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.

A meta-analysis examining the use of fibrin glue mesh fixation versus suture mesh fixation in open inguinal hernia repair.

BACKGROUND: The aim of this study was to systematically analyze the randomized trials comparing fibrin glue mesh fixation with suture mesh fixation in open inguinal hernia repair. METHODS: Information was collected from a literature search using PubMed, Springer, Cochrane Library database and reference lists. The methodological quality of included publications was evaluated. Statistical analysis was performed using Review Manager Version 5.2.5 software. RESULTS: Nine articles were identified for inclusion: four randomized controlled trials (RCTs) and five prospective observational clinical studies. All the trials were considered to be of fair quality. The results showed that there was a lower incidence of chronic pain (RR 0.42, 95% CI 0.22-0.79, I(2) 11%; p < 0.01), and hematoma/seroma (RR 0.43, 95% CI 0.21-0.87, I(2) 0%; p < 0.05) in the fibrin glue mesh fixation group. However, the results of meta-analysis revealed that the incidence of recurrence or urinary problems between the two procedures were similar. CONCLUSIONS: During the 6-15 months follow-up, fibrin glue mesh fixation is a feasible alternative for mesh fixation with sutures in open inguinal hernia repair. However, the poor quality of the included trials limits the evidence; rigorously designed trials are warranted to confirm this conclusion.

Iatrogenic direct rectal injury: an unusual complication during suprapubic cystostomy (SPC) insertion and its laparoscopic management.

Suprapubic cystostomy (SPC) is commonly used, instead of indwelling urethral catheter- ization, as indicated in many pathological conditions. Although considered to be a safe procedure that can be easily performed in an outpatient basis several complications have been reported in international literature. Bowel injury can be a serious complication with the small intestine affected in the majority of cases. We present a case of an acci- dental rectal injury by a suprapubic catheter misplacement, in a 76 year old demented patient with prostatic hyperplasia and chronic urinary retention. The injury was confirmed by cystogra- phy and injection of contrast meterial through the suprapubic catheter, and successfully treated laparoscopically by an extraperitoneal approach. The patient was discharged after 10 days with- out any complications. The above method, in experienced hands, can be an effective primary treatment option for such rare but devastating complications. The case and management is unique as, to our knowledge, as no similar cases have been presented.

The efficacy of additive tolterodine extended release for 1-year in older men with storage symptoms and clinical benign proastatic hyperplasia.

AIM: To determine the efficacy of toterodine extended release (ER) treatment for 1 year in older men with benign prostatic hyperplasia (BPH) and storage symptoms treated with alpha-blockers and/or 5-alpha-reductase inhibitors (5ARI). METHODS: Men aged over 70 years with BPH/bladder outlet obstruction (BOO) and clinical storage symptoms were randomly treated with or without tolterodine ER in combination with alpha-blockers and/or 5ARI for 12 months. Among them, 50 patients (group 1) received additive tolterodine extended release (ER) 4 mg q.d., another 87 patients (group 2) did not. All patients had a baseline and 12th month post-treatment evaluation, which comprised of uroflowmetry, post-void residual (PVR) volume, International Prostate Symptom Score (IPSS), and quality of life index (QoL-I), transrectal ultrasound of the prostate and serum prostate specific antigen. RESULTS: One hundred thirty-seven of 153 enrolled patients with a mean age of 74.9 years completed the study. Treatment benefit demonstrated in both groups included deceased total, voiding and storage IPSS scores, increased peak urinary flow rate and deceased QoL-I. Inter-group difference was only observed on the storage domain of IPSS score (P = 0.012). The mean PVR after treatment did not significantly differ between two groups. Two patients of group 1 and three of group 2 developed acute urinary retention. Among group 1, six patients discontinued tolterodine ER for intolerable dry mouth; among group 2, three patients reported dizziness. CONCLUSIONS: This longer comparative study indicated that additive treatment with tolterodine ER in older men with BPH/BOO and significant storage symptoms is a beneficial and safe therapeutic option.

