The aim of this study was to compare the morbidity and short-term efficacy of retro-pubic (TVT) and inside-out trans-obturator (TVT-O) sub-urethral sling in the treatment of stress urinary incontinence. This was a prospective multi-centre randomised trial; 231 women with primary stress urinary incontinence were randomised to TVT (114) or TVT-O (117). The International Consultation on Incontinence-Short Form (ICIQ-SF), Women Irritative Prostate Symptoms Score (W-IPSS) and Patient Global Impression of Severity (PGI-S) questionnaires were used to evaluate the impact of incontinence and voiding dysfunction on QoL and to measure the patient's perception of incontinence severity. The primary and secondary outcome measures were rates of success and complications. The SPSS software was used for data analysis. The TVT-O procedure was associated with significantly shorter operation time and with a more extensive use of general anaesthesia when compared with TVT. There were 5 (4%) bladder perforations in the TVT group compared with none in the TVT-O group. Rates of early post-operative urinary retention and voiding difficulty were similar for both groups and no difference was found in the average hospital stay. Six patients (5%) in the TVT-O group complained of thigh pain in the post-operative course. The median follow-up time was 6 months. Two hundred eighteen patients were available for the analysis of outcomes. Subjective and objective cure rates were 92% and 92% in the TVT group and 87% and 89% in the TVT-O group. The ICIQ-SF questionnaire symptoms score showed a highly statistical decrease in both groups, the W-IPSS on the contrary was unchanged. Our data show that both procedures were equally effective in the short-term for the treatment of stress urinary incontinence with a highly significant improvement in incontinence-related QoL.

In the short-term follow-up, the Ajust™ system was effective in restoring continence in more than 85% of subjects with a highly significant improvement in QoL.

We present our initial experience with the Perige™ System for correction of prolapse of the anterior vaginal wall. We recruited twenty patients with anterior vaginal prolapse, underwent a prosthetic operation using the Perigee System, which consists of a large-pore, monofilament polypropylene mesh and four lateral arms made of the same material, positioned via the transobturator foramen. This system permits simultaneous correction of central and lateral defects. Prolapse and therapeutic outcome were evaluated using the POP-Q system. The 20 patients were suffering from grade III cystocele. The follow-up was conducted after six weeks, three months, six months, twelve months and eighteen months. After six weeks and three months the cystocele was MInIMally-InVaSIVe correzIone proteSIca tranSoBturator MInIInVaSIVa per VIa correctIon tranSotturatorIa of cyStocele Del cIStocele r Baccichet*, c Braghin, a azzena Obstetrics and GynaecOlOGy Unit, Ospedale civile di cOneGlianO venetO, Ulss 7 *UrOGynaecOlOGy department, Obstetrics and GynaecOlOGy Unit, O.c. cOneGlianO venetO, Ulss 7 Key words: prolapse anterior vaginal wall, cystocele, transobturator foramen, minimally-invasive urogynecological surgery, tension-free technique of mesh, entirely resolved (grade 0) in the 20 patients. After six months the cystocele was resolved (grade 0) in 17 patients, while three had grade I cystocele. After 12 months and 18 months the cystocele remain grade 0 in 16 patients, while four had grade I cystocele. No vascular damage or significant bleeding was observed. Two cases of vaginal erosion and one of de novo urinary incontinence were observed. Our experience appears to show that transobturator prosthetic correction of cystocele represents a safe, effective and reproducible minimally-invasive surgical technique that permits adequate restoration of normal anatomy