Treatment Of Genuine Stress Incontinence Research Articles

Complications and Success Rate in Women Undergoing Burch Colposuspension for Urinary Stress Incontinence

Our goal was to study the success rates and peri-operative and post operative complications of Burch colposuspension in women having urinary stress incontinence. The study was performed in the department of gynaecology and obstetrics, MTI Hayatabad Medical Complex, MTI Lady Reading Hospital and a private set in Peshawar. Peri and postoperative outcomes were reviewed in 54 patients who underwent Burch Colposuspension from 2012 to 2017. All operations were performed by a single experienced surgeon and patients were followed post procedure for 18-24 months. Prior to the procedure, urodynamic studies were performed on 34 patients, while others showed signs of pure stress incontinence, so they did not require urodynamic studies. Urodynamics of 28 women showed genuine stress incontinence while six showed mixed stress incontinence. 10 patients underwent additional procedures along with Burch Colposuspension, mostly posterior colporrhaphy in 6 patients. The complication rate was relatively low, with 14.8% of patients experiencing voiding difficulties and 11% experiencing Denovo detrusor instability. Burch Colposuspension is a safe surgical treatment for genuine stress incontinence.

Pubovaginal sling, the godfather of midurethral slings that remained so

Forty years ago, autologous fascial slings became the gold standard in the treatment of genuine stress incontinence. In 1996, a synthetic material sling was introduced to the urogynecological literature known as tension-free vaginal tape. Some years later, another synthetic tape was introduced through a novel trajectory: transobturator. Due the conception of most polypropylene synthetic tapes, scores of devices, applicators and tape designs evolved. Now, with reports surfacing in the urologic literature on the adverse events of synthetic tapes and their potentially fatal complications, it is prudent to endeavor once more the place of autologous pubovaginal sling. This review addresses the evolution of pubovaginal slings and milestones of its journey to its current position in surgery of incontinence.

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AIMS AND OBJECTIVES: To analyse the outcome of TOT mesh repair in genuine stress urinary incontinence. MATERIALS & METHODS: 25 patients with symptoms of genuine stress urinary incontinence who attended the outpatient department between October 2010 - December 2012 were studied. All patients were evaluated by detailed history, physical examination, stamey grading, pad test, uroflow, VLPP, cystoscopy and bonney's test. 25 patients were subjected to TOT mesh repair under spinal anaesthesia with mean follow up of 12 months. RESULTS: Total 25 patients were evaluated. Majority fall in 41-45 years age group. 60% have grade I and 40% have grade 2 SUI. 60% patients weight of pre op pad is 3.5gms. 15 out of 25 patients have 80-120 cm H2Oof VLPP. 92% of patients were cured. 8% patients show improvement of symptoms. No failures were noted. 23 out of 25 patients were pad free post operatively. CONCLUSION: TOT mesh repair is an effective and safe technique for the treatment of genuine stress incontinence.

Transobturator tape for female stress urinary incontinence: short term results after surgical procedure

The aim of the present prospective study was to assess the success and safety of TOT Trans-Obturator-Tape (TOT) operation using the manipulation of 45 degree reverse trendelenburg position in lithotomy for adjusting the tension of vaginal tape for each patient. Methods. Between June 2005 and April 2006, a total of 80 patients underwent TOT operation in which intraoperative 45 degree reverse terendelenburg position for adjusting tension rate of tape was used at Zekai Tahir Burak Women Health and Research Hospital, Turkey. The pre- and postoperative assessments included medical history, pelvic examination, BMI (kg/m2), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF, Turkish version), urine analysis, stress test (cough provocation), one-hour pad test, URA measurement via transperineal ultrasonography and urodynamic studies were conducted in all of preoperative cases in order to support diagnosis and in postoperatively unsuccessful cases in order to have a much adequate understanding of the machinery of this condition. The majority of patients (64/80, 80%) underwent one or more concurrent surgical procedures at the time of their TOT procedure. A non-elastic polypropylene monofilament tape was placed under the mid-urethra. Results. The mean follow-up period was 6.4 months (2-13). Success rate was 92.5%. The total perioperative complication rate was 3.75% (3/80). URA has changed in the range of 0º-50º (mean 16.5º). The postoperative complication rate was moderate (7.59%). None of the patients developed urinary retention. Conclusions. TOT is an effective and safe procedure for the treatment of genuine stress incontinence and the intraoperative adjustment of tension of vaginal tape using reverse terndelenburg position maybe helpful for improving success of operation. <br/><a href=

