Long-term follow-up of the outcome of supracervical versus total abdominal hysterectomy.

INTRODUCTION AND HYPOTHESIS: Hysterectomy for benign indications can be performed either as a supracervical or a total procedure. It is controversial whether removing the cervix is beneficial or not. This study aimed at comparing long-term outcomes after supracervical (n = 107) and total (n = 105) abdominal hysterectomy. METHODS: Two prospective questionnaire-based studies were conducted among the original 212 patients operated on between February 1978 and May 1979 at Turku University Hospital, Finland. In the first study in 1997, a nonvalidated questionnaire was mailed to 193 patients to inquire about any postoperative symptoms. In the second study in 2011, a validated questionnaire and an invitation to a follow-up visit were sent to 153 women. During the visit, pelvic support was assessed using the Pelvic Organ Prolapse Quantification system. Additionally, hospital records were reviewed to identify any gynecological operations at both evaluation times. RESULTS: In the first evaluation, the response rate was 94 %, and in the second, the rate was 62 %. Objective evaluation was possible in 75 women in 2011, 37 in the supracervical group and 38 in the total hysterectomy group. There were no significant differences in the rates of subjective urinary and sexual symptoms or subsequent operations for urinary incontinence and genital prolapse between women in the supracervical group and women in the total hysterectomy group. Four patients in the supracervical group required a re-operation: three for a prolapsed cervical stump and one for a cervical abscess. CONCLUSIONS: Supracervical and total hysterectomies resulted in similar postoperative outcomes regarding subjective symptoms and subsequent gynecological operations during a follow-up of 33 years. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ( www.clinicaltrials.gov ): NCT02166749.

Posterior Transvaginal Mesh without Concurrent Surgery: How Does It have an Effect on the Untreated Vaginal Compartment?

BACKGROUND/AIMS: To report objective and subjective outcomes and adverse events after placement of Elevate® Posterior transvaginal mesh without concurrent surgery. Changes in non-affected anterior compartment were under special interest. METHODS: A prospective study of Elevate® Posterior procedure in patients with symptomatic posterior compartment prolapse. Pelvic organ prolapse (POP) quantification (POP-Q) measurements and Pelvic Floor Dysfunction Inventory-20 (PFDI-20) and POP/urinary Incontinence Sexual Questionnaire (PISQ-12) questionnaires were used. Primary outcome was the incidence of de novo anterior prolapse. Secondary outcomes were complication rate and posterior compartment objective and subjective cure. RESULTS: A total of 111 women underwent an Elevate® Posterior mesh procedure and 109 attended a control visit at 3 months. De novo anterior prolapse emerged in 3.2-15% of the women, depending on the definition. Posterior POP-Q stage ≤I was obtained in 92 (84%) women and leading edge at or above the hymen in 107 (98%) women. Bulge symptoms disappeared in 86% of the cases. One (0.9%) mesh exposure was detected. Reoperation rate was 2.8, and 3.7% patients experienced postoperative pain. PFDI-20 and PISQ-12 scores improved significantly. CONCLUSIONS: A trend of de novo prolapse formation in the non-affected vaginal compartment is observed. The Elevate® Posterior method is effective in terms of both objective and subjective outcomes. According to our results, the mesh exposure rate is low.

Tension-free vaginal tape - a suitable procedure for patients with recurrent stress urinary incontinence.

OBJECTIVE: To evaluate the efficacy of the tension-free vaginal tape operation (TVT) in patients with and without previous anti-incontinence surgery. DESIGN: Prospective follow-up study. SETTING: University hospital in Finland. POPULATION: A total of 130 women who had a TVT procedure from August 1998 to December 2002. MAIN OUTCOME MEASURES: Subjective cure, complications and voiding symptoms. METHODS: Sixty women with recurrent (group A) and 70 women with primary stress urinary incontinence (SUI) (group B) were compared. One follow-up visit took place two months postoperatively and a questionnaire-based evaluation was carried out three years after operation. Further information was collected a mean of eight years after the operation. RESULTS: There was no difference in the transient postoperative retention rate (17 vs. 19%, p = 0.78) and number of complications (20 vs. 13%, p = 0.29) between group A and group B. At two months after operation, 85% of patients in group A and 94% in group B were cured of SUI and were satisfied with the operative result (p = 0.096). The satisfaction rates at three years were 86 and 91% in groups A and B, respectively, and cure rate of SUI was 93% in both groups. At follow-up, 20% of the patients in group A and 5.7% in group B (p = 0.013) had de novo urge symptoms and the rate of voiding difficulties increased especially in group B women over time. CONCLUSIONS: TVT results in the same cure and complication rates when performed for primary SUI and recurrent SUI. The procedure is effective and associated with a low and acceptable level of complications. It is well suited to treat also recurrent SUI.

Tension-free vaginal tape and laparoscopic mesh colposuspension for stress urinary incontinence.

