Abstract

A new surgical technique, the inside-out transobturator tension-free urethral suspension (TVT-Obturator), has been developed for treatment of women suffering from stress urinary incontinence (SUI). This simple procedure uses specifically designed surgical instruments to allow the accurate passage of a synthetic tape from underneath the urethra, through the obturator foramens, toward the thigh folds, with the tape being positioned without tension under the junction between mid and distal urethra. Cadaver dissection studies have demonstrated that the anatomical trajectory of the tape in tissues is strictly perineal and consistently coursed away from neighboring neurovascular structures, including the obturator, femoral, and saphenous nerves and vessels, as well as the pudendal nerve. Consequently, as opposed to retropubic sling systems, no perioperative cystoscopy is required because the TVT-O tape does not enter the pelvic region at any time during the procedure. These anatomical data, which suggest the TVT-O technique is safe, have been corroborated by initial clinical experience. Our feasibility and ongoing efficacy studies have shown that TVT-O is associated with a low incidence of perioperative and postoperative complications. In our current series of more than 500 consecutive patients treated with TVT-O, no injury to the bladder or urethra was encountered and no perineal or obturator hematoma, heavy bleeding, or neurological complication was observed. Medium-term results have suggested that TVT-O is as efficient as retropubic tension-free slings for treatment of female SUI, with +/-90% complete cure rates after one-year follow up.

Abstract

Many lasers are widely used in urological surgery for several applications. Their use to treat the superficial bladder cancer (SBC) is safe and minimally invasive. The Holmium:YAG (Ho:YAG) laser represents the pinnacle of laser technology in Urology. The authors carried out this study on safety, efficacy, complication rates, postoperative catheterization time, and hospital stay of high-risk patients who underwent Ho:YAG vs. transurethral resection (TUR). Two groups of high-risk patients with SBC and comorbidities underwent either Ho:YAG or TUR. Different clinical aspects of the tumours and recurrences were considered. No significant difference between the two groups was noted regarding number, progression of grade and stage and place and time of recurrences. In the Ho:YAG patients, perioperative complications occurred at a lower percent than in the TUR group. Also, in 54% of patients, the catheter was removed within 24 hours; 76% had a postoperative hospital stay of 24 to 48 hours. In the TUR patients: 4% had the catheter removed within 24 hours and 6% left the hospital within 24 to 48 hours. In SBC treatment, Ho:YAG and TUR were equally as effective; the Ho:YAG laser was associated with shorter catheterization time and hospital stay. These Ho:YAG features could be advantageous from a psychological standpoint, particularly for elderly, high-risk patients and in terms of cost:benefit ratios.