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Chapter 28 Long-term Results After Surgery for Urinary Incontinence
tion define, in a urinary incontinence case one reconstructed the pelvic floor as anatomically as possible with an anterior colporrhaphy,and if necessary, also with a posterior colporrhaphy. As previously mentioned, a Kelly plication would be integrated as
a specific operation to restore continence following various schools of thought. The
older literature also seems to confirm this procedure.
Park and Miller (1988) compared the long-term results of combined Kelly plication/anterior colporrhaphy with Marshall-Marchetti-Kranz colposuspension and needle suspension according to Pereyra,in a retrospective study (Pereyra 1959). The anterior colporrhaphy with Kelly plication was only carried out on patients with grade 1
stress incontinence, whereas the other two operations were carried out on patients
with grade 2 stress incontinence. Therefore, only colposuspension and needle suspension can be compared to each other. The success rate of the operation was measured by
means of a questionnaire. Operative success was rated by the patients by indicating no
or little leakage of urine.
After the combined Kelly plication/anterior colporrhaphy, 80%, 70% and 66% of
patients were cured of their grade 1 stress incontinence after 1, 5 and 10 years, respectively. Perioperative wound infection occurred in 3% of patients, 7.4% required a blood
transfusion. Only 2.1% reported cystitis.
Vahlensieck and Schander (1985) reported on over 200 patients who had received
an anterior colporrhaphy and Kelly plication as treatment for stress incontinence as an
additional operation alongside a vaginal hysterectomy. Of these patients, 62% were
cured immediately after surgery, and symptoms were considerably improved in 18%.
After 2–8 years,the patients were questioned about their operative results by means of
a questionnaire: 47% of them were healed and 25% showed a clear improvement.Consequently, the authors gave a success rate of 70%. Reported serious complications were
ligature of a ureter, two wound infections and eight cases of heavy bleeding; 61% of patients with significant bacteriuria were found to have a symptomatic urinary tract infection. Late-onset complications included two patients with dyspareunia due to the
introitus being too narrow and one patient was found to have an enterocele as well as
adhesions that required treatment.
Beck and co-workers (1991) described their experience of a time period of 25 years
with a total of 519 anterior colporrhaphies, 194 of which were carried out as treatment of bladder incontinence. Pre- and postoperative clinical and tonometric control examinations were performed.The follow-up period was between 6 months up to
over 5 years. Some collectives were examined and analyzed separately. The treatment
of incontinence was carried out with an anterior colporrhaphy and Kelly-Kennedy
plication or a modification of this technique in the style of a vaginal retropubic colposuspension. Out of 72 patients treated with the original method, 75% were continent at the time of the control examination; 122 patients were treated with the modified method, and of these, 92% were continent. All in all, it was found that the operative results were clearly more favorable after primary operations (96%) than after
relapse operations (after one operation 92% healed, after more operations, 57%). The
results for mixed urinary incontinence were unsatisfactory, with a cure rate of only
64%. The following complications were reported: de novo urge incontinence 6%,
urethrovaginal fistula 0.4%,need for a blood transfusion 0.5%, and urinary retention
0.5%.
Harris et al. (1995) gave a continence rate of 46% after an average postoperative period of 5.5 years in a telephone-conducted retrospective analysis.Anterior colporrhaphy was also carried out here in combination with Kelly plication. In addition, 93% of
patients received a posterior colporrhaphy.
387
28
388
Wolfgang Zubke, Ella Retzlaw, Diethelm Wallwiener
In a prospective comparative study by Bergman and Elia (1995), the long-term results of combined colporrhaphy and Kelly plication were analyzed.After 5 years, only
37% of patients, all primary operative cases, were continent.One year postoperatively,
the figure was 63%.
In a prospective study, Kammerer-Doak and co-workers compared objective and
subjective success rates. Unfortunately,the study extended only over 12 months; however, it must be stated here that this study was exactly carried out and was objectively
measured after the short time period, with only 31% of patients being continent.
Tamussino et al. (1999) evaluated their objectively measured operative success in a
retrospective study. The results had already been communicated in another form in
1995 (Tamussino et al. 1995). The authors gave a success rate of 61% after 5 years, and
when mild stress incontinence and moderate to severe stress incontinence were differentiated,82% and 49%, respectively, were cured.