The Long-Term Results of Pubovaginal Sling Surgery Using Acellular Cross-Linked Porcine Dermis in the Treatment of Urodynamic Stress Incontinence

Acellular cross-linked porcine dermis is a potential substitute for rectus fascia as a sling material with the advantage of decreased morbidity. However, the long-term efficacy is unknown. We compared the 3-year efficacy of PD vs autologous rectus fascia as a sling material for pubovaginal sling surgery in the treatment of urodynamic stress incontinence. Between July 2000 and December 2001 a total of 101 consecutive, nonrandomized patients with USI underwent a PD (51) or RF (50) sling procedure. Patients were assessed at 6 weeks, and at 3, 6 and 12 months postoperatively. Urodynamic study was repeated in cases of treatment failure. A detailed survey questionnaire was mailed to all patients at least 36 months after surgery and all responders were then retested by telephone interview by a blinded assessor. The primary outcome measure was patient perceived success rate (cured or improved) at least 36 months after PVS. Secondary outcome measures were patient satisfaction 36 months after surgery, durability of success with time and reoperation rate. Complete data were available on 94 patients (48 treated with PD and 46 treated with RF sling). The groups were well matched for age, leak point pressure, prior incontinence surgery and urge symptoms. Pubovaginal sling was successful (cured or improved) in 37 (80.4%) patients treated with RF but in only 26 (54%) patients treated with PD 36 months after surgery (Fisher's exact test p = 0.009; 95% CI 8.03, 44.4). Treatment failure occurred by 9 months after RF and by 24 months after PD sling procedure. Repeat urodynamic study showed USI to be the cause of treatment failure in 18 (37.5%) of 20 patients treated with PD but in only 3 (6.5%) of 8 patients treated with RF. We have shown that use of the PD sling, although reducing early morbidity, results in a significantly inferior long-term cure rate in comparison to the RF sling. Therefore, acellular cross-linked porcine dermis should not be used as a substitute for rectus fascia.

238: Non Surgical Radio Frequency Bladder Neck Suspension Procedure for Treatment of Genuine Stress Incontinence in Women

