非重度妊娠期高血压、子痫前期终止妊娠时机和方式的探讨

目的:分析经闭孔无张力尿道中段悬吊术（TVT-O）后复发性压力性尿失禁（SUI）女性患者的临床特点和治疗。方法:回顾性分析2013年1月至2019年6月于首都医科大学附属北京朝阳医院住院的TVT-O术后复发性SUI女性患者16例的临床资料,患者复发后均采用耻骨后无张力尿道中段悬吊术（TVT）治疗。分析患者的临床特点、手术疗效和安全性,并采用尿失禁问卷简表（ICI-Q-SF）、生活质量问卷（I-QOL）及尿动力学检查对术前与术后的情况进行比较。结果:16例患者年龄60.6±9.3岁,TVT-O术后2.5±1.3年SUI复发,复发后10例患者体质量指数（BMI）≥28.0 kg/m2,14例患者有尿道括约肌关闭功能受损。12例患者的既往吊带位于尿道中段,其中3例位于阴道肌层,无术中并发症。与术前相比,术后ICI-Q-SF评分显著降低,I-QOL评分则显著提高,差异均有统计学意义(（印）P（正）<0.05)。TVT术后主、客观治愈率均为93.8%（15/16）。随访8～46个月,所有患者均未出现SUI复发及中远期并发症,1例患者术后出现排尿困难,2例患者出现单侧会阴区疼痛,均予对症处理及时缓解。术后2个月复查各项尿动力学指标,与术前相比差异均无统计学意义(（印）P（正）>0.05)。结论:TVT-O术后SUI的复发可能与肥胖、吊带位置不正确和术式选择不当有关,二次行TVT术可有效和安全地治疗TVT-O术后复发性SUI。     

经闭孔阴道无张力尿道中段悬吊带术治疗女性压力性尿失禁的远期结局及进展

压力性尿失禁(SUI)是影响女性身心健康的常见疾病,有多种治疗方法,其中阴道无张力尿道中段悬吊带术是一线手术治疗SUI的常用方法,目前临床上多选择闭孔路线。经闭孔从外向内穿刺的无张力尿道中段吊带术(TOT)及经闭孔从内向外穿刺的无张力尿道中段吊带术(TVT-O)安全性高、手术时间短、疗效好、并发症少,可显著提高SUI患者的生活质量、维持或改善性功能,且膀胱穿孔、肠管损伤及排尿功能障碍等围手术期并发症的发生率均较低。经闭孔路径悬吊带术(包括TVT-O和TOT)的特有并发症为下肢疼痛,可以通过药物治疗或随着时间推移减轻症状。     

经耻骨后与经闭孔无张力尿道悬吊术治疗女性压力性尿失禁并发症分析

目的比较经耻骨后无张力尿道悬吊术（TVT）和经闭孔无张力尿道悬吊术（TVT—O）治疗女性压力性尿失禁的手术并发症。方法回顾性分析我院2002年9月-2007年6月应用TVT和TVT—O治疗女性压力性尿失禁患者167例（TVT术74例,TVT-O术93例）的临床资料。结果术中膀胱穿孔：TVT组发生率为9．46％,TVT—O组为1．08％（P〈0．05）;术中出血〉100ml：TVT组发生率为16．22％,TVT—O组6．45％（P〈0．05）,其他术中、术后并发症发生率两种手术方法比较,差异无显著性（P〉0．05）。结论与TVT比较,TVT-O手术并发症的发生率低,且手术操作简便、手术时间短,是一种较理想的治疗女性压力性尿失禁的手术方法。     

