Eur Urol Suppl 2011;10(9):621 C34 POST-vOId RESIduAl uRINE IN wOmEN ShOuld AlwAyS bE INvESTIgATEd Dybowski B., Radziszewski P., Borkowski A. Medical University of Warsaw, Dept. of Urology, Warsaw, Poland Introduction & Objectives: Post-void residual (PVR) volume in men is regarded the least reliable parameter of obstruction and does not have a defned upper limit of norm. In women it is a rare fnding, partly because not looked for. It may be unexpectedly discovered during urodynamic examination (URD). Detrusor hypocontractility and diferent forms of bladder outlet obstruction are possible reasons but clinical value of this fnding in women has not been established yet. We investigated relationships between incomplete bladder emptying in women, lower urinary tract symptoms (LUTS), results of URD and clinical outcomes. material & methods: A search in our urodynamic databases was done for neurologically intact women with maximal fow rate <=12 ml/s on a pressure- fow study, not treated surgically for urinary incontinence. Patients who entered the study were invited for follow-up visits consisting of history taking, flling questionnaires (IPSS, UDI-6), urofowmetry, USG and PVR measurement. Any PVR volume was considered signifcant. Relationships between PVR and clinical or URD parameters were calculated using U Mann-Whitney test or chi square test depending on type of variables. Results: 61 women aged 19-78, who had had URD examination in years 1997- 2008 underwent follow-up test according to the protocol. Median time from an initial URD study to a follow-up visit was 57 (IQR: 38 - 96) months. PVR urine was found in 30 patients: 1-50 ml in 15 patients, 51-100 ml in 7, 101-200 ml in 3, and over 200 ml in 5 women. Their clinical and URD parameters were compared to those of women without PVR urine. Women with PVR were reporting more often voiding phase symptoms (70% vs 29%; P=0.001) and recurrent urinary tract infections (43% vs 16%; P=0.02), while less often flling phase symptoms (40% vs 71%; P=0.015) They had higher detrusor pressure (amplitude of pdet(Qmax) 40 vs 22 cmH2O; P=0.02). No signifcant diferences were in: age, rates of symptomatic improvement, pelvic organ prolapse, maximal fow rate on URD and free urofow. Although not statistically signifcant it is important to note that all patients with urethral stricture (n=4), all with bladder diverticuli (n=4) and 7 of 8 patients with thickened detrusor wall (P=0.051) had PVR. Patients with higher PVR volume (>50ml) did not difer from those with PVR < 50ml. Conclusions: Any PVR volume should be considered signifcant in women. One should consider measuring PVR in case of voiding phase LUTS. Post-void residual urine is an indication for urodynamic investigation because it is frequently associated with bladder outlet obstruction both anatomical and functional one. C35 CAuSES ANd mANAgEmENT OF vESICOvAgINAl FISTulAS - SINglE CENTER EXPERIENCE Valova Z., Zamecnik L., Hanus T., Macek P. General University Hospital, Dept. of Urology, Prague, Czech Republic Introduction & Objectives: Retrospective evaluation of the success rate of the management of vesicovaginal fstulas (VVF) according to an underlying cause and a type of repair surgery. material & methods: Retrospective assessment of hospital records identifed 19 patients operated on between 2006 and 2010. Etiology of VVF was evaluated, as well as the underlying diseases, primary treatment, time to diagnosis, timing and type of reconstruction. Persistence or recurrence of VVF was assessed. Results: The mean age of patients was 54 years (range 33-84). VVF alone was present in 16 cases and 3 were complex (one VVF + rectovesical fstula, one VVF + rectovaginal fstula and one VVF + ureterovaginal fstula). Primary cause of the fstula was cervical cancer surgery in 12 cases, ovarian cancer surgery in 1, surgery for uterine myoma in 4 cases, once a complex pelvic foor defect repair and there was also 1 case of postpartum VVF. Sixteen patients underwent hysterectomy and 6 also radiotherapy. Time to diagnosis of VVF was less than one month in 11 cases, two to eight months in seven cases and once even 5 years. Time between diagnosis and repair was on average 4.3 months (range 1-14). Patients with rectal fstulas had colostomy carried out primarily. VVF repair was carried out transvaginally in 9 cases, transvesically in 5 cases and transabdominally in 3 cases. Combined repair was used in 2 cases. Persistence/recurrence of VVF occurred in 11 patients, including all six with previous radiotherapy. All were operated again with further 3 cases of recurrence/persistence. Conclusions: The total success rate of all patients operated due to VVF was 84% (16 out of 19 patients). There were better results with transvesical compared to transvaginal approach. C36 mINI-SlINgS – AN OPTION IN STRESS uRINE INCONTINENCE TREATmENT – OwN EXPERIENCE Blewniewski