The aim of the study was the analysis of perioperative complications in women who were randomly assigned to receive two different techniques for the treatment of stress and mixed urinary incontinence. Our study included 120 women in whom we performed either TVT-O or Monarc procedure in local anesthesia. The duration of the operation and its likely complications were followed up. The success of treatment was evaluated after 3 months. Surgical time was identical for both procedures (13 min). The prevalence of vaginal wall perforation and laceration was higher during the outside-in procedure. The inside-out procedure was more painful (p < 0.000), the pain persisted significantly longer (21.6 vs 7.5 days; p = 0.03) and was more intense after discharge in these patients. In conclusion, inside-out and outside-in procedures are equally successful methods for the treatment of urinary incontinence at 4 months, however, inside-out procedure appears to be more painful.
(1) Background: There are limited data on the success of conservative treatment of high-grade cervical squamous intraepithelial lesions (HSIL) with imiquimod directly compared to standard of treatment with LLETZ. (2) Methods: Patients aged 18–40 with histological HSIL (with high-grade cervical intraepithelial neoplasia, CIN2p16+ and CIN3), were randomly assigned to treatment with imiquimod or LLETZ. The primary outcome was defined as the absence of HSIL after either treatment modality. The secondary outcomes were the occurrence of side effects. (3) Results: 52 patients were allocated in each group and were similar regarding baseline characteristics. In the imiquimod group, 82.7% of patients completed treatment, which was successful in 51.9%. All patients in the LLETZ group completed treatment, which was successful in 92.3% (p < 0.001). In the subgroup of CIN2p16+ patients, treatment with imiquimod was not inferior to LLETZ (73.9% vs. 84.2%, p = 0.477). During and after treatment, no cases of progression to cancer were observed. Side effects and severe side effects (local and systemic) were more prevalent in the imiquimod than in the LLETZ group (88.5% vs. 44.2% (p-value < 0.001) and 51.9% vs. 13.5% (p-value < 0.001), respectively). (4) Conclusion: Generally, in patients with HSIL, LLETZ remains the gold standard of treatment. However, in a subgroup analysis of patients with CIN2p16+, the success rate was comparable between the two treatment modalities. Due to the prevalence of side effects, the treatment compliance with imiquimod use may, however, present a clinically important issue.
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