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Urethro-raphy — a new technique for surgical management of stress urinary incontinence (SUI)
THURSDAY,
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FC4.13.06 MORPHOLOGIC ENDOMETRIAL STUDIES OF ADULT RATS SUBMITTED TO CONTINUOUS LIGHT AND AFTER MELATONIN ADMINISTRATION m EI Hinoue, CE Lang, JM Soares Jr, MJ SimBes, G
Rodrigues de Lima, EC Baracat Department of Gynecology Federal University of SBo Paula, Escola Paul&a de Medicina, SBo Paula, Brazil. Objective: The aim of this work was to evaluate the morphological endometrial changes of adult rats submitted to continuous light and after melatonin administration. Study Methods: Thirty adult rats were divided in three groups after three normal cycles: GI control group; GII rats submitted to continues light; GIII rats submitted to continues light and received melatonin in their drink water (40pgiliter). The water was only given during 12h in each group in the same schedule. All animals were also submitted to vaginal smear diary to feature estral cycle. After three months, all animals in estrous phase were sacrificed and the uterus was removed and fixed in 10% formaldehyde. The material was proceed and colored by H.E. and Masson Trichrome. Results: The superficial glandular epithelium and stroma cells showed well development with squamous metaplasia in GII compared with GI. In GIII, we do not find significant cell changes when they were compared with GI. Conclusion: Melatonin replacement may block the continuous light effect under the endometrium of adult rats.
FC4.13.07 INFLUENCE OF ALLOIMMUNIZATION ON THE CELLULAR AND HUMORAL IMMUNE RESPONSE IN WOMEN WITH RSA OF UNKNOWN CAUSE. O. National Medical University, OstrovskogolS, apt.69,
Kiev, Ukraine. Objective: There are many evidences that cellular and humoral immune response during pregnancy are changed in women with history of reccurent spontaneous abortion (RSA) of unknown cause. The aim of this study was to evaluate the influence of immunotherapy with paternal leucocytes and conventional treatment on immune response in women with RSA. Methodes: We have investigated immunophenotypic profiles of peripheral blood leukocytes ( CD 3+, CD 4+, CD 8+, CD 56+) and levels of immunoglobulins (IgG, Ig M, IgA) before and 2 weeks after treatment in pregnant women with RSA. Patients with abortions owing to genetic, structural, endocrine, infections and autoimmune causes were excluded from our study. We studied 10 pregnant with RSA who were treated by alloimmunization with paternal leukocytes (I group), 15 pregnant with RSA who took conventional therapy (II group), 15 healthy pregnant (control group). Results: Pregnant of I group demonstrated significant increase CD 3+, CD 8+ cells, decrease CD 4+, CD 56+ cells and ratio CD 4+/CD 8+ after alloimmunization. The same data were seen in control group. The level of CD 3+, CD 22+, CD 4+ cells has been found to be unchanged in women of II group after treatment, the level of CD 8+ cells increased, ratio CD4+/CD8+ decreased slightly. Pregnant women with RSA of both groups have demonstrated significant decrease the level of IgM, IgA after treatment. The level of IgG has increased significantly after treatment in women of I group in comparison with slight enhancing of IgG level in women of I group. Conclusion: Immunotherapy results in returning the parameters of cellular and humoral immune response to normal level more significantly than conventional therapy.
FC4.14 STRESS INCONTINCENCE
SEPTEMBER
SURGERY
FC4.14.01 PERIURETHRAL AUTOLOGOUS FAT INJECTION AS A TREATMENT FOR FEMALE STRESS URINARY INCONTINENCE P. Dept. OBIGYN, Sunnybrook & Women’s College Health
Sciences Centre (S&WCHSC), Toronto, ON, Canada, R. Kong, Dept. OBIGYN, S&WCHSC, H. Drutz, Dept. OBIGYN, Mount Sinai Hospital, Toronto, ON, Canada Objective: To evaluate the effectiveness of periurethral autologous fat injection as a treatment for female stress urinary incontinence. Study Methods: Women with stress incontinence were randomized in a double blinded fashion, to receive periurethral injections of either autologous fat (treatment group) or saline (placebo group). Post injection, patients were evaluated monthly for three months, with a validated standardized incontinence questionnaire, a one hour pad test and a cough test. Patients who remained incontinent were offered reinjection using the same initial agent to a maximum of three injections. Every three months post injection, patients were assessed with a standardized questionnaire, a pad test, a cough test, and urodynamics. Those who did not qualify for re-injection at 3 months were then followed at 6, 9, 12, 18, and 24 months (or until failure). Results: Of 68 women enrolled, 35 received fat and 33 received saline injections. Both groups were comparable in baseline parameters. 56 patients completed the study (27 in the fat group and 29 in the placebo group). A total of 189 injections (91 fat, and 98 saline) were performed. At 3 months there was a cure/improved rate of 6127 (22.2%) in the fat group and 6129 (20.7%) in the saline group. Complications included: cystitis (91189 injections), urinary retention (61189 all from the fat injection group), urge incontinence (9168 patients) and pulmonary fat embolism resulting in death (11189 procedures). Conclusions: In this study, periurethral fat injection does not appear to be more efficacious than placebo for the treatment of stress incontinence.
