Efficacy of tension-free vaginal tape compared with transobturator tape in the treatment of stress urinary incontinence in women: analysis of learning curve, perioperative changes of voiding function.

BACKGROUND: In this study, by comparing TVT surgery and TOT surgery for stress urinary incontinence in women, the characteristics and learning curves of both operative methods were studied. METHODS: A total of 83 women with stress urinary incontinence treated with tension-free vaginal tape (TVT) (n = 38) or transobturator tape (TOT) (n = 45) at Saiseikai Central Hospital between April 2004 and September 2009 were included. We compare the outcomes and learning curves between TVT surgery and TOT surgery. In statistical analysis, Student's t test, Fisher's exact test, and Mann-Whitney's U test were used. RESULTS: The surgical durations were 37.4 ± 15.7 minutes with TVT surgery and 31.0 ± 8.3 minutes with TOT surgery. A longer period of time was required for TVT surgery (p = 0.025). The residual urine at post-operative day 1 was higher in TVT surgery (25.9 ± 44.2 ml) than in TOT surgery (10.6 ± 19.2 ml) (p = 0.0452). The surgical duration of TVT surgery was shortened after the operator had performed 15 operations (p = 0.019). CONCLUSIONS: In comparison of TVT surgery and TOT surgery, the surgical duration of TVT surgery was longer and the residual urine of TVT surgery was higher at post-operative day 1. Surgical experience could shorten the duration of TVT surgery.

[Assessments of quality of life in women with urinary incontinence using: King's Health Questionnaire and International Consultation on Incontinence Questionnaire-Short Form].

The differences in quality of life (QOL) impairment due to urinary incontinence between elderly and younger women were evaluated using King's Health Questionnaire (KHQ) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The subjects were 313 women who consulted the Women's Urinary Incontinence Clinic of Saiseikai Central Hospital between March, 2005 and January, 2008. They were divided into those below or above the cut-off age of 55, 60 or 65 years. The difference in QOL impairment was greatest when the cut-off age was 60 years. Similar comparisons were made by dividing the subjects into those aged 65-74 years and those aged 75 years and above, but no significant difference was noted in the score of any KHQ domain or ICIQ-SF between the two groups. The stress urinary incontinence occurred in younger women and caused the severest impairment. The response rate to KHQ in this study was low especially in the elderly, but that to ICIQ-SF was as high in the elderly as in younger age group. Social activities and lifestyle change around age 60 were considered to be associated with the change of QOL impairment in women with urinary incontinence. The stress urinary incontinence caused the severest impairment. KHQ was often difficult for the elderly to complete, but, ICIQ-SF seemed to be easy.

[A case of double cancer involving the urachus and the bladder].

A 49-year-old male was referred to our hospital with the chief complaint of gross hematuria. We performed cystoscopy, and found a solid tumor at the dome of the bladder. Sagittal magnetic resonance imaging revealed an extravesical tumor at the position of the urachus. Transurethral resection of bladder tumor was performed. A solid tumor at the dome and two papillary tumors at the right lateral region of the bladder were observed. A pathological examination revealed adenocarcinoma from the solid tumor and urothelial carcinoma from the papillary tumors. Under a diagnosis of double cancer, adenocarcinoma of the urachus and urothelial carcinoma of bladder, we performed a total cystectomy, neobladder and total resection of the urachus.

[Primary small cell carcinoma of the ureter: a case report].

An 84-year-old female was referred to our hospital to be examined for left hydronephrosis. Abdominal pelvic computed tomography and ureteroscopy showed an obstructing mass in the left ureter. A biopsy of the mass revealed the presence of small cell carcinoma. A left nephroureterectomy were thus performed.

[A case of intravesical foreign body with a vesical rupture invading the peritoneal cavity: a case report].

A 63-year-old male presented with an intravesical foreign body. We could not remove it by a transurethral operation. We performed open surgery, and found the urinary bladder to be perforated by a foreign body which invaded the peritoneal cavity. To our knowledge, there were 10 similar cases in Japan.