Abstract: OBJECTIVE: We established a voluntary registry to collect data on the perioperative course of transobturator tape operations for stress incontinence. STUDY DESIGN: Forty-seven centers completed a 1-page, 15-item questionnaire per procedure. RESULTS: Data on a total of 2543 operations with 11 different tape systems were collected. Intraoperative complications were noted for 120 procedures (4.7%). These included 85 cases of increased bleeding (3.3%), 10 vaginal perforations (0.4%), 10 bladder perforations (0.4%), and 2 urethral perforations. Reoperations attributable to the tape procedure were reported for 57 patients (24 tapes cut or loosened for voiding dysfunction, 11 vaginal erosions, 7 abscesses with erosions). One patient was reoperated at 14 days for a retropubic hematoma. There were no reports of bowel or major vessel injuries or mortality. Significant postoperative pain was reported for 12 patients (0.5%), although this was not specifically asked for in the questionnaire. CONCLUSION: Significant complications with transobturator tapes are uncommon. Bladder perforations occurred more frequently with outside-in than with inside-out techniques. Vaginal erosions, abscesses, and pain may be more common with transobturator than with retropubic tapes, and this may be due to the structure of the tapes rather than to the route of passage.

Abstract: BACKGROUND: Hereditary hemochromatosis is an autosomal recessive disorder of iron metabolism that is characterized by excess accumulation of iron in various organs and often leads to diabetes mellitus (DM). To study whether mutations in the hemochromatosis gene (HFE) could be a risk factor for the development of gestational diabetes mellitus (GDM), the prevalence of HFE mutations in patients with GDM was compared to that of healthy pregnant controls. METHODS: GDM was diagnosed in 208 of 2,421 pregnant woman screened between the 24th and 28th week of gestation over a period of 18 months. Patients and 170 matched control subjects were screened for the HFE gene mutations C282Y and H63D. RESULTS: In North and Central European GDM patients, the allele frequency of the C282Y mutation (7.7%) was higher than in pregnant controls (2.9%; p = 0.04), while the frequency of the H63D mutation was not different (p = 0.45). Three patients with GDM were homozygous for H63D (3.1%), 1 patient was homozygous for C282Y (1.0%), 2 patients were compound heterozygous (2.0%) and 26 were heterozygous [11 C282Y (11.2%) and 15 H63D (15.3%)]. C282Y and H63D allele frequencies were not different between controls and GDM patients of Southern European or non-European origin. Irrespective of the HFE-mutation status, serum ferritin levels were increased in patients with GDM compared to healthy pregnant controls (p = 0.01), while transferrin saturation was similar in both groups. CONCLUSIONS: In North and Central European patients with GDM, the C282Y allele frequency is higher than in healthy pregnant women, suggesting a genetic susceptibility to the development of GDM.

Abstract: OBJECTIVE: This study was undertaken to analyze bleeding problems with tension-free vaginal tape (TVT) operations in a national registry. STUDY DESIGN: We studied patients for whom increased intraoperative bleeding or reoperation for bleeding/hematoma with TVT operation were reported to the registry. RESULTS: Bleeding problems were reported for 151 of 5578 (2.7%) TVT operations. Increased intraoperative bleeding was reported for 106 (1.9%) and reoperation (or conversion) in 45 (0.8%) patients (both in 5 patients). Increased intraoperative bleeding was managed conservatively in 103 patients (95%). Overall, 45 (0.8%) patients required reintervention for bleeding or hematoma. The reinterventions comprised 34 laparotomies, 4 transvaginal evacuations of hematomas, 3 revisions for bleeding from a suprapubic catheter site, and 2 revisions of the vaginal incision (details unclear in 1 patient). Bleeding was considered arterial in 12% (including 1 external iliac artery injury and 1 obturator artery injury) and venous or unknown in 88%. Of reoperated patients, 39% were reoperated within 24 hours, 20% within 2 to 10 days, and 41% within 11 to 56 days after TVT placement. Overall, 19 patients received blood transfusions (range, 1-10 units). There were no deaths from bleeding complications. CONCLUSION: Bleeding complications were reported with less than 3% of 5578 TVT operations. Most cases of increased intraoperative bleeding were managed conservatively; 0.8% of patients required conversion or reoperation.