Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success.

OBJECTIVE: The purpose of this study was to reanalyze the results of a previously published trial that compared 3 methods of anterior colporrhaphy according to the clinically relevant definitions of success. STUDY DESIGN: A secondary analysis of a trial of 114 subjects who underwent surgery for anterior pelvic organ prolapse who were assigned randomly to standard anterior colporrhaphy, ultralateral colporrhaphy, or anterior colporrhaphy plus polyglactin 910 mesh from 1996-1999. For the current analysis, success was defined as (1) no prolapse beyond the hymen, (2) the absence of prolapse symptoms (visual analog scale ≤ 2), and (3) the absence of retreatment. RESULTS: Eighty-eight percent of the women met our definition of success at 1 year. One subject (1%) underwent surgery for recurrence 29 months after surgery. No differences among the 3 groups were noted for any outcomes. CONCLUSION: Reanalysis of a trial of 3 methods of anterior colporrhaphy revealed considerably better success with the use of clinically relevant outcome criteria compared with strict anatomic criteria.

Ultrasound Evaluation of the Urethra and Bladder Neck Before and After Transurethral Bulking.

OBJECTIVES: The aims of the study were to describe ultrasound findings in women with stress urinary incontinence (SUI) after transurethral injection of Coaptite, to describe symptoms 3 months after injection, and to determine whether there was an association between degree of improvement and sonographic findings. METHODS: This is a prospective cohort study of women with SUI undergoing transurethral Coaptite injection. Subjects completed the Urinary Distress Inventory and Incontinence Severity Index preinjection and 3 months postinjection. Translabial ultrasound was performed immediately after and 3 months postinjection. Two- and three-dimensional images were captured to measure the dimensions and location of Coaptite in relation to the bladder neck as well as degree of coaptation. Change in volume of injection over time was calculated using these measurements. RESULTS: Twenty subjects were enrolled in the study. At 3 months, 45% of subjects had 90% or greater improvement, 45% had 50% to 75% improvement, and 10% had less than 30% improvement. Mean distance of Coaptite from the bladder neck at 3 months was not statistically different from the distance immediately after injection. There was a 40.9% to 45.8% mean reduction in volume at 3 months as well as a 39.5% reduction in coaptation. Degree of improvement was associated with mean change in volume over time: those with the least improvement had the greatest reduction in volume. Volume of initial injection, percent coaptation, and number of vials used to perform the injection were not associated with patient symptoms. CONCLUSIONS: In this series, 90% of patients who underwent Coaptite injection for SUI reported 50% or greater improvement. The volume of Coaptite decreased by 40% over time, and the degree of shrinkage correlated with clinical outcomes.