Objective To evaluate the effectiveness and indications of a new minimally invasive surgical procedure,the tension-free vaginal tape-SECUR (TVT-S),in the treatment of female stress urinary incontinence (SUI). Methods Twenty-seven consecutive women with stress urinary incontinence underwent the procedure under local anesthesia.The mean age of the study group was 51 (range 25-69)years,average disease duration was 7 (1-20) years.In one case,repair of pelvic floor defects had been made previously.According to the pelvic organ prolapse quantitive(POP-Q) (American College of Obstetrics and Gynecology),the Aa＞-1 cm.Swab tests have shown that the angle of urethra Was greater than 60 degrees,while the evaluation of clinical symptoms were grade Ⅱ.The urodynamie test preoperatively of 27 cases display that bladder compliance was normal,mean maximum urethral closure pressure was 40cm H2O(25-60 cm H2O),and VLPP was greater than 60 cm H2O.Minimum follow up was three months (range 3-15 months).The pre-operative maximal urethral cloSHre pressure (MUCP) of all patients was above 30 cm H2O.Ninety-six percent of patients had pure USI,one patient had mixed urodynamic incontinence (MUI).Collection of the data included operative time a well as pre-and post-operative complications.Patients were post-operatively assessed by a validated urinary incontinence-specific measure of Quality of Life (QoL) questionnaire which was completed by all patients at least three months after surgery. Results All patients who underwent the procedure were under local anesthesia.Of these patients,4 cases (MUCP＜30 cm H2O) underwent TVT-S with U position while the other 23 underwent TVT-S with Hammock position.The mean operation time was 8 minutes (range 6-15 min) and blood loss during operation was about 10 ml.There were no urethral and bladder injuries during the procedure.Postoperative indwelling duration was 0-1 day.After follow-up,26 patients were cured without pad usage and 1 with mixed UI had prominent improvement in urgency incontinence symptoms.The quality of life was also improved significantly.93 % patients were satisfied with the postoperative improvement in urinary incontinence symptoms,and the more severe preoperative symptoms the higher satisfaction rate postoperatively. Conclusions TVT-S iS a safe,effective and minimally invasive procedure for SUI with less complication.The patients with normal bladder compliance and MUCP,urethral hypermobility are indicated for this surgery,some elderly patients or patients with low urethral pressure were proposed to undergo U position TVT-S or TVT.

Objective To investigate the incidence of contrast-induced nephropathy (CIN) in the elderly undergoing coronary angiography and the correlated clinical risk factors.Methods 0.90% sodium chloride (1 ml · kg~-1 · h~-1 ) was administered 6 hours before and 12 hours after contrast media administration for 195 elderly patients,and the dose of sodium chloride was half when the patients were suffering from severe congestive heart failure.The levels of serum creatinine (Scr) and cystatin C were measured 3 days before and on the 2nd,5th day after the administration of contrast,respectively .Results(1) The incidence of CIN was 8.7% (17/195).The renal function of 11 cases recovered to baseline level 3 months after the use of contrast,2 cases had transformation to chronic renal failure but without undergoing maintenance hemodialysis,and 3 cases were dependent on maintenance hemodialysis,while 1 case developed multiple organ dysfunction until death.(2) There was no significant difference between pre-and post-contrast administration in the level of cystatin C (t=O.137,P= 0.891). But the concentration of Scr was reduced significantly on the 2nd day compared with the baseline (t=4.776,P = 0.000).Both the cystatin C and Scr recovered to the baseline on the 5th day.(3) There were no significant differences between the CIN and non-CIN group in gender,the dose of contrast,the baseline Scr,and the proportion of coronary heart disease.But there were significant differences in age,the baseline serum cystatin C,the proportions of diabetes mellitus,hypertension and congestive heart failure.(4) The clinical risk factors of CIN were the baseline Scr (OR = 1.039),the baseline serum cystatin C (OR=6.654),diabetes mellitus (OR=8.104) and congestive heart failure (OR=9.597) according to the analysis of logistic regression.ConclusionsWith the hydration and the use of low-osmolar nonionic contrast,it is safe to receive contrast examination for the elderly patients.The baseline serum levels of Scrand cystatin C,diabetes mellitus and congestive heart failure are the clinical risk factors of CIN.Compared with Scr,serum cystatin C is the more powerful predictor for the development of CIN.