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In the course of a prospective study 43 women underwent axillary immunolymphoscintigraphy (ILS) shortly before a planned operation for suspected carcinoma of the breast. The aim was to test the feasibility of this procedure for the noninvasive staging of lymph-nodes. Three antibodies were used: HMFG-1 (3 patients), HMFG-2 (13) and 3C6F9 (27). The diagnosis was confirmed in 35 patients. They underwent radical mastectomy with removal of the lymph-nodes. There were marked differences in the usefulness of HMFG-2 and 3C6F9 for ILS in these circumstances. There were too few patients to evaluate HMFG-1. Sensitivity and specificity of the test were 0.57 and 0.83, respectively, for HMFG-1 and 0.83 and 0.93 for 3C6F9.

Sowohl bei der Entstehung als auch bei der Therapie der weiblichen Harninkontinenz spielen die Anatomie und die Funktion des Beckenbodens eine wichtige Rolle. Das Ziel dieser Fallkontrollstudie war es, festzustellen wie der Kenntnisstand geriatrischer Frauen mit Harninkontinenzsymptomen bezuglich ihres Beckenbodens, ist und wieweit sie imstande sind die Beckenbodenmuskulatur willkurlich willkurlich und reflektorisch zu kontrahieren. 377 geriatrische Frauen mit Harninkontinenzsymptomen wurden im Rahmen eines Harninkontinenz-Basis-Assessments untersucht. Die Fahigkeit zur Kontraktion der Beckenbodenmuskulatur wurde mittels einer digitalen vaginalen Palpation gepruft. Das Ausmas der festgestellten Muskelkraft wurde eingeteilt mit der sechsteiligen Oxford Grading Scale nach Laycock 1994. 65,5% der Patientinnen wussten nicht, was der Beckenboden ist und waren zu keiner Beckenbodenmuskelkontraktion fahig (Grad 0 bis 1 nach Laycock), 22% hatten eine vage Ahnung von der Lage ihres Beckenbodens—konnten aber nur eine insuffiziente Muskelkontraktion erreichen (Grad 2 nach Laycock). Nur bei 12,5% der Patientinnen konnte eine sichere, masige bis starke Muskelkontraktion festgestellt werden (Grad 3 bis 4 nach Laycock). Eine Untergruppe bestehend aus 83 Patientinnen hatte in der Vergangenheit bereits Bekkenbodenubungen durchgefuhrt, 80 davon mit konventionellen Unterweisungen, 3 mit digitaler vaginaler Kontrolle. In dieser Untergruppe konnten 54,2% der Patientinnen den Beckenboden nicht (Grad 0 bis 1 nach Laycock), 25,3% nur insuffizient (Grad 2 nach Laycock) kontrahieren. 20,5% waren zu einer sicheren Beckenbodenkontraktion fahig (Grad 3 bis 4 nach Laycock). Die 3 Patientinnen, deren Beckenbodenubungen mittels einer digitalen vaginalen Palpation kontrolliert worden waren, befanden sich in dieser Gruppe und erreichten eine Beckenbodenmuskelkraft Grad 4 nach Laycock. Ein groser Prozentsatz geriatrischer Patientinnen mit Harninkontinenzsymptomen hat keine oder eine eingeschrankte Kenntnis uber die Lage und die Funktion des Beckenbodens. Der Einsatz konventioneller Beckenbodenubungen ohne zielgerichtete Kontrolle scheint bei geriatrischen Patientinnen die Fahigkeit zu einer Beckenbodenmuskelkontraktion als Schutz vor einem unfreiwilligen Harnverlust nicht zu verbessern.

