Bladder Neck Plication Research Articles

V04-04 ROBOTIC BLADDER NECK PLICATION FOR INCONTINENCE TREATMENT: TECHNICAL IMPROVEMENTS

You have accessJournal of UrologyCME1 Apr 2023V04-04 ROBOTIC BLADDER NECK PLICATION FOR INCONTINENCE TREATMENT: TECHNICAL IMPROVEMENTS Dario Guido Minoli, Carolina Bebi, Michele Gnech, Erika Adalgisa De Marco, Irene Paraboschi, Giancarlo Albo, Filippo Molinari, Emanuele Montanari, Gianantonio Manzoni, and Alfredo Berrettini Dario Guido MinoliDario Guido Minoli More articles by this author , Carolina BebiCarolina Bebi More articles by this author , Michele GnechMichele Gnech More articles by this author , Erika Adalgisa De MarcoErika Adalgisa De Marco More articles by this author , Irene ParaboschiIrene Paraboschi More articles by this author , Giancarlo AlboGiancarlo Albo More articles by this author , Filippo MolinariFilippo Molinari More articles by this author , Emanuele MontanariEmanuele Montanari More articles by this author , Gianantonio ManzoniGianantonio Manzoni More articles by this author , and Alfredo BerrettiniAlfredo Berrettini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this video we describe our experience in bladder neck plication, robotically assisted, to achieve continence in selected patients. METHODS: In the last three years we performed three robotically assisted bladder neck plication procedures: two females with persistent total incontinence following previous surgeries for ectopic ureters and epispadias and one isolated epispadias in an adolescent male. For all a laparoscopic robotically-assisted bladder neck plication was electively selected. The first two procedures were successfully conducted with Da Vinci SI, while in the third case the Da Vinci XI was used. The progressive narrowing of the proximal urethra was always confirmed with combined endoscopic view. RESULTS: All the patients were discharged on 4th post-operative day without complications. A follow-up MCUG confirmed fully preserved spontaneous voiding without post-void residuals and renal US showed persistence of normal upper urinary tracts. CONCLUSIONS: Bladder neck plication has been described successfully as complementary technique in other procedures as robotic radical prostatectomy. Open bladder neck plication, combined with endoscopic control of the urethral lumen, has been used to reach continence in epispadiac females, too. The anatomical access to the bladder neck region is extremely difficult in open surgery especially in adolescent patients. Robotic access allows a perfect combined endoscopic-laparoscopic approach to the bladder neck area and the firefly vision mode is an extremely useful addition for the correct and precise identification of the urethral segment to be plicated. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e339 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dario Guido Minoli More articles by this author Carolina Bebi More articles by this author Michele Gnech More articles by this author Erika Adalgisa De Marco More articles by this author Irene Paraboschi More articles by this author Giancarlo Albo More articles by this author Filippo Molinari More articles by this author Emanuele Montanari More articles by this author Gianantonio Manzoni More articles by this author Alfredo Berrettini More articles by this author Expand All Advertisement PDF downloadLoading ...

Complete Female Epispadias with Urinary Incontinence: A Single-Stage Perineal Urethroplasty and Cystoscopic-Guided Bladder Neck Plication

Abstract Isolated female epispadias without bladder exstrophy is an extremely rare congenital anomaly. The presenting features of female epispadias are urinary incontinence and abnormal anatomical features. A 4-month-old girl presented with primary urinary incontinence since birth. On physical examination, she had a bifid clitoris and labia minora along with an anteriorly placed introitus and wide-open bladder neck. The vagina and hymen were normal. With the diagnosis of isolated complete female epispadias, a single-stage reconstruction of the urethra, labia minora and clitoris was performed along with cystoscopic-guided bladder neck plication. This index case highlights the surgical technique and the necessity to operate on these patients at a younger age in infancy with a single-stage perineal repair to achieve better functional and cosmetic outcomes.

Effects of Bladder Neck Plication on Climacturia After Robot-Assisted Laparoscopic Prostatectomy.

