- Email: [email protected]
Urinary tract infections in genital descensus and urinary stress incontinence
MONDAY,
SEPTEMBER
4
14.5
P1.19.25 THE URETEROSIGMOIDOSTOMY
always mean improvement of urinary symptoms. Further studies are needed to clarify what contribute to the prognosis.
P1.19.23 URINARY URINARY
TRACT STRESS
INFECTIONS IN GENITAL INCONTINENCE
DESCENSUS
AND
MKauusevski, Special Gynecology & Obstetrics Hospital Cair, Dizonska bb, Skopje, Macedonia, 1000. Objectives: The aim of the study was to determine the incidence of urinary infections in patients with established diagnosis of genital descensus and stress urinary incontinence (SUI). Study methods: Study included 50 patients with different grade of genital descensus and stress incontinence. All of them had preoperatively obtained urine analysis and cistoscopy. Furthermore, urine culture was performed in patients with bacteriuria. Results: In 25 (50%) of the analyzed patients bacteriuria was found. Urine culture was obtained in all of them, in 21 cases (84%) of them Escherichia coli was isolated, and the remaining isolated bacteria were Staphylococcus agalacticae inlcase (4%), Proteus spp. 1(4%), Enterococcus 1 (4%) and Staphylococcus saprophyticus 1 (4%). The whole group had cistoscopicaly determined different grade of cystocela. Conclusions: Concerning the high incidence of urinary tract infections in all the patients with genital descensus and SUI, preoperative performing of urine culture and cistoscopy is highly recommendable.
P1.19.24 QUALITY OF LIFE IN ELDERLY PATIENTS AND VAGINAL HYSTERECTOMY FOR GENITAL PROLAPSE N.Badzakov. M.Lazarevski, D.Chakmakov, V.Iliev, Medical Faculty,
Veljko Vlahovic 2015, Skopje, Macedonia,
MK-91000.
Objectives: The aim of the study was to evaluate vaginal surgery for genital prolapse in elderly patients and quality of life before and after operative treatment. We review results of study group with vaginal hysterectomy compared with control group of patients refused surgery or had intolerance to operative intervention. Study Methods: Study group of 36 patients (mean age 64 years, parity 2.4) who underwent vaginal hysterectomy with suburethral duplication of vaginal wall for stress urinary incontinence and Control group of 34 patients (mean age 66 years,parity 2.6) who perceived intolerance to surgery and were threated conservatively with application of ring pessaries, are compared with a quality of life assessment questionnaire. All patients had a complete history, physical examination,urodynamics, echosonography. Two group underwent a quality of life assessment pre and post tretment (operative and conservative) with five -point questionnaire.Complications included hemorrhagie,wound infections, urinary tract infections, persistent stress urinary incontinence, de nova “regency, urinary retention, valut prolapse. Statistic analysis included Wilcoxon rank sum testing. Results: Quality of life pre and post treatment (operative or conservative) were with median of 716 (p=O.45) and 12112 (p=O.16). Mean follow up was 21122 months. Complications ashaemorrhagie were 2/l (p=O.53); urinary tract infections 2115 (p=O.Ol); persistent stress urinary incontinence 3112 (p=O5); de nova urgency 212 (p=O.88); urinary retention O/l (p=O.48) There were no cases with wound infections and vault prolapse at study group patients. Conclusions: The elderly patients have an exellent improvement of quality of life, low complication rate when vaginal hysterectomy are performed, compared with application of ring pessaries. Advanced age show not dissuade the surgeon from performing an appropriate procedure when indicated.
AS AN ALTERNATIVE METHOD OF THERAPY FOR PATIENTS WITH UNREPAIRABLE VESICOVAGINAL FISTULAS IN A MISSION HOSPITAL IN NIGER Wacker .I., Dept. OBIGYN, Hospital Bruchsal; University of Heidelberg, Germany. Reulecke M., Hospital SIM Galmi, Madaoua, Niger. Utz B., Dept. OBIGYN, Hospital Bruchsal, Germany. Objectives: In developing countries the ureterosigmoidostomy (US) is by far the most common type of urinary diversion used for patients with unrepairable obstetric vesicovaginal fistulas (VVFs), even though many possible complications are known. But so far no studies about complications after US in developing countries have been published. Study methods: In a retrospective study all hospital charts of patients operated on for a VVF between June 1989 and April 1996 were evaluated, considering the type of VVF, the kind of operation done and especially the outcome of the operation. Only when the woman was completely dry, the operation was considered a success. 60 charts of women who needed US were further evaluated, especially looking for the type of VVF which required the ureterosigmoidostomy. In a clinical follow up 43 women were asked about their health after the operation, about symptoms of urinary tract infection, about their continence/incontinence, about their quality of life after operation, abut their marital status and if they had delivered a baby after the operation. Results: We followed up 43 patients who underwent US for VVFs. The mortality rate was 1.6%. 4.5% of the women developed a pyelonephritis and 4.5% complained occasionally about loin pain. Over 90% had no symptoms at all. 90.5% of the women were satisfied with their quality of life after the operation. Conclusion: The results support the role of the US in the therapy of unrepairable VVFs. However, as this is the first study in a developing country with a rather small number of patients further studies of this kind are recommendable.
