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Suburethral slings (or tapes) placed by a transobturator approach may be an alternative to established retropubic tension-free vaginal tapes. Comparisons are hampered by the number of available systems. Injury of the bladder, bowel and major vessels appears less frequent with transobturator systems whereas vaginal tape erosion and infectious complications appear to be more common. Results of adequately powered randomized trials are not yet available.

We describe a patient with wound rupture and burst abdomen after cesarean section with the Misgav-Ladach technique.A 33-year-old woman underwent primary cesarean section at 36 + 5 weeks gestation for a fetal indication. The procedure was done according to the Misgav-Ladach technique, i.e. the uterus was closed with a one-layer continuous locking stitch and the visceral and parietal peritoneal layers were left open. The rectus sheath was stitched with a continuous nonlocking stitch, the skin was closed with a continuous intracutaneous suture. On the seventh postoperative day, omentum was seen extruding from the skin incision. Reexploration showed that the suture of the rectus sheath had ruptured. The further postoperative course was uneventful.Although no general recommendations can be deduced from a single case, further reports on any complications of this technique will show whether it is as safe as believed until now.

In 1959 A.J. Pereyra published a simple transvaginal surgical method to elevate and fixate the bladder neck and proximal urethra with a specially designed needle in women with stress urinary incontinence. This method was repeatedly modified during the last 35 years. Mild to moderate stress incontinence with or without pelvic floor relaxation is regarded as an indication for needle bladder neck suspension. Contraindications include severe stress incontinence, low-pressure urethra, urge incontinence and recurrent stress incontinence. Postoperative continence rates range from 40% to 91% depending on inclusion criteria, preoperative diagnostics, criteria for success or failure, and duration of follow-up. There are no controlled clinical studies comparing different needle suspension techniques.

To evaluate results 5 years after anterior colporrhaphy with or without needle suspension of the bladder neck and after Burch colposuspension.186/291 women (64%) operated on between 1989 and 1990 underwent clinical and urodynamic reevaluation.Objective continence rates after anterior colporrhaphy were 80% (20/25), 46% (22/47) and 12.5% (1/8) in patients with first-, second- and third-degree stress incontinence according to Ingelman-Sundberg. Continence rates in patients with second- and third-degree stress incontinence were 59% (29/49) after additional needle suspension and 86% (50/58) after the Burch procedure.Anterior colporrhaphy can cure mild stress incontinence but is not indicated for severe incontinence. The Burch procedure provides the best continence rates in patients with severe stress incontinence.

To compare the separation in time of urethral and bladder pressure pulses and urodynamic parameters after successful and unsuccessful anterior colporrhaphy and needle suspension of the bladder neck in patients with stress urinary incontinence.Retrospective evaluation of urethral pressure profiles at rest and under stress in 10 successfully and 10 unsuccessfully operated patients.In the successfully treated group, the onset of the urethral pressure increase preceded that of the bladder pressure by an average of 300 ms. Pressure transmission ratios in the 3 proximal quartiles of the urethra were significantly improved after successful surgery. Women who remained incontinent showed neither an advanced onset of the urethral pressure pulse during stress nor improved pressure transmission ratios.Successful anterior repair and needle suspension of the bladder neck support the bladder neck and thus improve the pressure transmission to the urethra. Improved pressure transmission is associated with the finding that pressure increases in the urethra precede those in the bladder in continent women.

This study aimed to investigate the influence of anterior repair on pudendal nerve terminal motor latency. Neurourodynamic investigation (urethral profilometry, measurement of pudendal nerve terminal motor latency according to the method of Snooks and Swash) was performed before and 8 weeks after anterior repair (n = 14) and before and after additional endoscopic bladder neck suspension (n = 23). Stress incontinence and pudendal neuropathy were found preoperatively in all patients. In 17/37 (48%) of patients who were incontinent postoperatively the pudendal nerve latency was significantly prolonged.

This study aimed to compare pelvic floor exercise only (group A) with pelvic floor exercise plus vaginal cones (group B) for the treatment of stress urinary incontinence. 46 premenopausal women were randomized into two groups. The subjective improvement or cure rates were 85.5% in group A and 84.5% in group B. Urethral pressure profiles showed a significant improvement in the transmission factor in the midurethra in each group and for the maximum urethral closure pressure in group A.

40 women (average age 65 years) who underwent vaginal hysterectomy and colpoperineoplasty for total prolapse of the uterus with (26) or without Stamey's procedure (14), were tested urodynamically before and 14 months after surgery. 6/14 (43%) women were clinically and urodynamically continent after vaginal hysterectomy and anterior and posterior repair, compared to 20/24 (83%) after an additional Stamey's procedure. The pressure transmission ratio was significantly improved after both procedures (p = 0.05). These results indicate that anatomic correction does not suffice to correct latent stress urinary incontinence in patients with uterovaginal prolapse. Endoscopic suspension of the bladder neck seems to be a successful method in these cases. The transmission ratio was improved by both operative procedures. The results show, that colpoperineoplasty alone cannot correct stress incontinence in patients with total prolapse of the uterus. In such cases Stamey's procedure is a successful method.

