Sexual function after sacrospinous fixation for vaginal vault prolapse: bad or mad?

BACKGROUND: The main indication for sacrospinous ligament suspension is to correct either total procidentia, a posthysterectomy vaginal vault prolapse with an associated weak cardinal uterosacral ligament complex, or a posthysterectomy enterocele. This study aimed to evaluate sexual function and anatomic outcome for patients after sacrospinous ligament suspension. METHODS: For this study, 52 patients who had undergone sacrospinous ligament fixation during the preceding 5 years were asked to complete the Female Sexual Function Index (FSFI) questionnaire. The patients were vaginally examined using the ICS POP score, and the results were compared with their preoperative status. For statistical analysis, GraphPad for Windows, version 4.0, was used. RESULTS: The 52 patients were examined during a follow-up period of 38 months. No major intraoperative complications were noted. Recurrence of symptomatic apical descent was noted in 6% of the patients and de novo prolapse in 13.5%. Only one patient was symptomatic. Three patients experienced de novo dyspareunia, which resolved in two cases after stitch removal. Sexual function was good, rating higher than three points for each of the domains including satisfaction, lubrication, desire, orgasm, and pain. CONCLUSION: Sacrospinous ligament fixation still is a valuable option for the treatment of vaginal vault prolapse. Sexual function is satisfactory, with few cases of de novo dyspareunia.

Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful?

OBJECTIVE: To evaluate quality of life and pelvic organ and sexual function before and during pessary use in patients with symptomatic pelvic organ prolapse and to determine reasons which lead to cessation of pessary use. DESIGN: Prospective observational study. SETTING: Tertiary referral center. PATIENT(S): Patients with symptomatic stage II or more prolapse of the anterior, posterior, or apical vaginal wall with or without uterus were included in this study. INTERVENTION(S): We used the Female Sexual Function Index questionnaire and the Sheffield prolapse questionnaire. For quality of life we used the King's Health Questionnaire. MAIN OUTCOME MEASURE(S): Main outcome measures were quality of life and sexual and pelvic organ function. RESULT(S): A total of 73 women participated in this study; 31 were sexually active. Desire, lubrication, and sexual satisfaction showed statistically significant improvement, and orgasm remained unchanged. Statistically significant improvement in the feeling of bulge occurred during therapy, stool outlet problems were significantly improved, overactive bladder symptoms were significantly better, and pessaries did not significantly alter incontinence. CONCLUSION(S): Pessaries have been shown to be a viable noninvasive treatment for pelvic organ prolapse improving organ and sexual function as well as general wellbeing.

Male and female sexual function after surgical repair of female organ prolapse

INTRODUCTION: Few data are available referring to male and female sexual function after prolapse repair of symptomatic pelvic organ. AIM: Primary aim of this study is to determine the male and female sexual function before and after surgery for pelvic organ prolapse. MAIN OUTCOME MEASURES: We used the Female Sexual Function Index (FSFI) questionnaire for female patients and for their male partners the Brief Male Sexual Inventory (BMSI) as measurement of sexual function. METHODS: We included sexually active heterosexual couples that were referred to the Department of Urogynaecology because of symptomatic cystocele, rectocele or vault descent. For cystoceles, anterior repair was performed, for rectoceles posterior repair, and for vault descent sacrospinous ligament fixation. FSFI and BMSI questionnaires were distributed before and after pelvic organ surgery and 4 months after. Female clinical examination assessing the degree of prolapse was performed before and 6 weeks after surgery. RESULTS: A full data set of 70 female questionnaires and 64 male questionnaires could be evaluated. Two cases of female de novo dyspareunia occurred. In women, FSFI scores improved significantly in the domains desire, arousal, lubrication, overall satisfaction, and particularly pain. Orgasm remained unchanged. In men, interest, sexual drive, and overall satisfaction improved significantly. Erection, ejaculatory function, and orgasm remained unchanged. Despite remaining unchanged, erection, strength of erection, ejaculation, and orgasm were not considered problems anymore compared to preoperative BMSI scores. CONCLUSION: Surgery for pelvic organ prolapse improves male and female sexual function in some domains but not in all.

Robotic-assisted laparoscopic "salvage" rectopexy for recurrent ileoanal J-pouch prolapse.

Total restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA) has become the standard of care for the surgical treatment of ulcerative colitis. Despite its correlation with an excellent quality of life and favorable long-term outcomes, RP/IPAA has been associated with several complications. Prolapse of the ileoanal pouch is a rare and debilitating complication that should be considered in the differential diagnosis of pouch failure. Limited data exist regarding the prevalence and treatment of pouch prolapse. We present the case of a recurrent J-pouch prolapse treated with a novel minimally invasive "salvage" approach involving a robotic-assisted laparoscopic rectopexy with mesh.

