BACKGROUND:To minimise the rate of recurrent prolapse after traditional native tissue repair (anterior colporrhaphy), clinicians have utilised a variety of surgical techniques. OBJECTIVES:To determine the safety and effectiveness of surgery for anterior compartment prolapse. SEARCH METHODS:We searched the Cochrane Incontinence Group Specialised Register, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In Process (23 August 2016), handsearched journals and conference proceedings (15 February 2016) and searched trial registers (1 August 2016). SELECTION CRITERIA:Randomised controlled trials (RCTs) that examined surgical operations for anterior compartment prolapse. DATA COLLECTION AND ANALYSIS:Two review authors independently selected trials, assessed risk of bias and extracted data. Primary outcomes were awareness of prolapse, repeat surgery and recurrent prolapse on examination. MAIN RESULTS:We included 33 trials (3332 women). The quality of evidence ranged from very low to moderate. Limitations were risk of bias and imprecision. We have summarised results for the main comparisons. Native tissue versus biological graft Awareness of prolapse: Evidence suggested few or no differences between groups (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.52 to 1.82; five RCTs; 552 women; I2 = 39%; low-quality evidence), indicating that if 12% of women were aware of prolapse after biological graft, 7% to 23% would be aware after native tissue repair. Repeat surgery for prolapse: Results showed no probable differences between groups (RR 1.02, 95% CI 0.53 to 1.97; seven RCTs; 650 women; I2 = 0%; moderate-quality evidence), indicating that if 4% of women required repeat surgery after biological graft, 2% to 9% would do so after native tissue repair. Recurrent anterior compartment prolapse: Native tissue repair probably increased the risk of recurrence (RR 1.32, 95% CI 1.06 to 1.65; eight RCTs; 701 women; I2 = 26%; moderate-quality evidence), indicating that if 26% of women had recurrent prolapse after biological graft, 27% to 42% would have recurrence after native tissue repair. Stress urinary incontinence (SUI): Results showed no probable differences between groups (RR 1.44, 95% CI 0.79 to 2.64; two RCTs; 218 women; I2 = 0%; moderate-quality evidence). Dyspareunia: Evidence suggested few or no differences between groups (RR 0.87, 95% CI 0.39 to 1.93; two RCTs; 151 women; I2 = 0%; low-quality evidence). Native tissue versus polypropylene mesh Awareness of prolapse: This was probably more likely after native tissue repair (RR 1.77, 95% CI 1.37 to 2.28; nine RCTs; 1133 women; I2 = 0%; moderate-quality evidence), suggesting that if 13% of women were aware of prolapse after mesh repair, 18% to 30% would be aware of prolapse after native tissue repair. Repeat surgery for prolapse: This was probably more likely after native tissue repair (RR 2.03, 95% CI 1.15 to 3.58; 12 RCTs; 1629 women; I2 = 39%; moderate-quality evidence), suggesting that if 2% of women needed repeat surgery after mesh repair, 2% to 7% would do so after native tissue repair. Recurrent anterior compartment prolapse: This was probably more likely after native tissue repair (RR 3.01, 95% CI 2.52 to 3.60; 16 RCTs; 1976 women; I2 = 39%; moderate-quality evidence), suggesting that if recurrent prolapse occurred in 13% of women after mesh repair, 32% to 45% would have recurrence after native tissue repair. Repeat surgery for prolapse, stress urinary incontinence or mesh exposure (composite outcome): This was probably less likely after native tissue repair (RR 0.59, 95% CI 0.41 to 0.83; 12 RCTs; 1527 women; I2 = 45%; moderate-quality evidence), suggesting that if 10% of women require repeat surgery after polypropylene mesh repair, 4% to 8% would do so after native tissue repair. De novo SUI: Evidence suggested few or no differences between groups (RR 0.67, 95% CI 0.44 to 1.01; six RCTs; 957 women; I2 = 26%; low-quality evidence). No evidence suggested a difference in rates of repeat surgery for SUI. Dyspareunia (de novo): Evidence suggested few or no differences between groups (RR 0.54, 95% CI 0.27 