P1.19.26 LAPAROSCOPIC CERVICOSACROPEXY (A SLING PROCEDURE) AN INNOVATIVE ENDOSCOPIC CONSERVATIVE SURGERY FOR THE PROLAPSED UTERUS
Neeta War&l, G. Niyogi2, A. Padmawarl. 1Sanjeevani Endoscopy Centre, B/4, Alaknanda Apts., Dattani Park Complex, WE Highway, Kandivli East, Mumbai, India, 400 101; 2Somaiya Hospital, Mumbai, India. Objectives: 1. To provide an anatomically correct conservative surgery for uterine prolapse in patients desiring menstrual and child-bearing functions. 2. To ananlyse the procedural minutae, cure rates, complications, post operative hospitalisation and resumption of normal activity and failure rates in this procedure which restores the pelvic anatomy to near normal. Mean follow up of two years has been done and parameters studied. Study methods: 22 patients with II degree uterine prolapse to procidentia underwent laparoscopic cervicosacropexy using Merselene tape since November 1997 at Sanjeevani Endoscopy Centre. Inclusion criteria: Young women with uterovaginal prolapse desirous of menstrual and fertility functions with a healthy cervix. Results: Immediate correction of prolapse was confirmed. Patients were in the age group of 25-40 years. Complications : 4 patients (18.1%) had backache. One patient (4.5%) had bleeding from the sacral vessels which was controlled laparoscopically. One patient (4.5%) had graft rejection, necessitating removal of tape. Out of 21 patients, 2 (9.52%) conceived; one was delivered by Caesarian section and one had a normal delivery without recurrence of prolapse. Conclusions: All patients of prolapse connot be treated by shortening the existing ligaments as all women do not have an adequately strong endopelvic fascia. Laparoscopic cervicosacropexy ( a SLING procedure) can become a treatment option for women desiring conservative surgery. Though technically challenging, it is safe in trained hands.
SEPTEMBER
4
14.5
P1.19.25 THE URETEROSIGMOIDOSTOMY
always mean improvement of urinary symptoms. Further studies are needed to clarify what contribute to the prognosis.
P1.19.23 URINARY URINARY
TRACT STRESS
INFECTIONS IN GENITAL INCONTINENCE
DESCENSUS
AND
MKauusevski, Special Gynecology & Obstetrics Hospital Cair, Dizonska bb, Skopje, Macedonia, 1000. Objectives: The aim of the study was to determine the incidence of urinary infections in patients with established diagnosis of genital descensus and stress urinary incontinence (SUI). Study methods: Study included 50 patients with different grade of genital descensus and stress incontinence. All of them had preoperatively obtained urine analysis and cistoscopy. Furthermore, urine culture was performed in patients with bacteriuria. Results: In 25 (50%) of the analyzed patients bacteriuria was found. Urine culture was obtained in all of them, in 21 cases (84%) of them Escherichia coli was isolated, and the remaining isolated bacteria were Staphylococcus agalacticae inlcase (4%), Proteus spp. 1(4%), Enterococcus 1 (4%) and Staphylococcus saprophyticus 1 (4%). The whole group had cistoscopicaly determined different grade of cystocela. Conclusions: Concerning the high incidence of urinary tract infections in all the patients with genital descensus and SUI, preoperative performing of urine culture and cistoscopy is highly recommendable.
P1.19.24 QUALITY OF LIFE IN ELDERLY PATIENTS AND VAGINAL HYSTERECTOMY FOR GENITAL PROLAPSE N.Badzakov. M.Lazarevski, D.Chakmakov, V.Iliev, Medical Faculty,
Veljko Vlahovic 2015, Skopje, Macedonia,
MK-91000.
