Efficacy of modified TOT surgery on patients with failed previous anti-incontinence procedures / 现代泌尿外科杂志

【Objective】 To analyze the causes of the failure of previous operations in female patients with stress urinary incontinence (SUI), and to evaluate the efficacy and safety of modified transobturator outside-in tape (TOT). 【Methods】 A total of 42 female SUI patients who had failed in previous anti-incontinence surgery during Aug.2016 and Jul.2022 were enrolled. The causes of failure were analyzed. All patients were treated with modified TOT, and the operation time, estimated blood loss, duration of catheterization, symptom improvement and complications were observed. The outcomes were evaluated with the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), pad test and urodynamic study. 【Results】 All operations were technically successful. The average operation time was (32.4±18.6) min, and estimated blood loss was (54.2±34.5) mL. There were no obvious complications. After operation, the ICI-Q-SF score significantly decreased (P0.05). The overall effective rate was 88.1%. 【Conclusion】 Modified TOT can be used for the treatment of patients with failed anti-SUI surgery, which is simple and easy to perform, with a low complication rate and satisfactory postoperative results.

Evaluation of the significance of DIT on SUI with suspected detrusor contraction weakness / 实用医学杂志

Objective To investigate the value of detrusor isovolumetric test(DIT)on female SUI with sus-pected detrusor contraction weakness. Methods A total of 86 SUI patients with suspected detrusor contraction weakness diagnosed by preoperative bladder cystometry(CMG)were enrolled in this study.DIT method was used to evaluate the bladder function. The difference of first sensation cystometry capacity, maximum cystometric capacity, bladder compliance and maximum detrusor pressure were compared between the two methods.Patients in group Ⅰwhowere diagnosed with normal detrusor function with DIT method underwent TOT surgery. Ninety normal SUI patients were selected as control group Ⅱ,who were diagnosed with normal detrusor function with CMG method. The surgery effect was compared between the two groups. Results By using DIT detection,there were 65 cases showed normal detrusor function of the 86 cases(75.6%).The maximum detrusor pressure with DIT was(31.2 ± 12.9)cm H2O versus(11.7 ± 3.1)cm H2O with cystometry(P＜0.05).No significant differences were observed in the first sensation cystometry capacity,maximum cystometric capacity and bladder compliance.The effective rate of TOT in both group Ⅰ and group Ⅱ was more than 95%,with no significantly difference between the two groups (P＞0.05). Conclusions DIT is a valuable method to evaluate the bladder function of female SUI patients with suspected detrusor contraction weakness.

Analysis of transcriptional factors expression profile during dedifferentiation of liver cell cultured in vitro / 生物工程学报

Primary hepatocytes are widely used in drug metabolism and toxicity assessment. As the culture of primary hepatocytes in vitro is a process of dedifferentiation, hepatocytes lose normal metabolic detoxification function gradually. The mechanism of hepatocyte dedifferentiation has been not clear so far. TFs play an important role in the dedifferentiation and non-parenchymal cells can maintain the function of hepatocytes in vitro. However, the current methods cannot be used in effective identification and quantitative analysis of a large number of TFs. In this paper, the mo-culture system (only primary hepatocytes) and co-culture system (primary hepatocytes and non-parenchymal cells) were established. The cells were cultured for 24 h, 48 h, 72 h as monolayer. The changes of TFs during the culture were obtained by TOT (Transcription factor response elements on tip) transcription factor enrichment method and mass spectrometry. A total of 219 TFs were identified in three individual replicates. The result revealed that up-regulated TFs were enriched in cell proliferation, death and immune response pathways, and down-regulated TFs were involved in metabolism pathway. The establishment of such culture-TFs identification system is of great significance to reveal the mechanism of primary hepatocyte dedifferentiation and crosstalk between hepatocytes and non-parenchymal cells.

