Papers by Adolf Lukanović
International Journal of Gynecology & Obstetrics
ObjectiveTo evaluate the efficacy and safety of non‐ablative vaginal Er:YAG laser device in stres... more ObjectiveTo evaluate the efficacy and safety of non‐ablative vaginal Er:YAG laser device in stress urinary incontinence (SUI) treatment.MethodsWe conducted a multicenter blinded randomized sham‐controlled trial in which women with urodynamic SUI were randomization to active arm using Er:YAG laser therapy, and sham arm using sham handpiece. Patients received two treatments 1 month apart. The primary outcomes measure was 1 h pad weight test measured at 6 months. Secondary outcomes were durability of treatment success at 12 months, and questionnaires for assessment of SUI severity (ICIQ‐UI SF), sexual function (PISQ‐12) and HRQoL (KHQ), and incidence and severity of device related adverse events and pain (VAS).ResultsA total of 110 participants with SUI were recruited; 73 in the active arm and 37 in the sham arm. Two participants were excluded; one was assigned the wrong treatment and one withdrew their consent. Treatment success was observed in 36% of the sham arm and 59% of the activ...
International Urogynecology Journal, Mar 6, 2023
Introduction and hypothesis This systematic review analyzes published studies about magnetic stim... more Introduction and hypothesis This systematic review analyzes published studies about magnetic stimulation (MS) treatment for UUI and determines whether this treatment is effective and non-invasive. Methods A systematic literature search was conducted using PubMed, the Cochrane Library, and Embase. The international standard for reporting results of systematic reviews and meta-analyses (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to guide the methodology of this systematic review. The key search terms were as follows: "magnetic stimulation" and "urinary incontinence." We limited the time frame to articles published from 1998, when the FDA approved MS as a conservative treatment option for UI. The last search was performed on 5 August 2022. Results Two authors independently reviewed 234 article titles and abstracts, of which only 5 fitted the inclusion criteria. All 5 studies included women with UUI, but every study had different diagnostic and entry criteria for patients. They also differed in their treatment regimens and methodological approaches to assessing the efficacy of treating UUI with MS, which made it impossible to compare the results. Nonetheless, all five studies established that MS is an effective and non-invasive way of treating UUI. Conclusions The systematic literature review led to the conclusion that MS is an effective and conservative way of treating UUI. Despite this, literature in this area is lacking. Further randomized controlled trials are needed, with standardized entry criteria, UUI diagnostics, MS programs, and standardized protocols to measure the efficacy of MS in UUI treatment, with a longer follow-up period for post-treatment patients.
International Urogynecology Journal
Introduction and hypothesis This systematic review analyzes published studies about magnetic stim... more Introduction and hypothesis This systematic review analyzes published studies about magnetic stimulation (MS) treatment for UUI and determines whether this treatment is effective and non-invasive. Methods A systematic literature search was conducted using PubMed, the Cochrane Library, and Embase. The international standard for reporting results of systematic reviews and meta-analyses (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to guide the methodology of this systematic review. The key search terms were as follows: “magnetic stimulation” and “urinary incontinence.” We limited the time frame to articles published from 1998, when the FDA approved MS as a conservative treatment option for UI. The last search was performed on 5 August 2022. Results Two authors independently reviewed 234 article titles and abstracts, of which only 5 fitted the inclusion criteria. All 5 studies included women with UUI, but every study had different diagnostic and entry cr...
Insights Into Incontinence and the Pelvic Floor
Insights Into Incontinence and the Pelvic Floor
Insights Into Incontinence and the Pelvic Floor
Neurourology and Urodynamics, 2012
Hypothesis / aims of study Several studies confirmed that there is a significant correlation betw... more Hypothesis / aims of study Several studies confirmed that there is a significant correlation between anal sphincter damage during vaginal birth and subsequent development of anal incontinence in women. It is possible that also the damage of the nerves innervating anal sphincter can cause anal incontinence. Mediolateral episiotomy is usually performed on the right side for convenience in cutting and suturing by right handed operators. Knowledge of the location of the innervation zones (IZs) could allow choosing the side for performing episiotomy. Avoiding the incision in innervation regions during episiotomy would presumably reduce the incidence of anal incontinence. The aim of the TASI-2 project (Technologies for Anal Sphincter analysis and Incontinence) was to evaluate the effect of delivery related trauma on the external anal sphincter (EAS) muscle with surface electromyography (EMG).
