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Apeldoorn, Netherlands

Withagen M.I.,Radboud University Nijmegen | Milani A.L.,Reinier Of Graaf Group | De Leeuw J.W.,Ikazia Hospital | Vierhout M.E.,Radboud University Nijmegen
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2012

Objective To compare the de novo prolapse rate in the untreated vaginal compartments following conventional vaginal prolapse repair and tension-free vaginal mesh repair. Design Secondary analysis of a randomised controlled trial. Setting Thirteen centres in the Netherlands. Population Women with recurrent pelvic organ prolapse stage II or higher. Methods Random assignment to either conventional vaginal native tissue repair or vaginal mesh insertion. Main outcome measures Primary outcome: de novo pelvic organ prolapse stage II or higher in the untreated vaginal compartments at 12 months after surgery. Secondary outcomes: de novo pelvic organ prolapse at and beyond the hymen, de novo prolapse beyond the hymen and prolapse domain scores of the Urogenital Distress Inventory. Results At 12 months ten of 59 women (17%) in the conventional group versus 29 of 62 women (47%) in the mesh group were diagnosed with a de novo pelvic organ prolapse stage II or higher in the untreated compartment (P < 0.001, odds ratio 4.3, 95% confidence interval 1.9-10.0). Additional apical support to a mesh-augmented anterior repair significantly reduced the de novo prolapse rate. Women with a de novo prolapse in the mesh-treated group demonstrated significantly higher mean bother scores on the domain genital prolapse of the Urogenital Distress Inventory score (13.1 ± 24.2) compared with those without de novo prolapse (2.9 ± 13.9) (P = 0.03). Conclusion Mesh-augmented prolapse repair in only one vaginal compartment is associated with a higher de novo prolapse rate in the untreated compartments compared with conventional vaginal native tissue repair in women with recurrent pelvic organ prolapse. © 2012 RCOG. Source


Milani A.L.,Reinier Of Graaf Group | Hinoul P.,ETHICON,Inc. | Gauld J.M.,ETHICON,Inc. | Sikirica V.,ETHICON,Inc. | And 2 more authors.
American Journal of Obstetrics and Gynecology | Year: 2011

OBJECTIVE: To evaluate anatomic and functional outcomes at 1-year following trocar-guided transvaginal prolapse repair using a partially absorbable mesh. STUDY DESIGN: Prospective multicentre cohort study at 11 international sites. One hundred twenty-seven patients with pelvic organ prolapse stage ≥ III had surgery and were evaluated at 3 months and 1-year postsurgery compared with baseline. Instruments of measurements: Pelvic Organ Prolapse Quantification, Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire-7, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12, and Patients Global Impression of Change. RESULTS: Anatomic success, defined as prolapse stage ≤ I in the treated vaginal compartments, was 77.4% (95% confidence interval, 69.084.4%). Significant improvements in bother, quality of life, and sexual function were detected at 3 months and 1 year compared with baseline. At 1-year after surgery, 86.2% of patients indicated their prolapse situation to be "much better." Mesh exposure rate was 10.2% and rate of de novo dyspareunia 2% at 1 year. CONCLUSION: These results demonstrate improved anatomic support, associated with excellent functional improvements, without apparent safety concerns. © 2011 Mosby, Inc. Source


Withagen M.I.J.,Radboud University Nijmegen | Vierhout M.E.,Radboud University Nijmegen | Milani A.L.,Reinier Of Graaf Group
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2010

Introduction and hypothesis: The objective of this study was to assess the effect of the tension-free vaginal mesh (Prolift™) procedure on the non-treated and initially unaffected vaginal compartments. Methods: This prospective observational cohort study involved 150 patients who underwent a Prolift™ procedure. Pelvic organ prolapse (POP) quantification and evaluation of prolapse symptoms with validated questionnaires was performed pre-operatively and 6 and 12 months postoperatively. Primary outcome was the rate of POP stage ≥II in the non-treated vaginal compartments. Results: Twenty-three percent of all patients developed a de novo POP stage ≥II in the untreated compartment. This occurred in 46% and 25% of patients after an isolated anterior and isolated posterior Prolift™, respectively. Conclusion: Tension-free vaginal mesh treatment of one vaginal compartment seems to provoke the development of vaginal prolapse in initially unaffected vaginal compartments, particularly after an isolated anterior Prolift™ procedure. Source


Lagarde S.M.,Saint Lucas Andreas Hospital | Vrouenraets B.C.,Saint Lucas Andreas Hospital | Stassen L.P.S.,Reinier Of Graaf Group | van Lanschot J.J.B.,Erasmus Medical Center
Annals of Thoracic Surgery | Year: 2010

Evidence-based medicine is the conscientious, explicit, and judicious use of best available evidence in making decisions for individual patient care. The present review gives an evidence-based review of esophageal cancer surgery. The literature search was restricted to the highest level of evidence on the surgical treatment of esophageal cancer. © 2010 The Society of Thoracic Surgeons. Source


Gerth Van Wijk R.,Erasmus University Rotterdam | Patiwael J.A.,Erasmus University Rotterdam | De Jong N.W.,Erasmus University Rotterdam | De Groot H.,Reinier Of Graaf Group | Burdorf A.,Erasmus University Rotterdam
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2011

Background: Avoidance of occupational allergens or reduction in exposure has been advocated as the mainstay of the management of occupational rhinitis. Sparse data to the effect of allergen avoidance are available. Objective: To identify factors that may lead to leaving work and to address the effect of subsequent allergen avoidance on quality of life. Methods: A survey to the prevalence of occupational allergy to bell pepper performed in 1999 comprised 472 employees, of which 254 had work-related rhinitis and 228 completed the Rhinitis-related Quality of Life Questionnaire. After 8-year follow-up in 2007, 91 workers with rhinitis in 1999 were available to fill out the questionnaire again and were used to evaluate the course of nasal disease in terms of perceived severity and impact on daily life. Results: Workers with rhinitis at baseline were more likely to leave their job in bell pepper cultivation for another job (OR = 1.62, 95% CI 0.95-2.75). Among the 91 workers, 58 subjects were still at work, whereas 33 subjects had left work. The subjects who left jobs reported substantial improvement in quality of life. The magnitude of the changes ranged from -0.31 to -1. The effect of quitting work on the mean quality of life score amounted -0.76 ± 0.15. Conclusions: The current study is the first large longitudinal studies showing that leaving work and subsequent occupational allergen avoidance have a beneficial effect on rhinitis-related quality of life. The study suggests that occupational rhinitis can be a reason to leave work. © 2011 John Wiley & Sons A/S. Source

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