Tasa de éxito subjetivo y objetivo en pacientes operados con cinta suburetral transobturatriz: ocho años de seguimiento / Subjective and objective success rate in patients operated with transobturator suburethral tape: eight years of follow-up

Antecedentes: La Incontinencia Urinaria de Esfuerzo (IOE) representa el 50% de las incontinencias urinarias en la mujer, produciendo un gran impacto en su calidad de vida. Actualmente el TOT es una de las técnicas quirúrgicas más utilizadas para su tratamiento. Objetivos: Determinar la tasa de éxito objetiva y subjetiva de las pacientes operadas por IOE e incontinencia de orina mixta (IOM) mediante TOT, y determinar la tasa de complicaciones perioperatorias. Métodos: Se realizó un estudio retrospectivo de cohorte de 8 años de seguimiento, en el que se evaluó mediante anamnesis, examen físico y protocolos quirúrgicos la tasa de éxito objetivo y subjetivo del TOT. Resultados: La tasa de éxito objetivo y subjetivo fue 92% y 76% respectivamente. El 8,3% de las pacientes presentó alguna complicación y la tasa de exposición de malla fue de 1,2%. Conclusiones: El TOT es una excelente alternativa para el tratamiento de la IOE en el Hospital de Quilpué.

Background: Stress Urinary Incontinence (SUI) represents 50% of urinary incontinence among women, causing a considerable impact on quality of life. Currently, the Mid-urethral slings such as the TOT are among the most common surgical technique for the treatment SUI. Objectives: The purpose of this study is to determine objective and subjective success rate in female patients with SUI and mixed urinary incontinence (MUI) treated with a transobturator mid urethral sling and to determine perioperative complications rate. Methods: We performed a retrospective cohort study of patients' records analyzing patients clinical history, physical examination and surgical records to evaluate the rate of objective and subjective success from TOT was performed. Results: objective and success rate was 92% and 76% respectively. The complications rate was 8,3% and mesh exposure was 1.2 %. Conclusions: TOT is an excellent alternative for the treatment of SUI in Quilpue's Hospital.

Research ethics training of trainers: developing capacity of bolivian health science and civil society leaders / Formación en ética de investigación para profesionales: desarrollando capacidades para las ciencias de la salud y líderes de la sociedad civil en Bolivia / Pesquisa ética no treinamento de estagiários: desenvolvendo a capacitação da ciência da saúde boliviana e em líderes da sociedade civil

Research and research ethics (RE) capacity is a key element for addressing health priorities of low - and middle-income countries (LMICs). With support from a NIH/FIC Research Ethics Education and Curriculum Development grant, a RE Training of Trainers (TOT) was implemented in Bolivia. The Steering Committee, including representatives from four Bolivian universities and PAHO, developed the RE TOT that included face-to-face, online and practicum components. Twenty trainees including faculty, researchers and community leaders participated. Pre/Posttest results demonstrated significant increases in overall RE knowledge (13.1% improvement, p-value < 0.0001). An evaluation demonstrated participants valued participatory learning strategies and the flexibility of the online component. TOT participants during the practicum component delivered RE workshops to their university and civil society communities in four regions (n= 3,700 people). The goals of the grant were accomplished through the development of a Steering Committee and implementation of the TOT course. Next steps include the design and implementation of a master’s level research ethics education program in Bolivia.

La capacidad de investigación y ética de la investigación (EI) es un elemento clave para hacer frente a las prioridades de salud de los países de ingresos bajos y medios (PIBM). Con el apoyo de la subvención de ética de la Investigación de NIH/FIC, una capacitación para capacitadores (CPC) fue implementado en Bolivia. El Comité Directivo, que incluye representantes de universidades y la OPS, desarrolló un CPC en EI que incluía componentes presenciales, virtuales y de práctica. Veinte participantes, incluyendo docentes, investigadores y líderes de la comunidad participaron. Los resultados de la pre/post prueba demostraron aumentos significativos en el conocimiento de EI (13,1% de mejora, valor de p< 0,0001). Una evaluación demostró que los participantes valoraron las estrategias de aprendizaje y la flexibilidad del componente virtual. Durante el componente de prácticas, los participantes hicieron talleres de EI que fueron presentados a sus comunidades universitarias y a la sociedad civil en cuatro regiones (n = 3,700 personas). Los objetivos de la subvención se llevaron a cabo mediante el desarrollo de un Comité Directivo y la implementación del CPC. Los próximos pasos incluyen el diseño e implementación de un programa de educación en ética de investigación a nivel de maestría en Bolivia.

