title: [Four corner bladder base and bladder neck suspension with intraosseous anchorage in the treatment of moderate cystocele].
abstract: During the last 10 years the original Pereyra technique of needle bladder neck suspension has been object of more than 36 modifications with the goal to improve long term results and to enhance feasibility. It represents also a part of the so called four corner bladder and bladder neck suspension (anterior suspending sutures) which is at present a reliable and durable manner to manage mild to moderate cystocele; this procedure reestablishes safely and simply support to bladder base, bladder neck and urethra preventing the onset of a denovo stress urinary incontinence. Complications include post-operative pain which could represent a problem in about 16% of the patients: it has been related to the entrapment of the ileoinguinal nerve between prolene sutures and rectus fascia and may be responsible of a delay in the re-establishment of a normal voiding pattern due to the pain elicited during any rectus muscle contraction. We propose a refinement of this procedure which includes the osseous anchoring of the suspending suture through the Mitek G II anchor system. Reduction in postoperative pain and fast recovery of a normal voiding pattern soon after surgery seems to be the most important result of this modification. Osteitis pubis has not been noted. Any improvement in long term durability of the procedure has not yet been determined due to the short follow-up and limited series of cases and the need for subsequent long term follow-up.
authors.affiliation: Clinica Urologica, Università degli Studi di Cagliari.
authors.forename: R
authors.initials: R
authors.lastname: Migliari
authors.forename: D
authors.initials: D
authors.lastname: Pistolesi
authors.forename: A
authors.initials: A
authors.lastname: Solinas
authors.forename: M
authors.initials: M
authors.lastname: Paoluzzi
authors.forename: P
authors.initials: P
authors.lastname: Giannotti
authors.forename: E
authors.initials: E
authors.lastname: Usai
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D011859:Radiography; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014546:Urinary Catheterization; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014554:Urination / Q000502:physiology; D014563:Urodynamics