results show encouraging pregnancy rates without complications. Larger studies are still needed.
ShearWave™ Elastography in Chronic Liver Diseases: Clinical Research Literatu...Joel Gay
By the end of 2016, SuperSonic Imagine’s proprietary ShearWave™ Elastography (SWE™) reached a track record of over 100 peer-reviewed publications focusing on the evaluation of liver fibrosis severity in patients with chronic liver diseases. Therefore, it has become the most clinically studied shear-wave based elastography technique for liver fibrosis assessment.
In this all new webinar, we will walk you through a literature review that will help you to familiarize yourself with clinical research results related to the use of ShearWave™ Elastography (SWE™) within the field of chronic liver diseases.
DOI: 10.21276/ijlssr.2016.2.3.15
ABSTRACT- Abnormal cervical cytology includes lesions of the cervix caused due to various infections, hormonal
disturbances, premalignant and malignant conditions. Screening of all the symptomatic women complaining of vaginal
discharge, irregular menstrual bleeding, dyspareunia, post-coital bleeding or post-menopausal bleeding is necessary for
detection and also to pick up any aberration in cervix epithelium i.e. dysplasia or early cervical cancer.
Key-words- Negative for Intraepithelial Lesion or Malignancy, Atypical Squamous Cell of Undetermined Significance,
Low grade Squamous Intraepithelial Lesion, High grade Squamous Intraepithelial Lesion, Squamous Cell Carcinoma
The Bethesda System is a standardized terminology used for reporting cervical and vaginal cytology test results, such as Pap smears. It was established in 1988 at a conference in Bethesda, Maryland and has since been updated in 1991, 2001, and 2014. The system provides a structured format for specimen details, adequacy, interpretation, and any necessary follow-up testing. It aims to improve consistency and reduce ambiguity in cervical cancer screening.
This document summarizes pre-clinical and clinical data on the Colon Ring for circular anastomosis. A porcine study showed the Colon Ring had higher burst pressure and preserved natural lumen size compared to stapling. Over 1050 human procedures showed an overall leak rate of approximately 2%. Planned clinical studies include a 300-patient prospective study of the Colon Ring for rectal anastomosis starting in 2009, and a 150-patient comparison study of the Colon Ring versus stapling.
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsSujoy Dasgupta
Dr Sujoy Dasgupta was invited to moderate a panel discussion on "Fertility Management: Synergy between Endoscopists and Fertility Specialists " in a CME by Torrent held on 27 May 2023.
Stapler circumcision uses an inner and outer bell device to efficiently remove the foreskin and close the incision with staples, providing good hemostasis. Recent studies comparing stapler to conventional circumcision with stitches found stapler circumcision resulted in less intra-operative blood loss, shorter operating time, lower mean pain scores after surgery, and faster wound healing times. The studies provide medical evidence that stapler circumcision has advantages over conventional circumcision.
Prostatitis and seminal vesiculitis that is intractable , ie no effect from 4-6 weeks quinolone, with chronic symptoms of perineal discomfort, hemospermia, frequency and urgency of urination, suprapubic pain, dysuria with urethral discharge, seen by doctors and told to have chronic pelvic pain syndrome should consider to consult urologist for indications of transurethral seminal vesiculoscopy.
This document discusses tools and techniques for holmium laser enucleation of the prostate (HoLEP). It provides tips for different laser settings for cutting and coagulation. It emphasizes the importance of hemostasis during morcellation and describes techniques for handling the prostate in lobes or en bloc. Potential complications like transient stress urinary incontinence are addressed. Experience levels for surgeons of different prostate sizes are noted, and the value of mentorship programs is highlighted.
Precision Oncology symposium Hong Kong Sanatorium & Hospital 崔 家倫
This document provides information about transperineal injection of a rectal spacer by a urologist. It begins with background on prostate cancer rates in Hong Kong and traditional use of transrectal biopsy. It then discusses the myths and disadvantages of transrectal biopsy, including risk of life-threatening sepsis. Transperineal biopsy and injection of a rectal spacer are presented as alternatives that avoid puncturing the rectal mucosa and can reduce infection risks. The document provides details of the urologist's experience performing over 600 transperineal biopsies with a rectal spacer, which had a very low infection rate. It suggests this technique may offer cost savings compared to transrectal biopsy due to
POCUS (Point Of Care UltraSound) should be taught in medical school and can replace the stethoscope. It provides useful information to help diagnosis at the point of care. For flank pain/renal colic, POCUS can help identify upper ureteric stones, distal ureteric stones, and assess hydronephrosis and cortical loss. Doppler ultrasound can differentiate between hydronephrosis and vasculature. POCUS is also useful for identifying renal cysts, perinephric haematomas, and assessing prostate enlargement.
