Sling Suspension Therapy Utilization in Musculoskeletal Rehabilitation

The development of an effective and inexpensive device to restore and enhance the human musculoskeletal functions is of particular interest. Sling exercise therapy (SET) is one of the most effective developed tools in rehabilitation of musculoskeletal disorders, which has been successfully used in various applications ranging from diagnosis to treatment. To the best of our knowledge, SET has never been comprehended and reviewed previously. Therefore, it was highly required to further understand the role of SET in various therapeutic applications. Inspired by this herein, this study is dedicated to emphasize the advancement in utilization of the SET in both diagnosis and treatment as well as their related challenges. This would be concluded by future perspectives of the SET.

The Outpatient Burch-Sling Procedure: A Nerve-Sparing Method for Correcting Female Urinary Incontinence

Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve-sparing Burch-Sling method represents a surgical advancement through the use of a nerve-sparing sling to treat genuine stress urinary incontinence. The procedure involves retropubic urethropexy using the FDA-approved Burch-Sling device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction to the mid-urethra toward Cooper’s ligament above the base of the bladder. Then, the anterior vaginal wall and fascia are used as an endogenous suburethral sling without dissection. Two hundred twenty cases were included in this study;two hundred patients underwent the outpatient nerve-sparing sling method, and the other twenty underwent the novel abdominal Burch method. There were no major complications. The follow-up duration ranged from 6 months to eight years. All procedures were performed at the U.S. Women’s Institute at a 400-bed hospital in Fountain Valley, CA.

Single incision slings: Past, present, and future

Pubovaginal slings have become the gold standard to treat stress urinary incontinence. Traditionally, the sling referred to a suspensory that was placed under the urethra and brought through the retropubic space and anchored on either side of the midline. Since this original concept, there have been many materials used for the sling, and there have been many different anchoring approaches. Most agree that one of the best materials is polypropylene mesh. However, the means of anchoring the device and where best to have this anchorage placed is debatable. The options for anchoring simply include using darts vs not to hold the sling in place. The location of this anchorage, on the other hand, is much more controversial. The main locations are retropubic, transobturator, and via a single incision. The obturator and retropubic slings have become the standard of care over time. The single incision sling, on the other hand, is starting to be more acceptable which has resulted in it being used more frequently. The single incision relies on mainly anchoring the sling through the obturator internus muscle with possible inclusion of the obturator membrane. The purpose of this review article is to present the data that exists for the use of the single incision sling.

Long Term Follow up of the Solyx Single Incision Sling in the Treatment of Female Stress Urinary Incontinence (SUI)

Objectives: The Solyx System was developed to be easier and safer to use than other slings. It was the objective of this study to retrospectively assess the long-term safety and efficacy of the SolyxTM SIS Sling System. Methods: After IRB approval and informed consent, chart reviews with follow up phone questionnaires of 69 subjects implanted with the Solyx Sling were collected at 2 sites. All of the patients had SUI and had urethral hypermobility with a q-tip test of >30 degrees. All subjects underwent surgery from 12/2008 to 01/2010 with a mean follow up of 43 months (range 39 -49). Subjects included in this data collection had a mean age of 67 years (range 30 -87). The dominant type of incontinence within the study patients was SUI while 17/69 (25%) of the subjects also had a component of urge incontinence. 38/69 (55%) of study patients had concomitant procedures. Results: Long-term Solyx results showed 64/69 (93%) of patients were subjectively dry by questionnaire and were satisfied with their outcome. 63/69 (91%) would have the procedure again. There were 4 cases of denovo urge incontinence and 2 reports of transient retention. There were no serious adverse events including no bladder, bowel, vessel or nerve perforations and no erosions or extrusions. No pain was reported that was attributed to the implant. Conclusions: Chart review with follow phone questionnaires indicated that the Solyx Sling was a safe, efficacious and less-invasive option for patients requiring SUI surgery and that these results were sustainable for an average of 43 months.