改良型TVT-O术式治疗女性压力性尿失禁的临床效果分析

目的探讨改良型经闭孔尿道中段悬吊带术(改良型TVT-O)治疗女性压力性尿失禁(SUI)手术时间、并发症发生率及治疗效果。方法选取该院2015年10月至2016年10月收治的SUI患者60例为研究对象,随机分为对照组和观察组,每组各30例。对照组采用经闭孔无张力尿道中段悬吊带术(TVT-O)手术治疗,观察组采用改良型TVT-O术式手术治疗,比较两组患者手术时间、Grouts-Blaivas评分及并发症情况。结果观察组手术时间短于对照组,差异有统计学意义(P 0.05),Grouts-Blaivas评分在术后1、6、9及12个月时差异无统计学意义(P0.05);对照组术后腿痛发生率高于观察组,差异有统计学意义(P 0.05),其他并发症差异无统计学意义(P0.05)。结论改良型TVT-O术式和传统TVT-O术式治疗效果相同,但改良型TVT-O术式可缩短手术时间,降低手术难度,减少术后腿部疼痛的发生率,具有良好的临床应用价值。     

前瞻性随机对照研究比较阴道无张力吊带和经闭孔尿道下吊带两种手术治疗压力性尿失禁的效果

压力性尿失禁（SUI）是困扰中老年女性的一种常见病理情况，其手术方式繁多，却极少有资料客观前瞻性评价这些术式。近年手术治疗SUI的基本原理发生了改变。虽然无张力性尿道吊带（TVT）有较高的手术成功率．但因该术可发生肠道和大血管损伤。膀胱和尿道穿孔．术后排空障碍如一过性尿潴留等，对手术安全性提出质疑。本研究采用前瞻性随机对照法评价TVT和经闭孔的尿道吊带（TOT）两种手术治疗SUI的临床效果和术后膀胱出口的阻力。     

合并其他阴式手术的经闭孔尿道中段悬吊术治疗压力性尿失禁的疗效分析

目的探讨合并其他阴式手术的经闭孔尿道中段悬吊术（TVT—O）治疗压力性尿失禁（SUI）的近期疗效和影响因素。方法选取2006年12月至2012年5月南京军区福州总院收治的SUI患者184例,根据是否合并其他阴式手术将其分为联合TVT—O组（57例）和TVT—O组（127例）。分析两组患者的围手术期并发症及术后1年的疗效,并采用泌尿生殖道疾病相关问卷-6（UDI-6）和尿失禁影响程度相关问卷-7（ⅡQ-7）评估患者术后的生活质量。结果联合TVT—O组患者术中出血量、手术时间和尿管留置时间分别为（80．52±53．68）ml、（65．37±33．12）min和（75．31±47．84）h;TVT～O组分别为（16．26±11．72）ml、（17．45±8．92）min和（23．69±11．11）h,两组比较,差异均有统计学意义（P均〈0．05）;联合TVT—O组并发症发生率（14．04％,8／57）与TVT-O组（11．02％,14／127）比较,差异无统计学意义（P〉0．05）;联合TVT-O组与TVT-O组随访时间分别为（36．82±22．34）个月和（38．30±25．75）个月,联合TVT—O组治愈率（94．74％,54／57）与TVT-O组（97．64％,124／127）比较,差异无统计学意义（P〉0．05）;术后1年联合TVT-0组UDI-6和IIQ-7评分分别为（0．72±0．70）分和（0．74±0．69）分,TVT-O组分别为（0．69±0．72）分和（0．71±0．71）分,均较术前降低（P〈0．05）,但两组间比较,差异无统计学意义（P〉O．05）。结论TVT—O合并其他阴式手术虽然延长了尿管留置及术后住院时间,但并不影响TVT—O治疗SUI的近期疗效。     

