Ultrasonic differential diagnosis analysis of female urethral diverticulum and vaginal wall cyst / 中华超声影像学杂志

Objective:To explore the clinical and ultrasound image characteristics and differential diagnosis of female urethral diverticulum(UD) and vaginal wall cysts.Methods:A retrospective analysis of the clinical and ultrasound image features of 12 female patients with UD were collected as UD group and 30 patients with vaginal wall cysts confirmed by surgical pathology and clinical follow-up were collected as vaginal wall cysts group in Peking Union Medical College Hospital from January 2017 to May 2021. Ultrasound image characteristics, and the main points of the differential diagnosis of the two were analyzed and summarized.Results:There were no significant differences in the age of the patients and the maximum diameter of the lesions between UD group and vaginal wall cysts group(all P>0.05). Eight cases (66.7%) of female patients with UD had urinary system symptoms, 5 cases (16.7%) of vaginal wall cysts had urinary system symptoms, the difference was statistically significant ( P<0.05); In 10 cases (83.3%) the UD lesions were located in the upper middle and upper pelvic floor, and vaginal wall cyst lesions in 23 cases (76.7%) were located in the lower middle and lower pelvic floor, the difference was statistically significant ( P<0.05). In terms of ultrasound image characteristics, UD lesions were often irregular in shape, surrounding the urethra, with unclear borders, cyst wall thickness >0.1 cm, internal wall not smooth along with calcification, internal visible separation, partly visible to the urethra, and peripheral blood flow signals were abundant. Vaginal wall cysts were mostly round-shaped, not surrounding the urethra, clear borders, thin and smooth walls, less internal partitions, not communication with the urethra, and the peripheral blood flow signals were not abundant. The differences between the two group were statistically significant (all P<0.05). Whether the sound transmission inside the lesion was not statistically significant ( P>0.05). Conclusions:Combined with urinary system symptoms, lesion location, ultrasound characteristics (morphology, whether surrounding the urethra, boundary, cyst wall thickness, inner wall calcification, internal separation, whether it is connected to the urethra, blood flow distribution) can be used to distinguish between UD and vaginal wall cysts, whether the sound transmission inside the lesion cannot be used as the basis for the differential diagnosis of the two.

Laparoscopic Rectovaginal Septal Repair without Mesh for Anterior Rectocele

A rectocele with a weakened rectovaginal septum can be repaired with various surgical techniques. We performed laparoscopic posterior vaginal wall repair and rectovaginal septal reinforcement without mesh using a modified transperineal approach. A 63-year-old woman with outlet dysfunction constipation complained of lower pelvic pressure and sense of heaviness for 30 years. Initial defecography showed an anterior rectocele with a 45-mm anterior bulge and perineal descent. Laparoscopic procedures included peritoneal and rectovaginal septal dissection directed toward the perineal body, rectovaginal septal suturing, and peritoneal closure. The patient started a soft diet the following day and was discharged on the 5th postoperative day without any complications. The patient had no dyschezia or dyspareunia, and no problem with bowel function; 3-month follow-up defecography showed a decrease in bulging to 18 mm. Laparoscopic posterior vaginal wall and rectovaginal septal repair is safe and feasible for treatment of a rectocele, and enables early recovery.

Preparation and micro/nano structure analysis of human vaginal wall acellular matrix / 上海交通大学学报（医学版）

Objective · To investigate the micro/ nano structure of human vaginal wall acellular matrix, and provide parameters for bionic vagina.Methods · A total of 35 vaginal specimens were obtained from 35 postmenopausal patients who underwent cystocele repair and/or rectocele repair.Cells in specimens were entirely removed, and the extracellular matrix was maintained. Then the acellular matrix was observed by general observation,H-E staining, Masson staining, scanning electron microscope and Micro-CT. The external and internal structure properties were measured and analyzed.Results · All cells in 35 vaginal specimens were totally removed. The vaginal wall acellular matrix was a double-layer fibrous reticular structure composed of interlaced collagen fibers, which were further arranged into bundles. Pores were distributed among fiber bundles. Epithelial side structure of vaginal wall acellular matrix was dense and subepithelial tissue was loose. There was no significant difference in fiber diameter [(82.4±9.3) nm vs (87.5±10.2)nm, P=0.432] and fiber bundle thickness [(67.6±9.3) μm vs (65.3±5.2) μm, P=0.634] between the dense and loose layers. Fiber bundle separation [(180.1±24.5) μm vs (118.2±23.0) μm, P=0.003] and total porosity [(77.1±4.2)% vs (66.6±2.8)%, P=0.002] were higher in loose layer. There was no significant difference in the micro/nano structure parameters of the acellular matrix between the anterior vaginal wall and the posterior vaginal wall.Conclusion · There was no significant difference in the fiber diameter and the fiber bundle thickness between the dense layer and the loose layer of vaginal wall acellular matrix, but the porosity of the dense layer fiber bundle was smaller than that of the loose layer.

