Tension-Free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women.

The aim of this prospective multicenter study was to evaluate the safety and efficacy of tension-free vaginal tape (TVT) for the surgical treatment of female stress incontinence. Four hundred and four women underwent the TVT procedure. Their mean age was 57 years (range 31-83). The median follow-up time was 21 months (range 12-35). The subjective and objective cure rates were 92% and 90%, respectively. Another 4% of the women were significantly improved by the procedure. Intra- and postoperative complications were few and included uneventful bladder perforations (6%), retropubic bleeding requiring surgery (0.5%), voiding difficulties (4%) in the postoperative course, and one obturator nerve injury. We conclude that the TVT procedure is associated with a high cure rate and a low morbidity.

Marshall-Marchetti-Krantz urethropexy and Burch colposuspension for stress urinary incontinence in women with low pressure and hypermobility of the urethra: early results of a prospective randomized clinical trial.

OBJECTIVE: The aim of the study was to compare the effects of Burch colposuspension and Marshall-Marchetti-Krantz urethropexy with videourethroscopic control in the correction of stress urinary incontinence in patients with low pressure and hypermobility of the urethra. STUDY DESIGN: Thirty women were randomly assigned to undergo 1 of the 2 surgical procedures from November 1993 to May 1996 (15 Burch colposuspensions and 15 Marshall-Marchetti-Krantz urethropexies) and were evaluated subjectively and objectively for stress urinary incontinence at 2 and 12 months. Data obtained were analyzed with the Student t test, the Fisher exact test, and the Wilcoxon signed rank test. RESULTS: At 1 year of follow-up 15 women in the Marshall-Marchetti-Krantz urethropexy group (100%) and 10 women in the Burch colposuspension group (66%) were subjectively considered cured (P =.02, 2-tailed Fisher exact test), and stress test results were negative in 14 women (93%) and 8 women (53%), respectively (P =.017, 2-tailed Fisher exact test). The resumption of spontaneous voiding was attained after 6.5 +/- 3.3 days in the Burch colposuspension group and in 20.5 +/- 13.4 days in the Marshall-Marchetti-Krantz urethropexy group (P <.001, 2-tailed Wilcoxon rank sum test). CONCLUSION: The high cure rate and low associated morbidity mark the Marshall-Marchetti-Krantz procedure with videourethroscopic control as more effective than Burch colposuspension in repairing stress urinary incontinence associated with low pressure and hypermobility of the urethra.

Transabdominal repair of cystocele by wedge colpectomy during combined abdominal-vaginal surgery.

The aim of the study was to evaluate the effectiveness of transabdominal wedge colpectomy as surgical treatment for cystocele. One hundred and sixty-three women with either first or second-degree cystocele (Beecham classification), rectocele and concomitant stress urinary incontinence or benign pelvic masses were submitted for a combined operation. Transabdominal repair of the cystocele was performed by wedge colpectomy employing two different absorbable sutures, Vicryl and PDS. The choice of suture was not random but depended on the period at which surgery was performed. Data obtained were analyzed with Student's t-test and Fisher's exact test. The cystocele cure rate was 90.2% (110 out of 122) at 3-year follow-up and was significantly associated with the preoperative degree, being 95.5% and 76.5% in first and in second degree, respectively (P = 0.003). At 1-year follow-up the cure rate was significantly associated with the type of the suture employed (P = 0.01). At 2-year follow-up rectocele cure rate was 97.2% and vaginal vault prolapse appeared in 3.5% of cases. Stress urinary incontinence relapsed in 10% of patients after Burch colposuspension. After the operation 94.1% of the women declared normal coitus. In the present series wedge colpectomy was found to be effective in repairing first-degree cystocele, whereas a high incidence of relapse was observed when second-degree cystocele was present preoperatively. The suture material employed influenced the cure rate.