43: Outcome Measures and Definition of Cure in Female Stress Urinary Incontinence Surgery

Oral Presentations temperature, pain, analgesia requirements and time in hospital was collected. A questionnaire was completed 24 hrs after the operation, detailing pain and analgesia requirements. There was a trend towards reduced post-operative pain and analgesia requirements in the treatment group, although this was not statistically significant. There were no statistically significant differences between the two groups with respect to body temperature, time in recovery or time in hospital. Pain scores 24 hours after the operation were similar between the two groups. Conclusion: Heated, humidified carbon dioxide is postulated to reduce tissue dessication, subsequent inflammation and therefore pain. Although our study suggested a trend towards reduced pain in the treatment group, this finding was not significant. Further studies are planned to clarify this relationship, especially with regards the effect of heated humidified carbon dioxide on prolonged operative laparoscopy. 43 Outcome Measures and Definition of Cure in Female Stress Urinary Incontinence Surgery Castillo P. Cleveland Clinic Florida, Weston, Florida Study Objective: To evaluate outcome measures utilized in defining success following anti-incontinence procedures for stress urinary incontinence in females. Design: A Medline search of indexed peer review journals between January 2005 and December 2006 was performed. Criteria for articles included in this study were based on primary surgical treatment of female stress incontinence. Non-indexed journals, case reports, studies involving treatment of male stress incontinence, studies that did not focus on post surgical outcome and non-surgical management of failed anti-incontinence procedures were excluded from this review. Data including mean follow-up, specific outcome measures used, success rates and definition of cure in each study were tabulated and analyzed. Measurements and Main Results: A total of 88 published studies from 26 journals by 80 principal authors were reviewed including 17 randomized control trials, 28 retrospective studies, and 43 prospective cohort studies. The number of patients in each study ranged from 4 – 809 with a mean follow-up range of 1–96 months. Outcome measures utilized and definitions of cure from these studies are tabulated. Of the objective outcomes measures described, Cough Stress Test (all variations) was used in 46 (52%), Pad Test (all variations) was used in 20 (23%), Urodynamics was used in 21 (24%), and a Combination was used in 10 (11%). Subjective outcome mesures described include Self assessment 44 (50%), Voiding Diary 2 (2.3%), Questionnaires Validated 31 (35%), Questionnaires Non-validated 19 (22%), and QOL questionnaires 33(38). When definition of cure was analyzed, 4 (5%) used Subjective Only, 28 (32%) used Objective Only, and 56 (64%) used a Combination. Conclusion: This review strongly suggests the need for consensus or standardization in the choice of outcome mea-

S17 sures and method of defining cure following anti-incontinence procedures.

44 Endometrial Cytology and Office Hysteroscopy: A Pilot Study Ceci O, Resta L, Pontrelli G, Achilarre M. Bari, Italy Study Objective: Currently endometrial cytology technique includes use of brush. This technique induces easily bleeding from the mucosa and the samples are often overlapped by red cells. Moreover samples can be unsatisfactory when endometrium is thin. We performed hysteroscopy using saline solution as distension media. The collection of this fluid may represent valuable material for cytological assessment. Design: Women referred with diagnosis of endometrial adenocarcinoma after uterine curettage and asymptomatic patients on tamoxifen for breast cancer with increased endometrial thickness at ultrasound (⬎ 5 mm) were considered for this study. All patients underwent office hysteroscopy to evaluate the endometrial cavity. A sample of endometrial fluid was collected during the procedure to assess the endometrial cytology. Setting: University teaching hospital. Patients: Nine patients with diagnosis of endometrial adenocarcinoma, and seven patients on tamoxifen were recruited. Intervention: After the introduction of the continuous flow hysteroscope in the uterine cavity, the first 10 cc of distension medium were collected from the outer out-flow sheath using a syringe and then fixed with alcohol. The sample was processed in monolayer by Thin-Prep. A biopsy of endometrial tissue was used as gold standard. The pathologist was blind to actual diagnoses. Measurements and Main Results: The cytological assessment confirmed the presence of adenocarcinoma cells in 8 out of 9 cases. In the tamoxifen group, no cytological alteration was found whereas biopsies revealed five cases of cystic atrophy and two endometrial polyps. Conclusion: The endometrial cytology gives a global appraisal of the endometrial mucosa, while the eye-targeted endometrial biopsy gives a specific sample of a focal lesion. Therefore, the two techniques seem to be complementary rather than competitive. Moreover assessment of the flowing-back saline solution for endometrial cytology can provide useful information in cases of thin endometrium where the biopsy often turns out to be difficult and unsatisfactory. 45 A Multicentered Series of 750 Daycase Laparoscopic Subtotal Hysterectomies in the UK and Greece: The New Approach to Hysterectomy 1 Chandakas S, 2Erian J. 1Attikon Hospital, University of Athens, Greece; 2Princess Royal University Hospital London, United Kingdom