POS-01.13: Why do pre-pubic slings fail?

UNMODERATED POSTER SESSIONS

nations, maximum cystometric capacity in urodynamic study, voided volume in uroflowmetry and maximum volume found in 3-day voiding diary were accepted as maximum bladder capacity and these results were compared with each other. Results: Capacity in uroflowmetry and voiding diary capacities are found to be similar (p⫽0.703). Maximum cystometric capacity in urodynamic study was found to be both higher than capacity uroflowmetry and voiding diary capacities and the differences are statistically significant (respectively p⫽ 0.006 ve p⫽ 0.012) (Table 1). Table 1. POS-01.10 Urine volume (ml) Uroflowmetry 406⫾206 (36-1070) Voiding diary 414⫾183 (50-1000) Maximum cystometric 463⫾177 (71-868) Conclusion: Our results indicate that in incontinent women, maximum cystometric capacity found in urodynamic study can indicate more accurate results as bladder capacity. POS-01.11 Comparison of uroflowmetry parameters in women with urge, stress and mixed type urinary incontinence Sen I, C¸amtosun A, Onaran M, Kirac¸ M, ¨ , Bozkirli I Tan MO Gazi University, School of Medicine, Urology Department, Ankara, Turkey Introduction: We aimed to evaluate the changes in uroflowmetry in women with different types of urinary incontinence as urge, stress and mixed. Methods: 184 women with different types of urinary incontinence were enrolled into the study. According to the patients’ history, women were grouped as urge, stress and mixed urinary incontinence. After routine examination, all patients underwent uroflowmetry. Postvoiding residual urinary volumes (PVR) were assessed with BladderScan®. Means of uroflowmetry parameters were compared.

Results: Of all patients, 31 had urge, 43 had stress and 110 had mixed type of urinary incontinence. Uroflowmetry parameters in different types of incontinence and postvoiding residual volumes were found to be statistically insignificant. (Table 1) Conclusion: Uroflowmetry parameters don’t show any difference according to types of urinary incontinence in women. POS-01.12 The effects of estrogen on nNOS, eNOS expression and histologic composition in the rat bladder and urethra Park SW, Lee CY, Lee JZ Pusan National University. Hospital, Busan, Korea

Fig. 1. POS-01.12: The mean expression percentage of nNOS. Control; control group, Ox; oophrectomy group, HRT; hormone replacement group, *p⬍0.05 vs control group, †p⬍0.05 vs oophorectomy group.

Introduction: We investigated the effects of estrogen on neuronal nitric oxide synthase (nNOS), endothelial nitric oxide synthase (eNOS) expression, and histologic composition in the rat bladder and urethra. Methods: Forty-five mature female Sprague-Dawley rats (10-11wks, 235250gm) were randomly divided into three groups; control group (C), oophorectomy group (O) and hormone (estradiol) replacement group (H). The degree of expression of nNOS, eNOS in bladder and urethral tissues were investigated by immunohistochemical stain, and described as mucosa, smooth muscle and vessel. We also investigated the changes of histologic composition by masson’s trichrome stains. Results: In the urethra, nNOS and eNOS expression rates were significantly increased in O group, but decreased in H group (p⬍0.05)(Fig. 1 and 2). In the bladder, eNOS expression rates were significantly increased in O group, but decreased in H group (p⬍0.05)(Fig. 2). But, nNOS expression rates of vessel in the bladder were only significantly increased in O group and decreased in H group (Fig. 2). The relative collagen ratios significantly increased in bladder and urethra, to 121.2⫾12.7% and 135.5⫾25.2% in O group, but decreased to 95.6⫾15.2% and 93.7⫾12.8% in H group, respectively (p⬍0.05)(Fig. 3).

