What's New ?

Mesh Reconstruction

Around the world more and more surgeons are becoming convinced that vaginal repair with mesh offers the best chance for repair of prolapse with a durable result. However, a number of experts are concerned that complications of surgery make the procedure unacceptable in clinical practice. The FDA in the USA has recently issued a warning for patients and surgeons regarding the use of mesh in the vagina. Fortunately, new technologies such as the A.M.I. Advanced Pelvic Floor Repair System are now available that appear to further reduce the incidence of mesh related complications.

Click here for more information on the A.M.I. Advanced Pelvic Floor Repair System

Incontinence Update

Read Dr Farnsworths recent article in the Sydney Adventist Hospital newsletter outlining recent developments in the management of incontinence.

Click here to read Incontinence Update

Mini-Slings

A number of new slings for the treatment of stress incontinence have become available in the last year. The concept of these slings is very attractive. Until now slings for incontinence have been placed through the abdominal cavity or through the obturator fossa and groin.

The transobturator slings are essentially safer than the retropubic or transabdominal slings and seem to be equal in efficacy in most cases. In some special situations the traditional retropubic sling has advantages.

The new Mini-slings are a drastic change from what has previously been available to treat stress incontinence. They are only about 8cm long and do not pass through the body and exit through the skin like other slings. These slings are self fixing to the soft tissues of the pelvis. There is minimal pain and a much better safety profile than before.

The first mini sling made available in Australia was the TVT Secur. Dr Farnsworth commenced using the TVT Secur in December 2006. In his first 30 cases performed Dr Farnsworth has noticed a lower success rate than the more traditional techniques.

Further Information on TVT Secur®

Mini-arc

Recently a new Mini-Sling the MiniArc has been introduced into Australia by American Medical Systems. Reports from overseas suggest that this device may have a greater durability than the TVT Secur. At present Dr Farnsworth is recommending caution with regard to these technologies until more long term results are available.

The Mini-arc is especially suited to mild incontinence in a patient who is unsuitable for a more significant anaesthetic and is prepared to sacrifice lack of long term data for the ease and painfree mini procedure.

Accessa® or Miniaturo

This is a small electronic device similar to a pacemaker that is placed in the body and used to send an electrical signal to interfere with the messages between the bladder and the brain. Dr Farnsworth is currently an investigator in the first international multicentre trial to evaluate this device as a treatment for urge incontinence. The Accessa is not yet available commercially but implantation is available to suitable patients as part of a clinical trial..

Shirley (left) from AMS and Clinical Nurse Specialist Robyn with an Accessa® device and computerised telemetry device used to adjust the stimulation parameters after implantation.

Click here for further information

Pelvisoft®

A new biological implant has become available in Australia with significant potential advantages over the previously available biological material known as Pelvicol. Both materials are made of collagen extracted from Porcine dermis and then crosslinked to make them resistance to breakdown in the body. Pelvisoft differs from Pelvicol in that it contains multiple perforations which increase the surface area of the implant and enables the biological mesh to integrate into the patient more effectively. Pelvicol and Pelvisoft are permanent biological implants which are useful when a permanent synthetic implant such as polypropylene is contraindicated.

Biological mesh has the advantage that if it becomes infected or eroded after surgery it does not necessarily need to be removed. It will heal and recover like natural issue. Pelvisoft can be used as a sling or in sheets to relace fascia. It has also been used to augment traditional repairs and found to be soft and pliable so as to retain the original shape and contours of the host tissues.

Further Information: Pelvisoft Company Website

The Electric Chair®

A new way to strengthen the Pelvic Muscles seems to the best when used in conjunction with Pelvic Floor Training. The treatment consists of sitting in a special chair while an electromagnetic signal penetrates the muscles from below. There is a sensation of muscle contraction which can result in discomfort afterwards much like after strong exercise.