We reviewed 245 patients, who underwent surgical treatment of stress urinary incontinence between 1982 and 1989. All patients underwent clinical and urodynamic assessment before and an average of 23 months after surgery (range 12-28). 159 patients had not undergone a previous incontinence operation and 86 one or more previous procedures. 42 patients with recurrent stress incontinence underwent a Burch colposuspension, 20 an anterior colporrhaphy and colpoperineoplasty, and 24 a Stamey endoscopic bladder neck suspension. All operations were successful, more frequently in patients undergoing the first surgical attempt at correction of incontinence than in those undergoing surgery for recurrent incontinence (Burch colposuspension 88% vs 69%; anterior and posterior repair 62% vs 20%; Stamey bladder neck suspension 80% vs 52%). In patients with severe stress incontinence both the Burch and Stamey procedures yielded significantly better results than anterior and posterior repair (73% and 66% vs 37%). The urethral closure pressure at rest was unchanged in patients continent after surgery, but significantly reduced in the surgical failures. Stress profile values differed significantly between patients continent after surgery and surgical failures. Also, the vesicourethral junction was elevated further in the continent than in the incontinent women.

A total of fourteen patients with primary papillary serous carcinoma of the peritoneum (PPSCP) were treated at the Department of Obstetrics and Gynaecology of the University of Graz between 1980 and 1991. The presence of tumours from other sites, particularly the pancreas and the ovary, had been excluded. Due to extensive spreading of the disease mainly in the upper abdomen, only seven of the 14 patients underwent exploratory laparotomy. The median overall survival time was 10 months (range, 1-28 months). These results are due to the extent of spreading of the disease at diagnosis, and also to the fact, that optimal cytoreductive surgery was possible only in four of the 14 patients. The four patients with optimal cytoreduction showed a better survival than those, who underwent less radical surgery. These results seem to indicate, that, as in primary ovarian cancer, the amount of residual disease may be an important prognostic determining factor in PPSCP.

70 women were evaluated clinically and urodynamically both before and, on average 16 (12-48) months after undergoing endoscopic suspension of the bladder neck, following Stamey, for genuine stress urinary incontinence. The average age of the patients at surgery was 52 (35-85) years; the average parity was 3 (0-10). Preoperative and postoperative lateral colpocystograms were performed on 48 patients. 40 patients had marked descent of the pelvic organs; 30 patients had previously undergone vaginal hysterectomy and anterior colporrhaphia. Overall, 70% of the patients were postoperatively clinically and urodynamically continent at follow-up; however, only 44% of the patients with a preoperative urethra closure pressure (UCP) less than 20 cm H2O were continent. The functional urethral length was unchanged but the point of maximum closure pressure was shifted to the proximal third of the urethra. The UCP at rest decreased significantly (p = 0.0277). Radiologically, the bladder neck was elevated further and the angle beta decreased more in the patients continent after surgery, than in those who remained incontinent. These data suggest that the Stamey operation is effective in selected patients with stress incontinence, but not in patients with a low UCP at rest.

In a prospective study the results of FIGO staging and MR staging in uterine cervical carcinoma were compared with the findings of stepwise serial examination of en-bloc-resected specimens in 28 patients. Overall accuracy of MR staging was 59% compared to 41% in FIGO staging. Sensitivity in assessing parametrial tumour extension was 85% in MRI and 64% in clinical examination. Specificity was 74% in MRI and 69% in physical examination. Accuracy in parametrial tumour extension was 67 per cent in FIGO-Classification and 80 per cent in MRI.

184 women who underwent surgery because of stress incontinence during the years 1982-1986 were examined both before and after surgery. The interval between operation and post operational control was from 12 to 60 months. After colporrhaphy anterior and colcoperineoplasty 69% of the women were continent; 14% showed a stress incontinence of first degree, 17% a stress incontinence of second degree. After Marshall-Marchetti 75% of the patients were continent; 16% were stress incontinent to degree I. The best result was achieved by lifting the neck of the bladder (Stamey-method): 82% of the women were continent, 18% stress incontinent. The urethral closure pressure at rest went down significantly after colporrhaphia anterior; it rose slightly after Marshall-Marchetti and the endoscopic lifting of the bladder neck (Stamey-method). All postoperatively continent women showed an improval of pressure transmission, the best result having been achieved after the endoscopic lifting of the bladder neck (Stamey-method). Contrary to colporrhaphia anterior and colpoperineoplasty the miction was impaired after abdominal operational methods. The results will be shown and discussed.

In a retrospective study to evaluate the sexuality of patients after radical surgery for cervical cancer, we interviewed with a standardized questionnaire 87 women who had undergone radical abdominal (N = 76) or radical vaginal (N = 11) hysterectomy between 1971 and 1985. Apart from employment and partnership, we assessed sexual behaviour as reflected by frequency of coitus, libido, and orgasm. The patients were questioned about each aspect preoperatively before knowing the diagnosis, post-operatively after the immediate effects of surgery had passed, and at the time of the interview. 6.6% of the women could be considered invalids. There was a clear decrease in frequency of coitus and an anxiety-related decrease of libido. However, the number of patients without sexual activity was not statistically different from that in an age-matched group of women who did not undergo surgery. 4.5% of partnerships broke up as an immediate consequence of the surgery. Only 20% of the patients felt they had been adequately informed of possible sexual consequences of treatment by the surgeon.