Biodegradable braided poly(lactic-co-glycolic acid) urethral stent combined with dutasteride in the treatment of acute urinary retention due to benign prostatic enlargement: a pilot study.

OBJECTIVE: To evaluate, in a pilot study, the efficacy and safety of combining a braided poly(lactic-co-glycolic acid) (PLGA, a copolymer of l-lactide and glycolide) urethral stent and dutasteride in the treatment of acute urinary retention (AUR) due to benign prostatic enlargement (BPE). PATIENTS AND METHODS: Ten men with AUR due to BPE were treated as outpatients. A biodegradable braided PLGA urethral stent was inserted into the prostatic urethra, using a specially designed insertion device under visual control. Dutasteride treatment was started and the patients were followed up for 3 months after insertion of the stents. RESULTS: In all patients the stents were placed successfully with the new insertion device. All men were able to void after inserting the stent. At 1 month five patients voided freely with a low residual urine volume (<150 mL), two voided but had a high residual urine volume and a suprapubic catheter was placed, and three needed a suprapubic or an indwelling catheter before 1 month, due to AUR or comorbidities. At 3 months five patients were voiding with no problems. CONCLUSIONS: We have developed a new and effective insertion device for biodegradable braided prostatic stents. The new braided-pattern stent overcomes the earlier problems of migration and sudden breakage into large particles associated with biodegradable spiral stents. However, the mechanical properties of the new stent need to be improved and tested in a longer follow-up. We consider that this new biodegradable braided-pattern urethral stent could provide a new option in the future treatment of AUR.

Efficacy and safety of solifenacin succinate in Korean patients with overactive bladder: a randomised, prospective, double-blind, multicentre study.

PURPOSE: We assessed the efficacy and safety of solifenacin compared with tolterodine for treatment of overactive bladder (OAB) in Korean patients. MATERIALS AND METHODS: The study was randomised, double-blind, tolterodine-controlled trial in Korea. Patients had average frequency of >or= 8 voids per 24 h and episodes of urgency or urgency incontinence >or= 3 during 3-day voiding diary period. Patients were randomised to 12-week double-blind treatment with either tolterodine immediate release (IR) 2 mg twice daily (TOL4) or solifenacin 5 mg (SOL5) or 10 mg (SOL10) once daily. The outcome measure was mean change in daily micturition frequency, volume, daily frequency of urgency incontinence, urgency and nocturia from baseline to week 12. Quality of life was assessed using the King's Health Questionnaire. RESULTS: A total of 357 were randomised and 329 were evaluated for efficacy. All voiding parameters recorded in micturition diary improved after treatment in all three groups. Mean changes in volume voided were 19.30 ml (26.69%) in TOL4, 30.37 ml (25.89%) in SOL5 and 37.12 ml (33.36%) in SOL10 group (p = 0.03). Speed of onset of SOL10 efficacy on urgency incontinence was faster than that of SOL5 and TOL4. Quality of life improved in all three groups. Dry mouth was the most common adverse event; its incidence was the lowest in SOL5 group (7.63%, compared with 19.49% and 18.64% in SOL10 and TOL4 groups respectively). CONCLUSIONS: Solifenacin succinate 5 and 10 mg once daily improve OAB symptoms with acceptable tolerability levels compared with tolterodine IR 4 mg. Solifenacin 5 mg is a recommended starting dose in Korean patients with OAB.

Comparing vaginal tape and transobturator tape for the treatment of mild and moderate stress incontinence.

