M Stumm

Surgical Treatment of Urgency Urinary Incontinence, OAB (Wet), Mixed Urinary Incontinence, and Total Incontinence by Cervicosacropexy or Vaginosacropexy

We previously developed a standardized surgical method to replace the uterosacral-ligaments in patients with genital prolapse. These cervicosacropexy (CESA) or vaginosacropexy (VASA) operations were effective in treating genital prolapse and urinary incontinence. In this study, we investigated the effects of these operations in combination with a transobturator tape (TOT) 8/4 procedure for the treatment of urgency urinary incontinence (UUI), overactive bladder (OAB), mixed urinary incontinence (MUI), and total incontinence (TI) in patients without symptomatic prolapse. Material and Methods: Patients with UUI, OAB, MUI, and TI were eligible for the study and an informed consent was obtained. Patients with genital prolapse POP-Q stage>I were excluded. The USLs in all the patients were replaced by standardized polyvinylidene fluoride structures by CESA/VASA. If patients remained incontinent, they received a TOT 8/4. Main outcome analysis was performed 4 months after the previous surgery. Data were analyzed retrospectively. Results: 133 patients were operated by CESA (n=57) or VASA (n=76). Subsequently, continence was reestablished in 57 patients (43%). The respective continence rates ranged from 27% (CI [5-49%]) in patients with TI to 73% (CI [54-92%]) in patients with UUI. After 75 patients received an additional TOT 8/4, the overall continence rates were 33% and 86% for patients with TI and those with UUI, respectively. Conclusion: The results of this study strongly support the hypothesis that urinary continence is based on the anatomical changes of the different levels of the holding apparatus of the bladder. The bilateral suspension of level I by CESA/VASA cured 66%-72% of the patients with UUI and OAB. In patients with MUI, an additional repair of level III by a TOT 8/4 was necessary to achieve a cure rate of 76%. Only patients with TI demonstrated a success rate of 33% after the suspension of the levels I and III indicating an additional problem of level II.

TOT 8/4: A Way to Standardize the Surgical Procedure of a Transobturator Tape.

Suburethral tapes are placed “tension-free” below the urethra. Several studies reported considerable differences of the distance between urethra and tape. These distances ranged from 1 to 10 mm amongst different patients. This either caused urethral obstruction or had no effect on urinary incontinence. Therefore, we decided to standardize the procedure by placing a Hegar dilator of 8-millimeter diameter in the urethra and another Hegar dilator of 4-millimeter diameter between the urethra and the tape during transobturator tape placement. Using that simple technique, which we named “TOT 8/4,” we observed that 83% of the tapes were placed in the desired distance between 3 and 5 millimeters below the urethra.

Laparoscopic bilateral cervicosacropexy (laCESA) and vaginosacropexy (laVASA) – new surgical treatment option in women with pelvic organ prolapse and urinary incontinence

Abstract Objective: Sacrocolpopexy (SCP) is the gold standard for apical prolapse treatment. However, the technical performance of each SCP is strongly dependent on the surgeons own discretion and comparison of clinical outcomes with respect to urinary incontinence (UI) is difficult. We developed a comprehensible laparoscopic surgical technique for the treatment of apical prolapse with UI. Methods: A total of 120 women with UI underwent laparoscopic bilateral SCP for apical prolapse. Thereby, the uterosacral ligaments (USLs) were bilaterally replaced by polyvinylidene fluoride (PVDF) tapes of identical length and shape, which were fixed at defined anatomical landmarks (cervix/vaginal vault and S1). Results: The restoration of apical vaginal support was achieved in 116 patients (97%); restoration failed in the first 4 patients owing to the use of fast-absorbable sutures. Seventy-eight patients (65%) with mixed and urgency UI symptoms before surgery achieved continence. The mean hospitalization was 3 days; no major complications were observed intraoperatively. Conclusion: The advantage of laparoscopic cervicosacropexy (laCESA) and laparoscopic vaginosacropexy (laVASA) lies in the comprehensible surgical technique (clearly defined technique) and the minimal amount of material used (no polypropylenes). The possibility of a short operating time and short hospitalization depicts this laparoscopic bilateral USL replacement as one treatment alternative in patients with apical prolapse suffering from UI.

PD54-09 FIRST RESULTS – THE URGE 1 STUDY - RANDOMIZED TRIAL TO COMPARE SOLIFENACIN AND BILATERAL MESH REPLACEMENT OF THE UTEROSACRAL LIGAMENTS IN THE TREATMENT OF URGENCY URINARY INCONTINENCE

cephalosporin group (36%), p1⁄40.042. On multivariable regression analysis, predictors of post-procedure UTI included single IM dose of prophylaxis (OR 2.80, 95% CI 1.2-6.5, p1⁄40.016) and positive preprocedure urine culture (OR 1.31, 95% CI 1.03-1.66, p1⁄40.027). Age, BMI and diabetes were not associated with post-procedure UTI. CONCLUSIONS: In our series comparing two different antibiotic prophylaxis regimens for Botox injection, we found a significantly lower rate of UTI when patients received a three-day course of an oral fluoroquinolone as opposed to a single IM dose of a third-generation cephalosporin. Patients with a positive pre-procedure culture may benefit from longer duration of antibiotics at the time of Botox injection.