Objective. The aim of the study was to evaluate feasibility and results of ambulatory transurethral injections of Macroplastiqueusing the system MISunder local anaesthesia, for treatment of female stress urinary incon...Objective. The aim of the study was to evaluate feasibility and results of ambulatory transurethral injections of Macroplastiqueusing the system MISunder local anaesthesia, for treatment of female stress urinary incontinence. Material and methods. We have performed a prospective multicentre study which has enrolled 20 patients between January 2003 and May 2004. Mean age was 72.8 ans (range 40 to 91)- . Preoperative inclusion criterias were positive stress test, 24 hours PAD test more than 10 g and post-void residual less than 100 ml. Urethral hypermobility was present in 8 patients (42.1% ), and 3 patients was diagnosed as intrinsic sphincter deficiency (16.7% ) on urodynamics examination. Pre and postoperative evaluation of urinary symptoms and quality of life were performed with the MHU score (Mesure du Handicap Urinaire), the Ditrovie score and the Contilifescale. The Macroplastique implant (Uroplasty) contains silicone and a bioabsorbable gel. Injections were perfomed under the midurethral mucosa (2.5 ml at 6 hours and 1.25 ml at 2 and 10 hours) using the system MIS(Uroplasty). No cystoscopy was required and the mean operative time was 15 minutes. Results. The procedure was feasible under pure local anaesthesia in all cases. No intra-operative complications occurred. Postoperative complications had included 2/19 local pain (10.5% ), 3/19 minimal urethrorrhagia (15.8% ) and 6/19 urinary retentions (31.6% ), which were treated by heterologous intermittent catheterization during 3 to 20 days. Eight patients returned home the same day (42.1% ). The mean hospital stay was 2.3 days. Mean postoperative followup was 8.3 months (range 2.7 to 19.1). No patient required a second injection. Results had shown a 36.9% success rate (7/19), 52.6% improvement (10/19) and 10.5% failure (2/19).At follow- up, stress test was negative in 66.7% of patients (12/18) and PAD test was<10 g in 66.7% (10/15). Modifications on maximal flow rate were non significant after injections. Postoperatively, all urinary symptoms were improved except nocturia and voiding difficulties. Quality of life was improved on all parameters. Conclusion. The surgical treatment of female stress urinary incontinence by transurethral injections of Macroplastiqueusing the system MISunder local anaesthesia was feasible in all cases with a success or improvement rate of 89.5% at a mean follow-up of 8.3 months. Ambulatory treatment was compromised by the high rate of postoperative urinary retention (31.6% ).展开更多
Objectives. We evaluated the results of surgical insertion of a polypropylene mesh via the vaginal route in young women presenting genital prolapse. Material and methods. Retrospective study concerning 20 women under ...Objectives. We evaluated the results of surgical insertion of a polypropylene mesh via the vaginal route in young women presenting genital prolapse. Material and methods. Retrospective study concerning 20 women under age 50 who underwent between July 2000 and December 2003 surgical insertion of an anterior (n = 14), posterior (n = 3) or double (anterior and posterior) (n = 3) polypropylene mesh via the vaginal route. A minimum follow-up of 6 months was required for inclusion in the study. Anatomical results were assessed using the Pelvic Organ ProlapseQuantification (POP- Q) according to ICS (International Continence Society) recommendations. To document the functional results, the patients answered 3 validated self-assessment questionnaires related to pelvic symptoms, sexual behaviors and quality of life. Results. Mean follow-up was 21 months (6 to 52 months). A vaginal erosion of the mesh occurred in 2 women (10% ). Cystocele recurred in one woman among the 17 patients who had an anterior polypropylenemesh (GynemeshTM, Gynecare ,Ethicon ). Seventeen women were sexually active before the surgical procedure and 19 post-operatively. Among these women, 5 (26% ) reported alteration of sexual activity after surgery (with dyspareunia in 4 cases (21% ), and 14 women (74% ) reported no changes or improvement in sexual activty. Conclusion. Surgical management of genital prolapse using a polypropylene mesh inserted via the vaginal route has proven its anatomical efficacy in young women. The potential adverse consequences on sexual life would require clinical research concerning the surgical approach (abdominal or vaginal route) and synthetic materials used in prolapse surgery for young women.展开更多