OBJECTIVE: To compare the efficacy and safety of the tension-free vaginal tape (TVT) and transobturator suburethral tape (TVT-O) procedures for the treatment of mild and moderate stress urinary incontinence (SUI). METHODS: A total of 56 women were randomly selected to undergo the TVT-O or the TVT procedure. In some patients, vaginal repair or vaginal hysterectomy was done simultaneously for associated indications. RESULTS: Mean blood loss and hospital stay duration were the same for the 2 groups, but mean +/- SD operative time was significantly shorter in the TVT-O than in the TVT group (16+/-4 min vs 27+/-6 min; P<0.001). On the second day following surgery a residual urine volume less than 100 mL was noted in 86% and 89% of the patients in the TVT-O and TVT groups, respectively; cure was achieved in 92.9% and 92.6% of the patients. No serious complications occurred in either group. Outcome was subjectively assessed, with the patients followed-up for a mean of 27.6 months. CONCLUSION: No significant differences in rates of cure, postoperative urine retention, or operative complications were found following the TVT-O or the TVT procedure.

Symptomatic pile tailored procedure. A new perspective for hemorrhoidal disease treatment.

AIM: Aim of the present paper was to evaluate the role of tailored different single pile treatment in the clinical outcome of hemorrhoids. MATERIAL OF STUDY: The surgical strategy considered to treat only pathological piles with different procedure according to each pathological Goligher's degree, presence of fibrous, inelastic redundant internal pile(F) and presence of external pathological pile (external pile congestion or subversion of dental line (E) and skin tag not tolerated from the patient (S)). We treated with Hemorrhoidopexy second and third degree pile without F or ES; with Hemorrhoidopexy and excision of external component every second and third degree pile with E or S and with complete semi-closed pile excision all third degree with F and IV degree piles. The number of post operative days of self administered analgesics was the primary end point and short/long term post operative complications, hospital stay, re-admission and recurrence were secondary end points. RESULTS: 157 patients were treated. No differences were noted in term of time of discharge between hemorrhoidopexy and complete or external excision. The painkiller assumption increases with the number of treated pile (r= 0.227, p=0.006). We observed 10.2% early complications (48h) all secondary to urinary retention and 7% late complications (2-15days) within only one reoperation for bleeding. After mean follow up of 16 months no patients required further treatments for hemorrhoids. DISCUSSIONS: A tailored approach showed to be effective in terms of short and long term complications and moreover to relapse. CONCLUSIONS: Single pile tailored treatment showed good results. KEY WORDS: Excision, Hemorrhoids, Hemorrhoidectomy, Hemorrhoidopexy, Pain, Tailored.

Double Tension Adjustments with Novel Modification on Tension-Free Vaginal Tape.

OBJECTIVE: To evaluate the results of novel modifications on tension- free vaginal tape (TVT) for the treatment of women with stress urinary incontinence (SUI). MATERIALS AND METHODS: Sixteen female patients (average age 49.29 years, range: 31-78) who underwent anti-incontinence surgery to correct their SUI in the period between June 2010 and August 2014 were included in the study. In situ anterior vaginal wall sling was prepared, and monofilament polypropylene tape passed below the in situ-sling and standard TVT procedure was performed. Both ends of the mesh in the suprapubic region were labeled with Vicryl sutures and left outside the wound. The middle of the mesh in the vaginal region were labeled with similar suture and left outside the vagina. Foley catheter was removed on the third postoperative day. The average period of follow-up was 8 months (range: 5-17). RESULTS: All patients benefited from the surgery; 15 (94%) of them completely cured and one patient clinically improved. Urinary retention was observed in one patient where the tension of the tape was reduced using adjustment sutures. No vaginal mesh erosion was detected during the gynecological examination postoperatively. No significant post-voiding residue was detected after catheter removal. CONCLUSION: This technique gives feasible option to adjust the tension of the mesh in the early post-operative period in case of urinary retention. Presence of intervening in situ sling reduces the risk of vaginal erosions. Long-term success is expected because dislocation of the mid-urethral sling is less likely.

Pubovaginal sling using polypropylene mesh and Vesica bone anchors.