Severe unilateral congenital ptosis with poor levator function:tarsoconjunctival mullerectomy plus levator resection vs frontalis sling procedure

AIM:To compare frontalis sling and tarsoconjunctival mullerectomy plus levator resection(TCMLR)in subjects with severe unilateral congenital ptosis with poor levator function(LF).METHODS:A prospective non-randomized nonblinded single center clinical trial.Fifty patients with severe unilateral congenital ptosis with poor LF were recruited.The frontalis sling and TCMLR were performed and the functional,cosmetic outcomes,complications,and success rate were evaluated at 1,3,and 6mo postoperatively.The t-test,Chi-square,Fishers exact,and nonparametric MannWhitney tests were used by SPSS software.RESULTS:Frontalis sling and TCMLR procedures were performed on 26 and 24 patients respectively.The mean age was 10.97±10.67y.LF was significantly better in the TCMLR group at months 1,3,and 6(P=0.002).Lagophthalmos was more common in the TCMLR group(no significant difference).At month 3,mild punctate epithelial erosions were observed more in the frontalis sling group(P=0.002).Significant complete success rate of 1st and 6th month for the frontalis sling vs TCMLR groups were 50%vs 20.8%(P=0.02),and 38.4%vs 50%(P=0.03)respectively.CONCLUSION:Complete success rate of TCMLR is higher in long-term follow-up in contrast with the frontalis sling in the short-term.Transient complications are more detected in mid-term follow-ups in both groups.

Effect of Tuina-SET Sling Exercise Therapy on Analgesic Substances in Serum of Patients with Nonspecific Low Back Pain

[Objectives]This paper aimed to investigate the effect of Tuina combined with sling exercise therapy(SET)and psoas&abdominal training on serum 5-hydroxytryptamine(5-HT)andβ-endorphin(β-EP)levels in patients with nonspecific low back pain(NLBP).[Methods]Total 46 patients with NLBP who visited the Tuina Department of the First Affiliated Hospital of Hainan Medical University from August 2019 to May 2020 were randomly and evenly divided into control group and treatment group.On the basis of Tuina therapy,the patients in the control group and treatment group were treated with psoas&abdominal training and SET,respectively.After the treatment,the serum 5-HT andβ-EP levels of the patients were detected.[Results]The serum 5-HT andβ-EP levels in the treatment group were significantly improved compared with the control group(P<0.05).[Conclusions]The nerve&muscle reconstruction techniques of Tuina combined with SET or psoas&abdominal training can improve serum 5-HT andβ-EP levels in patients with NLBP.

经sling法治疗女性压力性尿失禁术前术后护理

我院自1996年至今采用sling法治疗压力性尿失禁病人22例,疗效满意.现围手术期的护理体会报告如下.

The Effect of Isometric and Isotonic Exercises of Lower Limbs Extensor Sling on Static and Dynamic Balance in Basketball Players with Patellofemoral Pain

Background: Patellofemoral Pain Syndrome (PFPS) is one of the most common conditions among athletes. Although there are various causes for this condition, reduced balance is the problem most frequently expressed by these patients. The aim of the present study was to examine the effect of Extensor Muscle Sling Isometric and Isotonic (EMSII) exercises of lower limbs on female basketball players suffering from PFPS. Method: A total of 30 participants, all female basketball players suffering from PFPS, with an average age of 20 - 30 years, were divided into two isometric/isotonic and control experimental groups. Eight weeks of isometric and isotonic exercises were recommended to the participants with a focus on EMSII exercises of lower limbs in two four-week phases. The control group received no specific exercise program. Pre-test and post-test included the use of Stork balance test (SBT) and Y Balance tests (YBT) to assess the static and dynamic balance, respectively. Results: After eight weeks of performing separate isometric and isotonic exercises on the mentioned muscles, and according to the results of the pre-test, a significant increase was observed in the results of both static and dynamic balance tests (P Conclusion: EMSII exercises of lower limbs showed a significant effect on the increased balance. Recommended exercises can be suggested according to the type of exercises as a factor for increasing static and dynamic balance.

