Comparison of Morphological and Histological Characteristics of Human and Sheep: Sheep as a Potential Model for Testing Midurethral Slings in vivo.

INTRODUCTION: The sheep was evaluated as a potential model for preclinical evaluation of urethral slings in vivo based on: (1) anatomical measurements of the sheep vagina and (2) histological tissue integration and host response to polypropylene (PP) slings. METHODS: Eight female, multiparous sheep were utilized. Three of 8 animals underwent surgery mimicking human tension-free vaginal tape protocols for midurethral slings and were euthanized at 6 months. The following measurements were obtained: vaginal length, maximum vaginal width with retraction, symphysis pubis length, and distance from the pubic bone to incision. Explanted sling samples from sheep and human were stained with hematoxylin and eosin for host reaction assessment. RESULTS: Geometric measurements were similar between humans and sheep. Sheep vaginal anatomy allowed sling placement similar to procedures in human surgeries, and all sheep recovered without problems. Comparative histology between the sheep and human indicated similar host reaction and collagen deposition around implants, confirming suitability of the sheep model for biomaterial response assessment. CONCLUSION: Sheep vaginal length is comparable to humans. Tissue integration and host response to PP slings showed chronic inflammation with rich collagen deposition around the material in both sheep and human specimens, highlighting the sheep as a potential animal model for preclinical testing of midurethral slings.

Polypropylene and polyvinylidene fluoride transobturator slings for the treatment of female stress urinary incontinence: 1-Year outcomes from a multicentre randomized trial.

AIMS: To compare the effectiveness and safety of polypropylene (PP) and polyvinylidene fluoride (PVDF) transobturator tapes (TOT) for the treatment of female stress urinary incontinence (SUI). METHODS: This is a multicentre randomized trial. Women with SUI or stress-predominant mixed urinary incontinence and scheduled for a TOT procedure were randomized to PP or PVDF slings. The primary outcome was 1-year cure or improvement rate using composite criteria. Complications were also compared. Relationships with outcomes were analyzed using multivariable logistic regressions models. RESULTS: From April 2016 to January 2018 285 participants were randomized. PP and PVDF slings showed similar high cure or improvement rate (91.0% vs. 95.6%, p = .138). Improvement in validated questionnaires was also similar. PVDF slings were associated with a lower rate of de novo urgency incontinence (adjusted odds ratio = 0.35; 95% confidence interval = 0.15-0.80). We found no statistical differences in complications rates, although a higher incidence of long-term pain events were observed in the PP group. The study is underpowered to find differences in specific complications owing to the low number of events. CONCLUSION: PP and PVDF TOTs are equally effective, although PVDF is associated with fewer cases of de novo urgency incontinence. Further studies are needed to give robust conclusions on safety profiles.

Two-year outcomes of surgeon-tailored trans obturator tape for female stress urinary incontinence: a randomized, comparative, trial with traditional trans obturator tape.

BACKGROUND: Previously, we presented the short-term outcomes of surgeon-tailored mesh in patients with SUI undergoing TOT. In this report, we aim to highlight the two-year outcomes of surgeon tailored mesh in terms of subjective and objective cure rates, as well as late complications. METHODS: We performed a randomized, open-label comparative trial that recruited women with SUI who were scheduled to undergo TOT. Eligible patients were randomly allocated in a 1:1 ratio to receive traditional TOT mesh or surgeon-tailored polyethylene mesh. All patients were followed up for two years. RESULTS: At the end of the follow-up, there were 13 women in the traditional TOT mesh group and 14 patients in the surgeon-tailored polyethylene mesh group. Concerning the primary outcome of the present study, the cure rate was 100% in the surgeon-tailored polyethylene mesh (n = 14) and 92.9% in the traditional TOT mesh group (p = 0.39). One woman reported improved symptoms in the traditional TOT mesh group. There were no reported failures in both groups. Concerning safety, the incidence of de novo urgency was 0% in the surgeon-tailored polyethylene mesh group, compared to 7.1% in the traditional TOT mesh group (p = 0.34). None of the women in both groups reported mesh erosions, dyspareunia, or need for reoperation. CONCLUSION: Surgeon-tailored mesh for patients undergoing TOT is a cost-effective technique, which has comparable long-term outcomes, in terms of cure rate and complications, to the traditional costly meshes. Larger multicentre studies should confirm our results.

