Retropubic vs. transobturator tension-free vaginal tape for female stress urinary incontinence: 3-month results of a randomized controlled trial.

BACKGROUND: We conducted a prospective randomized controlled noninferiority trial to compare objective and subjective outcomes of retropubic tension-free vaginal tape (TVT) with those of transobturator tape (TVT-O) as primary treatment for stress urinary incontinence (SUI) in women. STUDY DESIGN: The study was conducted at 25 gynecology units in Austria and Germany; regional and academic hospitals participated. A total of 569 patients were randomly assigned to undergo TVT or TVT-O. RESULTS: A total of 480 patients (85%) were examined at 3 months. A negative cough stress test with stable cystometry to 300 ml was seen in 87% of patients after TVT and in 84% after TVT-O; 64% and 59% of patients, respectively, reported no pad use, and 88% of patients in both groups considered themselves much or very much better on the Patient Global Impression of Improvement (PGI-I) scale. Quality of life (QoL) as assessed with the SF-12 Health Survey, Kings' Health Questionnaire, (KHQ), and EuroQol-5D (EQ-5D) was significantly improved in both arms, with no differences between arms. There were no significant differences in postoperative pain or complications. CONCLUSIONS: Results of this trial demonstrate noninferiority between TVT and TVT-O with regard to postoperative continence and QoL and suggest little difference in perioperative problems (ClinicalTrials.gov NCT 00441454).

The posterior intravaginal slingplasty operation: results of the Austrian registry.

OBJECTIVE: We set up a registry to assess complications and short-term results of the posterior intravaginal slingplasty operation. STUDY DESIGN: A total of 14 gynecology departments in Austria completed questionnaires addressing the patient's history, the operation itself and the postoperative course. In the follow-up we asked for information on tape exposure and functional and anatomical results. RESULTS: Fourteen centers entered a total of 577 patients operated between 2001 and 2006. 560 (97%) posterior slingplasty operations were done in conjunction with other procedures. Intraoperative complications were reported for 16 (2.8%) procedures. Postoperatively five hematomas required reoperation. 496 (86%) patients were available for follow-up after a median of 7 weeks (range, 1-156). 54 (9.4%) patients required reoperation. Vaginal tape exposure was seen in 50 (8.7%) women. Physicians assessed the functional and anatomical results as excellent or good in 83% and 88% of patients, respectively. CONCLUSION: Despite the limitations of a registry and the high rate of concomitant procedures, this study provides data on the complications and results of the posterior intravaginal slingplasty operation.

A simple teaching tool for training the pelvic organ prolapse quantification system.

The pelvic organ prolapse quantification (POPQ) system is currently the most common and specific system describing different prolapse stages. Nevertheless, its use is not yet accepted worldwide in routine care. Our aim was to develop a simple teaching tool for the POPQ system capable of simulating different stages of uterovaginal prolapse for use in medical education with hands on training. We constructed a moveable and flexible tool with an inverted Santa Claus' cap, which simulated the vaginal cuff and the tassel at the end representing the cervix. A wooden embroidery frame fixed the cap and served as the hymen, the reference point for all measurements. Inside the cap, we sewed buttons to define the anatomic landmark points Aa and Ap located 3 cm distal from the frame. After explaining the device to the students, we used the three-by-three grid for recording the quantitative description of the pelvic organ support. First, each student had to demonstrate a specific prolapse with his cap device. Then, a prolapse was simulated on the cap, and the student had to take the relevant measurements and record them in the POPQ grid. The main training effect to understand the POPQ system seems to be the possibility for each trainee to simulate a three-dimensional prolapse with this flexible vagina model.