Preoperative prediction of retroperitoneal lymph node involvement in clinical stage IB and IIA cervical cancer.

Objective: Lymph node metastasis (LNM) is the most important factor affecting survival in early-stage cervical cancer (CC). International Federation of Gynecology and Obstetrics revised the staging of CC in 2018 and reported LNM as a staging criterion. We investigated the preoperatively assessable risk factors associated with LNM in surgically treated stage IB1-IIA2 CC patients. Materials and Methods: This was a retrospective cohort study of women who underwent radical hysterectomy and pelvic lymphadenectomy with or without para-aortic lymphadenectomy for CC stage IB1-IIA2 from 2004 to 2019. All patients included in this study were examined with speculum inspection, parametrial assessment by rectovaginal palpation under general anesthesia, transvaginal ultrasonography, magnetic resonance imaging (MRI), and chest radiography. Clinical staging was done according to the preoperative findings. MRI was used to measure tumor and lymph node dimensions. Results: Out of the 149 women included in the study, 29 (19.4%) had LNM. Univariate analysis revealed that larger tumor size (≥30 mm), lymphovascular space invasion (LVSI) detected with diagnostic biopsy, parametrial involvement, and deep stromal invasion status were significantly different between the group with LNM and the group without LNM. In multivariate analysis, specific preoperative risk factors such as MRI based tumor diameter ≥30 mm and LVSI (+) on the diagnostic biopsy were found to be independent risk factors for LNM in the multivariate analysis. Conclusion: The rate of LNM is high in patients with CC with a tumor size ≥30 mm and preoperative biopsy LVSI status even if they are clinically in early stages. Surgeons can take this into account while deciding between primary surgery and chemoradiotherapy in the treatment of CC.

A 5-year follow-up study comparing Burch colposuspension and transobturator tape for the surgical treatment of stress urinary incontinence.

OBJECTIVE: To compare the effectiveness of transobturator tape (TOT) and Burch colposuspension in the treatment of stress urinary incontinence (SUI). METHODS: The present retrospective study included 770 patients who underwent SUI surgery with Burch colposuspension (n=498) or TOT (n=272). Clinical follow-up occurred at 2 weeks, 3, 6, and 12 months, and annually thereafter. Objective and subjective cure rates and intra- and postoperative complications were assessed. RESULTS: Among patients who had SUI surgery without another concomitant procedure, the Burch group had a significantly longer mean operation time (41.48 ± 10.61 minutes versus 23.77 ± 10.49 minutes; P<0.001) and a significantly longer length of hospital stay (3.11 ± 0.49 days versus 1.98 ± 0.40 days; P<0.001), compared with the TOT group. The rates of unintended functional outcomes were lower among women undergoing TOT than among those undergoing the Burch procedure (long-term voiding dysfunction 0.7% versus 4.2%, P=0.007; urinary retention 10.7% versus 26.9%, P<0.001). The 5-year cure rates were similar in the 2 groups (objective cure rate, 73.9% versus 77.5%, P=0.574; subjective cure rate, 76.8% versus 81.7%, P=0.416). CONCLUSION: In terms of efficacy, TOT appears equal to Burch colposuspension; however, TOT has fewer unintended functional outcomes than Burch colposuspension.

Results of TOT operations alone and combined with other vaginal surgical procedures.

OBJECTIVE: To evaluate the safety and efficacy of transobturator vaginal tape (TOT) procedure in women with stress urinary incontinence (SUI). METHODS: The study population consisted of 210 patients who were diagnosed as having stress urinary incontinence, and they underwent a TOT operation alone (99) or concomitant vaginal surgery (101) between January 2005 and February 2009 and were followed up for at least one year. Patients with detrusor overactivity and intrinsic sphincter deficiency were excluded. The cure and complication rates were investigated. RESULTS: The mean follow-up was 46.4 ± 8.7 months (range 13-48). No vascular, nervous system, or digestive perioperative complications were observed; however, 3.9% of the patients had voiding difficulty. The overall 12-month objective cure and subjective cure rates were 89.0% and 89.0% respectively. The overall four-year objective and subjective cure rates were 83.3% and 86.2% respectively. There was no difference between the four-year objective and subjective cure rates when TOT alone was performed (83.8 and 86.9%) or when performed as part of another surgical procedure (82.9 and 85.6%). CONCLUSION: The TOT procedure is a safe, effective and minimally invasive procedure for treating SUI with a low rate of complications. Moreover, it can be carried out safely and effectively in association with vaginal surgery.

