Long-term outcomes of primary cystocele repair by transvaginal mesh surgery versus laparoscopic mesh sacropexy: extended follow up of the PROSPERE multicentre randomised trial.

OBJECTIVE: To compare the effectiveness and safety of laparoscopic sacropexy (LS) and transvaginal mesh (TVM) at 4 years. DESIGN: Extended follow up of a randomised trial. SETTING: Eleven centres. POPULATION: Women with cystocele stage ≥2 (pelvic organ prolapse quantification [POP-Q], aged 45-75 years without previous prolapse surgery. METHODS: Synthetic non-absorbable mesh placed in the vesicovaginal space and sutured to the promontory (LS) or maintained by arms through pelvic ligaments and/or muscles (TVM). MAIN OUTCOME MEASURES: Functional outcomes (pelvic floor distress inventory [PFDI-20] as primary outcome); anatomical assessment (POP-Q), composite outcome of success; re-interventions for complications. RESULTS: A total of 220 out of 262 randomised patients have been followed at 4 years. PFDI-20 significantly improved in both groups and was better (but below the minimal clinically important difference) after LS (mean difference -7.2 points; 95% CI -14.0 to -0.05; P = 0.029). The improvement in quality of life and the success rate (LS 70%, 61-81% versus TVM 71%, 62-81%; hazard ratio 0.92, 95% CI 0.55-1.54; P = 0.75) were similar. POP-Q measurements did not differ, except for point C (LS -57 mm versus TVM -48 mm, P = 0.0093). The grade III or higher complication rate was lower after LS (2%, 0-4.7%) than after TVM (8.7%, 3.4-13.7%; hazard ratio 4.6, 95% CI 1.007-21.0, P = 0.049)). CONCLUSIONS: Both techniques provided improvement and similar success rates. LS had a better benefit-harm balance with fewer re-interventions due to complications. TVM remains an option when LS is not feasible. TWEETABLE ABSTRACT: At 4 years, Laparoscopic Sacropexy (LS) had a better benefit-harm balance with fewer re-interventions due to complications than Trans-Vaginal Mesh (TVM).

Complications after pelvic floor repair surgery (with and without mesh): short-term incidence after 1873 inclusions in the French VIGI-MESH registry.

OBJECTIVE: To assess the short-term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse. DESIGN: Prospective longitudinal cohort study using a surgical registry. SETTING: Thirteen public hospitals in France. POPULATION: A cohort of 1873 women undergoing surgery between February 2017 and August 2018. METHODS: Preliminary analysis of serious complications after a mean follow-up of 7 months (0-18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals' information systems. MAIN OUTCOME MEASURES: Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life-threatening complication requiring resuscitation, or death. RESULTS: Fifty-two women (2.8%, 95% CI 2.1-3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow-up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7-2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1-1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2-1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0-5.0%) after MUS alone, 7.0% (2.8-11.3%) after MUS with prolapse surgery, 1.7% (0.0-3.8%) after vaginal native tissue repair, 2.8% (0.9-4.6%) after transvaginal mesh, and 1.0% (0.1-1.9%) after laparoscopy with mesh. CONCLUSIONS: Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long-term risk associated with mesh use and to identify its risk factors. TWEETABLE ABSTRACT: Short-term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.

Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 5-year prospective follow-up study.

INTRODUCTION AND HYPOTHESIS: To evaluate clinical effectiveness and complication rates at 5 years following the total Trans Vaginal Mesh (TVM) technique to treat pelvic organ prolapse. METHODS: Prospective, observational, multi-centre study in patients with prolapse of stage II or higher. RESULTS: Of the 90 women enrolled in the study, 82 (91%) were available for the 5-year follow-up period. At the 5-year endpoint, success, defined as no surgical prolapse reintervention and leading edge <-1 (International Continence Society [ICS] criteria) or above the level of the hymen, was 79% and 87% respectively. A composite criterion of success defined as: leading edge above the hymen (<0) and no bulge symptoms and no reintervention for prolapse was met by 90%, 88% and 84% at the 1-, 3-, and 5-year endpoints respectively. Quality of life improvement was sustained over the 5 years. Over the 5-year follow-up period, a total of only 4 patients (5%) required re-intervention for prolapse, while a total of 14 patients (16%) experienced mesh exposure for which 8 resections needed to be performed. Seven exposures were still ongoing at the 5-year endpoint, all asymptomatic. Only 33 out of 61 (54%) sexually active patients at baseline remained so at 5 years. De novo dyspareunia was reported by 10%, but no new cases at the 5-year endpoint. One patient reported de novo unprovoked mild pelvic pain at 5 years, 5 reported pains during pelvic examination only. CONCLUSIONS: Five-year results indicated that TVM provided a stable anatomical repair. Improvements in QOL and associated improvements in prolapse-specific symptoms were sustained. Minimal new morbidity emerged between the 1- and 5-year follow-up.