Ureteral stents: the good the bad and the ugly.

PURPOSE OF REVIEW: Ureteral stents are necessary in the routine practice of an urologist. Choosing the correct stent and being aware of the options available will allow urologists to provide the best possible care for patients and value to the healthcare system. This review seeks to educate urologists regarding improvements in stent technology currently available or in development. RECENT FINDINGS: Research from around the world is underway to discover an ideal stent - one that is comfortable for patients, resists infection and encrustation and is affordable for hospital systems. Stent design alterations and stent coatings are revealing reductions in encrustation and bacterial colonization. Biodegradable stents and magnetic stents are being tested to prevent the discomfort of cystoscopic removal. Intraureteral stents are proving efficacious while eliminating an irritating coil from the bladder and the symptoms associated with it. SUMMARY: The studies highlighted in this review provide encouraging results in the pursuit of the ideal stent while opening discussion around new concepts and further areas of research.

Urethral bulking with Bulkamid: An analysis of efficacy, safety profile, and predictors of functional outcomes in a single-center cohort.

AIMS: The aim of the present work is to analyze the safety profile, effectiveness, and favorable and unfavorable predictors of clinical outcome in urethral bulking with Bulkamid, and to better identify the ideal candidate for the procedure. METHODS: We included all consecutive female patients treated with urethral bulking with Bulkamid at our institution within 2 years. Patients were affected by stress urinary incontinence (SUI) or mixed incontinence. Incontinence severity was classified as "mild" (urinary leakage <50 g/die), "moderate" (50-200 g/die), or "severe" (>200 g/die) at 24-hours pad test. Clinical success was defined as "dry" (no pads); clinical failure included "partial improvement" (>50% 24-hours pad test reduction) and "no benefit" (<50% 24-hours pad test reduction). The χ2 and Mann-Whitney tests were performed to assess the predictors of clinical outcome. RESULTS: The success rate was 36.1% (n = 35). Forty-three patients (44.3%) reported continence improvement. Complications included eight urinary retention cases (8.2%). Statistically significant correlation was observed between incontinence severity and clinical outcome in thee χ2 test (P = .008). No significant correlation was found between functional outcome and urodynamic incontinence features, postoperative urinary retention, previous pelvic surgery, age, and other physiological, pathological, and urodynamics characteristics. Urinary retention following the surgical procedure appeared to be related to clinical success with nonsignificant P value (P = .10). CONCLUSIONS: Bulkamid procedure could be proposed with good results in elderly patients or in patients requiring a low-invasive procedure with low risk of complications, affected either by SUI or mixed incontinence and with mild to moderate incontinence. Previous training to clean intermittent self-catheterization maneuver should be performed.

Efficacy and safety of non-ablative vaginal erbium:YAG laser treatment as a novel surgical treatment for overactive bladder syndrome: comparison with anticholinergics and ß3-adrenoceptor agonists.