Colombo et al. (2000) observed patients over an average of 13.9 years in a prospective long-term study. Objectively, 42% were cured, subjectively,52%.
De Tayrac and co-workers (2002) determined subjective and objective operative
success after 36 months in a retrospective study. Despite the low time scale of 3 years,
this study showed a certain trend in the examination results. After 3 years, 53.6% of
patients were objectively cured, and 57.1% subjectively. However, with only 28 patients included, the sample was relatively small, which limits the conclusions of this
study.
Putting together the cited long-term results (5 years and longer) in the style of a
meta-analysis, we have a long-term success rate for anterior colporrhaphy as a treatment method for stress incontinence of 62%. This correlates well with a meta-analysis
by Glazener and Cooper (2003), where the success rate was quoted as being 68% (Table 28.1).
Comparing the studies with and without Kelly plication, a positive use for Kelly plication is not certainly proved.
As further trends show, retrospective studies report better success rates than prospective studies, and the newer studies have shown a certain trend towards lower success rates for anterior colporrhaphy as an operative treatment method for stress incontinence.
28.3 Needle Suspension
For a long time,needle suspension,e.g., according to Pereyra (1959), Stamey (1973) and
Raz (1981), was considered an option for the operative treatment for stress incontinence.
In a prospective study, Park and Miller (1988) reported success rates of 70% after
5 years and over 56% after 10 years.
In a retrospective study, Trockman et al. (1995) investigated the subjective therapy
success of needle suspension in 135 patients after an average of 9.8 years. Only 20 patients showed a complete treatment success where the incontinence was completely
cured, 71% showed an improvement, and a total of 73% were satisfied with the operative results.
Jongen and Brouwer (1999), in a retrospective study,also showed the subjective success of needle suspension.After an average of 64 months, 68% of patients were completely cured and a further 24% were improved. With only 25 subjects, relatively few
patients were included in this study, and this limits the conclusions.
Chapter 28 Long-term Results After Surgery for Urinary Incontinence
5 years 70
1 year 80
10 years 66
6–60+ 75
66 46
12 63
60 61
13.9 years 42
389
measure (months) (%)
30 60 37
Mild SI 39 60 82
Moderate/severe SI 68 60 49
Subjective 19
Subjective 52
128 >5 years 68
Subjective 57,1
Author SP Study design Outcome Number of patients Follow-up Success rates
Table 28.1. A selection of long-term studies, reporting the urodynamic outcome of anterior colporrhaphy with and without suburethral plication
Park and Miller (1988) Yes Prospective Subjective 336
Vahlensieck and Schander (1985) Yes Retrospective Subjective 200 24–96 70
Beck et al. (1991) Yes Retrospective Objective 72
Harris et al. (1995) Yes Retrospective Subjective 50
Bergman and Elia (1995) Yes Prospective Objective 35
Kammerer-Doak et al.(1999) No Prospective Objective 16 12 31
Tamussino et al. (1995) No Retrospective Objective All 107
Colombo et al. (2000) No Prospective Objective 33
De Tayrac et al. (2002) No Retrospective Objective 28 36 53,6
Glazener and Cooper (2003) Meta-analysis 259 5 years 68
SP suburethral plication,SI stress incontinence.
390
Wolfgang Zubke, Ella Retzlaw, Diethelm Wallwiener
Masson and Govier (2000) included 135 patients in their retrospective study and recorded subjective therapy success after 50 months. Only 14% had no involuntary urine
loss, 42% had mild urinary incontinence,38% moderate incontinence and 6% reported severe urinary incontinence.
In the previously cited prospective study from Bergman and Elia (1995), the objective success of needle suspension after 5 years in 30 patients was investigated: 43%
were successfully treated.
Colombo et al. (1997) also conducted a prospective study of therapeutic control by
needle suspension in urinary incontinence cases.After an average of 6.7 years, 57% of
patients were still objectively cured, and 71% reported a subjective cure.
Tamussino and co-workers (1999) combined colporrhaphy with needle suspension
in 121 patients.After 5 years, 49% of patients were still healed.
The operative results show a very high variation, from 14% to 70%. Collecting the
long-term results in the style of a meta-analysis, we have a continence rate of 43% after 5 years or longer. Jarvis (1994) put together 3,352 cases with an observation period
of 1 year in his meta-analysis and found a postoperative continence rate of merely
21.7% (Table 28.2).
