- Email: [email protected]
Concomitant pelvic reconstructive surgery and transobturator tape for stress urinary incontinence
BRIEF COMMUNICATIONS Table 1
47
Eph B4 and Ephrin B2 expression according to clinicopathologic characteristics of patients with cervical carcinoma
Characteristic
Age, years < 40 ≥ 40 FIGO stage Stage I Stage II Stage III Histotype SCC Adenocarcinoma Tumor grade G1 G2 G3 Tumor diameter < 4 cm ≥ 4 cm Lymphatic metastasis Yes No
No. of patients
Eph B4
Ephrin B2
++ staining, no. (%)
χ
P value
++ staining, no. (%)
χ2
P value
41 49
25 (61.0) 33 (67.3)
0.40
0.53
32 (78.0) 36 (73.5)
0.25
0.62
34 30 26
18 (52.9) 18 (60.0) 22 (84.6)
6.84
0.03
1.69
0.43
72 18
44 (71.0) 14 (72.5)
0.32
0.57
4.87
0.03
24 38 28
17 (70.8) 24 (63.16) 17 (60.7)
0.63
0.73
1.31
0.52
62 28
34 (54.8) 24 (85.7)
8.03
0.005
42 (67.7) 26 (92.9)
6.59
0.010
18 72
12 (66.7) 46 (63.9)
0.048
0.83
14 (77.8) 54 (75.6)
0.06
0.81
2
24 (70.6) 22 (73.3) 22 (75.6) 58 (80.6) 10 (55.6) 19 (79.2) 30 (78.9) 19 (67.9)
Abbreviation: SCC, squamous cell carcinoma.
Concomitant pelvic reconstructive surgery and transobturator tape for stress urinary incontinence M.J. Jeon, S.K. Kim, S.W. Bai ⁎ Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea Received 11 August 2006; received in revised form 13 September 2006; accepted 19 September 2006
KEYWORDS Transobturator tape; Pelvic reconstructive surgery; Stress urinary incontinence
⁎ Corresponding author. Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Shinchon-dong 134 Seodaemun-gun, Seoul, 120-752, Korea. Tel.: +82 2 2228 2230; fax: +82 2 313 8357. E-mail address: [email protected] (S.W. Bai). doi:10.1016/j.ijgo.2006.09.024
Since Delorme E introduced transobturator tape (TOT) as a new minimally invasive surgical technique for stress urinary incontinence (SUI) in 2001 [1], it has been popularly used and seems to have comparable cure rates and lower intraoperative and postoperative complications compared with tension-free vaginal tape [2]. However, there is no well-designed report on the safety of TOT done concomitantly with pelvic reconstruction. The aim of this study was to compare the outcomes when TOT was done alone and when done concomitantly with pelvic reconstructive surgery in patients with SUI and to evaluate whether pelvic reconstructive surgery affects the outcome of TOT. The study population consisted of a total of 125 patients who were diagnosed as urodynamic stress incontinence,
48 Table 1 surgery
BRIEF COMMUNICATIONS Concomitantly performed pelvic reconstructive
Problems
Procedure
Number
Anterior repair Posterior repair Anterior and posterior repair Anterior and posterior repair + paravaginal repair Anterior and posterior repair + iliococcygeal hitch with mesh Posterior repair + iliococcygeal hitch with mesh Posterior repair + abdominosacral colpopexy with mesh Total
1 19 6 3
Table 2
Table 3
17 1 17 64
Overall cure rates of SUI
Follow-up months
TOT alone (n = 61)
TOT with pelvic reconstructive surgery (n = 64)
p-value
1 month 3 months 6 months 12 months
61 (100%) 58 (95.08%) 56 (91.88%) 54 (88.52%)
63 59 59 56
1.000 0.718 1.000 0.860
(98.44%) (92.19%) (92.19%) (87.50%)
Postoperative complications Follow-up TOT alone TOT with pelvic p-value months (n = 61) reconstructive surgery (n = 64)
Voiding Immediate 10 (16.39%) 19 (29.69%) difficulty 1 month 14 (22.95%) 15 (23.40%) 3 months 9 (14.75%) 9 (14.06%) 6 months 5 (8.2%) 6 (9.38%) 12 months 3 (4.91%) 6 (9.38%) De novo Immediate 0 0 urgency 1 month 7 (11.48%) 4 (6.25%) 3 months 6 (9.84%) 5 (7.81%) 6 months 4 (6.56%) 3 (4.69%) 12 months 4 (6.56%) 2 (3.12%) UTI Immediate 0 1 (1.56%) 1 month 1 (1.64%) 3 (4.69%) 3 months 1 (1.64%) 0 6 months 4 (6.56%) 2 (3.12%) 12 months 2 (3.28%) 3 (4.69%) Hematoma Immediate 1 (1.64%) 0 1 month 1 (1.64%) 0 3 months 0 0 6 months 0 0 12 months 0 0
0.078 0.949 0.912 0.816 0.493 0.303 0.690 0.713 0.432 1.000 0.619 0.488 0.432 1.000 0.4880 0.4880
Abbreviations: UTI, urinary tract infection.