PURPOSE: To examine the efficacy and safety of non-ablative vaginal erbium:YAG laser (VEL) for the treatment of overactive bladder syndrome (OAB) compared with those of two other common pharmacotherapies, namely, anticholinergics and ß3-adrenoceptor agonists. METHODS: Female subjects aged 60-69 years who presented with symptoms of OAB from 2015 to 2017 were assigned to three groups (n = 50) receiving treatment with an anticholinergic agent (4 mg fesoterodine), a ß3-adrenoceptor agonist (25 mg mirabegron), or VEL (20 min/session of VEL performed thrice). The OAB symptom score (OABSS), Vaginal Health Index Scale (VHIS), and occurrence of adverse effects were examined prior to and at 1 year following treatment initiation. RESULTS: The three groups showed significant improvement (p < 0.001) for all items of the OABSS questionnaire. Improved VHIS scores were observed only in the VEL group. Furthermore, after VEL treatment, a negative correlation was observed between questions 3 (urinary urgency) and 4 (urgency urinary incontinence) of the OABSS and VHIS. Regarding safety, no adverse events were observed in the VEL group. However, subjects in the other two groups complained of constipation, as indicated by the Constipation Assessment Scale scores, and mouth dryness. The therapeutic effects were inadequate for one and two subjects in the VEL and ß3-adrenoceptor agonist groups, respectively. CONCLUSIONS: VEL safely and effectively improved OABSS through a different mechanism than that involved in pharmacotherapy. We propose the use of VEL as a novel surgical treatment option in the field of urology.

Bulking for stress urinary incontinence in men: A systematic review.

AIMS: An updated literature review on outcomes in men treated with currently commercially available bulking agents was performed to determine whether this is a reasonable option in selected patients. METHODS: The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework of systematic reviews. A comprehensive search of PubMed, Medline, and Embase was undertaken. Abstracts were independently screened by two investigators to include men with stress urinary incontinence treated with a peri-urethral injection of bulking agents currently available in the market. RESULTS: Only eight original articles met the inclusion criteria. The bulking agents used were Macroplastique in five studies (total 123 patients), Opsys, Durasphere, and Urolastic in one study each (10, 7, and 2 patients, respectively). Only one study was randomized; Macroplastique vs AUS in men with mild or total incontinence. The included populations were heterogeneous and encompassed endoscopic, perineal, abdominal and laparoscopic prostate surgery as well as spinal cord injuries and urethral sphincter insufficiency. Significant dissimilarity was evident for the duration of incontinence (9-108 months), mean volume of bulking agent used (2.3-13.5 mL), number of cushions (1-5), depth and position of the cushions. The outcomes varied significantly, with reported dry rates between 0% and 83%. Outcomes were limited by relatively short follow-up in most studies. CONCLUSION: Following initial enthusiasm and then dismay with collagen-based compounds, sparse and heterogeneous literature data were produced on newer non-migrating and nonabsorbable bulking agents. Some studies have suggested encouraging, if short term outcomes, however, future studies are needed in this field to support recommendations for widespread use.

Is a 10-minute surgical scrub necessary in urologic prosthetic surgery? A randomized study of the effect of a 5- vs 10-minute surgical scrub on bacterial colony counts in the genital skin.

AIMS: To determine the antiseptic efficacy on bacterial colony counts of a 5- vs 10-minute surgical site scrub in urologic surgery. METHODS: A prospective cohort study was conducted in 101 patients presenting for elective urological procedures. Patients were randomized to a 5- or 10-minute groin scrub with Betadine (povidone-iodine). Skin swabs were taken immediately after skin clipping and following routine painting with Betadine. A third swab was taken after the betadine skin scrub. Bacterial colony counts were reported as a number of colony-forming units (CFUs). The primary outcome measure was a quantitative comparison of CFUs in the two arms. RESULTS: Fifty-three patients were randomized to a 5-minute scrub and 48 to a 10-minute scrub. After Betadine painting, CFUs were present in 38% of patients in the 5-minute group (mean, 33.5 CFU) and in 27% of the 10-minute group (mean, 45.4 CFU). Following the surgical scrub, only 7.5% of the 5-minute group and 8.3% of the 10-minute group had a measurable CFU count of greater than or equal to 1, and colony counts were low in both groups (5- minute group: mean, 1.5 CFU; 10-minute group: mean, 2.0 CFU). There was no significant difference in CFUs following a 5- or 10-minute scrub (P = 0.28). CONCLUSIONS: The addition of a surgical skin scrub leads to a fourfold reduction in the skin CFU count compared with Betadine painting. However, there is no difference between the antibacterial effects of a 5- and 10-minute scrub. A 5-minute scrub may be sufficient in urologic prosthetic surgery.

