[TVT-O treatment of stress urinary incontinence: immediate and one-year results]. / Traitement de l'incontinence urinaire d'effort par bandelette TVT-O: résultats immédiats et à un an.

OBJECTIVE: To compare one-year results between the classic retropupubic (TVT) and the in-out transobturator approaches (TVT-O) of tension-free vaginal tape for the treatment of stress urinary incontinence (SUI). PATIENTS AND METHODS: The first 82 patients operated for SUI by TVT-O in our institution were included in the analysis. Patients were evaluated at 1 and 12 months. The global satisfaction rate was assessed at 12 months by a self-reported questionnaire. Results were compared to those of the first 124 patients operated of SUI by TVT in the same institution and by the same surgeons between 1996 and 1999. RESULTS: Except a younger mean age in the TVT-O group (57 versus 60 years), no other preoperative parameter was significantly different between the TVT and the TVT-O groups. The mean operating time was shorter in the TVT-O group (15 versus 30 minutes, P<0.001). No intraoperative complication occurred. The rate of bladder perforation was significantly lower in the TVT-O group (0 versus 8.8%, P=0.004). The rate of post-voiding residual less than 100 ml was higher in the TVT-O group (88 versus 61%, P<0.001). In the TVT-O group, 40% of patients had postoperative inguinal pain (mean=9 days, range 2-15 days). After 12 months from TVT-O, 85% of patients were completely dry, 6% had de novo over bladder activity, and 93.5% of patients were satisfied with the treatment they received. The 12-month results were not significantly different between the TVT and the TVT-O groups. DISCUSSION AND CONCLUSION: With a follow-up of 12 months, TVT-O is as efficient as TVT and has a lower risk of bladder injury, a cut by half operating time, and less postoperative dysuria.

Obstetrical outcome following epidural analgesia in 506 consecutive deliveries.

We relate the experience of 506 consecutive deliveries under epidural analgesia in the same hospital, by the same obstetrician (JSS). 336 patients delivered without epidural analgesia during the same period. In the epidural group (n = 506), 93 patients had a normal spontaneous vaginal delivery, 357 had a low forceps, 22 had a mid-forceps, 4 had an assisted breech extraction, and 30 delivered by cesarean section. There were 24 cases (out of 506) of significant hypotension; all of them responded to an intravenous bolus of ephedrine. There was one case of accidental dural puncture that was treated with a blood patch. The degree of pain relief obtained by the epidural was deemed satisfactory in 456 patients (90%). The primary cesarean section rate in patients who received an epidural was not higher than that in patients who did not. Eleven newborns in the epidural group had one-minute Apgar scores between 4 and 6, but they all had excellent Apgar scores at five minutes. None had a one-minute Apgar score below 4. We conclude that epidural analgesia is a safe and highly effective method of pain relief during labor.