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1/61. Identification of microtacks in the bladder after laparoscopic pelvic surgery.

    Laparoscopic techniques are simplified and the operative time is reduced with the use of laparoscopic stapling and tacking devices. We present our experience in identifying and removing surgical tacks in 2 patients after laparoscopic pelvic surgery.
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ranking = 1
keywords = operative
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2/61. Bilateral S3 nerve stimulation, a minimally invasive alternative treatment for postoperative stress incontinence after implantation of an anterior root stimulator with posterior rhizotomy: a preliminary observation.

    STUDY DESIGN: A preliminary report. OBJECTIVES: Urinary stress incontinence following implantation of an anterior root stimulator and a posterior rhizotomy is a rare complication which is difficult to treat. It is seen in patients with an open bladder neck (T9-L2 lesion). An artificial urinary sphincter is a possible treatment for this condition but has a higher failure rate in patients with neurogenic bladder disease and could complicate micturition. SETTING: Ghent, belgium. methods: A male paraplegic patient (T9, complete lesion) aged 36 was suffering from severe urinary incontinence due to detrusor hyperreflexia. Preoperatively the bladder neck was closed on cystography. Following implantation (6/95) of an intradural anterior root stimulator with posterior rhizotomy, severe urinary stress incontinence presented. Bilateral S3 foramen leads were implanted and connected to a pulse generator. RESULTS: The patient has been continent with continuous stimulation of both S3 roots for 4 years, and no fatigue of the levator muscles has been seen. Preoperative urodynamics are compared to results 3 years postoperatively. CONCLUSION: Bilateral S3 stimulation is a feasible and minimally invasive treatment of urinary stress incontinence following implantation of an anterior root stimulator.
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ranking = 7
keywords = operative
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3/61. Bladder leiomyoma: a rare cause of urinary stress incontinence.

    Lejomyoma of the bladder is an uncommon lesion and usually present as small intramural or submucosal lesions. Preoperative evaluation based on careful physical and radiologic examinations must rule out malignant and other lesions. It is readily and successfully treated in most cases with transurethral or open resection. The prognosis of this tumor is excellent and no malignant degeneration has been reported. The most common presentations are obstructive voiding symptoms, irritative symptoms, and hematuria. Occasionally, it may be a cause of urinary stress incontinence. Although this condition is rare, it should be considered in the causes of urinary stress incontinence.
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ranking = 1
keywords = operative
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4/61. Urinary tract injuries during advanced gynecologic laparoscopy.

    Urinary tract injuries are important complications of laparoscopic surgery. The intraoperative diagnosis may be delayed, resulting in severe clinical complications, such as fistulas, in the immediate and late postoperative periods. A review of 776 endoscopic procedures revealed 6 urinary tract injuries and postoperative complications during laparoscopy. We believe that surgical experience, intraoperative diagnosis, immediate repair of the lesion, and close follow-up are the main factors contributing to decreased morbidity associated with these injuries.
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ranking = 4
keywords = operative
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5/61. Management of urethral erosion caused by a pubovaginal fascial sling.

    Urethral erosion by a fascial sling is a rare postoperative complication, and its repair can become a major surgical endeavor. We present a case of autologous fascial sling erosion into the mid-urethra in a 46-year-old woman that was diagnosed after traumatic urethral catheterization. After 3 months of conservative management failed, we released the sling tension surgically by bilateral excision of the graft, leaving the midline structures undisturbed. This allowed resumption of normal voiding, with complete long-term symptomatic relief.
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ranking = 1
keywords = operative
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6/61. Severe hemorrhage complicating tension-free vaginal tape (TVT): a case report.

    A 59-year-old non-obese woman with genuine stress incontinence underwent an uneventful TVT procedure. Postoperatively a hemorrhage in the space of Retzius became more and more prominent, and a secondary laparotomy was performed. Large clots as well as the TVT tape were removed. No active bleeding was found. She recovered uneventfully but needed 10 units of blood. A coagulation defect could not be diagnosed.
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ranking = 1
keywords = operative
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7/61. Treatment of postoperative urinary retention by elongation of tension-free vaginal tape.

    Tension-free vaginal tape elongation with a polypropylene intermediate piece was successfully carried out in a patient with urinary retention after an initial tension-free vaginal tape surgical procedure. This resulted in immediate residual-free voiding and continence, unchanged at 6 months follow-up. Postoperative urinary retention may thus be treated by elongation instead of dissection of the tension-free vaginal tape.
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ranking = 5
keywords = operative
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8/61. Urethral erosion of tension-free vaginal tape.

    Tension-free vaginal tape (TVT) is gaining popularity as a treatment of choice for women with stress urinary incontinence. It is a minimally invasive procedure with reported short operative and postoperative hospitalization times and low complication rates. We describe urethral erosion of a TVT sling material in a 55-year-old woman who presented with immediate postoperative urinary retention. The sling material was surgically removed and the urethral defect repaired, with the patient continent at the 3-month follow-up visit. A mid-urethral synthetic sling such as the TVT can erode into the urethra.
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ranking = 3
keywords = operative
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9/61. Repeat tension-free transvaginal tape (TVT) sling for the treatment of recurrent stress urinary incontinence.

    The pubovaginal sling is one of the preferred procedures for the treatment of female stress urinary incontinence because of its improved long-term cure rates. Recently a modified technique of the pubovaginal sling, known as the tension-free transvaginal tape (TVT), has gained popularity. We present the first reported cases of repeat TVT pubovaginal sling for the treatment of patients with recurrent stress urinary incontinence. Both patients had repeat TVT slings performed between 6 and 9 months following the initial procedure without revision or removal of the previous TVT sling. Both patients reported surgical cure without significant intraoperative or postoperative complications. It appears that reapplication of the TVT polypropolene sling may be a viable option in the event of initial TVT sling failure.
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ranking = 2
keywords = operative
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10/61. Endoscopic management of an unusual foreign body in the urinary bladder leading to intractable symptoms.

    A 70-year old female patient presented with intractable lower abdominal pain and recurrent urinary tract infection following an endoscopic bladder neck suspension. Investigations revealed it to be a case of suture and pledget migration leading to foreign body granuloma in urinary bladder. It is being reported as an uncommon complication of endoscopic bladder neck suspension. An early endoscopic evaluation should be carried out in cases of unexplained lower urinary tract symptoms following any surgical procedure for incontinence. It is also appropriate to retrieve these foreign bodies endourologically without resorting to open surgery and thus extending safe, comfortable, and short postoperative course with good long term results.
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ranking = 1
keywords = operative
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