Objective: The objective of this study was to report which preoperative and intraoperative factors influence the success of the tension-free vaginal tape procedure for stress urinary incontinence. Study design: This w...Objective: The objective of this study was to report which preoperative and intraoperative factors influence the success of the tension-free vaginal tape procedure for stress urinary incontinence. Study design: This was a prospective cohort study of 809 patients. In 28 teaching hospitals and 13 local hospitals, 54 gynecologists and urologists performed the tension-free vaginal tape procedure. Results: Before treatment and 2 years postoperatively, the following question from the Urogenital Distress Inventory for stress urinary incontinence was selected to define success or failure: “Do you experience urinary leakage during physical activity, coughing, or sneezing?”Secondary outcome measurement was the outcome of the doctor’s question,“Do you leak during physical activity, coughing, or sneezing?”asked at the 2-year follow-up. Response rate was 78.7%. The success rate was significant higher in all analyses when the surgeons had performed more than 20 tension-free vaginal tape procedures (P = .003; beta = 1.918 [95%confidence interval 1.24-2.97]). General anesthesia had a negative effect on the success of the tension-free vaginal tape (P = .032; beta = 2.21 [95%confidence interval 1.07-4.55]). Conclusions:Inexperience of the surgeon with the tension-free vaginal tape procedure and general anesthesia had a negative effect on the result. We believe that the tension-free vaginal tape should be performed only by experienced surgeons.展开更多
Objective: The increased perinatal morbidity in diabetes may be partly related to vascular dysfunction. Because potassium channels play an important role in the regulation of vascular tone, this study explores the imp...Objective: The increased perinatal morbidity in diabetes may be partly related to vascular dysfunction. Because potassium channels play an important role in the regulation of vascular tone, this study explores the impact of diabetes on potassium channel function in the fetoplacental vascular bed. Study design: Vascular potassium channel function was investigated by ex vivo dual perfusion of isolated placental cotyledons (n = 47). Appropriate control experiments were carried out to exclude nonspecific effects. Results: Glibenclamide (KATP channel blocker) increased perfusion pressure to a maximum fetoplacental arterial pressure of 37 ± .6 mm Hg in controls versus 15 ± 6 mm Hg in diabetes (P <. 05). 4- Aminopyridine (KV channel blocker) equally increased fetoplacental arterial pressure in controls, and in diabetes (21 ± 4 mm Hg vs 22 ± 2 mm Hg). Apamin and charybdotoxin (KCa channel blockers) caused a negligible rise in fetoplacental arterial pressure. Conclusion: In the fetoplacental circulation, KATP channels and KV channels significantly contribute to baseline vascular tone. In diabetes, vascular KATP channel function is impaired.展开更多
Objective: The intra-and postoperative anatomic complications, frequency, and influence of risk factors of the tension-free vaginal tape are described. Study design: This was a prospective cohort study of 809 patients...Objective: The intra-and postoperative anatomic complications, frequency, and influence of risk factors of the tension-free vaginal tape are described. Study design: This was a prospective cohort study of 809 patients. Results: The total intraoperative complication rate was 6.2% . Previous prolapse surgery was a risk factor for complications (odds ratio, 2.86; 95% CI, 1.15-7.11). We found more intraoperative complications in patients with general anesthesia than with local analgesia with sedation (odds ratio, 4.14; 95% CI, 2.01-8.53). In teaching hospitals the postoperative complication frequency was higher than in non-teaching hospitals (odds ratio, 0.55; 95% CI, 0.35-0.85). The learning curve is short, and more postoperative complications were found in the second 10 patients who underwent operation by 1 surgeon (odds ratio, 1.94; 95% CI, 1.14-3.29). Spinal analgesia gives fewer postoperative complications than local analgesia with sedation (odds ratio, 0.35; 95% CI, 0.13-0.92). Conclusion: Tension-free vaginal tape is a relative safe procedure; concomitant pelvic surgery can be performed safely. Several risk factors for complications were identified: menopausal state, previous prolapse surgery, mode of anesthesia, teaching hospital, and the second ten procedures of each surgeon.展开更多
Objective:Long-term outcome of tension-free vaginal tape (TVT) in women with a history of surgery for urinary incontinence and/or prolapse. Study design:Prospective cohort study of 809 women. Twenty-eight teaching and...Objective:Long-term outcome of tension-free vaginal tape (TVT) in women with a history of surgery for urinary incontinence and/or prolapse. Study design:Prospective cohort study of 809 women. Twenty-eight teaching and 13 local hospitals,54 gynecologists and urologists performed the TVTs. The Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) were used to measure the results of the TVT procedure (preoperative at 2,6,12,24,and 36 months postoperative). According the recommendation of the International Continence Society,the question “Do you experience urinary leakage during physical activity,coughing or sneezing?”was selected from the UDI to assess stress urinary incontinence. Results:The decrease in IIQ/UDI mean scores was statistically significant. The UDI scores of women with a history of previous prolapse and/or incontinence surgery were not statistically different to the scores for primary cases after 3 years follow-up (P = .193). Conclusion:TVT is effective for women with recurrent stress urinary incontinence and/or previous prolapse surgery.展开更多
