The object was to study prospectively the results of a modified intravaginal slingplasty for the surgical treatment of female stress incontinence, carried out under local anesthesia as a day procedure. Seventy five patients with genuine stress incontinence were operated upon and followed for a 2-year period. All patients were diagnosed urodynamically to have genuine stress incontinence. Pad tests and quality of life assessments were carried out in all patients both pre- and postoperatively. There were no intra- or postoperative complications and 63 patients (84%) were completely cured throughout the 2-year follow-up period. Six patients (8%) were significantly improved, i.e. they did not loose urine apart from an occasional leakage during severe cold etc. In the remaining 6 patients (8%) no improvement was seen. These failures were obvious at the first postoperative check-up after 2 months. Thus, there were no relapses after 2 months. All but 5 patients were able to void properly directly after surgery. These 5 needed an indwelling catheter during the night directly after the operation. All 75 patients were released from the hospital the same day or the day after surgery without catheterization. Mean sick leave was 10 days and mean operation time 22 minutes. No defect healing or rejection of the sling occurred. It is concluded that the procedure described is a promising new technique for the surgical treatment of female stress incontinence. Prospective long-term studies including more patients are in progress to establish the definitive place of this technique in the clinical routine.

Objective Study design ParticipantsTo study the long term results of tension-free vaginal tape, a new ambulatory surgical procedure for treatment of female stress urinary incontinence.A prospective open study using a standardised protocol for pre-and post-operative evaluation.Fifty consecutive women participated in the study. All suffered from genuine stress incontinence. The mean age was 57 years (SD ll), 42 women (84%) were multiparous, 8 (16%) nulliparous.Surgical method Tension-free vaginal tape implies the implantation of a prolene tape around mid-urethra via a minimal vaginal incision. The procedure is carried out under local anaesthesia, allowing the surgeon to check intra-operatively that continence has been obtained.Results All the women except one could be operated on an ambulatory basis under local anaesthesia. Mean operation time was 29 minutes (range 16-47). Ninety percent of the women were able to micturate spontaneously within 24 hours with insignificant residual volumes. In another 10% of the women an in-dwelling catheter had to be used temporarily. There was no need for long term postoperative catheterisation (> 14 days). Post-operative evaluation was carried out after 2 to 6, 12,24 and 36 months. According to the protocol, 86% of the women were completely cured and another 11% were significantly improved. No signs of deterioration of the results over time were observed. No defect in healing or rejection of the tape occurred.Conclusion We consider the tension-free vaginal tape operation to be a safe and effective surgical procedure for the treatment of female urinary stress incontinence. The technique can be considered as an ambulatory procedure performed under local anaesthesia, allowing the majority of the women to be discharged from the clinic the same day or the day after the procedure.

Editorial Comment: This article is presented not as a reflection of agreed on conclusions, but to highlight the fact that there are no objectively proved answers to the questions: should incontinence surgery be undertaken in this group of patients. If so, what is the preferred operative procedure? Should such a patient subsequently deliver vaginally or undergo elective cesarean section? Objective: To test the effect of pelvic muscle exercise on postpartum symptoms of stress urinary incontinence and pelvic muscle strength in primigravidas during pregnancy and postpartum.Methods: A prospective trial randomized women into treatment (standardized instruction in pelvic muscle exercise) or control (routine care with no systematic pelvic muscle exercise instruction). Urinary incontinence symptoms were measured by questionnaire. Pelvic muscle strength was quantified by an instrumented gynecologic speculum. Time points were 20 and 35 weeks' gestation and 6 weeks, 6 months, and 12 months postpartum.Results: Outcomes are reported for 46 women with vaginal or cesarean birth and for a subsample of 37 women with vaginal birth. Longitudinal analyses are reported for cases with complete data across time points. Diminished urinary incontinence symptoms were seen in the treatment group, with significant treatment effects demonstrated at 35 weeks' gestation (F[1,431 = 4.36, P = .043), 6 weeks postpartum (F[1,43] = 4.94, P = .032), and 6 months postpartum (F[1,431 = 4.29, P = .044). A repeated measures analysis of variance showed a significant interaction between time and treatment for urinary incontinence (F[4,41] = 2.83, P = .037). A significant effect of initial pelvic muscle strength was demonstrated; ie, pelvic muscle strength at 20 weeks' gestation predicted significantly 12-months postpartum strength (F[1,13] = 8.12, P = .014). Group differences in pelvic muscle strength were observed (the treatment group had greater strength at 6 weeks and at 6 months postpartum than did controls), but these differences were not statistically significant.Conclusion: Practice of pelvic muscle exercise by primiparas results in fewer urinary incontinence symptoms during late pregnancy and postpartum.Editorial Comment: The incontinence differences disappeared by 12 months. The authors recommend that providers teach pelvic muscle exercise to antepartum and postpartum women. They also recommend that providers evaluate pelvic muscle strength in nulligravid women who are planning eventual pregnancy, and encourage pelvic muscle exercise if any muscle weakness is noted.Alan J. Wein, M.D.OBJECTIVE: We compared the efficacy of bladder training, pelvic muscle exercise with biofeedbackassisted instruction, and combination therapy, on urinary incontinence in women. The primary hypothesis was that combination therapy would be the most effective in reducing incontinent episodes.STUDY DESIGN: A randomized clinical trial with three treatment groups was conducted in gynecologic practices at two university medical centers. Two hundred and four women diagnosed wi...

The aim of the study was to evaluate the safety and efficacy of TVT (tension-free vaginal tape) for the surgical treatment of stress urinary incontinence. The design was a prospective open multicenter study including six centers, each operating an approximately 20 patients. In total 131 patients suffering from genuine stress incontinence were included. They were followed for at least 1 year using a specific protocol for objective and subjective evaluation of the outcome. All patients underwent the operation under local anesthesia. Mean operation time was 28 minutes (range 19-41 minutes); 119 (91%) of the patients were cured according to the protocol and another 9 (7%) were significantly improved. There were 3 (2%) failures. The majority of the patients (about 90%) were operated upon on a day-care basis, which implied that they were released from the hospital within 24 hours, with no postoperative catheterization. No defect healing and no tape rejection occurred. Three patients needed an indwelling catheter for 3 days. In 1 patient catheterization was necessary for more than 10 days. Two uncomplicated hematomas and one uncomplicated bladder perforation occurred. Based on the results, we conclude that TVT is a safe and effective ambulatory procedure for surgical treatment of genuine stress urinary incontinence.