The Suburethral Sling Transobturator Approach for Stress Urinary Incontinence Treatment in Women in the Maternity and Neonatology Center of Tunis (WTSC)

The authors, through a descriptive retrospective study have evaluated the results of surgical treatment, by Tension-Free Obturator tape (TOT) technique, of urinary incontinence in the first 68 patients operated in the Department “C” of Obstetrics and Gynecology of the Maternity and Neonatology Centre of Tunis (WTSC). The average age in those patients was 55.14 ± 8.47 years with extremes of 40 and 82 years. The majority of the patients (72%) were under the age of 60 years. In sixty-one patients (89%), no urine leak has been detected and they were healed. In three patients (4%) there was improvement with partial recovery. Three other (4%) did not notice any improvement after the surgery. No case of dysuria or rejection of the strip has been reported. It was concluded that the declared satisfaction rate is 93%.

A retrospective comparative series comparing monarc and sparc suburethral slings

A Retrospective Comparative Series Comparing Monarc and Sparc Suburethral Slings. Introduction and Hypothesis: There are a number of suburethral slings used in current practice to treat female urinary incontinence. To date there has been a lack of larger comparative series. This paper aims to evaluate the effectiveness and complications of two types of suburethral sling. Methods: A retrospective comparative series comparing 113 consecutive Sparcsuburethral slings with 112 consecutive Monarc slings. Results: The success rate of SparcvsMonarc was similar at 6 weeks (96.1% vs 94.2%, NS) and at 6 months (96.0% vs 92.6%, NS). The Monarc procedure had less intraoperative bladder fenestrations & less postoperative urgency. Conclusions: Both procedures had a similar success rate, while the Monarc had less complications. Brief Summary: Both procedures had a similar success rate, while the Monarc had less complications of intraoperative bladder fenestration & postoperative urgency.

Cadaveric Assessment of Synthetic Mid-Urethral Sling Placement

Purpose: To determine if 3 types of mid-urethral synthetic slings are visually the same. Materials and Methods: A retropubic, obturator, and single incision sling was individually placed in three cadavers. Tension was set using a spacer (obturator and retropubic). Single incision sling (SIS) tension was set by visual inspection. Thirty physicians were asked to determine placement method, tension, and location of the 3 slings. Results: Physicians were composed of 5 urologists, 7 urogynecologist, and 18 general gynecologists, with an average of 53 slings performed per year. Conclusion: This study showed that after placement of a sling it is hard to tell how the sling was placed and that most physicians felt the SIS was tensioned the best and most likely at the mid-urethra.

Clinical value of needleless sling in treatment of female stress urinary incontinence

BACKGROUND Stress urinary incontinence(SUI)is a common disease in women.The emergence of the needle-free sling has led to a new clinical treatment for SUI in women.AIM To explore the clinical value of the needleless sling without acupuncture in the treatment of SUI in women.METHODS From February 2017 to November 2018,according to the order of admission,44 patients(mid-suspension group)were treated by tension-free transobturator urethral suspension,and 44 patients(non-acupuncture group)were treated with a needleless non-acupuncture band.The clinical effects of the two treatments were evaluated.RESULTS There was no significant difference between the two groups in the total clinical effectiveness rate(P=0.374),but intraoperative blood loss and visual analogue scale score at postoperative day 1 were significantly lower in the non-acupuncture suspension group than in the middle urethral suspension group(P=0.396).The incidence of complications in the needle-free sling group was significantly lower than that in the middle urethral suspension group(P=0.025).CONCLUSION The clinical effectiveness of acupuncture-free suspension in treating SUI in female patients is better than that of traditional tension-free transobturator mid-urethral suspension.

Left Pulmonary Artery Sling Associated with Patent Ductus Arteriosus and Atrial Septal Defect: Evaluation with Multidetector CT

We report a case of left pulmonary artery sling associated with patent ductus arteriosus and atrial septal defect in a 21-month-old child. 256-slice MDCT provides valuable information, such as abnormal origin of the left pulmonary artery, the relationship between pulmonary artery and airway, the diameter of the patent ductus artery and atrial septal defect. The information is helpful in diagnosis, pre-operative evaluation and post-operative follow-up of LPS.