Capacitação em pesquisa e ética em pesquisa (RE) de capacidade é um elemento-chave para abordar as prioridades de saúde em países de baixa e média renda (LMICs). Com o apoio de bolsa do NIH / FIC Research Ethics Education and Curriculum Development, uma RE Training of Trainers (TOT) foi implantada na Bolívia. O Comitê Dirigente, incluindo representantes das universidades bolivianas e PAHO, desenvolveu a RE TOT que envolveu modo presencial, online e componentes práticos. Participaram vinte estagiários, incluindo faculdades, pesquisadores e líderes comunitarios. Resultados pré / pós-teste demonstraram aumentos significativos no conhecimento RE geral (melhoria de 13,1%, p <0,0001). Uma avaliação demonstrou participantes valorizados por estratégias de aprendizagem participativa e a flexibilidade do componente online de participantes. Participantes TOT realizaram workshps da prática RE fornecida às suas comunidades universitárias e à sociedade civil em quatro regiões (n = 3.700 pessoas). Os objetivos da subvenção foram realizadas através do desenvolvimento de uma Comissão de Coordenação e implementação do curso TOT. Os próximos passos incluem a concepção e implementação de programa de educação em ética da investigação, ao nível de mestrado, na Bolívia.

Tot fixation using customized polypropylene mesh – Safe and effective approach for SUI repair

Introduction: Stress urinary incontinence (SUI) is defined as involuntary loss of urine due to increased intraabdominal pressure and intravesical pressure, which exceeds the pressure that the urethral closure mechanism can withstand and urinary loss results. SUI prevalence increases with age and becoming popular day by day. The tot fixation in SUI repair is a common operation done in Gynaecology Department. Hence it is necessary to evaluate this technique in terms of safety and feasibility in our set up and also to evaluate the feasibility, simplicity, cost effectiveness of trans obturator fixation procedure using propylene mesh of adequate size was placed loose at midurethral level, extending from one paraurethral gutter to the other and was fixed with No.1-0 Vicryl on lateral sides in the management of female stress urinary incontinence (SUI). Aim and objectives: The objective was to assess safety, efficacy, complication and cost-effectiveness of polypropylene mesh in patients with SUI undergoing tot fixation and to analyze functional results. Materials and methods: This study included about 25 cases. All of them were examined and investigated after taking their informed consent. This was a retroprospective experimental study to see the outcome measures in patients of SUI treated with transobturator sling. It was an experimental design to assess safety, efficacy, complication, and cost-effectiveness of polypropylene mesh in patients with SUI undergoing tot fixation and study intra-operative parameters like mean operative

Comparación entre las técnicas de la gota de agua y la tijera de Metzembaum en la técnica del TOT (trans obturatriz tape) para la aplicación de la tensión Sling en el ángulo sub-uretral para la cura de la incontinencia urinaria de la mujer en el Hospital Nacional Arzobispo Loayza, Lima-Perú / Comparison between two different techniques, the drop of water technique versus the Metzembaum scissors technique, to give an adecuate tension to the suburethral sling where TOT is used as treatment for urinary incontinence in The Arzobispo Loayza National Hospital, Lima-Peru

