Objectives: To compare postoperative urinary retention and pain control when bupivacaine versus saline for hydrodissection is used while placing tension-free vaginal tape midurethral slings. Methods: A prospective, randomized, double-blind trial was performed after institutional review board approval. Sixty women were randomized to receive bupivacaine or saline for hydrodissection. Subjects and research team were blinded to subject assignments. Group characteristics were compared using the Student t test, the χ2 test, and the Mann-Whitney U test. Proportions of subjects with a successful postoperative voiding trial along with measurements of postoperative pain and analgesic use were compared using similar appropriate tests. The study was powered to detect differences in voiding trial success from an estimated 58% to greater than 90% with P < 0.05 and 0.8 power using 25 subjects per group. Results: Thirty patients were allocated to each group. One subject in the saline-only group was excluded. Group characteristics were not different. After surgery, pain medication use (20/30 vs 25/29 for bupivacaine vs saline only; P = 0.08), pain scores (36 ± 22 vs 31 ± 24; P = 0.49), and successful voiding trials did not differ (14/30 vs 19/29; P = 0.14), whereas postvoid residuals did differ (225 ± 180 mL vs 140 ± 147 mL; P = 0.043). Conclusions: Bupivacaine was not seen to improve immediate postoperative pain after placement of a tension-free vaginal tape. It did not increase the risk of failing a postoperative voiding trial. Without an obvious benefit, the use of an additional medicine is not supported. We suggest saline alone be used for hydrodissection.

Introduction: The knowledge of anatomy is crucial for introduction of new surgical methods. It is also of especial use while dealing with surgical complications during surgeries with limited surgical field, where the way of approach limits the management of complications. It was assumed that common anatomical variations would influence different efficacy of surgeries and would explain potential complications. Methods: During anatomical dissections fifty female cadavers were dissected and tension-free vaginal tapes TVT-S H, TVT-S U, TVT Abbrevo and Ajust were studied. A novel descriptive system for localisation of the tape was created. During the dissection the tape was located and its localisation and fixation was described. Results: Common anatomical variation in the sample was corona mortis with frequency of 72 %. Preperitoneal fatty plug, which is recognized by some authors as the first stage of obturator hernia, was found in 40 % in obturator canal. The proper fixation of TVT-S H was achieved in 53.6 %. In 10.5 % urinary bladder was injured. In case of TVT-S U the proper fixation occurred in 63.8 %. In two cases the inserter was nearby corona mortis. Within the group of TVTO Abbrevo the tape was fixated properly into the obturator complex (consists of the obturator membrane and obturator muscles) in...

Introduction: The knowledge of anatomy is crucial for introduction of new surgical methods. It is also of especial use while dealing with surgical complications during surgeries with limited surgical field, where the way of approach limits the management of complications. It was assumed that common anatomical variations would influence different efficacy of surgeries and would explain potential complications. Methods: During anatomical dissections fifty female cadavers were dissected and tension-free vaginal tapes TVT-S H, TVT-S U, TVT Abbrevo and Ajust were studied. A novel descriptive system for localisation of the tape was created. During the dissection the tape was located and its localisation and fixation was described. Results: Common anatomical variation in the sample was corona mortis with frequency of 72 %. Preperitoneal fatty plug, which is recognized by some authors as the first stage of obturator hernia, was found in 40 % in obturator canal. The proper fixation of TVT-S H was achieved in 53.6 %. In 10.5 % urinary bladder was injured. In case of TVT-S U the proper fixation occurred in 63.8 %. In two cases the inserter was nearby corona mortis. Within the group of TVTO Abbrevo the tape was fixated properly into the obturator complex (consists of the obturator membrane and obturator muscles) in...

A 66-year-old para III with a 20-year history of stress urinary incontinence underwent placement of tension-free vaginal tape. Intraoperative arterial bleeding occurred. An expanding hematoma was palpated postoperatively. Interventional radiology performed a pelvic arteriogram with selective bilateral internal iliac arteriograms, a supraselective anterior division and obturator arteriogram, a left external iliac arteriogram, coil embolization of a branch of the left obturator artery, and gel foam embolization of the anterior division of the left internal iliac artery.

Title: Quality of life of women with urinary stress incontinence Objectives: The aim of this thesis was to assess quality of life of women after conservative therapy and chirurgic therapy of urinary stress incontinence in Brno-město and Brno- venkov district. Methods: We did a questionnaire survey on quality of life by using a standardized questionnaire I-QoL (Urinary Incontinence Quality-of-life questionnaire). The questionnaire survey was conducted in patients after conservative or surgical therapy by TVT or TOT tape. Subjectively perceived quality of life of these patients after completion of the therapy was observed. The results were compared between the groups undergoing conservative and surgical therapy by TVT or TOT tape. Results: After the output assessment of quality of life of patients after the treatment, we found that there is a difference in the quality of life of patients treated conservatively and surgically by TVT or TOT tape. Patients treated surgically had higher quality of life than patients treated conservatively by 9%. We also found that there is a difference in the physical, mental and social scores of the groups. The respondents who were treated conservatively had lower score in all evaluated areas with the greatest difference in the physical area and the smallest difference...