文摘Objective: The objective of this study was to report which preoperative and intraoperative factors influence the success of the tension-free vaginal tape procedure for stress urinary incontinence. Study design: This was a prospective cohort study of 809 patients. In 28 teaching hospitals and 13 local hospitals, 54 gynecologists and urologists performed the tension-free vaginal tape procedure. Results: Before treatment and 2 years postoperatively, the following question from the Urogenital Distress Inventory for stress urinary incontinence was selected to define success or failure: “Do you experience urinary leakage during physical activity, coughing, or sneezing?”Secondary outcome measurement was the outcome of the doctor’s question,“Do you leak during physical activity, coughing, or sneezing?”asked at the 2-year follow-up. Response rate was 78.7%. The success rate was significant higher in all analyses when the surgeons had performed more than 20 tension-free vaginal tape procedures (P = .003; beta = 1.918 [95%confidence interval 1.24-2.97]). General anesthesia had a negative effect on the success of the tension-free vaginal tape (P = .032; beta = 2.21 [95%confidence interval 1.07-4.55]). Conclusions:Inexperience of the surgeon with the tension-free vaginal tape procedure and general anesthesia had a negative effect on the result. We believe that the tension-free vaginal tape should be performed only by experienced surgeons.
文摘Objective: The increased perinatal morbidity in diabetes may be partly related to vascular dysfunction. Because potassium channels play an important role in the regulation of vascular tone, this study explores the impact of diabetes on potassium channel function in the fetoplacental vascular bed. Study design: Vascular potassium channel function was investigated by ex vivo dual perfusion of isolated placental cotyledons (n = 47). Appropriate control experiments were carried out to exclude nonspecific effects. Results: Glibenclamide (KATP channel blocker) increased perfusion pressure to a maximum fetoplacental arterial pressure of 37 ± .6 mm Hg in controls versus 15 ± 6 mm Hg in diabetes (P <. 05). 4- Aminopyridine (KV channel blocker) equally increased fetoplacental arterial pressure in controls, and in diabetes (21 ± 4 mm Hg vs 22 ± 2 mm Hg). Apamin and charybdotoxin (KCa channel blockers) caused a negligible rise in fetoplacental arterial pressure. Conclusion: In the fetoplacental circulation, KATP channels and KV channels significantly contribute to baseline vascular tone. In diabetes, vascular KATP channel function is impaired.
文摘Objective: The intra-and postoperative anatomic complications, frequency, and influence of risk factors of the tension-free vaginal tape are described. Study design: This was a prospective cohort study of 809 patients. Results: The total intraoperative complication rate was 6.2% . Previous prolapse surgery was a risk factor for complications (odds ratio, 2.86; 95% CI, 1.15-7.11). We found more intraoperative complications in patients with general anesthesia than with local analgesia with sedation (odds ratio, 4.14; 95% CI, 2.01-8.53). In teaching hospitals the postoperative complication frequency was higher than in non-teaching hospitals (odds ratio, 0.55; 95% CI, 0.35-0.85). The learning curve is short, and more postoperative complications were found in the second 10 patients who underwent operation by 1 surgeon (odds ratio, 1.94; 95% CI, 1.14-3.29). Spinal analgesia gives fewer postoperative complications than local analgesia with sedation (odds ratio, 0.35; 95% CI, 0.13-0.92). Conclusion: Tension-free vaginal tape is a relative safe procedure; concomitant pelvic surgery can be performed safely. Several risk factors for complications were identified: menopausal state, previous prolapse surgery, mode of anesthesia, teaching hospital, and the second ten procedures of each surgeon.
文摘Objective:Long-term outcome of tension-free vaginal tape (TVT) in women with a history of surgery for urinary incontinence and/or prolapse. Study design:Prospective cohort study of 809 women. Twenty-eight teaching and 13 local hospitals,54 gynecologists and urologists performed the TVTs. The Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) were used to measure the results of the TVT procedure (preoperative at 2,6,12,24,and 36 months postoperative). According the recommendation of the International Continence Society,the question “Do you experience urinary leakage during physical activity,coughing or sneezing?”was selected from the UDI to assess stress urinary incontinence. Results:The decrease in IIQ/UDI mean scores was statistically significant. The UDI scores of women with a history of previous prolapse and/or incontinence surgery were not statistically different to the scores for primary cases after 3 years follow-up (P = .193). Conclusion:TVT is effective for women with recurrent stress urinary incontinence and/or previous prolapse surgery.
