In situ anterior vaginal wall sling for treatment of stress urinary incontinence extended application and further experience

Our aim was to evaluate the efficacy of utilizing in situ anterior vaginal wall sling in the treatment of stress urinary incontinence [SUI]. The study included 11 women with a median age of 50 years [range, 36 to 60 years] who were operated on during the period of November 2005 to August 2006. They were diagnosed with SUI and were operated on using placard-shaped in situ anterior vaginal wall sling technique. Nine patients underwent surgical treatment for the first time, while 2 patients had postoperative recurrent SUI. In all of the patients, urethral hypermobility with or without cytocele was observed. The mean follow-up period was 22.5 months [range, 17 to 28 months]. Ten patients [90.9%] were considered cured and 1 [9.1%] started leakage of urine after 1 month during the postoperative period. One patient [9.1%] had urinary retention. Three patients [27.3%] had evidence of wound infection which was treated by appropriate oral medical therapy. In situ anterior vaginal wall sling technique is accredited with a good success rate and low incidence of complications. It is easy to learn and cost-effective, making it a suitable technique for SUI. Longer follow-up and larger number of patients are needed before final conclusion could be drawn

Novel technique for the treatment of stress urinary incontinence Early experience

To evaluate the efficacy of in situ anterior vaginal wall sling, reinforced with polypropylene mesh, in the treatment of stress urinary incontinence [SUI]. Seventeen patients with mean age of 51.29 years [range: 27-73] underwent surgery for SUI from August 2006 to August 2007 at Osmaniye State Hospital, Osmaniye, Turkey. Two out of 17 patients gave history of previous anti-incontinence surgical intervention, while the remaining were primary cases. In situ anterior vaginal wall sling, reinforced with semi-size monofilament polypropylene tape [size of the mesh was similar to size of in situ sling], was used as an anti-incontinence procedure. The mean follow-up period was 9.29 months [range: 4-16]. In-situ anterior vaginal wall sling reinforced with polypropylene mesh was successful in 16 [94.1%] patients, 14 of them were cured, and 2 had clinical improvement. There was no report of preoperative urethral, bladder, or bowel injury. One patient developed postoperative urinary retention that resolved after decreasing the tension of the suspension sutures, and one patient had suprapubic wound sepsis treated by oral antibiotics and anti-inflammatory drugs. No postoperatively significant post-voiding residue was detected. The early results of this technique are encouraging. It is easy to learn, economical, with a good success rate. Urethral erosion is less likely to occur due to the presence of intervening vaginal mucosa. In the future, a prospective study recruiting a larger number of patients undergoing this technique with long-term follow-up is recommended

Study of pancreatic islet cell function in cirrhotic patients due to hepatitis C virus

The liver is of key importance in the proper functioning of most of endocrine system. It is a major organ for metabolic degradation of many hormones. In chronic liver disease, there is a change in the concentrations of main pancreatic hormones. In this study, we aimed to study pancreatic islet cell hormones in non ascitic non diabetic cirrhotic HCV patients by measuring these hormones basally and after intravenous glucose load with different concentrations to evaluate pattern of endocrine pancreatic hormonal response at increasing glucose concentration. This case-control study included 25 non ascitic non diabetic patients with cirrhosis due to HCV infection; age ranged from 28 to 60 years. They were selected from outpatient clinic of National Hepatology and Tropical Medicine Research Institute [NHTMRI] during June 2004 to January 2005. Fifteen age and sex matched apparently healthy control subjects from same area were also included in study. Assessment of pancreatic islet cell function was done by assaying insulin, C-peptide, somatostatin and glucagon hormones. All hormones were determined by radioimmunoassay [RIA] for both patients and controls. Basal insulin, basal somatostatin and basal glucagons levels were significantly higher than that of controls [p<0.05]. Basal C-peptide was significantly lower than that of controls [p<0.05]. After intravenous glucose load with different concentrations 5%, 10% and 25%, insulin level showed a significant increase than controls [p<0.05], while other hormones showed no significant difference as compared to controls [p>0.05]. Pancreatic islet cell functional defects with liver cirrhosis due to HCV infection

Urodynamic evaluation after Stamey's bladder neck suspension

Between January 1993 and December 1995, eighteen patients were subjected to Stamey's bladder neck suspension at our center, with an overall success rate of 94.4%. All patients had preoperative uroflowmetry, water cystometry and profilometry using water-filled catheters. Resting and stress urethral pressure profiles were recorded at 3, 6, 9 and 12 months postoperatively and then every 6 months thereafter. The mean follow-up was 1 year. Patients in whom surgery was successful were further subdivided into two subgroups [A and B] for the purpose of comparison. Group A included 12 patients who had achieved complete cure and group B 6 patients who showed improvement. Success was assessed both subjectively [through direct questions given on subsequent follow-up visits] and objectively [through doing a stress test at each visit]. It was found that different profilometry variables showed a statistically significant increase in postoperative traces for the successful group in general, and a significant difference existed when comparing the two subgroups