Cure of Underactive and Overactive Bladder Symptoms in Women by 1,671 Apical Sling Operations Gives Fresh Insights into Pathogenesis and Need for Definition Change.

INTRODUCTION: To check evidence that symptoms identical with those constituting "underactive bladder" (UAB) and "overactive bladder" (OAB) are caused by apical prolapse and cured by repair thereof. MATERIAL AND METHODS: After repair of apical prolapse by mesh tape reinforcement of lax uterosacral ligaments (USL) data form 1,671 women were retrospectively examined to determine the presence of OAB and UAB symptoms and to check, how many were cured surgically. Thereby 3 different techniques were performed: elevate (n = 277), "Posterior IVS" (n = 1,049), and TFS cardinal (CL)/USL (n = 345). RESULTS: Symptoms identical with those comprising UAB and OAB were cured in up to 80% of cases following surgical repair of the CL/USL complex. CONCLUSIONS: These symptoms may be consistent with symptoms of the posterior fornix syndrome, which comprises 4 main symptoms: micturition difficulties, urge/frequency, nocturia, chronic pelvic pain, all consequent on USL laxity. Surgical cure of OAB and UAB is inconsistent with existing definitions, which imply pathogenesis of the detrusor muscle itself. A reconsideration and reformulation of existing definitions may be required. Altering UAB definition to "bladder emptying difficulties" and return to former definitions for OAB such as "detrusor" or "bladder instability" may help to restore compatibility with surgical cure of these conditions.

Modified posterior intravaginal slingplasty: does the additional bilateral tape attachment to the sacrospinous ligament improve the results?

INTRODUCTION: High failure and recurrent prolapse remains an important issue for pelvic organ prolapse (POP) surgery. The posterior intravaginal slingplasty (PIVS) is a minimally invasive, transperineal technique providing level I support, by creating neo-sacrouterine ligaments using a mesh. In order to reduce the POP recurrence rate, achieve a safer apical support and thereby better functional outcomes, we attached PIVS tape to the sacrospinous ligament bilaterally and compared the anatomical and functional outcomes for our modified technique versus the original PIVS. MATERIAL AND METHODS: We evaluated 368 patients, with a symptomatic pelvic organ prolapse in various grades, who had undergone a total pelvic floor reconstruction. Seventy-seven of 368 (21%) patients underwent the original PIVS, 291 (79%) patients were treated by the modified PIVS. When necessary, the following procedures were added: anterior transobturator mesh, posterior wall repair, perineal body repair and suburethral transobturator sling. All had follow-up checks for at least one year. The primary outcome was an objective cure, defined as grade 0 or grade 1 according to Baden-Walker. Secondary outcomes were prolapse recurrence, symptoms, visual analogue scales for satisfaction, quality of life, recommendation, reoperation rates and presence of complications. RESULTS: The total reconstructions we made, using each technique, were successful. We achieved an apical success rate of 97 to 96%, on average, with the modified and original IVS respectively. We found a statistically significant improvement in urge incontinence and frequency symptoms than the original PIVS with our modified technique. CONCLUSIONS: Modified PIVS in combination with concomitant procedures generates high anatomical and functional cure rates with low complications and recurrences.

H1N1 infection in Pregnancy: clinical course in two women.

Pregnant women are one of the major risk groups for disease related morbidity and mortality from influenza A (H1N1, swine flu) pandemic. Healthy pregnant women are supposed to have 4 to 5 fold increased rate of serious illness and hospitalization compared to non-pregnant subjects. Herein, the clinical course of novel influenza A (H1N1) infection in two pregnant women was presented. One woman expired due to delay in treatment, while the other one was discharged on day six after prompt treatment. We would like to emphasize that obstetricians should be aware of the clinical and radiological manifestations of influenza A for prompt diagnosis and treatment. Obstetricians also should prepare themselves to provide adequate care for pregnancy related complications encountered by pregnant women with H1N1 infection.