A rupture of a splenic artery aneurysm in the postpartal period is a rare but dramatic event with a high rate of maternal mortality. We report on a 29-year-old woman who, after a normal ambulant delivery in our department, experienced an attack of pain in the left epigastrium 7 hours later at home and fell into a state of hemodynamic shock. Owing to a targeted diagnostic work-up and immediate surgical intervention, the patient survived this incident with no damage. According to the international published literature, the mortality rate for this condition is 50%. In developed countries a rupture of a splenic artery aneurysm during pregnancy or the postpartal period is a very significant cause of maternal morbidity and mortality. Based on a review of the published literature, the causes, diagnosis, clinical work-up and treatment of these ruptures are addressed in the Discussion section. For the purpose of differential diagnosis, every obstetrician and emergency medicine specialist should be familiar with this relatively rare condition. Immediate diagnosis and prompt establishment of the indication for laparotomy are essential in order to ensure that the mother and the child survive the incident.

Purpose: The aim of this prospective randomized study was to evaluate the safety and efficacy of tension-free vaginal tape (TVT) versus transobturator vaginal tape (TOT) for the surgical therapy of female stress urinary incontinence (SUI). Material and Methods: Clinical and urodynamic examinations were carried out in 110 women suffering from stress urinary incontinence. Mean age was 51 years (range, 37-75). Patients with overactive bladder symptoms, pelvic prolapse and previous surgery for stress urinary incontinence were excluded from the study. The women were randomized into two groups, TVT (n = 52) and TOT (n = 53). The tapes were positioned without tension under the junction between the mid and distal urethra. The women received spinal and general anesthesia according to patient preference. 105 women were re-examined 12-17 months after these procedures. Results: Patient characteristics and urodynamic evaluations were similar in the two groups. The cure rate at follow-up was 86% for the TVT procedure and 84% for the TOT procedure. In both groups urethral pressure profiles demonstrated a significant improvement in Dep.Q (p < 0.05). We observed no prolonged pain or sling rejection. Operation time was significantly shorter in the TOT group (15 min vs 26). No bladder injuries and no vascular (hematoma or bleeding) complications occurred in the TOT group versus 13% (n=7) in the TVT group. In 5 cases (12%-TVT) and 6 cases (10%-TOT) we observed new onset detrusor instability. Conclusion: The TOT procedure appears to be as effective as TVT for the surgical treatment of female stress urinary incontinence at 15 months follow-up. TOT avoids damage to the urethra and bladder and, therefore, makes cystoscopy unnecessary. Overall, the TOT seems to be a good alternative to the TVT.

Purpose: Patients with stress urinary incontinence at low urethral closure pressure, defined as maximum closure pressure equal or lower than 20 cm H 2 O, are at a higher risk for failure of surgical intervention. The aim of the study was to evaluate the objective healing and the changes of the urethral closure pressure of such women with severe urinary stress incontinence at hypotone urethra undergoing tension-free vaginal tape procedure. Material and Methods: Out of 150 patients who underwent TVT procedure between May 1999 and August 2000 because of urinary stress incontinence we found 29 of them with hypotone urethra. 25 of these were followed up in this study. Condition for enclosure was a positive stress test (leakage of urine like a jet at filled bladder with 300 ml while coughing as well in lying as in standing position) and a maximum urethral closure pressure lower or equal to 20cm H 2 O 4-6 weeks before surgery while performing urodynamic examination. 7 (4-12) months after surgery urodynamics and stress test were repeated. Healing was defined as negative stress test and regular maximum urethral pressure (higher than 20 cm H 2 O) at the time of control. Results: 19 (76%) patients had a negative stress test and a regular urethral pressure. At 4 (16%) women we found a negative stress test and still a hypotone urethra although maximum urethral pressure had risen but not up to 20 cm H 2 O. One (4%) patient still had a positive stress test with regular urethral closure pressure and one (4%) patient had a positive stress test as well as a hypotone urethra. Over all 23 (92%) patients had a negative stress test and were healed of urinary stress incontinence in all day situation. Conclusion: Our dates confirm TVT as a minimal invasive procedure to cure urinary stress incontinence in women with low pressure of the urethra.

