Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
DOI 10.1007/s00192-007-0382-0
2007 IUGA ABSTRACTS
Unmoderated Poster Presentations
32nd annual IUGA meeting, Cancún, Mexico, 12–16 June 2007
183
ASSESSMENT OF THE EXPRESSION
OF GLYCOSAMINOGLYCANS FROM BLADDER
AND URETHRAL OF RATS DURING
AND AFTER PREGNANCY
Mitrano, PGGM; Girão, MJBCG; Sartori, MGFS; Nader,
HBN; Nogueira, MDN
Federal University of Sao Paulo, Brazil
Objective: To evaluate the expression of glyscosaminogly-
cans (GAGs) in the bladder and urethra of rats in estrus,
during and after pregnancy.
Method: Twenty rats, divided into the following groups, were
studied: in estrus; on the 10th day of pregnancy; on the 20th
day of pregnancy and on the 5th day of puerperium. All
animals were sacrificed six hours after radioactive sulfate
injection. GAGs were extracted from the bladder and urethra
tissues by proteolysis and precipitation with trichloracetic acid
and characterized by agarose gel electrophoresis. Quantifica-
tion was through densitometry at 525 nm of the gel stained
with toluidine blue. Radioactive GAGs were quantified
measuring the incorporated radioactivity after the exposure
of the electrophoresis gel to a fluor radiosensitive film.
Hyalouronic acid determination was performed with an
ELISA-like fluorimetric assay. The samples were submitted
to enzymatic degradation with heparitinases I and II, chon-
droitinases AC and ABC. Non-parametric Kruskal-Wallis and
Mann-Whitney tests were used for statistical analysis.
Results: In all groups there was predominance of dermatan
sulfate (DS), approximately 66%, followed by heparan
sulfate (HS) and hyaluronic acid (HA). A significant
decrease in total GAG content was observed in the bladder
in the beginning of pregnancy, with a progressive increase
in its concentration along this period, although not reaching
the levels before pregnancy. Behavior of the synthesis of
these molecules was similar. In the urethra, GAG content
modifications were restricted to the end of pregnancy, that
is, with increase in their concentration, although with
restriction in their synthesis. The determination of hyal-
uronic acid showed a significant increase in the bladder
during puerperium and decrease in the urethra in the
beginning of pregnancy. Enzyme degradation confirmed
the presence of dermatan sulfate, heparan sulfate and
hyaluronic acid in the composition of the studied samples.
Conclusion: We demonstrated that there were differences
between the bladder and urethra tissues in pregnancy, with
total GAG level reductions in the bladder and also in the
urethra at the end of pregnancy. The synthesis of these
molecules was also affected by pregnancy with increase in
activity in the bladder and reduction in the urethra.
Hyaluronic acid content was increased in the bladder in the
puerperium and reduced in the urethra during pregnancy.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
184
CAN WE REDUCE VOIDING DYSFUNCTION
FOLLOWING TENSION-FREE VAGINAL TAPE
PROCEDURES FOR STRESS URINARY
INCONTINENCE
Hill, SR; Fayyad, AM; Hill, A; Batra, S
Royal Blackburn Hospital, UK
Objective: The tension-free vaginal tape (TVT) procedure
has become the surgical procedure of choice for women with
urodynamic stress incontinence. Voiding dysfunction can
affect up to 20% of women following TVT. Clean intermittent
self catheterisation is a complication women find difficult to
accept. In this case series we present a modification of the
procedure, and report on the incidence of voiding dysfunction
postoperatively along with long term cure rates.
Materials and methods: A prospective evaluation of 280
women who underwent TVT procedure over a 3 year period.
The procedure was performed as described by Ulmsten with
four quadrant infiltration of 30 ml of water around the
bladder neck. The bladder was filled with 500 ml of water
and tension of the tape was adjusted with Canney Riles
urethral dilators inserted between the tape and the urethra to
S108
measure minimum tension required to achieve continence
with cough test. The dilators were removed before the
cough, and if leakage continued tape tension adjusted with a
smaller dilator till continence achieved. Patients were dis-
charged home once resumed normal voiding, and followed
up with a King’s Health Questionnaire to assess improve-
ment rates and the incidence of de novo storage symptoms.
Results: In 85% of cases, a 16–19 Canney dilator was
needed to achieve continence with the cough test. 10% of
the cases needed a size 14–16 dilator, the remainder needed
smaller calibre dilators. Five patients (1.7%) developed
voiding dysfunction post operatively defined as high post
void residuals of more than 100 ml. Two of them had
concomitant surgery for cystocoele repair. In four patients,
voiding dysfunction settled after a maximum period of
16 weeks. One patient needed long term intermittent self
catheterisation. Cure rates of incontinence were 65% with
improvement noticed in further 19% of the cases. De novo
storage symptoms developed in 7% of the cases.
Conclusion: Voiding dysfunction following TVT can be
reduced when using the four quadrant infiltration of water
around the bladder neck and adjusting the tension of the
tape using a combination of cough test and Canney dilators
underneath the urethra to keep the tension of the tape to the
minimum required to achieve continence. In 85% cases the
tension of the tape needs to be as loose as a 16–19 Canney
urethral dilator.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
185
CHANGES OF LOWER URINARY TRACT SYMPTOMS
(LUTS) AFTER TENSION-FREE TRANSVAGINAL
TAPE (TVT) PROCEDURE: 3-YEAR FOLLOW-UP
Lee, DH1; Suh, HJ1; Lee, JY1; Kim, JC1; Park, WH2
1
Catholic University of Korea, Seoul, Korea; 2Inha Uni-
versity, Incheon, Korea
Objective: TVT is a popular procedure for managing
female stress urinary incontinence (SUI) because of its
high success and low complication rates. However, the
effects of TVT on lower urinary tract symptoms (LUTS)
other than SUI are reported to be variable. We evaluated the
changes of LUTS after 3 years of TVT procedure in
patients who had LUTS before surgery.
Material and methods: 75 women with a mean age of 53
and follow-up of 39 months who underwent TVT were
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
included in this study. Patients who showed preoperative
postvoid residual urine (>100 ml) and low flow rate (peak
flow<15 ml/sec) were excluded.
Results: The mean time from surgery to telephone
interview was 25.6 months. 57 (76.0%) stated that they
had complete resolution of SUI, 12 (16.0%) were continent
with small amount of leakage when coughing and 6 (8.0%)
showed recurrence. In 46 patients who complained of
urgency or urge incontinence before surgery-36 (64.3%)
out of 56 who had urgency or urge incontinence before
surgery indicated improvement of symptoms following
surgery. In 62 who had frequency, symptom was improved
in 48 (77.4%), and in 44 who had nocturia, symptom was
improved in 32 (72.7%). Minor degree of obstructive
voiding symptoms was developed in 16 (14.0%). No major
intraoperative complications were observed. In 114, 98
(86.0%) were satisfied with their continence. When asked
whether they would undergo the procedure again, 66.7%
answered ’yes’.
Conclusions: These data demonstrate that transobturator
Monarc procedure is a safe and effective treatment for
women with SUI comparable with TVT, and voiding
symptoms can be expected to be improved after trans-
obturator procedure as well. However, we do not know how
long the improvement of voiding symptoms would last. So
additional long term follow-up should be done.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
186
DOES PROLAPSE WORSEN WITH AGE?
Dietz, HP
University of Sydney, Australia
Objective: Female pelvic organ prolapse is common and
may give rise to symptoms of vaginal fullness and
dragging, with the patient eventually noticing a lump in
the vagina. Commonly, prolapse surgery is undertaken on
the assumption that the condition is likely to worsen over
time. This assumption has recently become less plausible,
as the authors and others have been able to show that mild
to moderate pelvic organ descent is common in young,
nulligravid women.
Methods: At a tertiary urogynaecological centre, 1112
women were seen for a standardised interview, clinical
examination, multi-channel urodynamics and ultrasound
imaging supine and after voiding. Pelvic organ descent on
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244 S109

ultrasound was determined relative to the inferoposterior in a clinical ‘non trial setting’ and to identify any urodynamic
margin of the symphysis pubis. Records were evaluated parameters which could explain why a subset of women with
retrospectively to investigate the relationship between mixed incontinence got worse following treatment.
patient age at presentation and prolapse. Materials and methods: Women complaining of mixed
Results: After removal of 139 datasets of women with symptoms were offered duloxetine for a four week period,
previous incontinence or prolapse surgery, 973 datasets at the end of which, a patient global impression of
remained. Mean age was 54 years (range 17–90), mean improvement (PGI-I) score for each patient was completed.
vaginal parity was 2.4 (range 0–12), with 31% of women A subset of these women underwent urodynamics. A
complaining of symptoms of prolapse. There were no database was created and statistical analysis comparing
meaningful correlations between clinical prolapse assess- urodynamic parameters of women who were no worse and
ment and patient age, with r values between 0.015 (uterine those who were worse following treatment, was performed
descent) and 0.08 (rectocele). On univariate regression, we using SPSS.
found a weak and complex relationship between age and Results: Seventy six women were recruited in total. Their
cystocele, with a positive correlation to menopause and a PGI-I scores are summarized in table 1. 59% experienced
negative relationship thereafter (r2 adj.=3.2%, P<0.001). some improvement. A subset of fifty seven women with
On multivariate regression a large part of this positive mixed incontinence, had urodynamic investigation. Of
relationship between age and cystocele in premenopausal these eight (14%) were worse following treatment. An
women was explained by childbirth. The same was true for Unpaired t-test comparing the urodynamic parameters of
rectocele (r2 adj.=4.2%, P<0.001), but for uterine descent women who got worse with women who were no worse are
the relationship was stronger (r2 adj.=8.6%, P<0.001) and in table 2.
virtually linear.
Conclusion: From our data obtained in a large cohort of
women symptomatic for pelvic floor disorders, it appears that Table 1. PGII scores following treatment
ageing plays only a very limited role in the aetiology and
pathogenesis of pelvic organ prolapse. There may be an N=76 PGI-I
Very much better 13(17%)
increase in organ descent in premenopausal women due to
Much better 10(13%)
ageing, but this effect is reversed after menopause, at least for A little better 22(29%)
anterior and posterior compartment prolapse. Our results No change 20(27%)
contradict epidemiological studies showing age to be a risk A little worse 6(8%)
factor for pelvic reconstructive surgery. This discrepancy may Much worse 4(5%)
be due to confounders such as urogenital atrophy and bladder Very much worse 1(1%)
or bowel dysfunction influencing surgical decision making.
Table 2. Unpaired t-test of urodynamic parameters
Disclosures N=57 Unpaired t-test
Was consent obtained from patients? No. Bladder capacity 0.152
Was this work supported by industry? No. Maximal detrusor pressure 0.528
Volume voided 0.579
Does the presenter or any of the authors act as a consultant,
Maximal flow rate 0.853
employee (part time or full time) or shareholder of an Voiding time 0.045
industry? No.
Women with a prolonged voiding time and mixed incon-
tinence got worse following treatment with duloxetine.
Conclusion: Duloxetine may be a suitable treatment for
187 mixed incontinence. However prolonged voiding time may
DULOXETINE FOR MIXED INCONTINENCE; DOES IT be useful in determining which women got worse following
WORK? CAN URODYNAMICS PREDICT OUTCOME? treatment with duloxetine.
Vella, MV1; Duckett, JRA2
1
King’s College Hospital, London, UK; 2Medway Maritime
Hospital, Gillingham, UK Disclosures
Was consent obtained from patients? Yes.
Objective: Although Duloxetine was licensed for use in Was this work supported by industry? No.
stress incontinence, studies have shown it may be effective in Does the presenter or any of the authors act as a consultant,
treating mixed incontinence. The aim of our study was to employee (part time or full time) or shareholder of an
assess whether duloxetine was helpful in mixed incontinence industry? No.
S110
188
EFFICACY OF TRANSOBTURATOR MIDURETHRAL
SLING PROCEDURE IN FEMALE STRESS
INCONTINENCE WITH DECREASED URETHRAL
FUNCTION: A COMPARATIVE STUDY
OF INSIDE-OUT AND OUTSIDE-IN
Kim, JC1; Jang, J1; Kim, JJH2; Lee, DH1
1
Catholic University of Korea < Seoul, Korea; 2Yonsei
University, Seoul, Korea
Objective: To evaluate the efficacy of transobturator
midurethral sling procedure in female stress incontinence
with decreased urethral function and comparisons between
inside-out and outside-in procedures have been analyzed.
Materials and methods: 87 women with stress inconti-
nence and VLPP less than 90 cmH2O who underwent
transobturator midurethral sling procedures and followed
up for more than one year were included in this study.
Patients were divided into 2 groups based on VLPP, then
subdivided into 4 groups in subject to procedural types.
Group A and B included patients with VLPP less than
60cmH2O and underwent inside-out (n=11) or outside-in
procedure (n=21), respectively. Group C and D included
patients with VLPP ranging from 60 cmH2O to 90 cmH2O
and underwent inside-out (n=18) or outside-in procedure
(n=37), respectively. The preoperative evaluation included
a careful history taking, physical examination, voiding
diary, I-QoL and a urodynamic study. The postoperative
evaluation included degree of incontinence, patients’
subjective satisfaction, voiding diary, uroflowmetry with
postvoid residuals and I-QoL. Complete cure was defined
as the absence of stress incontinence confirmed by both
perception of patient and examination of the patient with a
full bladder.
Results: The cure rates for VLPP less than 60 cmH2O
group and VLPP between 60 to 90 cmH2O group were 72%
(23/32) and 85% (47/55), respectively, which exhibited
proportional decrease as the urethral function declined.
Cure rates for the 4-group (A, B, C, D) subdivision were
73, 71, 78 and 89%, respectively. Group D showed to have
highest cure rate, but there was no statistical significance.
Maximal urethral closing pressure (MUCP) for the cured
and non-cured patients were 50.2±18.2 cmH2O and 32±
13.0 cmH2O, respectively, which demonstrated a signifi-
cantly low MUCP in recurred group (p<0.001). However,
there were no differences in VLPP between cured (65.5±
18.4 cmH2O) and non-cured patients (61.8±22.6 cmH2O).
Subjective satisfaction, which included ‘very satisfied’
and ‘satisfied’ on satisfactory questionnaire were 64, 67,
61 and 73% in respect to group A, B, C and D.
Frequency and nocturia in voiding diary were decreased
in all groups and no significant differences were noted in
maximal uroflowmetry and postvoid residuals between
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
the subgroups. Total score of I-QoL significantly in-
creased postoperatively (p<0.001).
Conclusion: Transobturator midurethral sling procedure
appears to have low cure rate in decreased urethral function,
especially when MUCP is low. Procedural preferences
regarding inside-out and outside-in seems to have no effect
on the results. Further studies are needed to establish its
long-term results.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
189
INCIDENCE OF OVERACTIVE BLADDER
AFTER VAGINAL SURGERY FOR PELVIC ORGAN
PROLAPSE
Diez-Itza, I; Becerro, A; Aizpitarte, I
Hospital Donostia, San Sebastian, Spain
Objective: The purpose of this study was to determinate
the incidence of overactive bladder (OAB) after vaginal
surgery for pelvic organ prolapse (POP) in patients
previously asymptomatic.
Materials and methods: We included 216 patients with
POP, who underwent vaginal hysterectomy with anterior
and posterior colporrhaphy, between the years 2000 and
2004 in Donostia Hospital. In 32 patients with urodynamic
stress urinary incontinence, tension free vaginal tape (TVT)
was associated to prolapse surgery.
Exclusion criteria had been: History of a prior gynaeco-
logical abdominal or vaginal surgery, history of abdominal
radiotherapy or vaginal brachytherapy, central or peripheral
neurological disorders, cognitive disorders, history of OAB
symptoms prior to surgery, impossibility of localization
after surgery or reoperation for POP or IU in the follow-up
period. Characteristics of the patients were collected from
their clinical histories. The follow-up visit was performed
by telephone interview. We asked the women about
changes in medical disorders or medication intake since
POP surgery, and if they had been reoperated for POP or UI
in other hospitals. We inquired into OAB symptoms (2002
ICS definition): We asked about the sensation of urinary
urgency, the time of onset and if it was associated with urge
urinary incontinence.
Results: Of the total, 183 had had a POP operation alone
and 33 had been operated for POP and UI. Patients
demographic characteristics were: mean age 69.50 years
(SD:9.32); mean BMI 26.04 (SD:3.64); mean parity 3.05
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
(SD:1.57); mean age at menopause 49.54 years (SD:4.15).
All the women included in the study had prolapse symptoms
before surgery and 77.8% had an advanced prolapse grade in
at least one compartment.
‘The novo OAB’ was diagnosed in 42 patients (19.4%) after
surgery. When we analysed the results depending on the type
of surgery we observed that in the vaginal hysterectomy
group the incidence of OAB was 15.3%, in those operated of
vaginal hysterectomy and TVT the incidence was 42.4%.
The mean time of onset of OAB symptoms was 7.7 months,
with a range from 0 to 36. Urge urinary incontinence was
present in 27 patients (64.3%).
Conclusion: Performing vaginal hysterectomy for POP indi-
cation can be a cause of OAB. When POP surgery is
associated to IUE surgery (TVT) the incidence is even higher.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
190
LABORATORY TESTING OF SUBURETHRAL MESH
SLINGS: A COMPARISON OF THEIR STATIC
AND DYNAMIC PROPERTIES
Neymeyer, J1; Abdul-Wahab, W1; Beer, M1; Spethmann,
J2; Groneberg, D3; Große-Siestrup, C3
1
Franziskus Hospital, Berlin, Germany; 2University of
Greifswald, Germany; 3Charitè University, Berlin, Germany
Objective: Our aim was to investigate the most common
suburethral meshes used in the treatment of stress inconti-
nence. physical structure, mechanical properties, density
and aspect ratio (average fibers length and diameter).
Materials and Methods: The strength of the meshes was
checked on the Zwick Universal Material Test Machine.
The power strength curves, Point of Deformity and point of
Destruction were measured for each of the following
commonly used sub-urethral meshes: American Medical
Systems (Monarc), Bard (Uretex), Dynamesh (SIS), Dyna-
mesh (SIS direct), GfE (TiLOOP Tape extralight and
TiLOOP Tape light), Gynecare (TVT), Mentor (Aris), Tyco
(IVS Tunneler blue (IVS 02M) and IVS Tunneler green
(IVS 04M)) and Serag Wiessner (Serasis). A standard
portion of 7 cm of each original width of the aforemen-
tioned Meshes was placed between the two Zwick clamps
and the meshes were then each subjected to a standardized
strain to a magnitude of 800 mm/min.
Results: It was observed that there were different power
curve results for the meshes. Some meshes showed minimal
S111
deformity until the Point of Breaking as seen with the
Dahlhausen and Serag Wiessner meshes. Comparatively,
other meshes had longer deformation curves prior to
reaching their breaking points as seen with the Gynecare
and AMS meshes. The range of results for the Point of
Deformity was found to be between 40 and 70% of the
original form of the mesh. The range for the Point of
Breaking was found to be between 40 N (TiLOOP extra-
light) and as high as 140 N (Dynamesh SIS).
Conclusion: After research, It has been proven that human
fascia deforms 20–30% when subjected to a strength of
16 N. Therefore higher deformity points and stronger
meshes may not be necessary for the treatment of urinary
incontinence due to the higher possibility of overcorrection
as well as a higher possibility of migration of mesh due to
this added strength. Therefore, it may concluded that the
most appropriate mesh is not necessarily the strongest but
one which resembles natural human tissue the most.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
191
LONG TERM RESULTS OF THE BERLINER
NEOBLADDER IN FEMALES: A FOUR YEAR
REVIEW
Neymeyer, J; Abdul-Wahab, W; Beer, M
Franziskus Hospital, Berlin, Germany
Objective: The gold standard treatment for invasive bladder
cancer is a cystectomy and creation of an ileum neobladder,
when possible. However, earlier techniques in women have
yielded unsatisfactory results due to long term complications
like hypercontinence which can be seen in up to 80% of
patients. These techniques also included anterior excintration
and hence prevented sexual intercourse. Therefore, our aim is
to take these factors into consideration by preserving the
vagina to aid in a normal sexual life and to perform a
colposacropexy with a titanium coated polypropelenium mesh
to prevent the development of prolapse and hypercontinence.
Methods: A total of 65 women diagnosed with invasive
bladder cancer and meeting the criteria for cystectomy and
neobladder creation were included in the study. These patients
were subjected to a combined urological and gynecological
approach simultaneously. The urological component con-
sisted of a cystectomy, pelvic lymph node dissection and
creation of an ileum neobladder and the gynecological
component consisted of a hysterectomy, oophorectomy,
S112
preservation of the vagina and most notably, colposacropexy
with a titanium coated polypropelenium mesh.
Results: Our combined surgical method has succeeded in
preventing the development of pelvic floor prolapse that
would have led to hypercontinence. A total of 65 female
patients have been treated for their bladder cancer with this
technique and none of the 65 patients have developed
hypercontinence post-operatively for a mean of 48 months.
In addition, 34 patients accounting for 54% of the total
have resumed full sexual activity.
Conclusion: First and foremost, the fundamentals of cancer
surgery have not been compromised in any way. In addition
to this, a better quality of life has been offered to these
patients by the prevention of hypercontinence and by the
preservation of normal sexual intercourse.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
193
ON THE USE OF NUMERICAL SIMULATION
TECHNIQUES TO STUDY THE DEFORMATION
FIELD OF THE PELVIC FLOOR MUSCLES
Natal Jorge, R1; Mascarenhas, T2; Parente, M1; Fernandes,
A1; Martins, P1; Martins, JOAO3; Ferreira, A4;
Farouk El Sayed, R5
1
IDMEC, Faculty of Engineering, University of Porto,
Portugal; 2Faculty of Medicine, University of Porto, S Joao
Hospital, Portugal; 3Instituto Superior Tecnico, Lisbon,
Portugal; 4Faculty of Engineering, University of Porto,
Portugal; 5Faculty of Medicine, Radiology Department,
Cairo University, Egypt
Objectives: Several published works have shown that
pelvic floor injuries during a vaginal delivery can be
considered a significant factor in the development of
urinary incontinence, fecal incontinence and pelvic organ
prolapse. In this work the Finite Element Method is used to
estimate the deformation and stress fields that occur on the
pelvic floor during a vaginal delivery.
Materials and methods: The pelvic floor is discretized
using 3D hexahedral finite elements being the geometrical
point data obtained from cadaver measurements by Janda et
al. (J Biomech, 2003). The constitutive equation adopted in
this work for the 3D behavior of the pelvic floor muscles is
a modified form of the incompressible transversely isotro-
pic hyperelastic model proposed by Humphrey and Yin
(J Biomech Eng, 1987). In order to connect the pelvic floor
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
muscles to the bony model two new finite element meshes
are added which represent the supportive structures of the
pelvic floor. The fetus is modeled using tetrahedral
elements and is considered as deformable body, but with
high stiffness. The movement of the fetus is imposed by
controlling the movement of several points. During the
simulation, the engagement, descent, flexion, internal
rotation and extension of the fetal head is carried out. The
movements of the fetus are defined in order to present the
smallest diameter of the fetal head to the birth canal.
Results: The maximum stretch ratio obtained in the present
work is 1.63, which exceeds the largest non-injurious stretch,
1.5, as it was refereed by Lien et al. (Am J Obstet Gynecol,
2005). This maximum value of stretch occurs for a vertical
displacement of the fetus head of 60 mm. The maximum
deformation (defined as a nondimensional quantity that
measures the length variation occurred on a fiber compared
to the original length) estimated within this simulation is 0.66.
Conclusions: In this work the finite element method, a
non-invasive technique, was used to study the mechanical
behaviour of the pelvic floor muscle of woman during a
vaginal delivery. It is important to note that, if injury can be
caused by fiber stretch exceeding a maximum permissible
value, one may conclude that a risk exists for injury of the
muscles of the pelvic floor during the second stage of labor.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
194
OUTCOMES FOLLOWING ANTERIOR PELVIC
FLOOR REPAIR USING PERIGEE SYSTEM
Götze, W; Melcher, J
Krankenhaus Märkisch-Oderland GmbH, Strausberg, Germany
Objective: To evaluate surgical outcomes and long term
results in patients with Perigee implantation (AMS Co.) for
anterior repair.
Materials and methods: This is a prospective observational
case-study of up to 195 patients with pelvic organ prolapse
(POP grade III) who underwent Perigee implantation
between 1.10.2004 and 31.12.2006. All patients were re-
examined 8 weeks after the operation and all 106 cases
operated on before 31.12.2005 had one year follow up-
examination and interview. Assessment was made of
anatomical reconstruction results, mesh presentation, shrink-
age effects, erosions, the development of reactive entero/
rectoceles, residual urine, cure or persistence of incontinence
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
etc. Patient satisfaction, improvement or worsening of
quality of life and side effects such as dyspareunia, dysuria
etc. were surveyed during interviews. The study is planned to
extend over a period of at least 5 years. Median patient age=
66 years (41 to 89 years). Simultaneous hysterectomy was
performed in 4 cases with level I defect.
Results: No intra operative adverse effects were observed
(except one bladder lesion caused by blunt dissection with no
direct relation to the perigee implantation system). 3 (of 195)
postoperative hematomas were observed in the anterior wall
zone and treated by revision. 2 (of 195) hematomas in the
fossa obturator were treated conservatively. No mesh
infection or abscess was observed. 8 (of 195) asymptomatic
mesh erosions were treated successfully. SUI and residual
urine were cured in 90%. Reactive Entero/Rectocele was a
real problem in 12 (of 195) patients -cured by 9 Apogee
implantations and 3 classic posterior colporrhaphia. One
hysterectomy and two amputation of cervix uteri were
necessary in 3 (of 195) cases with development of elongatio
colli uteri. One-year follow-up: reconstruction results (97 of
106 optimal, 4 of 106 sufficient, 5 of 106 suboptimal-but
only one case with an anterior high cystocele relapse needed
re-treatment). Patient satisfaction regarding all complaints
(94 of 106 very satisfied or satisfied). No worsening of
quality of life was reported by our patients. 104 (of 106)
would recommend this operation to others. 2 (of 106) cases
of de novo dyspareunia were observed. Main problem was
persistence of urge in 6 of 106.
Conclusion: The perigee system allowed a safe and
effective treatment of pelvic floor defects at all 3 levels
and could be the first choice in the future of POP-treatment-
if more long term data confirms our results.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
195
PREVALENCE OF LOWER URINARY TRACT
SYMPTOMS IN THE THIRD TRIMESTER
OF PREGNANCY
Herrmann, V; Scarpa, K; Palma, P; Riccetto, C
University of Campinas, Brazil
Objective: to evaluate the prevalence of lower urinary tract
symptoms (LUTS) in the third trimester of pregnancy.
Methods: In total, 340 women attending the prenatal clinic
at the Obgyn Department, State University of Campinas
(Unicamp), SP, Brazil were selected.
S113
Results: Overall, 329 women (96.8%) presented LUTS
during pregnancy: 80.6% presented nocturia, 70.3% urinary
frequency, 50.2% post-micturition dribbling, 50.0% stress
urinary incontinence (SUI), 46.9% incomplete empty sensa-
tion and 44% urgency. LUTS were considered severe enough
to cause social or hygienic problem by 157 women (46.2%).
No statistic correlation has been observed between SUI and
route of delivery or parity but, when considering distinct
efforts that lead to SUI, parity was significantly associated to
cough or laugher (p=0.0478; p=0.0046, respectively). The
prevalence ratio (PR) revealed that parous women with 4 or
more deliveries presented 1.4 times more risk to complain of
SUI on cough and sneeze and 2.0 times more risk to leak
urine at laugher compared to nulliparous women. Parity was
also significantly correlated to nocturia and urinary frequen-
cy (p=0.0354; p=0.0327, respectively.
Conclusion: There is a very high prevalence of urinary
symptoms in the third trimester of pregnancy in our
population. Parity ≥ 4 was significantly associated to SUI on
cough and laugher and to nocturia and urinary frequency.
There was no correlation between LUTS and route of delivery.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
196
RISK FACTORS ASSOCIATED
WITH THE DEVELOPMENT OF OVERACTIVE
BLADDER AFTER VAGINAL SURGERY
FOR PELVIC ORGAN PROLAPSE
Diez-Itza, I; Aizpitarte, I; Becerro, A
Hospital Donostia, San Sebastian, Spain
Objective: The purpose of this study was to determinate the
risk factors associated to the development of overactive bladder
(OAB) after vaginal surgery for pelvic organ prolapse (POP).
Materials and methods: We included 183 patients with
POP, who underwent vaginal hysterectomy with anterior
and posterior colporrhaphy, between the years 2000 and
2004 in Donostia Hospital. Exclusion criteria had been:
Association of stress urinary incontinence surgery to the
POP surgery, history of a prior gynaecological abdominal
or vaginal surgery, history of abdominal or vaginal
radiotherapy, central or peripheral neurological disorders,
cognitive disorders, history of OAB symptoms prior to
surgery, impossibility of localization after surgery or
reoperation for POP in the follow-up period. The character-
istics of the patients were collected from their clinical
S114
histories. The follow-up visit was performed by telephone
interview. We asked the women about changes in medical
disorders or medication intake since POP surgery, and if
they had been reoperated for POP or UI in other hospitals.
We inquired into OAB symptoms (2002 ICS definition):
We asked about the sensation of urinary urgency. We also
asked about recurrence of prolapse symptoms.
Results: We establish two groups, one of 155 patients who
didn’t have symptoms of OAB after POP surgery and other
of 28 patients who developed OAB. We analysed: age,
BMI, parity, age at menopause, diagnosis of diabetes,
prolapse grade prior to surgery and recurrence of prolapse
symptoms. The women with ’the novo’ OAB were older
(mean age 73.14 years vs. 68.50 years; P=0.011), with a
higher BMI (mean BMI, 26.73 vs. 25.90; P=0.271) and
had a prolapse grade ≤II in the anterior compartment
(Baden Walker classification) (P=0.05). Age was catego-
rised forming two subgroups (≤70 years, and > 70 years). A
multiple logistic regression model was performed with the
variables of borderline significance to determine which
patients’ characteristics were associated independently with
the novo OAB. We observed that age >70 years (OR 2.46;
95% CI, 1.02–5.96; P=0.045) and prolapse grade ≤II (OR
2.77; 95%CI, 1.14–6.69; P=0.023) appear to have a greater
likelihood of develop ‘the novo’ OAB after POP surgery.
Conclusion: Older women and those with lower prolapse
grade are at more risk of developing OAB symptoms after
POP surgery.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
197
ROBOTIC ENDOSURGERY IN PELVIC ORGAN
PROLAPSE REPAIR
Struppl, D
Department of Gynaecology and Minimally Invasive
Surgery, Na Homolce Hospital, Prague, Czech Republic
Introduction: The robotic surgery is often reported as
revolutionary step in evolution of endoscopic surgery.
These systems are designed for assistance or as fully
robotized devices with surgical instruments fixed to robotic
arms. The surgeon’s movements are converted to the
instruments by advanced computer interface and precise
mechanic transmission. The final movement can be scaled
according to the surgeon’s demand. We present our first
experience using Da Vinci robotic system.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: to evaluate the development of robotic surgical
systems and to assess their role, efficiency and application
in urogenital prolapse surgery.
Materials and methods: A feasibility pilot study including
first patients who underwent robotic surgery for various
degree of urogenital prolapse (including robotically assisted
hysterectomy, total robotic hysterectomy or complex multi-
compartmental mesh repair with sacrocolpopexy).
Results: All surgeries were successfully completed with no
major complication as bowel or vessel injury or massive
hemorrhage. The surgery time was longer than using classic
laparoscopy but due to moderate learning curve became
within 15 cases comparable. The blood loss was minimal.
The postoperative follow-up was 6,9 months (1–15 with no
significant morbidity.
Conclusion: The robotic surgery has a potential to abolish
the limits of laparoscopy especially in advanced dissection
and suturing due to instruments flexibility. As disadvantage
we find the absence of tactile perception, time of
preoperative preparation and costs. Our target is using the
robotic system in the advanced complex laparoscopic
procedures and to cooperate with other robotic centres.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
198
SYMPTOMATIC AND QUALITY OF LIFE
OUTCOMES FOLLOWING SITE-SPECIFIC FASCIAL
REATTCHMENT FOR PELVIC ORGAN PROLAPSE
Fayyad, AM1; Hill, SR1; Redhead, E1; Awan, N2;
Kyrgiou, M2; Smith, ARB3
1
Royal Blackburn Hospital, UK; 2Royal Preston Hospital,
UK; 3St Mary’s Hospital, London, UK
Objective: There is paucity of data on the outcome of site
specific fascial reattachment for pelvic organ prolapse
using validated quality of life questionnaires. Previous
studies that assessed surgical outcomes used retrospective
data analysis and non-validated quality of life question-
naires. The aim of this study is to assess the outcome of
anterior and posterior fascial defect repair for pelvic organ
prolapse. Patients’ outcomes assessed were quality of life
scores and symptoms relating to prolapse, urinary and
bowel functions.
Methods: 192 patients undergoing site specific fascial
reattachment surgery for pelvic organ prolapse filled
validated prolapse quality of life (P-QOL) questionnaires
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
twenty-four hours prior to surgery. Impact of prolapse on
quality of life and symptoms scores at baseline were
calculated. Follow-up postal questionnaires were sent six
months post-operatively. 101 patients (53%) responded,
forty nine of them underwent anterior repair, and fifty two
underwent posterior repair. Pre and post operative quality of
life and symptoms scores were calculated, and compared
using Wilcoxon Signed Rank Test.
Results: Quality of life scores showed significant improve-
ment in both anterior and posterior repair groups, with the
exception of general health. Anterior repair significantly
improved urinary storage symptoms (frequency, urgency,
and urge incontinence) along with poor urinary stream.
Posterior repair group showed significant improvement in
defecatory symptoms. Both operative groups showed
significant improvement in sexual function and general
prolapse symptoms, including ‘feeling a bulge in the
vagina,’ and ‘vaginal bulge interfering with sex’.
Conclusion: Using P-QOL questionnaires, colporrhaphy
procedures for urogenital prolapse result in significant
improvements in quality of life scores six months after
surgery. Anterior repair results in significant improvement in
urinary storage symptoms six months post operatively.
Posterior repair improves bowel defecatory dysfunction. Use
of P-QOL questionnaires is highly recommended to assess
treatment outcome following surgery for pelvic organ prolapse
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Astellas.
Level of support? No industry support in study design or
execution.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
199
THE EFFECT OF SURGICAL CONSULTATION
ON PATIENTS’ SELECTED GOALS
Lowenstein, LL; Kenton, KK; Pierce, KP; FitzGerald,
MPF; Mueller, EM; Brubaker, LB
1
Loyla Medical Center, Chicago, IL, USA
Objective: Patient-reported goals in a clinical setting can
be used to direct evaluation and treatment and improve
satisfaction. The aim of this study was to determine if
patients’ self-reported goals change after their initial
urogynecologic evaluation.
Materials and methods: After obtaining IRB approval, we
reviewed consecutive charts of new patients presenting to
our tertiary care referral practice from July to September
2006. All patients completed an open-ended questionnaire
S115
asking them to describe and rank their personal goals prior
to and immediately after their initial visit. Demographic
information, co-morbidities, clinical diagnoses and
responses to the Medical Epidemiological and Social
Aspects of Aging (MESA) questionnaire and the short
form of the Pelvic Floor Distress Inventory (PFDI) were
recorded. Goals were categorized as: (1) treatment related,
(2) symptom resolution, (3) lifestyle (quality of life
improvement), (4) emotional (less embarrassed by inconti-
nence), and (5) information seeking. Three reviewers
categorized goals with consensus obtained in cases of
disagreement. Data analysis was done using SPSS Version
13 (Chicago, IL). Wilcoxon signed rank test was used to
compare continuous variables among related groups. Chi-
square test of association was used for ordinal data. All
tests were considered significant at the .05 level.
Results: Fifty-four women with a mean age of 53 (18–83)
years reported a total number of 312 goals. The majority
were Caucasian (84%) with 9% African American and 7%
Hispanic. Women listed significantly more goals after than
prior to their first visit (median of 3±1.2 vs. 2±1.2
respectively, p<.004). Category or type of women’s goals
changed significantly after the visit. The self-identified
‘most important’ goal changed in more than half of patients
(56%). Symptoms resolution (45%) and information seek-
ing (20%) goals were most common prior to visit; while
treatment related goals (37%) were most common after the
visit. Emotional goals increased significantly after the visit
(32.5% from 11. 8% before the visit, p<.0001).
Conclusion: Women’s pelvic goals change after their initial
physician interaction. Not surprisingly, post-visit goals focus
less on information seeking and more on treatment. Given the
association between patient satisfaction and goal achieve-
ment, clinicians should regularly assess patients’ goals as
they may change over time, and thus, impact satisfaction.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
200
THE LEVATOR URETHRAL GAP MEASUREMENT:
AN OBJECTIVE MEANS OF DETERMINING
LEVATOR AVULSION?
Abbu, A1; Dietz, HP2; Shek, KL2
1
Philippines Society of Ob-Gyne; 2Urogynecology, Australia
Objective: The commonest defect of the levator ani
muscle, an avulsion of its insertion from the pelvic
S116
sidewall, is characterized by a widening of the gap between
muscle insertion and urethra. The widening of this gap
seems to be the most reproducible finding on palpation.
This study used 4D pelvic floor ultrasound to measure the
levator urethra gap (LUG) as another means of identifying
pelvic floor defects on imaging.
Methods: In a retrospective study, we reviewed 118
women who had undergone pelvic floor ultrasound using
a GE Kretz Voluson 730 Expert System and clinical
assessment for levator trauma. Using multislice or tomo-
graphic imaging (TUI)), a set of tomographic slices was
obtained at intervals of 2.5 mm at maximal levator
contraction. We measured the closest distance between the
center of the urethra and the levator insertion at the plane of
minimal dimensions, 2.5 and 5 mm above. Assessment of
ultrasound data occurred blinded against clinical data.
Results: Of 118 datasets, two were excluded due to poor
image quality. Mean age was 52 (range 17–80) years).
Clinically a defect had been diagnosed in 32 women (28%).
In a test-retest series the intraclass correlation for LUG was
excellent (ICC 0.93, CI 0.90–0.95). On using Receiver
Operator Curve Analysis (ROC) to study the relationship
between LUG and Pelvic Floor Avulsions we obtained an
area under the curve of 0.663 (confidence interval 0.604–
0.722). A cut off of 21 mm showed acceptable discrimina-
tory power with 72% sensitivity and 53% specificity. For
exclusion of avulsion injury we propose a cut-off of 25 mm
(sensitivity 36% and specificity 85%).
Conclusion: Measurement of the levator-urethra gap is
highly reproducible but of limited use for the diagnosis of
levator avulsion, probably mainly due to inter-individual
variation in hiatal biometric indices. However, a gap
measurement of over 25 mm had a specificity of over
85% for levator avulsion as diagnosed by digital assessment
and may therefore be useful in doubtful cases.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
202
URINARY INCONTINENCE AND PELVIC FLOOR
MUSCLE STRENGTH DURING PREGNANCY
AND AFTER CHILDBIRTH
Mascarenhas, T; Bernardes, J; Patricio, B
Faculty of Medicine, Hospital S Joao, Porto, Portugal
Objectives: The aim of this study was to assess pelvic
floor muscle strength and its relation with urinary incon-
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
tinence in women during first pregnancy and following
childbirth.
Materials and methods: Primigravidae women attending
for antenatal care, with no urinary incontinence (UI)
symptoms before pregnancy, were invited to participate on
a prospective study at 3rd trimester (T) of pregnancy,
6 weeks (w) and 6 months (mo) post-partum (pp). Pelvic
floor muscle strength was evaluated by vaginal EMG,
vaginal squeeze pressure (Kontinence Clinical 2000) and
palpation of the pelvic floor muscles (digital muscle testing-
Oxford scale 0–5). The results were statistically analysed
with SSPS Software v. 13.0.
Results: The questionnaires were completed by 109
women at 3rd T of pregnancy, 80 women at 6 w pp and
82 at 6 mo pp. It was observed that at the 3rd T of
pregnancy 52% were incontinent; after childbirth 15% were
incontinent at 6 w pp and 18% at 6 mo pp. The analysis of
the global population shows that only 30% of women in the
3rd T of pregnancy, 39% at 6 w pp and 35% at 6 mo pp,
respectively, had weak pelvic floor (Oxford scale ≤3).
Continent women at 6 mo pp showed a tendency to
increase the values of muscle strength in comparison with
those at 3rd T of pregnancy (although not statistically
significant), incontinent women, on the contrary showed a
significant deterioration of the pelvic floor strength (PFS) at
6 mo pp (vaginal pressure p=0.040). Incontinent women
had a decreased pelvic floor muscle strength compared to
continent women in all observations. However, the differ-
ence was higher at 6 mo pp (palpation p=0.002; vaginal
pressure p=0.014; vaginal EMG p=0.002).
Conclusions: This study shows that only a minority of
women shows a weak pelvic floor muscle strength.
Different behaviour among women with and without UI
was found. The negative impact of UI on PFS suggests that
the pelvic floor muscle strength plays an important role
maintaining urinary continence and demonstrates the
importance of the functional evaluation of the pelvic floor
muscle strength during pregnancy and after delivery.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
203
USING DOPPLER ULTRASONOGRAPHY TO EVALUATE
THE ANATOMY OF THE OBTURATOR VESSELS
Lo, TS; Wang, AC; Tseng, LH; Liang, CC
1
Chang Gung Memorial Hospital, Chang Gung University,
Taoyuan, Taiwan
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: To evaluate the anatomy of the obturator vessels
within the obturator region and its relationship to the trans-
obturator sling.
Materials and Methods: 20 urodynamic stress incontinent
patients without severe pelvic organ prolapse (POPQ <
stage II) who required a trans-obturator tape surgery (T.O.
T.) were recruited. Before and after the standard trans-
obturator tape surgery (Monac.), trans-obturator colour
Doppler ultrasonography was applied with the patient in
lithotomy position. The sector scanning method was
adopted using the skin incision points for TOT at obturator
region as reference. Diameter of various vessels and its
relations to various landmarks before and after TOT
procedure were measured on both side of obturator region.
Shortest distance from the TOT sing to blood vessels with
diameter larger than 2 mm was recorded.
Results: All 20 patients completed the TOT with 12 had a
concomitant anterior colporrhaphy for the concurrent cys-
tocele. The mean age was 43.2 years. There were no intra-
operative surgical complications observed. The average
distance for obturator artery to TOT slings was 4.5 cm on
right and 4.8 on left. Multiple obturator artery branches were
observed within the region of interest. The device passed on
average 0.9 cm on right and 1.0 cm on left from the most
nearest vessels with diameter larger than 2 mm. Mapping on
the vessels reviewed that the nearest vessels were branch of
obturator artery and feeding vessels for the obturator muscles.
Conclusion: Vascular anatomy presents in obturator region
demonstrated a significant degree of variability. An average
safe distance of 0.9 cm was observed when the correct TOT
techniques were followed. Yet, a potential hazard of
vascular injury has to be noted while performance the
surgery procedure within the region of obturator.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
204
LAPAROSCOPIC MESH IMPLANTATION IN PROLAPSE
SURGERY, TECHNIQUE, INDIVIDUALISATION
AND RESULTS
Struppl, D
Department of Gynaecology and Minimally Invasive
Surgery, Na Homolce Hospital, Prague, Czech Republic
Objective: The surgical repair of pelvic organ prolapse
(POP) has a major role to play nowadays, but due to aging
the population will be even more important in the future.
S117
There are many innovative changes in the concept of POP
surgery during last decade, especially in new techniques
and implants to reach the optimal tissue support. The (POP)
is a multicompartmental disorder and usually consists of
urethrocele, urethral hypermobility, cystocele, uterine or
vault prolapse, enterocoele or rectocele. The simmilar
aethiology explains frequent coincidency of occult or
evident urinary incontinence as well.
Materials and methods: We evaluate the current role of
laparoscopy in POP surgery and present our experiences
and results in prospective cohort of 144 consecutive cases
of women who underwent laparoscopic global prolapse
mesh repair including sacrocolpopexy during three years
period (2002–2006). 32 women prolapse mesh repair only,
112 women underwent concomitant antiincontinence sur-
gery (transobturator urethropexy-TOT). Mean follow-up
was 26,9 month. Our aim was to assess the success of the
procedure and to compare the impact on the urinary
continence in these groups.
Results: The cure rate in prolapse surgery was 97,9% at the
time of follow up. 95,8% women were dry in TOT group,
84,4% in prolapse surgery alone group.
Conclusion: Our first experience is encouraging and
according to our results we perform the concomitant
transobturator urethropexy in women with POP with occult
or evident incontinence preoperatively. The long term
assessment will be target of our further study.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
205
CORRELATION BETWEEN VOIDING DYSFUNCTION
SYMPTOMS AND UROFLOWMETRY IN WOMEN
SUFFERING FROM STRESS URINARY
INCONTINENCE
Hubeaux, K; Deffieux, X; Jacq, C; Sheikh Ismael, S;
Raibaut, P; Amarenco, G
Objective: Urinary retention and voiding dysfunction (VD)
symptoms (hesitancy, straining to void, difficulty in starting
micturition, diminished stream, and feeling of incomplete
bladder emptying) are common and problematic features
occurring after surgery for stress urinary incontinence
(SUI), especially suburethral sling procedures. The objec-
tive of the current study was to determine whether
completing a VD questionnaire has a good predictive value
regarding bladder outlet obstruction (BOO) on urodynamic
S118
data in a population of women suffering from stress urinary
incontinence (SUI).
Materials and methods: From a urodynamic database of
415 SUI women admitted in the department in 2005, 93
with isolated SUI who underwent urodynamic investiga-
tions were eligible for this study. Patients with obvious
etiologies of obstruction were excluded. VD symptoms
were explored with the BFLUTS Questionnaire. BOO was
defined as a maximal flow rate under 15 ml/s for a urine
volume >200 ml, or a post-void residual volume greater
than 50 ml, or an abnormal pattern of the flow curve. The
sensitivity, specificity, positive and negative predictive
value of questioning VD were calculated. Statistical
analysis was done using a Wilcoxon test for continuous
data and Fisher exact test for categorical data, and
multivariate analysis.
Results: Reported VD has a poor specificity (41%) and
positive predictive value (32%) of BOO on uroflowmetry. No
statistical correlation was found between VD symptoms and
BOO defined on uroflowmetry (p=0.64) in this specific SUI
population showing no obvious etiologies of obstruction.
Conclusions: No correlation between obstructive symp-
toms and BOO as defined on uroflowmetry was found in a
specific population of SUI women showing no obvious
etiologies of obstruction. Since pre-existing BOO is known
to be a risk factor in post-surgery obstructive disorders, our
results suggest a systematic urodynamic evaluation of the
voiding phase among all SUI women before continence
surgery.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
206
FECAL INCONTINENCE: SHOULD OBGYN’S BE
AWARE OF IT?
Wenzel, C; Descouvieres, C; Rondini, C; Morales, A;
Alvarez, J; Troncoso, F; Aros, S; Troncoso, C
Hospital Padre Hurtado, Universidad del Desarrollo,
Santiago, Chile
Objective: To determine the prevalence of fecal inconti-
nence (FI) in a General Gynecology Unit (GGU) and in a
Pelvic Floor Disorders Unit (PFDU) at a regional referral
hospital.
Materials and methods: We ran a transversal observation-
al study which included 859 consecutive patients referred to
our hospital between September 2006 and December 2006.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
We asked all of our patients to fill out the Cleveland Clinic
Incontinence Score (CCIS). We then reviewed FI rates, FI
grading and epidemiological features in both units.
Results: Of the 859 patients, 663 were referred for
gynecological complaints and were evaluated at our GGU
and 196 patients were referred to our PFDU for any pelvic
floor disorder, except FI. From 663 patients attending our
GGU, 141 (21.3%) stated some kind of FI. The FI rates
according to the CCIS were as follows: mild, 134 patients
(20.2%), moderate, 5 patients (0.8%) and severe, 2 patients
(0.3%).
From 196 patients attending our PFDU, 104 (52.6%) stated
some kind of FI. The FI rates according to the CCIS were
as follows: mild, 82 patients (44.9%), moderate, 13 patients
(6.6%) and severe, 2 patients (1%).
We then regrouped the patients using a CCIS ≥4 (at least
one episode of liquid stool incontinence once a month) to
define clinically significant FI. We found that 18 patients
(2.7%) in the GGU and 30 patients (15.3%) in the PFDU
had a CCIS of 4 or above.
When comparing different epidemiological variables our
results were as follows: Age (42.2 vs. 52.4 p<0.05), parity
(2.1 vs. 3.1 p<0.05), new born birth weight (3511 vs. 3729
p=0.1), history of instrumental delivery (0.14 vs. 0.19 p=
0.4) and body mass index (29.2 vs. 31.4 p=0.1).
Conclusion: 1 out of 5 patients attending our GGU and 1
out of 2 attending our PFDU complaints of any kind of FI.
Almost 1 out 30 patients attending our GGU and 1 out of 7
attending our PFDU complaints of at least one liquid stool
incontinence episode once a month.
Patients older than 50 years old and a parity of 3 or more
seems to be the most important associated epidemiologic
characteristics.
In our view, FI should be seek and evaluated in gyneco-
logical patients, specially in those with pelvic floor
dysfunction.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
207
NEOVAGINOPLASTY WITH OXIDIZED CELULLOSE:
CLINICAL AND MORPHOLOGICAL EVALUATION
Crema, LC1; Jármy-Di Bella, ZIK2; Ribalta, JCL2;
Simões, MJ2; Girão, MJBC2; Baracat, EC3; Sartori, MGF2
1
Federal University of São Paulo, Brazil; 2Federal Univer-
sity of São Paulo, Brazil; 3Federal University of São Paulo,
Brazil
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: The purpose of this study was to present our
experiences of an innovate surgical approach for vaginal
agenesis using oxidized cellulose membrane (Intercede®)
covering the neuralgia.
Study design: The current study involved 11 subjects who
9 were diagnosed with vaginal agenesis and 2 with
postoperative vaginal stenosis. After the creation of the
neovagina, a silicon mold that had been wrapped with the
cellulose oxidized membrane was placed in the tunnel. We
realized biopsies of the neovagina wall to evaluate the
vaginal epithelium development.
Results: We had as postoperative complications 1 case of
total stenosis after not using the mold and 2 cases of partial
stenosis in patients without sexual intercourse after the
surgery. The duration of the operation was <35 minutes,
and the blood loss, the postoperative pain and secretion
were minimal. Initial epithelialization of the neovagina was
achieved 1 month after the operation, and complete
epithelialization after 9 months. The neovagina that was
created with this procedure was similar the normal adult
vagina, and the patients who had sexual intercourse did not
relate any difficulties.
Conclusion: This procedure seems to be an alternative
approach for the therapy of vaginal agenesis by presenting
excellent morphological and clinical results, using a non-
biological material covering the neovagina.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Johnson.
Level of support? No industry support in study design or
execution.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
208
PARTIAL THIRD DEGREE TEARS: DOES TYPE
OF REPAIR MATTER?
Toozs-Hobson, P1; Webb, S1; Pretlove, S1; Radley, S2;
Parsons, M1
1
Birmingham Women’s Hospital, UK; 2Queen Elizabeth
Hospital, Birmingham, UK
Introduction: Over the last 5 years increasing importance
has been attached to the description of the type of repair
performed for OASIS (Obstetric anal sphincter injuries).
Much debate has centred on overlap vs end to end repairs.
The description of an overlap repair includes dividing any
residual fibres of the sphincter to provide adequate tissue to
overlap and in theory prevent ischaemic change due to
tension in the non divided fibres. However in practice
S119
repairs are described as overlap where no attempt to divide
residual fibres has occurred. We had previously reported
our rates of symptoms for OASIS as 61% with 22% leaking
liquid or solids. Since this time protocols for management
included repair using PDS sutures in theatre, antibiotic
prophylaxis and lactulose post surgery and all women being
followed up.
Study design: A three year retrospective analysis of the
repairs of women attending our dedicated OASIS clinic
who had sustained a partial thickness injury to the anal
sphincter to see whether the different types of repair had
different outcomes. Also to review whether the change in
protocols had impacted on symptoms compared to histor-
ical controls in our unit
Methods: Retrospective case note review of all women
with 3a or 3b tears (partial thickness tears). Analysis was
performed using a chi squared test looking at the
expected frequency of symptomatic women. All women
were repaired in theatre with a long term absorbable
suture (PDS) with antibiotic cover and lactulose post
repair.
Results: 92 women were identified where the notes had
given a description of a partial (3a &3b) tear along with
a description of the repair. 51 women underwent an end
to end repair and 41 a non dividing overlap repair. 4
(7.8%) women described symptoms at follow up in the
end to end group and 3 (7.3%) in the overlap group.
These findings were non significant on a chi squared
test. Regardless of repair type there appeared to be a
dramatic reduction in symptoms compared to historical
controls.
Conclusions: Our results fail to identify a difference in
symptoms in women repaired with a ‘non classical’ overlap
repair compared to an end to end repair. Our results suggest
that it may be the correct identification of the injury and
repair in theatre with a long term absorbable suture followed
by careful attention to post repair management using
antibiotic prophylaxis and lactulose cover which is impor-
tant in reducing symptoms.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
209
TREATMENT OF PERINEAL PAIN
BY INTRALESIONAL INJECTION
Jeffery, ST; Parappallil, S; Vashisht, A; Franco, A; Fynes, M
St George’s Hospital, London, UK
S120
Objective: Postpartum and post-operative perineal pain is
common in women. It is particularly more frequent and
severe in women who have had intrapartum perineal
trauma. The management of this chronic condition remains
challenging. This was a pilot study of perineal injection in
women suffering from perineal pain.
Methods: Consecutive women presenting to a urogynaecol-
ogy clinic with perineal pain either due to postpartum trauma
or vaginal surgery were offered perineal injections. Women
were evaluated using a structured proforma, pain scores (0–
10) and the Abbreviated Sexual Function Questionnaire
(ASFQ). Each subject was examined, the area of tenderness
identified and then a combination of 10 ml Bupivicaine 2%,
Hydrocortisone 100 mg and 1500 u Hyaluronidase was
injected. Women were evaluated at 4 weeks and offered a
repeat injection if the pain had not resolved.
Results: In this pilot study, 9 women received perineal
injection. The mean age of the cohort was 39.5 years (range
31–60). 7 women had developed pain following obstetric
trauma including 3rd degree tear in 3 women and 2nd
degree in 4 women. 6 of the women were para 1. Of the
post-partum women, the mean time since delivery was
20.5 weeks (range 8–33). 4 of the 9 subjects were not
sexually active all due to severe dyspareunia. The 5
sexually active women all described severe superficial
dyspareunia. 8 of the 9 women had no pain at rest. The
site of injection was 3 o’clock in 2 women, 4o’clock in 1, 5
o’clock in 1, 6 o’clock in 4, 7 o’clock in 2 and 8 o’clock in
1 and all received the full 10 ml dose. At a mean follow-up
of 4.2 weeks (range 4–5 weeks) there was a significant
reduction in mean pain scores from 6.7 to 4.7 (p=0.01). 1
additional woman had become sexually active since the
injections due to improvement in the pain. 8 of the 9
women described vaginal dryness pre-treatment compared
to 6 at follow-up, which was not statistically significant (p=
0.317). On ASFQ there were no significant improvements
across any of the 4 domains. We did not demonstrate any
improvement in libido.
Conclusion: In this small series of 9 women, we have
demonstrated a significant improvement in mean pain
scores following perineal injection of Bupivicaine, Hyal-
uronidase and Hydrocortisone. We did not, however
demonstrate any significant improvements in sexual func-
tion following one injection. This study needs to be
repeated in a larger a series with multiple treatment courses
to further evaluate this treatment.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
210
TVT OBTURATOR (TVT-O) FOR TREATMENT
OF STRESS URINARY INCONTINENCE IN WOMEN
WITH INTRINSIC SPHINCTER DEFICIENCY
Triopon, G1; Fatton, B2; Amblard, J2; Jacquetin, B2
1
University of Nimes, France; 2University of Clermont-
Ferrand, France
Objective: to compare in a retrospective case-control study
the results of the TVT-O™ procedure (non-absorbable
monofilament polypropylene tape-Gynecare, Sommerville,
NJ, USA) in the treatment of stress urinary incontinence
(SUI) in patients with versus without intrinsic sphincteric
deficiency (ISD).
Materials and methods: All the patients undergoing a TVT-
O procedure to correct SUI with ISD between January 2004
and March 2005 were identified and matched for preoperative
urinary symptoms and type of surgery (single or combined
procedure) using a control group of women without ISD who
underwent TVT-O during the same period. No statistically
significant differences were found between the two groups in
age, parity, body mass index, and number of pads daily used.
The combination of maximal urethral closure pressure
(MUCP) <30 cm H2O and valsalva leak point pressure
(VLPP) <60 cm H2O was required to define ISD. Patients
with fixed urethra were excluded (clinical examination with
cotton swab urethral support testing and preoperative ultra-
sound imaging at valsalva and cough stress test). Surgical
outcome was measured by using our own symptoms
questionnaire and the Contilife questionnaire (self adminis-
trated validated quality of life questionnaire). Patients
included in Group 1 had a complementary objective assess-
ment including physical examination, stress test and urody-
namic testing. Statistical analysis was undertaken using SAS 9
software (Student or Wilcoxon test and MacNemar test).
Results: Fifty patients were matched successfully using the
criteria above. Thirty five patients in both groups underwent
TVT-O as a single procedure while 15 had a concomitant
pelvic organ prolapse (POP) repair. Procedure was performed
under spinal, general or local anesthesia respectively in
85.7%, 12.3% and 2% in group 1 and 91.8%, 6.1% and 2%
in group 2 (not statistically significant (NS)). Surgical
procedure was standardized with a systematic cough test if
available. Mean follow-up was 15.1 months in group 1 and
23.2 months in group 2. Previous SUI or POP surgery was
observed more frequently in group 1. No statistically
difference was found in subjective success rate for urinary
incontinence between the group 1 and 2 (respectively 67.4%
and 79.4%, p=0.25). Subjectively, 89.9% of women in group
1 were cured of SUI, compared with 93.9% in group 2 (NS).
Objective cure rate of SUI was 89.8% in group 1. Satisfaction
and QOL score (8.15/10 in group 1 versus 8/10 in group 2, p=
0.64) were similar after surgery in patient with or without ISD.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Conclusion: TVT-O is an effective procedure to correct
SUI in patients with ISD associated with a persistent
urethral hypermobility.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
211
TWO, THREE, AND FOUR-DIMENSIONAL
ULTRASOUND OF PELVIC FLOOR MUSCLES DURING
VALSALVA: A STUDY ON INTRA-OBSERVER
RELIABILITY
Majida, MM1; Hoff Brækken, IHB2; Bø, KB2; Umek,
WU3; Dietz, HPD4
1
Akershus university Hospital, Norway; 2Norwegian
School of Sport Sciences, Oslo, Norway; 3Medical Univer-
sity of Vienna, Austria; 4Nepean Clinical School, Univer-
sity of Sydney, Australia
Objective: Modern 3D and 4D real time volume imaging
ultrasound techniques have made it possible to evaluate the
pelvic floor muscles during dynamic events such as valsalva
maneuver (bearing down), a pelvic floor muscle contraction,
and coughing. While repeatability indices for pelvic floor
ultrasound imaging are available for supine data acquisition,
this is not the case for imaging in the standing position. The
standing position may be preferable for some indications,
and we therefore aimed to test intra observer reproducibility
for levator hiatal dimensions and the position of the bladder
neck during valsalva with the patient standing.
Materials and methods: 17 healthy female volunteers
(mean age 47,9 years, range 29–71) were recruited for the
study. A GE Kretz Voluson 730 Expert ultrasound system
(G.E Medical Systems Norway) 4–8 MHz volume trans-
ducer with an acquisition angle of 85 degrees was used for
2D, 3D, and 4D examinations. Analyses were performed
offline on a laptop using the software ‘4D View v 5,0’ (GE
Healthcare, Norway). Two test series were performed
within 1–3 weeks by the same examiner. Recordings were
made with the participants in a standing position at rest and
during valsalva. The transverse diameter and the area of the
levator ani (LA) hiatus were measured in the axial plane, at
the level of minimal hiatal dimensions. The position of the
urethral meatus (middle of the bladder neck) was identified
in the midsagittal plane relative to a horizontal line from the
inferior posterior margin of the symphysis pubis.
Results: Intra class correlation coefficients (ICC) values for
hiatal area 0.84 (95% CI 0.55–0.95) at rest and ICC 0.86
S121
(95% CI 0.52–0.95) at maximum valsalva. ICC values for
transverse diameter of levator hiatus was 0.86 (95%CI
0.64–0.95) at rest and 0.67 (95% CI 0.20–0.89) at
maximum valsalva. The coefficient of variation (CV) varied
from 5%–10% for measures of the levator hiatus. ICC
values for bladder neck position in the horizontal and in the
vertical plane varied from 0.74 (95% CI 0.35–0.91) and
0.047 (95% CI 0.00–0.56) respectively. Five examinations
during valsalva were excluded when analyzing the area of
the LA hiatus due to inadequate imaging of the posterior
part of the LA muscle.
Conclusion: It is possible to measure levator hiatal
dimensions with 2D, 3D, and 4D ultrasound in the standing
position on Valsalva with fair to very good reproducibility.
Technical difficulties in capturing the whole muscle
however made it necessary to exclude almost 1/3 of the
examinations.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
212
ULTRASOUND IMAGING OF THE LOWER
URINARY TRACT IN WOMEN WITH LOWER
URINARY TRACT SYMPTOMS (LUTS)
AFTER BURCH COLPOSUSPENSION
Krofta, L; Feyereisl, J; Otcenasek, M; Kasikova, E; Pan, M
Institute for the Care of Mother and Child, Prague, Czech
Republic
Objective: To demonstrate the significance of introital
ultrasound of the lower urinary tract in the diagnostic
algorithm in patients with lower urinary tract symptoms
(LUTS) after Burch colposuspension.
Methods: Twenty six women with voiding dysfunction
directly associated with prior anti-incontinence surgery
(Burch colposuspension) were included in the study (Group
A). The control group (Group B) consisted of twenty eight
women after Burch colposuspension with a good clinical
result without LUTS. Introital ultrasound was performed at
rest and at maximum voluntary contraction to measure the
monitored parameters (angle α: the inclination angle of the
urethra, angle β: the posterior urethrovesical angle, angle γ:
the angle between the axis of the symphysis and the line
segment connecting the region of the internal urethral
orifice and the lower margin of the symphysis, distance H:
the distance between the internal urethral orifice and the
horizontal axis running through the bottom edge of the
S122
symphysis, distance p: the distance between the internal
urethral orifice and the lower margin of the symphysis).
Results: Significant differences were found in bladder neck
position and mobility between those women with LUTS
and control group. At a 5% confidence interval, both
groups differ in mean values of the angles α, β a γ, and in
the mean values of segments p and H on straining. Ventral
displacement of the bladder neck (characterized by angles α
and γ) at rest and during straining was present in all women
in group A. The difference was statistically significant (p=
0.001). Angle β also demonstrates abnormal position and
minimal mobility of the bladder neck in group A. As a
result of bladder neck dislocation in the ventral direction, at
rest, this parameter shows significantly lower values in
comparison with group B. This difference is more apparent
on Valsalva, where as a result of minimal mobility of the
bladder neck. This parameter has even lower values in
group A in comparison with group B. The bladder neck in
patients with LUTS after Burch colposuspension shows not
only ventral displacement of the bladder neck but also a
significant reduction in dorsocaudal movement during
straining.
Conclusion: In women with LUTS after Burch colposuspen-
sion, atypical changes in the position and mobility of urethra
can be demonstrated when compared with women who
underwent successful surgery for incontinence. This study
was supported by the Internal Grant Agency of the Ministry of
Health of the Czech Republic, grant number NR 7903–3.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
213
VAGINAL PARAVAGINAL REPAIR
WITH AN ALLODERM GRAFT: LONG-TERM
OUTCOMES
Ward, RM1; Sung, VW1; Clemons, JL2; Myers, DL1
1
Women and Infants Hospital, Warren Alpert Medical
School of Brown University, Providence, RI, USA;
2
Madigan Army Medical Center, Tacoma, WA, USA
Objective: To describe the long-term objective and
subjective outcomes after vaginal paravaginal repair with
AlloDerm graft (LifeCell, Branchburg, NJ).
Materials and methods: Thirty-three women with either
recurrent stage II or with primary or recurrent stage III-IV
anterior vaginal wall prolapse underwent a vaginal para-
vaginal repair with AlloDerm (cadaveric dermal graft)
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
between November 1998 and April 2002. Short-term
outcomes were previously reported1; long-term outcomes
on 24 of the 33 subjects are presented here. The primary
outcome was objective failure, defined as a stage II or
greater anterior wall defect on pelvic organ prolapse
quantification exam. Secondary outcomes included recur-
rent symptomatic cystocele (defined as vaginal bulge or
pressure), recurrence requiring further treatment (repeat
surgery, pessary or physical therapy), other compartmental
defects, graft complications, urinary symptoms and new
onset dyspareunia. Follow-up visits occurred annually.
Descriptive statistics were performed.
Results: Long-term data was obtained on 24/33 (72.7%)
subjects. The mean length of follow-up was 52.0 months
(range 18–86 months). Fourteen of the 24 patients (58.3%)
had recurrent stage II prolapse in the anterior compartment.
Eighty-six percent of these failures (12/14) occurred by
18 months and their stage of prolapse did not progress during
subsequent follow-up (mean follow-up of 52.6 months). No
failures were detected beyond 24 months. Of the failures,
only 4/14 (28.6%) were symptomatic; 1 of whom underwent
an abdominal sacrocolpopexy. Subsequent defects in other
compartments requiring surgical repair and/or physical
therapy occurred in 7/24 patients (29.2%): 4 developed
stage II-III rectoceles, 3 developed stage II apical prolapse.
There were no graft erosions. Of the subjects without
preoperative incontinence, 2 of 7 (29%) reported de novo
urge incontinence and 2 of 10 (20%) reported de novo stress
incontinence; 75% were remote from the time of surgery. Of
19 subjects who were sexually active preoperatively, 1
developed new onset dyspareunia.
Conclusion: Long-term evaluation of vaginal paravaginal
repairs with AlloDerm graft reveals good subjective success,
but a high rate of objective failure within the first 24 months.
Reference
1. Clemons JL, Myers DL, Aguilar VC, Arya LA. Am J
Obstet Gynecol 2003;189:1612–1619.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
215
VAGINAL STENOSIS DUE TO LICHEN PLANUS
TREATED WITH VAGINOPLASTY USING
INTERCEED(R): CASE REPORT
Crema, L; Kajiwama, M; Cesarino, ER; Ribalta, JLC;
Jármy-Di Bella, ZIK; Girão, MJBC; Sartori, MGF
Federal University of São Paulo, Brazil
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: Lichen planus of the vulva and vagina is part of
a systemic manifestation of the skin and the mucosal
membrane. The exact cause is unknown, but the disorder is
likely to be related to an allergic or immune reaction. Skin
involvement is characterized by small, polygonal viola-
ceous papules. Erosive lesions may cause vaginal synechia
resulting in stenosis. Interceed® is used during surgery to
protect raw tissue surfaces as they heal and has the purpose
to reduce adhesions. The objective of this case report is to
show the use of Interceed® to treat this manifestation of the
vulvar and vaginal skin.
Methods: A 33-year-old woman was diagnosed with lichen
planus due to ulcerations at the oral mucosa. Later she started
to complain of dyspareunia. Physical examination revealed
stenosis of the vagina. The vagina was 2 cm in length. The
initial treatment was with oral corticosteroid (prednisone)
and betamethasone cream. Improvement in oral and vulvar
lesions were observed. Vaginoplasty was performed to
correct the vagina damaged by the lichen planus. To prevent
recurrent stenosis, after the procedure, the vagina was treated
locally with Interceed®. After one year follow-up, the patient
had no sexual complaints. The total vaginal length was 6 cm
and there were no oral or mucosal lesions.
Conclusion: Stenosis of the vagina is a potential compli-
cation of lichen planus. When vaginoplasty is done as a
treatment, the use of a oxidized regenerated cellulose
barrier may prevent recurrence of this complication, that
causes a reduction in quality of life.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Johnson.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
216
5-YEAR FOLLOW-UP OF TENSION-FREE VAGINAL
TAPE (TVT) OPERATION
Bjelic Radisic, V; Tamussino, K; Greimel, E; Frudinger, A;
Zeck, W; Bader, A; Kern, P; Winter, R
Medical University, Graz, Austria
Objective: We evaluated objective and subjective conti-
nence following the tension-free vaginal tape (TVT)
operation and the relationship between quality-of-life
(QOL) and objective findings.
Materials and methods: A total of 151 patients undergo-
ing a retropubic TVT operation between 1999 and 2001
were invited to a follow-up visit after 5 years. The follow-
S123
up visit included a pertinent urogynecologic history, clinical
and urodynamic examination, cystoscopy and a clinical
stress test. Patients were considered objectively cured if
they had stable cystometry, a negative clinical stress test
and residual urine volume <100 ml. QOL was assessed
with the Incontinence Outcome Questionnaire (IOQ).
Results: 108 (72%) patients were available for examination
after 5 years (range, 54–62 months). The mean age at
follow-up was 62 years (range, 43–91). The overall
objective continence rate was 86%. 59% of patients
reported subjective cure, 31% improvement and 10% no
change or worsening of incontinence symptoms. 25% of
patients reported overactive bladder symptoms, but objec-
tively these symptoms were found in 12%. Eight patients
were reoperated: 7 tapes were cut because of voiding
problems or de novo OAB and one mesh erosion was
repaired.
Conclusion: The objective continence rate 5 year after
TVT operation was 86%. The subjective outcome assessed
by the IOQ showed a correlation with the objective
continence rate, though less than expected.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
217
AUGMENTATION CYSTOPLASTY IN PATIENTS
WITH MULTIPLE SCLEROSIS: LONG-TERM
FOLLOW-UP
Zachoval, R1; Vik, V1; Zalesky, M1; Heracek, J2; Urban,
M2; Mayerova, K3; Medova, E3; Pitha, J3
1
Department of Urology, Faculty Thomayer Hospital,
Prague, Czech Republic; 3Department of Urology, 3rd
Faculty Hospital, Prague, Czech Republic; 3Department of
Neurology, 3rd Faculty Hospital, Prague, Czech Republic
Objective: To evaluate a long-term follow-up of patients
with augmentation cystoplasty due to multiple sclerosis-
progressive disease deteriorating essentially body functions
and ability to take care of augmented bladder.
Material and methods: 17 patients (12 women and 5 men)
mean age 40 with multiple sclerosis underwent augmenta-
tion cystoplasty (Goodwin’s cup-patch). The indication for
all of them was overactive bladder refractory to a conserva-
tive treatment, in one case with bilateral vesico-ureteral
reflux and renal insufficiency and in the other patient with
large symptomatic bladder diverticulum. All patients were
assessed before the surgery, 6 months after the operation and
S124
at present. Subjective evaluation was performed by means of
questionnaires (micturition problems, needs for clean inter-
mittent autocatheterization (CIAC), incontinence and quality
of life). Objective parameters were evaluated by micturition
diary, urodynamic studies, imaging methods and blood and
urine tests.
Results: Expanded Disability Status Scale score worsened
from 4,2 to 5,3 (ambulatory without aid or rest for about
100 meters; disability severe enough to preclude full daily
activities) with the mean follow-up 61 months. 4 patients
were performing CIAC before the surgery with the mean
frequency 10,3 a day, the others with a spontaneous voiding
showed the mean IPSS 22 points. All patients performed
CIAC with the mean frequency 3,3 a day at 6 months after
the augmentation and 7 of them were still able to urinate
spontaneously. Currently all patients perform CIAC with
the mean frequency 4,7 a day and one patient has
difficulties with the CIAC. 13 patients were incontinent
before the operation and all of them become fully continent
afterwards. The mean quality of life improved from 4,7 to
1,0 (scale 0–6) at 6 months after the surgery and it still
remains unchanged. The mean maximal bladder capacity
increased from 116 ml to 637 ml at 6 months after surgery
and to 580 ml at present. The mean maximal bladder
pressure decreased from 84 cm H20 to 26 cm H20 at
6 months after operation and to14 cm H20 at present. The
mean fluid intake per 24 hrs increased from 1100 ml before
surgery to 2200 ml at present. Creatinine decreased from
286 μmol/l to 150 μmol/l in the patient with renal
insufficiency. There was one early complication (orchiepi-
didymitis requiring orchidectomy) and two late complica-
tions (multiple bladder calculi requiring cystolithotomy).
Conclusion: Augmentation cystoplasty is safe and efficient
method in selected patients with multiple sclerosis and it
significantly improves their quality of life in the long terms.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
218
BLADDER BACTERIA IN PROLAPS SURGERY:
IS PROFYLAXIS WORTHWHILE-A RANDOMIZED
STUDY
Winberg, T1; Boij, R2
1
Höglandssjukhuset, Nässjö, Sweden; 2Ryhov Hospital,
Jönköping, Sweden
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: To evaluate if antibiotic prophylaxis with fosfo
mycin is effective at time of surgery, if it enhances
resumption of normal voiding or shortens time of hospital
stay after prolapse surgery.
Material and methods: 198 patient (median age 64) who
had no symptoms of UTI were randomized for single-dose
fosfomycin 3 g or placebo. No meshes were used at
surgery. Urinary culture was taken on the morning of
operation before randomization. A second was taken after
the indwelling catheter was removed (always within
24 hrs. after operation), and a third was analyzed 4–
6 weeks after operation. Time to re-establish normal
voiding, and length of stay in hospital was measured.
Results: Preoperatively 27% were culture positive with a
potentially pathogen strain in significant amount (10000 or
more cfu/ml). At second culture 7% in the fosfomycin
group and 60% in the placebo group were significantly
colonized.
At 4–6 weeks postoperatively the third culture showed an
overall colonization of 29% despite the fact that all patients
who had colonization at second culture got immediate and
appropriate antibiotic treatment.
Average time for re-establishing normal voiding after
operation was almost identical in the two groups as was
hospital stay.
Conclusion: In this group of patients colonization is
common but symptoms are vague. No difference on time
to re-establish normal voiding was seen, nor the time of
hospital stay. Fosfomycin prophylaxis was highly effec-
tive to make the urine bacteria free just after the
operation.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
219
COMPARISION OF THE OUTCOME
AND COMPLICATIONS OF THE PUBOVAGINAL
SLING AND THE RETROPUBIC
AND TRANSOBTURATOR MIDURETHRAL SLINGS
FOR FEMALE STRESS URINARY INCONTINENCE
Na, YG1; Gil, G1; Lim, JS1; Kim, H1; Kim, ET2; Han, DS3;
Sul, CK1
1
Chungnam National University, Taejon, Korea; 2Eulji
University, Seoul, Korea; 3Konyang University, Daejeon,
Korea
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244 S125

