Reoperative retropubic surgery for recurrent stress incontinence

605 HIGH-FLOW/LOW-FLOW EXPERIENCE Geavlete “Saint

Petrisor, Cauni Victor,

PRIAPISM Georgescu

- DIFFERENTIAL

DIAGNOSIS

Dragos

John” Emergency Clinical Hospital, Bucharest, Romania

INTRODUCTION & OBJECTIVES: Low-flow prmpism (LFPP) as a veno-occlurive type is the common clinical expression of priapism (PP) until high-flow priapism (HFPP) is a rare entity, with arterial damage. Differential diagnosis is often difficult. the treatment being completely different.

MATERIAL & METHODS: Between February 1995 and February 2001 we studred 7 cases with HFPP (I8 to 47 vears old) and 19 cases with LFPP (19 to 63 wars olcl~. Our , evaluation protocol was re&esented by: history and physical examination, neurologic exams, cavernous blood gas measurement, colour and pulsed Doppler ultraround, pharmacocavemosography and selective penile arteriography. In HFPP cases we described in 6 cases perineal injury and in one case direct injury of the penis. In LFPP cases we described idiopathic (primary) aetiology in 6 cases and secondary in 13 cases.

RESULTS: We described the follow&w different asoects: LFPP

HFPP

I.History

Frequently without clear aetiology (secondary aetiology)=, 3 C~FCC i&R 4’%,

Follow an permeal or penile m,ury =I” all ca*e\ (1006)

Z.Clinical aspect

Usually pamful=,,

Pamle\\=h ca\e\ (X5.79)

CB\CF(89.56,

4.Duplex Doppler ultrasound (colour and pulsed) 1

Venous star al cavemosogmphy (blockmg of the ven~“s dramage of the corpora cavemoaa)= practlsed in Y case5

L.Cavernous blood gas measurement

Blood gas values simdar to veno”\ blo&=m all ca\e\ (ItXMc)

‘ISelective penile arteriography

Abwnce of the fi\tula between ca\emo”\ anery and carp”, cavrma\“m (venous blo
Mean

follow-up

1

Rapid drainage of the carp”\ cavemo~“m at cavemosography (normal dralnage of the corpora caYemw)=i” 811CBW\ (100%)

and PP the

method5 of diagnosis could be bettered, evaluated and organ&d. We proposc a multilevel diagnostic approach (clinical, echographic, biochemical and vascular) for the differential diagnosis between LFPP and HFPP.

REOPERATIVE RETROPUBIC INCONTINENCE

SURGERY FOR RECURRENT

here.

pad usage was 4.8 pa& per day. Of those women who underwent orocedure. 80% (12115) are currentlv usina O-l oads a dav. I oatient

the has

leakage and 23%‘(4/15) report’de noio urgkncy. SO& rep& no role limitation as a result of urinary symptoms and 74% are “perfectly happy” with their surgical outcomes. 13% still require intermittent self catheterisation. Of those women
who underwent colposuspension only, 85% (I 7120) are currently using O-I pads a day. 7 report persistent symptoms of stress leakage, 3 of who are pad free and not bothered by their symptoms. 55% (I l/20) have de-now urgency. 80% report no role limitation as a result of urinary symptoms and 60% are “perfectly happy” with outcome. I patient in this group still requires ISC. 7 of the 8 women with persistent stress leakage underwent repeat urodynamics. In all 7 there was ISD with a well-supported bladder neck.

CONCLUSION:

Repeat retropubic surgery for recurrent stress incontinence is associated with a high success rate and good patient satisfaction in the medium term. The combination of a sling procedure and colposuspens~on ir a worthwhile optmn in

women with severe recurrent stres\ incontinence but patients must be counselled about the higher risk of voiding dysfunction. The main cawe of dissatisfaction is urinary urgency.

European Urology Supplements

1 (2002) No. 1, pp. 154

Brazil

CONCLUSION: SIS proved to be a simple, safe and effective procedure. Our early results warrant further evaluation of the SIS as a suburethral sling for use in surgical treatment of stress urinary incontinence.

RESULTS

Amiel Glad, Kastin Alexander, Moshkovitz Boaz. Nativ Ofer

RESULTS: Data was available for 35 women at a mean follow-up of 45 months (range 3-89 months). Their mean age was S3 (range 33-67 years) and they had undergone a median of 1.9 (range l-5) previous continence procedures. Mean

postoperatively

Campinas,

Barbosa

INTRODUCTION & OBJECTIVES: A new sling material derived from porcine small intestinal submucosa (SIS) is now available for surgical treatment of stress urinary incontinence (SUI). It consists of a natural matrix of collagen and other tissue components, which provide the strength and flexibility important to an effective sling device. In this study, we report on the early outcomes of the use of SIS for treatment of SUI.

