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Objective: To evaluate and quantify early and late changes in mesh length after anterior vaginal repair with implants with ultrasound., Type of Study: Prospective interventional study., Methods: Ultrasound assessment of 35 patient randomized in two groups both with Gynemesh insertion. In one group with Gynemesh Prolift anterior kit and second group with individualized size of the Gynemesh. Ultrasound measurement of the mesh in sagittal plane was performed postoperative day 4 and after 3-4 month. Measured values were put in proportions, together with the original size of the mesh. Results are expressed as a percentage of shortening., Results: In comparison of measurements from the late ultrasound scans with original size the shortening of the Prolift was 45% vs. 25% in Mesh group. When we compared the late and early ultrasound scans, there was no difference in the shrinking of the mesh in both group 16% vs 20%., Conclusion: Insufficient spreading and anchoring of the anterior Prolift has a major impact on the final length of the mesh. The tissue reaction expressed as shrinking of the mesh is only 16-20%.

Objective: We aimed to assess the occurrence of stress urinary incontinence (SUI) and urgency (U) before and after an operation to treat anterior compartment defect, and to ascertain whether there is a correlation between the position or mobility of the urethro-vesical junction (UVJ) and the lowest point of bladder base (N) and SUI and U before and after surgical treatment of the defect, using various procedures., Design: Prospective, randomized study., Settings: Department of Gynecology and Obstetrics, First Medical Faculty, Charles University and General Teaching Hospital, Prague., Materials and Methods: 87 women were enrolled who had proven symptomatic Pelvic Organ Prolapse POP > or = II (Pelvic Organ Prolapse Quantitative--POP-Q)--specifically anterior compartment defect cystocele; they were then randomized into three group according to the type of surgical procedure planned: the BM group, treated with the traditional Barnett-Macků technique of anterior vaginal plastic surgery (BM; n=18); the Gynemesh group, treated with anterior plastic surgery with free insertion of individualized mesh (Mesh; n=33); and the Prolift group, treated with an original kit with pre-set standard-size mesh which is anchored to the lower arm of pubis (Prolift; n=36). SUI tests were carried out for the women before the operation and 3-4 months afterwards, using International Consultation on Incontinence Questionnaire - Short form (ICIQ-UI SF) and objective assessment by cough-test, while we also took into account the urge symptom. Before and after the operation patients were also examined by 4D imaging (GE Voluson 730 Expert), with emphasis on the position of UVJ and N point at rest and at maximum Valsalva. Data were processed and analysed in open computer environment, R language, version 2.9.1., Results: The different groups of patients did not show statistically significant differences in demographic data. The results also show that there is no statistical difference between individual operation groups regarding occurrence of SUI: objectively this was established for 33% of patients, and according to ICIQ for 79%. Among women where SUI was not objectively proven, 74% felt SUI, while among women with objectively proved SUI, only one did not feel the urine leakage. This means that SUI is much more often subjectively felt than objectively proven. After the operation objective improvement of SUI occurred for 6% (5) patients, while it worsened for 16% (12) patients. The differences are not statistically significant. 78% (65 patients; n=83) felt incontinent before the operation compared with 66% (54 patients; n=82) after the operation, according to the ICIQ questionnaire. 18% (14) patients showed improvement and 5% (4) deterioration. In subjective assessment of the symptoms, improvement of SUI is more often recorded than worsening, to a statistically significant degree. 34% (30) patients in total suffered from urge before the operation (for three of them urge incontinence, for the others just urgency) and 8% (7) patients after the operation (of which one suffered from urge incontinence and 6 just urgency). This means that improvement occurred for 32% (25) and deterioration for just 3% (2) if patients. We have not ascertained any correlation between UVJ mobility, N point and urinary incontinence before and after the operation., Conclusions: The results of our study imply that the presence of SUI and U before an operation to treat anterior compartment defect is one of the main symptoms accompanying prolapse. While the operation may solve the SUI problem, it very often does not, as it deals mainly with eliminating the prolapse, or para-vaginal effect. We also failed to establish any correlation between mobility of the UVJ or N point and occurrence of SUI before and after the operation. We may, however, state that elevation of the N point--bladder base due to the operation results in mitigating U. Therefore, for reconstructive surgeries that do not treat SUI it is necessary that the operation is followed by a tape procedure in the second stage, ideally after the first operation has healed, i.e., 3 months at minimum.