Hypothesis / aims of study: Anal incontinence (AI) is devastating condition in women after delive... more Hypothesis / aims of study: Anal incontinence (AI) is devastating condition in women after delivery. It was estimated that it affects 0,17% of women aged 15 to 64 and 1,3-11 % of women over 64 years of age. The causes of anal incontinence can be different. The main cause of anal incontinence is trauma due to delivery. The role of the episiotomy in prevention of anal incontinence is uncertain. A systematic review concluded that the effect of episiotomy on the development of pelvic floor disorders remains unknown. The episiotomy is surgical enlargement of the vaginal orifice by an incision of the perineum during the last part of the second stage of labour. This procedure is done with scissors or scalpel and requires repair by suturing. There are different ways of performing episiotomy, in the midline, mediolateral, lateral left or right. Although episiotomy is one of the most commonly performed surgical procedures in the world, it was introduced without scientific evidence of its effe...
International Journal of Fertility & Sterility, 2016
Among the different causes of gynecological acute pelvic pain, ovarian torsion represents a surgi... more Among the different causes of gynecological acute pelvic pain, ovarian torsion represents a surgical emergency. It is a rare case in the pediatric/adolescent aged group that must be included in the differential diagnosis of any girl with abdominal pain or pelvic/abdominal mass. Current recommendations suggest that laparoscopic detorsion should be performed in order to preserve the integrity of the ovaries and fertility, although oophoropexy may be considered in case of severe necrosis. Nevertheless, maintaining the circulation of the ovary after detorsion deteriorates the tissue injury and leads to a pathologic process called ischaemia/reperfusion (I/R) injury, which is characterized by oxidative stress. During the detorsion process, an excess amount of molecular oxygen is supplied to the tissues, and reactive species of oxygen (ROS) such as superoxide radical (O2-), hydrogen peroxide (H2O2), hydroxyl radical (OH•), as well as reactive nitrogen species (RNS) are produced in excess. ...
Midwifery, 2017
To examine potential association between mediolateral episiotomy and reduced incidence of obstetr... more To examine potential association between mediolateral episiotomy and reduced incidence of obstetrical anal sphincter injuries (OASIS) diagnosed by endoanal ultrasound. Design Prospective cohort study. Setting Tertiary referral university hospital. Participants Sixty nulliparous women at 28-33 weeks of gestation with singleton pregnancies were included between 2010 and 2012. Measurements and findings Participants were examined with endoanal ultrasound at 28-33 weeks gestation and at 6-7 weeks post-partum. At both visits, symptoms of anal incontinence were assessed using Cleveland Clinic (Wexner) faecal incontinence scoring system. Mann Whitney U-test and Chi square test was used to compare groups with vs. without episiotomy and groups with vs. without OASIS diagnosed by ultrasound. Chi square test was used to assess correlation between OASIS and anal incontinence symptoms (p ≤0.05 considered significant). None of the women included had sphincter injury or anal incontinence before delivery. All delivered vaginally. Mediolateral episiotomy was performed in 33 (55%) cases. Six (10%) had OASIS on endoanal ultrasound (two were also diagnosed clinically), and 11 had symptoms of anal incontinence post-partum. No significant differences were seen in clinical characteristics between groups with vs. without episiotomy. No significant differences were seen in episiotomy rate (p=0.14), angle (p=0.42) and length (p=0.14) between groups with vs. without OASIS on ultrasound. Correlation between anal incontinence symptoms and sonographically diagnosed OASIS was statistically significant (p=0.04). Key conclusions Mediolateral episiotomy does not seem to be protective against clinically or sonographically diagnosed OASIS even when episiotomy technique is considered. Endoanal ultrasound allows a significantly better detection of symptomatic OASIS compared to clinical examination alone. Implications for practice Mediolateral episiotomy should be considered only when shortening the second stage of labour is indicated due to foetal distress, and not as a means of OASIS prevention.