Abbreviations: SUI, stress urinary incontinence; TOT, transobturator tape.
underwent TOT (polypropylene, Iris), and have received proper follow-ups up to 1 year at the Department of Obstetrics and Gynecology, Yonsei Medical Center, between March 2004 and June 2005. Patients were followed up at postoperative 1, 3, 6, and 12 months, and urinary symptoms and other problems were assessed at each visit. Cure was defined as an absent subjective complaint of leakage and an absence of urinary leakage on a cough stress test with full bladder. Voiding difficulty was defined as urinary retention or weak urine stream, which required medical or surgical intervention. De novo urgency, urinary tract infection, vaginal mesh erosion and hematoma were also evaluated. The Student's t-test, χ2-test, and Fisher's exact test were used for statistical analysis. Sixty-one patients underwent TOT alone and 64 received TOT with pelvic reconstructive surgery. Mean age (51.61 vs. 59.63 years, p < 0.0001), mean parity (2.46 vs. 3.25, p = 0.0007), menopause (39.34% vs 75.00%, p < 0.0001) and hormone replacement therapy status (50.00% vs 18.75%, p = 0.006) were different between the two groups. Other
patients' characteristics and the results of preoperative urodynamic studies showed no significant difference between the two groups. Concomitantly performed pelvic reconstructive surgeries are listed in Table 1. The cure rates in the TOT alone group and concomitant surgery group at postoperative 1, 3, 6, and 12 months were 100% vs. 98.44%, 95.08% vs. 92.19%, 91.80% vs. 92.19%, and 88.52% vs. 87.50%, respectively, with no significant differences (Table 2). Even though the immediate postoperative voiding difficulty was more frequent in the concomitant surgery group (16.39% vs. 29.69%, p = 0.078), there were no significant differences in all kinds of complications between the two groups (Table 3). TOT can be safely performed with concomitant pelvic reconstructive surgery.
References [1] Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001;11:1306–13. [2] Mellier G, Benayed B, Bretones S, Pasquier JC. Suburethral tape via the obturator route: is the TOTa simplification of the TVT? Int Urogynecol J Pelvic Floor Dysfunct 2004;15:227–32.
47
Eph B4 and Ephrin B2 expression according to clinicopathologic characteristics of patients with cervical carcinoma
Characteristic
Age, years < 40 ≥ 40 FIGO stage Stage I Stage II Stage III Histotype SCC Adenocarcinoma Tumor grade G1 G2 G3 Tumor diameter < 4 cm ≥ 4 cm Lymphatic metastasis Yes No
No. of patients
Eph B4
Ephrin B2
++ staining, no. (%)
χ
P value
++ staining, no. (%)
χ2
P value
41 49
25 (61.0) 33 (67.3)
0.40
0.53
32 (78.0) 36 (73.5)
0.25
0.62
34 30 26
18 (52.9) 18 (60.0) 22 (84.6)
6.84
0.03
1.69
0.43
72 18
44 (71.0) 14 (72.5)
0.32
0.57
4.87
0.03
24 38 28
17 (70.8) 24 (63.16) 17 (60.7)
0.63
0.73
1.31
0.52
62 28
34 (54.8) 24 (85.7)
8.03
0.005
42 (67.7) 26 (92.9)
6.59
0.010
18 72
12 (66.7) 46 (63.9)
0.048
0.83
14 (77.8) 54 (75.6)
0.06
0.81
2
24 (70.6) 22 (73.3) 22 (75.6) 58 (80.6) 10 (55.6) 19 (79.2) 30 (78.9) 19 (67.9)
Abbreviation: SCC, squamous cell carcinoma.
