Monoprosthesis for anterior vaginal prolapse and stress urinary incontinence: midterm results of an international multicentre prospective study.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) can occur simultaneously with anterior vaginal prolapse (AVP) in up to 30% of patients. We studied a monoprosthesis that combines prepubic and transobturator arms for simultaneous treatment of AVP and SUI. METHODS: One hundred four women with AVP underwent surgical treatment using a monoprosthesis (NAZCA TC). POP-Q was used for anatomical evaluation. Functional results were evaluated by quality of life questionnaires, stress test and Stamey score. Patients were evaluated at 1, 3, 6 and 12 months postoperatively. RESULTS: There were significant and sustained improvements in points Aa, Ba and C. Positive stress test was observed in 29.8% preoperatively and decreased to 1.9% after 12 months. There was no significant impact in sexual symptoms. Mesh exposure was noted in 5.7% of patients. CONCLUSIONS: Monoprosthesis with combined prepubic and transobturator arms presented high success rates for AVP repair and simultaneous SUI treatment. It has also been shown to be safe and appears to preserve sexual function.

TOT does not affect the urethral sphincter innervation: a pilot study.

INTRODUCTION AND HYPOTHESIS: To exclude a neuromuscular denervation damage due to prosthetic mini-invasive surgery using transobturator tape (TOT) by pre and postoperative electromyography (EMG) of the striated urethral sphincter. METHODS: Seventeen women with SUI were enrolled by urogynecologic and urodynamic examination. Each of them underwent EMG of striated urethral sphincter performed by 25-mm concentric needle that was put in as far as 5 mm inside internal urethral sphincter. Amplitude and duration of EMG potentials were measured during caught, maximal contraction, and at rest. Four months after TOT treatment women underwent EMG. RESULTS: The mean amplitude of EMG potentials does not show significant statistical differences between pre- and post-TOT (P=NS). The duration of potentials, instead, changed between pre and posttreatment only during the maximal contraction test (P ≤ 0.05). CONCLUSIONS: TOT prosthesis surgery, avoiding denervation and devascularization of pelvic structures does not produce damage of the urethral sphincter.

Quality of life and sexual changes after double transobturator tension-free approach to treat severe cystocele.

OBJECTIVES: To study the quality of life and sexual function changes of women affected by severe cystocele and treated with the double transobturator tension-free approach. STUDY DESIGN: 23 women (mean age 60.6) with third and fourth degree cystocele (according to Baden and Walker classification) were monitored by Short Form-36 (SF-36) and Pelvic Organ Prolapse/Urinary Incontinenece Sexual Questionnaire (PISQ-12) before and 12 months after surgical treatment. Each woman also underwent translabial color Doppler ultrasonography to measure the Resistance Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV), and End-Diastolic Velocity (EDV) of the clitoral arteries, before surgery and 12 months postoperatively. RESULTS: SF-36 showed a considerable increase in all of the categories (physical functioning, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning, and mental health) compared to those obtained at baseline (P<0.05). PISQ-12 also showed a considerable increase in the behavioural emotive factor score, in the physical factor score, in the partner-related factor score and, consequently, in the total score compared to that obtained at baseline (P<0.05). Color Doppler measurement showed that the mean Pulsatility Index, Peak Systolic Velocity, Resistance Index and End-Diastolic Velocity were not significantly lower to those obtained at baseline (P=NS). CONCLUSIONS: Double transobturator tension-free approach to treat severe cystocele considerably improves quality of life and sexual function, and does not significantly influence clitoral blood flow. Our data could add new information about sexual behaviour after prolapse treatment, particularly about the impact on clitoral blood flow changes.

Clitoral blood flow changes after surgery for stress urinary incontinence: pilot study on TVT Versus TOT procedures.

OBJECTIVES: To study the effects of mini-invasive surgery using the tension-free vaginal tape (TVT) procedure and the transobturator tape (TOT) procedure in modifying clitoral blood flow in women affected by stress urinary incontinence. METHODS: The setting of the prospective open clinical study was the Urogynecologic Service of the Department of Microbiological and Gynecological Science, University of Catania School of Medicine (Catania, Italy). A total of 105 women underwent surgery; 42 (mean age 52.8 years) and 63 (mean age 53.9 years) were treated with TVT and TOT, respectively. Each woman underwent translabial color Doppler ultrasonography to measure the resistance index, pulsatility index, peak systolic velocity, and end-diastolic velocity of the clitoral arteries, before and 6 months postoperatively. RESULTS: In the TVT group, the mean pulsatility index and mean peak systolic velocity were significantly lower and the mean resistance index was significantly greater compared with the pretreatment values (P <0.5). In the TOT group, each color Doppler measurement was similar to that obtained at baseline (P = NS). CONCLUSIONS: The different vaginal approach for these two surgical methods influenced clitoral blood flow. Our data could add new information about sexual behavior after incontinence treatment, particularly the impact of clitoral blood flow changes.

Transobturator SAFYRE sling is as effective as the transvaginal procedure.

INTRODUCTION: SAFYRE is a monofilament polypropylene mesh held between two self-anchoring silicone columns that associates universal approach with readjustability. This unique feature allows for comparing two different approaches, i.e., transvaginal and transobturator, using the same sling. MATERIALS AND METHODS: A total of 226 patients with clinical and urodynamic diagnosis of SUI underwent SAFYRE sling procedure, which was performed either by transvaginal (group 1; 126 patients) or transobturator approach (group 2; 100 patients). The mean age was 63 years, in group 1 and 61 years in group 2. Physical examination, stress and pad test and urodynamic assessment were performed before the surgery. RESULTS: The average follow-up period was 18 months in group 1 and 14 months in group 2. There was no difference in cure rate in both groups. The mean operative time was longer (25 min) in group 1 than in group 2 (15 min) (P<0.05). Bladder injury was significative greater in transvaginal group [respectively, 12/126 (0%) versus 0/100 (0%)]. Postoperatively, 20.6% of the patients presented transient irritative voiding symptoms in group transvaginal group as opposed to 10% in transobturator group. DISCUSSION: SAFYRE sling performed by transobturator approach is as effective as the transvaginal procedure. Fewer complications and less operative time were additional advantages of the transobturator approach.

Role of DEXA and ultrasonometry in the evaluation of osteoporotic risk in postmenopausal women.

BACKGROUND/AIM: The aim of this study was to compare the role of quantitative ultrasonography (QUS) and dual energy X-ray absorptiometry (DEXA) in the assessment of osteoporosis. METHODS: From June 1999 to November 2001, 596 women who have not been diagnosed osteoporosis and without previous history of pathologic fractures were enrolled in this study. They had a mean age of 58.7+/-8.5 years, a mean height of 166+/-3.5 cm and a mean weight of 66+/-4.1 kg. According to the age, women were divided into three groups: group A included women between 45 and 55 years; group B women between 56 and 66 years and group C women between 67 and 77 years. Each patient underwent to both methods to determine the presence of osteoporosis. RESULTS: QUS resulted in a greater number of women of group A at risk of osteoporosis, whereas DEXA indicated that more women of group C were at increased osteoporotic risk. QUS and DEXA gave concordant results only in women of group B. CONCLUSION: These results suggested that QUS screening for osteoporosis may be more suitable for 'younger' postmenopausal women.