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The aim of this study was to compare the morbidity and short-term efficacy of retro-pubic (TVT) and inside-out trans-obturator (TVT-O) sub-urethral sling in the treatment of stress urinary incontinence. This was a prospective multi-centre randomised trial; 231 women with primary stress urinary incontinence were randomised to TVT (114) or TVT-O (117). The International Consultation on Incontinence-Short Form (ICIQ-SF), Women Irritative Prostate Symptoms Score (W-IPSS) and Patient Global Impression of Severity (PGI-S) questionnaires were used to evaluate the impact of incontinence and voiding dysfunction on QoL and to measure the patient's perception of incontinence severity. The primary and secondary outcome measures were rates of success and complications. The SPSS software was used for data analysis. The TVT-O procedure was associated with significantly shorter operation time and with a more extensive use of general anaesthesia when compared with TVT. There were 5 (4%) bladder perforations in the TVT group compared with none in the TVT-O group. Rates of early post-operative urinary retention and voiding difficulty were similar for both groups and no difference was found in the average hospital stay. Six patients (5%) in the TVT-O group complained of thigh pain in the post-operative course. The median follow-up time was 6 months. Two hundred eighteen patients were available for the analysis of outcomes. Subjective and objective cure rates were 92% and 92% in the TVT group and 87% and 89% in the TVT-O group. The ICIQ-SF questionnaire symptoms score showed a highly statistical decrease in both groups, the W-IPSS on the contrary was unchanged. Our data show that both procedures were equally effective in the short-term for the treatment of stress urinary incontinence with a highly significant improvement in incontinence-related QoL.[PUBLICATION ABSTRACT]

Urinary and anal incontinence, pelvic organ prolapse, perineal pain and reduction in pelvic floor muscle strength and function can occur after delivery as a result of damage to the pelvic structures. Debate is open on risk factors, prevalence and management of pelvic postpartum dysfunctions. In Italy few centers offer a specific management of obstetric pelvic injuries and often the treatment of these dysfunctions relies on the willingness of single professionals. Moreover there is often inadequate communication between the birth center and professionals who take care of the woman during the puerperal phase and most women are poorly, or not at all, informed about postpartum pelvic dysfunctions, their evolution and treatment opportunities. To face these problems the Italian Society of Urodynamics, continence neurourology and pelvic floor (SIUD) has established a specific committee. Starting from existing experiences, the group has created a recording tool aiming at standardizing women pelviperineal assessment in the postpartum period and selecting women who need to be addressed to conservative treatment. This tool has been named “SIUD delivery & pelvic dysfunctions card” and is presented here.

Aims of the study: to estimate the prevalence of urinary and anal incontinence and their impact on women’s quality of life, and to identify the constitutional and obstetric factors significantly related to urinary and anal incontinence. Materials and methods: Data were collected from a cohort of 960 nulliparae (full term delivery 37-42 weeks). Each woman was evaluated both at 2-3 days post-partum and at three months follow-up with: the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Wexner’s CGS continent grading system. Results: 161 women revealed persistent urinary incontinence, 121 women persistent anal incontinence and 43 women both conditions together. Concerning constitutional risk factors, positive family history of incontinence and incontinence before and during pregnancy were significantly related to urinary and anal incontinence 3 months post-partum. For obstetric factors the vaginal delivery is a strong risk factors for UI. Conclusions: Many constitutional variables were found to be significantly related to both faecal and urinary incontinence. The vaginal delivery is undoubtedly the more important and recognized obstetrical risk factor for urinary incontinence, while the caesarean delivery did not assume any protective role in the development of anal incontinence