Background: To assess the efficacy and complications of tension-free vaginal tape (TVT) versus tension-free vaginal tape obturator in women with urodynamic stress incontinence. Methods: Prospective, randomized study. Initially, 91 patients were included in the study and 89 of them were available at 12 months follow-up. Forty-six patients were subjected to classic TVT procedure and 43 to transobturator vaginal tape from inside to outside (TVT-O) operation. There was no significant difference between the groups for age, BMI, menopausal status and prolapse. No patients had cystocele greater than stage I. Subjective and objective cure and improvement rate, mean operative time, hospital stay and complications incidence were assessed. Results: Mean operative time was significant shorter in the TVT-O group (17.4 ± 6.9 min) compared to the TVT group (26.7 ± 8.6 min). There was no significant difference in the duration of hospital stay between two groups. The objective cure rate for TVT group was 89%, the improvement rate was 6.5%, the failure rate was 4.3% and the subjective cure rate 73.9%. The objective cure rate for TVT-O group was 90%, the improvement rate was 7.6%, the failure rate was 2.5% and the subjective cure rate 76.7%. The hemoglobin loss ranged between 1.0 ± 0.5 g/dl for TVT group and 0.9 ± 0.4 g/dl for TVT-O group. Conclusion: The TVT-O technique presents success rates comparable to the classic TVT method in the short term.
The purpose of this study was to review the cases of ureteric injuries during major pelvic surgery that occurred in our department over the last 15 years, in relation to possible predisposing factors and patient management according to the type of injury. From 5,122 major gynecologic operations we found 18 cases of ureteric injury, including 4 cases of urinoma. Parameters that were examined included the indication for surgery and the type of operation, coexisting pathological conditions, the position of and the delay in recognition of the ureteric damage. The incidence of ureteric injury was 0.35%. The time of recognition of injury in 9 cases was during primary surgery and end-to-end anastomosis was performed, whereas in the other 9 cases the injury was recognized after surgery and repair of the ureter was performed, with reimplantation into the bladder in 4 cases and end-to-end anastomosis in 5. Action to prevent the development of iatrogenic ureteral injury must be taken in advance, and the management of ureteric injuries could be improved with prompt recognition and repair by a skilled surgeon.
The aim of the study was to compare the efficacy and complications of the Transobturator tape (Monarc) vs the tension-free vaginal tape obturator (TVT-O) in women with urodynamic stress incontinence. A prospective, randomized study was conducted. One-hundred and twenty patients were included in the study, and 114 of them were available at 12 months follow-up. Sixty-one patients were subjected to the TVT-O procedure and 53 to the Monarc procedure. Subjective and objective cure and improvement rate and complications incidence were assessed. The objective cure rate was 87% for the TVT-O procedure and 90% for the Monarc group. The subjective cure rate was 80% for the TVT-O group and 77% for the Monarc group. The improvement was 13 and 11.5% for the TVT-O and Monarc groups, respectively. There was one accidental injury to the urethra with the Monarc technique. The Monarc technique presents success rates and complications comparable to the TVT-O method at 1 year follow-up.
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