M., Markowski M., Różanski W. Medical University of Lodz, Dept. of Urology, Lodz, Poland Introduction & Objectives: Stress urinary incontinence (SUI) is a social disease. C32 COmPARATIvE uROdyNAmIC EvAluATION OF blAddER OuTlET ObSTRuCTION duE TO SuRgICAl PROCEduRES FOR STRESS uRINARy INCONTINENCE IN wOmEN Chibelean C. 1 , Stoica R. 1 , Surcel C. 1 , Gingu C. 1 , Dusca R. 1 , Mirvald C. 1 , Savu C. 2 , Sinescu I. 1 1 Fundeni Clinical Institute, Center of Urological Surgery and Renal Transplantation, Bucharest, Romania, 2 Fundeni Clinical Institute, Dept. of ICU, Bucharest, Romania Introduction & Objectives: To evaluate the obstructive efect of diferent surgical procedures for stress urinary incontinence by measuring their impact on urinary fow rate (Qmax), maximum bladder pressure (Pvesmax) and bladder pressure at Qmax during micturition. material & methods: We retrospectively analyzed the urodynamic investigations of patients for which we had available preoperative and postoperative data at intervals of 6-12 months. The analyzed procedures were: Burch colposuspension (11 cases), TVT (26 cases), TVT-O (41 cases), and myoblast periurethral injection (4 cases). Signifcant changes in urine fow were recorded for surgical procedures, except for myoblast injection. Followed variables were postmictional volume (PVR), Qmax, Pves, Pves / Qmax. Urethral proflometry data obtained were inconsistent with the standard urodynamic evaluation protocol. Results: Qmax decreased for TVT with an average of 4.9 ml/s (2-7 mL/s at urodynamic control) and a consequent increase in Pves / Qmax of 1.8 cm H2O. For TVT-O we found lower average Qmax of 4.1 mL/s and Pdet / Qmax increase was 1.5 cm H2O. For the group of patients with type Burch colposuspension we recorded an average decrease in Qmax of 7.7 mL/s and Pdet / Q max increase of 8.6 cm H2O. For patients with myoblasts implant, changes in Pdet Qmax / Qmax were minimal and statistically insignifcant in the context of inclusion criteria, but noticed a trend of minimal change in the urodynamic characteristics, namely, decrease of Qmax with 2.1 mL/s and increase by 0.6 cm H2O of Pves / Qmax. In terms of clinical impact of these urodynamic described changes, only two patients needed intermittent catheterization for a period of two months, one case of TVT and one Burch colposuspension, the remaining cases are either without PVR or below 100 mL. Conclusions: In terms of urodynamic fndings observed after surgical procedures for stress urinary incontinence, decrease of Qmax, increase of Pves, and Pves / Qmax , are most strikingly after Burch colposuspension (7.7 mL/s), and less for TVT and TVT-O, otherwise we observed only an adjustment of Qmax and Pves values according to the anatomical principle of the anti incontinence procedure – the creation of BOO, most of them being, unfortunately, non-physiological. It seems that the development of myoblasts implant, (if they will pass the time-proof test) could represent an advance in treating this condition. C33 PERIPhERAl STImulATION OF NERvuS TIbIAlIS IN PATIENTS wITh dETRuSOR hyPERACTIvITy Rejchrt M., Schmidt M., Havlova K., Jarolim L., Babjuk M. Charles University and University Hospital Motol, Dept. of Urology, Prague, Czech Republic Introduction & Objectives: Evaluation of peripheral stimulation in patients with detrusor hyperactivity non-responding to pharmacological treatment. material & methods: In prospective study 16 patients (12 with idiopathic and 4 with neurogennic) were treated with peripheral stimulation of nervus tibialis. Stimulation lasting 30 minutes has been applied in 12 series weekly. Overactive Bladder Questionnaires (OAB-q) and micturition diaries were used for treatment evaluation. Daily micturition rate and daily incontinence rate were recorded weekly. Wilcoxon test was used for statistical evaluation. Results: Improvement of all followed parameters was detected in 7 patients (44%). Improvement of micturition symptomatology and subjective perception were achieved in 10 patients (63%). Signifcant decrease of OAB-q score from 89,6 ± 23,8 before treatment to 65,2 ± 13,4 after treatment was detected in total group. Average daily micturition rate has declined during stimulation from 11,6 to 8,4. Average daily incontinence rate has declined during treatment from 2,4 to 1,3. Decrease in both parameters was statistically signifcant (p < 0,05). Stimulations reduced daily micturition rate by 28% and daily incontinency rate by 46%. No signifcant changes in urodynamics before and after treatment has been found. No adverse events and complications during treatment were detected. Conclusions: Stimulation of nervus tibialis is minimally invasive and safe method with low costs. As an alternative procedure may be indicated in patients with detrusor hyperactivity after pharmacological treatment failure.Project was supported by IGA MZ CR NT 11409