[The place of lumo-aortic and pelvic lymph node dissection in the treatment of ovarian cancer]. / Place du curage lombo-aortique et pelvien dans les cancers épithéliaux de l'ovaire.

Ovarian cancer often invades regional lymph nodes but the patterns of involvement are variable; spread to para-aortic and pelvic lymph nodes can be unilateral, contralateral or bilateral. For staging purposes, complete lymph node dissection seems more reasonable and effective than simple lymph node sampling. In early stage disease, lymph node dissection has both diagnostic and therapeutic value allowing identification and optimal management of Stage IIIc tumors with retroperitoneal spread; it may also have direct therapeutic value by removing retroperitoneal micrometastatic disease including cell clones which may be resistant to chemotherapy. Therefore, complete lymph node dissection is recommended in early-stage disease with the exception of stage I mucinous ovarian cancer. In advanced-stage disease, lymph node involvement is an additional factor of poor prognosis correlating with increased tumor aggressivity. Optimal debulking resection of all visible tumor offers the best chance for a prolonged disease-free interval if patient condition permits and morbidity can be limited. Survival benefit for complete lymph node dissection has not been evaluated by randomized controlled trials; but several non-randomized studies and two long-term prospective trials have shown objective improvement in disease-free survival and improved quality of life when debulking surgery leaves no residual tumor larger than 1 cm.

[Not Available]. / Place du curage lombo-aortique et pelvien dans les cancers épithéliaux de l'ovaire.

D. Salet-Lizée, S. Alsary Ovarian cancer often invades regional lymph nodes but the patterns of involvement are variable; spread to para-aortic and pelvic lymph nodes can be unilateral, contralateral or bilateral. For staging purposes, complete lymph node dissection seems more reasonable and effective than simple lymph node sampling. In early stage disease, lymph node dissection has both diagnostic and therapeutic value allowing identification and optimal management of Stage IIIc tumors with retroperitoneal spread; it may also have direct therapeutic value by removing retroperitoneal micrometastatic disease including cell clones which may be resistant to chemotherapy. Therefore, complete lymph node dissection is recommended in early-stage disease with the exception of stage I mucinous ovarian cancer. In advanced-stage disease, lymph node involvement is an additional factor of poor prognosis correlating with increased tumor aggressivity. Optimal debulking resection of all visible tumor offers the best chance for a prolonged disease-free interval if patient condition permits and morbidity can be limited. Survival benefit for complete lymph node dissection has not been evaluated by randomized controlled trials; but several non-randomized studies and two long-term prospective trials have shown objective improvement in disease-free survival and improved quality of life when debulking surgery leaves no residual tumor larger than 1 cm.

[Not Available]. / Place du curage lombo-aortique et pelvien dans les cancers épithéliaux de l'ovaire.

D. Salet-Lizée, S. Alsary Ovarian cancer often invades regional lymph nodes but the patterns of involvement are variable; spread to para-aortic and pelvic lymph nodes can be unilateral, contralateral or bilateral. For staging purposes, complete lymph node dissection seems more reasonable and effective than simple lymph node sampling. In early stage disease, lymph node dissection has both diagnostic and therapeutic value allowing identification and optimal management of Stage IIIc tumors with retroperitoneal spread; it may also have direct therapeutic value by removing retroperitoneal micrometastatic disease including cell clones which may be resistant to chemotherapy. Therefore, complete lymph node dissection is recommended in early-stage disease with the exception of stage I mucinous ovarian cancer. In advanced-stage disease, lymph node involvement is an additional factor of poor prognosis correlating with increased tumor aggressivity. Optimal debulking resection of all visible tumor offers the best chance for a prolonged disease-free interval if patient condition permits and morbidity can be limited. Survival benefit for complete lymph node dissection has not been evaluated by randomized controlled trials; but several non-randomized studies and two long-term prospective trials have shown objective improvement in disease-free survival and improved quality of life when debulking surgery leaves no residual tumor larger than 1 cm.

