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Modern technologies in the assessment and treatment of pelvic organ prolapse - experimental and clinical studies
Urbánková, Iva ; Krofta, Ladislav (advisor) ; Mašata, Jaromír (referee) ; Kachlík, David (referee)
This project has shown that pelvic organ prolapse is linked with maternal age and delivery-related injuries. Up to every eight women may have a symptomatic prolapse already one year after their first delivery. Moreover, those with muscle injury have a higher short-term risk of pelvic organ prolapse development. To improve our knowledge we further explored the potential of an ovine model for prolapse and vaginal surgery. We showed that many anatomical and morphological features and vaginal wall changes induced by specific lifespan factors (first delivery, artificial menopause, and hormonal replacement) are similar to what is observed in women. We further used this model for testing novel implants and mesh visualization techniques. We believe that the ovine model can be used in future research on pelvic organ prolapse pathophysiology and novel treatment modalities.t
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Obstetric interventions and pelvic floor disorders
Rušavý, Zdeněk ; Kališ, Vladimír (advisor) ; Roztočil, Aleš (referee) ; Mašata, Jaromír (referee)
Obstetric interventions and pelvic floor disorders - Abstract One of the principal objectives of obstetric interventions in the second stage of labor is prevention of pelvic floor trauma and associated pelvic floor disorders. The most commonly used and also most frequently discussed interventions are manual perineal protection and episiotomy. The majority of pelvic floor disorders are of subjective nature. Therefore, tools for objectification and severity quantification of these disorders are the key to reliable comparison and identification of the most effective interventions. The aim of the dissertation was to find the most effective modification of manual perineal protection, to compare two frequently used types of episiotomy regarding all pelvic floor disorders and finally to find a consensus on the most suitable instrument for anal incontinence severity assessment. Our studies concerning manual perineal protection experimentally described the direction and extent of perineal deformation during vaginal delivery. The subsequent studies on biomechanical model demonstrated that the most effective method of manual perineal protection in peak perineal strain reduction is when the fingers are placed on the perineum 6 cm laterally and 2 cm ventrally from the posterior commissure at both sides and are...
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Detection of neuronal activity associated with function of lower urinary tract with use of functional magnetic resonance imaging
Holý, Petr ; Zachoval, Roman (advisor) ; Hanuš, Tomáš (referee) ; Mašata, Jaromír (referee)
of the thesis Considerable research attention has been paid to the neural regulation of the lower urinary tract (LUT) in past three decades. The aim of this work is mapping of a brain activity by functional magnetic resonance imaging (fMRI) using refined scanning protocol with synchronously performed urodynamics. We aimed to detect neural activity associated with pelvic floor muscle (PF) contractions, filling of urinary bladder and miction. In addition we evaluated using fMRI brain activity associated with urinary bladder filling in patients with a complete spinal cord injury (SCI). We hypothesized activation of brainstem and forebrain areas in receiving information from the vagal nerves. Adjustments of urodynamic system enabled successful implementation of synchronous filling cystometry with fMRI evaluation of cortical activity. We concluded that synchronous urodynamic examination is a novel feasible method that facilitates and enhance interpretation of fMRI data acquired. The main clusters of brain activation during PF contractions were observed in the medial surface of the frontal lobe (primary motor area) and supplementary motor area (SMA). We detected neural activity associated with filling of urinary bladder and miction in middle and inferior frontal gyrus, angular gyrus, posterior and...
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Variation of abnormalities of foramen obturatum and retropubic space and its relation to complications of tape surgery
Hubka, Petr ; Mašata, Jaromír (advisor) ; Smetana, Karel (referee) ; Krofta, Ladislav (referee)
Introduction: The knowledge of anatomy is crucial for introduction of new surgical methods. It is also of especial use while dealing with surgical complications during surgeries with limited surgical field, where the way of approach limits the management of complications. It was assumed that common anatomical variations would influence different efficacy of surgeries and would explain potential complications. Methods: During anatomical dissections fifty female cadavers were dissected and tension-free vaginal tapes TVT-S H, TVT-S U, TVT Abbrevo and Ajust were studied. A novel descriptive system for localisation of the tape was created. During the dissection the tape was located and its localisation and fixation was described. Results: Common anatomical variation in the sample was corona mortis with frequency of 72 %. Preperitoneal fatty plug, which is recognized by some authors as the first stage of obturator hernia, was found in 40 % in obturator canal. The proper fixation of TVT-S H was achieved in 53.6 %. In 10.5 % urinary bladder was injured. In case of TVT-S U the proper fixation occurred in 63.8 %. In two cases the inserter was nearby corona mortis. Within the group of TVTO Abbrevo the tape was fixated properly into the obturator complex (consists of the obturator membrane and obturator muscles) in...