Objectives: This study was performed to determine the 220

outcome and complications of the various sling operations, COMPARISON OF TENSION-FREE VAGINAL TAPE
especially voiding difficulty. (TVT) AND TRANS-OBTURATOR SUBURETHRAL
Materials and methods: From January 1998 to August TAPE FROM INSIDE TO OUTSIDE (TVT-O)
2005, we studied 356 women that we were able to follow FOR TREATMENT OF URODYNAMIC STRESS
up for over 12 months after the sling operation. Patient INCONTINENCE
characteristics, urodynamic study results, cure rates, and Tzu-Yin, L; Tsung-Hsien, S; Wen-Chu, H
complication rates were compared. The primary proce- Mackay Memorial Hospital, Taipei, Taiwan
dures for the management of postoperative voiding
difficulty were alpha-blockers medication and intermittent Objective: The aim of this study was to compare the
catheterization. Hegar dilation and urethral pull-down short-term results between tension-free vaginal tape
procedure were performed as secondary methods. For (TVT) and trans-obturator suburethral tape from inside
those patients who showed persistent obstructive symp- to out (TVT-O) for urodynamic stress incontinence
toms, the cutting of sling materials or urethrolysis were (USI)
performed. Materials and methods: Fifty-seven patients of USI for
Results: In the cases of pubovaginal sling, lower success TVT procedures and thirty-five patients for TVT-O proce-
rates were found than the others (p<0.05). Postoperative dures were recruited into this study. The median follow-up
voiding difficulty was significantly higher in the cases of period was 39 months in TVT group and 16 months in
pubovaginal sling (p<0.05), but after the abovementioned TVT-O group. All patients were proven USI by urodynamic
procedures were performed no statistically significant study (UDS). Preoperative assessment included pelvic
differences were found. In the case of the retropubic examination, UDS and chain cystography, and repeated
route, the bladder perforation rate was significantly higher 3 months after operation. Operation time, perioperative
but did not effect hospital stay (Table). complications, and hospital stay were recorded. Cure of
Conclusions: In the aspect of voiding difficulty, the USI was defined as no leakage during stress test at the
retropubic and transobturator midurethral sling group is follow-up UDS.
superior to pubovaginal sling one. However postoperative Results: Patients’ characteristics and urodynamic evalua-
voiding difficulty was treated successfully by conservative tion were similar in two groups. The operative time was
management. shorter in TVT-O group than in TVT group (12.6±4.9 vs
26.9±7.7 mins, p<.05). The hospital stay was shorter in
TVT-O group than in TVT group (4.3±1.2 vs. 6.0±
Pubovaginal Retropubic Transobturator
13.7 days, p<.05). No bladder perforation was found in
sling route route (n=106)
(n=100) (n=150)
both procedures. Urine retention in UDS was 5.2% (3/
Operation results 57) in TVT group versus 0% (0/35) in TVT-O group
Cured* (%) 59.0 78.0 78.3 (p>.05). De-Novo DO was 7.0% (4/57) in TVT group
Improved† (%) 28.0 20.0 19.8 versus 8.6% (3/35) in TVT-O group (p>.05). One patient
Failure (%) 13.0 2.0 1.9 had wound infection in TVT group and one vaginal
Postoperative voiding difficulty erosion occurred in TVT-O group. The success rate was
At the day of catheter 36.0 24.0 23.6 78.9% (45/57) in TVT group versus 71.4% (25/35) in
removal (%)
TVT-O group (p>.05).
At 1 month after operation 7 0.7 1.9
day (%) Conclusion: TVT-O procedure in treatment of USI had
shorter operation time and hospital stay compared with
*: complete dryness, †: 50% decrease of incontinence, not TVT group. However, TVT-O had equally success and
required complication rates as TVT in the treatment of USI at the
short-term follow-up.
Disclosures
Was consent obtained from patients? Yes. Disclosures
Was this work supported by industry? No. Was consent obtained from patients? Yes.
Does the presenter or any of the authors act as a consultant, Was this work supported by industry? No.
employee (part time or full time) or shareholder of an Does the presenter or any of the authors act as a consultant,
industry? No. employee (part time or full time) or shareholder of an
industry? No.
S126
221
DYNAMIC MUTUALISM AND OTHER TOOLS
TO AID ETHICAL DECISION MAKING
FOR THE UROGYNAECOLOGIST
Brenner, B
Pelvic Floor Clinic
Objectives: The overall aim of the presentation will be to
highlight some of the ethical issues the urogynaecologist is
exposed to today. The ethical theories provide infrastructure
that aids in ethical decision making. An awareness of the
issues and some tools to assist in decision making is surely
the way forward.
Materials: Ethical dilemmas facing urogynaecology today
are profuse. The large choice of surgical procedures and
the comparative high cost of materials for incontinence
and pelvic floor support have created a new environment
where the profession and the medical devise and pharma-
ceutical industry are playing for much higher stakes. The
high costs of materials almost completely preclude the use
of these modern treatments for the developing world-an
issue that Western medicine seems to ignore. Industry
supported research and journal advertising open areas of
potential conflict of interest adding fuel to the debate of
what is right and proper in this relationship. Gifts of high
financial value to physicians like overseas travel costs to
attend conferences may be seen as exerting subliminal
influence on the benefactor. This presentation will review
the literature on how industry influences physicians. This
literature although prolific in general terms is rather sparse
in the specific area of urogynaecology.
Conclusion: A review of ethical theory relevant to ethical
decision making will be presented with special reference to
virtue ethics and professional integrity. Dynamic mutualism,
the Disclosure principle and the Game Theory will be
postulated as some tools to assist in ethical decision making.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
222
IMPACT OF SACROSPIOUS FIXATION IN POP-Q
AND LUTS: A PROSPECTIVE ANALYSIS
Castro, E1; Herrmann, V; Palma, P; Riccetto, C; Thiel, M;
Fraga, R; Dambros, M2
1
University of Campinas, Brazil; 2UNIFESP, Brazil
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: The aim of this study was to prospectively and
objectively evaluate the results of the sacrospinous vault
fixation utilizing the Pelvic Organ Prolapse Quantification
System (POP-Q). To our knowledge this is the first
quantitative evaluation of this procedure.
Subjects and methods: Forty-seven patients with uterine
or vaginal vault prolapse underwent the procedure (28 with
uterine prolapse; 18 with vaginal vault prolapse and 1
cervical prolapse). The same surgeon operated all patients
and mean follow-up was 142.7 days. Pre-op evaluation
consisted of physical exam, POP-Q scores and evaluation
of urinary symptoms by analogic and visual scale. All
patients complained of genital prolapse.
Results: Mean age was 63.6 years, mean parity was 5.7. Urge
incontinence, urgency and nocturia improved significantly
after surgery. SUI was similar both before and after surgery.
Two patients complained of pain in the right gluteal region,
which subsided after 3 months. Total vaginal length pre-op
was 8.8 cm and post-op was 7.7 cm. POP-Q scores before and
after surgery were, respectively: Aa (+0.7 versus −1.7), Ba
(+3.2 versus −1.7), C (+3.2 versus −7.6), Ap (−0.2 versus
−2.7) and Bp (+2.1 versus −2.7), all with p values<0.0001
(Fig. 1). No patient complained of prolapse after surgery.
Conclusion: Sacrospinal ligament fixation has low mor-
bidity and high cure rate, demonstrated by POP-Q scores.
Although there was a significant improvement in LUTS
after surgery, we notice 70% of asymptomatic anterior
vaginal wall prolapse after one year follow-up, probably
due to alteration of the vaginal axis.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
223
INFLUENCE OF MIGRATION ON THE UNDERSTANDING
AND HELP SEEKING BEHAVIOUR OF INDIAN WOMEN
WITH URINARY INCONTINENCE
Doshani, A1; Pitchforth, E2; Maitra, N3; Mayne, C1;
Tincello, D4
1
University Hospital of Leicester NHS Trust, UK; 2Depart-
ment of Health Sciences, University of Leicester, UK;
3
Medical College Baroda, MS University, Baroda, India;
4
Reproductive Science Section, Cancer Studies and Molec-
ular Medicine, University of Leicester, UK
Objective: The global burden of urinary incontinence and
the influence of ethnic origin is poorly understood.
Knowledge of socio-cultural factors will be vital in
developing culturally sensitive services. Leicester in the
UK has a large migrant population from West India
(Gujarat). We wished to compare and contrast the aware-
ness of and help seeking behaviour for urinary incontinence
among Gujarati women in Leicester, and women from
similar socioeconomic backgrounds in Gujarat in India.
Materials and methods: Women were recruited from
community centers, religious groups and women’s clubs.
Four focus groups were held in each country, facilitated in the
women’s preferred spoken language. Topics covered were
awareness and experience of incontinence, help seeking, and
awareness of treatments, quality of life and suggestions for
improving service provision. Groups were recorded, translat-
ed into English and transcribed electronically. Qualitative
thematic analysis was performed on the data. Two groups
from each country were used for this comparative study.
Results: The cross-cultural comparison highlighted several
common features in knowledge and management of urinary
incontinence symptoms.
In both countries, women were: keen to talk about the topic;
expending considerable effort to manage and conceal their
symptoms; normalising symptoms as a normal fact of
ageing, and thus not seeking help; found to be in favour of
opportunistic screening by health professionals during the
course of other consultations; more interested in receiving
media based information dissemination (radio & television).
Women in the UK preferred a female physician; whilst in
India women felt that expertise was more important.
Women in the UK were willing to access help via nursing
health professionals, whilst in India they would prefer to
see a medical practitioner. Women in India were interested
in ‘peer educators’ informing the community of relevant
health issues.
Conclusion: This study is the first of its kind in trying to
understand the influence culture has on the migrant Indian
S127
women in regards to incontinence and demonstrates the
need to understand the cultural aspects of the community in
order to provide culturally competent care. Assumptions
cannot be made. These data will help to formulate strategies
to improve awareness, help seeking and management of
incontinence for ethnic minority women.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
224
IRRITATIVE SYMPTOMS ARE THE BEST
PREDICTOR OF THE SUBJECTIVE CURE RATE
AFTER TRANSOBTURATOR TAPE PROCEDURE
Pakiz, M; But, I
General Hospital, Maribor, Slovenia
Objective: To identify which symptoms best predict the
subjective cure rate estimated by the patients after trans-
obturator tape procedure.
Methods: 80 patients with stress or mixed urinary
incontinence underwent transobturator tape procedure.
Preoperatively and three months postoperatively all
patients completed the Urogenital Distress Inventory
(UDI) and the objective cure rate was set by urogynecol-
ogist at the office. The subjective success of surgery was
evaluated by means of VAS score and subjective cure rate
was given in percents from 0% to 100%. Patients were
divided in two groups, group 1 consisting of women who
estimated the success rate 95% or more and group 2
consisting of women who estimated the success rate less
than 95% on VAS. For statistical analysis the descriptive
statistics, Mann-Whitney U test and discriminant analysis
were used.
Results: The mean age of the patients was 52,6 years and
the mean follow-up was 15,6 weeks. The median VAS
value was 95% and the objective cure rate was 98%.
Average degree of preoperative (higher in group 1, p=
0.010)) and postoperative stress symptoms (higher in
group 2, p=0.000) was significantly different between the
groups. Average degree of postoperative irritative symp-
toms was also significantly different between the groups
(p=0.000), higher in second group, where subjective
success was less than 95%. Using discriminant analysis
the subjective cure rate is positively predicted by the degree
S128 Int Urogynecol J (2007) 18 (Suppl 1):S107–S244

of the preoperative stress symptoms (Wilks’ Lambda= Results

0,936; p=0.025), preoperative irritative symptoms are
negatively related to the outcome (Wilks’ Lambda=0, N=38 Age Parity Evolution Sandvik Occult ICI-Q POP Operative
957, p=0.070). Postoperative irritative symptoms are the (years) (years) Test SUI (QoL) surgery time (min)
TVT-O® 60.82 2.6 5–7 7.5 5 5,5 11 16.6
best predictor of the subjective cure rate (Wilks’ Lambda= (33–83) (0–8) (1–12) (3–10) (2,8) (7–25)*
NEEDLE- 59,8 2,4 7.4 6.3 2 7.45 10 15.6
0.678, p=0.000). LESS® (39–79) (1–4) (1–30) (4–10) (3–9) (10–20)*
Conclusion: We believe that it is very important to look Intraop. Hospital Postop. Follow- Cure ImproveFailure ‘De
complicat. stay complicat. up novo’
for irritative symptoms and carefully treat them before and (months) urge
incont.
after transobturator tape procedure because these symp- TVT-O® 0 1* 2** 3.3 14 2 1 2
toms are the main reason for dissatisfaction of the patients (1–5) (82.3%) (11.8%) (5.9%)
NEEDLELESS® 0 1* 2*** 2.8 18 2 1 1
after surgery for urinary incontinence. All patients with (1–5) (85.8%) (9.5%) (4.7%)

mixed urinary incontinence should be warned before

surgery is conducted that irritative symptoms may not *Excluded associated POP surgery cases; **1 inguinal
relieve after the procedure or may become even more pain, 1 urinary infection; ***1 partial mesh erosion, 1
bothersome. urinary infection.

Disclosures Conclusion: The NEEDLELESS® technique is easy of use,

Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
safe and effective. It provides a new concept in the
treatment of SUI with a tension free sling. This preliminary
results make us think that it is a technique to add to the
actual techniques portfolio. Long term follow up and
further studies are awaited.

225
NEEDLELESS®: A NEW TECHNIQUE
FOR CORRECTION OF URINARY INCONTINENCE.
RANDOMIZED CONTROLLED TRIAL COMPARED
WITH TVT-O®. PRELIMINARY RESULTS
Amat, LL; Martínez Franco, E; Hernández Saavedra, A;
Vela Martínez, A
Sant Joan de Déu Hospital, University of Barcelona, Spain
Objective: To simplify the previous techniques and
minimize the complication rates related to the pass of the
needles, a new technique has been developed maintaining
the principle of a tension free sling, and introducing the
concept of ‘needleless’. The sling is positioned without
needles, under the mid urethra as a hammock (Needleless
Technique®). In this prospective and randomize trial we
compare obturator tension-free vaginal tape (TVT-O®) with
NEEDLELESS® for the surgical treatment of stress urinary
incontinence (SUI) in women.
Materials and methods: 38 women with SUI were random-
ize assigned to either TVT-O® (n=17) or Needleless® (n=
21). There was no significant difference between the 2
groups for clinical findings. Preoperative evaluation
included a QoL, ICI-Q and Sandvik questionnaires,
urogynecological examination and urodynamic evaluation.
Cure and improvement rate, operative time, hospital stay
and complications incidence were assessed.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
226
OBSTRUCTION FOLLOWING SLING PROCEDURES
IS MORE FREQUENT IN AUTOLOGOUS
THAN SYNTHETICS: URETHROLYSIS
EFFECTIVENESS IS SIMILAR
Riccetto, C1; Palma, P1; Fraga, R1; Dambros, M2;
Herrmann, V1; Oliveira, R1
1
University of Campinas, Brazil; 2UNIFESP, Brazil
Introduction and objective: Bladder outlet obstruction
(BOO) is a troublesome complication of anti-incontinence
surgery. Urethrolysis is successful in relieving 65–93% of
cases. The aim of this study was to determine the frequency
and success of urethrolysis after synthetic and autologous
pubovaginal sling.
Materials and methods: There were 436 patients that
underwent sling procedures for stress urinary incontinence.
Retrospective analysis of the charts of 20 women who
underwent urethrolysis for post-sling voiding dysfunction
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
between 1995 and 2003 was performed. Preoperatively, a
history was taken, pelvic examination and urodynamic were
done. Mean patient age was 48 years, and the median time
between the anti-incontinence procedure and the urethrol-
ysis was nine months (rage three months to eight years). All
patients suffered from refractory urgency/frequency syn-
drome with varying post void residual. The diagnosis of
BOO was assessed by history, physical examination and
urodynamic. Pre operatively, the urodynamic study dem-
onstrated a mean voiding flow rate of 9,9 ml/s and a mean
detrusor pressures at maximum flow of 48 cmH2O.
Previous surgery included autologous pubovaginal sling in
18 patients (18/210), Tension-free vaginal tape in one (1/
100) and trans vaginal Safyre (readjustable sling made of
polypropylene and silicone) in one case (1/126). Urethrol-
ysis was performed by transvaginal approach. Outcomes
measured were patient ability to void spontaneously,
decreased post-void residual urine and resolution of lower
urinary tract symptoms.
Results: The rate of BOO in patients that underwent
autologous sling was 8.5% (18/210), as compared to 0.9%
for synthetics (2/226). Mean length of follow-up after
urethrolysis was 14 months. Of the 20 patients 15 (75%)
had relief of symptoms after a single urethrolysis, while two
patients underwent a second transvaginal urethrolysis, with
placement of a Martius flap between the urethra and the
symphysis. Stress urinary incontinence recurred in 2
patients and persisted in the 1 in whom it had been present
before urethrolysis. There was no correlation between
preoperative parameters examined and the outcome from
urethrolysis.
Conclusion: Bladder outlet obstruction rate after pubova-
ginal sling procedure is higher following autologous than
synthetics. Urethrolysis can be highly successful for
relieving retention after synthetic as well as non-synthetic
pubovaginal slings.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
227
PELVIC FLOOR MUSCLE STRENGTH ASSESSMENT
USING DIFFERENT TOOLS DURING PREGNANCY
AND POST-PARTUM
Mascarenhas, T; Bernardes, J; Patricio, B
1 1
Faculty of Medicine, Hospital S Joao, Porto, Portugal
S129
Objectives: The aim of this study was to determine the
correlation among three different tools of pelvic floor
muscle strength assessment in women during first pregnan-
cy and post-partum.
Materials and methods: Primigravidae women attending
for antenatal care, were invited to participate on a
prospective study at 3rd trimester (T) of pregnancy and
6 months (mo) post-partum (pp). Pelvic floor muscle
strength was evaluated by vaginal EMG, vaginal squeeze
pressure (Kontinence Clinical 2000) and palpation of the
pelvic floor muscles (digital muscle testing-Oxford scale
0–5). The results were statistically analysed with SSPS
Software v. 13.0.
Results: The questionnaires were completed by 109 women
at 3rd T of pregnancy and 82 at 6 mo pp. In the evaluation of
the muscle strength at 3rd trimester (T) a moderate positive
correlation was observed among maximum pelvic floor
muscle contraction evaluated by palpation, vaginal pressure
and vaginal EMG (r=0.560, p<0.001; r=0.642, p<0.001
respectively).); at 6 mo pp a moderate to strong positive
correlation was observed among maximum pelvic floor
muscle contraction evaluated by palpation, vaginal pressure
and vaginal EMG (r=0.722, p<0.001; r=0.761, p<0.001
respectively).
At 3rd trimester (T) a moderate positive correlation was
observed between the duration of maximum pelvic floor
muscle contraction evaluated by palpation and vaginal
pressure (r=0.533, p<0.001);equally at 6 mo pp a moderate
positive correlation was observed between the duration of
maximum pelvic floor muscle contraction evaluated by
palpation and vaginal pressure (r=0.517, p<0.001);
Conclusions: This study shows that palpation exhibits a
moderate to strong correlation with other objective tech-
niques of evaluation of the pelvic floor muscle strength
during pregnancy and after childbirth, suggesting that
palpation may be a good option.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
228
PERIGEE™ TRANSOBTURATOR CYSTOCELE
REPAIR SYSTEM: FURTHER ON
Kannan, K; Balakrishnan, S; Corstiaans, A; Rane, A
James Cook University, Townsville, Australia
S130
Objective: The Perigee™ Transobturator Cystocele repair
system (AMS) was designed and first used in Townsville,
Australia. An initial prospective study to evaluate the
efficacy and safety of this device for the management of
large and recurrent cystoceles was presented in IUGA 2006.
This paper is a further on of the same study to evaluate the
effectiveness in the long term.
Materials: All patients who underwent surgery with the
Perigee™ system in Townsville, Australia from October
2004 until June 2006 were reviewed and followed up.
Methods: This prospective study involved a questionnaire
and POP-Q assessments both pre and post operatively. The
patients were followed up at 6 weeks, 3 months, 6 months,
12 months and then twice yearly to evaluate the success
rate and also the long term complication rate.
Results: A total of 102 patients underwent surgery with
the Perigee™ system. There were no immediate compli-
cations with the Perigee™ system procedure, confirmed
with a check urethro-cystoscopy and per rectal examina-
tion. Ninety four (92.2%%) of the patients went home the
same day. The rest of them went home later due to
medical problems not related to the Perigee™ system. On
the first review visit 93% of patients were well. Seven
patients had urgency of which 4 patients had a sub
urethral sling put in. Eight patients (7.8%) had mesh
erosion, all treated with oestrogen cream with or without
trimming. On the second visit it was noted that there were
two (2.87%) patients who had recurrence of a small stage
1 cystocele.
Discussion/conclusion: The Perigee™ system is an excel-
lent procedure for the treatment of large and recurrent
cystoceles. There were no immediate complications and
minimal long term complaints. The erosion rate of the mesh
was about 7.8% and this was successfully treated with
trimming and local oestrogen. A longer follow-up of this
procedure is still underway.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
229
POLYPROPYLENE MESH STRUCTURE MISCONCEPTS:
IN VIVO STEREOLOGICAL STUDY
Riccetto, C1; Palma, P1; Fraga, R1; Myaoka, R1;
Dambros, M2; Herrmann, V1
1
University of Campinas, Brazil; 2UNIFESP, Brazil
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: This experimental study aims to compare the
local tissue reaction and volumetric density of collagen
fibers elicited by two monofilament and two multifilament
polypropylene meshes, implanted in the subcutaneous
tissue of female rats.
Methods: Thirty eight-week-old female Wistar rats under-
went implantation in the subcutaneous abdominal area, of
four 8×4 mm monofilament polypropylene meshes coming
from TVT and Sparc, and multifilament from Plus and
IVS. The M-42 stereological grid system was used to
analyze the collagen fibers, stained by Picro-sirius. Differ-
ences of histological findings of the groups were obtained
using the Kruskal-Wallis test; and the Friedman test was
used for comparisons among meshes in the same animal.
Results: The acute inflammatory response as well as granu-
lomatous reaction were more intense in multifilament meshes
(p<0,001). The stereological analysis showed significant dif-
ferences between mono and multifilament meshes, for the
first induced a greater collagen density deposition (p<0.001).
Surprisingly macrophages were found between the strands
of multifilament meshes as well.
Conclusion: Multifilament meshes elicited a greater and
more persistent inflammatory and granulomatous reaction.
Collagen fiber density was greater in monofilament meshes.
Macrophages due to their plasticity have the ability to
penetrate multifilament meshes.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
230
POSTERIOR INFRACOCCYGEAL SACROPEXY
PROCEDURE FOR VAGINAL VAULT PROLAPSE:
ANATOMICAL AND FUNCTIONAL RESULTS
ON A SERIES OF 86 PATIENTS
Deffieux, X; Faivre, E; Gervaise, A; Frydman, R; Fernandez, H
University of Paris-Sud, Clamart, France
Objective: To evaluate the results of infracoccygeal
sacropexy procedure for cure of vaginal vault prolapse.
Materials and methods: A descriptive retrospective study
concerning a continuous series of 86 women, mean age
63 years (±11), who have undergone infracoccygeal
sacropexy procedure for the treatment of vaginal vault
prolapse. Surgical approach was as follows : after opening
the ischiorectal fossa into a transversely incised posterior
vaginal fornix, a sling is inserted by trans-gluteal approach :
IVS© (n=53) or I-STOP© (n33). Bilateral gluteal skin
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
incisions were made 3 cm lateral and below the external
anal sphincter. The IVS© or I-STOP© tunneller was placed
into the ischiorectal fossa, and then turned inwards for
passage through the rectovaginal fascia, so as to reach the
transverse vaginal incision. The procedure is repeated on
the contralateral side. The tape is secured to the vaginal
vault and also to the remnants of the uterosacral ligaments.
Mean follow-up was 15 months (±10). All subjects were
asked to complete the PFDI and PFIQ questionnaires.
Results: There was no rectal perforation. One per-operative
ischiorectal fossa hemorrhage was observed and a post-
operative gluteal hematoma occurred, but this did not
required re-intervention. No perineal abscess or cellulitis has
been observed. Postoperative perineal pain was reported by 4
(4%) women. Two of them required sling removal: one case
of pudendal nerve damage and one case of mesh shrinkage.
Vaginal extrusion of the sling occurred in 5 women, but this
complication was observed only with IVS© sling (vaginal
extrusion rate with IVS© sling : 9%). None vaginal extrusion
has been observed with I-STOP© sling. Recurrent vaginal
vault prolapse, ICS grade 3 or 4, developed in 2 patients (2%)
but this recurrence did not required re-intervention. Only five
patients were unsatisfied at last follow-up, with no or few
improvement of symptoms and quality of life.
Conclusion: The current study shows good functional
results and low rate of vaginal vault prolapse recurrence
following this ‘mini-invasive’ procedure. However, patients
and surgeons must be aware of the risk of complications
such as perineal or gluteal pain. New polypropylene
meshes, such as I-STOP© device, seem to sharply diminish
the risk of vaginal extrusion of the sling.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
231
PROSPECTIVE MULTICENTRE ANALYSIS
OF THE AVAULTA® TRANSOBTURATOR VAGINAL
MESH SYSTEM: PRELIMINARY SAFETY RESULTS
Vaart, CH van der1; Vollebregt, A2
1
University Medical Center, Utrecht, The Netherlands;
2
Spaarne Ziekenhuis, Haarlem, The Netherlands
Objective: To analyze the perioperative safety and compli-
cations of the collagen coated polypropylene Avaulta®
transobturator prolapse repair system.
Materials and methods: From December 2005 a multi-
center prospective observational study of women operated
S131
with the Avaulta® (Bard, USA) mesh was started. All
women had a pelvic organ prolapse POP-Q stage 2–4.
Fifty-one percent of women had the Avaulta® repair as
primary surgical procedure. Data on peri- and postoperative
complications were collected.
Results: One hundred and nineteen women had surgery
and were available for follow-up. Seventy-three women
had an anterior mesh repair, 32 a posterior mesh repair
and 7 women had a combined procedure. Median age
was 63 (range 31–85). In 54% of women spinal analgesia
was used. Median operating time was 34 minutes (range
20–90), median blood loss was 40 cc (4–550 cc). In 5
women (4.2%) a peri-operative complication occurred.
One woman had a temporary cardiac arrhythmia after
vaginal hydro-dissection with a 1:200.000 adrenaline
solution. Four women (3%) had a bladder lesion, three
of them where recognized during surgery and resolved
by closing the defect vaginally and leaving an indwelling
bladder catheter for 7 days. After the occurrence of a
perforation no mesh was placed. In one woman the
bladder lesion was recognized 2 days after surgery. She
had a local cellulitis of the right inner thigh due to urine
leakage. An uneventful re-operation with removal of the
mesh was performed. Postoperatively 5 women devel-
oped a short period of hyperthermia. Two of these
women had a lower urinary tract infection and they
recovered quickly after antibiotics. Postoperative urinary
retention was seen in 17 (14%) of women. With the use
of clean intermittent self-catheterization all resolved
within 14 days. One woman developed a vaginal
haematoma of 2 cm that resolved spontaneously. At a
median follow up of 6 months (range 1–13 months) 1
case (0.8%) of mesh erosion was seen. This erosion
occurred in the woman who had the haematoma. It is
likely to have occurred due to the delayed wound heal-
ing. The vaginal epithelium was sutured over the erosion
in day surgery setting, after which complete healing
occurred.
Conclusion: Our preliminary results show that the
Avaulta® anterior and posterior mesh is safe to use and
has a low risk of mesh erosion.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? Yes, by Bard company.
Level of support? No industry support in study design or
execution.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
S132
232
REMIFENTANIL: ASSISTED LOCAL ANESTHETIC
(ALA) OF CHOICE IN UROGYNECOLOGY?
Haylen, BT1; Katz, S2; Chetty, N1
1
St Vincent’s Clinic, Sydney, Australia; 2Royal Hospital for
Women, Sydney, Australia
Objective: Conventional assisted local anesthesia (ALA)
for suburethral tape procedures for urodynamic stress
incontinence requires the combined use of (i) a general
anaesthetic agent such as propofol; (which can impair
patient cooperation if cough-testing is required); (ii) a short
to medium acting opioid (e.g. pethidine or fentanyl); (iii)
a sedative/ amnesic (e.g. midazolam); (iv) local anaes-
thetic (e.g. lignocaine). An infusion of remifentanil (an
ultra-short acting opioid) is assessed for its ability to
reduce the use of (i) propofol (ii) other medications and
(iii) reduce postoperative pain.
Materials and methods: A retrospective review was
performed of the charts of 31 women (mean age
58.4 yrs), all of whom underwent a tension free vaginal
tape (TVT) under ALA using a remifentanil infusion by
one of four anaesthetists. Each was assessed for use of other
medications, postoperative pain and efficacy of cough
testing.
Results: Intraoperatively, only 12 (39%) required propofol,
with average dose 69.2 mg (range 30–140 mg); 30 (97%)
were given midazolam with average dose 3.6 mg (range
1–10 mg); 3 (10%) required additional opioid (1×5 mg
morphine, 2×37.5 mcg fentanyl).
Postoperative pain scores were nil (20: 65%); minimal
(5: 16%); moderate (6: 19%). Ten (32%) had analgesia in
recovery. Two (20%) of these had propofol intraoperatively
whilst 10 of the 21 (48%) who did not require analgesia
had propofol. Cough testing was effective in all patients.
Local anaesthetic injection was comfortable in all patients.
Dose-related respiratory depression and, less commonly,
bradycardia are possible. The addition of a paracervical
block to the remifentanyl/midazolam allowed concomitant
hysteroscopic surgery.
Conclusion: A remifentanil infusion (mostly in associa-
tion with midazolam) proved an effective ALA technique
for TVTs in terms of analgesia and patient co-operation
for cough-testing. A majority will require no additional
intraoperative medication; the rest may require small
doses of propofol or opioid. We recommend the
technique for the consideration of gynecologists and their
anesthetists.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
233
SACRAL NEUROMODULATION THERAPY SURGICAL
SITE INFECTION: TWO CASE REPORTS
Shahryarinejad, AS; Vardy, MD; Olivera, CK; Ginath, S;
Brodman, M
1
Mount Sinai Hospital, New York, USA
Objective: To report the identification and investigation
process of two surgical site infections at the time of sacral
neuromodulator placement for the treatment of refractory
urge urinary incontinence.
Materials and methods: Chart review and investigation
of two patients with sacral neuromodulator therapy who
developed similar sacral cellulites postoperatively. Pre-
sentation of the surveillance methods of Infectious
Control Committee in conjunction with the Department
of Microbiology.
Results: Patient #1 is an 85 year-old WF who failed two
years of conservative treatment for urge incontinence.
Sacral neuromodulator therapy completed in December
2004 provided her with complete continence for two years.
Decreased efficacy led to lead removal and replacement in
the operating room under sterile conditions on 7/10/06. She
presented on 7/24/06 with a grossly infected sacral area
requiring surgical debridement and two weeks of IV
antibiotics. Patient #2 is an 81 yo WF who failed six
months of conservative treatment for urge incontinence.
She was successfully treated with sacral neuromodulator
therapy for two years until sudden failure occurred in June
2006. On 7/10/2006 a battery replacement and lead testing
was done under sterile conditions in the operating room. On
8/1/2006 patient presented for follow-up with sacral
cellulites requiring surgical debridement and two weeks of
IV antibiotics. Both patients’ blood cultures and wound
cultures were positive for a penicillin resistant coagulase
positive staphylococcus species. Investigation of six in-
volved staff in both cases revealed two positive for
coagulase positive staphylococcus. Only one swab had the
same anti-biogram susceptibility pattern as the patients’
isolates. Matching susceptibility patterns done at the Mayo
Clinic Laboratory showed Patient #1 and Patient #2 were
infected with different strains of the same organism.
However Patient #1 and the company representative had
the same strain.
Conclusion: Sacral neuromodulation therapy consists of a
first or percutaneously placed testing stage and a second or
permanent implantation stage. Both stages are done in the
operating room under sterile conditions. However, lead
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
setting and reprogramming is done as an outpatient by
company representatives. Retrospective reviews of individ-
ual institutions report an infection rate of 2–10%. Most
institutions manage infections with explantation however
no reports of source identification are made. The investi-
gation of the specific DNA strain which infected our
patients led to the representative who manipulated the settings
in the recovery room and as an outpatient. This surveillance
reveals that reprogramming and handling of all wires should
be done under standard universal infection control standards
including hand washing, gloves and perhaps even masks.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
234
THE EFFECT OF AMITRIPTYLINE
IN FEMALE OVERACTIVE BLADDER
PATIENTS WITH NOCTURIA
Jeong, HJ1; Park, SC1; Han, DY1; Oh, SJ1; Roh, JH2;
Baek, SH1; Kim, SO3; Lee, JH1; Ryu, SH1
1
Wonkwang University Hospital, Iksan, Korea; 2Kwang Ju
Christian Hospital, Gwangju, Korea; 3Chonnam National
University Hospital, Gwangju, Korea
Objective: The aim of this study is made to know the effect
of amitriptyline, as the first-line treatments in overactive
bladder patients with nocturia.
Materials and methods: Between June 2005 and June
2006, a prospective randomized study was conducted on 45
female patients with overactive bladder without nocturnal
polyuria. Mean age was 57.6 years and the patients were
treated with doxazocin (Group I), doxazocin with tolter-
odine (Group II), doxazocin with amitriptyline (Group III).
All 45 (Group I: 15, Group II: 15, Group III: 15) patients
were followed up for 4 weeks. The treatment efficacy was
measured by 3 days of voiding diaries.
Results: Actual number diurnal voids were more improve-
ments after treatment, 8.67±2.29 vs 7.93±2.02 (I), 8.73±
3.06 vs 7.47±2.61 (II), 8.33±2.74 vs 6.86±1.99 (III)
(respectively, p<0.05). But there was no difference in
treatment results between Group II and Group III (p>
0.05). Actual number nightly voids were more improve-
ments after treatment, 2.80±1.47 vs 1.47±1.50 (II), 2.47±
1.41 vs 1.27±1.53 (III) (respectively, p<0.05), but no
change in Group I (3.00±1.25 vs 3.47±1.50). There was
no difference in Group II and Group III (p>0.05). There was
no difference in total voiding volume, functional bladder
S133
capacity, nocturia index, nocturnal bladder capacity index
between pre-treatment and post-treatment on each groups (p
>0.05). Although 2 cases of Mild dry mouth were seen in
Group II, 1 case mild dry mouth, 1 case mild drowsiness in
Group III, any enrolled patients was not dropped out.
Conclusion: There are some enhanced effects with actual
number diurnal voids and actual number nightly voids in
patients treated with doxazocin with amitriptyline (Group
III). Therefore, amitripyline would be helpful as a first-line
treatment in female overactive bladder patients with
nocturia.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
235
THE EFFICACY OF MIDURETHRAL SLING
PROCEDURE IN FEMALE STRESS URINARY
INCONTINENCE WITH OVERACTIVE BLADDER
Seo, JT1; Kim, JH2; Kim, YH3; Kim, HJ4; Lee, SJ5; Lee, JZ6
1
Department of Urology, Cheil General Hospital,
Sungkyunkwan University, Seoul, Korea; 2Department of
Urology, Yonsei University College of Medicine, Seoul,
Korea; 3Department of Urology, Soon Chun Hyang
University, Buchun, Korea; 4Department of Urology,
Dankook University College of Medicine, Cheonan, Korea;
5
Department of Urology, Kyung Hee University Medical
Center, Seoul, Korea; 6Department of Urology, Pusan
National University College of Medicine, Korea
Objective: To investigate the efficacy of synthetic mid-
urethral sling in stress urinary incontinence patients with
overactive bladder (OAB).
Methods: From May 2002 to March 2004, a total of 152
women with stress urinary incontinence (SUI) were
assigned to midurethral sling procedure. Out of those 152
the patients with a follow-up of at least 12 months were
only intended to be included in this study. Finally 118
patients out of 152 were screened in. They were divided
into three groups, pure SUI (group 1, n=44), SUI with
OAB dry (group 2, n=29) and SUI with OAB wet (group 3,
n=45). Preoperative history check-up, symptoms question-
naires and 3-day micturition diaries were performed to
evaluate urgency and urge urinary incontinence (UUI).
Pelvic examination and urodynamic investigations were
also done preoperatively. Questionnaires by phone were
used to evaluate the postoperative improvement of urinary
incontinence and urgency.
S134
Results: The mean follow-up period was 16.4 months in
pure SUI group (group 1, n=44), 16.5 months in SUI with
OAB dry group (group 2, n=29) and 22.7 months in SUI
with OAB wet group (group 3, n=45). There was no
significant differences in the 3 groups in terms of the cure
rate for stress component (group 1, 88.6% vs group 2, 86.2%
vs group 3, 86.7%, p=0.943). 92.0% (23/25) of Group 1
have improved in frequency and 7 patients (15.9%)
complained about de novo urgency. In Group 2, 81.5% (22/
27) and 89.7% (26/29) have improved in frequency and
urgency respectively, and 4 patients (13.8%) complained
about de novo urge incontinence. In Group 3, 76.9% (30/39)
and 82.9% (34/41) have improved in frequency and urgency
respectively, and the cure rate of UUI was 84.4% (38/45).
There were no statistical differences in the 3 groups in mean
age, previous pelvic surgery history, symptom duration,
operating time, catheter indwelling time, blood loss and
postoperative uroflowmetry. Neither group experienced the
perforation of bladder and major complications.
Conclusion: Upon carrying out midurethral sling proce-
dure, this investigation witnessed the improvement of
frequency and urgency, and cure of UUI in the SUI patients
with OAB as well as in pure SUI patients. A midurethral
sling procedure is simple, safe and highly effective to treat
SUI with OAB. However, it is suggested that SUI patients
with OAB should be offered preoperative counseling about
the possibility of persistent urgency and urge incontinence.
Further studies are needed to establish the long-term
efficacy.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
236
THE QUANTITY OF URINE LEAKAGE: IS THERE
A CONNECTION WITH QUALITY OF LIFE, BODY MASS
INDEX, AGE, PARITY AND RESULTS OF TREATMENT?
Guldberg, R; Sörensen, T
Kolding Hospital, Denmark
Objective: The aims of the study were to investigate if the
quantity of urine leakage had an influence on the Quality of
Life and the subjective result of a relevant treatment and
also to investigate the influence of Body Mass Index
(BMI), age and parity on the quantity of urine leakage in
women with urinary incontinence.
Materials and methods: At study entrance the women
completed a questionnaire in which they reported age,
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
height, weight and parity. They were also asked to quantify
their discomfort on a Visual Analogue Scale (VAS) as well
as to which degree their urinary incontinence affected their
lives (Incontinence Impact Questionnaire (IIQ-7)). The
BMI was calculated and the urine leakage was measured
by a 24-hour Pad Test (PT). They were seen at the
outpatient department after relevant treatment where they
again were asked to quantify their discomfort on VAS and
to complete IIQ-7. They were also asked if their symptoms
of incontinence were cured, considerably improved or
unchanged. Thus all the patients acted as their own control
group.
Results: A total of 505 patients completed the question-
naires and performed a PT. But only 458 patients were
seen at the outpatient department after relevant treatment.
A total of 245 patients quantified their discomfort on VAS
and IIQ-7 before and after the treatment. Our study
showed no association between Quality of Life and the
quantity of urine leakage. The patients with unchanged
symptoms after the treatment had a larger average leakage
than the patients who reported to be cured or had
considerable improvement of symptoms but the difference
was not significant. In the women with higher BMI and
higher age there was a tendency towards a larger urine
leakage. However, the differences were not significant.
The parity had no influence on the quantity of urine
leakage.
Conclusion: The study showed no significant connection
between the quantity of urine leakage and Quality of Life,
BMI, age, parity and results of treatment.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
237
THE RELATIONSHIP BETWEEN OXFORD GRADING
OF MUSCLE STRENGTH AND LEVATOR DEFECTS
Dietz, HP
University of Sydney, Australia
Objective: Levator avulsion injury seems to be a common
consequence of vaginal childbirth. While this form of
trauma is associated with anterior and central compartment
prolapse, it is not clear as to how much such injuries
affect pelvic floor function. One of the most basic forms
of functional assessment of the levator ani is palpation and
the grading of contraction strength and endurance accord-
ing to the Oxford grading system. We therefore conducted
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
a retrospective study to investigate the relationship between
levator trauma and Oxford Grading on vaginal palpation.
Methods: Over a period of 2 years 1111 women had been
seen for pelvic floor assessment in a tertiary urogynaeco-
logical unit. They were assessed by interview, an examina-
tion using the ICS POP-Q staging system, and assessment
of the levator ani muscle by 3D/ 4D translabial ultrasound
(n=660) and/ or digital assessment.
Results: Mean age was 55 (range 17–90) years, median
vaginal parity was 2 (range 0–12). 843 Patients (76%)
complained of stress incontinence, 829 of urge inconti-
nence (75%), and 354 of prolapse (32%). 23 women
could not be assessed digitally due to vaginal stenosis,
scarring or refusal, leaving 1088 datasets for analysis.
Levator defects were found in 252 women (23%), with
223 on the right, 103 on the left, and 74 bilateral defects.
The difference between right and left is highly significant
(P<0.001). On levator palpation the median for right and
left Oxford grades were equal at 3; interquartile ranges
were also equal at 2–3.5. The presence of defects was
associated with a highly significant reduction in global
Oxford Grading (mean 2.07 vs. mean 2.81, P<0.001). The
side affected by a palpable avulsion injury showed a
significantly lower Oxford grading (1.9 vs. 2.77, P<
0.001). The prevalence of avulsion injury increased
markedly depending on side differences in Oxford
grading: from 16% when there was no difference, to
25% at 0.5 difference, to 52% when there was a side
difference of one degree, and to 76% when the side
difference was 1.5 or higher (P<0.001 on ANOVA).
Conclusion: Avulsion injury of the levator ani as diagnosed
on translabial 3D/4D ultrasound and/ or palpation is
associated with a highly significant reduction in Oxford
grading. A side difference of Oxford 1 or more on vaginal
palpation is strongly associated with levator injury. This
implies that such a finding on palpation may help in
identifying such trauma and should alert the examiner to the
possibility of levator avulsion.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
238
THE URETHRAL ELASTANCE AND OPENING
PRESSURE IN HEALTHY AND STRESS
INCONTINENT WOMEN
Klarskov, N; Lose, G
Glostrup Hospital, Denmark
S135
Objective: Conventional urethral pressure measurements
are insufficient to characterize the sphincter function of the
urethra. Urethral elastance (reciprocal of compliance)
expresses the ability of the urethra to resist dilation in the
resting state. In this study the urethral elastance was
measured with Urethral Pressure Reflectometry (UPR).
UPR is a method for simultaneous measurements of
pressure and cross-sectional area (CA) in the female
urethra. Only a very thin polyurethane bag is introduced
into the urethra, the CA of the entire length of the urethra is
measured 10 times/second with sound waves (reflectome-
try). A pump expands the bag by increasing the pressure in
the bag in steps of 5 cmH2O. The reproducibility of UPR
has been shown to be better than the conventional perfusion
technique. The aim was to compare the elastance and the
opening pressure between groups of healthy women and
women suffering from urodynamic stress incontinence
(USI).
Materials and methods: 23 healthy female volunteers
(never experienced incontinence) and 23 women with USI
were measured in the supine position with UPR. The
women had no previous incontinence or cystocele surgery.
The healthy females were found by advertising while the
patients were referred to the department. The study was
approved by the local ethics committee and all the women
signed an informed consent.
Results: The opening pressure was 76.9 (SD=12.5) and
42.1 (12.1) cmH2O (P<0.000001) in the healthy and USI
women respectively while the elastance (slope of the curve)
was 2.2 (0.5) and 1.5 (0.3) cmH2O/mm2 (P<0.000001)
respectively.
Conclusions: Continence implies that the lumen of the
urethra is difficult to open which means that both the
opening pressure and the elastance are ‘high’. Both
parameters were significantly decreased in the USI patients.
A subgroup of USI patients with intrinsic sphincter
deficiency (ISD) because of urethral fibrosis is known to
have a very low opening pressure combined with an
increased elastance but these patients were excluded from
S136
this study by excluding women with previous incontinence
surgery. We expect UPR to be a method for differentiate
urethral fibrosis from other types of ISD as the method is
capable of measuring the opening pressure and the
elastance.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Oticon.
Level of support? No industry support in study design or
execution.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
239
TVT SECUR™ : MORE AND MORE MINIMAL
INVASIVE-PRELIMINARY PROSPECTIVE STUDY
ON 40 CASES
Debodinance, P1; Lagrange, E2; Amblard, J2; Jacquetin, B2
1
CH Dunkerque, France; 2CHU Clermont-Ferrand, France
Objective: To evaluate the efficacy and safety of this new
procedure which seems to be less invasive than the
retropubic and the obturator approaches.
Materials and methods: Prospective, observational study
of our first 40 patients operated for stress urinary
incontinence with the TVT Secur™, a polypropylene sling
similar to that of the TVT but shorter, that remains perineal,
avoiding dangerous spaces, necessitating less dissection and
less anaesthesia. Patients were operated between 24/8/06 and
5/12/06 in 2 centers, and were all controlled at 2 months.
Mean age was 59 years with an average BMI of 26.8 and a
rate of menopause rate of 69%. Twenty six patients had pure
stress incontinence with 9 of them presenting a sphincteric
insufficiency (IS). Fourteen had a mixed urinary inconti-
nence (MUI) with 6 of them having SI. Preoperatively, 15
patients complained of urgency and 3 had dysuria. No
associated surgical procedure was performed with the TVT
Secur™ and the ‘hammock’ type have chosen by the authors.
Three patients had previous failed surgery for incontinence
(1 Stamey, 1 Burch and 1 Marshall Marchetti Krantz), 3 had
previous cure of pelvic organ prolapse (2 sacrocolpopexies
and 1 anterior colporrhaphy) and 7 had already been
hysterectomised. Anaesthesia was local in 29 patients
(72.5%) (center 1=100% and center 2=35%), epidural in
10 and general in 1. Postoperative pain was evaluated using a
visual analogical scale (VAS) quoted from 1 to 10.
Results: Mean operative time (incision-closure) was
5 minutes [3–15]. No per operative bladder catheterization
was used. Ten patients needed bladder catheterization for
24 h postoperatively. The mean length of stay in hospital
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
was 18.5 h [6–96 h]. There were two intraoperative
complications: an haemorrhage of 150 ml and the device
could not be placed successfully in a patient necessitating
the use of a TVT-O.
In the immediate postoperative phase, 5 patients had post-
mictional residues in between 100 and 200 ml. At the
2 month control, we noted 1 tape exposure and 2 lateral
vaginal cords. None of the 16 sexually active patients
complained of dyspareunia. For 29 patients having had
local anaesthesia, the mean peroperative VAS score for pain
was 2,4 and 0,9 immediately after completion of the
procedure. Postoperatively and considering all the patients,
VAS scores were 0,3 and 0,08 at 6 hours and 12 hours
respectively. At 2 month, 7 patients reported painful
postoperative course lasting from 4 up to 30 days (mean=
16): one in the vaginal, one on the route of the tape, one in
right iliac fossa and 3 without precise locations. Results are
summarized in the Table 1.
Table 1.
Cured Improved Failed
Pure SUI without SI n=17 14(82.4%) 2(11.8%) 1(5.8%)
Pure SUI with SI n=9 7(77.8%) 2(22.2%)
Mixed UI n=14 9(64.3%) 2(14.3%) 3(21.4%)
Total n=40 30(76.9%) 6(15.4%) 4(7.7%)
In the most severe group of 6 patients (Mixed UI+SI), 1
was cured, 2 improved and 3 failed. Among the 15 patients
with urgencies at baseline, 10 (67%) were cured. De novo
urgencies appeared in 16% of the patients with de novo
urge incontinence in 1 (4%). De novo dysuria (max flow<
15 ml/s) was found in 5.4% of the patients. The overall rate
of satisfaction was 8.2/10 [2–10]. All patients recommend
local anaesthesia.
Conclusion: TVT Secur™ is a tension-free mini invasive
sling to be placed under the mid-urethra with no skin
incisions. It can be performed under local anaesthesia in
either the ‘hammock’ or ‘U’ position. The procedure was
found to be simple, fast and reproducible with minimum
vaginal dissection in almost all cases. Postoperative pain
was minimal in particular at the level of the thigh.
Nevertheless, the procedure necessitates to be very cautious
for adjusting the tension of the tape and for disconnecting
the inserter from the tape.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244 S137

240 Level of support: industry funding only investigator

EVALUATION OF SEXUAL FUNCTION IN WOMEN
WITH STRESS URINARY INCONTINENCE USING
THE ABBREVIATED SEXUAL FUNCTION
Franco, AVM; Wang, K; Jeffery, S; Fynes, MM
St George’s Hospital, London, UK
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.

Objective: To evaluate sexual function using the Abbrevi- 241

ated Sexual Function Questionnaire (ASFQ) in women with INTRAOPERATORY STRESS TEST
stress urinary incontinence (SUI) pre- and post-placement IN TRANSOBTURATOR TAPE (TOT)
of a trans-obturator tape (TOT). PROCEDURES: IS IT WORTH IT?
Methods: 81 women with SUI were recruited. The trans- Rondini, C; Descouvieres, C; Wenzel, C; Morales, A;
obturator tape procedure was performed as per protocol. Alvarez, J; Troncoso, F; Aros, S; Troncoso, C
The ASFQ was administered pre-operatively, and at 6 Hospital Padre Hurtado, Universidad del Desarrollo, San-
weeks, 6,12, and 24 months post-operatively. tiago, Chile
Results: Mean age is 55 (R36–85). 56 (69%) were sexually
active, 7 (12%) reported coital incontinence pre-operatively. Objective: To determine if an intraoperative stress urinary
Post-operatively, none reported coital incontinence. The incontinence test (IOST) affects TOT outcome.
ASFQ scores indicate a high probability of sexual dysfunc- Materials and methods: We ran a prospective study on
tion (SD) observed in all 4 domains. The higher rate of SD 430 patients who underwent a TOT for stress urinary
observed during the 6 week follow up is attributed to the incontinence (SUI). Every patient who underwent a TOT
fact that the questionnaire encompasses only activity that during the following evaluation period: 295 patients had a
has occurred within 4 weeks. SD seemingly worsens at IOST routinely done as part of our surgical protocol.
24 months post-operatively however this may be due to the Afterwards from the period: due to a change in our policies
small number of respondents. we decided to remove the IOST from our surgical protocol.
During this period 133 patients underwent a TOT. Conti-
nence status, urinary retention rate and post void volume
Parameter Pre-op 6 weeks 6 months 12 months 24 months
were prospectively assessed at 6 months.
n=87 n=83 n=60 n=49 n=24
Results: 430 patients underwent a TOT. 428 (99.5%) were
SUI 87 9 (11%) 7(12%) 7(14%) 7(29%)
symptoms evaluated (2 were lost during follow up). 295 patients
ASFQ 72(83%) 72 (87%) 59(98%) 44(90%) 24(10%) (group 1) had a IOST and 133 (group 2) did not. 48 patients
Respose rate (11.2%) in group 1 and 4 patients (0.9%) in group 2 had
Scored 44 51 48 27 17 urinary retention (p<0.05) at 6 months. Of the 52 patients
Domain: No. of women with high probability of sexual with urinary retention 47 of them were transient, the other 5
dysfunction patients required a urethrolysis. All 5 of them belong to
Desire 31(70%) 42(82%) 33(69%) 19(70%) 13(76%)
Group 1. No differences were detected between both
Arousal- 34(77%) 43(84%) 32(67%) 20(74%) 13(76%)
Sensation
groups regarding urinary continence (93.8% vs. 88%, p=
Arousal- 28(64%) 50(98%) 35(84%) 21(78%) 14(82%) 0.148) at 6 months. Post voiding volume in group 1 was
lubrication 99.5 cc and in group 2 was 78.1 cc (p<0.05).
Orgasm 21(48%) 37(73%) 24(73%) 16(59%) 11(65%) Conclusion: Routine intraoperative stress test is statistical-
ly associated with a higher rate of postoperative urinary
retention and higher post-voidal volumes. Continence status
Conclusion: There is a need to further investigate and did not differ between each group. We do not recommend
address the seemingly high rate of sexual dysfunction in IOST for routine use in TOT procedures.
women with SUI. Long-term follow-up of post-TOT
patients is necessary to better judge if the procedure affects Disclosures
sexual function. Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Disclosures Does the presenter or any of the authors act as a consultant,
Was consent obtained from patients? Yes. employee (part time or full time) or shareholder of an
Was this work supported by industry? Yes, by Mentor-Porges. industry? No.
S138
243
MICROSLING: TOWARDS THE IN-OFFICE
PROCEDURE
Palma, P; Fraga, R; Riccetto, C; Herrmann, V; Oliveira, R
University of Campinas, Brazil
Objective: Minimally invasive procedures for the manage-
ment of Stress urinary Incontinence (SUI), has replaced
open procedures in many countries. Despite reducing
trauma, the blind nature of these procedures may lead to
severe complications. We present our preliminary results
with a special micro sling that may be performed by
percutaneous approach under local anesthesia as an
outpatient procedure.
Methods: A total of 15 patients with urodynamic con-
firmed SUI, with no prior anti-incontinence procedure were
enrolled in this study.
A self-anchoring polypropylene thread, 12 cm in length is
used to provide the backboard support to the midurethra.
The procedure is carried out under local anesthesia, using
5 ml of 2% Lidocaine solution, injected at the midurethra
towards the vaginal fornix, advancing 2 cm in the internus
muscles bilaterally. Either a 4 mm incision or a 14G special
needle insertion guided by the index finger may be used.
The micro sling is inserted through the needle that is
removed while an anatomical forceps keeps it in place. The
same maneuvers are repeated on the other side using a mini
trocar with a lateral opening. To avoid undue tension a
Foley catheter is left in place and the sling is brought in
contact with the urethra with no tension. The vaginal wall is
closed with a single stitch and the patient is discharged after
spontaneous voiding.
Results: Follow-up ranged from 3 to 14 months, mean
6 month. There were 13 (86%) patients dry, 1 (6%)
improved and 1 (6%) failure. There were no vascular or
visceral complications, nor bleeding or pain.
Conclusion: The preliminary results with this micro sling
are encouraging and shift the procedure from the incision to
the puncture. Longer follow-up and lager series will define
the role of micro sling in the management of SUI.
Figure 1. A self-anchoring polypropylene (Nano Sling)
inserted in vaginal incision and the features of the device.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
244
NOVEL 3-D TRANSVAGINAL ULTRASOUND
IN THE EVALUATION OF MORPHOLOGICAL
DIFFERENCES OF THE FEMALE URETHRAL
COMPLEX BETWEEN NULLIPAROUS
AND MULTIPAROUS PATIENTS
Wieczorek, AP; Wozniak, MM; Bogusiewicz, M;
Stankiewicz, A; Rechberger, T; Futyma, K
Medical University of Lublin, Poland
Objective: Urinary continence relies on the finely coordi-
nated activities of the muscles of the urethra (the most
important is the rhabdosphincter (RS)), bladder, skeletal
muscles, voluntary inhibition, and the autonomic nervous
system. Traditional imaging techniques such as transvaginal
(TV) and transperineal (TP) ultrasound (US) are insufficient
in the precise assessment of the urethral complex. Novel 3-
D US techniques encourage attempting the precise evalu-
ation of the urethral complex morphology. The aim of the
study was to assess the differences in 3-D morphology of
the urethral complex and RS muscle between nulliparous
(NP) and multiparous (MP) patients.
Materials and methods: Seventy three women underwent
novel 3-D TV US examinations. Twenty eight of the patients
were nulliparous (median age: 25.24±10.75; range: 20.00–
61.34) and 45 were multiparous (median age: 54.87±10.66;
range: 28.93–76.47). The exams were performed with B-K
Medical (Denmark) equipment: a 12–16 MHz, rotational
360° probe with a built-in 3-D mover and a 9 MHz linear
probe with ‘free-hand’ 3-D acquisition. 3-D US evaluation
included the assessment, measurements and subsequent
comparison of the morphology of the whole urethral
complex, RS itself, distance between bladder neck and lower
margin of pubic bones (BSD) and the assessment of the
shape, echogenicity and demarcation of the RS.
Results: There was no statistical difference in the volume
of the urethral complex between NP and MP women
(median volume in NP group 3,89 ml±0,81 ml, MP group
3,19 ml±1,18 ml). However, significant differences (p<
0,001) were observed among RS volume between the two
groups of patients (median volume of the RS in NP:
0,48 ml±0,10 ml; in MP: 0,33 ml±0,15 ml). BSD was
smaller in MP patients, however the difference was not
statistical (median BSD in NP: 31 mm±4.64 mm; in MP:
23 mm±6.81 mm). Differences in the shape, echogenicity
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
and the demarcation of the RS between the two groups
were also observed.
Conclusions: The novel 3-D US techniques applied in the
study appeared to be very efficient in the precise imaging of
the female urethral complex anatomy. Unlike other imaging
modalities used nowadays they appeared to be cheap, fast,
easily accessible, repeatable and reliable methods allowing
detailed evaluation of the morphology and the functionality
of the female urethral complex.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
245
PATIENT-REPORTED REASONS FOR DISCONTINUING
OVERACTIVE BLADDER MEDICATION
Benner, JS1; Jumadilova, Z2; Bavendam, T2; Alvir, J2;
Hussein, M1; Becker, R1; Brubaker, L3
1
ValueMedics Research, LLC, Falls Church, Virginia,
USA; 2Pfizer Inc., USA; 3Loyola University, Chicago, IL,
USA
Objective: To identify patient-reported reasons for discon-
tinuing prescription antimuscarinics for overactive bladder
(OAB)
Methods: In Phase I, a survey to identify individuals with
probable OAB was sent to a representative sample of
260,000 US households. In Phase II, a follow-up survey
was sent to 6577 Phase I respondents who had reported
using ≥1 antimuscarinic during the 12 months preceding
Phase I. The Phase II survey included questions about
demographic and clinical characteristics, use of antimusca-
rinics, adherence rates, reasons for discontinuation, and
OAB symptom bother. Phase II respondents who discon-
tinued ≥1 OAB medication within the past 21 months were
grouped according to the frequencies of each of 14
precoded reasons for discontinuation using latent class
analysis (LCA). The Lo-Mendell-Rubin likelihood ratio test
was used to determine the number of classes, and the
conditional probability of reasons for discontinuing was
estimated for each class. Multivariable regression was
used to assess the influence of covariates, including age,
sex, race, income, and history of incontinence on
respondent class assignment.
Results: Usable surveys were returned by 162,906 respon-
dents (63%) in Phase I and 5392 respondents (82%) in
Phase II survey. Phase II respondents were mostly women
(78%) and white (85%); mean age was 63 years. One fourth
S139
of respondents (n=1322) reported discontinuing ≥1 OAB
medication within the past 21 months. The mean (SD)
number of reasons reported for discontinuation was 2.3
(1.6); the most frequently reported reasons were ‘didn’t
work as expected’ (46%), ‘switched to a new medication’
(25%), ‘learned to get by without medication’ (23%), and
‘side effects’ (21%). Two groups of respondents (P=
0.0095) were detected by LCA. In one latent class, which
included the majority of respondents (89%), the most
frequently reported reasons for discontinuing were ‘didn’t
work as expected,’ ‘switched to new medication,’ and ‘side
effects.’ In the other latent class (11% of respondents), the
most frequently reported reasons for discontinuing were
‘don’t like taking any medications,’ ‘don’t like taking
medications for too long,’ and ‘learned to get by without it.’
None of the covariates tested were significant predictors of
class assignment.
Conclusion: LCA identified 2 classes of respondents that
appear to have distinct reasons for noncompliance with
prescribed medication. Whereas a small percentage
respondents discontinued for reasons related to an aversion
to taking medication in general, the majority of respondents
reported reasons related to the efficacy and tolerability of
the OAB medication.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Pfizer Inc.
Level of support: industry initiated, executed and funded
study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
246
PERIPHERAL TIBIAL NEUROSTIMULATION (PTNS)
VERSUS TOLTERODINE IN THE TREATMENT
OF WOMEN WITH URGE URINARY INCONTINENCE
AND URGE SYMPTOMS
Preyer, O1; Gabriel, B2; Mailath-Pokorny, M1; Doerfler, D1;
Laml, T1; Umek, W1; Zehetmayer, S3; Hanzal, E1
1
Department of Obstetrics and Gynecology, Medical Uni-
versity of Vienna, Austria; 2Department of Obstetrics and
Gynecology, Medical University of Freiburg, Germany;
3
Institute for Medical Statistics, Vienna, Austria
Objective: The aim of our study was to conduct a
prospective randomized trial to compare the effectiveness
of peripheral tibial neurostimulation (PTNS) (Urgent PC®)
versus Tolterodine (Detrol®) in the treatment of women
with urge urinary incontinence and urge symptoms.
S140
Materials and methods: Between June 2004 and July
2006 we included 31 patients (≥18 years) in our study.
Sixteen patients were randomized into the neurostimula-
tion arm, fifteen patients into the drug arm. Exclusion
criteria: Contraindications against anticholinergics, preg-
nancy, tolterodine before. Major study endpoints: Micturi-
tions in 24 hours, patient’s quality of life. Minor study
endpoints: Incontinence episodes in 24 hours, side effects
of both therapies. Duration of therapy: Twelve weeks in
each study group (PTNS once a week for 30 minutes, 2
times 2 mg Tolterodine administered orally per day).
Follow-up intervals: 3, 6 and 12 months after starting the
therapy. Full urodynamic workup at visit 0 and visit 2
(after 12 weeks).
Results: Mean age of patients: 59.4±10.9 years (range
26–85 years). Postmenopausal: 96.6%. BMI: 28.7±5.6
(21.3–41). Hysterectomized: 13.9%. Parity: 1.6 ± 0.9
children (range 0–4 children). Caesarean section: 13.8%.
Incontinence Operation: 20.7%. Smokers: 20.7%. More
than three medications daily: 65.6%. The following data
represent the factor of change in absolute numbers of the
studied variable in both therapy arms: The number of
micturitions remained in both groups the same between
first visit and end of therapy (0.1 [CI 95%, −3.3–3.6] vs.
0.7 [CI 95%, −2.3–3.7], p=0.77), the patient’s quality of
life improved in both groups (4.4 [CI 95%, 1.7–7.1] vs.
4.6 [CI 95% 2.1–7.0], p=0.93). In both groups the
number of incontinence episodes declined (1.3 [CI 95%,
0.6–3.2] vs. 2.6 [CI 95%, 0.1–5.3], p=0.4), as well as
the number of urge episodes (9.3 [CI 95%, 7.0–11.7] vs.
9.5 [CI 95%, 6.3–12.7], p=0.92). Side effects: 1 patient
(3.4%) in the PTNS group and 6 patients (20.7%) in the
drug group. Drop outs: 3 patients (10.3%) in the PTNS
group and 2 patients (6.9%) in the drug group.
Conclusion: There was no statistical significant difference
between the both groups of therapy regarding the chosen
major study endpoints and minor study endpoints. A
distinct lower rate of side effects in the PTNS group (3.4
vs. 20.7%) has been shown to be an obvious advantage of
PTNS as non-medical treatment in a group of patients with
a number of co-morbidities and therefore high drug load
(65.9%).
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Uroplasty,
Pfizer.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
247
PRESSURE TRANSMISSION RATIO (PTR) AS A
MEASURE OF SEVERITY OF INCONTINENCE
Hessami, S; McKinney, TB; Saddeek, RW; Sankar, N;
Dhamotharan, S; Hassan, KA
Saint Joseph Regional Medical Center, South Bend, IN,
USA
Objective: The purpose of this study is to develop an
objective Severity Index (SI) which would correlate with
validated subjective questionnaires such as the Urogenital
Distress Inventory (UDI) and/or the Incontinence Impact
Questionnaire (IIQ). This new SI is derived from the
Pressure Transmission Ratio (PTR) and the actual volume
of urine leaked. PTR (Range 0 to 1) is derived from the
relative change in Maximal Urethral Closure Pressure
(ΔMUCP) and the change in vesicle pressure (ΔP) from
a resting state to that during a Valsalva maneuver.
PTR=ΔMUCP/ΔP. SI (Range 0–300)=(1-PTR) X Leaked
Volume
Methodology: Measurements for MUP and Vesicle Pres-
sure were obtained during multichannel urodynamic test-
ing. Leak volume was measured to assess the severity of
incontinence during the same urodynamic testing, with each
patient generating at least 100 cm of H2O of Valsalva, with
bladder filled to 300 cc. Patients who presented with
subjective complaints of incontinence, but were found to
have no leakage by urodynamic testing were excluded from
this study, in addition to patients with advanced prolapse
(stage 3 and 4), pure urge incontinence, and prior anti-
incontinence surgery.
Results: In this preliminary study 12 patients who
complained of symptoms of urinary incontinence complet-
ed the UDI and IIQ surveys. Of those 8 were found to have
urinary incontinence through urodynamic testing. Plotting
SI vs. UDI score resulted in a linear correlation with a
correlation coefficient of 0.74 and an r2 value of 0.55 which
was significant at p<0.05. Plotting SI vs. IIQ score resulted
in a linear correlation with a correlation coefficient of 0.84
and an r2 value of 0.70 which was significant at p<0.05.
Conclusion: PTR derived SI correlates with the validated
questionnaires IIQ and UDI. Larger study population is
needed to determine its usefulness.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244 S141

