Objetives: Single incision slings are the latest generation of suburethral bands that seek to minimize morbidity and major complications of transobturator bands. In short and medium term, their results in terms of success and safety are similar to transobturator and retropubic bands. Nevertheless, there is little data on their long-term outcomes. Our objective was to evaluate safety and efficacy of Altis® mini-sling during the short, medium and long-term follow-up. Methods: Prospective observational study in 67 women who underwent surgery with Altis® for a period of 6 years (2013-2019). The main variables evaluated were: total continence, objective cure and subjective cure (satisfaction). The secondary variables studied were: complications and number of pads used per day after surgery. Statistics: Student t-test or U-Mann-Whitney for quantitative variables, Chi-Square for categorical variables. Results: Objective cure rates were: 96.77%, 87.04%, 87.50%, 85.71%, 76.92% and 50% (from 1 to 6years), and total continence: 85.48%, 72.22%, 64.88%, 50%, 46.15% and 50% (from 1 to 6years). Degree of satisfaction was: 9, 8.2, 8.3, 7.7, 7.6 and 6.5 points (from 1 to 6years). 30 patients (44.78%) had some type of complication and the most common were: “de novo” urinary urgency (20.90%), recurrence of stress urinary incontinence (14.93%) and pain (5.97%). Conclusion: Altis® presents high rates of objective and subjective continence in short and medium-term (1-5years), during 6-year follow-up. It is safe and does not associate severe complications. We found a high percentage of “de novo” urgency and recurrence of stress urinary incontinence, especially after the fifth year.

Objetive: The objective is to identify factors associated with the risk of recurrence of stress urinary incontinence at 4years, after surgical treatment with transobturator suburethral tape. Methods: A prospective four-year follow-up observational study (2015-2019, n=341) was performed in women who underwent SUI using the tension-free vaginal tape-obturator. The sample was 71 patients with recurrence of SUI. Statistics: T-Test or U-Mann and ROC for quantitative variables, Chi-Square and OR for qualitative variables. Results: The frecuency of SUI recidive was 11.27% (8 patients). Of all the variables analyzed, they only showed a significant association with the SUI recurrence: age, fetal macrosomia and mixed urinary incontinence. The frequency of recurrence in case mixed incontinence amounted to 19.5%, if the patient had 1 delivery >4 kg to 22% and if the antecedent was ≥2 macrosomal deliveries it increased up to 50%. Conclusion: Advanced age, macrosomic delivery and mixed urinary incontinence have shown a significant association with the risk of relapse of SUI after tension-free vaginal tape-obturator at 4 years. Therefore, it would be necessary to inform them of a greater risk of failure in the medium term in the preoperative interview.

Objetives: Compare the efficacy and post-surgical complications of single-incision sling (SIS) and transobturator band (TO) for the treatment of stress urinary incontinence (SUI) over 7 years’ follow up. Methods: This is a prospective observational study that included 289 women with SUI who went under surgical treatment, either TO (109) or SIS (180). Patients were evaluated pre- and postoperatively through anamnesis, physical examination and ultrasound. Epidemiological information, complications and surgical time were recorded. The primary outcomes were total continence, objective and subjective cure rates at 7-year follow-up. Statistics: T-Student or U-Mann-Whitney for quantitative variables, Chi-Square for qualitative variables. Results: The groups were similar regarding demographic and medical history parameters, except for age and arterial hypertension, which were higher in TO group, and that SIS patients were more physically active tan TO patients. The TO band compared to SIS associated with increased frequency repair of pelvic organ prolapse. Depending on the type of urinary incontinence, pure SUI was more frequent in SIS and mixed in TO. The duration of the surgery was shorter with SIS. During the 7-year follow up there were no differences in the objective cure, subjective cure and complication rates. Conclusion: After 7-years follow-up, no significant differences were found with regard to subjective and objective outcomes, and post-surgery complication rates between the single incisión sling and the transobturator band.

Introduction: Intestinal loop Evisceration (VE) complicates the 35- 67% Of Vaginal Cuff Dehiscence (VCD), constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. Clinical case: 94-year-old patient with VE after VCD, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy. Results: Vaginal repair was performed abdominally, due to the size and condition of the eviscerated loops, requiring intestinal resection. An omentum flap was attached to the vaginal cuff to improve healing and to try to occlude the Douglas space. Conclusions: VE requires vaginal, abdominal or mixed repair, generally deferring the definitive treatment of the prolapse to a second stage. We recommend being very careful with vaginal vault closure after any type of hysterectomy, avoiding electrosurgery, infection and bleeding, performing the colporrhaphy with bidirectional barbed suture or two layers with braided suture and facing enough tissue at the suture. Keywords: Vaginal evisceration; Vaginal cuff dehiscence; Complications after hysterectomy; Long-standing pessary.

Background: Vulvar hematomas are more frequent in the obstetric population generally as a consequence of episiotomies, precipitated or instrumental deliveries. The most common causes in the general population are accidental trauma or spontaneous rupture of blood vessels. Management in both etiologies depends on size, involvement of adjacent organs, hemodynamic compromise, and the existence of fractures or lacerations that need to be repaired. Edema is a common complication usually resolved with conservative management. Clinical presentation: We present two cases. A traumatic vulvar hematoma in a 22-year-old patient and an obstetric vulvar hematoma in a 30-year-old primigravida which already presented pitting edema prior to delivery. Both cases required surgical drainage due to clinical evolution and poor pain control. Conclusions: The approach can be conservative or surgical depending on several factors but the use of intravenous analgesia is essential for pain management. Although hematomas related with traumatic causes are less frequent than puerperal ones, they can be very dangerous if they are associated with arterial bleeding that leads to hemodynamic instability.