INTRODUCTION AND HYPOTHESIS:This global consensus conference was designed to define best practice for the controversial aspects of primary surgical management of uterovaginal pelvic organ prolapse (U-POP), to identify unanswered clinical questions, and to educate junior researchers on systematic review and meta-analysis methodology. METHODS:Eleven committees were created with geographically diverse representation and tasked with answering pragmatic questions specific to U-POP surgical decision making. A systematic search of MEDLINE, Embase, and ClinicalTrials.gov from 2000 through December 2025 was performed with specific search terms for each committee. Relevant abstracts and full texts were doubly screened and included articles were doubly extracted. Guided by literature, consensus statements were created and assigned high, moderate, and low levels of evidence. Statements with low levels of evidence were presented and voted upon in-person at a consensus conference, hosted by the Department of Urology at Wake Forest University School of Medicine in Winston Salem, NC, USA. RESULTS:Contributions from 154 participants (including 33 junior researchers) from 19 countries led to 29 systematic searches, screening of 51,143 abstracts and 3,869 full-text manuscripts. There were 133 consensus statements presented at the conference; 6 were supported by high-quality, 28 by moderate-quality, and 99 by low-quality or no evidence respectively, and required Delphi process consensus. Among expert opinion statements, 58 were accepted, 32 were rejected, and 9 were eligible for revision. CONCLUSIONS:A total of 92 statements are presented here to guide clinical decision making and best practices in surgical management of primary U-POP.
This is the second of two articles presenting the European Crohn's and Colitis Organisation [ECCO] evidence‑based consensus guidelines on the management of adult patients with ulcerative colitis [UC]. The first article covers the medical management of UC, including acute severe colitis. The present article addresses the surgical management of medically refractory UC, including the general surgical approach and perioperative optimisation, surgical strategies and techniques, and recommended levels of centre expertise and surgical specialisation. Together, these two articles aim to inform shared decision‑making and to guide clinicians and healthcare professionals involved in the care of patients with UC, drawing on the best available evidence.
BACKGROUND:Fracture risk in patients with chronic kidney disease (CKD) is excessively high. A recent European consensus provides guidance on the comprehensive screening for CKD-associated osteoporosis in patients with CKD stages G4-5D. However, data on the yield and therapeutic implications of this approach in patients with kidney failure is lacking. METHODS:All prevalent dialysis patients aged >50 years or postmenopausal with life expectancy >1 year at a single center were invited for comprehensive bone health assessment, including the evaluation of risk factors, calcium intake, mineral metabolism parameters, bone turnover markers, fracture history, bone mineral density and vertebral fractures by dual-energy X-ray absorptiometry (DXA), handgrip strength and self-reported physical activity. RESULTS:Of 203 patients screened, 121 (mean age 75 years, 55% male) were eligible, of whom 71 underwent comprehensive phenotyping including DXA. CKD-associated osteoporosis was identified in 73% of participants, based on a T-score ≤-2.5 at the hip or lumbar spine (65%), history of fragility fracture (41%) and/or finding of a vertebral fracture (13%). Vitamin D insufficiency (<30 ng/mL) and insufficient calcium intake (<800 mg/day) were observed in 35% and 29%, respectively. Despite bio-intact parathyroid hormone levels exceeding the KDIGO target range in only 17%, bone turnover markers suggested high bone turnover in 53% of patients. Handgrip strength was below sarcopenia threshold in 65%, while physical activity was low in 55% of participants. Only 21% of patients with CKD-associated osteoporosis were treated with bone targeting therapy. CONCLUSION:Comprehensive bone health assessment identified CKD-associated osteoporosis in 7 out of 10 patients with kidney failure and unveiled several therapeutic opportunities ranging from optimization of mineral metabolism to non-pharmacological and pharmacological bone-targeting interventions. The present single-center findings call for reflection and confirmation.
Objective: The objective of the Vascular Mimetic Implant-Common Femoral Artery Study (VMI-CFA) investigation is to evaluate the mid-term (24 months) outcome of treatment of the common femoral artery (CFA) with the Supera Peripheral Stent System (Abbott Vascular Inc., Santa Clara, USA) in symptomatic (Rutherford 2-4), de novo stenotic or occlusive lesions. Methods: One hundred patients with atherosclerotic lesions in the CFA were recruited for the VMI-CFA trial during routine consultations in hospitals in Belgium and France. The key inclusion criterion was de novo, stenotic (>50%) or occlusive lesions located in the native CFA. The main exclusion criteria were asymptomatic disease, (in-stent) restenosis and occlusion of the deep femoral artery. The primary efficacy and safety endpoint were defined respectively as primary patency at 12 months core lab adjudicated and any periprocedural adverse events up to 30 days post-procedure. The secondary endpoints included technical success rate, primary patency at 1, 6 and 24 months post-procedure, freedom from target lesion revascularization (TLR) at 1, 6, 12 and 24 months post-procedure and clinical success. Results: The Supera Stent was deployed and implanted successfully in all 100 patients. At 12 and 24 months, the primary patency rate was 95.2% and 92.8%, respectively. Two patients had to undergo a TLR between 6 and 12 months of follow-up, which resulted in a freedom from TLR rate of 97.8%. This rate remained the same at 24-month follow-up. Regarding the primary safety endpoint, there were 17 periprocedural adverse events in the first month after the index procedure, but no device- or procedure-related deaths, TLRs, major target limb amputations or thromboses were reported. Survival rate at 12 months was 91.8%. At 1, 6 and 24 months of follow-up, the survival rate was 100%, 96.9% and 85.5%, respectively. Fourteen patients died during the 2-year follow-up period. None of the deaths was procedure- or study-device related. A clear shift from Rutherford classification 2 to 4 toward 0 to 1 was seen and displays the clinical success of the endovascular therapy with the Supera Peripheral Stent System. Conclusion: The VMI-CFA trial shows that endovascular treatment of the “no-stent zone” CFA atherosclerotic disease with the Supera Peripheral Stent System is a safe and efficient therapy in CFA treatment. Clinical Impact This study provides prospective evidence supporting Supera stenting for common femoral artery disease, traditionally treated by open endarterectomy. The encouraging patency and safety outcomes suggest a minimally invasive alternative for selected patients, particularly those with hostile groin anatomy or increased risk of wound complications. By specifically evaluating an interwoven nitinol stent in this challenging arterial territory, these findings may help clinicians individualize revascularization strategies. However, the nonrandomized design does not establish superiority over endarterectomy. Randomized comparative evidence is needed before broader adoption or changes to the current standard of care.