Objectives: The aim of the study was to evaluate vaginal surgery for genital prolapse in elderly patients and quality of life before and after operative treatment. We review results of study group with vaginal hysterectomy compared with control group of patients refused surgery or had intolerance to operative intervention. Study Methods: Study group of 36 patients (mean age 64 years, parity 2.4) who underwent vaginal hysterectomy with suburethral duplication of vaginal wall for stress urinary incontinence and Control group of 34 patients (mean age 66 years,parity 2.6) who perceived intolerance to surgery and were threated conservatively with application of ring pessaries, are compared with a quality of life assessment questionnaire. All patients had a complete history, physical examination,urodynamics, echosonography. Two group underwent a quality of life assessment pre and post tretment (operative and conservative) with five -point questionnaire.Complications included hemorrhagie,wound infections, urinary tract infections, persistent stress urinary incontinence, de nova “regency, urinary retention, valut prolapse. Statistic analysis included Wilcoxon rank sum testing. Results: Quality of life pre and post treatment (operative or conservative) were with median of 716 (p=O.45) and 12112 (p=O.16). Mean follow up was 21122 months. Complications ashaemorrhagie were 2/l (p=O.53); urinary tract infections 2115 (p=O.Ol); persistent stress urinary incontinence 3112 (p=O5); de nova urgency 212 (p=O.88); urinary retention O/l (p=O.48) There were no cases with wound infections and vault prolapse at study group patients. Conclusions: The elderly patients have an exellent improvement of quality of life, low complication rate when vaginal hysterectomy are performed, compared with application of ring pessaries. Advanced age show not dissuade the surgeon from performing an appropriate procedure when indicated.
AS AN ALTERNATIVE METHOD OF THERAPY FOR PATIENTS WITH UNREPAIRABLE VESICOVAGINAL FISTULAS IN A MISSION HOSPITAL IN NIGER Wacker .I., Dept. OBIGYN, Hospital Bruchsal; University of Heidelberg, Germany. Reulecke M., Hospital SIM Galmi, Madaoua, Niger. Utz B., Dept. OBIGYN, Hospital Bruchsal, Germany. Objectives: In developing countries the ureterosigmoidostomy (US) is by far the most common type of urinary diversion used for patients with unrepairable obstetric vesicovaginal fistulas (VVFs), even though many possible complications are known. But so far no studies about complications after US in developing countries have been published. Study methods: In a retrospective study all hospital charts of patients operated on for a VVF between June 1989 and April 1996 were evaluated, considering the type of VVF, the kind of operation done and especially the outcome of the operation. Only when the woman was completely dry, the operation was considered a success. 60 charts of women who needed US were further evaluated, especially looking for the type of VVF which required the ureterosigmoidostomy. In a clinical follow up 43 women were asked about their health after the operation, about symptoms of urinary tract infection, about their continence/incontinence, about their quality of life after operation, abut their marital status and if they had delivered a baby after the operation. Results: We followed up 43 patients who underwent US for VVFs. The mortality rate was 1.6%. 4.5% of the women developed a pyelonephritis and 4.5% complained occasionally about loin pain. Over 90% had no symptoms at all. 90.5% of the women were satisfied with their quality of life after the operation. Conclusion: The results support the role of the US in the therapy of unrepairable VVFs. However, as this is the first study in a developing country with a rather small number of patients further studies of this kind are recommendable.
P1.19.26 LAPAROSCOPIC CERVICOSACROPEXY (A SLING PROCEDURE) AN INNOVATIVE ENDOSCOPIC CONSERVATIVE SURGERY FOR THE PROLAPSED UTERUS
Neeta War&l, G. Niyogi2, A. Padmawarl. 1Sanjeevani Endoscopy Centre, B/4, Alaknanda Apts., Dattani Park Complex, WE Highway, Kandivli East, Mumbai, India, 400 101; 2Somaiya Hospital, Mumbai, India. Objectives: 1. To provide an anatomically correct conservative surgery for uterine prolapse in patients desiring menstrual and child-bearing functions. 2. To ananlyse the procedural minutae, cure rates, complications, post operative hospitalisation and resumption of normal activity and failure rates in this procedure which restores the pelvic anatomy to near normal. Mean follow up of two years has been done and parameters studied. Study methods: 22 patients with II degree uterine prolapse to procidentia underwent laparoscopic cervicosacropexy using Merselene tape since November 1997 at Sanjeevani Endoscopy Centre. Inclusion criteria: Young women with uterovaginal prolapse desirous of menstrual and fertility functions with a healthy cervix. Results: Immediate correction of prolapse was confirmed. Patients were in the age group of 25-40 years. Complications : 4 patients (18.1%) had backache. One patient (4.5%) had bleeding from the sacral vessels which was controlled laparoscopically. One patient (4.5%) had graft rejection, necessitating removal of tape. Out of 21 patients, 2 (9.52%) conceived; one was delivered by Caesarian section and one had a normal delivery without recurrence of prolapse. Conclusions: All patients of prolapse connot be treated by shortening the existing ligaments as all women do not have an adequately strong endopelvic fascia. Laparoscopic cervicosacropexy ( a SLING procedure) can become a treatment option for women desiring conservative surgery. Though technically challenging, it is safe in trained hands.