Purpose: This study was undertaken to evaluate the use of pubovaginal sling for the treatment of female stress urinary incontinence in patients with intrinsic sphincteric deficiency and patients with urethral hypermobility.Materials and Methods: Sixty-two patients aging 22 to 73 years-old (mean = 49.6) with a median parity of 4.1 (range 0 -14) who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence from August/1999 to August/2002 were prospectively analyzed. Objective pre and postoperative urodynamic evaluation was performed in all cases. The patients were divided into 2 groups: thirty-nine patients (62.9%) with urethral hypermobility (Valsalva leak point pressure equal or superior to 60 cm of H 2 O) and twenty-three patients (37.1%) with intrinsic sphincteric insufficiency (Valsalva leak point pressure below 60 cm of H 2 O).Results: The average follow-up period was 24.8 months, ranging from 3 to 38 months. Three patients (4.8%) had detrusor overactivity before the operation, and 36 patients (58.1%) had voiding dysfunction before surgery. The postoperative objective cure rate was 88.7% for stress urinary incontinence. The study also showed that 32.2% of the patients had voiding dysfunction and 11.3% had detrusor overactivity. The mean hospital stay was 3.1 days (range 2 -4). No difference in the above parameters was noticed between patients with intrinsic sphincteric deficiency and those with urethral hypermobility.Conclusion: Construction of a pubovaginal sling is an effective technique for the relief of severe stress urinary incontinence, for both patients with urethral hipermobility and with intrinsic sphincteric deficiency, having a cure rate of 88.7%. The high frequency of postoperative voiding urgency was not related to the detrusor overactivity as evaluated by urodynamic studies.
Telomerase activity in the tumor is not associated with clinicopathological findings or tumor recurrence in patients with early stage cervical carcinoma.
Etiological factors and treatment considerations for these uncommon complications of sacrospinous colpopexy are discussed in detail, and prophylactic measures, when applicable, are emphasized.
Objective: This study was undertaken to evaluate factors influencing the operative time and early complications of vaginal hysterectomy of a nonprolapsed uterus.Methods: This was a prospective, observational study, including 128 patients (mean age, 45.7 years) undergoing vaginal hysterectomy for benign conditions, except uterine prolapse. Main outcome measures were operative time, intraoperative complications (bleeding or lacerations), and conversion to laparotomy.Results: The median operative time was 60 minutes (range, 25-180 minutes) and the mean hospital stay was 36 hours (range, 24 -240 hours). A multivariate logistic regression showed that the operative time was significantly influenced by uterine weight (P <0.001) and adnexectomy (P ؍ 0.045). There were 10 (6.3%) intraoperative complications, of which 6 (4.7%) were with excessive bleeding, 3 (2.3%) bladder lacerations, and 1 (0.8%) rectal laceration. Two patients underwent conversion to laparotomy for nonfeasibility of the vaginal route and both had a uterine weight higher than 400 g. After multivariate analysis, only uterine weight influenced the occurrence of intraoperative complications (P ؍ 0.002).Conclusion: The uterine weight is an independent predictor of operative time and perioperative complications of vaginal hysterectomy for benign conditions in patients with a nonprolapsed uterus.
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