Probleme bei der augen�rztlichen Bescheinigung von Blindheit

BACKGROUND

We compared the medical test results of 117 persons examined by the superintendent for blindness assessment in 2002 with their certificates of blindness (5.5% of the applications, 42% of the testimonial examinations performed in Hessen in 2002).

METHODS

If the ratings as "blind" or "severely visually handicapped" (corresponding to a visual acuity of not more than 0.02 or 0.05, resp.) differed between the medical test and the certificate, visual acuity, visual field, further findings, and the methods of assessment were analyzed on the basis of the medical records.

RESULTS

The medical test confirmed 75 certificates. Fourteen persons with a certificate of blindness were graded as severely visually handicapped by the medical test. In 8 and 12 cases, respectively, the criteria of neither blindness nor severe visual handicap were fulfilled. Eight persons with a certificate of severe visual handicap were graded as blind by the medical test.

DISCUSSION

In 29% of the cases, the visual handicap did not reach the certified grade. Striking differences occurred between the certificate and the functions shown in the medical test. In the certificates, the declared visual handicap was regularly judged to correspond to the objective findings, but apparently in these cases symptom validity had not been critically assessed. An improvement of diagnostic validity could be achieved using relatively uncomplicated subjective and objective tests.

Combined tension-free vaginal tape and prolapse repair under local anaesthesia in patients with symptoms of both urinary incontinence and prolapse

OBJECTIVE

To study the combination of tension-free vaginal tape (TVT) and prolapse repair under local anaesthesia in patients suffering from stress incontinence and prolapse.

STUDY DESIGN

The study was designed as a prospective, open, nonrandomized study. A standardized protocol was used for pre- and postoperative evaluation. Check-ups were performed after 2, 6, 12 and 24 months. The protocol included medical history, stress test (supine and standing position with a comfortably filled bladder), life quality assessment including a visual analogue scale, 24- to 48-hour pad test, and 48-hour micturition diary.

PATIENTS

In total 32 patients participated. All suffered from urinary stress incontinence (grade 1-3) and prolapse (grade 1-3). 2 patients had previously undergone surgery 2 and 3 times, respectively, for urinary incontinence with methods other than TVT (traditional anti-incontinence surgery). 3 patients had a history of total hysterectomy. 1 patient had a large rectocele with urinary and faecal incontinence. Mean age was 54 (range 31-74) years, mean parity 2 (range 0-5), and mean duration of incontinence 13 (range 2-29) years.

SURGICAL TECHNIQUE

TVT was carried out according to the standardized technique as originally described. The prolapse repair included anterior and/or posterior colporrhaphy. All operations could be performed under local anaesthesia.

RESULTS

30 of 32 patients (93%) were cured. One patient (3%) was considerably improved, and 1 patient (3%) was considered a failure. Mean urinary leakage in 24 h was 96 (range 12-355) g preoperatively, and postoperatively 2.7 (range 0-28) g. Mean intraoperative bleeding was 75 (range 25-300) ml. Mean residual urine preoperatively was 15 (range 0-85) ml, and postoperatively 7 (range 0-40) ml. The mean stay in hospital after surgery was 2 (range 1-5) days. No postoperative urinary retention, no defective healing, and no tape rejection occurred. There was one uneventful bladder perforation in a patient who had previously undergone traditional incontinence surgery. This patient left the hospital the day after surgery without postoperative catheterization.

CONCLUSION

The study clearly demonstrates that TVT can be combined with prolapse surgery to effectively treat symptoms of prolapse and urinary stress incontinence.

A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence

The aim of the study was to evaluate the safety and efficacy of TVT (tension-free vaginal tape) for the surgical treatment of stress urinary incontinence. The design was a prospective open multicenter study including six centers, each operating an approximately 20 patients. In total 131 patients suffering from genuine stress incontinence were included. They were followed for at least 1 year using a specific protocol for objective and subjective evaluation of the outcome. All patients underwent the operation under local anesthesia. Mean operation time was 28 minutes (range 19-41 minutes); 119 (91%) of the patients were cured according to the protocol and another 9 (7%) were significantly improved. There were 3 (2%) failures. The majority of the patients (about 90%) were operated upon on a day-care basis, which implied that they were released from the hospital within 24 hours, with no postoperative catheterization. No defect healing and no tape rejection occurred. Three patients needed an indwelling catheter for 3 days. In 1 patient catheterization was necessary for more than 10 days. Two uncomplicated hematomas and one uncomplicated bladder perforation occurred. Based on the results, we conclude that TVT is a safe and effective ambulatory procedure for surgical treatment of genuine stress urinary incontinence.