Purpose: The aim of this study is to investigate the effect of bladder neck plication during transperitoneal robot-assisted radical prostatectomy (tRARP) on orgasm-related incontinence (climacturia) and the relationship between International Index of Erectile Function 5 (IIEF-5) scores and climacturia. Materials and Methods: We evaluated 118 patients who underwent nerve-sparing tRARP in our clinic and survived the first postoperative year. Patients were divided into two groups: those who underwent bladder neck plication (Group 1, n = 58) and those who did not (Group 2, n = 60). Our study investigated whether there is a difference between the groups in terms of climacturia or if there is a relationship between IIEF-5 scores and climacturia. Results: Of the patients in Group 1, 10.3% had incontinence and 13.8% had climacturia. Of the patients in Group 2 who did not have bladder neck plication, 10% had incontinence and 15% had climacturia. There was no difference between the groups in terms of climacturia (P > .825). Three patients (5.2%) in Group 1 and four patients (6.6%) in Group 2 requested treatment. There was no statistically significant correlation between IIEF-5 scores and climacturia in both groups (Group 1, P > .208; and Group 2, P > .508). Conclusions: In our study, the frequency of climacturia in patients who underwent bladder neck plication during tRARP was consistent with the literature and did not show a statistically significant difference from patients who did not undergo bladder neck plication. It has been observed that bladder neck plication, which has no effect on long-term continence, does not contribute to prevention of climacturia. No correlation was found between IIEF-5 scores and climacturia.

Introduction of a modified single stage reconstruction technique of male penopubic epispadias

ObjectiveTo represent the long-term outcomes of our modified single-stage technique for the reconstruction of isolated penopubic epispadias in male patients.Patients and methodsData from 113 patients were obtained from bladder-exstrophy-epispadias database of our tertiary center. A total of seven boys with isolated penopubic epispadias with no prior history of surgery and any other anomaly underwent our modified surgical approach from February 1997 to September 2019. The mean ± SD age at surgery was 6.5 ± 2.4 years. Volitional voiding status and cosmetic appearance were evaluated at each follow-up interval. Postoperative follow-up was performed at quarterly intervals in the first year and once a year in subsequent years.ResultsThe mean ± SD of follow-up was 8.5 ± 6 years. All boys who were incontinent achieved urinary control and the ability of normal transurethral micturition following the surgery. Four boys became completely dry, and the other three attained social dryness. Postoperative mean (SD) bladder capacity was significantly increased from 54.5 (11) to 124 (40.0) within 6 months, and to 194 (47.5) at 18 months after surgery. Dorsal curvature has been resolved in all cases, and no postoperative complications were noted except for surgical site infection in one patient treated with antibiotics and bilateral vesicourethral reflux resolved after injection of bulking agents. Four patients had normal erectile function and ejaculation, while the others have not reached puberty yet. Moreover, none of the patients developed urethrocutaneous fistula, stricture, or penile ischemia.ConclusionThe present findings suggest the safety and effectiveness of the combination of single-stage urethro-genitoplasty, bladder neck plication, and fat pad pedicled flap in management of boys with isolated penopubic epispadias that can lead to the achievement of urinary control, acceptable sexual function, and cosmetically satisfactory genitalia. Minimal morbidity, low complication rate, and promising outcomes are essential factors, supporting the notion of introducing this technique as a valid option for management of this entity.

Le Fort Colpocleisis

<h3>Study Objective</h3> To highlight a safe and effective technique of the Lefort Colpocleisis for treating pelvic organ prolapse in an elderly patient. <h3>Design</h3> Educational Video. <h3>Setting</h3> OR. <h3>Patients or Participants</h3> The index patient is an 82-yo G2P1011 patient with symptomatic stage III pelvic organ prolapse; the anterior compartment was the leading edge. Due to the prolapse the patient was unable to exercise and walk as much as she desired. She failed an initial trial of ring pessary. After appropriate counseling, the patient opted for surgical intervention via a Lefort Colpocleisis with the understanding that this would preclude vaginal intercourse in the future. Preoperative evaluation with cystoscopy, urodynamic studies and a pelvic ultrasound were all within normal limits. We started the procedure by marking rectangular areas on the anterior and posterior vagina. The marked areas are then removed by careful sharp and blunt dissection. The edges of the rectangle and the denuded vaginal mucosa were then closed; leaving laterally created tunnels for drainage of cervical mucus. As successive sutures were placed; it was ensured that the knots were within the epithelial lined tunnels. This carefully maneuvered technique allowed the uterus and vaginal apex to be gradually turned inward. A bladder neck plication suture was then placed due to the high risk of stress incontinence accompanying these cases. A perineorrhaphy was completed to narrow the vaginal introitus. A cystoscopy was then performed confirming ureteral patency and excluding lower urinary tract injury. At her postoperative visit the patient had resolution of her symptoms and was pleased with the outcome of her surgery. <h3>Interventions</h3> LeFort Colpocleisis. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> This technique is a good approach for the management of pelvic organ prolapse in elderly patients or those who are not candidates for major reconstructive surgery.