Comparar dos técnicas que se usan en las cirugías donde se utiliza la TOT para regular y dar la tensión adecuada al Sling sub-uretral en la cura de la Incontinencia Urinaria de Esfuerzo femenina: la técnica de la gota de agua y la de la tijera de Metzembaum, para evaluar la morbilidad infecciosa de las vías urinarias y el tiempo desarrollado en ejecutar cada una de ellas. Material y Métodos: El estudio, se realizó en el Servicio de Ginecología del Hospital Nacional Arzobispo Loayza, entre noviembre del 2009 y setiembre del 2011, aleatoriamente en dos grupos de pacientes: grupo "A", que utilizó la técnica de la gota de agua y el "B", que utilizó la Tijera de Metzembaum, siendo un clásico estudio prospectivo analítico observacional de casos y controles. Resultados: La morbilidad infecciosa fue prácticamente la misma, pero si existió una diferencia sustancial de tiempo operatorio a favor del grupo "B". Conclusión: Ambas técnicas utilizadas en el TOT fueron efectivas y solo se diferenciaron por el menor tiempo operatorio con la tijera de Metzembaum...

The purpose of this prospective study was to compare two different techniques, the drop of water technique versus the Metzembaum scissors technique, to give an adequate tension to the suburethral sling where TOT is used as treatment for urinary incontinence. Material and Methods: The study took place in the Gynecology service of the Arzobispo Loayza National Hospital, from November 2009 to September 2011. The two groups of patients; Group "A" (Drop of water technique) and Group "B" (Metzembaum scissors technique) were randomly chosen. Results: It was shown thatmorbidity caused by infection was similar in both groups, nevertheless, a substantial reduction in surgery time existed in Group "B". Conclusion: Both techniques used in the TOT were effective and only differentiated by the shorter surgery time with Metzembaim scissors...

TOT ambulatorio con ajuste intraoperatorio de la malla en pacientes con incontinencia urinaria de esfuerzo / Ambulatory TOT with intraoperative adjustment of mesh tension in stress urinary incontinence

Antecedentes: La Incontinencia Urinaria de Esfuerzo (IUE) es una patología frecuente y en ascenso entre las mujeres, produce un deterioro significativo en la calidad de vida de ellas. Objetivos: Evaluar los resultados en el tratamiento de la IUE mediante un TOT ambulatorio con ajuste intraoperatorio de la tensión de la malla. Método: Se realizó un estudio prospectivo, descriptivo en el que se evaluaron los resultados objetivos y subjetivos en el tratamiento de la IUE con TOT ambulatorio, con ajuste intraoperatorio de la tensión de la malla. Resultados: Se obtuvo continencia normal en el 93,3 por ciento de las pacientes, 87 por ciento se consideró "sana". No se presentaron complicaciones mayores ni sobrecorrección a los 24 meses de seguimiento. El 93 por ciento de las pacientes abandonó el hospital el mismo día de la cirugía. Conclusiones: El ajuste de la malla intrao-peratorio permitiría mejorar los resultados publicados de continencia en la cirugía de TOT ambulatorio, disminuyendo el riesgo de sobrecorrección de la IUE en forma segura y rápida. Consideramos que debiera ser un paso obligatorio en el TOT.

Background: Stress urinary incontinence (SUI) is a common condition and rising among women, with a significant deterioration of quality of life. Objectives: To evaluate the results in the treatment of SUI by ambulatory TOT with intraoperative adjustment of mesh tension. Methods: We performed a prospective descriptive study that evaluated the objective and subjective outcomes of the SUI treatment with ambulatory TOT intraoperative adjustment of mesh tension. Results: Normal continence was obtained 93.3 percent of patients, 87 percent were considered cured. There were no major complications or over correction at 24 months follow up. 93.3 percent were discharged on the day of surgery. Conclusions: The intraoperative adjustment of the mesh would improve continence results published in TOT outpatient surgery, reducing the risk of overcorrection of SUI safely and quickly. We believe it should be a mandatory step in the TOT.

