Objective cure rates and patient satisfaction after the transobturator tape procedure during 6.5-year follow-up.

STUDY OBJECTIVE: To report the subjective and objective outcomes and patient satisfaction with the outside-in transobturator tape (TOT) procedure during long-term follow-up. DESIGN: Clinical follow-up study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: One hundred ninety-one women who underwent the TOT procedure. Of these, 66% had stress urinary incontinence and 34% had mixed urinary incontinence, and 45% underwent concomitant surgery. INTERVENTIONS: Patients underwent surgery between May 2003 and December 2004 using the TOT procedure. After a mean follow-up of 6.5 years, postal questionnaires and an invitation for a follow-up visit to the outpatient clinic were sent to the patients. Objective cure was defined as a negative result of a stress test and no repeat operation because of stress urinary incontinence during follow-up. Subjective outcome was evaluated using the following validated questionnaires: UISS (Urinary Incontinence Severity Score), DIS (Detrussor Instability Score), VAS (visual analog scale, 0-100), short versions of the IIQ-7 (Incontinence Impact Questionnaire-7) and UDI-6 (Urogenital Distress Inventory-6), and the EQ-5D and EQ-5D VAS. Patient satisfaction was evaluated using a self-tailored questionnaire. MEASUREMENTS AND MAIN RESULTS: Of 191 patients, 139 (73%) were evaluated after a mean follow-up of 6.5 years. Objective and subjective cure rates were 89% and 83%, respectively. Of the patients with genuine stress urinary incontinence, 92% were completely or quite satisfied with the surgery, and 76% of the patients with mixed urinary incontinence were satisfied (p < .001). Patients with body mass index >30 had significantly higher scores on the IIQ-7, UDI-6 (p < .01 for both), VAS (p < .001), UISS (p < .01), and DIS (p < .001), thus indicating a less favorable outcome of the procedure. CONCLUSION: A high objective cure rate persisted after a mean follow-up of 6.5 years. Caution is advised when the TOT procedure is planned in patients with mixed urinary incontinence or severe obesity.

Tension-free vaginal tape procedure without preoperative urodynamic examination: long-term outcome.

OBJECTIVES: To evaluate the long-term outcome of the tension-free vaginal tape procedure. METHODS: A total of 191 patients were operated on with tension-free vaginal tape between January 1998 and May 2000. Of these, 127 (66%) had stress urinary incontinence, 64 (34%) had mixed urinary incontinence and 39 (20%) had recurrent incontinence. A total of 34 (18%) patients had had concomitant surgery. The diagnosis of incontinence was based on a history of leakage during stress and physical examination with a supine stress test in all patients. Tension-free vaginal tape was carried out under local (82%) or spinal (18%) anesthesia. After a mean of 10.5 years follow up, the assessment included a gynecological examination and a supine stress test. Subjective outcome was evaluated with Urinary Incontinence Severity Score, Detrusor Instability Score, visual analog scale, European quality of life-five dimensions, European quality of life - visual analog scale and short versions of Incontinence Impact Questionnaire-7 and Urogenital Distress Inventory-6. Objective cure was defined as a negative stress test and an absence of reoperation for incontinence during the follow up. RESULTS: A total of 138 (72%) of 191 patients were evaluated. Patients with minimally invasive surgery before operation had significantly higher scores in Urinary Incontinence Severity Score, Detrusor Instability Score, Incontinence Impact Questionnaire-7 and Urogenital Distress Inventory-6 at follow up than the patients with stress urinary incontinence (P < 0.01). Recurrent incontinence and concomitant surgery did not affect the long-term outcome. Three patients (2.3%) had late-onset adverse events. The objective and subjective cure rates were 90% and 78%, respectively. CONCLUSIONS: The tension-free vaginal tape procedure is effective and safe even after 10 years. The objective cure rate is high, but the subjective outcome is significantly lower in mixed urinary incontinence patients compared with patients with pure stress urinary incontinence. Recurrent stress urinary incontinence does not affect the outcome, and tape-related problems are rare.

Sexual dysfunction after trocar-guided transvaginal mesh repair of pelvic organ prolapse.

OBJECTIVE: To estimate sexual dysfunction before and after trocar-guided transvaginal mesh surgery for pelvic organ prolapse. METHODS: Sexually active women participating in a prospective multicenter study were recruited at 26 centers. All participants underwent a standardized surgical procedure and were evaluated before (n=105) and 1 year after (n=84) surgery using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Nonparametric statistics were used for comparisons. RESULTS: Mean age at surgery was 61.5 years (standard deviation [SD] 7.6), median parity was 2 (range, 1-6), and mean body mass index was 26.8 (SD 4.3) (body mass index is calculated as weight (kg)/[height m]). Anterior transvaginal mesh repair was performed in 46 patients (44%), posterior in 26 patients (25%), and combined anterior and posterior in 33 patients (31%). Overall sexual function scores worsened from 15.5 (SD 8.0) at baseline to 11.7 (SD 6.9) 1 year after surgery (P<.001). The trend toward deteriorating sexual function scores was similar for all three surgical procedures. There was an overall worsening of all symptoms in the behavioral-emotive and partner-related items, whereas improvements were observed in physical function. Overall rates and severity of dyspareunia in specific neither improved nor worsened. CONCLUSION: Sexual function scores deteriorate 1 year after trocar-guided transvaginal mesh surgery. The worsening was attributed primarily to a worsening in behavioral-emotive and partner-related items. Anatomical cure after surgery was not associated with improved PISQ scores. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00402844 LEVEL OF EVIDENCE: II.