OBJECTIVES: To report preliminary results from a modified pubovaginal sling procedure using polypropylene mesh as the sling suspended by nonabsorbable sutures anchored to the pubic tubercle with Vesica bone anchors. METHODS: Thirty-five women with type III stress urinary incontinence (SUI) (with or without associated urethral hypermobility) or type II SUI with additional risk factors such as obesity, chronic obstructive pulmonary disease, or failed prior incontinence-correcting procedures underwent this modified pubovaginal sling procedure. Postoperative voiding status was evaluated during office follow-up visits and telephone surveys. RESULTS: With a mean follow-up of 8.4 months (range 2 to 18), 32 women (91.4%) were dry, 1 improved, and 2 remained incontinent. The pubovaginal sling procedure was the only operation performed in 46% of patients, with a mean operative time of 72 minutes, a mean estimated blood loss of 137 mL, and a mean hospital period of 2.3 days. Patients on whom concomitant gynecologic procedures were performed had a mean duration of surgery of 122 minutes, a mean estimated blood loss of 202 mL, and a mean hospitalization period of 2.9 days. Thirteen women had preoperative urgency that persisted in 31% of patients. De novo urgency developed in 3 patients. Seven women required prolonged suprapubic tube drainage but no patient remained in permanent retention. There has been no infection or erosion. CONCLUSIONS: Our experience with this modified pubovaginal sling procedure using polypropylene mesh and Vesica bone anchors showed excellent results with greater technical ease, minimal morbidity, and decreased hospitalization period when compared to a traditional pubovaginal sling performed in our hands. Additional follow-up will be needed to assess long-term efficacy.

Interstitial laser coagulation and biodegradable self-expandable, self-reinforced poly-L-lactic and poly-L-glycolic copolymer spiral stent in the treatment of benign prostatic enlargement.

BACKGROUND AND PURPOSE: Interstitial laser coagulation of the prostate (ILCP) induces necrosis, edema, and an increased risk of postoperative urinary retention. The object here was to evaluate the efficacy, safety, and utility of a new self-expandable self-reinforced (SR) PLGA copolymer(lactic:glycolic ratio 80/20) spiral stent inserted after ILCP to promote voiding. The SR-PLGA stent has a degradation time of 2 to 2.5 months. PATIENTS AND METHODS: Fifty men with a mean age of 70.5 years (range 52-85 years), suffering from lower urinary tract symptoms secondary to benign prostatic enlargement underwent ILCP. A suprapubic catheter was inserted, ILCP performed, and an SR-PLGA 80/20 spiral stent inserted on completion of the operation. The suprapubic catheter was removed when voiding commenced. As prophylactic antibiotic, ciprofloxacin was used in a single dose before ILCP, followed by trimethoprim or nitrofurantoin for 2 weeks. RESULTS: All except three patients started to void on the first postoperative day. In two of the three cases, the stent had moved proximally and had to be relocated, whereafter voiding succeeded. The mean maximum and average flow rates increased, while DAN-PSS-1 symptom score and post voiding residual urine volume decreased statistically significantly. At 2 months, the stent was still intact in the urethra in all except three patients. At 4 months, it had been degraded into small fragments, and at 6 months, it had been completely eliminated. The only exceptions were three patients with an uncalcified piece of the stent in the bladder. Half of the patients had irritative symptoms caused at least partly by ILCP itself; 10% had asymptomatic urinary infection postoperatively. CONCLUSIONS: The self-expandable SR-PLGA copolymer stent is safe and highly biocompatible. It ensures voiding in the case of temporary obstruction caused by prostatic edema. The degradation time is long enough in all patients to cover the need for postprocedure urinary drainage.

Is postoperative intensive care monitoring necessary after uvulopalatopharyngoplasty?