Seguimiento a 6 meses de mujeres tratadas con cabestrillos mediouretrales para Incontinencia Urinaria de Esfuerzo entre 2007 y 2009, en la Clínica Universitaria Pontificia Bolivariana en la ciudad de Medellín (Colombia): cohorte histórica / Six months follow up of females treated with medium tension-free urethral slings for Urinary Stress Incontinence between 2007 and 2009 at the Pontificia Bolivariana teaching hospital in the city of Medellin, Colombia: historical cohort

Objetivo: describir las complicaciones intraoperatorias y tempranas, el estado de continencia posquirúrgica, así como la satisfacción posquirúrgica a los 6 meses de la cirugía para el manejo de la IUE con cabestrillos medio uretrales. Materiales y métodos: cohorte retrospectiva constituida por 231 pacientes, atendidas en la Clínica Universitaria Pontificia Bolivariana durante el período comprendido entre enero de 2007 a diciembre de 2009. Todas las pacientes fueron clasificadas con urodinamia, y en todas se utilizó material quirúrgico similar. Además se contó con el aval del comité de ética de la institución. Se describen las características sociodemográficas, clínicas, complicaciones intraoperatorias y tempranas, estado de continencia subjetiva y satisfacción posquirúrgica. Resultados: se realizó un total de 231 cirugías con cabestrillo mediouretral, en la Clínica Universitaria Bolivariana durante este período. Se evaluaron 181 pacientes en el posquirúrgico inmediato, de continencia luego de la cirugía; el 4,3% de las pacientes presentaron morbilidad intraoperatoria. Se evidenciaron 2 lesiones vesicales asociadas al TVT. A los 6 meses se encontró incontinencia leve en el 3,9%, moderada en el 2,4%, y severa en el 6,9% de las pacientes. Conclusiones: el tratamiento para la incontinencia urinaria de esfuerzo con cabestrillo mediouretral tiene bajos porcentajes de complicaciones intraoperatorias y tempranas secundarias a la técnica quirúrgica. El seguimiento a los 6 meses es satisfactorio para las pacientes y presenta bajas tasas de recurrencia de la IUE.

Objective: describing intraoperation and early complications and the state of post-surgical continence as well as post-surgery satisfaction 6 months after surgery for managing Urinary Stress Incontinence with medium tension-free urethral slings. Materials and methods: a retrospective cohort consisted of 231 patients who were attended at the Pontificia Bolivariana teaching hospital in Medellin from January 2007 to December 2009. All of them were classified by means of urodynamic tests and surgical treatment was done using similar material; the institution’s ethics committee approved the study. The sociodemographic and clinical characteristics were described, as were intraoperation and early complications, state of subjective continence and post-surgery satisfaction. Results: a total of 231 surgeries involving medium tension-free urethral sling were performed at the Bolivariana teaching hospital during this period. 181 patients were evaluated during the immediate post-surgery period and 97.3% were found to have become continent following such surgery and 4.3% of the patients presented intra-operation morbidity. There were 2 lesions of the bladder associated with tension-free vaginal tape (TVT). Slight incontinence was found in 3.9% of the patients’ after six months, moderate incontinence in 2.4% and severe incontinence in 6.9%. Conclusions: treating urinary effort incontinence with medium tension-free urethral sling resulted in a low percentage of intraoperation and early complications secondary to the surgical technique used. 6-month follow-up showed that patients were satisfied and low UEI recurrence rates were presented.

Cinta suburetral transobturatriz libre de tensión para el tratamiento de la incontinencia de orina de esfuerzo: 3 años de seguimiento / Tension-free subureteral tape for stress urinary incontinence