Fragestellung: Ziel der therapeutischen Bestrebungen in der Urogynakologie ist das Beheben einer Harninkontinenz. Welche Vorteile bietet die Verwendung des Endo-Stitch-Nahtinstrumen

In a prospective clinical study we investigated 115 patients prior to vaginal surgical interventions to determine the antimicrobial efficacy of six different procedures for vaginal antisepsis. To sample the microorganisms we used a cotton swab moistened with a neutralising fluid. Immediately after the time of action of the antiseptic procedures (3 minutes), providone-iodine solution, applied undiluted or diluted 1:10, yielded the strongest median reduction of the vaginal flora (log RF 3.60 and 2.68, respectively). Of three detergents with antiseptic efficacy, octenidine 0.1% was the most efficient formula (log RF 2.32). After 30 minutes the log reduction factors (log RF) of almost all procedures (log RF 2.79-3.25) were in a fairly close range, excepting chlorohexidine 0.05% (log RF 2.07). Overall, the antiseptic detergents showed a marked residual effect, which was less pronounced, if at all, with providone-iodine solutions. A germ-reducing effect of povidone-iodine vaginal suppositories, applied 2 to 3 hrs prior to surgery, was not confirmed, while additional findings indicated that providone-iodine solution applied with the help of a vaginal douche yields a similarly strong germ reduction as the application by means of a ball swabs.

In a retrospective study the survival rates of 161 patients with stage Ib cervical cancer after radical operation (Latzko, Wertheim-Meigs) including complete or incomplete pelvine lymphadenectomy were compared. To increase radicality of lymphadenectomy, preoperative targeting of pelvic lymph nodes was done in all the patients using 99mTc-Sb2S3 radiocolloid. Intraoperatively, a gamma-camera being integral part of an operating table allowed delineation and scintigraphy-guided resection of pelvic lymph nodes. Dependent on the evidence of remaining pelvine foci of radioactivity at the end of the operation, lymphadenectomy was assessed as complete or incomplete. Mean observation time of completely lymphadenectomised patients (n = 117,72.67%) were 80 months (5-169 months) and 42 months (1-149 months) of the incompletely lymphadenectomised patients (n = 44,27.33%). In 28 (23.93%) completely lymphadenectomised patients against only 5 (11.36%) patients with incomplete lymphadenectomy, lymph node metastases were proved histologically. Five year-survival rate of completely lymphadenectomised patients was 85.47% and 88.64% of incompletely lymphadenectomised patients (not significant, Mantel-Test). Also, selective comparison of lymph node-positive patients did not suggest a divergent trend indicated by 13 (46.43%) deaths of completely and 3 (60.0%) deaths of the incompletely lymphadenectomised patients after an observation of five years. The technique of scintigraphy-guided pelvic lymphadenectomy using 99mTc-Sb2S3 radiocolloid cannot be expected to improve prognosis of patients with cervical cancer stage Ib.

Detrusor instability is the second most common cause of femal urinary incontinence. Oxybutynin chloride anticholinergic action with direct muscle-relaxant properties. 39 women with persistent-urgeincontinence participated in a pilot study of intravesical oxybutynin application. Patients received either 20 mg oxybutynin or placebo as 40 ml sterile sodium chloride solution administered intravesically over a period of 10 days. Urodynamic assessment as well as micturition protocols were performed before and after treatment. The intravesical oxybutynin-application was significantly better than the placebo application concerning reduction of pollakisuria and nycturia. Oxybutynin also increased bladder capacity more than in the placebo-treated group (p < 0.01) and provided an improvement of bladder compliance (p < 0.05). No local or systemic side effects were observed which would have immediately terminated the oxybutynin treatment.

Local intravaginal application of oestriol is part of the therapeutical programme of sensory urge-incontinence. The effectiveness of a new method--intravesical administration of 1 mg oestriol versus a placebo--has been proved in a prospective randomised study. 21 patients each were treated over a period of three weeks with oestriol or with the placebo-substance intravesically. The effectiveness of the administered therapy was checked with clinical and urodynamic parameters. The intravesical administration of 1 mg oestriol proved to be efficient and free of side effects in respect of the parameters such as imperative micturition, bladder capacity, of the maximum urethral closure pressure as well as the number of micturitions per diem. The intravesical administration of oestriol may be considered as additional method of therapy for treatment of sensory urge-incontinence.