Prolift系统盆底重建术的临床疗效及对患者生活质量的影响

目的研究女性Prolift系统盆底重建术的临床疗效及对患者生活质量的影响。方法回顾性分析2007年1月至2010年6月因重度盆腔器官脱垂（POP）在北京大学人民医院妇科接受Prolift系统进行盆底重建手术治疗的98例患者的资料,通过比较患者术前、术后POP-Q分期、盆底功能影响问卷-简表7（PFIQ-7）、盆底功能障碍问卷-20（PFDI-20）及性生活质量问卷-31评分情况,评价Prolift盆底重建系统在妇科的应用价值。结果 98例患者中83例患者按时随访并回收问卷,平均随访时间（34.07±23.43）个月。患者平均手术时间（82.34±26.78）min;平均术中出血量（109.06±70.45）ml。无术中严重并发症。解剖治愈率87.95%（73/83）。脱垂复发10例（12.05%）,补片侵蚀7例（8.43%）,盆腔血肿4例（4.82%）。术前合并压力性尿失禁（SUI）37例患者同时行抗尿失禁手术,术后SUI症状消失33例（89.19%）,而术前无SUI的患者中术后有14.29%出现了SUI。调查问卷显示,患者术后生活质量有明显改善,但术前、术后性生活质量比较,差异无统计学意义（P〉0.05）。结论应用Prolift行盆底重建术可明显提高患者的生活质量,复发率较传统手术低。术后新发SUI应引起重视。远期效果还需长期随访。     

两种经闭孔无张力尿道悬吊术治疗压力性尿失禁疗效对比研究

目的回顾性评估由外向内经闭孔无张力尿道悬吊术（‘outside-in’ transobturator tape,TOT）与由内向外经闭孔无张力尿道悬吊术（‘inside—out’ transobturator tape,TVT-O）治疗压力性尿失禁的安全性和有效性。方法选择2004年4月～2007年1月本院压力性尿失禁患者79例,其中,行TOT患者41例,行TVT-O患者38例。TOT组和TVT-O组患有混合性尿失禁者分别为17例和13例;伴有盆腔脏器脱垂者9例和7例。对比两种手术方式的治愈率和术后并发症,评估两者的安全性和有效性。结果单纯性尿失禁患者平均手术时间为11min（TOT）和15min（TVT-O）。TVT—O组发生膀胱穿孔1例。TOT组平均随访时间为26个月,TVT-O组为14个月。TVT-O组和TOT组的1年总治愈率分别为92％和90％（P〉0．05）。结论TOT和TVT-O均能有效的治疗伴有或不伴有盆腔器官脱垂的压力性尿失禁。     

146例压力性尿失禁患者的发病相关因素分析

目的对妇产科门诊压力性尿失禁（stress urinary incontinence，SUI）患者进行压力性尿失禁发病相关因素分析。方法对2005年1月~2005年2月在河南省郑州大学第一附属医院妇产科门诊进行B超检查的2500例体检者抽样调查349例，对其中发现的146例SUI患者进行相关因素分析。其中27例进行膀胱尿道B超影像检查。结果无明显器质性病变患者103例中，女性SUI发病率随年龄增加而增加，在14-20岁、21-40岁、40-87岁三个年龄阶段，SUI发病率分别为12.5%（1/8）、20.8%（10/48）、76.6%（36/47），三者比较显著性差异（P=0.000）。60例已生育患者（45.0±10.7）岁受检者中，经阴道顺产54例，发现SUI36例，占66.7%（36/54），剖宫产6例，仅发现1例SUI，占16.7%（1/6），两者相比差异有显著性（P〈0.027）。64例生育一胎的受检者中，SUI的发病率为37.5%（24/64），41例生育两胎或以上者，SUI的发病率为58.5%（24/41），而70例未生育患者中，SUI的发病率为4.3%（3/70），三者的差别具有统计学意义（P=0.000）。11例子宫脱垂患者全都有SUI。27例尿失禁患者进行了经阴道B超检查，发现16例（59.3%）膀胱充盈后膀胱颈口呈漏斗形改变。结论女性SUI发病率随着年龄的增长而增加；多种妇产科因素如经阴道分娩、多产和子宫脱垂等都与女性SUI密切相关。B超影像学检查可以为正确评估女性SUI提供客观依据。     