[TVT-O treatment of stress urinary incontinence: immediate and one-year results]. / Traitement de l'incontinence urinaire d'effort par bandelette TVT-O: résultats immédiats et à un an.

OBJECTIVE: To compare one-year results between the classic retropupubic (TVT) and the in-out transobturator approaches (TVT-O) of tension-free vaginal tape for the treatment of stress urinary incontinence (SUI). PATIENTS AND METHODS: The first 82 patients operated for SUI by TVT-O in our institution were included in the analysis. Patients were evaluated at 1 and 12 months. The global satisfaction rate was assessed at 12 months by a self-reported questionnaire. Results were compared to those of the first 124 patients operated of SUI by TVT in the same institution and by the same surgeons between 1996 and 1999. RESULTS: Except a younger mean age in the TVT-O group (57 versus 60 years), no other preoperative parameter was significantly different between the TVT and the TVT-O groups. The mean operating time was shorter in the TVT-O group (15 versus 30 minutes, P<0.001). No intraoperative complication occurred. The rate of bladder perforation was significantly lower in the TVT-O group (0 versus 8.8%, P=0.004). The rate of post-voiding residual less than 100 ml was higher in the TVT-O group (88 versus 61%, P<0.001). In the TVT-O group, 40% of patients had postoperative inguinal pain (mean=9 days, range 2-15 days). After 12 months from TVT-O, 85% of patients were completely dry, 6% had de novo over bladder activity, and 93.5% of patients were satisfied with the treatment they received. The 12-month results were not significantly different between the TVT and the TVT-O groups. DISCUSSION AND CONCLUSION: With a follow-up of 12 months, TVT-O is as efficient as TVT and has a lower risk of bladder injury, a cut by half operating time, and less postoperative dysuria.

[Urogynecology pelvic organ prolapse French surgical training during and after residency]. / Formation des internes et jeunes assistants de gynécologie-obstétrique en statique pelvienne en France.

OBJECTIVES: For the treatment of prolapse, the vaginal route is less standardized than laparoscopy and seems abandoned by younger doctors. Our objectives were to evaluate the surgical experience of resident and youth gynecology and obstetrics assistants in pelviperineology and the level of confidence and mastery of the different surgical treatment of pelvic. METHODS: An anonymous questionnaire sent via an Internet platform interviewing residents and young assistants of gynecology and obstetrics (promotion 2005 to 2010) in France on their surgical training in pelviperineology. RESULTS: Twenty-nine percent (208/724) of the persons contacted responded with two thirds of residents and one third of young assistants, all regions of France were represented. Sixty-four percent of respondents wanted to favor a surgical career. The laparoscopic sacrocolpopexy was declared to be the best method mastered while residents and young assistants reported being more often leading operator in vaginal techniques during their medical training. CONCLUSION: Surgical practice during medical training of resident and young assistants did not seem associated with declared mastery level of technique. Different clinical surgical practice training techniques such as simulation, cadaveric study, movies on surgical technics may also improve the level of confidence and mastery of young doctors for surgical techniques.

[Endometrial choriocarcinoma in peri-menopausal women]. / Choriocarcinome utérin en péri-ménopause.

We report a case of a primary uterine choriocarcinoma associated with adenocarcinoma occurring during peri-menopausal age, and review the literature. The clinical course and the histopathology of the case were reviewed and a Medline literature search for other cases was performed. BHCG and analysis of uterine curettage provided the diagnosis of choriocarcinoma. Polychemotherapy, started immediately after the patient's clinical condition deteriorated, was successful. Colpohysterectomy and pelvic lymphadenectomy were performed 5 months later. Treatment was completed by vaginal curietherapy. Histopathologic examination of the surgical specimen revealed only adenocarcinoma. The patient was followed for 18 months without evidence of recurrence. The literature search revealed that primary forms are exceptional; the etiology is unknown. Treatment is based on polychemotherapy. Primary choriocarcinomas are rare tumours, associated with other histopathological forms. We document a case occurring during the peri-menopausal period and review the literature on this pathology. The very poor prognosis in the past has changed with early polychemotherapy.