Table 1. POS-01.11

Q Max. (ml/sec) Time to reach Q Max.(sec) Voiding volume (ml) Mean flow (ml/sec) Corrected Q Max. (ml/sec) PVR (ml)

192

Urge incontinence 29⫾14 11⫾10 375⫾194 16⫾12 19⫾15 28⫾65

Stress incontinence 30⫾15 13⫾16 403⫾236 14⫾8 19⫾8 9⫾41

Mixed incontinence 31⫾13 10⫾8 406⫾205 17⫾11 19⫾5 10⫾40

p value 0.76 0.15 0.62 0.12 0.88 0.13

Fig. 2. POS-01.12: The mean expression percentage of eNOS. Control; control group, Ox; oophrectomy group, HRT; hormone replacement group, *p⬍0.05 vs control group, †p⬍0.05 vs oophorectomy group.

Fig. 3. POS-01.12: Masson’s trichrome stains. Relative collagen ratio was markedly increased in oophrectomy group. Control; control group, Ox; oophorectomy group, HRT; hormone replacement group, *p⬍0.05 vs control group, †p⬍0.05 vs oophorectomy group.

Conclusion: These data suggest that estrogen replacement therapy decreases nNOS, eNOS expression of urethra, and much increases collagen component of bladder and urethra in oophorectomy rats.

POS-01.13 Why do pre-pubic slings fail? Palma P, Silveira A, Riccetto C, Prudente A, Dambros M, Netto, Jr N University Of Campinas-UNICAMP, Sa ˜o Paulo, Brazil Introduction & Objective: To evaluate the safety and efficacy of the pre-pubic sling procedure in women with urinary stress incontinence.

UROLOGY 70 (Supplment 3A), September 2007

UNMODERATED POSTER SESSIONS

Methods: We conducted a prospective clinical trial using a pre-pubic suburethral polypropylene tape for the treatment of urinary stress incontinence. There were thirty patients (mean age 56 years) with clinical and urodynamic diagnosis of urinary stress incontinence that underwent the pre-pubic procedure. The patients were evaluated 1,3 and 6 months postoperatively. The objective cure rate was evaluated by physical examination, urodynamic in failures and subjectively using the QLSF questionnaire. The pre-pubic approach is intended to reinforce the anterior pubourethral ligament. With the patient in the lithotomy position, a vaginal incision is made accessing the middle third of the urethra, at the level of the insertion of the pubourethral ligament. Starting from this incision dissection is extended towards the ascending ramus of the pubic bone. After this, two 1 cm supra-pubic incisions were made 2.5 cm lateral to the patient’s midline. Next, the needles were introduced transvaginally using the pre-pubic approach towards the suprapubic region. The same maneuvers were repeated on the other side. No cystoscopy was needed. Next the polypropylene mesh were connected to the needle and brought through the suprapubic incisions. After tension free placement of the mesh, the incisions were sutured. A Foley catheter was left in place overnight. Results: There were 28 (93.3%) dry patients at the one week visit and 2 (6.6%) failures. At the one month follow-up, 7 (23.3%) patients presented distal tape migration with mesh exposure. All patients presented lower urinary tract symptoms. Physical examination disclosed distal mesh exposure in all patients with symptons. Conclusions: Although the imediate results were satisfactory, the distal migration of the tape leads to an unacceptable high mesh exposure rate and this trial was discontinued.For this technique was effective prior to the tape migration, it suggests that pre-pubic approach should only be used in meshes with others anchoring tails to avoid migration.

