Surgical treatment of stress urinary incontinence using the tension-free vaginal tape-obturator system (TVT-O) technique.

OBJECTIVE: The purpose of the research was to provide a review of the efficacy of the TVT-O technique for the surgical treatment of stress urinary incontinence (SUI) and to assess surgical and postsurgical complications related to this technique. STUDY DESIGN: An initial assessment was carried out on 44 women who underwent TVT-O surgery between 16 September 2004 and 1 February 2005. The follow-ups after 3 and 12 months were attended by 37 and 35 patients, respectively. All 44 patients were included for the statistical estimation of intra- and postoperative complications, whereas improvement in the quality of life was assessed only in those patients who came for a follow-up visit. To assess the efficacy of the treatment, the participants were surveyed using the King questionnaire on the day preceding surgery and during a follow-up visit 3 and 12 months after surgery. The participants whose scores from the two questionnaires changed > or =90% were deemed to be cured. A considerable improvement in quality of life was recorded when the score was 89-75%. With scores of 74-50%, there was a reduction in SI symptoms. However, when the score was 50-0%, no improvement in quality of life was reported, and in participants with scores <0% the quality of life deteriorated. Statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS) V. 10.0, with the Spearman correlation and Chi-squared tests. The results were considered statistically significant when P<0.05. RESULTS: After 12 months, total cure was achieved in 15 participants (42.8%), significant improvement was noted in 6 (17.1%), SUI symptoms abated in 4 (11.4%), no improvement was noted in 7 (20%), and quality of life deteriorated in 3 (8.7%). CONCLUSION: TVT-O surgery is an efficient and reasonably safe method of SUI treatment in women. The ease of use, short duration of surgery and hospitalisation, minor postsurgical discomfort and a small proportion of complications make this method acceptable to patients. With regard to the results of treatment, additional patients should be analysed for a longer period of time.

[HELLP syndrome complicated by liver rupture]. / Pekniecie watroby w zespole HELLP.

The object of our study was the liver rupture as a complication of HELLP syndrome. We described a case of 27-year-old primigravida who underwent the cesarean section because of HELLP syndrome, followed by four laparotomies, due to capsular hematoma and liver rupture. Surgery with packing, argon coagulation or embolization of hepatic artery remain the only treatment for subcapsular hematoma and liver rupture. The main issue is to state the early diagnosis of HELLP syndrome because its clinical presentation at the beginning is very unclear and diagnosis is often delayed. It is important because the morbidity and mortality rates associated with the syndrome have been reported to be as high as 25 percent.