文摘Objective. The aim of the study was to evaluate feasibility and results of ambulatory transurethral injections of Macroplastiqueusing the system MISunder local anaesthesia, for treatment of female stress urinary incontinence. Material and methods. We have performed a prospective multicentre study which has enrolled 20 patients between January 2003 and May 2004. Mean age was 72.8 ans (range 40 to 91)- . Preoperative inclusion criterias were positive stress test, 24 hours PAD test more than 10 g and post-void residual less than 100 ml. Urethral hypermobility was present in 8 patients (42.1% ), and 3 patients was diagnosed as intrinsic sphincter deficiency (16.7% ) on urodynamics examination. Pre and postoperative evaluation of urinary symptoms and quality of life were performed with the MHU score (Mesure du Handicap Urinaire), the Ditrovie score and the Contilifescale. The Macroplastique implant (Uroplasty) contains silicone and a bioabsorbable gel. Injections were perfomed under the midurethral mucosa (2.5 ml at 6 hours and 1.25 ml at 2 and 10 hours) using the system MIS(Uroplasty). No cystoscopy was required and the mean operative time was 15 minutes. Results. The procedure was feasible under pure local anaesthesia in all cases. No intra-operative complications occurred. Postoperative complications had included 2/19 local pain (10.5% ), 3/19 minimal urethrorrhagia (15.8% ) and 6/19 urinary retentions (31.6% ), which were treated by heterologous intermittent catheterization during 3 to 20 days. Eight patients returned home the same day (42.1% ). The mean hospital stay was 2.3 days. Mean postoperative followup was 8.3 months (range 2.7 to 19.1). No patient required a second injection. Results had shown a 36.9% success rate (7/19), 52.6% improvement (10/19) and 10.5% failure (2/19).At follow- up, stress test was negative in 66.7% of patients (12/18) and PAD test was<10 g in 66.7% (10/15). Modifications on maximal flow rate were non significant after injections. Postoperatively, all urinary symptoms were improved except nocturia and voiding difficulties. Quality of life was improved on all parameters. Conclusion. The surgical treatment of female stress urinary incontinence by transurethral injections of Macroplastiqueusing the system MISunder local anaesthesia was feasible in all cases with a success or improvement rate of 89.5% at a mean follow-up of 8.3 months. Ambulatory treatment was compromised by the high rate of postoperative urinary retention (31.6% ).
文摘Objectives. We evaluated the results of surgical insertion of a polypropylene mesh via the vaginal route in young women presenting genital prolapse. Material and methods. Retrospective study concerning 20 women under age 50 who underwent between July 2000 and December 2003 surgical insertion of an anterior (n = 14), posterior (n = 3) or double (anterior and posterior) (n = 3) polypropylene mesh via the vaginal route. A minimum follow-up of 6 months was required for inclusion in the study. Anatomical results were assessed using the Pelvic Organ ProlapseQuantification (POP- Q) according to ICS (International Continence Society) recommendations. To document the functional results, the patients answered 3 validated self-assessment questionnaires related to pelvic symptoms, sexual behaviors and quality of life. Results. Mean follow-up was 21 months (6 to 52 months). A vaginal erosion of the mesh occurred in 2 women (10% ). Cystocele recurred in one woman among the 17 patients who had an anterior polypropylenemesh (GynemeshTM, Gynecare ,Ethicon ). Seventeen women were sexually active before the surgical procedure and 19 post-operatively. Among these women, 5 (26% ) reported alteration of sexual activity after surgery (with dyspareunia in 4 cases (21% ), and 14 women (74% ) reported no changes or improvement in sexual activty. Conclusion. Surgical management of genital prolapse using a polypropylene mesh inserted via the vaginal route has proven its anatomical efficacy in young women. The potential adverse consequences on sexual life would require clinical research concerning the surgical approach (abdominal or vaginal route) and synthetic materials used in prolapse surgery for young women.
