Pregnancy with clam ileocystoplasty and appendix Mitrofanoff procedure: vaginal delivery can be considered.

The surgical treatment of intractable detrusor overactivity is complex and includes clam ileocystoplasty and appendix Mitrofanoff. Due to improved health and quality of life of these patients after surgery, the option of pregnancy is made possible for them. Pregnancy for these women can be complicated and requires multidisciplinary team input. The option of vaginal delivery can be considered in the absence of obstetric and medical contraindications.

Tension-free vaginal tape: 162 cases in a district general hospital.

From March 1999 to July 2002 a prospective study was carried out of 162 consecutive cases of urodynamically confirmed stress and mixed incontinence who underwent the tension-free vaginal tape (TVT) procedure. Patients were followed up at 6 weeks and 6 months and with a quality of life questionnaire at 1 year. The intraoperative complication rate was 7.6% and the postoperative complication rate was 18.8%. The subjective cure rate for patients suffering from urodynamic stress incontinence was 85%, with a further 11% experiencing significant improvement in their symptoms. The subjective cure rate for patients with mixed incontinence was 88%, with a further 9% experiencing significant improvement. The TVT procedure appears to be safe and effective for both stress and mixed incontinence for up to three years in a district general hospital. Complications in the short term are uncommon and can be managed easily.

Tension free vaginal tape: a procedure for all ages.

OBJECTIVE: To assess the success and complications of the tension free vaginal tape (TVT) procedure in different age groups. PATIENTS AND METHODS: This prospective long-term study of 179 consecutive cases of urodynamically confirmed urinary incontinence that had had the TVT procedure was conducted from March 1999 to December 2002 at a District General Hospital. To assess whether outcome was influenced by the patient's age, the patients were divided into three age groups: group A (30-49 years old), group B (50-69 years old) and group C (70-90 years old). Operative details and early and late complications were recorded, and patients were followed up with clinic visits at 6 weeks and 6 months and a quality of life questionnaire was completed at 1 year. RESULTS: Of the 179 patients included in the study, 53 (29.6%) were in group A, 91 (50.8%) in group B and 35 (19.5%) in group C. The subjective cure rate for the patients was 84.9%, 81.3% and 85.3% in groups A, B and C, respectively. A significant improvement in symptoms was reported by 3.8%, 14.3% and 8.6% women, respectively. The failure rate was 11.3%, 4.4% and 5.7%, respectively. The intraoperative complication rate was 5.6%. The overall postoperative complication rate was 29.6%. A total of 86.2% of the patients were treated as day cases. Patients who had intraoperative complications or initial voiding difficulties (i.e. those patients requiring "in/out" catheterization before spontaneous voiding was established) were in hospital for 1-2 days. CONCLUSIONS: Our data showed better subjective cure rates and substantial improvement rates without any significant increase in intraoperative complications with increasing age. Postoperative complications of urgency and vaginal wall erosion were more common in the older aged patients but were easily resolved. Hospital stay and recovery period were short, making TVT a suitable procedure for all ages.