[Clinical management of non palpable breast lesions: experience about a series of 176 consecutive cases]. / Prise en charge des lésions infracliniques du sein : expérience à propos de 176 cas consécutifs.

OBJECTIVE: To propose a rational attitude to treat infraclinic breast lesions about a 176-case retrospective analysis. PATIENTS AND METHODS: Between January and December 2000, 176 patients were addressed for an infraclinic breast lesion. The epidemiologic and mammographic data, diagnostic management and histological results were collected. RESULTS: Patients were addressed for an ACR 2 lesion in 0.8% of cases, ACR 3: 34.8%, ACR 4: 43.2% and ACR 5: 21.2%. One hundred and sixteen patients underwent a stereotactic macrobiopsy: 55 Advanced Breast Biopsy Instrumentation (ABBI), 61 Minimal Invasive Breast Biopsy (MIBB). Histologically, 59.5% were benign, 33.6% malignant, 2.6% borderline and 4.3% suspicious or non contributive. Forty-two patients underwent an open surgical biopsy. Histologically 56.1% were benign, 41.5% malignant and 2.4% borderline. Eighteen patients were controlled by mammography. Among ACR 3s there were 90% of benign lesions and 46% of malignancy in ACR 4s. Patients with malignant, borderline or suspicious result in stereotactic biopsy, underwent one-time surgery in 97% vs 55% in surgical biopsy (P < 0.0001). DISCUSSION AND CONCLUSION: Infraclinic breast lesions must be radiologically classified with the ACR classification. Stereotactic macrobiopsies are reserved for ACR 4 and ACR 5 lesions. Because of their reliability, practice of macrobiopsies avoids surgery in about 50% of ACR 4 lesions which correspond to benign lesions. When the result is malignant, it allows most of times surgical procedure one-time.

[Abdominal approach of rectocele and colpocele]. / Approache abdominale des rectocèles et des élytrocèles.

The authors report a series of 62 female patients operated for rectocele and/or elytrocele via an abdominal approach. The technique was based on insertion of a retrovaginal prosthesis attached to the sacrum. Other surgical procedures can be performed at the same operation: hysterectomy, insertion of a prevaginal prosthesis, retropubic colpopexy. The anatomical and functional results were excellent in these patients previously operated for urinary incontinence or prolapse (99%). The indication for total hysterectomy during the same operation must be limited as this procedure increases the morbidity and impairs the functional results. Dyschexia is improved, but may be followed by postoperative constipation. Abdominal treatment of rectoceles and/or elytroceles by interposition of an interrectovaginal prosthesis attached to the sacrum is particularly indicated after hysterectomy in the case of associated or recurrent genitourinary prolapse.

[The reliability of study methods of the endometrium. A comparative study of 178 patients]. / Fiabilité des méthodes d'exploration de l'endomètre. Etude comparative chez 178 patientes.

OBJECTIVE: To compare the reliability of different methods for investigating the endometrium. DESIGN: A prospective study from November 1990 to October 1991. SETTING: Department of surgery and gynaecology Diaconesses Hospital, Paris. SUBJECTS AND INTERVENTIONS: In a total of 178 symptomatic patients, hysteroscopy with curettage in a day-centre under general anesthesia was performed. Before this operation, 79 women had had endometrial cytology, 98 women had had endometrial biopsy with the endometrial Pipelle, 112 women had ultrasonography and 120 women hysterography. MAIN OUTCOME MEASURES: Endometrial cytology and biopsy, ultrasonography, hysterography and hysteroscopy were correlated with curettage. RESULTS: the Pipelle's diagnostic accuracy appeared better than that of cytology. The hysteroscopic diagnosis agreed with the histologic diagnosis showed by the curettage except for atypical hyperplasia. The positive predictive value for identifying endometrial atrophy with ultrasonography is 100%. A vaginal ultrasonographic examination showing an endometrial thickness of < or = 5 mm can be used to exclude endometrial carcinoma as the cause of post menopausal bleeding. CONCLUSIONS: The combination of hysteroscopy and endometrial biopsy is the diagnostic method of choice for the endometrium. It is possible to avoid some useless curettages for diagnosis in women with abnormal uterine bleeding.

