Browsing by Author "Brouard, Kendall"

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    Open Access
    Comparison of short-term outcomes between two sacrospinous suture capture devices : a randomised controlled trial
    (2016) Ras, Lamees; Brouard, Kendall; Jeffery, Stephen
    BACKGROUND Sacrospinous Fixation is a procedure for mid-compartment apical suspension in pelvic organ prolapse surgery with high success rates. The approach by traditional wide dissection has been well-documented. The literature is lacking however with regard to newer devices on the market that use less extensive dissection to perform this procedure. METHODS A randomised controlled trial was carried out comparing the Boston Scientific's Capio Slim® (control) and Bard's Fixt® (intervention) for bilateral sacrospinous fixation in women with mid-compartment prolapse requiring surgery and who met the study criteria. The primary outcome was time (in seconds) to successful bilateral suspension suture placements. Secondary outcomes examined were used to assess short-term safety and efficacy of the devices at the time of the procedure and at the six week follow-up.
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    Open Access
    Incidence and nature of complications post primary repair of Obstetric Anal Sphincter Injury (OASI): Retrospective chart review
    (2019) Paulsen, Carrie; Brouard, Kendall; Petro, Gregory
    Background. A multitude of data exists regarding global incidence of OASI as well as its contributing factors and complications. Little to no data exists regarding the incidence of OASI or its complications and the nature of these complications within South Africa. Objective. To describe the rate and nature of complications of OASI that occur within 6 weeks following primary repair of an OASI, followed up at the GSH perineal clinic. Secondarily, to investigate the incidence of OASI and follow up rate post primary repair Methods. This was a retrospective chart review. Participants were identified from theatre record books between January 2014 and December 2015. The charts of those that attended the perineal clinic follow up were reviewed and complications and possible associated risk factors were identified from the clinical notes. Primary aims were to identify the incidence and nature of complications seen in this population as well as possible related risk factors. The secondary aims were to determine the incidence of OASI and follow up rate for complication following primary OASI repair. Results. The mean age of participants was 25.85 years with a mean body mass index of 25.15kg/m2 . The mean birthweight seen was 3382.05 grams. Constipation (10.87%), pain with defaecation (11.96%) and anal incontinence (10.87%) were the most frequently reported complications. Wound infection was found on examination in 3.26% of participants and wound dehiscence was seen in 6.67%. Incidence of OASI in this study group was 8.64 per 1000 vaginal deliveries. The follow up rate of these participants was 26.20%. A total of 374 OASI were repaired within this region during the study period. Only 97 of these attended follow up, for which 93 folders were available to be included in analysis Conclusion. The Incidence of OASI in this Western Cape region is within the range seen worldwide but the proportion of complications seem to be less than global data suggests despite adverse conditions, theatre delays and the fact that repairs were mostly performed by specialists in training. It was not possible to identify any relationship with possible associated factors. There is a very poor follow up rate within this community which needs to be explored and systems need to be put in place to ensure all participants are given the opportunity of follow up.
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    The outcomes of intravesical botox a injections in patients with refractory overactive bladder syndrome treated in GSH from 1 January 2016 to 31 December 2018
    (2021) Yaloko, Kibeni; Brouard, Kendall
    Abstract Over the last 50 years botulinum toxin has become an effective medical therapy, used in a variety of specialities for different indications. A growing body of evidence indicates its beneficial effects in treating medication refractory detrusor over activity. This modality of treatment has been offered at Groote Schuur Hospital (GSH) in South Africa since 2012. Therefore, a review of our outcomes is necessary. Objective: Primary: 1. Determine the subjective success following intravesical Botox injections for the treatment of OABS. Secondary: 1. Describe the population of patients receiving intravesical Botox injections for the treatment of refractory OABS 2. Determine the rate and type of complications associated with intravesical Botox injection and the duration of treatment success. 3. Determine any patient factors associated with shorter duration of treatment success following the treatment of refractory OABS with intravesical Botox injections Methods: We conducted a quantitative, descriptive, retrospective study. The data collection sheet included the following details from the participants: demographic details, pre-existing medical conditions, method of diagnosis, and any previous treatment, the reason for stopping previous treatment, intra operative details and early complications at 1-6 weeks. Also included were details of any symptoms at follow up visits at 6- and 12-months post procedure. Subjective success was defined as the patients reporting improvement of symptoms at the first follow up visit. Duration of treatment success was defined as the time that lapsed between the date of Intravesical Botox injections and when the patient requested repeat treatment. Inclusion and exclusion criteria: We included patients who received intravesical Botox injections for OABS from 1 January 2016 - 31 December 2018. We excluded those who received intravesical Botox treatment for reasons other than OABS. Statistical analysis: A sample of 50 subjects was used. Summary statistics for age were reported as mean and standard deviation. Categorical variables were reported as simple frequencies and percentages. Associations between categorical variables were evaluated using the Fisher's exact test. Groups were compared in terms of age using the Tow-sample Mann-Whitney test. Analyses were performed using Stata Version 16. Results: The age of our participants ranged from 25 to 85 years (m = 54.72, ds = 14.74). 36% were post- menopausal, 92% were para 1 or more, 52% had a BMI of more than 30 kg/m2 , 30% were smokers, 40% were hypertensive and 10% had diabetes mellitus. All the patients reported improvement of symptoms at the 2-6 weeks' follow-up review. At the 6 months follow up visit less than a third of the participants complained of overactive bladder symptoms with only four (8%) patients requesting repeat intravesical Botox treatment. At the 12 months follow up visit just over half of the patients were experiencing overactive bladder symptoms with 21 (42%) requesting repeat intravesical Botox injections. There were few complications related to the intravesical Botox injection procedure. All the procedures were performed under local anaesthesia none of which needed to be abandoned due to pain of bleeding. Seven (14%) patients required temporary clean intermittent catheterisation (CIC). Eight (16%) patients had experienced a UTI (urinary tract infection) by the six weeks follow up visit. We found that hypertensive patients were significantly more likely to request repeat Botox at six months compared to non-hypertensive patients. Fisher's exact of 0,020. No other patient related factors showed any significant association in relation with repeat Botox injections at 6 months and 12 months. Conclusion: Our findings confirmed the benefit of intravesical Botox injection treatment in patients with OABS with minimal complications.