Objetivos: Evaluar nuestros resultados en la corrección de la incontinencia de orina de esfuerzo (IOE) con una técnica de cinta suburetral transobturatriz modificada (TOTm) con malla desnuda de polipropileno y anestesia local, midiendo efectividad, calidad de vida y grado de satisfacción por 3 años de seguimiento. Método: Evaluación prospectiva de 56 pacientes operadas entre los años 2003 y 2005, con IOE moderada o severa, según diagnóstico por clínica y cistometría simple. Se logró realizar un seguimiento del 87 por ciento de las pacientes, por 37,9 meses (19-51 meses). Se realizó control con examen físico y se aplicó una encuesta de satisfacción en visita domiciliaria por un grupo independiente de encuestadores. Resultados: Un 88 por ciento de las pacientes se encuentra sin IOE en el examen físico. A la encuesta de satisfacción, las pacientes manifestaron sentirse mejor o mucho mejor en frecuencia miccional diurna (79 por ciento), disfunción del vaciamiento vesical (69 por ciento), dolor pelviano (58 por ciento), urgeincontinencia (84 por ciento) y función sexual (53 por ciento). Un 90 por ciento manifiesta sentirse mejor o mucho mejor de la IOE que antes de la operación. La urgencia o urgeincontinencia de novo apareció en un 6 por ciento. Conclusiones: La técnica TOTm utilizada por nuestro grupo tiene resultados comparables con las técnicas TOT originales, con mejoría significativa en la calidad de vida de las pacientes.

Objective: To review our results in the correction of stress urinary incontinence (SUI) with a modified TOT technique using polypropylene mesh and local anesthesia, measuring effectiveness, quality of life and degree of satisfaction during 3 years of follow-up. Method: Prospective evaluation of 56 patients operated between 2003 and 2005, with modérate or severe SUI, or mixed urinary incontinence with effort predominance, according to clinical diagnosis and simple cystometry. A follow-up of 87 percent of the patients over a period of 37.9 months (19-51 months) was achieved. A physical examination was realized and a survey of satisfaction was applied by a team of independent interviewers on home visits. Results: On physical examination, 88 percent of patients are without SUI. In the survey of satisfaction, the patients manifested feeling better or much better in terms of daytime voiding frequency (79 percent), voiding dysfunction (69 percent), groin pain (58 percent), urge incontinence (84 percent) and sexual function (53 percent); 90 percent manifested feeling better or much better about their SUI than before the operation. De novo urgency or urge incontinence appeared in 6 percent. Conclusions: The modified TOT technique used by our group obtains results that are comparable to those of the original TOT techniques, with a significant improvement in the quality of life of patients.

Complicaciones de técnicas con cinta suburetral en el tratamiento de la incontinencia urinaria de esfuerzo / Complications of suburethral sling techniques in the treatment of urinary stress incontinence

Introducción: Revisamos las complicaciones de TVT, TOT y CSUSA (cinta sub-uretral sin aguja) en pacientes operadas de incontinencia de esfuerzo en nuestro Servicio. Método y Pacientes: Se consideraron las primeras 42 pacientes operadas de TVT, 15 de TOT y 41 de CSUSA. El período de observación fue 49,7; 21 y 12,5 meses respectivamente. Resultados: Complicaciones menores: TVT (28 por ciento): 8 pacientes con aguja intravesical, 2 pacientes dolor hipogástrico durante cuatro meses y 2 durante un año. TOT (27 por ciento): 4 pacientes con dolor de muslos. CSUSA: sin complicaciones. Complicaciones mayores: TVT: 5 pacientes (12 por ciento), 2 con extrusión de cinta, 1 retención urinaria crónica, 1 rotura uretral, 1 cinta intravesical. TOT: 2 pacientes (13 por ciento), 1 hematoma perivesical importante y 1 rotura uretral. CSUSA sin complicaciones. Todas las complicaciones fueron resueltas y las pacientes están continentes. Conclusiones: Las tres técnicas resuelven con éxito la IOE. No hay diferencia significativa entre las complicaciones de TVT y TOT. La técnica CSUSA no ha tenido complicaciones hasta el momento.

Introduction: We reviewed the complications of TVT, TOT and the suburethral sling without needle(STWN) in patients operated of stress incontinence at our institution. Methods: The first 42 patients operated with TVT, 15 with TOT and 41 patients operated with STWN technique. Follow-up time was 49,7; 21 and 12,5 months for each technique respectively. Results: Minor complications for TVT were: 8 patients with bladder perforation, 2 had hipogastrial pain during 4 months and 2 for a year. TOT: 4 patients with thigh pain. STWN: Without any complications. Mayor complications for TVT were: 5 patients (12 percent), 2 with mesh extrusion, 1 chronic urine retention, 1 intrasurgical urethral break, 1 intravesical mesh. TOT: 2 patients (13 percent) 1 mayor perivesical haematoma and 1 intrasurgical urethral break. STWN: without complications. All complications were resolved and patients are continent. Conclusions: The three techniques achieve success to resolve stress incontinence; there are no significant differences between the complications of TVT and TOT. STWN technique has had no complications until this moment at our institution.