Only Neochordoplasty Achieves Physiological Trans-valvular Pressure Gradients After Repair Of Acute Posterior Leaflet Prolapse In Porcine Mitral Valves

Objective: Minimizing resection and preserving leaflet tissue has been previously shown to be beneficial for mitral valve function and leaflet kinematics after repair of acute posterior leaflet prolapse in porcine valves. We examined the effects of different additional methods of mitral valve repair (neochordoplasty, ring annuloplasty, edge-to-edge repair and triangular resection) on hemodynamics at different heart rates in an experimental model. Methods: Severe acute P2 prolapse was created in eight porcine mitral valves by resecting the posterior marginal chordae. Valve hemodynamics was quantified under pulsatile conditions in an in vitro heart simulator before and after surgical manipulation. Mitral regurgitation was corrected using four different methods of repair on the same valve: neochordoplasty with expanded polytetrafluoroethylene sutures alone and together with ring annuloplasty, edge-to-edge repair and triangular resection, both with non-restrictive annuloplasty. Residual mitral valve leak, trans-valvular pressure gradients, flow and cardiac output were measured at 60 and 80 beats/min. A validated statistical linear mixed model was used to analyze the effect of treatment. The p values were calculated using a two-sided Wald test. Results: Only neochordoplasty with expanded polytetrafluoroethylene sutures but without ring annuloplasty achieved similar hemodynamics compared to those of the native mitral valve (p range 0.071-0.901). Trans-valvular diastolic pressure gradients were within a physiologic range but significantly higher than those of the native valve following neochordoplasty with ring annuloplasty (p=0.000), triangular resection (p=0.000) and edge-to-edge repair (p=0.000). Neochordoplasty alone was significantly better in terms of hemodynamic than neochordoplasty with a ring annuloplasty (p=0.000). These values were stable regardless of heart rate or ring size. Conclusions: Neochordoplasty without ring annuloplasty is the only repair technique able to achieve almost native physiological hemodynamics after correction of leaflet prolapse in a porcine experimental model of acute chordal rupture.

Variational Calculation of the Hydrogen Molecular Cation Using Maple

The variational calculation of the energy of the Hydrogen Molecular (H2+) Cation's LCAO-MO for the sigma and sigma* states as functions of the AO's screening constant and the internuclear distance is carried out explicitly in great detail.

Variational Calculation of the Hydrogen Molecular Cation using Maple (II). The pi and pi-star Orbitals

The pi and pi-star orbitals of the hydrogen molecular cation are obtained using Maple in the same manner as the sigma and sigma-star orbitals were obtained in paper-36.

Mitral valve prolapse and its relationship with stroke

The purpose of this study was to elucidate the relationship between mitral valve prolapse and stroke. A population-based historical cohort investigation was conducted among residents of Olmsted County, Minnesota who had an initial echocardiographic diagnosis of mitral valve prolapse from 1975 through 1989. This cohort (N = 1085) was followed for stroke outcomes using the resources of an operational medical record linkage system. There was an overall two-fold increase in the incidence of stroke among individuals with mitral valve prolapse relative to a standard population (standardized morbidity ratio = 2.12, 95% confidence limits = 1.33-3.21). When the data were partitioned by duration of follow-up from the diagnosis of mitral valve prolapse, or by the calendar years at echocardiographic diagnosis, respectively, the association between mitral valve prolapse and stroke was not modified. Mitral valve prolapse subjects 85 years and older were at highest increased risk of developing strokes relative to the general population (standardized morbidity ratio = 5.47, 95% confidence limits = 2.20-11.24). Coronary heart disease, atrial fibrillation, diabetes mellitus and hypertension, were unlikely to have confounded the association between mitral valve prolapse and stroke.^ The cumulative risk of first stroke among individuals initially diagnosed with mitral valve prolapse age 15 to 64 years, given survival to 15.2 years of follow-up, was 4.0%. The cumulative risk of first stroke among individuals initially diagnosed with mitral valve prolapse age 65 to 74 years, given survival to 11.2 years of follow-up, was 13.2%. The cumulative risk of first stroke among individuals initially diagnosed with mitral valve prolapse age 75 years and older, given survival to 6.7 years of follow-up, was 30.6%.^ Among individuals with mitral valve prolapse, age, diabetes, and atrial fibrillation were associated with an increased risk of stroke. Atrial fibrillation was associated with a four-fold rate of stroke and diabetes associated with a seven-fold rate of stroke.^ Findings from this research support the hypothesis that mitral valvular heart prolapse is linked with a stroke sequela. ^