Concomitant pelvic reconstructive surgery and transobturator tape for stress urinary incontinence M.J. Jeon, S.K. Kim, S.W. Bai ⁎ Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea Received 11 August 2006; received in revised form 13 September 2006; accepted 19 September 2006
KEYWORDS Transobturator tape; Pelvic reconstructive surgery; Stress urinary incontinence
⁎ Corresponding author. Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Shinchon-dong 134 Seodaemun-gun, Seoul, 120-752, Korea. Tel.: +82 2 2228 2230; fax: +82 2 313 8357. E-mail address: [email protected] (S.W. Bai). doi:10.1016/j.ijgo.2006.09.024
Since Delorme E introduced transobturator tape (TOT) as a new minimally invasive surgical technique for stress urinary incontinence (SUI) in 2001 [1], it has been popularly used and seems to have comparable cure rates and lower intraoperative and postoperative complications compared with tension-free vaginal tape [2]. However, there is no well-designed report on the safety of TOT done concomitantly with pelvic reconstruction. The aim of this study was to compare the outcomes when TOT was done alone and when done concomitantly with pelvic reconstructive surgery in patients with SUI and to evaluate whether pelvic reconstructive surgery affects the outcome of TOT. The study population consisted of a total of 125 patients who were diagnosed as urodynamic stress incontinence,
48 Table 1 surgery
BRIEF COMMUNICATIONS Concomitantly performed pelvic reconstructive
Problems
Procedure
Number
Anterior repair Posterior repair Anterior and posterior repair Anterior and posterior repair + paravaginal repair Anterior and posterior repair + iliococcygeal hitch with mesh Posterior repair + iliococcygeal hitch with mesh Posterior repair + abdominosacral colpopexy with mesh Total
1 19 6 3
Table 2
Table 3
17 1 17 64
Overall cure rates of SUI
Follow-up months
TOT alone (n = 61)
TOT with pelvic reconstructive surgery (n = 64)
p-value
1 month 3 months 6 months 12 months
61 (100%) 58 (95.08%) 56 (91.88%) 54 (88.52%)
63 59 59 56
1.000 0.718 1.000 0.860
(98.44%) (92.19%) (92.19%) (87.50%)
Postoperative complications Follow-up TOT alone TOT with pelvic p-value months (n = 61) reconstructive surgery (n = 64)
Voiding Immediate 10 (16.39%) 19 (29.69%) difficulty 1 month 14 (22.95%) 15 (23.40%) 3 months 9 (14.75%) 9 (14.06%) 6 months 5 (8.2%) 6 (9.38%) 12 months 3 (4.91%) 6 (9.38%) De novo Immediate 0 0 urgency 1 month 7 (11.48%) 4 (6.25%) 3 months 6 (9.84%) 5 (7.81%) 6 months 4 (6.56%) 3 (4.69%) 12 months 4 (6.56%) 2 (3.12%) UTI Immediate 0 1 (1.56%) 1 month 1 (1.64%) 3 (4.69%) 3 months 1 (1.64%) 0 6 months 4 (6.56%) 2 (3.12%) 12 months 2 (3.28%) 3 (4.69%) Hematoma Immediate 1 (1.64%) 0 1 month 1 (1.64%) 0 3 months 0 0 6 months 0 0 12 months 0 0
0.078 0.949 0.912 0.816 0.493 0.303 0.690 0.713 0.432 1.000 0.619 0.488 0.432 1.000 0.4880 0.4880
Abbreviations: UTI, urinary tract infection.
Abbreviations: SUI, stress urinary incontinence; TOT, transobturator tape.
underwent TOT (polypropylene, Iris), and have received proper follow-ups up to 1 year at the Department of Obstetrics and Gynecology, Yonsei Medical Center, between March 2004 and June 2005. Patients were followed up at postoperative 1, 3, 6, and 12 months, and urinary symptoms and other problems were assessed at each visit. Cure was defined as an absent subjective complaint of leakage and an absence of urinary leakage on a cough stress test with full bladder. Voiding difficulty was defined as urinary retention or weak urine stream, which required medical or surgical intervention. De novo urgency, urinary tract infection, vaginal mesh erosion and hematoma were also evaluated. The Student's t-test, χ2-test, and Fisher's exact test were used for statistical analysis. Sixty-one patients underwent TOT alone and 64 received TOT with pelvic reconstructive surgery. Mean age (51.61 vs. 59.63 years, p < 0.0001), mean parity (2.46 vs. 3.25, p = 0.0007), menopause (39.34% vs 75.00%, p < 0.0001) and hormone replacement therapy status (50.00% vs 18.75%, p = 0.006) were different between the two groups. Other
patients' characteristics and the results of preoperative urodynamic studies showed no significant difference between the two groups. Concomitantly performed pelvic reconstructive surgeries are listed in Table 1. The cure rates in the TOT alone group and concomitant surgery group at postoperative 1, 3, 6, and 12 months were 100% vs. 98.44%, 95.08% vs. 92.19%, 91.80% vs. 92.19%, and 88.52% vs. 87.50%, respectively, with no significant differences (Table 2). Even though the immediate postoperative voiding difficulty was more frequent in the concomitant surgery group (16.39% vs. 29.69%, p = 0.078), there were no significant differences in all kinds of complications between the two groups (Table 3). TOT can be safely performed with concomitant pelvic reconstructive surgery.
References [1] Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001;11:1306–13. [2] Mellier G, Benayed B, Bretones S, Pasquier JC. Suburethral tape via the obturator route: is the TOTa simplification of the TVT? Int Urogynecol J Pelvic Floor Dysfunct 2004;15:227–32.