TERM

questionnaire.

preoperative

of Campinas,

Miriam,

606

MATERIALS & METHODS: 47 women with recurrent type 2 stress incontinence underwent colposupension. 21 of these women with coexisting ISD (indicated by Stamey grade 3 symptoms and an open bladder neck at rest on video cystometry) underwent a concomitant pubovaginal rectus fascia sling. Postoperative continence status, current symptoms and patient satisfaction were determined by selfadministered questionnaires including Bristol Female Lower Urinary Tract Symptoms

combined

Urology, University

Viviane. Dambros

THE IN-FASTTM MINIMALLY INVASIVE PUBOVAGINAL SLING FOR URINARY STRESS INCONTINENCE: A FIRST REPORT OF LONG-

INTRODUCTION & OBJECTIVES: Failed ureteropexy is often associated with significant sphincteric weakness. The appropriate management of patients with combined urethral hypermobility and sphincteric weakness (ISD) remains unclear. Combining colposuspension with a pubovaginal sling may correct both hypermobility and ISD whilst minimising the risks of postoperative obstruction and detrusor instability by allowing the sling to be placed without tension. The medium term outcome of this procedure in women with combined type 2 and type 3 stress

persistent

Palma Paula, Riccetto Cassio, Herrmann Cassiano, Netto Jr. Nelson

607

Department of Urology, Sheffield Teaching Hospitals. Sheffield. United Kingdom

is presented

PUBOVAGINAL SLING USING THE PORCINE SMALL INTESTINE SUBMUCOSA. A PROMISING ALTERNATIVE FOR TREATMENT OF STRESS URINARY INCONTINENCE

STRESS

Qwek Pearllyn, Bradshaw Helen, Radley Stephen, ChaDDle Christooher

incontinence

606

RESULTS: The mean follow-up was 8 months (range 2 to I7 months). Of the 30 patients, 28 (93.3%) were cured of stress incontinence and I reported improvement. Postoperative urinary retention was observed in 3 patients (10%). Neither urinary nor wound infection was detected, and no patient developed postoperative urinary irritative symptomatology. There was no evidence of local or systemic reaction to the material in any of the patients.

period was 21 months (range 2 to 34).

CONCLUSIONS: Despite the new knowledgea about erectile dysfunction

FEMALEUROLOGY: OlAGNOSiSANDTREATMEWT II Tuesday,February 26,13.45-15.15 hrs, Room D

MATERIALS & METHODS: Since March 2000, thirty women with proven stress incontinence underwent suburethral sling procedures using the SIS biomaterial as the sling material. The average patient age was SO years (range: 30 to 73 years). Among the 30 female patients 63.3% had had some previous surgical treatment for SUI and 40% had some degree of cystocele. Valsalva leak point pressure (VLPP) revealed anatomic SUI in 43.3% (mean VLPP 102 cm H,O) and sphincteric intrinsic deficiency was diagnosed in 56.7% (mean VLPP 52 cm H,O). The dry SIS biomaterial is presented as a 2x IO cm multi-layer strip. Before the procedure it was soaked in antibiotic solution for I5 minutes for hydration prior to use. The surgical protocol included transvaginal placement of the SIS sling suspended by polypropylene sutures fixed to the rectus fascia.

3.Physical examination

SCavernosography

P35

Urology, Bnai-Zion

Vald Moshe, Kravtsov Alexander,

Issaq Elias.

Medical Center, Haifa, Israel

& OBJECTIVES: The In-Fast’M vaginal sling haa become a popular method for the treatment of female urinary stress incontinence. However, previous series describing results and complication rates were small. Furthermore, little has been published on the long-term results (more than 2 years) of the In-Fast 1‘Msling. The aim of this study is to present a large series of IO8 women who underwent this procedure and to report the longterm success and complication rate of the In-Fast SlingTM. INTRODUCTION

MATERIALS & METHODS: I08 women aged 35 to 79 years (mean 59 years) were evaluated preoperatively by a thorough history and physical examination, counting and weighing wet pads, voiding diary, urodynamics, residual urine and a bonney test. Thereafter, the In-Fast TM bone anchor system (Intluence. Inc., San Francisco, CA) was introduced: A miniature anchor (screw) with prethreaded no. I polypropylene suture was deployed directly into the pubic bone on each side of the bladder neck, lateral to the urethra. Passing a right angle clamp from one lateral vaginal opening to a contralateral one created a submucosal tunnel. A synthetic gelatin coated 5 cm. Dacron sling was inserted into the submucosal tunnel at the bladder neck region and its edges were fixed to the pubic bone by tying the anchored polypropylene sutures. No case of over-correction causing permanent retention, or severe blood loss requiring blood transfusion was observed. In 5% the anchor screw fell, in 4% detrussor instability has developed, 4% suffered from pain during intercourse, 3% from urinary retention that resolved spontaneously and 2% from urinary tract infection. In a mean follow-up of 37 months (range 2-S I months) 86.1 c/c (93 patients) were completely dry, 8.3% (9) reported a significant improvement and 5.6% (6) did not experience any improvement in symptoms. RESULTS:

CONCLUSION: The In-Fast I’M vaginal sling was found to be safe and effective. Long-term results demonstrated an excellent 94% partial or complete resolution of female urinary incontinence.