to 1.06; eight RCTs; n = 583; I2 = 0%; low-quality evidence). Native tissue versus absorbable mesh Awareness of prolapse: It is unclear whether results showed any differences between groups (RR 0.95, 95% CI 0.70 to 1.31; one RCT; n = 54; very low-quality evidence), Repeat surgery for prolapse: It is unclear whether results showed any differences between groups (RR 2.13, 95% CI 0.42 to 10.82; one RCT; n = 66; very low-quality evidence). Recurrent anterior compartment prolapse: This is probably more likely after native tissue repair (RR 1.50, 95% CI 1.09 to 2.06; three RCTs; n = 268; I2 = 0%; moderate-quality evidence), suggesting that if 27% have recurrent prolapse after mesh repair, 29% to 55% would have recurrent prolapse after native tissue repair. SUI: It is unclear whether results showed any differences between groups (RR 0.72, 95% CI 0.50 to 1.05; one RCT; n = 49; very low-quality evidence). Dyspareunia: No data were reported. AUTHORS' CONCLUSIONS:Biological graft repair or absorbable mesh provides minimal advantage compared with native tissue repair.Native tissue repair was associated with increased awareness of prolapse and increased risk of repeat surgery for prolapse and recurrence of anterior compartment prolapse compared with polypropylene mesh repair. However, native tissue repair was associated with reduced risk of de novo SUI, reduced bladder injury, and reduced rates of repeat surgery for prolapse, stress urinary incontinence and mesh exposure (composite outcome).Current evidence does not support the use of mesh repair compared with native tissue repair for anterior compartment prolapse owing to increased morbidity.Many transvaginal polypropylene meshes have been voluntarily removed from the market, and newer light-weight transvaginal meshes that are available have not been assessed by RCTs. Clinicans and women should be cautious when utilising these products, as their safety and efficacy have not been established.
BACKGROUND:Pelvic organ prolapse (POP) is common in women and frequently associated with stress urinary incontinence (SUI). SUI may be present following prolapse reduction (occult SUI) and may develop after surgery for POP (new-onset SUI). OBJECTIVES:To determine the impact of surgery for symptomatic POP, with or without concomitant or delayed two-stage continence procedures, to treat or prevent SUI, on postoperative bladder function. SEARCH METHODS:We searched the Cochrane Incontinence Specialised Register, two trials registries, journals and conference proceedings (searched 29 April 2024, updated 23 July 2025), and reference lists of articles. SELECTION CRITERIA:Randomised controlled trials (RCTs) including surgical interventions for POP with or without continence procedures in continent or incontinent women. Our primary outcome was subjective postoperative SUI. Secondary outcomes included POP on examination, overactive bladder, further continence surgery, and voiding dysfunction. DATA COLLECTION AND ANALYSIS:We used standard Cochrane methodological procedures. We assessed evidence certainty using GRADE. MAIN RESULTS:We included 22 RCTs with 3095 women. Evidence certainty ranged from low to moderate. Limitations were risk of bias (especially blinding of outcome assessors), indirectness, and imprecision associated with low event rates and small samples. POP surgery in women with SUI Vaginal POP surgery with versus without midurethral sling: a concomitant midurethral sling may decrease SUI, (risk ratio (RR) 0.30, 95% confidence interval (CI) 0.19 to 0.48; 2 studies, 319 women), and rates of further continence surgery (RR 0.04, 95% CI 0.00 to 0.74; 1 study, 134 women), both low-certainty evidence. This suggests that if the risk of SUI with POP surgery alone is 39%, the risk with midurethral sling is between 8% and 19%. Vaginal POP surgery with concomitant versus delayed midurethral sling: low-certainty evidence suggested little or no difference in SUI (RR 0.41, 95% CI 0.12 to 1.37; 1 study, 140 women). Vaginal transobturator mesh versus vaginal POP surgery with midurethral sling: evidence from one study with 84 women suggested