Four-corner colposuspension: clinical and functional results.

We report our experience with four-corner colposuspension and the long-term functional and objective results. Thirty-seven women aged 42-74 affected by cystocele, associated with stress incontinence in 27, underwent four-corner colposuspension, combined with posterior colpoperineoplasty in 5 and vaginal wall sling in 5. Preoperative work-up included clinical examination, a symptoms questionnaire, transrectal dynamic ultrasonography and a urodynamic test. The mean follow-up to date is 62 months (range 36-83). Check-ups included a clinical examination, responses to a questionnaire on symptoms, uroflowmetry, transrectal ultrasound, and a urodynamic test in 25. All patients underwent four-corner colposuspension, together with vaginal wall sling in 5 with severe incontinence and colpoperineoplasty in another 5 with symptomatic rectoceles. There were no major complications. The urethrocele was stably corrected in all. No relapses occurred in 19 patients with grades I-II cystocele preoperatively. Various forms of prolapse recurred in 12/18 patients with grade III cystocele. Incontinence was successfully resolved in 23/27 patients (85%). Instability persisted in 8/14 patients. Obstruction persisted in 6 patients with prolapse recurrence. The ideal candidate for four-corner suspension is a patient with moderate cystocele and no signs of uterine prolapse who may, or may not, be incontinent.

Colposacropexy with Gore-tex mesh in marked vaginal and uterovaginal prolapse.

This study focusses on abdominal sacral colpopexy which appears to provide the most anatomically correct restoration and secure and durable support for advanced vaginal or uterovaginal prolapse. 21 patients underwent colposacropexy or hysterocolposacropexy using Gore-tex mesh. All patients referred symptoms of vaginal heaviness and urinary dysfunctions. Five presented with complete vaginal vault prolapse, 7 with third-degree anterior colpoceles and 9 with uterovaginal prolapse. Hydronephrosis was present in 4. Five patients had previously undergone total hysterectomy, and underwent only sacropexy; 9 underwent standard total abdominal hysterectomy before sacropexy; 7 underwent hysterocolposacropexy, preserving the uterus. In colposacropexy anchorage was designed to provide a large vagina-mesh contact area thus reducing the risk of suspension failure. Hysterocolposacropexy was performed using 3 stitches to anchor the synthetic mesh to the vagina and the uterine isthmus. Postoperative follow-up times range from 12 to 68 months. Overall results for 19/21 patients were satisfactory. In all 21 patients the descensus was markedly reduced. Hydronephrosis was completely resolved. Slight incontinence persisted in 3, but protection was not required. Slight dysuria persisted in 2. First-degree cystoceles recurred only in 3 patients who underwent hysterocolposacropexy. Sacropexy with synthetic mesh seems to be the most valid support of uterovaginal prolapse as the physiological vaginal axis is restored and vaginal function is preserved. Our success rate and the overall satisfaction expressed by 19/21 patients have encouraged us to continue in this surgical approach.

Implant surgery in Peyronie's disease.

The etiology and evolution of Peyronie's disease are not well known, and this certainly affects patient management. If spontaneous regression or stabilization of the disease is lacking, actually all therapies, except surgery, seem to be only partially successful. We attended 88 patients affected by Peyronie's disease, and 21 patients (23.6%) were referred for surgery and penile implantation; plaque excision was necessary in 8 patients (38.1%). We implanted 10 malleable prostheses and 11 soft prostheses. So far, potency has been the only parameter for evaluating the results of surgery, but in our view both the patient and his partner should be satisfied aesthetically and functionally.

[Echography during drug-induced erections in the study of penile plastic induration]. / Ecografia in corso di erezione farmaco indotta nello studio dell'induratio penis plastica.

Clinical investigation is still fundamental in the diagnosis of La Peyronie's disease. In this study 36 patients underwent clinical investigation and ultrasound in basal conditions and during drug-induced erection, and the results were compared. In basal condition US does not provide much useful supplementary informations. During drug-induced erection US accurately visualizes plaque site and dimensions and anatomical abnormalities about corpora cavernosa, albuginea, septum and dorsal vessels.

Real-time transrectal sonographic voiding cystourethrography.

Transrectal linear array transducer makes possible a sagittal view of the bladder base-plate, prostatic urethra, and membranous urethra yielding an image similar to that obtained with voiding cystourethrogram. This permits lack of time limitation, such as imposed by the use of fluoroscopy, and the possibility of visualizing not only the lumen of the bladder neck and urethra but also the surrounding soft tissue. Using ultrasonographic urodynamics in neuromuscular dysfunctions of the bladder and urinary voiding obstructions we obtained excellent results in patients with detrusor-sphincter dyssynergia and in those with posterior ledge at the bladder neck. Both conditions are clearly visualized, particularly the existence of the posterior ledge which is responsible for the failure of the sphincterotomy in patients with periurethral striated sphincter spasm.

Vaginal metastasis from unsuspected renal cell carcinoma.

The Authors report on a case of renal cell carcinoma with vaginal metastasis, which appeared on clinical examination as a primary vaginal disease without urinary symptoms.

Feminine urinary incontinence and urodynamic examination.

The Authors performed urodynamic examinations on all patients affected by urinary incontinence. This examination enabled them to classify incontinence precisely, from the etiopathogenetic point of view. Incontinence may be due to an altered transmission of the abdominal pressure, to sphincteral lesions or insufficiency, or to stimuli. This classification provides clear indications for the choice of the most suitable therapy (surgical, medical, instrumental). It thereby contributes to improving the outcome and decreasing the number of relapses so far reported by all Authors using any of the suggested surgical techniques.