28.4 Colposuspension Techniques
28
In 1949, Marshall, Marchetti and Krantz introduced colposuspension as a treatment
for female urinary incontinence. In the following years, the modification of this technique by Burch (1961) was in wider use than the original method. There are also endoscopic techniques described (Wallwiener et al. 1994,1995, 1996).
Park and Miller (1988) investigated the subjective therapy success of Burch colposuspension after 5 and 10 years in a prospective study of 227 women. The success rates
were 70% and 57%, respectively.
In a retrospective study involving 87 women, Feyereisl and co-workers (1994) reported the objective therapy success of Burch colposuspension after 5 and 10 years.
81.6% of women were cured.
Harris and co-workers (1995) in a study of the therapy success of colposuspension
(Marshall,Marchetti and Krantz) showed that after 66 months,75% of the women were
continent.
Bergmann and Elia (1995) in a prospective study,showed that 33 patients had a continence rate of 82% after 6 months (Burch 1961).
Tamussino and co-workers (1999) also recorded the objective success of Burch colposuspension in their retrospective study.After 5 years,79% of women were cured.
Jongen and Brouwer (1999),by means of a retrospective study, reported a subjective
success rates of 62.5% (complete cure),and 33.3% (symptom improvement).The validity of this study is limited on the grounds of a small number of subjects (24).
In a prospective study, Colombo and co-workers (2000) showed an objective success rate of 75% after an average of 14.2 years,and a subjective rate of 86%.
Petri (2001) reporting retrospectively on 2450 colposuspensions, with a personal
Burch technique modification,showed an average success rate after more than 2 years
of 81%. Treated as a primary operation,the cure rate was 89%, and as a relapse operation only 72%.
Alcalay and co-workers (1995) examined their patients after Burch colposuspension
over a time period of 10–20 years. Over the first 12 years, there was a definite decline in
the cure rate, which leveled out over the years and then reached a plateau of almost
Chapter 28 Long-term Results After Surgery for Urinary Incontinence
Improved: 71
Satisfied: 73
10 years 56
Improved: 24
Failure: 8
Mild leakage: 42
moderate incontinence: 38
Severe leakage: 6
391
Subjective 71
Subjective 100
Author Study design Measure N Follow-up (months) Success rates (%)
Table 28.2. Selection of long-term studies reporting the urodynamic outcome of needle suspensions
Park and Miller (1988) Prospective Subjective 97 5 years 70
Trockman et al. (1995) Retrospective Subjective 125 9.8 years No incontinence: 20
Jongen and Brouwer (1999) Retrospective Subjective 25 64 Complete cure: 68
Masson and Govier (2000) Retrospective Subjective 135 50 No leakage: 14
Bergman and Elia (1995) Prospective Objective 30 60 43
Colombo et al. (1997) Prospective Objective Clinical SUI: 21 6.7 years 57
Tamussino et al. (1995, 1999) Retrospective Objective 121 (+AC) 60 49
Jarvis (1994) Meta-analysis 3,352 1 year 21.7
AR anterior colporrhaphy, SUI stress urinary incontinence.
28
392
Wolfgang Zubke, Ella Retzlaw, Diethelm Wallwiener
70% after 12 years.These authors were also able to show a difference between primary
surgery and surgery for relapses (Table 28.3).
Gathering together our results in a meta-analysis, the cure rate is 70% after 5 years
and longer(Fig. 28.1).
28.5 Tension-free Vaginal Tape
Ulmsten et al. (1996) developed a retropubic suburethral sling out of alloplastic material for the operative treatment of female urinary incontinence. The sling is placed
under the middle of the urethra in order to stabilize the insufficient pubourethral ligaments, see also Zubke et al. (2001).
Although this new method has circulated relatively quickly, there are currently few
long-term results available.
Ulmsten et al. (1999) determined objective therapy success after 3 years in a prospective study of 50 patients. The success rate was 86%.
Olson and Kroon (1999) determined subjective therapy success in a retrospective
study of 50 patients: 90% of patients were continent.
Debodinance et al. (2002) observed 15 patients over 3 years in a prospective study
and then defined the therapy success.The healing rate was 87%.
