- Email: [email protected]
Efficacy of laparoscopic bladder autoaugmentation for women with detrussor instability and low bladder compliance
THURSDAY,
46
FC4.13.06 MORPHOLOGIC ENDOMETRIAL STUDIES OF ADULT RATS SUBMITTED TO CONTINUOUS LIGHT AND AFTER MELATONIN ADMINISTRATION MA 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
THURSDAY,
SEPTEMBER 7
treating women with urodynamic diagnosis of detrussor instability or low compliance after failure of conservative management. Study Methods: Prospective clinical study included fifteen women with urodynamic diagnosis of detrussor instability (13 women) or low bladder compliance (2 women). Standard operative laparoscopy under general anesthesia was done and the peritoneum and detrussor fibers or a moderately filled bladder had been divided till the bladder epilithelium was exposed. The procedure was continued until a thin quite large diverticular parch of bladder epithelium bulging from the bladder dome as it filled up was done. Results: During the follow-up period, the mean diurnal frequency decreased among the study group from 9 *3 to 5 *3 and the mean nocturnal frequency decreased from 5*2 to 2*1. Repeated urinary tract infection reported in all patients preoperatively improved dramatically following auto-augmentation. On urodynamic evaluation, the bladder capacity increased in all cases with a mean percentage of 21% and the mean bladder capacity increased from 219.5e54.6 ml to 265e56.7 ml postoperatively. A statistical significant improvement (~~0.05) of bladder volume was noticed at 40 cc water intravesical pressure where the bladder capacity increased by 130% from 102.5e86.4 ml to 235e61.4 ml after auto-augmentation. The leak point pressure eventually markedly decreased following laparoscopic auto-augmentation by 34% from 61e4.9 cm water to 40.5e8.7 cm water. Conclusion: Laparoscopic bladder auto-augmentation has been shown to be technically feasible and safe acceptable procedure after failure of medical and pharmacological therapy of urinary incontinence as a result of detrussor instability and low compliance. Laparoscopic autoaugmentation avoids the potential morbidity of using bowel for enterocystoplasty for bladder augmentation. Moreover, it offers advantages over other surgical approaches of shorter operative time, shorter operative stay with early return to normal activity as well as better cosmetic outcome.
FC4.14.04 CONVALESCENCE RECOMMENDATIONS FOLLOWING VAGINAL SURGERY FOR UTERO-VAGINAL PROLAPSE M. Ottesen’,z,3, C. Moeller’,z, H. Kehlet4 & B. Ottesen’ Department of Gynecology and Obstetrics’, Laparoscopic Unitz, Clinical Research Uni? and Department of Surgical Gastroenterology“, Copenhagen University Hospital, Hvidovre, Denmark. Background: Convalescence recommendations after vaginal surgery are not evidence based. Objective: To investigate clinical practice of convalescence recommendations following vaginal surgery for utero-vaginal prolapse. Study methods: Questionnaires were sent to hospital-employed gynecologists (HG) n=356, private practicing gynecologists (PPG) n=79 and a random sample of general practitioners (GP) n=491. Results: 291 HG (82%), 64 PPG (81%) and 300 GP (61%) replied. After uncomplicated posterior and anterior repair the recommended postoperative hospital stay was median 2 and 3 days (O-7) respectively. The recommended convalescence was median 4 weeks (l- 28) if the patient had physically light work. If the patient had physically strenuous work GP recommended a median of 6 weeks (2.12), HG 6 weeks (3-12) and PPG 8 weeks (4-12) of convalescence. About 70% gave specific advice about lifting restrictions. The variability of lifting restrictions ranged from 1 kg for l-8 weeks, 5 kg for l-12 weeks to 10 kg for l-12 weeks. There was also a marked variability in recommendations on when to resume activities such as tub baths, pelvic floor exercises, driving, intercourse and house cleaning. In general PPG tended to be the more restrictive. Conclusion: There is an evident variability in convalescence recommendations given to patients following vaginal surgery for uterovaginal prolapse. A scientific evaluation and consensus need to be established.
47
FC4.14.05 THE COMBINATION OF KOVAC-PROCEDURE WITH PELVIC FLOOR REPAIR IS AN IMPROVED METHOD FOR CORRECTING STRESS URINARY INCONTINENCE U. Retzke, H.-J. Hagemeier, M. Skrobol, R. Illing, H. Graf, Dept. OBIGYN, Zentralklimikum Hospital, Suhl, Sudthuringen, Germany Objectives: The pubic bone suburethral stabilization sling according to KOVAC is a most logic and highly successful method for the treatment of correcting stress urinary incontinence. The aim of our study was to investigate if this sophisticated procedure can be combined with the classic pelvic floor repair according to RICHTER (Munich). This operative combination seems to be meaningful because most incontinent patients suffer from problems arising from deficient pelvic floor too. Study Methods: 105 women with deficient pelvic floor and stress urinary incontinence because of urethral hypermobility were included in this clinical study. During the same procedure, the RICHTER-method followed by the modificated KOVAC-method has been performed. The follow-up time was 3-18 months. Before and after the operation, a complete urodynamic assessment was done in more than 70% of the cases. Results: In all cases, this combined procedure was practicable. The colpotomy should be done longitudinally instead of transversally to prevent vaginal dehiscence with all its consequences. The success-rate was more than 90%. Conclusions: A combination of the KOVAC-method and the classic pelvic floor repair according to RICHTER is a practicable and recommendable procedure. The profit by this combined therapy of stress urinary incontinence is much higher than the profit by the KOVAC procedure alone.