TVT-O和TVT治疗单纯女性压力性尿失禁的疗效对比:立足随机对照试验的Meta分析

目的:系统评价经阴道无张力尿道中段悬吊带术(闭孔路径)(TVT-O)和经阴道无张力尿道中段悬吊带术(TVT)治疗女性压力性尿失禁的客观成功率和并发症发生率。方法:计算机配合手工检索1994年1月~2007年6月各数据库和灰色文献中TVT-O和TVT疗效的随机对照试验(RCT),用Revman4.2.2软件,对两种术式的客观成功率、并发症发生率进行Meta分析。结果:共纳入10个随机对照试验。TVT-O组553例,TVT组575例。Meta分析显示,TVT-O客观成功率、主观成功率均与TVT相似[P>0.05,OR 0.78,95%可信区间(CI):0.47~1.30;P>0.05,OR 0.93,95%CI:0.51~1.68)],TVT-O的"膀胱损伤"发生率低于TVT(P<0.01,OR 0.16,95%CI:0.05~0.49),TVT-O的"尿路症状"发生率与TVT相似(P>0.05,OR 0.90,95%CI:0.61~1.34)。因文献的异质性和结论的高敏感性,不能确定TVT-O"术后疼痛"发生率是否增高。结论:TVT-O术是一种疗效确切的无张力阴道吊带术,与TVT术的成功率、尿路症状相似而膀胱损伤的风险减少。但须进一步研究确证"术后疼痛"发生率是否增加。     

不同路径阴道无张力尿道中段悬吊术治疗重度压力性尿失禁

目的 探讨经耻骨后路径阴道无张力尿道中段悬吊(TVT)术及经闭孔路径阴道无张力尿道中段悬吊(TVT-O)术治疗女性重度压力性尿失禁的临床效果.方法 前瞻性随机对照单盲方法选取重度压力性尿失禁患者69例(其中35例行TVT,34例行TVT-O),部分患者合并Ⅰ～Ⅱ度子宫脱垂及阴道前壁膨出.分别记录两种路径手术的手术时间、术中出血量、术后住院时间、住院费用,以及术中、术后并发症的类型和发生率.运用尿道疾病程度分类问卷(UDI-6)和尿失禁相关生活质量问卷(ⅡQ-7)对两组患者组内及组间手术前后生活质量的变化进行评估.结果 TVT-O组平均手术时间为(18±5)min,明显短于TVT组的(27±5)min,差异有统计学意义(P＜0.01).两组术中出血量、术后第1天B超测量残余尿量的合格率、并发症发生率、术后住院时间和住院费用均相似,差异均无统计学意义(P均＞0.05).术后随访率100%,平均随访时间14.5个月.TVT组治愈率88.6%(31/35),略高于TVT-O组[85.3%(29/34)],但两组间比较,差异无统计学意义(P＞0.05).吊带侵蚀发生率TVT组为5.7%(2/35),高于TVT-O组[2.9%(1/34)];耻骨上、腹股沟或大腿内侧酸痛发生率TVT组为5.7%(2/35),低于TVT-O组[14.7%(5/34)],但差异均无统计学意义(P均＞0.05).两组间手术前后UDI-6和ⅡQ-7问卷各项目评分及总体评分分别比较,差异均无统计学意义(P均＞0.05).两组内手术后UDI-6问卷(除梗阻项目)和ⅡQ-7问卷各项目评分及总体评分较手术前均明显降低,差异均有统计学意义(P均＜0.01),UDI-6问卷中梗阻项目评分,两组内手术前后比较,差异无统计学意义(P＞0.05).结论 TVT-O路径较TVT路径手术时间短,术后短期随访结果显示,两种手术路径均可有效治疗重度压力性尿失禁、改善患者生活质量且不增加尿道梗阻风险,但长期疗效有待进一步随访观察.     

自制吊带经闭孔尿道中段悬吊术治疗压力性尿失禁疗效观察

目的:观察自制吊带行改良经闭孔尿道中段悬吊术治疗女性压力性尿失禁的临床效果。方法:50例中、重度压力性尿失禁患者采用聚丙烯网片自制吊带行改良经闭孔无张力吊带尿道中段悬吊术,观察手术情况及术后效果。结果:50例患者手术均成功。平均手术时间11.5±10.1min,术中平均出血量19.9±14.4ml;平均住院7.5±3.3d;无手术并发症发生。随访6-36个月,47例完全治愈,3例有效,有效率100%。无远期并发症,无复发病例。结论:聚丙烯网片自制吊带尿道悬吊术治疗压力性尿失禁疗效确切。     

Tension-free vaginal tape obturator versus Ajust adjustable single incision sling procedure in women with urodynamic stress urinary incontinence

Objective

To assess the efficacy and complications of inside-out transobturator tension-free vaginal tape (TVT-O) in comparison with a single incision sling procedure (Ajust) for the treatment of urodynamic stress urinary incontinence.

