- Email: [email protected]
UP-2.15: The effect of stage II or less cystocele on voiding pattern after midurethral sling
UNMODERATED POSTER SESSIONS
UP-2.13 Characteristics of lower urinary tract symptoms and efficacy of treatment with desmopressin in female patients Cho HJ, Kim SJ, Yun BI, Hong SH, Lee JY, Kim SW, Hwang TK Dept. of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea Introduction and Objective: Nocturia is one of the important lower urinary tract symptoms to cause a decline in quality of life and about 15% of females experience more than 2 voids per night. However, there are few studies about nocturia in females. Therefore we studied, retrospectively, the cause of nocturia, the efficacy of desmopressin and the relation with other lower urinary tract symptoms in female patient. Materials and Methods: Seventy-two female patients who were bothered by voiding one or more times nightly concomitant with other LUTS and treated with desmopressin 0.2 mg were included in this study. The baseline evaluation included a careful history taking, physical examination, international prostate symptom score (IPSS) and consecutive voiding diaries for 3 days. Voiding diary data was used to derive nocturnal polyuria index (NPi) and nocturnal bladder capacity index (NBCi). Nocturnal polyuria was defined as a nighttime urine volume of more than 35% of the total daily urine volume and reduced nocturnal bladder capacity was defined as NBCi greater than 0. After treatment with desmopressin, a reduction by more than half in the number of nocturnal voids compared with baseline was regarded as effective. Results: The mean patient age was 66.8 (40-88). The mean nocturnal voids were 3.6⫾1.0 per night. Nocturnal poyuria and reduced nocturnal bladder capacity were observed in 20/72(27.8%) and 4/72(5.6%), respectively. Forty-eight patients (66.7%) showed both nocturnal polyuria and reduced nocturnal bladder capacity. Mean IPSS total score, mean IPSS voiding subscore, mean IPSS storage sub-score and QoL score were 18.9⫾9.7, 9.3⫾7.1, 10.1⫾4.4 and 4.2⫾1.5, respectively. Twenty-four patients were treated with antimuscarinics and 4 patients took alpha blockers. Twenty-one patients showed a significant decrease in the mean nocturnal voids from 3.6⫾1.0 to 1.4⫾1.2 after treatment (p⬍0.05). There were no remarkable differences in the baseline IPSS score and LUTS regardless of the improvements of nocturia after therapy with desmopres-
S84
sin. The patients did not respond to the desmopressin and showed significantly increased NBCi (0.9⫾0.5) compared to the patients who showed improvement (0.5⫾0.4) (p⬍0.05). However, 62.5% (45/ 72) patients with response to desmopressin also showed decreased NBCi. Conclusions: The important cause of nocturia in female patients is considered as not only nocturnal poyuria but also reduced nocturnal bladder capacity. Moreover, reduced nocturnal bladder capacity was noted in more than 50% in the patients as a treatment effect. Therefore desmopressin may have an effect on reduced nocturnal bladder capacity as well as nocturnal polyuria in female patients with nocturia. UP-2.14 The effects of the REMEEX system® for treatment of re-do urinary incontinence and intrinsic sphincteric deficiency Jung H1, Song P1, Kim J1, Oh T2, Park J3 1 Dept. of Urology, College of Medicine, YeungNam University, Daegu; 2 SungKyunkwan University, Masan Samsung Hospital, Masan; 3Dept. of Urology, College of Medicine, Daegu Catholic University, Daegu, South Korea Introduction and Objective: This study was conducted to evaluate the effectiveness of the REMEEX system® (EXternal MEchanical REgulation, Neomedic International, Terrassa (Barcelona), Spain) for treatment of re-do urinary incontinence and intrinsic sphincteric deficiency. Materials and Methods: From August 2006 to January 2009, a total of 43 patients underwent the REMEEX system威. Patients were categorized into failed urinary incontinence (Group A, 16 patients) and intrinsic sphincteric deficiency (Group B, 27 patients). Of the 43 patients, 16 had previous incontinence surgical interventions, 9 had other pelvic surgeries, and 10 either had spine surgery, diabetes mellitus, cerebrovascular accident, Parkinson’s disease, spine fracture, herniated lumbar disc, mood disorder or so on. The success rate of patients after surgery was assessed by cure and satisfaction rate followed up postoperatively at 1, 6, and 12 months. Clinical, urodynamic, peri- and post-operative data with respect to success rates were analyzed. Results: The mean age of patients was 61.7 years (range 44-81) and the mean follow-up period was 20.1 months (range 12-34). Total cure rates with the REMEEX system威 (Group A/Group B) were 100.0%/