Preparation and micro/nano structure analysis of human vaginal wall acellular matrix / 上海交通大学学报（医学版）

Objective · To investigate the micro/ nano structure of human vaginal wall acellular matrix, and provide parameters for bionic vagina.Methods · A total of 35 vaginal specimens were obtained from 35 postmenopausal patients who underwent cystocele repair and/or rectocele repair.Cells in specimens were entirely removed, and the extracellular matrix was maintained. Then the acellular matrix was observed by general observation,H-E staining, Masson staining, scanning electron microscope and Micro-CT. The external and internal structure properties were measured and analyzed.Results · All cells in 35 vaginal specimens were totally removed. The vaginal wall acellular matrix was a double-layer fibrous reticular structure composed of interlaced collagen fibers, which were further arranged into bundles. Pores were distributed among fiber bundles. Epithelial side structure of vaginal wall acellular matrix was dense and subepithelial tissue was loose. There was no significant difference in fiber diameter [(82.4±9.3) nm vs (87.5±10.2)nm, P=0.432] and fiber bundle thickness [(67.6±9.3) μm vs (65.3±5.2) μm, P=0.634] between the dense and loose layers. Fiber bundle separation [(180.1±24.5) μm vs (118.2±23.0) μm, P=0.003] and total porosity [(77.1±4.2)% vs (66.6±2.8)%, P=0.002] were higher in loose layer. There was no significant difference in the micro/nano structure parameters of the acellular matrix between the anterior vaginal wall and the posterior vaginal wall.Conclusion · There was no significant difference in the fiber diameter and the fiber bundle thickness between the dense layer and the loose layer of vaginal wall acellular matrix, but the porosity of the dense layer fiber bundle was smaller than that of the loose layer.

Vaginal Leiomyoma: Unusual Case Presentation.

Vaginal leiomyomas are rare to exist as a primary tumor of vagina. Approximately 300 cases have been reported in world literature. They usually arise from anterior vaginal wall and are firm to hard in consistency with varied clinical presentations. Here, we report a case of vaginal leiomyoma presenting as mass per vagina, diagnosed postoperatively with the help of histopathological and immunohistochemical studies.

Vaginal paravaginal repair plus vaginal bridge repair in treatment of female pelvic organ prolapse / 中国医师进修杂志

Objective To explore the effectiveness and safety of vaginal paravaginal repair(VPVR) plus vaginal bridge repair in the treatment of female pelvic organ prolapse (POP). Methods Sixty-five patients with different defects of pelvic floor underwent VPVR or plus vaginal bridge repair for posterior vaginal wall. Patients were followed up after operation. The cure rate was estimated subjectively and objectively. The patients' quality of life was evaluated by the pelvic floor distress inventory short form 20 (PFDI-20). Results All 65 cases were treated by vaginal hysterectomy and anterior vaginal repair, in which there were 33 cases underwent VPVR while 32 cases underwent VPVR plus middle area repair. Forty concomitant procedures for vaginal bridge repair were also performed. The average operative time was (110.00±20.12) min and blood loss was (119.52±45.33) ml. The symptom of stress urinary incontinence of 25 cases significantly released after operation. Four incision recovery delayed and there were no other complicatious occurred. Patients were followed up for 6-29 months,the objective cure rate was 100.00% (65/65) and subjective cure rate was 92.31%(60/65), and 58 cases (89.23%)improved significantly with the quality of life comparing with that of pre-operation by completing PFDI-20 (P<0.01). Conclusions It is an effective and safe procedure for VPVR plus vaginal bridge repair to correct median to severe anterior vaginal prolapse and posterior vaginal wall prolapse. More clinical trials are needed to evaluate their long-term outcome.

