Procedure for Incontinence in Women May Lose Effectiveness With Time

In 7-year study, failure rate for pelvic organ prolapse surgery gradually increased

By Serena Gordon

HealthDay Reporter

TUESDAY, May 14 (HealthDay News) -- The success of a common surgery for pelvic organ prolapse -- a painful and distressing condition affecting many women -- lessens over time, according to a new study.

Abdominal sacrocolpopexy is a procedure used to relieve the problem. It involves stitching a piece of mesh on the top of the vagina and attaching it to a strong ligament from the back of the pelvic bone. This surgery helps to support the pelvic organs.

But the new study found that with each passing year, the rate of pelvic organ prolapse surgery failure increased. The rate of mesh erosion (the primary material used to provide support) reached 10.5 percent by seven years after surgery.

The study also found that the risk of urinary incontinence rose with each year after the surgery.

"This is the longest follow-up of a common operation for women with pelvic organ prolapse. We found that pelvic organ prolapse and urinary incontinence rates increased gradually over follow-up," said study author Dr. Linda Brubaker, a professor of obstetrics and gynecology and urology at Loyola University Medical Center.

Even though surgeons might define a procedure as a failure, many of the patients did not. Only about 17 percent of women had additional pelvic floor surgeries, according to the study.

Pelvic organ prolapse leads to surgery in 7 percent to 19 percent of women, according to study background information. Normally, muscles, ligaments and connective tissue keep all of the pelvic organs where they're supposed to be. But, weakness or tears in these supportive tissues can allow pelvic organs, such as the uterus and vagina, to protrude through the vaginal opening.

This can lead to problems with pelvic organs, according to the American Urogynecologic Society. For example, if the bowel is protruding, constipation or fecal incontinence can result. If the bladder is affected, urinary incontinence may occur.

As to why these surgeries might fail, Brubaker said, "surgeries don't stop time. Women continue to age and the underlying biology continues. Patients may gain weight, too," added Brubaker, who is also dean of the Loyola University Chicago Stritch School of Medicine.

Results of the study are published in the May 15 issue of the Journal of the American Medical Association.

Each year, as many as 225,000 American women have surgery for pelvic organ prolapse, the study authors noted. However, very little long-term follow-up data is available on the success of these procedures, Brubaker said. Most studies only follow women for two years.

The current study included seven years of follow-up. Abdominal sacrocolpopexy isn't the only procedure available for pelvic organ prolapse, but it is commonly used. And, in more recent years, the surgery is being done laparoscopically, so it's less invasive.

View the original article here

New Procedure May Shrink Enlarged Prostate Without Surgery

By Serena Gordon
HealthDay Reporter

MONDAY, April 15 (HealthDay News) -- Men who need treatment for an enlarged prostate may soon have a new nonsurgical option, a small, early study suggests.

Called prostatic artery embolization (PAE), the technique uses a catheter threaded into an artery in the leg. The catheter is guided to the artery that supplies blood to the prostate. Then, tiny beads are injected into the artery, which temporarily block the blood supply to the prostate.

The temporary loss of blood supply causes the prostate to shrink, relieving symptoms, according to study lead author Dr. Sandeep Bagla. What's more, the new treatment doesn't appear to have the same risk of serious complications, such as incontinence and impotence, that often accompany enlarged prostate treatment.

"This is fantastic news for the average man with benign prostatic hyperplasia. Many men decline current treatments because of the risks. But, for the average man, PAE is a no-brainer," said Bagla, an interventional radiologist at Inova Alexandria Hospital, in Virginia.

The procedure has only been available as part of Bagla's trial until recently, but he said some interventional radiologists have started doing prostatic artery embolization, and he expects the procedure will become more widely available by the end of the year.

Benign prostatic hyperplasia is the medical term for an enlarged prostate. An enlarged prostate is very common as men get older. As many as half of all men in their 60s will have an enlarged prostate, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). By the time men are in their 70s and 80s, up to 90 percent have benign prostatic hyperplasia, according to the NIDDK.

Some men experience no symptoms, while others may feel the need to urinate frequently, but they have a weak urinary stream, the NIDDK says. There are a number of treatments available for benign prostatic hyperplasia, including medications and surgery.