Robotic repair of vesicovaginal fistulas using fibrin sealant.

INTRODUCTION: Although infrequent, when encountered vesicovaginal fistulas (VVF) are a difficult condition for both patients and physicians alike. After the first robotic repair was described in 2005, this has been an increasingly common treatment modality. At our institution between 2009 and 2014, eleven of these patients were evaluated and treated with robotic repair. However, fibrin sealant was used in place of the traditional tissue flap. Included are six patients who had previously undergone operative repair. MATERIALS AND METHODS: After IRB approval was obtained, a retrospective study was undertaken to identify patients with VVF. Inclusion criteria were operative repair utilizing a da Vinci robotic system; there were no exclusion criteria. A total of eleven patients were identified, and in each case, a robot assisted laparoscopic approach was utilized and Tisseel fibrin sealant was used in lieu of tissue interposition. RESULTS: All patients underwent successful repair of their VVF without evidence of recurrence at a mean follow up of 15.6 months. CONCLUSIONS: Robotic vesicovaginal fistula repair with fibrin sealant seems to be a safe and viable alternative to the traditional repair utilizing a tissue flap.

[Management of recurrent stress urinary incontinence after anti-incontinence surgery]. / Management recidivující stresové inkontinence moci po selhání efektu anti-inkontinentních operací.

OBJECTIVE: The review article describes the possibilities of procedures for failed anti-incontinence surgery - sling procedure or "bulking agent"? DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague. MATERIALS AND METHODS: The correct choice of procedure type to treat persistent SUI (Stress Urinary Incontinence) which persists or soon reoccurs after anti-incontinence surgery is often problematic. The procedures that treat SUI decrease excessive mobility of the urethra by partially compressing it. If the excessive mobility of the urethra and BN (bladder neck) persist and MUCP (Maximal Urethral Closure Pressure) is within normal range, then we choose a new sling operation to treat the persistent SUI. What type of sling procedure is preferable in this situatitons: transobturator, retropubic or possibly SISs (Single Incision Slings)? SISs are not adequately fixed to the surrounding structures after implantation and are often not of the correct size - especially regarding length - with poor compliance (elasticity). For mentioned reasons we do not use them in reoperations. In this cases we choose such a sling which is properly fixed to the surrounding structures, is of sufficient length, and of appropriate elasticity. When choosing the right type of procedure we also have to consider previous operations: for example, whether reconstructive surgery of pelvic floor defects using mesh has been carried out, where the mesh has been placed, and whether it might be an obstacle to the newly implanted sling. If there is a low urethral mobility after the unsuccessful incontinence operation and a low MUCP is observed on urodynamic examination, then we prefer either a retropubic sling or the application of a bulking agent. The decision of which method to choose also depends on other circumstances, such as whether the patient has undergone radiation treatment or more than on previous surgery to treat SUI. The results of urodynamic, ultrasound and other examinations are very important. CONCLUSIONS: The choice of the right type of surgery to treat SUI after a previous failed procedure depends on information and findings from complex examination of the patient. Case history, examination results, imaging and the experience of the surgeon in individual procedures are therefore most important.

Renal capsule for augmentation cystoplasty in canine model: a favorable biomaterial?

PURPOSE: To evaluate effectiveness of canine renal capsule for augmentation cystoplasty. MATERIALS AND METHODS: Ten adult dogs participated in this study. After induction of anesthesia each animal underwent bed side urodynamic study, bladder capacity and bladder pressure was recorded. Then via mid line incision abdominal cavity was entered, right kidney was identified and its capsule was dissected. Bladder augmentation was done by anastomosing the renal capsule to the bladder. After 6 months bed side urodynamic study was performed again and changes in bladder volume and pressure were recorded. Then the animals were sacrificed and the augmented bladders were sent for histopathology evaluation. RESULTS: Mean maximum anatomic bladder capacity before cystoplasty was 334.00±11.40cc which increased to 488.00±14.83cc post-operatively (p=0.039). Mean anatomic bladder pressure before cystoplasty was 19.00±1.58cmH2O which decreased to 12.60±1.14cmH2O post-operatively (p=0.039). Histopathology evaluation revealed epithelialization of the renal capsule with urothelium without evidence of fibrosis, collagen deposits or contracture. CONCLUSIONS: Our data shows that renal capsule is a favorable biomaterial for bladder augmentation in a canine model.