Comparison of Urethral Length and Anterior Vaginal Wall Thickness between Continent and Incontinent Women / 대한비뇨기과학회지

PURPOSE: Few studies are available on the role of female urethral length (UL) and anterior vaginal wall thickness (AVWT) in stress urinary incontinence (SUI). The aim of this study was to evaluate the usefulness of characterization of female UL and AVWT associated with SUI. MATERIALS AND METHODS: Between May 2006 and October 2006, a total of 53 women with or without SUI were included in this study. Twenty-three women with SUI and 30 healthy volunteers serving as controls underwent transvaginal ultrasound with use of a 7.5MHz transrectal probe. Measurement comprised UL and three portions of AVWT classified as proximal, middle, and distal according to the location against the urethra. RESULTS: The women's median age was 51.1 (range: 30-73) years. The UL (mm, mean+/-SD) was significantly shorter in women with SUI than in women without SUI (28.7+/-2.8 vs 31.2+/-4.5, respectively, p=0.02). The AVWT of women with SUI (mm, mean+/-SD) was 16.2+/-2.8 in the proximal, 10.7+/-1.9 in the middle, and 9.3+/-2.0 in the distal portion, and those of women without SUI were 16.8+/-3.2, 10.1+/-1.8, and 6.9+/-1.3, respectively. Distal AVWT was significantly thicker in women with SUI than in women without SUI (p=0.01). There were no significant differences in AVWT or UL between pre- and postmenopausal women. A significant positive correlation was found between advancing in age and decrease in UL (p=0.03). Body mass index and parity showed no correlation with UL or any AVWT (p>0.05). CONCLUSIONS: These results suggest that women with shorter UL and thicker distal AVWT are likely to have SUI. Furthermore, UL was shorter in older women.

Reparación del cistocele por vía vaginal con malla subvesical sin tensión: técnica y resultados / Tension-free vaginal mesh repair for anterior vaginal wall prolapse: technique and outcomes

Objetivos: Determinar la eficacia y tolerancia de la interposición de una malla de polipropileno monofilamento colocada sin tensión por vía vaginal bajo la vejiga para la corrección quirúrgica del cistocele, evaluando sus resultados anatómicos postoperatorios, la mejoría en la calidad de vida y sus complicaciones a mediano plazo. Pacientes y Método: El ensayo incluyó a 28 mujeres consecutivas (edad promedio 64 años), portadoras de cistocele grado II o III según la clasificación POP-Q, quienes fueron intervenidas entre septiembre de 2004 y octubre de 2006. Después de una completa disección de la vejiga y plicatura de la fascia perivesical, se labraron 2 túneles laterales hasta perforar la fascia endopélvica a cada lado; luego se configuró la malla de polipropileno monofilamento (Ginemesh®), dimensionada con un cuerpo central y dos ramas laterales, posicionándola sin tensión ni fijación bajo la vejiga, introduciendo y abandonando sus extensiones laterales hacia el espacio paravesical. Del total de la serie, 8 pacientes tenían cistocele G II (29 por ciento) y 20 tenían prolapso G III (71 por ciento); 11 mujeres presentaban además IOE (39 por ciento). El promedio de duración de la cirugía fue de 30 minutos. Como evaluación del resultado anatómico se utilizó la clasificación POP-Q. Para evaluar la satisfacción personal objetiva se usó el cuestionario validado de calidad de vida (I-QOL) al 3º, 6º y 12º mes post cirugía. El promedio de seguimiento fue de 18 meses (10-36).Resultados: La cirugía fue realizada sin problemas en todas las pacientes. La tasa de complicaciones tempranas fue de 7 por ciento (una erosión vaginal y 1 hematoma severo). No se reportó infección de la malla. La tasa de éxito fue de un 93 por ciento. Al sexto mes, el índice de satisfacción en la calidad de vida fue de 89 por ciento, al 12º mes fue de 86 por ciento...