We conducted a retrospective review of 347 consecutive patients who underwent surgical treatment for obstructive sleep apnea syndrome. We analyzed perioperative data to identify the nature and rate of complications in an attempt to determine whether intensive care unit monitoring is needed after uvulopalatopharyngoplasty (UPPP) and associated procedures including septoplasty, tonsillectomy, turbinate reduction, geniohyoid advancement, and tracheostomy. In the 347 cases, 14 complications occurred (4%), including 5 involving the airway, 5 postoperative hemorrhages, and 4 complications classed as "other," including dehiscence of a tracheostomy flap, abdominal ileus, urine retention, and increased creatinine concentration. We found no difference between preoperative lowest oxygen saturation and oxygen-saturation readings in the postoperative period and no correlation between complication rate and apnea severity. An association was detected between multiple simultaneous procedures and the development of complications: 50% of the patients in whom complications developed had undergone nasal procedures along with UPPP, compared with only 15% of the patients without complications. Except for one patient, all complications that occurred on the surgical ward were treated without transfer to the intensive care unit. Although surgery on the upper airway must be performed with caution in patients with sleep apnea, our findings suggest that UPPP is a safe procedure and that postoperative monitoring in an intensive care setting is not necessary for most patients.

The use of intraurethral prostatic spiral in high risk patients for surgery with benign prostatic hyperplasia.

Under local anaesthesia, 31 patients underwent insertion of an expandable stainless steel tubular spiral into the prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. Most of them had long-term indwelling urethral catheters (14 patients). The spiral allowed unobstructed voiding and is a good alternative to an indwelling urethral catheter. We recommend insertion of a spiral in patients with urinary obstruction if they are unfit for surgery.

[Clinical efficacy of the Porges Urospiral, a reversible intraprostatic spiral stent, in patients with benign prostatic hypertrophy].

The Porges Urospiral, a urethral spiral stent made of stainless steel wire, is designed for patients with benign prostatic hypertrophy. To evaluate the safety and efficacy of the stent, a prospective uncontrolled study was performed on 60 patients who complained of urinary retention (48 patients) or severe dysuria (12 patients) due to prostatic hypertrophy. Four patients had neurogenic disorders resulting in bladder dysfunction. The average age of the patients was 77.4 years old, ranging from 61 to 91 years old. In 48 patients, the stent was used instead of transurethral resection of the prostate (TUR-P) because of the patients poor general conditions, while in 12 patients the stent was transiently used until TUR-P. Subjective symptoms, according to an original scoring system, and objective signs, uroflowmetry measurements and residual urine volume, before and 3 months after stent insertion were compared. The stent was indwelt for more than 3 months in 40 of the 57 patients in whom the stent could be inserted. Out of 37 evaluable patients, subjective symptoms improved in all the patients and objective symptoms improved in 26 patients (70.3%). Complications included urinary incontinence, urination pain, urethral pain, gross hematuria or migration of the stent. Although these complications disappeared in a few days after the insertion of the stent in a majority of the patients, the stent was removed in 17 patients due to complications within 3 months after insertion. The overall clinical efficacy of this stent was 56% in 50 evaluable patients who had no neurogenic disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

[Urinary retention secondary to surgical treatment of stress urinary incontinence]. / Retención urinaria secundaria al tratamiento quirúrgico de incontinencia urinaria de esfuerzo.

A retrospective, descriptive study at the National Institute of Perinatology (INPer), was carried out. 401 records of patients with stress urinary incontinence who underwent surgical treatment, were reviewed. The objective of this study was to know the urinary retention rate. Urinary retention was present in 103 of 401 patients (25.68%). In modified Pereyra's procedure it was present in 67 of 195 (34.35%); in modified Burch's procedure, in 25 of 131 (19.08%); in Kelly's procedure in 9 of 70 (12.85%) and in 2 of 5 patients with sling procedure with polytetrafluoroethylene (Goretex). The problem of urinary retention was observed more frequently in vaginal surgery (modified Pereyra procedure and/or sling procedure).

Trans-Obturator-Tape (T.O.T.) "outside-in" approach in surgical treatment of female stress urinary incontinence.

