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OBJECTIVE: The objective of this study is to evaluate the efficacy of the procedure of shortening the tape in the treatment of persistent stress urinary incontinence when the tension-free vaginal tape (TVT) SECUR procedure proves unsuccessful. DESIGN: Retrospective study. SETTINGS: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General Teaching Hospital, Prague. MATERIALS AND METHODS: Eight patients with persistent stress urinary incontinence (SUI) after the TVT-S procedure were included in our study. In order to resolve their condition, the tape was shortened. We used the overlap and the cut-off technique. Pre- and postoperative urodynamic and ultrasound (US) examinations were carried out, and the efficacy of this procedure was evaluated by cough test, pad-weighting test (PWT) and by the questionnaires Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ12) and the International Consultation on Incontinence Questionnaire--Short form (ICIQ-UI SF). All data were processed and statistical analyses performed in statistical environment R, version 2.5.1. RESULTS: In six patients the cough test and PWT were negative after reoperation, indicating no stress urinary incontinence, while in two patients mild leakage of urine persisted. The reoperation significantly increased the value of Maximum Urethral Closure Pressure (MUCP) while coughing. From the US examination we can conclude that the tape is tightened closer to the urethra and pubic bone. CONCLUSIONS: We describe a method--shortening the tape--for the treatment of persistent stress urinary incontinence when the TVT-S procedure fails. Based on our results we have established that this procedure is simple and as effective as inserting a new tape, but cheaper.

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OBJECTIVE: Pelvic organ prolapse affect 50% of parous women over 50 years of age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 is 11.1%. Recurrence rates for classical prolapse surgery are as high as 30%. For this reason various graft materials have been proposed to improve the long-term surgical outcomes. The aim of our study was to investigate the safety and efficacy of posterior colporrhaphy incorporating Vypro II (polyglactin 910-polypropylene) mesh in the treatment of posterior vaginal wall prolapse. DESIGN: Retrospective study. SETTING: Gynaecological and Obstetric Clinic, First Medical Faculty of Charles University and General University Hospital, Prague. METHODS: Standard posterior colporrhaphy was performed with levator ani muscles plication. Vypro II (Ethicon, Somerville, NJ, USA) is a type III macroporous mixed fibre lightweight mesh composed of 50% absorbable multifilamentous polyglactin 910 and of 50% non-absorbable multifilamentous polypropylene fibres. This operation was performed in 28 women between March 2003 and November 2005. All patients underwent before surgery, urodynamics, ultrasound and physical examination. 22 women (78.5%) had a previous hysterectomy, 16 women (57%) had previous pelvic surgery for prolapse and/or urinary incontinence. Concomitant surgeries performed included vaginal hysterectomy 7% (n = 2), anterior colporrhaphy 50% (n = 14), anterior colporrhaphy with Vypro II mesh 21.4% (n = 6), TVT 7% (n = 2), TVT O 7% (n = 2), sacrospinous vaginal vault suspension 32% (n = 9). The pelvic organ prolapse was staged in ICS POP-Q system. All women had stage II-IV symptomatic prolapse of the posterior compartment (11 patients 39.2% with stage II, 14 patients 50% with stage III and 3 patients 10.7% with stage IV). All patients were examined always in case of complications and were invited to follow-up 2 months after surgery and once a year. The mean follow-up was 26.2 months (range 2-58), whereas 71% of patients had a follow up longer then 24 months. RESULTS: Patients mean age was 63.7 years (range 46-83), mean parity 2.1 (1-3) and mean BMI 30.34 kg/m2 (25-42). There were no operative or early postoperative complications like bowel erosion or rectovaginal fistula. The incidence of rectocele recurrence was 10.7%: 1 case of stage II rectocele and 2 cases of stage III rectocele. The incidence of mesh vaginal erosion was 10.7%. Two cases were resolved by repeated excision in office and by local estrogen and local antimicrobial therapy. The third case required reoperation and mesh exstirpation. CONCLUSION: Posterior colporrhaphy with levator ani muscles plication and incorporating a Vypro II mesh was associated with a higher incidence of post-operative complications even if cure rate was quite good.

