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Objective: This study aims to evaluate safety and efficacy of four arms polypropylene mesh in the longterm follow-up in the management of stress urinary incontinence (SUI) associated with cystocele. Material and methods:This prospective study was conducted on 50 female patients with SUI associated with cystocele. Patients underwent placement of transobturator four-arms mesh implants. Stress incontinence was evaluated using cough stress test with and without prolapse reduction, Stamey's grading of SUI, the validated Arabic version of the International Consultation on Incontinence Questionnaire-Short Form and King Health Questionnaire forms. Perioperative parameters evaluated included age, body mass index, grade of SUI, time of procedure, hospital stay after surgery, difference between pre-, and postoperative serum hemoglobin values, and need for blood transfusion. Follow-up visits were planned at 3, 9 and 18 months after surgery. Results:The mean operative time was 37.4±10.2 (25-60) minutes. Blood transfusion was not required. The mean hospital stay was 30.5±10 (24-48) hrs. Five (10%) patients had fever and urinary tract infections were noticed in five (10%) patients. Two (4%) women had urine retention after catheter removal and vaginal mesh erosion was present in one (2%) patient. Forty (80%) patients were cured from SUI, 8 (16%) patients were improved and 2 (4%) patients failed to respond. Conclusion:Cystocele associated with SUI can be repaired with transobturator four-arms mesh with promising results, improved quality of life, and tolerable side effects.

Objective: To evaluate the safety and efficacy of intravesical instillation of hyaluronic acid/chondroitin sulfate in the treatment of refractory painful bladder syndrome.Material and methods: Forty patients were subjected to intravesical instillations of hyaluronic acid/chondroitin sulfate weekly for 4 weeks and at 6., 8., 12. and 16. weeks, afterwards. Then we evaluated the efficacy of this treatment modality by determining the mean changes in visual analogue scale (VAS) pain score, the pelvic pain and urgency/frequency questionnaire, the O'Leary-Sant interstitial cystitis symptoms index/ problems index and 3 day-voiding diary results including daily number of voids and mean voided volume at 2 weeks, 3, and 9 months after the last dose (4 th month) and urodynamic studies including cystometric capacity, 1 st sensation of urination, and Q-max at 9 months after the last dose.Results: Thirty-seven patients (6 males 16.2%, 31 females 83.8%) completed the entire follow-up protocol of this study. Age of the patients ranged from 22 to 37 years (mean, 30.7±4.18 years) and their body mass indexes (BMIs) ranged between 29 and 37 kg/m 2 (mean, 33.5±2.58 kg/m 2 ). An initial response to treatment in all parameters at variable degrees was noticed at 2 weeks after the last instillation when compared to the baseline, and these changes were statistically significant (p<0.001). Progressive improvement in all test parameters was noticed at 3 months after treatment, and this improvement was statistically significant compared with baseline and 2 weeks after treatment, respectively (p<0.001). Conclusion:Intravesical instillation with both hyaluronic acid/chondroitin sulfate in the treatment of refractory painful bladder syndrome is safe, effective and well tolerated by all patients with no recorded side effects.

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