Objectives: To determine the efficacy and tolerance of the introduction of a vaginal tension-free monofilament polypropylene mesh placed under the bladder for the surgical correction of cystocele. Patients and Methods: The trial included 28 consecutive women mean age 64 years), with diagnosis of grade II - III cystocele based on POP-Q classification, who were operated between September2004 and October 2006. Surgical technique include a complete dissection of the bladder and fixation of perivesical fascia. Two laterals tunnels were developed to pierce the lateral side of the endopelvic fascia at either side. Then a designed monofilament polypropylene mesh (Ginemesh ®), was placed without any tension free the bladder, positioning their lateral extensions into paravesical space. We evaluated the postoperative anatomical results, improvement in the quality of life and mid-terms complications. Results: Of the total series, 8 patients had G II cystocele (29 percent) and 20 had G III prolapse (71 percent ), 11women had also SUI (39 percent). Mean operative time for surgery was 30 minutes. Anatomical results were objectively measured with POP-Q classification. Evaluate of personal satisfaction was done by application of a validated questionnaire of quality of life (I-QOL) that was full filled at 3, 6 and 12months post surgery. Mean follow-up of the series was 18 months (10-36). No operative complication occurred. Early complication rate was 7 percent (a vaginal erosion and severe bruising ). No infection was reported in the mesh. The success rate for the series was 93 percent. At the sixth month, the rate of satisfaction in the quality of life was has been 89 percent and 86 percent at 12 months...

Transobturator tension-free mesh for female anterior pelvic floor reconstruction / 上海第二医科大学学报

Objective To investigate the efficacy and safety of anterior pelvic floor reconstruction with transobturator tension-free vaginal mesh in the treatment of moderate to severe or recurrent anterior vaginal wall prolapse. MethodsAnterior pelvic floor reconstruction with transobturator tension-free vaginal polypropylene mesh were performed on 36 women with stage 3 to stage 4 or recurrent anterior vaginal wall prolapse.Those with stress urinary incontinence(SUI) or potential SUI were also treated with transobturator inside-out tension-free vaginal tape(TOT).The surgical efficacy was determined by comparison of POP-Q classification system pre-and post-operation.Complications of the procedure were statistically analyzed. Results The mean time of operation for anterior pelvic floor reconstruction with transobturator tension-free vaginal polypropylene mesh was 52 min,mean intraoperative blood loss was 55 mL,and mean hospital stay was 3.5 d.No operative complications occurred.All the anterior vaginal wall prolapse was corrected.No recurrence was observed after the follow up for 2 to 24 months,with the effective rate of 100%.The grade of urinary incontinence was improved remarkably,with the effective rate of 100%.The erosion after the procedure with vaginal polypropylene mesh happened in 2 cases,with the incidence of 5.56%. Conclusion Anterior pelvic floor reconstruction with transobturator tension-free vaginal polypropylene mesh is a minimally-invasive procedure for the treatment of moderate to severe or recurrent anterior vaginal wall prolapse.TOT should also be performed for those with SUI or potential SUI.Though erosion of mesh may take place post-operation,this procedure is safe and has a favourable short-term effect.The long-term effect leaves for further investigations.

Use of Y-shaped mesh in the treatment of anterior vaginal wall cystocele and strees urinary incontinence / 中国微创外科杂志

Objective To evaluate the short-term efficacy of the use of Y-shaped mesh in the treatment of anterior vaginal wall cystocele and stress urinary incontinence. Methods A total of 34 women diagnosed as having anterior vaginal wall cystocele complicated with stress urinary incontinence underwent intravaginal slingplasty using a Y-shaped mesh from April 2003 to May 2006. Evaluations on symptom improvement and postoperative recurrence rate were made. Results All the patients could spontaneously void urine after catheter removal at 24 hours after operation, with the residual urine less than 100 ml. Follow-up checkups for 3~37 months (mean, 26 months) found no urinary retention, urinary tract infection, bladder dysfunction, or recurrence. Conclusions Use of Y-shaped mesh in the treatment of both anterior vaginal wall cystocele and strees urinary incontinence is feasible.