OBJECTIVE: The aim of the study was to analyzed the efficacy and safety of a minimally invasive surgical procedure using the Trans- Obturator-Tape with "outside-in" approach for treatment female stress urinary incontinence. PATIENTS AND METHODS: 171 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2014). 27 patients were previously operated for incontinence. Mean age was 59 years (37-80). 6 patients were having mixed incontinence, and 51 had SUI with urgencies. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. RESULTS: Mean follow-up was 22 months (4-45). At 12 months follow-up 91,2% of the patients were completely cured. The overall peri-operative complication rate was 6.4% with no vascular, nerve or bowel injury. 5 patients (2.9%) had post-operative urinary retention. CONCLUSION: The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

Use of autologous rectus fascia in a new transobturator hybrid sling for treatment of female stress urinary incontinence: a pilot study.

OBJECTIVE: This article reports the early results of a novel sling used for the treatment of female stress urinary incontinence (SUI). This sling has a piece of autologous rectus fascia in its middle part and two arms of polypropylene mesh. MATERIAL AND METHODS: The study included 44 women with SUI. The preoperative work-up involved complete history taking, physical examination, cough stress test (CST) and 1 h pad weight test (PWT). Two questionnaires, the Urogenital Distress Inventory - Short Form (UDI-6) and the Incontinence Impact Questionnaire - Short Form (IIQ-7), were also completed preoperatively. The previously described sling was then inserted via the transobturator route in all patients. Postoperatively, the previous work-up was repeated for objective evaluation of the procedure and the subjective improvement was assessed by the Patient Global Impression of Improvement scale. RESULTS: At the end of the first year, 92.9% of the patients had a negative CST, 85.7% had 1 h PWT <1 g and the subjective cure rate was 90.5%. In addition, the scores for both UDI-6 and IIQ-7 were found to be decreased significantly (p < 0.001). The recorded complications included temporary urinary retention, dyspareunia, de novo urge incontinence and groin pain in 4.8%, 4.8%, 7.1% and 11.9% of patients, respectively. CONCLUSION: This hybrid sling appears to have good short-term efficacy and low cost.

Late-onset allergic reaction to povidone-iodine resulting in vulvar edema and urinary retention.

BACKGROUND: Povidone-iodine, a surgical antiseptic, is associated with adverse side effects ranging from minor skin irritation to anaphylaxis, with symptoms occurring within minutes and up to 8 hours after contact. CASE: We report a case of a patient, with no history of allergy to povidone-iodine, who developed an allergic reaction 24 hours after intraoperative exposure to povidone-iodine, presenting with acute urinary retention secondary to extensive vulvar edema, which resolved after administration of antihistamines. CONCLUSION: Allergic reactions to povidone-iodine can be late in onset and, in vaginal surgeries, may present with atypical symptoms such as acute urinary retention secondary to vulvar edema. Prompt diagnosis and effective treatment requires strong clinical suspicion in patients presenting postoperatively with a known history of exposure.

Open preperitoneal mesh repair of recurrent inguinal hernia.

PURPOSE: To determine the outcome of open preperitoneal mesh repair of recurrent inguinal hernia. METHODS: A prospective study included 45 consecutive male patients with unilateral recurrent inguinal hernias which were repaired using a polypropylene mesh (15 × 15 cm) placed in the preperitoneal space and anchored by several sutures. RESULTS: All postoperative complications were minor. There were two superficial wound infections, one seroma, two hematomas, and two cases of urine retention. Follow-up was completed for all patients for a mean of 31.3 ± 10.8 months. No recurrences were found. One patient developed hydrocele of the distal hernial sac. None of the patients developed testicular atrophy, vaginal hydrocele, or chronic residual neuralgia. CONCLUSION: Open preperitoneal mesh repair for recurrent inguinal hernia has a low complication rate and is highly effective in preventing re-recurrence. It is easy to learn and should be the general surgeons' procedure of choice for recurrent inguinal hernia repair.