Rezapour et al.(2001) checked the objective therapy success in a prospective study
of 80 women 4 years after surgery.The success rate was 85%.
Nilsson and Kuuva (2001) showed in a prospective study that just 5 years after surgery,84.7% of patients were still continent.
Nilsson et al.(2003) reported that 7 years postoperatively, 81.3% of women were objectively and subjectively continent.
From the previous data, the majority of which is from Ulmsten and co-workers,
who established the method, we must give the tension-free vaginal tape TVT operation
a success rate of between 80% and 85% after 5 years or more (Table 28.4).
Fig 28.1. Success rated of colposuspension depending on the postoperative interval (Alcalay et al.
1995, from Walters and Karram 1999)
Chapter 28 Long-term Results After Surgery for Urinary Incontinence
Improved: 33.3
86
10 years 57
393
7.6 years 81.3
33 60 82
Subjective
1st Operation 89
Relapse operation 72
Park and Miller (1988) Prospective Subjective 227 5 years 70
Author Study design Outcome measure Number of patients Follow-up (months) Success rates (%)
Table 28.3. Selection of long-term studies reporting the urodynamic outcome of colposuspensions
Feyereisl et al.(1994) Retrospective Objective 87 5–10 years 81.6
Harris et al. (1995) Retrospective Subjective 26 66 75
Tamussino et al. (1999) Retrospective Objective 106 60 79
Bergman and Elia (1995) Prospective Objective
Jongen and Brouwer (1999) Retrospective Subjective 24 63 Complete cure: 62.5
Colombo et al. (2000) Prospective Objective 35 14.2 years 74
Petri (2001) Retrospective 2,450 >24 81
Table 28.4. Selection of long-term studies reporting the urodynamic outcome of TVT operations
Author Study design Outcome measure Number of patients Follow-up Success rates (%)
Ulmsten et al. (1999) Prospective Objective 50 3 years 86
Rezapour et al.(2001) Prospective Objective 80 4 years 85
Nilsson et al. (2001) Prospective Objective 85 56 months 84.7
Olson and Kroon (1999) Retrospective Subjective 51 3 years 90
Debodinance et al. (2002) Prospective Subjective 15 3 years 87
Nilsson et al. (2003) Prospective Objective + subjective 64
28
394
Wolfgang Zubke, Ella Retzlaw, Diethelm Wallwiener
28.6 Discussion
Various difficulties are demonstrated in the comparison of the long-term results of the
most important operative techniques for the treatment of female urinary incontinence. The methods themselves are not always comparable,retrospective studies show
a favorable trend; the same is valid for subjectively gained results.The objective results
are also not always comparable because various tests are cited, the clinical validity of
which are clearly variable. Despite all these limitations, some results hold true. The
Kelly plication, also in combination with an anterior colporrhaphy, as the method of
operative treatment for female urinary incontinence, is less suitable than other methods, if at all.Anterior colporrhaphy is also inferior to other methods in its long-term
results. The best investigated method is the colposuspension according to MarshallMarchetti-Krantz modified by Burch. Colposuspension has proved itself over the last
few decades and has been critically rated in worldwide studies. With a cure rate of
around 70%, it also shows excellent long-term results.A considerable disadvantage of
colposuspension is the artificial displacement of the urethra to a ventral position,
through which the development of a central prolapse or rather a prolapse of the posterior compartment is promoted. This disadvantage is not exhibited by Ulmsten’s
TVT-plasty. The operative procedure is also easier than colposuspension. The available results up to now show even better cure rates after a shorter and longer time.
However, they require more independent and further studies by competent centers.
Despite these restrictions, in our clinic we favor treatment of female urinary incontinence with TVT procedure,currently using the de Leval modification (de Leval 2003;
Reisenauer et al.2004). Here,the TVT is placed through the foramen obturatum rather than retropubically, as in the original method. By using this method, we see intraand immediate postoperative benefits such as less risk of injury and less formation of
residual urine in the bladder. But there are no long-term studies available on this modification.
