Periurethral injection with polyacrylamide after previous TVT surgery.

INTRODUCTION AND HYPOTHESIS: The aim of this registry study was to assess the clinical utility of using periurethral bulking with polyacrylamide hydrogel in women with stress urinary incontinence (SUI) after previous midurethral sling surgery. METHODS: The study period was 2007 through 2019. Using data from the Norwegian Female Incontinence Registry we included 57 women who had received Bulkamid® because of insufficient improvement or recurrent SUI after previous retropubic TVT surgery. The primary outcome was cure of SUI, and secondary outcomes were patient satisfaction, degree of leakage, change in urgency incontinence (UUI), free flow rate, postvoid residual volume, and complications. Descriptive statistics were used to characterize data and Wilcoxon signed-rank test to compare pre- and postoperative results for pairs, with level of significance at p < 0.05. RESULTS: Pure SUI was seen in 19 (33.3%) while 38 (66.7%) had mixed incontinence. Postoperatively 72.9% had a negative stress test and 73.7% were satisfied with treatment. There was only 1 complication in 67 injections (1.5%). De novo UUI occurred in five patients, corresponding to 8.8% of the whole study group, but 26.3% among those with no preoperative UUI problems. Among the patients with preoperative UUI, 39.5% were cured of this problem and a further 36.8% were improved. CONCLUSIONS: The cure rate and satisfaction rate of periurethral bulking with polyacrylamide after previous MUS are favorable and complications are rare. There seems to be a risk of overactive bladder symptoms developing in women with no such symptoms preoperatively.

European operative registry to avoid complications in operative gynecology.

The aim of this study is to determine how complications can be avoided in gynecological minimally invasive surgery in Europe. The Norwegian Gynecological Endoscopic Registry (NGER) facilitates medical research over a long duration. Can experiences from the Norwegian registry be used to develop a European registry to avoid complications? To answer this question, we used the NGER data from February 2013 until March 2015 to analyze the complications of gynecological endoscopy. The registry includes sociodemographic factors, related comorbidity, previous surgery, present procedure, and intraoperative complications. Postoperative complications were identified with a questionnaire administered 4 weeks after surgery. The risk factors leading to complications in gynecological endoscopy were found to be obesity, diabetes mellitus, heart disease, hypertension, previous surgery due to cervical carcinoma in situ, and low educational level. Regional differences in the complication rate were noted. National web-based operation registries such as the NGER can identify the risk factors for complications of gynecological endoscopic surgery and can help improve the outcome after surgery. The experience from NGER can be used to establish a European register.

Oxidative stress in women with perimenopausal symptoms.

OBJECTIVE: In this study, we examined the relationships between perimenopausal symptoms, biochemical parameters, and markers of oxidative stress in women in perimenopause and compared them with those of premenopausal women. METHODS: Sixty-two women (age, 53.2 ± 5.7 y) with perimenopausal symptoms were recruited to participate in our study. The control group consisted of 18 women without perimenopausal symptoms (age, 40 ± 5 y).Clinical perimenopausal symptoms were evaluated via the questionnaire of the Menopausal Rating Scale. Our participants were checked for basic biochemical parameters. The oxidative status of our samples was determined through the examination of lipoperoxides, 8-oxoguanine (8-oxoG) levels, and the total antioxidant status (TAS). RESULTS: Perimenopausal women had higher total cholesterol values and lower paraoxonase-1 (PON1) activity compared to reference values. Other biochemical parameters as well as 8-oxoG levels were unchanged compared with those of healthy control women. Lipoperoxide levels were significantly increased compared with those of premenopausal women. We found an indirect correlation between PON1 arylesterase (PON1 A) activity and lipoperoxide levels, between PON1 A activity and atherogenic index, between age and TAS, and between age and 8-oxoG levels. DNA repair ability and the total antioxidant status of women in perimenopause were significantly increased compared with women in premenopause. Hypercholesterolemic women had significantly increased low-density lipoprotein cholesterol levels when compared with normocholesterolemic individuals, but these values were still within the reference range. Normocholesterolemic women had significantly decreased high-density lipoprotein cholesterol levels, below the reference range. We found no correlations between perimenopausal symptoms and biochemical parameters or oxidative stress markers. CONCLUSIONS: We found that women in perimenopause are under increased oxidative stress manifested by reduced PON1 A activity and elevated lipoperoxidation, DNA repair ability, and TAS. Nutritional antioxidant supplementation may be an effective approach in improving menopausal symptoms.