Impact on urinary incontinence after management of complications related to a retropubic midurethral sling.

INTRODUCTION AND HYPOTHESIS: The most common complications to midurethral sling (MUS) operations for stress urinary incontinence are postoperative urinary retention (POUR), vaginal MUS exposure, and urgency. They are well described but consensus regarding their management is missing. An evaluation of the treatment of POUR, exposure and urgency after the MUS procedure in our department was implemented. Incontinence status after treatment of complications was evaluated. METHODS: A review of the medical records of women undergoing MUS procedures from 1 January 2017 to 31 December 2021 (n = 329). RESULTS: A total of 279 women (85%) had no complications. Fifty women had one or more complications. Twenty-three women (7%) experienced POUR. Final treatment in 9 women was clean intermittent self-catheterization (CISC). All remained continent. Nine women had the MUS mobilized. This was successful in 8 women who remained continent. Six women had their MUS incised (one after unsuccessful mobilization). Four became incontinent again and 2 remained continent. Eight women had vaginal MUS exposure. Seven attempted recovering of the MUS. This was successful in 3 patients. The remaining had a partial MUS removal. Only 33% remained continent after removal. Ten patients developed de novo urge, but only 2 needed medication. CONCLUSIONS: Mobilization of the MUS must be considered the optimal treatment for POUR when CISC fails. It is the most effective intervention with the best effect on POUR and the lowest risk of incontinence. Concerning vaginal exposure, a trial of recovering should be attempted as the risk of incontinence when undergoing a partial removal of the MUS is considerable.

Urinary incontinence.

Around 500,000 Danes are suffering from urinary incontinence, and stress urinary incontinence and urgency urinary incontinence, alone or mixed, are the most common types. Diagnostic workup is similar for all types of urinary incontinence (men and women) and can be done by the GP. Most conservative interventions can be commenced by the GP. In complicated or treatment-resistant cases and when surgery is needed, referral to a urologic or gynaecological department can be necessary, as argued in this review.

Treatment of stress urinary incontinence with polyacrylamide hydrogel in an office setting: patient perspectives.

INTRODUCTION AND HYPOTHESIS: The office setting provides the opportunity for surgeons to perform specific procedures more efficiently than in a day case operating theater. Consequently, health care systems are interested in altering surgical services from a day case operating theater to an office setting. The impact on patient's satisfaction is more challenging to estimate. The bulking procedure is an intervention for urinary stress incontinence. It was originally performed in the day case operating theater under general anesthesia or sedation. Today, the procedure is mostly done under local anesthesia. The aim of this study was to assess patient satisfaction changing from day case operating theater to office setting. Our hypothesis was that patients preferred the office setting. METHODS: A prospective cohort study was executed from 15 September 2020 to 1 June 2021. A total of 115 women underwent a bulking procedure in the office setting. A follow-up (phone questionnaire) 3 months post-operatively for quality assurance is mandatory. The office setting experience was assessed concurrently. RESULTS: A total of 95.6% (110 out of 115) preferred the bulking procedure performed in the office setting. The reasons were: a short waiting time (71 out of 110; 64.5%), less nervousness (47 out of 110; 42.7%), and they felt more secure (49 out of 110; 44.5%). On a visual analog scale (VAS) from 0 to 10, 37.4% (43 out of 115) considered a short waiting time important (VAS 10) and 81.7% (94 out of 115) rated a short waiting time ≥ VAS 5. CONCLUSIONS: The office setting provides a patient-friendly and comfortable place for the bulking procedure and is generally preferred by the patient over the day case operating theater. Important for the preference is the accessibility and minimal waiting time. The office setting is therefore both convenient and efficient for surgeon and patient.

Location of recurrences in high-risk stage Iendometrial cancer patients not given postoperative radiotherapy: A Danish gynecological cancer group study.

OBJECTIVES: To study recurrence rates in Danish high-risk stage I endometrial cancers not given radiotherapy in accordance with the decision of the Danish Gynecological Cancer Group. METHODS: This prospective national cohort study includes all 4707 endometrial carcinomas diagnosed from 2005 to 2012. Of these, 623 patients had grade 3 endometroid adenocarcinoma with >50% myometrial invasion or serous/clear/undifferentiated carcinoma (with any depth of invasion). In 305 patients with high-risk stage I on final pathology, 14.1% received adjuvant external beam radiotherapy and 9.6% adjuvant chemotherapy. No patients received brachytherapy. 5-year Kaplan-Meier survival estimates and actuarial recurrence rates were calculated, and adjusted Cox regression analysis used for comparison. Recurrence rates were compared with historical Danish population data (DEMCA 98-99). RESULTS: For non-irradiated patients, 5-year overall survival, cancer-specific survival, and progression-free survival rates in high-risk stage I patients were 65%, 78%, and 73%, respectively. For non-irradiated patients, isolated local recurrences were uncommon (vaginal 3.1%, pelvic 0.4%). Death was mainly due to a high occurrence of non-local recurrences, with 8.8% experiencing a first recurrence in the abdominal cavity (outside the field where radiation traditionally have been given) and 13.0% a distant metastasis outside the abdominal cavity. Grade 3 tumors with >50% myometrial invasion seem to be characterized by a different pattern of recurrences, with significantly more isolated vaginal recurrences (7.9% vs 2.2%) and fewer total number of abdominal recurrences (7.9% vs 15.3%) as compared with unfavorable tumor types. CONCLUSION: Isolated vaginal and pelvic recurrences were rare (3-5%) in patients with a final pathologic diagnosis of high-risk stage I endometrial cancer even after the Danish Gynecological Cancer Group decided to omit all types of postoperative radiotherapy and introduce lymph node staging.