The Relationship between Maximal Urethral Closure Pressure and Functional Urethral Length in Anterior Vaginal Wall Prolapse Patients According to Stage and Age

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n=13), 50s (n=53), 60s (n=54), and 70 and over (n=16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n=35), stage III (n=76), and stage IV (n=25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.

Changes of Subtypes of Anterior Vaginal Wall Collagen in Female with Stress Urinary Incontinence

PURPOSE: Objective of this study is to determine changes in the levels of type I and III collagen in women with stress urinary incontinence (SUI). MATERIALS AND METHODS: Forty-nine women were enrolled to this study and e divided into two groups. Forty-four patients with SUI and 5 patients with without SUI for control. All the women were underwent a pre-operative evaluation. The presence of collagen type I and III was determined by immunohistochemical technique. Analysis of staining was studied with help of specialist of pathology with Image Pro computerized program. The student t-test was used for statistical analysis. RESULTS: Collagen type I and III was significantly reduced (p<0.05) in patients with SUI in anterior vaginal wall tissue. compared to patients in control. Both collagen type I and III were marked reduced in the patient of severe grade of stress urinary incontinence. However there were no significant relation between quantity of collagen and other etiological factors including age, parity, grade, and menopausal. CONCLUSION: In this study, women with SUI have less collagen type I and III around the urethra regardless of the degree of pelvic relaxation, SUI grade, parity, menopausal, age. It appears that collagen has a significant role in the maintenance of urinary continence.

Vaginal Wall Sling for Female Stress Urinary Incontinence: Efficacy and Outcome Analysis

PURPOSE: The objective of this study was to assess the efficacy and clinical outcome of vaginal wall sling in the management of women with stress urinary incontinence. MATERIALS AND METHODS: A total of 37 patients with stress urinary incontinence underwent vaginal wall sling procedure by a single surgeon from January 1998 to December 2001. All patients were evaluated preoperatively with detailed history, physical examination, urinalysis, abdominal ultrasonography, Q-tip test and stress provocation test. The 4 sutures comprising vaginal wall sling (two at the level of mid-urethral complex and two at the level of bladder neck) provide a rectangle of support and compression from the bladder neck to the mid-urethra. The efficacy and clinical outcomes of this procedure were evaluated. RESULTS: With a mean follow-up of 19.2 months(5 to 46 months), 30 patients(81%) failed. Mean operation time was 63.3 minutes. Mean duration of indwelling catheter was 5.2 days and mean duration of hospitalization was 7.2 days. One patient(2.7%) suffered from prolonged voiding difficulty for 30 days. One patient(2.7%) had postoperative bleeding necessitating blood transfusion. De novo urge incontinence developed in 3 patients(8.1%). Other transient minor complications were urinary tract infection(13 cases), suprapubic discomfort(5 cases), and urgency(4 cases). CONCLUSIONS: We consider that vaginal wall sling is a simple and effective procedure for the treatment of stress urinary incontinence, though longer follow-up is necessary to assess the long term effect.

Comparison between Anterior Vaginal Wall Sling and Pubovaginal Sling Using Cadaveric Fascia Lata for the Treatment of Female Sphincteric Incontinence / 대한비뇨기과학회지

PURPOSE: Sling procedure has been performed mainly in stress urinary incontinence (SUI) patients with intrinsic sphincteric deficiency (ISD). The purpose of this study was to compare the safety and efficacy of anterior vaginal wall sling with pubovaginal sling using cadaveric fascia lata in the treatment of women with ISD. MATERIALS AND METHODS: Among 43 patients with ISD who had received sling procedure, we retrospectively compared 21 women treated with anterior vaginal wall sling (Group A) to 22 women treated with pubovaginal sling using cadaveric fascia lata (Group B). Preoperative evaluations included cystourethrography, urodynamic study and incontinence staging with SEAPI (stress-related leakage, emptying ability, anatomy, protection and inhibition) classification. The operation time, rate of complication, duration of suprapubic catheterization, length of hospital stay, postoperative presence of stress or urge incontinence, and satisfaction scores were checked. RESULTS: In group A, 17 patients (81.0%) were cured and 3 (14.3%) showed improvement within 14.2 months of mean follow-up, whereas in group B, 18 patients (81.8%) were cured and 3 (13.6%) showed improvement within 13.5 months. De novo urgency was presented in 2 patients (9.5%) from group A and 1 (4.5%) from group B. There was no statistically significant difference between the 2 groups in terms of complication rates and postoperative subjective SEAPI scores. CONCLUSIONS: We concluded that anterior vaginal wall sling and pubovaginal sling using cadaveric fascia lata are both effective surgical treatments for SUI with ISD.