A comparative study of two transobturator tape procedures: 'Outside-in' (TOT) and 'inside-out' (TVT-O) for surgical treatment of female stress urinary incontinence / 대한산부인과학회지

OBJECTIVE: To compare the outcomes of the 'outside-in' (TOT) and 'inside-out' (TVT-O) transobturator tape procedures for surgical treatment of female urinary incontinence. METHODS: We enrolled 320 stress urinary incontinence women who could be followed-up and they underwent the TOT procedure (N=184) and TVT-O procedure (N=136) from January 1, 2003 to June 30, 2006. The preoperative evaluation included a history taking, physical examination, residual urine check, pad test, Q-tip test and urodynamic test. And we investigated the patients' characteristics, success rates, operation times, concomitant surgeries, hospital days, hemoglobin changes and complications. RESULTS: There were no statistically significant differences in patients' characteristics and urodynamic tests except the intrinsic sphincter deficiency rate (ISD: 5.6% vs. 30.6%, p=0.000). The success rates were similar in both groups (98.4% vs. 97.8%). Most common complication of TOT group is operation site erosion (2.1%), and TVT-O group is thigh or vaginal pain (3.6%). There were noted other complications, such as postoperative urinary retention, de novo urgency and urinary tract infection. Total complication rates of both groups were not statistically different (7.6% vs. 9.5%, p=0.415). There were no statistic differences in the postoperative complication rates of between only TOT group and TOT with colporrhaphy group (p=0.371), also between only TVT-O group and TVT-O with colporrhaphy group (p=0.692). There were no correlation with ISD and postoperative complications in TOT (p=0.373) and TVT-O group (p=0.082). CONCLUSIONS: The two procedures of transobturator tape procedure for female stress urinary incontinence appear to be equally effective and safe. However, long-term follow-up, surgeons' learning course, skill and experience for transobturator tape procedures should be evaluated at further studies.

Uterine artery embolization for the management of uterine artery bleeding after transobturator tape operation: A case report / 대한산부인과학회지

Transobturator tape (TOT) operation for urinary stress incontinence is associated with less complication rate than Tension free vaginal tape (TVT). The two procedures yield similar rates of success. The TOT is lead through the obturator foramen, reducing the risk of bladder injury as well as damage of structures located in the Retzii cave, e.g. nerves and blood vessels. However the complications of TOT procedure may have several complications associated with obturator foramen. They are the injury of obturator nerve and vessels, abscess formation on th obturator foramen, vulvar hematoma, etc. There is no report the uterine artery injury after TOT procedure so far. Recently we experienced a case of successful control of bleeding of the uterine artery after TOT operation via uterine artery embolization. Therefore we report our case with brief review of the literatures.

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.

Combined Biological Function of TOT and LED and Mechanism of Acceleration in Wound Healing / 医疗卫生装备

Objective To study the biological function of Topical Oxygen Therapy(TOT) and Infrared Light-Emitting Diode(LED) therapy and mechanism of combination of both therapy in wound healing.To develop a device combined with TOT and LED therapy.Methods Wound models were made using rabbits which were grouped in four groups such as control group,TOT group,LED group and combined group by random.Except control group,the other groups were carried on TOT,LED and TOT+LED therapy respectively.Wound healing situations were observed.Results TOT+LED therapy could cut the wound healing time whose mechanism was to form composition force in the processing of wound healing by prompting inside growth factors and outside factors.Conclusion The therapy combined with TOT and LED can facilitate the wound healing.The theory of the wound healing device is feasible according to the results of the experiments.