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Quality of life after urogynecologic surgery Comparation of change of quality of life after urogynecologic surgery in relation to anatomy of the pelvis foor
Drahorádová, Petra ; Mašata, Jaromír (advisor) ; Zachoval, Roman (referee) ; Naňka, Ondřej (referee)
Introduction: Stress urinary incontinence is a common problem which affects a high percentage of women. Anti-incontinent surgery has played an important role in the treatment of stress urinary incontinence. Burch colposuspension was considered a gold standard in anti-incontinence surgery, with good long-term results. However, over the past decade this procedure has been largely replaced by the application of various types of TVTs (tensionfree vaginal tapes). In our study we have focused on comparing developments in the quality of life and the occurrence of complications in a long-term follow-up after TVT, TVT O and colposuspension. For subjective assessment of urinary incontinence we have chosen a validated specialized Incontinence Quality of Life questionnaire (I-QoL). The aim of our study was to monitor the trends with quality of life after TVT, TVT O and colposuspension procedures and to establish whether the occurrence of complications affects the quality of life (QoL) and compare of the quality of life among anti-incontinence procedures and longterm subjective and objective outcome. Methods: The study included 215 women who underwent a TVT, TVT O or Burch procedure between 1.6.2002 - 31.5.2005. Women were completely urogynecologic examined and urodynamic stress incontinence was documented....
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Modern technologies in the assessment and treatment of pelvic organ prolapse - experimental and clinical studies
Urbánková, Iva ; Krofta, Ladislav (advisor) ; Mašata, Jaromír (referee) ; Kachlík, David (referee)
This project has shown that pelvic organ prolapse is linked with maternal age and delivery-related injuries. Up to every eight women may have a symptomatic prolapse already one year after their first delivery. Moreover, those with muscle injury have a higher short-term risk of pelvic organ prolapse development. To improve our knowledge we further explored the potential of an ovine model for prolapse and vaginal surgery. We showed that many anatomical and morphological features and vaginal wall changes induced by specific lifespan factors (first delivery, artificial menopause, and hormonal replacement) are similar to what is observed in women. We further used this model for testing novel implants and mesh visualization techniques. We believe that the ovine model can be used in future research on pelvic organ prolapse pathophysiology and novel treatment modalities.t
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Obstetric interventions and pelvic floor disorders
Rušavý, Zdeněk ; Kališ, Vladimír (advisor) ; Roztočil, Aleš (referee) ; Mašata, Jaromír (referee)
Obstetric interventions and pelvic floor disorders - Abstract One of the principal objectives of obstetric interventions in the second stage of labor is prevention of pelvic floor trauma and associated pelvic floor disorders. The most commonly used and also most frequently discussed interventions are manual perineal protection and episiotomy. The majority of pelvic floor disorders are of subjective nature. Therefore, tools for objectification and severity quantification of these disorders are the key to reliable comparison and identification of the most effective interventions. The aim of the dissertation was to find the most effective modification of manual perineal protection, to compare two frequently used types of episiotomy regarding all pelvic floor disorders and finally to find a consensus on the most suitable instrument for anal incontinence severity assessment. Our studies concerning manual perineal protection experimentally described the direction and extent of perineal deformation during vaginal delivery. The subsequent studies on biomechanical model demonstrated that the most effective method of manual perineal protection in peak perineal strain reduction is when the fingers are placed on the perineum 6 cm laterally and 2 cm ventrally from the posterior commissure at both sides and are...
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Detection of neuronal activity associated with function of lower urinary tract with use of functional magnetic resonance imaging
Holý, Petr ; Zachoval, Roman (advisor) ; Hanuš, Tomáš (referee) ; Mašata, Jaromír (referee)
of the thesis Considerable research attention has been paid to the neural regulation of the lower urinary tract (LUT) in past three decades. The aim of this work is mapping of a brain activity by functional magnetic resonance imaging (fMRI) using refined scanning protocol with synchronously performed urodynamics. We aimed to detect neural activity associated with pelvic floor muscle (PF) contractions, filling of urinary bladder and miction. In addition we evaluated using fMRI brain activity associated with urinary bladder filling in patients with a complete spinal cord injury (SCI). We hypothesized activation of brainstem and forebrain areas in receiving information from the vagal nerves. Adjustments of urodynamic system enabled successful implementation of synchronous filling cystometry with fMRI evaluation of cortical activity. We concluded that synchronous urodynamic examination is a novel feasible method that facilitates and enhance interpretation of fMRI data acquired. The main clusters of brain activation during PF contractions were observed in the medial surface of the frontal lobe (primary motor area) and supplementary motor area (SMA). We detected neural activity associated with filling of urinary bladder and miction in middle and inferior frontal gyrus, angular gyrus, posterior and...
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