Bilateral anterior sacrospinous ligament suspension associated with a paravaginal repair with mesh: short-term clinical results of a pilot study.

INTRODUCTION AND HYPOTHESIS: This study aims to assess anatomical and functional results of bilateral anterior sacrospinous ligament suspension associated with paravaginal repair with mesh. METHODS: Forty-eight patients were operated between March 2007 and August 2008. Mean age was 67 years old. Nineteen patients (39.6%) had been previously operated for a genital prolapse. All patients had both anterior vaginal wall prolapse and a level 1 defect; stage 2 to 4 (POP-Q). RESULTS: Median follow-up is 8 months (range 1 to 18). Perioperative complications were: one bladder injury (2.1%), three haematomas (6.3%), two ureteral kinking (4.2%) and two sciatic pain (4.2%). Anatomical success was observed in 47/48 patients (97.9%) for uterine or vaginal vault prolapse and 46/48 patients (95.8%) for anterior vaginal wall prolapse. CONCLUSIONS: This procedure is a challenging surgical technique requiring a significant level of skill and training, which yields a very high success rate; however, it is not without potential ureteral and neurologic complications.

[Recommendations for endoscopic, laboratory and electrophysiological examinations in the investigation of non-neurological female urinary incontinence]. / Recommandations pour la pratique des explorations endoscopiques, biologiques, et électrophysiologiques dans l'évaluation d'une incontinence urinaire féminine non neurologique.

CYSTOURETHROSCOPY: Cystourethroscopy is not recommended in the initial work-up of urinary incontinence except in the following circumstances: Microscopic or macroscopic haematuria requiring screening for an associated tumour especially in the presence of risk factors for urothelial tumour (smoking, occupational exposure). Signs of bladder irritation in the absence of urinary tract infection. Unexplained bladder or pelvic pain. Recurrent urinary tract infections. Discordance between clinical features and urodynamic assessment, which fails to reproduce the symptoms described by the patient. Work-up of a failure, recurrence or complication of urinary incontinence surgery. Suspected urogenital fistula. TEST FOR STERILE URINE: A test for sterile urine is recommended in the following situations: Woman with urge or mixed urinary incontinence. Elderly woman who regularly uses pads for urinary incontinence, regardless of the type of urinary incontinence. Before performing a urodynamic assessment or cystoscopy. This test can be performed by urine dipsticks or urine culture. URINE CYTOLOGY: Is not recommended in the assessment of pure urinary stress incontinence. But is recommended in the presence of signs of bladder irritation in the absence of urinary tract infection, microscopic haematuria, risk factors for bladder tumour (smoking, occupational exposure). And must be performed on concentrated urine by a urocytopathologist. PERINEAL ELECTROPHYSIOLOGICAL STUDIES: Perineal electrophysiological studies are not recommended in the investigation of non-neurological female urinary incontinence.

Transobturator tape sling for female stress incontinence with polypropylene tape and outside-in procedure: prospective study with 1 year of minimal follow-up and review of transobturator tape sling.

OBJECTIVES: To assess the efficacy and safety of a minimally invasive surgical procedure using a polypropylene transobturator tape to treat female stress urinary incontinence during a minimal follow-up of 1 year and to present a review of this technique. METHODS: A total of 206 women with stress urinary incontinence who underwent the transobturator tape procedure in a French multicenter prospective open tracker study, with a minimal follow-up of 1 year (range 12 to 33 months), were assessed. A nonelastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique used a vaginal and transobturator percutaneous approach. Postoperative assessments included clinical examination, cough-stress test (full bladder), uroflowmetry, and postvoid residual urine volume performed after 1, 6, 12, 18, and 24 months. RESULTS: The mean follow-up was 16 months (range 12 to 33). Of the 206 patients, 79.1% were completely cured, 13% improved, and 7% failed. No vascular, nervous system, or digestive perioperative complications were observed; however, 2.4% of the patients had postoperative urinary retention. CONCLUSIONS: The results of the present study have confirmed the optimal results in stress incontinence previously reported in short-term studies. These results suggest that the transobturator tape procedure is a valuable alternative to the transvaginal tape procedure, with a low rate of complications.