The effect of introducing pelvic lymphadenectomy on survival and recurrence rates in Danish endometrial cancer patients at high risk: a Danish Gynecological Cancer Group study.

OBJECTIVES: To evaluate the rate of survival and recurrence related to the introduction of pelvic lymphadenectomy in Danish high-risk endometrial cancer patients. STUDY DESIGN: Data on 713 high-risk patients defined as grade 3 with >50% myometrial invasion or serous/clear/undifferentiated carcinomas stage I-IV endometrial cancer patients diagnosed from 2005 to 2012 were retrieved from the Danish Gynecological Cancer Database. Of these, 305 were high-risk stage I. Five year Kaplan-Meier survival estimates and actuarial recurrence rates were calculated, and adjusted Cox used for comparison. Findings were compared with earlier Danish results. RESULTS: Lymphadenectomy in 390 radically operated high-risk patients resulted in upstaging of 31 patients from stage I to IIIC and 19 patients from stage II to IIIC corresponding to 12.8%. Upstaging from stage I to IIIC had a cancer-specific survival of 77%, almost comparable to lymph node-negative high-risk stage I patients (81%). Lymphadenectomy patients had a significant higher overall survival as compared with non-lymph node resected for all patients, but not for stage I patients. Lymphadenectomy, however, did not significantly affect cancer-specific survival, progression-free survival, recurrence rate or risk of local, distant, or lymph node recurrence. When the survival of high-risk stage I patients was compared with earlier Danish results, a small improvement in overall survival (7%) and cancer-specificsurvival (8%) was demonstrated. CONCLUSION: Only a small number of high-risk patients were upstaged from stage I to III due to lymphadenectomy. These patients showed a surprisingly good survival possibly due to correct stage identification and subsequent relevant adjuvant therapy. However, even though introduction of lymphadenectomy in the Danish high-risk population seems to increase overall survival, no significant change in cancer-specific survival, progression-free survival or recurrence patterns was demonstrated.

Valid and complete data on endometrial cancer in the Danish Gynaecological Cancer Database.

INTRODUCTION: It is a comparative register study designed for data validation of surgery, pathology and recurrence for endometrial cancer in the Danish Gynaecological Cancer Database (DGCD) in the 2005-2009 period. The main outcomes were completeness of the data registered in the DGCD, agreement concerning data reported and comparability between the DGCD and a definite reference. MATERIAL AND METHODS: DGCD data on women with endometrial cancer or adenomatous hyperplasia supplemented with patient charts for data on recurrence were retrieved and compared with a definite reference (the pathology report and clinical journals). RESULTS: The completeness of data on pathology and surgery reported to the DGCD was 97.3%. The comparability between the DGCG and the definite reference was 94.4%. The agreement for the reported data in the DGCD was 88.3%. For recurrence, the comparability was 94.5% and the agreement was 71.6%. Completeness could not be determined due to the design of the database, where recurrence is composed of optional variables only. CONCLUSION: The data on endometrial cancer registered in the DGCD regarding surgery and pathology are valid and complete, and they provide a solid base for research. Due to the relatively infrequent incidence of recurrences, and the fact that these are rarely entered into the database when they do occur, agreement concerning recurrence is low. Based on this study, the DGCD cannot alone provide information on recurrence that will give a reliable foundation for research. FUNDING: Funding was provided by the Health Research Fund of the Region of Central Jutland and the Department of Gynaecology and Obstetrics, Aarhus University Hospital. TRIAL REGISTRATION: not relevant.

[No firm evidence for screening for Chlamydia in connection with spontaneous abortion]. / Usikker evidens for Chlamydia-podning i forbindelse med spontan abort.

Infection with genital Chlamydia while undergoing a vaginal instrumentation increases the risk of pelvic inflammatory disease with pain and sterility as sequelae. A literature study was performed in order to find out if screening and treatment for Chlamydia trachomatis should be offered to all women with miscarriages. This article reviews the available literature on the topic. The results show that there is a need for larger clinical trials before an evidence-based answer can be given.