International urogynecology journal and pelvic floor dysfunction最新文献

Introduction and hypothesis: The purpose of this study was to evaluate the safety and efficacy of a modified transobturator vaginal tape inside-out (TVT-O) procedure for stress urinary incontinence (SUI) using custom-tailored polypropylene mesh and helical needles.

Methods: A 1x15-cm mesh made from the Gynemesh is positioned without tension under the mid-urethra using custom-made helical needles through the obturator.

Results: The procedure was carried out in 80 consecutive patients (mean age 65.0+/-13.2 years). The mean operative time was 15 min (range 6-22 min). All patients had a follow-up visit at 1 year after surgery. Of the 80 patients, 75 (93.68%) were cured, and 5 (6.2%) were improved; no failure occurred. No bladder or urethral injuries and no vascular or neurological complications were encountered.

Conclusion: Our modified TVT-O procedure is a simple, safe, efficacious, and economic surgical procedure for SUI. The technique avoids damage to the urethra and bladder. The promising results are currently under evaluation.

Introduction: The purpose of this study was to generate normative data for perineal length for Caucasian and Asian women in labour.

Methods: The distance from the posterior fourchette to the centre of the anal orifice was measured in 1,000 women in the first stage of labour. Data on ethnicity, body mass index, delivery mode and perineal trauma were collected prospectively.

Results: The mean perineal length in Caucasian women was 3.7 +/- 0.9 cm and in Asian women, 3.6 +/- 0.9 cm. Primigravid women with short perineum were more likely to have a third-degree perineal tear in labour (p = 0.03).

Conclusion: This is the first paper to report normative data for perineal length in Caucasian and Asian women in labour. We found a negative correlation between perineal length and third-degree tear in primigravid women. These data may be useful in clinical practice to determine the risk of significant perineal tears in labour.

Introduction and hypothesis: The objective of this study is to evaluate cervical amputation with uterosacral ligament plication (modified Manchester) and compare it to vaginal hysterectomy with high uterosacral ligament plication procedure with special regard to the middle compartment.

Methods: Consecutive women with pelvic organ prolapse who underwent either vaginal hysterectomy or a modified Manchester procedure were included. Assessments were made preoperatively and at 1-year follow-up, including physical examination with pelvic organ prolapse quantification standardised questionnaires (incontinence impact questionnaire, urogenital distress inventory, and defaecatory distress inventory).

Results: Between 2002 and 2007, 156 patients were included. Ninety-eight patients returned for a 1-year follow-up. In the modified Manchester group, we found no middle compartment recurrence versus two (4%) in the vaginal hysterectomy group. Anterior and posterior compartment prolapse recurrences (stage >or=2) were similar (approximately 50%). Considering operating time and blood loss, modified Manchester was more favourable. There was no difference in the pre- and postoperative subjective scores. The overall functional outcome was acceptable.

Conclusions: We found an excellent performance of both procedures regarding middle compartment recurrences.

TVT-Secur is a new "less" invasive derivative of the tension-free vaginal tape (TVT). We report an unusual case of dyspareunia for both the patient and her husband resulting from a retained finger pad from the TVT-Secur introducer. The sling was also explanted because of malposition.

Introduction and hypothesis: Women with overactive bladder (OAB) might have a greater detrusor wall thickness (DWT) suggestive of detrusor overactivity (DO).

Methods: DWT was measured by transabdominal ultrasonography (TAU) and transvaginal ultrasonography (TVU) in normal and women with OAB-dry and OAB-wet. The subjects were further classified as normal, hypersensitive bladder, or DO by urodynamic results. DWT measured by TVU at empty bladder, and TAU at 250 ml and bladder capacity were compared among symptom and urodynamic subgroups.

Results: TVU-measured DWT was significantly greater at the bladder neck than other sites of the bladder wall. No significant difference of TVU-measured DWT was noted among subgroups. No significant difference of TAU-measured DWT among subgroups at 250 ml, but DWT at bladder capacity was significantly greater in OAB-wet or DO than other subgroups.

Conclusions: A greater DWT at bladder capacity measured by TAU can be useful as biomarker for DO in patients with OAB.

