Rolled Vaginal Wall Flap for the Treatment of Stress Urinary Incontinence

Objectives: Anterior vaginal wall slings (AVWS) have been used for decades in the treatment of female stress urinary incontinence (SUI). The main drawback of using the vaginal wall as a sling is its tendency to weaken and stretch over the course of years. The use of synthetic tapes for the treatment of SUI is effective but costly. For patients who cannot afford synthetic tapes; we describe the preliminary results of a modified AVWS technique for the treatment of SUI types II and III. Patients and Methods: In this series; a modification of the AVWS was applied in 35 female patients with SUI. A fortified and rolled flap is used to provide compression and support of the urethra. The vaginal mucosal surface of the flap is cauterized and two diagonal sutures are placed across it. The flap is then rolled on itself with a running 2/0 vicryl suture. Two sutures attached to both ends are passed retropubically to the anterior abdominal wall and tied over the rectus sheath. Results: All 35 female patients had type II/III SUI. After a median follow up of 43 months; 91of the patients were dry or used 0-1 pad per day. Only one patient suffered from transient retention for one week post-operatively. Conclusion: This is a simple method to reinforce vaginal wall flaps. It could offer a durable and effective option for the treatment of SUI in patients who can not afford synthetic tapes. Long-term follow up is required to evaluate the durability of the procedure

Rectus Fascia Sling for the Treatment of Total Urethral Incontinence in Males

Objectives: Urinary incontinence in patients with neurological disease is a major health problem. A modified rectus fascial sling has been assessed in incontinent male patients. Patients and Methods: Fourteen adult male patients with total incontinence due to neurogenic or post-traumatic and etiology were included in this study. A rectangular rectus sheath flap was harvested and defatted.The flap was placed around the bulbar urethra and sutures were passed both in front of and behindthe pubic bone. Both sutures on each side were tied to each other over the pubic bone. Results: Of the 14 patients; 9 (64.3) were completely dry; 3 (21.4) reported improved continence; while 2 (14.3) were a failure. In total; 71.4of the patients showed significant improvement using the Incontinence Quality of Life (IQoL) questionnaire. A significant decrease in the number of pads used per day of 61.3(p

Doxazosin versus finasteride for the treatment of large symptomatizing benign prostatic hyperplasia : a questionnaire and urodynamic-based study

Objectives: To evaluate and compare the efficacy of both Finasteride and Doxazosin in the treatment of moderately symptomatizing large-sized benign prostatic hyperplasia and to correlate symptomatic changes with alterations in urodynamic values using the OCO values (Schafer nomogram). Patients and Methods: Fifty male patients with moderately symptomatizing BPH ( 40 cc) as assessed by ultrasound; were randomized to receive either Finasteride (5 mg/day)or Doxazosin (1-4 mg/ day) for 12 months. Results: Both Finasteride and Doxazosin significantly improved the urinary flow rates. Pressure-flow studies confirmed that both Doxazosin and Finasteride were effective in decreasing the opening detrusor pressure; the detrusor pressure at maximum flow (PdetQmax) and the detrusor pressure at least flow (Pdet least). When applying the Schafer nomogram; the OCO values were found to have improved in both treatment groups. There was; however; a significant difference between both groups with respect to the OCO values denoting a better improvement of the degree of obstruction in patients treated with Finasteride. Conclusion: The use of a compatible numerical format for grading the degree of bladder outlet obstruction would maximize the usefulness of pressure-flow studies in the evaluation of obstructed patients. Using the OCO value revealed that Finasteride was superior to Doxazosin regarding the degree of improvement in obstruction caused by benign prostatic hyperplasia

Brain imaging and urodynamic correlation in patients with cerebrovascular stroke

Objective: To identify urodynamic abnormalities in patients with cerebrovascular accidents and correlate both with CT or MRI findings. Patients and Methods: From September 2001 to March 2003; a total of 44 males and 16 females were prospectively examined urodynamically in different phases after cerebrovascular accidents; and as early as two days after stroke. Results: In most cases; the urodynamic findings could be correlated with CT or MRI findings. The most determining factor was the site of the lesion followed by the size. Small lesions were frequently silent unless located in critical sites. It was found that frontal; frontoparietal; parietal; basal ganglia and internal capsular ischemic lesions were associated in most cases with detrusor hyperreflexia; whereas thalamic; pontine and cerebellar infarcts were linked to detrusor hyporeflexia. Multiple lesions within the same group produced the same effect; while mixed lesions produced variable ef-fects. There was no effect of laterality or dominance and an initial shock phase could not be identified. Detrusor-sphincter-dys-synergia (DSD) and hence upper tract deterioration were not observed. The effect of stroke was also modified by already present or predominant conditions such as BPH. Conclusion: Correlating urodynamic and CT findings is very difficult in stroke patients because of the diffuse nature of the lesions; the unknown function of many brain centers in micturition control; the innumerable connections between the different brain regions and the extremely complicated influences that the brain regions exert upon each other and upon the bladder. The optimal understanding of the problem is dependent upon the better understanding of the function of each part of the brain. Further studies in this direction are recommended