Modified autologous fascial sling technique ('sling on a string') for stress incontinence.

Introduction And Hypothesis: Describe the modified autologous fascial sling procedure that has been employed in the largest randomized controlled trial comparing autologous slings, mesh slings and xenografts.

Methods: The video aims to demonstrate the modified Aldridge technique. The surgical procedure is demonstrated.

Anal canal to pubis angle: a novel clinical ultrasound technique for the assessment of the anorectal region.

Introduction And Hypothesis: Posterior compartment prolapse is associated with severe morbidity including faecal incontinence and defaecation dysfunction. The aim of this study was to develop and validate a novel ultrasound marker (anal canal to pubis angle) for the assessment of the anal axis in the context of posterior compartment prolapse in women and in controls (healthy, nulliparous, non-pregnant volunteers).

Methods: Anal canal to pubis (AC/Pubis) angle is measured with 2D transperineal ultrasound in precisely the midsagittal plane.

Ultrasound imaging of the perineal body: a useful clinical tool.

Introduction And Hypothesis: The perineal body is a fibromuscular pyramidal structure located between the vagina and the anus. It has been difficult to image because of its small size and anatomical location. This study used 2D transperineal ultrasound to measure the perineal body and assess whether there is an association with prolapse.

Ultrasound technique for the assessment of urethral descent assessment technique (UDAT) in healthy volunteers.

Bladder neck descent (BND) has been implicated in the pathophysiology of stress incontinence and prolapse. The aim of this study was to evaluate a novel 2D technique for the evaluation of BND, the Urethral Descent Assessment Technique (UDAT). UDAT involves measuring BND during dynamic manoeuvres in live 2D ultrasound, by using the geometrical properties of parallel lines.

Validation study of ultrasound bladder wall thickness measurements.

Introduction And Hypothesis: The aim was to validate ultrasound bladder wall thickness measurements. We scanned at three frequencies (5 MHz, 7 MHz and 9 MHz), using two techniques described in clinical practice and compared them with direct micrometre calliper measurements.

Methods: Bladder dome cadaver specimens were dissected from male and female cadavers.

Levator Ani avulsion: The histological composition of this site. A cadaveric study.

Introduction: The sonographic appearance of a levator muscle "avulsion" representing the literal detachment of the pubovisceral muscle (PVM) enthesis has been contested. The nature of the levator ani "avulsion" is still not fully understood. It is known, that the tensile strength of a tendon is dependent on collagen with increased synthesis of collagen occurring in tissue with increased mechanical load levels.

Urodynamics are necessary for patients with asymptomatic pelvic organ prolapse.

Aim: To evaluate the role of pre-operative urodynamics in women with pelvic organ prolapse, who are asymptomatic for urinary symptoms. Correlate urodynamics findings with King's Health Questionnaire (KHQ) responses.

Materials And Methods: Retrospective review of prospectively collected data on routine pre-operative urodynamics investigations in women with urogenital prolapse requiring surgery.

Vascular injury at laparoscopy: a guide to management.

Vascular laparoscopic injuries are rare (0.2/1000), however, they are associated with 6-13% morbidity and mortality. Commonest sites for catastrophic haemorrhage are the right iliac vessels, inferior vena cava and less commonly the abdominal aorta.

In surgeons performing cardiothoracic surgery is sleep deprivation significant in its impact on morbidity or mortality?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is there a difference in cardiothoracic surgery outcomes in terms of morbidity or mortality of patients operated on by a sleep-deprived surgeon compared with those operated by a non-sleep-deprived surgeon? Reported search criteria yielded 77 papers, of which 15 were deemed to represent the best evidence on the topic. Three studies directly related to cardiothoracic surgery and 12 studies related to non-cardiothoracic surgery.

Is vaginal delivery or caesarean section the safer mode of delivery in patients with adult congenital heart disease?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is vaginal delivery or caesarean section (CS) the safer mode of delivery in patients with adult congenital heart disease? Of the 119 studies, 13 papers represented the best evidence on the topic. Recommendations are based on 29 262 patients.