Ultrasound can be used in clinic for a better diagnosis, esp in emergency circumstances. Urological surgeon can make better decision for patient care with the help of ultrasound imaging at the point of care.
This document summarizes the issues surrounding female urinary incontinence and the use of mesh. It notes that several governments and regulatory agencies have placed restrictions on transvaginal mesh due to inadequate evidence of long-term safety and efficacy and risk of harm. Studies show mesh can lead to complications like pain, infection, and erosion. Alternatives to mesh discussed include exercises, bulking agents, and new non-surgical therapies like BTL Emsella which uses electromagnetic stimulation of the pelvic floor muscles.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
DECLARATION OF HELSINKI - History and principlesanaghabharat01
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
6. In 2014 the Scottish government put in place
a suspension in the use of mesh for stress
urinary incontinence.
7. The Australian government has issued a
national apology to women affected by a
vaginal mesh scandal, acknowledging
decades of "agony and pain".
The Royal Australian and New Zealand college
of obstetricians and gynaecologists admit that
‘there is very little information on the efficacy
and long term safety of polypropylene mesh’.
Australia bans
transvaginal mesh
products on Dec 2017 as
'too risky'
8. The FDA has stated that “it is not clear that transvaginal
POP repair with mesh is more effective” than non-mesh
repair, and “may expose patients to greater risk.”
On April 16, 2019, the FDA ordered all manufacturers of surgical mesh
intended for transvaginal repair of anterior compartment prolapse (cystocele)
to stop selling and distributing their products immediately.
12. “The ban on mesh for stress
urinary incontinence reflects the
inadequate evidence base that let
risky mesh devices on to the
market, the lack of long-term
evidence to inform their use and
the inadequate response of
health professionals to emerging
harms.”
13. The National Institute for Health and Care Excellence
(Nice) clinical guidelines for urinary incontinence and
pelvic organ prolapse continue to include surgical use of
mesh as one option for women with particular conditions.
However, the guidelines say surgery should only be offered
to women for whom non-surgical approaches have failed or
been rejected.
They also stress that women must be counselled about the
possible complications and that both short- and long-term
outcomes must be recorded in a national registry.
April 2019
Health and social minister Jackie Doyle-Price has urged
women who were injured by vaginal mesh to take legal
action against medics as well as manufacturers
14. No more referals are allowed to mesh removal expert,
surgeon Suzy Elneil of UCLH, owing to a huge backlog of
work. The announcement shows a widespread lack of care
and treatment options, says MP Owen Smith, who
recognises the distress the news will cause for women.
19. BTL EMSELLA™
POWERED BY HIFEM™ TECHNOLOGY
BTL EMSELLA works on the principle
of patented High Intensity Focused
Electromagnetic Technology (HIFEM).
This is an extremely powerful focused
electromagnetic field. Its high intensity
enables to reach supramaximal muscle
contractions, while the patient comfortably
sits on the Emsella applicator.
*This product, the methods of its manufacture and the use are covered by one
or more US and foreign patents or pending patent applications.
