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O595 The assessment of double transobturator approach (D-TOT) technique in stress urinary incontinence (SUI)
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
women with Turner Syndrome attending Groote Schuur Hospital was conducted. Results: The age of the women was between 19 and 45 years and the average height was 1.39 meters. Most participants had poor knowledge about their condition. Most women considered infertility to be the most traumatic consequence of the syndrome leading to low self image. Short stature was not a cause of low self image. Interpersonal relationships were not negatively affected. Some evidence of delayed partner relationships was evident. There was evidence of some cognitive deficits particularly difficulties with mathematics. Having Turner Syndrome did not negatively impact on job opportunities. Most participants felt that psychosocial support was lacking from their doctors. Conclusion: The results of this study give insight about the psychosocial impact of Turner Syndrome on women in our clinical setting. The study has highlighted some opportunities for interventions to improve the healthcare of these women. Medical care givers need to focus more on the psychosocial aspects of this condition. Patients must be given adequate information about Turner Syndrome and its effects. Feedback about the results of this study needs to be given to our paediatric unit to facilitate earlier psychosocial support. Studies are needed on the psychosocial impact of Turner Syndrome on women elsewhere in South Africa. O593 Raised vaginal pH in mid trimester of pregnancy increases preterm delivery risk (preliminary results) R. Matijevic1 , O. Grgic2 , M. Knezevic1 . 1 Department of O & G, Sveti Duh hospital, Sv Duh 64, 10000 Zagreb, Croatia, 2 Department of O & G, University hospital for tumors, Ilica 197, 10000 Zagreb, Croatia Objective: To assess diagnostic accuracy and relationship of vaginal pH measurement in mid trimester of pregnancy regarding prediction of preterm delivery (PTD) in general population. Study design: Prospective ongoing cohort study of 310 asymptomatic pregnant women (preliminary results) in normal, uncomplicated pregnancy. Vaginal pH measurement was evaluated between 16 and completed 23 weeks. Percentiles for vaginal pH measurement were analyzed with the use of chi-square tests. The cut off values of 4.7 and 5.0 were evaluated. Primary outcome measure include diagnostic accuracy of both values regarding the prediction of PTD <37 weeks. Results: Vaginal pH > 4.7 was found in 20.9% (65/310) whereas the pH > 5.0 positive was found in 4.8% (15/310). The overall incidence of PTD < 37 weeks was 7.1% (22/310). Both pH measurement >4.7 and >5.0 had statistically significant accuracy regarding the prediction of PTD < 37 weeks (likelihood ratio for positive results (LR+) for pH > 4.7; 4.58 95% CI [3.21–6.34] and for pH > 5.0; 25.23 95%CI [10.35–61.47]. Conclusion: Both cut off values (4.4 and 5.0) of vaginal pH are related to increased incidence of PTD but pH value >5.0 had 5 times higher LR than compared to >4.7. O594 Comparison of postoperative outcomes between tension-free vaginal mesh and traditional procedures of reconstructive surgery for pelvic organ prolapse J. Matsumoto1 , R. Okagaki2 , Y. Ito2 , T. Takahashi3 , I. Nagata4 . 1 Ogawa Red Cross Hospital, 2 Saitama Medical University, 3 Kumagaya General Hospital, 4 Saitama Medical Hospital Objectives: To compare the outcomes of tension-free vaginal mesh procedure (TVM) with those of traditional procedures (TDT) for reconstructive surgery of pelvic organ prolapse (POP). Materials and Methods: Nineteen women who underwent TVM for POP following the technique of TVM Group (France) have been followed up (TVM group). Eighteen women underwent anterior and posterior TVMs and another one had anterior TVM alone.
