[Surgical treatment of the female stress urinary incontinence - from needles to mini-slings]. / Chirurgická lécba stresové inkontinence moci u zen - od jehel az k (mini)pásce.

OBJECTIVE: Stress urinary incontinence (SUI) is a clinical problem affecting a large part of female population, its incidence increases with age. Aim of this article is to show the spectrum of surgical procedures which are used to treat SUI, their advantages and limits, and define suitable patients. DESIGN: Review article. SETTING: Department of Gynecology and Obstetrics LF OU and University Hospital Ostrava; Department of Gynecology and Obstetrics LF MU and University Hospital Brno. METHODS: Systematic literature review using keywords and Medline database with detailed survey results analysis - full-text papers or abstracts published in years 1966-2016. RESULTS: Historical and recent methods of SUI testament are summarized including its effectiveness and complications focused mainly on techniques developed in the last two decades. CONCLUSION: There is a wide spectrum of surgical techniques available for SUI treatment for women and in last twenty years the procedures improved significantly regarding its effectiveness and complication rate. This paper review and summarize these methods, its efficacy, recent indications, advantages and limits. Although none of those techniques is perfect, patients treated by experienced surgeons have significant chance in quality of live improvement.

[Efficacy of surgical treatment of stress urinary incontinence with mini-invasive single incision sling]. / Výsledky operacní lécby stresové inkontinence moci mini-invazivní transobturatorní páskou z jedné inc.

OBJECTIVE: The purpose of this study is to evaluate the surgical treatment of stress urinary incontinence by the single incision sling Ophira (Promedon). DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynaecology, Masaryk University and University Hospital Brno, Brno. METHODS: Patients with confirmed urodynamic stress urinary incontinence (SUI) were included in the study. Patients with urgent urinary incontinence or mixed incontinence with predominance of urgent folder, patients with insufficiency of internal sphincter of the urethra and pelvic organ prolapse, as well as after previous surgical treatment, patients with pelvic organ prolapse or with other serious pathology of organs of small pelvis were excluded. All patients included in the study received single incision sling (SIS) Ophira (Promedon). The length of the surgery and blood loss and complication was observed. Postoperative observation one year after the treatment was set and evaluated objective and subjective parameters of SUI. RESULTS: In the study were 138 patients examined, total of 45 (34.8%) were included. Postoperative observation completed 44 (97.7%) patients. Mean age was 62.3 years. The mean follow-up was 12.9 months, when 40 patients (90.9%) had a negative cough standardized test (CST). Total of 41 patients (93.1%) evaluated the operation as a major improvement by using a questionnaire Patient Global Impression of Improvement (PGI-I). Quality of life scores were evaluated by International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Before the surgery ranged from 14.8 ± 2.5 points, after the surgery 3.3 ± 2.0 which is an improvement of 11.5 ± 3.1 points. There weren't serious perioperative and postoperative complications. CONCLUSION: Our results are comparable with literary data and are correlated with other studies evaluating the effectiveness of other types of SIS. The method seems to be safe and efficient enough. Observing the group of patients will be continued in order to assess the short- and long-term results.

[Outcomes of anterior vaginal wall repair using polypropylene mesh]. / Výsledky operacní lécby sestupu prední posevní steny s pouzitím polypropylenové sítky.

INTRODUCTION: Pelvic organ prolapse (POP) is a major health concern especially in the elderly women. Anterior vaginal wall prolapse (AWP) represents the most common form of POP with reoperation rate 30-40% when primary treated by anterior colporrhaphy. Modern surgical techniques of POP repair uses polypropylene (PP) mesh implants to better support pelvic structures and lower the risk of recurrence. Aim of our study was to assess the safety and efficacy of anterior vaginal wall prolapse repair using PP mesh system NAZCA TC (Promedon). The kit consists of preformed PP mesh anchored to pelvic structures by two needle inserters via pre-pubic and trans-obturator route. METHODS: From January 2010 to February 2011, 21 patients with stage III/IV AWP underwent transvaginal repair with implantation of PP mesh. The stage of POP measured according to POP-Q system, surgery length, blood loss and complications has been evaluated six month after the surgery. Surgery has been assessed as successful when POP stage 0/I o has been reached. In 42.9% of patients AWP repair was combined with other procedures: vaginal hysterectomy or posterior vaginal repair. (Statistical evaluation was done by Wilcoxon test.). RESULTS: The average age of operated women was 62.4±9.4 years, average body mass index was 27.5±4.1 kg/m2, with overall parity of 2.2±1.4 children. The surgery time was 64.0±26.0 minutes with average blood loss of 185.0±17,0 ml. No serious per-operating complication has been recorded. The objective cure rate at 6 months was 90.5%. Statistically significant difference in the position of points Aa, Ba and C (p<0,05) has been observed. Difference in the position of other POP-Q points has not been statistically significant. Post operatively one case of small mesh erosion managed by observation only has been documented. CONCLUSION: Transvaginal repair of AWP with polypropylene mesh is an effective and safe technique in the hands of surgeon experienced in classical POP reconstruction techniques. For the assessment of long term efficacy the further follow-up of patients is necessary.