Disclosures Does the presenter or any of the authors act as a consultant,

Was consent obtained from patients? N/a. employee (part time or full time) or shareholder of an
Was this work supported by industry? No. industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No. 249
QUALITY OF LIFE ASSESSMENT IN WOMEN
WITH STRESS URINARY INCONTINENCE
248 AFTER A TRANSOBTURATOR TAPE PROCEDURE
PSYCHIATRIC TRAITS AND QUALITY OF LIFE Franco, AVM; Wang, K; Jeffery, S; Fynes, MM
IN WOMEN WITH PELVIC FLOOR DYSFUNCTION St George’s Hospital, London, UK
Aston, R; Barnick, C; Knowles, C; Porrett, T; Roberts, C
Homerton University Hospital, London, UK Objective: To evaluate the effect of the trans-obturator tape
(TOT) procedure on the quality of life (QOL) of women
Objective: Urinary and Faecal incontinence has been with stress urinary incontinence (SUI) using the Impact
associated with psychiatric morbidity. A prospective obser- Questionnaire (IIQ-7) and the Urogenital Distress Inventory
vational study was carried out to investigate the relationship (UDI-6).
between a validated Quality of Life (QOL) measure and the Methods: Women with SUI were asked to complete the
existence of anxiety and depression in women attending an IIQ-7, UDI-6 and a 1-hr pad test pre-operatively and at
integrated Pelvic Floor Dysfunction Clinic. 6 weeks, 6, 12, and 24 months post-operatively. The TOT
Materials and methods: Prior to consultation, 94 English procedure was performed as per protocol.
speaking patients with no known psychiatric complaints
completed the short form versions of the Pelvic Floor
Results
Distress Inventory (PFDI-20), the Pelvic Floor Impact
Questionnaire (PFIQ-7) and the Hospital Anxiety and
Depression Scale (HADS) Parameter Pre-op 6 wks 6 mths 12 mths 24 mths
Results: Anxiety levels above normal were detected in 48% (n=87) (n=83) (n=60) (n=49) (n=23)
and depression in 34%. Mild depression was observed in IIQ-7
18%, moderate depression in 16% and severe depression Response 67(77%) 61(73%)* 49(82%)* 40(82%)* 22(96%)
rate
was not identified. Of those who were anxious 16% had mild
No effect 2 33 31 25 13
anxiety, 17% moderate and 15% severe. There was a Mild 37 22 16 10 7
moderate association between PFIQ-7 and anxiety (β coef- Moderate 16 3 0 2 2
ficient 0.04, CI 0.02–0.06, r2 =0.16, p<0.0001) and depres- Severe 12 3 2 3 0
sion (β coefficient 0.03, CI 0.02–0.04, r2 =0.18, p<0.0001). UDI-6
There was less association between the HAD scores and the Response 71(82%) 67(81%)* 50(83%)* 41(84%)* 21(91%)
PFDI (p<0.02), although this was numerically significant. rate
No effect 1 17 16 13 6
Conclusion: These results show that our population of
Mild 32 44 32 22 14
women attending a PFD clinic have higher detectable levels
Moderate 26 4 1 4 0
of anxiety and depression than the normal population. Severe 12 2 1 2 1
There is a significant association between psychiatric traits Pad test 6.6 (IQR0.6– 0.5* 0.5* 0.6* 0.6*
and the impact these have on quality of life as detected by (gms) 56.9) (IQR0.2– (IQR 0.1– (IQR 0.2– (IQR 0.2–
the PFIQ-7 and a small association with the distress it 0.9) 2.0) 1.9) 2.0)
causes, as assessed by the PFDI-20. This suggests that
*s=statistically significant (p<0.001) when compared to
women with PFD, anxiety and depression are more
pre-operative values.
impacted by their conditions than those without these
psychiatric traits. Our study has implications for treatment,
as women with anxiety and depression are thought to do Conclusion: The TOT significantly improves the QOL in
less well with therapeutic interventions, this warrants women with SUI at 6 weeks, 6 & 12 months. Failure to
further investigation. maintain this effect at 24 months may be due to low
numbers.
Disclosures
Was consent obtained from patients? N/a. Disclosures
Was this work supported by industry? No. Was consent obtained from patients? Yes.
S142
Was this work supported by industry? Yes, by Mentor-Porges.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
250
RISK OF MESH EROSION AFTER LAPAROSCOPIC
SACRAL COLPOPEXY
WITH OR WITHOUT CONCURRENT
HYSTERECTOMY: ANALYSIS OF 419 PATIENTS
Miklos, JR; Stepanian, AA; Moore, R; Mattox, F
Center for Women’s Care and Reproductive Surgery,
Atlanta, GA, USA
Objective: To examine the incidence of mesh-related
complications and mesh erosion rate in patients undergoing
laparoscopic sacral colpopexy with or without concurrent
hysterectomy.
Materials and methods: 419 consecutive patients with
uterovaginal or vaginal vault prolapse who underwent
laparoscopic sacral colpopexy (LSCP) between 2003 and
2006 were treated with laparoscopic sacral colpopexy in
conjunction with other laparoscopic and/or vaginal proce-
dures. Y-shaped polypropylene mesh was uniformly used.
Data was collected in the form of chart reviews and patient
questionnaires. Patient demographics, history, intraopera-
tive complications, and short- and long-term complications
were analyzed. Length of follow up was 2–54 months.
Results: The overall mesh erosion rate was 1.2%. Patients
who had concurrent hysterectomy had an erosion rate of 2.5%
(3/122) as compared to 1.1% (3/274) erosion rate in patients
with history of previous hysterectomy. Patients who retained
their uterus and had laparoscopic sacral colpopexy had no
evidence of erosion, 0% (0/23). 0.95% (4/419) patients
experienced mesh-related infection. Small bowel obstruction
occurred in 1.4% (6/419) of patients, 2 of whom required
reoperation and 4 of whom were managed conservatively in
the course of rehospitalization. 1 patient with mesh erosion
(0.2%, 1/419) developed staphylococcal sacral osteomyelitis.
Mesh was removed in all 4 patients with infection and in 3
patients with persistent pelvic pain unresponsive to other
methods of therapy. All 6 patients with mesh erosion as a
result of LSCP underwent various degrees of mesh revision.
Surgical failure rate for LSCP was 1.5%.
Conclusion: Absolute risk of mesh erosion after laparo-
scopic sacral colpopexy with or without concurrent hyster-
ectomy is small. If medically indicated, hysterectomy can
be performed at the time of laparoscopic sacral colpopexy.
LSCP is a safe and efficacious procedure for correction of
vaginal vault or uterovaginal prolapse.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
252
SUCCESSFUL THERAPY FOR THE CHALLENGING
PATIENT: TRANSVAGINAL BIOFEEDBACK
AND ELECTRICAL STIMULATION IN URINARY
URGENCY AND FREQUENCY ASSOCIATED
WITH PELVIC FLOOR MUSCLE SPASM
Bendana, E1; Belarmino, J2; Cook, C3; Dinh, J4; De, E2
1
Albany Medical College, NY, USA; 2Albany Medical
Center, NY, USA; 3Bellevue Women’s Hospital; 4Uro-
logical Institute of Northeastern New York, USA
Objective: Women with pelvic floor spasm can develop
debilitating urinary urgency and frequency (U&F) that is
difficult to treat. Transvaginal Biofeedback and Electrical
Stimulation (TVBEstim) is a behavioural modality that can
be used to treat this difficult patient population and its
efficacy was evaluated.
Materials and methods: 67 patients originally referred
with U&F were found to have palpably tense and tender
levator ani muscles ± vaginismus on initial evaluation.
TVBEstim was recommended to all patients. 51 patients
completed TVBEstim and 1 patient declined Estim. The
average age of patients included in the study was 44.9
(±17 SD, n=52) years. Eight had a prior diagnosis of
interstitial cystitis, 20 ‘recurrent UTI’ and 43 with refractory
U&F syndrome. Nine patients had endometriosis, 4 herpes, 19
hematuria and 24 pelvic pain. TVBEstim consisted of 6
sessions of education, exercises monitored by graphic
representation of vaginal probe activity, and passive electrical
stimulation. Data were collected on a systematic tabular
symptom quantification form by clinic interview at every
visit. 10-point visual analogue scale (VAS) of symptom
severity and effect on daily life as well as American
Urological Association Symptom Scores (AUA-SS) and
AUA quality of life score (AUA-QOL) were collected.
Results: All 52 patients who initiated treatment completed
therapy. Mean subjective improvement after TVBEstim was
63.5% (±4.1 SE). Significant improvement was also seen in a
scaled 0–5 urge intensity scale (−1.00±0.19 SE, p<0.001),
frequency (1.22 greater hours per void ±0.16 SE, p<0.001)
and nocturia (−1.04 events±0.26 SE, p<0.001). Of the 24
women that reported pelvic pain, there was a reported 47.8%
(±8.5 SE) improvement in the pelvic pain. A subset of 23
patients (44%) completed the VAS: improvement was seen
in symptom severity (−2.38±0.64 SE, p<0.001) and effect
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
on daily life (−2.43±0.58 SE, p<0.001). A subset of 21
patients (40%) completed the AUA-SS and AUA-QOL.
AUA-SS improved by (−8.32±1.4 SE, p<0.001) and the
AUA-QOL improved by (−1.58±0.41 SE, p=0.001). Statis-
tically significant improvement was seen with incomplete
emptying, frequency, intermittency, urgency and weak
stream.
Conclusion: TVBEstim in women with U&F associated
with pelvic floor spasm is highly effective at 6 weeks for
improving urgency and frequency symptoms and severity
as well as alleviating pelvic pain.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
253
DATA MINING FROM A LARGE PROSPECTIVE
SURGICAL TRIAL USING GEOMETRIC
Ginath, S1; Vardy, MD2; Olivera, CK2; Zhou, HS2; Ascher-
Walsch, CJ2; Shahryarinejad, A2; Flisser, AJ2; Brodman, ML2
1
Obstetrics and Gynecology, Sackler School of Medicine,
Wolfson Medical Center, Holon, Israel; 2Mount Sinai
School of Medicine, New York, USA
Objective: To evaluate the utility of a novel data mining
tool in assessing a large prospective surgical trial database.
Materials and methods: 2-year prospective multicenter
study to evaluate treatment of patients with GSI or mixed
incontinence (stress predominant) and a positive (+)
standing cough stress test (CST) at 300 cc with the aIVS.
Other concomitant site-specific procedures were performed
as indicated. At 3 weeks, patients completed pain scale
assessments, Pelvic Floor Impact Questionnaire (PFIQ)
(including urinary, colorectal-anal, and prolapse subscales),
CST; and 6, 12 and 24 months, POPQ, PFIQ and CST were
recorded. Data mining is accomplished by laying 200
variables in from this study out along parallel coordinate
axes. By logically combining visual color coded queries
associated with good, better, and best outcomes (blue, pink,
and yellow bands respectively) at multiple time points,
latent patterns are uncovered in the clinical data set.
Results: Red triangles (enclosed by large red ovals) in
figure 1 indicate visual queries, which are logically
combined to interrogate the dataset. This visualization
analysis points to best urinary outcome for all lowest
POPQ points (red box). Geometric processing revealed that
a bimodal distribution potentially exists with respect to
patient height and optimal urinary outcome (yellow bands
S143
enclosed by red circles). Also found was an association of
race with adverse events. Best urinary outcomes may be
seen to cluster between patient ages 30–42 years old (red
vertical oval). Standard statistics verified height and race as
cofactors (p=0.01) and age less than 34 using Fisher exact
test and Mantel-Haenszel test for trend.
Conclusion: Multidimensional data visualization and anal-
ysis holds promise for rapid discovery of relationships
otherwise invisible in this large dataset for this prospective
surgical trial. Verification of insights gained by this data
mining technique through conventional statistical analysis
may confirm the utility of these visual methods for future
clinical trials.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Tyco/ US
Surgical.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
255
VULVODYNIA AND OXIMETRY
Hurt, K; Halaska, M; Sottner, O; Krcmar, M; Krajcova, A
1
Charles University, Prague, Czech Republic
Objective: Vulvodynia is defined as chronic vulvar
burning, stinging, rawness, soreness, or pain in the absence
of objective clinical or laboratory findings to explain these
symptoms. Although believed in the past to be uncommon,
vulvodynia is now recognized as a fairly frequent syn-
drome. Data from a population-based study funded by the
National Institutes of Health (NIH) found that 15.7% of
S144
women reported lower genital tract discomfort persisting
3 months or longer.
Vulvodynia is divided into 2 classes: vulvar vestibulitis
syndrome is vestibule-restricted burning/pain and is elicited
by touch; dysesthetic vulvodynia is burning/pain not
limited to the vestibule and may occur without touch/
pressure.
Standard therapy includes treating neuropathic pain. Addi-
tional therapies include: pelvic floor rehabilitation com-
bined with surface electromyography, interferon alfa,
estrogen creams, and surgery.
We would like to investigate whether optical measurement
of tissue oxygen saturation in the perineum of affected
woman differs to that free of any problems. Hypoxia is
significantly detrimental to the synthesis of collagen and
the differentiation of fibroblasts.
Materials and methods: Ten women, aged 30–52 years,
with objective vulvodynia and a minimum 2-year history of
chronic pelvic disorders were recruited. We measured their
subcutaneous perineum oxygenation in the area of post.
labial commissure with an optical infrared pulse gadget.
Ten controls, free of any problems had been measured
under the same conditions.
Results: On a significance of (P < 0.01) we proved
statistical decrease of oxygenation of perineal tissue
between the group of affected women and the controls.
Conclusion: Hypoxia of perineal tissue could cause
adverse formation of perineal collagen and thus influence
adverse sensation of the whole perineal area. This method
could be widely used for this kind of diagnostics.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
256
WHEN DO WE TREAT THE URGENCY
AFTER MIDURETHRAL SLING PROCEDURE
FOR STRESS URINARY INCONTINENCE DURING
A PERIOD
OF POSTOPERATIVE 1 YEAR?
Song, C1; Park, SH1; Kim, JY1; Choo, MS1; Lee, SJ2;
Na, YG3; Park, WH4; Lee, JG5; Kim, HY6
1 257
Ulsan University, Seoul, Korea; 2Kyung Hee University,
Seoul, Korea; 3Chungnam National University, Taejon,
Korea; 4Inha University, Incheon, Korea; 5Korea Universi-
ty, Seoul, Korea; 6Hallym University, Seoul, Korea
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: We prospectively followed perioperative urgen-
cy after midurethral sling to determine the symptom course
and suggest proper timing of treatment.
Materials and methods: Ninety-one patients who had
undergone tension-free vaginal tape-obturator system
(TVT-O®) procedure for SUI were serially followed up.
Before and at 1, 6, and 12 months after surgery, voiding
symptom interviews were repeated to check for improve-
ment, persistence or worsening in the preexisting urgency
or newly acquired urgency. Serial changes in the urgency
and demographical, micturitional and urodynamic charac-
teristics were compared to identify risk factors for symptom
persistence to 1 year.
Results: Changes in the urgency after surgery were variable
at each respective postoperative period. Improved urgency
maintained or aggravated, and de novo urgency disappeared
or reappeared (Figure). Of the 59 patients with preexisting
urgency, 32 (54.2%), 21 (35.6%), and 23 (39.0%) demon-
strated symptom persistence at postoperative 1, 6, and
12 months respectively. Of the 32 patients with persisting
urgency at 1 month 16 (50.0%) had symptom persistence
until 12 months. Of the 32 patients without preoperative
urgency, 1 (3.1%) and 6 (18.8%) patients demonstrated de
novo urgency at 1 and 6 months after surgery respectively,
but symptom resolved spontaneously in most and persis-
tence until 12 months was observed in only 2 (6.2%) of
them. Overall, urgency lasting until 12 months after surgery
was observed in 25 (27.5%) of the entire cohort. Factors
significantly related to symptom persistence until 1 year
after surgery were presence of preoperative urgency (p=
0.001, odds ratio 9.583) and urgency at postoperative
1 month (p=0.001, odds ratio 5.124). Other clinical and
urodynamic parameters were not significantly related.
Conclusion: Although urgency is treated on patient’s
demand at any time after midurethral sling treatment may be
recommended when urgency is noted at 1 month after surgery
in patients with preexisting urgency and it may be deferred
until after 6 months in those without preoperative urgency.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
OUTCOME AND RECURRENCE RATES
OF SECONDARY PROLAPSE SURGERY USING
THE SUBINTESTINAL SUBMUCOSA (SIS) GRAFT
Jeffery, ST; Parappallil, S; Doumouchtsis, S; Fynes, M
St George’s Hospital, London, UK
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: Recurrence rates for vaginal prolapse surgery
are high. Various graft materials have been used to improve
the surgical outcomes. Our aim was to investigate the
outcome and recurrence rates of secondary prolapse
surgery using the biological prosthesis Porcine Subintes-
tinal Submucosa (SIS).
Method: The SIS graft was used in 21 women undergoing
surgery for recurrent prolapse. The graft was placed
anteriorly, posteriorly or in both compartments depending
on the area of recurrence. Women were assessed pre-and
post-operatively for symptoms of prolapse. Subjects had
pre-and post-op assessment of prolapse severity using the
Baden-Walker Halfway (BW) and ICS POPQ systems and
completed the PISQ-31 sexual function questionnaire.
Results: The mean age was 63 years (range 42–89 SD=/−9).
11 women had Anterior Vaginal Repair with SIS (AVR
+SIS), 7 women had Posterior Vaginal Repair with SIS
(PVR+SIS) and 3 had both AVR+SIS and PVR+SIS.
Concomitant procedures included Bilateral iliococcygeus
fixation in 4 patients, posterior IVS in 4 and transobturator
tape in 3. 20 (95%) patients reported the symptom of vaginal
bulge and 20 (95%) reported vaginal discomfort preopera-
tively. Of those women who had AVR+SIS, 84% had at least
a Grade 2 cystocele on BW and more than Stage 2 anterior
prolapse on POPQ points Aa and Ab pre-op. 90% of those
women who had PVR+SIS, had at least Grade 2 rectocele
on BW or Stage 2 on POPQ pre-op. At mean follow-up of
29 months (range 9–47 months SD=/−10) for the whole
cohort, 6 (28%) (p=0.001) patients complained of vaginal
bulge and 8 (38%) complained of vaginal discomfort (p=
0.001).
At mean follow -up of 26 months, 91% of the women who
had AVR +SIS had a Grade 1 cystocele and Stage 1 or less
prolapse for point Aa and Ab. This represents a reduction
from a pre-op mean of +0.57 for point Ab to a post-op
mean of −1.57 (p=0.33). At a mean follow-up of 31 months
for those women who had PVR+SIS, 100% had Grade 1
prolapse or Stage 1 or less on POPQ point Pa or Pb. The
only graft related complication was the development of a
haematoma in one patient. There were no graft erosions. 12
subjects completed the PISQ 31 sexual function question-
naire. The post-op total mean score was 84 (maximum 125
where a higher score indicates good function). The mean
score in the physical domain was 33 (max 40).
Conclusion: The porcine SIS graft is associated with low
anatomical recurrence rates when used in vaginal prolapse
surgery. It is also associated with good post-operative
sexual function. There were no erosions in our cohort.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
S145
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
258
GOALS AND EXPECTATIONS: PATIENT VS
SURGEON PERSPECTIVE IN RELATION
TO OUTCOME SATISFACTION
Nnochiri, A; Roberts, C; Barnick, C
Homerton University Hospital, London, UK
Objective: clinicians and patients tend to assess surgical
outcomes differently, mostly because clinicians take a more
traditional approach while patients on the other hand take a
more global view. Achieving the expectations and set goals
of the patient have a positive impact on the level of patient
satisfaction. This study compares the expectations and
goals of the clinician to those of the patient. It also assesses
how achievement or otherwise of these expectations and
goals correlate with patient satisfaction.
Materials and methods: 30 consecutive consenting
patients seen in the women outpatient clinic of our hospital
being booked for surgery were asked to record their
expectations and goals in relation to the surgical outcome
on a self administered questionnaire. Both consultant
surgeons carrying out the procedures were also asked to
enumerate their expectation/goals of the treatment outcome.
They were blinded to the patients’ answers. All Patients
were seen post operatively at 6 weeks when the surgical
outcomes were measured subjectively using a visual
analogue scale.
Results: Our results will be presented
Conclusion: The results of this study will hopefully help
clinicians to better understand what influences patients’
perception of a successful surgical outcome. Incorporating a
global approach to assessing surgical outcomes would
enhance overall patient experience and satisfaction.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
260
ASSESSING THE DIAGNOSIS AND MANAGEMENT
OF UTI PRIOR TO URODYNAMICS
McDougald, M
1
Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
S146
Objective: To assess current UK practice in the determi-
nation of urinary tract infection prior to urodynamic studies
in the light of the recent paper by Hashim and Abrams(1) To
examine the cost implications of restricting testing to urine
dipstick.
Method: A telephone survey was carried out of UK
hospital departments who routinely perform urodynamic
studies. Information was sought on the workload, whether
urine was routinely tested by dipstick, the criteria for a
positive result and the subsequent action in terms of
treatment and continuation with the procedure. An estimate
was made of the number of cancellations due to a positive
result.
Results: To date 49 departments have been contacted, of
whom 16 (32%) do not carry out dipstick testing. Of those
who do test, 27% test a sample brought in by the patient,
54% dipstick test a sample from uroflowmetry and 18% test
a sample obtained by catherisation.
Of these, 31/33 (94%) departments send samples to
microbiology for culture and sensitivity if the dipstick shows
nitrites and leucocytes but 2/33 would send a sample which
showed only nitrites only. The presence of symptoms and / or
haematuria on testing would result in microbiological testing
in 18/33 (55%) departments. 24/33 would treat on the results
of dipstsick testing without waiting for the results of culture
and sensitivity and 29/33 would postpone urodynamics. All
of the 33 departments who carry out dipstick testing send a
sample to laboratory for formal microbiology, yet 24/33
(73%) treat on dipstick result alone and 29/33 (88%)
postpone the urodynamics. Of these, 6/33 (18%) have
already catherised the patient. The cost of commencing the
procedure must be added to the risks occasioned by an
unnecessary catherisation The annual cost of the laboratory
urine testing equates to £7643 p.a. for this sample.
Conclusion: 54% of departments sampled are dipstick
testing a flowmetry sample, as recommended by Hashim
and Abrams. Given the high proportion who act on the
results of dipstick testing alone, considerable savings could
be made by eliminating laboratory testing.
1. Hashim H and Abrams P: Flow meter urine testing; a
practical proposition in patients attending for urodynamics:
BJU 2006, 97, 1027–1029.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
261
CLINICAL ANALYSIS OF QOL IN PELVIC ORGAN
PROLAPSE PATIENTS WHO UNDERWENT
TENSION-FREE VAGINAL MESH OPERATION
Uesaka, Y; Fukumoto, Y; Ito, S; Yamamoto, K;
Yamanaka, M; Kimura, T; Takayama, M
Department of Urology, Osaka Central Hospital, Osaka,
Japan
Objective: Quality of life (QOL) in pelvic organ prolapse
(POP) patients are much impaired even if these diseases
themselves are not life threatening. The aim of this study is
to evaluate not only objective data but also subjective
factors to assess the curative effect of tension-free vaginal
mesh (TVM) operation for the disease.
Patients and methods: We performed TVM (tension-free
vaginal mesh) procedure with Nonabsorbable PROLENE*
Soft Mesh (GYNEMESH *PS) on 245 POP patients from
June 2005 to December 2006. These patients were asked
their satisfaction level and QOL using two questionnaires,
SF-36 (Medical Outcome Study Short-Form 36 Item Health
Survey) and P-QOL (a prolapse quality of life question-
naire) before and 3 months after the operation. We made a
P-QOL Japanese language version experimentally and used
it because there is no validated Japanese questionnaire to
estimate disease-specific health performance. The objective
condition of their disease was also evaluated with POP-Q
(pelvic organ prolapse quantification) at the same time.
Results: Nearly 90% of the patients were satisfied with their
condition after the treatment. There was no case of recurrence
within 3 months according to POP-Q score. Norm-Based
Scoring (NBS) of SF-36 profile of women with POP revealed
that there were significant improvement in General Health,
Role-Emotional (P<0.001), Physical Functioning, Role-
Physical, Body Pain, Mental Health (P<0.01).P-QOL
revealed that POP suffered the patients’ daily life and mental
condition. There were significant and clinically important im-
provements on 7 scales beside private relationship. (p<0.001)
Conclusions: Though POP is just a limited physical
disease, the mental condition of this patient is much
distressed. We performed TVM procedure, which is a
radical (and not so invasive) treatment for POP, and found
good results in not only physical but also mental conditions
of the patients. We conclude that TVM is an effective
treatment for improvement of QOL in POP patients.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
262
COLPOPERINEOPLASTY IN WOMEN
WITH A SENSATION OF WIDE VAGINA: 100 CASES
Pardo, J; Solà, V; Ricci, P
Clínica Las Condes, Santiago, Chile
Objective: In women complaining of a wide vagina and
decreased sexual satisfaction we performed a laser assisted
colporrhaphy-including perineoplasty in almost every case.
Methods: Between November 2003 and August 2006, a
total of 100 patients were selected for surgery at the
Urogynecology and Vaginal Surgery Unit, Clinica Las
Condes, Santiago, Chile. Any patient had a genital prolapse
greater than I grade. The patients were requested to assess
the results of surgery in terms of experienced vaginal
tightening and regained or enhanced sexual satisfaction.
Results: Four months after the surgery, 95% experienced a
tighter vagina during the intercourse. 85% said they were
able to achieve vaginal orgasm. Expectations were fulfilled
in 79%, partially fulfilled in 14%, and not met in 7%. Only
two patients (4%) regretted surgery, and two patients had
minor surgical complications.
Conclusion: In a selected group of women with acquired
sensation of a wide vagina, colporrhaphy seems to improve
symptoms and enhance sexual gratification in a majority of
the women.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
263
COMPARISON OF ACCURACY OF FUNCTIONAL
MEASUREMENTS IN TRANSPERINEAL VS NOVEL
3-D TRANSVAGINAL ULTRASOUND
IN THE ASSESSMENT OF URETHRAL COMPLEX
IN INCONTINENT WOMEN
Wieczorek, AP; Bogusiewicz, M; Wozniak, MM;
Rechberger, T; Stankiewicz, A; Futyma, K
Medical University of Lublin, Poland
Objective: Transperineal ultrasound (TP US) evaluates the
dimensions, relations towards lower margin of symphysis
pubis and mobility of urethral complex not informing about
the causes of hypermobility and detailed morphology of the
urethra. To be able to assess precise morphology of the
urethral complex and surrounding structures high frequency
novel 3-D transvaginal (TV) transducer should be used.
However, this technique may influence the statics and
S147
anatomy of pelvic floor structures. The objective of the
study was comparison of accuracy of functional measure-
ments of urethral complex in incontinent women performed
in TP and novel 3-D TV US.
Materials and methods: 25 incontinent patients underwent
TP and novel 3-D TV US exams (median age: 56.28±11.01;
range: 28.93–76.47) with B-K Medical (Denmark) equip-
ment. TP US was performed with a 6 MHz convex
transducer. TV exams were performed with a 6,5–9 MHz
linear and sector transducer with ‘free-hand’ 3-D acquisition
with perpendicular beam formation to the urethra. Mobility
of urethra evaluated on the basis of bladder-symphysis
distance (BSD) and the length of urethral complex were
assessed at rest, Valsalva manoeuvre and squeeze.
Results: In the group of 10 (40%) incontinent patients with
no coexisting anatomical disturbances there were no
statistical differences in the length of the urethral complex
between measurements taken by TP and TV US performed
at rest, Valsalva and squeeze. The values of BSD at rest and
Valsalva were accordant in both methods, whereas at
squeeze differed significantly (p<0.01). In the group of
15 (60%) incontinent patients with recto/enterocoele or
cystocoele the length of urethral complex measured in TP
and TV US differed significantly in all 3 tests (p<0.001).
Measurements of BSD at rest, and squeeze were signifi-
cantly different (p<0.01 rest; p<0.05 squeeze) between TP
and TV US. The BSD values in Valsalva varied between TP
and TV US although not statistically.
Conclusion: The assessment of the length and the mobility
of urethral complex in incontinent patients with recto/
enterocoele or cystocoele using novel 3-D TV US is
inaccurate due to alterations of anatomical relations caused
by the introduction of the probe into the vagina. Similarly,
the evaluation of BSD in incontinent patients with no coele is
not reliable in squeeze with TV US because of the same
reason. However, all the other measurements in incontinent
patients with no coexisting anatomical disturbances are the
same accurate in both methods.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
264
CORRELATION OF SUBJECTIVE PARAMETERS
TO THE 1 HOUR PAD TEST IN WOMEN
WITH STRESS URINARY INCONTINENCE
Franco, AVM; Wang, K; Swaby, P; Fynes, MM
St George’s Hospital, London, UK
S148
Objective: The 1 hour pad test is a validated tool for the
objective assessment of stress urinary incontinence (SUI).
This technique however may be difficult to perform in a
routine clinical setting. The aim of this study was to correlate
the 1 hour pad test in women with urodynamic stress
incontinence (USI) to other accepted subjective parameters.
Methodology: 98 women with UDS and a stable bladder
underwent a 1 hr pad test according to ICS protocol. These
values were compared to other subjective parameters
including VAS (0–10), and subjective patient-based symp-
tom severity scale (1–3) with higher scores indicating
greater urinary loss. Quality of life parameters included
ICIQ-SF, IIQ-7, and UDI-6. 72 women completed all the
quality of life (QoL) questionnaires.
Results: Median pad test values were 31.3g (IQR7.2–77.7).
The table below shows the correlation of the different
parameters with the one hour pad test.
Parameter Median Kendall’s tau b P value
VAS (0–10) 8(IQR 6–8) 0.066 0.455
Severity scale (1–3) 2(IQR 1–2) 0.150 0.165
ICIQ 14(IQR 11–16) 0.177 <0.05 (0.037)*
UDI-6 50(IQR 39–67) 0.046 0.592
IIQ-7 38(IQR 28–67) 0.048 0.567
Conclusion: The ICIQ is easy to administer and
correlate best with the 1 hour pad test incorporating
both symptom severity and quality of life parameters in
women with USI. We recommend the routine use in
clinical practice.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
265
CYSTOCELE REPAIR WITH POLYPROLENE MESH
Al-Nazer, MA
Dubai Hospital, UAE
Objective: Is to present the surgical technique, morbidity
and cure satisfaction as primary outcomes for anterior
vaginal wall repair with mesh.
Patients and methods: Patients attending outpatient gyne-
cology clinic at Ain Shams Maternity hospital for Cystocele
repair between 2003 and 2005 were offered the technique.
Twenty patients with stage II or more anterior vaginal wall
prolapse according to Pelvic Organ Prolapse Quantification
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
(POPQ) system were included in the study. The mesh
(GYNEMESH*PS, Gynecare, Ethicon, France) was tailored
intra-operatively to suite the size of the vagina and shaped to
acquire two anterior arms (right and left) that were brought out
into the obturator foramen in a way similar to TOT. The
posterior part of the mesh was fixed to the fascia near the cervix.
Clinical evaluation and assessment took place preopera-
tively and postoperatively at intervals of 6 weeks, 3, 6 and
12 months for follow up.
Functional and anatomical outcome were based on preop-
erative and 12-month postoperative assessments for symp-
toms and POPQ stages respectively.
Recorded data were tabulated in an investigative result form
and results were analyzed by using statistical program for
social science (SPSS).
Results: Regarding functional outcome there was improve-
ment in urinary and sexual symptoms. For anatomical
outcome, evaluating points Aa, Ba, Ap and Ap on the
POPQ system showed significant improvement.
Conclusion: The presented surgical technique is easy, safe and
efficient in cystocele repair on a 12 months follow-up basis.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
266
DO AGE AND SYMPTOM SEVERITY INFLUENCE
THE OUTCOME OF TVT?
Jha, S; Radley, S; Farkas, A
Royal Hallamshire Hospital, Sheffield Teaching Hospitals
NHS Trust, UK
Objective: Tension-free vaginal tape (TVT) is now the
most commonly undertaken surgical procedure for stress
urinary incontinence (SUI). However, little is known about
the effects of age & symptom severity on outcome. Using a
validated electronic pelvic floor symptoms assessment
questionnaire (e-PAQ) we assessed the influence of these
2 factors on symptomatic outcome in terms of stress urinary
incontinence (SUI), overactive bladder (OAB), voiding
dysfunction (VD) & quality of life (QoL).
Materials and methods: e-PAQ provides a valid & reliable
measure of urinary, bowel, vaginal & sexual symptoms, with
19 psychometrically robust, clinically meaningful symptoms
domains (all scored on a scale of 0–100). The urinary
dimension provides domain scores for SUI, OAB, VD &
QoL. 50 women undergoing TVT for USI were assessed pre &
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244 S149

postoperatively using the e-PAQ. Sub-group analysis was Objective: Prevalence of female pelvic floor statics
carried out, comparing women ≤50 with women >50 years of disorders is 30% in developed countries. Life time risk for
age (N=27 & 23 respectively). Wilcoxon signed ranks test was being operated due to cystocoele, rectocoele or uterine
used to measure differences between groups in these 4 prolaps is 11%. Nowadays classical operations for manage-
domains, as well as change following surgery. Linear regres- ment of prolapse are replaced by new, less invasive and
sion was used to assess the relationship between symptom more efficient techniques which reinforce damaged pelvic
severity & pre & post-op changes in SUI & QoL scores. connective tissue with prosthesis. The purpose of this study
Results: There was a significant trend towards greater was to evaluate the efficacy of Prolift System in female
overall improvement in younger women who also had lower pelvic floor static disorders.
overall post-op SUI scores; 93% of women <50 improved by Materials and methods: Between February and December
≥20 points, whereas 83% of women >50 had a corresponding 2006 one hundred and twelve patients (mean age 59 years)
≥20 point improvement in SUI (p=0.0484). Age & preop- were operated because of pelvic organ prolapse. We used
erative symptom severity did not influence postoperative Prolift System, Anterior, Posterior, Total or Anterior and
OAB or VD scores. Linear regression found greater pre-op Posterior at one time. According to POPQ scale twenty
symptom severity to be associated with greater post-op patients (17,85%) were classified as POPQ II, sixty nine
improvement. For every 1-point increment in the pre-op SUI (61,6%) as POPQ III and twenty three (20,5%) as POPQ
score, there was a corresponding improvement in post-op IV. Forty three woman (38,4%) underwent Anterior,
score of 0.65 points (p<0.001). For every 1-point increment eighteen (16,1%) Posterior, thirty seven (33%) Anterior
in pre-op QoL score, there was a corresponding post-op and Posterior and fourteen (12,5%) Total Prolift System
improvement of 1.00 points (p<0.001). operation. Fifty three patients (47,3%) had an additional
procedure during the surgery, including IVS 02 and 04,
Table. Mean pre and post op. SUI, QoL and OAB scores in cervix amputation or posterior colporrhaphy. During follow
<50 & >50 yr old women undergoing TVT up (one and six months) clinical outcome (objective and
subjective) was estimated.
Results: During surgery one bladder perforation occurred
Age Pre-op. Post-op. Age Pre-op. Post-op.
domain (mean) (mean) domain (mean) (mean)
and three patients required evacuation of hematomas few
<50 SUI 54 7 >50 SUI 65 12 hours after surgery. Eighty woman (71,4%) were available
<50 Qol 65 7 >50 Qol 64 9 for clinical evaluation of efficacy of Prolift System on first
<50 28 14 >50 41 20 follow-up visit and medium day count from surgery is 47.
OAB OAB Anatomical outcome of operation was considered as
excellent in every patient (100% success rate), however 5
patients developed stress urinary incontinence, two devel-
Conclusions: The age at which TVT is performed appears
oped rectocoele after initial anterior repair and five
to influence outcome. In addition, women with more severe
complained about groin pain while seated.
symptoms have greater improvement, both in SUI & QoL
Conclusion: Prolift System is very safe and efficient in
scores following surgery.
surgical treatment of pelvic organ prolapse.
Disclosures
Was consent obtained from patients? Yes. Disclosures
Was this work supported by industry? No. Was consent obtained from patients? Yes.
Does the presenter or any of the authors act as a consultant, Was this work supported by industry? No.
employee (part time or full time) or shareholder of an Does the presenter or any of the authors act as a consultant,
industry? Yes. employee (part time or full time) or shareholder of an
industry? No.
268
EFFICACY OF PROLIFT SYSTEM IN THE TREATMENT
269
OF PELVIC FLOOR DISORDERS: EXPERIENCE
HISTOLOGICAL ANALYSIS OF PERI-PROSTHETIC
AFTER FIRST HUNDRED CASES
TISSUES OF MESH EXPLANTED FOR COMPLICATION
Rechberger, T; Futyma, K; Adamiak, A; Gogacz, M;
AFTER SUI OR POP SURGERY
Skorupski, P; Tomaszewski, J
Yahi, YH1; Clavé, CH2; Hammou, JCH3; Gounon, GP4;
II Department of Gynecology, Medical University of
Cosson, MC1
Lublin, Poland
S150
1
Gyencology CHRU, Lille, France; 2Gynecology Clinique
Saint George, Nice, France; 3Anatomo-pathology, Nice,
France; 4Electronic Microscopy Sofia Antipolis, France
Introduction: the use of synthetic meshes in SUI and POP
surgery increase. Complications such as exposition, infec-
tion and retraction are described. The purpose of this study
is to analyse links between clinical complications and
histological findings.
Materials and methods: This study is a multicentric
retrospective study realized over a period of 2 years. A
bank of 100 mesh samples implanted for SUI or POP
surgery were included. The clinical complications leading
to the explantation are listed: exposition, infection, retrac-
tion. A histological study of each mesh sample was realized
after Haematoxylin-Eosin-Saffron staining. We analysed
the correlation between clinical complications, type of mesh
and histological results.
Results: 84% mesh samples could be analysed (n=84/100).
The mesh bank was composed of 4 mesh types: 60,5%
polypropylene monofilament (PPMF, n=51/84), 14,5% poly-
propylene multi filament (APP, n=12/84), 15% polyethylene
terephthalate (PET, n=13/84), 10% polypropylene and poly-
glactine (PP/PGA, n=8/84). The histological analysis allowed
to define 3 types of histological reactions: 43% cases of
predominant infection (type I, n=36/84), 43% cases of
predominant chronic inflammation (type II, n=36/84), 14%
sclerosis reactions (type III, n=12/84). Except for the infection
and the type I, other clinical findings were not correlated with
histological findings. Histological types I and II were present
in all mesh groups even for PPMF. Histological type III was
found in PET and more often in PPMF.
Conclusion: except in case of infection, there is a bad
correlation between clinical findings at time of mesh
explantation and histological analysis. Predominant infec-
tion and chronic inflammation were observed in most cases
even for PPMF. The study shows the use of histological
analysis to improve the knowledge of complications in
order to improve treatment. More studies are required to
analyse the link between PPMF and infection which is not
all well described in the literature.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? Yes, by Sofradim.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
270
INTERMITTENT PELVIC FLOOR STIMULATION
FOR TREATMENT OF URINARY URGE
INCONTINENCE PATIENTS
Jong, PR de1; Farnsworth, B2; Radziszewsk, P3; Borkowski,
A3; O’Connell, HE4; Nordling, J5; Parsons, M6; Cardozo,
L6; Chapple, C7; Cervigni, M8; Rosamilia, A9; Groen, J10;
Bosch, RJLH11; Nissenkorn, I12
1
Groote Schuur Hospital, Obstetrics and Gynecology, Cape
Town, South Africa; 2Sydney Adventist Hospital, Center
for Pelvic Reconstructive Surgery, Sydney, Australia;
3
University of Warsaw School of Medicine, Urology,
Warsaw, Poland; 4Royal Melbourne Hospital, NeuroUrol-
ogy Unit, Melbourne, Australia; 5Herlev Hospital, Urology,
Herlev, Denmark; 6King’s College Hospital, Urogynaecol-
ogy, London, UK; 7Royal Hallamshire Hospital, Urology
Research, Sheffield, UK; 8San Carlo di Nancy Hospital,
Urogynaecology, Rome, Italy; 9Monash Medical Center,
Obstetrics and Gynecology, Melbourne, Australia; 10Eras-
mus Medical Center, Urology, Rotterdam, The Netherlands;
11
University Medical Center, Urology, Utrecht, The Nether-
lands; 12Sackler School of Medicine Tel-Aviv University,
Surgery/Urology, Tel Aviv, Israel
Objective: Urinary Urge Incontinence (UUI) is one of the
symptoms associated with Overactive Bladder (OAB) and
affects 33% of all OAB sufferers. It is defined as the
involuntary and accidental loss of urine when a person is
aware of the need to get to the bathroom but is not able to
hold the urine long enough to get there. The gender-specific
prevalence differs substantially by severity of symptoms. In
women, the prevalence of UUI and OAB ranges from 2
(aged 18–24 years) to 19% (aged 65–74 years), increasing
markedly after 44 years of age. The most common cause of
UUI is involuntary detrusor muscle contraction resulting in
leakage.
Materials and methods: 16 female patients, mean age
59 years old (range: 23–79 years), were eligible for
permanent intermittent pelvic floor stimulation and partic-
ipated in a self-controlled, prospective study (miniaturo™-I
system, BioControl, Israel). All patients underwent a
screening procedure and subsequently a simple surgical
procedure in which a bipolar electrode was placed adjacent
to the mid-urethra and connected to a pulse generator
located subcutaneously in the anterior abdominal wall. We
present the efficacy of the treatment on two major objective
symptoms: UUI and Urinary Frequency (UF). All subjects
completed a voiding diary at baseline and 6 months post
operation.
Results: Leakage episodes were reduced by 65.1% from
11.4±8.6 times at baseline to 4.0±4.3 times at 6 months, p
<0.001 (median 8.8 and 2.3, respectively). 5/16 patients
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
were completely dry, 8/16 patients had more than 50%
reduction in leakage episodes, 2/16 had an average
reduction of 32% and for one patient the number of leakage
episodes increased from 2.7 to 4.7 times per day. The
average of UF changed by 42.3% from 18.2±6.8 at baseline
to 10.5±3.7 times/day at study endpoint, p=<0.001 (median
16.4 and 10.5, respectively). 6/16 subjects experienced more
than 50% reduction in UF; for 9/16 patients the average
reduction of UF was 31% and one patient reported no change
in UF.
Conclusion: Patients can achieve symptomatic improve-
ment in UUI with this form of electrostimulation. Longer
follow-up period is required to establish the efficacy of this
method.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by BioControl
Medical (BCM) Ltd..
Level of support: industry initiated, executed and funded study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
271
MONARC VS BURCH IN COMBINED SURGERY
Velasco, JCA; Ehrman, P
CEMIC University Hospital, Buenos Aires, Argentina
Objective: To analyze the time consumed and the morbid-
ity associated in performing SUI surgical treatment with
two methods: (A) classical Burch colposuspension and (B)
Monarc transobturator technique during major combined
surgical procedure.
Materials and methods: During 12 months (dec. 06/dec.
07) an homogeneous team of surgeons (JCV and PH)
operated a total of 14 patients with MONARC standard
procedure (group B) simultaneously combined with 13
hysterectomies, 8 abdominal colposacropexies,14 posterior
colporraphies, 14 perineoplasties, 6 dermolipectomies, 5
rectus anterior overlapping surgery.
During 24 months (oct.04 and nov.06) the same team
operated a total of 31 patients with classical Burch
colposuspension (Group A) in combination with 26
hysterectomies, 4 multiple myomectomies, 31 posterior
colporraphies, 8 dermolipectomies, 8 rectus anterior over-
lapping technique, 1 bilateral oophorectomy-both groups
have similar demographic characteristics-all the patients
have urodynamically proved stress incontinence, and stage
III or IV genital prolapse (POP-Q). Postoperative controls
were taken at 1, 3, 6,12, 18 and 24 months by the same
team of surgeons.
S151
Results: At sixth months SUI was cured in 12/14 (85.71%)
patients of group A (MONARC) and in 27/31 (87.09%) of
group B. There was 2 haematomas in group B and one
partially obstructed, managed conservatively. Mean time
consumed in group A during surgery were 227 minutes
(135–339) and in group B 249 minutes (158–304) (NS).
Mean time for MONARC was 16±4,2 minutes and 25±
5,2 minutes for classic Burch (p<0.01).
Conclusions: There is a significant difference in time
consumed which favors the use of MONARC in major
procedures where operating time is a important variable.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
272
NAZCA: A MONOPROSTHESIS
FOR THE SIMULTANEOUS MANAGEMENT
OF CYSTOCELE AND STRESS URINARY
INCONTINENCE: A PROSPECTIVE
MULTICENTRIC STUDY
Palma, P1; Riccetto, C1; Muller, V1; Fraga, R1; Sarsoti, C2;
Contreras-Ortiz, O2; Paladini, M2; Cianci, A2; Adile, B3;
Barthos, P4
1
University of Campinas, Brazil; 2Argentina; 3Italy; 4Czech
Republic
Objective: NAZCA is a device system that allows for
correction of stress urinary incontinence (SUI) and anterior
vaginal wall prolapse at the same time. The aim of this
open prospective multicentric trial was to evaluate the
safety and efficacy of this new mesh.
Materials and methods: A total of 100 women with
anterior vaginal wall prolapse associated or not with SUI
underwent a combined approach, pre pubic and trans-
obturator, 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. The ICIQ-SF question-
naire 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. A midline incision is made
from the midurethra to the 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
S152
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 previ-
ously 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 tension. Next the helical
transobturator needles are inserted parallel to the ascending
ramus of the pubic bone, and turning the wrist and guided
by the surgeon index finger, exit through the vaginal
incision. After connectors fixation the inferior tapes are
pulled through till the lateral edge of the cystocele. Vaginal
incision is closed using overlap technique to avoid contact
of the suture line with the mesh. Finally, the remaining flap
is sutured over the interposed flap to cover it. A Foley
catheter and vaginal packing is let in place overnight.
Results: Seventy tree patients were cured of the anterior
prolapse. There was 1 recurrence. SUI persisted in 3 (4%)
patients. The mean ICI-q value was 2,9. Complications
included 3 meshes exposure (4%), dyspareunia in 2 (2.7%),
1 (1.4%) patient developed enterocele. The Anova test was
used to compare the results. There were significant
improvement in ICIQ as well in the POP-Q results.
Conclusion: Preliminary results are very encouraging,
demonstrating a safe and effective procedure. Mesh
exposure incidence was low, comparing with others similar
devices. SUI was cures in 78% of the cases and no de novo
SUI or overactive bladder symptoms were observed in this
series.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
273
OBTRYX (TM) SYSTEM: TRANSOBTURATORY
OUT-IN SLING IN THE TREATMENT OF ISOLATED
OR POP-ASSOCIATED URINARY INCONTINENCE
Dati, S1; Dutto, L2; Micali, F2; Finazzi Agrò, E2; Di Luzio,
F1; Cinque, B3
1
Urogynecology and Reconstructive Pelvic Surgery Unit,
’Policlinico Casilino’ Hospital, Rome, Italy; 2Department
of Urology, University of Rome ’Tor Vergata’, Rome, Italy;
3
Department of Obstetrics and Gynecology, ‘Policlinico
Casilino’ Hospital, Rome, Italy
Objective: The objective of our study was to evaluate,
through a prospective medium term clinical trial, the
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
feasibility and effectiveness of a mini-invasive tension free
transobturatory access (TOT) procedure with a sub-urethral
polypropylene monofilament sling Obtryx™ (Boston Sci-
entific, Natick, MA, USA) with the use of an ‘out-in’
access in the treatment of isolated or pelvic organ prolapse
(POP) associated stress urinary incontinence (SUI).
Materials and methods: From February 2005 to Novem-
ber 2006 37 pts consecutively underwent TOT procedure
using Obtryx™. All pts presented with SUI, which was
associated to urge incontinence (mixed incontinence) in 7
(18.9%) pts. All pts had positive stress test with urethral
hypermobility. Isolated SUI was present in 11 (29.7%) pts
and a concomitant POP was observed in 26 (70.3%) pts (all
stadium III or IV of the POP-Q System) who were treated
with associated procedures. All pts underwent a complete
urogynaecological workup based on ST, Q-Tip test, bladder
diary, urodynamic evaluation, POP Q-System and VAS for
prolapse and quality of life questionnaires: UDI 6 s.f., IIQ 7
s.f. and PISQ-12 for the 18 sexually active pts. Mean age
was 55.6 (38–70a.), mean BMI 27.9 (18–44), mean parity
2.1; mean n° pads/day 2.1. The 7 pts who suffered from
OAB-DO related mixed incontinence have been pretreated
with antimuscarinic drugs for 8 weeks prior to the
procedure. Follow up visits were performed at 3, 6, 12
and 24 months. In our study pts were considered as ’cured’
if showing a negative stress test and if the use of pads was
no longer necessary after treatment.
Results: Mean operating time was 24.5 min. No intra-
operative or immediately postoperative complications were
observed. No voiding difficulty, urinary tract infections or
acute urinary retention were observed after decatheteriza-
tion. At a mean follow-up of 11.6 months cure rate was
91.9%(34/37 pts). 5 out of the 7 pts with mixed
incontinence no longer referred OAB-related symptoms.
Adverse events include: 2 relapsing SUI (5.4%), 2 partial
extrusions of the mesh (5.4%), of which 1 pt resulted
continent and 1 pt incontinent (2.7%), at 13 and 16 months
that have been treated with an office-based procedure and 2
‘de novo’ urge incontinence (5.4%) which were success-
fully treated with antimuscarinics. The postoperative ques-
tionnaires scores for UDI 6 s.f. (preop. mean 10.6, postop.
mean 0.3, p<0.01) and IIQ 7 s.f. (preop mean 12.5, postop
mean 0.8, p<0.01) demonstrated a significant improvement
in the QL assessment.
Conclusion: preliminary results of the Obtryx™ TOT sling
highlight its effectiveness and simplicity of use in the
treatment of isolated- or POP-associated SUI and the low
percentage of adverse events in the medium term. Such
promising results will obviously need to be confirmed in a
long term trial and on a wider number of cases.
Disclosures
Was consent obtained from patients? Yes.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244 S153

Was this work supported by industry? No. Overall, most women mostly or strongly agreed that the
Does the presenter or any of the authors act as a consultant, questionnaire was relevant to their condition (96%) and that
employee (part time or full time) or shareholder of an it helped them communicate about their problem (92%).
industry? No. 96% mostly or strongly agreed the statement relating to
ease of completion & 92% agreed that that they would be
happy to use it again as part of their future care. When
274 comparing the performance of the ePAQ in the different
PATIENT EXPERIENCE OF AN ELECTRONIC centres using the Anova test, there was a statistically
QUESTIONNAIRE IN CLINICAL PRACTICE significant difference in the patient experience in centre D
Jha, S1; Radley, S1; Toozs-Hobson, P2; Parsons, M2; (N=9 patients) when compared to the other centres.
Brown, S3; El Naqa, A4; Farkas, A1; Jones, G5 Conclusion: The e-PAQ has high patient value and low
1
Royal Hallamshire Hospital, Sheffield Teaching Hospitals bother when used in routine clinical practice. It performed
NHS Trust, UK; 2Birmingham Women’s Hospital, Birming- well in all centres, though its acceptability was greatest in
ham Women’s Health care NHS Trust, UK; 3Northern the centre where it was already established as a clinical tool
General Hospital, Sheffield Teaching Hospitals NHS Trust, (Centre A) when compared with newer centres (Centre D).
UK; 4New Cross Hospital, Royal Wolverhampton Hospitals
NHS Trust, UK; 5Lecturer in Social Science, University of Disclosures
Sheffield, UK Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Objective: The electronic pelvic floor assessment ques- Does the presenter or any of the authors act as a consultant,
tionnaire (e-PAQ) is an interactive, web-based computer- employee (part time or full time) or shareholder of an
ised interview, designed for use in routine clinical practice. industry? Yes.
It offers a user-friendly clinical tool, which provides valid
and reliable data and enables comprehensive symptom
assessment in 4 dimensions: Urinary, Bowel, Vaginal & 277
Sexual. It is now being used in several UK hospitals. The POTENTIAL RISK FACTORS OF TRANSIENT
objective of this study was to evaluate patients’ experience URINARY RETENTION AFTER TRANSOBTURATOR
of using the e-PAQ in clinical practice. TENSION-FREE VAGINAL TAPE PROCEDURE
Materials and methods: Data was collected from 4 clinics FOR FEMALE URINARY INCONTINENCE: A LARGE
(A, B, C, D) currently using e-PAQ. 93 women completing RETROSPECTIVE STUDY
the e-PAQ were asked their views of the electronic Bae, JH1; Cho, DH1; Lee, JG1
1
questionnaire using the QQ-10; a 10-item questionnaire. Korea University, Seoul, Korea
The QQ-10 assesses patients’ views on varied aspects of the
value & burden of e-PAQ use during their clinical episode. Objectives: To identify the potential risk factors for
Preliminary psychometric testing of the QQ-10 supports its transient urinary retention associated with after transobtu-
validity as a tool for the evaluation of questionnaire use in rator tension-free vaginal tape (TOT) procedure.
clinical practice. Each item includes a statement about the
patient’s experience of using the questionnaire during their
Total Group I Group II P value
clinical episode, followed by a 5-point Likert response scale Age (yr) 52.7±8.8 50.4±8.9 52.9±8.8 0.287
from ‘strongly disagree’ to ‘strongly agree’. Two domain Qmax (mL/sec) 26.6±9.6 21.2±10.9 27.1±9.3 0.015
scores are computed, 6 items being grouped as positive PVR (mL) 17.7±28.5 41.8±58.1 15.7±23.7 0.094
(value of using the questionnaire) and 4 items negative Pdetmax (cmH2O) 27.1±12.0 30.6±14.4 28.6±11.7 0.06
(burden of using the questionnaire). Raw scores were VLPP 65.9±31.0 92.6±35.0 63.7±29.7 <0.001
transformed on a scale of 0 to 100 (0 being the worst
possible view and 100 the best possible view). Mean scores Materials and methods: We reviewed 210 medical records
for the value & burden scales were calculated and of SUI patients who had TOT procedure. The patients who
independent t test used to assess differences between had transient urinary retention more than 24 hours after
groups. The results of responses were also compared TOT procedure, defined as Group I (n=16) and the others
between centres and analysed using Anova. as Group II (n=294). The patients who had tape cutting
Results: Responses to individual QQ-10 items found that because of prolonged or severe retention were excluded.
the overall acceptability for e-PAQ was high. The mean Preoperatively, whole subjects were evaluated with history
score for positive items (value of e-PAQ) was 83.9 and for taking, physical examination and complete multichannel
negative items (burden of e-PAQ) was 79.4 (p<0.001). urodynamic study. Age, previous pelvic surgery history, co-
S154 Int Urogynecol J (2007) 18 (Suppl 1):S107–S244

existence of cystocele, number of vaginal delivery and all Does the presenter or any of the authors act as a consultant,
the urodynamic parameters were compared between group I employee (part time or full time) or shareholder of an
and II. industry? No.
Total Group I Group II P value
Diabetes 1.0
(+) 15 (7.1%) 1 (6.3%) 14 (7.2%) 278
(–) 195 (92.9%) 15 (93.8%) 180 (92.8%) PREDICTION OF EARLY POSTOPERATIVE URINARY
Cystocele repair 0.025 RETENTION AFTER TENSION-FREE VAGINAL TAPE
(+) 26 (12.4%) 5 (33.3%) 21 (10.8%) Papanikolaou, NS; Duckett, JRA
(–) 184 (87.6%) 10 (66.7%) 174 (89.2%) Medway Maritime Hospital, Gillingham, UK
Maximal flow rate <0.001
(Qmax, mL/sec) Objective: To determine whether early postoperative
15≤ 24 (11.4%) 7 (43.8%) 17 (8.8%)
voiding dysfunction can be predicted before inserting a
>20 150 (71.4%) 8 (50.0%) 142 (73.2%)
Post-voiding residual 0.009 TVT, so that patients can be counselled regarding the need
urine volume for clean intermittent self catheterisation.
(PVR, mL) Materials and methods: Multiple parameters including
20≤ 161 (76.7%) 10 (62.5%) 151 (77.8%) demographic data, history of previous anti-incontinence
20∼40 30 (143%) 2 (12.5%) 28 (14.4%) surgery, anaesthetic type, operator experience, type of
4∼60 8 (3.8%) 0 8 (4.1%) surgical procedure (TVT alone or combined with other
>60 11 (5.2%) 4 (25.0%) 7 (3.6%)
prolapse surgery) and preoperative urodynamic studies
Maximal detrusor 0.070
pressure (Pdetmax,
were analysed by univariate analysis and stepwise multiple
cmH2O) logistic regression. The data from 500 women was
20≤ 66 (31.4%) 4 (25.0%) 62 (32.0%) prospectively collected.
20∼40 115 (54.8%) 5 (31.3%) 110 (56.7%) Results: Early voiding dysfunction occurred in 5.8% of
>40 29 (13.8%) 7 (43.8%) 22 (11.3%) women postoperatively. Using stepwise multiple logistic
Valsalva leak-point 0.004 0.004 regression voiding by other than detrusor contraction (p<
pressure (VLPP, 0.05), pre-operative pressure flow rate less than 15 ml/sec
cmH2O)
(p<0.01) and general anaesthesia (p<0.05) were the only
30≤ 20 (9.5%) 0 20 (10.3%)
30∼60 84 (40.0%) 4 (25.0%) 80 (41.2%)
factors that predicted early post-operative voiding dysfunc-
60∼90 63 (30.0%) 4 (25.0%) 59 (30.4%) tion. The point estimate relative risks were 4.2, 2.9 and 5.2
>90 43 (20.5%) 8 (50.0%) 35 (18.0%) respectively. Despite this, the positive predicting values
were 11.4%, 11.8% and 16.1% and the sensitivity 21%,
41.3% and 17.24% respectively.
Results: Of the subjects, 16 patients (7.6%) had transient Conclusion: Despite statistically significant associations
retention. The retention was spontaneously resolved within with early voiding dysfunction the positive predictive
8 days in all patients. The means of maximal uroflow rate values of the identified factors remain low, limiting the
(Qmax) and valsalva leak point pressure (VLPP) was accurate prediction of early voiding dysfunction.
significantly different between group I and II. The other
parameters were not significantly different between groups. Disclosures
Multivariant analysis showed that only VLPP had signifi- Was consent obtained from patients? Yes.
cance. Linear by linear association analysis showed that Was this work supported by industry? No.
cystocele repair, Qmax, post void residual urine volume Does the presenter or any of the authors act as a consultant,
(PVR) and VLPP had significantly related to transient employee (part time or full time) or shareholder of an
retention. industry? No.
Conclusion: On the basis of our analysis, potential risk
factors for transient retention might be low Qmax and high
VLPP. Accordingly, the patients who had low Qmax and 279
high VLPP need to be cautioned for transient urinary PREOPERATIVE ASSESSMENT OF PATIENT
retention. CENTERED OUTCOMES: CURE, IMPROVEMENT
AND FAILURE
Disclosures Aigmueller, TA; Bartmann, IB; Riss, PR
Was consent obtained from patients? No. KH Moedling, Vienna
Was this work supported by industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: Patient centered outcomes (EGGS-expectations,
goals set, goals achieved, satisfaction) have been proposed
to evaluate the result of pelvic reconstructive surgery. In
this pilot study we developed a tool for the preoperative
assessment of expectations and goals set by the patient
undergoing pelvic reconstructive surgery.
Method: We constructed a survey including the questions
on the preoperative expectations of the patient in regard to
their hospital experience, communication with the physi-
cians, and postoperative recovery period. In the second part
we asked the patient about the goals set in connection with
surgery: change in quality of life, and impact on typical life
style events. The survey was administered by a physician
on the day prior to surgery and after informed consent had
been obtained by the hospital staff. The survey was offered
to patients undergoing pelvic reconstructive surgery and
benign gynaecologic surgery. We then evaluated the
feasibility of the survey in the preoperative setting.
Results: The survey was given to 25 asymptomatic patients
undergoing gynaecologic surgery for benign conditions,
and to 25 patients undergoing pelvic reconstructive surgery
for symptomatic prolapse or urinary incontinence. We
found that asymptomatic patients had difficulty describing
their expectations and were unable to define goals they
hoped to achieve with the operation. On the other hand
patients with functional disorders had clearly defined goals
in connection with the operation. In general both groups of
patients had great difficulty in describing specific expec-
tations in connection with the hospital stay and the recovery
period.
Conclusion: Patient centered outcomes have to focus on
the specific complaints and symptoms of the patient.
Patients have great difficulty verbalizing their expectations
and in general do not seem to attach much importance to
them. However patients are able to describe specific goals-
changes in quality of life and lifestyle events-they hope to
achieve with the surgery. These goals should be the points
of reference for follow up examinations.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
280
PREVALENCE AND ATTITUDES TOWARDS
URINARY AND FAECAL INCONTINENCE
AMONG NORTH AFRICAN WOMEN (SUDANESE)
S155
Elmadi, A1; Mustafa, N2; Abuzeid, H3; Nar, A4
1
Stafford General Hospital, UK; 2Ribat University Hospital,
Khartoum, Sudan; 3Soba University Hospital, Khartoum,
Sudan; 4Khartoum Teaching Hospital, Khartoum, Sudan
Objective: To determine the prevalence and attitude of
urinary and faecal incontinence among North African
Women (Sudanese) and to assess the basic knowledge and
treatment-seeking behaviors among women with urinary
and faecal incontinence.
Methodology: This study of 535 women attending gynae-
cological outpatients’ clinics in Khartoum over a 4 week
period (15 November-15 December 2006) was undertaken
by completing a structured questionnaire. All participants
gave informed consent prior to inclusion into the study. The
main exclusion criteria were pregnant women, those with
urinary or bowel symptoms and those with a history of
bowel disease.
The pre-tested questionnaire included demographic details
as well as clinical data relating to urinary and faecal
incontinence-knowledge, practice and attitude towards the
disease. The data was analyzed using SPSS and summa-
rized using frequency counts and percentages.
Results: The prevalence of urinary incontinence among
Sudanese women was found to be 19.6% of which 14.6%
was stress incontinence, 12% was urge incontinence and
4.1% mixed incontinence.
On the contrary the prevalence of faecal incontinence was
almost negligible.
17.1% of women sought medical advice while 82.9% did
not. The reasons were multifactorial, 39.1% thought it was
a normal aging process, 49.4% thought it was a normal
result of child birth, 8% were embarrassed.
Conclusion: This study confirms that urinary incontinence
is quite common amongst North African (Sudanese)
women. The attitudes towards the disease are not surpris-
ingly similar to the western literature.
The authors hope that addressing the objectives of this
study would encourage young researchers within the
African continent to look into this disease area and
contribute with studies to advance the management of
incontinence with technologies appropriate to the develop-
ing countries.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
S156
281
REPEATABILITY OF DIGITAL PALPATION
FOR THE DETECTION OF LEVATOR TRAUMA
Dietz, HP; Shek, KL
University of Sydney, Australia
Objective: It has recently become clear that trauma to the
levator ani muscle is a common consequence of vaginal
childbirth. While palpation for the diagnosis of such trauma
has never been systematically assessed, it should be
possible to detect major defects by digital examination.
From previous data it appears that the correlation between
palpation by a conventionally trained physiotherapist and
ultrasound assessment may be very poor (kappa 0.1). In this
study we tested for agreement between two trained
examiners and between ultrasound and either of those two
examiners.
Methods: 110 women were seen in a tertiary urogynaeco-
logical unit. They were interviewed and underwent an
examination using the ICS POP-Q staging system, assess-
ment of the levator ani muscle by digital palpation as well
as 3D/ 4D translabial ultrasound. Both examiners were
blinded against ultrasound findings and against each other’s
clinical findings. The second observer had been trained for
a total of over 100 cases before commencement of this
study. Ultrasound volume data was retrospectively analysed
using tomographic ultrasound (GE Kretz 4D View v 5.0),
blinded against clinical results.
Results: Mean age of patients was 55.5 (range 17–85)
years, median parity was 2 (range 0–8). Three patients
could not be assessed due to vaginal atrophy or scarring,
leaving 107 datasets representing 214 assessments of a right
or left pubovisceral muscle. Presenting complaints were
stress incontinence (85/110) urge incontinence (82/110) and
prolapse (46/110). Levator defects were found in 21/110
women (19%), with 9 bilateral defects. On blinded
assessment by palpation, there was agreement between
assessors in 173/214 (81%), yielding a Cohen’s kappa of
0.411, signifying moderate agreement. Agreement between
the observers and an independent blinded review of
tomographic ultrasound data was k=0.495 (observer 1)
and 0.382 (observer 2). Agreement between clinical
examiners was 78% for the first 50 and 84% for the last
50, also indicating some degree of teaching effect.
Conclusion: Even after substantial training, agreement
between assessors using digital palpation for the diagnosis
of levator trauma remains moderate to poor. There seems to
be a substantial learning curve. Palpatory detection of major
levator trauma is clearly less repeatable than identification
by ultrasound (kappa=0.83 on analysis of whole volumes
and kappa=0.61 for single slices) as shown by the authors
previously.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
282
TENSION READJUSTABLE SLING IN ISD
ASSOCIATED WITH GENITAL PROLAPSES
Dati, S1; Leanza, V2
1
Department of Obstetrics and Gynecology, Urogynecology
and Reconstructive Pelvic Surgery Unit, ‘Policlinico
Casilino’ Hospital, Rome, Italy; 2Department of Obstetrics
and Gynecology, Catania University, Italy
Objective: To verify practicability and effectiveness of
TRT procedure (Tension Readjustable Tape) in treatment of
patients affected by ISD associated with POP and urethral
hyper/hypomobility in a retrospective trial with middle-
term follow-up.
Materials and methods: Since April 2004 till November
2006 we selected 29 patients affected by ISD associated to
≤III stage (ICS POP-Q) pelvic prolapses. Diagnostic course
included: score symptoms, micturation diary, Inghelman-
Sundberg grading, Q Tip Test, POP-Q score prolapse staging,
supine stress test (Hsu), Agachan-Wexner score, complete
urodynamic, 1 h. pad test (ICS), UDI-6 s.f. and IIQ 7 s.f.,
sexual questionnaire PISQ-12. ISD diagnosis was based on
subjective ‘symptom’ severity and on high negative incidence
of MUCP<30 cmh2O (insufficiently reproducible, unsteady
and with various pathogenesis). Patients middle-age was
58.2, parity was 2.3 (1–5), 26/29 were menopausal. POP-Q
score average point of Ba was −0.4 cm in 9 pts (I stage),
+0.2 cm in 15 pts (II stage) and +1.8 cm in 5 pts (III stage).
22 pts were at III grading and 7 at II Inghelman grading. 17
pts were affected by urethral hypermobility >35°, 10<30°
and 2<15° (previously treated with urethrolysis). 20 pts
showed a 1 h. Pad test>50 gr. and 9 pts had test between 10
and 50 gr. All patients were positive to Stress Test. V.L.P.P.
(McGuire) was <60 cmH2O and MUCP was <30 cmH2O in
14 pts and >30 in the other 15 ones. OAB dry without
detrusor overactivity in 10. Validated questionnaire UDI 6 s.f.
was 9.8, IIQ 7 s.f.m. was 16.9 and in 19 pts sexually active
PISQ-12 m. was 26.7. Intra-postoperative complications did
not occurred. Mean hospitalization time was 4 days; catheter
was removed after 48 h from intervention; first readjustment
was made after 6–12 h from catheter removal. During fourth
day patients were discharged: stress test negative and P.R.U.
<100 ml. Second adjustment was made after 7 days from
discharge in the outpatient’s department and external manip-
ulator was removed.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Results: We performed follow-up according to subjective/
objective examination (mean f.u. 17.1 months) and V.L.P.P. at
6 months. We evaluated effectiveness of associated ISD
procedure subjectively/objectively in 26/29 pts (89.6%). At 6–
8 months 2 pts underwent to tension readjustment in D.H. We
had 2 failure (seroma) and we had to remove the device, 1 SUI
post readjustment. (6.9%) were ‘de novo’ affected by urge. 2
pts had wound infection and were treated topically. 2/10 OAB
dry with anticholinergic drugs. No mesh extrusions/erosions.
Conclusion: Analysis of results supports: intraoperative
low procedure complications, low short/mean term follow-
up morbidity, high therapeutic effectiveness, advantage of
mesh tension in any time
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
283
THE COMPARISION OF ABDOMINAL LEAK POINT
PRESSURE AND 1-HOUR PAD TEST IN THE PATIENT
WITH STRESS URINARY INCONTINENCE
Kim, H1; Lee, KS2; Choo, MS3; Park, WH4
1
Department of Urology, Kangdong Sacred Heart Hospital,
Hallym University, Seoul, Korea; 2Department of Urology,
Sungkyunkwan University, Samsung Medical Center,
Seoul, Korea; 3Department of Urology, Asan Medical
Center, Seoul, Korea; 4Department of Urology, Inha
University Hospital, Incheon, Korea
Objective: The aim of this study was to determine whether
or not the 1-hour pad test demonstrates the objective
severity of female stress urinary incontinence.
Materials and methods: One hundred eighteen female
patients with stress urinary incontinence symptom were
prospectively evaluated with a 1-hour pad test as recom-
mended by ICS and they also underwent videourodynamics
to determine the ALPP. The patients were divided into 2
groups by the ALPP: group A (n=94) was the low leak point
pressure group (ALPP≤100 cmH2O), and group B (n=24)
was the high leak point pressure group (ALPP>100 cmH2O
or no leakage). A pad test gain≤2 g was considered a
negative pad test. Student’s t-test was done to evaluate the
difference of urine leakage between two groups.
Results: The mean amount of urine leakage measured by 1-
hour pad test for groups A and B were 53.4±47.2 and 50.9±
53.9g respectively, and there was no statistically significant
differences between two groups (p = 0.839). Eighteen
(15.2%) women did not leak during ALPP measurement
S157
and 6 (5.1%) women had a negative pad test. Among the 18
women with no leakage on the ALPP, 15 had a positive pad
test and 3 had a negative pad test. Among the 6 women with
a negative pad test, 3 had leakage and 3 had no leakage
during the ALPP measurement. One hundred fifteen patients
received an operation for stress urinary incontinence. The
three patients who had no leakage on ALPP and who also
had a negative pad test did not received the operation.
Conclusion: These data suggest that the 1-hour pad test did
not demonstrate the objective severity of stress urinary
incontinence. However, the 1-hour pad test was more
sensitivity to demonstrate the leakage than the ALPP;
therefore, in case of no leakage during the ALPP
measurement, the 1-hour pad test is needed to check the
leakage.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
284
THE EPIDEMIOLOGICAL STUDY OF WOMEN
WITH URINARY INCONTINENCE IN CHINA
Zhu, I; Lang, J
Peking Union Medical College Hospital, Beijing, PRC
Objectives: To evaluate the prevalence, type, associated
risk factors and consultation rates of women with urinary
incontinence in China. Methods In the cross-sectional
study, 20000 Chinese women aged ≥20 years were
interviewed through a questionnaire including Bristol
Female Lower Urinary Tract Symptoms Questionnaires,
BFLUTS). Excluding unevaluable questionnaires, which
included in analysis is 19024. The mean (± standard
deviation) age of sample was 45 (±16). The data were
analysed as 10-year age, Divided into eight age groups.
Results: The overall prevalence of urinary incontinence
(UI) was 30.9%(5876/19024), while stress urinary incon-
tinence (SUI), urge urinary incontinence (UUI) and mixed
urinary incontinence (MUI) was 18.9% (3596/19024),
2.6% (489/19024) and 9.4% (1791/19024), respectively.
Their structural proportion was 61%:8%:31%. SUI was the
most prevalent type in 50-year age group for 28% (814/
2885), although the prevalence of MUI increased with age.
About 25% (948/3793) women with UI had consulted a
doctor for it.
Conclusions: The prevalence of UI is relative high, SUI is
the commonest type in China; Older age, vaginal delivery,
S158 Int Urogynecol J (2007) 18 (Suppl 1):S107–S244

