[Analysis of the results of urinary incontinence treatment in women using free suburethral synthetic sling: the experience of 1000 operations].

The study presents an analysis of the experience of treatment of urinary incontinence in women using free synthetic suburethral sling. Between 2001 and 2008, 1081 patients underwent surgery. Of these, 841 (77.8%) suffered from stress urinary incontinence, 202 (18.62%) suffered from the mixed form of urinary incontinence with a predominance of the stress component, and 38 (3.52%) had recurrent urinary incontinence. Group 1 included patients with stress urinary incontinence who underwent surgery using suburethral synthetic sling with retropubic access (TVT operation); Group 2 included patients, who underwent surgery using suburethral sling implanted with transobturator access (TVT-O operation). Group 3 consisted of patients with mixed urinary incontinence, who underwent TVT-O operation. Retropubic suburethral TVT sling was implanted in 273 (25.25%) patients, transobturator TVT-O sling--in 740 (68,45%) patients, and other synthetic suburethral slings--in 68 (6.3%) patients. The average follow-up period was 50.1, 31.1 and 32,6 months in each group, respectively. Cough test was used for the objective evaluation of the effectiveness, and visual analogue scale--for the subjective evaluation of effectiveness. In the TVT group, the negative cough test in the postoperative period remained at 85.58% of the patients, and in in TVT-O group--in 84.36% of patients. Analysis of the frequency of intraoperative complications showed that the probability of occurrence of complications was not associated with age, body mass index and obstetric history of patients. It was noted that the perforation of the bladder and pelvic hematoma were more likely to occur when using the retropubic access. Transobturator access is associated with a higher risk of injury of the lateral vaginal fornix, although bladder injury is not ruled out. Objective and subjective indicators of efficacy of treatment of mixed form of urinary incontinence were 86.15 and 87.69%, respectively. The study suggests that the operations using suburethral TVT and TVT-O slings are safe and effective methods of treatment of stress urinary incontinence in women.

[The free synthetic loop in the treatment of urinary stress incontinence in women: comparative analysis of postoperative complications].

Operations with application of a free synthetic loop were made in 504 female patients with urinary stress incontinence (USI). The patients were divided into two groups. Patients after TVT operation, not operated with reconstruction of the pelvic fundus entered group 1 (n = 207). Patients after TVT-0 operations (n = 109) entered group 2. The data were processed with the criterium chi-square, significance was stated in p < = 0.05. The following intra- and postoperative complications were registered: de novo imperative symptoms, pelvic hematoma, perforation of the urinary bladder. The latter complication occurred in 1 (0.48%) patient of group 1 and in none from group 2. Pelvic hematomas were in 2.9 and 0.92% patients, respectively. De novo imperative symptoms were observed in 2.9 and 1.83%, respectively. It was stated that differences in complications between the groups were insignificant. Further multicenter controlled randomized studies are necessary.

[Long-term use of ovestin by postmenopausal women with urinary incontinence]. / Opyt dlitel'nogo primeneniia preparata "Ovestin" u zhenshchin, stradaiushchikh rasstroistvami mocheispuskaniia v postmenopauzal'nom periode.

The aim of the study was to improve diagnosis and treatment of women suffering from clinical manifestations of urogenital atrophy in menopause: stress and urgent urine incontinence, disturbances of urination, recurrent infections of the lower urinary tracts. A total of 237 menopausal women were treated for urogenital atrophy for four years. The age of the patients ranged from 51 to 78 years (mean age 64.5 years). after treatment with ovestin they were followed up for 1 to 2.1 years. It was found that stress incontinence is more common in young women, older females suffer more frequently from urgent and imperative incontinence. Ovestin, as a local replacement therapy, relieved symptoms within the first several days of treatment, the complaints disappeared completely after 25 days of ovestin intake. Side effects (nausea, head ache, breast discomfort) occurred rarely, were mild and disappeared within the first two weeks of the treatment. The conclusion is made that urogenital atrophy is a common disease of postmenopausal women arising as a result of lacking estrogenization of the vagina and adjacent tissues. Urogenital atrophy manifests as stress and urgent urinary incontinence, disurea and recurrent infection of the lower urinary tracts. Ovestin therapy should be given for at least 1.5 months. In positive effect the duration of the treatment is not limited.