96.3% at 1 month and 100.0%/76.2% at 12-month follow-up. Satisfaction rates were 100.0%/88.8% at 1 month and 83.4%/71.5% at 12-month follow-up in group A and B. Neither bladder puncture (37.2%) nor surgical wound infection (7.0%) statistically influenced the cure and satisfaction rate of the REMEEX system威 in either group (P⫽0.681, P⫽0.451, respectively) by Fisher’s exact test. Conclusions: The REMEEX system威 may be an effective procedure regardless of previous incontinence surgical interventions and intrinsic sphincteric deficiency. The absence of adverse events associated with the REMEEX system威 until 12-month follow-up and high subjective and objective 12-month postoperative success rates make the REMEEX system威 a recommendable surgical treatment for re-do urinary incontinence and intrinsic sphincteric deficiency. UP-2.15 The effect of stage II or less cystocele on voiding pattern after midurethral sling Kim H1, Paick S1, Lho Y1, Park H1, Park W2, Jo M3 1 Konkuk University, School of Medicine, Seoul; 2Inha University College of Medicine, Incheon; 3Korea Cancer Center Hospital, Seoul, South Korea Introduction and Objective: The presence of cystocele is known to be negative effect after sling surgery. We investigate the effect of stage II or less cystocele on voiding pattern after sling surgery in stress incontinence patients. Materials and Methods: From March 2008 to November 2010, we reviewed medical records of 164 patients who underwent mid urethral sling and did not undergo cystocele repair concomitantly. Urodynamic study was done to all patients. According ICS cystocele grade, we classified patients into 0, I and II grade. No cystocele group was defined as patients who had cystocele of 0 and cystocele group was defined as grade I or II. We compared the preoperative and postoperative IPSS score, quality of life (QoL) scare, peak uroflow (Q max), post void residual (PVR) and success rate of sling surgery between two groups. Results: Among the 164 patients, 137 were in no cystocele group and 27 in cystocele group. The mean patient age, preoperative Q max, PVR, IPSS score and QoL score were similar in the two groups. In urodynamic study, MUCP and VLPP value were no different between two groups. After 3 month of sling surgery, Q
UROLOGY 76 (Supplement 3A), September 2010
UNMODERATED POSTER SESSIONS
max, PVR, IPSS score and QoL score were not statistically different between two groups. The success rate of sling surgery was 90% and 92% respectively and did not statistically different. Conclusions: Sling surgery without cystocele repair did not affect voiding pattern or sling success rate to patients who have stress incontinence and cystocele grade I or II compared to patients who have no cystocele. Our study suggests that cystocele repair is not mandatory with sling surgery for patient who have cystocele grade I or II.
Conclusions: Obese SUI patients had worse SUI symptom grade, urgency and urge incontinence symptoms than nonobese patients. However, surgical correction using TOT operation could restore the symptoms and voiding parameters as effectively as with non-obese patients.
UP-2.16 The influence of obesity on patients with female stress urinary incontinence Kim Y1, Kim W1, Tchey D1, Yun S1, Lee S1, Kim W1, Jo S2 Dept. of Urology, 1Chungbuk National University College of Medicine, Cheongju; 2 Cheongju Saint Mary’s Hospital, Cheongju, South Korea
UP-2.17 Postoperative voiding difficulty after midurethral sling surgery in female stress urinary incontinence: when does it get better? Lee D1, Kim J2, Kim Y3, Choi J4, Kim H5, Lee T6, Park W6 Depts. of Urology, 1Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon; 2Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon; 3Bucheon Soonchunhyang Hospital, Soonchunhyang University, Bucheon; 4Ajou University, Suwon; 5St. Paul’s Hospital, The Catholic University of Korea, Seoul; 6Inha University Hospital, Incheon, South Korea
Objective: The purpose of our study was to evaluate the influence of obesity on the clinical characteristics, quality of life (QoL) and outcomes in the stress urinary incontinence patients who underwent the transobturator tape (TOT) surgery. Materials and Methods: The items of preoperative evaluations consisted of history taking, physical examination, cystometrography, 3 day frequency-volume chart, King’s health questionnaire (KHQ) and symptom perception scale questionnaires. Patients with any neurologic diseases that affect the voiding pattern were excluded. From 2007 to 2009, 107 patients with TOT operation were enrolled. The patients were divided into non-obese (BMI⬍25) and obese group (BMIⱖ25). Results: The non-obese group was 55 (51.4%) patients and obese group was 52 (48.6%). The median age was 49.0 (30.873.5) years in non-obese group and 52.7 (35.5-73.5) in obese group (p⬎0.05). The obese group showed the higher SUI symptom grade, urethral hypermobility, urgency and urge incontinence scale than the non-obese group (each p⬍0.05). Each domain of KHQ and item of 3-day frequency-volume chart did not show the differences between two groups (each p⬎0.05). After the operation, the symptom scales and parameters in the 3-day frequency-volume chart of the obese group were similar to those of the nonobese group (each p⬎0.05). The objective success, recurrence and complication rates in 1 year were similar in the two groups (each p⬎0.05).