multipara, drinking, central obesity (female waist circum-

Pre- 6 months post- p-
ference ≥80 cm), constipation, chronic pelvic pain (CPP), operative operative value
the previous disease of respiratory system, Gynecological Ba (undergoing anterior +3(0/9) −3(−3/0) 0.02
events, pelvic surgery and peri-menopausal period as well prolift n=23)
as menopause are potential risk factors for SUI. The Bp (undergoing posterior +1(−3/9) −2(−3/4) 0.02
consultation rate of UI is low in China included in this prolift n=30)
study: only 25%. C (undergoing total −4(−5/6) −8(−8/−7) 0.02
prolift n=7)
UDI genital prolapse 67(0–100) 0(0–67) <0.001
Disclosures UDI discomfort/pain 33(0–100) 0(0–100) 0.006
Was consent obtained from patients? Yes. UDI obstructive 33(0–100) 0(0–67) <0.001
Was this work supported by industry? Yes, by national micturation
scientific nature foundation. DDI constipation 0(0–50) 0(0–50) NS
Level of support? No industry support in study design or DDI obstructed 8(0–67) 0(0–67) NS
defecation
execution.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an Data in medians with range; high score on UDI/DDI means
industry? No. more bother.
Conclusion. Our first experience with the Tension free
Vaginal Mesh system is promising. The technique was easy
285 to perform in all patients. Anatomical results (POP-Q) and
TOTAL VAGINAL MESH IN PELVIC ORGAN subjective results (UDI) after six months have significantly
PROLAPSE: RESULTS AFTER SIX MONTHS improved. There were only few complications and 8%
Withagen, MIJ1; Milani, AL2; Akker, PAJ van den1; erosion occurred.
Kluivers, KB1; Vierhout, ME1
1
St Radboud Hospital, Nijmegen, The Netherlands; Disclosures
2
Reinier de Graaf Groep, Delft, The Netherlands Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Objective: To evaluate the Prolift® (Tension free Vaginal
Does the presenter or any of the authors act as a consultant,
Mesh) procedure in two centres.
employee (part time or full time) or shareholder of an
Materials and methods: In two centres, specialised in
industry? No.3
pelvic organ dysfunction, prolapse surgery with the Prolift®
system was undertaken from September 2005 onward.
Preoperatively all patients underwent a pelvic organ
286
prolapse quantification (POP-Q) assessment and filled in a
TRANSOBTURATOR CROSSOVER READJUSTABLE
disease-specific quality of life questionnaire (Urogenital
SLING IN A SEVERE SUBSET FEMALE INCONTINENT
Distress Inventory (UDI) and the Defecatory Distress
PATIENTS:TECHNIQUEANDPRELIMINARYRESULTS
Inventory (DDI)). Surgery was performed by four gynae-
Palma, P1; Riccetto, C1; Fraga, R1; Dambros, M1;
cologists, trained for the Prolift procedure. Complications
Muller, V1; Grossi, O2
were registered. Patients were examined six months and 1
University of Campinas, Brazil; 2Argentina
one year after surgery. (POP-Q and disease-specific quality
of life questionnaires) Data were analysed with SPSS,
version 12.0.1, Wilcoxon Signed Rank test was used. Objective: In spite of improvement in techniques and
Results: 105 patients underwent prolapse surgery with a devices to treat Urinary Incontinence, there is a subset of
Prolift® procedure. Until now six months follow-up was patients refractory to standard anti-incontinence procedures.
achieved in 49 patients. Median age was 62 years (range Those patients may benefit from more obstructive slings, that
19–80). Median hospital stay was 4 days (range 3–11 days). may be achieved fixing the sling with some tension while tied
In five patients complications occurred during the operation down with more tension than in usual circumstance or ideally
or postoperative: two bladder lesions (1.9%), a tiny lesion using a reajustable sling. We present a technique that provides
of the serosa of the rectum (0.9%), one urinary retention circumferential coaptation of the urethra as a salvage
and one post-operative hemorrhage. After 6 months we procedure in this severe subset of patients.
found four erosions, two were treated with estrogens and in Materials and methods: We prospectively evaluated 16
two minor surgical intervention was needed. patients who had a transobturator crossover sling. Adjust-
able hybrid slings were used and silicone washer were used
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
over the anchoring columns to keep them in place and to
facilitate any posterior adjustments (Figs. 1 and 2).
Results: Mean age of our patients was 58 years and mean
follow up was 12 months. At presentation patients had
undergone a mean of 3.0 incontinence procedures and wore
a mean of 6 pads daily. There was a mean 93.7% overall
cure in symptoms. There was one intraoperative complica-
tions (urethra perfuration) that was resolved by closing the
wall urethra. De novo urge incontinence developed in 2/16
patients. All patients (3/16) who had preoperative urge
incontinence achieved resolution with the procedure.
Conclusion: The transobturator crossover sling is an effec-
tive salvage procedure that may be considered in a selected
subset of female patients with a nonfunctional urethra.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
288
UNSUSPECTED LOWER URINARY TRACT
DYSFUNCTION IN NEUROLOGICALLY NORMAL
ADULT INCONTINENT INDIAN WOMEN
Sinha, S; Sinha, R; Kumar, S; Leela, B; Srinivas, K;
Sharma, R
Medwin Hospital, Hyderabad, India
Objective: The study was carried out to assess the
prevalence of unsuspected lower urinary tract dysfunction
in neurologically normal adult incontinent Indian women.
Additionally, the accuracy of a clinical diagnosis of the type
of urinary incontinence was ascertained by comparison with
urodynamics diagnosis.
Materials and methods: This retrospective study of 121
women analyzed urodynamic findings and clinical presen-
tation for all neurologically normal adult incontinent
women who underwent urodynamics at our center. All
had detailed history, examination, focused neuro-urological
examination, stress test and ultrasonography. Those with
neurological problems, any voiding symptoms, severe
constipation or large residual were excluded. Study includ-
ed all women with stress incontinence and women who had
failed conservative treatment (lifestyle change, anticholi-
nergics) for urge incontinence. Patients were classified into
3 clinical groups: I (n=48) pure clinical stress incontinence
SUI, II (n=31) pure clinical urge incontinence UI, and III
(n=42) clinical mixed incontinence MUI. All patients
underwent urodynamics as per the International Continence
S159
Society ‘Good Urodynamics Practice Guidelines’ on a
Laborie machine. Predominant urodynamics finding was
recorded as the primary urodynamics diagnosis. This was
compared with the clinical diagnosis. This included
provocative testing and leak point pressure testing.
Results: Of 48 in group I, 40 had SUI and 8 had other
diagnoses (1 each had poor compliance, acontractility,
dysfunctional voiding; 5 normal). Of 31 in group II, 20
had detrusor overactivity, 2 had SUI, 9 had other
diagnoses (4 bladder outlet obstruction, 1 each had
acontractililty, poor compliance; 3 normal). Of 42 in
group III, 10 had MUI, 23 had SUI and 9 had other
diagnoses (5 detrusor overactivity, 4 normal). 73/90
patients with clinical SUI could have their diagnosis
confirmed. 35/73 patients with clinical UI had their
diagnosis confirmed. No abnormality was demonstrable
in about 10% of each group. Unsuspected lower urinary
tract dysfunction was found in 9/121patients (4 in group I,
5 in group II and 0 in group III. No specific clinical group
was more likely to have unsuspected lower urinary tract
dysfunction. The negative predictive value of clinical
evaluation was very high at 93.5% and 100% for SUI and
UI respectively but the positive predictive values were low.
Conclusion: Unsuspected lower urinary tract dysfunction is
not uncommon in neurologically normal adult incontinent
Indian women. Clinical evaluation can exclude stress or
urge incontinence in this group. However, the positive
predictive value of the diagnosis is low and urodynamics
may completely alter the line of evaluation and manage-
ment in some of these women.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
289
URINARY INCONTINENCE AND SEXUAL
DYSFUNCTION IN RELATION TO PREGNANCY
AND LABOUR
Sottner, O1; Zahumensky, J1; Krcmar, M1; Hurt, K1;
Kolarik, D1; Brtnicka, H1; Dvorska, M1; Zmrhalova, B1;
Gabriel, B2; Halaska, MJ3; Krofta, L4; Halaska, M1
1
Department of OB/Gyn, Teaching Hospital Na Bulovce,
Charles University, Prague, Czech Republic; 2Department
of OB/Gyn, Freiburg University Medical Centre, University
of Freiburg, Germany; 3Department of OB/Gyn, Teaching
Hospital Motol, Charles University, Prague, Czech Republic;
4
Institute for the Care of Mother and Child, Prague, Czech
Republic
S160
Objective: The aim of our study is to objectify the
influence of pregnancy and labour on the incidence of
urinary incontinence and sexual dysfunction.
Materials and methods: All primiparas who gave birth at
our maternity ward from June 12, 2004 through February
28, 2005 were included into our study, i.e. 499 females
were asked for cooperation. The data on occurrence of
urinary incontinence and sexual dysfunction was collected
via two questionnaires. We used modified questionnaires
from the Oxford study of Barrett et al. The first question-
naire was distributed on the day two or three after the
delivery and the second one six months after it. We had
these standard questionnaires in six versions (Czech,
English, Chinese, Vietnamese, Russian and Ukrainian).
All our findings were statistically analysed using Chi
square test and Student’s t-test. The results were considered
to be significant if p<0,05. The study was approved by the
local Ethics Committee and the informed consent was
obtained. Our project was supported by Grant of Ministry
of Health of Czech Republic.
Results: The response rate was approximately 75%. We
found the statistically significant increase in the occurrence
of urinary incontinence during pregnancy followed by the
significant decrease immediately after the delivery (p=
0,0001). 63% of females reported urinary incontinence at
the end of pregnancy on the contrary to the baseline
prevalence before it of 15%. High prevalence at the end of
pregnancy decreased back to 16% six months after the
labour. The ratio of stress to urge urinary incontinence
changes during the pregnancy and puerperium; proportion
of urge incontinence grows in time. In the issue of
incontinence after the labour we proved significance of just
one obstetrical factor-it was the protective influence of
Caesarean Section.
Concerning sexual dysfunction, 43% of females report
worsening of sexual life and 19% of them suffer from the
significant dyspareunia six months after the labour. We
found significance of some risk factors (both obstetrical and
else) for the occurrence of dyspareunia-education, episiot-
omy, rupture of vaginal wall extended to the vault, duration
of the second stage of a labour more than 60 minutes and a
longer healing process of the wound.
Conclusion: Our results document the importance of
pregnancy as a risk period for the onset of urinary
incontinence but most of this impact seems to be
transitional, at least in the short run. Although we
documented some factors for worsening of sexual life after
the delivery, we are not able to propose the universal
protective recommendations at this stage of our study.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Ministry of
Health of the Czech Republic.
Level of support? No industry support in study design or
execution.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
290
COMMONALITIES AMONG WOMEN WHO
DEVELOPED VESICO-VAGINAL FISTULAE
AS A RESULT OF OBSTETRIC TRAUMA IN NIGER:
RESULTS FROM A SURVEY GIVEN
AT THE NATIONAL HOSPITAL FISTULA CENTER,
NIAMEY, NIGER BY THE INTERNATIONAL
ORGANIZATION FOR WOMEN AND DEVELOPMENT
Ascher-Walsh, CJAW1; Meyer, LM2; Norman, RN3;
Idrissa, AI4; Kimso, OK4; Herbert, HH5; Wilkinson, JW6
1
Mt Sinai School of Medicine, New York, USA; 2Columbia
University, New York, USA; 3Stanford University, CA,
USA; 4National Hospital, Niamey, Niger; 5Rochester
School of Medicine, NY, USA; 6Duke University, Chapel
Hill, NC, USA
Objective: To evaluate the histories of women suffering
from urinary incontinence due to vesico-vaginal fistulae as
the result of obstetric trauma by questioning women who
underwent vesico-vaginal fistulae repair at the National
Hospital in Niamey, Niger. This is a critical review to attempt
to determine possible risk factors for the development of
vesico-vaginal fistulae and to identify social or medical
practices that could decrease the incidence of this trauma.
Methods: From 9/05 to 1/06, 58 women who were treated
for vesico-vaginal fistulae at the National Hospital in
Niamey, Niger were given a questionnaire to better
understand the history leading to the development of their
conditions.
Results: Among these patients, the average age of marriage
was 13.9 years and the average age during the first
pregnancy was 16.0 years. 94.8% of the women began
their labor at home primarily being cared for by a family
member. By the time of delivery, 91.4% had gone to a
health care center. The average length of labor in these
women was 2.61 days and the average length of labor
before seeking further assistance was 1.61 days. 91.4% of
these women gave birth to stillborn infants, and by 2 days
post-partum, 96.6% of the babies were dead. 22.4%
delivered by caesarean section, 13.8% with forceps assis-
tance and 63.8% via spontaneous vaginal route. For 44.9%
of the women, this was their first pregnancy. 51.7% had
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
between 1–7 live births before this last pregnancy. For
multiparous women, only 28.1% believed that this labor
was different from previous labors in which live infants
were born.
Conclusion: Early marriage and young age at first
pregnancy have long been thought to be risk factors for
the development of obstetric fistulae. This is confirmed in
our patient population. Length of labor is also directly
related to the development of fistulae. The average length
of labor in our population was 2.6 days. More significant,
however, is that it was not until an average of 1.6 days that
our patients considered seeking additional help for their
delivery. The most common reason given for this delay was
that it was very far to the nearest health care station. Most
of these women were able to deliver vaginally even after
going to a health care center but the vast majority gave birth
to stillborn infants or infants who died shortly after
delivery. The most obvious problem for these women is
lack of medical attention in the early stages of their labor.
Given a reported maternal mortality in Niger reported at
approximately 1%, increasing access to healthcare in early
labor is of paramount importance if improvements are to be
made in this area.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
291
DOES THE IMPACT OF INCONTINENCE RISK
FACTORS DEPEND ON CONTINENCE STATUS
DURING 1ST PREGNANCY OR POST PARTUM
PERIOD 12 YEARS BEFORE?
Viktrup, L1; Rortveit, G2; Lose, G1
1
Glostrup Hospital, University of Copenhagen, Denmark;
2
Section for General Practice, Department of Public Health
and Primary Health Care, University of Bergen, Norway,
and Research Unit for General Practice, Unifob Health,
Bergen, Norway
Objective: To assess the impact of known risk factors for
urinary incontinence (UI) in two groups of women with
different history of UI; women who were incontinent
during their 1st pregnancy or post partum period and
women without such initial symptoms.
Methods: In a longitudinal cohort study 242 women
answered validated questions about UI after 1st delivery
and 12 years later. Ten women were excluded from
S161
analyses due to pre-pregnancy UI or missing data on UI
status at the time of first pregnancy and post partum period.
The participants were divided into two risk groups; Group1;
those who were continent during 1st pregnancy or post
partum period, and Group 2; those who were incontinent
during these time periods.
Risk factors for UI were investigated, and all results
stratified by group status.
Results: In group 1, 32.6% (44/135) had UI symptoms
12 years after the first delivery (12-year incidence).
Corresponding figure in group 2 was 66.0% (64/97) (P<0.05).
Overweight (body mass index ≥25) was a strong risk factor
in group 1 with an RR of 2.5 (95% confidence interval 1.5–
4.1), but not in group 2 (RR 1.1, CI 0.9–1.5).
Pelvic organ prolapse symptoms were strongly associated
with UI in group 1 (RR 2.1, CI 1.3–3.5), but weaker in
group 2 (RR 1.6, CI 1.3–2.0). Heavy lifting at work was
associated with a higher risk in group 1 (RR 1.7, CI 1.0–
2.9) compared to group 2 (RR 0.9, CI 0.6–1.3), though the
risk was insignificant in both groups.
Other risk factors such as age, breastfeeding >=6 months
after 1st or 2nd delivery, smoking status, bowel habits and
straining with bowel movements or urinary infections last
year did not seem to be associated differentially with UI in
the two groups.
Conclusion: The impact of different non-obstetric risk
factors for UI symptoms in pre-and peri-menopausal
women seems to vary depending on UI status during their
1st pregnancy or post partum period years before. Women
without initial UI seem to be more affected by present risk
factors.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
292
FUNCTIONAL AND ANATOMICAL OUTCOME
OF PROLAPSE REPAIR SURGERY USING PROLIFT
MESH AT 6 MONTHS
Roberts, CH; Nnochiri, A; Rostom, N; Barnick, C
Homerton University Hospital, London, UK
Objective: To evaluate preliminary results of prolapse
surgery using Prolift mesh in a single surgical centre in
women followed up for at least 6 months.
Materials and methods: Forty women with symptomatic
prolapse were included in this study. Patients underwent
surgery between April 2005 and July 2006. Pre-operatively
S162
patients had a standardised history taken using a structured
questionnaire and pelvic organ prolapse (POP-Q) assess-
ment. Patients were operated on by one of 2 Consultants
trained in the procedure. Peri and post operative complica-
tions were recorded. Patients were reviewed at 6 weeks and
6 months with regard to the functional and anatomical
outcome.
Results: 2 patients were lost to follow up in the study
period. All 40 patients had previously complained of a
bothersome lump, 30/40 had associated bladder symptoms,
7/40 troublesome bowel symptoms. All had at least stage
III prolapse. 19/40 had at least one previous surgical
procedure for prolapse.
A total of 23 anterior, 29 posterior and 3 total Prolift
meshes were inserted. 13 additional procedures performed
at the same time-9 TVT-O, 4 cervical amputations. The
operation time was 30–100 minutes (mean 60 min) with
blood loss 50–400 ml (mean 143 ml). There were 4
immediate/early complications comprising 2 bladder perfo-
rations (primary repair, no mesh inserted), 1 case of
postoperative urinary retention and 1 thigh haematoma.
Follow-up at 6 months revealed 1 case of recurrent uterine
prolapse in a woman who had undergone anterior and
posterior Prolift with uterine conservation. She subsequent-
ly required hysterectomy and laparoscopic sacrocolpopexy.
There was one case of asymptomatic stage II anterior wall
prolapse in a woman who had undergone anterior Prolift
(38/40–95% no recurrent prolapse). 6 of the first 16 patients
operated on in the first 4 months of this study developed
prolapse of another compartment requiring intervention (4
anterior Prolift procedures where posterior Prolift had been
performed, 2 amputation of the cervix). No further patients
developed new prolapse.
1/7 patients with preoperative bowel symptoms complained
of post operative constipation. 5/23 patients with overactive
bladder symptoms preoperatively had symptoms at
6 months. There were 4 cases of pain or dyspareunia (1
requiring excision of mesh) and 2 significant mesh erosions
(5%). One patient required division of anterior mesh
causing bladder outflow obstruction.
Conclusion: Prolift mesh repair is a safe procedure whose
precise role requires careful evaluation.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
293
IMPACT OF THE GENITAL HIATUS ON RECURRENCE
OF ANTERIOR VAGINAL WALL PROLAPSE
Medina, CA; Takacs, P
Miller School of Medicine, Jackson Memorial Hospital,
Miami, FL, USA
Objective: To determine if the aperture of the genital hiatus
has an effect on anterior vaginal wall support and determine
recurrence following anterior repair.
Materials and methods: Retrospective case-control study
comparing women undergoing anterior repair for vaginal
wall prolapse at Jackson Memorial Hospital between
January 2002 and March 2006. Patients were excluded if
they had a concurrent posterior repair, perineorrhaphy or
graft augmentation. During this time period 65 patients
were identified, but only 51 patients are included in this
study and 14 were excluded because of having a genital
hiatus between 4 and 5 cm or incomplete data set. Patients
were divided into two groups, the study group with a large
genital hiatus (≥5 cm) and the normal group with a genital
hiatus ≤4 cm. Failure in the anterior vaginal wall was
defined as a POP-Q score of −2 or greater. Data was
analyzed utilizing the paired and unpaired t-test and Fisher
exact test.
Results: The overall rate of recurrent prolapse at the anterior
vaginal wall for the entire cohort was 21.6% (11/51). There
were 35 (68.6%) patients with large genital hiatus (LGH) and
16 (31.4%) with normal genital hiatus (NGH). There was not
significant difference in mean age (57.7±12.3 vs. 60.9±
12.7 years), median parity (2 (R 1–5) vs. 3 (R 1–5) or mean
weight (83.7 ± 18.9 vs. 78.7 ± 23.3 kg). There was no
significant difference between the two groups in preopera-
tive POP-Q points Aa, Ba, C, Pb, TVL, Ap and Bp. The
genital hiatus was significantly larger in the LGH group as
expected (median 6 cm vs 4 cm). There was no difference in
number of concurrent procedures between the two groups.
There was a greater failure rate in the LGH group 22.8% (8/
35) than in the NGH group 18.8% (3/16), however, this was
not statistically significant. Of interest, the two patients that
sustained a stage 2 recurrence in the anterior vaginal wall
were in the LGH group.
Conclusion: Although there is a trend for patients with a
larger genital hiatus to sustain recurrent prolapse of the
anterior vaginal wall following anterior repair, this was not
statistically significant. Concurrent attention to apical
support remains an important feature when correcting
anterior vaginal wall prolapse.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
294
INFRACOCCIGEAL SLINGPLASTY:
AN OBSERVATIONAL STUDY
Geo, MS; Lima, RSBC; Laranjeira, CLS; Figueredo, JM;
Iaminn, LA; Menezes, AC
Mater Dei Hospital, Belo Horizonte, Brazil
Objective: Evaluate all patients who submitted to infra-
coccigeal slingplasty in a Urogynecology Unit of a tertiary
private Hospital according to anatomical and functional
results and complications.
Materials and methods: All women who submitted to
infracoccigeal slingplasty (n=46) were evaluated pre and
post operative according to symptomatology and anatom-
ical parameters (January 2003 to December 2006). This
study is a part of a tertiary private hospital surveillance to
evaluate the results of each surgical procedure realized by
the urogynecology team. We divided the symptoms in local
(vaginal laxity, vaginal lump) and intestinal (constipation,
chronic straining, fecal incontinence, incomplete evacua-
tion). All patients were staged using the POP-Q method of
genital prolapse evaluation. All the data were carefully
analyzed in the interview and examination of pre-operative
and post-operative (3 m, 6 m and annually).
Results: the median follow-up was 25 months (3–
47 months), age between 32 to 84 years old, parity vary 0
to 13. The infracoccigeal slingplasty was used to treat
symptomatic posterior and apical prolapse described by
Petros in 1999. 40 women had another associated procedure
(transobturatory and transvaginal slings to treat stress
incontinence demonstrated by urodynamics-38 and vaginal
hysterectomy-2). Previously the surgical procedure 95%
(42/44) had posterior vaginal wall prolapse > stage 2 :31–
70% stage 2; 10 (23%) stage 3 and 1 (2%) stage 4. 43
(98%) women had apical prolapse >2: 28–64% stage 2; 14
(32%) stage 3 and 1 (2%) stage 4. The symptomatology
profile before the procedure were: 29 (66%) complained of
a vaginal lump; 18 (41%) vaginal laxity; 15 (34%) chronic
straining to evacuate; 13 (30%) fecal incontinence and 2
(5%) intestinal constipation.
The anatomical improvement was 42 (95%) had posterior
vaginal wall prolapse 0 or 1 and 40 (91%) patients had apical
prolapse stage 0 or 1 after the procedure. The functional
improvement was: 87% (13/15) in chronic straining; 92%
(12/13) in fecal incontinence; 50% (1/2) intestinal constipa-
tion; 93% (27/29) in vaginal lump and 83% (15/18) in
vaginal laxity. The complications observed were 2 cases of
S163
anterior prolapse stage 2 and 3; one vaginal extrusion of the
mesh and 1 patient recurrence of apical prolapse.
Conclusion: This observational study where there was no
selection of patients showed good functional and anatom-
ical results. This kind of study demonstrate a real routine of
a private practice but has limitations concerning the power
of evidence. Other studies with a great number of patients
are necessary to confirm these findings
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
295
LOWER URINARY TRACT INJURIES ASSOCIATED
WITH THE OUT-IN TRANSOBTURATOR TAPE: IS
CYSTOSCOPY REQUIRED? AN ARGENTINEAN
MULTICENTER EXPERIENCE
Altuna, S1; Lombroni, J1; Sänger, I2; Cahaud, S2; Perez
Junqueira, S3; Sarsotti, C4; Galarga, R5
1
Hospital Austral, Buenos Aires, Argentina; 2Hospital
Penna, Buenos Aires, Argentina; 3OSECAC, Buenos Aires,
Argentina; 4OSECAC, Buenos Aires, Argentina; 5Hospital
RVR Gatiezza, Monte Chingolo, Argentina
Objective: Identify urethral and bladder injuries associated
with the use of out-in transobturator tapes and the
consequent necessity of performing cystoscopy during this
procedure in three
Materials and methods: A retrospective study of patients
who had the out in TOT technique for the management of
SUI between January 2005 & December 2006 at three
major centers in Argentina. Four different types or tapes
were used (Monarc®, Safyre T®, Unitape® and Obtryx®)
Tapes were placed using the classic fashion or ‘blindly’
which means without placing the index finger in the
dissected paraurethral channel.
Cystoscopy was done in all cases as part of the Residence
teaching program. Surgeons involved were staff members
as well as fellows and residents. LUT injuries were
examined.
Results: During the aforementioned period 226 patients
underwent the procedure, including 155 Monarc 16 Safyre,
48 Unitape, 7Obtryx respectively. 135 (59,7%) women
received concomitant vaginal reconstructive surgery. A total
of three patients (1,3%) with a distal urethral puncture were
identified, all of them diagnosed by direct vision. No bladder
injuries seen. Both lesions were seen in the ‘blindly’ group.
All lesions were in TOT exclusive procedures and were
S164
managed with 72 hs Foley catheterization. No differences in
surgeon’s training seen. No sequelae.
Conclusion: LUT injury is an extremely rare complication
of the out-in TOT procedure irrespective of the technique
used. Intra-operative cystoscopy is a short and safe
procedure. Though seeming unnecessary and avoidable, in
our opinion it should still be considered as part of the safety
measures in pelvic reconstructive surgeries as LUT injuries
could happen, moreover when teaching institutions like
ours are considered.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
296
OBSTETRIC URINARY FISTULA IN KWAZULU-
NATAL, SOUTH AFRICA
Ramphal, SR; Kalane, G; Fourie, T; Moodley, J
University of KwaZulu-Natal, South Africa
Objective: To perform a clinical and surgical audit of
women with obstetric urinary fistula (OUF) attending the
Urogynaecological Unit at King Edward VIII Hospital
(Durban) from 1999–2003.
Materials and methods: The hospital records of all
women with OUF were prospectively reviewed using a
structured data form. Demographic, clinical and detailed
obstetric, neonatal and surgical data were noted. For the
purpose of this report, OUF was classified into three
categories, viz. 1) simple vesicovaginal fistulae (VVF); 2)
complicated VVF and 3) vesico-uterine fistulae. Successful
repair was defined as total continence.
Results: A total of 41 cases from the rural areas of
KwaZulu-Natal were identified. The mean age was
29 years (15–51), the mean parity was 3 and 21 were
primigravida, 14 of whom had unplanned pregnancies.
The mean weight was 48.2 Kg (38–80) and 48% weighed
≤50 Kg. Thirty four were less than 150 cm in height
(118–168). All were from low social economic back-
ground and had limited or no access to antenatal care. The
duration of labour was prolonged in all cases. There were
5 live births, 2 of whom died neonatally. Eleven of the 41
had previously failed surgery. The route of repair was
abdominal in 26, vaginal in 13 and 2 had a combined
approach. Specific to VVF repair in the unit, 12 were
operated by an urologist, 10 by a gynaecologist and the
remainder by both disciplines. 22 had simple VVF repair
of which 8 were high lesions (above the trigone). 4 had
previous repairs, 9 were operated vaginally and 13
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
abdominally. At the time of discharge, 19 of the 22 were
continent. 14 were complicated VVF. All had extensive
fistulae involving trigone, bladder neck and proximal
urethra. 6 underwent primary repair (2 vaginal, 4
abdominal) with successful outcome in four. The 2
vaginally operated patients had closure of fistula but
urethral incontinence. Three of the other 7 who had had
failed primary surgery in other hospitals and another with
irreparable damage underwent Mainz 2 uretero-sigmoidos-
tomy with success. Four patients had vesico-uterine and
one had an uretero-utero-vaginal fistulae following cae-
sarean sections. All the fistulae in this category were
successfully repaired. At the time of discharge, 33 of the
41 were continent. Of the remaining 8, 5 had urethral
incontinence, and 3 had true surgical failures.
Conclusion: This study showed that OUF is still a problem
in Southern Africa and surgical repair by experienced
personnel in specialised units results in good outcomes.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
297
PATIENT INDICATIONS FOR LABIA MINORA LASER
REDUCTION SURGERY
Miklos, JR1; Moore, RD1; Simopoulos, A2
1
Atlanta Urogynecology Associates, GA, USA; 2Laser
Vaginal Rejuvenation of Los Angeles, CA, USA
Objective: To identify patient indications for seeking
surgical reduction of the labia minora and whether there
exists outside influences affecting the decision to pursue the
procedure.
Methods: The medical records of 131 patients undergoing
labiaplasty over a 32 month period were reviewed
retrospectively. Three subsets of patients were evaluated:
Patients seeking the procedure strictly for aesthetic reasons,
patients with identifiable functional impairment/symptoms
(pain and discomfort), and patients with both aesthetic and
symptomatic motives to undergo treatment. Of the patients
undergoing the procedure for aesthetic reasons, it was
determined whether the decision for surgery was strictly
personal or was influenced either by a male partner or a
female friend and/or partner.
Results: Of the 131 labiaplasty procedures, Group 1 (n=
49) were identified as patients undergoing the procedure
strictly for cosmetic reasons and comprised 37% of the
total. Group 2 (n= 42) were patients undergoing the
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
procedure for symptomatic reasons (discomfort wearing
clothing, during exercise and activity or during intercourse)
and comprised 32% of the total. Group 3 (n=40) underwent
the procedure for aesthetic and symptomatic reasons and
comprised 31% of the total. Of the patients in group 1, four
(8.2%) admitted being influenced by their male partners as
reason to seek the procedure. Group 2 patients uniformly
sought treatment due to symptoms and within group 3
(combined symptoms/aesthetic), three patients (7.5%) were
influenced by their male partners and two (5%) were
influenced by other females to consider the procedure. Of
the patients in groups 2 and 3, 54% had more than one
symptom with 55% describing discomfort while wearing
clothing, 46% with discomfort during exercise and activity,
and 60% with painful intercourse. Of all study patients,
forty nine (37%) underwent labiaplasty for purely cosmetic
reasons, and eighty two (63%) had one or more symptom-
atic complaints as motivating factors for surgery. 93.1% of
the study population sought surgery due to purely personal
reasons and 6.9% admitted to being influenced by a male
partner or female friend or partner as a factor in deciding to
undergo the procedure.
Conclusion: The majority of patients undergoing laser
labia reduction do so for functional/symptomatic reasons
with minimal outside influences affecting their decision for
treatment.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
298
PRE-PUBIC PATHWAY IN THE TREATMENT
OF STRESS URINARY INCONTINENCE (SUI)
AND CYSTOCELE
Vito, L1; Stefano, D2; Nicola, G3
1
Obstetric and Gynecologic Department; 2Urogynecologic
Unit, Casilino Policlinic Hospital, Rome, Italy; 3Obstetric
and Gynecologic Unit
Objective: A prospective open study was conducted to
evaluate the pre-pubic pathway to solve both incontinence
and cystocele (T.I.C.T.: (Tension-free Incontinence Cysto-
cele Treatment).
Materials and methods: 110 patients suffering from stress
or mixed urinary incontinence were operated by prepubic
route mainly under spinal anaesthesia using fly-shaped
polypropylene mesh. The wings of the mesh anchored by
thread to needle eye are passed in front of pubic bone, wile
S165
the body lies under the bladder. A cough test is done to
modulate the mesh. Evaluation included detailed clinical
examination with stress test, pads, and urodynamic assess-
ments and questionnaires in order to detect prognostic
factors and to have a global treatment policy for associated
low urinary tract symptoms and prolapse.
Results: Mean follow-up time was 25 months No intra-
operative complications occurred. All patients urinated after
catheter removal. The mean post voiding residual urine was
20 ml.
Objectively, S.U.I. was cured in 96 (87%). The cystocele
was cured 98 (89%) patients.
Postoperative complications included neither cases of ’de
novo’ instability nor obstruction, whereas 8 (7%) patients
suffered from urge incontinence, 9 (8.1%) patients from
urgency and 6 (5.4%) patients from pollakiuria. There were
5 cases (4.5%) of erosion treated by the excision of
protruding mesh without suturing vaginal skin and the
pelvic floor was not compromised. During follow-up no
other pelvic procedures were ever requested. Postoperative
Q tip test average was 26 degrees (range 12–50).
No significant modification of sexual activity occurred.
Conclusion: among the various mininvasive techniques,
actually the pre-pubic approach appears the easiest, besides
being both sure and effective for treatment of S.U.I. and
cystocele
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
299
SELF RECOMMENDATION IS NO RECOMMENDATION
Srikrishna, S; Robinson, D; Cardozo, L
1
King’s College Hospital, London, UK
Objective: The primary aim of this study was to correlate
achievement of patient centred goals and overall patient
satisfaction. The secondary aim was to compare patient
satisfaction with that of the operating surgeon.
Materials and methods: This prospective longitudinal
observational study recruited women on the waiting list for
pelvic reconstructive or continence surgery from a tertiary
referral centre. Patients and their operating surgeons listed up to
5 personal goals they hoped to achieve following surgery and
documented degree of goal fulfilment at post operative review.
Patients also completed a Patient Global Impression of
Improvement (PGI-I) score at each review. Patient goals were
categorised as being related primarily to symptom relief, return
S166 Int Urogynecol J (2007) 18 (Suppl 1):S107–S244

to physical activity, social activities, sexual function and body Han, HC; Sharifa, SA; Lee, LC
image. They were also classified as realistic or unrealistic. KK Women’s and Children’s Hospital, Singapore
Surgical goals were categorised as being related to anatomical
correction, functional improvement, avoidance of new bladder/ Objective: To compare the recurrent cystourethrocele rates and
bowel symptoms, avoidance of complications, long term cure complications after standard anterior vaginal wall repair versus
and improvement of Quality of Life. Statistical analysis was anterior vaginal wall repair reinforced with Gynemesh*PS.
done with paired t-test for PGII scores. Materials and methods: A retrospective review of all
Results: 61 women were followed up over 1 year. Patients patients underwent primary anterior vaginal wall repair for
and surgeons reported a total of 218 goals and 254 goals severe cystourethrocele (grade 3 &4 by Baden Walker
with 84.9% and 91.5% mean goal achievement respective- classification) between 25 February 2004 and 20 July 2005.
ly. (Table 1). PGII scores showed an improvement from the One hundred and eight patients were studied: 54 had
6 week review (1.58) and this was maintained at the 1 year standard anterior vaginal wall repair and 54 had anterior
review (1.45) (Graph 1) Patient goals based on symptom vaginal wall repair reinforced with mesh. Before surgery,
relief were more likely to be achieved when compared to 51%(n=55) and 49%(n=53) had grade 3 and 4 cystour-
unrealistic goals and those based on sexual function. ethrocele respectively. Patients were followed up for up to
Conclusion: This study confirms that patient centred goals 1 year. Recurrent cystourethrocele was defined as grade 2
are subjective and sometimes unrealistic. Surgeon’s goals anterior vaginal wall prolapse or worse.
are more consistent, largely based on objective outcome Results: There was no difference in demographic data
measures, and more significantly achieved. between the two groups. Preoperatively, 59.3%(n=32) and
38.9%(n=21) had grade 4 cystourethrocele underwent
anterior repair reinforced with mesh and standard anterior
repair, respectively. There were two intraoperative compli-
cations. One rectal perforation in the mesh group and one
excessive blood loss (500 ml) in the control group. Post-
operatively, five patients had fever for 2–3 days in the mesh
group and it was subsided with antibiotic. The duration of
hospitalization and postoperative bladder catheterization
were the same in both groups. Eighty-two patients (76%)
Patient goals % Achieved
came for one-year follow-up (41 with mesh and 41 with no
Symptom relief 91.30
Physical/social activity 81.52 mesh). Six women (14.6%) in the mesh group and 8 women
Sexual function 55.50 (19.5%) in the control group had recurrent cystourethrocele
Body image 86.30 (P>0.5) at 1-year follow-up The incidence of mesh erosion
Surgeon goals % Achieved at one year was 9.7% (4 out of 41 who came for follow-up).
Anatomical cure 96.2 Conclusions: The use of Gynemesh*PS had reduced the
Long term cure 91.70 recurrence rate of cystourethrocele by 5%, although this is
Improve QoL 90.70
not statistically significant. A longer follow-up is recom-
Avoid complications 99.00
mended and a randomized controlled trial is needed for
further evaluation of the role of Gynemesh*PS in cystour-
Disclosures ethrocele repair.
Was consent obtained from patients? Yes.
Was this work supported by industry? No. Disclosures
Does the presenter or any of the authors act as a consultant, Was consent obtained from patients? Yes.
employee (part time or full time) or shareholder of an Was this work supported by industry? No.
industry? No. Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
300 industry? No.
THE INCIDENCE OF RECURRENT
CYSTOURETHROCELE AFTER ANTERIOR
VAGINAL WALL REPAIR 302
WITH AND WITHOUT REINFORCEMENT TRANSURETHRAL BULKING AGENT INJECTION:
WITH POLYPROPYLENE MESH (GYNEMESH *PS) : PROMISSORY RESULTS USING THE NEW ’VANTRIS’
1-YEAR FOLLOW-UP MACROPARTICLE IN THE TREATMENT
OF INTRINSIC SUI
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Zangone, MA1; Gomez, S1; Olmedo, T2; Olea, M2;
Guichard, C2; Palma, C21Hospital Bernardino Rivadavia,
Buenos Aires, Argentina; 2Hospital San Jose Urology Unit,
and Urology Service at Hospital Clínico Universidad de
Chile, Santiago, Chile
Objective: Assess clinical effectiveness and periurethral
tissue permanence of a biocompatible bulking substance for
the treatment of SUI due to intrinsic sphincter deficiency
(ISD).
Materials and methods: In this study, 25 female patients
without vaginal dystopia were incorporated, with clear
semiology of stress incontinence, evaluated by the ques-
tionnaire (ICIQ-SF), 24-hour pad weight test, verified by
physical examination, and urodynamics. The substance
used was a biocompatible polyacrylate/polyalcohol copol-
ymer particle with an average size of 320 microns, without
migration capacity and with excellent periurethral perma-
nence post implant.
It was transurethrally implanted through direct vision,
administered at hours 2, 6, 10 one centimeter from the
bladder neck at the submucosa site of the proximal urethral,
using an average material amount of 6.4 cc (4.5–7.6 cc) in
prefilled 1 cc syringes with a needle made up of a 5 Fr
catheter and a 23 Gauge needle.
Results: With an average 27-month follow-up (15–31).
Mean age was 62 years, with urodynamic parameters lower
than 60 cm of water of leakage pressure. The average of the
preoperative 24-hour pad test was 95 grs.
Follow-up with questionnaire (ICIQ-SF), postoperative pad
test at 30, 90, 180 and 360 days, transvaginal ultrasound,
pelvic CAT with pre-micturition and post-micturition
bladder.
A resolution of the stress urinary incontinence by 80% is
shown in n=13 (52%) patients with total dryness and n=7
(28%) patients with improvement (improvement above or
equal to 65% of the initial urinary incontinence measured
with a 24-hour pad test). Patients with an improvement
below 65% as compared to their initial incontinence
measured with a 24-hour pad test (considered failure): n=
5 cases (20%).
Of the 25 patients, 5 (20%) had reimplantation 90 days after
the first procedure: 2 patients were dry, 1 showed
improvement and 2 failed. Five patients developed acute
urinary retention and required intermittent catheterization
for less than 48 h.
Conclusion: We believe we have obtained promissory
results due to the semiological effectiveness and perma-
nence in the periurethral tissue throughout the follow-up for
more than 15 months, if compared with standard proce-
dures performed with other substances available in Urogi-
necology for ISD treatment.
S167
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by PROM-
EDON.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
303
URETHRAL MYOBLAST INJECTION IN URINARY
STRESS INCONTINENCE
Romero-Nava, LE; Gutierrez-Najar, A; Borja-Cacho, E;
Medina, J
Hospital Angeles del Pedregal, Mexico City, Mexico
Objective: To evaluate the efficiency of urethral myoblast
injection in the treatment of urinary stress incontinence.
Materials and methods: This is a pilot, prospective study
of 6 patients with urodynamic stress incontinence. The
myoblasts were obtained by a biceps biopsy and culture. A
count of 3 million myoblast was injected at the urethral
submucosa under sedation by cystourethroscopy. The
patients were evaluated previous to the procedure and
6 weeks later by q-tip test, cough test with full and empty
bladder, urodynamics studies, King’s health and severity
questionnaires.
Results: Clinically with a median follow-up of 6 weeks all
patients continue without incontinence and showed im-
provement in the tests applied.
Conclusion: Myoblast urethral injection is a new option in
the treatment of urinary stress incontinence. The results
encourage a randomized study versus TVT.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
304
URINE LEAKAGE RELATED TO PHYSICAL FATIGUE
IN WOMEN WITH STRESS URINARY
INCONTINENCE
Deffieux, X; Hubeaux, K; Porcher, R; Jacq, C;
Sheikh Ismael, S; Raibaut, P; Amarenco, G
Objective: Many women with stress urinary incontinence
(SUI) claim to exhibit urine leakage not after a single cough
but following repeated efforts. Moreover, urinary inconti-
S168
nence is sometimes related to physical fatigue, or reported
at the end of the working day. The objective of the current
study was to evaluate the frequency of urine leakage related
to physical fatigue in women presenting with SUI using a
specific questionnaire, and to assess its correlation with the
BFLUTS questionnaire and urodynamic findings.
Materials and methods: 61 SUI and 10 continent women
completed BFLUTS questionnaire and a specific question-
naire focused on urine leakage related to physical fatigue.
Question #1: Does urine leakage get worse when you are
physically exhausted or feel tired? Question #2: Does urine
leakage get worse when you feel physically worn out at the
end of the working day? Question #3: Do you find that
urine leaks out after one cough or several coughs?.
Urodynamic exploration was also performed including
cystometry and sphincterometry. Maximal urethral closure
pressure (MUCP) was evaluated by means of 3 different
MUCP measurements at rest. Then, the patient was asked
to perform 7 successive cough efforts and MUCP was
immediately measured after the last cough effort.
Results: 23 (37%) SUI women claimed to exhibit urine
leakage related to physical fatigue more often than one third
of the time and 29 (47%) claimed to exhibit urinary leakage
only after more than one cough. There was a positive
correlation between the findings of the specific question-
naire and the presence of a sharp decrease in MUCP
following repeated cough efforts: question #1 (p=0.02);
question #2 (p=0.00002); question #3 (p=0.04).
Conclusion: More than one third of the women presenting
with SUI claim to exhibit urine leakage related to physical
fatigue. There is a strong correlation between this ques-
tionnaire focused on urine leakage related to fatigue and the
presence of a decrease in MUCP following repeated
coughs.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
305
URODYNAMICS: CAN THEY PREDICT SUCCESS
OR COMPLICATIONS IN TRANSOBTURATOR (TOT)
PROCEDURES?
Rondini, C; Descouvieres, C; Wenzel, C; Morales, A;
Alvarez, J; Troncoso, F; Aros, S; Troncoso, C
Hospital Padre Hurtado, Universidad del Desarrollo,
Santiago, Chile
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: To evaluate different urodynamic parameters
and their association with success or failure in TOT
procedures.
Materials and methods: We ran a prospective study that
involved 79 stress urinary incontinence (SUI) patients
evaluated by Multichannel Urodynamics (MU). All 79
patients underwent a TOT. We classified our patients
according to Abdominal-Valsalva Leak Point Pressure (A-
VLPP) at 300 cc, setting a cut off point at 60 cm H2O. We
then analyzed the actuarial continence rate at one year
follow up.
We defined surgical success as a dry asymptomatic patient
after one year follow up. Surgical failure was defined as a
patient with any stage of SUI. Urinary retention was
defined as Post Voidal Volume (PVV) of 200 cc or more
at the moment of discharge with spontaneous result or a
patient requiring urethrolysis. The MU retention parameter
predictor analyzed were preoperative Post Voidal volume
≤50 cc and if the patients were in the Blaivas 0 zone or
higher.
Results: All 79 patients underwent a TOT procedure and
were followed for an average of 8.8 months (range 1–36).
Of the 79 patients, 33 had an A-VLPP ≤60 (Group 1) and
46 had >60 (Group 2). The actuarial continence rate at
12 months was 83,0% v/s 80,1% (p=0,58) respectively. 53
patients had a Post Voidal Volume of less than 50 cc and
8 patients had more than 50 cc. Their retention rates were:
7,5% v/s 0% (p=0,42). 56 patients were in Blaivas 0 zone
and 16 were in zone 1 or higher. Their urinary retention
rates at one year were: 7,1% v/s 18,8% respectively (p=
0,167).
Conclusion: In this Study an A-VLPP at 300 cc with a cut
off point of 60 cm H20 does not seems to be associated with
continence status at one year. Apparently, belonging to a
Blaivas zone above 0 seems to be associated with a higher
probability of post operative urinary retention.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
306
ANATOMICAL AND FUNCTIONAL ASSESSMENT
OF VAGINAL PROLAPSE TREATMENT IN WOMEN
UNDERGOING TRANSVAGINAL SYNTHETIC MESH
IMPLANTATION (GYNECARE PROLIFT®)
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Jakimiuk, AJJ; Borucki, WB; Beta, JB; Maciejewski, TM;
Durczyñski, AD
1
Department of Obstetrics/Gynecology, Central Clinical
Hospital of Ministry of Interior and Administration,
Warsaw, Poland
Objective: The study was undertaken to assess the
anatomical and functional outcomes of transvaginal syn-
thetic mesh implantation in the treatment of pelvic organ
prolapse.
Patients and methods: Forty women evaluated preopera-
tively and 6 month after surgery, using the POPQ
classification and HRQOL specific questionnaires (PFDI-
20 and PFIQ-7). All of them underwent the transvaginal
synthetic mesh implantation (Prolift Gynacare, Ethicon,
Poland).
Results: Significant improvement in the prolapse measured
by the POPQ classification (p<0.001) was observed. No
life-threatening complications were noted. One patient
suffered from urinary retention and one from the lumbar
postoperative pain. No single case of mesh erosion was
observed. At follow-up the 100% efficacy of the method
was assessed in 92% of cases. Only in three cases the
recurrence of the prolapse (Stage I) was observed.
Significant improvements in the quality of life in PFDI-20
and PFIQ-7 questionnaires were observed (both p<0.001).
All three scales of the PFDI-20 and PFIQ-7 demonstrated
excellent postoperative responsiveness (SRM: 1.44–1.90,
ES: 0.77–2.27 and SRM: 0.98–1.94, ES: 1.17–2.21
respectively, p<0.001).
Conclusions: Transvaginal synthetic mesh implantation is
an effective, safe and quality-of-life-improving treatment
method.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
307
COMPARATIVE STUDY OF LIGASURE VESSEL
SEALING SYSTEM VERSUS CONVENTIONAL
SUTURE LIGATURE FOR VAGINAL HYSTERECTOMY
Filho, AL; Triginelli, SA; Monteiro, MVC; Rodrigues, AM;
Silva, YMBP; Rosa, DG; Wernwck, RA; Bavoso, N
Department of Gynecology and Obstetrics, School of
Medicine, Federal University of Minas Gerais, Belo
Horizonte, Brazil
S169
Objective: This study was undertaken to compare the use
of Ligasure vessel sealing system with conventional suture
ligature in vaginal hysterectomy (VH) on a non-prolapsed
uterus.
Materials and methods: Women referred for VH for
uterine myoma were randomised to Ligasure (n=30) or
conventional suture ligature VH (n=30). Exclusion criteria
were uterine prolapse and indication associated surgical
procedures. Main outcome measures were operative time,
blood loss, hospital stay, pain status, intra and post
operative complications. Data of patients were collected
prospectively. Statistical analysis was performed using χ2
and Student’s t test as appropriate.
Results: There were no differences in patients’ mean age,
parity and uterine size between groups. Patients in the
Ligasure group had a significantly reduced operating time,
operative blood loss, requirement of surgical sutures, pain
status and hospital stay compared to the control group. The
overall complication rate in the study was 5% (3/60). One
patient in Ligasure sustained a bladder injury and one
patient in the control group underwent conversion to
laparotomy. The patient who had bladder injury had one
previous caesarean section and significant bladder adhe-
sions to the anterior peritoneum. The injury was not related
with the vessel sealing procedure. The bladder lesion was
recognized and treated by abdominal route during the
primary surgery. The conversion to laparotomy was
indicated by non-feasibility of the vaginal route resulting
from a narrow subpubic arch. There was also one patient in
control group with pelvic cellulitis who was treated with
parenteral antibiotics.
Conclusion: The Ligasure vessel sealing system is an
effective and safe haemostatic control method in VH, with
reduced operating time, intraoperative blood losses, post-
operative pain and hospital stay.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Valleylab.
Level of support? No industry support in study design or
execution.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
308
FEMALE SEXUAL DYSFUNCTION-RELATED
FACTORS IN KOREAN WOMEN
Min, KS1; Kang, DI1; Kim, HJ1; Choi, SH2; Bae, JI2
1
Paik Institute of Clinical Research, Inje University, School
of Medicine, Busan, Korea; 2Dankook University, School
of Medicine, Seoul, Korea
S170 Int Urogynecol J (2007) 18 (Suppl 1):S107–S244

Objective: Although concerns for female sexual dysfunc- Materials and methods: Prospective multicenter observa-
tion (FSD) are increasing in Korea, it is very limited in tional study of the Avaulta® anterior and posterior mesh,
basic study for prevalence of FSD or sexual dysfunction- used to correct symptomatic stage 2 or 3 cystoceles and
related factors. The aim of this study was to establish the rectoceles. Functional outcome was assessed with the
basic data for FSD and FSD-related factors in Korean Dutch version of the Urogenital Distress Inventory (UDI).
women. The UDI consists of different domains, with each domain
Materials and methods: One thousand women aged over having a score range between 0 (no symptoms) and 100
20 years old and resident in regional urban and rural area (maximum severity of symptoms). A similar questionnaire
were analyzed by visit survey with an organized question- to assess bowel symptoms was used. Mean differences
naire. Female sexual function index (FSFI) for measurement between pre and postoperative (6 months) symptom
of sexual dysfunction, and pre-validated questionnaires for severity were assessed with a paired sample t-test.
sexual distress scale, sexual attitude, depression scale,
marital adjustment scale, crisis scale and stress event for Results
sex-related factors were used for analysis. Significance
between degree of sexual dysfunction and general demo- Anterior Anterior p- Posterior Posterior p-
graphics of the participants was analyzed by student t-test baseline 6 months value baseline 6 months value
UDI domains N=26 N=23 N=14 N=14
and ANOVA test. Relationship of degree of sexual dysfunc- Overactive 36.7 (5.8) 14.0 (4.0) 0.020 42.1 (8.7) 32.5 (7.7) 0.265
tion and related factors was analyzed by Pearson’s correla- bladder
Obstructive 38.4 (6.0) 8.0 (2.8) 0.000 17.9 (6.9) 15.6 (5.7) 0.756
tion coefficient. micturition
Results: FSFI in Korean women was 19.97±4.87 ranged 7 Discomfort/ 34.8 (5.1) 14.5 (3.4) 0.001 45.3 (8.5) 20.2 (6.4) 0.010
pain
to 29. Of demographics of participants, old age, co- Urinary 24.0 (5.0) 17.4 (3.7) 0.269 26.2 (8.1) 21.4 (6.0) 0.561
morbidity, menopause, medication, no contraception, lon- incontinence
Genital 64.5 (5.0) 9.4 (4.4) 0.000 56.0 (11.1) 4.7 (3.2) 0.000
ger marital duration and lower education were significantly prolapse
related with lower FSFI score. Pearson’s correlation DDI domains N=23 N=23 N=15 N=15
Constipation 13.8 (3.9) 7.3 (2.0) 0.119 23.8 (6.7) 11.1 (3.9) 0.119
coefficient revealed the significance in sexual stress (r= Obstructive 18.8 (4.2) 12.0 (2.7) 0.091 25.6 (6.8) 5.0 (1.6) 0.007
−0.441), degree of depression (r=−0.257), marital adjust- defecation
Painful 13.8 (4.8) 2.1 (1.6) 0.023 5.6 (3.5) 7.8 (6.7) 0.767
ment scale (r=0.303), crisis scale (r=−0.229) and stress defecation
event (r=−0.166) with sexual function index score. Fecal 5.0 (3.5) 10.1 (5.2) 0.373 15.6 (7.7) 8.9 (5.1) 0.450
incontinence
Conclusion: The women with sexual dysfunction should be Incontinence 45.8 (7.4) 41.7 (7.8) 0.636 33.4 (12.4) 25.9 (9.3) 0.342
evaluated for these sexual function-related factors in history for gas
taking, and these data would be a basis for epidemiologic
study for sexual dysfunction. Conclusions: At 6 months follow-up, the use of Avaulta®
anterior and posterior implants showed a dramatic improve-
Disclosures ment in genital prolapse symptoms. The Avaulta® anterior
Was consent obtained from patients? Yes. system also significantly improved other bladder symp-
Was this work supported by industry? No. toms, where the Avaulta® posterior system significantly
Does the presenter or any of the authors act as a consultant, reduced obstructive defecation symptoms.
employee (part time or full time) or shareholder of an
industry? No. Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? Yes, by Bard Co.
309 Level of support? No industry support in study design or
FUNCTIONAL RESULTS OF VAGINAL PROLAPSE execution.
SURGERY WITH THE AVAULTA® COLLAGEN Does the presenter or any of the authors act as a consultant,
COATED MESH MATERIAL employee (part time or full time) or shareholder of an
Vaart, CH van der1; Vollebregt, A2 industry? No.
1
University Medical Center, Utrecht, The Netherlands;
2 310
Spaarne Ziekenhuis, Haarlem, The Netherlands
IS 24 HOURS ENOUGH? DURATION OF BLADDER
Objective: To assess the functional outcome of vaginal CATHETERISATION AFTER ANTERIOR VAGINAL
prolapse repair with the Avaulta® (Bard, USA) collagen WALL REPAIR
coated mesh material (Avaulta®) at 6 months after surgery. Sharifa, SA; Lee, LC; Han, HC
KK Women’s and Children’s Hospital, Singapore
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: To find out if 24 hours bladder catheterization
after anterior vaginal wall repair procedure is sufficient to
prevent post-operative urinary retention (difficulty in
passing urine).
Materials and methods: This is a retrospective study of all
patients who had anterior vaginal wall repair procedure
from 1st July 2006 to 31st August 2006. Patients’ data were
collected and analyzed. Indwelling bladder catheter was
removed on 1st post-operative day and residual urine (RU)
was measured 6 hours later. Patients with RU<150 ml
would be allowed to pass urine at own pace. Patients with
RU≥150 ml would be re-catheterized. On 2nd post-
operative day, trial off catheter would be done again.
Patients with RU>150 ml would be re-catheterised and sent
home with catheter and reviewed at our Urogynaecology
Centre 1 week after discharge.
Results: A total of 29 patients were included in the study.
12 patients were able to pass urine successfully after
removal of the urinary catheter on the first post-operative
day (POD). 17 patients required reinsertion of the catheter.
9 of these patients were successful in passing urine after
removal of the catheter on the second POD. 8 required
catheterization more than 2 days.
Conclusion: Less than 50% of patients were able to pass
urine on the first POD. 58.6% of patients were able to pass
urine by second POD. Our unit’s protocol for catheter care
after anterior vaginal wall repair advised the removal of
urinary catheter on the second POD.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
311
LEVEL SPECIFIC CORRECTION OF APICAL
AND POSTERIOR PROLAPSES:
WHEN TRANS-SACROSPINOUS LIGAMENT
FIXATION MAKES A DIFFERENCE
Palma, P1; Riccetto, C1; Fraga, R1; Dambros, M2;
Pagotto, V1; Grossi, O3; Metrebien, S3; Paladini, M3;
Tejerizo, J3
1
University of Campinas, Brazil; 3UNIFESP, Brazil;
3
Argentina
Objective: Rectoceles are usually associated with other
genital prolapses. There are no conclusive data on its real
incidence. The creation of utero-sacral neoligaments,
S171
described by Petros, evolved into a new procedure allowing
for the anatomical reconstruction of the three levels
proposed by DeLancey.The aim of this study is evaluate
safety and efficacy as well the clinical outcome according
to the level of the defects and its fixation point.
Materials and methods: A multicentric open prospective
study was conduct from December 2004 to October 2006.
The mean follow up was 14 months (9–19). A total of 49
patients with symptomatic vaginal wall prolapse including
apical defect (n=15) and posterior defect (n=34) grade III
and higher underwent this procedure. Mean age was
64,4 years (41–81). The site of fixation was Ileococcigeous
muscle (n=33) and Sacrospinous ligament (n=16). Surgical
Technique: The ischiorectal fossa is dissected. Next two
small skin incisions are made 3 cm lateral and inferior to
the center of the anus.A proper needle is introduced,
vertically towards the ischial spine, guided by the surgeon
index finger, 2 cm medially avoiding the Alcok canal. The
armpit of the mesh is connected to the tip of the needle and
brought to the perineal region. No site specific correction is
made. In most of the cases sacrospinal ligament trans-
fixation was performed when an apical defect was
associated. (Fig. 1)
Results: The cure rate was 94% (46/49) and global
recurrence was 6% (3/49), including one enterocele. It was
observed recurrence related to Ilecoccigeous fixation on
apical defects 9,1% (3/33) and no recurrence related to
sacrospinal ligament. No visceral, nerve or vascular injuries
were observed. The mesh exposure rate was 4% (2/49) with
mean area of exposure of 0,45 cm2. Among the complications
there were dyspareunia 2% (1/49) and dysuria 4% (2/49).
Conclusion: This procedure is an attractive minimally
invasive alternative for the anatomical reconstruction of the
posterior and apical defects. Attention should be paid to the
presence of apical defect associated with posterior vaginal
wall prolapse for it is a risk factor for recurrence. In these
cases sacrospinal fixation is recommended.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
312
MESH SHRINKAGE IN SACROCOLPOPEXY: FACT
OR FICTION?
Digesu, GA; Khullar, V; Fernando, R; Miskry, T; Panayi, D
Department of Obstetrics and Gynaecology, Urogynaecol-
ogy Unit, St Mary’s Hospital, London, UK
S172
Objective: This prospective study aims to evaluate the
mesh shrinkage after a sacrocolpopexy in women with
vaginal vault prolapse.
Materials and methods: Women with symptomatic vagi-
nal vault prolapse were recruited. All women self complet-
ed a Prolapse Quality of Life questionnaire to assess the
severity of prolapse symptoms and were digitally examined
in the left lateral position using the Pelvic Organ Prolapse
Quantification score preoperatively and after 3 months
postoperatively. All women underwent sacrocolpopexy,
either open or laparoscopic using a standardised technique
with attachment of a macroporous polypropylene mesh to
the sacrum and fixed to the vault and posterior wall of the
vagina using ethibond sutures. The mesh was visualised
with a transvaginal ultrasound 5 MHz convex probe placed
at posterior fourchette postoperatively prior to their hospital
discharge and then after 3 months postoperatively. The
distance between the perineum and the caudal edge of the
mesh was measured in cm. The Wilcoxon test was used
(SPSS inc, Chicago, USA) to compare the ultrasonographic
measurements.
Results: Twelve women were studied. Eight women
underwent an open sacrocolpopexy whereas four women
had laparoscopic surgery. The median distance between the
perineum and the caudal edge of the mesh measured
immediately postoperatively and after 3 months postoper-
atively were1.3 cm (interquartile range 1.1–1.9) and 6.1 cm
(interquartile range 4.5–7.0) respectively (p value 0.002).
This meant that the posterior vaginal wall tissue between
the caudal end of the mesh and perineum stretched by 4.6
times during the study time from the postoperative period to
after 3 months.
Conclusion: Our data showed that significant shrinkage of
polypropylene meshes do occur. This may compromise the
repair increasing even more the risk of posterior vaginal
wall prolapse to occur due to the stretching of the tissue.
Thus a new method for performing sacrocolpopexy needs
to be developed to compensate for the shrinkage of the
mesh.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
313
MICROSCOPIC ALTERATIONS OF VAGINAL TISSUE
IN WOMEN WITH PELVIC ORGAN PROLAPSE
Kannan, K; McConnell, A; Rane, A
James Cook University, Townville, Australia
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: There is debate among urogynaecologists about
whether to resuture or excise excess vaginal tissue in
reconstructive surgery. Currently, there is no evidence in
support of either method. The objective of this study was to
identify microscopic changes that occur in vaginal skin that
has prolapsed and compare it to non prolapsed vaginal skin.
A finding that the tissue was markedly altered would have
been in support of the excisional surgical method.
Design: This was a histological study analysing both
prolapsed and normal vaginal tissue sampled from twenty
women booked for prolapse repair surgery from a gynae-
cological practice in Townsville, North Queensland.
Methods: Two tissue samples were taken during routine
surgery for pelvic organ prolapse from each woman in the
study, one of prolapsed vaginal skin and one of normal non-
prolapsed skin. Each tissue sample was stained with multiple
stains and analysed by a blinded pathologist. Fishers exact
test and Chi squared tests were employed to analyse the
findings for statistically significant relationships.
Results: The study found that there were statistically
significant differences between the tissue type, the presence
of myofibroblast differentiation (0.047) and abnormalities
of elastin (0.0483) and collagen (0.0095) depending on
whether the tissue was prolapsed or non-prolapsed. How-
ever the study population was small and there were
problems with the biopsy quality which limited the capacity
of this study to draw absolute conclusions.
Conclusions: Some microscopic components of prolapsed
vaginal skin were shown to be different to that of non-
prolapsed vaginal tissue. Histological analysis of vaginal
tissue is an inherently difficult task. In order to answer the
broader question regarding whether to excise or retain
vaginal tissue during reconstructive surgery, histology alone
is an insufficient indicator and further molecular, biochem-
ical studies may be required.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
314
SEQUENTIAL ASSESSMENT OF URODYNAMIC
FINDINGS BEFORE AND AFTER TRANSOBTURATOR
TAPE OPERATION FOR FEMALE URODYNAMIC
INCONTINENCE
Lin, HH; Hsiao, SM
National Taiwan University College of Medicine and
Hospital, Taipei, Taiwan
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: To sequentially compare the urodynamic find-
ings in patients with urodynamic stress incontinence (USI)
before and after transobturator tape (TOT) operation.
Methods: Between May 2004 and December 2005, 26
consecutive patients with USI who completed multi-
channel urodynamic study and 20-minute pad test before
operation and at 3, 6 and 12 months after operation were
enrolled. The sequential urodynamic findings of each case
were compared and analyzed.
Results: The mean age of the 26 patients was 56.7 years with
the mean parity of 3.3. Based on pad test, the cure and
improvement rates were 69.2% and 30.8%, respectively. No
statistical differences in voiding and storage functions before
and after TOT operation were noted. However, a significant
change of pressure transmission ratio (PTR) at maximal
urethral pressure (MUP) (P=0.013) but not other parameters
of stress urethral pressure profile were observed after
operation. The mean pad weight test decreased from 89 g
to 11.8 g, 3.6 g and 5.6 g at postoperative 3, 6 and 12 months,
respectively (P<0.001). Besides, the improvement group
(n=8) had significant lower mean values of preoperative
MUP and maximal urethral closure pressure (MUCP) than
the cure group (n=18) (P=0.032 and P=0.036, respectively).
Conclusion: This prospective study demonstrated that TOT
operation, if done properly, does not significantly impair
voiding and storage functions. The significantly increased
PTR at MUP may contribute to the high cure rate of TOT
operation. Those patients with lower MUP and MUCP
values are prone not to be continent after TOT operation.
(Grant support from: NSC 94-2314-3-002-213)
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by National
Science Council, Executive Yuan, R.O.C..
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
315
SEXUAL ACTIVITY AND QUALITY OF LIFE DO NOT
IMPACT TREATMENT CHOICES IN WOMEN
WITH PROLAPSE
Lowenstein, LL; Gracia, JG; Mueller, EM; Kenton, KK;
Fitzgerald, MPF; Brubaker, LB
Loyola Medical Center, Chicago, IL, USA
Objective: To determine if condition specific quality of life
(QOL) and sexual activity influences women’s decision for
treatment of their pelvic organ prolapse (POP).
S173
Methods: After obtaining IRB approval, consecutive charts
of new patients presenting to our tertiary care referral
practice with the complaint of pelvic organ prolapse in the
year 2004 were reviewed. The following data was
extracted: demographic information, clinical diagnoses
and responses to the urinary (UDI) and prolapse (POPDI)
subscales of the short form of the Pelvic Floor Distress
Inventory (PFDI). Sexual activity (yes\no), pelvic organ
prolapse staging, and patient treatment decision at the end
of the first visit were also recorded. Data analysis was done
using SPSS Version 13 (Chicago, IL). The Mann-Whitney
test to compare independent groups and the Chi-square test
of association to compare independent groups with respect
to percentages were used.
Results: Ninety-eight women with a mean age of 61 (32–88)
years were included in this analysis. The majority (88%) were
Caucasian and had a median POP stage of 3 (range 2–4).
Twenty percent of the women had a prior hysterectomy, 17%
had a prior prolapse surgery, and 9% had a prior incontinence
surgery. Forty-four women (45%) chose a non-surgical
treatment for their prolapse: (16% observation, 6% pelvic
physical therapy and 22% pessary). Among those who chose
surgical treatment, 50% chose to have an abdominal sacro-
colpopexy, 28% vaginal or abdominal hysterectomy with
uterosacral ligament fixation of the vaginal cuff, 17%
colpocleisis, 3% sacrospinous ligament fixation, and 2% had
a posterior wall repair. Sexual activity did not predict the type
of treatment patients chose (surgical vs. non surgical,
P=.654). Neither POP staging nor the POPDI or UDI scoring
were significantly different when comparing patients who had
sacrocolpopexy versus uterosacral fixation (p=.963, p=.212,
p=.111, respectively). Although surgical patients had more
advanced prolapse compared to the pessary group (p<.001),
the difference in age, POPDI and UDI scoring between the
groups were not statistically significant (p=.856, p=0.06,
p=.553, respectively).
Conclusion: Neither condition specific QOL or sexual
activity influence women’s treatment choice for POP.
Physicians should offer the wide spectrum of treatment
options to women presenting with POP.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
316
STRESS URINARY INCONTINENCE 3 YEARS
AFTER DELIVERY: CORRELATION TO PREGNANCY,
PARITY AND ROUTE OF DELIVERY
S174
Herrmann, V; Palma, P; Riccetto, C; Scarpa, K
University of Campinas, Brazil
Objective: The aim of this study was to evaluate the
incidence of stress urinary incontinence (SUI) 3 years after
delivery in women previously interviewed on the third
trimester of pregnancy and its correlation to mode of
delivery and parity.
Methods: A longitudinal cohort study was conducted with
340 women attending the Antenatal Clinic at the State
University of Campinas (Unicamp) between June and
October 2003 and 120 were interviewed by telephone
3 years after delivery.
Results: Urinary incontinence was present in 37 (30.8%) of
the 120 women interviewed. There was a significant
difference in the incidence of post partum SUI among
patients with SUI during pregnancy (p>0.0001). Mode of
delivery was vaginal in 67 (55.8%) cases and c-section in
53 (44.2%). Stress urinary incontinence was reported by
19.2% in the vaginal-delivery group and only 8.0% of the
c-section group, but it were not statistically significant,
even when considering a unique mode of delivery. The
incidence of SUI after delivery dropped significantly from
51.1% to 24.4% (p=0.0073) in the primiparous and from
60.0% to 28.3% (p<0.0001) in the multiparous 2–3, but not
in the multiparous with 3 or more deliveries (66.7% to
60.0%) (p=0.5637). A significant correlation has been
observed between parity and SUI (p=0.0299).
Conclusion: Pregnancy predisposes to SUI 3 years after
delivery as well as parity. No correlation has been
demonstrated between mode of delivery, and SUI.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
317
THE PREVALENCE OF PREMENSTRUAL
SYNDROME AND PREMENSTRUAL DYSPHORIC
DISORDER AND ITS RELATIONSHIP TO SEXUAL
FUNCTIONING, PELVIC PAIN AND DEPRESSED
MOOD
Aschkenazi, S; Botros, S; Beaumont, J; Miller, J; Gamble,
T; Sand, PK; Goldberg, RP
Evanston Continence Center, Division of Urogynecology,
Evanston Northwestern Healthcare, IL, USA
Objective: To assess the relationship between premenstrual
syndrome/dysphoric disorder (PMS/PMDD) and sexual
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
function, pelvic pain and depressed mood, using validated
questionnaires in identical twin sisters of reproductive age,
to allow for control over genetic variance.
Materials and methods A multi-item survey including
the Premenstrual Symptoms Screening Tool (PSST), the
Beck Depression Inventory-II (BDI-II), the short Pelvic
Organ Prolapse (POP)/Urinary Incontinence (UI) Sexual
Questionnaire (PISQ-12), an Index of Female Sexual
Function (IFSF), and Pelvic Pain and Urgency/Frequency
symptom scale (PUF) was administered to 362 pre-
menopausal monozygotic twin sisters attending the 2005
and 2006 Twins Day Festivals in Twinsburg, Ohio. The
PSST was used to identify women who suffer from
severe PMS/PMDD and would be likely to benefit from
treatment. Generalized estimating equations for clustered
data were used for group comparisons between twins
with PMS/PMDD vs. those without. A multivariable
linear mixed effects model was used to assess the effect
of PMS on depression scores, adjusted for PUF scores
and twinning.
Results: PMS/PMDD was found in 44 women, indicating
a prevalence of 12%. Eight twin pairs were concordant
(36%) and 28 twin pairs were discordant for PMS/
PMDD. Age, BMI, race, parity, delivery mode, smoking,
education or income were similar between groups.
Women with PMS/PMDD had worse total BDI-II (p<
0.0001) and total PUF (p=0.0036) scores. Women with
PMS/PMDD had worse BDI-II scores on almost all
individual items, as well as worse dyspareunia, bladder
pain, urinary urgency, and sexual and partner satisfaction.
In women with the combination of POP/UI and PMS/
PMDD (38/44), total BDI-II, PUF scores and individual
PISQ-12 items were significantly worse (p<0.0001).
Multivariable regression analysis indicates that women
with dyspareunia and urgency on the PUF scale have
higher BDI-II depression scores. After adjusting for these
PUF scores, women with PMS/PMDD still had worse
BDI-II scores that were 5 points higher (p=0.0004).When
comparing total BDI-II scores in the 28 twins discordant
for PMS/PMDD, women with PMS/PMDD were signif-
icantly more depressed than their twin sister without
PMS/PMDD p=0.0002.
Conclusion: Women with PMS/PMDD had increased
pelvic pain, dyspareunia and depressive comorbidity which,
according to this analysis of identical twin sisters, appears
to extend beyond genetic variability. In the presence of
PMS/PMDD, screening for other disorders should be
considered to improve diagnosis and treatment, and
ultimately, enhance women’s functional status and overall
quality of life.
Disclosures
Was consent obtained from patients? Yes.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
318
TREATMENT OF STRESS INCONTINENCE
AND CYSTOCELE USING PERIGEE ALONE
Kannan, K; Balakrishnan, S; Corstiaans, A; Rane, A
James Cook University, Townsville, Australia
Objective: The Perigee™ has been successfully used as a
treatment for large and recurrent cystocoeles. However in
patients who have concomitant stress incontinence we
modified the placement of the superior aspect of the
Perigee mesh at the level of midurethra above the usual
placement at the level of bladder neck. This study is to
evaluate the success of Perigee in treating urinary stress
incontinence.
Materials: All patients with a Stage 2 and above size
cystocoele and had concomitant stress incontinence under-
went this procedure from January 2006 until June 2006.
Methods: This prospective study included a preoperative and
postoperative questionnaire. A routine POP-Q was done.
They underwent preoperative and 12 weeks postoperative
urodynamics to objectively assess the results of the procedure.
Results: A total of 18 patients underwent Perigee for
cystocoele and had objectively demonstrated urodynamic
stress incontinence both revealed and occult. There was no
immediate complications during the surgery. 13 patients
went home the same day after a successful trial of void and
the 4 had stayed overnight due to distance from the
hospital. At 12 weeks, 15 of the patients have had
urodynamics assessment done. 9 patients were cured of
the urodynamic stress incontinence with no objectively
demonstrable leakage. 5 patients had obvious demonstrable
urinary leakage and 1 patient had a minimal occult urinary
leakage. 3 of them mainly demonstrated postural induced.
These three patients had low maximum urethral closing
pressure less than 35 cm water prior to the procedure as
well as after the procedure suggesting the problem of
intrinsic sphincter deficiency and were subsequently
planned for urethral bulking procedures.
Discussion: From the initial assessment, it was found that 5
(33%) patients had apparent failure of the procedure.
However taking into account the patients with ISD, the
patients with pure urinary stress incontinence, there were
only 3 (25%) patients from 12 who had failure of the
procedure. These patients had ultrasound investigation and
the results suggested that the mesh had dislocated to the
level of bladder neck thereby causing the failure. We are
encouraged by this finding from the pilot study and will be
S175
conducting a continuous study with exclusion of patients
with apparent ISD. We are will also be fixing the superior
aspect of the mesh to the periurethral fascia to prevent the
mesh dislocation. Hopefully with this, the efficacy of the
Perigee in treating concomitant urinary stress incontinence
will be better demonstrated.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
319
VAGINAL WALL PROLAPSE REPAIR
WITH AND WITHOUT MESHES: A GLOBAL
ANALYSIS OF THE IMPACT ON SYMPTOMS,
QUALITY OF LIFE AND SEXUALITY
Palma, P1; Riccetto, C1; Thiel, R1; Perchon, L1; Dambros,
M1; Muller, V1; Dambros, M2; Fraga, R1; Herrmann, V1
1
University of Campinas, Brazil; 2UNIFESP, Brazil
Objective: The aim of the study was to compare the impact
on quality of life lower urinary tract symptoms and sexuality
after anterior vaginal wall prolapse repair with mesh
Materials and method: A total of 31 women underwent
colporrhaphy 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). Question-
naires 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≤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 improve-
ment 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.
S176
Conclusion: Surgical correction of vaginal wall prolapse
improves QoL, LUTS and sexuality. The use of meshes do
not adversely impact the results.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
320
VOIDING DIFFICULTY IN WOMEN UNDERGOING
SURGERY FOR ADVANCED PELVIC ORGAN
PROLAPSE
Liang, CC; Lo, TS; Wang, AC
Chang Gung Memorial Hospital, Taipei, Taiwan
Objective: This study was undertaken to determine
whether the elevated postvoid residual volume would
be resolved after surgery for advanced pelvic organ
prolapse.
Materials and methods: We reviewed the records of all
women underwent surgery at our hospital between March
2003 and June 2006 for stage 3 or 4 pelvic organ
prolapse of ICS classification. Patients were included in
this review if they had a postvoid residual volume of
≥100 ml documented by ultrasound or catheterization on
at least 2 occasions, and had undergone postoperative
multi-channel urodynamic testing at 3 months after
surgery. Patients were interviewed regarding the presence
of symptoms that would suggest voiding difficulties.
Urodynamic evidence of voiding difficulty was consid-
ered as a maximum flow rate less than 12 ml/s (voided
volume greater than 100 ml). Demographic, symptoms of
voiding difficulty, urodynamic data and outcome were
analyzed.
Results: Fifty-seven patients (40 with symptoms of
voiding difficulty and 17 patients with symptoms of
voiding difficulty free) satisfied the criteria for inclusion
in the review. Thirty-eight patients received prolapse
repair alone and 19 patients received prolapse repair and
concomitant anti-incontinent surgery. The mean preoper-
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
ative postvoid residual volume was 177 ml (range, 100–
560 ml). Eighteen patients (32% of total) had urody-
namic voiding difficulties before surgery, including 40%
(16/40) of patients in the group of symptoms of voiding
difficulty and 12% (2/17) of patients in the group of
symptoms of voiding difficulty free). Three months after
surgery, 48 patients (84% of total) had normal postvoid
residual volumes after surgery, 2 patients (4% of total)
had symptoms of voiding difficulty and 1 patient had
urodynamic voiding difficulty (2% of total). Of 9 patients
who had elevated postvoid residual volumes after
surgery, 78% of patients (n=7) had symptoms of voiding
difficulty before surgery and 67% of patients (n=6)
received prolapse repair and concomitant anti-incontinent
surgery.
Conclusion: It seems to increase a risk of developing
postsurgical voiding difficulty in patients with advanced
pelvic organ prolapse and elevated postvoid residual
volume who received concomitant anti-incontinent surgery.
However, most of these patients had normalization of the
postvoid residual volume after surgical correction of the
pelvic organ prolapse.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
321
A PRELIMINARY STUDY TO COMPARE
THE VAGINAL PALPABILITY OF TWO DIFFERENT
MESH MATERIALS USED FOR LAPAROSCOPIC
SACROCOLPOPEXY
North, CE; Reid, FM; Smith, ARB
Warrell Unit, St Mary’s Hospital, Manchester, UK
Objective: The ideal graft material for sacrocolpopexy has
yet to be determined. The need for a strong mesh must be
balanced against the potential resulting rigidity and the
negative impact this may have on functional outcome,
particularly sexual function. Previous published reviews of
outcomes of laparoscopic sacrocolpopexy from our unit
have involved sacrocolpopexy using Premilene mesh (B
Braun). Mini-mesh (Mpathy Medical Devices Ltd) is an
ultra lightweight, macroporous, monofilament, polypropyl-
ene mesh designed for prolapse repair. It has a noticeably
‘softer’ feel than Premilene mesh and may, therefore, be
associated with improved functional outcome of laparo-
scopic sacrocolpopexy.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Materials and method: In this preliminary study 19
women who had undergone laparoscopic sacrocolpopexy
at our unit attended for assessment. 13 had sacrocolpo-
pexy using Mini-mesh and 6 had Premilene mesh
inserted, according to mesh availability. An examiner,
blinded to the type of material used, performed a vaginal
assessment of the palpability of the mesh, the degree of
post-operative vaginal rigidity and presence of any
tenderness.
Results: The results of this study suggest that the women
who had laparoscopic sacrocolpopexy with Mini-mesh
tended to have less post-operative dyspareunia. They were
also more likely to have no vaginal tenderness and no
palpable mesh on vaginal examination. Scores of vaginal
rigidity and vaginal tenderness appeared to be lower in the
Mini-mesh group.
Conclusion: This preliminary study suggests there may be
an advantage to use of an ultra lightweight polypropylene
mesh at sacrocolpopexy with regard to post-operative
vaginal function.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Mpathy
Medical Devices Ltd.
Level of support? No industry support in study design or
execution.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
322
1-YEAR OUTCOME OF TRANSOBTURATOR (ARIS)
TAPE PROCEDURE FOR FEMALE STRESS URINARY
INCONTINENCE: EXPERIENCE OF A UK DISTRICT
GENERAL HOSPITAL
Elmardi, A; Duvver, S; Khan, F; Chandru, S
Stafford General Hospital, UK
Objective: To evaluate the safety and efficacy of using the
new woven polypropylene monofilament tape Aris® (Men-
tor-Porges-Coloplast) to treat women with stress urinary
incontinence.
Materials and methods: Between May 2005 and May
2006, 43 consecutive women (mean age 51) operated by
the outside-in TOT procedure of Delorme with the Aris®
history, physical examination and urodynamic evaluation
including a cystometry, uroflowmetry and urethral profil-
ometry. All were done under GA. All women were
evaluated at 1, 6 and 12 months postoperatively. The
objective cure was evaluated by clinical examination and
S177
the subjective cure rate was assessed using the KHQ and
BFLUTS questionnaire.
Results: The cure rates were consistently high at 95–96%
at 6 months and 85% at 12 months duration of follow-
up. There was 85% significant improvement of stress
incontinence symptoms among mixed incontinence group.
Voiding difficulties were 4.6% (2 women) in this series
much lower than quoted in the literature (16–17%) and
in comparison to TVT group (25%). Difficulty in voiding
was temporary and limited to the immediate postopera-
tive period requiring less than 24 hours of catheteriza-
tion. 13.9% of (n=6) patients developed de novo detrusor
urgency. No bladder injury was reported. There was no
tape exposure or erosion encountered.
Conclusion: Transobturator Aris® Tape procedure is an
effective and safe treatment for women with stress urinary
incontinence. Local complications such as vaginal tape
exposure and erosion we previously reported with non-
woven tapes were not seen with this woven ARIS tape.
Long term follow up is needed.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
323
A COMPARATIVE STUDY OF COMPLICATIONS
IN TVT, SPARC, TVTO, AND MONARC SLING
PROCEDURES
Kim, D-Y1; Lee, JW2; Jung, HC3; Park, CH4; Min, KS5;
Hwa, JS6; Choi, JD11
Catholic University of Daegu, Korea; 2Pochon Cha Uni-
versity, Seoul, Korea; 3Yeungnam University, Gyeong San,
Korea; 4Keimyung University, Daegu, Korea; 5Inje Uni-
versity, Incheon, Korea; 6Gyeongsang National University,
Jinju, Korea
Objectives: Mid-urethral slings are becoming the treatment
of choice for the management of stress urinary inconti-
nence. Although TVT, SPARC, TVTO and MONARC
sling procedures show a high success rate for a minimally
invasive procedure, the widespread use of this procedure
has led to an increasing number of various complications.
Materials and Methods: 291 women with stress inconti-
nence (TVT 96, TVTO 70, SPARC 72, and MONARC 90)
were studied between February 2003 and February 2006.
The operative techniques complied with the manufacturers
instructions.
S178 Int Urogynecol J (2007) 18 (Suppl 1):S107–S244