[Surgical abdominal access for prolapse using a Vicryl composite lattice. Preliminary study]. / Cure de prolapsus par voie abdominale à l'aide d'un treillis de Vicryl composite. Etude préliminaire.

OBJECTIVE: Promontory fixation is a reliable technique for genitourinary prolapsus. Results obtained with Mersurtures are good, but infectious episodes have been described and the fixation is rigid. The pelvic organs loose their mobility with possible functional impairment. To avoid these problems, we tested a composite implant composed of 60% absorbable polyglactine 910 (Vicryl) and 40% non-absorbable terephthalic polyester (Dacron). SUBJECTS AND METHODS: A series of 32 patients with genito-urinary prolapsus were treated by one operator using the new material. Promontory fixation was performed in all cases, with at least one implant. The patients were followed for mean 24.2 months for evaluation of tolerance to the new material and the functional impact. These parameters were compared retrospectively with former experience with Mersutures. RESULTS: The new material was perfectly tolerated and no infectious complication was observed. The anatomic results were identical to those obtained with the Mersutures, giving 93.4% good anatomic results, 68% cure rate for urinary incontinence and 20% major improvement in urinary incontinence. It was difficult to analyse results for sexual activity and digestive tract function. CONCLUSION: The Vicryl composite is useful for promontory fixation in patients with prolapsus. This material which reduces the amount of inert material remaining in the form of a thin lattice of highly flexible Dacron, should be tested prospectively to determine the functional benefit of prolapsus care.

[Changing attitudes on the surgical treatment of urogenital prolapse: birth of the tension-free vaginal mesh]. / Evolution des idées sur le traitement chirurgical des prolapsus génitaux: naissance de la technique TVM.

OBJECTIVES: To describe, in view of the new standardization, the technique for urogenital prolapse repair using a one-piece synthetic mesh. MATERIALS AND METHODS: The history and development steps through which the Tension free Vaginal Mesh (TVM) technique emerged are described. The use of a mesh was prompted by the 20-30% recurrence rate associated with conventional repair techniques. Selection of the type of mesh is discussed. Non-absorbable synthetic meshes have shown their usefulness in visceral surgery. A list of materials along with their respective advantages and inconveniences is reviewed and particular emphasis is put on both the tolerance and erosion issues, the latter being specific to the vaginal route. The TVM Group selected a one-thread polypropylene mesh, Prolene Soft, which seemed the most appropriate for the transvaginal approach of prolapse surgical repair. The prosthesis and its design rationale are described. Full details are given on the consecutive intervention steps and underlying concepts. RESULTS: The relevant literature is scarce and there is a lack of methodologically sound studies validating the materials and techniques used. After completion of a first step of technique refinement and feasibility assessment involving about 300 surgical interventions, the authors initiated a prospective multicenter study. Clinical outcome assessments using feasibility, complications, and efficacy endpoints will be published after twelve months, three years, and five years of follow-up. CONCLUSION: Fruitful reasoning led to the development of the TVM technique of complete surgical repair of genital prolapse, which uses a synthetic materiel carefully selected after several tests. All surgeons can apply this technique after a short training period.

[Preventive treatment of lymphoceles after enlarged lymphadeno-colpohysterectomy: non-reperitonization with epiplooplasty]. / Un traitement préventif des lymphocèles après lymphadéno-colpo-hystérectomie élargie (L.C.H.E.): la non repéritonisation avec épiplooplastie.

Pelvic lymphadenectomy for genital cancer can lead to numerous complications, particularly lymphoceles. Two types of drainage were compared in a series of 86 patients treated by enlarged lymphadeno-colpohysterectomy. In the first group (n = 66), hermetic peritonization with aspiration drainage was performed and in the second group (n = 20), non-peritonization combined with omentoplasty was practiced. Lymphoceles developed in 23% of patients in group I, requiring 7.7% of recovery operations (5 cases). Lymphoceles did not occur in group 2. Qualities of reabsorption of peritoneum and omentum are discussed. Their combined use to avoid lymphocele complications is of benefit, particularly in patients receiving preoperative pelvic radiotherapy.