Robotic bladder neck plication for incontinence treatment.

Robotic bladder neck plication for incontinence treatment.

Robotic bladder neck plication for incontinence treatment

Robotic bladder neck plication for incontinence treatment

SC339 - Robotic bladder neck plication for incontinence treatment

SC339 - Robotic bladder neck plication for incontinence treatment

Female epispadias: Single-stage approach – A technique to achieve continence

This video provides a case report of a 3 year old girl with epispadia and the highlights of the surgery. A cystoscopic guided bladder neck plication was performed to achieve continence. Key points include: (1) Skin incision planning; (2) Cutaneous flap liberation to create a new urethra; (3) Complete bladder neck release to allow a controlled plication; (4) Use of cystoscopy to achieve the ideal bladder neck closure; (5) Bladder neck manipulation to achieve continence.

Single-stage Female Epispadias Repair by Combined Infrasymphyseal Bladder Neck Plication and Urethrogenitoplasty: A Novel Technique

To evaluate the role of infrasymphyseal bladder neck plication and suspension from the pubic bone along with urethrogenitoplasty as a single-stage procedure for treating isolated cases of female epispadias. Six patients with female epispadias having grade 3 urinary incontinence were treated through bladder neck plication and suspension from the pubic bone along with urethrogenitoplasty from December 2013 to March 2016. Of the 6 patients with a mean age of 5.91 years (3-10 years) and a mean postoperative follow-up of 13.17 months (4-29 months), 5 patients stopped wearing diapers and were fully continent with a dry period of more than 3 hours from the first week of catheter removal. One patient experienced urine leakage while playing or crying in the initial postoperative period. However, this patient became continent with a dry period of more than 3 hours after 4 months of follow-up. All patients had an excellent cosmetic outcome without any considerable postoperative complications. All patients were voiding well without significant postvoid residual urine. The present technique is simple, safe, and effective for achieving urinary continence in patients with female epispadias.