women. It is important that incontinence symptoms be treated since it impacts not only the physiological, but also psychological realms of a person’s life. Researchers and clinicians are increasingly aware of the importance of identifying urinary incontinence and in particular that causes distress or adversely effects health-related quality of life among women. Methods: A total of 31 women underwent colporraphy for grade III or higher vaginal wall prolapses. The surgical technique was anterior colporraphy with mesh in 54.17% of patients and without mesh in 16.7%; posterior colporraphy with mesh in 25% and without mesh in 4.17%. Mean follow up was 8.15 months (2 to 16) at the mesh group and 11 months (2 to 23) at the no mesh group. The mean age was 55, range from 39 to 75 years). Questionnaires were applied pre and post operatively to assess quality of life (QoL), lower urinary tract symptoms (LUTS-OABq-SF), and the female sexual function index (FSFI). Statistical analysis was performed using the ANOVA and Tukey⬘s Post-hoc for p ⱕ 0,05. Results: Mean surgical time was 50 minutes at mesh group and 95 minutes at no mesh group (statistically difference). The improvement of stress urinary incontinence, stress test, prolapsus degree and dyspareunia was similar in both groups. There was improving of pelvic pain in the group without mesh. The subjective analysis of patient improvement was: 60% cured, 20% ameliorate and 20% failed at the repair with mesh; 80% cured and 20 % failed at the repair without mesh. Mesh exposition occurred in 5 patients: 3 with the tension free technique, 1 with posterior colporraphy and 1 mesh using a combined pre- pubic and transobturator approaches. Quality of life, LUTS and sexual function index improved in both groups, despite the technique used.

Sem Tela Com Tela

Sem Tela Com Tela

30

Introduction: Urinary incontinence impacts at least 20% of healthy middle-aged

25

80

FSFI - Total

POS-01.14 Vaginal wall prolapse repair with and withot meshes: A global analysis of impact on symptons, quality of life and sexuality Palma P1, Riccetto C, Thiel R, Perchon L, Dambros M, Muller V, Netto, Jr N University Of Campinas-UNICAMP, Sao Paulo, Brazil

OAB-q SF 6

100

60 40 20

20 15 10 5

0

0

Tempo Pré

Image 1.

Tempo Pós

Tempo Pré

Tempo Pós

POS-01.14

Conclusion: Surgical correction of vaginal wall prolapse improves QoL, LUTS and sexuality. The use of meshes do not adversely impact the results.

UROLOGY 70 (Supplment 3A), September 2007

POS-01.15 Nazca: a monoprosthesis for the simultaneous correction of cystocele and urinary stress incontinence - a multicentric trial Palma P1, Riccetto C1, Muller V1, Fraga R1, Contreras O2, Sarsotti C3, Paladini M4, Cianci A5, Barthos P6 1 University of Campinas-UNICAMP Sa ˜o Paulo, Brazil; 2University of Buenos Aires; 3Hospital Italiano, Buenos Aires; 4 Universidad catolica de Cordoba, Argentina; 5Universidad de Catania, Italy; 6 Praha Hospital, Czech Republic Introduction: Anterior vaginal wall prolapse is a frequent condition affecting 11% of American women. Urinary incontinence impacts at least 20% of healthy middleaged women. This device system allows for safe, effective and minimally invasive correction of stress urinary incontinence and anterior vaginal wall prolapse at the same time. Material & Methods: A total of 100 women with anterior vaginal wall prolapse associated or not with stress urinary incontinence (SUI) underwent a combined approach, pre pubic and transobturator, monoprosthesis. The mean age was 61 years. Previous surgeries included 30% of anterior repair and 16% of hysterectomies. There were 50 (50%) patients with associated SUI. For anatomical results the POP-q system was used. Functional results were evaluated by the following questionnaires: ICIQ-SF, OABq-SF and ISFI. The ICIQ-SF questionnaire disclosed a mean value of 10.2 pre operatively. All patients presented grade III or higher cystoceles, 15 presented posterior wall prolapse and 7 apical defect. The mean follow-up was 1 year. The procedure was performed with the patient in lithotomy position, an Allis clamp is applied at the level of the mid urethra. A midline incision is made from the midurethra to the cervix. The dissection should be done laterally to the medial edge of the ischio-pubic ramus and inferiorly up to the uterine cervix. Next mark needle entry points on the suprapubic and vulvar skin. Suprapubic points are marked 2 cm apart at just above of the pubic bone. The inferior marks are made using the following landmarks: genitofemoral folds at the level of the clitoris, than 3 cm below and 3 cm lateral. The superior needles are inserted transvaginally in a pre-pubic manner, towards the previously made marks on each side.The arms of the graft are connected to the tip of the needles and pulled the length till the Armpits take the superior part of the body of the mesh to the mid urethra with no

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