Objective: Describe the medium-term safety of the tension free vaginal tape obturator (TVT-O) procedure in terms of complications, cure and changes in quality of life (QoL) after the surgery. Materials and methods: Descriptive historical cohort that included women over 18 years of age who underwent TVT-O due to objectively proven stress urinary incontinence, urethral hypermobility or mixed urinary incontinence in which the stress component predominated, confirmed on urodynamic testing between July 2013-April 2017, in a reference hospital located in the city of Murcia Spain. Women with previous anti-incontinence surgery, concomitant vaginal surgery and planning pregnancy were excluded. Follow-up was determined for each patient based on the time elapsed between surgery and the time when the research protocol was applied. Complications were stratified according to the modified Clavien-Dindo classification; also we evaluated subjective cure rate, quality of life using the ICIQ-SF score, before and after surgery. Results: The mean age was 52.6 (SD± 10.5) years and 80.1% of patients were at least overweight. The incidence of complications at 12 months was: 8.3% (12/144). We did not detect complications after this period in the followed patients at 24, 36 and 48 months. The subjective cure determined at 12, 24, 36 and 48 months was 62.5% (90/144), 59.09% (55/88), 50.81% (31/61) and 50% (7/14), respectively. There was a significant improvement in quality of life, as determined by the ICQ-SF mean score before and after surgery (13.76[6,34] vs 3.84[5.76]; p<0.05). Conclusions: The TVT-O surgery is a safe therapy associated with a low complication incidence at 12 months, an acceptable subjective cure rate in stress urinary incontinence, and quality-of-life improvement. Classifications of complications related to the insertion of the prosthesis and of those inherent to surgery, such as urinary tract infection, are required.

Description of the clinical case: A 79-year-old man who consulted for an episode of facial angioedema without other symptoms. Upon physical examination, he presented erythema on the face and neck, peri-palpebral angioedema and erythematous macules on the back of the hands. A biopsy of a skin lesion compatible with Gottron papule was performed. A computed tomography urography was performed to rule out systemic disease, observing grade III left ureterohydronephrosis, possibly due to ureteral neoplasia. Extension study negative. Laparoscopic left nephroureterectomy and endovesical instillation of Mitomycin C were performed, with anatomopathological results of multifocal high grade papillary urothelial carcinoma. The patient presented a favorable postoperative evolution with improvement of dermal lesions, but 7 months later he developed multiple metastases and died. Relevance: The association of dermatomyositis with neoplasms is well known, but few cases have been described with urological malignancy. Ureteral cancer with amyopathic dermatomyositis is extremely rare. Clinical implications: It is important to perform cancer screening in patients with dermatomyositis in order to treat them and improve their prognosis. Conclusion: Dermatomyositis is a rare paraneoplastic syndrome that is very infrequently associated with ureteral cancer. Cancer screening in these patients is very important to improve the prognosis. The surgical treatment of this tumor led to the disappearance of the skin changes.