V12-13 URETHROLYSIS FOR SYNTHETIC PERI-URETHRAL BULKING AGENT COLLECTION

You have accessJournal of UrologyReconstruction1 Apr 2015V12-13 URETHROLYSIS FOR SYNTHETIC PERI-URETHRAL BULKING AGENT COLLECTION Tony Nimeh, William Kobak, Whitney Halgrimson, and Ervin Kocjancic Tony NimehTony Nimeh More articles by this author , William KobakWilliam Kobak More articles by this author , Whitney HalgrimsonWhitney Halgrimson More articles by this author , and Ervin KocjancicErvin Kocjancic More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2783AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although urethral bulking therapy (UBT) is a minimally invasive procedure for stress incontinence, it nevertheless carries risks and potential for complications. We present the case of a 63 year old female with a history of hysterectomy and stress incontinence who failed sling placement and a subsequent peri-urethral Durasphere ® injection and presented with incontinence, bladder spasms and sharp, throbbing pain. An MRI 6 months after her UBT revealed a periurethral submucosal soft tissue mass. transvaginal ultrasonography revealed a 1 cm spherical periurethral collection at the bladder neck. Cystoscopy revealed a spherical bulge in the proximal urethral wall and retroflexion revealed a spherical bulge at the bladder neck. We present a video demonstrating the surgical technique utilized to perform a transvaginal urethrolysis and removal of peri-urethral Durasphere ® collection. METHODS A circumferencial incision was made around the urethral meatus. Sharp and blunt dissection was then carried out to mobilize the urethra from the meatus to the bladder neck. The pubo-urethralis muscle was then divided, and circumferential urethrolysis was carried out proximally. The urethro-pelvic ligament was also incised. Urethrolysis was carried out to the bladder neck with care taken not to injure the urethral wall. The peri-urethral collection was dissected and the collection of Durasphere (R) with exudate was identified. The collection sac was then thoroughly examined using the flexible cystoscope and no communications was found with the urethral lumen. Intra-operative flexible cystoscopy was repeated and revelead a resolution of the previously noted spherical bulge at the bladder neck. The urethra was then plicated bilaterally on the lateral walls using 4.0 vicryl interrupted sutures and the the urethra was wrapped with a strip of Interseed mesh to guide the healing process. 4.0 vicryl sutures were used to stabilize the Interseed mesh and to prevent its migration and the peri-meatal incision was closed. RESULTS There were no complications and the patient was discharged home the following day with an indwelling foley catheter which was removed 10 days following the procedure. Two weeks postoperatively the patient had complete resolution of her pain as well as incontinence. CONCLUSIONS Transvaginal urethrolysis can correct complications associated with paraurethral Durasphere ® injections. When combined with a urethral and bladder neck plication, this technique can also lead to resolution of the original incontinence symptoms. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e980-e981 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tony Nimeh More articles by this author William Kobak More articles by this author Whitney Halgrimson More articles by this author Ervin Kocjancic More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy.

Urinary incontinence after robot-assisted radical prostatectomy (RARP) is one of the most bothersome complications affecting patients’ daily lives. The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013. Patients were randomized 1:1 to undergo surgery with (n = 79) or without (n = 79) the bladder neck plication stitch, and their time to recovery from incontinence, defined as being pad free, was compared. Recovery from incontinence at 1, 3, and 6 months were observed in 22 (27.8%), 42 (53.2%), and 57 (72.2%) patients, respectively, treated with, and 23 (29.1%), 47 (59.5%), and 59 (74.7%) patients, respectively, treated without the bladder neck plication stitch, with no significant difference in time to recovery from incontinence between the two groups. Multivariate analysis showed that age, membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP. The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARP.

Urinary incontinence after robot‐assisted radical prostatectomy: Pathophysiology and intraoperative techniques to improve surgical outcome

Robot-assisted radical prostatectomy has been shown to have comparable and possibly improved postoperative continent rates compared with retropubic and laparoscopic radical prostatectomy. However, postoperative urinary incontinence has remained one of the most bothersome postoperative complications. The basic concept of the intraoperative technique to improve postoperative urinary continence is to maintain as normal anatomical and functional structure in the pelvis as possible. Therefore, improved knowledge of the normal structure in the pelvis should lead to a greater understanding of the pathophysiology of urinary incontinence, and further development of intraoperative techniques to improve the outcomes of urinary continence. It might be necessary to carry out three steps to realize improvement of the early return of urinary continence after robot-assisted radical prostatectomy: (i) preservation (bladder neck, neurovascular bundle, puboprostatic ligament, pubovesical complex, and/or urethral length, etc.); (ii) reconstruction (posterior and/or anterior reconstruction, and/or reattachment of the arcus tendineus to the bladder neck, etc.); and (iii) reinforcement (bladder neck plication and/or sling suspension, etc.). On the basis of these steps, further modifications during robot-assisted radical prostatectomy should be developed to improve urinary continence and quality of life after robot-assisted radical prostatectomy.