Eight women had vaginal hysterectomy (VH). For comparison, 19 women who underwent TDT for POP were used (TDT group). TDT included VH, anterior and posterior colporrhaphy, and uterosacral or sacrospinous ligament fixation of the vaginal apex. Two women with posthysterecomy vault prolapses were included. Both groups were matched in demography and follow-up time. Chi-square test and t test were used for comparison between the two groups. Results: The mean age was 66.3 in TVM group and 66.6 in TDT group. Follow-up time was 15.3 months and 17.7, respectively. POP-Q stage was 3 or 4 in both groups before surgery. There was no difference in POP-Q stage at the follow-up study between the two groups. Thirteen women in TVM group were stage 0, 5 women stage 1, and one stage 3. Thirteen in TDT group were stage 0 and 6 stage 1. Total vaginal length was similar in the two groups at follow-up. Both groups did not differ in storage symptoms and voiding symptoms at the follow-up study. There was one bladder injury during TVM. One woman developed temporary obstruction of the right ureter due to vaginal hematoma after TVM. No vaginal protrusion of the mesh has been noticed so far in the TVM group. Conclusions: TVM and traditional procedures for surgical repair of POP have shown satisfactory results so far at the follow-up study although sample size is small. O595 The assessment of double transobturator approach (D-TOT) technique in stress urinary incontinence (SUI) R. Matusiak, I. Szymusik, A. Banaszek-Wysoczanska, K. KosinskaKaczynska, P. Kaminski. 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland Objectives: To assess the efficacy and safety of D-TOT in SUI treatment. Material and Methods: The study group consisted of 81 women with SUI operated on at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, from March 2005 till May 2008. All of them were qualified for D-TOT operation basing on symptoms, gynecological (POPQ –pelvic organ prolapse quantification: I – 3 cases; II – 21; III – 42; IV – 15) and urodynamic examination (66 SUI, 15 mixed UI). Additional surgical procedures were performed in 52 women. The mean age of the patients was 64 (47–78), average BMI 27.4 (22–40). All the studied patients experienced vaginal delivery, 69 were multiparous. All D-TOT procedures were performed according to standards after 6 weeks of vaginal oestrogens, with the use of the same material. A single dose of antibiotic was administered as prophylaxis in each case. Results: SUI symptoms disappeared in every patient after the operation. All women had as well organ prolapse corrected. The mean time of the operation was 44 minutes (30–120 min). The average hospitalization time was 6.2 days (3–12 days). There were no intraoperative complications. Postoperative complications included: vaginal bleeding-9 patients; headache-7; abdominal pain-6; dysuria-5. The follow-up 3 and 6 months after D-TOT revealed 100% efficacy for SUI symptoms (anamnesis, gynecological and urodynamic examination). Mesh erosion has been noted in 5 cases so far. Conclusions: D-TOT technique is a safe and efficient method of SUI treatment with/without POP. The procedure is easy for the operator to study and at the same time efficient and with small percentage of complications. O596 Massive ascites associated with endometriosis in a patient from Ghana D. Mavridou1 , B. Webb2 , L. Seomkin3 , C. King4 . 1 Senior House, 2 Gynaecology, 3 Histopathology, 4 Radiology Endometriosis-related ascites is a rare and specific manifefstation of endometriosis that is more common in African women than in Caucasian women. This is a case presentation of a 31 year
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
women with Turner Syndrome attending Groote Schuur Hospital was conducted. Results: The age of the women was between 19 and 45 years and the average height was 1.39 meters. Most participants had poor knowledge about their condition. Most women considered infertility to be the most traumatic consequence of the syndrome leading to low self image. Short stature was not a cause of low self image. Interpersonal relationships were not negatively affected. Some evidence of delayed partner relationships was evident. There was evidence of some cognitive deficits particularly difficulties with mathematics. Having Turner Syndrome did not negatively impact on job opportunities. Most participants felt that psychosocial support was lacking from their doctors. Conclusion: The results of this study give insight about the psychosocial impact of Turner Syndrome on women in our clinical setting. The study has highlighted some opportunities for interventions to improve the healthcare of these women. Medical care givers need to focus more on the psychosocial aspects of this condition. Patients must be given adequate information about Turner Syndrome and its effects. Feedback about the results of this study needs to be given to our paediatric unit to facilitate earlier psychosocial support. Studies are needed on the psychosocial impact of Turner Syndrome on women elsewhere in South Africa. O593 Raised vaginal pH in mid trimester of pregnancy increases preterm delivery risk (preliminary results) R. Matijevic1 , O. Grgic2 , M. Knezevic1 . 1 Department of O & G, Sveti Duh hospital, Sv Duh 64, 10000 Zagreb, Croatia, 2 Department of O & G, University hospital for tumors, Ilica 197, 10000 Zagreb, Croatia Objective: To assess diagnostic accuracy and relationship of vaginal pH measurement in mid trimester of pregnancy regarding prediction of preterm delivery (PTD) in general population. Study design: Prospective ongoing cohort study of 310 asymptomatic pregnant women (preliminary results) in normal, uncomplicated pregnancy. Vaginal pH measurement was evaluated between 16 and completed 23 weeks. Percentiles for vaginal pH measurement were analyzed with the use of chi-square tests. The cut off values of 4.7 and 5.0 were evaluated. Primary outcome measure include diagnostic accuracy of both values regarding the prediction of PTD <37 weeks. Results: Vaginal pH > 4.7 was found in 20.9% (65/310) whereas the pH > 5.0 positive was found in 4.8% (15/310). The overall incidence of PTD < 37 weeks was 7.1% (22/310). Both pH measurement >4.7 and >5.0 had statistically significant accuracy regarding the prediction of PTD < 37 weeks (likelihood ratio for positive results (LR+) for pH > 4.7; 4.58 95% CI [3.21–6.34] and for pH > 5.0; 25.23 95%CI [10.35–61.47]. Conclusion: Both cut off values (4.4 and 5.0) of vaginal pH are related to increased incidence of PTD but pH value >5.0 had 5 times higher LR than compared to >4.7. O594 Comparison of postoperative outcomes between tension-free vaginal mesh and traditional procedures of reconstructive surgery for pelvic organ prolapse J. Matsumoto1 , R. Okagaki2 , Y. Ito2 , T. Takahashi3 , I. Nagata4 . 1 Ogawa Red Cross Hospital, 2 Saitama Medical University, 3 Kumagaya General Hospital, 4 Saitama Medical Hospital Objectives: To compare the outcomes of tension-free vaginal mesh procedure (TVM) with those of traditional procedures (TDT) for reconstructive surgery of pelvic organ prolapse (POP). Materials and Methods: Nineteen women who underwent TVM for POP following the technique of TVM Group (France) have been followed up (TVM group). Eighteen women underwent anterior and posterior TVMs and another one had anterior TVM alone.