Comparison of Using Anterior Vaginal Wall and Cadaveric Fascia Lata in Sling Operation for the Management of Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Sling procedures have become the gold standard for treating all types of stress urinary incontinence (SUI) in women because of their simplicity of procedure and good outcomes. We compared the outcomes of anterior vaginal wall sling with cadaveric fascia lata sling. MATERIALS AND METHODS: Between October 1996 and April 2000, 43 women with SUI who were treated with anterior vaginal wall sling and 23 women with SUI who were treated with cadaveric fascia lata sling were analyzed. Mean follow-ups were 43.0 months (29-56) for anterior vaginal wall sling and 21.5 months (16-30) for cadaveric fascia lata sling. All patients were evaluated preoperatively with a detailed history, pelvic examination, urinalysis, voiding diary, and urodynamic study including Valsalva leak point pressure. Parameters of comparison included presence of stress incontinence, length of hospital stay, duration of catheterization, operation time, and complication and success rates. RESULTS: The success rates, including satisfaction rates, were 83.7% in the anterior vaginal wall sling group and 82.6% in the cadaveric fascia lata sling group. The complication rates were 23.3% in the anterior vaginal wall sling group and 26.1% in the cadaveric fascia lata sling group. CONCLUSIONS: Both procedures were equally effective in the management of female SUI with high cure rates and acceptably low complication rates. However, further long-term follow-up study of these procedures is required to determine the persistence of the good results in women with SUI.

Result and Factors Contributing to Patients' Satisfaction of Anterior Vaginal Wall Sling Operation / 대한비뇨기과학회지

PURPOSE: Due to their high success rate, sling operations have recently been widely performed for stress urinary incontinence (SUI) associated with intrinsic sphincter deficiency (ISD) and urethral hypermobility. Despite the encouraging short-term results of the sling surgery using anterior vaginal wall, the long-term results have been shown not to be as good as those in short-term studies. This study was designed to investigate the long term results of a Raz's anterior vaginal wall sling (AVWS), and to determine factors contributing to patients' satisfaction. MATERIALS AND METHODS: An outcome-based study was conducted on 77 patients who had undergone an AVWS performed by the same surgeon. Patients were preoperatively evaluated for their history, by physical examination, standardized symptom questionnaires and urodynamic studies. Patients with a follow-up of at least 1-year were assessed by the parameters of voiding symptoms and subjective satisfaction from the postoperative questionnaires. RESULTS: Of the 62 patients (81%) available for long term follow-up, 43 (69.4%) were currently satisfied with the urinary status, 35 (56.5%) were dry all the time, 12 (19.4%) were occasionally wet, but the severity had improved, 15 (24.1%) had not improved or had worsened. A review of the charts of the 15 failures revealed all of them were postoperatively urgent. Late complications occurred in 4 patients; 1 had recurrent cystocele and 3 had dyspareunia. De novo urge incontinence occurred in 5 patients. CONCLUSIONS: The stress incontinence was cured, or improved, in 75.8% of the patients after a follow-up of at least 1-year. The satisfaction of patients was closely associated with the presence, or resolution, of postoperative urgency or urge incontinence.