Low-cost transobturator vaginal tape inside-out procedure for the treatment of female stress urinary incontinence using ordinary polypropylene mesh.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to describe the use of ordinary polypropylene mesh and our modified helical passers through a transobturator vaginal tape inside-out technique (TVT-O) as a low-cost alternative to available commercial kits in the treatment of stress urinary incontinence (SUI) with evaluation of its long-term safety and efficacy. This is important in developing countries due to limited health care resources. METHODS: Tailored (11 × 1.5 cm) polypropylene tape was inserted in 59 women from June 2006 to June 2009 at the Urology Department, Cairo University Hospitals as an open prospective study. SUI was diagnosed by positive cough stress test (CST) and abdominal leak point pressure (ALPP). Patients with post-void residual urine (PVRU) > 100 ml, bladder capacity < 300 ml, or neurological lesions were excluded. The Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ), urodynamic parameters, and other variables were compared pre- versus postoperatively with paired t, Wilcoxon signed rank, McNemar, or chi-square tests. RESULTS: The mean age was 47.47 ± 8.52 years. Twenty-one (35.6 %) patients had intrinsic sphincter deficiency (ISD). The mean operative time was 21.22 ± 4.26 min (15-30). Procedures for prolapse were done in four (6 %) patients. Complications were vaginal discharge (6 %), dyspareunia (1 %), groin pain (20 %), urinary tract infection (3 %), obstructive symptoms (1 %), accidental cut of polypropylene suture (1 %) and felt subcutaneous polypropylene sutures (3 %). We had no cases of erosions or de novo urgency. SUIQQ indices improved significantly, while urodynamic parameters showed no significant difference postoperatively. Of the patients, 54 (91 %) were cured and 3 (5 %) improved, while failure was detected in 2 (3 %) patients. CONCLUSIONS: Our technique is safe with excellent 5-year results. It should be considered as a low-cost alternative to available commercial kits in the treatment of SUI mainly for public health systems with few financial resources.

The Use of Haemostatic Agents and Sealants for the Prevention of Lymphocele After Urological Surgery: A Review of the Literature.

BACKGROUND: Despite the continuous technological innovation in urological surgery procedures, lymphocele represents one of the major and more frequent complications both in tumour and transplant surgery. Haemostatic agents have been used hypothesizing a beneficial effect on the prevention of lymphoceles. We aimed to review the published literature to establish whether haemostatic agents and sealants are an effective option for lymphocele prevention following urological procedure. MATERIALS AND METHODS: An extensive PubMed search was performed including the following keywords: "lymphocele", "lymphocele prevention", "fibrin glue", "collagen patch", "fibrin patch", and "haemostatic material". The search, which collected data until January 2000, was restricted to the full text available articles in the English language and human studies. RESULTS: Our research identified 64 articles, among these only four fulfilled the inclusion criteria. A total of 133 patients underwent surgery and were treated with haemostatic agents and/or sealants to reduce the lymphoceles formation. The mean age was 56.1 years. A negligible variability in study design and in results and complication reporting is common. The 6.45% of patients treated with haemostatic biomaterials developed lymphocele. The rate difference of lymphoceles formation and recurrence between patient groups treated with sealant than in the controls groups is small (6.45% vs 6.88%). CONCLUSIONS: The evidences presented in the examined studies are only preliminary and insufficient to draw significant conclusions. A major, multicentre, randomized controlled trial is strongly needed.

Comparison of Laparoscopic and Open Cystopexy in a Cadaveric Canine Model.

