COMPARATIVE OUTCOME ANALYSIS OF LAPAROSCOPIC COLPOSUSPENSION, ABDOMINAL COLPOSUSPENSION AND VAGINAL NEEDLE SUSPENSION FOR FEMALE URINARY INCONTINENCE:

Concomitant tension-free vaginal tape for urinary incontinence during laparoscopic hysterectomy

OBJECTIVE

To evaluate the effectiveness and safety of placing tension-free vaginal tape (TVT) during a laparoscopically assisted vaginal hysterectomy (LAVH) in women with stress urinary incontinence and coexistent benign gynaecological disease.

DESIGN

Retrospective clinical study (Canadian Task Force classification II-2).

SAMPLE

Thirty patients diagnosed with genuine stress incontinence and benign gynaecological disease were studied.

METHODS

All the patients underwent LAVH and concomitant TVT procedure.

RESULTS

There was no significant difference in urodynamic parameters before and after surgery. All patients were followed postoperatively for a mean duration of 24.6 +/- 11.5 months (range 12-40). The cure rate of stress urinary incontinence was 96.7%.

CONCLUSIONS

Concomitant placement of tension-free vaginal tape during a laparoscopically assisted vaginal hysterectomy proved to be an efficacious and safe procedure for women with benign gynaecological disease and coexistent stress urinary incontinence.

Dynamic rectus abdominis tendon colposuspension for female stress urinary incontinence: a new procedure and its follow-up

AIMS AND OBJECTIVE

To describe the technique, results and follow-up of dynamic rectus abdominis tendon colposuspension (DRTC) in the management of female stress urinary incontinence (SUI).

PATIENTS AND METHODS

Eighteen patients with SUI were studied prospectively from 1998 to 1999 who underwent DRTC. Type I and type II SUI patients with or without mild to moderate cystocoele were included in the study. A complete preoperative work-up was done as described in detail in this article. Follow-up assessment was done at 6 weeks, 3 and 6 months and then annually involving a SEAPI quality-of-life score, a satisfaction questionnaire, urge symptoms and assessment of dryness.

RESULTS

Mean follow-up of these 18 patients was 20 +/- 6 months. Cure of symptoms and dryness was achieved in 16/18 (89%) of the patients. Four of 9 patients had residual urge symptoms and 2 developed de novo urge, which settled by 3 months; no patient required long-term anticholinergics. Three patients required clean self-intermittent catheterization (CSIC) immediately postoperatively but only 1 patient continued to perform CSIC after 3 months. Mean operating time was 41 +/- 10 min and mean hospital stay was 3.5 +/- 1 days. There were two failures, one in a patient with a neurogenic bladder and one in a patient with multiple previous pelvic operations. One so-called failure uses <2 pads/day postoperatively with an improvement in both symptom and dryness score. Postoperative complications include blood transfusion in 1, urinary tract infection in 1 and wound infection in 1 patient. All the patients with initial good results showed persistent results over follow-up.

CONCLUSIONS

DRTC is a simple procedure with minimal morbidity showing good results, which are consistent on follow-up.

The efficacy of laparoscopic mesh colposuspension: results of a prospective controlled study

OBJECTIVE

To investigate the efficacy of laparoscopic mesh colposuspension as an equivalent approach to the 'gold standard' open Burch colposuspension.

PATIENTS AND METHODS

A prospective controlled study of laparoscopic mesh colposuspension was conducted over 2 years; 87 patients with genuine stress incontinence (GSI) were recruited. The preoperative evaluation included a history, examination, midstream urine analysis, urinary voiding diary, a Urilos pad test, and twin-channel subtracted cystometry, including urethral profilometry and measurement of the postvoid residual volume. The study included patients who had undergone previous incontinence surgery, but those with detrusor instability or neurogenic bladder were excluded. The patients were assessed at 6 weeks, 6 months and 1 year after surgery and then yearly thereafter. The urodynamic assessment was repeated 3 months after surgery.

RESULTS

Forty-nine patients underwent laparoscopic colposuspension using Prolene mesh and titanium tacks to elevate the bladder neck, while 38 patients had open Burch colposuspension. There was no difference between the groups in age, parity, body mass index, menopausal status, medical history, previous bladder neck surgery and prolapse. At 6 weeks the cure rate was similarly high in the two groups (91% laparoscopic and 94% open). After a mean follow-up of 32 months, both groups showed a decline in efficacy, which was more marked in the laparoscopic group. Cure rates were 62% for laparoscopy and 79% for open surgery, and the improvement rates were 77% and 89%, respectively (P < 0.05).

CONCLUSION

Laparoscopic colposuspension using a mesh and tacker technique reduces the technical difficulty and operating time of the endoscopic procedure, but the long-term cure rates are inferior to open Burch colposuspension.