Anterior colporrhaphy plus inside-out tension-free vaginal tape for associated stress urinary incontinence and cystocele.
OBJECTIVE
To reveal the efficacy and feasibility of concomitant anterior colporrhaphy and tension-free vaginal tape-obturator to treat stress urinary incontinence (SUI) and concomitant cystocele.


METHODS
Controlled trial without randomization (Canadian Task Force classification II-1).


METHODS
University hospitals in Rome, Italy.


METHODS
Fifty consecutive patients with SUI associated with symptomatic cystocele were enrolled into the study. Exclusion criteria were: uterine prolapse greater than or equal to 1, rectocele greater than or equal to 1, overactive bladder, overactive bladder symptoms, intrinsic urethral sphincter deficiency, urinary retention, previous anti-incontinence and/or prolapse surgery, neurologic bladder, psychiatric disease, body mass index greater than 30, and elevated intraabdominal pressure. The preoperative evaluation consisted of: complete history, physical examination, 3-day voiding diary, and urodynamic testing. The International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) was used to subjectively quantify the patient perception of SUI symptom severity.


METHODS
All patients underwent an ultralateral anterior colporrhaphy plus tension-free vaginal tape-obturator.


RESULTS
In all, 43 (91%) and 46 (92%) patients were objectively cured for cystocele and SUI, respectively. The median operating time, blood loss, and hospitalization were 43 minutes (range 35-56), 64 mL (range 40-148), and 1 day (range 1-2), respectively. Overall early postoperative complication rate was 16%, although all were minor. Only 1 patient, at 12-month follow-up, developed tape erosion that required surgical removal. The ICIQ-UI SF questionnaire scores were 13.4 +/- 6.8 and 3.5 +/- 3.2 (p <.01) between preoperative and 12-month follow-up, respectively.


CONCLUSIONS
Concomitant tension-free vaginal tape-obturator plus ultralateral anterior colporrhaphy are feasible and safe procedures for the treatment of SUI and with associated cystocele with a high success rate and low intraoperative and postoperative complications rate.
Departments of Obstetrics and Gynecology at Campus Bio Medico, University of Rome, Italy. m.zullo@unicampus.it
Marzio Angelo
MA
Zullo
Alfonso
A
Ruggiero
Francesco
F
Plotti
Filippo
F
Bellati
Stefano
S
Basile
Natalina
N
Manci
Ludovico
L
Muzii
Roberto
R
Angioli
Pierluigi Bendetti
PB
Panici
D000328:Adult; D000368:Aged; D015897:Comorbidity; D052858:Cystocele / Q000453:epidemiology* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D014621:Vagina / Q000601:surgery*