Introduction and Objective: This study was designed to clarify the time when the voiding difficulty caused by midurethral sling procedure was disappeared spontaneously by prospective observation of the patients’ natural courses with regard to obstructive symptom after sling procedure. Materials and Methods: We observed patients’ voiding difficulties that occurred immediately after transobturator sling surgery for female stress urinary incontinence from October 2006 to August 2007. Those patients who have complained of voiding difficulties were asked about the time when those symptoms were disappeared spontaneously at weekly interval. Voiding difficulty was defined as postoperative subjective symptom of decreased urine flow compared to that before surgery. Patients who underwent urethral dilatation, tape release or administration of alpha blocker due to large postvoid residual urine were excluded in this study. Results: Sixteen (12.7%) out of 126 patients had complained of voiding difficulties immediately after surgery. However, 2 patients who were managed by urethral dilatation or tape release because of larger amount of postvoid residual urine (⬎400 ml) were excluded. The mean age of 14 patients were 44.7 years old and 5 had low valsalva leak point pressure (⬍60 cmH2O); 1 had low peak urine flow (⬍20 ml/sec). Concomitant surgeries were hysterectomy in 3, perineorrhaphy in 3 and 3 patients were mixed incontinence. All had no residual urine at the time of discharge
UROLOGY 76 (Supplement 3A), September 2010
from hospital. Voiding difficulties were disappeared spontaneously; 5 in the second, 3 in the third, 1 in the fourth, 2 in the fifth, 1 in the sixth, 1 in the eighth week. However, the remaining 1 had complained of persisted voiding difficulty since 4 months after surgery. Voiding difficulties disappeared within 6 weeks in 12 (85.7%) out of 14 patients. Conclusions: Most of the postoperative voiding difficulties immediately after sling surgery disappeared spontaneously within 6 weeks. Therefore, we need to make those patients who showed voiding difficulties after sling surgery feel relieved. UP-2.18 Evaluation of a modified novel vaginal flap operation in stress urinary incontinence (SUI) using dynamic MRI Fayed A, Abdelkarim A, Mahfouz W, Elsalmy S Genitourinary Surgery, Alexandria University, Alexandria, Egypt Introduction and Objective: Stress urinary incontinence is a common problem among women in all age groups. Numerous risk factors have been identified as age, parity, menopause and hysterectomy. Dynamic MRI has been used to evaluate success after surgical treatment of incontinence. The objective of this study was objective evaluation of tension-free vaginal flap (TVF) operation in SUI using Dynamic MRI and understanding the possible mechanisms of continence offered by this operation. Materials and Methods: Twenty female patients were included in this prospective study from September 2006 to February 2008. All patients underwent thorough history taking, physical examination, urodynamics and dynamic MRI. The operation was done with creation of a trapezoid vaginal flap based on the midurethra. The endopelvic fascia was opened on both sides through the retropubic spaces. Four corners prolene sutures were taken in the flap. The sutures were drawn to the suprapubic region through two separate stab incisions situated 2 cm lateral to the midline using a Stamey needle. The sutures of each side were ligated to each other without tension, 1 cm superficial to the rectus sheath. Dynamic MRI was done in the supine position one week preoperatively and six months postoperatively. Images were obtained in the mid-sagittal plane both at rest and during straining. Images were evaluated for anatomical stress urinary incontinence alterations, such as the increased distance between the pubococcygeal line and the bladder
S85
UP-2.13 Characteristics of lower urinary tract symptoms and efficacy of treatment with desmopressin in female patients Cho HJ, Kim SJ, Yun BI, Hong SH, Lee JY, Kim SW, Hwang TK Dept. of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea Introduction and Objective: Nocturia is one of the important lower urinary tract symptoms to cause a decline in quality of life and about 15% of females experience more than 2 voids per night. However, there are few studies about nocturia in females. Therefore we studied, retrospectively, the cause of nocturia, the efficacy of desmopressin and the relation with other lower urinary tract symptoms in female patient. Materials and Methods: Seventy-two female patients who were bothered by voiding