References
Alcalay M, Monga A, Stanton SL (1995) Burch colposuspension: a 10–20 year follow-up.Br J Ob-
stet Gynaecol 102:740–745
Beck RP, McCormick S, Nordstrom L (1991) A 25-year experience with 519 anterior colporrhaphy
procedures.Obstet Gynecol 78 :1011–1018
Bergman A, Elia G (1995) Three surgical procedures for genuine stress incontinence: five-year
follow up of a prospective randomized study. Am J Obstet Gynecol 173 :66–71
Burch JC (1961) Urethrovaginal fixation to Cooper’s ligament for correction of stress inconti-
nence, cystocele and prolapse. Am J Obstet Gynecol 81 :281–291
Colombo M, Maggioni A, Scalambrino S,Vitobello D, Milani R (1997) Surgery for genitourinary
prolapse and stress incontinence: a randomized trial of posterior pubourethral ligament pli-
cation and Pereyra suspension.Am J Obstet Gynecol 176 :337–343
Colombo M,Vitobello D, Proietti F, Milani R (2000) Randomised comparison of Burch colposus-
pension versus anterior colporrhaphy in women with stress urinary incontinence and anteri-
or vaginal wall prolapse. Br J Obstet Gynaecol 107: 544–551
Debodinance P, Delporte P, Engrand JB, Boulogne M (2002) Tension-free vaginal tape (TVT) in
the treatment of urinary stress incontinence: 3 years experience involving 256 operations.Eur
J Obstet Gynecol Reprod Biol 105: 49–58
De Leval J (2003) Novel surgical technique for the treatment of female stress urinary inconti-
nence: transobturator vaginal tape inside-out.Eur Urol 44 :724–730
De Tayrac R, Salet-Lizee D,Villet R (2002) Comparison of anterior colporrhaphy versus Bolong-
na procedure in women with genuine stress incontinence. Int Urogynecol J 13: 36–39
Chapter 28 Long-term Results After Surgery for Urinary Incontinence
Feyereisl J,Dreher E, Haenggi W et al (1994) Long-term results after Burch colposuspension.Am
J Obstet Gynecol 171 :647
Glazener CMA, Cooper K (2003) Anterior vaginal repair for urinary incontinence in women.
Cochrane Database of Systematic Reviews 1
Harris RL, Yancy CA, Wiser WL et al (1995) Comparison of anterior colporrhaphy and retro-
pubic urethropexy for patients with genuine stress incontinence. Am J Obstet Gynecol 173 :
1671
Jarvis GJ (1994) Stress incontinence. In:Mundy AR,Stephenson TP, Wein AJ (eds) Urodynamics:
principles, practice and application,2nd edn. Churchill Livingstone,New York
Jongen VH, Brouwer WK (1999) Comparison of the modified Pereyra procedure using perma-
nent suture material and Burch urethropexy. Eur J Obstet Gynecol Reprod Biol 84 : 7–11
Kammerer-Doak D, Dorin M,Rogers R,Cousin M (1999) A randomized trial of Burch retropubic
urethropexy and anterior colporrhaphy for stress urinary incontinence. Obstet Gynecol 93:
75–78
Kelly HA,Dunn VM (1914) Urinary incontinence in women, without manifest injury to the blad-
der.Surg Gynecol Obstet 18: 444
Kennedy WT (1937) Incontinence of urine in the female, the urethral sphincter mechanism, dam-
age of function, and restoration of control.Am J Obstet Gynecol 34 :576
Marshall VA, Marchetti AA, Krantz KE (1949) The correction of stress incontinence by simple
vesicourethral suspension. Surg Gynecol Obstet 88: 509
Masson DB,Govier FE (2000) Modified Pereyra bladder neck suspension in patients with intrin-
sic sphincter deficiency and bladder neck hypermobility: patient satisfaction with a mean
follow-up of 4 years.Urology 55: 217–221; discussion 221–222
Nilsson CG, Kuuva N (2001) The tension-free vaginal tape procedure is successful in the major-
ity of women with indications for surgical treatment of urinary stress incontinence. Br J Ob-
stet Gynaecol 108: 414–419
Nilsson CGN, Rezapour M, Falconer C (2003) 7 years follow-up of the tension-free vaginal tape
(TVT) procedure. Int Urogyn J 14: S35
Olson I, Kroon U-B (1999) A three-year postoperative evaluation of tension-free vaginal tape.
