Comparison on effects and complications of tension-free vaginal tape and transobturator tape in the surgical management of female stress urinary incontinence / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to compare the effectiveness and complications between TVT and TOT in the surgical management of female stress urinary incontinence. METHODS: From December, 2005 to July, 2006, 72 patients were performed anti-incontinence surgery at our hospital. Group of TVT surgery were 35 cases and group of TOT surgery were 37 cases. We reviewed medical records and analyzed these cases about age, parity, weight, height, severity of incontinence, operation time, operation outcome, duration of hospitalization and complications. RESULTS: There were no differences in patients' mean age, parity, weight, height, menopausal status and severity of incontinence. Mean operation time of TOT group (40.2+/-30 min) was shorter than TVT group (46.7+/-32.4 min), but there was no statistical difference. In case of excluded LAVH, mean operation time of TOT group (21.4+/-9.4 min) was significantly shorter than TVT group (27.0+/-7.7 min). There were no statistical differences on mean hemoglobin drop and mean hospital stay. The objective rates of cure (88.6% vs 86.5%), improvement (5.7% vs 8.1%), and failure (5.7% vs 5.4%) were similar for the TVT and TOT groups, respectively. The subjective rates of cure (80% vs 81.1%), improvement (14.3% vs 13.5%), and failure (5.7% vs 5.4%) were similar for the TVT and TOT groups, respectively. In case of bladder perforation, TVT group (2 cases) was higher than TOT group (0 case) but there was no statistical difference. In case of vaginal erosion, urinary tract infection, pelvic hematoma, de novo overactive bladder, there were no statistical differences. CONCLUSION: The TVT and TOT are both effective surgical treatment for stress urinary incontinence. Especially, TOT is safe and time saving procedure because it needs no cystoscopy.

Comparison study on results of LAVH according to prior abdominal surgery / 대한산부인과학회지

OBJECTIVE: To evaluate the result of laparoscopically assisted vaginal hysterectomy (LAVH) according to history of prior abdominal surgery. METHODS: From January, 2003 to June, 2005, a total of 504 patients were performed LAVH at our Hospital. The patients were divided into 2 groups: Group of non prior abdominal surgery (Op. Hx(-) group) included 262 cases and group of prior abdominal surgery (Op. Hx(+) group) had 242 cases. We reviewed medical records and analyzed these cases regarding age, parity, weight, height, operation indication, operation outcome, duration of hospitalization and complication. RESULTS: There were no differences in terms of patients' mean age, parity, weight and height, and indications for surgery between the two groups. Mean operation time of Op. Hx(+) group (86.9+/-28.2 min) was longer than Op. Hx(-) group (80.7+/-20.0 min). There was no statistical difference on mean postoperative hemoglobin drop and mean uterine weight between the 2 groups. Mean hospital stay of Op. Hx(+) group (4.6+/-1.7 days) was longer than Op. Hx(-) group (4.3+/-0.9 days). The incidence of major surgical complications was higher in Op. Hx(+) group (10 cases - 4.1%) than Op. Hx(-) group (3 cases - 1.2%). In case of blader injury, Op. Hx(+) group (5 cases) was higher than Op. Hx(-) group (0 case). Op. Hx(+) group had 2 ureteral injuries and 1 rectal injury but there were no statistical differences. In case of trocar site bleeding, both group had 2 cases trocar site bleeding respectively. Op. Hx(-) group had 1 inferior vena cava injury but there was no statistical difference. CONCLUSION: At the time of LAVH, the incidence of bladder injury was higher in group of patients with history of prior abdominal surgery. So special attention should be paid to prevent bladder injury.

Comparison study on results of LAVH according to prior abdominal surgery / 대한산부인과학회지

OBJECTIVE: To evaluate the result of laparoscopically assisted vaginal hysterectomy (LAVH) according to history of prior abdominal surgery. METHODS: From January, 2003 to June, 2005, a total of 504 patients were performed LAVH at our Hospital. The patients were divided into 2 groups: Group of non prior abdominal surgery (Op. Hx(-) group) included 262 cases and group of prior abdominal surgery (Op. Hx(+) group) had 242 cases. We reviewed medical records and analyzed these cases regarding age, parity, weight, height, operation indication, operation outcome, duration of hospitalization and complication. RESULTS: There were no differences in terms of patients' mean age, parity, weight and height, and indications for surgery between the two groups. Mean operation time of Op. Hx(+) group (86.9+/-28.2 min) was longer than Op. Hx(-) group (80.7+/-20.0 min). There was no statistical difference on mean postoperative hemoglobin drop and mean uterine weight between the 2 groups. Mean hospital stay of Op. Hx(+) group (4.6+/-1.7 days) was longer than Op. Hx(-) group (4.3+/-0.9 days). The incidence of major surgical complications was higher in Op. Hx(+) group (10 cases - 4.1%) than Op. Hx(-) group (3 cases - 1.2%). In case of blader injury, Op. Hx(+) group (5 cases) was higher than Op. Hx(-) group (0 case). Op. Hx(+) group had 2 ureteral injuries and 1 rectal injury but there were no statistical differences. In case of trocar site bleeding, both group had 2 cases trocar site bleeding respectively. Op. Hx(-) group had 1 inferior vena cava injury but there was no statistical difference. CONCLUSION: At the time of LAVH, the incidence of bladder injury was higher in group of patients with history of prior abdominal surgery. So special attention should be paid to prevent bladder injury.