20. BTL EMSELLA™ MECHANISM OF ACTION
*
▶ BTL EMSELLA uses High Intensity Focused
Electromagnetic Technology (HIFEM) to cause deep
pelvic floor muscles stimulation
▶ Key effectiveness is based on focused electromagnetic
energy, in-depth penetration, and stimulation of the entire
pelvic floor area
▶ A single session brings thousands of supramaximal
pelvic floor muscle contractions, which are extremely
important in muscle re-education of incontinent patients
23. EMSELLA EXPERIENCE IN HONG
KONG
▶ In Prince of Wales Hospital
▶ SUI/OAB patient pool from PWH
▶ One finished pilot study:
▶ 1-hour Pad test on 20 SUI patients while 9 have complete data
▶ One recruiting study:
▶ Evaluation of Emsella Efficacy and safety on Urinary Incontinence on
Male and Female – 60 patients
24. ▶ The patient should sit
at the centre of the
chair with spine
straight
▶ Set the chair height
so that the patient’s
feet are on the ground
25. EFFICACY OF EMSELLA – PILOT
STUDY
▶ 9 patients (8 female and 1 male) with Stress UI
▶ Age 49-86 (Average: 63)
▶ 6 Tx, Twice per week
▶ 2 – 4 weeks follow up after the 6th Tx
▶ Intensity of 100%
▶ Assessments:
a) 1- hour Pad test Pre and Post
b) I-PSS (International Prostate Symptom Score)
c) IIQ7 (Incontinence Impact Questionnaire)
d) UDI6 (Urgenital Distress Inventory)
e) OABSS (OverActive Bladder Symptom Scores)
26. PROTOCOL FOR 1 HOUR PAD TEST
1. Empty the urinary bladder
2. Record the weight of a new pad and let patient wear it
3. Drink 500ml water within 15 mins
4. Walk for 30 minutes (Includes going up and down one flight of stairs,
voiding is not allowed durng the procedure)
5. Bladder Scan
6. 15 mins exercises as follow:
a) Stand up and sit down 10 times
b) Place running 1 minute
c) Hard coughing 10 times (Standing with legs apart)
d) Pick up small objects from the floor 5 times
e) Wash hands 1 min
7. Weigh the same pad again after finishing the above steps
27. RESULTS – 1-HOUR PAD TEST
▶ For the 1-hour Pad Test, an increase of 1 to 10 g represents mild
incontinence, 11 to 50 g represents moderate incontinence and > 50 g
represents severe incontinence*
*Krhut J, et al. Neurourol Urodyn. 2014;33(5):507–510.
Pre (g) Post (g) Reduced
by (g)
Reduced
by %
21.4 4 -17.4 81.31%
4.5 0.5 -4 88.89%
8.5 5.5 -3 35.29%
1.6 1.4 -0.2 12.50%
5.1 1.6 -3.5 68.63%
17.5 12.8 -4.7 26.86%
8.2 2.4 -5.8 70.73%
3.6 1.8 -1.8 50.00%
10.9 0.4 -10.5 96.33%
Average: -5.66 59%
Colored indicates
Moderate Incontinence
Colored indicates
Mild Incontinence
Colored indicates
No Incontinence
28. RESULTS- 1 HOUR PAD TEST
*1 tail t-test p-value = 0.01
P <0.05*
29. RESULTS – INTERNATIONAL
PROSTATE SYMPTOM SCORE
P <0.05*
Mild (symptom score less than of equal to 7)
Moderate (symptom score range 8-19)
Severe (symptom score range 20-35)
*1 tail t-test p-value = 0.009
30. RESULTS – OVERACTIVE BLADDER
SCORE
P <0.05*
OABSS: A total score ranging from 0-15
*1 tail t-test p-value = 0.008
33. CASE REPORT IN HK
▶ Ms Choi; Age: 65; 2 Childs
▶ Diagnosis of Mixed Incontinence for > 3 years
▶ Pelvic floor training recommended, but not much improvement.
▶ Urine Leakage whenever cough, jump, laugh, or play with kids
▶ Pre-treatment:
▶ > 3 pads per day
▶ 1-hour Pad test: 21.4g
▶ Post-treatment:
▶ 1 pad per day
▶ 1-hour Pad test: 4g
▶ “Before I couldn’t even sense my pelvic floor muscle, so I don’t
know how to contract it, so Kegel was not so effective to me.
But now, I could feel the muscle! I tried jump after the 1st
treatment but nothing leaks out!”