Gynecol Obstet Invest 48: 267–269
Park GS,Miller EJ (1988) Surgical treatment of stress urinary incontinence – a comparison of the
Kelly plication,Marshall-Marchetti-Krantz and Pereyra procedures.Obstet Gynec 71 : 575–579
Pereyra AJ (1959) A simplified surgical approach for the correction of stress urinary inconti-
nence in women.West J Surg Obstet Gynecol 67:223–226
Petri E (2001) Die Kolposuspension zur Behandlung der weiblichen Stressinkontinenz.Urologe
40: 292–299
Raz S (1981) Modified bladder neck suspension for female stress incontinence. Urology 17 :82
Reisenauer C,Zubke W,Wallwiener D (2004) Eine alternative Therapieoption in der Behandlung
der Stressinkontinenz.Geburtsh Frauenheilkd 64: 634–636
Rezapour M,Falconer C,Ulmsten U (2001) Tension-free vaginal tape (TVT) in stress incontinent
women with intrinsic sphincter deficiency (ISD) – a long-term follow-up. Int Urogynecol J
[Suppl] 2:S12–S14
Richter K (1998) Gynäkologische Chirurgie des Beckenbodens. Bearbeitet von F Heinz und V
Terruhn. Thieme,Stuttgart, p 134
Stamey TA (1973) Endoscopic suspension of the vesical neck for surgically curable urinary in-
continence in the female.Monogr Urol 2: 65
Tamussino K, Zivkovic F, Pieber D et al (1995) Fünf-Jahres-Ergebnisse nach Inkontinenzopera-
tion, Gynakol Geburtshilfl Rundsch 35: 175
Tamussino KF,Zivkovic F, Piper D, Moser F, Haas J, Ralph G (1999) Five-year results after anti-in-
continence operations. Am J Obstet Gynecol 181 :1347–1352
Trockman BA, Leach GE, Hamilton J et al (1995) Modified Pereyra bladder neck suspension: 10-
year mean follow up using outcomes analysis in 125 patients.J Urol 154: 1841
Ulmsten U,Henriksson L, Johnson P, Varhos G (1996) An ambulatory surgical procedure under
local anesthesia for treatment of female urinary incontinence.Int Urogynecol J 7: 81–86
Ulmsten UR, Johnson P, Rezapour M (1999) A three year follow up of tension-free vaginal sling
for surgical treatment of female stress urinary incontinence. Br J Obstet Gynaecol 106:
345–350
Vahlensieck WK, Schander K (1985) Long-term results of the operative treatment of stress incon-
tinence by anterior colporrhaphy with diaphragmplasty. Geburtsh Frauenheilkd 45: 887–890
395
28
396
Wolfgang Zubke, Ella Retzlaw, Diethelm Wallwiener
Wallwiener D, Grischke EM, Rimbach S, Sohn C, Stolz W, Kaufmann M, Bastert G (1994) Inkon-
tinenzoperation per “Retziusskopie”? Eine endoskopische Modifikation der Marshall-Mar-
chetti-Krantz-Operation.Geburtsh Frauenheilkd 54: 383–386
Wallwiener D,Grischke EM, Rimbach S, Sohn C,Stolz W, Kaufmann M, Bastert G (1995) Endosko-
pische Kolposuspension (“Retziusskopie”versus Laparoskopie) – eine sinnvolle Erweiterung
des Operationsspektrums der Streßinkontinenz? Geburtsh Frauenheilkd 55: 235–239
Wallwiener D,Grischke EM, Rimbach S,Maleika A,Stolz W, Noll U, Bastert G (1996) Die abdom-
inalen Kolposuspensionen: eine Synopsis der verschiedenen Zugangswege und Techniken
incl. endoskopischer Modifikationen. Zentralbl Gynakol 118: 98–106
Walters MD, Karram MM (1999) Urogynecology and reconstructive pelvic Surgery, 2nd edn.
Mosby, St Louis, p 164
Zubke W, Schröter M,Wallwiener D (2001) TVT – zum Vorgehen in der Praxis. Geburtsh Frauen-
heilkd 61: 426–427
Zubke W, Reisenauer C,Wallwiener D (2004a) Suspensionsverfahren bei Stressharninkontinenz,
Teil 1. Geburtsh Frauenheilkd 64:R101–R124
Zubke W, Reisenauer C,Wallwiener D (2004b) Suspensionsverfahren bei Stressharninkontinenz,
Teil 2. Geburtsh Frauenheilkd 64:R125–R156
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