little or no difference in SUI (RR 1.47, 95% CI 0.51 to 4.26); POP (RR 6.29, 95% CI 0.79 to 50.03); new-onset overactive bladder (RR not estimable); and voiding dysfunction (RR 3.14, 95% CI 0.13 to 75.02), low-certainty evidence. Abdominal sacrocolpopexy with versus without Burch colposuspension: an additional Burch colposuspension may have little or no effect on SUI after five years (RR 1.17, 95% CI 0.60 to 2.26; 45 women), or on overactive bladder (RR 0.85, 95%CI 0.61 to 1.18), new-onset overactive bladder (RR 1.92, 95% CI 0.19 to 19.73) or voiding dysfunction (RR 0.96, 95%CI 0.06 to 14.43) all after one year (1 study, 47 women, all low-certainty evidence). Abdominal sacrocolpopexy with concomitant midurethral sling or Burch colposuspension: midurethral sling may decrease SUI at two years (RR 0.54, 95% CI 0.34 to 0.86; 113 women) but not POP (RR 1.85, 95%CI 0.18 to 19.62; 79 women), overactive bladder (RR 1.18, 95% CI 0.71 to 1.94; 44 women), new-onset overactive bladder (RR 0.59, 95% CI 0.06 to 6.09; 48 women), or voiding dysfunction (RR 1.23, 95% CI 0.52 to 2.90; 92 women), low-certainty evidence from one study. This suggests that if the risk of SUI with Burch is 55%, the risk with midurethral sling is between 19% and 48%. POP surgery in women with occult SUI Vaginal POP surgery with versus without midurethral sling: probably decreases SUI (RR 0.38, 95% CI 0.26 to 0.55; 5 studies, 369 women) and further continence surgery rates (RR 0.15, 95% CI 0.04 to 0.53; 4 studies, 279 women) both moderate-certainty evidence. This suggests that if the risk with POP surgery alone is 34%, the risk with concomitant midurethral sling is between 10% and 22%. Low-certainty evidence suggests little or no difference in POP (RR 0.86, 95% CI 0.34 to 2.19; 1 study, 50 women), overactive bladder (RR 0.75, 95% CI 0.52 to 1.07; 1 study, 43 women), new-onset overactive bladder (RR 2.11, 95% CI 0.73 to 6.11; 2 studies, 75 women) or voiding dysfunction (RR 1.00, 95% CI 0.15 to 6.55; 1 study, 50 women). POP surgery in stress urinary continent women Vaginal POP surgery with versus without concomitant midurethral sling: there is probably no difference in SUI between groups (RR 0.69, 95% CI 0.47 to 1.00; 1 study, 220 women; moderate-certainty evidence). This suggests that if the risk with POP surgery alone is 40%, the risk with concomitant midurethral sling is between 19% and 40%. Abdominal sacrocolpopexy with versus without Burch colposuspension: there may be little or no effect on SUI after two years (RR 0.72, 95% CI 0.53 to 0.99; I² = 75%; 2 studies, 364 women; low-certainty evidence). This suggests that if the risk with sacrocolpopexy alone is 36%, the risk with concomitant Burch colposuspension is between 19% and 36%. Low-certainty evidence from one study suggests there may be little or no difference in POP (RR 0.98, 95% CI 0.74 to 1.30, 250 women), new-onset overactive bladder (RR 1.41, 95%CI 0.25 to 7.91, 66 women) and voiding dysfunction (RR 8.49, 95% CI 0.48 to 151.59, 66 women). Vaginal transobturator mesh repair versus native tissue repair: low-certainty evidence suggests that transobturator mesh repair may increase SUI at 3-7 years (RR 1.77, 95% CI 1.08 to 2.91; 3 studies, 417 women) but may decrease POP (RR 0.40, 95% CI 0.31 to 0.52 ; 3 studies, 458 women). There may be little or no difference in voiding dysfunction at 12 months (RR 1.65, 95% CI 0.22 to 12.10; 2 studies, 125 women). AUTHORS' CONCLUSIONS:In women with POP and symptomatic or occult SUI, a concomitant midurethral sling probably reduces SUI, but adverse effects remain unclear. It is also feasible to postpone the midurethral sling and perform a continence procedure only if required. In continent women, a Burch colposuspension during abdominal POP surgery reduced new-onset SUI rates in one underpowered study, but another RCT reported conflicting results. Adding a midurethral sling during vaginal POP repair might prevent new-onset SUI. An anterior native tissue repair might be better than vaginal transobturator mesh for preventing new SUI; however, POP recurrence may be more common with native tissue repair.
