The results of recent multicenter trials using either the Edwards SAPIEN valve or Core Valve Revalving System have shown that the procedure is safe and effective. Moreover, in the majority of series, the two technologies were associated with success rates >90% and 30-day procedural mortality rates <10% even though the trials involved very high-risk patients. In addition, it should be noted that several studies have shown that these prosthetic valves have good
hemodynamic characteristics over both the short- and medium-term. The prospective randomized PARTNER study, whose results will be available towards the end of 2010, will make a significant contribution to clearly establishing the safety and efficacy of the percutaneous treatment Screening Library manufacturer of aortic valve disease in patients who are inoperable or at a high surgical risk. Finally, we must await long-term results on potential complications and on the durability of transcatheter valves before this treatment approach can be applied in younger patients or those at a low surgical risk.”
“The urogenital fistula is a devastating condition for women. Despite advances in medical care, the vesicovaginal fistula continues to be a distressful problem. Complex vesicovaginal fistulae repair selleck compound may need tissue interposition. It can be achieved by
vaginal or abdominal approach and depends on the surgeon’s experience and local factors like size, location,
and previous radiotherapy. The aim of this study was to demonstrate that using traditional approaches is possible and reasonable to treat any sort of vesicovaginal fistula.
Between January 2004 and August 2007, we treated 23 patients with complex urogenital fistulae. Of those with concomitant ureteral fistula requiring re-implantation or bladder augmentation, the vaginal approach was the first choice in 17 and abdominal approach in six. Patients were clinically evaluated at 1, 4, and 12 weeks postoperatively, then every 3 months in the first year.
Seventeen women were treated by vaginal click here approach and six patients were treated by abdominal approach. Hysterectomy was the major etiology (73.9%). Ten patients (43.5%) had at least one previous abdominal surgery for fistulae repair without success before. In those patients with abdominal approach, the hospitalization was longer than vaginal approach (80.5+/-6 h versus 48+/-3 h). In both, there were no major intraoperative or postoperative complications; 13% developed urgency and 4% developed stress urinary incontinence. No patients have recurrence of fistulae (success rate 100%).
Complex vesicovaginal fistulas are a big challenge for the urologist, and there is no gold standard surgical approach. The majority of complex vaginal fistula can be successfully managed by vaginal repair.