Single incision slings:Are they ready for real life?

AIM： To review of the efficacy and safety outcomes of different single incision slings （SIS） systems, also in comparison with traditional slings.METHODS： A literature search was conducted in PubMed/MEDLINE database. The research was re-stricted to randomized and/or prospective trials and retrospective studies, published after 2006, with at least 20 patients with non-neurogenic stress urinary incontinence （SUI）. The studies had to assess effcacy and/or safety of the SIS with a minimum follow-up of 12 mo. All the paper assessing the performance of tension free vaginal tape secur were excluded from this review. The fnal selection included 19 papers fulflling the aforementioned criteria. Two authors independently reviewed the selected papers.RESULTS： Four different SIS systems were analysed： Ajust , Ophira , Altis and MiniArc . The average objective cure rate was 88%. Overall no statistically significant differences were found between SIS and traditional mid-urethral slings （MUS） in terms of objective cure （all P 〉 0.005）. Only one paper showed a statistically lower success rate in MiniArc？ vs Advant-age？ slings （40% vs 90%） and higher rates of failure in the SIS group. Since there was a great variability in terms of tests performed, it was not possible to com-pare subjective cure between studies. The vast part of the studies showed no major complications after SIS surgery. We also observed very low reported pain rates in SIS patients. The RCTs on Ajust？ and MiniArc？, showed better outcomes in terms of post-operative pain compared to MUS. None of the patients reported long- term pain complains. CONCLUSION： SIS showed similar effcacy to that of traditional slings but lower short-term pain, complication and failure rates.

Ten-Year Outcomes of Transobturator Mid-Urethral Sling for Treatment of Stress Urinary Incontinence in Hong Kong Chinese Women with or without Reconstructive Pelvic Floor Surgery

Objective: To evaluate the outcomes of transobturator mid-urethral sling (TO-MUS) with or without reconstructive pelvic floor surgery (RPFS) in Chinese women with stress urinary incontinence (SUI) after 10 years. Methods: This was a prospective observational study on Chinese women undergoing the insertion of TO-MUS with or without RPFS. All patients were assessed at 1-year and 10-year by urodynamic study (UDS). Objective cure was defined as the absence of urine leakage during provocative maneuvers on filling cystometry. Data regarding subjective outcome (patient perception), quality of life changes (Urogenital Distress Inventory-short form (UDI-6), Incontinence Impact Questionnaire-short form (IIQ-7)) and adverse events were also collected. Results: Of 104 eligible patients, 99 patients completed the 10-year evaluation. 57 patients (57.6%) underwent TO-MUS only and 42 patients (42.4%) underwent TO-MUS with concomitant RPFS. At 10-year follow-up, the overall objective cure rate was 86.9% and overall subjective cure rate was 80.8%. In TO-MUS only group, the objective and subjective cure rates at 10-year were 84.2% and 78.9% respectively. In TO-MUS with RPFS group, the objective and subjective cure rates at 10-year were 90.5% and 83.3% respectively. Compared TO-MUS only group with TO-MUS with RPFS group, there were no statistically significant differences in objective cure rate (84.2% vs. 90.5%, p = 0.55) and subjective cure rate (78.9% vs. 83.3%, p = 0.58). Conclusion: TO-MUS is an effective treatment for SUI in Hong Kong Chinese women. Concomitant RPFS during the procedure of TO-MUS does not affect the success.

Re-Adjustable Male Slings

Re-adjustable male slings are well established and should be offered to incontinent men with mild, moderate or severe incontinence. However, they should be able to interrupt their stream. Solely the slight increase of the urethral resistance (10 - 15 cmH20) supporting the smooth muscle component will provide continence for such patients. Argus, Remeex and Atoms allow exactly setting the urethral resistance to a level, which will provide continence thus avoiding obstructive voiding. Implantation may be carried out retropubically (Remeex), via a transobturator route (Atoms) or alternatively (Argus). The success rates after more than one-year follow-up come up to 84%. Intraoperative bladder perforations may occur in 6% - 11%, late complications are infections possibly leading to explantation in 8% - 12%. Postoperative perineal pain and/or numbness may be present.