OBJECTIVE: To compare objective and subjective outcomes after the tension-free vaginal tape procedure (TVT) with laparoscopic mesh colposuspension as a primary treatment for female stress urinary incontinence. Objective outcome measures were stress test and 48-hour pad test. METHODS: In 6 departments of gynecology in Finland, including 4 university teaching hospitals and 2 central hospitals, 128 women with urodynamic stress incontinence were randomly allocated to 2 treatment groups. Seventy were treated with TVT and 51 by means of laparoscopic mesh colposuspension. There were 7 dropouts. Inclusion criteria were history of stress incontinence, positive stress test, and urodynamic conformation of stress incontinence. Exclusion criteria were age older than 70 years, previous incontinence surgery, more than 3 episodes of urinary tract infection within the last 2 years, coincident other gynecological surgery, body mass index more than 32 kg/m(2), urethral closure pressure less than 20 cm H(2)O, and residual volume more than 100 mL in preoperative urodynamic evaluation. Assessment took place before treatment and at 12 months postoperatively with the cough stress test, Urge Score, 48-hour pad test, King's College Health Questionnaire, Visual Analog Scale, and Urinary Incontinence Severity Score. RESULTS: When negative stress test was used as criteria for cure, 85.7% of women in the TVT group and 56.9% in the laparoscopic mesh colposuspension group were objectively cured. Subject satisfaction was significantly better after the TVT procedure than after laparoscopic mesh colposuspension. CONCLUSION: Treatment with TVT results in higher objective and subjective cure rates at 1 year than treatment by means of laparoscopic mesh colposuspension.

Concomitant vaginal surgery did not affect outcome of the tension-free vaginal tape operation during a prospective 3-year followup study.

PURPOSE: We compare outcomes when vaginal surgery and a tension-free vaginal tape (TVT) operation were done concomitantly and when only a TVT operation was done in patients with stress or mixed urinary incontinence. MATERIALS AND METHODS: Outcomes in 75 consecutive patients who underwent a TVT operation concomitantly with vaginal surgery (group 1) were compared with outcomes in 75 who underwent only a TVT operation (group 2) between August 1998 and June 2000. Group 2 patients were matched for age and incontinence type with group 1 patients. All study subjects had a followup visit to the study hospital 2 months after the operation. Questionnaire based assessments were done 2 and 3 years after the operation. RESULTS: Ten group 1 (13%) and 6 group 2 (8%) patients had a lower urinary tract infection. Other infections occurred after operation in 10 group 1 (13%) and 1 group 2 (1.3%) patients. Four cases (5.3%) of intraoperative bladder perforation occurred in group 1. A total of 15 group 1 (20%) and 7 group 2 (9.3%) patients were treated for transient urinary retention. Two months after the operation 93% of group 1 and 97% of group 2 were free of stress urinary incontinence. The corresponding percents 2 years after operation were 88% and 93%, and at 3 years they were 87% and 92%, respectively. CONCLUSIONS: Complications and transient urinary retention occurred more often after TVT operations and concomitant vaginal surgery than after the TVT operation alone. There were no statistically significant differences in regard to the cure of stress urinary incontinence and incidence of urge symptoms during the 3-year followup.

Hysterectomy for gynaecological cancer: a follow-up study of subjective and objective outcome.

AIMS: To evaluate morbidity and subjective outcome associated with hysterectomy either with or without pelvic or pelvic and para-aortic lymphadenectomy for gynaecological cancer. METHODS: Ninety-nine patients who underwent hysterectomy with lymphadenectomy (n = 38) or simple hysterectomy (n = 61) for ovarian, endometrial and cervical cancer in Turku University Hospital, Turku, Finland, were followed-up prospectively to determine the incidence of complications during a 1-year period after operation. Subjective outcomes were assessed using two questionnaires, 6 weeks and 1 year after operation. Hospital records of the patients were reviewed up to 6 years after operation. RESULTS: During their hospital stay 58% of patients in the hysterectomy with lymphadenectomy group and 56% in the simple hysterectomy group experienced some type of complication. Serious complications occurred in four patients (10.5%) in the former group and in two patients (3.3%) in the latter group. In the study population overall, the incidence of subjective complaints increased from 18% of respondents 6 weeks after operation to 55% 1 year after operation. Most patients (95 and 92%, respectively) remained satisfied with the operation at both times of evaluation. CONCLUSIONS: More than half of the patients experienced morbidity related to surgical treatment for gynaecological cancer. The incidence of complications and subjective complaints were unaffected by the type of operation.

Tension-free vaginal tape and laparoscopic mesh colposuspension in the treatment of stress urinary incontinence: immediate outcome and complications--a randomized clinical trial.

BACKGROUND: The purpose of the study was to evaluate the immediate outcome and complications of the tension-free vaginal tape (TVT) and laparoscopic mesh colposuspension (LC) procedures in the treatment of female stress urinary incontinence (SUI). METHODS: One hundred and twenty-eight patients suffering from urodynamically confirmed SUI were recruited to this multicenter, randomized clinical trial. After randomization there were seven drop-outs--121 patients were operated upon: 70 patients in the TVT group and 51 in the LC group. The patients were evaluated according to the study protocol before operation and 6 weeks after it. The independent sample t-test and the Mann-Whitney U-test were used to calculate statistical differences between the study groups. RESULTS: Immediate cure rates, defined as negative stress test with 300 mL saline in the bladder, were similar (92.9% in the TVT group and 88.2% in the LC group; p = ns). Return to normal voiding was faster in the TVT group (9.2 h in the TVT group vs. 24.4 h in the LC group; p = 0.004). Fewer analgesics were used in the TVT group and hospital stay was shorter in this group. Complication rates associated with the procedures were similar and the number of complications was small. CONCLUSIONS: The immediate outcome of both procedures is the same. The rates of complications were similar. However, the TVT procedure seems to be less invasive and requires fewer hospital resources than LC.