Introduction and hypothesis: The aim of this study was to compare outcome and quality of life of tension-free vaginal tape "inside-out" (TVT-O) and Monarc transobturator tapes after 2-4 years.

Methods: The method used was a prospective comparative study. Participants (n = 191) were assigned to either a TVT-O (n = 93) or a Monarc (n = 98) procedure. Cure of stress urinary incontinence (SUI) was defined as the statement of the woman of not experiencing any loss of urine upon physical exercise.

Results: Cure rates after 2-4 years were 72% for TVT-O and 65% for Monarc, while improvement was observed in, respectively, 12% and 21% (p = 0.3). There was a statistically significant improvement in quality of life but no differences were found between both procedures.

Conclusions: After a 2-4-year follow-up period, both procedures were equally safe and effective in curing SUI.

Introduction and hypothesis: The use of vaginally implanted polypropylene meshes in the treatment of prolapse is becoming increasingly popular. We set out to detect how often bacterial colonisation of the mesh occurs and if the intraoperative sterility procedures that are applied matter.

Methods: In 64 consecutive women, bacterial colonisation was compared between two intraoperative sterility procedures. Culture swabs of the core mesh were taken during surgery, and the mesh arms removed at the end of surgery were cultured separately.

Results: Sixty-seven implants were cultured. In 56 (83.6%) implants, a positive culture with vaginal bacteria was found with very low bacterial density (<10(3 )colony-forming units). No significant differences in bacterial species, density, clinical infection and erosion (two anterior and one posterior) were found between the two intraoperative sterility methods.

Conclusions: Colonisation of vaginally implanted mesh occurs frequently but in low bacterial densities, irrespective of the intraoperative sterility procedure used.

A 32-year-old female with Crohn's disease experienced a rectovaginal fistula and abscess with rectal expulsion of posterior Prolift. She underwent diagnostic laparoscopy, transanal incision and drainage of abscess, transanal excision of mesh, and laparotomy with loop ileostomy. Weeks later, she underwent colectomy, near-total proctectomy, end ileostomy, and fistula repair.

Introduction and hypothesis: Nationwide use and costs of anticholinergic drug for overactive bladder are unknown.

Methods: We performed a nationwide study based on the Swedish Register on Prescribed Pharmaceuticals.

Results: From 2000 to 2007, there was a 68.8% increase in dispensed anticholinergic drugs in a population of 9 million. More than 93 million DDDs (calculated average maintenance dose per day) of anticholinergic drugs were dispensed corresponding to an overall DDD/TID (DDD per 1,000 inhabitants per day) of 3.5 per 1,000 persons per year. Approximately two thirds of anticholinergic drugs were prescribed to women, regardless of drug type. In 2007, the cost for anticholinergic drugs was 22 million of which tolterodine comprised 70.8%. Solifenacin and darifenacin steadily increased their DDD/TIDs after market introduction.

Conclusions: In this nationwide study, there was a 70% increased rate of expedited prescriptions of anticholinergic drugs for the treatment of overactive bladder in a relatively stable population.

Introduction and hypothesis: We examined how preoperative urodynamic findings are related to the urinary problems following surgical repair of pelvic organ prolapse (POP).

Methods: The clinical records of 87 women who underwent surgery for POP were reviewed retrospectively. Preoperatively, cough stress test and urodynamic testing, including pressure-flow study, were performed with prolapse reduction. Postoperative evaluation included uroflowmetry, postvoid residuals, and symptom assessment using questionnaires.

Results: A cough stress test with simple filling was sufficient for diagnosis of occult stress urinary incontinence (SUI). The presence of detrusor overactivity was a good predictor of postoperative persistence of urgency and urge urinary incontinence. Postvoid residuals (PVR) largely increased immediately after surgery, but usually recovered within 1 month. Poor detrusor contractility was the best predictor of large PVR occurrence.

Conclusions: Preoperative urodynamic evaluation of SUI and detrusor function was useful for predicting postoperative urinary conditions in POP patients. Its cost-effectiveness remains to be examined.