This prospective randomised study involved 52 female patients suffering from recurrent stress urinary incontinence, objectively confirmed by means of clinical incontinence tests and urodynamic examinations. They alternatively underwent colposuspension according to Burch or suburethral sling procedure surgery. Urodynamic and sonographic examinations were carried out before and 2.5 years (i.e. within a range of 2-3) after surgery according to Burch or suburethral sling procedure. There was no significant difference between the two methods with respect to subjective and objective rate of cure, which amounted to 85% of the cases involving colposuspension and 88% of cases involving the suburethral sling procedure. Both methods resulted in a significant improvement of the depression quotient and a significant elevation of the internal urethral meatus (p < 0.05). Apart from an aggravation of urge symptoms in both groups, the patients with surgery according to Burch tended towards enterocele and rectocele in the medium range, whereas urination disorders had to be accepted in the patients operated on according to the sling procedure in the long term.

A collective of 31 women with recurrent stress urinary incontinence was subject to Burch colposuspension. The average time interval between the primary treatment (anterior colporrhaphy) and surgical colposuspension was 5.5 years. All patients underwent clinical, urodynamic and sonographic assessment of incontinence prior to and after surgery. The follow-up examination was performed at an average of 14.5 months after colposuspension according to the method reported by Burch. In 87% of patients, continence was achieved. 90% of patients were able to void without any formation of residual urine in the bladder. In the attempt to optimise the diagnostic and therapeutic procedures pertaining to female incontinence, introitus sonography and urodynamic assessment have proved to be valid adjuvant tools.

In postmenopausal patients, stress and urge incontinence often occur as a consequence of oestrogen deficiency. We performed a comparative study in a prospectively randomised and placebo controlled group of women with urge incontinence to investigate different dosages of intravaginally applied oestriol. Clinical and urodynamic parameters were also compared. 15 women (Group I) received 1 mg oestriol applied daily intravaginally over 3 weeks; 15 women (Group II) received a daily dosage of 3 mg and 10 women received a placebo. A complete clinical and urodynamic evaluation was carried out twice at a 4-week interval. The women receiving a daily dose of 3 mg oestriol applied intravaginally demonstrated a significant improvement of the parameters strong desire to void, pollakisuria, and nycturia. No improvement was seen in patients with motoric urge incontinence.

In the treatment of urge incontinence, drug therapy predominates. In a prospective randomised study on treatment of females with motor urge incontinence, intravesically administered lidocaine-gel and oral emepronium bromide were compared using clinical and urodynamic parameters. From 30 patients, 15 women were treated for 3 weeks with repeated intravesical lidocaine gel instillations whilst the other 15 had a peroral emepronium bromide medication. The intravesical lidocaine gel installation proved more efficient compared with peroral emepronium bromide therapy with regard to the parameters of imperative micturition, occurrence of detrusor contractions as well as number of urinary frequencies per diem. Intravesical application of lidocaine-gel is particularly indicated in patients with increased sensitivity against parasympathicolytics and anticholinergics.

Besides the relatively frequent perioperative and postoperative dysfunctions of micturition, urogenital fistulae are the most frequent complication occurring after surgical gynaecologic interventions. Vesico-vaginal fistulae are the most common communication between efferent urinary passages and genital tract. From 1969 to 1986, 36 women developed a vesico-vaginal fistula after abdominal or vaginal surgery and were operated on again. Upon admission, all 36 patients were subject to surgical closure of the vesico-vaginal fistula according to the vaginal method of Chassar Moir. In 35 women (97.2%) continence was re-established by adequate closure.

In recent years, accurate preoperative diagnosis has been increasingly emphasized as an important therapeutic aspect of urinary incontinence in women. Forty patients suffering from recurrent stress incontinence underwent a dura-sling operation, i.e. loop surgery. The mean period od incontinence complaints prior to secondary surgery was 2.6 years. Follow-up urodynamic parameters revealed a slight improvement in urethral closure pressure (UCP) as well as significant improvement in functional urethral length and depression quotient. Radiologic investigations before and after sling surgery demonstrated good morphological results (angle beta). One year after surgery, 85% of the women had both clinical and urodynamic continence. Medium-term micturition complaints, however, have to be accepted in some of the patients.

