Laparoscopic repair of iatrogenic vesicovaginal and rectovaginal fistula.

OBJECTIVE: To investigate the clinical efficacy of laparoscopic repair of iatrogenic vesicovaginal fistulas (VVF) and rectovaginal fistulas. METHODS: Seventeen female patients with iatrogenic fistulas (11 cases of VVF and 6 cases of high rectovaginal fistulas) were included. All patients were hospitalized and underwent laparoscopic fistula repair in our hospital between 2008 and 2012. The mean age of the patients was 44.8 ± 9.1 years. The fistulas and scar tissue were completely excised by laparoscopy, orifices were tension-free closed using absorbable sutures, omental flaps were interposed between the vagina and the bladder or rectum, and drainage was kept after repair. RESULTS: Laparoscopic repair of fistulas was successful in all 17 patients. No complication was found during or after repair. No reoperation was needed after the repair. The operative time was 80.2 ± 30.0 minutes (range 50-140 minutes). The blood loss was 229.4 ± 101.6 ml (range 100-400 ml). The double J catheters were placed in 7 patients and removed 1-2 months after repair. Eight VVF patients underwent cystoscopy 3 months after laparoscopic repair and there were no abnormal findings. The follow-up time was 17.1 ± 6.5 months (range 8-29 months). CONCLUSION: Laparoscopic repair of VVF and rectovaginal fistulas is a safe and an effective minimally invasive procedure for treatment of iatrogenic fistula.

A new surgery for recurrent or persist stress urinary incontinence in females after primary mid-urethral slings.

OBJECTIVE: To retrospectively evaluate the efficacy of a new complementary mid-urethral sling surgery (Tong's hammock anterior, THA) in treatment of recurrent or persist stress urinary incontinence (SUI) in females after primary synthetic mid-urethral slings (MUSs). METHODS: THA was performed in 27 females with recurrent or persist SUI after primary MUSs from June 2005 and July 2010. These patients were followed up for one year, and clinical data including main complaints, operation duration, blood loss, efficacy and complications were reviewed. RESULTS: All 27 SUI patients were treated with THA surgery, a trans-vaginal mid-urethral sling on the descending pubic ramus. The average operation time was 39 min (range: 25-70 min), average blood loss was 70 ml (range: 20-120 ml). After urinary catheter removal, all patients could micturate and their average residual urine was 25.2 ml (range: 0-80 ml). The average hospital stay was 4.7 days (rage: 3-7 days). SUI symptom was persistent in 2 patients after THA surgery and the effective rate reached 92.5%. At 3 months, 6 months and 1 year after surgery, the effective rate was 92.5% (25/27), 92% (23/25) and 87.5% (21/24), respectively. 6 months after THA surgery, 2 were lost to follow up; 1 had recurrent SUI at 1 year and 1 had mesh erosion, 1 died of other diseases, and operative complications were absent after surgery. CONCLUSIONS: THA surgery is an effective method for treating recurrent or persistent SUI after primary MUSs. It is cheap, efficient, and easy to handle.

The comparison of an inexpensive-modified transobturator vaginal tape versus TVT-O procedure for the surgical treatment of female stress urinary incontinence.

OBJECTIVE: To compare the safety and efficacy of an inexpensive-modified transobturator vaginal tape procedure with the transobturator tension-free vaginal tape (TVT-O) procedure for the surgical treatment of female stress urinary incontinence (SUI). MATERIALS AND METHODS: Patients with SUI were randomly allocated to either the test group receiving the inexpensive-modified transobturator vaginal tape procedure or the control group receiving the GYNECARE TVT-O procedure. Treatment outcomes and Quality-of-life scores were recorded and analyzed between two groups. RESULTS: A total of 156 patients were enrolled in this trial. Eighty patients underwent the modified transobturator vaginal tape procedure. Among them 75(93.8%) were cured and 5(6.2%) were improved. The rest of the 76 patients underwent the GYNECARE TVT-O procedure with a 92% (70 of 76) cure rate and an 8% (6 of 76) improvement rate. No inefficient or aggravated cases occurred in both groups. The success rates between groups had no significant statistic difference (p > 0.05). The operative time, blood loss, hospital stay, and medical cost were significantly lower in the test group (p < 0.01); the increases in Quality-of-life scores were comparable between groups. CONCLUSIONS: The modified transobturator vaginal tape procedure is an efficacious and economic surgical treatment for female SUI.

[Clinical research of a butterfly shaped mesh in the treatment of stress urinary incontinence].

OBJECTIVE: To investigate the effect of a butterfly shaped mesh in treatment of stress urinary incontinence (SUI). METHODS: From July 2003 to January 2004, 82 patients with SUI were treated with a butterfly shaped mesh. All patients were followed up at 1st, 3rd, 6th month after operation. According to their complaints, the cure standard of urinary incontinence is that the patient can control micturate by herself. The improved is that the times and volume of urinary incontinence is less than before. The inefficacy is that the patients' symptoms is not improved even more than before. RESULTS: All patients were operated under local anesthesia. Mean operation time was (27 +/- 9) min, and mean blood loss was (21 +/- 6) ml. Seventy two patients were able to micturate spontaneously at 2nd hour after operation and the volume of residual urine was less than 100 ml after 24 hour behind operation. They were discharged on the next day. 10 patients, an in-dwelling catheter had been used for 48 hours because the volume of residual urine was more than 100 ml. Seventy eight of 82 patients had no signs of stress incontinence. The remaining 4 patients with apoplexy history showed leakage of urine slightly. But their signs were improved obviously after a month. Seventy six patients had been followed up for from 1 to 6 month: 74 patients were completely cured, and the other 2 patients were improved. No urine retention, infection or bladder dysfunction were observed. CONCLUSION: A butterfly shaped mesh is effective, simple and safe procedure to treat stress urinary incontinence.