Prenatally Diagnosed Anterior Abdominal Wall Defects / 대한산부인과학회잡지

OBJECTIVE: Anterior abdominal wall defects are classified into three basic types: omphalocele, gastroschisis and bodystalk anomaly. Its incidence and prognosis are different according to each type of anomaly. We aimed at investigating its demographic characteristics and risk factors. METHODS: From Jan. 1996 to Jun. 2002, 20 cases of anterior abdominal wall defects were diagnosed by prenatal ultrasonography and all ultrasonographic findings and delivery records were reviewed. RESULTS: We had experienced 13 cases of omphalocele, 5 cases of gastroschisis and 2 cases of bodystalk anomaly. Mean maternal age was 29.9 (+/-5.5) years in omphalocele, 25.6 ( +/- 1.7) in gastroschiss, 32 ( +/- 4.2) in bodystalk anomaly. The median gestational weeks at the time of diagnosis was 17.6 for omphalocele, 20 for gastroschisis, 14.5 for bodystalk anomaly. Live born cases were 3 in omphalocele, 1 in gastroschisis and none in bodystalk anomaly. Of the 13 cases of chromosomal analyses, there was one case of trisomy 18 in omphalocele. Multiple anomalies were found in all bodystalk anomalies including kyphoscoliosis, facial defect, central nervous system defects. 54% of associated anomalies were found in omphalocele and no associated anomaly in gastroschisis. CONCLUSION: Omphaloceles were most frequently detected in abdominal wall defects and the gastroschisises were the next. Our results suggested that the pathogenesis of anterior abdominal wall defect might be different one another, but we could not find out definite risk factors for the individual type of defect.

A Clinical Study of Pregnancy and Delivery in Women Aged 40 Years and Older / 대한산부인과학회잡지

OBJECTIVE: To access the pregnancy tendency and delivery in women aged 40 years and older. METHODS: From January 1999 to June 2001, 7882 deliveries were in Gacheon Medical School. Among them we compared 95 cases of pregnant women aged 40 years and older with 94 cases of those aged under 40 years as a control group. RESULTS: The parity was higher in women aged older than 40 years compared to control group. Number of prenatal special studies was higher in women aged older than 40 years (n=82) compared to control group (n=14). In modes of delivery and indications for c/sec, there were no difference in two groups. There were no difference in prenatal complications between two groups. But, number of cases related to placenta previa, myoma and anemia were increased in women aged older than 40 years. In postpartum complications, uterine atony and hysterectomy, postpartum bleeding and placenta accreta were higher in women aged older than 40 years compared to control group. CONCLUSION: For pregnant women aged 40 years and older, a careful approach and appropriate management will be necessary for good pregnant outcome.

Current Status and Clinical Analysis of Gynecological Pelviscopy in Korea / 대한산부인과학회잡지

OBJECTIVE: To evaluate the current status and new trends in gynelcological pelviscopy in Korea. METHODS: A survey was conducted and analyzed based on 20997 cases of operative pelviscopy hom May, 1985 to February, 1998 reported from twenty four university hospitals in Korea. RESULTS: The results obtained were ss followings; 1) 45.9 % of the total cases was 30 to 39 years old age group and it was the most dominant age group, 2) The previous operative history was found in 10.9% of the tota1 cases and included cesarean section(30.0%), ectopic pregnancy(20.3%), etc. 3) The operative indications were diagnostic(26.2%), myoma uteri(23.1%), ectopic pregnancy(21.4%), adnexal mass(18.4%), etc. In cases of diagnostic indication, the most common post-operative diagnosis of pelviscopic surgery was tubal pregnancy(30,6%). 4) The operative titles were salpingectomy(25.1%), hysterectomy(19.9%), salpinghorectomy(19.8%), etc. 5) The complications of operative pelviscopy were composed of subcutaneous emphysema(0.58%), preperitoneal bleeding(0.3%), bladder injury(0,3%), bowel injury(0.3%), etc. 6) lhe survey showed that 57.1% of the respondents desired more than 1 year of period for well peration between the operator and the assistant. 56.7% of respondents indicated that the surgical technique of the operator was the most important factor for a successful pelvisocopic surgery. 7) The most beneficial effect of the pelviscopy included the comfortableness of the patient(40.0%), cosmetic effect(22.8%), decrease of complications(14.2%), etc. CONCLUSION: The modem methods of operative pelviscopy have been successfully used in the treatment of gynecological disease. Today, pelviscopic surgery is being applied in almost all the cases of gynecological disease. Hence, the majority of pelviscopy techniques and pracedures being performed by surgeon must be taught in the controlled setting of a residency or a fellowship training program.