Study ObjectiveTo assess the safety and efficacy of a new nonsurgical transvaginal device (The Solarant System, Solarant Medical, Livermore, CA) that delivers RF energy transvaginally to the endopelvic fascia (EPF) without incisions to treat GSI in women.DesignProspective single arm feasibility trial of 20 patients receiving treatment with the Solarant System.SettingMajor academic hospital in Guadalajara, Mexico.Patients20 women with GSI due to urethral hypermobility confirmed by urodynamic evaluation. Preoperatively all 20 patients had >1 urinary incontinence episode per day (average 3.8 episodes/day) and a positive cough Valsalva. Detrusor instability was excluded by cystometry.InterventionAll women underwent a procedure with the Solarant System. During this procedure, the system delivered precisely controlled RF energy bilaterally to the anterior vaginal wall, lateral to the urethra and proximal to the bladder neck causing the EPF to heat and shrink. Concomitantly, the system cooled the surface tissue layer of the vaginal mucosa.Measurements and Main ResultsProcedure time was less than an hour. All patients voided spontaneously within 2-5 hours and were discharged within 3-5 hours. No patient developed urge, frequency or retention. Several patients had vaginal mucosal tissue changes at treatment sites—most were asymptomatic and resolved with conservative management. At 3 month follow-up, 85% (17/20) were dry or <1 incontinence episode/day and 75% (15/20) had a negative cough Valsalva.ConclusionThis new nonsurgical RF system and procedure appears to be a safe and effective minimally invasive approach to treatment of GSI in women. Further follow-up is ongoing and additional clinical studies are planned.(NOTE: This is an investigational device; this study was sponsored by Solarant Medical, Inc., Livermore, CA.) Study ObjectiveTo assess the safety and efficacy of a new nonsurgical transvaginal device (The Solarant System, Solarant Medical, Livermore, CA) that delivers RF energy transvaginally to the endopelvic fascia (EPF) without incisions to treat GSI in women. To assess the safety and efficacy of a new nonsurgical transvaginal device (The Solarant System, Solarant Medical, Livermore, CA) that delivers RF energy transvaginally to the endopelvic fascia (EPF) without incisions to treat GSI in women. DesignProspective single arm feasibility trial of 20 patients receiving treatment with the Solarant System. Prospective single arm feasibility trial of 20 patients receiving treatment with the Solarant System. SettingMajor academic hospital in Guadalajara, Mexico. Major academic hospital in Guadalajara, Mexico. Patients20 women with GSI due to urethral hypermobility confirmed by urodynamic evaluation. Preoperatively all 20 patients had >1 urinary incontinence episode per day (average 3.8 episodes/day) and a positive cough Valsalva. Detrusor instability was excluded by cystometry. 20 women with GSI due to urethral hypermobility confirmed by urodynamic evaluation. Preoperatively all 20 patients had >1 urinary incontinence episode per day (average 3.8 episodes/day) and a positive cough Valsalva. Detrusor instability was excluded by cystometry. InterventionAll women underwent a procedure with the Solarant System. During this procedure, the system delivered precisely controlled RF energy bilaterally to the anterior vaginal wall, lateral to the urethra and proximal to the bladder neck causing the EPF to heat and shrink. Concomitantly, the system cooled the surface tissue layer of the vaginal mucosa. All women underwent a procedure with the Solarant System. During this procedure, the system delivered precisely controlled RF energy bilaterally to the anterior vaginal wall, lateral to the urethra and proximal to the bladder neck causing the EPF to heat and shrink. Concomitantly, the system cooled the surface tissue layer of the vaginal mucosa. Measurements and Main ResultsProcedure time was less than an hour. All patients voided spontaneously within 2-5 hours and were discharged within 3-5 hours. No patient developed urge, frequency or retention. Several patients had vaginal mucosal tissue changes at treatment sites—most were asymptomatic and resolved with conservative management. At 3 month follow-up, 85% (17/20) were dry or <1 incontinence episode/day and 75% (15/20) had a negative cough Valsalva. Procedure time was less than an hour. All patients voided spontaneously within 2-5 hours and were discharged within 3-5 hours. No patient developed urge, frequency or retention. Several patients had vaginal mucosal tissue changes at treatment sites—most were asymptomatic and resolved with conservative management. At 3 month follow-up, 85% (17/20) were dry or <1 incontinence episode/day and 75% (15/20) had a negative cough Valsalva. ConclusionThis new nonsurgical RF system and procedure appears to be a safe and effective minimally invasive approach to treatment of GSI in women. Further follow-up is ongoing and additional clinical studies are planned.(NOTE: This is an investigational device; this study was sponsored by Solarant Medical, Inc., Livermore, CA.) This new nonsurgical RF system and procedure appears to be a safe and effective minimally invasive approach to treatment of GSI in women. Further follow-up is ongoing and additional clinical studies are planned.

NON-ORAL POSTER 16: EH05-003: A Retrospective Evaluation Comparing Porcine Dermis and Cadavaric Fascia for the Treatment of Genuine Stress Incontinence and Low Pressure Urethra With a Transvaginal Cooper??s Ligament Sling

NON-ORAL POSTER 16: EH05-003: A Retrospective Evaluation Comparing Porcine Dermis and Cadavaric Fascia for the Treatment of Genuine Stress Incontinence and Low Pressure Urethra With a Transvaginal Cooper??s Ligament Sling

Randomized Comparison of Burch Urethropexy Procedures Concomitant with Gynecologic Operations

