Factors influencing the outcome of a no incision endoscopic urethropexy

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Cìtations from the Literature

pressure protïlometry demonstrated a pressure depression or biphasic curve in al1 nine cases with diverticula. Stress incontinence was noted in one of these nine women. A biphasic curve was also noted in one woman with a Skene duet cyst and in the one who had genuine stress incontinence only. According to preset criteria for protïlometry, excision was the planned operative procedure for all. Conclusions: Cystourethroscopy and voiding cystourethrography were satisfactory techniques for diagnosing urethral diverticula and planning appropriate surgical treatment. The urethra1 pressure profile conflrmed the presence of a diverticulum, but noted pressure depressions in cases other than diverticula. Erofilometry did not change the surgical plan for treating diverticula, but allowed the planning of additional incontinence surgery in one patient. Faetom InfIneneIng the outcome of a w incision endoscopic metbropexy Kursh ED Division of Vrology. 2074 Abington Road, Cleveland, OH 44106, USA SURG GYNECOL OBSTET 1992 175/3 (254-258) A urethropexy without incision has been used in 108 women with a minimmn of 1 year follow-up evaluation. Most of the patients (81%) experienced postoperative urinary retention, with the mean period of retention being 22 days. The cure rate was 81.5%. The technique was successful in women with grade 1 stress urinaty incontinence (97%), but not as effective in women with high grade stress incontinence (45.5% in women with grade 111 stress urinary incontinence). The success rate, therefore, correlated signillcantly with the grade of incontinence (P 0.001). It is noteworthy that there were no failures in 36 women who were premenopausal and the cure rate of 72% in the postmenopausal group represented a significant reduction (P 0.001). The approach without incision is often effective in patients who have failed previous anti-incontinence procedures, with a cure rate of 82% in 22 women in this category, but most patients with a successful outcome in the more complex instances of stress urinary incontinence were also noted to be premenopausal. These data suggest that the success of the repair is dependent on the strength and integrity of the vaginal mucosa. When using the no incision technique, it is advisable to avoid the use of foreign body material in the suprapubic stab sites because of the high incidence of infection and tender nodules. CempwbmoofsBasticrhIgsandeleetrocorgpln tionfor lapar* scopic tld)eI Iigation lmder IocaI anesthh Lipscomb GH, Stovall TG, Ramanathan JA; Ling FW Department Obstetrics and Gynecology, Vniversity of Tennessee, 853 Jefferson Avenue, Memphis, TN 38163, USA OBSTET GYNECOL 1992 80/4 (645-649) Objective: To compare objectively the pain associated with tuba1 occlusion by Silastic rings versus lectrocoagulation during laparoscopic tubal ligation under lccal anesthesia. Methods: Consecutive patients scheduled for laparoscopic tuba1 ligation under local anesthesia were randomixed to Silastic rings (N = 50) or electrocoagulation (N = 52) as the Int J Gynecol Obstet 41

method of tubal occlusion. Sterilixation was performed under local anesthesia in a standard fashion. Bupivacaine 0.5% was used as the local anesthetic agent. Opemtive pain was measured based on intraoperative anesthesia requirements and a modifled McGill pain questionnaire. This questionnaire was used to assess pain at 15 min, 1 h, and 24 h postoperatively. Results: Demographics were similar for the two groups. Operative time was shorter in the Silastic-ring group (16.7 vs. 21.8 min; P = O.OOl),and this group also required less intraoperative anesthesia (P = 0.004). There were no statistical differences between the groups in self-reported pain intraoperatively or postoperatively. NO patient in either group required antiemetics or pain medication in the recovery room. Conclusion: Silastic rings appear preferable to bipolar electrocoagulation for laparoscopic tubal sterilixation under local anesthesia when long-acting local agents are used for tubal anesthesia. Uterlne dehleceoce followlng laparoxopic myomeetomy Harris WJ Regio& Medical Center, James H. Quillen Coll. of Medicine. Eust Tennessee State Vniversity, Bristol, TN, USA OBSTET GYNECOL 1992 80/3 11(545-546) Background: Laparoscopic myomectomy is a new procedure that is growing in popularity. The natura1 history of pregnancy following roscopic myomectomy is unknown. Case: A 24yearold white woman, gravida 0, with infertility and endometriosis, conceived after a laparoscopic procedure that included myomectomy. At 34 weeks’ gestation, the patient experienced uterine dehiscence at the site of myomectomy. An emergency cesarean delivery was perfonned and the uterus was oversewn. Both mother and infant had satisfactory hospita1 courses. Conclusion: Meticulous closure of the myometrial bed following myomectomy is difficult via the laparoscope, and this could interfere with the integrity of the star. If further studies contïrm this experience, then laparoscopic myomectomy may need to be limited to patients who do not desire further childbearing. Laparoscopic

repairof

ureter rescted

doriog operative

~lwoseopY Nexhat C; Nezhat F 5555 Peachtree Dunwoody Road NE, Atlanta, GA 30342, USA OBSTET GYNECOL 1992 80/3 11(543-544) Ureteral injury is a recognized complication of gynecologic surgery. During operative laparoscopy performed to treat extensive endometriosis of the pelvic sidewall, a 1.5-cm portion of the right ureter was resected and was repaired successfully. Repair of a resected ureter may be effectively accomplished endoscopically by experienced operative laparoscopists. Hysteroscopic eodometrial ablation osing tbe rollerball electrode Daniell JF; Kurtz BR; Ke RW 2222 Stare Streef, Nashville, TN 37203, USA OBSTET GYNECOL 1992 80/3 1 (329-332) Objective: To assess the efficacy of hysteroscopic endometrial ablation with the rollerball resectoscope. Methods: From April 1989 to March 1991, 64 women underwent hysteroscopic endometrial ablation using electrosurgery. Tele-