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OBJECTIVE: The aims of this study were to compare ultrasonographic findings of the urethra and the tape position and mobility following the tension-free vaginal tape secure system (TVT-S) procedure and to correlate these data with clinical signs of cure and failure of this procedure in the treatment of stress urinary incontinence (SUI) in women. Another aim of our study was to determine indications for particular position of the tape (the "hammock" or "U" position) based on ultrasonographic findings of the urethra and the tape position following TVT-S. DESIGN: Prospective, randomized study. SETTINGS: Department of Gynecology and Obstetrics, First faculty of Medicine, Charles University and General Teaching Hospital, Prague. MATERIALS AND METHODS: Analyses of the position of the urethra and the tape of 85 patients were performed using perineal ultrasonography. The efficacy of the TVT-S procedure was evaluated by cough test and by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF). RESULTS: Objective assessment by cough test showed that 53 (62%) of our patients were completely dry, and in 32 (38%) patients leakage of urine persisted after the operation. From the US examination and results we can conclude that 3 months after the operation the mobility of the urethra and bladder neck are restricted. A correlation between cure effect and the restriction of the movement of the urethra was found between the position at the middle of the urethra before and after the operation. Subjective assessment of the cure effect of this operation by the ICIQ-UI SF questionnaires (n=81) showed that 39 (48%) of our patients were completely dry and 24 (30%) of patients improved, which means that in 42 (52%) patients leakage of urine persists after the operation. There are differences in the restriction of urethral mobility between the cured patients and those where leakage persisted. The middle of the urethra and UVJ are more restricted in movement in cured patients. We found no statistically significant differences between the US measurements of the position of the urethra of patients with the tape in the "hammock" and the "U" position. The only statistically significant difference found is a slightly higher tension of the "U" tape three months after the operation during the Valsalva maneuver; the median width of the tape in the "hammock" position is 10.1 mm, while in the "U" position it is 8.1 (Wilcoxon test p = 0.0056). There were six patients diagnosed with urgency de novo, without urge incontinence in this series. In seven cases we found vaginal erosion. CONCLUSIONS: From the US examination and results we can conclude that after the TVT-S operation, mobility of the urethra and bladder neck is restricted. After comparing ultrasonographic findings of the urethra and the tape position following TVT- Secure we can determine that there is no certain indication for placement of the tape in the "hammock" or the "U" position. The cure effect for different positions of the tape is similar. In some respects the slightly higher tension of the tape in the "U" position suggests that this tape position may be preferred in patients with intrinsic sphincter defect (ISD) of the urethra. A comparison of the cure effect of the TVT-S procedure with other tape procedures suggests a lower cure effect of this operation.

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The authors examined by actocardiography a group of 98 women in the third trimester of pregnancy. They evaluated the duration, frequency of different movements and the frequency of FHR accelerations in three groups of pregnant women (normal controls, pregnant women with retarded foetal growth and normal PI and finally women with retarded foetal growth and raised PI values). Progression of intrauterine stress led in the investigated group to a gradual decline of motor activity of the foetus along with a decline of the frequency and ratio of FHR accelerations in the total movements and isolated movements of the head and extremities. Statistical significance was proved in four basic parameters. The authors confirmed the priority of the flowmetric diagnosis as compared with actocardiographic recording of developing foetal stress. In the submitted preliminary communication the authors present data on actocardiographic findings during normal delivery. They revealed in particular a marked coincidence of general foetal movements and uterine contractions.

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Three main methods of prenatal diagnosis (Amniocentesis AMC, Chorionic villi sampling CVS and Cordocentesis FBS) have been used in Perinatal Centre of Central Bohemia. The chromosomal abnormalities in a group of 3,098 patients have been detected in 1.4% of fetuses. The inherited disorders were diagnosed using DNA analysis and biochemical examination of amniotic fluid. X-linked diseases in a group of 68 patients in 30.8% of fetuses have been diagnosed and inborn error of metabolism in a group of 29 indicated patients in 17.2% of fetuses were diagnosed. The incidence of fetal losses before 28th week of gestation was 0.4%.