[Ovestin in preparation for transvaginal surgeries]. / Ovestin v podgotovke k transvaginal'nym operatsiiam.

The trial of the efficiency of the drug estriol-ovestin in preoperative preparation of patients to transvaginal operations included 118 patients (mean age 48.6 years). 82 patients received ovestin as a vaginal suppository and creams in a daily dose of 500 mu for 2-3 weeks before the operation. 36 control patients did not receive ovestin in their preoperative preparation. Effectiveness of ovestin was assessed by duration of pain symptom in the postoperative period, duration of the vaginal postoperative discharge, duration of dysuria after removal of a urethral catheter, the time of renewal of sexual intercourses. The results of the study proved effectiveness of ovestin in preoperative preparation of patients for vaginal surgery.

[Current aspects in the diagnosis and treatment of chronic cystitis in women]. / Sovremennye aspekty diagnostiki i lecheniia khronicheskogo tsistita u zhenshchin.

Chronic cystitis (CC) in females is annually encountered now in 15,000-20,000 per 1,000,000. Etiological and pathogenetic factors in CC are closely related. Bacteriologically, CC is represented primarily by Enterobacter. The infection, as a rule, ascends the lower urinary tracts. The contributing factors are: weak local antibacterial mechanisms of the urogenital system, anatomical variants and anomalies of the urethra and introitus, sexual activity, impaired urodynamics of the lower urinary tracts. The diagnosis of chronic inflammation of the bladder is made mainly endoscopically, with obligatory endovesical multifocal biopsy of the bladder followed by histological examination. The treatment of CC includes antibacterial, general and local antiinflammatory therapy, measures to normalize urodynamics of the lower urinary tracts, correction of hygienic and sexual factors, immunostimulation. 16 nonresponders to conservative treatment of interstitial cystitis with progressive contraction of the bladder were subjected to supratrigonal or subtotal resection of the bladder with one-stage ileocystoplasty.

[The diagnosis and treatment of ureterovaginal fistulae]. / Diagnostika i lechenie mochetochnikovo-vlagalishchnykh svishchei.

The paper describes 15-year experience gained by the authors in diagnosis and surgical treatment of ureterovaginal fistulas (UVF) in 300 patients. Etiological and pathogenetic mechanisms of this condition were studied. This enabled the authors to develop and introduce into clinical practice the algorithm of UVF diagnosis which employs an optimal complex of diagnosis methods practiced in patients with traumatic ureteral fistulas. The authors emphasized the importance of performing transcutaneous puncture nephrostomy and transperitoneal approach for plastic reconstruction of distal portions of the ureters. Satisfactory outcomes were obtained in 259 (86.3%) patients.

[The indications for a transvesical approach in the surgical treatment of vesicovaginal fistulae]. / Pokazaniia k transvezikal'nomu dostupu pri operativnom lechenii puzyrno-vlagalishchnykh svishchei.

Basing on 139 cases with vesicovaginal fistulas treated, the authors review diagnostic and clinical aspects of these fistulas, the performance of fistuloplasty via transvesical approach. Clear indications for fistuloplasty via transvesical approach have been formulated.

[Experience in the treatment of 152 women with bilateral injuries of the ureter]. / Opyt lecheniia 152 zhenshchin s bilateral'nymi povrezhdeniiami mochetochnikov.

Data on the treatment of 152 women with bilateral injuries to the ureters are presented. Many-year experience gained in the treatment of women with such injuries permitted the authors to single out their main causes and to find the most rational methods of derivation of the urine and develop the treatment policy depending on the type of injury to the ureters, complications of these injuries, and anatomo-functional status of the urinary system. Plastic surgery brought good results in 84.4% of patients.