Bagla said that interventional radiologists in Europe and South America have been using prostatic artery embolization, and that the current study is the first in the United States to test the procedure.

He and his colleagues hope to treat a total of 30 patients, but they're reporting on the results from the first 18 patients on Monday at the annual meeting of Society of Interventional Radiology, in New Orleans. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

For the study, the average age of the patients who underwent prostatic artery embolization was 67 years. None of the men had to be admitted to the hospital after the procedure.

Ninety-four percent of the men (17 of 18) had a significant decrease in their symptoms one month after surgery. And, none reported any major complications following the surgery.

Bagla said the exact cost of the new procedure is difficult to estimate right now, but prostatic artery embolization will be cheaper than most of the currently used procedures, he said, because there's no need for an operating room and overnight hospital stays. In addition, he said, because the new procedure doesn't appear to cause complications, that will save health care dollars as well.

"This may become part of the armamentarium of treatments that can be offered for [benign prostatic hyperplasia]," said Dr. Art Rastinehad, director of interventional urologic oncology at North Shore-LIJ Health System in New Hyde Park, N.Y. He was not involved with the new study.

"This was a small series and a limited study to draw significant conclusions from. But, it's very exciting to see it evaluated and moving forward," he said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Sandeep Bagla, M.D., interventional radiologist, Inova Alexandria Hospital, Alexandria, Va.; Art Rastinehad, D.O., director of interventional urologic oncology, North Shore-LIJ Health System, New Hyde Park, N.Y.; April 15, 2013, presentation, Society of Interventional Radiology annual meeting, New Orleans

View the original article here

New Procedure May Shrink Enlarged Prostate Without Surgery

'Prostatic artery embolization' didn't cause troublesome side effects in study

By Serena Gordon

HealthDay Reporter

MONDAY, April 15 (HealthDay News) -- Men who need treatment for an enlarged prostate may soon have a new nonsurgical option, a small, early study suggests.

Called prostatic artery embolization (PAE), the technique uses a catheter threaded into an artery in the leg. The catheter is guided to the artery that supplies blood to the prostate. Then, tiny beads are injected into the artery, which temporarily block the blood supply to the prostate.

The temporary loss of blood supply causes the prostate to shrink, relieving symptoms, according to study lead author Dr. Sandeep Bagla. What's more, the new treatment doesn't appear to have the same risk of serious complications, such as incontinence and impotence, that often accompany enlarged prostate treatment.

"This is fantastic news for the average man with benign prostatic hyperplasia. Many men decline current treatments because of the risks. But, for the average man, PAE is a no-brainer," said Bagla, an interventional radiologist at Inova Alexandria Hospital, in Virginia.

The procedure has only been available as part of Bagla's trial until recently, but he said some interventional radiologists have started doing prostatic artery embolization, and he expects the procedure will become more widely available by the end of the year.

Benign prostatic hyperplasia is the medical term for an enlarged prostate. An enlarged prostate is very common as men get older. As many as half of all men in their 60s will have an enlarged prostate, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). By the time men are in their 70s and 80s, up to 90 percent have benign prostatic hyperplasia, according to the NIDDK.

Some men experience no symptoms, while others may feel the need to urinate frequently, but they have a weak urinary stream, the NIDDK says. There are a number of treatments available for benign prostatic hyperplasia, including medications and surgery.

Bagla said that interventional radiologists in Europe and South America have been using prostatic artery embolization, and that the current study is the first in the United States to test the procedure.

He and his colleagues hope to treat a total of 30 patients, but they're reporting on the results from the first 18 patients on Monday at the annual meeting of Society of Interventional Radiology, in New Orleans. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

For the study, the average age of the patients who underwent prostatic artery embolization was 67 years. None of the men had to be admitted to the hospital after the procedure.

Ninety-four percent of the men (17 of 18) had a significant decrease in their symptoms one month after surgery. And, none reported any major complications following the surgery.

Bagla said the exact cost of the new procedure is difficult to estimate right now, but prostatic artery embolization will be cheaper than most of the currently used procedures, he said, because there's no need for an operating room and overnight hospital stays. In addition, he said, because the new procedure doesn't appear to cause complications, that will save health care dollars as well.