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The group comprises 50 intrauterine transfusions in 15 patients with a severe form of foetal erythroblastosis. The authors describe the results and complications in hydropic and non-hydropic foetuses, diagnosed by ultrasound before transfusion treatment was started. In the group of non-hydropic foetuses the success rate of transfusion treatment was 90.1% and 10 neonates were born with a mean weight of 2030 g. The mean gestation period was 34 weeks. From four hydropic foetuses it proved possible to save only one, the success rate in this group was only 25%. The mean weight of hydropic foetuses was 1650 g and the gestation period at delivery 29 weeks. The rate of Caesarean sections in both groups was as high as 80%. Serious complications included thrombosis of the umbilicus, thromboembolism of the a. axillaris in a hydropic neonate and acute hypoxia of the foetus after transfusion. Four of six serious complications were recorded in hydropic foetuses.

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Introduction of ultrasonic techniques made more detailed follow-up of the motor activity of the foetus in its natural environment possible. The objective of the submitted paper is to present actocardiography as a method which makes it possible to visualize differences of motor activity of the foetus, in particular during the third trimester and to map different types of movements. The authors obtained thus objective records in a group of pregnancies which will be suitable for comparison with the motor activity of foetuses with signs of hypoxia, with foetuses with retarded growth or foetuses threatened by other risks. This method can be thus included and used as a method of routine in the spectrum of examinations of imminent foetal stress.

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Subjective evaluation of urinary incontinence cannot assess the degree of abnormality. Objective assessment of the escape of urine is essential for assessment of the degree of incontinence or for evaluation of the therapeutic results. Therefore a simple standard test was elaborated which can be used for the objective measurement of urinary losses in all patients. The International Continence Society (I.C.S.) recommended in 1983 a one-hour test for objective assessment of escape of urine. The latter assesses the loss of urine by weighing pads or dispers before and after standard activities. The authors tried in their clinical department to assess the significance of a modified 40-minute test in women with urinary incontinence--it was only 44%. They also compared the results of the PWT and Puraclo,max and compared these results with the number of women operated on account of incontinence. In the group of patients with a positive PWT a neg-puraclo,max was recorded in 88.2%. Conversely in patients with a neg-puraclo,max the PWT was positive only in 50%. Surgery was used in neg-puraclo,max in 75% and in positive PWT in 76.6% women. In a negative PWT a neg-puraclo,max was recorded in 65% of the patients of whom 61.5% were operated and two refused operation. In the conclusion the authors emphasize that PWT alone provides only basic objective information on the patient's complaints. The reliability of evaluation of the patient's complaints is increased by complete urodynamic examination.

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The authors applied the Atropine test in 28 patients with the motor type of urgent incontinence in an attempt to establish the prognosis of the success of treatment with parasymthatholytics. Atropine was administered in amounts of 0.01 mg/kg body weight by the i.m. route and after 30 mins. a urodynamic control examination was made. The assumption that a reduced frequency or amplitude of detrusor contractions will occur or that they will disappear in patients, where subsequent treatment with parasympatholytics will be successful, was not confirmed. The patients were subsequently treated by a combination of dilthiazem (Diacordin), 3 X 30 mg by the oral route per day and oxyphenonium (Oxyphenon dupl.) 2 X 10 mg by the oral route per day. After evaluation of the therapeutic results the group was divided into two sub-groups. The first one comprised patients where during the urodynamic check-up examination a drop of the intracystic pressure occurred after Atropine administration. The second group comprised patients where the drop of intracystic pressure did not occur. The therapeutic effect in these groups was evaluated separately. In the course of treatment there was a relatively high percentage of undesirable side-effects of the drugs in 43% of the patients. After the general evaluation of the therapeutic effect when the patients had no complaints or improved markedly in 70.4% there were no marked differences between the sub-groups.

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Anamnestic and urodynamical results are evaluated before and after bladder retraining drill (BRD) in women suffering from urge incontinence. A continence rate of 74% was determined 6 to 24 months after BRD. This agrees with dates reported by literature. Urodynamically we obtained an improvement of cystometric parameters (even in parts statistically significant). The values of the urethrocystographic angles and the urinary flow rate have been not changed. We could state that the BRD is a good possibility to realize multistep-therapy of female incontinence.

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