Surgical treatment of female urinary stress incontinence using tension-free vaginal tape

Abstract

54. Surgical Treatment of Female Urinary Stress Incontinence Using Tension-Free Vaginal Tape H Fernandez, A Gervaise, R de Tayrac. Hopital Antoine B~cl&e, Clamart, France. Objective. To describe sling-plasty with tension-free vaginal tape (TVT) for treatment of GUSI alone or associated with urge incontinence. Measurements and Main Results. The surgical procedure was carried out under local or epidural anesthesia. A 2-cm, vertical vaginal incision was made starting 0.5 cm from the outer urethral meatus. Using scissors, paraurethral tissues were dissected on both sides up to the lower brim of the pubic bone. Prolene tape was introduced with pointed introducers to which each end of the tape is attached. Introducers were placed on opposite sides of the midurethra, advanced close to the pubic bone, and extracted through 1-cm incisions placed suprapubically. This maneuver placed a U-shaped sling around the miduretha. Cystoscopy was performed to make sure that the bladder was intact. The bladder was then filled with 30 ml of fluid and the patient was asked to cough vigorously. The sling was brought up enough to stop urinary leakage. Ends protruding from the suprapubic incisions were cut and all three incisions closed. No serious intraoperative or postoperative complications occurred. When cystoscopy revealed perforation of the bladder wall, the sling was removed and replaced. No healing defect or tape rejection occurred. All procedures were completed within 30 minutes. After more than 1 year of follow-up, 80% of patients were completely cured of GUSI and 15% reported considerable improvement, experiencing only occasional urinary leakage. Conclusion. The TVT procedure seems to be minimally invasive and very effective when performed under local or regional anesthesia for GUSI. 55. Interactive Multimedia Course for Teaching Hysteroscopy JJ Fern4ndez-Alba, R Torrejdn, A Martin, MJ Rodriguez-Cornejo, R Comino. University Hospital of Puerto Real, Cadiz, Spain. Objective. To describe an interactive multimedia course on diagnostic hysteroscopy. Measurements and Main Results. We developed a computer graphic program based on Windows 98. We used the Asymetrix Multimedia Toolbook 4.0 as our software. Beginning from a predesigned outline, we integrated texts, still images, and video sequences to obtain the final product. As well as normal and pathologic images of the endouterine cavity, we included a number of general topics, such as a technical and historic introduction to diagnostic hysteroscopy and its instrumentation. Conclusion. Presenting endoscopic techniques in a multimedia format, integrating text, still photography, and video sequences in such a way that they may be interactively handled by the user, may facilitate learning this type of surgery, in addition to providing authors with a new means of disseminating biomed-