ABSTRACT
Aim of the work is to compare the new urethropexy technique, the T.V.T and the gold standard Burch colposuspension, both clinically and urodynamically in patients with genuine urinary stress incontinence. Prospective randomized study. The study was held in Ain Shams University Maternity Hospital between June, 2002, and March, 2003. A randomized study involving 20 patients of combarable age and parity. Randomization were done using a table of random numbers then each patient were given a serial number and received the corresponding therapy. They were divided into two groups. The first group underwent T.V.T for treatment of genuine S.U.I. The second group underwent Burch colposuspention for treatment of genuine S.U.I. The tension free vaginal tape fulfill the criteria of minimal invasive incontinence surgery which are short hospital stay, early postoperative mobilization, no need for urinary catheter or drains, normal everyday physical activity, the use of regional anaethesia, minimal tissue destruction, short duration of operative technique and less need for postoperative analgesia. Results showed that TVT procedure is highly effective in treating female genuine stress incontinence. The results TVT was comparable to the results of the gold standard Burch colposuspension. The study also showed the effect of TVT on the bladder neck mobility and rotational angle which differs from the effect of colposuspension. In the T.V.T. group, the subjective success rate was 90% three month postoperatively. In the Burch group, the subjective success rate was 90% three month postoperatively. In the T.V.T. group, the objective success rate was [90%] three month postoperatively. In the Burch group, the objective success rate was [90%] three month postoperatively. Duration of the operation descriptive statistics and analytical difference between the two studied groups [in minutes] showed that there is very highly significant difference between the two groups, as regards operative time in favour of TVT group. As regard postoperative hospital stay descriptive statistics and analytical difference between the two studied groups [in days], There was very highly significant difference between the two groups, as regards the postoperative hospital stay, in favour of TVT group. From the present study, it is concluded that the tension free vaginal tape is a safe and effective minimally invasive surgical procedure for the treatment of female genuine stress incontinence. The TVT procedure appears to be technically feasible and effective as a treatment for stress urinary incontinence when combined with other pelvic floor reconstructive surgery. Care must be taken to make sure that the sling does not migrate to the bladder neck and that it is not at all obstructive
Subject(s)
Humans , Female , Suburethral Slings/adverse effects , Recurrence , Anesthesia, Local , WomenABSTRACT
The study aims to characterize the effect of laparoscopic ovarian electrocautery on serum lipid profile in women with PCOS. Prospective randomized study. Infertility clinic of Ain Shams University Hospital, Department of Obstetrics and Gynecology. The study included 30 infertile women diagnosed to have PCOS. The patients were diagnosed on the basis of two years infertility, primary or secondary, menstrual irregularities, obesity and or hirsuitism, transvaginal ultrasound, the final diagnosis was confirmed by laparoscopy. Patients with chronic illnesses or on drugs that lowering serum lipids were excluded. Routine investigation and ultrasonography, measurments of cholesterol, triglycerides, low density lipoprotein and high density lipoprotein were done. The patients were undergone laparoscopic electrocautery of the ovaries. Four weeks post operative serum lipid profile was repeated and statstically analysed to evaluate the effect of electrocautery of the ovaries on lipid profile. The study group included 24 patients with primary infertility [80%] while 6 patients with secondary infertility [20%]. Menstrual irregularities were present in 80%, while regular menses were present in 20%. Obesity were in 7 patients [23.4%] with body mass index more than 30% and in 15 patients [50%] showed hirsutism. The preoperative measurments of the profile showed mean value of cholesterol 207.8 +/- 25.2mg/dl, triglycerides 145.8 +/- 34.8mg/dl, LDL-chol 128.2 +/- 21.7mg/dl and HDL-chol 48.8 +/- 8.9. Four weeks postoperative, the mean value of cholesterol 181.6 +/- 21.2mg/dl, mean value of triglycerides 124.1 +/- 33.9mg/dl, LDL-chol 107.8 +/- 15.8mg/dl and HDL-chol 50.66 +/- 8.9mg/dl. There is a highly significant [P < 0.001] decrease in the mean level of cholesterol, triglycerides, LDL-chol, and significant [P < 0.05] increase in the mean level of HDL-chol. The mean level of cholesterol decreased by 12.5%, triglycerides by 14.4% and LDL-chol by 15.9% while the mean value of HDL-chol increased by 3.58%. Laparoscopic ovarian electrocautery significantly improve the dyslipidemia usually found in PCOS women and hence decreasing the risk of coronary heart diseases, myocardial infarction and atherosclerosis. Other benefits are improvement of ovulatory rate, pregnancy rate, low cost of infertility treatment, less monitoring demand comparing to HMG and GnRH analogue