Ekaterina Shapovalova

V2-05 THE NOVEL TECHNIQUE OF POST-HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: APICAL SLING AND “NEOCERVIX” FORMATION

tension-free, multilayer closure is feasible, the use of tissue interposition can achieve higher closure rates in larger fistulae or where the surrounding tissue is devitalized. Different materials have been described for fistula closure, including peritoneal tissue and gluteal muscle as well as artificial materials. METHODS: Our videopresentsa robot-assisted techniqueusing a peritoneal flap patch for reconstruction of the VVF. A daVinci SI-system with 4 arms and 6-port access was used. Preoperatively a Fogarthy catheter is placed through the fistula to mark the fistula channel , and the ureters are also stented. After initial adhesiolysis and preparation of the vesicovaginal space, the vagina is incised. Then, the fistula is identified and excised with the surrounding tissue both on the vaginal and bladder side. Following the closure of the vagina, a pedicle peritoneal flap is harvested and interposed between vagina and dorsal bladder wall. Finally, the bladder closure is performed with double-layer sutures. The analysis was performed retrospectively including operative parameters, perioperative complications and functional outcome for all patients. RESULTS: Median operative time (skin to skin) was 219 (181331) minutes without relevant blood loss. Median length of hospital stay was 8 (4-13) days. The indwelling catheter was removed after 10 days and a normal cystogram. Postoperatively all patients (n1⁄410) showed a recurrence-free total continence (0 pad/day). The highest postoperative complication was fever requiring antibiotic treatment (Clavien grade II). CONCLUSIONS: Robotic vesicovaginal repair of high vesicovaginal fistulae and peritoneal flap inlay is a safe minimal invasive approach with a high satisfaction rate and no recurrences in this pilot series to date.

ADJUSTABLE TRANSOBTURATOR SLING FOR TREATING PATIENTS WITH COMPLICATED STRESS URINARY INCONTINENCE

Introduction . The optimal tension of suburethral tape is an important component of effectiveness and safety of the surgery. By now, there is no common standardized guidance on the tensioning of the sling. There is a limited number of publications, devoted to adjustable systems with the ability to correct tape tension in postoperative period. To evaluate the effectiveness of this method, the long-term results of postoperative adjustment of the sling are necessary. Aim . To evaluate the results of complicated stress urinary incontinence (SUI) surgical treatment using a transobturator adjustable sling Urosling (Lintex). Materials and methods . The study included 89 women with complicated SUI. All patients underwent the transobturator adjustable midurethral tape placement. The tension adjustment was performed during 3 days after surgery. Postoperative evaluation included vaginal examination, cough stress test, 1-h Pad-test, uroflowmetry, bladder ultrasound and post-void residual (PVR) urine measurement, validated questionnaires (UDI-6, UIQ-7, ICIQ-SF, PICQ-12) and visual analogue scale (VAS). Results . Mean operative time was 15.74±7.49 min. The tension adjustment was performed in 45.0% (40/89) patients the next day after surgery. On the second day tension re-adjustment was required in 14,6% (13/89) patients. In 3.4% (3/89) women the tension was also tuned on the 3 day. The loosening of the sling was needed in 13.5% (12/89) patients. After adjustment, all patients were continent without any signs of bladder outlet obstruction (BOO). Mean follow-up was 14.3±2.1 months. The objective cure rate was 92.9%. There was no statistically significant difference in the urodynamic parameters. Assessment of patient satisfaction showed that 95.2% (80/84) of the patients were «very» or «very» satisfied. Conclusion. The adjustable transobturator suburethral tape Urosling allows to achieve high effectiveness of treatment in female patients with complicated SUI and to reduce the risk of postoperative BOO development.