title: Concomitant surgical correction of severe stress urinary incontinence and anterior vaginal wall prolapse by anterior vaginal wall wrap: 18 months outcomes.
abstract: BACKGROUND
  The aim of this study is to evaluate the outcome of an innovative, minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse (AVWP).
  
  
  METHODS
  Fifty-six women with stress urinary incontinence (SUI) or mixed urinary incontinence and AVWP were randomly assigned into two groups: In Group A (26 patients), anterior colporrhaphy (Kelly placation) and sling placement using a strip of anterior vaginal wall were performed, and in Group B (30 patients), transvaginal mesh correction of AVWP and tension-free vaginal tape (TVT) insertion (retropubic - craniocaudal route) using polypropylene mesh were carried out. The patients were followed-up for over 18 months and were assessed objectively using a 48 h frequency-volume chart, a 48 h pad test and a standardized stress test. Related surgical complications and outcomes were recorded and compared.
  
  
  RESULTS
  Surgical cure rates for Group A and Group B at the first (3 days) and last (18 months) post-operative visits were 62% and 84%; and 54%, and 72%, respectively (P = 0.09 and 0.31). Complications occurred in 9 patients (44%) of Group B, but only 3 patients (12%) in Group A.
  
  
  CONCLUSIONS
  Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates. Although, the surgical success rate of this technique is lower than T-Sling, larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery.
authors: Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mahtab
authors: M
authors: Zargham
authors: Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Farshid
authors: F
authors: Alizadeh
authors: Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Farhad
authors: F
authors: Tadayyon
authors: Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mohammad-Hatef
authors: MH
authors: Khorrami
authors: Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Kia
authors: K
authors: Nouri-Mahdavi
authors: Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mohammad Reza
authors: MR
authors: Gharaati
authors: Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mohammad Hossein
authors: MH
authors: Izadpanahi
authors: Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mohammad
authors: M
authors: Yazdani
authors: Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Hamid
authors: H
authors: Mazdak
keywords: Autologous sling; prolapsed; tension free vaginal mesh; urinary incontinence