Fascia lata sling cystourethropexy for the management of female urinary incontinence.

Pubovaginal sling cystourethropexy has rapidly become one of the primary surgical treatment options for women with urinary incontinence. The procedure has evolved over time with regard to clinical indications, patient selection criteria and surgical techniques. This article reviews the historical development of pubovaginal sling cystourethropexy, including recent technical advances. The selection of graft materials is considered and the utility of fascia lata emphasized. Clinical results and potential complications of the procedure are also reviewed.

Future therapies for the treatment of bladder neoplasms.

The last several decades have witnessed an exponential growth in the understanding of the biology of human neoplasms. As a consequence, a number of new strategies for the treatment of urologic cancers are currently under evaluation. We provide an overview of promising new treatment approaches as they apply to the management of transitional cell carcinoma of the urinary bladder.

Comparative cost analysis of collagen injection and fascia lata sling cystourethropexy for the treatment of type III incontinence in women [ssee comments].

PURPOSE: We examined the cost of 2 common forms of surgical treatment of genuine stress urinary incontinence due to intrinsic sphincter deficiency, that is sling cystourethropexy and periurethral collagen injection. MATERIALS AND METHODS: Between May 1994 and July 1995, 14 women with intrinsic sphincter deficiency underwent sling cystourethropexies. A total of 14 matched patients with intrinsic sphincter deficiency underwent endoscopic collagen injection during the same period. RESULTS: The total cost per treatment of fascia lata sling cystourethropexy ($10,382) was 2.1 times greater than that for collagen injection ($4,996, p < 0.001). At an average followup of 14.9 months for fascia lata cystourethropexy and 21.3 months for collagen injection, 71.4% of patients in the former and 26.7% in the latter groups were completely continent (p = 0.05). One or no pads were used daily by 85 and 40% of the patients, respectively. CONCLUSIONS: Fascia lata sling cystourethropexy may be a more cost-effective surgical treatment than periurethral endoscopic collagen injection for treating genuine stress urinary incontinence in women with intrinsic sphincter deficiency when the greater success rate of the former procedure is considered.

Outcome of extracorporeal shockwave lithotripsy monotherapy for large renal calculi: effect of stone and collecting system surface areas and cost-effectiveness of treatment.

The treatment options for large renal calculi are controversial. We report on our experience with 65 treatments of renal calculi > 3 cm using extracorporeal shockwave lithotripsy (SWL) monotherapy. We stratified our results according to stone and collecting system surface areas (measured by computer image analyses), stone location, and stone type. The overall success rate of SWL monotherapy was 27% at 3 months. The best stone-free rate (60%) was obtained for stones < 500 mm2 and located primarily within the renal pelvis. The stone-free rate for stones with surface areas > 1000 mm2 was only 8%. None of the cystine stones was treated successfully, whereas 80% of patients with uric acid stones became stone free. We estimated an average cost of $67,048 to render a patient with a large renal calculus stone free using SWL monotherapy. We recommend that other treatment options, such as percutaneous nephrolithotomy, be considered as first-line therapy for large renal calculi.

Complication of penile injection of autologous fat.

A new penile enlargement procedure using injection of autologous fat obtained by liposuction has been publicized by the media. We report on a 36-year-old man who suffered 2 painful inflammatory nodules requiring surgical excision 3 months after undergoing this new penile enlargement procedure.