"This may become part of the armamentarium of treatments that can be offered for [benign prostatic hyperplasia]," said Dr. Art Rastinehad, director of interventional urologic oncology at North Shore-LIJ Health System in New Hyde Park, N.Y. He was not involved with the new study.

"This was a small series and a limited study to draw significant conclusions from. But, it's very exciting to see it evaluated and moving forward," he said.

View the original article here

Procedure for Incontinence in Women May Lose Effectiveness With Time

In 7-year study, failure rate for pelvic organ prolapse surgery gradually increased

By Serena Gordon

HealthDay Reporter

TUESDAY, May 14 (HealthDay News) -- The success of a common surgery for pelvic organ prolapse -- a painful and distressing condition affecting many women -- lessens over time, according to a new study.

Abdominal sacrocolpopexy is a procedure used to relieve the problem. It involves stitching a piece of mesh on the top of the vagina and attaching it to a strong ligament from the back of the pelvic bone. This surgery helps to support the pelvic organs.

But the new study found that with each passing year, the rate of pelvic organ prolapse surgery failure increased. The rate of mesh erosion (the primary material used to provide support) reached 10.5 percent by seven years after surgery.

The study also found that the risk of urinary incontinence rose with each year after the surgery.

"This is the longest follow-up of a common operation for women with pelvic organ prolapse. We found that pelvic organ prolapse and urinary incontinence rates increased gradually over follow-up," said study author Dr. Linda Brubaker, a professor of obstetrics and gynecology and urology at Loyola University Medical Center.

Even though surgeons might define a procedure as a failure, many of the patients did not. Only about 17 percent of women had additional pelvic floor surgeries, according to the study.

Pelvic organ prolapse leads to surgery in 7 percent to 19 percent of women, according to study background information. Normally, muscles, ligaments and connective tissue keep all of the pelvic organs where they're supposed to be. But, weakness or tears in these supportive tissues can allow pelvic organs, such as the uterus and vagina, to protrude through the vaginal opening.

This can lead to problems with pelvic organs, according to the American Urogynecologic Society. For example, if the bowel is protruding, constipation or fecal incontinence can result. If the bladder is affected, urinary incontinence may occur.

As to why these surgeries might fail, Brubaker said, "surgeries don't stop time. Women continue to age and the underlying biology continues. Patients may gain weight, too," added Brubaker, who is also dean of the Loyola University Chicago Stritch School of Medicine.

Results of the study are published in the May 15 issue of the Journal of the American Medical Association.

Each year, as many as 225,000 American women have surgery for pelvic organ prolapse, the study authors noted. However, very little long-term follow-up data is available on the success of these procedures, Brubaker said. Most studies only follow women for two years.

The current study included seven years of follow-up. Abdominal sacrocolpopexy isn't the only procedure available for pelvic organ prolapse, but it is commonly used. And, in more recent years, the surgery is being done laparoscopically, so it's less invasive.

View the original article here

Skipping Aspirin Before Artery Procedure May Boost Death Rates

Title: Skipping Aspirin Before Artery Procedure May Boost Death Rates
Category: Health News
Created: 3/7/2013 12:36:00 PM
Last Editorial Review: 3/8/2013 12:00:00 AM

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New Procedure May Aid Stubborn High Blood Pressure

Dec. 18, 2012 -- People who can’t get their high blood pressure down with drugs may be helped by a new procedure that deactivates overactive nerves in the kidneys, a small study shows.

The procedure is already available in Europe and other countries. It’s being tested in the U.S.

It’s meant to treat people with a severe type of high blood pressure that’s difficult to control, even with multiple medications. People who develop this condition, which is called resistant hypertension, are at higher than average risks for strokes, heart attacks, kidney disease, and heart failure. Resistant hypertension affects about 1 in 11 people who have high blood pressure.

“We all have these patients. They’re very thin. They exercise. They eat right. They’re on four medications and it’s still very difficult to control their blood pressure,” says Varinder Singh, MD, chairman of cardiology at Lenox Hill Hospital in New York City.

“In those patients, you’re looking for another treatment method,” says Singh, who was not involved in the research. “I look forward to having this.”