Does local vaginal estrogen after tension-free transobturator vaginal tape reduce overactive bladder symptoms in postmenopausal women? A prospective randomized, controlled study

Objective:We aimed to evaluate the efficacy of topical estrogen after transvaginal tension-free vaginal tape-obturator(TVT-O)in the treatment of de novo overactive bladder symptoms that appear after surgery.Methods:This is a prospective randomized controlled study performed in the Urology and Gynecology Departments,Kasr Al Ainy Hospital,Cairo University,Cairo,Egypt.Two hundred and ten postmenopausal females presenting during the period between January 2017 and November 2020 with stress urinary incontinence were included in the study.Patients were divided into two groups,105 patients in Group A(treatment group)and 105 patients in Group B(control group).Patients in Group A underwent transvaginal TVT-O followed by local vaginal estrogen treatment for 6 months,while patients in Group B underwent transvaginal TVT-O only.The study included any postmenopausal female with urodynamic stress urinary incontinence.All patients had to fulfill a 3-day bladder diary,overactive bladder symptoms score,urine analysis,urodynamic study,and post-voiding residual urine measurement by abdominal ultrasound preoperatively and at 3-month and 6-month follow-ups.Results:At 6-month follow-up,daytime frequency was reduced to 8%in Group A(increased to 21%in Group B)with a statistically significant difference between both groups(p=0.009).At 6-month follow-up,nocturia was 8%in Group A(11%in Group B)with no statistically significant difference between both groups(p=0.469).There was a statistically significant difference between both groups as regards to urinary urgency at 6-month follow-up(p=0.024).There was a statistically significant difference in postoperative wound healing events as regards to cure,hyperemia,gapping,and wound infection 1 week after intervention between both groups(p=0.008).No local or systemic side-effects were reported from local estrogen use.Conclusion:Local vaginal estrogen treatment given to postmenopausal patients after midurethral sling procedures can reduce the symptoms of daytime frequency and urinary urgency.Long-term follow-up is needed.

涡轮动力模拟器甩油盘热流模型与流场特性研究

甩油盘作为涡轮动力模拟器(TPS)的重要零件,能有效地促进模拟器内循环系统润滑油的回流,提高轴承的润滑性并降低系统温升,为整机安全可靠运行提供了基础性保障。为了解决TPS内循环系统润滑油的回流问题,对TPS甩油盘及其内部循环流道进行了研究。首先,确定了涡轮动力模拟器轴承发热量及散热系数随转速的变化、甩油盘内部流体控制方程和边界条件;然后,构建了一类TPS甩油盘及其内部循环流道的完整内循环热流模型,并对比了轴承处温度仿真结果与实验结果以确保模型的合理性;最后,数值仿真得到了不同转速下内部循环流道的温度场、压力场和速度场。研究结果表明:转速增加能显著引发系统内最高温度上升,甩油盘作用下的内循环流场温度变化较为平稳,典型工况条件下仿真与实验得到的最高温度相对误差最大为12.3%,表明了热流模型的合理性。研究结果对于指导TPS甩油盘结构设计和提高整机运行安全稳定性具有重要的价值。