Objective: We compared the success of laparoscopic Burch colposuspension with the laparotomic Burch colposuspension for the treatment of genuine stress incontinence (GSI) concomitant with gynecologic operations. Materials and Methods: Fifty-two women with symptoms of GSI, also requiring additional gynecologic operations, were randomly assigned to undergo laparoscopic (n = 26) or laparotomic (n = 26) Burch colposuspension. For all patients complete histories were taken and physical examination, urinalysis, urine culture, multi-channel urodynamics with cystometry, uroflowmetry, and measurement of Valsalva leak-point pressure were performed. Variables analyzed included: age, surgical time, length of catheterization, number of days in hospital, and complications. Results: Both groups were similar in age, parity and menopausal status. Valsalva leak-point pressure significantly increased in the laparoscopy group after the operation. There were no statistical differences in other urodynamics in both groups. The mean operating time in the laparoscopy group was longer than in the laparotomy group. The laparoscopy group required a significantly shorter hospitalization and catheterization than the laparotomy group. The success and complication rates did not differ significantly for both groups. Conclusion: The laparoscopic approach for the treatment of GSI in patients requiring additional gynecologic procedures is associated with a shorter duration of hospital stay compared with the abdominal approach.

Laparoscopic colposuspension using sutures or prolene meshes: a 3-year follow-up

Objective( s): To compare the long-term effectiveness of two different laparoscopic colposuspension procedures. Study design: Sixty women affected by genuine stress incontinence (GSI) were enrolled in a prospective randomized controlled trial (RCT) and treated by transperitoneal laparoscopic colposuspension using nonabsorbable sutures (group A) or prolene mesh fixed with tackers or staplers (group B). In each group the subjective and objective failure rates were evaluated at 12, 24, and 36 months after surgery. For the subjective evaluation patients were asked whether they had experienced urine leakage and any urine loss they reported was recorded on a visual analogue scale (VAS). The objective evaluation was performed by means of a clinical examination and multichannel urodynamic studies. The data were analyzed by the intention-to-treat method. Results: The subjective failure rate was significantly ( P < 0.05) lower in group A than in group B at 12 months (3.3% versus 13.3%, respectively), 24 months (20.0% versus 36.7%, respectively), and 36 months (33.3% versus 53.3%, respectively) after surgery. The objective failure rate also differed significantly ( P < 0.05) between the two groups after 12 (10.7% versus 25.0% for group A and group B, respectively), 24 (29.6% versus 57.7%, respectively), and 36 (42.3% versus 61.5%, respectively) months of follow-up. Conclusion( s): Laparoscopic colposuspension performed with sutures is more effective than laparoscopic colposuspension accomplished with the use of prolene meshes in the long term, and the use of prolene meshes should be avoided in treatment of GSI.

Tension free vaginal tape: is the intra-operative cough test necessary?

The tension-free vaginal tape (TVT) procedure is recognised as an effective treatment for genuine stress incontinence. It was first described using local anaesthesia, with an intra-operative cough test helping to correctly position the tape. Many patients prefer general anaesthesia and often, patients with genuine stress incontinence do not leak when supine. This aim of this study was to compare the outcome in TVTs performed under general anaesthesia with those performed under spinal anaesthesia. Retrospective analysis of 105 patients, all of whom had urodynamically proven genuine stress incontinence and underwent TVT procedure, was performed: 52 under spinal anaesthesia and 53 under general anaesthesia. The primary and secondary outcome measures were the success or failure of the procedure and the complication rate, respectively. There was no significant difference in outcome or complication rate between the two groups. The type of anaesthetic used does not influence the outcome and we question the necessity of an intra-operative cough test.