The procedure is done under local anesthesia. Doctors make a small incision in an artery near the groin and use it to thread a catheter up to the kidneys. A machine then fires short bursts of radio waves to deaden the sympathetic nerves.

“The sympathetic nerves are the stimulant nerves of the kidneys. They are commonly activated in [high blood pressure],” says researcher Murray Esler, MD, PhD, professor and senior director of the Baker IDI Heart and Diabetes Institute in Melbourne, Australia.

When the nerves are overactive, they cause the body to retain too much sodium. Too much sodium drives up blood pressure, Esler says.

The new study is a continuation of a trial that assigned 106 patients to receive either the new procedure or usual care.

People were enrolled in the study if they were on at least three medications for high blood pressure and had a baseline systolic blood pressure, the top number, over 160, or over 150 if they had diabetes. Most continued to struggle with high blood pressure, despite taking an average of five different medications. 

At the end of six months, people who got the new procedure, which is called renal denervation, saw their blood pressure drop from an average of 178/97 to 143/85, while people who continued getting usual care actually saw their high blood pressure climb slightly.

For the second phase of the study, researchers asked members of the comparison group if they wanted to try the new procedure. Most did. 

Their results were similar to those of patients in the first treatment group. The majority of patients saw their blood pressure drop by at least 10 points. Average reductions for the group were even bigger, about 20 to 30 points for systolic blood pressure, the top number. Diastolic blood pressure, the bottom number, was also lowered significantly.

But most people didn’t see their blood pressures return to normal levels. Normal blood pressure is considered to be less than120/80.

View the original article here

New Procedure May Aid Stubborn High Blood Pressure

ByBrenda Goodman, MA
WebMD Health News Reviewed byLaura J. Martin, MD

Dec. 18, 2012 -- People who can’t get their high blood pressure down with drugs may be helped by a new procedure that deactivates overactive nerves in the kidneys, a small study shows.

The procedure is already available in Europe and other countries. It’s being tested in the U.S.

It’s meant to treat people with a severe type of high blood pressure that’s difficult to control, even with multiple medications. People who develop this condition, which is called resistant hypertension, are at higher than average risks for strokes, heart attacks, kidney disease, and heart failure. Resistant hypertension affects about 1 in 11 people who have high blood pressure.

“We all have these patients. They’re very thin. They exercise. They eat right. They’re on four medications and it’s still very difficult to control their blood pressure,” says Varinder Singh, MD, chairman of cardiology at Lenox Hill Hospital in New York City.

“In those patients, you’re looking for another treatment method,” says Singh, who was not involved in the research. “I look forward to having this.”

The procedure is done under local anesthesia. Doctors make a small incision in an artery near the groin and use it to thread a catheter up to the kidneys. A machine then fires short bursts of radio waves to deaden the sympathetic nerves.

“The sympathetic nerves are the stimulant nerves of the kidneys. They are commonly activated in [high blood pressure],” says researcher Murray Esler, MD, PhD, professor and senior director of the Baker IDI Heart and Diabetes Institute in Melbourne, Australia.

When the nerves are overactive, they cause the body to retain too much sodium. Too much sodium drives up blood pressure, Esler says.

Testing the New Procedure

The new study is a continuation of a trial that assigned 106 patients to receive either the new procedure or usual care.

People were enrolled in the study if they were on at least three medications for high blood pressure and had a baseline systolic blood pressure, the top number, over 160, or over 150 if they had diabetes. Most continued to struggle with high blood pressure, despite taking an average of five different medications. 

At the end of six months, people who got the new procedure, which is called renal denervation, saw their blood pressure drop from an average of 178/97 to 143/85, while people who continued getting usual care actually saw their high blood pressure climb slightly.

For the second phase of the study, researchers asked members of the comparison group if they wanted to try the new procedure. Most did. 

Their results were similar to those of patients in the first treatment group. The majority of patients saw their blood pressure drop by at least 10 points. Average reductions for the group were even bigger, about 20 to 30 points for systolic blood pressure, the top number. Diastolic blood pressure, the bottom number, was also lowered significantly.

But most people didn’t see their blood pressures return to normal levels. Normal blood pressure is considered to be less than120/80.

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