Outcomes of Midurethral Slings in Women with Concomitant Preoperative Severe Lower Urinary Tract Voiding Symptoms.

Background: Women with stress urinary incontinence and concomitant obstructive (voiding) lower urinary tract symptoms (LUTS) represent a challenging patient population. Furthermore, their diagnosis and management remain incompletely studied and controversial. We evaluated the outcomes of midurethral sling procedures in women with severe obstructive LUTS.

Increasing patient preparedness for sacral neuromodulation improves patient reported outcomes despite leaving objective measures of success unchanged.

Purpose: We assessed how a group shared appointment influenced patient preparedness for sacral nerve stimulation for refractory overactive bladder and/or urge urinary incontinence. We also evaluated subjective and objective outcomes.

Materials And Methods: Patients considering sacral nerve stimulation were prospectively enrolled and invited to attend a group shared appointment.

Purely transvaginal/perineal management of complications from commercial prolapse kits using a new prostheses/grafts complication classification system.

Purpose: Commercial prolapse mesh kits are increasingly used in the management of pelvic organ prolapse. We present our experience with the transvaginal/perineal management of synthetic mesh related complications from prolapse kits. In addition, we used the new ICS/IUGA (International Continence Society/International Urogynecological Association) prostheses/grafts complication classification system to report on our contemporary series.

Mid-urethral slings in female incontinence: Current status.

The advent of the mid-urethral sling (MUS) 15 years ago has drastically changed the surgical management of stress urinary incontinence (SUI). Both retropubic and transobturator MUS can be placed in the ambulatory setting with excellent results. The tension-free vaginal tape (TVT) sling has the most robust and long-term data, but more recent literature suggests that the transobturator tape sling may offer comparable efficacy in appropriately selected patients.

Laparoendoscopic single-site (LESS) hysteropexy.

Uterine prolapse is one of the common reasons for hysterectomy throughout the world. However, recent data has shown that uterine-sparing techniques appear to be equivocal to that of hysterectomy. Older reports of intra-abdominal uterine suspension describe open approaches and more recent descriptions involve robotic and laparoscopic approaches utilizing mesh.

Force of stream after sling therapy: safety and efficacy of rapid discharge care pathway based on subjective patient report.

Purpose: We evaluated the safety of a mid urethral sling postoperative care pathway using patient subjective reporting of force of stream to minimize length of stay and catheter placement.

Materials And Methods: Women undergoing solitary mid urethral sling surgery were prospectively enrolled in our study. Force of stream after the sling therapy protocol consisted of retrograde bladder filling with 300 ml fluid within 1 hour after surgery.

Surgically corrected urethral diverticula: long-term voiding dysfunction and reoperation rates.

Objectives: To present the largest reported cohort of women with urethral diverticula and to evaluate the surgical outcomes and long-term voiding symptoms after urethral diverticulectomy. Studies evaluating the outcomes after urethral diverticulectomy have been limited by small patient numbers and short-term follow-up.

Methods: Women who had undergone diverticulectomy at our institution from 1996 to 2008 were mailed surveys.

Incidence of perioperative urinary tract infection after single-dose antibiotic therapy for midurethal slings.

Objectives: A recent Best Practice Statement published by the American Urological Association (AUA) recommends that antibiotic therapy in patients undergoing midurethral synthetic slings (MUS) should be 24 hours or less. Subjects at our institution are routinely administered a single dose of intravenous antibiotics before MUS surgery. We prospectively evaluated urinary tract infection (UTI) rates and risk factors for UTI in subjects undergoing MUS who receive single-dose antibiotic therapy.

Pure transvaginal removal of eroded mesh and retained foreign body in the bladder.

Introduction And Hypothesis: We present a pure transvaginal approach to the removal of eroded mesh and a retained foreign body involving the bladder secondary to placement of transvaginal mesh for management of pelvic organ prolapse (POP) using a mesh kit.

Methods: Transvaginal excision of mesh erosion involving the bladder after mesh placement using a prolapse kit was performed. A U-shaped incision was made in the anterior vaginal wall; mesh was identified, divided in the midline, and then dissected from the bladder.

Single-port transvesical excision of foreign body in the bladder.

Objectives: To present a novel technique to remove intravesical polypropylene mesh through a single laparoscopic port placed directly into the bladder.

Methods: A Triport single-site access system was placed transvesically and carbon dioxide was used for insufflation of the bladder. A combination of straight and articulating laparoscopic instruments was used to dissect the mesh away from the bladder mucosa and transect each end for complete removal of foreign bodies.

Retropubic synthetic midurethral slings: techniques and outcomes.

Retropubic midurethral slings have evolved to become one of the standard therapies for treatment of stress urinary incontinence. The current slings can be placed through a small vaginal incision, with minimal dissection, in the ambulatory setting. With improvements in technique, complications are minimal.

Does periprostatic block reduce pain during transrectal prostate biopsy? A randomized, placebo-controlled, double-blinded study.

Introduction: Currently, the use of local anesthetic at the time of transrectal ultrasound-guided biopsy of the prostate is not universally accepted, as the needle injection itself causes pain. In prior studies, lidocaine was compared to placebo in separate patient groups. We present the first study to evaluate both lidocaine and placebo injected in each patient.

NOTES transvaginal nephrectomy: first human experience.

Objectives: To present the operative outcomes of the first natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy.

Methods: A 57-year-old woman with hypertension, right-sided flank pain, and radiographic evidence of an atrophic right kidney consented for NOTES transvaginal nephrectomy. Pneumoperitoneum was achieved with a Veress needle inserted deep in the umbilicus.

Neuromodulation and female sexual function: does treatment for refractory voiding symptoms have an added benefit?

Introduction And Hypothesis: Women undergoing InterStim implantation for overactive bladder (OAB) or painful bladder syndrome (PBS) were prospectively evaluated to determine if neuromodulation has any effect on female sexual function (FSF).

Methods: Sexually active women in our InterStim database completed a female sexual function index (FSFI) preoperatively and at 6 months.

Results: Of 105 women, 54 have 6-month follow-up data.

Inguinal herniation of a transplant ureter: rare cause of obstructive uropathy.

We present a rare case of late renal allograft failure from ureteral obstruction resulting from inguinal herniation. A 72-year-old man presented with an elevated creatinine and hydroureteronephrosis of a transplanted kidney on ultrasound. Noncontrast computed tomography demonstrated an inguinal hernia containing ureter, and a nephrostomy tube was placed.

Dilemmas in diagnosing pelvic pain: multiple pelvic surgeries common in women with interstitial cystitis.

We determined the prevalence of pelvic surgeries in women with interstitial cystitis (IC) compared to community-based controls through responses to a survey from 215 women with IC and 823 controls. Women with IC had a statistically higher prevalence of hysterectomies (cases=42.3%, controls=21.

Bladder herniation through suprapubic incision for penile prosthesis.

To our knowledge, we present the first case of bladder herniation after insertion of an inflatable penile prosthesis. A 65-year-old man presented with a suprapubic bulge. He had his third inflatable penile prosthesis placed 1 year earlier.