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Objective: Midurethral slings have become the standard of care for women with stress urinary incontinence; prolapse repair is often also required. The primary objective of our study was to compare voiding dysfunction rates and the need for reoperation between patients having midurethral sling procedures alone versus those having midurethral sling procedures with concomitant prolapse repair., Methods: We performed a retrospective chart review over a two-year period in a tertiary urogynaecology clinic. Of 108 charts, 93 had complete data for analysis., Results: Patients having concomitant prolapse repair had a longer operating time, a longer hospital stay, and a longer time to resume normal voiding in the immediate postoperative period., Conclusion: Although tension-free vaginal tape or transobturator tape procedures with concomitant prolapse repair have a higher incidence of voiding dysfunction in the immediate postoperative period, we found that this did not persist to the six-week follow-up visit. There appeared to be no greater risk of lasting voiding dysfunction or need for reoperation after concomitant procedures.

Objective: The purpose of this study was to determine the effectiveness of a teaching module using simulation for the tension-free vaginal tape (TVT) procedure on procedural knowledge and skill., Methods: Twenty-five gynecology residents participated in a teaching module about the TVT procedure and urinary incontinence, which included a simulated insertion on a training model. Questionnaires using 10-point scales for self-rated competence and knowledge and a written examination were administered before and after the module. A simulated TVT insertion was evaluated at an examination at 7 weeks and at 7 months., Results: A significant median improvement of 44% on the written examination and at least one point on each of the self-rated competence and knowledge scales were observed after the teaching module. Residents performed the insertion well at both examinations (89% and 90%), regardless of surgical experience. More than 94% agreed the module was useful and improved their understanding of the procedure., Conclusion: A short teaching module and simulation session can effectively teach residents and improve their perceived competence with the TVT procedure.

Genital prolapse is common among ageing women. Urinary obstruction and hydronephrosis have been reported as one of the most severe and fortunately uncommon complications. An 82-year-old multiparous woman with symptomatic pelvic organ prolapse quantification stage 4 genital procidentia fails multiple trials of pessary and abandons the trials due to significant side effects. She chooses to pursue conservative management with estrogen cream and tight underwear. However, she fails to follow up as planned. Two years later, she presents with acute abdomen and renal failure due to renal calyceal rupture and perirenal urinary extravasation from complete procidentia. She is treated promptly with urinary catheter, manual prolapse reduction, and Gellhorn pessary which relieves anuria and stabilizes her condition. She then receives definitive surgical treatment 2 weeks later. Her renal failure and abdominal pain resolve post-operatively.

Background: Multidisciplinary team care is becoming more popular for complex health issues, including pelvic floor dysfunction., Methods: We conducted a retrospective review of the records of 207 patients attending a multidisciplinary pelvic floor dysfunction clinic. A telephone survey was also conducted. The outcomes investigated included conservative versus surgical management, comorbidities, number of specialists seen, and subjective patient feedback., Results: The average patient was 59.9 years old and travelled an average distance of 128.6 km to attend the clinic. Common clinical presentations were urge urinary incontinence (58.9%) and stress urinary incontinence (54.6%). Ninety-three of 178 patients (52.2%) presented with at least two comorbidities. At the time of data collection, 52.2% of patients had opted for surgical management, 27.5% had chosen conservative management, and the remainder remained undecided. One hundred sixty-five women participated in the telephone survey and their responses were grouped into major themes: (1) wait times, (2) multidisciplinary clinic feedback, and (3) parking, patient education, and information distribution., Conclusion: Based on feedback, the majority of patients were accepting of a multidisciplinary approach to pelvic floor dysfunction and were satisfied with that approach.

Tension-free vaginal tape (TVT) is increasingly being used as the gold standard to treat stress urinary incontinence. Previously reported complications include peritoneal perforation with acute bowel injury. A thin, petite 51-year-old woman with stress urinary incontinence underwent uneventful TVT placement. Three years later, she presented to hospital with de novo small-bowel obstruction. Laparotomy revealed TVT tape violating the peritoneum and causing the distal ileum to adhere to the pelvic sidewall. The compromised bowel was resected and primary anastomosis performed. Delayed, adhesion-related small-bowel obstruction can be a complication of TVT.

