The effect of local anaesthetic infiltration on urethral function during the tension-free vaginal tape (TVT) procedure.
ABSTRACT Different anaesthetic techniques are used for the tension-free vaginal tape (TVT) procedure. Using local anaesthetic and spinal techniques allows surgeons to adjust sling tension with the cough test. The aim of this study was to asses whether the periurethral infiltration of the local anaesthetic technique for TVT results in a significant alteration in urethral function. Twenty-five women who underwent a TVT procedure for stress incontinence were studied prospectively. Urethral function was assessed with the urethral retro-resistance pressure (URP) before and after the infiltration of local anaesthetic. Paired t tests were used to compare values. The mean URP value was 48.0 cm/H2O (SD, 18.4) before and 52.0 cm/H2O (SD, 34.5) after the periurethral infiltration of local anaesthetic. There was no statistical significance between the two groups (p = 0.37). Local anaesthetic does not alter urethral function, as measured by URP, allowing coughing to mimic non-anaesthetic conditions.
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ABSTRACT: PurposeAnesthetic management of tension-free vaginal-tape (TVT) procedures is sometimes difficult to deal with, especially when surgeons request a cough test. Dexmedetomidine has unique sedative and analgesic properties while having minimal respiratory effects, making it suitable for perioperative use in monitored anesthesia care. We aimed to compare dexmedetomidine and epidural anesthesia in TVT patients. MethodsForty-nine women [American Society of Anesthesiologists (ASA 1–3)] with genuine stress incontinence confirmed by preoperative bladder function studies were included in this double-blind, randomized study. The patients were randomly assigned to one of two groups: group D received 0.5μg/kg dexmedetomidine IV applied as bolus over 10min and continued with 0.5μg/kg/h infusion, and local anesthesia (lidocaine 2% with epinephrine) performed by the surgeon. Group E received epidural anesthesia with 15ml of 0.25% bupivacaine+100μg fentanyl. Patients were monitored every 5min for mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation, respiratory rate, sedation, and intraoperative and postoperative pain. Ability to cough was also evaluated by the surgeon. ResultsThere was no difference in ability to cough, and this was evaluated by the surgeon as adequate, and there was no difference in scores between groups. Significant decreases in MAP and HR were observed 10min after the start of surgery in group D compared with group E, and they were significantly decreased until first and second postoperative hours, respectively (p<0.05). None of the patients had respiratory rate decrease or apnea. Side effects encountered postoperatively were similar. ConclusionDexmedetomidine can be an alternative to epidural anesthesia in TVT procedure requiring cough test. KeywordsDexmedetomidine–Epidural–Tension-free vaginal tapeJournal of Anesthesia 06/2011; 25(3):386-391. · 0.87 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the efficacy and feasibility of concomitant trocar-guided transvaginal mesh (TVM) surgery with a midurethral sling (MUS) for treating women with advanced pelvic organ prolapse (POP) and stress urinary incontinence (SUI) or occult SUI (OSUI). Eighty-nine women with advanced POP and SUI or OSUI were retrospectively enrolled. The Total Prolift and Tension-free Vaginal Tape-Obturator Systems were used for trocar-guided TVM surgery and MUS. Patients received regular follow-up at 1 week, and 1 month, 3 months, 6 months, and 12 months postoperatively, and then annually thereafter. The endpoints were the success rate for POP, and perioperative and postoperative complications. Functional outcomes were the presence of voiding difficulty, persistent or de novo overactive bladder symptoms, postoperative SUI, and paresthesia. The median follow-up period was 35 months (range, 12-50 months). Within the follow-up period, 84 patients (94.4%) were objectively cured, five patients (5.6%) had vaginal apical mesh exposure, 29 individuals (32.6%) had persistent or de novo overactive bladder symptoms, six individuals (22.5%) had de novo SUI (two were found by urodynamics), and nine individuals (10.1%) had voiding difficulties (two were found by urodynamics). In addition, the vaginal hysterectomy group had greater blood loss, longer operation times, and a higher mesh erosion rate compared to the uterine suspension group. Concomitant trocar-guided TVM surgery and MUS with the use of total Prolift and Tension-free Vaginal Tape-Obturator offer good efficacy in treating women with advanced POP and SUI or OSUI. The vaginal hysterectomy group had more perioperative complications.Taiwanese journal of obstetrics & gynecology 12/2013; 52(4):516-22.
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ABSTRACT: The menopause heralds a time of significant change in the hormonal milieu of a woman. This may present both physical and emotional challenges to the clinician, encompassing a wide time frame before and after the onset of menopause. While some symptoms are quite specific to menopause, some are not. The most commonly encountered problems in the early postmenopausal period in the urogynecological setting are: utero-vaginal/pelvic organ prolapse (POP), urinary incontinence (UI), recurrent urinary tract infections (RUTI) and uro-genital atrophy. This article reviews the presentation, assessment and initial management of these problems. A comprehensive review of the management of these conditions is beyond the scope of this article.Expert Review of Obstetrics & Gynecology 01/2014; 8(6).