The Anterior Vaginal Wall Sling Operation for Female Stress Urinary Incontinence: long-term follow-up results

PURPOSE: Sling operation has been known the best treatment of woman with anatomical urinary incontinence(AI) and intrinsic sphincteric deficiency(ISD). We evaluated the clinical outcome of anterior vaginal wall sling as a treatment for stress urinary incontinence. MATERIALS AND METHODS: Thirty three patients with stress urinary incontinence who treated with anterior vaginal wall sling from October 1995 to March 2000 were analyzed. Patients were evaluated preoperatively with history, physical examination, voiding cystourethrography, evaluation with SEAPI classification and urodynamic study including of Valsalva leak point pressure(VLPP) and maximal urethral closing pressure(MUCP). All patients were assessed for the outcome of the procedure and subjective satisfaction by questionnaires. Surgical outcomes were then analyzed in relation to VLPP , MUCP and subjective SEAPI score. Of the total 33 patients, 26(78.8%) had AI and 7(21.2%) had ISD. According to the Stamey grades, 6(18.2%) were grade I, 23(69.7%) were grade II and 4(12.1%) were grade III. RESULTS: With a mean follow-up of 42.4 months (range 14 to 66). Urinary incontinence completely disappeared in 20 patients(60.6%), significantly improved in 8 patients(24.2%), failed in 5 patients(15.2%). Complication included urinary retention in two patients, suprapubic pain in two patients, and urge incontinence in two patients. Pre- and postoperative urge incontinence was major factor for failure rate. CONCLUSIONS: Anterior vaginal sling operation is a simple, safe and effective procedure for treatment of both AI and ISD. The urge incontinence is closely related to success rate.

Anterior Vaginal Wall Sling for Female Stress Urinary Incontinence / 영남의대학술지

BACKGROUND: The purpose of this study was to determine the efficacy and safety of the anterior vaginal wall sling in the management of women with stress urinary incontinence. MATERIALS AND METHODS: From January 1998 to December1999, 42 patients(31 with genuine stress urinary incontinence and 11 with mixed urinary incontinence, 38 with anatomical incontinence and 4 with intrinsic sphincteric deficiency) underwent anterior vaginal wall sling at Yeungnam University Hospital were studied retrospectively. The mean age was 49.3 years(ranging from 34 to 66 years of age) and the mean follow-up period was 29.4 months(ranging from 16 to 40 months). Intra- and postoperative complication, success rate and patient's satisfaction were evaluated. RESULTS: The mean operation time was 79 minutes(ranging from 65 to 124 minutes) and the mean hospital stay was 5.1 days(ranging from 4 to 10 days). Mean postoperative Foley catheter drainage was 2.1 days(ranging from 1 to 5 days). As a complication, bladder perforation occurred in one patient(2.4%), residual urine sensation developed in seven patients(16.7%). and suprapubic pain was complained in five patients(11.9%). which improved gradually. Vaginal epithelial inclusion cyst occurred in one patient(2.4%) at postoperative 31 months. Four(9.4%) patients with de novo instablility were improved by anticholinergics medication. The success rate was 92.9% and 38 patients(90.5%) were satisfied with this procedure. CONCLUSION: We consider that the anterior vaginal wall sling to be a safe and effective surgical procedure for the treatment of female stress urinary incontinence. but a longer follow-up is necessary to determine long term effect.

Comparison of Vaginal Wall Sling and Pubovaginal Fascial Sling in Management of Genunine Stress Urinary Incontinence

No abstract available in English.

In Situ Anterior Vaginal Wall Sling in Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The clinical outcome of the in situ anterior vaginal wall sling with bone anchor suture fixation was evaluated to determine the efficacy and safety in the treatment of women with anatomical incontinence(AI) and intrinsic sphincteric deficiency(ISD). MATERIALS AND METHODS: 62 women(45 with AI and 17 with ISD) underwent this modified sling procedure with the sling anchored to the pubic bone. Preoperative evaluation included detailed history, physical examination, urinalysis, urodynamic test, Q-tip test and incontinence staging with Stamey grade. All patients were followed up on a 3-month basis. RESULTS: With a mean follow-up of 7.2 months(range 3 to 12), 61 women(98%) reported satisfaction (55 dry, 6 improved). Mean operative time was 72.5 minutes and mean hospital stay was 4.2 days. Mean postoperative catheter drainage was 5.4 days and 3 patients(5%) required prolonged catheter drainage, which required more than 2 weeks but no longer than 1 month. De novo urgency developed in 3(5%) patients. CONCLUSIONS: In situ anterior vaginal wall sling represents an effective, simple and safe option for the treatment of both anatomic incontinence and intrinsic sphincteric deficiency.