Study design

Prospective closely matched controlled study. In total, 171 patients were included in the study: 86 women underwent the TVT-O procedure, while in other 85 cases the Ajust procedure was performed. Subjective and objective cure, improvement and failure rates, mean operative time, hospital stay and incidence of complications were assessed.

Results

There was no statistically significant difference between the two groups for age, body mass index, parity, menopausal status and severity of prolapse. No major intraoperative complications occurred. There was no significant difference in the mean operative time and the duration of hospital stay between the two groups. The mean follow-up time of the study was 22.3 months (range 12–36 months). For the TVT-O group the objective cure rate was 86%, the improvement rate was 5.9% and the failure rate was 8.1%, while the subjective cure rate was 82.6%. For the Ajust group the objective cure rate was 84.7%, the improvement rate was 4.7%, 10.6% of patients showed no change in their symptoms and the subjective cure rate was 81.2%.

Conclusions

The Ajust sling procedure presents success rates, at 22 months’ mean follow up, comparable to the TVT-O method. Both techniques seem to be safe and effective for the treatment of urodynamic stress urinary incontinence.     

TVT-O treatment of stress urinary incontinence: immediate and one-year results

OBJECTIVE: To compare one-year results between the classic retropupubic (TVT) and the in-out transobturator approaches (TVT-O) of tension-free vaginal tape for the treatment of stress urinary incontinence (SUI). PATIENTS AND METHODS: The first 82 patients operated for SUI by TVT-O in our institution were included in the analysis. Patients were evaluated at 1 and 12 months. The global satisfaction rate was assessed at 12 months by a self-reported questionnaire. Results were compared to those of the first 124 patients operated of SUI by TVT in the same institution and by the same surgeons between 1996 and 1999. RESULTS: Except a younger mean age in the TVT-O group (57 versus 60 years), no other preoperative parameter was significantly different between the TVT and the TVT-O groups. The mean operating time was shorter in the TVT-O group (15 versus 30 minutes, P<0.001). No intraoperative complication occurred. The rate of bladder perforation was significantly lower in the TVT-O group (0 versus 8.8%, P=0.004). The rate of post-voiding residual less than 100 ml was higher in the TVT-O group (88 versus 61%, P<0.001). In the TVT-O group, 40% of patients had postoperative inguinal pain (mean=9 days, range 2-15 days). After 12 months from TVT-O, 85% of patients were completely dry, 6% had de novo over bladder activity, and 93.5% of patients were satisfied with the treatment they received. The 12-month results were not significantly different between the TVT and the TVT-O groups. DISCUSSION AND CONCLUSION: With a follow-up of 12 months, TVT-O is as efficient as TVT and has a lower risk of bladder injury, a cut by half operating time, and less postoperative dysuria.     