[Pyosalpinx: anatomo-clinical experience and therapeutic inferences. Apropos of a retrospective study of 58 cases]. / Les pyosalpinx: rappel anatomo-clinique et déductions thérapeutiques. A propos d'une étude rétrospective de 58 cas.

Data from a series of 58 patients admitted with pyosalpinx, and representing 17.3% of cases of upper genital infections, were used to provide detailed information on therapy. Diagnosis was confirmed by celioscopy or laparotomy in all cases, and treatment essentially multiple antibiotic therapy by parenteral administration of wide spectrum compounds. Three subgroups of patients were distinguished: group 1 (15 cases) received immediate surgery due to severity of clinical picture or doubt as to diagnosis: in 54% the treatment was radical (hysterectomy-castration); group II (26 cases) received medical treatment only; group III (17 cases) underwent surgery after failure of medical treatment; operation was conservative in 52% of cases. Failure of medical treatment was related to a pyosalpinx volume of 8 cm3 or more in 86% of cases. No patient needed recovery surgery, while 3 had long term complications. Microbial flora was mainly anaerobic, diagnosis being dependent of celioscopy findings. Medical treatment alone allowed young women desiring pregnancy to conserve their genital apparatus in 44.8% of cases. When there is a lack of response to treatment, incomplete regression or recurrence then only surgery can be curative: the uterus and ovarian parenchyma should be conserved as far as possible because of new therapeutic perspectives.

[Treatment and prevention of urinary stress incontinence by the Bologna procedure in prolapse with large cystocele. Surgical technic]. / Traitement et prévention de l'incontinence urinaire d'effort par le procédé de Bologna dans les prolapsus avec volumineuse cystocèle. Technique opératoire.

Bologna's procedure allows the curative or preventive treatment for urinary stress incontinence during surgical cure of prolapse with large cystocele (2nd or 3rd degree). An infra-cervical sling is created with 2 vaginal bands dissected from the anterior colpocele, passed through the retropubic space on either side of the bladder neck and fixed to the abdominal wall, after making a suprapubic approach to the aponeurosis of the rectus abdominis muscle. This colposuspension technique, performed via a mixed approach, is generally accompanied by vaginal hysterectomy and colpectomy designed to treat the various elements of the prolapse. This operation is easily reproducible and the postoperative course is generally uneventful. The intermediate term anatomical and functional results are very satisfactory in women over the age of 60 years. There is not sufficient follow-up at the present time to consider this procedure for young women.

[A new treatment procedure in stress urinary incontinence (SUI): suburethral prolene sling under local anesthesia]. / Un nouveau procédé de traitement de l'incontinence urinaire d'effort (IUE) : soutènement sous-urétral par une bandelette de Prolène sous anesthésie locale.

An original technique for the treatment of USI under local anaesthesia is described. It consists of insertion of a Prolene sling under the middle part of the urethra. This sling is not placed under tension, but simply supports the suburethral region. In a series of 22 patients without prolapse requiring surgical correction and presenting USI confirmed by clinical examination, 20 were totally cured by this technique and the postoperative voiding flow rate was not decreased. This technique therefore appears to be simple, non-dysuric and effective.

[A new treatment procedure for stress urinary incontinence: sub-urethral support using a Prolene sling under local anesthesia]. / Un nouveau procécé de traitement de l'incontinence urinaire d'effort (IUE): soutènement sous-urétral par une bandelette de Prolene sous anesthésie locale.

An original technique for the treatment of USI under local anaesthesia is described. It consists of insertion of a Prolene sling under the middle part of the urethra. This sling is not placed under tension, but simply supports the suburethral region. In a series of 22 patients without prolapse requiring surgical correction and presenting USI confirmed by clinical examination, 20 were totally cured by this technique and the postoperative voiding flow rate was not decreased. This technique therefore appears to be simple, non-dysuric and effective.