Vaginoplasty: modified McIndoe using xenograft and a tailored 3D-printer mold.

INTRODUCTION AND HYPOTHESIS: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the congenital absence of the vagina with variable uterine development. Different methods have been reported for vaginoplasty treatment. The preferred vaginal approach to treating this condition is usually McIndoe vaginoplasty supported by regular dilatation of the neovagina. We present a case video of a McIndoe modified vaginoplasty technique with a heterologous graft using a covering customized 3D-printed mold, its postoperative follow-up and postoperative complications. METHODS: Video presentation of a McIndoe modified vaginoplasty technique using porcine intestinal submucosa performed in a 18-year-old woman diagnosed with MRKH syndrome. Different sizes of a polylactic acid mold were manufactured with 3D printers. After dissection of the recto-vesical space, a mold tailored in terms of length and width was chosen for this patient. RESULTS: After 13 days of follow-up, the patient presented graft infection and subsequent total graft detachment. However, the patient continued to use the vaginal dilator permanently. After 7 months, 8 cm vaginal length with 90% epithelialization and satisfactory sexual intercourse were achieved. CONCLUSION: Functional, histological and anatomical results were reached despite the graft detachment. New technologies such as 3D printing facilitate the development of techniques using tailored molds.

Transvesical laparoscopy for bladder leiomyoma excision: a novel surgical technique.

INTRODUCTION AND HYPOTHESIS: Leiomyomas of the urinary bladder are rare tumors. Submucosal leiomyomas, when small and easily accessible, can be treated with transurethral resection, while unfavorably positioned or larger leiomyomas may be treated through an abdominal approach. In these cases, a laparoscopic approach for intravesical surgery is an alternative that may be considered. We aim to demonstrate a novel transvesical laparoscopic approach to bladder leiomyoma excision with a video. METHODS: A 45-year-old woman with urinary symptoms and a 40-mm submucosal bladder leiomyoma located at the interureteric ridge was referred to our hospital (tertiary referral hospital). Due to the location and size of the leiomyoma, and to increase the probability of complete resection, a transvesical laparoscopic approach was decided. A step-by-step video is presented to describe the surgical technique. RESULTS: There were no intra- or postoperative complications. The patient was discharged 48 h after the surgery. At 60 months' follow-up, the patient remains asymptomatic. CONCLUSIONS: Transvesical laparoscopy may be considered for excision of bladder leiomyomas. This approach is feasible for trained surgeons as it requires a small working space.

Latin American consensus on uncomplicated recurrent urinary tract infection-2018.

An estimated 20-30% of adult women who experience an initial urinary tract infection (UTI) will have recurrent infection. In these patients, prophylaxis may be considered to improve their quality of life and control overuse of antibiotics. Despite this need, there is currently no Latin American consensus on the treatment and prophylaxis of recurrent UTIs. This consensus, signed by a panel of regional and international experts on UTI management, aims to address this need and is the first step toward a Latin American consensus on a number of urogynecological conditions. The panel agrees that antibiotics should be considered the primary treatment option for symptomatic UTI, taking into account local pathogen resistance patterns. Regarding prophylaxis, immunoactive therapy with the bacterial lysate OM-89 received a grade A recommendation and local estrogen in postmenopausal women grade B recommendation. Lower-grade recommendations include behavior modification and D-mannose; probiotics (Lactobacilli), cranberries, and hyaluronic acid (and derivatives) received limited recommendations; their use should be discussed with the patient. Though considered effective and receiving grade A recommendation, antimicrobial prophylaxis should be considered only following prophylaxis with effective non-antimicrobial measures that were not successful and chosen based on the frequency of sexual intercourse and local pathogen resistance patterns.

Long-term outcomes of transvaginal mesh (TVM) In patients with pelvic organ prolapse: A 5-year follow-up.

OBJECTIVE: The objective of this study was to evaluate the overall outcomes and complication rates of the transvaginal mesh (TVM) placed for the management of pelvic organ prolapse (POP) at 5-years follow up. STUDY DESIGN: Retrospective cohort study in Urogynecology section in a single center in Argentina. Patients with prolapse stage II or higher were included. Seventy-six patients had TVM surgery for POP and 72 (95%) were available for the 5-year follow-up period. RESULTS: The cure rate using the combined criteria (leading edge ≤0 according to Pelvic Organ Prolapse Quantification System (POP-Q), no bulge symptoms and no new treatment for prolapse) was 79.2% (57/72) (95% CI 68-88%). Only 5.5% (4/72) (95% CI 1.5-13.6) were re-operated for prolapse recurrence. Mesh exposure occurred in 16.6% of cases (n = 12; 95%CI 8.9-27.3). The incidence of de-novo dyspareunia was 13.3% (2/15) (95%CI 1-40) CONCLUSIONS: We observed that TVM is a durable treatment for prolapse and that adverse events were acceptable without severe complications at 5-year follow-up.