Clinical and quality-of-life outcomes in women treated by the TVT-O procedure

OBJECTIVES: To objectively assess the success rate at 6 months after tension-free vaginal tape obturator (TVT-O) procedure. To assess subjective success rates, complications, patient satisfaction, and quality of life (QOL). DESIGN: A prospective observational study. SETTING: A tertiary referral urogynaecology practice. POPULATION: A cohort of 100 consecutive women who underwent the TVT-O procedure between March and October 2004. METHODS: The TVT-O technique was performed as described. Three standardised QOL questionnaires were completed preoperatively at 6 months and 12 months. At 6 months, a urogenital history, visual analogue scale score (VAS) for patient satisfaction, uroflow, and urinary stress test were performed. After 12 months, a urogenital history and patient satisfaction verbal analogue score (VeAS) were obtained by telephone interview. MAIN OUTCOME MEASURE: Objective success rate of the TVT-O procedure was measured by negative stress test. Secondary outcomes were subjective success rates at 6 and 12 months, pre- and postoperative comparison of urodynamic parameters, complications, postoperative symptomatology, QOL analysis, and patient satisfaction. RESULTS: Mean follow up was 18.5 months. Objective success rate was 95%. Subjective success rates were 92 and 84% at 6 and 12 months. Complications included recurrent urinary tract infection (six), voiding difficulty (two), persistent groin discomfort (three), haematoma (one), wound infection (one), vaginal tape erosion (one), and urethral irritation (one). Prevalence of de novo urge incontinence was 4.1 and 4.8% at 6 and 12 months. QOL analysis showed significant improvements in QOL scores postoperatively. Visual and verbal analogue scores indicated high patient satisfaction (VAS, VeAS >or= 80%) in 77 and 67% at 6 and 12 months. CONCLUSION: The TVT-O is a safe and effective treatment for female stress urinary incontinence.     

女性压力性尿失禁的综合治疗

目的:探讨女性压力性尿失禁(stressurinaryincontinence,SUI)的治疗方法和效果。方法:压力性尿失禁51例采用经阴道无张力尿道中段悬吊带术治疗23例,药物和功能训练治疗28例。结果:手术治疗组23例手术时间平均35min,出血量平均15ml,随访患者3~23月, 21例(91 .3% )治愈, 2例明显改善。4例出现并发症,其中术中膀胱损伤3例,术后尿潴留1例。非手术治疗28例2例治愈, 18例有不同程度地改善, 8例无效,总有效率为71 .4%。结论:经阴道无张力尿道悬吊带术是治疗女性压力性尿失禁十分有效的微创方法,药物治疗和功能训练有一定的改善作用。     

Tension-Free Vaginal Tape-O and -Secur for the Treatment of Stress Urinary Incontinence: A Thirty-Six–Month Follow-Up Single-Blind,Double-Arm,Randomized Study

ObjectiveTo compare the efficacy of the inside-out tension-free vaginal tape–obturator (TVT-O) device versus the single-incision TVT-Secur device 36 months after the procedure.MethodsA single-blind, randomized, parallel-group study on 154 patients with stress urinary incontinence (77 treated with TVT-O and 77 with the TVT-Secur hammock approach). The primary endpoint was the objective cure rate 36 months after the procedure evaluated with the challenge stress test. Secondary endpoints were subjective cure rate (evaluated with bladder diary, quality-of-life questionnaires, and patient-reported outcome tools) and intraoperative and postoperative complications. The primary endpoint was evaluated with a noninferiority study design.ResultsSixty-six patients in the TVT-O group and 64 in the TVT-Secur group concluded the study. Thirty-six months after the procedure, 57/66 patients (86.4%) in the TVT-O and 50/64 (78.1%) in the TVT-Secur groups were objectively cured (noninferiority unilateral u test: p < .05). No differences were observed in the subjective cure and complication rates.ConclusionsTVT-Secur seems not to be inferior to TVT-O in the surgical treatment of stress urinary incontinence and causes less postoperative pain. The possibility of severe blood loss cannot be ruled out when TVT-Secur is used.     

Trans-obturator urethral sling for the surgical correction of female stress urinary incontinence: Outside-in (Monarc) versus inside-out (TVT-O): Are the two ways reassuring?

