Surgical results and urodynamic studies 10 years after retropubic colpourethrocystopexy.

Retropubic colpourethrocystopexy has been shown to be associated with good immediate cure rate in treating female urinary stress incontinence. Urodynamic data is often lacking in follow-up studies. This study presents long-term results 8-12 years after operation. Between 1979-1982, 72 women suffering from genuine stress incontinence underwent a colpourethrocystopexy. Follow-up was done 1989-1990. Each patient had a complete urodynamic evaluation preoperatively and at the follow-up. Mean age at operation was 46.2 years and follow-up was done on average 9.4 years later (8-12 years). 71% were postmenopausal at the time of follow-up. Surgical cure rate was 90.3%, 9.7% (seven patients) were considered failures. Five of the seven patients had experienced much improvement. A number of patients showed a decrease in one or more urodynamic parameter without a recurrence of stress incontinence. The bladder neck was incompetent in 38 (52.8%) of the patients, 31 of the 38 patients were still continent. Retropubic colpourethrocystopexy should be considered the primary operation for the treatment of female stress incontinence. Cure rate and postoperative evaluation cannot be judged by urodynamic parameters only, as some of the continent women showed a decrease in one or more urodynamic parameters that are considered important for continence. Bladder neck competence is not necessary for postoperative continence.

Beta-adrenoceptor agonists and hypoxia in sheep fetuses.

Sheep fetuses, near term, were studied to test the influence of a tocolytic beta agonist, terbutaline, on fetal responses to hypoxia. After fetal exteriorization the drug was administered intravenously to the mother in three different doses: The max group comprised 11 ewes receiving 67-134 micrograms min-1. Seven ewes were given 30 micrograms min-1 and eight ewes were infused with 10 micrograms min-1. Seventeen fetuses served as controls. Hypoxia was induced by intermittent complete occlusions of the maternal abdominal aorta. Maternal terbutaline levels were high (range 50-748 nmol l-1) in the max group and the 30-micrograms group, whereas those in the 10-micrograms group were in the clinical range (range 11-58 nmol l-1). Fetuses in the max and 30-micrograms groups reacted to moderate hypoxia with excessive responses of heart rate, blood pressure myocardial contractility and ST waveform changes and a 50% mortality rate during severe hypoxia as compared with 12% in the control animals. Ten micrograms min-1 did not decrease the survival but caused an increase in myocardial workload and a negative energy balance during severe hypoxia.

Ovarian pregnancy and IUCD use in a defined complete population.

During 1968-82, 759 histologically verified ectopic pregnancies occurred in Iceland. Retrospective analysis revealed that 26 of these were ovarian pregnancies. All but three of the ovarian pregnancies occurred in parous women. In 21 cases (80.8%), there was an association with the use of an IUCD at the time of conception. There was a significant difference (p less than 0.001) between the 10.7% rate of ovarian implantation in ectopic pregnancies in IUCD users and the 0.9% rate in non users. Although ovarian pregnancy is rare, the observed incidence in our material was nearly five times as high as previously described. Women with ectopic pregnancy while using an IUCD appear to be at significantly higher risk of having an ovarian implantation.

PIP: During the period 1968-82, 82,759 histologically verified ectopic pregnancies occurred in Iceland. Retrospective analysis revealed that 26 of these were ovarian pregnancies. All but 3 of these pregnancies occurred in parous women. In 21 cases (80.8%), there was an association with the use of a IUD at the time of conception. There was a significant difference (P0.001) between the 10.7% rate of ovarian implantation in ectopic pregnancies in IUD users and the 0.9% rate in nonusers. Although ovarian pregnancy is rare, the observed incidence in this material was nearly 5 times as high as previously described. Women with ectopic pregnancy occuring during IUD use appear to be at significantly higher risk of having an ovarian implantation.