one or more times nightly concomitant with other LUTS and treated with desmopressin 0.2 mg were included in this study. The baseline evaluation included a careful history taking, physical examination, international prostate symptom score (IPSS) and consecutive voiding diaries for 3 days. Voiding diary data was used to derive nocturnal polyuria index (NPi) and nocturnal bladder capacity index (NBCi). Nocturnal polyuria was defined as a nighttime urine volume of more than 35% of the total daily urine volume and reduced nocturnal bladder capacity was defined as NBCi greater than 0. After treatment with desmopressin, a reduction by more than half in the number of nocturnal voids compared with baseline was regarded as effective. Results: The mean patient age was 66.8 (40-88). The mean nocturnal voids were 3.6⫾1.0 per night. Nocturnal poyuria and reduced nocturnal bladder capacity were observed in 20/72(27.8%) and 4/72(5.6%), respectively. Forty-eight patients (66.7%) showed both nocturnal polyuria and reduced nocturnal bladder capacity. Mean IPSS total score, mean IPSS voiding subscore, mean IPSS storage sub-score and QoL score were 18.9⫾9.7, 9.3⫾7.1, 10.1⫾4.4 and 4.2⫾1.5, respectively. Twenty-four patients were treated with antimuscarinics and 4 patients took alpha blockers. Twenty-one patients showed a significant decrease in the mean nocturnal voids from 3.6⫾1.0 to 1.4⫾1.2 after treatment (p⬍0.05). There were no remarkable differences in the baseline IPSS score and LUTS regardless of the improvements of nocturia after therapy with desmopres-
S84
sin. The patients did not respond to the desmopressin and showed significantly increased NBCi (0.9⫾0.5) compared to the patients who showed improvement (0.5⫾0.4) (p⬍0.05). However, 62.5% (45/ 72) patients with response to desmopressin also showed decreased NBCi. Conclusions: The important cause of nocturia in female patients is considered as not only nocturnal poyuria but also reduced nocturnal bladder capacity. Moreover, reduced nocturnal bladder capacity was noted in more than 50% in the patients as a treatment effect. Therefore desmopressin may have an effect on reduced nocturnal bladder capacity as well as nocturnal polyuria in female patients with nocturia. UP-2.14 The effects of the REMEEX system® for treatment of re-do urinary incontinence and intrinsic sphincteric deficiency Jung H1, Song P1, Kim J1, Oh T2, Park J3 1 Dept. of Urology, College of Medicine, YeungNam University, Daegu; 2 SungKyunkwan University, Masan Samsung Hospital, Masan; 3Dept. of Urology, College of Medicine, Daegu Catholic University, Daegu, South Korea Introduction and Objective: This study was conducted to evaluate the effectiveness of the REMEEX system® (EXternal MEchanical REgulation, Neomedic International, Terrassa (Barcelona), Spain) for treatment of re-do urinary incontinence and intrinsic sphincteric deficiency. Materials and Methods: From August 2006 to January 2009, a total of 43 patients underwent the REMEEX system威. Patients were categorized into failed urinary incontinence (Group A, 16 patients) and intrinsic sphincteric deficiency (Group B, 27 patients). Of the 43 patients, 16 had previous incontinence surgical interventions, 9 had other pelvic surgeries, and 10 either had spine surgery, diabetes mellitus, cerebrovascular accident, Parkinson’s disease, spine fracture, herniated lumbar disc, mood disorder or so on. The success rate of patients after surgery was assessed by cure and satisfaction rate followed up postoperatively at 1, 6, and 12 months. Clinical, urodynamic, peri- and post-operative data with respect to success rates were analyzed. Results: The mean age of patients was 61.7 years (range 44-81) and the mean follow-up period was 20.1 months (range 12-34). Total cure rates with the REMEEX system威 (Group A/Group B) were 100.0%/
96.3% at 1 month and 100.0%/76.2% at 12-month follow-up. Satisfaction rates were 100.0%/88.8% at 1 month and 83.4%/71.5% at 12-month follow-up in group A and B. Neither bladder puncture (37.2%) nor surgical wound infection (7.0%) statistically influenced the cure and satisfaction rate of the REMEEX system威 in either group (P⫽0.681, P⫽0.451, respectively) by Fisher’s exact test. Conclusions: The REMEEX system威 may be an effective procedure regardless of previous incontinence surgical interventions and intrinsic sphincteric deficiency. The absence of adverse events associated with the REMEEX system威 until 12-month follow-up and high subjective and objective 12-month postoperative success rates make the REMEEX system威 a recommendable surgical treatment for re-do urinary