INTRODUCTION: In 2001, the trans-obturator route was proposed for the surgical positioning of tape with a view to avoiding the retropubic space and its disadvantages. The route, originally described outside-in by Delorme was presented inside-out by de Leval. Since then, anatomical discussions have attempted to prove that one technique is safer than the other. OBJECTIVE: Demonstrating the safety of the two techniques through personal and published experience. MATERIAL AND METHODS: Non-randomized, prospective, observational, open-label, longitudinal study of 100 female patients (50 tension-free vaginal tape (TVT)-O and 50 Monarc). All the female patients presented with isolated stress urinary incontinence. Only four patients presented with mixed incontinence in the Monarc (MON) group. Sphincter incompetence was observed four times in the MON group and three times in the TVT-O group. Almost all the patients were undergoing their first procedure. All the patients underwent surgery under assisted local anesthesia in a day-hospital setting. All the patients underwent a full gynecological examination and a urodynamic assessment. Only those patients presenting with patent established urinary incontinence, corrected by the TVT test, underwent surgery. Post-operative control was conducted at 3 months and 1 year when a physical examination and urodynamic assessment were implemented. RESULTS: All the patients underwent control up to time point 12 months. The duration of hospitalization was 10h for 48 patients in the MON group and 49 in the TVT-O group. The duration of hospitalization was 24h for one patient in each group and 4 days for one patient in the TVT-O group due to transient urine retention. The only per-operative complication was a vaginal perforation in the lateral angle of the vagina for a MON patient. Tape repositioning was necessary. Early post-operative complications were observed in the MON group: three cases of urinary tract infection, one of transient urine retention, three of pain in the thighs spontaneously resolving within 4 days and one of permanent pain in one leg at time 1 year, which remained bearable. For the TVT-O group the post-operative complications consisted in: one case of urinary tract infection, one of transient retention and four of pain in the thigh. No hematoma was reported in either group. Amongst the late complications, the de novo symptoms included one case of imperious urges to urinate in the TVT-O group and objective dysuria in two cases in the MON group versus seven in the TVT-O group. There was no statistically significant between-group difference in the complications. No tape exposure was observed. Overall, the recovery rate was 90% at 1 year for MON versus 94% for TVT-O (p=NS) with two cases of recurrence between 3 months and 1 year in that series. Mixed incontinence was corrected at time point 1 year in 75% of cases for MON, with one case of recurrence in the year. For the patients presenting with sphincter incompetence, competence was maintained at 3 months and 1 year in all cases in the MON group. The three TVT-O were cured at 3 months, but two recurrences were observed at 1 year. Almost all the patients were satisfied or very satisfied at time point 1 year and those who had sexual relations (54%) did not report any disorder at time point 1 year. DISCUSSION: The outside-in technique necessitates more marked peri-urethral dissection and vesical complications are possible. The cadaveric studies by the outside-in partisans show a vascular and nervous risk, which has little reflection in terms of complications in the literature. Post-operative leg pains are encountered with both techniques and are usually only transient. All the studies of the two routes report a recovery rate of over 90% for pure stress incontinence. CONCLUSION: The author's experience, like that reported in the literature, shows that the two trans-obturator access routes are equally safe and do not require per-operative cystoscopic control. The clinical results would appear to be equivalent, in terms of recovery, to the rates obtained with retropubic TVT. Attempting to find anatomical or etiological arguments in order to prove one technique superior to the other appears somewhat parochial.     

The tension-free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence

Objectives To evaluate the effectiveness and safety of the ambulatory, minimally invasive tension-free vaginal tape procedure in women scheduled for incontinence surgery.
Design A prospective open study with a standardised protocol for pre- and post-operative evaluation.
Participants One hundred and sixty-one consecutive women with urodynamically proven stress incontinence. The mean age was 56 years; 45 women (28%) had recurrent incontinence, 59 women (37%) had mixed incontinence and 18 women (11%) had a low pressure urethra.
Main outcome measures Subjective and objective cure rates, complications and length of hospital stay.
Results The average follow up time was 16 months. Ninety-four percent of the treated women were completely cured or significantly improved. Eighty percent of the women were released from hospital on the afternoon of the day of surgery. There were no major complications and 80.2% of the women had no complication at all. Seven women (4.3%) had no more than four days of urinary retention problems, five women (3.1%) developed de novo urge symptoms, ten women (6.1%) had urinary tract infection, six cases (3.7%) of intraoperative bladder perforation occurred and less than 3% had bleeding or infection problems. There was no difference in the cure rate between women suffering from primary, recurrent or mixed incontinence.
Conclusions The tension-free vaginal tape operation is an effective and safe procedure for treatment of most cases of female urinary stress incontinence. The operation can be performed as an ambulatory procedure because of the low risk of post-operative morbidity.