34. CASE REPORT IN HK
▶ Mr Lee; Age:83
▶ Prostatectomy on 2017 March
▶ SUI post-prostatectomy
▶ Pre-treatment:
▶ Nocturia > 3 times daily
▶ 6 pads per day
▶ Sudden urge resulting urine leakage > 5 times daily
▶ After Emsella 6 Tx,
▶ Nocturia =1 time daily
▶ 2 pads per day
▶ Sudden urge resulting urine leakage = 1 time daily
35. ONGOING STUDY – EVALUATION OF
EMSELLA EFFICACY AND SAFETY ON
URINARY INCONTINENCE IN MALE AND
FEMALE
- Prince of Wales Hospital Initiated
- 60 patients (male and female) with SUI
- For male patients, they should had undergone prostatectomy for at
least 1 year
- ICIQ-UI-SF > 6 points
- Primary objective: 50% reduction from baseline in daily number of
SUI episodes
- Primary Endpoint of Safety is the incidence of treatment-related
serious adverse events (SAEs)
- Secondary objective: % of patients successfully maintaining the
primary effectiveness at 12 month
Wagner TH, Patrick DL, Bavendam TG, et al. Quality of life with urinary incontinence: development of a new measure. Urology 1996; 47(1):
62-72
Uebersax JS, Wyman JF, Shumaker SA, McClish DK, et al. Short forms to assess life quality and symptom distress for urinary incontinence in
women: The incontinence impact questionnaire and the urogenital distress inventory. Neurology and Urodynamics 1995; 14: 131-139
Sandvik H, Hundskaar S, et al. Validation of a severity index in female urinary incontinence and its implementation in an epidemiological
survey. J Epidemiol Community Health 1993; 47:497-499. AND Sandvik H, Selm A, et al. A severity index index for epidemiological surveys of
36. ONGOING STUDY – EVALUATION OF
EMSELLA EFFICACY AND SAFETY ON
URINARY INCONTINENCE IN MALE AND
FEMALE
- Emsella treatment – 6Tx, Twice a week
- Follow up at 3 months after last treatment
- Assessments:
- 1 hour Pad test
- Incontinence Quality of Life (IQOL)
- Incontinence Impact Questionnaire (IIQ7)
- Urogenital Distress Inventory (UDI6)
- Global Quality of Life Assessment (GQOL)
Ueversax JS, Wyman JF, Shumaker SA, McClish DK, et al. Short forms to assess life quality and symptom distress for urinary incontinence in women:
The incontinence impact questionnaire and the urogenital distress inventory. Neurology and Urodynamics 1995; 14: 131-139.
This question is taken from the International Prostate Symptom Score (IPSS) Assessment. The IPSS assessment includes the same seven questions as
the American Urological Association (AUA) Symptom index plus an additional quality of life (QOL) question. The question referred to here as the GQOL
is the QOL question from the IPSS Assessment Ref: AUA Practice Guidelines, Committee (2003). :AUA guideline on management of benign prostatic
hyperplasia. Chapter 1: Diagnosis and treatment recommendations”. J. Urol. 170 (2 Pt 1): 530-47.
39. Joseph Berenholz, MD, Michigan, USA
Tracey Sims, MD; George Botros, MD, Liverpool, UK
• 30 patients; all types of urinary incontinence
• 6 therapies; scheduled 2x a week
• Standardized King´s Health Questionnaire, Number of used
hygienic pads
Results:
• 95% of treated patients improved quality of life
• 67% of treated patients totally eliminated or decreased
the use of hygienic pads
• The results were maintained during 6-month follow-up
HIFEM Technology Can Improve Quality of Life of Incontinent
Patients
40. Red Alinsod, MD, Laguna Beach, California
Vasil Vasilev, MD, Sofia, Bulgaria
38th ASLMS Annual Conference on
“Energy-based Medicine and Science”, 2018
• 30 patients; stress urinary incontinence
• 6 therapies; scheduled 2x a week
• Standardized King´s Health Questionnaire
Results:
• 93% of treated patients reported decreased
negative incontinence impact on quality of life
• The results were maintained during 6-month
follow-up
HIFEM Technology – A New Perspective In Treatment
of Stress Urinary Incontinence
41. Julene Samuels, MD, Louisville, KY;
Nathan Guerette, MD, Richmond, VA
38th ASLMS Annual Conference on “Energy-
based Medicine and Science”, 2018
• 20 patients; stress/urge/mixed urinary incontinence
• 6 therapies; scheduled 2x a week
• Standardized King´s Health Questionnaire (KHQ)
Results:
• 60% improvement in both parts of KHQ
• The results were maintained during 6-month
follow-up
HIFEM Technology – The Non-invasive Treatment of Urinary
Incontinence
42. Delgado Cidranes E, MD, Madrid, Spain
Estrada Blanco, MD, Madrid, Spain
Medical and Clinical Research, Vol.3 (2)
• 32 patients; urinary incontinence
• 6 therapies; scheduled 2x a week
• KHQ; ICIQ-SF; MRI; Uroflowmetry; Urethrocystoscopy
Results:
• Significant changes in objective evaluations were
detected in 84% of patients
• Elastographic changes were detected in 94%
of patients
Safety And Preliminary Efficacy of Magnetic Stimulation of
Pelvic Floor with HIFEM Technology in Urinary Incontinence
43. Er:YAG Smooth Mode Controlled Tissue Heating Process
Temp °C
Time
(sec)
35°
40°
45°
50°
55°
60°
Laser
Pulses
0 1 2 3
Pulse Train
Temp °C
Time
(sec)
35°
40°
45°
50°
55°
60°
Laser
Pulses
0 1 2 3
Pulse Train
Applications FAQ
How does it work?