OBJECTIVE: To describe a technique for laparoscopic cystopexy using knotless barbed suture and to compare this technique with traditional cystopexy using standard suture in a cadaveric canine model. STUDY DESIGN: Cadaveric study. ANIMALS: Male canine cadavers (n = 12). METHODS: Cadavers were randomly assigned to 2 groups: laparoscopic (n = 6) and open (n = 6) cystopexy. Laparoscopic cystopexy was performed intracorporeally using barbed, glycomer 631 suture. Open cystopexy was performed using standard glycomer 631 suture. Pre- and postoperative positive contrast cystography was performed in all dogs. Cystopexy procedure time, length and adherence, as well as number of bladder mucosal suture penetrations were compared between groups. RESULTS: Mean ± SD cystopexy procedure time was 14.0 ± 3.0 minutes and 5.2 ± 0.5 minutes for the laparoscopic and open groups, respectively (P = .0007). Laparoscopic and open cystopexy lengths were 2.5 ± 0.4 and 2.4 ± 0.5 cm, respectively (P = .43). Partial suture pullout occurred in 1 dog in the laparoscopic group but subjective cystopexy adherence was adequate in all dogs. Bladder mucosal suture penetration occurred in 3 dogs in both groups (P = .86). Two of 6 cadavers with luminal suture penetration had minor contrast leakage on postoperative contrast cystography. Pre- and postoperative contrast cystography revealed appropriate bladder position in all cadavers. CONCLUSION: Laparoscopic cystopexy using knotless suture was comparable to an open cystopexy but was associated with a slightly longer procedure time and should be suitable for laparoscopic cystopexy in vivo.

Assessment of perioperative, early, and late postoperative complications of the inside-out transobturator tape procedure in the treatment of stress urinary incontinence..

OBJECTIVE: To evaluate the complications of urinary incontinence surgery with transobturator tape (TVT-O) system and to describe its diagnosis and management. MATERIALS AND METHODS: A total of 156 patients who were diagnosed as having stress incontinence and mixed incontinence with stress predominance underwent a TOT operation under spinal anesthesia by one surgeon or two surgeons (MB, AEY) from the team. TVT-obturator inside out material was used in the operation. Urodynamic tests and pad tests were done on all the patients. This is a prospective and retrospective study of the complications of TVT-O. The operation was performed under regional anesthesia, as described by Deval et al. Patients were excluded from the study if they had been operated under general or local anesthesia, had undergone any vaginal operations except for anterior repair (cystocele), wanted to have a baby, had severe systemic diseases or had been diagnosed as having urge incontinence in urodynamic tests. These situations may affect the rate of complications, the authors also excluded slings that had materials other than monofilament polypropylene, and patients who were suspected of having neurologic bladder conditions. The bladder and urethra were evaluated using cystoscopy. The durations of the TOT procedure, cystoscopy, and if performed, the cystocele operation, were recorded. Perioperative, early, and late postoperative complications were analyzed by follow-up visits (after two months to four years). RESULTS: Of the 156 patients included in the study, 100 (64.1%) had pure stress urinary incontinence and 56 (35.9%) had mixed incontinence, 20 (12.8%) had previous incontinence surgery. The mean duration of follow up was 30.3 ± 7.4 (range 17-42) months. The mean age of the patients was found to be 48.43 ± 6.24 years (range 42-68). The mean parity of the patients was 5.24 ± 2.86 (range 2-13), and mean body mass index was found to be 23.7 ± 4.8. Mean maximum detrusor pressure was 10.30 ± 4.08 and the mean ALP value was 80.80 ± 25.57. Mean operative time was found to be 13.8 ± 5.16 min in patients who underwent only TOT and TOT-anterior repair. Vaginal injury including to the lateral fornix (4.4%), hemorrhaging of more than 200 ml (3.2%), vascular damage (1.9%), hematoma on the leg (1.9%), hemorrhaging of more than 500 ml (0.064%), and bladder perforation (1.2%) were detected as perioperative complications. Urethral injury and perioperative nerve and intestinal injury did not occur. The most common complication in early postoperative period was inguinal pain extending the legs (30.7%), followed by headaches (23.7%), fever (12.8%), urinary tract infection (5.7%), and urinary retention (3.2%), respectively. Late postoperative complications included vaginal erosion (4.4%), de novo urge incontinence (8.9%), de novo dyspareunia (7.1%), perineal pain (4.4%), and worsening urgency (8.9%). CONCLUSION: Although the TVT-O technique is a minimal invasive surgery method applied to treat the urinary incontinence surgically, it does not imply that it is a complication-free surgical procedure. Despite the low incidence of intraoperative complications, there is a mild risk of early and late postoperative complications. Fortunately these complications can be taken under control by either conservative and simple medical treatments or surgical procedures.

