Long-term functional results after unilateral mid-urethral sling transection for voiding dysfunction.

OBJECTIVE: To investigate the long-term outcomes of unilateral mid-urethral sling transection to treat voiding dysfunction after synthetic mid-urethral sling placement for stress urinary incontinence. STUDY DESIGN: Twenty-three patients who underwent an unilateral sling transection were analyzed retrospectively. Patient records were analyzed for subjective outcome, and pre- and postoperative flow patterns were used as objective outcome parameters. RESULTS: At the first postoperative follow-up, 77.3% of the patients remained dry. After a mean follow-up of 42 months, 73.9% of patients were continent. The flow pattern after lateral sling transection was significantly better than pre-operatively, with higher maximum flow rate (24.2ml/s, p=0.001), higher mean flow rate (10.4ml/s, p=0.001), higher voided volume (308.5ml, p=0.002) and lower residual volume (28.7ml, p=0.003). At final postoperative follow-up, eight patients (34.8%) reported urgency and six patients (26.1%) were incontinent; four of these patients (17.4%) mainly had urge incontinence. CONCLUSIONS: Unilateral mid-urethral sling transection is a safe, effective technique to treat voiding symptoms with good preservation of continence. The technique repairs the obstructive flow effectively. Urgency and urge incontinence after mid-urethral sling placement are difficult to treat with transection alone.

Urinary incontinence in Belgium; prevalence, correlates and psychosocial consequences.

This article describes the prevalence of urinary incontinence in the Belgian population and assesses factors associated with urinary incontinence. The significance of urinary incontinence as a public health problem is evaluated through its psychosocial consequences. The data comes from the participants of the 1997 national health survey in Belgium, 15 years and older, (n = 7266). The presence and frequency of the urinary incontinence was estimated through self-reporting using a standard questionnaire. The prevalence of urinary incontinence in the population was 1.4% in men and 4.6% in women ranging from less than 1% under the age of 25 years to 13% in males and 21% in females aged 75 years and older. The prevalence in women was higher in all age groups. The prevalence of frequent incontinence (at least once a week) was 0.8% in males and 2.4% in females. Over the age of 75 years 9.8% of the males and 7.9% of the females reported weekly incontinence. Factors associated with the incontinence were physical limitations, comorbidity, having a prostate problem or uterine prolapse, being obese. Further, the prevalence of urinary incontinence was higher in women reporting chronic urinary infection and with a sedentary lifestyle. The prevalence of subjective ill-health, of mental ill-health, of a low appreciation of social contacts and of a low functional content of social contacts was higher in subjects with urinary incontinence. Urinary incontinence is common in both men and women, especially in older ages. Urinary incontinence is associated with other health problems. The substantial psychosocial consequences of urinary incontinence stress the need for more public health and medical attention.

[Spontaneous and manual embryo reduction in mares: a twin prevention programme]. / Natuurlijke versus manuele embryoreductie van tweelingdracht bij de merrie resulterend in een tweeling preventie programma.

Data from the literature and own data for 67 twin pregnancies were used to establish the factors essential to the decision on how to treat twins at different gestational ages. Spontaneous (natural) reduction was compared with manual embryo reduction. Manual embryo reduction is always indicated when a twin is diagnosed before day 16 after ovulation. Thereafter, the type of fixation is the main determinant. Manual embryo reduction is always first choice for bilateral and unilateral non adjacent embryos and must be applied as early as possible. The change of natural reduction up to day 30, is higher for unilateral adjacent twins than is the chance of success after manual reduction. From day 30 onwards manual embryo reduction is preferable. The results are summarized in a twin prevention programme which describes how twin pregnancies can be avoided after the development of endometrial cups.

Influence of antibiotics on IgA and IgG response and persistence of Yersinia enterocolitica in patients with Yersinia-associated spondylarthropathy.

The IgA and IgG antibody response to plasmid-encoded outer membrane proteins was studied in 59 patients with yersinia-associated spondylarthropathy during 15 months of follow-up. Initially, all patients had specific IgA and IgG antibodies to the 36 and 46 kDa and 30% also to the 26 and 58 kDa released proteins, which correlated with the finding of virulent Yersinia bacilli in intestinal biopsies. IgA disappeared in 69% of untreated patients after nine months and persisted in 31% after one year. IgA disappeared within three to six months in 81% of the patients treated with antibiotics for four to six weeks and persisted in 6% after one year (p less than 0.002). IgG antibodies to the 36 and 46 kDa outer membrane proteins persisted in 80% of all patients. Disappearance of IgA was coupled with disappearance of yersinia from intestinal biopsies.

Postoperative spindle cell nodule of bladder.

We describe a new tumor of the bladder resembling sarcoma. The tumor typically develops after damage to the bladder wall, and the clinicopathologic features make it possible to recognize it as a benign lesion rather than the malignant lesions for which it can be mistaken.

Urethral advancement for distal hypospadias repair, indications, techniques and results.

Urethral advancement is a less well known technique for the repair of distal hypospadias. We treated 37 patients with a median age of 3 years for coronal and subcoronal hypospadias, with excellent results.

Combined free autologous bladder mucosa/skin tube for urethral reconstruction: an update.

A combined free autologous bladder mucosa/skin graft was used to reconstruct the urethra in 23 patients. Although the complication rate remains high (61%), the results represent a significant improvement over the use of complete mucosal tubes to the tip of the penis. The technique is recommended for those patients with failed hypospadias surgery, where sufficient skin is not available for urethral reconstruction.

The use of bladder mucosa and combined bladder mucosa/preputial skin grafts for urethral reconstruction.

Autologous bladder mucosa was used as a free graft for urethral reconstruction in 47 patients. However, in some cases the graft extended to the tip of the penis and became exposed to air. The resultant columnar metaplasia and hypertrophic changes in the mucosa produced stickiness and occlusion of the meatus. As a result a combined graft has superceded the simple mucosal graft for urethral substitution extending to the tip of the penis. The terminal few millimeters of such a graft are fashioned from preputial or penile skin, and they prevent exposure of the bladder mucosa to air. Our initial results are encouraging, although followup is short.

Pain treatment in metastatic prostatic carcinoma by radiofrequency thermolesion on the pituitary gland. Preliminary report.

Radiofrequency thermolesion on the pituitary gland is a simple and safe procedure to reduce pain in metastatic prostatic carcinoma. The method is indicated in patients with multiple and bilateral painful areas due to bone metastases, which are resistant to hormonal therapy and Estracyt. A good pain relief is achieved in over 60% of patients. Only one infectious complication has been encountered in a series of 17 patients treated this way.