To assess the effectiveness and safety ofinside-out (TVT-O) vs. outside-in transobturator-tape procedures (TOT) in the surgical management of female stress urinary incontinence (SUI).A total of 8 randomized controlled trials were retrieved from the literature and analyzed by metaanalysis with RevMan 5.0 software.Meta-analysis showed that no statistical differences existed in objective cure rate,objective failure,postoperative voiding dysfunction,groin/thigh pain and sling exposure in both procedures (P ＞ 0.05).These preliminary results suggest there is no evidence of significant differences in the efficacy and safety between TVT-O and TOT.

Objective To analyze re-treatments of recurrence after the pelvic floor repair surgery.Methods The protocol and the effect of re-treatments were investigated by reviewing and analyzing the clinical data of 81 recurrent patients (grade Ⅱ and above),who had received the pelvic floor repair surgery from January 2011 to January 2016.Pelvic organ prolapse quantitation system (POP-Q) and two questionnaires about quality of life [pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7)] were used to evaluate objective and subjective efficacy,respectively.Results Among 81 recurrent patients who were followed up for a median of 35 months (10-69 months),78 cases (with prolapse up to grade Ⅲ or Ⅳ) were treated by surgical operation with both objective cure rate and subjective satisfaction being 100％ (78/78);3 cases (with grade Ⅱ prolapse) were treated by pelvic floor electrical stimulation biofeedback,and 1 case among the three cases had the vaginal foreign body sensation,the subjective satisfaction was 2/3.The methods of surgical operation for the 78 recurrent patients included:total pelvic floor reconstructive surgery (55 cases;3 of which involve trachelectomy),anterior pelvic reconstructive surgery (2 cases),posterior pelvic reconstructive surgery (3 cases),Y-mesh sacral colpopexy (2 cases),colpocleisis (11 cases),vaginal hysterectomy combined posterior fornix forming (3 cases),and vaginal hysterectomy combined posterior pelvic reconstructive surgery (2 cases).Conclusion The extent of recurrence,the recurrent site and complications must be carefully considered and evaluated for re-treatments of recurrence after pelvic floor repair surgery,and then an appropriately individualized re-treatment protocol could be designed for each of the patients.

Objective To investigate the accuracy of ultrasonographic assessment of the total uterine weight and the feasibility of using this method in the pelvic floor reconstruction.Methods Firstly,81 cases with hysterectomy due to benign uterine diseases or uterine prolapse were studied.The preoperative dimensions and gravities of corpus uteri and cervix were calculated by formulas,and were then compared with the postoperative measurements.Subsequently,46 cases with pelvic floor reconstruction and preserved the uterus were subjected to retrospectively analysis of uterine measurement parameters.Results There were no statistically differences between the preoperative and postoperative diameters of corpus uteri and cervix (P ＞ 0.05),and no statistically differences between the weight of corpus uteri and cervix estimated by the formulas [(87±55),(32±6) g] and the true weight [(88±57),(33±6) g; P＞0.05].In 46 cases that underwent the pelvic floor reconstruction by transvaginal mesh repair and preserved the uterus,42 cases were successful treated and the average weight of total uterus was (49 ± 13) g (95％CI:39.90-49.88 g) ; the 4 relapsed cases were treated with hysterectomy and the weight of total uterus were 85.24,82.69,92.67 and 120.06 g which were consistent with the weights estimated by the formulas (87.36,82.00,90.88,123.12 g ; all P ＞ 0.05).Conclusions The uterine weight might be a significant factor for uterus preservation in pelvic floor reconstruction,while ultrasonographic assessment can accurately estimate the uterine weight preoperatively.All these raised the feasibility of assessing uterine weight preoperatively in pelvic floor reconstruction.