incontinence and intrinsic sphincteric deficiency. UP-2.15 The effect of stage II or less cystocele on voiding pattern after midurethral sling Kim H1, Paick S1, Lho Y1, Park H1, Park W2, Jo M3 1 Konkuk University, School of Medicine, Seoul; 2Inha University College of Medicine, Incheon; 3Korea Cancer Center Hospital, Seoul, South Korea Introduction and Objective: The presence of cystocele is known to be negative effect after sling surgery. We investigate the effect of stage II or less cystocele on voiding pattern after sling surgery in stress incontinence patients. Materials and Methods: From March 2008 to November 2010, we reviewed medical records of 164 patients who underwent mid urethral sling and did not undergo cystocele repair concomitantly. Urodynamic study was done to all patients. According ICS cystocele grade, we classified patients into 0, I and II grade. No cystocele group was defined as patients who had cystocele of 0 and cystocele group was defined as grade I or II. We compared the preoperative and postoperative IPSS score, quality of life (QoL) scare, peak uroflow (Q max), post void residual (PVR) and success rate of sling surgery between two groups. Results: Among the 164 patients, 137 were in no cystocele group and 27 in cystocele group. The mean patient age, preoperative Q max, PVR, IPSS score and QoL score were similar in the two groups. In urodynamic study, MUCP and VLPP value were no different between two groups. After 3 month of sling surgery, Q
UROLOGY 76 (Supplement 3A), September 2010
UNMODERATED POSTER SESSIONS
max, PVR, IPSS score and QoL score were not statistically different between two groups. The success rate of sling surgery was 90% and 92% respectively and did not statistically different. Conclusions: Sling surgery without cystocele repair did not affect voiding pattern or sling success rate to patients who have stress incontinence and cystocele grade I or II compared to patients who have no cystocele. Our study suggests that cystocele repair is not mandatory with sling surgery for patient who have cystocele grade I or II.
Conclusions: Obese SUI patients had worse SUI symptom grade, urgency and urge incontinence symptoms than nonobese patients. However, surgical correction using TOT operation could restore the symptoms and voiding parameters as effectively as with non-obese patients.
UP-2.16 The influence of obesity on patients with female stress urinary incontinence Kim Y1, Kim W1, Tchey D1, Yun S1, Lee S1, Kim W1, Jo S2 Dept. of Urology, 1Chungbuk National University College of Medicine, Cheongju; 2 Cheongju Saint Mary’s Hospital, Cheongju, South Korea
UP-2.17 Postoperative voiding difficulty after midurethral sling surgery in female stress urinary incontinence: when does it get better? Lee D1, Kim J2, Kim Y3, Choi J4, Kim H5, Lee T6, Park W6 Depts. of Urology, 1Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon; 2Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon; 3Bucheon Soonchunhyang Hospital, Soonchunhyang University, Bucheon; 4Ajou University, Suwon; 5St. Paul’s Hospital, The Catholic University of Korea, Seoul; 6Inha University Hospital, Incheon, South Korea
Objective: The purpose of our study was to evaluate the influence of obesity on the clinical characteristics, quality of life (QoL) and outcomes in the stress urinary incontinence patients who underwent the transobturator tape (TOT) surgery. Materials and Methods: The items of preoperative evaluations consisted of history taking, physical examination, cystometrography, 3 day frequency-volume chart, King’s health questionnaire (KHQ) and symptom perception scale questionnaires. Patients with any neurologic diseases that affect the voiding pattern were excluded. From 2007 to 2009, 107 patients with TOT operation were enrolled. The patients were divided into non-obese (BMI⬍25) and obese group (BMIⱖ25). Results: The non-obese group was 55 (51.4%) patients and obese group was 52 (48.6%). The median age was 49.0 (30.873.5) years in non-obese group and 52.7 (35.5-73.5) in obese group (p⬎0.05). The obese group showed the higher SUI symptom grade, urethral hypermobility, urgency and urge incontinence scale than the non-obese group (each p⬍0.05). Each domain of KHQ and item of 3-day frequency-volume chart did not show the differences between two groups (each p⬎0.05). After the operation, the symptom scales and parameters in the 3-day frequency-volume chart of the obese group were similar to those of the nonobese group (each p⬎0.05). The objective success, recurrence and complication rates in 1 year were similar in the two groups (each p⬎0.05).
