Treating anterior vaginal wall prolapse with polypropylene mesh via the transoburator route minimizing the complications with the use of preventing measures. A prospective study with 2-year follow-up.

AIM: Our objectives were to evaluate the efficacy of the Perigee™ transoburator (TOT) mesh kit (American Medical Systems [AMS]-Minnetonka, MN, USA) in the treatment of ≥ stage 2 symptomatic AVP following a 2-year follow-up and to discuss the role of the pre-, peri- and postoperative measures taken to prevent complications METHODS: A total of 50 patients were eligible and were subjected to AVP surgical treatment with the use of the Perigee™ system. All patients were followed-up at 4 weeks, 2, 6, 12 and 24 months. Our primary objective was treatment success and efficacy after anatomical examination of the patient at the 24-month follow-up. Efficacy was defined as ≤ stage I AVP. All patients completed the 24-month follow-up. Our secondary objective was to examine the complication rates in relation to the use of preventative measures. RESULTS: The proportion of patients with II to III stage significantly decreased postoperatively (P<0.001). A significantly improvement was found in all POP-Q measures (P<0.05) while mean vaginal length was similar to the preoperative values. At 24-month follow-up, 45 women were defined as ≤ stage I, indicating a 90% objective success rate (95% CI: 81.4-98.6%). Two patients had vaginal mesh extrusion (4.0%) both treated with conservative measures. No erosions occurred at any point postoperatively. De novo dyspareunia was reported in two of the 17 cases (11.8%) who reported being sexually active at follow-up. One of the two had also mesh extrusion and with appliance of the vaginal estrogen and the office excision of the exposed mesh the symptoms were resolved, while the other was treated with vaginal estrogen. Two cases (4.0%) reported de novo incontinence and both were treated with a TOT sling (monarc AMS) procedure three months after the cystocele repair. Three cases (6.0%) reported pain vaginal pain postoperatively and again our treatment of choice was vaginal estrogen cream for 4 weeks with the addition of antinflammatories for 10 days and their symptoms resolved. CONCLUSIONS: The treatment of AVP with the use of Perigee™ TOT system can be both effective and safe. The goal is the improvement of the quality of life of the patients and is important to avoid or to keep as minimum as possible the complications. Main complications that the surgeon should bear in mind are the vaginal erosion, vaginal mesh extrusion, de novo dyspareunia, de novo incontinence and vaginal pain. Proper patient selection, the appliance vaginal estrogen cream pre- and postoperatively and following strict surgical principles are the mainstay of the success of the TOT operation. It is crucial for POP procedures to be performed by high-volume surgeons in this field, with extensive knowledge of the pelvic floor anatomy and the mesh's characteristics. Of course this is a small study and further clinical studies with larger number of patients are needed in order to further scientific evaluate the TOT operation.

Double-blind ureteral duplication: a rare urologic anomaly.

We present an extremely infrequent urologic entity of asymptomatic double-blind ureteral duplication in an 8-year-old girl. Contemporary imaging modalities provided major assistance in the diagnosis. Surgical management is advocated because of the potential for future complications, such as lithiasis, obstruction of the collecting system, and renal failure.

Angiomyolipoma of the left ureterovesical junction associated with ipsilateral renal agenesis.

To our knowledge we report the first case of retroperitoneal angiomyolipoma located at the left ureterovesical junction associated with ipsilateral renal agenesis. Radiologically, the mass had the characteristics of a cystic soft tissue tumor. Final diagnosis was determined by histopathological examination, which revealed the specific characteristics of angiomyolipoma. The tumor is theorized to be a result of developmental malformation of fetal mesenchymal elements along the ureteral bud during fetal development since it was associated with ipsilateral renal agenesis.

Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy.

OBJECTIVE: To evaluate the comparative effectiveness of electromyographic (EMG) biofeedback with verbal instructions as learning tools of pelvic muscle exercises (PMEs) in the early management of urinary incontinence after radical prostatectomy. PATIENTS AND METHODS: Forty-two consecutive patients (mean age 64 years, sd 4.2), with urinary incontinence after radical retropubic prostatectomy for localized prostate cancer, were randomized to receive biofeedback (group A, 28 men) or verbal feedback (group B, 14 men) as learning tools for PMEs immediately after catheter removal. Group A received 15 sessions of EMG biofeedback (three times weekly, 30 min each) and group B verbal instructions. Evaluation at baseline and 1, 2, 3 and 6 months included the 1-h pad-test and a questionnaire (number of pads/day and incontinence episodes). RESULTS: By the last follow-up, 27 patients had received biofeedback and 15 verbal instructions. Data were analysed according to the intention-to-treat principle. Urine loss as assessed by the 1-h pad-test at baseline, 1, 2, 3 and 6 months was 39, 18, 7, 4 and 3 g for group A and 31, 11, 3, 1 and 0 g for group B, respectively (P > 0.05). The number of pads/day was 3.9, 3.4, 1.2, 0.8 and 0.4 for group A and 3.6, 1.8, 0.9, 0.4 and 0.2 for group B, respectively (P > 0.05). The overall continence rate at 6 months was objectively (urine loss > 1 g) 91% and subjectively (0-1 pad/day) 95%. CONCLUSION: Intensive verbal instructions and biofeedback were both very effective behavioural methods and learning tools for PMEs in the early management of urinary incontinence after radical prostatectomy.