By 40 women with stress incontinence II.-III. degrees we performed a preperitoneal pelviscopic colposuspension (Burch) modified by Gill with the "Nottingham Needle". An urodynamic and sonographic assessment before and 6-9 months after the pelviscopic operation were done. In 38 cases from the 40 women (95%) we saw a good result. The new modification of the pelviscopic colposuspension showed us a low intra- and postoperative morbidity and we consider it a big advantage for obese women.

The menopausal syndrome consists of a variety of psychic and physical signs of different intensity. At our outpatient department for problems in menopause and prevention of osteoporosis (1. Dept. of Gynaecol. and Obstetrics, Vienna) 1287 women who were consulting this department for the first time because of prevailing complaints or prophylactic reasons, were registered during the years 1988 and 1989. In the course of this work we paid particular attention to the symptom "eye complaint" as a sign of the beginning of the menopausal period. 98 out of 430 patients with eye complaints were examined ophthalmologically. Referring to our patient population we tried to analyse epidemiologically the frequency and the degree of severity of menopausal eye complaints as well as the therapeutical response to a hormone substitution therapy. To what extent an endocrinological explanation can be found and which facts lead us assume such a statement, we have tried to demonstrate in the discussion.

In 21 patients, suffering from amenorrhoeic hypergonadotropic ovarian insufficiency (age 27 +/- 3 years [FSH: 43 +/- 10, LH: 40 +/- 8]), the bone density was measured by single-photon densitometry (SPA), before starting a hormonal replacement therapy with oestrogen/progesterone. Every 5 months, the trend in bone density change was measured in all cases. The bone density before hormonal treatment was lower in the WHO III-group (1.36 +/- 0.21 g/cm; 1.09 +/- 0.26 g/cm2) than in the age-matched group (1.57 +/- 0.21 g/cm; 1.28 +/- 0.31 g/cm2). Bone density increased after hormonal therapy (p less than 0.05). These results point to the necessity of hormonal replacement therapy in cases of WHO III.

To determine whether the detection limit of immunolymphoscintigraphy (ILS), reported to be > or = 1 cm, can be improved by comparing imaging after administration of breast cancer-specific monoclonal antibody (MAb) BCD-F9 and breast cancer-nonspecific 4C4, 25 patients with suspected breast cancer were given injections of both 123I-labelled MAbs. The ILS was performed independently for both MAbs, the 4C4 scans serving as an ipsilateral negative control, and was used preoperatively to detect lymph node metastases. Twenty-one patients had breast cancer of whom 11 patients suffered from axillary involvement. Single interpretation of BCD-F9 scans gave true positive results in six of 11 and true negative results in 12 of 14 patients, whereas combined interpretation of BCD-F9 and 4C4 scans gave true positive results in nine of 11 and true negative results in 14 of 14 patients. On the basis of comparison of scintigrams of both MAbs, ILS allowed the detection of lymph node metastases 0.3-0.8 cm in diameter (n = 3). Immunohistochemistry of BCD-F9 and 4C4 MAbs of tumour-free and tumour-bearing lymph nodes correlated with ILS, with the exception of one patient. The study suggests that comparing scans obtained with BCD-F9 and 4C4 MAbs may improve the detection limit of ILS in the preoperative staging of axillae.

In 36 women with cystometric evidence of bladder instability we investigated the efficacy of intravesical instillation of oxybutynin. The intravesical application of oxybutynin had a significant effect regarding the reduction of pollakiuria and nocturia and an improvement of bladder capacity. No local or systemic side effects were noted.

