Transvaginal sling using acellular human dermal allograft: safety and efficacy in 253 patients.

PURPOSE: We evaluated the safety and efficacy of using human dermal allograft material for transvaginal slings to treat female stress urinary incontinence (SUI). MATERIALS AND METHODS: We present a prospective series of 253 patients with SUI treated with a transvaginal sling using a Repliform cadaveric human dermal allograft (LifeCell Corp., The Woodlands, Texas) and a bone anchor fixation kit. Clinical history, urogynecologic examination and videourodynamics were performed preoperatively. Results were assessed by a third party through validated quality of life questionnaires (Incontinence Impact Questionnaire and Urogenital Distress Inventory), overall impression and percent of improvement as perceived by the patients, and pad use. Scheduled followup examination were performed to rule out erosion, infection, obstruction, pain or recurrent incontinence. RESULTS: Complete followup was available on 234 of 253 patients. Average followup was 18 months. Of the patients 78% were cured or improved according to the questionnaires. The average improvement was 80%. At 18 months of followup incontinence average distress and scores decreased 10 and 7 points, respectively. Complications were de novo urgency in 5% of cases, recurrent SUI in 15% with no cases of persistent SUI, retention in 2% and slow vaginal wall healing in 1.7%. Of 156 patients 51 (22%) had persistent urgency. There were no cases of vaginal or urethral erosion, osteitis pubis or osteomyelitis. CONCLUSIONS: Our data indicate that use of human dermal allograft for transvaginal slings is associated with low complication rates and favorable outcomes at an average of 18 months of followup.

Early surgical management of extensive gynecologic ureteral injuries.

Early ureteral reconstruction was performed during the immediate postoperative period upon 12 patients who sustained ureteral injuries secondary to gynecologic surgical procedures. The injuries occurred postoperatively for benign disease: endometriosis in one patient, fibrosis in eight patients and tubo-ovarian abscess in one patient. In three instances, portions of the ureter were noted in the pathologic specimen. After unsuccessful attempts at retrograde catheterization or stenting, all ureteral injuries were explored within three weeks of the primary gynecologic operation. Ureteral reconstruction was successful in all. The advantages of early operative intervention versus endoscopic or delayed operative intervention, or both, are discussed.

Cytologic diagnosis of prostatic carcinoma by fine-needle aspiration biopsy. Community hospital experience.

Transrectal fine-needle aspiration and transrectal or perineal core biopsies were simultaneously performed on 31 patients with suspected prostatic cancer over an eighteen-month period. Of the 29 aspirations that were adequate for cytologic diagnosis, there was histologic correlation in 24 (83%). The sensitivity of aspiration for the diagnosis for prostatic cancer was 92 per cent (11 of 12) compared with 85 per cent (11 of 13) for the core biopsy method. There were no apparent false negative or false positive diagnoses with the aspiration biopsy technique. Insufficient material was obtained by aspiration in 2 cases. A febrile urinary tract infection occurred in 1 patient after transrectal aspiration and core biopsy. Our results suggest that fine-needle aspiration may be utilized by the practicing urologist in conjunction with a pathologist trained in the interpretation of fine-needle aspirates as a safe, relatively inexpensive, and sensitive diagnostic procedure for suspected prostatic cancer.

Misconceptions about posterior approach for renoureteral surgery.

Misconceptions about the posterior approach for renal and ureteral surgery are dispelled. A review of the pertinent lumbar anatomy and a few fine points of technique are emphasized. The advantages of easy access to the kidney, minimal postoperative pain, and absence of the occurrence of postoperative hernia warrant more frequent use of this procedure.