Results: Of the total 41 complications (14.1%) that were manual reduction of the anterior vaginal wall, vaginal
recorded; intraoperative bladder perforation developed in 7 pessary use, intermittent self-catheterization, and recon-
patients, postoperative vaginal mucosal erosion in 5 structive pelvic surgery. In many cases, women are
patients, suprapubic or inguinal pain in 9 patients, de novo incapable or unwilling to take advantage of these
urgency in 4 patients, newly developed frequency in 7 therapies. To address this problem, we describe a novel
patients, dyspareunia in 7 patients, and wound infection in use of the Colpexin Sphere fitting tool to reduce prolapse
2 patients. to allow for improved bladder evacuation. The patient is
Conclusions: Complications of the trans-obturator sling instructed to insert the tool into the vagina before voiding.
operations were relatively low and all types of sling The sphere temporarily reduces the prolapse and straight-
required surgical intervention in rare situations. Although ens the urethra to allow for more complete bladder
further studies are needed to establish its long-term efficacy evacuation. Success of this method of management is
and safety, TVT, SPARC, TVTO and MONARC sling measured by improved symptoms, a decrease in the
procedures might be effective tools for the treatment of occurrence of urinary tract infections, and smaller post-
female stress urinary incontinence. void residuals.
Results: We have used this technique in patients with
Complication No. of patients Total advanced prolapse and urinary retention who were unable
TVT TVT SPARC MONARC to self-catheterize, retain a vaginal pessary, or undergo
(n=96) (n=70) (n=72) (n=90) surgical therapy. The most significant results have been
Bladder 3 0 4 0 7(2.4%)
perforation normalized post-void residuals with resolution of urinary
Vaginal erosion 1 1 1 2 5(1.7%) tract infections and a decrease in urinary frequency and
Pain 3 2 3 1 9(3.1%)
De novo 1 0 2 1 4(1.4%)
nocturia.
urgency Conclusion: Use of the Colpexin Sphere fitting tool
Frequency 3 1 2 1 7(2.4%) appears to be a safe and effective option for patient-directed
Dyspareunia 3 1 2 1 7(2.4%)
Wound infection 1 1 0 0 2(0.7%) management of urinary retention related to anterior com-
Total 15 6 14 6(6.7%) 41 partment prolapse.
(15.6%) (8.6%) (19.4%) (14.1%) Reference
*Lukban JC, Aguirre OA, Davila GW, Sand PK (2006)
Disclosures Safety and effectiveness of Colpexin Sphere in the
Was consent obtained from patients? Yes. treatment of pelvic organ prolapse. Int Urogynecol J Pelvic
Was this work supported by industry? No. Floor Dysfunct 17:449–454.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an Disclosures
industry? No. Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
324 employee (part time or full time) or shareholder of an
A NOVEL ALTERNATIVE TO INTERMITTENT industry? Yes.
SELF-CATHETERIZATION TO MANAGE
OBSTRUCTIVE URINARY RETENTION DUE
TO ANTERIOR COMPARTMENT PROLAPSE 325
Klaassen, MK; Aguirre, OA A RARE COMPLICATION OF THE SURGICAL
Pelvic Specialty Care, USA REPAIR OF PELVIC PROLAPSE
WITH TRANS-OBTURATOR MESH (TVM):
Objective: To describe use of the Colpexin Sphere* fitting IMAGIOLOGIC DIAGNOSIS AND SURGICAL REPAIR
tool to facilitate voiding in women with urinary retention Valentim-Lourenço, AVL; Barata, SB; Bernardino, MB;
due to anterior compartment prolapse. Ribeirinho, ALR
Materials and methods: Urinary retention can cause Hospital Santa Maria, Fac Medicina, Lisboa, Portugal
discomfort, urinary frequency, nocturia, overflow inconti-
nence, chronic urinary tract infections, and hydroneph- Background: The surgical repair of pelvic prolapse with
rosis. It is often seen in women with anterior compartment mesh by obturator route is an effective and simple
prolapse due to urethral kinking. Current therapies for technique. Bleeding/haematoma and infection are the most
obstructive urinary retention related to prolapse include frequent early complications. Late complications of this
technique are erosion and/or mesh rejection, relapse and de
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
novo prolapse, vesico or recto-vaginal fistula and dysfunc-
tional constipation/micturition. The complications rate
depends on the mesh type, the surgical technique and the
experience of the surgeon.
Case: A 51-year-old female patient, with a pelvic prolapse-
cystocele grade III and histerocele grade I (POP-Q standard
classification) was submitted to an anterior surgical correc-
tion with prolene mesh (Anterior Prolift®), without intra-
operative complications. Since surgery, the patient had
pelvic pain and pain in left leg with functional limitation.
An abdomen radiogram and the pelvic CT, one month after
surgery, showed a heterogeneous pelvic mass in the vesical
wall, over the left ureter insertion, near the left obturator
hole. The image was suggestive of the presence of a
retained gauze packing. Four months later, after medical
conservative treatment, a diagnostic laparoscopy was
performed followed by a laparotomy for foreign body
removal and partial cystectomy including the resection of a
granuloma of the vesical wall. Eighteen months after
surgery, the patient has no prolapse (POP-Q) and has no
symptoms.
Comments: Persistent pelvic pain and/or persistent pain in
legs after surgical repair of pelvic prolapse by trans-
obturator route are not frequently reported and may be
associated with trauma and local inflammatory reactions. If
associated with a foreign body reaction in the vesical wall,
the complication and their symptoms can be solved with its
surgical removal
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
326
ACCESS TO HEALTHCARE FOR WOMEN
SUFFERING FROM VESICO-VAGINAL FISTULAE
IN WESTERN NIGER IS LIMITED: A REPORT
FROM A SURVEY GIVEN AT THE NATIONAL
HOSPITAL FISTULA CENTER, NIAMEY, NIGER
BY THE INTERNATIONAL ORGANIZATION
FOR WOMEN AND DEVELOPMENT
Ascher-Walsh, CJAW1; Meyer, LM2; Norman, RN3;
Herbert, HH4; Kimso, OK5; Idrissa, AI5; Wilkinson, JW6
1
Mt Sinai School of Medicine, New York, USA; 2Columbia
University, New York, USA; 3Stanford University, Palo
Alto, CA, USA; 4Rochester School of Medicine, NY, USA;
5
National Hospital, Niamey, Niger; 6Duke University,
Chapel Hill, NC, USA
S179
Objective: To evaluate access to health care among women
who were treated for vesico-vaginal fistulae in Niger.
Materials and methods: From 9/05 to 1/06, 58 women
treated for vesico-vaginal fistulae at the National Hospital
in Niamey, Niger were given questionnaires to evaluate
their accessibility to health care. The questionnaires and the
counseling were performed by native speakers of either
Hausa or Zarma.
Results: The 58 women represented 7 different ethnic
groups with the majority being Hausa (39.7%) and Zarma
(37.9%) and came from 54 different villages. The average
age of the patients was 25.3 years and they had waited an
average of 3.35 years before seeking help. 43.1% heard of
the opportunity for repair from local health care providers,
22.4% from radio announcements, 20.7% from friends or
family, and 13.8% by simply walking into a hospital in the
city without advanced knowledge of what was available.
The women traveled an average of 11.52 hours to reach the
hospital in Niamey. The average cost of their journey to the
hospital was 7,032.5 West African Francs (approximately
$14.07). 56.9% arrived by bush taxi, 15.6% by bus, 8.5%
by hired car, 6.8% by donkey cart, and the other 12.2%
were local. 50% of the women considered themselves
housewives without any form of income. 30.8% were
farmers, 6.9% craftmakers, 5.2% were weavers, 3.4% food
vendors, and the other 3.7% were unemployed. Only 9 of
these women had attended school, 2 for the longest period
of three years. 62% of these women were married, the rest
either separated or divorced.
Conclusion: Access to health care for women in western
Niger suffering from vesico-vaginal fistulae is severely
limited. Although treatment for this condition has been
available in the capital city of Niamey for over 10 years,
most women suffer for over three years before seeking help.
This is due to a lack of knowledge regarding treatment
opportunities and difficulties in reaching those opportuni-
ties. The average per capita income is $269 per year and the
vast majority of Nigerians live by subsistence farming
without any excess income, making the $14 necessary to
get to the capital prohibitive. Expanded surgical opportuni-
ties via foreign teams have only been available for the past
two years and radio announcements only began at that time.
To reach the estimated 100,000–300,000 women suffering
from vesico-vaginal fistulae in Niger, an increase outreach
effort will be required. Since most women heard about the
opportunity for care from local providers, these providers
represent a valuable source for dispersing information.
Additional financial resources will also be necessary to
enable these women to get to the care centers.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
S180
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
327
BLADDER OUTFLOW OBSTRUCTION FOLLOWING
TOTAL PROLIFT REPAIR
Roberts, CH; Nnochiri, A; Rostom, N; Barnick, C
Homerton University Hospital, London, UK
Introduction: Pelvic organ prolapse is a common
disorder for which a multitude of surgical procedures
are available to restore functional and anatomical nor-
mality. Repair procedures are considered safe and
effective although each is acknowledged to have associ-
ated risks including failure.
Case report: A 48 year old woman, para 3, presented to
our Urogynaecology Clinic complaining of a troublesome
lump in the vagina which significantly impacted on
activities of daily living. She had undergone vaginal
hysterectomy, TVT, laparoscopic colposuspension, laparo-
scopic sacrocolpopexy and posterior repair in the past
10 years for prolapse/stress incontinence. On examination
she was noted to have total vaginal eversion (Ba +6, Bp +6,
D +8). After full discussion and informed consent she
underwent Total Prolift repair performed as described in
published literature. The procedure was uncomplicated,
operative time 90 mins, blood loss 350 mls. A vaginal pack
was left in situ for 48 hours with continuous bladder
drainage via a Foley catheter. Persistent high residual
volumes were noted following removal of the Foley
catheter requiring suprapubic drainage for 2 weeks. On
review at 6 weeks the patient was well, voiding normally
with no prolapse. At 3 months she complained of persistent
frequency and urgency and was commenced on anticholin-
ergic medication. As the symptoms did not settle she was
cystoscoped 6 weeks later. A tight bladder neck was evident
and dilated to 26F. The bladder was otherwise normal.
Unfortunately her symptoms had recurred on review
6 weeks later and direct questioning was suggestive of
outflow obstruction with chronic urine retention +/−
overflow incontinence. Ultrasound scanning confirmed a
post micturition bladder volume of 500 mls with moderate
bilateral hydronephrosis and hydroureter. Renal function
was impaired-creatinine 136 μmol/ confirmed on mag3
renogram. Unfortunately this patient presented 2 days later
with septicaemia secondary to an E coli confirmed
pyelonephritis and required 3 days on ITU. Following
insertion of an indwelling catheter her renal function
improved. She subsequently underwent uncomplicated
excision of Prolift mesh beneath the bladder neck with
subsequent resumption of normal voiding.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Conclusion: Surgical repair of prolapse is common
although recurrence is a recognised problem with all of
the available procedures. Whilst insertion of mesh is
considered safe there are a number of rare, potentially life
threatening complications that may be associated. Particu-
larly where women have undergone multiple previous
procedures, where outcome deviates from that to be
expected, great care should be taken in history taking and
examination to ensure that complications such as bladder
outlet obstruction, as in this case, are not missed.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
328
COMPARISON OF RETRO-PUBIC TVT, PRE-PUBIC
TVT AND TVT TRANSOBTURATOR IN SURGICAL
TREATMENT OF WOMEN WITH STRESS URINARY
INCONTINENCE
Oliveira, LM de; Girão, MJBC; Sartori, MGF; Castro, RA;
Fonseca, ESM
Federal University of São Paulo, Brazil
Objective: The purpose of this study is to compare the
safety and efficacy of the classic retro-pubic tension-free
vaginal tape (TVT) with the pre-pubic TVT and TVT
transobturator (TVT-O) for the surgical treatment of stress
urinary incontinence (SUI) in women.
Methods: Our objective is to include one hundred patients
in the study, with and without intrinsic sphincter deficien-
cy. Eighty-five women with SUI were randomly assigned
to either retro-pubic TVT (n=35), pre-pubic TVT (n=13)
or TVT-O (n=37) between October 2004 and December
2006. Preoperatively, all patients have undergone urody-
namic study, pad-test and quality of life evaluation. The
same protocol has been used 1, 6 and 12 months after the
surgery. The retro-pubic TVT and pre-pubic TVT were
performed under local anesthesia and TVT-O was per-
formed under spinal anesthesia. Mean age was 52,4 years
(28–80).
Results: The median follow-up was 14 months (1–
26 months). The rates of cure were 97,1% vs 91,9% vs
15,4% for TVT, TVT-O and pre-pubic TVT, respectively.
The rates of improvement were 2,9% vs 30,8% for TVT
and pre-pubic TVT, respectively. The rates of failure were
8,1% vs 53,8% for TVT-O and pre-pubic TVT, respectively.
Vaginal erosion occurred in 15,4% (n=2) in pre-pubic TVT
group, in 5,4% (n=2) in TVT-O group and in 5,7% (n=2)
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
in TVT group. Pain in the thigh occurred in 16,2% (n=5)
and in 5,7% (n=2) in TVT-O group and in TVT group,
respectively. Urinary tract infection was more frequent in
TVT group (20,0% and n=7) than in TVT-O group (13,5%
and n=5) or in pre-pubic TVT group (7,6% and n=1).
Vulvar ecchymosis occurred in 30,8% (n=4) in pre-pubic
TVT group. Urgency and urge incontinence occurred in
15,4% (n=2) and in 61,5% (n=8) in pre-pubic TVT group;
in 16,2% (n=6) and in 32,4% (n=12) in TVT-O group and
in 22,9% (n=8) and in 28,6% (n=10) in TVT group,
respectively. The rate of urinary retention was 5,4% (n=2)
in TVT-O group and 11,4% (n=4) in TVT group and the
tape was cut in one of these retentive patients of TVT group
(2,9%).
Conclusion: In this study, we have observed that the pre-
pubic TVT technique was less efficient than the TVT-O and
the TVT techniques. Furthermore, the patients of the pre-
pubic TVT group presented several complications. There-
fore, we decided to leave this technique in May 2005 and
since then, we have continued the study with the TVT-O
and the TVT techniques only. These procedures are safe
and effective techniques for the treatment of female SUI.
Our data do not demonstrate a significant difference
between two TVT techniques. However, the inclusion of
other women in the study and one year follow-up for all
patients will confirm or not these results.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Johnson &
Johnson.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
329
COMPARISON OF THREE DIFFERENT SYNTHETIC
SLINGS
Geo, MS; Lima, RSBC; Laranjeira, CS; Menezes, AC;
Figueredo, JM; Iaminn, LA; Sette, M
Mater Dei Hospital, Belo Horizonte, Brazil
Objective: Compare three different synthetic slings for
stress urinary incontinence: SafyreTransobturatory (Prom-
edon), IVS® (Tyco) e TVT® (Gynecare).
Methods: This is an observational study that included
stress urinary incontinence patients who were treated in an
urogynecology unit of a tertiary private hospital between
1999 to 2007. There were 3 moments: 1999 to 2002 79
patients were submitted to TVT®; 2003 to 2007 57
S181
submitted to SafyreT® (transobturatory sling) and 78 to
IVS®. The patients did not differ concerning age, parity,
urodynamic diagnosis. The Valsalvas leak point pressure
median were 98 cmH2O for TVT®, 72 cmH2O for
SafyreT® and 71cmH2O for IVS®. The post operative data
were careful analyzed based in the 24 hrs pad test and a
validated questionnaire applied by a third person (Blaivas
and cols. 1999). The complications were analyzed in the
per-and post-operative (3 m, 6 m, annually).
Results: The median follow-up was 20 months in TVT®
group, 15 months in SafyreT® group and 18 months in
IVS® group. Negative 24 hours pad tests (<8 grs) were
seen in 78% TVT®; 70% SafyreT® and 73% IVS®.
According to the questionnaire, 96% of TVT® group;
95% of SafyreT® group and 92% IVS® group were
considered themselves more than 80% improved (p>
0,05). Concerning to complications the bladder perforation
was the most common occurring in 16% of women in TVT
group, 3,2% in IVS group and no patients in SafyreT group
(p<0,05 Safyre T® X IVS® X TVT®). Urgency as a new
complain in postoperative was present in 11,4% TVT®, 8%
SafyreT® e 19% IVS® (p<0,05 IVS® X Safyre T®);
urinary retention 2,5% TVT®, 0% SafyreT® e 8% IVS® (p
<0,05 e IVS® X Safyre T®), vaginal extrusion 2,5%
TVT®, 6% SafyreT® e 1,3% IVS® (p>0,05).
Conclusion: This is an observational study that showed
good cure/improvement with three types of slings, two retro
pubic and one transobturatory, with no statistic differences.
The bladder perforation was obviously more common in
TVT and IVS group. The occurrence of urgency and
retention were statically higher in IVS and TVT than in
Safyre Transobturatory. We conclude that transobturatory
route has less complication with the same success.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
330
OUR 3 YEARS EXPERIENCE WITH TVT
IN A DISTRICT GENERAL HOSPITAL
Nnochiri, A1; Mattar, M2
1
Homerton University Hospital, London, UK; 2Sandwell
General Hospital, West Bromwich, West Midlands, UK
Objective: To evaluate how our practice in a district
general hospital complies with the NICE guidelines; assess
the subjective success rate and the rates of intra operative
and post operative complications
S182
Materials and methods: A retrospective audit of all TVTs
performed from March 2000 to October 2003 at Sandwell
general Hospital. 84 case notes were reviewed. A Proforma
was designed for collection of data. The collated data was
analysed
Results: Urodynamics was performed in 81% of patients
and 84.5% had conservative management prior to surgery,
5.5% had previous continence surgery. Only 1 case was
performed under general anaesthesia. 74% of patients
completed post-operative follow-up. 87% were continent
at the end of the follow up period. The bladder was
perforated in 6% of the patients, with significant haemor-
rhage in only one patient. Temporary urinary retention
occurred in 9.5% and UTI in 8.3% of cases.
Conclusion: The majority of our cases were performed
under local anaesthesia, and this was acceptable to most of
our patients after proper and adequate counseling. Our
patients’ satisfaction rates and subjective cure rates are
comparable to those quoted in bigger series, with similar
complication rates. TVT performed under local anaesthesia
as it was originally intended should be encouraged as this
would help in reduction of cost to hospitals and general
anaesthetic risks to patients.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
331
PERCEPTION OF THE DEGREE OF PROFESSIONAL
SATISFACTION AMONGST PHYSICIANS THAT SEE
PATIENTS WITH UROGYNECOLOGIC PATHOLOGY
Lizaola-Diaz de Leon, H; Rodriguez-Colorado, S;
Escobar-Del Barco, L; Gorvea-Chavez, V
Clinica de Urologia Ginecologica, Instituto Nacional de
Perinatologia, Dr Isidro Espinosa de los Reyes, Mexico
City, Mexico
Objective: To evaluate the degree of professional satisfac-
tion in the urogynecologic medical community.
Methods and materials: Anonymous electronic surveys
were sent to analyze the degree of professional satisfaction
amongst physicians that treat urogynecologic pathology.
The variables analyzed included: age, level of education,
years in practice, type of medical practice, general work
environment (place, economic remuneration, work load),
professional activities (provider, investigation), marital
status, time dedicated to personal activities and recreation,
as well as, future planning. Data were analyzed in an
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
attempt to find significant correlations and possible associ-
ations. Only completed surveys were included.
Results: We found a significant correlation between the
degree of professional satisfaction and some independent
factors like level of education, work hours, off-days,
reimbursement rates, patient load, institutional setting
(private/public), time actually spent working, the percent-
age of urogynecologic pathology in comparison with
general gynecologic pathology encountered during a typical
work day, and time until retirement.
Conclusion: It is common practice to research the degree
of satisfaction amongst patients, but we rarely find
articles investigating the degree of satisfaction amongst
professionals.
A motivated and content physician is normally a better
practitioner. It can be erroneously believed that gender and
income significantly influence professional satisfaction.
This common myth seems to be non-applicable when it
comes to urogynecologists. Physicians that were in general
more satisfied with their practice, were older, more
experienced, academicians, saw a predominance of urogy-
necologic patients and had at least two off days per week.
Surveys on the perceived degree of satisfaction are
commonly used to quantify the actual conditions at the
time of diagnosis, the natural evolution of the disease or the
response obtained after a certain form of therapy has been
applied. Satisfaction surveys are important tools in decision
making, future strategies and future norms in practice.
Consequently, this raises the question of how important
these surveys can be in obtaining insight into the degree of
satisfaction obtained by those that treat these patients. This
poster attempts to address this issue.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
332
POSTERIOR CORRECTION OF RECTOCELE PLUS
LONGO’S PROCEDURE
Valentim-Lourenço, AVL; Araujo, CA; Bernardino, MB;
Ribeirinho, ALR
Hospital Santa Maria, Fac Medicina Lisboa, Portugal
Introduction: Rectocele and anal mucosa prolapse are
rarely associated. Surgical repair of rectocele with collagen
mesh is an effective and simple technique. Staple anopexy/
haemorrhoidectomy, also known as Longo’s technique,
corrects anal mucosa prolapse by means of circumferential
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
excision and shortening of the supra-haemorrhoidal rectal
mucosa. The objective of this work is to describe a case
where these two procedures were performed at the same
operative time.
Case report: A 73-year-old woman, with a history of
chronic constipation, was referred to our department
because of a rectocele grade III (POP-Q standard classifi-
cation) and associated anal mucosa prolapse. The rectocele
was corrected with a collagen mesh (Pelvicol®) and the
anal prolapse with a staple anopexy using Longo’s
technique. The surgical procedure consisted of rectal
dissection, followed by lifting and fastening of the anal
mucosa and of the haemorrhoidal piles to their natural
anatomical site using a stapler device and finely suturing
the collagen mesh to the rectovaginal septum with
monofilament nonabsorbable lateral stitches.
Comments: The coexistence of these two situations
demands a multidisciplinary team, including a gynaecolo-
gist and a general surgeon. Longo’s technique is a simple
procedure for experienced surgeons. The choice of a
collagen mesh, as opposed to a synthetic one, is justified
by the lower risk of infection, erosion and constipation
associated with this type of material.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
333
SATISFACTION OF TOLTERODINE: ASSESSING
PATIENT-REPORTED GOAL ACHIEVEMENT
IN THE TREATMENT OF OVERACTIVE BLADDER
IN FEMALE PATIENTS (STARGATE STUDY)
Kim, JY1; Song, C1; Choo, MS1; Doo, CK1; Lee, KS2
1
Ulsan University, Seoul, Korea; 2Sungkyunkwan Univer-
sity, Seoul, Korea
Objective: This study is to evaluate the effect of tolterodine
extended release (ER) on patient-reported goal achievement
of each overactive bladder (OAB) symptom in females.
Materials and methods: Eligible patients had frequency
≥8/24hours and urgency ≥2 episodes /24hours with or
without urgency incontinence. Patients were asked to
complete 3-day voiding diary with 5-point urgency rating
scale on each voiding before and after tolterodine ER (4 mg
once daily) medication for 12 weeks. For the patient goal
achievement post-treatment acquired level of each symptom
improvement compared to initially expected improvement
was reported by the patients. Visual analogue scale for each
S183
OAB symptom severity, patient perception of bladder
condition (PPBC) and willingness to continue treatment
were also assessed.
Results: Among 56 patients, 35 (62.5%) experienced an
improvement at least two points of bladder condition on the
PPBC questionnaire. There was a significant achievement
of patient goal compared to initial patients’ expectation
(100%): 60% for frequency, 60% for urgency, 80% for
urgency incontinence, 50% for nocturia and 30% for
tenesmus (p<0.001). At 12 weeks, the median reduction
of symptom severity were −45% for frequency, −55% for
urgency, −52% for urge incontinence, −66% for nocturia
and −26% for tenesmus (p<0.001). In patients who had
more than 50% improvement of each symptom severity the
actual reductions in voiding diary were −2.8 for frequency,
−5.8 for episodes of urgency, −70.6 for sum of urgency
score, −2.7 for urge incontinence. 28 (50%) patients wanted
to take more medication at the end of the study.
Conclusion: OAB symptoms improved significantly by
tolterodine ER 4 mg in terms of patient goal achievement.
The level of patient reported goal achievement was similar
to the level of the improvement of each symptom severity.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
334
SUBURETHRAL MINI-INVASIVE TAPES:
COMPARISON OF THE OUTCOME OF TVT, TOT
AND TVT-O
Halaska, M1; Sottner, O1; Krcmar, M1; Kolarik, D1;
Halaska, MJ2; Driak, D1
1
Department of Ob/Gyn, Teaching Hospital Na Bulovce,
Charles University, Prague, Czech Republic; 2Department
of Ob/Gyn, Teaching Hospital Motol, Charles University,
Prague, Czech Republic
Objective: New developments in the mini-invasive surgery
of stress urinary incontinence require the comparison of
approaches as well as their complications and functional
results. The aim of our study is to assess the possible
differences between these methods. At the beginning of our
millennium TVT replaced formerly widely used Burch
operation. With introducing of the transobturator approach
out-in and with the announcement of a novel in-out
technique we decided to prepare the prospective study of
the patients’ cohorts consecutively coming for stress
S184
urinary incontinence (SI) surgery at the time of the new
developments.
Materials and method: Study material consisted of 150
women divided into three groups of 50 patients each
according to the development of method - 1) TVT
Gynecare (woven polypropylene mesh, retropubic ap-
proach), 2) ObTape Mentor (thermally bonded nonwoven
polypropylene mesh, transobturator approach, out-in tech-
nique), 3) TVT-O Gynecare (woven polypropylene mesh,
transobturator approach, in-out technique). These patients
were invited for the check up during the second half of the
year 2005 and in the year 2006 so the follow up was at least
12 months. There were no significant differences in
demographic parameters (age, height, weight, body mass
index, parity) and history of previous surgery in between
these three groups. During the study standardized set up we
compared the following parameters: cystometric parameters
before and after the surgery (maximum urethral closure
pressure, maximum cystometric capacity, maximum detru-
sor pressure and first desire to void) as well as type of
anaesthesia, surgical complications, tape protrusion, hyper-
correction frequency (assessed by symptoms and ultrasound
imaging of urethral mobility), post void residual volume
and patients continence. Chi square test and ANOVA
analysis were used to compare the results between the
groups. The results were considered to be significant if p<
0,05. The study was approved by the local Ethics
Committee and the informed consent was obtained. We
did not receive any external funding of our study or grants.
Results: The only difference between the groups was
significantly higher incidence of tape protrusion in the
second group of ObTape in comparison with both group
one (TVT) and group three (TVT-O). All other parameters
including continence after surgery showed no statistically
significant differences.
Conclusions: Our results prove the high success rate of all
mini-invasive tapes used in our practice with no statistical
differences between the groups. The protrusion rate is
significantly lower in the woven polypropylene in consent
with favourable non-inflammatory reaction of the tissue in
our histological study.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
335
THE EFFECTS OF PREGNANCY ON URINARY
INCONTINENCE AND PELVIC DEFECTS
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Leanza, V1; Dati, S2
1
Obstetric and Gynecologic Department; 2Urogynecologic
Unit, Casilino Policlinic Hospital, Rome, Italy
Objective: To correlate both pregnancy and modality of
delivery with stress urinary incontinence (S.U.I.) and pelvic
defects.
Methods: Out of 11.380 pregnancies happened between
January 1995 and December 2003, 400 asymptomatic
nulliparas were enrolled during the first trimester of
pregnancy. This sample was studied by means clinical
examination, in first trimester, in third trimester, at 9 weeks
and 36 weeks of postpartum.
Results: After 36th week of pregnancy S.U.I. was found on
15% (60/400) while prolapse on 9.75% (39/400); whereas
at 32 weeks of postpartum, S.U.I. was found on 2.20%
following Caesarian section (3/136) and on 14.01% (37/
264) following vaginal delivery and then prolapse on
1.47% (2/136) following Caesarian section and 18.56%
(49/264) following vaginal delivery.
Prolapse following pregnancy referred to anterior compart-
ment in 20 cases (5%), posterior compartment in 10 cases
(2.5%), central compartment in 7 cases (1.75%) and mixed
form in 14 cases (3.5%).
Statistical analysis was performed with chi-squared test and
p<0.001 was taken as indicating a statistical significance.
Comparing the incidence of S.U.I. between the two groups
(caesarian section and vaginal delivery), a significant
difference was found (2.20% versus 14.01%, p<0.001),
other that concerning prolapse a significant difference
between caesarian section and vaginal delivery was found
(1.47% versus 18.56%, p<0.001).
Conclusion: Perineal damage depends on both pregnancy
and modality of delivery. Pregnancy may cause urinary
incontinence and increase the risk of postpartum urinary
incontinence whether delivery is vaginal or by Caesarean.
However, Caesarean delivery is associated with a signifi-
cant lower risk of urinary incontinence and pelvic defects.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
336
TVT SECUR® IN TREATING FEMALE STRESS
URINARY INCONTINENCE : EARLY EXPERIENCE
Han, HC; Shukiman, I; Lee, LC
1
KK Women’s and Children’s Hospital, Singapore
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: To report early experience of TVT SECUR®,
specifically assessing the perioperative complications and
early cure rates.
Materials and methods: TVT SECUR® is a new,
innovatively designed tension-free vaginal tape that facili-
tates a less invasive approach and thus eliminates thigh
discomfort which is associated with TVT Obturator. The
TVT SECUR® is four times shorter in length than the
traditional slings. The first 30 cases of TVT SECUR® were
done from 22 August 2006 to 29 December 2006 on
women with urodynamically confirmed stress urinary
incontinence. The procedures were done with the recom-
mended steps and all cases were performed by the same
surgeon. Operative details (type of anesthesia, duration,
blood loss) and perioperative complications (bladder per-
foration, fever, thigh pain, voiding disorders) were recorded
and all patients were seen at one week and one month after
the procedures.
Results: Thirty patients were included in the study. Thirty
percent (9) of women had TVT SECUR® procedure in
conjunction with other vaginal surgeries and 70% (21) had
TVT SECUR® alone. None had previous continence
surgery. Intraoperatively there was 1 bladder perforation
(3.3%) and 1 bladder abrasion (3.3%). The blood loss was
minimal (mean 12 mls) in patients who had TVT SECUR®
only. 96.7% of women had spontaneous voiding with no
need for catheterization. There were no patients with fever,
urinary tract infection, thigh pain or bruises. There was no
readmission. The woman was regarded as cured if she was
continent and had negative stress test, improved if she had
less leaking and failed if her symptoms were the same as
before operation. At one-month follow-up, the cure rate
was 67% (20 cases), 23% (7) improved and 10%(3) failed.
There was no newly developed urgency or urged inconti-
nence at one-month follow-up.
Conclusion: TVT SECUR® is a safe procedure with only
minor complications when performed by surgeon who had
experience with retropubic and transobturator tape proce-
dures. The one-month cure rate was rather low when
compared to TVT and TVT-Obturator. However, we may
have to look at the long-term cure rates as it may improve
after contraction of tape, which is likely to occur later.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
S185
337
WHAT HAPPENS TO BOWEL SYMPTOMS
AFTER TREATMENT FOR URINARY
INCONTINENCE?
Tan, EJK; Calandrini, M; Tekkis, PP; Fernando, R; Khullar, V
1
St Mary’s Hospital, Imperial College, London, UK
Objective: Anticholinergic medication has effects on the
muscarinic type 3 receptor which can potentially lead to
reduced gastrointestinal motility. This has not been previ-
ously documented by direct questioning and investigation.
This study attempts to assess the effect of anti-cholinergic
medication on the defaecatory function of women with
urodynamically proven urinary incontinence. A possible
benefit of increased constipation could be a reduction in
faecal incontinence which women with lower urinary tract
dysfunction are known to suffer from.
Materials and methods: Women with lower urinary tract
dysfunction were recruited from a urogynaecology unit. All
the women underwent free flowmetry and cystometry. These
women were also asked to complete the Manchester Health
Questionnaire (MHQ), a validated bowel dysfunction symp-
tom and quality of life questionnaire. After six months
follow-up, women were again asked to complete the same
questionnaire. Women who opened their bowels less than
once a day were considered to be suffering from constipation.
Results: Initially 110 women completed a MHQ. After
6 months, 54 women had responded to a follow-up
questionnaire. Seven women of these women (13%) reported
being constipated at baseline before treatment. Of this group
six women who reported that their constipation before
treatment was present then continued to be constipated after
anti-cholinergic treatment. In addition 10 women further
reported being constipated following treatment. Thus after
treatment, a total of 17 women (31.5%) out of the 54 patients
reported being constipated. This result was significant (p=
0.001). Women with combined urinary and faecal inconti-
nence did not show significant improvement in their
symptoms of faecal incontinence post-treatment.
Conclusion: Women taking anti-cholinergics for urinary
incontinence appear to suffer from an increased incidence
of constipation which is higher than reported in clinical
trials. This increased rate of constipation does not translate
into faecal continence. An increased awareness and
treatment of bowel symptoms is required in women with
lower urinary tract dysfunction. Further studies are needed
to elicit the full effects of anti-cholinergics on bowel
function.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
S186
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
339
ASSESSMENT OF URODYNAMIC CHANGES
BEFORE AND AFTER TRANSOBTURATOR VAGINAL
TAPE INSIDE-OUT (TVT-O) OPERATION
FOR FEMALE URODYNAMIC STRESS
INCONTINENCE
Tsung-Hsien, SU; Wen-Chu, H; Tzu-Yin, LIN
Mackay Memorial Hospital, Taipei, Taiwans
Objective: To compare the pre-and postoperative urody-
namic findings of women who received TVT-O operation
for treatment of urodymanic stress incontinence.
Materials and methods: From January 2005 to February
2006, forty-two women underwent TVT-O operation in
Mackay Memorial Hospital. Preoperative evaluation in-
cluded urine analysis, one-hour pad test, complete urody-
namic investigation, chain urethrocystography, and quality
of life questionnaire with short form of Urogenital Distress
Inventory (UDI-6) and Incontinence Impact Questionnaire
(IIQ-7). Seven patients who lost follow-up or didn’t receive
the follow-up urodynamic study were excluded. Finally,
thirty-five women were enrolled.
Results: Among the thirty-five women enrolled in this
study, the mean operative time was 12.6±4.8 minutes.
Postoperative suprapubic catheterization duration was 1.3±
0.5 days, and total hospital stay was 4.3±1.1 days. Mean
follow-up period was 12.8 months. The subjective and
objective cure rates were 80% and 71.4%, respectively. The
postoperative one-hour pad test reduced significantly (32.6
±24.4 gm vs. 2.6±8.0 gm, paired t-test p value<0.001) and
quality of life revealed significantly improved postopera-
tively (UDI-6, 6.6±4.4 vs. 1.7±1.6, p value<0.001; IIQ-7,
8.5±4.8 vs. 1.2±2.8, p value<0.001). The maximal urethral
pressure was significantly reduced after operation (67.0±
21.1 cmH2O vs. 58.9±20.2 cmH2O, p=0.007). Postoper-
ative chain urethrocystographic values for bladder neck
descent in reference to pubosacral tip line showed signif-
icant anatomic correction (bladder neck mobility, 1.1±0.5
vs. 0.6±0.4, p=0.002).
Conclusion: Comparing urodynamic parameters before and
after operation, there was significant decrease of maximal
urethral pressure. Postoperative chain urethrocystographic
values for bladder neck descent in reference to pubosacral
tip line revealed significantly decreased. The anti-inconti-
nent effect of TVT-O procedure was to provide an adequate
support during stress without elevating the bladder neck
and proximal urethra.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
341
GLOBAL POSTURAL REEDUCATION (GPR): A NEW
STRATEGY FOR CONSERVATIVE MANAGEMENT
OF STRESS URINARY INCONTINENCE
Fozzatti, C; Herrmann, V; Palma, P; Riccetto, C;
Dambros, M; Fraga, R
1
University of Campinas, Brazil
Objective: Global postural reeducation is a technique based
on the stretching of muscular groups and reestablishment of
the skeleton axis. Normal pelvic floor function depends on
the distribution of the forces over its fascia and ligaments
and also on the levator ani muscles activity. Evaluate the
GPR as new tool in the conservative management of female
stress urinary incontinence (SUI) and the impact on the
quality of life.
Materials and methods: A total of 26 women with SUI
underwent a GPR treatment. The age ranged from 23 to
72 years, mean age x and body mass index from 19.90 to
34.21. Patients work-up included history, physical exami-
nation, physiotherapeutic evaluation and aerodynamic
study. Patients with overactive bladder were excluded from
the study. All patients were treated for six months using
GPR, 50 minutes weekly sessions during three months and
three more months of sessions every other week. During the
sessions, the patients were positioned in stretching postures,
according to the deficiency of the main muscular group and
also assuming postures that impact on the bones, muscles
and ligaments of pelvis. The patients were evaluated before
and after the treatment, and also at 3 and 6 months follow-
up. Outcome measures were made using King’s Health
Questionnaire, 3 days voiding diary, pad test and functional
evaluation of pelvic floor (FEPF). Six months after
treatment, the patient satisfaction was evaluated trough a
standardized analogical visual scale.
Results: Twenty-five patients were available for follow-up.
At the end of the treatment there were 4 (16%) patients
completely dry, 18 (72%) improved and 3 (12%) failures.
At 6 months follow-up there were 6 (24%) patients
completely dry, 16 (64%) improved and 3 (12%) failures.
Significant differences were noted in the number of leak
episodes, pad use and FEPF. Regarding the king’s health
questionnaire, improvement in all domains was observed,
especially in general perception of health, leakage impact in
all the four moments of evaluation.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Conclusion: GPR significantly improved the symptoms and
quality of life in women with SUI. This treatment may
represent a new strategy in the conservative management of
SUI, especially for those patients with significant postural
problems.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
342
INFLUENCE OF SELF-PERCEIVED INCONTINENCE
SEVERITY ON QUALITY OF LIFE AND SEXUAL
FUNCTION IN WOMEN WITH URINARY
INCONTINENCE
Paick, J-S; Cho, M; Ku, J; Son, H; Kim, S
1
National University College of Medicine, Seoul, Korea
Aims: We examined the impact of patient-perceived
incontinence severity (PPIS) on health-related quality of
life (QoL) and sexual function in women with urinary
incontinence (UI).
Methods: Patients were recruited from clinic practices at
one hospital. Between May 2004 and June 2006, 353
women 27 to 79 years old (mean 55.7) underwent detailed
evaluations. To obtain health-related QoL and sexual
function assessments, the patients were asked to fill the
questionnaires including the Incontinence Quality of Life
(I-QoL) and Female Sexual Function Index (FSFI). Patients
were categorized into the three groups according to the
PPIS; ‘mild’, ‘moderate’ and ’severe’.
Results: Among groups, the duration of symptoms, rate of
mixed UI, mean number of treatment visits over the past
year, rate of UI associated without any activity, and
Valsalva leak point pressure (VLPP) was significantly
different (P<0.05). The I-QoL total score and subscale
scores deteriorated significantly as the PPIS increased (P<
0.001). Of the 6 domains in the FSFI questionnaire, 4
domains, namely, ‘arousal’ (P=0.026), ‘lubrication’ (P=
0.012), ‘orgasm’ (P=0.017) and ‘pain’ (P=0.037) as well
as the FSFI total score (P=0.004) were significantly
different among the groups.
Conclusions: Our findings suggest that PPIS significantly
influences health-related QoL and sexual function, and that
strategies for assessing PPIS should be incorporated for
assessing patients with UI.
Disclosures
Was consent obtained from patients? Yes.
S187
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
343
LEVEL OF SATISFACTION AND OF SUBJECTIVE
CLINICAL IMPROVEMENT AFTER PELVIC FLOOR
MUSCLE TRAINING IN THE TREATMENT
OF URINARY INCONTINENCE
Castillo Vico, MT1; Haimovih Segal, S1; Tejero Sánchez,
M2; Muniesa Portolés, JM2; Marco Navarro, E2; Sebastià
Vigata, E2; Boza Gómez, R2; Duarte Oller, E2; Samitier
Pastor, CB2; Escalada Recto, F2; Carreras Collado, R1
1
Hospital del Mar, Barcelona, Spain; 2Hospital de la
Esperanza, Barcelona, Spain
Objective: The aim of this study was to find the subjective
clinical improvement and the level of satisfaction in
patients with urinary incontinence (UI) after pelvic floor
muscle training.
Study design: observational transversal study of 100
women with UI that went through pelvic floor muscle
rehab. Outcome variable included age, time of evolution of
the UI, precipitating factors, number of vaginal deliveries,
type of incontinence, grade of UI, previous treatments,
improvement after treatment, current clinical improvement,
follow-up of home treatment and the current self satisfac-
tion level.
Results: 58 patients with Stress Incontinence (SI) and 48
with Mixed Incontinence (MI). Over 85% of the patients
were satisfied with the treatment. More than 75% of the
patients with Grade I of UI, expressed a clinical improve-
ment of the symptoms (p=0.035), not related with the type
of UI. The patients who continued performing self exercises
at home belonged to the group that presented the best
clinical response to treatment (p=0.01) and they showed a
better level of self satisfaction (p<0.001).
Conclusion: The patients with SI or MI who went through
pelvic floor muscle training expressed a clinical improve-
ment, especially in case of UI grade I. They also reported a
better level of self satisfaction. Continuity with home pelvic
floor exercises is related with subjective clinical improve-
ment and with the level of self-satisfaction.
Remark: Treatment with pelvic floor muscle training must
be part of the flowchart of UI treatment.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
S188
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
345
MONOFILAMENT TAPE VERSUS MULTIFILAMENT
TAPE:WHICH CAUSES WHAT?
Sivaslioglu, AA; Dolen, I; Unlubilgin, E
Ankara Etlik Maternity and Women’s Health Teaching
Hospital, Turkey
Objective: Various kinds of polypropylene sling operations
are being performed in the treatment of stress urinary
incontinence. In this study, we aimed to point out the
complications and their relation with the type of polypro-
pylene tape that had been used.
Materials and methods: The sling operations with a
multifilament tape or a monofilament tape for the treatment
of stress urinary incontinence with or without a concomi-
tant prolapse surgery in the urogynecology department of
Ankara Etlik Maternity and Women’s Health Teaching
Hospital between March 2002-March 2006 were scruti-
nized. Patients were followed up at 6 weeks, 6 months and
annually after the operation with further clinical history,
examination and, where appropriate, urodynamic study.
Tape erosions, voiding dysfunctions, de novo urgency and
the effect of concomitant surgery has been evaluated. p<
0.05 was set statistically significant.
Results: There were 89 patients in the monofilament sling
group. The mean age of the patients was 46±6 years old.
Vaginal urethrolysis was performed in 5 (6%) patients due
to obstructive voiding symptoms and all of the patients
have had a concomitant pelvic prolapse surgery. De novo
urgency was observed in 22 patients (25%). No mesh
erosion was noticed during the follow up period.
There are 80 patients in the multifilament sling group. The
median age of the patients was 46±5 years old. Vaginal
urethrolysis was performed in 1 patient (1%). This patient
has had a concomitant pelvic organ prolapse surgery. De
novo urgency was observed in 7 patients (9%). Tape
erosion was observed in 4 patients (5%). Retzius haema-
toma developed in 1 patient.
Conclusion: Tape erosion is much higher in the multifilament
group. Voiding dysfunction is seen mostly in the monofilament
group. De novo urgency is much higher in the monofilament
tape group. Concomitant surgery seems to increase the voiding
dysfunction in both monofilament and multifilament tape
replacement but higher with monofilament tapes.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
347
OUTCOMES OF RECTOCELE REPAIR
WITH CHEMICALLY PROCESSED (TUTOPLAST®)
FASCIA LATA
Ghoniem, GM; Abdelwahab, HA; Elmissiry, MM
Cleveland Clinic, Weston, FL, USA
Objective: A rectocele is a defect of the rectovaginal
septum. Interposition of biological graft avoids dependence
on the already weakened native tissue without narrowing of
the vaginal canal. Patient symptom improvement and
satisfaction rates seemed better than those after traditional
rectocele repair. The objective of this study is to assess the
outcomes of rectocele repair with Tutoplast® processed
human fascia lata.
Materials and methods: This is a retrospective chart
review of 41 patients who had rectocele repair with
Tutoplast® fascia lata by one surgeon with a mean follow
up of 2.6 years. History, physical examination, operative
data, and postoperative data were used to assess the
outcomes of the surgical procedure. Cure was defined as
postoperative examination showing no rectocele (grade 0),
Improvement meant there was recurrent rectocele but its
grade was lower than preoperative assessment, and Failure
meant the rectocele grade was the same or even more than
preoperative assessment.
Results: Forty-one patients included in this study who had
an average age of 62.6 years and parity 2.6. The presenting
symptoms of the patients included; pressure symptoms 13
patients (31.7%), constipation 9 patients (22%), pelvic pain 6
patients (14.6%), manual assisted defecation 3 patients
(7.3%), and dyspareunia 2 patients (4.9%). There was history
of previous pelvic surgery in 22 patients (53.5%). Rectocele
grade I was 19.5%, grade II in 70.7%, and grade III in 9.8%
of patients. Operative complications were vaginal infection
in 7 patients (17.1%), treated successfully with antibacterial
vaginal suppository, constipation in 4 patients (9.8%),
dyspareunia in 2 patients (4.9%), and vaginal hematoma in
one patient (2.44%). None of the patients had graft exposure.
None of the patients failed, 40 patients (97.6%) were cured,
and one patient (2.44%) improved.
Conclusion: Rectocele repair using Tutoplast® facia lata is
a safe and effective procedure with minimal postoperative
complications.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
348
SINGLE-BLIND RANDOMIZED CLINICAL TRIAL
COMPARING EFFICACY AND SAFETY OF TVT
(TENSION FREE VAGINAL TAPE) VS TVT-O
(TENSION FREE VAGINAL TAPE OBTURATOR
SYSTEM) IN TREATMENT OF STRESS URINARY
INCONTINENCE-POLTOS-PRELIMINARY REPORT
Jakimiuk, AJJ1; Maciejewski, TM1; Fritz, AF2;
Baranowski, WB2; Wladysiuk-Blicharz, MW-B3
1
Department of Ob/Gyn, Central Clinical Hospital of
Ministry of Interior and Administration, Warsaw, Poland;
3
Department of Gynaecology and Gynaecological Oncolo-
gy, Warsaw, Poland; 4HTA Consulting, Krakow, Poland
Objective: A prospective, multicenter single-blind random-
ized clinical trial is designed in order to assess efficacy and
safety of two surgical procedures: TVT vs TVT-O in
treatment of stress urinary incontinence (SUI) in Poland.
Patients and methods: Patients with SUI confirmed by
urodynamic examination and pad test, with no prior history
of surgical treatment for SUI, are eligible for the study.
Assuming 80% test power, 5% level of significance and
10% drop-out rate it will be necessary to recruit at least 260
patients in order to detect a 10,1% difference in the
subjective cure rate. Patients fulfilling all the inclusion
criteria and meeting none of the exclusion criteria, after
their written informed consent is obtained, will undergo
randomization process resulting in assignment to one of the
two treatment groups (TVT or TVT-O) in a 1:1 ratio. Both
procedures will be performed in the same manner in each
investigation site according to standard protocol. During the
intervention patient will have additional incisions to fulfill
the protocol of single blinded trial. The number of subjects
per site will not be limited under the competitive enrolment.
Quality of life, subjective and objective cure rate, mean
time of the surgery, duration of hospital stay and compli-
cations will be assessed. The follow-up will last 7 years and
the visits will be scheduled as follow: 3, 6, 12 month and 3,
5, 7 year. The trial will be monitored by external CRO and
supported by Polish Scientific Committee (Grant nr
N40301331/0469)
Results: Statistical analysis of the results will be performed
at the end of the study: per protocol analysis and intention
to treat analysis. During the study interim analyses will be
performed after six month follow-up of each 50 included
patients.
Conclusion: This is the first single blinded, randomized
trial of two surgical procedures in the treatment of SUI in
S189
women. The POLTOS study will be performed on a much
larger group of patients than previously published studies.
The results of the study will answer to the question if these
two procedures will differ significantly in their efficacy and
safety. Thus it could help drawing precise conclusions on
clinical significance of both procedures.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
349
VALUE OF PRESSURE FLOW STUDIES IN WOMEN
WITH URINARY INCONTINENCE
Vanga, P1; Arunkalaivanan, AS1; Sorinola, L2; Holmes, J3;
Elmardi, A3
1
City Hospital, Birmingham, UK; 2Warwick Hospital, UK;
3
Stafford General Hospital, UK
Objective: To compare pressure flow parameters in the
different urodynamic diagnoses in women with urinary
incontinence (UI).
Materials and methods: This prospective multi-centric
study was carried out on urodynamic traces of women with
incontinence. Detrusor pressures at the start of flow (ODP),
detrusor pressure at peak flow rate (PdetQmax), peak flow
rate (Qmax) and detrusor pressure at the end of flow (CDP)
were measured and compared with 3 different urodynamic
diagnoses: urodynamic stress incontinence (USI), detrusor
overactivity (DO), mixed urinary incontinence (MUI).
Results: 357 urodynamic traces were prospectively
investigated January and December 2006. 89% (317)
traces were analysed as the normal urodynamic traces
were excluded as the number was too small for
comparison. 142 (45%) had DO, 113 (36%) women had
USI, 62 (19%) had MUI. All three groups were matched
for parity but younger women (53±17) have DO than
MUI (60±5) or USI (60±13) p=0.001.
Variable DO USI MUI
ODP cm H2O 25(14–38) 13*(6–23) 15(9–27)
CDP cm H2O 66(40–86) 44*(11–90) 35(26–66)
PdetQmax cm H2O 27(20–40) 23*(12–32) 19*(10–26)
Qmax ml/sec 20(14–27) 28*(21–36) 25*(18–31)
p<0.05 by Tukey’s post hoc test. Data described as median
and interquartile range by ANOVA.
Women with DO have significantly higher ODP, CDP and
PdetQmax than women with USI. The median ODP for DO
is >20 cm H2O which may suggest association of bladder
S190
outlet obstruction with DO. Qmax was significantly greater
in women with urodynamic stress incontinence compared
to women who had detrusor overactivity (P<0.05, by
Tukey’s post hoc test). Women with MUI had pressure
flow parameters intermediate between women with DO and
those with USI except for CDP measurement where it is the
lowest.
Conclusion: Despite higher detrusor pressures, Qmax is the
lowest in the DO group compared to USI and MUI. This
indicates women with DO may have increased incidence of
incomplete voiding. Therefore patients on anticholinergic
therapy should have regular post-void residual volume
measurements.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
350
WOMEN WHO EXPERIENCE DETRUSOR
OVERACTIVITY
Lowenstein, LL; Kenton, KK; Dooley, YD; Mueller, EM;
Brubaker, LB
1
Loyola Medical Center, Chicago, IL, USA
Objective: To explore the relationship of cystometric
volume at the time of first detection of detrusor overactive
incontinence (DOI) to condition-specific quality of life
(QOL).
Materials and methods: We reviewed consecutive charts
of women diagnosed with pure DOI during urodynamic
testing. DOI volume was defined as the cystometric volume
at the first detection of DOI. Responses to the Urine
Distress Inventory (UDI6) and Incontinence Impact Ques-
tionnaire (IIQ7) were recorded. Spearman correlations were
used to compare independent groups with respect to
continuous variables.
Results: Eighty-six women were included in this analysis.
DOI volume was inversely correlated with UDI6 and IIQ7
scores (Spearman’s ρ=−.514, p<.001 and Spearman’s ρ=
−.611, p<.001). Maximal cystometric capacity was also
inversely correlated with UDI6 and IIQ7 scores (ρ=−.458,
p<.0001 and Spearman’s ρ=−.43, p<.0001).
Conclusion: Women who experience DOI at lower vol-
umes during urodynamics report greater bother and QOL
impact from incontinence than women who leak at higher
volumes.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Figure 1.
100
80
IIQ-7 Total Score
60
40
20
R Sq Linear =
0.344
0
0 200 400 600 800
DOI Volume
Correlation in between DOI volume and IIQ-7 score,
ρ=−.611, p<.001
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
351
A NEW BULKING AGENT (BULKAMID®)
FOR TREATING FEMALE STRESS INCONTINENCE:
A 9–24 MONTH FOLLOW-UP STUDY
Soerensen, HC; Sander, P; Lose, G
Glostrup Hospital, Denmark
Objective: To evaluate the patient subjective perception of
response, efficacy, satisfaction with the procedure and
safety after treatment with Bulkamid®.
Materials and methods: The study was conducted
retrospectively. Relevant data was extracted from the
patients’ records and the patients were assessed by a 9–24
(mean 15) month’s follow-up telephone interview. The
patients evaluated their subjective perception of response to
treatment (cured, improved, not changed or worsened) and
their satisfaction with the procedure. The ICIQ validated
questionnaire was completed preoperatively and at the
follow-up. Complications and general medical problems in
the period since injection were recorded.
Sixty four patients were injected between 1.5.2004 and
1.10.2005 of whom 61 (95%) agreed to participate in the
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
follow-up study. Mean age was 63 (38–87) years and mean
duration of incontinence before bulking was 9.5 (1–42)
years. 62% of the patients had stress, 36% mixed and 2%
had urge incontinence. Previously 35% had had an
incontinence procedure performed (12% abdominal proce-
dure, 8% sling procedure and 15% bulking with other
agents). The women had a median of 4 (1–15) incontinence
episodes per day and leakage at 24 h pad test of 61 (0–779)
g. 67% were unfit for conventional anti-incontinence
surgery and 33% wanted injection therapy, opposed to a
TVT sling.
Results: The subjective perception of response was overall
63%. The responder rate was higher in the SUI group
(71%) compared to the mixed group (50%). Significant
improvements were found in the total ICIQ score (median
change 6.5) and in each of the individual question scores.
16% reported no incontinence episodes four weeks prior to
follow-up, and 25% reported not bothered by incontinence
in quality of life in the ICIQ. 74% of patients were satisfied
with the procedure. The average injected volume at the
initial treatment was 2.2 ml. Only 20% was re-injected.
10% of the patients had minor short term complications
(urinary tract infection, urinary retention and pneumonia),
none had injection site complications. None reported long
term complications.
Conclusion: Bulkamid® injection seems to be an effective
and safe method for treating stress and mixed urinary
incontinence. Furthermore the treatment especially provides
an option for patients’ unfit for or refusing conventional
anti-incontinence surgery.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Contura
international.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
352
EXTRA-CORPOREAL MAGNETIC ENERGY
STIMULATION OF PELVIC FLOOR MUSCLES
FOR URODYNAMIC STRESS INCONTINENCE
Ismail, SIMF1; Emery, SJ1; Lucas, M2; Wareham, K2;
Forward, G2; Bastin, L2
1
Singleton Hospital, Swansea, UK; 2Morriston Hospital,
Swansea, UK
Objective: To assess the efficacy and practicalities of extra-
corporeal magnetic energy stimulation of pelvic floor
S191
muscles as a non-invasive technique for urodynamic stress
incontinence of urine in women that does not require
patients top undress or have electrodes inserted in the
vagina (or anal canal).
Materials and methods: This was a prospective non-
controlled study in 2 district general hospitals. It included
female patients with urodynamic stress incontinence of
urine. All had 18, twice weekly treatment sessions.
Assessment was made on recruitment, at the end of
treatment as well as at 3 months follow up. The outcome
measures included the ICS pad test, continence diary,
quality of life assessment using the King’s health and
EuroQol questionnaires as well as side effects and drop out.
Results: 48 patients were recruited, 31 completed treatment
sessions and 27 attended for follow up at 3 months. There
was no significant change in outcome measures at the end
of treatment as well as at 3 months follow up. Side effects
were encountered by 52.1% of patients and the drop out
rate was 35.4%. Relevant side effects were significantly
more common in those who dropped out.
Conclusion: Extra-corporeal magnetic energy stimulation
of pelvic floor muscles seems unlikely to improve
urodynamic stress incontinence of urine. This appears to
be due to the passive nature of the contractions evoked.
Side effects are prominent and appear to contribute to the
drop out rate.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
353
GRADE 4 RECTOCELE REPAIR USING POSTERIOR
AVAULTA® FIXED TO A PELVISOFT® BIOMESH
Herraiz, JL; Bernabeu, A; Gil, F; Mestre, J; Calpe, E
Hospital General de Castellon, Spain
Objective: Traditional rectocele repair has been primarily
accomplished with a midline plication of rectovaginal
fascia and/or levator muscles through a transvaginal
approach.
Although the etiology of rectocele remains debated, surgical
innovations and a large number of different biologic and
synthetic graft materials are currently promoted to improve
anatomic outcome. The aim of these surgeries is the
restoration of normal posterior compartment anatomy repair-
ing the site-specific tears in the rectovaginal fascia.
We have used porcine acellular collagen matrix (Pelvisoft,
C. R. Bard, USA) fixed to a polypropylene mesh (Avaulta
S192
Posterior, C. R. Bard, USA) for graft-augmented repair of
posterior vaginal wall defects and have experienced
excellent results.
The objective of this study was to determine the efficacy of
grade 4 rectocele repair using Pelvisoft with Posterior
Avaulta mesh.
Materials and methods: Graft-augmented posterior vagi-
nal wall repair was performed alone or in combination with
other procedures in 8 women presenting with grade 4
rectocele. A Posterior Avaulta mesh was placed with the
habitual technique and then we joined over it the Pelvisoft
graft fixing both meshes with two delayed absorbable
sutures (2/0 Vicryl).
The closure of the vaginal mucosa was accomplished with a
continuous No. 2–0 delayed absorbable suture. A vaginal
pack and urinary catheter were placed for the first 24 h.
Prophylactic antibiotics were used to decrease the risk of
postoperative infection.
Results: Median age was 64. Follow-up of 8 patients was
18 months and has demonstrated good anatomical results.
There were no major intraoperative or postoperative
complications (infections, abscess, hematoma, blood loss
greater than 500 ml, or transfusion). Previously seen
problems with early postoperative vaginal mucosal dehis-
cence with Avaulta alone were not encountered in any of
these 8 patients. There have been no complaints related to
bowel function.
Conclusions: Graft-augmented repair with posterior
Avaulta fixed to a Pelvisoft Biomesh is in our experience
an effective technique for management of posterior vaginal
wall defects.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
354
OUTCOME FOLLOWING TRANSOBTURATOR
MONARC TAPE SURGERY IN INDIAN WOMEN
WITH STRESS INCONTINENCE DUE TO INTRINSIC
SPHINCTER DEFICIENCY
Sinha, R; Sinha, S; Leela, B; Rao, S; Srinivas, K
Medwin Hospital, Hyderabad, India
Objective: To evaluate the outcome following transobtu-
rator Monarc tape surgery in Indian women with stress
incontinence due to intrinsic sphincter deficiency
Materials and methods: Case records of 16 women who
underwent the Monarc transobturator tape for stress
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
incontinence due to intrinsic sphincter deficiency were
analyzed. Only those women with a minimum follow up of
3 months were included. All women underwent initial
history, physical examination including POP-Q, stress test,
ultrasonography and urodynamics evaluation on a Laborie
machine in accordance with guidelines for ‘good urody-
namics practice’ as per the International Continence
Society. Abdominal leak point pressure was recorded by
means of Valsalva maneuver, without a urethral catheter in
situ, measuring pressure from the absolute zero (transducers
zeroed to atmosphere) using visual leak demonstration in
the standing position. 8 of the 16 patients had pelvic organ
prolapse: 6 anterior compartment, 5 posterior compartment
and 0 apical. 4 had undergone hysterectomy. Women were
a mean of 48 years of age. 2 had recurrent stress
incontinence after needle suspension and Burch colposus-
pension respectively. All women underwent the outside-in
Monarc (American Medical Systems) transobturator tape
operation as per the standard described technique. Howev-
er, the tape was subjectively kept more snug (although still
‘free of tension’) than in the usual patient. No intraoperative
stress test was performed. Patients were evaluated in follow
up by asking for a history of incontinence (subjective
continence) and a physical examination which included a
stress test (objective continence) as well as detailed
evaluation for tape related complications, post void residual
on ultrasonogram and a uroflowmetry.
Results: At a mean follow up of 16 months (range 3 to
31 months), 15/16 (94%) were subjectively continent. 1
showed incontinence on physical examination which the
patient did not report (objective continence 88%). One
patient had vaginal erosion which didn’t need any specific
therapy and healed spontaneously. There was no significant
difference between the initial and postoperative Qmax
although the voided volume was higher following surgery
(385 ml versus 320 ml, p<0.05). Post void residuals
remained unchanged.
Conclusion: Over a mean follow up of 16 months, Monarc
transobturator tape is effective in Indian women with stress
urinary incontinence due to intrinsic sphincter deficiency.
However, objective evaluation shows a poorer outcome
than subjective patient reporting. Whether this will translate
into a higher failure rate in long term follow up needs to be
evaluated.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
355
PELVIC FLOOR RECONSTRUCTION EMPLOYING
PROLIFT IN HIGH-RISK SURGICAL PATIENTS
USING PUDENDAL NERVE BLOCKADE
WITH INTRAVENOUS SEDATION
Aguirre, OA1; Minne, LA2
1
Pelvic Specialty Care, USA; 2Colorado Anesthesia Con-
sultants, Denver, CO, USA
Objective: To present the possibility of surgical repair of
advanced pelvic organ prolapse in elderly patients who have
failed conservative management and have comorbidities
excluding them from receiving general or spinal anesthesia.
Materials and Methods: Advanced pelvic organ prolapse
in the elderly is a common condition that requires special
consideration. When management with a vaginal pessary is
unsuccessful, consideration should be given to a colpoclei-
sis performed under regional or local anesthesia. However,
when a colpocleisis is not anatomically feasible or is
unacceptable to the patient, then pelvic floor reconstruction
becomes the only alternative. The elderly will often have
medical comorbidities (i.e., cardiovascular, pulmonary, etc.)
placing them at high risk for general and regional anesthesia.
To overcome these problems, we describe the possibility of
surgical repair of severe vaginal prolapse using bilateral
pudendal blockade with intravenous sedation. After a
complete preoperative evaluation including multichannel
urodynamics, cystourethroscopy and pelvic imaging (when
indicated) the patient is consented for a total vaginal mesh
procedure employing Gynemesh (PROLIFT) and Tension-
free Vaginal Tape suburethral sling (TVT), if indicated. The
patient is positioned in Allen stirrups and prepped and
draped for a vaginal procedure. With the patient under light
anesthesia using fentanyl and propofol, 10 cc of Ropivicaine
is injected adjacent to each pudendal nerve using a 20-gauge
6-inch needle through a needle guide with a 1/4 inch spacer.
The perineum is then tested to verify efficacy of the blockade
prior to commencing the procedure. Local anesthesia using
0.25% Marcaine with epinephrine diluted 1:1 in normal
saline is used within the vesicovaginal and rectovaginal
spaces as is customary in the performance of total vaginal
mesh procedures. Additional local anesthesia is also injected
subcutaneously at the trocar sites corresponding to the
PROLIFT and TVT sling procedures.
Results: We have used this technique in patients who were
not candidates for general anesthesia and in whom a spinal
anesthetic was contraindicated or presented more risk. We
have found that a similar amount of sedation is necessary to
complete the procedure while the patients remain comfortable.
Alteration in the surgical technique is not required nor is there
a difference in duration of hospitalization or surgical outcome.
S193
Conclusion: Use of bilateral pudendal nerve blockade in
reconstructive surgery is a safe and effective alternative to
spinal or regional anesthesia when performing PROLIFT
procedures in the elderly or medically compromised patient.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
356
PREVALENCE OF URETHRAL INSTABILITY
Jean-Michel, M; Davila, GW
Cleveland Clinic, Weston, FL, USA
Objective: To describe the prevalence of urethral instability
in a referral-based urogynecologic clinic.
Methods: 1585 multichannel urodynamic studies were
performed between February 2001 and June 2006. Fifty-
three patients were diagnosed with UI, which was defined
as visible oscillations in urethral pressure during filling
cystometrogram by at least 25 cm of water pressure,
accompanied by reproducible urgency. Demographic data,
including gravity, parity, presenting urinary symptomatolo-
gy, and multichannel urodynamic findings were collected.
Results: The prevalence of UI was 3.3% of all urodynamic
studies performed. The mean age was 54.4 years (range 23–
85), median gravity was 3 (range 0–6), and median parity
was 2 (range 0–5). Urinary incontinence was reported by
71.7% of patients: mixed urinary incontinence 43.4%,
stress urinary incontinence 18.9%, and urge urinary
incontinence 9.4%. The most predominant presenting
bladder symptom was urgency/frequency (62.3%), fol-
lowed by abnormal voiding/retention (32.1%), recurrent
UTI (32.1%), hematuria (11.3%), continuous loss (5.7%),
and postvoid dribbling (5.7%). Similar rates of these
bladder symptoms were found in patients with UI without
detrusor overactivity: urgency/frequency (61.9%), abnormal
voiding/retention (35.7%), recurrent UTI (35.7%), hematu-
ria (14.3%), continuous loss (7.14%), and postvoid drib-
bling (7.14%). The most common concomitant urodynamic
diagnoses in patients with UI were sensory urgency
(39.6%), stress urinary incontinence with hypermobility
(35.8%), abnormal voiding (17.0%), detrusor overactivity
(13.2%), and intrinsic sphincter deficiency with hypermo-
bility (11.3%). Similar prevalences of these diagnoses were
found in patients with UI without detrusor overactivity
(50%, 42.9%, 16.7%, and 11.9%, respectively).
S194
Conclusion: Urethral instability is an uncommon urody-
namic finding associated with symptoms of urgency/
frequency and mixed urinary incontinence.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
357
STRESS URINARY INCONTINENCE BEFORE AND
AFTER VAGINAL RECONSTRUCTIVE SURGERY,
RETROSPECTIVE OBSERVATIONAL STUDY
Svabik, K; Martan, A; Masata, J
General Teaching Hospital, Charles University, Prague,
Czech Republic
Objectives: There is a large group of women which suffer
with both prolapse symptoms and stress urinary incontinence
(SUI) and occult stress urinary incontinence may occur in up
to 80% women after repositioning of the prolapse. Hence do
we treat or create urinary incontinence with pelvic floor
reconstruction? Shall we insert tension-free vaginal tape at
the same time of reconstructive surgery? It is always difficult
to prognoses the outcome of the reconstruction of the pelvic
floor. Therefore should we insert the tape after the evaluation
of the effect of the reconstructive surgery? It was the aim of
the retrospective study.
Materials and Methods: We include in to the retrospective
study 56 consecutive women operated by one surgeon (from
June 2004-January 2006) who underwent combined pro-
lapse repair for the management of genitourinary prolapse
grade II or III. Anterior repair with (Group A, n=39, 46,2%-
with SUI, 53,8%-continent) or without (Group B, n=17,
41,2%-with SUI, 58,8%-continent) the insertion of polypro-
pylene mesh was performed to all of those patients. The
observational period was one year after the surgery.
Results: From 56 included women 28 were stress urinary
incontinent before surgery due the urethral hypermobility,
28 women were continent (11 had obstructive symptoms
due the vaginal wall descend). Mean age was 66,5 years
±9,8, mean BMI 26,6 ±3,0. From 56 patients 13 needed
subsequent anti-incontinence procedure-TVT-O for SUI
after pelvic floor reconstruction procedure-23,2%, 10 stress
incontinent patient were from the group of 28 women,
which complained about SUI before surgery-35,7%. From
the group of continent women before surgery 3 were
incontinent after the repair-10.7%. In group A-25,6%
respectively in group B -23,5% patient were incontinent
after surgery.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Conclusion: Our result shows that there is a large group of
patient without the need of tape insertion after pelvic floor
reconstructive surgery. It supports the ‘two step strategy’.
Mesh insertion does not have further improving effect on
the subsequent SUI.
This work was supported by the Grant Agency of the
Ministry of Health of the Czech Republic, grant NR/9216–3.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
358
SURVEY OF USE OF LOCAL ANAESTHETIC
AND VASOCONSTRICTOR INFILTRATION
IN VAGINAL SURGERY
Latthe, P; Kadian, S; Parsons, M; Toozs-Hobson, P
Birmingham Women’s Hospital, UK
Objective: To survey the practice and reasons of use of
local infiltration in pelvic floor surgery in UK. As vaso-
constrictors can cause tachyarrhythmias, we wanted to
explore their concomitant use and rationale behind it.
Materials and methods: An electronic survey of gynae-
cologists with special interest in urogynaecology, urogy-
naecologists, urologists and allied professionals who were
on the email list of international continence society (ICS),
UK was carried out in April-July 2006. The nonrespondents
were sent reminders. The responses were stored on Micro-
soft Excel.
Results: Out of the 238 questionnaires that were sent, 119
failed mail delivery and 60 questionnaires were returned
giving a response rate of 50.4%. Out of these, 8 were allied
professionals or research fellows, 6 were urologists and
only 46 completed the questionnaire. Of the respondents
who completed the questionnaire, 11 used the British
Society of Urogynaecology database, 26 were planning to
start using it and 11 did not use it nor had plans to use it.
Table 1. Use of local infiltration for urogynaecological
procedures (total respondents=46)
Type of surgery Yes (%) No (%)
Vaginal Hysterectomy 40(86.9) 6(13.1)
Cystocele or Rectocele Repair 40(86.9) 6(13.1)
TVT 43(93.4) 3(6.6)
TVM* 18(100) 0(0)
Others 35(76) 11(24)
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
*Only 18 of the respondents performed vaginal mesh
procedure).
Table 2: Rationale for using local infiltration (N=46)
Rationale for use Yes (%)
Reduction in bleeding 42(91.6)
Reduction in injuries 25(54.3)
Reduction in operation time 8(17.39)
Better planes of dissection 39(84.7)
Reduction in postoperative analgesia requirements 21(45.7)
With regard to use of adrenaline, 42 (90%) used it with
local anaesthetic, 4 did not and 1 respondent was unsure.
The most common concentration of adrenaline used was 1
in 1000 (31/42), though some surgeons (11/42) diluted it
with normal saline to 1 in 100000.
Conclusion: There is wide variation in the type and dose of
local anaesthetic used in pelvic floor surgery with or
without vasoconstrictors. A randomised controlled trial of
use of local anaesthetic with vasoconstrictors should be
carried out to assess outcomes like reduction in operation
time, complications, blood loss and use of postoperative
analgesia in pelvic floor surgery.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
359
THE ANATOMICAL AND FUNCTIONAL OUTCOME
OF LAPAROSCOPIC SACROCOLPOPEXY USING
AN ULTRA LIGHTWEIGHT POLYPROPYLENE MESH
(MINI-MESH)
North, CE; Smith, ARB
Warrell Unit, St Mary’s Hospital, Manchester, UK
Objective: The ideal graft material for sacrocolpopexy,
placed abdominally or laparoscopically, has yet to be
determined. Previous published reviews of the short and
long term outcomes of laparoscopic sacrocolpopexy from
our unit have involved the use of Premilene mesh (B
Braun). Mini-mesh (Mpathy Medical Devices Ltd) is an
ultra lightweight (19 grams per square metre), macro-
porous, monofilament, polypropylene mesh designed for
prolapse repair. It has a ‘softer’ feel than Premilene mesh
and may, therefore, be associated with improved functional
outcome of laparoscopic sacrocolpopexy.
Materials and methods: This study involved the review of
the first 18 patients to have laparoscopic sacrocolpopexy
S195
using Mini-mesh at our unit. 16 patients attended for review
and were assessed at 6 months using a standardised,
structured interview and POPQ examination. Data with
regard to pre-operative symptoms, operative complications
and length of hospital stay was determined from case note
No (%)
4(8.6)
review.
21(45.7) Results: At review all 16 patients had stage 0 or 1 apical
37(80.3) support and were cured of their sensation of a vaginal lump.
7(15.2) Stress urinary incontinence and bowel symptoms (with the
25(54.3) exception of difficult defecation) resolved in the majority of
patients. Half of patients with urge urinary incontinence or
voiding difficulties were cured. No patients felt aware of
the mesh and dyspareunia occurred de novo in one patient.
Pre-operative dyspareunia was cured in one patient. The
only long term complication was one case of mesh
extrusion at the vault.
Conclusion: These results compare favourably with our
previous experience with Premilene mesh and suggest that
Mini-mesh may be associated with improved functional
outcome following laparoscopic sacrocolpopexy.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? Yes, by Mpathy
Medical Devices Ltd.
Level of support? No industry support in study design or
execution.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
360
TRANSVAGINAL MESH WITH VAGINAL WALL
ISLAND (VWI) FOR ANTERIOR VAGINAL WALL
PROLAPSE REPAIR
Yoshimura, Y1; Irisawa, C2; Honda, K1; Yamaguchi, O1
1
Fukushima Medical University; 2Irisawa Urology Clinic
Objective: Without data of late complications, synthetic
meshes are increasingly used in the surgical management of
pelvic organ prolapse. Therefore, there is big concern about
the potentially severe complication such as mesh erosion
into the bladder at long term. In fact, many cases of
intravesical mesh migration after inguinal hernioplasty have
been reported. We hypothesized that vaginal wall between
mesh and bladder wall would avoid the migration of mesh
into the bladder. The aim of this study was to assess
whether vaginal wall could minimize the incidence of the
mesh migration.
Materials and methods: All women with anterior vaginal
wall prolapse >stage II requiring surgical repair were
randomly selected to receive transvaginal mesh (TVM)
S196
with or without vaginal wall island (VWI). In TVM with
VWI group, 3 cm (width) × 6 cm (length) vaginal wall is
left in the center of cystocele. To create VWI, full
thickness parallel longitudinal incisions are made on the
anterior vaginal wall and these two incisions are merged
at both ends. The surface epithelium of VWI is destroyed
by diathermy to avoid postoperative retention cyst.
Surrounding vaginal walls are dissected laterally until the
ATFP is identified. In TVM without VWI group, midline
incision is made on anterior vaginal wall and wide lateral
dissection is carried out in a conventional manner. After
the dissection of vaginal wall, polypropylene mesh with 4
arms is implanted using the ‘transobturator passage’
technique. Posterior repair was associated in all cases.
None of the patients underwent vaginal hysterectomy.
Prolapse severity was evaluated using the POP-Q system
and symptoms/QOL were examined using PFDI preoper-
atively and during follow-up. The main outcomes of this
study were the rate of cure and the rate of complications
related to the mesh.
Results: Between July 2004 and January 2005, 56 women
were enrolled in the study. After randomization, 27 patients
underwent TVM with VWI and 29 without. There were no
differences between the two groups with regard to clinical
characteristics. There is no significant difference in rate of
prolapse recurrence between two groups. PFDI was
significantly improved postoperatively in both groups.
Vaginal erosion of mesh was found in one case of TVM
with VWI group and in two cases of TVM without VWI
group. There were no mesh migration into the bladder in
both group.
Conclusions: We can not conclude in the present study that
TVM with VWI is superior to TVM without VMI for the
prevention of mesh migration into the bladder at two years
postoperatively. However, since we have no data of the
long term complications of mesh, the effort should be
strongly recommended to minimize the potential adverse
event in the future.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
361
UNSUCCESFUL RESULTS USING GNRH
ANALOGUES FOR THE MANAGEMENT
OF BLADDER ENDOMETRIOSIS
Oviedo, JGO; Shaw, RS; Olguin, AO
ABC Medical Center, Mexico City, Mexico
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: To contribute a case report in which an
endometriosic nodule of the bladder failed to respond to
therapy with GnRH analogues after hysterectomy.
Case description: A 36 year old female presented with a
thirteen year case history of recurrent urinary tract
infections and stenosis of the urethra, necessitating
multiple dilating procedures and combined antibiotic
administration. She eventually developed hematuria and
was subjected to a cystoscopy in which an endometriosic
nodule of 5 cm was observed towards the bladder roof.
A total abdominal hysterectomy was performed due to
pelvic pain secondary to endometriosis. During the
procedure, extensive adhesions were encountered and
resection of the endometriosic bladder nodule was not
performed due to prolonged surgical time and anesthetic
considerations. Postoperative therapy with GnRh ana-
logues was administered for 6 months with only partial
relief of urinary symptoms. A follow-up cystoscopy
revealed persistence of the nodule with only a moderate
decrease in size.
Conclusion: When dealing with bladder endometriosis a
conservative approach may not be sufficient to achieve
adequate clinical results, therefore complete resection of the
lesion must always be performed if possible.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
362
URINARY INCONTINENCE IN FEMALE MARATHON
RUNNERS
Araujo, M Poli; Sartori, MGF; Trevisani, VFM; Oliveira, E;
Zucchi, EVM; Girão, MJBC
Federal University of São Paulo, Brazil
Objective: To determine the prevalence of the symptom of
urinary incontinence in female marathon runners.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244 S197