This international, multidisciplinary consensus report represents the first effort to systematically define and characterize fatty pancreas. A key outcome of this endeavor was the recommendation to adopt "fatty pancreas" as the standardized and inclusive term to describe all forms of fat accumulation in the pancreas. This terminological consensus provides a critical foundation for unified reporting and clinical communication. Another major contribution of the report is the consensus on diagnostic imaging findings, which was based on radiological and endoscopic modalities. The proposed criteria aim to enhance consistency in clinical assessment and support the development of standardized research protocols. In addition to establishing terminology and diagnostic frameworks, the report also synthesizes current knowledge across a wide range of relevant domains. These include the etiology and epidemiology of fatty pancreas, as well as its associations with alcohol consumption, smoking, acute and chronic pancreatitis, pancreatic exocrine insufficiency, type 2 diabetes mellitus, and surgical outcomes. The potential links between fatty pancreas and neoplastic conditions such as intraductal papillary mucinous neoplasms and pancreatic cancer are also addressed, alongside the current understanding of its metabolic implications (beta-cell function and glucose homeostasis) and treatment strategies. Throughout the consensus process, a consistent theme emerged: the limited availability of high-quality, prospective clinical data. Therefore, many of the recommendations in this report are based on expert consensus rather than strong empirical evidence. As such, the statements require rigorous prospective validation before they can be adopted into routine clinical practice. This underscores a critical need for further research, particularly studies aimed at clarifying causal relationships, validating diagnostic tools, and determining the clinical relevance of fatty pancreas across diverse patient populations. This report serves as both a summary of our current understanding and a roadmap for future investigations, aiming to close existing knowledge gaps and guide evidence-based clinical practice in this emerging field.
The global expansion of travel and online supplement markets has eliminated traditional geographic barriers to toxic plant exposures. We report a case of a 42-year-old female presenting with digoxin-like intoxication symptoms, including nausea, vomiting, and hypotension. Electrocardiography revealed sinus bradycardia (51/min), first-degree AV block, and downsloping ST-segment depressions with reverse tick morphology. Upon further comprehensive anamnesis, the patient revealed the consumption of a weight-loss supplement labeled as "Tejocote root" (Crataegus Mexicana), purchased during a travel to the USA. Serum digoxin assays yielded conflicting results across different platforms. The patient was managed with supportive care, including fluid replacement and antiemetics. Bradycardia persisted for five days, with complete resolution of symptoms and ECG abnormalities by day nine. Subsequent forensic toxicological analysis using liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS) and DNA barcoding confirmed the presence of yellow oleander (Thevetia peruviana) in the supplement, with no detection of the advertised Crataegus mexicana. While standard toxicological screening panels do not include plant-derived cardiac glycosides, cross-reactivity in digoxin assays may aid early diagnosis. Clinicians should maintain high suspicion for exotic plant poisonings in patients presenting cardiac glycoside-like symptoms, particularly following use of imported or online-purchased supplements. This case underscores the critical importance of multidisciplinary collaboration in determining the root cause of intoxication and highlights significant gaps in current forensic analytical capabilities for detecting botanical adulterants with public health implications.
BACKGROUND:Reporting adverse drug reactions (ADRs) is essential for drug safety. In Switzerland, healthcare professionals are legally required to report serious and unlabelled ADRs, yet under-reporting remains widespread. We tested a novel method to increase reporting of ADR-related hospitalizations. METHODS:This retrospective observational study used ADR-indicative ICD-10 codes to screen admissions to four Swiss hospitals, identify suspected drugs and send individual case safety reports (ICSRs) of confirmed cases to Swissmedic. RESULTS:Participating hospitals previously reported ~18 ICSRs annually. During the study period (7/2023-12/2023), 200 ADR-related hospitalizations were reported following a review of 814 pre-filtered admissions. Most ICSR data were available in structured format: Median age of patients was 59 (interquartile range [IQR] 42-75); 87 (44%) males; median of two comorbidities (IQR 1-3); the three most frequent ADRs were 'K52.1 Toxic gastroenteritis and colitis' (11 [6%]), 'T42.4 Poisoning by benzodiazepines' (10 [5%]) and 'R11 Nausea and vomiting' (10 [5%]). Discharge reports contained free-text information on suspected drugs: More than half of ADR-related hospitalizations were caused by antineoplastics (45 [23%]), psycholeptics (38 [19%]), opioids and other analgesics (34 [17%]). The median time to screen a case was 1 min, 8 min to collect, compile and send data of confirmed cases. CONCLUSION:The approach successfully increased reporting of serious ADRs. The time investment for creating ICSRs might soon be rendered obsolete, as most data are available in structured format, and large language models are key to identifying suspected drugs in discharge reports.