FC4.14.06 A NEW ADJUSTABLE BALLOON (ACT) FOR FEMALE INCONTINENCE A.M. M.V. Sadi, S. C. CarramPo, F.M.R. Almeida, Dept. of Gynecology and Urology, Universidade de Santa Amaro, SBo Paula, Brazil. Objectives: Balloons inserted around the urethra represent a new method for treating women with stress urinary incontinence (SUI). The current balloons do not permit an adjustment of the urethral compression necessary to promote continence and rely solely on the surgeon’s subjective impression. Usually, more than a single procedure is necessary to keep the patients dry. We present a new specially developed device (ACT) used to correct female SUI. Methods: Six patients with ages varying from 34 to 52 years had no previous therapy for urinary incontinence underwent the procedure. Five had type II and one type III SUI. All had video-urodynamic studies done pre-operatively. The device is a small silicon balloon filled with l-2 cc of diluted contrast, with a valve in its extremity. Through this valve, one can percutaneously adjust the volume of the balloon post-operatively, if necessary. One balloon was positioned on each side of the urethra close to the bladder neck using specially developed introducers. The valvular segment of the device was placed subcutaneously in the major labia. Patients were discharged on the second PO day and kept on oral cefalosporins for 7 days. Results: All patients became totally dry after the procedure. The balloons were easily positioned in the proximal urethra. One patient with no complications demanded to have the device removed on the sixth post-operative week. Complications included one bladder perforation during balloon implantation; distal migration of one balloon and one balloon and valve extrusions. All complications were easily corrected and after a mean follow-up of 6 months, all patients remained dry and apt. Conclusions: The ACT device promotes urinary continence in women. It is easily adjustable and if necessary can be removed without difficulties. Complication rates were similar to other previously reported peri-uretral devices and were easily manageable. All patients remain totally dry on follow-up.
46
FC4.13.06 MORPHOLOGIC ENDOMETRIAL STUDIES OF ADULT RATS SUBMITTED TO CONTINUOUS LIGHT AND AFTER MELATONIN ADMINISTRATION MA 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
THURSDAY,
SEPTEMBER 7
treating women with urodynamic diagnosis of detrussor instability or low compliance after failure of conservative management. Study Methods: Prospective clinical study included fifteen women with urodynamic diagnosis of detrussor instability (13 women) or low bladder compliance (2 women). Standard operative laparoscopy under general anesthesia was done and the peritoneum and detrussor fibers or a moderately filled bladder had been divided till the bladder epilithelium was exposed. The procedure was continued until a thin quite large diverticular parch of bladder epithelium bulging from the bladder dome as it filled up was done. Results: During the follow-up period, the mean diurnal frequency decreased among the study group from 9 *3 to 5 *3 and the mean nocturnal frequency decreased from 5*2 to 2*1. Repeated urinary tract infection reported in all patients preoperatively improved dramatically following auto-augmentation. On urodynamic evaluation, the bladder capacity increased in all cases with a mean percentage of 21% and the mean bladder capacity increased from 219.5e54.6 ml to 265e56.7 ml postoperatively. A statistical significant improvement (~~0.05) of bladder volume was noticed at 40 cc water intravesical pressure where the bladder capacity increased by 130% from 102.5e86.4 ml to 235e61.4 ml after auto-augmentation. The leak point pressure eventually markedly decreased following laparoscopic auto-augmentation by 34% from 61e4.9 cm water to 40.5e8.7 cm water. Conclusion: Laparoscopic bladder auto-augmentation has been shown to be technically feasible and safe acceptable procedure after failure of medical and pharmacological therapy of urinary incontinence as a result of detrussor instability and low compliance. Laparoscopic autoaugmentation avoids the potential morbidity of using bowel for enterocystoplasty for bladder augmentation. Moreover, it offers advantages over other surgical approaches of shorter operative time, shorter operative stay with early return to normal activity as well as better cosmetic outcome.