Objective: To assess the overall success of sling procedures and surgical sling release in achieving urinary continence and voiding function in women with stress urinary incontinence., Methods: We reviewed the charts of 107 patients with stress urinary incontinence who had a two-team abdominal-vaginal fascial sling procedure performed between January 2000 and December 2003. Data reviewed included the patients' medical history, demographic data, findings on physical examination, urodynamic studies, operative report, and findings at visits 6 weeks, 6 months, and 12 months after surgery. Patients with sling releases were followed up to assess pelvic organ prolapse, uroflowmetry, and post-void residual urine volume, and to complete the quality of life questionnaire IIQ-7., Results: At one year after pubovaginal sling surgery, 82.1% of patients were cured of stress urinary incontinence. The majority (85.1%) of patients did not develop postoperative voiding dysfunction. Only 5.6% of those who did develop postoperative voiding dysfunction required surgical sling release. Sling release resolved the post-sling voiding dysfunction in three out of five patients., Conclusion: Pubovaginal sling surgery is a highly successful strategy for the management of stress urinary incontinence and has a low rate of postoperative voiding dysfunction. Surgical sling release may resolve post-sling voiding dysfunction.

Objectives: We sought to identify the structure of academic protected time curriculum and to determine interest in a knowledge-sharing, web-based initiative., Methods: We undertook a survey of the 16 obstetrics and gynaecology program directors in Canada., Results: The response rate was 88%. Seventy-one percent of the responding program directors are responsible for developing protected time curriculum. Seventy-eight percent use a template based on a two-year rotation of topics, 64% use lectures as the main educational format, and 50% have incorporated professional competencies into academic time. The largest barrier to curriculum development is time constraints. Seventy-eight percent of program directors are interested in a network for sharing ideas., Conclusions: In most programs, the curriculum for academic protected time is developed by program directors, who are dependent upon lectures and limited by time constraints. Programs therefore have difficulty integrating professional competencies into the academic curriculum. This educational environment could prove fertile ground for establishing a collaborative curriculum initiative.

Objective: An aging population has resulted in higher prevalence of urinary incontinence (UI) and pelvic organ prolapse (POP). This study examines a nurse-run clinic and analyzes the factors contributing to successful pessary use., Study Design: A retrospective chart review of 1,216 patients was completed. History, pelvic examination and pessary fitting was done. Data was analyzed utilizing a categorical model of maximum-likelihood estimation to investigate relationships., Results: Median patient age was 63 years. Median number of pessaries tried was two. Eighty-five percent of post-menopausal women were on hormone replacement therapy (HRT) prior to fitting. Highest success rate of 78% was in the group on both systemic and local HRT. Success rates ranged from 58% for urge incontinence to 83% for uterine prolapse. Prior vaginal surgery was a factor impacting success. In our series highest success rates for fitting were obtained with ring pessaries, ring with support, and gellhorns., Conclusions: This model is a viable, option for the conservative management of UI and POP. Local HRT plays an important role in successful pessary fitting. Complications are rare.

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

This study assesses the use of Marlex mesh in conjunction with anterior colporrhaphy for the correction of cystocele with or without urinary stress incontinence. A retrospective review was carried out of 12 years' experience with 142 patients undergoing a modified anterior colporrhaphy reinforced with Marlex mesh. All patients had preoperative urodynamics. Pre- and postoperative symptoms were compared and patients were examined for recurrent prolapse and mesh complications. Mean follow-up time was 3.2 years. No patients experienced recurrent anterior vaginal wall prolapse. Three patients developed mesh erosions into the vagina. There was a 74% success rate in the treatment of urinary stress incontinence. Marlex mesh used as a reinforcement for anterior colporrhaphy is effective in preventing recurrent anterior wall descent, with minimal complications.