Zdravniski Vestnik, Dec 1, 2008
Maturitas, 2015
Hypothesis / aims of study The technical advantages of medical laser technology have been amply j... more Hypothesis / aims of study The technical advantages of medical laser technology have been amply justified and proven through its medical effects: biochemical, ablative and photo-thermal, are well established facts. Laser-generated thermal energy breaks up intermolecular cross-links and stabilizes the collagen triple-helix structure, thus resulting in the shortening of collagen fibres. In order to achieve a shrinking of the collagen protein without destroying its fibrilar structure and stimulation of neocollagenogenesis, the temperature must vary between 60 o C and 65 o C 1. Clinical studies in dermatology, aesthetic medicine and orthopedics have reported significant successes in the treatment of various disorders and conditions based on collagen damage. Inconvenience and fear of social stigma are the main reasons for not reporting stress urinary incontinence symptoms, leading to a 53% prevalence of undiagnosed SUI 2. Recent review showed that the menopause has little if any impact on the risk of urinary incontinence (UI). At the same time, up to 76% postmenopausal women reported symptoms of SUI and deteriorating QoL 3. Less or non-invasive intervention in premenopausal period may reduce incidence of postmenopausal SUI and promote QoL in postmenopausal years. Main objectives of study were comparison of the efficacy of two methods (Er:YAG Laser versus pelvic floor muscle training) for the treatment of stress urinary incontinence (SUI) and pelvic floor distension syndrome.
Journal of Pelvic Medicine and Surgery, 2004
Surgical innovation, 2015
We performed an observational longitudinal cohort study on patients affected by stress urinary in... more We performed an observational longitudinal cohort study on patients affected by stress urinary incontinence (SUI) and surgically treated with a transobturator adjustable tape sling (TOA) in order to evaluate this surgical procedure in terms of efficacy, safety, quality of life (QoL) improvement, and patient satisfaction. For all patients, we recorded: general features, preoperative SUI risk factors, obstetrics history, preoperative urodynamic tests, intraoperative/postoperative complications, number of postoperative sling regulations, postmicturition residue, and hospital stay. All patients were asked to complete the validated short version of the Urogenital Distress Inventory (UDI-6) questionnaire 18 months after discharge to evaluate the efficacy of the TOA system. We added 2 adjunctive items to the UDI-6 in order to evaluate patient satisfaction and QoL. All 77 surgical procedures were performed under locoregional anesthesia without complications. Postoperative TOA regulations we...
Minerva ginecologica, 2003
Stress urinary female incontinence (IUS) is an unpleasant symptom describing a loss of urine duri... more Stress urinary female incontinence (IUS) is an unpleasant symptom describing a loss of urine during physical exertion; genuine stress incontinence (GSI) is a socially unacceptable, involuntary loss of urine in absence of detrusor activity from the urethra associated with sudden cough or strain. The incidence of IUS is less than 10% in reproductive-age women but may approach 10-20% in postmenopausal women. The IUS pathophysiology is connected with two specific mechanisms: the urethral-bladder sliding out of anatomical area involves the normal system of endobladder/intraabdominal pressures, with a loss of urine; the second mechanism involves the damaged urethral sphincteric function, with a reduction of the urethral closure pressure and a urinary loss after minimal physical stimulation. The IUS medical therapy is troublesome and often inefficient, and the only approved effective measures are the surgical procedures, actually reserved for cases of unsuccessful medical therapy; surgical...
ZDRAVNISKI VESTNIK, 2003
Background. The article describes the problem of female urinary incontinence. The types of urinar... more Background. The article describes the problem of female urinary incontinence. The types of urinary incontinence are analized. The different etiology of stress and urge incontinence is stressed and the treatment of each is discussed. The description of the advantages of minimally invasive surgery is presented and the introduction of two new basic approaches in the surgical technique, the use of implants and the tension free technique are presented.
Ultrasound in Obstetrics and Gynecology, 2002
Abstract not available.
Muscle & Nerve, 1999
The external anal sphincter (EAS) anatomy is complex, and no exact technique of needle electrode ... more The external anal sphincter (EAS) anatomy is complex, and no exact technique of needle electrode insertion into it for electromyography (EMG) has been described. To define optimal positions for needle electrode insertions, EAS muscle topography was studied by concentric needle EMG. Fifteen women without uroneurological disorders were examined. Perpendicular insertions were made superficially (just under the mucosa) at the mucocutaneous junction, 5 and 10 mm more proximally (toward the anus), and at the anal orifice. In addition, at the anal orifice, deeper insertions were made. Superficially, EMG activity was detected at the mucocutaneous junction in 9 (60%) subjects. In the remaining 6, the muscle was found either 5 mm (in 5) or 10 mm (in 1) more centrally. At the anal orifice, superficial EMG activity was present in 67% of women. On deep insertion (15-25 mm) at the anal orifice, muscle was always present. It is suggested that, in further studies, the portions of the EAS muscle examined should be specified.
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Papers by Adolf Lukanović