FC4.14.02 URETHRO-RAPHY - A NEW TECHNIQUE FOR SURGICAL MANAGEMENT OF STRESS URINARY INCONTINENCE (SUI) M.A.A. El HemalL I.M. Kandil, M.M. Radwan, Dept. OBIGYN,
Faculty of Medicine, Al Azhar University,
Cairo Egypt
Objectives: A new concept was described in 1996 explaining micturition and urinary continence. It depends on a strong, sound and intact internal sphincter; and an acquired behavior of keeping a high and sympathetic tone. Weakness of the internal sphincter causes SUI. Weakness is mostly due to rupture and/or split of the wall. A new surgical technique to manage SUI is tried (El Hemaly). It depends on trying to repair the rupture in the wall and restore the integrity of the internal sphincter, hence its strength and its ability to maintain urinary continence Study Methods: 60 patients suffering from SUI grade II are evaluated clinically by urodynamics and ultrasonic studies. Urethra-raphy was done with repair of the sphincter wall by longitudinal 5-8 stitches approximating the torn edges together. Lateral ruptures are sutured by separate stitches. Patients were re-evaluated clinically, U.P.P and by US studies 1,6 and 12 months after surgery. Results: 90% success is obtained immediately and during the follow-up period. Conclusions: Urethra-raphy is a simple and effective operation that restores the normal anatomical construction of the internal sphincter, so that it can perform its physiological function.
FC4.14.03 EFFICACY OF LAPAROSCOPIC BLADDER AUTOAUGMENTATION FOR WOMEN WITH DETRUSSOR INSTABILITY AND LOW BLADDER COMPLIANCE A.W.M. Afify (l), M. Rasheed (2)
(1) (2)
Dept. OBIGYN, Banha University Hospital, Banha, Egypt. Dept. of Urology, Tanta University Hospital, Tanta, Egypt.
Objective: The aim of this study was to investigate the outcome of laparoscopic bladder auto-augmentation as a less invasive procedure for
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FC4.13.06 MORPHOLOGIC ENDOMETRIAL STUDIES OF ADULT RATS SUBMITTED TO CONTINUOUS LIGHT AND AFTER MELATONIN ADMINISTRATION m EI Hinoue, CE Lang, JM Soares Jr, MJ SimBes, G
Rodrigues de Lima, EC Baracat Department of Gynecology Federal University of SBo Paula, Escola Paul&a de Medicina, SBo Paula, Brazil. Objective: The aim of this work was to evaluate the morphological endometrial changes of adult rats submitted to continuous light and after melatonin administration. Study Methods: Thirty adult rats were divided in three groups after three normal cycles: GI control group; GII rats submitted to continues light; GIII rats submitted to continues light and received melatonin in their drink water (40pgiliter). The water was only given during 12h in each group in the same schedule. All animals were also submitted to vaginal smear diary to feature estral cycle. After three months, all animals in estrous phase were sacrificed and the uterus was removed and fixed in 10% formaldehyde. The material was proceed and colored by H.E. and Masson Trichrome. Results: The superficial glandular epithelium and stroma cells showed well development with squamous metaplasia in GII compared with GI. In GIII, we do not find significant cell changes when they were compared with GI. Conclusion: Melatonin replacement may block the continuous light effect under the endometrium of adult rats.
FC4.13.07 INFLUENCE OF ALLOIMMUNIZATION ON THE CELLULAR AND HUMORAL IMMUNE RESPONSE IN WOMEN WITH RSA OF UNKNOWN CAUSE. O. National Medical University, OstrovskogolS, apt.69,
Kiev, Ukraine. Objective: There are many evidences that cellular and humoral immune response during pregnancy are changed in women with history of reccurent spontaneous abortion (RSA) of unknown cause. The aim of this study was to evaluate the influence of immunotherapy with paternal leucocytes and conventional treatment on immune response in women with RSA. Methodes: We have investigated immunophenotypic profiles of peripheral blood leukocytes ( CD 3+, CD 4+, CD 8+, CD 56+) and levels of immunoglobulins (IgG, Ig M, IgA) before and 2 weeks after treatment in pregnant women with RSA. Patients with abortions owing to genetic, structural, endocrine, infections and autoimmune causes were excluded from our study. We studied 10 pregnant with RSA who were treated by alloimmunization with paternal leukocytes (I group), 15 pregnant with RSA who took conventional therapy (II group), 15 healthy pregnant (control group). Results: Pregnant of I group demonstrated significant increase CD 3+, CD 8+ cells, decrease CD 4+, CD 56+ cells and ratio CD 4+/CD 8+ after alloimmunization. The same data were seen in control group. The level of CD 3+, CD 22+, CD 4+ cells has been found to be unchanged in women of II group after treatment, the level of CD 8+ cells increased, ratio CD4+/CD8+ decreased slightly. Pregnant women with RSA of both groups have demonstrated significant decrease the level of IgM, IgA after treatment. The level of IgG has increased significantly after treatment in women of I group in comparison with slight enhancing of IgG level in women of I group. Conclusion: Immunotherapy results in returning the parameters of cellular and humoral immune response to normal level more significantly than conventional therapy.
