Transobturator Tape Operation Is More Effective in Premenopausal Women than in Postmenopausal Women with Stress Incontinence

PURPOSE: Midurethral synthetic slings for female stress urinary incontinence are minimally invasive polypropylene mesh tapes that are inserted under the midurethra with trocars. In the past decade, this new technology has become the most commonly performed procedure for female stress urinary incontinence, replacing the traditional open procedures. However, its effectiveness in pre- and postmenopausal women has not previously been compared. MATERIALS AND METHODS: We assessed the clinical outcome of the transobturator tape (TOT) procedure in premenopausal (n=45) and postmenopausal (n=49) women by means of self-report and the Urinary Distress Inventory 6 (UDI-6) questionnaire. RESULTS: The mean age of the pre- and postmenopausal women was 44 and 60 years, respectively. Mean parity was 2.4 and 3, respectively. There were no significant differences with respect to mean operation time, duration of hospitalization, or intraoperative and postoperative complications. However, premenopausal women were more satisfied with the operation than were postmenopausal women (p=0.014). Also, UDI-6 scores were significantly better in premenopausal women (p=0.027). CONCLUSIONS: The TOT operation appeared to be more effective in premenopausal women with stress urinary incontinence. However, further studies with larger sample sizes are needed to confirm our results.

hormonal profile in ectopic pregnancies

We prospectively investigated the maternal serum level of beta- human chorionic gonadotropin [beta-hCG]progesterone [P], estradiol [E2], human placental lactogen [HPL], alfafetoprotein [AFP] and cancer antigen 125 [CA 125] during the first trimester of normal and abnormal pregnancies. Serum samples were obtained from 20 women with normal intra-uterine pregnancy [IUPs]. Fifteen whose pregnancies were complicated with spontaneous abortion and 31 with surgically and pathologically confirmed ectopic pregnancies [EPs]. The mean serum levels of beta-hCG, E2 and P in patients with EPs [9490.55 +/- 3071.2 mIU/ml, 100.1 +/- 22.09 pg/ml, 4.18 +/- 1.19 ng/ml, respectively] were significantly lower than those measured in normal IUPs [73796.8 +/- 15554.7 mIU/ml, 500.15 +/- 98.84 pg/ml, 19.2 +/- 2.8 ng/ml respectively [p<0.001] and significantly lower than in patients with spontaneous abortion [22524 +/- 6213 mIU/ml, p<0.05, 339.8 +/- 112.16 pg/ml, p<0.01, 10.59 +/- 3.03 ng/ml, p<0.05 respectively]. No significant difference was recorded with respect to serum levels of HPL, AFP and CA 125 among the groups. We also investigated the diagnostic value of simple E2 and P in patients with EPs. We could not identify a discriminatory cutoff value because there was a considerable overlap in serum P and E2 levels between the patients with IUPs and EPs. In conclusion, it is not possible to define a cutoff discriminatory value of P and E2 that completely separates ectopic from IUPs, but the addition of these assays to the workup of a patient with suspected EP may facilitate the earlier diagnosis of EP