No abstract

Combined stress urinary incontinence (SUI) and genital prolapse after fracture of the female pelvis has not been well described to date; four such cases are reported. Three of the patients had undergone reconstructive urogynecologic surgery prior to referral. None of the patients had a history of urinary incontinence or genital prolapse prior to injury. In order to correct persistent urinary incontinence and prolapse the following operations were performed: pubovaginal sling and transvaginal cystocele repair, Raz needle suspension and rectus muscle graft to the pelvic floor followed by a unilateral Burch colposuspension. On follow-up at a mean interval of 14.2 months (range 12-17), 2 have mild SUI and all 4 are without significant genital prolapse.

We report on 2 patients, one female and one male transsexual; in both, Type III stress urinary incontinence developed after gender reassignment surgery. Both patients were treated by periurethral injection of gluteraldehyde cross-linked collagen resulting in a marked symptomatic improvement in association with a significant rise in abdominal leak point pressures. We believe these are the first reported cases of collagen injection being used for urinary incontinence after gender reassignment surgery.

A variety of plastic surgical techniques may be used in the repair of vesicovaginal fistulas. The indication for their use include: (a) diameter greater than 4 cm; (b) involvement of the bladder neck/proximal urethra; (c) radiation-induced fistulas; and (d) previous failed repair(s). In the developing world the vast majority of complex fistulas are caused by obstetric trauma; elsewhere they occur mainly following radiotherapy or radical surgery for gynecologic malignancy. The majority of complex fistulas requiring tissue donation may be effectively treated using a vaginal approach and a modified Martius graft. There is probably little or no advantage in encorporating bulbocavernosus muscle fibers in this graft. Although some concern exists regarding the long-term viability of these grafts in radiation-induced fistulas, in view of the relatively simple operative technique, together with the low associated morbidity, modified Martius grafts may be deemed suitable for first-time repairs. The gracilis muscle graft should be considered next in cases of exclusive transvaginal repair. The omental graft is undoubtedly the most versatile: it can be used in both abdominal and combined abdominovaginal procedures. The recently described posterosuperior sliding bladder flaps warrant further evaluation. For most fistulas involving the bladder neck/proximal urethra, there is no clear advantage in bladder flap reconstruction over vaginal flap reconstruction, the latter being augmented by an anti-stress incontinence procedure were appropriate. When continent urinary diversion is required, the Indiana pouch appears preferable to the Kock pouch; ureterosigmoidostomy is, however, technically

Abstract:The authors report a case of voiding dysfunction with reduced sensation and arefiexia 13 months after a repeat LUNA due to pelvic nerve injury. Anatomic distortion and increased vascularity were likely contributing factors. Repeat procedures may expose patients to a risk of such injury due to anatomic distortion.

Needle bladder neck suspension stabilized the supportive fascia of the urethra, and vascular injury may be minimized by detailed knowledge of paraurethral anatomy.

We review the long-term outcome of 2 patients in whom cutaneous ureterostomies were performed. Complications included necrosis and distal ureteral stenosis, peristaltic dysfunction, urosepsis, calculus formation and renal impairment. Fluoroscopic ureterometry confirmed high pressure collecting systems in both patients 14 to 17 years postoperatively. Subsequent management during the last 4 to 6 years with clean intermittent self-catheterization has resulted in a significant improvement in the urological status.

For pregnant women who have had previous successful surgery for genuine stress urinary incontinence, an elective cesarean section is generally recommended. Many of these patients are multiparous and can be expected to have a relatively short and uncomplicated labor. We report a case of vaginal delivery after a pubovaginal sling and urethral diverticulectomy with preservation of continence at 1 year.