FC4.14.04 CONVALESCENCE RECOMMENDATIONS FOLLOWING VAGINAL SURGERY FOR UTERO-VAGINAL PROLAPSE M. Ottesen’,z,3, C. Moeller’,z, H. Kehlet4 & B. Ottesen’ Department of Gynecology and Obstetrics’, Laparoscopic Unitz, Clinical Research Uni? and Department of Surgical Gastroenterology“, Copenhagen University Hospital, Hvidovre, Denmark. Background: Convalescence recommendations after vaginal surgery are not evidence based. Objective: To investigate clinical practice of convalescence recommendations following vaginal surgery for utero-vaginal prolapse. Study methods: Questionnaires were sent to hospital-employed gynecologists (HG) n=356, private practicing gynecologists (PPG) n=79 and a random sample of general practitioners (GP) n=491. Results: 291 HG (82%), 64 PPG (81%) and 300 GP (61%) replied. After uncomplicated posterior and anterior repair the recommended postoperative hospital stay was median 2 and 3 days (O-7) respectively. The recommended convalescence was median 4 weeks (l- 28) if the patient had physically light work. If the patient had physically strenuous work GP recommended a median of 6 weeks (2.12), HG 6 weeks (3-12) and PPG 8 weeks (4-12) of convalescence. About 70% gave specific advice about lifting restrictions. The variability of lifting restrictions ranged from 1 kg for l-8 weeks, 5 kg for l-12 weeks to 10 kg for l-12 weeks. There was also a marked variability in recommendations on when to resume activities such as tub baths, pelvic floor exercises, driving, intercourse and house cleaning. In general PPG tended to be the more restrictive. Conclusion: There is an evident variability in convalescence recommendations given to patients following vaginal surgery for uterovaginal prolapse. A scientific evaluation and consensus need to be established.
47
FC4.14.05 THE COMBINATION OF KOVAC-PROCEDURE WITH PELVIC FLOOR REPAIR IS AN IMPROVED METHOD FOR CORRECTING STRESS URINARY INCONTINENCE U. Retzke, H.-J. Hagemeier, M. Skrobol, R. Illing, H. Graf, Dept. OBIGYN, Zentralklimikum Hospital, Suhl, Sudthuringen, Germany Objectives: The pubic bone suburethral stabilization sling according to KOVAC is a most logic and highly successful method for the treatment of correcting stress urinary incontinence. The aim of our study was to investigate if this sophisticated procedure can be combined with the classic pelvic floor repair according to RICHTER (Munich). This operative combination seems to be meaningful because most incontinent patients suffer from problems arising from deficient pelvic floor too. Study Methods: 105 women with deficient pelvic floor and stress urinary incontinence because of urethral hypermobility were included in this clinical study. During the same procedure, the RICHTER-method followed by the modificated KOVAC-method has been performed. The follow-up time was 3-18 months. Before and after the operation, a complete urodynamic assessment was done in more than 70% of the cases. Results: In all cases, this combined procedure was practicable. The colpotomy should be done longitudinally instead of transversally to prevent vaginal dehiscence with all its consequences. The success-rate was more than 90%. Conclusions: A combination of the KOVAC-method and the classic pelvic floor repair according to RICHTER is a practicable and recommendable procedure. The profit by this combined therapy of stress urinary incontinence is much higher than the profit by the KOVAC procedure alone.
FC4.14.06 A NEW ADJUSTABLE BALLOON (ACT) FOR FEMALE INCONTINENCE A.M. M.V. Sadi, S. C. CarramPo, F.M.R. Almeida, Dept. of Gynecology and Urology, Universidade de Santa Amaro, SBo Paula, Brazil. Objectives: Balloons inserted around the urethra represent a new method for treating women with stress urinary incontinence (SUI). The current balloons do not permit an adjustment of the urethral compression necessary to promote continence and rely solely on the surgeon’s subjective impression. Usually, more than a single procedure is necessary to keep the patients dry. We present a new specially developed device (ACT) used to correct female SUI. Methods: Six patients with ages varying from 34 to 52 years had no previous therapy for urinary incontinence underwent the procedure. Five had type II and one type III SUI. All had video-urodynamic studies done pre-operatively. The device is a small silicon balloon filled with l-2 cc of diluted contrast, with a valve in its extremity. Through this valve, one can percutaneously adjust the volume of the balloon post-operatively, if necessary. One balloon was positioned on each side of the urethra close to the bladder neck using specially developed introducers. The valvular segment of the device was placed subcutaneously in the major labia. Patients were discharged on the second PO day and kept on oral cefalosporins for 7 days. Results: All patients became totally dry after the procedure. The balloons were easily positioned in the proximal urethra. One patient with no complications demanded to have the device removed on the sixth post-operative week. Complications included one bladder perforation during balloon implantation; distal migration of one balloon and one balloon and valve extrusions. All complications were easily corrected and after a mean follow-up of 6 months, all patients remained dry and apt. Conclusions: The ACT device promotes urinary continence in women. It is easily adjustable and if necessary can be removed without difficulties. Complication rates were similar to other previously reported peri-uretral devices and were easily manageable. All patients remain totally dry on follow-up.