44. Using the proper dosage of Smooth Mode
the temperature in mucosa reaches
60°C to 63°C
This is the optimal temperature for the
process of shortening the collagen fibers
and neocollagenesis [1]
1) Dams SD, de Liefde-van Beest M, Nuijs AM, Oomens CW, Baaijens FP : Pulsed heat shocks enhance procollagen type I
and procollagen type III expression in human dermal fibroblasts, Skin Res Technol. 2010 Aug;16(3):354-64
How does it work?
Applications FAQ
45. SMOOTH mode controlled Tissue Heating Process
Example of the calculated
depth of the thermally
affected mucous tissue
during STEP 2 of the
procedure:
Irradiation with four Er:YAG
SMOOTH mode pulses with
a full beam fluence of 3
J/cm2.
4th SMOOTH pulse
1st
2nd
3rd
67 0C
How deep is the heat going ?
46. 1. Photo-Thermal Interaction
2. Thermo-Mechanical Interaction
3. Growth of New Collagen Fibers
Mechanism of action consists of three components:
Mechanism of Action
47. Vaginal wall structure
Before
Shrinked and thicker wall
after neo-collagenesis
After
Photo-thermal effect
Laser Irradiation
Mechanism of Action
Thermal shrinkage of top
layers and mechanical
pull of deeper structures
CourtesyofJunaClinic
CourtesyofJunaClinic
M. Rivera measured an average shrinking of
vaginal canal of 12 mm (or 17%)
A.A. Bezmenko measured an average
thickening of vaginal wall of 1.5 mm (or 56%)
48. 48
Thermally processed vaginal wall
Laser beam is applied along the vaginal canal
until full tissue coverage is achieved
Non-ablative Er:YAG for Controlled Tissue Heating
51. Gynecology with FotonaSmooth
IncontiLase Intra
UUI MUI SUI
ISD
* Lukban J C, Aguirre O A, Van Hegewald W, Davila G W: THE PREVALENCE OF INTRINSIC SPHINCTER DEFICIENCY IN
PATIENTS WITH STRESS URINARY INCONTINENCE AND URETHRAL HYPERMOBILITY,
http://www.ics.org/Abstracts/Publish/42/000318.pdf
Prevalence of ISD
could be more
than 20% of SUI
patients*
58. 58
Er:YAG laser treatment for SUI
Accepted for publication in
IUJO
Dr. Yi-Wen Tien
Dr. Sheng-Muo Hsiao
Dr. Chien-Nan Lee
Dr. Ho-Hsiung Lin
National Taiwan University
Hospital IRB study
59. 59
Er:YAG laser treatment for SUI
Presented at Annual
Meeting of Taiwan
Association of Obstetrics
and Gynecology in 2016
Dr. Yi-Hao Lin
Chang Gung Memorial Hospital study
Urodynamics, 1h pad test, perineometry, sexual and UI questionnaires
60. 60
Er:YAG laser treatment for SUI
Chang Gung Memorial Hospital study (2016)
Urodynamics, 1h pad test, perineometry, sexual and UI questionnaires
61. 61
Er:YAG laser treatment for SUI
Chang Gung Memorial Hospital study (2016)
Urodynamics, 1h pad test, perineometry, sexual and UI questionnaires