Background: To assess the efficacy and complications of tension-free vaginal tape (TVT) versus tension-free vaginal tape obturator in women with urodynamic stress incontinence. Methods: Prospective, randomized study. Initially, 91 patients were included in the study and 89 of them were available at 12 months follow-up. Forty-six patients were subjected to classic TVT procedure and 43 to transobturator vaginal tape from inside to outside (TVT-O) operation. There was no significant difference between the groups for age, BMI, menopausal status and prolapse. No patients had cystocele greater than stage I. Subjective and objective cure and improvement rate, mean operative time, hospital stay and complications incidence were assessed. Results: Mean operative time was significant shorter in the TVT-O group (17.4 ± 6.9 min) compared to the TVT group (26.7 ± 8.6 min). There was no significant difference in the duration of hospital stay between two groups. The objective cure rate for TVT group was 89%, the improvement rate was 6.5%, the failure rate was 4.3% and the subjective cure rate 73.9%. The objective cure rate for TVT-O group was 90%, the improvement rate was 7.6%, the failure rate was 2.5% and the subjective cure rate 76.7%. The hemoglobin loss ranged between 1.0 ± 0.5 g/dl for TVT group and 0.9 ± 0.4 g/dl for TVT-O group. Conclusion: The TVT-O technique presents success rates comparable to the classic TVT method in the short term.

Objective: To investigate the relative expression and the DNA-binding status of estrogen receptors a and b in fibroids and normal myometrial tissue to explore the molecular basis of altered estrogen responsiveness of leiomyomas. Design: Biopsy samples from uterine fibroids and adjacent normal myometrial tissue at the follicular phase of the menstrual cycle. Result(s): The level of messenger RNA expression of estrogen receptor a and b and the level of estrogen receptor as a whole are increased on average to a similar extent in leiomyomas compared with normal myometrium. Occasionally, however, estrogen receptor a is disproportionately increased in leiomyomas, and this appears to increase the amount of estrogen receptor a that binds to the estrogen-responsive element of estrogen target genes as homodimer rather than as heterodimer with estrogen receptor b. Conclusion(s):The estrogen receptor a-to-estrogen receptor b expression ratio rather than the individual expression levels determines the fraction of DNA-binding homodimers of estrogen receptor a and possibly the growth potential of myomas. (Fertil Steril Ò 2008;-:---.

Tension-free vaginal tape procedure as anti-incontinence surgery significantly improves the quality of life in female patients with urodynamic stress incontinence.