Treatment of genuine stress incontinence with tension free vaginal tape: five years experience in tuen mun hospital

Aim: Tension free vaginal tape (TVT) is a minimal invasive treatment for genuine stress incontinence by providing a mid‐urethral support. The aim of this study is to review our experience in using the TVT in the treatment of stress incontinence in our hospital since 1999.Patients and methods: Twenty‐three patients with genuine stress incontinence were treated with the TVT between March 1999 and January 2004. The mean age was 50. The preoperative investigations included history, physical examination, and aerodynamic study. Patients with derisory instability or significant cystoscoele were excluded. They were followed up after the operation and the outcome of procedure including improvement in symptoms and number of pads used were assessed.Results: Operative time ranged from 25 to 50 min with a mean of 29. Blood loss was minimal and the hospital stay ranged from 1 to 4 days (mean 1.9 days). They were followed up for a period ranging from 2 to 60 months with a median of 62 months. 95.6% of the patients are completely dry and do not require the use of pad anymore. 91.3% of the patients are very satisfied with the result of the operation.Conclusion: TVT is a safe and effective procedure for stress incontinence. The short‐term good results have been documented in various studies. This study shows that the mid‐term results are very promising as well as the dryness is well sustained in our patients with a median follow up of 32 months.

Intractable Chronic Pelvic Pain Relieved After Bone Anchor Removal

Operative cure of genuine stress incontinence remains a challenge. While no ideal technique has emerged, investigators have continued to modify available methods to be minimally invasive without significantly affecting long-term outcome. Transvaginal needle suspension is an established treatment for genuine stress incontinence in women. Suspension suture pull-through has been proposed as one of the possible causes of failure. While bone anchors provide a solid structure for fixation of suspension sutures, they have been associated with complications such as chronic pelvic pain, osteomyelitis and osteitis pubis.1 The associated pain can occasionally be intractable and difficult to manage. Although Graham and Dmochowski have reported severe pain following bladder neck suspension using bone anchors, to our knowledge chronic intractable pain in the absence of infection has not been reported thus far.2 We report complete resolution of intractable pelvic pain following extraction of bone anchors in a 40-year-old woman who had undergone human dermal allograft pubovaginal slingplasty.

Investigation and treatment of lower urinary tract dysfunction

Recognition of the prevalence and distress caused by bladder symptoms has resulted in far greater emphasis on the assessment and treatment of bladder problems in primary and secondary care. Media attention to new and innovative treatments of urinary incontinence has educated both patients and doctors alike. Increasingly, patients armed with newspaper cuttings and internet printouts are likely to enter the surgery to discuss the previously taboo subject of their urinary problems. Lower urinary tract symptoms are common amongst women of all ages and a significant cause of quality of life impairment. Patients normally present with symptoms of bladder overactivity and/or stress incontinence. A thorough clinical assessment will identify those patients for whom treatment in primary care is appropriate and those for whom specialist referral should be made. The majority of patients can be managed in primary care without the need for complex investigations and treatment. Conservative therapies require both motivated patients and trained therapists to be maximally effective. Significant advances have been made in the pharmacotherapy of overactive bladder and the surgical treatment of genuine stress incontinence. Although it may not be possible to cure everyone of their urinary symptoms the majority of patients can be significantly improved.

Concomitant surgery with tension‐free vaginal tape

To evaluate the efficacy and feasibility of tension-free vaginal tape (TVT) surgery combined with gynecologic surgery using general anesthesia. One hundred and six women with genuine stress incontinence (GSI) diagnosed with a traditional urodynamic examination were prospectively enrolled into this study. All of the 106 women underwent TVT surgery for the treatment of GSI, along with a concomitant hysterectomy procedure, under general anesthesia. We estimated the severity of incontinence symptoms on a visual analog scale (VAS), and used a questionnaire for subjective assessment before and after TVT surgery. The objective assessment of urinary incontinence was carried out with a 1-h pad test and traditional urodynamic examination. Of the 106 patients, 50 had uterine prolapse and underwent transvaginal hysterectomy and anteroposterior colporrhaphy (APC), and another 50 had uterine myoma and underwent laparoscopic-assisted vaginal hysterectomy (LAVH). The follow-up mean interval was 18 months (range 12-36 months). The 50 women undergoing LAVH and TVT surgery had a mean hospitalization of 3.5 days. The subjective success rate was 90.5% and the objective success rate was 86.8%. The other group of 50 women undergoing vaginal total hysterectomy (VTH), APC and TVT surgery had a mean hospitalization of 4.8 days. The subjective success rate was 88.6% and the objective success rate was 84.9%. There were six patients lost to follow-up for several reasons. The rates of complications of bladder perforation, postoperative voiding difficulty and postoperative urinary urgency were 2%, 11% and 10%, respectively; neither pelvic hematoma requiring blood transfusion nor conversion to laparotomy occurred. The results of this study prove that the TVT procedure, performed under general anesthesia without the need for the intraoperative cough provocation test to treat GSI, and carried out concomitantly with other gynecologic surgeries, is safe and effective.