Bladder Neck Plication Stitch: A Novel Technique During Robot-Assisted Radical Prostatectomy to Improve Recovery of Urinary Continence

Efforts to improve postprostatectomy incontinence have led to many modifications in surgical technique. We present our experience with a novel technique to improve continence outcomes in patients who are undergoing robot-assisted radical prostatectomy (RARP). A consecutive series of 159 patients after initiation of a bladder neck plication stitch was compared with the most recent group before the change. After completion of the vesicourethral anastomosis, a single suture was used to plicate the distal bladder neck. A structured questionnaire was used for follow-up. Continence criteria used were 1 pad per day for social continence and 0 pad per day for total continence. A total of 334 patients were included in the study: 159 in the plication stitch group vs 175 in the control group. Average age was 59.1 vs 59.6 years, average body mass index was 27.9 vs 28.3 kg/m(2), and average prostate volume was 58.1 vs 60.9 cc, respectively. The mean time to reach social continence was 3.63±3.01 vs 5.33±4.89 weeks (P=0.004), and total continence was 5.10±3.80 vs 8.49±6.32 weeks (P=0.002), respectively. Chance of total continence improved with the bladder plication stitch: Odds ratio of 1.95±0.72 (P<0.001) at 1 month, 1.25±0.56 (P=0.113) at 3 months, and 2.07±0.66 (P=0.005) at 12 months. There were no bladder neck contractures or other urinary complications noted in either group. The bladder plication stitch is a simple and effective technical modification for shortening the period of recovery of urinary continence in RARP patients. Randomized controlled trials are under way to further evaluate this technique.

Female epispadias managed by bladder neck plication via a perineal approach

Female epispadias is a rare genitourinary anomaly characterized by urinary incontinence and typical appearance of the external genitalia. Traditional surgical approaches have involved a staged genitoplasty and interval bladder neck reconstruction. We describe further experience of a promising single-stage technique using a cystoscopically guided bladder neck plication via a perineal approach with combined genitoplasty.

Surgeon perception is not a good predictor of peri-operative outcomes in robot-assisted radical prostatectomy.

Surgeons have always used their cognitive intuition for the execution of skilled tasks and real-time perception of intra-operative outcomes. We attempted to measure the overall accuracy of intra-operative surgeon perception on the functional outcome of early continence after robot-assisted radical prostatectomy (RARP). A single experienced surgeon (D.I.L.) used a scoring sheet to prospectively capture his subjective opinion of how well a particular portion of the RARP procedure was completed. Surgeon perception of factors affecting post-operative continence such as quality of bladder neck preservation, nerve sparing, urethral length, anastomosis, striated sphincter thickness, quality of Rocco repair and bladder neck plication suture (total 7 variables) were graded as "poor", "average" or "good". Urinary continence was graded as either total continence [0 pads per day (PPD) or social continence (security pad or one PPD)]. A total of 273 (39 patients × 7 variables) responses were recorded: 58.6% were rated as "good", 32.2% as "average" and 8.4% as "poor". A log-rank test for all perception variables showed no significant differences in subsequent achievement of continence (either 0 or 1 PPD) (P>0.05) at both the 1- and 3-month time points. In the case of some perception variables, patients with "bad" scores gained continence a median of 3weeks sooner than patients with "good" scores. Surgeon perception of intra-operative performance during RARP is a poor predictive indicator of subsequent functional outcome in terms of urinary continence. Inter-surgeon variability of perception may vary and needs further investigation.

Single‐stage subsymphyseal cystoscopic‐guided bladder neck plication and urethrogenitoplasty in female epispadias: presentation of long‐term follow‐up

• To investigate the feasibility of an endoscopic technique as a guide to evaluate bladder outlet resistance during bladder neck plication (BNP) for treatment of female epispadias. • The postoperative outcomes with long-term follow-up of 10 girls with epispadias were reviewed (four had a previous history of bulking agent injection into the BN). • After taking a skin flap from the area between the crura of the bifid clitoris, subsymphyseal dissection was continued to the BN. • Under cystoscopic guidance, BNP was performed using absorbable sutures (two cases) or non-absorbable sutures (eight) aiming to attain a smooth closure of the BN during gradual withdrawal of the cystoscope. • Finally, urethrogenitoplasty was accomplished by urethral reconstruction with tubularization of the inter-clitorial flap followed by monsplasty and approximation of the two hemi-clitorises. • The mean (range) follow-up was 9.1 (5-15) years. • After primary surgery seven of the 10 girls were continent and all could void normally. • Of the three failed cases (including two that underwent BNP using absorbable suture), two became dry after injection of bulking agent into the BN and the remaining girl underwent BN reconstruction; she was socially continent at the final follow-up. • Ultimately, all 10 girls were socially continent, including six who were completely dry. • Urodynamic studies showed an increase in mean bladder capacity (P < 0.001) and a significant time-dependent improvement of the leak-point pressure and maximum urinary flow rate. • The present series suggests that single-stage subsymphyseal urethrogenitoplasty together with cystoscopic-guided BNP for management of female epispadias is reliable and effective with definite advantages. • The high success rate and safety of the procedure are important factors for the introduction of this method as a valid option for treatment of this rare congenital anomaly.