Functional outcomes of polypropylene midurethral sling resection for treatment of mesh exposure/extrusion: Does it lead to a relapse of incontinence?

OBJECTIVES: The Burch colposuspension, which was regarded as the gold standard treatment for stress urinary incontinence for several years, has been replaced by minimally invasive sling devices. Although these procedures are simple and minimally invasive, they are associated with complications such as infection, mesh erosion, chronic pain, and de novo detrusor overactivity, which may necessitate surgical resection or tape removal. The aim of the study was to assess urinary function outcomes including continence, after partial resection of suburethral tapes. MATERIAL AND METHODS: Patients were admitted for resection of tape due to extrusion/exposure, between 2011 and 2014. Patients were evaluated with physical examination, transvaginal ultrasound, cough stress test, 24-hour bladder diary, Incontinence Impact Questionnairre-7 form and Urogenital Distress Inventory-6 form. RESULTS: Minimum follow-up time was 2 months after treatment of the tape complication (mean 20, range 2 to 38). Recurrence of incontinence after partial tape resection was observed in 9% (3/32) cases. In two patients due to stress urinary incontinence recurrence repeat anti-incontinence surgery was necessary. Although one patient had suffered from incontinence after resection of tape, she did not desire operation. CONCLUSIONS: The results of this study indicated that preservation of the anti-incontinence effects of slings might not be dependent on the intactness of the sling. Recurrence of incontinence after partial tape resection is uncommon and in the majority of cases this stress incontinence is minimally and does not require repeat operation.

Randomized controlled trial comparing two procedures for anterior vaginal wall prolapse.

OBJECTIVE: To compare success rates between anterior colporrhaphy and abdominal paravaginal defect repair for treatment of anterior vaginal wall prolapse. METHODS: This was a prospective randomized controlled trial comparing anterior colporrhaphy plus polyglactin 910 mesh (vaginal) to paravaginal defect repair (abdominal) in women with symptomatic anterior vaginal wall prolapse. Pelvic organ prolapse quantification staging (POP-Q), pelvic floor distress inventory, pelvic floor impact questionnaire, and pelvic organ prolapse/urinary incontinence sexual questionnaires were administered pre and post-operatively. Women were followed up to 2 years. The primary outcome was anterior POP-Q stage, with failure defined as ≥stage II. RESULTS: We enrolled 70 patients, 35 in each group. Demographic and most peri-operative characteristics were similar between the groups. Mean anterior vaginal wall prolapse repair time (39 min) was shorter for vaginal versus abdominal repair (60 min; P < 0.001), with more concurrent hysterectomies in the vaginal (71%) versus abdominal group (42%), P = 0.01. At 2 years, objective failure rates for the vaginal and abdominal groups were 32% and 40%, respectively, P = 0.56. Subjective failure rates were lower and similar for both groups. Patient satisfaction rates were 88% for the vaginal and 73% for the abdominal group, P = 0.11. Quality of life questionnaires showed significant improvement from baseline but no difference between the groups (P = 0.12). CONCLUSIONS: At 2 years follow-up, anterior colporrhaphy with polyglactin 910 mesh and abdominal paravaginal defect repair have similar success rates, with most objective failures being asymptomatic.