Long-Term Results of Transvaginal Colposuspension for the Treatment of Genuine Stress Incontinence Combined with Vaginal Hysterectomy

We assessed the long-term efficacy of a modified transvaginal needle bladder neck suspension, combined with vaginal hysterectomy, for the treatment of female stress incontinence. Thirty-two women who underwent this procedure were followed up clinically and urodynamically 1 and 5 years postoperatively. A total of 27 women (84.4%) were cured 1 year postoperatively. Of the 29 women who were followed up 5 years postoperatively, 21 (72.4%) had a satisfactory result (p = 0.157). No significant differences were observed in maximum urine flow rate, residual volume of urine, and functional length of the urethra. On the contrary, the maximum urethral closure pressure was significantly decreased (p = 0.004). Although the results of our study show a decline in success rate by time, the overall long-term efficacy of this technique is undoubtedly satisfactory. This technique is promising as an easy and minimally invasive surgical procedure for bladder neck suspension.

Tension-free vaginal tape failure caused by sling displacement and successfully retreated using Burch colposuspension.

In 1995 Ulmsten and Petros first described the tension-free vaginal tape (TVT) procedure as a minimally invasive treatment of genuine stress incontinence (GSI). It restores the pubourethral ligament and subvaginal hammock and has cure rates comparable to retropubic urethropexy. While the success rate is comparable to traditional sling procedures it requires a hospital stay of less than 24 h. The causes of failure of this procedure have not been reported in the literature. We report a case of recurrent GSI after TVT that was then successfully treated by colposuspension. The cause of the failure is also discussed. (excerpt)

Transvaginal Radio Frequency Treatment of the Endopelvic Fascia: A Prospective Evaluation for the Treatment of Genuine Stress Urinary Incontinence

We evaluate the safety and efficacy of a new treatment modality for genuine stress urinary incontinence which was a transvaginal radio frequency applicator to deliver radio frequency energy to the endopelvic fascia. The purported mechanism of effect for this therapy is shrinkage of the collagenated tissue which composes the endopelvic fascia that supports the bladder neck and proximal urethra, thus stabilizing the proximal urethra and bladder neck. In prior animal trials and early pilot studies this therapy was shown to cause a reproducible thermal effect manifested by fascial shrinkage. Preliminary human trials indicated a therapeutic benefit of this therapy for women with genuine stress urinary incontinence. To our knowledge this is the first multicenter study of a transvaginal approach for radio frequency of the endopelvic fascia for treatment of genuine stress incontinence. Between June 1999 and June 2000, 120 consecutive women (mean age 49.9 years) at 10 sites underwent transvaginal radio frequency treatment in a prospective trial to evaluate the overall efficacy and safety profile of this therapy. All patients had preoperative urethral hypermobility (average cotton swab change 38 degrees). Detrusor instability was excluded by cystometry. In all procedures precisely controlled radio frequency energy was applied to the endopelvic fascia to heat and shrink the tissue. The patients were evaluated postoperatively at 1 week and at 1, 3, 6 and 12 months using objective and subjective measures. Primary end points consisted of physician assessment of continence, patient reported pad use and the number of patient reported episodes. Safety was determined for acute (immediate postoperative) and chronic time frames. Of the 120 patients 96 completed 1-year evaluation. Average operative time was less than 30 minutes, and all patients were treated as outpatients. Preoperatively 101 patients (84%) averaged 1 or more episodes of urinary incontinence per day. At 3, 6 and 12 months 57%, 66% and 59% of patients, respectively, averaged 1 or no daily episodes of urinary incontinence. At 12-month followup 79 of 109 patients (73%) reported being continent or improved. Preoperatively, 43% of patients reported using 1 or no pads daily. At 3, 6 and 12 months 69%, 70% and 72% of patients, respectively, required 1 or no pads daily. On urodynamic evaluation at 12-month followup 76.0% of the patients did not leak with a Valsalva maneuver. A total of 30 cases were classified as failures and 11 women were lost to followup. There were no intraoperative complications, 3 (4%) minor postoperative complications which resolved, and no device related complications. The transvaginal radio frequency applicator demonstrated good efficacy and excellent safety at 1-year followup. Ongoing analysis of the data has indicated opportunities for improvement of this new surgical technique that could result in higher efficacy rates without compromising safety. Further long-term evaluation is being conducted to assess chronic durability of the procedure.