Materials and methods: A total of 37 women completed midurethral sling procedure three years after initial surgery
the International Consultation on Incontinence Question- in women with urinary incontinence (UI).
naire-Short Form (ICIQ-SF) and the short version of the Methods: Between March 2002 and January 2005, 325
Eating Attitudes Test (EAT-26). EAT-26 can be an efficient consecutive women underwent a midurethral sling proce-
screening instrument in which those who score at or above a dure with the Uretex® urethral support system for the
cut-off score of 20 are referred for a diagnostic interview. To treatment of urinary incontinence. Implanted sling length
determine the urine loss a 1-hour pad test was performed. was recorded in all cases. We evaluated the objective and
Results: The mean age was 35,3 years old (range: 15 to subjective cure rates in a cohort of 74 women recruited for
68), mean parity was 2,1 (range: 0 to 2) and the mean of the follow up three years after the original procedure.
body index mass was 22 (range: 18 to 32). Overall, 20 Results: The initial cohort of 325 women had a median age
athletes (54%) reported urine loss while participating in of 59 years (IQR: 47–69), median BMI of 28 kg/m2 (IQR:
their sport and the mean of the ICIQ-SF was 4,03 (±5,06). 25–33), and median sling length implanted of 23 cm (IQR:
There were no statistically significant relations between 21–24). There was a significant correlation between median
incontinence and body mass index, age, training frequency sling length implanted and BMI (r = 0.58, p < 0.001).
and alimentary disorders (Table 1). Seventy-four women were recruited for a three-year follow
up assessment. The follow up cohort had a median age of
Table 1. Data of female marathon runners (n=37) presented 50 years (IQR: 50–57), median BMI of 29 kg/m2 (IQR: 24–
separately for leakage group and non-leakage group. Values 34), and the median sling length implanted at the time of
are given as median (range) or number surgery was 23 cm (IQR: 21–24). 70/74 women had BMI
documented at the time of surgery and 43% were obese
Leakage group Non-leakage group P-
(n=20) (n=17) value
(BMI>30). At follow up, 43% (32/74) of women were also
Age (years) 31 38,5 0,25 obese. Fifty-four patients (73%) had stress urinary incon-
Body Mass Index (Kg/ 22 22,25 0,3027 tinence and 20 patients (27%) had mixed symptoms.
m2) Thirty-eight percent of women were diagnosed with
Training frequency 2 2 0,4064 intrinsic sphincter deficiency. 47/74 (64%) had isolated
(hours/week) sling implantation and 27/74 (36%) had a sling implant
1-hour pad test 1,13 g 0,94 g 0,0440 with other concomitant procedures [4% (n=3) had a sling +
EAT-26 18,87 16,79 0,3711
vaginal hysterectomy only; 2% (n=2) had a sling +
abdominal hysterectomy only and 30% (n=22) had sling
Conclusion: Urinary incontinence is common in female and concomitant procedures for prolapse with or without
marathons. Coaches be aware and improve knowledge of hysterectomy].
the problem and establish cooperation with urogynaecolo- The objective cure rate at three years was 90% (66/73)
gist and physiotherapist. based on no leaking during LPP (leak point pressure) and
87% (62/71) based on a change in pad weight of <1 gram
Disclosures on one-hour pad test. Median LPP at three years was
Was consent obtained from patients? Yes. 126 cmH2O (IQR: 108–150). Subjective cure was calculat-
Was this work supported by industry? No. ed from question 3 on UDI-6: ‘How much are you bothered
Does the presenter or any of the authors act as a consultant, by leakage of urine related to activity’ with 93% (68/73) of
employee (part time or full time) or shareholder of an women responding with a score of 0=not at all or 1=
industry? No. slightly. Based on a total score of <7 on quality of life
questionnaire IIQ-7, the subjective cure rate was 88% (64/
73). Associations between continuous BMI at the time of
363 surgery, sling length, and objective and subjective outcome
BMI AND IMPLANTED SLING LENGTH: measures at three years were calculated. Patients with
IMPACT ON CURE RATES THREE YEARS leaking during LPP were more likely to have a greater BMI
AFTER TREATMENT OF URINARY INCONTINENCE (positive leak median BMI=45 kg/m2 vs. no leak median
Blandon, RB; Trabuco, EC; Klingele, CJ; Bagniewski, SM; BMI=28 kg/m2, p=0.009).
Weaver, AL; Gebhart, JB Conclusion: The Uretex® urethral support system shows
Mayo Clinic, Rochester, MN, USA very good long term success rates for patients with UI.
Sling length does not seem to be associated with success
Objective: Our aim was to investigate the relationship rates, but is significantly correlated with BMI.
between BMI, implanted sling length and efficacy of a
S198
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by CR Bard,
Inc.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
364
COMPARING TVT AND TVT-O SUB URETHRAL TAPE
FOR TREATMENT PATIENTS WITH MILD
AND MODERATE STRESS URINARY
INCONTINENCE
Zhu, I1; Lang, J1; Chen, R1; Hai, N1; Wong, F2
1
Peking Union Medical College Hospital, Beijing, PRC;
3
Department of O/G of Liverpool Hospital, University of
New South Wales, Australia
Objective: To compare the efficacy and safety of tension-
free vaginal tape (TVT) and the transobturator suburethral
tape (TVT-O) procedures for the treatment of mild and
moderate stress urinary incontinence (SUI).
Methods: 56 women were randomly allocated to undergo
the TVT-O and TVT procedure. In some patients vaginal
repair or vaginal hysterectomy was done simultaneously for
associated indications.
Results: The mean (M±SD) blood loss and hospital stay
were the same in the two study groups (P>0.05). The
duration of TVT-O’s procedure (16 min) was significantly
shorter than TVT’s (27 min). All patients were followed up
for an average of 27.6 months. According to subjective
assessment of the outcome, cure was achieved in 92.9% in
TVT-O group vs 92.6% in TVT group (P>0.05). Improve-
ment of symptoms was achieved in remaining 7.1% in
TVT-O group vs 7.4% in TVT group (P>0.05). Residual
urine at the second day after operation les than 100 ml was
86% in TVT-O group and 89% in TVT group (P>0.05). No
serious complication occurred in both groups.
Conclusion: This study demonstrated no significant differ-
ence, in terms of cure rates, postoperative urine retention
and operative complications. The duration of the TVT-O
was however significantly shorter.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
365
COMPARISON OF SURGICAL OUTCOMES OF TVTO
AS AN ISOLATED PROCEDURE AND WHEN
COMBINED WITH PROLIFT
Nnochiri, A1; Rostom, N1; Roberts, C1; Barnick, C1
1
Homerton University Hospital, London, UK
Objective: To compare the outcomes of surgery for urinary
stress incontinence when performed as an isolated proce-
dure (TVTO), to the outcomes when performed in
conjunction with prolapse surgery (PROLIFT with poly-
propylene mesh).
Materials and methods: A retrospective review of all
cases of TVTO performed as an isolated procedure or in
combination with PROLIFT for urogenital prolapse in our
centre from April 2005 to October 2006. The patients were
all assessed Pre-operatively, with the use of a standardized
history and examination pro forma. All procedures were
performed by two consultants utilizing a standardized
method under regional or general anaesthesia. Patients were
seen in the outpatient’s clinic at 6 weeks and 3 months post
operatively. Treatment outcomes were measured using the
POP-Q score for PROLIFT procedure and subjective
assessment for TVTO. Quality Of Life data was collected
prospectively in all patients. Data will be presented on
patient demographics, operative details, complications and
treatment outcomes.
Results: 36 patients in total had TVTO procedure
performed out of which 10 patients also had PROLIFT
for symptomatic prolapse. We found no difference in
treatment outcomes or complication rates when TVTO
was performed in isolation or in conjunction with PRO-
LIFT repair using polypropylene mesh.
Conclusion: TVTO and PROLIFT with polypropylene
mesh as a combined procedure is safe and effective
procedure for the management of urinary stress incontinence
associated with genital prolapse.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244 S199

366 Was this work supported by industry? No.

COMPARISON OF THE EFFECTS OF CERVICAL Does the presenter or any of the authors act as a consultant,
VASOPRESSIN VERSUS NO PRE-MEDICATION employee (part time or full time) or shareholder of an
ON BLOOD LOSS DURING VAGINAL industry? No.
HYSTERECTOMY: A RANDOMIZED
CONTROLLED TRIAL
Capes, TLC1; Michaels, AM1; Smith, JS1; 367
Ascher-Walsh, CJAW2 INSTITUTIONAL EXPERIENCE
1
Columbia University, New York, USA; 2Mt Sinai School WITH THE RETROPUBIC COLPOURETHROPEXIE
of Medicine, New York, USA WITH THE BURCH TECHNIQUE FROM 1999 TO 2003
Lizaola Diaz de Leon, H1; Rodriguez-Colorado, S1;
Objective: To compare the blood loss, operative time, Escobar-Del Barco, L1; Gorvea-Chavez, V1
1
and post-operative pain medication requirements in Instituto Nacional de Perinatologia, Dr Isidro Espinosa de
patients undergoing vaginal hysterectomy who were los Reyes, Mexico City, Mexico
randomized to receive preoperative, intra-cervical vaso-
pressin or nothing. Objective: To analyze in and objective manner the parameters
Methods: 58 women undergoing vaginal hysterectomy of the candidates to anti-incontinence surgery and their
were randomized to receive either 12 units of vasopressin association with failure or success with the Burch Colpour-
intra-cervically or nothing preoperatively from 1/04–1/05. ethropexy at the Urogynecology Clinic of the Instituto Nacional
A blinded researcher was brought into the OR to determine de Perinatologia Dr. Isidro Espinosa de los Reyes, Mexico.
blood loss. Independent samples t tests, Fisher’s exact test, Methods and materials: Retrospective analysis using
Pearson Chi square and ANOVA were used for the analysis medical records of the 122 surgeries for stress incontinence
of the data at the end of the study. RESULTS: There were with the Burch technique performed from January 1999 to
no significant demographic differences between the two December 2003 with emphasis of the data from the
groups in patient age, weight, parity or ethnicity. There also cystoscopy and urodynamic findings. To define success or
was no difference in indication for surgery and estimated failure to the surgical therapy and to classify the side effects
uterine size. The key operative and postoperative compar- we use the definitions used by the International Continence
isons between the groups are seen the following chart: Society.
Results: 132 surgeries were performed during the period of
Blood Δ Time Total Change PCA Intra- Hosp. study. We analyze the data from 122 patients (92.4%) with
loss HCT into Surg. in morphine and stay
(cc) (%) CDS Time Mean (mg) post-op (d) complete medical record.
[SD] [SD] (min) (min) BP at complic. [SD] The average patient was 45 years old, with 2 vaginal
[SD] [SD] 1 min
[SD] deliveries, with BMI below 30, 47% with mixed urinary
Vaso- 145.3 6.07 4.4 69.6 13.4 30.6 3 2.34 incontinence and 35% with pure stress incontinence, the
pressin [137.1] [3.5] [2.0] [20.9] [11.5] [21.7] [1.0]
Nothing 266.4 7.06 3.9 65.4 0.9 19.2 1 2.41 vast majority with POPQ II Aa and urethral hypermobility.
[240.5] [4.4] [2.1] [18.0] [9.3] [16.8] [.86] ALPP positive in 57% with Pves under 60 cm/H2O and
p-value .022 .36 .46 .42 .000 .03 .5 .65
46% below 90 cm/H2O.
The mean uterine weight for the vasopressin group was Sixty five percent of the patients had and abdominal
180 gm vs. 133 gm for the control but the difference was hysterectomy in association with the colpourethropexy.
not significant. There was still a significant difference in Urethral Foley draining was removed 24 hours posterior to
change in mean BP at 5 min after injection, 10.3 for the the surgery in 119 patients and in the rest within one week.
vasopressin group vs 2.5 for the control, p=0.043. Negative cough test and negative ALPP was found in 89%
of all the patients (objective cure).
Conclusions: As seen in previous studies, the injection of During the surgery we found transitional hematuria in 5/
vasopressin intracervically, pre-operatively leads to de- 122, bleeding 1/122 and bladder punction in 3/122. After
creased blood loss during vaginal hysterectomy. While the event we found bleeding in the Retzius space in 1/122,
there was a slight, insignificant increase in the length of transitional intolerance to diet intake in 1/122, transient
surgery, it did not lead to increased patient morbidity. There neuropathies in 2/122 and wound infection in 3/122.
was however a significant increase in post-operative Transient voiding dysfunction with elevated residual vol-
morphine use in the patients receiving vasopressin. ume in 23% and just 1 case of persistent voiding
dysfunction that was managed with auto-clean intermittent
Disclosures catheterization.
Was consent obtained from patients? Yes. We document 10% of de novo detrusor overactivity.
S200
The following-up period was 5 years within all the patients
with physical examination, cystoscopy and urodynamics.
We found a 10% progression of POPQ within 5 years of
follow-up in the study group being the anterior compart-
ment the most affected.
Conclusion: The vast majority of our findings were similar
with the published data in the medical literature.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
368
INTRA-VAGINAL SLING POSTERIOR (IVSP)
PROCEDURE FOR THE TREATMENT OF DESCENSUS
UTERI AND VAGINAL TOP PROLAPS
Bergmans, MGM1; Haest, KMJ2; Sanli, I3; Gondrie,
ETCM4; Hasaart, THM2
1
Laurentius Hospital, Roermond, The Netherlands; 2Cathar-
ina Hospital, Eindhoven, The Netherlands; 3Elkerliek
Hospital, Helmond, The Netherlands; 4Maasland hospital,
Sittard, The Netherlands
Objective: Estimation of safety, effectivity and patient
satisfaction of the intra vaginal posterior sling procedure
(IVSp) for correction of vaginal top prolapse or descensus
uteri.
Materials and methods: In 3 Dutch hospitals (Catharina
Hospital, Eindhoven; Laurentius Hospital, Roermond;
Maasland Hospital, Sittard) a population of 150 patients
was evaluated retrospectively who underwent an IVSp
between January 2002 and April 2005. Between 4 months
and 1.5 years after the operation an inquiry was sent to all
to evaluate the results after a middle-long follow-up period.
Results: In 87% (131/150) IVSp was combined with other
surgical techniques as vaginal hysterectomy, anterior and/or
posterior vaginal wall repair. There were no complications
during surgery. Complications post operatively were:
cystitis 13, fever 1, haematoma 8. After 8 weeks there
was no improvement of prolapse complaints in 16 patients
(11%). In 19 (13%) a secondary prolapse was found,
mainly cystocele (14 patients). Of the 100 patients with
micturition or urinary incontinence problems before the
operation, 70 experienced improvement of their complaints.
Urgency de novo was found in 12 patients (8%). Tape
erosion occurred in 4 patients (2.6%) during the follow-up
period. Response on the inquiry was 65%. The mean score
of patient satisfaction was 4.8 (range 0–5) and the mean
score of effectivity 4.6 (range 0–5).
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Conclusion: IVSp is a save and effective treatment of
vaginal top prolapse or descensus uteri, with a high score of
patient satisfaction, during a middle-long period of follow-
up. More research is necessary to evaluate the long term
results.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
369
LUTS IN PREGNACY AND PUERPERAL PERIOD: IS
THERE A CORRELATION BETWEEN SYMPTOMS
SCORE AND QUALITY OF LIFE?
Palma, P1; Riccetto, C1; Pareira, S1; Ribeiro, G2; Gomes,
J2; Brisola, M2; Herrmann, V1; Fraga, R1
1
University of Campinas, Brazil; 3Minas Gerais, Brazil
Objective: During pregnancy, hormonal change, increase
in the body mass index and the pressure caused by the
enlarged uterus over the bladder and pelvic floor, are some
factors involved in lower urinary tract symptoms (LUTS).
This study was made to evaluate the correlation between
pregnancy and delivery way with LUTS.
Materials and methods: This open prospective study was
carried out using the overactive bladder questionnaire short
form (OABq-SF). A total of 60 patients enrolled this study.
The mean age was 24 year, raging from 14 to 40 years. The
patients were evaluated during the third trimester and
6 months after delivery. Statistical analysis of the OABq-
SF scores was made using the Pearson method.
Results: Mean OABq-SF score during pregnancy was 35.2
and 6 months after delivery decreased to15. Quality of life
was 82.9 during pregnancy and increased to 88.4 at 6 month
after delivery. Patient’s perception, that is correlation, was
55.02 (p = 0.0001) during pregnancy and 36.1% (p =
0.0046). Clinical correlation index was 6.7%.
Conclusion: Our study demonstrated that in spite of LUTS
being more important during pregnancy, there is no
significant clinical correlation in patient’s perception.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
370
MULTICENTER, PROSPECTIVE ARIS™
TRANSOBTURATOR SUBURETHRAL SLING TRIAL:
ANALYSIS OF INITIAL OUTCOMES DATA
Stanford, EJ1; Ghoneim, G2; Steidle, C3; Keil, K4
1
Center for Advanced Pelvic Surgery PC, New York, USA;
2
Cleveland Clinic, Weston, FL, USA; 3Western Indiana
Research; 4Keil Urogynecology, Denver, CO, USA
Objective: To assess initial outcomes data of the Aris™
transobturator (TO) suburethral sling from a multicenter,
prospective trial.
Methods: After obtaining IRB approval for each site,
standardized pre-operative data was collected. The TO
suburethral sling was performed. Data obtained at 1 month
and 6 months were analyzed. Demographic, urodynamic,
quality of life, intraoperative, and post-operative data were
collected. The UDI-6, IIQ-7, and quality of life (QOL) were
assessed. We used a null hypothesis assuming no improve-
ment would be seen, a χ2 to perform a symmetry test
between pre-and post-operative improvement was done.
Results: Eight-four women underwent surgery to implant a
suburethral Aris™ sling using the transobturator approach.
One month and 6-month data are available on 69 and 37
patients, respectively. Demographic data shows that the
mean age is 56±11 years, weight 178±42 lbs, and body
mass index (BMI) is 31±7. Stress urinary incontinence
(SUI) was diagnosed in 49 (59%) and mixed incontinence
was found in 35 (41%). 89% of patients were either
dissatisfied (16), unhappy (36), or felt that there QOL was
terrible (24) prior to their TO-sling. Operative data shows
that the curved (54%) and helical (46%) trocars were used
equally between the sites. Most patients received the TO-
sling alone (87%) although some underwent concomitant
hysterectomy or prolapse repair. Post-operatively the
patients were managed with transurethral catheter drainage
for <23 hours (69%) or no catheter (31%). No patient
required a suprapubic catheter. Continence was reported at
1 month in 85% and in 90% at 6 months. QOL at 6 months
showed that 93% of patients reported significant improve-
ment. The data show significant improvements for QOL,
incontinence grade, and cough stress test (p-value (<0.001).
Complications were: overactive bladder symptoms (3),
vaginal exposure of mesh that was treated successfully
with local excision (2), and nocturia (1).
Conclusion: This initial outcomes analysis from a multi-
center, prospective trial on the transobturator Aris™
suburethral sling shows that the procedure is safe and
effective in treating SUI and mixed incontinence.
Disclosures
Was consent obtained from patients? Yes.
S201
Was this work supported by industry? Yes, by Coloplast.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
371
PELVIC ORGAN PROLAPSE QUANTIFICATION
INDEX (POP-Q-I): A NEW INTERPRETATION
OF THE POP-Q SYSTEM FOR POP RESEARCH
OPTIMIZATION
Lemos, NLBML; Auge, APF; Lunardelli, JL; Frade, AB;
Frade, CL; Oliveira, AL de; Ribeiro, PAAG; Aoki, T
1
Faculdade de Ciências Médicas da Santa Casa de São
Paulo, Brazil
For many years, researchers on this field have suffered from
the lack of an efficient method for describing pelvic organ
prolapse.
Struggling to solve this problem, the International Conti-
nence Society (ICS) has proposed a Pelvic Organ Prolapse
Quantification (POP-Q) System, which was validated as a
precise and reproducible technique for describing pelvic
organ position.
However, even though very precise at describing pelvic
organ position, our critics to this system is its limited ability
to quantify the prolapse itself, since it still classifies prolapse
into four grades, almost the same way as Baden & Walker
did in 1972. As a result, the same grade can include a wide
prolapse intensity range.
The objective of this paper is to propose a method that makes
POP research more efficient by directly measuring prolapse
as a continuous variable, which requires lesser numbers of
subjects in order to achieve statistical significance.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
372
PREVALENCE AND QUALITY OF LIFE IN WOMEN
WITH URINARY INCONTINENCE
Velazquez-Magaña, M1; Rodriguez-Purata, JM1; Oviedo-
Ortega, JG1; Neri-Ruz, E2
1
ABC Medical Center, IAP, Mexico City, Mexico; 2Clinica
de Especialidades de la Mujer, SEDENA, Mexico
S202
Objective: To determine the prevalence of urinary incon-
tinence and the quality of life in Mexican women between
20 and 80 years old in Mexico City.
Materials and methods: The present is an observational,
transverse and descriptive study. The questionnaire con-
sisted of 3 parts: The first was a questionnaire from the
international consult of urinary incontinence in it’s short
form (ICIQ-IU-SF), which was used to study of the
prevalence of the disease. The second was the continence
and quality of life questionnaire (I-Qol) and the third was
the EuroQol questionnaire (EQ5D). The last two investi-
gated the impact of urinary incontinence on the quality of
life in relation to health (HRQOL).
Results: The questionnaire was applied to 80 patients. The
average prevalence was 46.5%. The incidence increased
from 30.2% in women between 20–29 years to 54% and
57.8% in women between 40–49 years and 50–59 years
respectively, with a further increase of up to 71.4% in
women between 70 and 79 years of age. Women with
urinary incontinence have a higher BMI (27±5.5 kg/m2)
than those who are continent (24.6±4 kg/m2). Likewise,
women with urinary incontinence were more likely to be
overweight or to have type I, II and III obesity. Women with
urinary incontinence also had a higher number of pregnancies
and vaginal deliveries than continent women. Incontinent
women reported a quality of life ICIQ-IU-SF index of 8.8±
3.3, and an IQOL quality of life index of 77.2±21.7, with a
limitation on activity of 75.1±21.2, a psychosocial impact of
83.4±21.8 and social embarrassment of 69.5±27.3. Women
with urinary incontinence reported a lower quality of life
index in relation to health (EQ-5D) than continent women.
Conclusion: Psychosocial evaluation shows that urinary
incontinence in women is associated with a lesser quality of life.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
373
PREVENTING POSTHYSTERECTOMY VAGINAL
VAULT PROLAPSE AND ENTEROCELE
BY THE McCALL CULDEPLASTY
Chene, G1; Tardieu, AS2; Mansoor, A2
1
University of St Etienne, France; 2Issoire Hospital, France
Introduction: This prospective study was carried out to
evaluate the effectiveness of the McCall Culdeplasty in
maintaining posthysterectomy vaginal vault and sexual
function.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Materials and method: Between 1998 and 2004, 185
patients underwent vaginal hysterectomy for uterine pro-
lapse without prolapse of the posterior vaginal fornix and a
McCall Culdeplasty. Patients were examined preoperatively
and postoperatively (3 months, 12 months, 24 months),
according to the prolapse grading system (POPQ) of the
International Continence Society.
A successful culdeplasty was defined by a postoperative
point D at stage 0. Sexual function was evaluated by the
anatomical and functional correlation between measure-
ment of postoperative vaginal length and dyspareunia.
Results: At 2 months’ follow-up, there were no vaginal
vault prolapses or enteroceles. With a follow-up from
2 months to 2 years, only 10% had vaginal vault prolapse
without enterocele (9.2% at 1 year, 10% at 2 years, without
any significant difference).
No surgical complications and no cases of ureteral
obstructions were recorded.
Of the 154 patients who had postoperatively sexual
activities, only 5 patients (3.2%) suffered from mild
dyspareunia at 1 year but there was no vaginal stenosis or
shorter vagina. They were supplemented with topical
estrogen and dyspareunia disappeared except for 1 patient.
Discussion and conclusion: The McCall culdeplasty didn’t
lead to a disruption of the vaginal axis and gave excellent
results in maintaining support after vaginal hysterectomy,
especially in sexually active patients. It is a technically
simple procedure to offer an effective and prophylactic
measure against posthysterectomy vaginal vault prolapse
and enterocele.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
374
SOCIAL SUPPORT FOR WOMEN SUFFERING
WITH VESICO-VAGINAL FISTULAE IN NIGER,
A REPORT FROM A SURVEY GIVEN
AT THE NATIONAL HOSPITAL FISTULA CENTER,
NIAMEY, NIGER BY THE INTERNATIONAL
ORGANIZATION FOR WOMEN AND DEVELOPMENT
Ascher-Walsh, CJAW1; Meyer, LM2; Stanford, EJS3;
Idrissa, AI4; Crawford, BC5; Wilkinson, JW6
1
Mt Sinai School of Medicine, New York, USA; 2Columbia
University, New York, USA; 3Center for Advanced Pelvic
Surgery, Belleville Memorial, IL, USA; 4National Hospital,
Niamey, Niger; 5Reno, NV, USA; 6Duke University, Chapel
Hill, NC, USA
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: Women suffering from vesico-vaginal fistulae
are known to be ostracized from their community as a result
of their infliction. We propose to determine what support
remains for these women who are able to seek care.
Materials and methods: From 9/05 to 1/06, 58 women
who were treated for vesico-vaginal fistulae at the National
Hospital in Niamey, Niger were given a questionnaire
translated into their native languages.
Results: 65.5% of these women considered themselves
married, 24.1% were separated and 13.8% were divorced.
However, of the women who considered themselves
married, only 33.3% lived with their husband prior to
traveling to the hospital. 36.1% lived with one or both
parent and 30.5% had lived so long at the fistula hostel in
Niamey that they considered it as their home. As
previously reported, the journey to the hospital is both
difficult and costly. While 72.4% of the women presented o
the hospital accompanied by a family member, 27.6%
presented alone. Of those who presented with family, only
10.3% presented with their husband which represents
16.7% of those who considered themselves married. The
other family members who accompanied the women were:
mother-25.8%, both parents-10.3%, brother-9.1%, father-
6.9%, sister-5.2%, grandmother-3.4%, aunt-1.7%. Upon
completion of their care at the National Hospital, 65.5% of
the women planned on returning to their village. Only the
10.3% who came with their husbands planned to live with
their husbands, the rest planned to live with their parents.
31.0% planned to continue to live at the fistula hostel.
3.4% were to live in Niamey but not in the fistula hostel.
51.7% of the women claimed that they would not want to
get pregnant again due to fear of recurrence of their fistula.
However, 70% of these women believed that their family
would not be supportive of their decision to not have more
children.
Conclusion: Social supports for women suffering from
vesico-vaginal fistulae are limited in Niger. Nursing care at
the hospital is provided primarily by family members,
leaving over a quarter of these women to support
themselves. Because of social expectations, many of these
women would chose to risk recurrence of their fistula and
have another pregnancy than face the social isolation as a
result of choosing not. It is not surprising that a third of
these women choose to remain at the fistula hostel with
those who are understanding of the hardships they have
suffered and do not have the social expectations that may
result in a return to that condition.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
S203
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
375
THE TRANSOBTURATORIC TAPE PROCEDURE FOR
STRESS URINARY INCONTINENCE: RESULTS OF AN
ARGENTINEAN MULTICENTER EXPERIENCE
Sarsotti, C1; Lombroni, J2; Sänger, I3; Perez Junqueira, S1;
Altuna, S2; Cahaud, S3; Levit, C1
1
OSECAC Gyn Services, Buenos Aires, Argentina; 2Hos-
pital Austral, Buenos Aires. Argentina; 3Hospital Penna,
Buenos Aires. Argentina
Objective: To evaluate results and complications of the
Transobturator Tape (TOT) procedure for the treatment of
female SUI at three major centers in Argentina.
Materials and methods: We studied retrospectively 246
(87% with GSUI and 13% with mixed incontinence) who
underwent the TOT procedure between May 2004 and
December 2006.
Tapes used included Monarc® (67%), TVT-O®, Safyre®,
Unitape® and Obtryx®.
Results: Mean age was 54,3 (33–97). Mean follow up was
19 months (2–33) Fifty nine percent had concomitant
reconstructive surgery. The procedures were perfomed
under spinal 80%, local 17% and general 3%. Mean
operation time was 18′ (12–30) Mean hospital stay was
26 hs (6–48). Subjective cure rate was 93%. The most
frequent intraoperative complication was vaginal perfora-
tion. Three urethral punctures seen and no bladder, bowel
or vascular injuries. Four tapes were released under local.
No life threatening complications nor reoperations.
Conclusion: The treatment of SUI using transobturator
tapes is safe and effective for women with SUI. Mid term
follow up results show steady results after the first year.
Easy to learn and teach and friendly performed under total
local anesthesia TOTs are a reality in nowadays armamen-
tarium for the treatment or females SUI.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
S204
376
TO LEAK OR NOT TO LEAK! DOES INCONTINENCE
INFLUENCE SELF ESTEEM?
Basra, RKB
1
Guy’s and St Thomas’ NHS Foundation Trust, London,
UK
Objective: Loss of self esteem has been previously
reported in women with urinary incontinence. Self esteem,
defined as the ‘belief and confidence in one’s own ability
and value’ is distinct from well being, confidence and
depression. Self esteem influences health seeking and
coping behaviours, perception of illness and treatment
compliance; important factors in the successful manage-
ment of lower urinary tract symptoms (LUTS). The aim of
this study was to investigate self esteem using a validated
questionnaire, in women with overactive bladder (OAB)
with or without urinary incontinence.
Materials and methods: Women with a clinical diagnosis
of OAB or mixed urinary incontinence receiving care >1 yr,
were recruited from 2 urogynaecology clinics and a
community clinic. Participants completed 3 validated
questionnaires; the Rosenberg Self-esteem Scale (SES)
which is a self report, 10item questionnaire scored on a 4-
point Likert scale and has been used in the assessment of
diabetes, heart disease, cancer, mental health disorders and
drug abuse; the Kings Health Questionnaire (KHQ)-an
incontinence specific quality of life scale; and the SF36
generic health scale.
Results: 200 patients took part in the study, of which 135
patients’ responses were suitable for analysis. The mean
age of participants was 57 yrs. Participants were subdivided
into 3 groups; OAB without incontinence (OAB dry n=23),
OAB with urgency incontinence (OAB wet n=12) and
mixed incontinence (n=100). Mean SES scores for women
with dry OAB were higher than women with wet OAB or
mixed incontinence although this difference was not
statistically significant. SES scores were not significantly
affected by age, ethnicity or SF36 scores. There was a
positive correlation between overall SES scores and the
KHQ general health perception domain. There was a
negative correlation between overall SES scores and the
KHQ incontinence impact, role and physical limitations,
personal relationships, emotions, sleep and energy and
severity measures domains (P<0.01).
Conclusion: Women with OAB dry, wet or mixed
incontinence report similar SES scores. Symptomatic relief
of OAB dry may be as valuable as treatment of OAB wet
and mixed incontinence in influencing women’s’ self
esteem. The KHQ is more sensitive in detecting the quality
of life impact of LUTS and its effect on self esteem, than
the SF36.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
377
TVT-S VS TVT-O : RANDOMIZED, PROSPECTIVE
COMPARATIVE STUDY OF INTRAOPERATIVE
COMPLICATIONS, PERIOPERATIVE MORBIDITY
AND SHORT-TERM POSTOPERATIVE RESULTS
Friedman, M
Rambam Medical Center and Institution of Women’s
Health, Maccabi Health Care Services, Haifa, Israel
The Gynecare TVT Secure System (TVT-S) from Ethicon,
Inc.-the third TVT generation, a novel tension-free vaginal
tape midurethral sling implant has been launch on Septem-
ber 2006 during the IUGA 2006 international meeting in
Greece. This polypropylene mesh tape which is four times
shorter that traditional slings, is introduced to the patient
with a new attach-and-release mechanism that promotes
stable, controlled placement without skin exits.
It’s virtually no scientific papers appeared in the literature
on this subject, but obviously, some clinical trials have been
undertaken all over the world, and in the future it will be
possible to estimate the success rates of this new device.
The first in Israel TVT-S has been done by the author in
August 2006, and following the success of TVT-O slings it
has been decided to curry on a prospective randomized
comparative study of these two minimally invasive differ-
ent techniques for stress urinary incontinence performed by
one experienced surgeon. The main goals of this clinical
trial were to compare intraoperative complications, peri-
operative morbidity and short term postoperative efficacy
of both procedures.
Forty eight women who undergone TVT-S or TVT-O
implantations with or without concomitant mesh surgery
for pelvic organ prolapse were available at 6 month follow-
up and have been assessed by the author.
Different clinical data, subjective and objective parameters
of stress incontinence cure are presently under statistical
evaluation will be presented and discussed.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244 S205