[Gynaecological prolapses]. / Gynekologiset laskeumat.

Prolapses of the pelvic floor are common in women after childbirth. After hysterectomy, prolapse surgery is the second most common gynaecological surgery. Knowledge of pelvic anatomy and prolapses is essential for choosing a correct form of treatment and achieving a successful therapy. Follow-up is sufficient for prolapses that are asymptomatic or present minor symptoms. Rehabilitation of pelvic floor muscles may be helpful in the prevention of prolapses. The use of pessaries comes into question mainly in patients, to whom a surgical treatment is not applicable. Vaginal procedures are the primary ones for pelvic reconstructive surgery.

The tension-free vaginal tape procedure for female urinary incontinence without preoperative urodynamic evaluation.

BACKGROUND: We evaluated the short-term outcomes of the tension-free vaginal tape (TVT) technique for female urinary incontinence, when the diagnosis was based on incontinence symptoms and pelvic examination including cough stress test or transperineal ultrasonography or both, but without preoperative urodynamic verification. STUDY DESIGN: Tension-free vaginal tape was performed on 191 patients under local (82%) or spinal (18%) anesthesia. One hundred twenty-seven women (66%) had stress urinary incontinence and 64 (34%) had mixed incontinence. Fifty-eight percent had undergone previous surgery; 21% for incontinence. Thirty-four women underwent concomitant surgery. The age range was from 32 to 84 years (mean 60) and parity from 0 to 8 (mean 2). Seventy-four (39%) had concomitant chronic illnesses. The diagnosis of incontinence was based on specific questionnaires and physical examinations. Urogynecological ultrasonography was performed on patients with mixed incontinence. The mean followup was 17 months. RESULTS: The mean operative time was 27 min (16 to 63), the mean hospital stay was 2 days (1 to 10). Intraoperative complications were: bladder perforation in five patients (2.6%), hematoma in five patients (2.6%), heavy bleeding (400 mL) in one patient, and persistent retention in four patients (2.2%). Altogether, 164 of 187 patients (87.7%) were completely cured, and 23 patients experienced no improvement. Six patients (4.8%) developed de novo urge incontinence, 60% had less urge incontinence. The cure rates were: 97% among stress urinary incontinence patients versus 69% among mixed incontinence patients (p = 0.001); TVT alone, 88% versus in combination with other surgery 85% (p = 0.576); TVT under local anesthesia, 88% versus under spinal anesthesia 88%; TVT with recurrent incontinence, 85% versus primary incontinence 89% (p = 0.583); and in patients with concomitant illnesses, 82% versus healthy 91% (p = 0.076). CONCLUSIONS: Tension-free vaginal tape can be used to treat patients with primary or recurrent stress or mixed incontinence with or without concomitant surgery under local or spinal anesthesia. But the success rate is considerably lower in patients in whom TVT is performed for mixed incontinence.

Treatment of vulvovaginal erosive and stenosing lichen planus by surgical dilatation and methotrexate.

We treated five patients with stenosing lichen planus [LP] of the vulvovaginal region with methotrexate supplemented with ultrapotent corticosteroid cream and tacrolimus, in combination with surgical dilatation. All patients experienced long-term symptom relief, and there was only minimal or moderate re-stenosing of the vagina on follow-up for 2-41 months.

Hysterectomy for gynaecological cancer: a follow-up study of subjective and objective outcome.

AIMS: To evaluate morbidity and subjective outcome associated with hysterectomy either with or without pelvic or pelvic and para-aortic lymphadenectomy for gynaecological cancer. METHODS: Ninety-nine patients who underwent hysterectomy with lymphadenectomy (n = 38) or simple hysterectomy (n = 61) for ovarian, endometrial and cervical cancer in Turku University Hospital, Turku, Finland, were followed-up prospectively to determine the incidence of complications during a 1-year period after operation. Subjective outcomes were assessed using two questionnaires, 6 weeks and 1 year after operation. Hospital records of the patients were reviewed up to 6 years after operation. RESULTS: During their hospital stay 58% of patients in the hysterectomy with lymphadenectomy group and 56% in the simple hysterectomy group experienced some type of complication. Serious complications occurred in four patients (10.5%) in the former group and in two patients (3.3%) in the latter group. In the study population overall, the incidence of subjective complaints increased from 18% of respondents 6 weeks after operation to 55% 1 year after operation. Most patients (95 and 92%, respectively) remained satisfied with the operation at both times of evaluation. CONCLUSIONS: More than half of the patients experienced morbidity related to surgical treatment for gynaecological cancer. The incidence of complications and subjective complaints were unaffected by the type of operation.