Eight women had vaginal hysterectomy (VH). For comparison, 19 women who underwent TDT for POP were used (TDT group). TDT included VH, anterior and posterior colporrhaphy, and uterosacral or sacrospinous ligament fixation of the vaginal apex. Two women with posthysterecomy vault prolapses were included. Both groups were matched in demography and follow-up time. Chi-square test and t test were used for comparison between the two groups. Results: The mean age was 66.3 in TVM group and 66.6 in TDT group. Follow-up time was 15.3 months and 17.7, respectively. POP-Q stage was 3 or 4 in both groups before surgery. There was no difference in POP-Q stage at the follow-up study between the two groups. Thirteen women in TVM group were stage 0, 5 women stage 1, and one stage 3. Thirteen in TDT group were stage 0 and 6 stage 1. Total vaginal length was similar in the two groups at follow-up. Both groups did not differ in storage symptoms and voiding symptoms at the follow-up study. There was one bladder injury during TVM. One woman developed temporary obstruction of the right ureter due to vaginal hematoma after TVM. No vaginal protrusion of the mesh has been noticed so far in the TVM group. Conclusions: TVM and traditional procedures for surgical repair of POP have shown satisfactory results so far at the follow-up study although sample size is small. O595 The assessment of double transobturator approach (D-TOT) technique in stress urinary incontinence (SUI) R. Matusiak, I. Szymusik, A. Banaszek-Wysoczanska, K. KosinskaKaczynska, P. Kaminski. 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland Objectives: To assess the efficacy and safety of D-TOT in SUI treatment. Material and Methods: The study group consisted of 81 women with SUI operated on at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, from March 2005 till May 2008. All of them were qualified for D-TOT operation basing on symptoms, gynecological (POPQ –pelvic organ prolapse quantification: I – 3 cases; II – 21; III – 42; IV – 15) and urodynamic examination (66 SUI, 15 mixed UI). Additional surgical procedures were performed in 52 women. The mean age of the patients was 64 (47–78), average BMI 27.4 (22–40). All the studied patients experienced vaginal delivery, 69 were multiparous. All D-TOT procedures were performed according to standards after 6 weeks of vaginal oestrogens, with the use of the same material. A single dose of antibiotic was administered as prophylaxis in each case. Results: SUI symptoms disappeared in every patient after the operation. All women had as well organ prolapse corrected. The mean time of the operation was 44 minutes (30–120 min). The average hospitalization time was 6.2 days (3–12 days). There were no intraoperative complications. Postoperative complications included: vaginal bleeding-9 patients; headache-7; abdominal pain-6; dysuria-5. The follow-up 3 and 6 months after D-TOT revealed 100% efficacy for SUI symptoms (anamnesis, gynecological and urodynamic examination). Mesh erosion has been noted in 5 cases so far. Conclusions: D-TOT technique is a safe and efficient method of SUI treatment with/without POP. The procedure is easy for the operator to study and at the same time efficient and with small percentage of complications. O596 Massive ascites associated with endometriosis in a patient from Ghana D. Mavridou1 , B. Webb2 , L. Seomkin3 , C. King4 . 1 Senior House, 2 Gynaecology, 3 Histopathology, 4 Radiology Endometriosis-related ascites is a rare and specific manifefstation of endometriosis that is more common in African women than in Caucasian women. This is a case presentation of a 31 year