379 Conclusion: There was lower prevalence of urinary

URINARY INCONTINENCE AND PELVIC ORGAN symptoms and POP especially of posterior vaginal
PROLAPSE SCREENING AMONG INDIGENOUS prolapse in female indigenous. This is the first longitudi-
WOMEN IN THE XINGU INDIAN RESERVATION, nal study in indigenous community dwelling women that
CENTRAL BRAZIL: PRELIMINARY RESULTS provides POPQ data and uses validated pelvic floor
Araujo, M Poli; Takano, C; Pereira, E; Oliveira, E; Sartori, questionnaires.
MGF; Rodrigues, D; Girão, MJBC
UNIFESP, Brazil Disclosures
Was consent obtained from patients? Yes.
Objective: The Xingu Indian Reservation is a federal Was this work supported by industry? No.
indigenous reserve created in 1961 and today has an Does the presenter or any of the authors act as a consultant,
estimated population of 6000, spread throughout 30 employee (part time or full time) or shareholder of an
villages from 17 indigenous nations. The Reservation is industry? No.
located in the northern state of Mato Grosso and occupies
2.3 million hectares. The area is administered by Funai
(Indian National Foundation) and is under direct supervi- 380
sion of the Brazilian Justice Ministry. The objective of this URINARY SYMPTOMS IN WORKING WOMEN
study was to describe the prevalence of pelvic organ WITH PROLONGED INHIBITION OF VOLUNTARY
prolapse and urinary symptoms across indigenous women URINATION
in the Xingu Indian Reservation. Mendonça, NQ; Filho, ALS; Rodrigues, AM; Triginelli, SA
Materials and methods: A community-based cross-sec- Federal University of Minas Gerais, Belo Horizonte, Brazil
tional research was performed in 267 indigenous women of
Xingu (Mt-Brazil). Ethical approval was obtained. The Objective: This study was undertaken to evaluate urinary
community underwent an interview applying validated symptoms in working women with prolonged inhibition of
International Consultation on Incontinence Questionnaire- voluntary urination.
Short Form (ICIQ-SF). At the time of the visit, they were Materials and methods: Sixty one ‘call center’ working
examined supine using the International Continence Society women with limited access to toilet facilities due to work
(ICS) prolapse score (POP-Q). restrictions were included for analysis. Urinary symptoms
Results: The age range was 12 to 75 with mean age of were assessed by self-administered questionnaires that
30 years. Mean parity was 4 (0 to 12). Only 19/267 (7,1%) included the Kings Health Questionnaire and the Interna-
women reported urinary incontinence. The most common tional Consultation on Incontinence Questionnaire (ICIQ).
symptom was mixed incontinence (4,1%) followed by urge Statistical analysis was performed using χ2 and Student t
(3%). Table 1 shows the ICIQ-SF scores and table 2 shows test as appropriate.
mean POPQ values. There was significantly more anterior Results: The age of patients ranged from 19 to 33 years old
than posterior vaginal wall prolapse. (23.5±0.4 years) with mean body mass index of 23.1±
Table 1: ICIQ scores 0.5 Kg/m2 (ranging 19.9 to 37.1 Kg/m2). Stress urinary
incontinence was noted in 16 (28.1%) women and
ICIQ n % overactive bladder in 37 (60.6%) cases. The ICIQ score
0 248 93% ranged from 0 to 15 (4.2±0.6). Eighteen women (31.6%)
1–5 10 3,7%
used pads for urinary incontinence and 25 (43.9%)
6–10 5 1,9%
11–21 4 1,5%
presented repeated urinary tract infections. Intestinal con-
stipation was seen in 24 (39.3%) cases. Low concentration
Table 2: Mean POPQ values and worse productivity attributed to urinary symptoms was
Results Mean±SD (range)
noted in 29 (50.9%) women.
Aa −1,3±1,12 (−3 to 3) Conclusion: Prolonged inhibition of voluntary urination
Ba −1±1,3 (−3 to 4) due to work restrictions is associated with high rates of
Ap −2±0,9 (−3 to 0) urinary symptoms which may negatively impact on
Bp −1,9±1,1 (−4 to 3) production.
C −5±1,3 (−9 to −6)
D −6± 2,3 (−9 to −8)
Disclosures
TVL 6,9±1,4 (6 to 10)
Was consent obtained from patients? Yes.
PB 2,1±0,7 (2 to 5)
GH 3,4±1,1 (3 to 6) Was this work supported by industry? No.
S206
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
381
URODYNAMICS
BEFORE AND AFTER TRANSOBTURATOR SLING
Palma, P; Riccetto, C; Oliveira, R; Fraga, R; Herrmann, V
University of Campinas, Brazil
Objective: The aim of study is investigate the urodynamic
changes after TOT sling.
Methods: A prospective study in 20 patients with stress
urinary incontinence (SUI) was performed. All patients had
typical stress incontinence detected during a urodynamic
study preoperatively. After six months postoperation, an
urodynamic study was done to evaluate the patients. The
variables analyzed were the free maximum flow (Qmax),
first sensation, Valsalva leak point pressure (VLPP),
maximum cystometric capacity, detrusor pressure at max-
imum flow (Pdet Qmax) and residual volume. In all women
the surgery was performed with a transobturatory ‘outside
in’ approach, using the Safyre ™ (Promedon) sling placed
at the middle urethra.
Results: The mean age was 54 (±12.8) years, range from
35 to 77. No patients had significant pelvic organ prolapses,
therefore no associated reconstructive procedure was
necessary. There were no significant intraoperative compli-
cations. Significant postoperative urinary retention was not
present in these patients. At six months, 19 (95%) were dry
and one (5%) the procedure failed. Comparison of
urodynamic findings before and six months after the
surgery are show in Table 1.
Table 1. The most important urodynamic findings preoper-
atively and postoperatively
Urodynamic variables Preoperative Postoperative
(mean ± SD) (mean ± SD)
Qmax (free uroflowmetry, ml/s) 20±10.4 15.1±6.7
First sensation (ml) 133±53.9 237±94.01
Maximum cystometric capacity (ml) 365±88.5 372±97.8
VLPP 78.6±25.8 93.5±20.2
Pdet max. flow (cmH2O) 22.2±10.6 27.8±17.09
Residual urine (ml) 35±25 30.3±34.8
According the Blaivas-Groutz nomogram six (30%)
patients were classified as mildly and one (5%) as
moderately obstructed, however no patient had voiding
symptoms suggestive of obstruction. The mean/SD Qmax,
Pdet max flow, and residual urine, 15.7 (±4.6), 33 (±12.2)
and 39.7 (±57.7), respectively, were not significantly
different, compared with non-obstructed patients.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Conclusion: The transobturatory sling was not associated
with significant changes in the urodynamic parameters.
There was a unexpected high prevalence of obstruction,
according Blaivas-Groutz nomogram, which showed no
clinical importance.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
384
ZUIDEX: 5 YEARS WITHOUT STRESS
Blick, C; Marsh, HP; Foley, SJ
Harold Hopkins Department of Urology, Reading, UK
Introduction: The purpose of injectable treatment is to
provide a minimally invasive, effective and safe alternative
to open surgery for the treatment of stress urinary
incontinence. Zuidex is a copolymer of non-animal stabi-
lized hyaluronic acid and dextranomer microspheres
(NASHA/Dx) which can be injected under local anaesthetic
(LA) using the implacer system. We report the short and
medium term results of periurethral Zuidex injection for the
treatment of stress urinary incontinence.
Patients and methods: 145 female patients aged between
18 and 87 years underwent periurethral injection of Zuidex
using the implacer system between 2001 and 2006. Follow
up of patients varied from 4 months to 5 years and
6 months. 62% had the procedure under LA.
Results: 57.9% were satisfied and required no further
intervention.
12.4% had a repeat injection of Zuidex.
24.1% subsequently had surgical intervention.
5.6% were unsatisfied but did not consider their symptoms
severe enough to warrant further treatment.
Mild complications (urethritis, urinary tract infection, uri-
nary retention) were encountered in 26.2%
All patients were discharged the day of the operation, those
who were discharged with a catheter in situ or performed
intermittent self catheterisation were catheter free within 1
week.
Conclusion: The majority of patients were satisfied and
required no further intervention. The procedure is repeatable
and in our experience is free from serious complications.
Instillation is simple and can be performed in an out patient
setting. Zuidex has proved to be an effective first line
alternative in the treatment of stress incontinence and a single
instillation can provide symptomatic relief beyond five years.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
385
URINARY SYMPTOMS PREVALENCE IN WOMEN
SOCCER PLAYERS
Zucchi, EMV; Moreno, A; Carrazedo, T; Leme, J; Jármy-Di
Bella, ZIK; Girão, MJBC; Sartori, MGF
Federal University of São Paulo, Brazil
Objective: To verify the prevalence of the urinary
symptoms in nulliparous women athletes and to evaluate
the importance of a urogynecologic physiotherapy program
for athletes at the Olympic Center for Training and
Research of the city of São Paulo, Brazil (COTP).
Method: A transversal study at COTP between May and
June, 2006 on 21 nulliparous women athletes with 12 to
19 years of age that played soccer, was done to evaluate
some urogynecological aspects. A lecture was given to
these athletes about the steps of this research, details of the
urinary analysis and Pad Test, information about urge-
urinary incontinence and the reasons why to search the
prevalence of urinary incontinence and the need for
strengthening of the pelvic floor for these athletes.
Results: The average age of these 21 athletes was
13,71 years. These athletes began playing soccer at an
average age of 8,38 years. The average corporal mass index
was 20,10. Fifteen of these 21 athletes (71,42%) referred
urinary urgency with urinary symptoms, and 8 athletes
(38,09%) referred stress urinary incontinence.
Conclusion: The prevalence of urinary urgency and urinary
symptoms in athletes of the COTP was observed, showing
that stress urinary incontinence was not statistically
significant. We concluded that a physiotherapy program at
COTP is necessary to orient, prevent and treat urinary
symptoms.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
S207
386
URODYNAMICS: NORMAL FINDINGS
Escobar-del Barco, L; Flores Rueda, EV;
Márquez Hirlemann, AE; Avilez Cevasco, JC;
Rodríguez Colorado, S
Instituto Nacional de Perinatologia México, Mexico City,
Mexico
Objective: To divulge terminology, technique, findings and
interpretation of normal urodynamic study recommended
by the International Continence Society (ICS) and interna-
tional literature. To gather in one document the normal
values of each of the parameters in order to have a valuable
teaching and preparation instrument for gynecologic an
urogynecology residents.
Materials and Methods: Analysis of the actualized
literature was made, based on:
Standardization of terminology recommended by the ICS,
evidence based medicine and international literature, using
images of urodynamic studies of our Urogynecology
Division.
Urodynamics tests evaluate filling cystometry, bladder
storage and voiding phases. Filling cystometry and bladder
storage are used to diagnose urinary incontinence. The
result of micturition is evaluated in the voiding phase. The
modalities that have become the standard in evaluating
urodynamics are: uroflowmetry, urethral pressure profile,
filling cystometry, pressure flow studies and special tests as
abdominal leak point pressures an electromyography.
Conclusion: In our clinic 5651 urodynamics studies have
been done since 1992 to date. This experience has allowed
us to understand the need of gynecologists in get
experience in these procedures for the diagnostic and
therapeutic.
Urodynamic test is the most useful diagnostic instrument in
urogynecology when it is integrated with clinical findings.
It is of great importance to have actualized and reliable data
in order to take accurate therapeutic decisions and therefore
successful results.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
387
A NEW TECHNIQUE OF SACROSPINOUS LIGAMENT
FIXATION
Farnsworth, BN
Sydney Adventist Hospital, Australia
S208
Objectives: Forty three patients underwent sacrospinous
ligament attachment using a new instrument adapted from
orthopaedic surgery. Patients were evaluated between 12
and 19 months postoperatively to assess the efficacy of the
apical attachment.
Materials and methods: All patients underwent a pelvic
reconstruction procedure which included between 2 and 4
apical attachments. These attachments were performed as a
minimally invasive vaginal procedure and non absorbable
mono-filament sutures were tied into position without tension
so as to suspend the prosthesis and restore the natural angle of
the vagina. Patients underwent a full clinical assessment
including POPQ evaluation and lateral defect assessments.
Quality of life assessments were obtained preoperatively, and
at 3 months and 12 months postoperatively.
Results: All operations were performed by the author.
Thirty nine patients returned for follow up between 12 and
19 months after surgery and all 39 were found to have an
intact apical attachment. There were no major complica-
tions. 1 patient developed a post operative haematoma that
was treated conservatively. 3 patients had temporary
buttock pain. Thirty six patients reported no pain at all.
There were no pudendal, bladder or bowel injuries. 11
patients reported poor bladder function and subsequently
underwent urodynamic evaluation followed by implantation
of a suburethral sling. Two patients with a poor quality
urethra also underwent treatment with a periurethral
bulking agent.
Discussion: A minimally invasive technique is presented.
There were no cases of apical support failure at 12 months
follow up. Sacrospinous fixation with up to 4 attachments
allows a balanced support of the vagina. Pain is reduced
and durability of the attachment increased by sharing the
load between 4 independent attachments, each one placed
in position using an orthopaedic instrument specially
adapted for this purpose.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
388
A COMPARISON OF TENSION-FREE VAGINAL MESH
(TVM) TECHNIQUE VERSUS SITE-SPECIFIC
REPAIRS FOR PELVIC ORGAN PROLAPSE PATIENTS
Nomura, M; Yoshimura, K; Kitano, R; Hachisuka, T;
Matusmoto, T
University of Occupational and Environmental Health,
Fukuoka, Japan
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: The tension-free vaginal mesh (TVM) tech-
nique is developed as a minimally invasive surgical
technique by the TVM group. The aim of our study was
to evaluate restrospectively effectiveness and safety of this
technique with use of polypropylene mesh (Gynemesh®) in
comparison to site-specific repair without use of synthetic
mesh.
Materials and methods: Forty-two female patients with
POP stage more than 2 were enrolled. First 12 patients
underwent the site-specific repair using a combination of
procedures, including the transvaginal hysterectomy, the
McCall culdoplasty, the paravaginal and central defect
repairs, the posterior wall repair. Subsequent 30 patients
underwent the TVM technique with Gynemesh®. In TVM
technique, the anterior compartment repair used anterior
mesh anchored transversally between arcus tendineus with
two arms each side through obturator foramen. The
posterior compartment repair used posterior mesh an-
chored transversally between sacrospinal ligaments.
Patients were evaluated by questionnaires (King’s Health
Questionnaire, IPSS-QOL, OABSS, ICIQ-SF) and clinical
examination of vaginal profile and uroflowmetry before
and after surgery.
Results: The mean age in TVM and site-specific groups
was 67.3 and 70.4 years, respectively. Follow up ranged
from 11 to 16 months in the site-specific repair group and
from 3 to 6 months in the TVM group. No major
intraoperative complications were observed in either group.
No patients had a symptomatic recurrence after surgery in
either group. In TVM group, 4 (13.3%) of the 30 patients
were diagnosed with vaginal erosion. The mean operation
time in the TVM group was 72 minutes (range, 40–
120 minutes) compared with 165 minutes (range, 120–
188 minutes) in the site-specific repair group (P<0.01).
Estimated blood loss was significantly lower in the TVM
group (median, 50 ml) than in the site specific group
(median, 280 mL) (P<0.01). In both groups, quality of life
and storage and voiding symptom improved significantly
after the procedures. However, the improvement of storage
symptoms and the Qmax tended to be greater in the TVM
group than in the site-specific group.
Conclusion: Both methods provided a satisfactory anatom-
ical correction of POP, with a significantly improvement of
voiding and storage symptoms and positive impact of
quality of life. The TVM technique provided shorter mean
operation time and less estimated blood loss in comparison
to site specific repairs. These findings suggest that TVM
may be less invasive option for surgical correction of POP,
although considering the risk of vaginal mesh erosion.
Disclosures
Was consent obtained from patients? Yes.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
389
DYSPAREUNIA TREATMENT MODALITY
WITH BOTULINUM TOXIN A
Hurt, K; Halaska, M; Krcmar, M; Sottner, O; Krajcova, A
1
Charles University, Prague, Czech Republic
Objective: Dyspareunia is known as a recurrent or
persistent genital pain, associated with sexual intercourse
in either a male or a female. In women, it is generally
defined as genital pain occurring with penetration or during
or after intercourse but not exclusively vaginismus (a
common type of insertional dyspareunia caused by intense
involuntary contraction of the perineal muscles surrounding
the outer one third of the vagina).
Notation:
It is not always necessary to know the cause of dyspareunia
if there is not obvious organic reason. Relaxation exercises
may help a woman regain control over vaginal muscles,
reducing pain and making sexual intercourse more pleasur-
able. In a small group of patients we proved massive
improvement of dyspareunia after the administration of
botulinum toxin type A (DYSPORT) injected into the
levator ani muscles of woman with vaginismus, or into the
perineum (where is absence of spasticity).
We extended our group of patients and followed up for the
period of one year.
Materials and methods: Eleven women, aged 28–45 years,
were treated for dyspareunia. Two of them for dyspareunia
caused by vaginism, where 40 units of (DYSPORT) were
injected into the puborectalis and pubococcygeus muscles.
Nine patients with dyspareunia without any objective
reasons with no vaginism were treated with botulinum
toxin type A (DYSPORT) injection of 40 units into the
perineum and adjacent rectovaginal septum. We performed
8 punctures, every with 5 units.
We followed up the patients one week after the adminis-
tration and every two months until one year period (further
following is not included in this paper yet). We evaluated
individual response on a drug administration.
Results: On a P<0.001 level we proved rapid improvement
of disorder in a mentioned group. One patient with vaginism
was lost to follow-up and the second one required additional
doses of 40 units four months after the first administration.
Five patients with pure dyspareunia required additional
doses of 40 units after eight months, last four did not until
one year of follow-up.
S209
Conclusion: Botulinum toxin A injected into the pelvic
muscles and/or perineum and rectovaginal septum induces
long lasting reduction of dyspareunia and improvement of life.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
390
ELECTRICAL STIMULATION IN ANAL
INCONTINENCE
Rodriguez-Colorado, S; Escobar-del Barco, L; Gorvea-
Chavez, V; Gonzalez-Maldonado, J
Instituto Nacional de Perinatologia, Mexico City, Mexico
Objective: To determine the experience with electrical
stimulation and biofeedback in patients with diagnosis of
anal incontinence in the department of Urogynecology of
the Instituto Nacional de Perinatologia.
Materials and methods: observational, transverse, descrip-
tive, analytical, retrospective study.
From year 2002 to 2006, patients’ records were checked
with anal incontinence treated with biofeedback and
electrical stimulation therapy for muscular strengthening.
Demographic and clinical data related to anal incontinence
were obtained. Data on anal incontinence, management as
well as outcome were collected and analyzed.
Results: 27 record files were revised, of which 17 patients
were < 40-year-old, and 10 of > 40 years. Eleven had 0–1
parity, 10 with 2–3 parities, 4 of 4–5 parities and 2 with
more than 6 parities. IMC was obtained in 17 patients, 6
with normal weight, 6 with overweight and the rest were
obese. Four patients had prolonged second stage labour, 4
had midline episiotomy, and 13 had forceps delivery, 4 with
macrosomic babies, 8 patients with preceding sphincter
tears, previously repaired. By ultrasound 10 patients
presented anal sphincter disruption.
The treatment protocol was 8 patients with electrical
stimulation and 19 patients received electrical stimulation
plus biofeedback.
From the total of patients it was observed, that 17 patients
improved more than 90%, 7 improved up to 70% and 2
with no improvement.
The general improvement was more frequently observed in
patients that completed 12 sessions of treatment.
Conclusion: It is considered that the therapy with electrical
stimulation is an excellent therapeutic alternative in patients
with diagnosis of anal incontinence, with an effectiveness
even of 92%.
S210
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
391
ETIOLOGICAL FACTORS FOR VAGINAL PROLAPSE
AFTER HYSTERECTOMY
Lukanoviè, A
University Medical Centre
Objective: The exact incidence of vaginal prolapse
occurring after hysterectomy is not known. According
to the literature, vaginal vault prolapse, one of the rare
types of vaginal prolapse after hysterectomy develops in
less than 1% of cases. Additionally, the role of
hysterectomy as an etiologic factor for vaginal prolapse
has not been elucidated. The aim of this study was to
find the effect of some known risk factors for the
development of pelvic organ prolapse on the occurrence
of vaginal prolapse after hysterectomy.
Materials and methods: Retrospectively we reviewed
medical records of two groups of women, Group A (the
study group) consisted of 82 women operated on at the
Dept. of Gynecology & Obstetrics., University Medical
Centre of Ljubljana in the period 2000–2004 for problems
due to vaginal prolapse. All of them in the past undergone
hysterectomy. Group B (the control group) consisted of
124 women who had undergone hysterectomy for a
benign gynecological disease in the past as well, but
who were not operated on for a vaginal prolapse by the
beginning of the observational period. Both groups of
women were given a self administered questionnaire. The
answers contained additional information on risk factors
involved in the occurrence of pelvic organ prolapse.
Statistical comparison between the groups was done using
t-test, Chi-square test, Mann-Whitney test and a multivar-
iate logistic regression model. Statistical significance was
set at p<0.05.
Results: Vaginal prolapse after hysterectomy occurred
statistically significantly more frequently in women who
had undergone hysterectomy for pelvic organ prolapse,
who had a higher number of deliveries, who had had a
higher number of difficult labours, fewer caesarean
deliveries, who had experienced complications after
hysterectomy, who performed hard physical work or had
a neurologic disease and had pelvic organ prolapse in
family history.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Conclusion: The strongest significant correlation has been
found between the occurrence of vaginal prolapse and
pelvic organ prolapse as the indication for hysterectomy.
Presumably not all defects in the vaginal support were
recognized on hysterectomy and were thus not surgically
repaired. In women who had undergone hysterectomy for
pelvic organ prolapse and were in the reproductive age at
that time, disorders of collagen metabolism might be
considered an important risk factor for vaginal prolapse
after hysterectomy.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
392
FEMALE ATHLETE TRIAD AND THE SEARCH
FOR THE BRAZILIAN ATHLETE PROFILE
Parmigiano, TR; Jármy-Di Bella, ZIK; Zucchi, EMV;
Rosseto, JD; Barsottini, C; Girão, MJBC; Sartori, MGF
Federal University of São Paulo, Brazil
Introduction: The women participation in sports has
increased in the past few years. However, we must realize
that even though physical exercises leads to many health
benefits, its excessive practice may cause specific risks to
the their well being. Therefore, the known ’Female Triad
Athlete’, which includes disordered eating, low bone
mineral density and menstrual dysfunction, has increased
among young athletes, which may sacrifice their health,
family, education and social life to reach better perfor-
mance. Another issue considering these athletes is a later
urinary incontinence, usually related to prolonged high
impact activities.
Purpose: To study the profile of different kind of athletes,
searching for the prevalence of the components previously
mentioned. In spite of the large international literature in
our country, there are few studies on the mentioned subject,
which becomes our resource inspiration.
Methods: 51 female athletes were submitted to a question-
naire regarding factors related to the Female Athlete Triad
and urinary symptoms. College athlete are also being
interviewed for future correlation.
Results: 51 athletes of 7 different sports with age between
14 and 33 years old (average: 19,2) were interviewed.
Weekly training of 21,43 hours average. 43% of them have
presented menstrual dysfunction and a case of bulimia was
diagnosed as well. 31,3% had BMI<20 and 11,76%
reported previous stress fracture. 92% of the female athletes
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
had never heard about Female Athlete Triad. 35% men-
tioned rare urinary loss, which 77% was attributed to some
kind of exercise. Less than 1% of them mentioned urinary
urgency.
Conclusion: Part of the Brazilian female athletes are not
aware of the risk related to intense sports practice when not
assisted by a medical and nutritional group. It is important
that the professionals involved are aware of the responsi-
bility in protecting these women athletes health through
and early diagnose and correct intervention on these
situations.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
393
METHODOLOGY OF URETHROCYSTOSCOPY
Escobar-del Barco, L; Rodriguez Colorado, S; Márquez
Hirlemann, AE; Lizaola Díaz de León, H
Instituto Nacional de Perinatologia México, Mexico City,
Mexico
Objective: To divulge the technique of urethrocystoscopy.
Materials and methods: This poster describes the
technique of the urethrocystoscopy, noting the indica-
tions, contraindications, equipment and technique of the
procedure, illustrating urethrocystoscopy images of our
experience.
Results: The ability to evaluate the lower urinary tract
without the need of a surgical incision, distinguishes
urology from other disciplines, these procedures can be
done for diagnostic, therapeutic purposes, or both.
The urethrocystoscopy nowadays has been used in gyne-
cology as a basic tool in the assessment of inferior urinary
tract disorders of women with urinary incontinence.
Conclusions: In our clinic 5056 urethrocystoscopies have
been done since 1992 to date. This experience has allowed us
to understand the need of gynecologists in get experience in
these procedures for the diagnostic and therapeutic. Its
execution requires ability based on training and practice,
under the supervision of urologists or urogynecologists.
The urethrocystoscopy complements clinical history, phys-
ical examination and radiologic and urodynamic studies
enriching a right diagnosis and therefore offering the best
treatment to our patients.
S211
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
394
PELVIC ORGAN PROLAPSE REPAIR USING
THE AVAULTA ANTERIOR OR POSTERIOR
BIOSYNTHETIC SUPPORT SYSTEM
Herraiz, JL; Bernabeu, A; Gil, F; Mestre, J; Calpe, E
Hospital General de Castellon, Spain
Objective: The use of new biological or synthetic materials
and meshes, along with the new minimally invasive
surgical techniques to correct the pelvic organs prolapse
has recently won popularity.
Material and methods: Our group of work has carried out
a series of 37 patients treated with Avaulta Anterior or
Posterior Biosynthetic Support System.
Indications were: 25 cystoceles grade III-IV, 20 rectoceles
grade III-IV, being some of them recurrences of previous
treatments with conventional techniques to correct the
genital prolapse.
We practised a vaginal hysterectomy to 27 patients. Twenty
five meshes have been placed at the anterior compartment
and 20 at the posterior compartment.
Results: Complications appeared at the surgical time were:
two accidental bladder puncture and one case of intra-
operative moderate haemorrhage that didn’t need any blood
transfusion. We haven’t observed any vaginal vault hema-
toma, abscess or mesh infection at the recent postoperative
time, but there has been observed 7 cases of superficial
buttock bruises, fever peak in 2 cases and unspecific
perineal pain in 5 cases.
There have been no erosions on follow-up. We observed 3
cases of mesh extrusion and 1 case of fecal incontinence.
Any case has recurred and patients are subjectively satisfied
with the results.
Although we’ve had good results, follow up is ongoing to
evaluate the durability of the techniques.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
S212
395
PRELIMINARY EXPERIENCE OF TRANSOBTURATOR
VAGINAL TAPE FOR SURGICAL TREATMENT
OF FEMALE STRESS URINARY INCONTINENCE
Lee, SR1; Ju, W2; Kim, DY1; Kim, SH1; Chae, HD1; Kim,
JH1; Kim, YM1; Kim, YT1; Kang, BM1; Hong, JY3;
Nam, JH1
1
University of Ulsan, Asan Medical Center, Seoul, Korea;
2
Ewha Womans University, Seoul, Korea; 3College of
Medicine, Pochon CHA University, Seoul, Korea
Objective: To evaluate the clinical efficacy and safety of
transobturator vaginal tape (TVT-O) procedure for the
treatment for female stress urinary incontinence (SUI).
Materials and methods: Fifty seven female patients with
stress urinary incontinence who underwent the TVT-O
procedure between March 2004 to February 2005 were
included in this prospective study. We investigated the
patients’ characteristics, operation time, hospital days,
efficacy, and complication at 6 months, 12 months, and
18 months follow up. TVT-O (TVT-O™, Gynecare)
technique was performed as described. No cystoscopy
was performed.
Results: The mean age was 57.0±6.8 years (range 41–73),
mean parity was 2.8±1.0 (1.0–4.0), and mean BMI was 26.6
(kg/m2). Fifty-one patients were postmenopausal women
and 31 patients (60.8%) in this postmenopausal women had
a history of hormone replacement therapy. Thirteen patients
had undergone prior gynecological surgery; total abdominal
hysterectomy in 8 patients, Cesarean section in 4 patients,
unilateral salpingectomy in 1 patient. Four patients (7.01%)
had undergone prior stress urinary incontinence surgery,
TVT in 3 patients, Burch colposuspension in 1 patient. Of
the 57 patients, 23 patients (40.4%) underwent TVT-O only
and 34 patients underwent gynecological surgery concom-
itantly (vaginal hysterectomy in 5 patients, vaginal hyster-
ectomy combined with posterior colporrhaphy in 14
patients, and posterior colporrhaphy in 15 patients). The
mean operation time was 20.5 minutes (range 13–30). Of
the 23 patients who underwent TVT-O only, 20 patients
were discharged on the same day of surgery and mean
hospital stay was 1.0±0.9 day (range 0–4.0) including
thirty-four patients with combined gynecological surgery.
SUI was cured in 49 patients (86.0%) and improved in 6
patients (10.5%) at 18 months after operation. There was no
intraoperative bladder or bowel injury. Postoperative
transient urinary retention was noted in 3 patients (5.3%)
and two cases (3.5%) of postoperative hematoma which
were resolved without any surgical intervention in 2 months.
No one required any transfusion and no bladder injury was
noted in the two groups. There was no serious complication
during 18 months follow-up period.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Conclusions: Our experience showed that TVT-O is an
effective and safe procedure for the treatment of female
stress urinary incontinence. The extremely shorter operation
time and hospital day of TVT-O procedures than conven-
tional operation methods offer additional satisfaction to
both operator and patient.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
396
SURGERY OF LARGE AND RECURRENT ANTERIOR
WALL DEFECTS USING PERIGEE: RESULTS
OF AN ARGENTINEAN MULTICENTER EXPERIENCE
Lombroni, J1; Sanger, I2; Cahaud, S2; Altuna, S1; Perez
Junqueira, S3; Sarsotti, C4
1
Hospital Austral, Buenos Aires, Argentina; 2Hospital
Penna, Buenos Aires, Argentina; 3OSECAC, Buenos Aires,
Argentina; 4OSECAC, Buenos Aires, Argentina
Objective: Report the results of surgical treatment of large
and recurrent anterior wall defects using Perigee at three
major centers in Argentina.
Materials and methods: Between May 2005 and Decem-
ber 2006 an observational study using the Perigee system
for the treatment of large anterior wall and recurrent
prolapse was conducted. Perigee was associated with all
kinds of reconstructive surgeries.
Results: 32 women underwent surgery during the mentioned
period. Mean follow up was 14,9 mo (2–21). Perigee was
associated to VH and sacrospinous fixation, to sacrospinous
colpopexy, to Apogee, to hysteropexy, to posterior repair, and
to perineoplasty as well as to SUI procedures both retropubic
or transobturator. Eight (25%) cases had prior classical
anterior repairs. Complications included two symptomatic
hematomas. Healing abnormalities were seen in 18,75% of
the cases managed conservatively.
All but one patients were discharged the morning after
surgery. Only one patient (3,12%) had failed to present.
Conclusion: Though follow up is still short, Perigee
showed to be a highly effective and safe procedure for the
treatment of the large or recurrent anterior wall prolapse
which could be combined easily to any pelvic reconstruc-
tive surgery.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
397
TEGRESS® URETHRAL IMPLANT IN THE TREATMENT
OF STRESS URINARY INCONTINENCE
Herraiz, JL; Bernabeu, A; Gil, F; Mestre, J; Calpe, E
Hospital General de Castellon, Spain
Objective: Stress urinary incontinence can be defined as
involuntary loss of urine during a period of increased
abdominal pressure and the absence of detrusor activity.
Bulking agents used in the urethra are one of the newer
technologies for the treatment of Stress Urinary Inconti-
nence. The intention of this report is to review the
clinical results for Tegress® Urethral Implant (C.R. Bard)
used in patients with genuine stress urinary incontinence
and urethral hypermobility without intrinsic sphincteric
deficiency.
Materials and methods: The study protocol included 12
women with genuine stress urinary incontinence. Patients
could not have significant prolapse, were allowed to have
had prior incontinence surgery, and were required to have
specific urodynamic criteria.
Transurethral implantation of Tegress® Urethral Implant
solution was performed in all of the patients in the office
setting, with a periurethral local block. We placed Tegress
Implant approximately 2 cm distal to the bladder neck with
a slower rate of injection (60 seconds/implant site). Most
patients void immediately after surgery.
All patients were to be followed for efficacy at 3, 6 and
12 months post implant. Patients were defined as improved
after injection if they experienced an improvement in I-
QOL score by at least 50% or a negative stress test.
Results: Objective cure rates were 61% at 3 months, and
49% at 12 months. Subjective success rates were 86% and
68% at 3 and 12 months, respectively.
Hematuria was observed in 8 patients, pain during injection
in 3 patients, urinary urgency/frequency in 2 patients
(which disappeared in a month) and urinary tract infection
or urinary retention was not found.
Conclusions: Intraurethral injection of Tegress® Urethral
Implant is a safe and benign procedure, offering greatest
benefit to patients with a high anesthetic risk or patients
who decline a surgery.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
S213
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
398
THE VIRTUAL UROGYNAECOLOGY CLINIC
Jha, S1; Radley, S1; Bates, M1; Jones, G2
1
Royal Hallamshire Hospital, Sheffield Teaching Hospitals
NHS Trust, UK; 2Senior Lecturer, Social Sciences, Univer-
sity of Sheffield, UK
Objective: To assess the potential for on-line assessment of
women referred to urogynaecology services & the creation
of a ’virtual urogynaecology clinic’ based on the electronic
pelvic floor assessment questionnaire (e-PAQ).
Materials and methods: Women who attend our urogy-
naecology clinic now routinely complete a computerised,
interactive pelvic floor assessment questionnaire (e-PAQ)
on arrival & prior to their consultation. The questionnaire
comprises 4 dimensions (Urinary, Bowel, Vaginal &
Sexual), each with approximately 30 items. A report is
produced, which provides scores in 19 valid & clinically
meaningful domains (e.g. Overactive bladder, Irritable
bowel, Prolapse & Dyspareunia). 58 women who used the
e-PAQ in clinic were asked to complete a further
questionnaire relating to their current use of the Internet
& their feelings about potentially using the e-PAQ on-line.
A public access web site was subsequently created to allow
home completion via the Internet. Over a 2-week period,
women due to attend clinic were invited by letter to use this
web site in advance of their appointment. 13 women were
able to complete the questionnaire & were subsequently
seen with their results. These women then completed a 10-
item questionnaire (QQ-10) relating to their views &
experience of using e-PAQ online.
Results: In the initial survey, 62% of patients said that they
had home Internet access & 88% had either home access
themselves or a close friend or relative with Internet access.
64% had used the Internet previously & 67% said that they
would have found it useful to use e-PAQ before seeking
any medical help for their condition. 71% said that they
would be happy to complete e-PAQ instead of coming back
to clinic if all was well. Of the 13 women who then
completed e-PAQ on-line, 92% found the questionnaire
easy to use, 77% said that it helped them communicate &
77% felt it was relevant to their condition. 62% felt that the
questionnaire was too long, 23% reported feeling some
embarrassment & 38% found it complicated.
Conclusion: These initial results indicate the potential for
substantial improvements in efficiency & quality of
services offered by e-PAQ. Information & advice may be
provided instead of or in advance of clinic appointments,
S214
allowing patients to be appropriately triaged & accompa-
nied by a detailed & valid assessment of their condition.
Further refinements to will improve utility, as will contin-
ued growth in Internet access in the general population.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
399
THREE DIFFERENT PREOPERATORY STUDIES
FOR STRESS URINARY INCONTINENCE (SUI):
A COMPARISON OF COMPLICATION RATES
AND CONTINENCE STATUS AFTER A TRANS
OBTURATOR TAPE (TOT) PROCEDURE
Rondini, C; Descouvieres, C; Wenzel, C; Morales, A;
Alvarez, J; Troncoso, F; Aros, S; Troncoso, C
Hospital Padre Hurtado, Universidad del Desarrollo, San-
tiago, Chile
Objective: To compare complications and continence status
in patients with stress urinary incontinence (SUI) that were
studied preoperatively with three different study methods:
(1) by clinical means (CM), (2) eyeball cystometry (EBC),
and (3) multichannel urodynamics (MU).
Material and methods: A prospective study involving 438
patients with SUI diagnosed by any of the three methods
mentioned earlier. All 438 patients underwent a TOT.
Afterwards we compared urinary retention rates and
continence status for all three groups at one year follow up.
Results: All 438 patients were evaluated by the following
preoperative study method; 244 patients (55.7%) by CM,
96 patients (21.9%) by EBC and 88 patients (20.1%) by
MU. Continence status after one year for each preoperative
study group was: CM, 89.5%; EBC, 82% and MU, 83.7%
(p=0.09). Urinary retention rates depending on the preop-
erative study group were as follows: (1) CM 15.2%, (2)
EBC 7.3% and (3) MU 12.5% (p=0.148 for EBC vs. CM
and MU).
Conclusion: We found no statistical differences in conti-
nence status and urinary retention rates after one year
follow-up in the three different preoperative studies. In our
view MU should be used only in selected cases.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
401
TVT VERSUS TOT AT 2-YEAR FOLLOW-UP:
RESULTS AND COMPLICATIONS
Weemhoff, M1; Bremer, HA2; Kampschöer, PHNM3
1
University Hospital, Maastricht, The Netherlands;
2
Maasland Hospital, Sittard, The Netherlands; 3Atrium
Medical Center, Parkstad, The Netherlands
Objective: To compare the long term results regarding
success and complications of the retropubic tension-free
vaginal tape (TVT) with that of the transobturator tape
(TOT) procedure as primary treatment for female urinary
stress incontinence.
Methods: 120 patients were asked to fill in a questionnaire.
They underwent a TVT or a TOT procedure between March
2003 and March 2005. In May 2004 our hospital changed
from TVT to TOT slings. Patients were selected by date of
operation by the secretary service in the hospital; excluded
were the 2 months (May and June 2004) in which the new
technique was introduced. The mean follow-up was
26 months. The questionnaires were linked with the
information from the file and operation report.
Results: 120 women were sent a questionnaire. The
response rate was 92% with 110 questionnaires returned.
54 patients underwent the TVT procedure (TVT, Gynae-
care) and 56 patients underwent the TOT procedure
(Obtape, Porges). Besides the follow-up there were no
significant differences in patient characteristics. Mean
follow-up of the TVT group was 32 months against
20 months in the TOT group. In the TVT group 61% and
in the TOT 63% had no or very little leakage of urine.
Satisfaction measured on a scale of 1–5 showed good
satisfaction (scale 1 and 2) in 76% of TVT and 71% of
TOT. By asking if a patient would choose for the operation
again 87% and 83% answered ’yes’ in the TVT respectively
the TOT group. There are no significant differences
between TVT and TOT in these measures of success. 19%
of the TVT procedures were complicated by retention
problems with even one tape-release because of persistent
retention, while 4% of patients in the TOT group needed
prolonged catheterization (fisher-test, p=0,015). 6 erosions
with infection and 1 abscess occurred with the Obtape,
needing 7 releases of the tape, while in the TVT group no
such thing occurred (fisher-test, p=0,013).
Conclusion: Cure rate and satisfaction after a mean follow-
up of 26 months are the same for the TVT and the TOT
procedure. Satisfaction is good, even among women with
recurrent or relapse incontinence. Apparently patients
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
accept a certain amount of incontinence and do not expect
to be cured totally. In our study the TOT procedure is
associated with significant less retention problems postop-
eratively than the TVT sling. Erosions in association with
infection with Obtape occurred in 13%. For this reason in
our hospital Obtape is replaced by Aris tape.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
402
URINARY INCONTINENCE AS A LATE
COMPLICATION AFTER RADIOTHERAPY
IN WOMEN WITH CERVICAL CANCER
Nowak-Markwitz, E; Wróblewski, M; Spaczynski, M
University of Medical Science, Poznan, Poland
Objective: To evaluate the frequency and type of urinary
incontinence (UI) as a late complication following radio-
therapy in women with cervical cancer.
Materials and methods: We investigated 183 consecutive
patients with cervical cancer (stage FIGO IB to FIGO III),
treated with radiotherapy alone (n=51) or radiotherapy
following surgery (n = 132) between 1990 and 2005.
Patients were divided into two groups: more or less than
5 years after radiotherapy (64 and 119 women, respective-
ly). After receiving informed consent, the patients in
question filled in the questionnaire which distinguished
between the urinary continence and newly occurred after
radiotherapy non-continence ones. Urodynamics has been
performed to verify patient’s answers and to evaluate the
type of UI.
Results: Overall, 21 (11%) of 183 patients have been
complained because of UI. Urodynamics evaluations
confirmed UI in 18 (9,8%) women. Urge incontinence
was found in 33,3% (6 of 18 patients), mixed was classified
in 33,3% (6 of 18 patients). Pure stress UI was not
observed. In 4 women UI was classified as a bladder-
urethra dysfunction and in 3 patients over-filled UI was
recognized.
UI was observed more often in patient underwent radio-
therapy following hysterectomy than after radiotherapy
alone: 6,5% (12 of 183 women) and 3,2% (6 of 183
women), respectively. There were no statistical differences
between the types of UI into those groups.
In respect to time, UI was observed before 5 years in 10%
(12 of 119 patients), and in 9% (6 of 64 patients) after
S215
5 years after radiotherapy. Between the types of UI
statistical differences into those groups were not significant.
Conclusion: UI is no often late complication in patients
after cervical cancer treatment. Hysterectomy is the most
important risk factor of UI occurring after irradiation but
the time after treatment completion seems not to play any
role.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
403
URODYNAMICS DIAGNOSIS AND ITS CLINICAL
CORRELATION IN ADULT INDIAN WOMEN
PRESENTING WITH PREDOMINANT VOIDING
DIFFICULTY
Sinha, S; Sinha, R; Rao, S; Leela, B; Srinivas, K; Sharma, R
1
Medwin Hospital, Hyderabad, India
Objective: To ascertain the urodynamics diagnosis and its
clinical correlation in adult Indian women presenting with
predominant voiding difficulty.
Materials and methods: 25 adult women presented with
predominant voiding symptoms over 2 years. This included
17 women with voiding difficulty alone, 3 women who had
recurrent urinary retention, 4 patients with marked voiding
difficulty along with storage symptoms and one woman
who complained of voiding difficulty along with stress
incontinence. Women with abnormal focussed neuro-uro-
logical examination and those with a history of neurological
disease were excluded. The mean age was 41 y. All women
had detailed history, physical examination, ultrasonography
of the abdomen including residual urine measurement,
serum creatinine assay and urine examination. All women
underwent urodynamics in accordance with guidelines for
’good urodynamics practice’ as per the International
Continence Society. Obstruction was defined as per the
Blaivas Groutz nomogram. Urodynamic findings were
classified on the basis of the predominant finding.
Results: Of the 17 women with voiding difficulty alone,
8 had underactive detrusor (associated detrusor overactivity
in 3 and low compliance in 1), 8 had bladder outlet
obstruction (7 had dyssynergic external sphincteric activity,
1 had bladder neck obstruction) and 1 had poorly compliant
small capacity bladder. Of 3 women with recurrent
retention, 2 had acontractile detrusor and 1 had dyssynergic
external sphincter activity. All 4 women with voiding and
storage symptoms had dyssynergic external sphincter
S216 Int Urogynecol J (2007) 18 (Suppl 1):S107–S244

activity and 1 had associated small capacity bladder with StagePreoperative Postoperative Preoperative Postoperative
poor compliance. The one patient with voiding symptoms Avaulta® ant Avaulta® ant Avaulta® post Avaulta® post

and stress related leak had dyssynergic external sphincter Prolapse N=31 N=26 N=19 N=16
Cystocele ≥2 31 (100%) 1 (4%) 5 (26%) 4 (27%)
activity. 8/25 had elevated serum creatinine and 6 had ≤1 0 (0%) 25 (96%) 14 (74%) 12 (75%)
bilateral hydronephrosis. Both patients with low compli- U\terine/ ≥2 14 (39%) 1 (4%) 6 (32%) 1 (6%)
vaginal vault ≤1 19 (61%) 25 (96%) 13 (68%) 15 (94%)
ance and 3 patients with dyssynergic external sphincter had Rectocele ≥2 3 (10%) 3 (12%) 19 (100%) 0 (0%)
≤1 28 (90%) 23 (88%) 0 (0%) 16 (100%)
hydronephrosis. 2 women showed upper tract deterioration
despite a ’safe’ detrusor leak point pressure of below 40cm
H20. Conclusions: The Avaulta® collagen coated mesh for
Conclusion: Almost half the adult women presenting with genital prolapse surgery shows a 96 (anterior) to 100%
voiding symptoms have an underactive detrusor. Majority (posterior) anatomical success after a follow up of 6 months.
of women with bladder outlet obstruction have dyssynergic Nevertheless, de novo genital prolapse in another vaginal
sphincteric activity. Functional bladder neck obstruction is compartment do occur.
uncommon. Upper tract deterioration is common and
should always be evaluated. Disclosures
Was consent obtained from patients? N/a.
Disclosures Was this work supported by industry? Yes, by Bard Co.
Was consent obtained from patients? N/a. Level of support? No industry support in study design or
Was this work supported by industry? No. execution.
Does the presenter or any of the authors act as a consultant, Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an employee (part time or full time) or shareholder of an
industry? No. industry? No.

404 405
ANATOMICAL RESULTS FOR GENITAL PROLAPSE PATIENT SATISFACTION SURVEY
REPAIR WITH THE AVAULTA® COLLAGEN COATED AFTER ABDOMINAL SACROCOLPOPEXY
MESH MATERIAL: WITH POLYPROPELENE BIOSYNTHETIC MESH
Vaart, CH van der1; Vollebregt, A2 Sengupta, R; Gamal-Eldeen, H; Cooper, JC
1
University Medical Center, Utrecht, The Netherlands; University Hospitals of North Staffordshire, Stoke-on-
2
Spaarne Ziekenhuis, Haarlem, The Netherlands Trent, UK

Objective: To assess the anatomical results of vaginal
prolapse repair with collagen coated Avaulta® vaginal mesh
material.
Materials and methods: From December 2005 onward a
prospective observational study of patients operated with
the Avaulta® mesh in 3 centres is started. Before and
6 months after surgery the prolapse was staged according to
the Baden Walker or the POP-Q classification. All patients
fill in a disease specific QoL questionnaire pre- and
6 months postoperatively. In this analysis the preliminary
results about the anatomical effect of the procedure will be
presented.
Results: Forty-nine women have been operated with the
Avaulta mesh material. Thirty women had an anterior
repair, 18 a posterior repair and one had both. In 3 women
(6%) a symptomatic prolapse stage 2 occurred, all situated
in another compartment. One cystocele stage 3 was found
at 6 months after a posterior mesh repair.
Objective: To audit short term patient satisfaction rates
after abdominal sacrocolpopexy using the polypropylene
mesh.
Background: Vault prolapse is an infrequent complication
of total abdominal hysterectomy. To prevent these stumps
of the uterosacral and cardinal ligaments are fixed to the
vault during an abdominal hysterectomy.
More often these ligaments are too weak to suspend the
vault totally and abdominal sacrocolpopexy is required. To
preserve adequate functional activity the vagina needs to be
oriented along its physiologic axis. Polypropylene meshes
have been used for years for reconstructing the vaginal
vault.
Materials and methods: The Hospital Theatre Database
From 1997-January 2006 identified sixty three cases. Of
these only fifty five were found suitable for the final
analysis. Validated questionnaires were sent out to fifty four
patients as one patient died of natural causes. Forty two
patients returned the completed questionnaires. (74%
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
response rate) Calculations were done on the Excel
spreadsheets by the authors involved.
Results: In 9% of women there was mesh erosion or mesh
removal within the 5 year period. There was a 78% overall
patient satisfaction rate with the procedure. 40% of the
patients still complained of pressure symptoms twelve
months after surgery. 62% of the patients were sexually
active before the procedure and 52% after the procedure
which was not statistically significant.
Conclusion: Previous trials have demonstrated that abdom-
inal sacralcolpopexy may be better than the vaginal
sacrospinous fixation for vault prolapse. Abdominal sacro-
colpopexy is associated with a lower rate of recurrent vault
prolapse and dyspareunia than the vaginal sacrospinous
fixation.
The conclusion from this audit was that even if the
procedure was largely satisfying in majority of women
with vault prolapse we needed to identify patient expect-
ations before and after the procedure, assess urinary and
bowel symptoms carefully before and after the procedure
and organise careful follow up of these women with the
same Consultant team in an years’ time.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? Yes, by University
Hospitals of North Staffordshire, Stoke on Trent. United
Kingdom..
Level of support? No industry support in study design or
execution.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
406
TRANSOBTURATOR POSTANAL SLING (TOPAS)
FOR THE TREATMENT OF ANAL INCONTINENCE
Rosenblatt, PL1; Ferzandi, T1; Sasson, S1; Pulliam, SJ2
1
Mount Auburn Hospital, Cambridge, MA, USA;
2
Massachusetts General Hospital, Boston, MA, USA
Objective: To assess safety, efficacy, and quality-of-life
outcomes in women who underwent the transobturator
postanal sling (TOPAS) procedure for the treatment of anal
incontinence (AI).
Materials and methods: A preliminary retrospective
analysis was performed on 10 women who underwent the
minimally invasive TOPAS procedure, in which the
posterior pelvic floor support was augmented by placement
S217
of a synthetic polypropylene mesh in a sling-like position
behind the anus and/or rectum. Data collection included
intra- and postoperative complications, fecal incontinence
diary entries, Fecal Incontinence Quality of Life (FIQOL)
questionnaire, and the Wexner scale assessment of incon-
tinence and its impact on daily life. Assessments were
conducted at 2 weeks, 6 weeks, and 6 months; 12-month
follow-up is ongoing.
Results: To date, the TOPAS procedure was completed
successfully on 10 women with mean age of 66±12 years
and mean body mass index of 32±6. No intraoperative
complications were noted. Seven patients underwent a total
of 16 concomitant repairs, including perineorrhaphy (n=5),
tension-free vaginal tape-obturator (n=3), and bilateral
sacrospinous fixation with posterior repair (n=2). Diaries
were completed at baseline and 6 weeks by six patients.
Improvements were observed in 4 of these 6 patients, with
1 patient reporting complete continence, and 1 additional
patient experienced a > 50% decrease in incontinent
episodes. Improvements were observed on the FIQOL at 6
weeks, and were maintained in the subset evaluated at 12
weeks, 6 months, and 12 months. Wexner scores, with a
scale of 0–20, were completed by 9 patients post-implant.
The median score was 2 (range 0–7), with 3 patients
reporting a score of 0 (total continence). One postoperative
complication, a wound infection with separation of the
postanal incision and mesh exposure, resulted in sling
removal.
Conclusion: These data suggest that the TOPAS procedure
provides a therapeutic benefit with minimal risk to patients
with AI and, therefore, warrants further clinical investigation.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
407
TRANSVAGINAL MESH REPAIR OF PELVIC ORGAN
PROLAPSE WITH PROLIFT TECHNIQUE: ONE-YEAR
OUTCOMES
Fatton, B1; Boda, C1; Debodinance, P2; Amblard, J1;
Jacquetin, B1
1
Department of Obstetrics and Gynecology, University
Hospital of Clermont-Ferrand, France; 2Department of
Obstetrics and Gynecology, General Hospital of Dunker-
que, France
S218
Objective: to report the one year outcome of the Prolift ™
technique (soft knitted polypropylene monofilament mesh)
to correct pelvic organ prolapse (POP) by vaginal approach.
Materials and methods: A longitudinal case series of 67
consecutive women operated in 2 centres between February
2005 and October 2005. Women were assessed by a
specific questionnaire of pelvic floor symptoms, POP Q
and site specific vaginal examination preoperatively, and
postoperatively at 1 month, 3 months, and 1 year. All the
patients had a stage 2 or greater POPQ symptomatic
prolapse at enrollment, 26.8% had a previous hysterectomy
and 17.9% a previous POP surgery. Surgical procedure was
an Anterior Prolift repair (35.8%), a Posterior Prolift repair
(22.4%), a total monobloc Prolift repair (18%) or a
combined Anterior and Posterior Prolift repair (23.8%).
Concurrent procedures included vaginal hysterectomy (9
patients), sacrospinous uterine fixation (5 patients), enter-
ocele repair (6 patients), levator ani myorraphy (2 patients)
and suburethral sling procedure (28 patients). No financial
support was received from any company for the achieve-
ment of this study.
Results: Mean age was 65.5 years [40–89]. Sixty one
patients (91%) were postmenopausal, 12 of whom (19.6%)
on hormone replacement therapy. Mean operating time was
89 min. We reported 1 bladder injury and 1 urethral injury
recognized at surgery. Mean hospital stay was 3.6 days.
One patient with haematoma required surgical drainage one
week after surgery. Sixty two patients were available for
1 year follow-up. Mean follow-up was 14 months [12–21].
Patients who needed further repair for recurrence (3
patients) or symptomatic low grade prolapse (2 patients)
and patients with stage 2 POPQ prolapse at any compart-
ment at follow-up (7 patients) were considered as failure.
Objective success rate was 80.1%. The 3 patients who
required revision for recurrence had a stage 2 POPQ
prolapse (hymen level). Two patients had no evidence of
recurrence but complained of urinary retention (1 patient)
and persistent vaginal pain (1 patient) that required repeat
surgery and were considered also as failure. Of the 10
patients with recurrence (POPQ ≥2), 7 patients had
recurrence at operated site (11.3%) and 3 patients at another
compartment previously well supported (4.8%). Mesh
exposure rate within 1 year was 4.5%. Overall 42.2% of
the patients were sexually active at follow-up compared
with 46.3% pre-operatively. De novo dyspareunia occurred
in 2 patients. Intercourses were improved in 5 patients over
the study period.
Conclusion: Transvaginal mesh repair using Prolift™ kit is
an effective procedure to correct POP. Nevertheless
recurrence may occur despite mesh repair. Otherwise,
specific repair may provide prolapse in a site previously
well supported. Long term follow up results are needed to
support the expanding use of mesh by vaginal route.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
408
ANAPHYLACTOID REACTIONS
TO IODINATED CONTRAST MEDIA
DURING VIDEOCYSTOURETHROGRAPHY
Cartwright, R; Durling, R; Cardozo, L
1
King’s College Hospital, London, UK
Objective: The urothelium is thought to be an effective
barrier, preventing systemic absorption of contrast media.
The risk of anaphylactoid reaction to iodinated contrast
media during retrograde urography is quoted in the
literature as 0.26%. However, almost all reported cases of
contrast reactions during retrograde urography occur during
pyelography, when contrast fills the renal pelvices, rather
than with cystourethrography alone. This study aimed to
assess the rate of anaphylactoid reactions in a large series of
videocystourethrograms.
Methods: In our urogynecological practice, videocystour-
ethrography is employed in the investigation of adult
women with incontinence. In this population, Grade II or
above vesicoureteric reflux is an uncommon finding; the
renal pelvices are not typically filled with contrast. We
exclude women with a known history of anaphylactoid
reaction to IV infusion of iodinated contrast medium. The
bladder is filled with either Omnipaque 140 mg I/ml, or
Urografin-370 diluted to 92.5 mg I/ml with normal saline.
Dynamic imaging of the bladder and urethra during voiding
is then obtained using fluoroscopy. From a prospectively
compiled database of all videocystourethrograms performed
in our unit over the last 10 years we assessed the rate of
serious adverse reactions.
Results: Between January 1997 and January 2007 we
performed 11714 videocystourethrograms. There was a
single case of anaphylaxis, due to an unsuspected latex
allergy, occurring before administration of contrast. There
were no serious adverse reactions due to contrast. The risk
of an anaphylactoid reaction due to contrast is therefore less
than 0.01%.
Conclusion: Retrograde administration of iodinated con-
trast into the bladder, as performed during videocysto-
urethrography, is safer than has been previously reported.
Anaphylactoid contrast reactions may only occur when
contrast enters the renal pelvices.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
409
CAN Q TIP PREDICT SUCCESS OR URINARY
RETENTION IN PATIENTS WITH STRESS URINARY
INCONTINENCE TREATED WITH TOT?
Rondini, C; Descouvieres, C; Wenzel, C; Morales, A;
Alvarez, J; Troncoso, F; Aros, S; Troncoso, C
Hospital Padre Hurtado, Universidad del Desarrollo,
Santiago, Chile
Objective: To determine if a Q Tip alone can be associated
with either success or urinary retention in patient with stress
urinary incontinence that undergo a TOT procedures.
Materials and methods: We ran a prospective study that
involved 100 stress urinary incontinence (SUI) patients
evaluated preoperatively with Q Tip. All 100 patients
underwent a TOT. We grouped all 100 patients according
to their Q tip into 2 groups ≤40° or > 40°. Afterwards we
analyzed both surgical success and retention rates in each
group. Success was defined as an asymptomatic dry patient
at one year follow up. Surgical failure was defined as a
patient with any stage of stress urinary incontinence after
six months follow up. Urinary retention was defined as a
postvoidal volume of 200cc or more at the moment of
discharge with spontaneous resolution or a patient requiring
urethrolysis. We then compared the actuarial continence
status and urinary retention rates at 6 months follow up.
Results: All 100 patients were evaluated and followed for a
average time of 4,15 months (range 1–24). 35 patients had
a Q Tip of ≤40 and 65 > 40. The continence actuarial rate at
6 months was 89,3% v/s 92,8% p=0,23 respectively. The
Urinary retention rate was higher in patients with a Q Tip
≤40 11,4% v/s 4,6% p=020. This was not statistically
significant.
Conclusion: In our study, a > 40° Q Tip was not associated
with a higher continence rate at 6 months follow up.
Patients with a ≤40° Q Tip have a higher tendency to have
urinary retention after one year.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
S219
410
OUTCOME OF COMBINED ABDOMINO-VAGINAL
SLING IN MANAGEMENT OF RECURRENT STRESS
URINARY INCONTINENCE IN WOMEN
Al Kharusi, LA; Alarab, M; Pascali, D; Jose, J; Lovatsis, D;
Drutz, HP
1
University of Toronto, Ontario, Canada
Objective: To evaluate the outcome of combined abdom-
ino-vaginal sling using synthetic material attached to
Cooper’s ligament in women with recurrent stress urinary
incontinence (SUI).
Materials and methods: A retrospective chart review was
carried out between January 1995 up to December 2005.
Preoperative assessment included history and physical
examination, uroflowmetry and multichannel urodynamic
testing. Cases were carried out by laparotomy or laparos-
copy using Marlex or Prolene (Surgipro, Autosuture) mesh.
Post-operative follow up was at 6 weeks, 6 months then
annually. Subjective success was defined as absence of
symptoms of SUI. Objective success was defined with a
negative cough test at each visit; and negative findings on
urodynamics done one year after surgery. Descriptive
statistics were used. Local ethics board approval was
obtained.
Results: One hundred and nine patients were identified
with a mean follow-up of 17 months (6 weeks-10 years).
The mean age was 61 years (35–81 years). Previous
incontinence surgery included: 25 MMK, 51 retropubic
urethropexies, 21 Pereyra, 2 Fascia lata sling, 1 tension free
vaginal tape, and 58 anterior colporrhaphies. Average
hospital stay was 4.6 days (2–11). Intra-operative compli-
cations included hemorrhage in 6% patients and inadvertent
cystotomy in 5%. Ten patients were lost to follow-up. Post-
operative complications were: one repeat laparotomy
secondary to bleeding, one non fatal myocardial infarction,
3% patients needed blood transfusion, voiding dysfunction
in 26%. Fifteen patients (15%) developed mesh erosions
one of whom was treated conservatively and 14 patients
had surgical excision of exposed mesh. Post excision
continent rate was 85%. Overall subjective and objective
cure rates were 93% (92/99) and 90% (89/99) respectively.
During the first year, subjective and objective cure rates
were 96% (64/67) and 91% (61/67) respectively. Postoper-
ative persistent urge urinary incontinence (UUI) was 22%
(22/99) and de novo UUI 2% (2/99). There was no
difference in subjective or objective failure rates when
comparing open versus laparoscopic approach, body mass
index, or number of previous incontinence surgeries.
Conclusion: Combined abdominovaginal sling using syn-
thetic material is a safe and effective method of managing
recurrent SUI. The postoperative complications in this
study are comparable to current literature.
S220
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
411
OUTCOMES OF FREE TENSION TRANSOBTURATOR
SUBURETHRAL MESH (TOT) PROCEDURE
AT THE GENERAL HOSPITAL OF CASTELLON
Herraiz, JL; Bernabeu, A; Gil, F; Mestre, J; Calpe, E
Hospital General de Castellon, Spain
Objective: Urinary incontinence is a serious health prob-
lem that deeply affects to the patients. Tension-free vaginal
tapes are one of the different current surgical treatments.
The transobturator technique has been developed during the
last years obtaining similar results as the TVT technique.
The objective of this study was to determine to analyze the
effectiveness of the transobturator vaginal tape in the effort
urinary incontinence and its complications. We used the
Uretex® TO system in all patients.
Materials and methods: It is an observational study with
87 patients between March 2004 and March 2006. Parity
was 2.8 and the average age was of 64.8 years old.
The pathology associated to the urinary incontinence has
been: cystocele in 40 patients, 55 prolapses of the uterus, 14
rectoceles, 6 vaginal vault prolapses and 9 patients with no
pathology associated. Only 2 patients have had prior
incontinence surgery.
Results: There were 3 surgical complication cases: two
bladder puncture and a massive haemorrhage in the
periurethral space. There were 2 bladder retentions in the
immediate postoperative time. There were no erosions,
infections or bruises.
The healing amount at the first month was of 93%; at
12 months was of 89% and 88% at 18 months, being the
study opened nowadays and outstanding the evolution of
the last treated cases.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
413
THE EFFECT OF PELVIC FLOOR MUSCLE EXERCISE
USING BIOFEEDBACK FOR STRESS URINARY
INCONTINENCE
Kim, HG1; Paick, SH1; Lho, YS1; Park, WH2; Oh, SM3;
Kim, YT4
1
Konkuk University, Seoul, Korea; 2Inha University,
Incheon, Korea; 3 Suwon Women’s College, Korea;
4
Hanyang University, Seoul, Korea
Objective: Pelvic floor muscle exercise, biofeedback and
electrical stimulation have been known as initial treatment
options for women with stress urinary incontinence. We
evaluated the clinical outcome of pelvic floor muscle
exercise in combination with biofeedback and electrical
stimulation as a treatment for stress urinary incontinence. 1)
Materials and methods: Twenty three patients with stress
urinary incontinence who had been treated with biofeed-
back and electrical stimulation from June 2001 to March
2003 were analyzed. Patients were evaluated with their
medical history, physical examination, SEAPI score, and
urodynamic study including Valsalva leak point pressure
(VLPP). All patients were assessed for the outcome of the
procedure with subjective satisfaction by scores of SEAPI
classification and the relative strength of pelvic floor
muscle by maximal vaginal pressure and contraction time.
Results: Among 23 women followed up for 6 month to
1 year, urinary incontinence completely disappeared in 6
patients (26.1%), significantly improved in 13 (56.5%) and
not improved in 4 (17.4%). There was a significant increase
in maximal vaginal pressure, contraction time and decrease
in the scores of SEAPI classification.
Conclusion: Pelvic floor muscle exercise in combination
with biofeedback and electrical stimulation is a simple,
safe, and effective treatment of stress urinary incontinence.
The patient compliance is closely related to the success rate
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
414
THE IMPACT OF PELVIC ORGAN PROLAPSE
ON SEXUAL FUNCTION IN WOMEN
WITH AND WITHOUT URINARY INCONTINENCE
Athanasiou, S; Halabalaki, A; Sotiropoulou, M; Vlahos, G;
Chaliha, C; Goumalatsos, N; Antsaklis, A
Urogynaecology Unit, 1st Department of Obstetrics and
Gynaecology, University of Athens, Alexandra Hospital,
Athens, Greece
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: Pelvic organ prolapse (POP) and urinary
incontinence (UI) are common disorders which effect
various domains of well being. There is little data on
sexual function in women with POP/UI. Most studies have
lacked objective assessment of prolapse and few authors
studied the impact of UI and POP separately. We compare
sexual function in women with POP with and without UI to
continent controls with normal support.
Materials and methods: Women with POP were recruited
from the urogynaecology clinic. Controls were subjects
with benign gynaecological problems with normal pelvic
organ support and no UI. POP was assessed ICS POP-Q
grading system and UI by means of a cough stress test and
urinary diary. All women completed a modified POP/UI
sexual questionnaire
Results: 171 women were recruited: 101 with POP (+/−UI)
and 70 without. Women with prolapse were older (51.6 vs
45.6 yrs, p<0.002) more parous (p<0.001) and more likely
to have prior gynaecological surgery (p=0.02). Women
with POP were less sexually active (68% vs 87%). In those
with POP, ~50% abstained due to POP: there was lower
sexual desire, lower rate of orgasm, and a decreased
response to sexual partner. UI scores were higher and coital
incontinence noted in 42%. The POP group had higher
sexual dysfunction (SD) scores. There was SD score with
increasing grade of prolapse but this was not related to
presence of UI. Multivariate regression revealed no rela-
tionship with the menopause, parity, BMI, chronic illness,
surgery, marital status with SD Scores. Age and POP status
were the only variables that related to SD scores.
Table 1: SD scores - POP cases vs controls in sexually
active women
POP Group Controls
(n=69) (n=61)
Mean total SD scores (SD) 54.6 (14.5) 45.2 (14.6)
Mean sexual behaviour scores (SD) 37.3 (9.9) 31.8 (10.5)
Mean physical problems (SD) 6.1 (3.2) 5.1 (3.3)
Mean satisfaction scores (SD) 7.6 (3.2) 6.1 (3.1)
Mean UI scores (SD) 3.6 (2.2) 2.2 (0.7)
Conclusion: Women with POP have poorer sexual function
with reduced sexual activity and higher SD scores. When
present, UI has no worsening impact on sexual function.
This highlights the morbidity related to POP which may go
unrecognised.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
S221
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
415
THE RESULTS FOR VAGINAL DEFECT REPAIR
IN PELVIC FLOOR RECONSTRUCTION USING
POLYPROPYLEN MESH
Argirovic, R
Institute of Obstetrics and Gynecology
Objective: Pelvic organ prolapse is thought to result from a
stretching, weakening or tearing of the soft tissue structures
that support the pelvic organs. The aim of prolapse surgery
is to restore fascial support by suturing in back to its
original position. The use of meshes has been advocated for
improved cure rats, especially in patients with recurrent
prolapse. In our study the efficacy and safety of monofil-
ament polypropylene mesh (Herniamesh) was investigated
in patients undergoing transvaginal pelvic floor reconstruc-
tive surgery.
Materials and methods: From May 2005 to September
2006 22 patients were included in our study. Follow-up
investigation included clinical examination and QoL
questionnaire.
Results: The mean age of study group was 68,4 years
(range 59–81). N=18 (81,8%) of the patients had previous
hysterectomy (n=10 [45,4%] abdominal hysterectomy and
n=8 [36,3%] vaginal hysterectomy), 20 (90,1%) patients
had undergone previous prolapse surgery. A total of 22
meshes were applied, 17 (77,2%) meshes for anterior
defects and 5 meshes (22,8%) for posterior defects. All
patients were examined 4 weeks after surgery and then
P-value
every 6 months. Mean follow-up time was 10,2 months
(range 4–16 months). The recurrence rate of prolapse was
<0.001 18,2% (n=4). Two patients (9,1%) showed vaginal ero-
0.002 sions. No urinary retention, infection, vaginal stenosis or
0.008*
fistula was noted. Eighteen patients (81,8%) were very
0.0009*
satisfied with the result.
<0.001*
Conclusion: Pelvic floor reconstruction with polypropylene
mesh shows good anatomical results with less complica-
tions and very good satisfactory results. Our study showed
high number of patients with recurrence prolapse.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
S222
416
ANTERIOR VAGINAL REPAIR USING
THE SYMPHASIS XENOGRAFT
Fynes, M; Jeffery, ST
St George’s Hospital, London, UK
Objective: The failure rate following ’standard’ anterior
repair is high with reported recurrence rates between 5–
60% at two years. Different materials have been used to
increase the strength of the tissue and recently biological
grafts have been introduced to overcome the problems
associated with synthetic prostheses; specifically the risk of
erosion. Porcine small intestinal submucosa (SIS) has been
used extensively in the last five years and there are a
number of case series and abstracts supporting its role in
genital prolapse surgery. The thickness of this graft has
been increased to eight (SYMPHASIS™) rather than four
ply (Surgisis™) and is available in a variety of sizes for
reconstructive prolapse surgery. Our aim is to demonstrate
the technique of Anterior Vaginal Repair using the
SymphaSIS graft.
Method: A midline incision is employed and dissection of
the cystocele performed laterally as far as the levator fascia.
The use of infiltration is at the discretion of the surgeon. The
cystocele is reduced using 3.0 vicryl interrupted sutures.
Following reduction of the cystocele with 3.0 vicryl, 2.0
PDS sutures are inserted into the levator fascia using a
minimum of three on each side. The graft is then cut to an
appropriate size to cover the defect without tension. The
sutures are inserted into the graft on each side and tied; the
apical and caudal ends of the graft are then anchored.
Cystoscopy should be undertaken in each case to exclude
perforation and confirm ureteric patency.
Conclusion: Anterior vaginal repair using the SymphasSIS
graft is safe and easily performed by the experienced
vaginal prolapse surgeon.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
417
CLINICAL OUTCOME OF THE FIRST CASES
OF THE TVTSECUR IN THE UK
Finnegan, S; Fogarty, PP
Ulster Hospital, Belfast, UK
Aims/objectives: To present the outcome of the first cases
of the next generation of TVT, the TVTsecur.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Background: The tension free vaginal tape (TVT) was
introduced to the UK 8 years ago and has now been
established as the treatment of choice for urinary Stress
Incontinence. The TVTsecur system was launched in
Europe in September 2006. This system maintains many
of the key elements of the original TVT whilst offering a
new design which is postulated to be less invasive, incurs
less post operative pain and minimises complications.
Materials and methods: 25 women with urinary stress
incontinence who were suitable for TVT in day surgery
were offered and accepted the TVTsecur system. Prior to
surgery they were asked to complete the Kings Health
questionnaire. Details of the operation including anaesthe-
sia, operative time, blood loss, complications, difficulty
with using the new method, post-operative pain require-
ments and duration of hospital stay were noted. The women
were followed up at 6 weeks.
Results: Follow-up is at present in its early stages.
However, early results look promising. It is hoped that the
TVTsecur will offer women a less invasive procedure with
the same clinical success that is currently attributed to the
TVT.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
418
COSMETIC GYNECOLOGICAL SURGERY
ASSOCIATED WITH MID-SUBURETHRAL SLINGS
Pardo, J; Solà, V; Ricci, P
Clínica Las Condes, Santiago, Chile
Objective: Description of suburethral slings procedures
associated to ’Cosmetics’ Gynecological Surgeries.
Methods: Between November 2003 and December 2006, a
total of 120 patients were selected for suburethral slings at
the Urogynecology and Vaginal Surgery Unit, Clinica Las
Condes, Chile. 67 cosmetic gynecological surgeries were
associated. We describe this association.
Results: Of those 67 procedures 40 laser assisted colpor-
rhaphy in women whit sensation of wide vagina were done,
13 laser labioplasty and 8 labia majora lifting. No related
complication was observed.
Conclusion: in our practice, Gynecological cosmetics
procedures associated whit correction of urinary stress
incontinence is frequent and safe.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
419
EFFECT AND QUALITY OF LIFE AFTER TRANS
OBTURATOR TAPE OPERATION FOR URINARY
INCONTINENCE
Sörensen, T; Guldberg, R
Kolding Hospital, Denmark
Objective: As the new Trans Obturator Tape operation
(TOT) for urinary incontinence seemed to have some
advantages in comparison with the Tension-free Vaginal
Tape operation (TVT) we wished to examine the outcome
and the improvement in Quality of Life after the TOT
operation.
Material: The patients seeking treatment for stress urinary
incontinence completed a questionnaire at study entrance in
which they were asked to quantify their discomfort on a
Visual Analogue Scale as well as to which degree their
urinary incontinence affected their lives (Incontinence
Impact Questionnaire: IIQ-7).
Methods: The operations were performed in the day clinic
and the patients were discharged a few hours after the TOT
operation. It was planned to see them in the outpatient
department three, six and twelve months and two years
after the treatment. At this time they again completed the
IIQ-7 questionnaire and plotted the degree of discomfort on
a Visual Analogue Scale. Thus all the patients acted as their
own control group.
Results: A total of 94 patients have been seen at least once
after the operation. The mean observation time was
9.5 months (3–28). The mean age was 50.6 years (29–
80). Four patients (4%) had unchanged symptoms after the
operation. Twenty women (21%) experienced considerable
improvement and 70 patients (75%) were completely cured
after the operation. In one patient the tape had to be cut and
one patient developed a large hematoma in her right
labium. Fourteen patients (15%) developed de novo urge.
The improvement in Quality of Life was 90%. This
improvement was significant (p<0.001).
Conclusion: The TOT operation seems to be a safe and
efficient treatment of stress urinary incontinence leading to
a significant improvement in Quality of Life.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
S223
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
420
LONG-TERM FOLLOW-UP OF THE TENDINOUS
URETHRAL SUPPORT: AN ANATOMICAL
APPROACH FOR STRESS URINARY INCONTINENCE
Palma, P1; Riccetto, C1; Fraga, R1; Dambros, M2; Martins,
M1; Ikari, L1
1
University of Campinas, Brazil; 2UNIFESP, Brazil
Objective: Despite the good cure rate reported with TVT,
major complications such as, bowel and major blood
vessels injuries have been described. To avoid these
complications, transobturator approach was developed.
The continence rate of this procedure has been similar to
those obtained with transvaginal retropubic approach.
The study presents the long term follow up of the tendinous
urethral support (TUS), an anatomical approach for treating
female stress urinary incontinence that consists in placing a
mid-urethral tension-free tape anchored to the tendinous arc
bilaterally.
Materials and methods: An open prospective clinical
study involving SUI patients was conducted after receiving
the approval of the Hospital Ethics Committee.
From February 1999 to October 2000, 25 female patients
(mean age: 53 years old), with SUI underwent TUS
procedure, and 23 were available for follow-up. The mean
follow up was 76 months. The procedure was carried out
with the. A 2 cm long vertical vaginal incision was
performed at 0.5 cm from the urethral meatus. Minimal
vaginal dissection was performed laterally toward the
ascending ramus of the ischiopubic bone and the endopel-
vic fascia was entered until the tendinous arc bilaterally.
Two polypropylene (2–0) stitches were placed at the white
line on both sides. Next a 10cm small intestine submucosa
(SIS) tape was fixed to the tendinous arc at one side and
than trimmed to fit on the opposite side creating a tension-
free suburethral hammock.
The vaginal wall was closed in the usual manner. No
cystoscopy was necessary for there is no blind step in this
procedure and a Foley catheter was left in place overnight.
Results: The mean operative time was 35 minutes (30–
40 minutes) and the mean admission time was 1, 8 days
(range 1–3). There was no peri-operative complications.
The preoperative pad test disclosed mild incontinence in 4
(17.3%), moderate in 15 (65.2%) and severe in 4 (17.3%)
patients. After six years follow-up 15 patients (65.2%) were
cured, 3 (13%) improved and 5 (21.7%) incontinent
(graphic 1).
S224
Conclusion: Our long term data suggest that TUS is a safe
procedure and warrants further studies using different
materials and deliver instruments.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
421
SIMPLE ASPIRATION TECHNIQUE TO ADDRESS
VOIDING DYSFUNCTION ASSOCIATED
WITH TRANSURETHRAL INJECTION
OF DEXTRANOMER/HYALURONIC ACID
COPOLYMER: TWO CASE CLINICS
Castillo Vico, MT; Carreras Collado, R
1
Hospital del Mar, Barcelona, Spain
Introduction: Stress urinary incontinence secondary to
intrinsic sphincter deficiency may be treated with transure-
thral o periurethral bulking agents. The dextranomer/hyal-
uronic copolymer is used as a transurethral bulking agent to
treat female stress urinary incontinence. Urethral obstruction
is a recognized complication of bulking agents. We describe
on a simple outpatient-based aspiration technique to evacu-
ate the injected hyaluronic acid complex in the occasional
setting of iatrogenic-induced voiding dysfunction associated
with pseudoabscess formation and palpable mass. We report
two patients with this complication.
Case reports
Case 1: A 73 year old woman who presented a external
genitals tumor and voiding dysfunction with urinary
urgency and incomplete emptying, four months after
transurethral injection the dextranomer/hyaluronic copoly-
mer, by examination we see a 3–4 cm tumor rounding
urethra, not painful, no infection signs. The Nuclear
Magnetic Resonance (NMR) (Fig.1): cystic images in
urethral walls compatible with diverticula (granuloma
versus inflammation). Cystourethrography: no diverticula
images (Fig 2). Cystoscopy: urethral and vesical integrity.
With the local anesthesia we directly introduced into the
mass at the 7-o’clock position. Aspiration resulted (Fig 3)
in 25 ml of a light-green viscous fluid, with immediate
decompression of the mass. The final fluid cultures were
negative. After the procedure, the patient’s voiding dys-
function resolved and her physical examination was benign,
but re-begins urinary incontinence. One month later
becomes continent again.
Case 2: A 72-year-old woman presented 3 months after
injection with voiding dysfunction manifested by urinary
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
urgency, constant bladder pressure, and spasms. The patient
related a sensation of, and had found, a vaginal bulge. This
was confirmed on physical examination, at which a well
defined and soft suburethral mass was palpated in the mid-
urethra. The NMR confirmed a large suburethral fluid mass
(Fig. 4). In the clinic setting, transvaginal we aspired the 15
mL de viscous fluid. The fullness immediately decom-
pressed, and cultures revealed a sterile pseudoabcess. After
the procedure, the patient’s voiding dysfunction resolved,
her physical examination findings normalized, and her
stress urinary incontinence had no recurrence.
Conclusion: Injectable dextranomer/hyaluronic acid co-
polymer is intended to be a permanent implant; occasion-
ally, a pseudoabscess may occur and require evacuation
because of voiding dysfunction. Simple aspiration is
inherently attractive and offers immediate relief in this
treated population with potential preservation of urinary
continence.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
422
TENSION-FREE VAGINAL TAPE TRANSOBTURATOR
(TVT-O): 1-YEAR FOLLOW-UP
Han, HC; Ng, PY; Lee, LC
KK Women’s and Children’s Hospital, Singapore
Objective: The aim of this study was to assess the efficacy
and risks of TVT-O in the treatment of female stress urinary
incontinence (SUI).
Materials and methods: Eighty-five patients with clinical
evidence of SUI underwent TVT-O from 19 July 2004
through 31 July 2005. The preoperative evaluation included
a detailed urogynaecology history taking, physical exami-
nation, erect stress test and a comprehensive urodynamic
examination. The post-operative evaluation included a
history taking, physical examination and a comprehensive
urodynamic examination.
Results: In the 1-year follow-up, only 83 patients turned up
(1 patient each passed away and defaulted follow-up).
Mean age of patients was 53 years. Average parity of
patients was 2 (range 0–11). Six patients (7%) had previous
failed anti-incontinence surgery. Fifty-two (69%) patients
had pure SUI. The mean operative time was 14 minutes and
average blood loss was 28 ml. No significant vaginal wall,
urethral and bladder perforation was noted. The mean
bladder catheterization was 0.7 day (0–7). Thigh pain was
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
noted in 78% of patients. The average pain days were 4
days (1–60). One patient underwent tape release 2 weeks
post surgery for acute urinary retention and another patient
had tape loosening. Seventy-nine patients (95.2%) were
cured of their SUI while 3 (3.6%) patients had it improved.
Four (4.8%) patients developed de novo urgency and 3
(3.6%) patients had voiding difficulties. There was no mesh
erosion during the 12 months period.
Conclusion: The 1-year follow-up of TVT-O patients
showed that TVT-O was associated with low peri-operative
and post-operative complications and had a very high cure
rate.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
423
TENSION-FREE VAGINAL TAPE
UNDERNEATH BLADDER BASE: DOES IT PREVENT
CYSTOCELE RECURRENCE?
Tantanasis, T; Giannoulis, C; Papathanasioy, K;
Loufopoulos, A2; Danilidis, A; Dinas, K; Tzafettas, J
Hippokration University Hospital, Thessaloniki, Greece
Objective: The target of the current prospective study was
to assess the effectiveness of the polypropylene tapes in
preventing recurrence of cystocele formation when placed
underneath the bladder base.
Methods: Twenty two Caucasian women, enrolled into the
study. Vaginal reconstructive surgery including anterior
colporrhaphy, posterior colpoperineorrhaphy and/or hyster-
ectomy, was undertaken in all subjects. The polypropylene
tape was placed not under the midurethra, but underneath
the bladder base.
Results: The postoperative follow up was carried out in
frequent intervals every 4 months up to 2 years. The
assessment of the anatomic result included evaluation of the
operated sites and of the position of the tapes inserted on
clinical grounds and after perineal sonography. Urodynamic
assessment was performed at the presence of urinary
incontinence. In all patients the postoperative correction
of the anterior vaginal wall was sufficient, in 19 subjects
there was no evidence of genitourinary symptoms and
therefore were considered as cured; 3 patients were
designated as improved because despite sufficient anatomic
correction they reported urinary incontinence symptoms.
Retropubic haematoma occurred in 1 patient, transient
stress incontinence in 1, transient urge incontinence in 1
S225
and persistent stress incontinence also in 1 patient. There
was no erosion of the tape noticed. Mean residual urine was
30 ml, mean bladder base distance to the inferior edge of
the symphysis pubis was 1,2 cm and the mean total vaginal
length was 7 cm.
Conclusion: Despite relative short follow up period and the
limited number of patients enrolled, the use of polypropyl-
ene tapes as an adjunct for fortification of the anterior
pelvic segment could provide an option in preventing
recurrence of cystocele formation.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
424
TRANSPERINEAL ULTRASONOGRAPHY
IN UROGYNECOLOGIC FIELD
Yoshimura, K; Nomura, M; Kikuta, K; Kitano, R; Matsumoto,
T; Hachisuga, T
University of Occupational and Environmental Health,
Fukuoka, Japan
Objective: Recently, urogynecology is being established as
the fourth subspecialty of gynecologic field in Japan.
Diagnosis and evaluation of the pelvic organ prolapse
(POP) are performed by macroscopic findings and pelvic
examination. In addition, degree of cystocele, shape of
urethral internal os and posterior urethro-vesical angle
(PUVA) are evaluated by chain cystography (CCG).
Although CCG is performed routinely, it is a kind of
painful examination for the patients and X ray exposure is
problem. In this study, we evaluate the role of transperineal
ultrasonography for the patients of POP.
Materials and methods: 30 patients who underwent
tension free vaginal mesh (TVM) in our hospital due to
POP are subjected in this study. Clinical symptoms,
urination function, POP degree and transperineal ultraso-
nography findings are analyzed. We evaluated anterior
vaginal wall thickness, shape of urethral internal os, PUVA
and movement of urethral hypermobility by transperineal
ultrasonography.
Results: Preoperative anterior vaginal thickness was 7.8±
1.6 mm (mean±SD) and it thickened up to 10.5±2.1 mm
after TVM. In 6 patients who complained stress urinary
incontinence (SUI), funneling of urethral internal os was
observed and measurement of urethral internal os move-
ment during Valsalva manoeuvre was significantly longer
S226
than that of patients without SUI. PUVA by transperineal
ultrasonography correlated with that by CCG.
Conclusion: Transperineal ultrasonography could be an
safe, convenient, objective and useful diagnostic tool in
POP patients instead of relatively invasive CCG.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
425
URETHRAL CLOSURE PRESSURE AREA:
FUNCTIONAL CRITIC ZONE IN THE URINARY
CONTINENCE
Solano-Sanchez, SR
Instituto Nacional de Perinatología, Mexico City, Mexico
Objective: To determine if urethral closure pressure area is
an urodynamic value that represents the zone of critic
urethral elasticity for the maintenance of the urinary
continence.
Materials and methods: We realized a cross-sectional and
analytic study. We included all the patients whom realized
urodynamic study in the National Institute of Perinatology at
2004 which fulfilled the criteria selection. Three groups
according to the urodynamic diagnosis settled down: 1. Normal
study; 2. Urethral hypermobility and 3. Intrinsic urethral
sphincteric deficiency. We used the ANOVA one way test.
In second phase we realized a case control study to
determine the association between the urethral closure
pressure area and intrinsic urethral sphincteric deficiency.
We used Chi square statistic test.
Results: We found statistically significant difference of means
(p<0.05) for the urethral closure pressure area and we
determinate association between the urethral closure pressure
area and the urethral closure pressure area: OR 5.9 [1.9–17.9].
Conclusion: The urethral closure pressure area is the
urodynamic value that represents a progressive behavior
for the development of intrinsic urethral sphincteric
deficiency. It functionally represents the zone of critic
urethral elasticity for the maintenance of the urinary
continence.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
426
URINARY INCONTINENCE AFTER THE TREATMENT
OF GYNAECOLOGICAL ONCOLOGICAL SURGERY:
OUR EXPERIENCE
Castillo Vico, MT; Casas Balazote, AB; Fernnández López,
L; Muñoz Sánchez, R; Fusté Brull, P; Mancebo Moreno, G;
Carreras Collado, R
Hospital del Mar, Barcelona, Spain
Objectives: A retrospective evaluation of the incidence of
urinary incontinence (UI) in patients operated of gynaeco-
logical oncological surgery.
Materials and methods: We studied 164 patients diag-
nosed of a gynaecological cancer and operated in our
Service between 2003–2005. All of them were polled by
phone following the ICIQ-SF questionnaire (Espuña & col,
Medicina Clínica, 2001) validated by the Pelvic Floor
Section of the SEGO.
Results: In the review of all the patients of our dispensary,
we have not found differences in the debut of the UI
between oncological and non-oncological patients. From
the 158 contacted women, only answered 71 (44.93%) and
31 of them suffered UI (43.66%). The majority of them had
symptoms of stress urinary incontinence. In the group with
UI we found a 51% of patients with a history of
endometrial cancer, followed by a 25% of cervical cancer
and a 22% of ovary cancer.
Conclusions: Due to the results, we need to create
multidisciplinary units for the prevention and treatment of
the oncological treatment to improve survival and quality of
life. We believe that it is necessary to do more studies about
the impact of UI in oncological patients.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
427
GENITOURINARY FISTULA: EXPERIENCE
IN THE NATIONAL INSTITUTE OF PERINATOLOGY
Rodriguez-Colorado, S; Escobar-del Barco, L; Gorbea-
Chavez, V; Morales-Cruz, ML; Sesman-Bernal, M
Instituto Nacional de Perinatologia, Mexico City, Mexico
Objective: Analyze the experience in the etiology, inci-
dence, surgical approach and results of genitourinary fistulas
attended in the urogynecology clinic of the National Institute
of Perinatology (INPer) since January 1992 to January 2007.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Materials and methods: We present a descriptive /
retrospective study including of 53 patients who were attended
for genitourinary fistula since July 1992 to January 2007,
analyzing etiology, incidence, surgical approach and results.
Results: During the mentioned period there were 53 cases
of genitourinary fistulas, 75.5% were vesicovaginal, 20.7%
ureterovaginal, 1.9% vesicouterine and 1.9% vesicocuta-
neous. Respect to the size, 52% were smaller than 1 cm,
35% 1–2 cm, 9% 3–4 cm and 4% > 4 cm. Respect to the
etiology, 75.5% were gynaecological, 20.7% obstetrics,
1.9% postpartum and 1.9% laparoscopic. Vaginal approach
was done in 75.5% of cases and abdominal approach
24.5%. The main surgical technique used was Latzko
(73.5% of cases). After first surgery there were 12
(22.6%) surgical failures, and 90%of them resolved after
second intervention.
Conclusions: In our experience the surgical treatment of
the patients with fistula genitourinary showed good results
(71.4% of healing) with a most minimum percentage of
complications (28.5% of recurrence).
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
428
IS SACROSPINOUS FIXATION FOR PROLAPSE
A SPECIALIST OPERATION?
Venkitaraman, U; Doshi, S
Kettering General Hospital, UK
Objective: Is sacrospinous fixation for prolapse a specialist
operation?
Materials and methods: A casenote review of 34 patients
who underwent sacrospinous fixation (SSF) at Kettering
General Hospital over a two year period from October 2004
to October 2006 was performed. Data such as age, parity,
BMI, previous prolapse surgery, grade of prolapse, surgery
performed, anaesthesia, duration of surgery, complications,
outcome of the procedure and need for further treatment
were recorded from the notes.
Results: The median age of the patients was 58 years
[range 36–95], the median BMI was 26 [range 23–32] and
the median parity was 2 [range 2–8]. Twelve patients (35%)
had had previous prolapse surgery including vaginal
hysterectomy in 11 patients. Seven patients (21%) had
had an abdominal hysterectomy in the past.
The grade of prolapse was grade II in 7 patients (21%) and
grade III in 27 patients (79%).The procedure performed was
S227
sacrospinous fixation alone in 7 patients (21%) and bilateral
SSF with repair of posterior vaginal wall with mesh in 3
patients (9%). SSF was combined with other procedures
such as vaginal hysterectomy, anterior repair, posterior
repair, perineorrhaphy and tension free obturator tape
(TOT) in 17 patients (50%). Sacrospinous cervicopexy alone
and combined with other prolapse procedures was performed
in 7 patients (21%). Twenty two patients (75%) had the
procedure performed under general anaesthesia and the rest
had the procedure done under regional anaesthesia. The
median duration of surgery was 90 minutes [range 45–180]
and the median duration of hospital stay was 4 days [range3–
9]. Complications included haematoma in the ischiorectal
fossa in 1 patient (3%), urinary tract infection in 2 patients
(6%) and voiding difficulty in 1 patient (3%). The median
duration to follow-up was 7 weeks [range 4–36 weeks]. In 29
patients (85%) the vault was well supported with no prolapse
at the time of follow-up. Twenty eight patients (82%) were
pleased with the result of the operation. Vault prolapse
recurred in 2 patients (6%) and was treated with a
sacrocolpopexy in one patient and a bilateral SSF with
posterior vaginal wall repair with mesh in the other.
Cystocele and stress urinary incontinence developed in one
patient who subsequently underwent an anterior repair and
TOT and a cystocele alone developed in 2 patients (6%). One
of these patients had an anterior repair subsequently and the
other patients prolapse was controlled with a ring pessary.
Conclusion: The SSF operation can satisfactorily correct
prolapse in up to 85% of patients when performed by general
gynaecologistsandisnotanoperationforspecialistsalone.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
429
MEDIUM-TERM OUTCOME OF PROLIFT
FOR VAGINAL PROLAPSE
Groenen, R; Vos, MC; Vervest, HAM
St Elisabeth Hospital
Objective: To evaluate the medium-term outcome and
complications of polypropylene mesh (Prolift®) for the
surgical treatment of vaginal prolapse.
Methods: In 15, 19 and 2 women with resp. POP-Q stage
II, III and IV vaginal prolapse 9 anterior, 13 posterior and
14 total Prolift procedures were performed. Concomitant
surgery: 4 TVT-O for SUI and 1 vaginal hysterectomy. Data
S228 Int Urogynecol J (2007) 18 (Suppl 1):S107–S244

