Aims: A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point ¢xation is also reviewed. Methods: After proper vaginal dissection, a specially fashioned ''H'' shaped polypropylene mesh is positioned and ¢xed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior ¢xation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t-test, with Sigma Stat 1 . Results: Seventy-six patients (79%) were available with a mean follow-up time of 30.7 AE 1.7 months and mean age of 69.3 AE 11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, de¢ned as an occasional leak. For those with preoperative incontinence (n ¼ 36), average pad use per day decreased signi¢cantly from 2.1 AE 0.4 to 0.8 AE 0.2 (P < 0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9 AE 0.3 on a scale of 1 (least satis¢ed) to 10 (most satis¢ed). Conclusions: Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and e⁄cacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable. Neurourol. Urodynam. 26:53^58, 2007. ß 2006

Female stress urinary incontinence, while not life threatening, can present with various social and economic implications. Biomaterials, primarily synthetic, are often utilized to augment surgical correction. Repair with biomaterials involves midurethral support to function against weakened connective tissue caused by injury, abnormal collagen metabolism, or genetic predisposition. Even though efficacy rates are high, the potential for complications, such as erosion, are great without comprehension of inherent characteristics of each graft material. Low-weight, macroporous, monofilament synthetic grafts and noncross-linked biologic grafts are examples of biomaterials that implant reasonably well with host tissue. This paper reviews the justification for biomaterial use, host reaction, and the various parameters of natural and synthetic grafts.

Although they may present with significant morbidity, pelvic organ prolapse and stress urinary incontinence are mainly afflictions that affect quality of life. To appropriately treat these entities, comprehension of the various theories of the pathophysiology is paramount. Utilizing a Medline search, this article reviews recent data concerning intrinsic (i.e., genetics, postmenopausal status) and extrinsic factors (i.e., previous hysterectomy, childbirth) leading to organ prolapse or stress incontinence.

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Although the total number of genital infections has increased, infections among female children remain largely unchanged. Community-acquired methicillin-resistant S. aureus genital abscesses are more likely to be the result of colonization, rather than de novo infection, than nongenital abscesses. The effectiveness of individual treatment modalities and rates of recurrence are independent of abscess location, but genital abscesses may indicate the presence of resistant organisms, colonization, or both.

INTRODUCTION AND OBJECTIVE: Many patients with pelvic organ prolapse present with voiding complaints. Although a number of series have evaluated the symptoms and urodynamic (UDS) presentation of patients with grade 4 cystocele, overall urinary symptoms have not been systematically characterized. The purpose of this study was to prospectively evaluate the incidence, severity, and distribution of voiding symptoms in patients with Grade 4 cystocele.METHODS: We prospectively evaluated all consecutive patients from 2001-2004 who presented with Grade 4 cystocele at our institution. All patients underwent clinical evaluation, UDS, cystoscopy, and evaluation using the SEAPI Incontinence Classification System. We prospectively investigated the subjective incidence of stress urinary incontinence (SUI), urge incontinence (UI), and obstructive voiding (OV) in this cohort of patients.RESULTS: 365 patients were evaluated during the study period. Of these, 350 patients had SEAPI information. Mean age was 66. On average 90% of patients complained of at least one symptom. 22% complained of all three symptoms: SUI, Ul, and OV. The most common complaint was OV in 59% of patients. It was the only urinary symptoms in 31% of patients. 52% of women complained of SUI, but only 15% experienced it as a single symptom. Ul was reported in 176 patients (50%) and it was the only presenting symptom in only 13%. Age was the main predictor of symptom distribution. For patients in the 4th decade the most common symptom was SUI, and this symptom peaked in the 5th decade. OV, however, increased with age. Only 33% of 30-40yo had OV, versus 60% of 40-65yo, (p=0.007); and nearly 75% of 65-80yo patients had OV, (p=0.011 ). Also, advancing age and not degree of prolapse was the main predictor of s~mptoms of Ul. 21% of 30-40yo had Ul, whereas, 55% of patients in their 6 decade complained of Ul, and 64%of patients 80 and older had Ul, (p<0.001 ).CONCLUSIONS: A subjective urinary complaint in patients with grade 4 cystocele is extremely common. The incidence and severity of symptoms is higher in older patients except the incidence of SUI which peaks in the 5th decade. Although the prolapse itself might play a role in the etiology of these voiding symptoms, other factors, such as age, may independently impact who is at risk of subjectively experiencing a particular symptom. This might explain why overall success rates and satisfaction after prolapse repair varies in different age groups.

Interstitial cystitis is a condition that affects the urinary bladder and may be more prevalent than commonly thought. Symptoms range widely in severity and typically include urinary urgency, frequency and pelvic pain. Therapies usually target the known pathophysiology of this condition. Oral agents commonly include bladder surface mucin analogues, antihistamines, narcotics, tricyclic antidepressants and anticonvulsants. Intravesical therapy is usually used as second-line treatment. Multiple forms of pharmacotherapy are often provided simultaneously to improve efficacy and time to response.

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