Objective: The objective of this study is to evaluate the efficacy of the procedure of shortening the tape in the treatment of persistent stress urinary incontinence when the tension-free vaginal tape (TVT) SECUR procedure proves unsuccessful., Design: Retrospective study., Settings: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General Teaching Hospital, Prague., Materials and Methods: Eight patients with persistent stress urinary incontinence (SUI) after the TVT-S procedure were included in our study. In order to resolve their condition, the tape was shortened. We used the overlap and the cut-off technique. Pre- and postoperative urodynamic and ultrasound (US) examinations were carried out, and the efficacy of this procedure was evaluated by cough test, pad-weighting test (PWT) and by the questionnaires Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ12) and the International Consultation on Incontinence Questionnaire--Short form (ICIQ-UI SF). All data were processed and statistical analyses performed in statistical environment R, version 2.5.1., Results: In six patients the cough test and PWT were negative after reoperation, indicating no stress urinary incontinence, while in two patients mild leakage of urine persisted. The reoperation significantly increased the value of Maximum Urethral Closure Pressure (MUCP) while coughing. From the US examination we can conclude that the tape is tightened closer to the urethra and pubic bone., Conclusions: We describe a method--shortening the tape--for the treatment of persistent stress urinary incontinence when the TVT-S procedure fails. Based on our results we have established that this procedure is simple and as effective as inserting a new tape, but cheaper.

Objective: The aims of this study were to compare ultrasonographic findings of the urethra and the tape position and mobility following the tension-free vaginal tape secure system (TVT-S) procedure and to correlate these data with clinical signs of cure and failure of this procedure in the treatment of stress urinary incontinence (SUI) in women. Another aim of our study was to determine indications for particular position of the tape (the "hammock" or "U" position) based on ultrasonographic findings of the urethra and the tape position following TVT-S., Design: Prospective, randomized study., Settings: Department of Gynecology and Obstetrics, First faculty of Medicine, Charles University and General Teaching Hospital, Prague., Materials and Methods: Analyses of the position of the urethra and the tape of 85 patients were performed using perineal ultrasonography. The efficacy of the TVT-S procedure was evaluated by cough test and by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF)., Results: Objective assessment by cough test showed that 53 (62%) of our patients were completely dry, and in 32 (38%) patients leakage of urine persisted after the operation. From the US examination and results we can conclude that 3 months after the operation the mobility of the urethra and bladder neck are restricted. A correlation between cure effect and the restriction of the movement of the urethra was found between the position at the middle of the urethra before and after the operation. Subjective assessment of the cure effect of this operation by the ICIQ-UI SF questionnaires (n=81) showed that 39 (48%) of our patients were completely dry and 24 (30%) of patients improved, which means that in 42 (52%) patients leakage of urine persists after the operation. There are differences in the restriction of urethral mobility between the cured patients and those where leakage persisted. The middle of the urethra and UVJ are more restricted in movement in cured patients. We found no statistically significant differences between the US measurements of the position of the urethra of patients with the tape in the "hammock" and the "U" position. The only statistically significant difference found is a slightly higher tension of the "U" tape three months after the operation during the Valsalva maneuver; the median width of the tape in the "hammock" position is 10.1 mm, while in the "U" position it is 8.1 (Wilcoxon test p = 0.0056). There were six patients diagnosed with urgency de novo, without urge incontinence in this series. In seven cases we found vaginal erosion., Conclusions: From the US examination and results we can conclude that after the TVT-S operation, mobility of the urethra and bladder neck is restricted. After comparing ultrasonographic findings of the urethra and the tape position following TVT- Secure we can determine that there is no certain indication for placement of the tape in the "hammock" or the "U" position. The cure effect for different positions of the tape is similar. In some respects the slightly higher tension of the tape in the "U" position suggests that this tape position may be preferred in patients with intrinsic sphincter defect (ISD) of the urethra. A comparison of the cure effect of the TVT-S procedure with other tape procedures suggests a lower cure effect of this operation.