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.

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.

A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS).

A new technique using cadaveric fascia lata for the simultaneous repair of a cystocele and placement of a pubovaginal sling by means of a transvaginal approach is described, and our early results are reported. We refer to this as the cadaveric prolapse repair with sling (CaPS). Fifty patients, ages 37 to 90 years, underwent a new technique for simultaneous cystocele repair and transvaginal pubovaginal sling using a single piece of cadaveric fascia.

Pelvic prolapse.

Purpose: Pelvic prolapse is a common problem affecting women of all ages. We reviewed the pathophysiology, presentation, evaluation and treatment of pelvic prolapse.

Materials And Methods: We comprehensively reviewed the literature using MEDLINE, resources cited in those peer reviewed articles and abstracts from recent international meetings.

Erosion of woven polyester pubovaginal sling.

Purpose: Various materials have been used for pubovaginal slings to correct female stress urinary incontinence. Use of synthetic materials provides a theoretical advantage in that no graft harvesting is necessary. Major risks of synthetic material use are erosion and infection of the sling.

Stress urinary incontinence.

New techniques for the treatment of female stress urinary incontinence are constantly being developed. In assessing treatment modalities, one must consider many variables including patient satisfaction and quality of life, cure or improvement rate, patient selection, and long-term durability of results. In 1998, many papers comparing and examining the outcomes of various new and old techniques were published.