Female urethral and bladder neck injury after rape: an appraisal of the surgical management

The aim of this study was to discuss the surgical management of urethral and bladder neck injury after urethral coitus during rape. A 21-year-old lady presented with total urinary incontinence of 1-year duration after being raped. On examination, she had urethral laceration and a patulous urethra and bladder neck suggesting urethral coitus during the rape. Her introitus and vagina were however normal. She had repair of her urethral laceration and plication of her urethra and bladder neck via a vaginal approach. She regained her continence and voids without any residual urine. Urethral coitus is rare. Urethral coitus in the presence of a normal introitus and vagina is very rare. The urethral and bladder neck injury resulting from this can be satisfactorily corrected by urethral and bladder neck plication via a vaginal approach with the vaginal incisions positioned to forestall suture line apposition, which may lead to wound failure.

Treatment of adult female epispadias without exstrophy in the presence of rhabdosphincter function

Female epispadias without exstrophy is a very rare entity. Symptoms of female epispadias are primary urinary incontinence and anatomical abnormal features. A 24-year-old married women with two children presented with primary urinary incontinence. Due to previous failure of correct diagnosis and ineffective medical treatment, the patient developed psychological problems (anxiety and depression). In the presence of minimal rhabdosphincter function we could achieve socially acceptable urinary continence by bladder neck plication and a Burch colposuspension. The patient did not consent to a major reconstruction.

Risk Factors for Prolapse Recurrence After Vaginal Repair

One hundred seventy-six women who underwent surgical repair for vaginal prolapse (stage II or more) and incontinence and who had a 1-year postoperative examination were evaluated to identify demographic or clinical factors associated with recurrent prolapse. The pelvic organ prolapse quantification (POP-Q) staging system was used to describe vaginal prolapse. Recurrence was defined as stage II or worse at any vaginal site or the most advanced site of prolapse by centimeter measure beyond the hymen. In general, women with stage II prolapse were younger, more likely to have taken estrogen replacement therapy, and had fewer pregnancies than those with stage III or stage IV prolapse. One hundred two patients (58%) had recurrent prolapse at the 1-year follow up. Nearly all of these (n = 96, 94.1%) had stage II prolapse, including 42 with maximal extent 1 cm above the hymen, 43 with prolapse at the hymen, and 11 with prolapse 1 cm beyond the hymen. Four women had stage III (prolapse 2 cm beyond the hymen) and 2 had stage IV prolapse (stage III with vaginal length 4 cm or less). A multivariate analysis of patient characteristics found that women over 50 years of age and women with more than 1 site of preoperative prolapse had a higher rate of prolapse recurrence (P = 0.02 and P = 0.055, respectively). More women with preoperative stage III or IV prolapse (64.5%) than with preoperative stage II prolapse (50.6%) developed a recurrence, but the difference was not significant. Logistic regression analysis of patient characteristics or surgical procedures found patient age above 60 years and preoperative stage III or IV prolapse to be independently associated with recurrent prolapse at1 year (P = 0.001 and P = 0.005, respectively). Forty-seven percent of women who had 1 or 2 concomitant operative procedures had recurrent vaginal prolapse compared with 63% of those who had 3 to 7 additional procedures performed (P = 0.07). Bladder neck plication and posterior colporrhaphy were associated with anterior recurrent prolapse (P = 0.005 and P = 0.003, respectively). Bladder neck suspension, either Burch or sling, had a smaller risk of recurrent anterior vaginal prolapse (P = 0.003), and a greater risk of recurrent posterior vaginal prolapse (P = 0.008).