of intra- and postoperative performance were recorded. Conclusion: Prolift delivers adequate relief of recurrent
Median follow-up was 13.9 months (range 6–22). vaginal prolapse. Though not free of complications, its rate
Results: See table. For each specific type of Prolift a is low and in agreement with other studies.
related significant improvement in POP-Q scores was Disclosures
observed. Recurrences were observed in 3 women (8%): 2 Was consent obtained from patients? N/a.
rectoceles after an anterior Prolift in women with no Was this work supported by industry? No.
previous surgery resp. previous vaginal hysterectomy with Does the presenter or any of the authors act as a consultant,
anterior/posterior fascial plication (pre-operative Ap −3 & employee (part time or full time) or shareholder of an
Bp −3 in both; postoperative Ap −3 & 0, Bp resp. 0 & −1), industry? No.
1 rectocele after a total Prolift with previous vaginal
hysterectomy (pre-operative Aa −3, Ba 3, C 6, Ap 3, Bp 430
3; postoperative Ap 0, Bp 0). SURGICAL EXTRACTION OF A GREAT SIZE
Intra- and postoperative complications: blood loss > 100 ml CALCULI DURING PREGNANCY
in 11 women, temporary urinary retention in 8 women, Escobar-del Barco, L; Márquez Hirlemann, AE; González
pulmonary embolism in 1 woman. During follow-up 2 Maldonado, J; Avilez Cevasco, JC; Rodríguez Colorado, S
women developed a posterior vaginal erosion after 6 months Instituto Nacional de Perinatologia, Mexico City, Mexico
and 1 woman a vaginal mesonephric cyst (after 7 months).
Objective: To describe a case of a great size bladder calculi
diagnosed during pregnancy.
Demographic data
age (years)* 61.2±11.4 (61, 39 – 83)
multiparity 34 (94%) Materials and methods: Thirty year old patient, with
Previous urogynecological surgery history of cleaved palate corrected during adolescence,
no previous surgery 3 ( 8%) without urogenital malformations. With 7.4 weeks of
1 prolapse procedure 27 (75%) pregnancy and during ultrasound didelphys uterus was
2 prolapse procedures 6 (17%) detected, with a normal pregnancy in left uterus cavity and
colposuspension 6 (17%) intravesical mass of 90 x 70 mm (3.2x2.3 inch),
Surgery data
corresponding to a calculi. Clinical examination found
length (min)* 70.3±27.8 (67, 25– 120)
blood loss (ml)* 189±255 (100, 50 – 1200) suprapubic tumor, independent of the uterus. Cystoscopy
general anesthesia 31 (86%) failed because of the obstructive mass. Urine exam reported
spinal analgesia 5 (14%) nitrites (+), leukocytes 100 by field, abundant bacteria and
Changes in POP-Q parameters** epithelial cells, urine culture (+) to staphylococcus coagu-
preoperative follow-up p value lase (+) with 100,000 UFC. Rest of laboratories tests were
(mean ± SD) (mean ± SD) normal. The patient was treated with therapeutic and
Prolift anterior
prophylactic nitrofurantoin with monthly control urine
Aa −1,9±1,5 −2,2±1,3 0,680
Ba 2,2±2,2 −2,3±1,3 0,011
cultures. Pregnancy controls were normal.
C −6,3±3,3 −6,7±3,2 0,889 Results: Cystostomy by laparotomy was performed at 25th
Ap −3,0±0,0 −1,6±1,3 0,026 weeks of gestation, extracting a calculi of 200g (0.41
Bp −2,3±2,0 −1,7±1,4 0,340 pound) and 90×70 mm (3.2×2.3 inch) size, without
Prolift posterior complications. Medication used: tocolytics, therapeutic
Aa −2,6±0,9 −2,4±1,2 0,683 antibiotics and continuous vesical drainage with Foley
Ba −2,5±1,1 −2,5±1,2 0,564 catheter during 21 days. The pregnancy had a normal
C −2,8±3,2 −7,7±3,6 0,024
resolution. Control cystoscopy and intravenous urography
Ap 1,5±1,5 −2,3±1,2 0,002
Bp 1,5±1,3 −2,5±1,2 0,002
were normal.
Prolift total Conclusions: One pregnancy out of 1500 complicates with
Aa −2,1±1,7 −2,3±1,3 0,603 urolithiasis, 10% are situated in the bladder. Ninety percent
Ba 1,6±3,2 −2,4±1,3 0,002 of these cases resolve with conservative treatment
C 0,6±4,0 −7,1±4,0 0,002 Due to the difficulty of the spontaneous expulsion of the
Ap 0,4±2,3 −2,1±1,4 0,004 calculi or the contraindication of extracorporeal short wave
Bp 1,4±2,5 −2,1±1,4 0,001
lithotripsy, it is justified to perform cystostomy during the
* values are mean ± SD (median & range) second trimester of pregnancy, reducing the risk of
** Wilcoxon Signed Rank test (2-tailed) premature newborns and avoiding urinary infections,
bladder injuries, as well as dystocias related to obstructive
extrinsic mechanisms during deliveries.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
431
TFS IN THE TREATMENT OF GENITAL PROLAPSE
AND SUI (STRESS URINARY INCONTINENCE):
PRELIMINARY SHORT-TERM EVALUATION
Amo, E del; Santamaria, X; Castillo, MT; Fernández, L;
Basil, C; Carreras, R
Hospital del Mar, Barcelona, Spain
Target: Evaluating after 4 months the clinical subjective
improvement and the degree of satisfaction in patients
operated of pelvic floor pathology.
Patients and method: 16 patients (13 presented symptoms
of lump in external genitals, 3 out of them with SUI (Stress
Urinary Incontinence) associated and 10 with UUI (Urge
Urinary Incontinence) and nocturia and 3 only with SUI)
operated applying meshes of Tissue Fixation System (TSF)
following Dr. Petros technique.
Evaluated variables: Age, symptoms and grade of
prolapse, type of UI (Urinary Incontinence), previous
surgery, inserted meshes, postsurgery evaluation, compli-
cations, follow up after 4 months and grade of satisfaction.
Outcomes
Complications:
• Immediate postsurgery: 3 UTI (Urine Tract Infection).
• Late postsurgery : 2UI (Urinary Incontinence) Mesh
extrusion of the perineal bodies after 1 month.
Immediate postsurgery course: 3 patients presented mild
pain.
4 months after surgery:
• Symptomatic genital prolapse: asymptomatic.
• 3 with prolapse and SUI: 1 persistence of SUI but in
decreased grade.
• 6 with nocturia:3 persistence but in decreased grade
treated with anticolinergic therapy.
• 9 with urge: 3 persistence but in decreased grade treated
with anticolinergic therapy.
Grade of satisfaction: > 90%.
Conclusion: Patients with genital symptomatic prolapse +/
−SUI (Stress Urinary Incontinence) vs MUI (Mixed
Urinary Incontinence) and patients with pure SUI treated
with TFS state a clinical improvement and a high grade of
satisfaction.
Comments: TFS allows uterus preservation and functional
reconstruction of the vagina. We should be careful with the
results but we are satisfied with its good evolution.
S229
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
432
THE OCCURRENCE OF RECTOCELE
FOLLOWING LAPAROSCOPIC BURCH VERSUS TVT
Sayed Ahmed, R; Lovatsis, D; Drutz, H
Mount Sinai Hospital, Toronto, Ontario, Canada
Objective: To determine if the occurrence of de novo
rectocele following laparoscopic Burch is greater than that
after TVT.
Materials and methods: Retrospective chart review of 75
cases, 26 Lap Burch performed starting 2002 and 49 TVT
performed starting 1999. Only patients with primary
incontinence procedure with no additional vaginal surgery
were included. Patients were excluded if there was pre-
operative prolapse of any vaginal compartment at or
beyond the hymen or if post-operative follow up was less
that 1 year. The primary outcome was developing a
rectocele at or beyond the hymen any time after surgery.
Follow up ranging from 1 to 5 years. Local ethics approval
was obtained. The primary outcome was statistically
compared using Fisher’s exact test.
Results: Rectocele occurred post-operatively in 1/26
(3.8%) Laparoscopic Burch versus 1/49 (2%) TVT (p=
0.459 by Fisher’s exact test). There was also no difference
in do novo anterior or apical wall prolapse as no cases have
occurred.
Conclusion: Although rectoceles following Burch proce-
dure have been reported up to 15%, our chart review did
not find any difference when comparing the rectoceles after
TVT as a control group with our sample size.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
433
THE TRANSOBTURATOR APPROACH
FOR THE CORRECTION OF STRESS URINARY
INCONTINENCE
Franco, AVM; Wang, K; Swaby, P; Jeffery, S; Fynes, MM
St George’s Hospital, London, UK
S230 Int Urogynecol J (2007) 18 (Suppl 1):S107–S244

Objective: Evaluation of morbidity and continence out- emphasis on clinical history in the management of urinary
comes after placement of a trans-obturator tape (TOT). incontinence (UI). The guidelines state that UI should be
Materials and methods: Women with stress urinary categorised from the history as stress UI, mixed UI, or urge
incontinence (SUI) and without significant prolapse UI/overactive bladder syndrome (OAB). Initial treatment
(<grade2) were recruited. TOT placement followed by should be started on this basis. They also recommend that
cystoscopy was performed per protocol. Pre- and 6-week women with a clearly defined clinical diagnosis of pure
post-operative assessment included completion of a urinary stress UI can be treated surgically based on the history
diary, 1-hour pad test, urethral pressure profilometry (UPP), alone.
and uroflowmetry. 6, 12, and 24-month follow-ups were
identical but omitted UPP. Objective: The aim of this study was to determine whether
Results: 85 (98%) were performed under local anaesthetic. a patient’s history varied depending on the method by
Peri-operative and immediate post-operative complications which it was obtained.
include: vaginal perforation 3 (3%), UTI 4 (4.6%), and Materials and method: A retrospective review of 50 cases
voiding difficulty 7 (8%) which required catheterisation for of urodynamic stress incontinence was performed. Four
a mean duration of 46 hours. Post-operative complications methods of history taking were compared traditional oral
include tape erosion 6 (6%), persistent voiding difficulty 1 histories obtained in the primary care and secondary care, a
(1%), and vaginal pain (1%). non-standardised patient questionnaire and the Kings
Health questionnaire (KHQ) a validated instrument. All
Parameter Pre-op 6 weeks 6 months 12 months 24 months histories were obtained in the same chronological order as
n=87 n=83 n=60 n=49 n=24 listed.
SUI 87 9 (11%) 7 (12%) 7 (14%) 7 (29%) Results
symptoms
Incontinence severity 7(0–10) 4 )0–9) 2 (0–10) 2 (0–10) 3 (0–7) Primary Care Secondary Care Patient KHQ
(VAS 0–10)
Median pad 6.4 0.5 0.5 0.5 0.6
weight (g) (IQR0.7–36.5) (IQR0–01.0) (IQR0.1–1.6) (IQR0.2–1.4) (IQR0.03–2.1) Stress only 25 15 7 2
Flow rate (mls/sec) 22 (11–31) 24 (15–33) 26 (17–40) 22 (14–31) 19 (13–29) Mixed 15 32 41 45
Residual (ml) 0 (0–20) 10 (0–30) 10 (0–50) 10 (0–35) 5 (0–20)
UPP FL (mm) 27.1 26.1 OAB 2 0 0 1
(22.3–31) (22–30.5) Not Classified 7 – – –
UPPMUCP 35.9 (21–46) 32.7
(cm H20) (21.7–42)
Satisfaction (0–100) 90 (0–100) 86 (0–100) 83 (0–100) 87 (30–100) The median time between obtaining the first and last history
was 6 months (range 1–24 months).

Conclusion: TOT is a safe, effective, minimally invasive
technique for the correction SUI. While erosion may be
higher with some prostheses, attention to surgical technique
is essential to minimise this problem.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? Yes, by Mentor-
Porges.
Level of support: industry funding only investigator
initiated and executed study.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Discussion: The study demonstrates that symptom profiles
vary depending on method of history taking. These differ-
ences may be due to the effects of repetitive history taking,
change in symptoms over time, bias of the clinician,
pressure of time or the level of clinical acumen. However,
if operative decisions are to be based on histories alone then
there is a need to further evaluate the best method of taking
a history.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.

434
WHAT’S IN HISTORY? 435
Smith, RE; Reid, FM; Smith, ARB ABNORMAL URODYNAMICS: ABNORMAL
Warrell Unit, Manchester, UK FINDINGS AND ARTIFACTS
Escobar-del Barco, L; Rodriguez Colorado, S; Flores
Recently published guidelines by the National Institute of Rueda, EV; Avilez Cevasco, JC; Márquez Hirlemann, AE
Clinical Excellence (NICE), in the UK, have placed greater Instituto Nacional de Perinatologia, Mexico City, Mexico
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Objective: To divulge terminology. To describe abnormal
findings and interpretation of the study. To describe
artifacts in order to avoid errors in interpretation. To gather
in one document abnormal findings. To facilitate training of
gynecology and urogynecology residents.
Materials and methods: Review of actualized literature.
International Continence Society and other authors that lead in
the subject. Graphic illustration based on our own experience.
Urethral pressure profile: Maximum urethral closure
pressure, incompetent urethral closure mechanism, pressure
transmission ratio and urethral pressure measurements.
Bladder storage function: Detrusor function during filling
cystometry: Phasic or terminal detrusor overactivity, neurogenic
detrusor overactivity and idiopathic detrusor overactivity.
Bladder sensation during filling cystometry: Increased,
reduced, absent and non-specific sensation.
Urethral function during filling cystometry: Urethral relax-
ation with or without incontinence, urodynamic stress
incontinence, abdominal and detrusor leak point pressure,
intrinsic sphincter deficiency.
Urine flow: Detrusor: Underactivity and acontractile detrusor.
Urethra: Dysfunctional voiding, detrusor sphincter dyssy-
nergia, non relaxing urethral sphincter obstruction.
Artifacts: Mechanical or physiological.
Inadequate calibration and catheters, transducer failure,
pressure balloon rupture, rectal peristaltism, electrode
dysfunction.
Conclusion: In our division 5651 urodynamics studies
have been done since 1992 to date. This experience has
allowed us to understand the need of gynecologists in get
experience in these procedures for the diagnostic and
therapeutic.
Acquire knowledge of abnormal findings, understanding
physiological principles and standardization of terminology
will help us achieve accurate diagnosis when it is integrated
with clinical findings, offering an ideal treatment, leading
us to a successful ending and avoidance legal problems.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
436
ADVANCED MESH IMPLANTS FOR VAGINAL
PELVIC FLOOR RECONSTRUCTION: REPORT
OF 150 PROLIFT OPERATIONS
Neuman, M1; Friedman, M2
1
Shaare-Zedek MC, Jerusalem, Israel; 2Rambam MC,
Haifa, Israel
S231
Objective: Facing the women presenting with pelvic floor
relaxation and pelvic organ prolapse, both with intact uterus
or after hysterectomy, the Urogynecologists are looking
permanently for a simple, safe and effective ways to cure
this supportive pelvic floor defect. A novel surgical
technique, the Prolift mesh operation, was reported lately
to entail both - a high therapeutic rate and a low
complication rat. The authors evaluated the preliminary
data of first 150 Prolift patients’ series.
Materials and methods: A total of 150 patients with
advanced pelvic floor supportive defects and pelvic organ
prolapse had the Prolift operation.
Results: The Prolift procedure dose not requires laparoto-
my. Intra-operative and post operative complications were
recorded. Hospitalization period was relatively short. All
patients but five (5%) reported satisfaction with the
therapeutic results. Three patients had bladder penetration
and were treated with surgical closure at same session, three
patients had tape protrusion that was removed successfully
at the outpatient clinic and one patient had therapeutic
failure.
Conclusion: The Prolift is a novel operation, designed to
cure advanced pelvic floor relaxation, reduce complication
rate and rehabilitation period. This series result agrees with
previously reported efficacy, safety and simplicity of this
procedure. However, more long-term data is required for
drawing solid conclusion concerning the superiority of on
of the discussed operative technique.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
437
FISTULA URETERO-VAGINAL
WITH EXTRAPERITONEAL APPROACH:
CASE REPORT
Rodriguez-Colorado, S; Escobar-del Barco, L; Gorbea-
Chavez, V; Gil-Guerra, C
Instituto Nacional de Perinatologia, Mexico City, Mexico
Objective: Description of a patient with uretero-vaginal
fistula including diagnostic and treatment with extraperito-
neal approach.
Materials and methods: 34 years old female patient,
G4C3M1, with cesarean-hysterectomy 5 months ago
because of placenta accrete, 30 days after surgery the
patient complaint of vaginal discharge of urine. Physical
examination with double dye test was negative. A renal
S232
ultrasound reports left kidney with hydronephrosis and loss of
the corticomedullary relationship. No obstruction were ob-
served. Intravenous pyelogram demonstrate a standing column
of contrast within the ureter, extravasation of contrast around
the distal ureter through vagina, and left hydronephrosis.
Cystoscopy no evidence of vesical damage, left ureteral
meatus had stenosis. Retrograde pyelogram demonstrated
presence of ureterovaginal fistula. Renal function test had
normal parameters and no urinary tract infection, the patient
was informed consent and extraperitoneal approach Lich
Gregoir for ureteral reimplantation was chosen, dissect out
the ureter, reimplant the ureter in the upper bladder wall and
the ureter stented JJ catheter for 6 weeks postsurgery, without
surgical complications.
Conclusion: The uretero-vaginal fistula is a complication
of the obstetric hysterectomy. The identification of the
anatomical structures prevents injury of the urinary tract.
The vaginal discharge of urine, the double dye test,
cystoscopy, intravenous pyelogram, renal ultrasound and
retrograde pyelogram are diagnostic tools for injury size
and number of defects. The ideal approach for fistulas of
the third distal continues being the ureteroneocystostomy,
and is able to think about extraperitoneal approach.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
438
INCIDENCE OF UPPER TRACT ABNORMALITIES
IN WOMEN WITH ADVANCED PROLAPSE
Hessami, S; McKinney, TB; Guan, X; Sankar, N;
Dhamotharan, S; Hassan, KA
Saint Joseph Regional Medical Center, South Bend, IN,
USA
Objective: Pelvic organ prolapse (POP) can lead to gradual
partial or complete obstruction of one or both ureters.
Chronic and gradual obstruction as it occurs with POP is
usually indolent and asymptomatic. In this retrospective
study we will look at incidence of upper tract abnormalities
in patients with stage 3 or 4 prolapse.
Methodology: Retrospective chart review of 78 consecu-
tive patients with stage 3 and 4 prolapse. All radiologic
studies of the upper tracts were reviewed and all abnor-
malities tabulated.
Results: We found 7 patients with hydronephrosis, 16 with
simple renal cysts, and 2 with renal masses.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
POP: Stage 3 or 4
n=78
Anterior compartment Isolated or In Isolated Posterior or
Combination Apical
n=73 n=5
Incidence of Hydronephrosis Incidence of
Hydronephrosis
n=7 (8.9%) n=0 (0%)
Conclusion: Our results showed that there is an 8.9%
incidence of hydronephrosis in patients with stage 3 or 4
prolapse. This high incidence is significant as hydrone-
phrosis requires active patient management, either by
pessary or surgery. In addition, pre-operative knowledge
of existence of hydronephrosis will re-assure the physician
that its development was not related to any surgical
procedure undertaken to fix the prolapse.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
439
INSERTION OF A DRAIN WITH ATRANSOBTURATOR
VAGINAL TAPE PROCEDURE
Bader, AA; Bjelic-Radisic, V; Winter, R; Tamussino, KF
Medical University of Graz, Austria
Objective: Increased intraoperative bleeding and postoper-
ative hematomas can occur with transobturator sling
procedures. We devised a simple method to insert a drain
together with the transobturator tape to prevent hematomas
along the tract created by the transobturator tape needles.
Materials and methods: Using a TVT-Obturator system
(Gynecare, Somerville, NJ) in an inside-out manner a 10-
Charrière drain can be inserted underneath the plastic
sheath (Fig. 1A) and pushed forward till the attachment of
the plastic tube (Fig. 1B). The tape is passed through the
obturator membrane from the vaginal incision to the inside
of the thigh in usual fashion with the drain underneath the
plastic sheath passively following the plastic tube through
its passage without causing any additional resistance (Figs.
2A, B).
Results: A 64-year-old para-1, who had undergone a
vaginal hysterectomy with an anterior colporrhaphy
20 years previously, underwent a TVT-O operation at our
institution for stress urinary incontinence. Using blunt
dissection from a midline incision of the vaginal epithelium
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
towards the inferior pubic ramus, the obturator membrane
was perforated under controlled pressure using a curved
scissors. At this time considerable oozing from the
dissected channel at the right side was noted. A drain was
inserted underneath the plastic sheath as described and led
through the incision at the thigh. Suction was applied
yielding 20 mL of fluid during the further intraoperative
course. The tape was positioned and placed without tension
under the midurethra. There was no further drainage and
the drain was removed shortly after the operation.
Conclusion: A drain can be placed with a transobturator
sling procedure. Placing a drain simultaneously with the
passage of the sling does not change the minimally invasive
nature of the TVT-O operation and does not significantly
prolong the operation.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
S233
440
SACROSPINOUS FIXATION FOR THE MANAGEMENT
OF VAGINAL VAULT PROLAPSE: TEN YEARS
EXPERIENCE
Bayo, AI; Khan, F; Dixon, JE
Mid Staffordshire General Hospital, Stafford, UK
Objective: To ascertain the long term success and
complications of sacrospinous fixation (SSF) in the man-
agement of vaginal vault prolapse.
Materials and methods: Patients with major vaginal vault
prolapse were recruited into the study and had they had SSF
from 1998 to 2004. These patients were included in the first
phase of the study to evaluate the benefit and problems of
the procedure and were followed up after 6 months.
For the second phase of the study a questionnaire was sent
to the patients in 2006. Details of all the patients, in the
initial phase of the study, were checked against the death
register to avoid sending letters to dead patients. After
removing the names of the deceased patients a patient
postal questionnaire approved by the local Patient Advice
and Liaison manager and Ethics Committee., information
leaflet about the study and explaining patient’s rights and a
self-addressed envelope were sent to each of the patients.
Data from the returned questionnaires were analysed.
Results: Four of the 143 patients, who were in the first
phase of the study with full details, had died from causes
unrelated to the surgery. A total of 102 questionnaires were
completed and returned from the remaining 139 patients.
Follow up period ranged between 2–10 years with the
median of 6 years. When asked whether they had any
problem of vaginal prolapse similar to the one presenting
before surgery, 81.4% had none thus cured. Only 11% had
complains suggestive of recurrent /persistent vaginal pro-
lapse. Ten (9.8%) patients with persistent symptoms needed
further vaginal surgery of which only 4 were for vaginal
prolapse. On whether they had any new problems or
complications, 79.4% reported none. Nine of the 20 women
with problems reported urinary incontinence and 8 had
some difficulty with sexual intercourse. Overall 79.4% of
the patients said they were very satisfied or satisfied.
Conclusion: SSF has a good long-term cure rate for major
vaginal prolapse with low morbidity.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
S234
441
THE FIVE YEARS RESULTS OF TENSION-FREE
VAGINAL TAPE (TVT) FOR THE TREATMENT
OF STRESS URINARY INCONTINENCE
IN THAI WOMEN
Bunyavejchevin, S1; Veeranarapanich, S2
1
Chulalongkorn University, Bangkok, Thailand; 2Hatyai
Regional Hospital, Songkhla, Thailand
Objective: To evaluate the five years result of TVT
procedure in Thai women with genuine stress urinary
incontinence (SUI).
Materials and methods: Sixty six women, aged 35–
71 years attending gynecology clinic during January to
April 2000 were recruited in the study. Pre-operative
evaluation included voiding diary, 1-hr pad test, history
taking and physical examination. All had stress urinary
incontinence aerodynamically confirmed genuine stress
urinary incontinence and were treated with TVT. Follow
up at 3, 6, 12, 18, 24, 30, 36, 48, and 60 months were
scheduled after surgery.
Results: The mean + SD of operative time for TVT was
32.0+10.0 min. The mean + SD of hospitalization was 1.5
+ 2.0 days. Three patients had bladder perforations by the
trocar without severe bleeding and need no reparation. Two
case (3.0%) of healing defect of prolene mesh was found.
The mean pad tests were 16.3 + 8.0 grams preoperatively
vs 2.1+ 0.5 grams at 5 years (p<0.05). The cure rate was
93.9% (62 from 66 cases) at 5 years follow up.
Conclusion: Our five years results revealed that TVT was
effective and safe in the treatment of SUI in Thai women.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
442
THE USE OF TRANSVAGINAL MESH FOR SURGICAL
TREATMENT OF PELVIC ORGAN PROLAPSE:
IS IT SAFE?
Harris, NM1; Teo, R1; Mayne, CJ1; Tincello, DG2
1
University Hospitals of Leicester NHS Trust, UK;
2
Reproductive Science Section, University of Leicester, UK
Objective: The use of transvaginal mesh is becoming
established as a treatment option for the surgical manage-
ment of female pelvic organ prolapse (POP). However,
concern remains at the potential risk of mesh-related
complications, particularly infection and erosion. We have
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
reviewed our initial results, to determine complication rates
and to analyse short term POP cure rate.
Materials and methods: All patients undergoing POP
surgery between August 2005 and November 2006, in
which vaginal mesh was utilized, were included. Twenty-
eight Perigee™ and 18 Apogee™ repairs were performed.
Prolapse was assessed by clinical or POP-Q assessment and
grading. All but one patient had undergone previous pelvic
floor surgery.
Results: In the Perigee™ group, 26 anterior and 12 vault
prolapses were identified pre-operatively. At mean follow
up of 23 weeks, only 1 anterior and 1 vault prolapse were
clinically demonstrable. Median pre- (n=8) and post- (n=4)
operative POP-Q scores for Aa, Ba and C decreased from 0
to −3, 0 to −3 and 1 to −7 respectively. The only significant
complication was one intraoperative haemorrhage requiring
transfusion. No mess erosion or infections were identified.
In the Apogee™ group, 16 posterior and 7 vault prolapses
were identified. At follow-up (mean 21 weeks), only 2
vault prolapses were demonstrable. Median pre- (n=6) and
post- (n=5) operative POP-Q scores for Ap and Bp
decreased from 0 to −3 and 1 to −3 respectively. One
infected haematoma occurred, which settled with antimi-
crobial treatment. No mesh erosions were identified.
Conclusion: These data confirm that vaginal meshes are
safe and effective in patients undergoing POP surgery.
Immediate complication rates are acceptable and, in the
short term, mesh erosion does not seem to occur.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
443
TRANSOBTURATOR TAPE (TOT) FOR THE TREATMENT
OF URODYNAMIC STRESS INCONTINENCE IN WOMEN
Abdel-Haq, A
St Joseph Hospital
Objectives: To investigate the safety and short term
efficacy of the Tension Free Trans Obturator Tape (TOT)
in the treatment of Aerodynamic Stress Incontinence (USI)
in women.
Materials and methods: Prospective observational study
of 66 women undergoing TOT and followed up at 6 weeks
and 6 months.
Results: Seventy nine patients had a TOT inserted under
midurethra for the treatment of USI The intra operative
complications were limited to one vaginal wall perforation.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
The immediate post operative complications included two
cases of voiding difficulty and one patient with pyrexia.
Only sixty six patients were followed up at 6 weeks and
6 months postoperatively. At 6 weeks 94% of patients were
completely dry with two patients developing de novo
urgency without incontinence. At 6 months 64 patients
were completely dry, one patient reported some improve-
ment with a positive cough test, and one patient reported
occasional leak but her cough test was negative. Urgency
without incontinence remained the problem with one
patient only.
Conclusions: Transobturator Suburethral Sling appears to
be safe and effective as the first line measure in the surgical
treatment of USI in women. The procedure is simple, quick,
and carries only a few and mild intraoperative and short-
term postoperative complications. The cure rate is compa-
rable to the best results of similar procedures.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
444
TRANSOBTURATOR TAPE PROCEDURE IN WOMEN
WITH URINARY STRESS INCONTINENCE
Khan, M; Church, E; Hanna, L
Tameside General Hospital, Greater Manchester, UK
Objective: To determine the outcome of Transobturator
tape (TOT) procedures in women with urinary stress
incontinence.
Materials and methods: A total of 59 patients with
urodynamic stress or mixed incontinence underwent TOT
procedures at Tameside General Hospital, UK, from July
2005 to August 2006. The tape used was the ARIS Type 1
monofilament polypropylene mesh, manufactured by
Coloplast, Denmark. Patients were followed up as a
minimum with uroflowmetry and bladder residuals three
months post operatively.
Results: The success rate was 89.83%. The procedure
failed to improve symptoms in 8.47% of cases. Significant
complications included bladder injury 3.38%, vaginal tape
erosion 5%, bladder tape erosion 1.6%, and voiding
problems 3.38%. Minor complications included de novo
urgency (13.5%, treated with anticholinergics), and post
operative lower urinary tract infection (10.16%, resolved
with antibiotics).
Conclusion: Our short term success rate is consistent with
the findings of small randomised controlled trials. Vaginal
S235
tape erosion was the most common significant short term
complication. Transobturator tape (TOT) procedure is a
relatively recent minimally invasive day case procedure. Its
advantages include low cost, simplicity and shorter proce-
dure time. There is a lack of good quality evidence to
establish the long term efficacy of TOT.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
445
ABDOMINAL URETHROPEXY EFFICACY
Marroquín Parducci, A; Córdova Macías, E
Instituto Salvadoreño del Seguro Social, El Salvador
Objective: To evaluate long-term results of abdominal
urethropexies, in terms of cure rate of stress urinary
incontinence, performed in the Hospital ’1o de Mayo’,
from 1993 to 2002.
Materials and methods: Clinical files’ review of female
subjects admitted to our hospital with the diagnosis of
stress urinary incontinence, treated with an abdominal
urethropexy.
Results: Twenty-nine clinical cases were reviewed, medi-
an-age of 42.5 years old (35–56 years), median-weight of
68 kg (59–83 kg).
The main obstetrical & gynecological background features
detected were multiparity (75% of cases) with 3–4 births;
previous cesarian section in 24%; pelvic organ prolapse
(Grade 1–2) in 35% of cases and previous hysterectomy in
2 patients.
Other clinical background features were detected (38% of
cases): HBP were found in 16% of cases, Diabetes Mellitus
in 11%, COPD in another 11% and breast cancer in one
patient.
Patients developed stress urinary incontinence symptoms
two years before the surgery in 56% of cases. Patients
had more than ten years with the symptoms in 13% of
cases.
Burch cystourethropexy was performed in 100% of cases,
Burch cystourethropexy plus hysterectomy in 86% of cases.
Most common postsurgical complications were urinary
retention (one patient) and postoperative surgical site
infections (two patients)
Continence was shown in 99% of patients 5.25 years post
Burch procedure (4–10 years after the surgery).
Conclusion: The abdominal Burch remains the ’gold
standard’ for treatment of genuine urinary stress incontinence.
S236
Most of our patients had the advantage of hysterectomy in
the same surgical procedure.
Most of our patients let to pass too much time before to seek
medical advice to solve the stress urinary incontinence.
We corroborated the fact that the stress urinary incontinence
is related with multiparity, elderly, obesity.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
446
ANATOMICAL EVALUATION OF THE ANAL
SPHINCTER WITH A ENDOVAGINAL TRANSDUCTOR
OF 180°
Quintero Estrella, IM; Flores-Carreras, O
Hospitales Civiles de Guadalajara, Guadalajara, Jalisco,
Mexico
The origin of the fecal incontinence is multivariate but the
obstetrical injure is identified as the most important. The
anatomical structures affected may be the internal and
external sphincter muscles the connective tissues and
occasionally it is only detected by sonographic evidence.
The best way to obtain a good anatomical image would be
using a 360° endoanal transductor which does not exist in
our system
Objective: To show that it is possible to identify anatom-
ical sphincteric injures with a 180° endovaginal transductor.
Materials and methods: A transversal descriptive study
was performed including 60 patients of Gynecologic
department of the Civil Hospitals of Guadalajara. A vaginal
transductor of 6.5 Hz was used The sphincteric structures
were studied at the level of the medium third dividing the
sphincter in anterior and posterior planes
Results: The average age was 27.9 years SD+ 11.1 50% of
the patients presented one or more risk factors of
sphincteric injuries. Anatomical injure was present in
26.6% the one which 100% of the patients with symptoms
and only two without it. The most frequent anatomical
injure was with anterior plane between 12 and 2 of the
clock.
Conclusions: Our results suggests that endoanal 180°
transductor may be confidentially used to evaluate the
anatomical conditions of the anal sphincter injuries.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
447
COLLABORATIVE STUDY IN THE CORRECTION
OF THE FEMALE GENITAL PROLAPSE
WITH GYNEMESH PS THROUGH THE PROLIFT
SYSTEM ANCHORAGE
Solà, V1; Ubertazzi, E2; Ricci, P1; Pardo, J1
1
Clínica Las Condes, Santiago, Chile; 2Hospital Italiano,
Buenos Aires, Argentina
Objective: To evaluate the Gynemesh PS with Prolift
anchorage system for the female genital prolapse correction.
Patients and method: Prospective study of 32 patients that
have been submitted to correction of cystocele and/or
rectocele or vaginal cuff prolapse in the Urogynecology
Unit of Hospital Italiano, Buenos Aires, Argentina, and
Clínica Las Condes, Santiago of Chile. The age fluctuated
between 37 and 81 years old. The genital prolapses were
classified according to POP-Q and were corrected by
standardized technique with anterior or posterior Prolift
system. The results obtained also were evaluated by POP-Q
system.
Results: 51 meshes were placed. Five patients had only
cystocele (2 degree II, 2 degree III and 1 degree IV). Seven
patients had only rectocele (3 II, 4 III). 16 patients had
cystocele and rectocele (7 II, 7 III and 2 IV). Four patients
had vaginal cuff prolapse (2 III and 2 IV). The surgical time
was 40 minutes for anterior Prolift system and 30 minutes
for posterior Prolift. There were no reports intraoperative
complications. Two complications were reports during the
immediate postoperative time. Two prolapse recurrences
were registered during the delayed postoperative time
(degree IV to II and degree IV to I). Both were
asymptomatic.
Conclusion: According to our experience the Gynemesh
PS with Prolift anchorage system for the female genital
prolapse correction is safe and effective; nevertheless a long
follow-up is required to observe the good results in the
time.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
448
COLPOPERINEOPLASTY IN WOMEN
WITH SENSATION OF WIDE VAGINA
AND ASSOCIATE GYNECOLOGICAL SURGERIES
Pardo, J; Solà, V; Ricci, P
Clínica Las Condes, Santiago, Chile
Objective: In women complaining of a wide vagina and
decreased sexual satisfaction we performed a laser assisted
colporrhaphy - including perineoplasty in almost every
cases. Most of them had one or more gynecological
surgeries.
Methods: Between November 2003 and August 2006, a
total of 100 patients were selected for surgery at the
Urogynecology and Vaginal Surgery Unit, Clinica Las
Condes, Chile. We describe the associated surgeries.
Results: Only 15% were correction of the wide vagina
alone. 85% had another surgery. 47% had laser labioplasty.
21% hysterectomy, 9% laparoscopic tubal sterilization and
42% sub-urethral slings.
Conclusion: The colporrhaphy for wide vagina is associ-
ated in the great majority of cases whit another gynecolog-
ical condition. Ideally the surgical team must be able to
resolve all of them at he same time.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
449
RECURRENT VESICOVAGINAL FISTULA (VVF)
IN AN UNMARRIED GIRL: AN UNUSUAL ETIOLOGY
Rajamaheswari, N; Seetha Lakshmi, K; Srikala, T;
Padmapriya, S; Indra, V; Tamilselvi, A
Govt. Kasturba Gandhi Hospital and Madras Medical
College, Chennai, India
Introduction: The rare complication of VVF following
surgical management of genital tract anomaly is reported
for its rarity and to enlighten the possibility of such
occurrence.
Case report: 25 year old, unmarried girl presented with
continuous leakage of urine per vagina from 14 years of her
age despite her normal small voids. She underwent vaginal
surgery for primary amenorrhea and cyclical pain. She
resumed normal menstrual cycle and underwent vaginal
dilatation for pelvic pain due to suspected stenosis one
month later, following which she developed continuous
urinary leakage from the day of the procedure.
S237
She underwent an unsuccessful abdominal VVF repair for
supra-trigonal fistula at 16 years of her age and developed
incontinence of urine from 15th postoperative day.
On examination under anesthesia a blind vagina was
identified with fistula at its apex leading into the bladder.
Cervix was not visualized. Cystoscopy revealed bilateral
double ureteric orifice and supra-trigonal fistula about 2 cm
close to right ureteric orifice. MRI confirmed the urogenital
anomaly of double collecting system and bicornuate uterus.
Under anesthesia, firm mass in the middle vagina dissected
and cervix exteriorized by excising the fibrous tissue and
approximating the vaginal wall to cervix thus the commu-
nication with the uterus established. VVF repaired in layers
and the closure reinforced with Martius labial flap. The
repair was successful and she is completely continent of
urine. She has resumed a normal menstrual cycle.
Discussion: Though the patient had urogenital anomaly, the
urinary complication was iatrogenic. This report empha-
sizes the risks associated with surgical correction that can
occur following surgical correction of genital tract anomaly.
Conclusion: Though VVF is the most commonly acquired
fistula of the urinary tract, VVF as a complication of
surgical management of genital tract anomaly is uncommon
and requires management in a tertiary centre.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
450
IS DETRUSOR OVERACTIVITY RELIABLY
DIAGNOSED WITH URODYNAMIC TESTING?
Hessami, S; Chang, DT; Diarbakerli, F; Hassan, KA
Saint Joseph Regional Medical Center, South Bend, IN,
USA
Objective: To determine the reliability of urodynamic
testing in diagnosing overactive bladder.
Methodology: A total of 97 consecutive patient charts that
have undergone urodynamic studies were reviewed.
Patients with stress incontinence, mixed incontinence, and
those with negative workup were identified.
Results: 48% stress urinary incontinence (n=47); 8%
overactive bladder (n=7); 12% overflow (n=11); 3% mixed
(n=3); 30% negative workup (n=29).
Of note, 50% of patients with overactive bladder were not
diagnosed with premature detrusor contractions (5 mm H20
above baseline rise in intravesical pressure), but had small
S238
bladder capacities (300cc) with response to empiric
treatment with anti-cholinergics.
Conclusion: Urodynamic testing is not reliable in diagnos-
ing overactive bladder. Patients with small bladder capacity
should be offered empiric treatment with anti-cholinergics.
Thirty percent (30%) of patients in our group with small
bladder had overactive bladder.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
451
A RETROSPECTIVE REVIEW OF DONOR FASCIA
USE IN PELVIC FLOOR REPAIR
Radchenko, C; Schulz, J; Flood, C
University of Alberta, Edmonton, Canada
Objective: The use of donor fascia lata in surgical repair of
pelvic organ prolapse (POP) is not standard practice and the
perspectives on its use remain controversial. The objective
of our study was to evaluate the outcomes of pelvic floor
repair with, and without, the use of allograft fascia lata.
Materials and methods: A retrospective chart review of
patients who had surgical repair of POP between November
2001 and April 2003 was completed. Outcomes investigat-
ed included: recurrence of prolapse, urinary and fecal
incontinence, relief of symptoms, incomplete bladder
emptying, urination frequency, sensation of pain, and graft
erosion.
Results: There were no significant differences between the
fascia and control groups in recurrence of rectocele,
cystocele, enterocele, and vault/uterine prolapse. In addi-
tion, there were no differences between the two groups in
terms of post-operative pain, and vaginal infection. How-
ever, there was a significant difference between the two
groups in terms of the presence of urinary incontinence
post-operatively with more urinary incontinence in the
control group (Chi-square, p=0.0124). Also, graft erosion
was only seen in 2 out of 45 patients in the fascia group.
Conclusions: In our study population, no benefit was found
in using donor fascia lata graft. Previously cited concerns
associated with the use of donor fascia in pelvic floor repair
(such as vaginal infection, post-operative pain, and graft
erosion) were not seen as issues in this study.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
452
ACUTE URINARY RETENTION CAUSED
BY CERVICAL UTERINE LEIOMYOMA
Kaijkawa, M; Crema, L; Jármy-Di Bella, ZIK; Martins, SB;
Girão, MJBC; Sartori, MGF
Federal University of São Paulo, Brazil
Cervical uterine leiomyoma is a rare condition. A large
mass may that may compress adjacent pelvic organs like
rectum and bladder. Patients with cervical uterine leio-
myoma are likely to have acute urinary retention. This is a
case report that exemplify this situation.
A 48-year-old woman, (gesta IV, para IV), was admitted at
the Urogynaecology Center of the Federal University of
Sao Paulo, Brazil, with acute urinary retention. Her
menstruations were regular, and she complained of a
vaginal pressure. Physical examination revealed a mass
approximately 9 cm in diameter bulging the anterior
vaginal wall and pushing the uterine cervix forward.
Catheterization was performed to relieve the symptom.
Nuclear magnetic resonance revealed a cervical mass of
approximately 300 cc, compressing the bladder neck. There
were no alterations at the uterine corpus. Renal function
was normal and there was no signs of ureteral dilation.
Vaginal miomectomy was performed. After the surgery, the
patient urinated spontaneously.
Large uterine leiomyomas cause obstructive symptoms, like
constipation and urinary retention. This possible diagnosis
should always be remembered and thought about when
dealing with patients having acute urinary retention,
because with appropriate management these symptoms
may be treated and relieved.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
453
TVT-O SUCCESSIVE URINARY STRESS
INCONTINENCE SOLUTION
Iliev, VN; Kuzeska, K
Medical Faculty, Skopje, Macedonia
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Microinvasive suburethral sling procedure in the treatment
of the female stress urinary incontinence are described, an
assessment of its efficacy and complications.124 patients
with clinical and urodynamics diagnosis of stress urinary
incontinence were selected. Characteristic of the population
are analyzed as well as efficacy and complications during
and after the operation. Two of TVT-O patients presented
with recidivist mix incontinence. The mean surgical length
was 16 minutes and one day. The analyzed series revealed
about 94% of cured/improved continence status.
TVT-O
Period: September 2005 -February 2007
No of cases: 124
Age: Main 53 (41–59)
Indications: - SUI
- SUI recurrent
Contraindications:
- Another type of urinary incontinence
- Coagulopathy or therapy with anticoagulants
- Active urinary infection
- Patient denied this type of surgery
Operative time: 16 min (max. 24 min, min.11 min)
Hospitalization: 24 h
Complications:
- Groin pain: 2 (1.6%)
- Haematoma: 2 (1.6%)
- Transitory urine retention: 3 (2, 4%)
- UTI: 5 (4, 1%)
Continence status:
- Cured: 110 (88, 7%); Improved: 7 (5, 7%); Failed: 7
(5, 6%)
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
454
VAGINAL HYSTERECTOMY
AND COLPOPERINOPLASTY
Rodriguez-Colorado, S; Escobar-del Barco, L; Gorbea-
Chavez, V; Meraz-Avila, D; Morales-Cruz, ML
Instituto Nacional de Perinatologia, Mexico City, Mexico
Objective: Analyze the experience in Vaginal Hysterecto-
my and Colpoperineoplasty in the Urogynecology Clinic of
the National Institute of Perinatology (INPer) in the last
5 years
Materials and method: The study was descriptive,
retrospective, including the review of 187 patient’s files
S239
that were underwent to Vaginal Hysterectomy and Colpo-
perineoplasty. We analyze age, surgery indications, presur-
gical Q diagnostic, POP Q, additional pathology,surgical
time, anesthesia type, bleeding, complications and evolu-
tion patient.
Results: It was identified 150 complete files complete. The
average age was 54 years, median parity was 4, body mass
index (BMI) 28, average in surgery time was 2.05 hours,
and median bleeding 479cc. The main indication for this
surgery was POP Q stage II in 54%, and the type of
anesthesia was peridural. In 94% of the procedures, the
bladder injury was present in 3 of 150 surgery. The most
frequent medical history was high blood pressure with
18.6%.
Conclusion: In our experience the vaginal surgery repre-
sents a safe approach in patients with pelvic prolapsed
organs, because it has a smaller complications rate, shorter
convalescence and a minimal bleeding.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
455
INFLAMMATORY CYSTIC VAGINAL LESION
CAUSING URINARY DYSFUNCTION: A CASE
REPORT
Bortolini, MA; Crema, LC; Martins, KF; Martins, SB;
Kajikawa, M; Jármy-Di Bella, ZIK; Girão, MJBC; Sartori,
MGF
Federal University of São Paulo, Brazil
A 27 year old woman with acute voiding dysfunction and a
cystic lesion at the anterior vaginal wall for two months.
This patient had polacyuria, nocturia, and urge inconti-
nence. She had no previous history of pelvic surgery,
vaginal or urinary infection, urethral diverticulum or
systemic diseases associated. She had one child from a
cesarean section that weighed 4150 g. We observed a 5,0
cm diameter cystic lesion at the anterior vaginal wall
pressing the urethra outward. A local punction at the cystic
lesion showed an inflammatory and purulent discharge.
After culture analysis of this material, no bacteria was
found. This patient was treated with azitromycine 500 mg
per day during three days with inflammatory process
resolution. We had a clinical hypothesis of the cause of
this inflammatory process attributed to Chlamydia tracho-
matis. The reason why we decided to describe this case was
because at a first glance we thought of a surgical resolution,
S240
but after analyzing the process clinically we decided to take
a less aggressive conduct, less expensive and with a quicker
resolution.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? Yes.
456
NEW STRATEGY OF URINARY INCONTINENCE
SURGERY FOR POP PATIENT
Shimada, M; Inoue, K; Aoki, K; Shiiki, K; Sugawara, S;
Maruyama, K; Ogawa, Y
1
Showa University Northern Yokohama Hospital, Japan
We found new strategy to decide the indication of urinary
incontinence surgery with POP. If the femoral leg presses
the cystocele which located between both femorals and
outside of the genital hiatus, and if it stores much urine,
urine can leak by being pressed it, like overflow inconti-
nence. We called this third type of incontinence as ’Femoral
stress urinary incontinence (FSI or FSUI)’. On the other
hand, if the patient had rectocele and complained faecal
incontinence, there was a possibility that it occurred by
being pressed the rectocele, we called it as ’femoral stress
faecal incontinence (FSFI)’. If so, the FSI can be divided
two types (FSUI and FSFI). This must be a help for
decision-making the concomitant anti-urinary incontinence
surgery of POP surgery. We changed some the standards
halfway, and we hope it will become a clue for the precise
diagnosis of occult urinary incontinence in POP patients.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
457
POSTERIOR COMPARTMENT STATIC PROBLEM
SOLUTION: IVS - POSTERIOR
Iliev, V; Kuzeska, K
Medical Faculty, Skopje, Macedonia
Objective: The effectiveness of combination: vaginal
colphysterectomy and IVS-posterior in prevention and/or
treatment of postoperative vaginal prolapse was evaluated
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
in 22 patients with total uterine prolapse and vaginal
prosidentia.
Materials and methods: Before the operation, the median
stage of prolapse was: stage IV (range, III-IV) for anterior
site; stage III (range, II-IV) for posterior site; stage IV
(range, IV-IV) of the apical segment, and stage IV (range
IV-IV) for the most severe segment of prolapse. The
median follow-up was 25,5 months (range, 9–34 months).
Results: Operative time averaged 115 minutes, blood loss
averaged 270±110 ml (range, 120 to 430 ml). There were
no intraoperative injuries to the bladder, ureter, rectum or
small bowel. At the final follow-up control, the median
stage of prolapse was: stage 0 (range, 0-II) for anterior site,
posterior site and the most severe segment of prolapse; and
stage 0 (range, 0-I) for apical segment. The total vaginal
length (tvl) increased significantly (p<0.001) from the
preoperative mean value of (−3.12±1.89) to (−6.89±0.87),
and point C ascended from (+7.20±1.26), to (−6.89±0.87).
Conclusion: This proposed combination seems to be safe
and effective.
Disclosures
Was consent obtained from patients? N/a.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
480
DEFECTS OF THE LATERAL VAGINAL WALL
ATTACHMENT OBSERVED BY TWO-DIMENSIONAL
ULTRASOUND: THEIR RELATIONSHIP TO STRESS
URINARY INCONTINENCE
Masata, J1; Martan, A1; Svabik, K1; Zvarova, J2
1
Ob/Gyn Department, Charles University, Prague, Czech
Republic; 3Euromise Centre, Prague, Czech Republic
Objective: Lateral defects of the vaginal wall fixation to
lateral pelvis are caused by detachment of the endopelvic
fascia to the arcus tendineus fasciae pelvis or by avulsion
injury of the levator ani muscle. By means of trans-
abdominal ultrasound examination we are able to visualize
these defects. The aim of our study was to assess how the
presence such of a defect influences the lower urogenital
tract of continent and incontinent women and its relation-
ship to stress urinary incontinence.
Materials and methods: 319 women were included in this
study, 211 incontinent and 108 continent. For all women an
ultrasound scan was performed - transabdominal for
detection of lateral defect, transperineal for assessment of
the position and mobility of the urethra. The continent and
incontinent women were subdivided according to the
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
presence of the defect into three subgroups: no defect,
unilateral defect (differences between different side defects
were compared), and bilateral defect.
Results: In 53 (49%) of continent women no lateral defect
was detected, in 35 (32%) there was a bilateral defect and in
20 (19%) a unilateral defect. Defects are more often present
in older women with higher parity. The presence of the
defect significantly increases urethral mobility (bilateral
defect increases mobility more than a unilateral defect:
no defect 12.4 mm, unilateral 17.6 mm, bilateral
27.2 mm, p< 0.001). In the group of incontinent women
lateral defect is present in 178 (84%) individuals, in 63
(30%) unilateral, and in 115 bilateral (54%). The defect
does not influence the resting position of the urethra, but
again there are significant differences in the length of
the vector from rest to maximal Valsalva (no defect 15.1
mm, unilateral 17.1,bilateral 22.3 mm: p< 0.001). There
is no difference between left or right defects. Compared with
incontinent women, in continent women defect prevalence
is significantly lower. In incontinent women there is a higher
descent of the urethra at rest and a different type of
movement from rest to maximal Valsalva (in term of
direction). In continent women rotational movement pre-
vails, while in incontinent women a combination of rotation
and ’slipping’ dominates.
Conclusion: The reason for increased urethral mobility is a
defect of the lateral vaginal wall attachment. The defect is
significantly often present in parous women (delivery
induced pelvic floor trauma) and is more often present in
incontinent women. We did not confirm that repeated
labour increase the prevalence of this defect. Mobility
depends on the severity; the highest mobility was found in
patients with bilateral defects.
This work was supported by NR 8815-3/2006, GIGH-
0651-00-3-223
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
481
DIMENSIONS OF LEVATOR HIATUS IN WOMEN:
THE USE OF 3D/4D ULTRASOUND
IN THE EVALUATION OF LEVATOR ANI MUSCLE
Kasikova, E; Krofta, L; Otcenasek, M; Feyereisl, J
Institute for the Care of Mother and Child, Prague, Czech
Republic
S241
Objective: The levator ani is the main structure supporting
the pelvic organs and therefore thought to be of major
importance in the aetiology of pelvic organ prolapse and
incontinence. Transperineal, two-dimensional (2D) ultraso-
nography can be used for the assessment of female pelvic
floor. The rapid development of 3- and 4-dimensional (3D/
4D) technology may allow dynamic assessment of pelvic
floor anatomy. We intended to define levator hiatus in
group of nulliparous women.
Methods: In a prospective observational study, 26 nullip-
arous women underwent 2D and 3D/4D translabial ultra-
sound. We examined: a) the area of the urogenital hiatus, b)
the angle between vertical line segment connecting the
region of the urethra and rectum and the branch of pars
puborectalis m. levatoris ani on left and right side (PR
angle) and c) angle gamma (the angle between the axis of
the symphysis and the line segment connecting the region
of the internal urethral orifice and the lower margin of the
symphysis) at rest and on straining. Analysis of the datasets
was undertaken using the software GE 4D View. Statistical
analysis was performed using the Statistical Package for
Social Science (SPSS Version 11.5). Descriptive statistics
were computed for demographic and anamnestic patient
data. The results are presented as mean and SD. Ultrasound
results were analysed by non-parametric statistical methods:
paired test.
Results: Complete datasets were available for 26 women.
The mean age was 27. The mean hiatal area at rest was
131 mm2 (SD 26), at straining was 147 mm2 (SD 32)
(paired sample test and paired differences was 15,5 and SD
22,74, p-0.002). Angle gamma at rest was 52 degree (SD
14) and on straining 74 degree (SD 19) (paired samples test
and paired differences 21.78 (SD 18.1) and p<0.001). PR
angle on right side at rest was 20 degree (SD 9), on
straining 19 degree (SD 8). PR angle on left side at rest 22
degree (SD 9), on straining 19 degree (SD 8). The
differences among PR angle on both sides were statistically
non significant.
Conclusion: Biometric indices of the pubovisceral muscle
and levator hiatus can be determined by 3D ultrasound. The
acquired data will be used for comparison with morpho-
logical changes after vaginal delivery. This study was
supported by the Internal Grant Agency of the Ministry of
Health of the Czech Republic, grant number NR 8352.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
S242
482
DOES CONCOMITANT PELVIC ORGAN PROLAPSE
AFFECT VOIDING FUNCTION FOLLOWING
TENSION-FREE VAGINAL TAPE FOR STRESS
INCONTINENCE?
Fayyad, AM; Hill, S
Royal Blackburn Hospital, UK
Objective: Pelvic organ prolapse (POP) is a known risk
factor for voiding dysfunction, and incontinence operations
aimed to support the mid-urethra could theoretically result
in urethral kinking if there is co-existing prolapse. So far,
there has been no study to assess the relation between
pelvic organ prolapse and postoperative voiding dysfunc-
tion following TVT. The aim of this study is to assess the
relation between pelvic organ prolapse and post operative
voiding function in patients undergoing TVT procedures.
Materials and methods: Ninety five women undergoing
TVT operation for urodynamic stress incontinence were
enrolled in the study. Patients were examined pre opera-
tively using the pelvic organ prolapse (POP-Q) system.
Patients post void residuals were recorded postoperatively
along with the days needed to resume normal voiding.
Correlations between POP-Q measurements and urinary
residuals, and the number of days to resume normal voiding
were calculated using Spearman correlation coefficient
(SPSS 10).
Results: Anterior vaginal wall descent with valsalva
ranged between −3 to +2 cm, posterior wall measure-
ments ranged between −3 to +2.5 cm. Cervix/vault
descent ranged between −5 to 0 cm. 21 patients had
asymptomatic anatomical POP at or below the hymen. No
significant correlations were found between post-void
urinary residual and the degree of POP using POP-Q
(correlation coefficients: 0.19 to o.26, for the six points
of POP-Q examination). There was no correlation
between the stage of POP and the number of days to
return to normal voiding (correlation coefficient: 0.06 to
0.14). Two patients developed voiding dysfunction post-
operatively and performed bladder self catheterisation for
ten and fourteen days respectively. They did not have
anatomical prolapse on examination
Conclusion: Asymptomatic pelvic organ prolapse is not a
risk factor for voiding dysfunction following TVT surgery
for stress incontinence.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
483
LEVATOR TRAUMA AND FEMALE PELVIC ORGAN
PROLAPSE
Dietz, HP
University of Sydney, Australia
Objective: Trauma to the pubovisceral muscle is a common
consequence of vaginal childbirth, associated with vaginal
operative delivery and higher maternal age at first delivery,
as shown in studies using both magnetic resonance and
ultrasound imaging. In this study we set out to determine
the odds ratio of major morphological abnormalities of the
levator ani muscle in women with prolapse, and the relative
risk of significant prolapse in women with levator avulsion.
Methods: 801 women were seen in a tertiary urogynaeco-
logical unit. They were assessed with a standardised
interview which included questions regarding symptoms
of prolapse, an examination using the ICS POP-Q staging
system, and assessment of the levator ani muscle by 3D/ 4D
translabial ultrasound (n=350) and/ or digital assessment
(n=780). 789 women could be assessed by at least one
method.
Results: Mean age was 55.3 (range 17.9–90.8) years,
median parity was 2 (range 0–12). Patients complained of
stress incontinence, (79%) urge incontinence (76%) and
prolapse (28%). Levator defects were found in 172 women
(21.8%). Significant prolapse (stage 2 or above) was
diagnosed in 452 women (57.3%). When women with
previous incontinence or prolapse surgery were excluded,
leaving 697 datasets, unilateral defects were found in 23/
296 (7.7%) of women without, and in 130/ 401 (32.4) of
women with significant prolapse, yielding an Odds Ratio of
5.7 (Confidence Interval 3.5–9.1). For bilateral defects the
figures were 7/296 (2.4%) in women without, and 40/401
(10.0%) in women with significant prolapse. This converts
to an odds ratio of 4.6 (CI 2–10.3) for bilateral defects.
When the dataset was analyzed to obtain the relative risk of
significant prolapse dependent on levator defects, the RR
was 1.7 (CI 1.5–1.9).
Conclusion: Women with significant clinically diagnosed
pelvic organ prolapse are four to six times more likely to
show evidence of levator avulsion injury than those
without. Furthermore, it appears that the presence of a
levator defect in our population increases the risk of
significant prolapse by approximately 70%. It remains to
be shown to what extent these results are applicable to the
general population.
Disclosures
Was consent obtained from patients? No.
Was this work supported by industry? No.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
484
TO STUDY THE RELATIONSHIP OF THE ICIQ-UI SF
SCORE, THE PRESENCE OF COITAL URINARY
INCONTINENCE (UI) AND THE STRESS
AND URGENCY UI SYMPTOMS IN SEXUALLY
ACTIVE WOMEN WITH UI
Espuna Pons, M; Puig Clota, M; Perez, A; Palau, MJ
Hospital Clínic, Barcelona, Spain
Objective: To study the relationship between the ICIQ-UI
SF score, the presence of coital urinary incontinence (UI)
and the stress and urgency UI symptoms in sexually active
women with UI.
Materials and methods: Epidemiologic, observational,
cross-sectional and multicentric study of 1290 women with
diagnostic of urinary incontinence (UI). Patients who were
not sexually active (N=443) were excluded of present
analysis. All women fill out the ICIQ-UI SF questionnaire
(3 dimensions and global score). Sociodemographic data
and a complete register of urinary symptoms and the degree
of affectation which caused, were also collected.
Results: Prevalence of coital incontinence in sexually
active women was 29.4%. Women with coital incontinence
had similar mean age and body mass index than those of
women without coital incontinence. According to symp-
toms collected through the ICIQ-UI, 396 women (30.7%)
were classified as having ’only Stress UI-SUI’, 313
(24.2%) as ’only Urge UI-UUI’, 525 (40.6%) as Mixed
UI-MUI and 56 (4.5%) as other symptoms. Women with
coital incontinence were more likely to have symptoms of
only SUI (37.6% vs 27.7%) and less likely to have ’only
symptoms of UU’I (16.6% vs 27.4%) (`<0.001). ICIQ-UI
global score was higher in women with coital incontinence,
14.1 (3.6), than in those without coital incontinence, 12.1
(3.8) (p<0.001). The difference in ICIQ-UI global score was
mainly due to the difference in the dimension ’affectation’
rather than ’frequency’ and ’amount’ dimension scores.
Conclusion: The severity of the urinary incontinence
measured by the ICIQ-UI SF seems to be associated with
the presence of coital incontinence and its bother. Probably
this association is due to the fact that ICIQ-UI SF includes
in its score the affectation (quality of life) caused by UI and
coital incontinence has an important effect on the quality of
life of sexually active women.
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
S243
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.
485
VALSALVA MANOEUVRE USING ’BEARING DOWN’
TECHNIQUE OR FORCED EXPIRATION: WHAT
HAPPENS TO INTRA-ABDOMINAL PRESSURE?
King, J1; Freeman, RM2
1
Westmead Hospital, New South Wales, Australia; 2Derri-
ford Hospital, Plymouth, UK
Objective: There is no accepted technique for generation of
intra-abdominal pressure rise (IAP) during measurement of
bladder and pelvic floor mobility. A bearing down type
Valsalva manoeuvre is thought to produce most movement
but standardization of IAP is desirable for population
studies (ideally without the invasiveness of rectal or vaginal
pressure catheters). We compared IAP rise and urethra-
vesical junction mobility during a standard forced expira-
tion (SE), a maximal forced expiration (ME) and a maximal
bearing down Valsalva (BD) to determine which technique
offers the most consistent rise in IAP with the ability to
clearly demonstrate pelvic floor weakness.
Methods: IAP was measured in 225 patients via a 5Fr
water filled rectal catheter during a standard expiration
(30 mm Hg or approximately 40cm H2O) and maximal
expirations using a modified sphygmomanometer. Patients
also performed 3 x BD and the highest IAP rise was
recorded. Position was semi-supine and the bladder empty.
Urethro-vesical descent and rotation were calculated using
perineal ultrasound measurements.
Results: BD produced the greatest but also the least
consistent increased IAP - SE 25.9±7.7 cm H2O, range
8–56; ME 57.9±23.4 cm H2O, range 10–142; BD 77.3±
32.7 cm H2O, range 8–230. However there was good
correlation (r=0.6, P<0.0001) between IAP during ME and
BD. Correlation between repeat ME was excellent (r=0.87,
P<0.0001) and there was good correlation (r=0.62, P<
0.0001) between ME and measured IAP. Bladder neck
descent and rotation with BD were 3.67±6.3 mm and 5.6±
10.5° greater than seen with ME. Descent and rotation
during SE were minor - 6.1 mm±3.0 mm and 3.7±2.7°
respectively.
Conclusion: BD Valsalva technique generates more vari-
able rises in IAP than a ME but neither manoeuvre can be
recommended for population comparisons of pelvic floor
mobility due to the wide range of pressure increases. A low
SE equivalent to 40cm H2O generates minimal bladder
neck movement and does not distinguish those patients
with significant hypermobility. However there was good
correlation between IAP and bladder neck movement with
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ME and BD suggesting that the forced expiration /
sphygmomanometer technique is valid for assessment of
pelvic floor mobility. The main limitation is the difficulty
for all patients to achieve a ME which generates adequate
pelvic floor movement. We now need to determine if
patients can be coached, using the sphygmomanometer dial,
to reach higher intra-abdominal pressures.
Int Urogynecol J (2007) 18 (Suppl 1):S107–S244
Disclosures
Was consent obtained from patients? Yes.
Was this work supported by industry? No.
Does the presenter or any of the authors act as a consultant,
employee (part time or full time) or shareholder of an
industry? No.