Alois Martan

Severe bleeding from internal obturator muscle following tension-free vaginal tape Secur hammock approach procedure

Various perioperative and postoperative complications have been reported after the use of pubo-vaginal tension-free vaginal tapes. The transobturator approach was introduced to minimize the potential complications connected with entering the retropubic space, but different types of complications have also been described. The next generation of recently introduced minitapes such as TVT-Secur is intended to minimize the incidence of complications. This report concerns a patient who underwent a tension-free vaginal tape procedure—TVT-Secur hammock approach—and developed severe bleeding from the internal obturator muscle, which required surgical intervention.

Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial

To compare the efficacy of two standard surgical procedures for post‐hysterectomy vaginal vault prolapse in patients with levator ani avulsion.

Reasons for and treatment of surgical complications with alloplastic slings.

Suburethral slings with tension-free vaginal tapes have become a popular treatment for stress urinary incontinence. Case reports on singleton complications are numerous and of clinical interest. Four European centers for urogynecology report on 328 surgical reinterventions after tension-free slings. Poor surgical technique is the most frequent cause of problems (45%), followed by incorrect indication (38%). The most frequent symptom is functional or anatomical outlet obstruction; perforation or penetration and defect healing are rare, but, apparently more frequent than described in studies or follow-up series previously.

Ultrasound imaging of the lower urinary tract after successful tension-free vaginal tape (TVT) procedure.

To evaluate changes in the mobility of the whole urethra, in the proximal urethra (funneling) and in the thickness of the urinary bladder wall, after a successful tension‐free vaginal tape (TVT) procedure.

Initial experience with a short, tension-free vaginal tape (the tension-free vaginal tape secur system)

OBJECTIVE The aim of this study is to present our first experience with a novel modification of the tension-free sling idea and to evaluate the safety and efficacy of this new procedure for the treatment of stress urinary incontinence in women. STUDY DESIGN Eighty-five women with previously untreated stress urinary incontinence were recruited to participate in a clinical study. The efficacy of this surgical procedure was evaluated perioperatively and 3 months (+/-1 week) after operation--objectively by cough test and subjectively by the questionnaires Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire and the International Consultation on Incontinence Questionnaire-Short Form. All data were processed and statistical analyses performed in statistical environment R, version 2.5.1. RESULTS From our results we conclude that there were no perioperative complications, objectively 62% of these patients were completely dry and 25% of patients improved. We observed a higher proportion of vaginal wall erosion (7/85) and urgency de novo (5/85) in the learning period group with respect to the routine period group. CONCLUSIONS Our first experience with the tension-free vaginal tape secur system procedure is that it has a low percentage of perioperative complications. The learning curve has to be taken in account with reference to postoperative complications.

Multicenter inter-examiner agreement trial for the validation of simplified POPQ system

Introduction and hypothesisThe primary aim of this study was to evaluate the inter-examiner agreement of a previously described simplified pelvic organ prolapse quantification (S-POP) system in a multicenter, prospective, randomized, blinded fashion. Pelvic organ prolapse quantification (POPQ) system’s use in daily practice is hampered due to perceived complexity and difficulty of use. The S-POP was introduced in order to make the POPQ user-friendly and increase its usage (Swift et al. in Int Urogynecol J 17(6):615–620, 2006).MethodsFive hundred eleven subjects underwent two separate pelvic exams in random order by two blinded examiners employing the S-POP at 12 centers around the world. Data were compared using weighted kappa statistics.ResultsThe weighted kappa statistics for the inter-examiner reliability of the S-POP were 0.87 for the overall stage, 0.89 and 0.81 for the anterior and posterior vaginal walls, 0.82 for the apex/cuff 0.89, and 0.84 for the cervix and vaginal fornix, respectively.ConclusionThere is an almost perfect inter-examiner agreement of the S-POP system for the overall stage and each point within the system.

Women's quality of life and sexual function after transvaginal anterior repair with mesh insertion.

OBJECTIVE Current evidence about the impact of pelvic floor surgery on sexual function is conflicting. Only a few studies have reported with validated questionnaires on sexual function after transvaginal mesh repair, with a discrepancy in reported outcomes. The aim of this study was to prospectively explore the impact of anterior repair (AR) with mesh insertion on sexual function, quality of life and dyspareunia. STUDY DESIGN 69 women with symptomatic stage II or greater prolapse exclusively of the anterior compartment participated in a prospective study on safety and efficacy of two mesh implantation techniques for anterior vaginal wall prolapse repair between September 2007 and May 2009. They were invited to complete the validated condition-specific short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and quality of life (QoL) questionnaires (Pelvic Organ Prolapse (POP) Distress Inventory (POPDI), Urinary Distress Inventory (UDI), POP Impact Questionnaire (POPIQ), and Urinary Impact Questionnaire (UIQ)) pre-operatively and 6 months post-operatively. All data were processed and analyzed in Statistical Computing Environment R, version 2.9.1. RESULTS A significant decrease of Qol scores and a significant increase of PISQ-12 scores occurred after surgery. All sexually active women resumed sexual activity postoperatively. The majority of non-sexually active women remained sexually inactive. Postoperatively the frequency of pain during intercourse increased in 31% of cases and decreased or stayed unchanged in 69% of cases. The incidence of de novo dyspareunia after mesh repair was 4% while the incidence of dyspareunia slightly increased from 25% to 29% postoperatively. CONCLUSIONS The results of this study suggest no deterioration in sexual function, a significant improvement in quality of life and a low incidence of de novo dyspareunia six months after AR with mesh insertion. Despite these findings, the majority of non-sexually active women remain sexually inactive postoperatively. These conclusions should be confirmed in a longer follow-up.