Which type of mid-urethral sling procedure should be chosen for treatment of stress urinary incontinance with intrinsic sphincter deficiency? Tension-free vaginal tape or transobturator tape.

OBJECTIVE: To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency. DESIGN: Retrospective study. SETTING: Gynecology department, Bakirkoy Women and Childrens' Hospital, Istanbul. SAMPLE: Three hundred women urodynamically diagnosed with stress incontinence with intrinsic sphincter deficiency underwent synthetic mid-urethral sling procedures (TVT = 180, TOT = 120). METHODS: Before the operation, a complete medical history was taken and a gynecologic examination was performed. Subjects with detrusor overactivity or previous sling surgery were excluded. Clinical checkups were conducted at 3, 6, and 12 months, and then annually. MAIN OUTCOME MEASURES: Intraoperative complications, postoperative complications, and subjective cure rates. RESULTS: There were no significant differences in demographics between the TVT and TOT groups: mean age, parity, body mass index, menopausal status, and hormone replacement therapy. At a mean follow-up of 31.2 +/- 9.1 (range 12-46) months, the overall cure rates were 78.3% for TVT and 52.5% TOT (p < 0.0001). The risk of treatment failure in women who received TOT was 4.9 times higher than in women who underwent TVT. There were no significant differences in perioperative and postoperative complication rates between the two groups. CONCLUSION: TVT appears to be the preferable surgical option for the treatment of SUI with intrinsic sphincter deficiency.

Experience with laparoscopic-assisted vaginal hysterectomy for the enlarged uterus.

OBJECTIVE: The aim of this study is to evaluate the effect of uterine weight on the perioperative and postoperative outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for benign gynecological conditions. METHODS: In a retrospective observational study, 367 patients underwent LAVH (type I laparoscopic hysterectomy) for benign disorders at the Department of Gynecology at the Istanbul Bakirkoy Women and Children Hospital. Patients were divided into two groups with uterine weight <500 g and uterine weight > or =500 g. Outcome measures for both groups were studied comparatively in terms of length of operative time, pain score, amount of blood loss, requirement of blood transfusion, and length of hospital stay. RESULTS: There were no differences in patients' mean age, parity, gravidity, rate of postmenopausal state, previous pelvic surgery, and body mass index. The most common indications for surgery were myoma and abnormal uterine bleeding. The duration of operation, estimated blood loss and requirement of blood transfusion were significantly less for <500 g group than for > or =500 g group. Three women in the <500 g group sustained a blood loss in excess of 500 ml. By comparison, 18 women in the > or =500 g group sustained a blood loss in excess of 500 ml (P = 0.000). Total complication rate was 8.7%. Postoperative ileus and febrile morbidity were the most common complications. No significant difference was noted in overall complications between groups (P = 0.13). During the vaginal part of the procedure bladder injury occurred in one patient who had uterine weight > or =500 g. CONCLUSION: LAVH is a safe and efficient way to manage benign uterine disease and despite the increased operating time and blood loss, LAVH can be safely performed for enlarged uterus.

Results of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence: a 5-year follow-up study.

OBJECTIVE: We evaluated the long-term cure rates, surgical complications rates after treatment of urodynamically confirmed primary genuine stress incontinence with tension-free vaginal tape (TVT). METHODS: We performed a retrospective review of all patients undergoing the TVT procedure over a 5-year period to report intraoperative complication, postoperative complications and subjective cure rates. RESULTS: TVT was performed on 600 patients under general anesthesia. Among these patients, 563 were followed up for least 5 years; the remaining 47 patients could not be followed up. The mean follow-up interval was 63.1+/-3.1 (range 60-70) months. The mean age of the women was 51.7+/-11.6 years and mean body mass index 31.7+/-3.0 kg/m(2). Sixty-two percent (347) of women underwent the TVT procedure in conjunction with other vaginal surgery, and 38% (216) underwent TVT alone. The subjective analysis of the effect of surgery on the symptom of GSI was that, overall, 86.7% were completely cured, 6.0% were significantly improved and 7.3% found no change in the severity of her incontinence. No major nerve or vessel injury occurred, but 17 patients (3.0%) incurred bladder injury during the surgery. De novo voiding urgency occurred in 36 patients (6.4%). Thirty patients (5.3%) developed voiding problem, of which 19 patients had short-term voiding problem. CONCLUSION: The TVT procedure is a relatively safe and effective, minimally invasive surgical technique for the treatment of female urinary stress incontinence.