Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh

PURPOSE: To evaluate the medium-term efficacy and safety of transobturator four-arm polypropylene mesh in the treatment of high-stage anterior vaginal wall prolapse and concomitant stress urinary incontinence (SUI). MATERIALS AND METHODS: Between September 2010 and August 2013, a prospective single-center trial was performed to evaluate women with stage> or =3 anterior vaginal wall prolapse with or without SUI who presented to Labbafinejad Hospital, Teheran, Iran, and underwent anterior vaginal wall repair with polypropylene mesh. Pre- and postoperative evaluation included history; physical examination using the Pelvic Organ Prolapse Quantification system and cough stress test, both before and after reduction of prolapsed structures; Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ); urinalysis and culture; and a postvoid residual assessment. Complications were reported at a mean of 2 years of follow-up. RESULTS: A total of 71 patients underwent cystocele repair with the transobturator four-arm polypropylene mesh. Seven of the patients were lost to follow-up. There were no perioperative complications. The anatomical success rate was 87.5%. The subjective success rate was 92.1%. The PFDI and PFIQ were significantly improved after surgery (p<0.001). Among those with the simultaneous complaint of SUI, 82% were cured without any additional procedure. Three patients (4.6%) experienced vaginal mesh extrusion. Two patients (3.1%) reported worsening of dyspareunia after surgery. CONCLUSIONS: The four arms polypropylene mesh is an effective device for simultaneous correction of anterior vaginal wall prolapse and SUI with a low complication rate at a medium-term follow-up. The majority of the subgroup with concomitant SUI were cured without a second simultaneous procedure.

Neurologic Complications in Percutaneous Nephrolithotomy

PURPOSE: Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. RESULTS: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. CONCLUSIONS: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

Tension-free vaginal tape and autologous rectus fascia pubovaginal sling for the treatment of urinary stress incontinence: a medium-term follow-up

To compare two different procedures, tension-free vaginal tape [TVT] and autologous rectus fascia sling, according to their medium-term subjective and objective outcomes and satisfaction rates in the treatment of urinary stress incontinence in women. One hundred women with type II urinary stress incontinence were randomized to be treated with either TVT or autologous rectus fascia sling. They were evaluated by means of a cough-induced stress test, 1-hour pad test, Incontinence Impact Questionnaire [IIQ], and urodynamic study. They were reevaluated postoperatively every 6 months, and the collected data of more than 1 year's follow-up were compared with preoperative assessments. All patients completed the full 6-month postoperative assessment. However, of the 100 patients, only 61 [25 in the TVT and 36 in the sling group] were followed for more than 1 year. Mean follow-up time was 38.5 and 40 months in the TVT and sling group, respectively. Objective cure was achieved in 22 [88%] of the TVT group and in 30 [83%] of the sling group [p = 0.78] using a cough-induced stress test, and in 76 and 75% of the women in the TVT versus sling group [p = 0.83], respectively, using a 1-hour pad test. Postoperative mean IIQ scores were 44.3 [range 35.5-61.5] and 48.5 [range 38.5-69.7] in the TVT versus sling group [p = 0.46]. Five [20%] and 11 [30%] of the TVT and sling group, respectively, reported some changes in the voiding pattern or posture at more than 1 year's follow-up. There is no significant difference between the TVT and autologous rectus fascia sling procedures in the treatment of urinary stress incontinence at medium-term follow-up. There were changes in the voiding pattern for patients in both groups at more than 1 year postoperatively, which were not evident at early follow-up

Human Amniotic membrane as a suitable matrix for growth of mouse urothelial cells in comparison with human Peritoneal and Omentum membranes

For tissue engineering of the urinary tract system, cell culture requires to be established in vitro and an appropriate matrix acting as cell carrier should be developed. The aim of the present study was to assess the proliferation quality of mouse urothelial cells on 3 natural matrixes of human amniotic membrane [AM], peritoneum, and omentum, and to compare them with collagen matrix. Mouse urothelial cells were isolated by collagenase IV, and the urothelial cells [10[5] cells per milliliter]were cultured on the AM, peritoneum, omentum, and collagen. The pattern of growth and asymmetric unit membrane formation were analyzed by histologic examination and immunocytochemistry on the detached urothelium with pancytokeratin and uroplakin III, respectively. Electron micrographs were taken and cell layers, organelles, desmosomes, and junctions were studied. Immunocytochemistry of cultivated cells confirmed the urothelial cells phenotype. Up to 4 cell layers were obtained on the AM and 1 to 2 layers on the peritoneum. Distribution of the urothelial cells on the omentum was not favorable, which was due to its large pores. Cell proliferation started later on the AM [7 th day] compared to collagen [ 3 rd day]. Also, apoptosis started later on the AM [after 14 days] compared to collagen [7days]. These results showed that the AM can act as a cell carrier for culture of the urothelial cells, and its exceptional properties such as having various growth factors, availability, and cost-effectiveness make it a unique biological matrix for urothelial culture