In recent years, accurate preoperative diagnosis has been increasingly emphasized as an important therapeutic aspect of urinary incontinence in women. One of the diagnostic modalities employed is the lateral urethrocystogram. 25 patients with recurrent stress induced urinary incontinence were subjected to a dura-sling operation. The median duration of incontinence-related problems until secondary surgery (loop surgery) was 2.6 years. Radiological investigations before and after loop surgery showed, that this operation produces good morphological results, if the preoperative diagnosis is accurate. In 84% of the patients the continence obtained was verified by clinical evidence and radiologic findings.

30 patients with a recurrent stress incontinence were undergoing a dura-sling operation. The mean period of incontinence complaints up to the second surgery was 2.6 years. In the follow-up investigation the urodynamic parameters showed a significant improvement of the UCP, the urethral functional length and the DepQ. One year after surgery 86% of the women showed both a clinical and a urodynamic continence. A short term of urination disorders has to be considered in a part of the cases.

In this experimental study, the feelings of climacterium in two groups of menopausal women were compared (a test group with climacteric complaints vs a control group without complaints). 70 patients were given a questionnaire: EWL by Janke and Debus, FPI and Giessen-test. The evaluation of the socio-economic data exhibited the fact, that patients in the group with complaints took more drugs than the other group and were more inclined to weight gain. Gynecological data showed significant differences in the beginning and the experience of menstruation. Psychological tests of the group with complaints showed a lack of self-assurance and increased anxiety. These women had also a tendency toward psychosomatic disorders and were less assertive in their social contacts. The discriminant analysis of menopausal and personality variables classified the women equally into the group with complaints compared to the control group.

In a prospectively randomized double-blind study 28 patients with urinary retention after anterior colporrhaphy were administered either placebo or prostaglandin E2 in different doses (0.75 mg, 1.5 mg, or 2.25 mg) intravesically on postoperative days 6 and 7. Urodynamic assessment was performed before and after treatment. A moderate but not significant decrease of maximum bladder capacity, bladder compliance, and maximum urethral closure pressure was found in patients treated with 2.25 mg of prostaglandin E2. These urodynamic changes did not correspond to the clinical outcome: Residual urine decreased and effective bladder capacity increased significantly in all four groups uninfluenced by the type of therapy. The rate of success (defined by the amounts of residual urine after therapy) was similar in the four groups. A long-term effect of prostaglandin E2 could also be excluded, since the mean time interval from operation to the first day without residual urine was similar in the four groups. Therefore the therapeutic value of intravesically administered prostaglandin E2 in doses from 0.75 to 2.25 mg must be seriously questioned.

Unter den zahlreichen Symptomen des klimakterischen Syndroms stellen die Gelenkbeschwerden — vor allem der kleinen Gelenke — ein Symptom dar, welches sehr haufig fur die betroffene Frau bzw. den behandelnden Arzt ein groses Problem darstellt. Unsere Arbeitsgruppe hat sich im Rahmen dieser Arbeit vor allem die Frage gestellt, in welchem Prozentsatz die „klimakterischen Gelenkschmerzen“ auftreten und mit welcher Effizienz bzw. in welchem Zeitraum durch eine entsprechende Hormonsubstitutionstherapie eine Besserung bzw. eine Heilung erzielt werden kann.

Das Problem der weiblichen Harninkontinenz ist komplex. Operative Erfolge konnen nur durch eine ausreichend funktionelle Diagnostik (klinische Untersuchungen, Rontgenuntersuchungen des Beckenbodens) erreicht werden, um die Stresinkontinenz entsprechend abgrenzen zu konnen. Ziel dieser vorliegenden Studie war es, den Erfolg von Schlingenoperationen bei Rezidivstresinkontinenz sowie Veranderungen urodynamischer Parameter zu evaluieren.

The aim of the study was to investigate the influence of long-term administration of oral contraceptives on bone density in climacteric women. The existence of a correlation between long-term use and bone density was confirmed.

Ein positiver Effekt auf die periphere Knochendichte zeigte sich bei der Gruppe mit fruher Menarche, Paritat (1–2 Kinder), eine kurze Stillzeit (unter 6 Monate) und eine Einnahme oraler Kontrazeptiva.