FC4.14 STRESS INCONTINCENCE
SEPTEMBER
SURGERY
FC4.14.01 PERIURETHRAL AUTOLOGOUS FAT INJECTION AS A TREATMENT FOR FEMALE STRESS URINARY INCONTINENCE P. Dept. OBIGYN, Sunnybrook & Women’s College Health
Sciences Centre (S&WCHSC), Toronto, ON, Canada, R. Kong, Dept. OBIGYN, S&WCHSC, H. Drutz, Dept. OBIGYN, Mount Sinai Hospital, Toronto, ON, Canada Objective: To evaluate the effectiveness of periurethral autologous fat injection as a treatment for female stress urinary incontinence. Study Methods: Women with stress incontinence were randomized in a double blinded fashion, to receive periurethral injections of either autologous fat (treatment group) or saline (placebo group). Post injection, patients were evaluated monthly for three months, with a validated standardized incontinence questionnaire, a one hour pad test and a cough test. Patients who remained incontinent were offered reinjection using the same initial agent to a maximum of three injections. Every three months post injection, patients were assessed with a standardized questionnaire, a pad test, a cough test, and urodynamics. Those who did not qualify for re-injection at 3 months were then followed at 6, 9, 12, 18, and 24 months (or until failure). Results: Of 68 women enrolled, 35 received fat and 33 received saline injections. Both groups were comparable in baseline parameters. 56 patients completed the study (27 in the fat group and 29 in the placebo group). A total of 189 injections (91 fat, and 98 saline) were performed. At 3 months there was a cure/improved rate of 6127 (22.2%) in the fat group and 6129 (20.7%) in the saline group. Complications included: cystitis (91189 injections), urinary retention (61189 all from the fat injection group), urge incontinence (9168 patients) and pulmonary fat embolism resulting in death (11189 procedures). Conclusions: In this study, periurethral fat injection does not appear to be more efficacious than placebo for the treatment of stress incontinence.
FC4.14.02 URETHRO-RAPHY - A NEW TECHNIQUE FOR SURGICAL MANAGEMENT OF STRESS URINARY INCONTINENCE (SUI) M.A.A. El HemalL I.M. Kandil, M.M. Radwan, Dept. OBIGYN,
Faculty of Medicine, Al Azhar University,
Cairo Egypt
Objectives: A new concept was described in 1996 explaining micturition and urinary continence. It depends on a strong, sound and intact internal sphincter; and an acquired behavior of keeping a high and sympathetic tone. Weakness of the internal sphincter causes SUI. Weakness is mostly due to rupture and/or split of the wall. A new surgical technique to manage SUI is tried (El Hemaly). It depends on trying to repair the rupture in the wall and restore the integrity of the internal sphincter, hence its strength and its ability to maintain urinary continence Study Methods: 60 patients suffering from SUI grade II are evaluated clinically by urodynamics and ultrasonic studies. Urethra-raphy was done with repair of the sphincter wall by longitudinal 5-8 stitches approximating the torn edges together. Lateral ruptures are sutured by separate stitches. Patients were re-evaluated clinically, U.P.P and by US studies 1,6 and 12 months after surgery. Results: 90% success is obtained immediately and during the follow-up period. Conclusions: Urethra-raphy is a simple and effective operation that restores the normal anatomical construction of the internal sphincter, so that it can perform its physiological function.
FC4.14.03 EFFICACY OF LAPAROSCOPIC BLADDER AUTOAUGMENTATION FOR WOMEN WITH DETRUSSOR INSTABILITY AND LOW BLADDER COMPLIANCE A.W.M. Afify (l), M. Rasheed (2)
(1) (2)
Dept. OBIGYN, Banha University Hospital, Banha, Egypt. Dept. of Urology, Tanta University Hospital, Tanta, Egypt.
Objective: The aim of this study was to investigate the outcome of laparoscopic bladder auto-augmentation as a less invasive procedure for
7