Urinary retention after tension-free vaginal tape procedure: incidence and treatment.

OBJECTIVES: To review our experience with persistent urinary retention after the tension-free vaginal tape (TVT) procedure and report our treatment results. Ulmsten recently introduced the TVT procedure for female stress urinary incontinence. Although the morbidity is minimal, no surgical procedure is without risks, and experience will better define the morbidity of the TVT procedure. METHODS: Since November 1998, we have collectively performed 600 TVT procedures. Of these, 17 patients (2.8%) developed urinary retention or symptoms consistent with obstruction (including hesitancy, straining to void, or feeling of incomplete emptying) lasting more than 1 week from the date of the procedure. We reviewed the operative record, noting the operative time, estimated blood loss, presence of bladder penetration, and any reported complications. All 17 patients subsequently underwent transvaginal release on an outpatient basis. RESULTS: Seventeen patients (mean age 56 years, range 38 to 81) underwent sling release a mean of 64 days (range 6 to 228) after the TVT procedure. All patients voided to completion within 24 hours of release and reported no further subjective complaints of outlet obstruction. None of the subjects reported de novo urge incontinence or urgency. In each patient, the estimated blood loss was minimal; the operative time averaged 15 minutes. One urethral injury occurred and was managed intraoperatively without sequelae. Sixteen patients who underwent sling release have remained dry; the remaining patient, in whom a urethral injury was repaired, redeveloped stress incontinence and underwent an uncomplicated successful transvaginal sling procedure. CONCLUSIONS: Outlet obstruction is a risk of the TVT procedure and occurred with an incidence of 2.8% in our experience. The TVT mesh can be released by a simple vaginal incision under local anesthesia with rapid return to normal voiding. Although the number of patients studied was small, stress incontinence did not recur after uncomplicated release in our series.

Sacral nerve stimulation in patients with chronic intractable pelvic pain.

PURPOSE: Transforamenal sacral nerve stimulation with an implantable neuroprosthetic device has been shown to benefit patients with chronic voiding dysfunction. In this study we measured the effectiveness of sacral nerve stimulation in 10 patients with chronic intractable pelvic pain. MATERIALS AND METHODS: After successful percutaneous trial stimulation, a neuroprosthetic sacral nerve stimulation device was surgically implanted in 10 patients with chronic intractable pelvic pain. Leads were placed in the S3 and S4 foramen in 8 and 2 cases, respectively. Patients were evaluated throughout the study using a patient pain assessment questionnaire on a scale of 0-absent to 5-excruciating pain. Pain was assessed at baseline, during test stimulation, and 1, 3 and 6 months after surgical lead implantation. An additional long-term assessment was done at a median followup of 19 months. RESULTS: Of the 10 patients with the implant 9 had a decrease in the severity of the worst pain compared to baseline at a median followup of 19 months. The number of hours of pain decreased from 13.1 to 6.9 at the same followup interval. There was also an average decrease in the rate of pain from 9.7 at baseline to 4.4 on a scale of 10-always to 0-never having pain. At a median of 19 months 6 of 10 patients reported significant improvement in pelvic pain symptomology. CONCLUSIONS: These data imply that transforamenal sacral nerve stimulation can have beneficial effects on the severity and frequency of chronic intractable pelvic pain. Future clinical studies are necessary to determine the long-term effectiveness of this therapy.

Interleukin-6 in human milk.

Interleukin-6 (IL-6) in human milk collected during the first 2 days of lactation was investigated by a competitive radioimmunoassay (RIA) and column chromatography. The concentrations of IL-6 in the aqueous phase of fresh human milk were 151 +/- 89 pg/ml. The concentrations of IL-6 in milk increased after storage at 4 degrees C and decreased after storage at -20 degrees C (P < 0.01). Column chromatography revealed two molecular weight peaks of IL-6 in human milk, the first > or = 100 kDa and the second between 25 and 30 kDa. The 25-30-kDa peak corresponded to known isoforms of human IL-6 and to the elution pattern for 125I-labeled recombinant human IL-6, whereas the higher molecular weight peak may be in keeping with a bound or compartmentalized form of that cytokine. The precise molecular forms of this protein, the compartmentalization of or binding proteins for this cytokine and the in vivo effects of IL-6 in human milk upon the mammary gland or the recipient infant remain to be explored.