Leukoplakia of the bladder: a case report and literature review.

An 81-year-old woman presented with symptoms of recurrent urinary tract infections, urge incontinence and nocturia. Cystoscopy performed revealed a whitish plaque lesion on the fundus and right lateral wall of the bladder. The histology of the biopsy confirmed the diagnosis of leukoplakia vesicae of the bladder. The plan is to follow her up with repeat cystoscopy and biopsy in 6 months. The literature search revealed very little information on the pathogenesis and prognosis of this condition due to its rare occurrence. Analysis of the literature signifies the association of chronic irritation due to recurrent urinary tract infections being the commonest cause of leukoplakia vesicae. The recommended long-term follow-up and surveillance based on the literature review is by cystoscopy with or without biopsy.

Prospective study of the Perigee™ system for treatment of cystocele - our five-year experience.

OBJECTIVES: The Perigee™ transobturator cystocoele repair system (AMS) was designed and first used in Townsville, Australia. In this study, we are reporting our five-year experience with the Perigee™ system in the management of cystocoele stage III and above. METHODS: Women who underwent surgery with the Perigee™ system between March 2004 and June 2008 were reviewed. Women who consecutively presented to our clinic with a stage III cystocoele or above were given information regarding the Perigee™ mesh surgery. Those who consented were included in our study. The study involved a POPQ assessment pre- and post-operatively at six weeks, three months, six months, 12 months and subsequently biannually. RESULTS: A total of 376 women underwent surgery with the Perigee™ system between March 2004 and June 2008, of which 26 were lost to follow-up. The anatomical success rate for the device was 94.3%, and there were no life-threatening complications with the procedure. 39 (11.1%) of women were found to have small mesh extrusion through the vagina, and 20 (5.7%) had recurrence of stage II cystocoele. Of the subset of women analysed, 45.1% reported no sexual dysfunction, 40.9% reported improvement in sexual function, while 4.1% reported worsening of dyspareunia. CONCLUSION: In this five-year experience, the Perigee™ system is deemed safe with an acceptable recurrence risk rate and complication rate. Further randomised controlled trials comparing Perigee™ system with traditional anterior colporrhaphy should be performed to evaluate mesh-based surgery safety and efficacy for level one evidence.

Prospective study of the Perigee system for the management of cystocoeles--medium-term follow up.

OBJECTIVES: The Perigee transobturator cystocoele repair system (AMS) was designed and first used in Townsville, Australia. This prospective study evaluates the efficacy and safety of this device for the management of cystocoeles. METHODS: Patients who underwent surgery with the Perigee system between March 2004 and December 2005 were reviewed. Patients who consecutively presented to our clinic with a stage 3 cystocoele or above were given information regarding the Perigee mesh surgery. Those who consented were included in our study. The study involved a questionnaire and POPQ assessment pre- and postoperatively at six weeks, three months, six months, 12 months and subsequently biannually. RESULTS: A total of 70 patients underwent surgery with the Perigee system between March 2004 and December 2005. There were no life-threatening complications with the procedure. Five (7.1%) patients were found to have small mesh extrusion through the vagina, and three (4.28%) patients had recurrence of stage 2 cystocoele. DISCUSSION/CONCLUSION: On medium-term evaluation (18 to 36 months) of the Perigee system the results seem very encouraging. The morbidity is minimal, as is the recurrence and mesh extrusion rate.

Maternal urological problems in pregnancy.

Urological conditions in pregnancy represent a major diagnostic and therapeutic challenge. During pregnancy the urinary tract undergoes some anatomical and physiological changes that may result in many symptoms and pathological conditions affecting both the mother and fetus. With prompt evaluation and expeditious treatment, the prognosis is good. Fear of causing harm is unfounded. This article describes urological problems in pregnancy, specifically infection, calculus, renal failure, renal tumour, lower urinary tract symptoms and trauma and their management.

Sling distress: a subanalysis of the IVS tapes from the SUSPEND trial.

AIM: To study the incidence of erosions and tape infections following the use of intravaginal slingplasty (IVS) treatment for stress urinary incontinence after the SUSPEND trial period of 30 months. This subanalysis was carried out because of concerns regarding high percentage of delayed sling erosions and infections during follow up of the patients who participated in the trial. MATERIALS AND METHODS: The subanalysis patient group consisted of all IVS patients drawn from the SUSPEND randomised control trial that compared the safety and efficacy of three types of suburethral slings, TVT, SPARC and IVS, for the treatment of urodynamic stress incontinence. RESULTS: A total of 62 patients were reviewed during this study conducted from April 2002 to May 2003. Continence was achieved in 88% the patients. A total of eight (13%) sling erosions were found requiring sling removal. Forty-eight (77.4%) patients were followed up at 12 months with one case of erosion (1.7%). Twenty-nine (46.8%) of the 62 patients were followed up between 12 and 34 months, and seven cases of sling erosions were diagnosed. One patient had purulent suprapubic sinus, five patients had foul-smelling discharge, and one had recurrent urinary tract infection associated with pain and discharge. After the slings were removed the patients had no further symptoms. However, three of them had recurrent stress urinary incontinence. DISCUSSION/CONCLUSION: The delayed presentation of the sling erosion from this subanalysis is a concern, and pelvic reconstructive surgeons using IVS need to be aware of the delayed presentations we found in our cohort of patients.