A serious bleeding complication with injury of the corona mortis with the TVT-Secur procedure: two cases of contact of TVT-S with the corona mortis during cadaver study.

Dear Editor,Recently, Larsson et al. [1] reported a case bleeding fromcorona mortis during tension-free vaginal tape (TVT)-Securprocedure. As is stated in their article, the tape at the leftside was correctly placed at the second attempt. After thesurgery, early laparotomy was performed due to suspicionof haemorrhage—which was confirmed, and the bleedingcorona mortis was ligated.Our team performed several cadaver studies in order todescribe possible complications that might occur duringnew methods for treatment of stress urinary incontinence.One of the methods evaluated is TVT-S in the U position.We have witnessed and well documented two cases of verynear proximity (could be described as almost direct contact)of the TVT-S inserter and the vessels communicatingbetween obturator vessels and external iliac or deepepigastric vessels.The first contact we witnessed in the group forevaluation of TVT-S in the U position that consists of 19formalin-embalmed bodies. Due to the rigidity of theformalin-embalmed bodies, the legs needed to be placedin 30° flexion in the hip joint and in 30° abduction in thehip joint. For that reason, we have also included a group offresh frozen bodies, where the legs were positioned asrecommended in standard procedure. In this group of sixbodies, we have witnessed also one contact with the coronamortis after placing TVT-S in the U position.As can be seen on the attached pictures, the near contactwith the corona mortis is well shown and it would be amatter of fortune if those vessels will start bleeding aftertouching them with a scalpel-shaped inserter.We assume that the injury of the corona mortis describedby Larsson and colleagues [1] happened during the firstattempt to place the TVT-S and it seems to us that the firstattempt was made more upwards similar to the TVT-S inthe U position.For the first time, we thought that the direct contact withthe corona mortis does not have to lead towards injury ofthe aforementioned corona mortis and that the correlationwith the cadaver study to the live surgery might be difficult;still, the description of the injury witnessed by Larsson ismore than clear proof that cadaver study might showpossible complications occurring during a normal urogyne-cological surgery.

Persistence in the treatment of overactive bladder syndrome (OAB) with mirabegron in a multicenter clinical study

OBJECTIVE The objective of this project was to evaluate treatment persistence in patients being treated for overactive bladder syndrome (OAB) with mirabegron, employing clinical follow-up in a prospective, multicenter study. STUDY DESIGN This is an analysis of patients who started treatment with mirabegron between May and September 2014 and were evaluated 1year after treatment commenced. During this evaluation we determined how many patients stopped treatment and established their reasons for discontinuation. RESULTS 206 patients being treated for OAB with mirabegron were evaluated a year after starting treatment. It emerged that 60 patients (29.1%) had discontinued the treatment, citing the following reasons: 24/60 insufficient treatment efficacy, 26/60 other reasons, while 10 members of the group discontinued treatment because of side effects. 75 out of 206 patients were ≤60 years old and 28% terminated the study prematurely: 131 out of 206 were >60years old and 29.2% terminated the study prematurely. In the group of patients without previous OAB treatment 35.7% discontinued treatment with mirabegron, while 28.1% of patients with previous anticholinergic treatment discontinued treatment. CONCLUSION In our clinical prospective multicenter study, persistence in treatment with mirabegron reached a figure of 71%.

Longitudinal trends with Improvement in Quality of Life after TVT, TVT O and Burch Colposuspension Procedures

Summary Background Comparison of the quality of life (QoL) trends after TVT, TVT O and Burch colposuspension (BCS) procedures and comparison of long-term subjective and objective outcomes. Material/Methods The study included 215 women who underwent a TVT, TVT O or BCS procedure. We monitored QoL after each procedure and the effect of complications on the QoL as assessed by the IQOL questionnaire over a 3-year period. Results The study was completed by 74.5% of women after TVT, 74.5% after TVT O, and 65.2% after BCS procedure. In the long-term, the QoL improved from 46.9 to 88.7 and remained stable after BCS; after TVT and TVT O, it declined, but only after TVT O was the decline statistically significant compared to BCS. The IQOL for women with post-operative complications has a clear descending tendency. The effect of the complications is highly significant (p<0.001). Only the OAB complication had a statistically significant effect on QoL p<0.001. Preexistent OAB does not negatively affect postoperative results of anti-incontinence surgery. Conclusions There was a statistically significant decline with the longitudinal values of IQOL with TVT O, but not with TVT or BCS. Anti-incontinence operations significantly improve quality of life for women with MI, but compared to the SI group, the quality of life is worse when measured at a longer time interval after the operation. Anti-incontinence operations significantly improve quality of life, and the difference in preoperative status in the long-term follow-up is demonstrable.