Introduction and Objective: This study was designed to clarify the time when the voiding difficulty caused by midurethral sling procedure was disappeared spontaneously by prospective observation of the patients’ natural courses with regard to obstructive symptom after sling procedure. Materials and Methods: We observed patients’ voiding difficulties that occurred immediately after transobturator sling surgery for female stress urinary incontinence from October 2006 to August 2007. Those patients who have complained of voiding difficulties were asked about the time when those symptoms were disappeared spontaneously at weekly interval. Voiding difficulty was defined as postoperative subjective symptom of decreased urine flow compared to that before surgery. Patients who underwent urethral dilatation, tape release or administration of alpha blocker due to large postvoid residual urine were excluded in this study. Results: Sixteen (12.7%) out of 126 patients had complained of voiding difficulties immediately after surgery. However, 2 patients who were managed by urethral dilatation or tape release because of larger amount of postvoid residual urine (⬎400 ml) were excluded. The mean age of 14 patients were 44.7 years old and 5 had low valsalva leak point pressure (⬍60 cmH2O); 1 had low peak urine flow (⬍20 ml/sec). Concomitant surgeries were hysterectomy in 3, perineorrhaphy in 3 and 3 patients were mixed incontinence. All had no residual urine at the time of discharge
UROLOGY 76 (Supplement 3A), September 2010
from hospital. Voiding difficulties were disappeared spontaneously; 5 in the second, 3 in the third, 1 in the fourth, 2 in the fifth, 1 in the sixth, 1 in the eighth week. However, the remaining 1 had complained of persisted voiding difficulty since 4 months after surgery. Voiding difficulties disappeared within 6 weeks in 12 (85.7%) out of 14 patients. Conclusions: Most of the postoperative voiding difficulties immediately after sling surgery disappeared spontaneously within 6 weeks. Therefore, we need to make those patients who showed voiding difficulties after sling surgery feel relieved. UP-2.18 Evaluation of a modified novel vaginal flap operation in stress urinary incontinence (SUI) using dynamic MRI Fayed A, Abdelkarim A, Mahfouz W, Elsalmy S Genitourinary Surgery, Alexandria University, Alexandria, Egypt Introduction and Objective: Stress urinary incontinence is a common problem among women in all age groups. Numerous risk factors have been identified as age, parity, menopause and hysterectomy. Dynamic MRI has been used to evaluate success after surgical treatment of incontinence. The objective of this study was objective evaluation of tension-free vaginal flap (TVF) operation in SUI using Dynamic MRI and understanding the possible mechanisms of continence offered by this operation. Materials and Methods: Twenty female patients were included in this prospective study from September 2006 to February 2008. All patients underwent thorough history taking, physical examination, urodynamics and dynamic MRI. The operation was done with creation of a trapezoid vaginal flap based on the midurethra. The endopelvic fascia was opened on both sides through the retropubic spaces. Four corners prolene sutures were taken in the flap. The sutures were drawn to the suprapubic region through two separate stab incisions situated 2 cm lateral to the midline using a Stamey needle. The sutures of each side were ligated to each other without tension, 1 cm superficial to the rectus sheath. Dynamic MRI was done in the supine position one week preoperatively and six months postoperatively. Images were obtained in the mid-sagittal plane both at rest and during straining. Images were evaluated for anatomical stress urinary incontinence alterations, such as the increased distance between the pubococcygeal line and the bladder
S85