A randomized, controlled clinical trial of a novel intravesical pressure attenuation device for the treatment of stress urinary incontinence.

Purpose: In this clinical trial we evaluated the efficacy, safety and tolerability of a novel pressure attenuation device for the reduction or elimination of female stress urinary incontinence using a prospective, randomized, single-blind, multicenter design.

Materials And Methods: A total of 166 female patients with stress urinary incontinence were randomized 2:1 to treatment with an intravesical pressure attenuation device (112) or sham procedure (54). In the treatment arm the device was replaced every 90 days and in the sham arm device replacement was simulated every 90 days.

Role of invasive urodynamic testing in benign prostatic hyperplasia and male lower urinary tract symptoms.

The role of urodynamics in the evaluation of lower urinary tract symptoms in men with benign prostatic hyperplasia is controversial despite the additional information regarding bladder function and outlet obstruction it provides. This controversy is primarily based on outcome studies that suggest men without proved bladder outlet obstruction may benefit from outlet reduction with medication or surgical resection. The aim of this article is to describe the role of urodynamic studies in the evaluation of benign prostatic hyperplasia, including illustration of existing urodynamic techniques, reviewing best practice guidelines and current literature, and providing recommendations for use of urodynamics in clinical practice.

Current evaluation and management of female urethral diverticula.

The identification of female urethral diverticula remains a challenging problem for many clinicians. Many of these patients are often undiagnosed or misdiagnosed due to a clinical presentation that frequently mimics other pathologic processes. There can be significant variation in the urethral diverticular anatomy in terms of size, location, and configuration.

Initial experience with rectocele repair using nonfrozen cadaveric fascia lata interposition.

Objectives: To describe a rectocele repair reinforced with solvent-dehydrated, gamma-irradiated, human fascia lata and report our early results with a technique we are confident will have a greater, more durable success rate, with a lower incidence of dyspareunia, than the classic repair.

Methods: A total of 73 patients, aged 31 to 86 years, with symptomatic (stool trapping and/or vaginal/perineal splinting or postural modifications to facilitate stool evacuation) rectoceles underwent a site-specific repair reinforced with cadaveric fascia. Perioperative questionnaires, retrospective chart review, and telephone interview by a blinded third-party reviewer and physical examination was conducted.

Cadaveric prolapse repair with sling: intermediate outcomes with 6 months to 5 years of followup.

Purpose: We present the prospective, intermediate-term results for cadaveric prolapse repair with sling as combined treatment of stress urinary incontinence and cystocele.

Materials And Methods: A total of 251 of 295 (85%) patients undergoing cadaveric prolapse repair with sling (CaPS) had at least 6 months of questionnaire and pelvic examination followup. All patients had objectively demonstrated stress urinary incontinence and grade 2 to 4 cystocele before surgery.

Osseous complications after transvaginal bone anchor fixation in female pelvic reconstructive surgery: report from single largest prospective series and literature review.

Objectives: To report, from our prospective database and review of published studies (including primary reported patient series and case reports for osseous complications after transvaginal bone anchor fixation in female pelvic reconstructive surgery), our results and those from previously reported patient series to determine the incidence of osteitis pubis and osteomyelitis.

Methods: A total of 440 patients from our database of cadaveric transvaginal sling (n = 127) and cadaveric prolapse repair with sling (n = 313) procedures had at least 3 months of examination follow-up and were included in this report. We found 15 primary reported patient series involving transvaginal bone anchor fixation in published studies, for a total of 788 patients.

Abdominal sacral colpopexy for repair of neovaginal prolapse in male-to-female transsexuals.

Penectomy, bilateral orchiectomy, and penoscrotal flap vaginoplasty are procedures that increase the psychosocial well-being and enhance body acceptance of male-to-female transsexuals. The incidence of neovaginal prolapse is not known but is believed to be relatively rare. We report 2 cases of neovaginal prolapse that were successfully treated with abdominal sacral colpopexy at our institution.

Transvaginal surgery in the octogenarian using cadaveric fascia for pelvic prolapse and stress incontinence: minimal one-year results compared to younger patients.

Objectives: To evaluate prospectively our transvaginal surgery experience in octogenarian women and compare the results with those in younger patients. As our population has aged, the treatment of incontinence and prolapse in women older than 80 years, known as octogenarians, has become a significant clinical issue.

Methods: To date, our prospective database includes 455 women who have undergone transvaginal sling surgery using nonfrozen cadaveric fascia lata with or without concurrent prolapse repair.

Urethrolysis with Martius labial fat pad graft for iatrogenic bladder outlet obstruction.

This article evaluates treatment outcomes of urethrolysis with the Martius labial fat pad graft for patients with outlet obstruction after incontinence surgery. A total of 23 women were diagnosed with iatrogenic bladder outlet obstruction by urinary retention, urodynamic criteria, physical examination findings, and/or temporal relation of voiding dysfunction to anti-incontinence surgery. The urodynamic definition of female outlet obstruction was a maximum flow rate <12 mL/sec and a detrusor pressure at maximum flow >20 cm of water.

Needle suspension procedures for female incontinence.

In the past, needle suspensions were considered a viable option to treat female stress urinary incontinence. There have been many modifications since the first needle suspension over 40 years ago. Despite these modifications, the long-term outcome data does not support the efficacy of needle suspension procedures, with only a 67% cure/dry rate at > 48 months.

Continued multicenter followup of cadaveric prolapse repair with sling.

Purpose: Since our initial description of the technique of combining a transvaginal sling with a cystocele repair using solvent dehydrated cadaveric fascia lata and bone anchors we have continued to follow our outcomes closely to determine long-term results. We present the updated, multicenter results of the cadaveric prolapse repair with sling.

Materials And Methods: A total of 172 patients 35 to 90 years old (mean age 62.