悬吊推拿运动技术在改善青少年特发性脊柱侧弯患者椎旁肌不对称性中的作用

目的探讨悬吊推拿运动技术在改善青少年特发性脊柱侧弯(AIS)患者椎旁肌不对称性中的作用。方法选取2021年10月—2023年8月于山东中医药大学第二附属医院康复科就诊并符合纳入标准的AIS患者88例作为研究对象,采用随机数字表法分为对照组和试验组,每组44例。对照组参照德国Schroth脊柱侧弯三维矫正疗法进行常规康复训练,包括手法放松侧弯凹侧椎旁肌肌肉,“臀桥”“小燕飞”力量练习,施罗特体操包括“肌肉圆柱”“旋转坐位运动”“伸展运动”配合成角呼吸。试验组运用悬吊推拿运动技术治疗,主要包括在悬吊设备辅助下调节脊柱位置恢复脊柱中立位,以弹拨、按推等推拿手法往返作用于督脉、膀胱经行整体治疗和凸凹侧椎旁辨证补泻治疗,仰卧位、俯卧位和侧卧位的中立位控制训练,躯干屈伸、旋转、侧屈闭链运动训练。在治疗前和治疗4周后运用肌电生物反馈仪测量患者站立负重时椎旁肌的表面肌电图(sEMG),通过自带软件进行分析,采集均方根(RMS),并计算椎旁肌肉对称指数(PMSI=RMS凸/RMS凹);采用Cobb角评估患者脊柱侧弯的严重程度;采用躯干旋转角度(ATR)评估躯干的旋转程度、脊柱的功能和形态。结果治疗前,2组PMSI值、Cobb角、ATR值比较,差异均无统计学意义(P>0.05)。治疗4周后,试验组PMSI值为1.08(1.04,1.14),Cobb角为5(2,9)°,ATR值为2(1,3)°;对照组PMSI值为1.12(1.09,1.17),Cobb角为8.5(6,10)°,ATR值为2(2,3)°。组内比较,治疗后2组PMSI值均更接近1(P<0.05),Cobb角、ATR值均下降(P<0.05)。组间比较,治疗后试验组PMSI值、Cobb角改善效果均优于对照组,试验组PMSI值更接近1(P<0.05),Cobb角明显更低(P<0.05),但治疗后2组ATR值差异无统计学意义(P>0.05)。结论悬吊推拿运动技术可有效改善椎旁肌不对称性,达到降低患者的Cobb角的矫形目的,值得临床推广应用。

RMUS术治疗混合性尿失禁中尿急症、急迫性尿失禁症状的疗效观察

目的探索经阴道经耻骨后无张力尿道中段吊带(RMUS)术治疗混合性尿失禁(MUI)中尿急症、急迫性尿失禁(UUI)症状的疗效。方法回顾性分析2018年1月—2020年12月上海交通大学医学院附属仁济医院采用RMUS术治疗的44例女性MUI患者的临床资料。44例患者术前压力诱发试验、尿道抬举试验均为阳性。27例患者术前完成国际尿失禁咨询委员会女性下尿路症状长问卷(ICIQ-FLUTS-LF)调查,44例患者接受尿动力学(UDS)检查,其中9例(20.5%)出现逼尿肌过度活动(DO)。所有患者RMUS术中均通过解剖定位调整吊带张力。分析手术治疗效果和患者尿失禁改善情况。结果本研究44例患者平均年龄(58.59±9.08)岁,身体质量指数24.71±2.77。术后2年完成电话随访40例,主观治愈率为85.0%(34/40)。在27例完成ICIQ-FLUTS-LF问卷的患者中,手术前后漏尿发生率[100%(27/27)vs.18.5%(5/27)]、压力性尿失禁(SUI)发生率[100%(27/27)vs.18.5%(5/27)]、UUI发生率[70.4%(19/27)vs.29.6%(8/27)]差异均具有统计学意义(P<0.05);患者手术前后夜尿(≥1次)、尿急症、尿痛、排尿踌躇、排尿费力、排尿中断、遗尿发生率差异无统计学意义(P>0.05)。根据术前UDS检查结果进行的患者亚组分析显示,术后2年DO组和无DO组患者的主观治愈率差异有统计学意义[(55.6%(5/9)vs.93.5%(29/31),P<0.05],且两组患者术后SUI发生率[66.7%(4/6)vs.4.8%(1/21)]和UUI发生率[66.7%(4/6)vs.19.0%(4/21)]差异均有统计学意义(P<0.05),但尿急症发生率[66.7%(4/6)vs.33.3%(7/21)]差异无统计学意义(P>0.05)。结论采用RMUS术治疗压力诱发试验和尿道抬举试验阳性的MUI患者有效,术后可改善患者的SUI和UUI症状,但对于尿急症无明显改善。此外,DO组患者术后2年的主观治愈率劣于无DO组。