TLH with adequate training is associated with low morbidity, few complications and a high success rate.

The aim of the study is to illustrate that the midurethral positioning of the tension-free vaginal tape (TVT) may not be necessary to achieve continence. Our secondary aim is to highlight that a fair number of successfully performed TVT procedures do not result in midurethral position of the tape. A review of 31 women who underwent TVT operations and consecutively returned for their follow-up visits from July 2003 to November 2003 was conducted. Their TVT procedures were performed between March 2000 and August 2003. Transperineal three-dimensional ultrasound was used to identify and obtain objective measurements of the position of the TVT tape relative to the urethra. Any patients with significant coexisting vault or uterovaginal prolapse were surgically corrected at the same time. Their stress urinary incontinence was objectively diagnosed by performing urodynamic studies (dual-channel subtraction cystometry, erect stress test) in the outpatient urogynaecology clinic. Postoperatively, patients were reviewed at 1 month and then at 6 months followed by annual reviews subsequently. All women were reassessed at the 6-month follow-up visit with a filling and voiding cystometry to detect recurrent genuine stress incontinence and detrusor instability. Any woman complaining of stress urinary incontinence after that was reassessed with urodynamic studies as mentioned above. The majority of women (67.7%, 21 women) had the TVT tape located in the middle one-third of the urethra; 9.7% (3 women) and 22.6% (7 women) of women had the TVT tape situated in the proximal and distal one-third of the urethra, respectively. Despite this, all 31 women remained continent at their postoperative follow-up visits. The midurethral position of the TVT tape may not be essential in restoring continence. The TVT tape once inserted may not always rest in the midurethral position as described.

TLH is associated with a high success rate, and low morbidity with few complications.

No abstract

Introduction: Grade 4 cystoceles are among the most challenging to achieve a successful repair for gynaecologists. The high rate of recurrence of severe prolapse encouraged surgeons to use meshes. Only recently have meshes been used transvaginally for pelvic organ prolapse. The aim of our pilot study was therefore to determine the effectiveness of transvaginal anterior colporrhaphy reinforced with prolene mesh in the treatment of severe or recurrent cystoceles by looking at their primary surgical outcomes as well as their complications. Materials and Methods: This was a retrospective study conducted by the urogynaecology unit at KK Women’s and Children’s Hospital (KKWCH) in Singapore based on operations performed from April 2002 to December 2003. The inclusion criterion was that women had to have at least a grade 4 or recurrent grade 3 cystocele and had undergone a vaginal anterior colporrhaphy reinforced with prolene mesh. The women were further subdivided into 3 groups depending on whether vaginal hysterectomies were performed or not as well as the absence or presence of the uterus. Results: Thirty-seven patients with severe cystoceles underwent this procedure. The 3 mean follow-up times for the 3 groups ranged from 14.4 to 19.2 months (range, 2 to 32). Overall for the 3 groups, 75.7% were cured with no or grade 1 cystocele, 18.9% had asymptomatic grade 2 cystocele while 5.4% developed grade 3 or 4 cystocele. There were no mesh erosions. Conclusion: Transvaginal anterior colporrhaphy reinforced with a tension-free prolene mesh in the treatment of severe or recurrent cystoceles is simple, safe, easily performed and is associated with a low failure rate and morbidity. Key words: Morbidity, Prolapse, Retrospective study, Surgical mesh