Variational Stereo Imaging of Oceanic Waves with Statistical Constraints

An image processing observational technique for the stereoscopic reconstruction of the wave form of oceanic sea states is developed. The technique incorporates the enforcement of any given statistical wave law modeling the quasi Gaussianity of oceanic waves observed in nature. The problem is posed in a variational optimization framework, where the desired wave form is obtained as the minimizer of a cost functional that combines image observations, smoothness priors and a weak statistical constraint. The minimizer is obtained combining gradient descent and multigrid methods on the necessary optimality equations of the cost functional. Robust photometric error criteria and a spatial intensity compensation model are also developed to improve the performance of the presented image matching strategy. The weak statistical constraint is thoroughly evaluated in combination with other elements presented to reconstruct and enforce constraints on experimental stereo data, demonstrating the improvement in the estimation of the observed ocean surface.

Offshore stereo measurements of gravity waves: classical epipolar and novel variational techniques

Stereo video techniques are effective for estimating the space-time wave dynamics over an area of the ocean. Indeed, a stereo camera view allows retrieval of both spatial and temporal data whose statistical content is richer than that of time series data retrieved from point wave probes. Classical epipolar techniques and modern variational methods are reviewed to reconstruct the sea surface from the stereo pairs sequentially in time. Current improvements of the variational methods are presented.

Space-time Reconstruction of Oceanic Sea States via Variational Stereo Methods

We present a remote sensing observational method for the measurement of the spatio-temporal dynamics of ocean waves. Variational techniques are used to recover a coherent space-time reconstruction of oceanic sea states given stereo video imagery. The stereoscopic reconstruction problem is expressed in a variational optimization framework. There, we design an energy functional whose minimizer is the desired temporal sequence of wave heights. The functional combines photometric observations as well as spatial and temporal regularizers. A nested iterative scheme is devised to numerically solve, via 3-D multigrid methods, the system of partial differential equations resulting from the optimality condition of the energy functional. The output of our method is the coherent, simultaneous estimation of the wave surface height and radiance at multiple snapshots. We demonstrate our algorithm on real data collected off-shore. Statistical and spectral analysis are performed. Comparison with respect to an existing sequential method is analyzed.

A Variational Stereo Method for the Three-Dimensional Reconstruction of Ocean Waves

We develop a novel remote sensing technique for the observation of waves on the ocean surface. Our method infers the 3-D waveform and radiance of oceanic sea states via a variational stereo imagery formulation. In this setting, the shape and radiance of the wave surface are given by minimizers of a composite energy functional that combines a photometric matching term along with regularization terms involving the smoothness of the unknowns. The desired ocean surface shape and radiance are the solution of a system of coupled partial differential equations derived from the optimality conditions of the energy functional. The proposed method is naturally extended to study the spatiotemporal dynamics of ocean waves and applied to three sets of stereo video data. Statistical and spectral analysis are carried out. Our results provide evidence that the observed omnidirectional wavenumber spectrum S(k) decays as k-2.5 is in agreement with Zakharov's theory (1999). Furthermore, the 3-D spectrum of the reconstructed wave surface is exploited to estimate wave dispersion and currents.

A mathematical framework for finite strain elastoplastic consolidation. Part 1: Balance laws, variational formulation, and linearization

A mathematical formulation for finite strain elasto plastic consolidation of fully saturated soil media is presented. Strong and weak forms of the boundary-value problem are derived using both the material and spatial descriptions. The algorithmic treatment of finite strain elastoplasticity for the solid phase is based on multiplicative decomposition and is coupled with the algorithm for fluid flow via the Kirchhoff pore water pressure. Balance laws are written for the soil-water mixture following the motion of the soil matrix alone. It is shown that the motion of the fluid phase only affects the Jacobian of the solid phase motion, and therefore can be characterized completely by the motion of the soil matrix. Furthermore, it is shown from energy balance consideration that the effective, or intergranular, stress is the appropriate measure of stress for describing the constitutive response of the soil skeleton since it absorbs all the strain energy generated in the saturated soil-water mixture. Finally, it is shown that the mathematical model is amenable to consistent linearization, and that explicit expressions for the consistent tangent operators can be derived for use in numerical solutions such as those based on the finite element method.