Tension-free Vaginal Tape - Eine prospektive Evaluation

Purpose: We evaluated the medium-term results obtained with the Tension-free Vaginal Tape operation. Methods: Over a 3-year period a total of 122 patients underwent a Tension-free Vaginal Tape operation for treatment of genuine stress incontinence. All patients were studied prospectively and underwent urodynamic studies before and after surgery. Postoperatively patients underwent urodynamic testing and subjective assessment at 6-12 and at 12 - 24 months. Results: The subjective and objective cure rates were 70% and 61%, respectively. Perioperative complications included bleeding, bladder perforation, voiding problems and de novo urgency. Preoperative urgency seemed to improve postoperatively. Conclusion: Overall there were few complications and the procedure was successful despite a mixed level of surgical experience.

A Prospective Multisite Study of Radiofrequency Bipolar Energy for Treatment of Genuine Stress Incontinence

Study Objective To assess the efficacy of radiofrequency electrothermal energy to treat genuine stress incontinence (GSI). Design Multicenter, prospective, single-arm, longitudinal study (Canadian Task Force classification II-1). Setting Six North American university-affiliated and private clinic sites. Patients Ninety-four women undergoing laparoscopic treatment for GSI. Intervention Radiofrequency bipolar treatment of paravaginal tissue to induce tissue shrinkage causing bladder neck elevation. Measurements and Main Results Patients underwent complete urogynecologic evaluations, with urodynamic testing, including Valsalva leak point pressure, to confirm the diagnosis of GSI. Paravaginal tissue was treated lateral from the urethra and bladder neck out to the arcus white line, with bipolar electrothermal energy to shrink bladder-supporting connective tissue. Treatment resulted in 30% shrinkage in paravaginal endopelvic fascia surface area by direct measurement. At 1 year the objective cure rate was 79% by urodynamic testing, improvement in quality of life by questionnaire was 81%, decrease in leaking episodes and pad use was significant (p <0.001), and patient satisfaction was 83%. Complications (7%) were secondary to laparoscopy. There were no injuries from the radiofrequency probe. Conclusion Radiofrequency bipolar electrothermal energy appears to be a safe an efficient means of treating mild to moderate GSI. It results in shrinkage and elevation of paravaginal connective tissue, stabilizing the urethra and bladder neck, thereby restoring continence. Long-term follow-up is necessary.

Sexual function after using tension-free vaginal tape for the surgical treatment of genuine stress incontinence.

To determine whether the use of the tension-free vaginal polypropylene tape (TVT) procedure for the treatment of genuine stress incontinence (GSI) affects sexual activity. Sixty-seven women treated by insertion of a TVT between September 1998 and March 2001 for GSI were sent questionnaires 6-36 months after surgery to determine any urinary symptoms, sexual activity, patient satisfaction and the use of hormone-replacement therapy. The questionnaire was returned by 57 patients (87%); 43 (76%) reported being sexually active and 14 (25%) were not. Of the former, 31 (72%) reported no change in sexual function after surgery and only two reported an improvement; six (14%) reported that sexual function was worse and four did not reply to the questions. The patients reporting that sexual function was worse cited loss of libido as the main reason. No patients complained of dyspareunia. There was no significant change in sexual function or activity after the TVT procedure and patients can thus be reassured that this operation will not affect their sex life.