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Introduction: SAFYRE is a monofilament polypropylene mesh held between two self-anchoring silicone columns that associates universal approach with readjustability. This unique feature allows for comparing two different approaches, i.e., transvaginal and transobturator, using the same sling. Materials and methods: A total of 226 patients with clinical and urodynamic diagnosis of SUI underwent SAFYRE sling procedure, which was performed either by transvaginal (group 1; 126 patients) or transobturator approach (group 2; 100 patients). The mean age was 63 years, in group 1 and 61 years in group 2. Physical examination, stress and pad test and urodynamic assessment were performed before the surgery. Results: The average follow-up period was 18 months in group 1 and 14 months in group 2. There was no difference in cure rate in both groups. The mean operative time was longer (25 min) in group 1 than in group 2 (15 min) (P

Stress urinary incontinence (SUI) can occur simultaneously with anterior vaginal prolapse (AVP) in up to 30% of patients. We studied a monoprosthesis that combines prepubic and transobturator arms for simultaneous treatment of AVP and SUI. One hundred four women with AVP underwent surgical treatment using a monoprosthesis (NAZCA TC®). POP-Q was used for anatomical evaluation. Functional results were evaluated by quality of life questionnaires, stress test and Stamey score. Patients were evaluated at 1, 3, 6 and 12 months postoperatively. There were significant and sustained improvements in points Aa, Ba and C. Positive stress test was observed in 29.8% preoperatively and decreased to 1.9% after 12 months. There was no significant impact in sexual symptoms. Mesh exposure was noted in 5.7% of patients. Monoprosthesis with combined prepubic and transobturator arms presented high success rates for AVP repair and simultaneous SUI treatment. It has also been shown to be safe and appears to preserve sexual function.

Introduction and hypothesis: To exclude a neuromuscular denervation damage due to prosthetic mini-invasive surgery using transobturator tape (TOT) by pre and postoperative electromyography (EMG) of the striated urethral sphincter. Methods: Seventeen women with SUI were enrolled by urogynecologic and urodynamic examination. Each of them underwent EMG of striated urethral sphincter performed by 25-mm concentric needle that was put in as far as 5 mm inside internal urethral sphincter. Amplitude and duration of EMG potentials were measured during caught, maximal contraction, and at rest. Four months after TOT treatment women underwent EMG. Results: The mean amplitude of EMG potentials does not show significant statistical differences between pre- and post-TOT (P=NS). The duration of potentials, instead, changed between pre and posttreatment only during the maximal contraction test (P≤0.05). Conclusions: TOT prosthesis surgery, avoiding denervation and devascularization of pelvic structures does not produce damage of the urethral sphincter. © The International Urogynecological Association 2011.

Haematopoietic stem cell transplantation is an important therapy for certain haematological and malignant disorders. Umbilical cord blood contains a high proportion of potentially transplantable haematopoietic progenitor cells. However, the use of cord blood stem cell transplantation is limited by the low number of stem cells obtainable from a single cord blood donor. The aim of our study was to investigate the possibility that procedures during delivery might influence the number of umbilical cord blood haematopoietic progenitor cells available for transplantation. We assessed the effects of upper and lower positions of the newborn infant on the yield of cord blood stem cells in 51 vaginal deliveries. Neonates in the upper position group were placed by the midwife on the maternal abdomen immediately after birth, while those in the lower position group were placed on the delivery table, below the maternal introitus. The total volume of cord blood and the total number of CD34+ cells collected from babies in the upper position group were significantly higher than those from babies in the lower position group. There were no significant differences in cord blood haemoglobin levels and white blood cell counts between the two groups, nor were there any adverse effects in the newborn infants. The simple manoeuvre of placing the newborn on the maternal abdomen after delivery may thus increase the yield of transplantable haematopoietic progenitor cells in cord blood.

Objectives: To study the quality of life and sexual function changes of women affected by severe cystocele and treated with the double transobturator tension-free approach. Study design: 23 women (mean age 60.6) with third and fourth degree cystocele (according to Baden and Walker classification) were monitored by Short Form-36 (SF-36) and Pelvic Organ Prolapse/Urinary Incontinenece Sexual Questionnaire (PISQ-12) before and 12 months after surgical treatment. Each woman also underwent translabial color Doppler ultrasonography to measure the Resistance Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV), and End-Diastolic Velocity (EDV) of the clitoral arteries, before surgery and 12 months postoperatively. Results: SF-36 showed a considerable increase in all of the categories (physical functioning, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning, and mental health) compared to those obtained at baseline (P < 0.05). PISQ-12 also showed a considerable increase in the behavioural emotive factor score, in the physical factor score, in the partner-related factor score and, consequently, in the total score compared to that obtained at baseline (P < 0.05). Color Doppler measurement showed that the mean Pulsatility Index, Peak Systolic Velocity, Resistance Index and End-Diastolic Velocity were not significantly lower to those obtained at baseline (P = NS). Conclusions: Double transobturator tension-free approach to treat severe cystocele considerably improves quality of life and sexual function, and does not significantly influence clitoral blood flow. Our data could add new information about sexual behaviour after prolapse treatment, particularly about the impact on clitoral blood flow changes. © 2010 Elsevier Ireland Ltd. All rights reserved.

The aim of this study is to show the safety and efficacy of the double transobturator approach, a new technique for anterior vaginal wall prolapse, using several different kinds of meshes (synthetic and biological).This is a retrospective study of 74 women treated between 2005 and 2007. The patients underwent a 3, 6 and 12 month follow-up. The anatomical cure rate, defined as grade of prolapse

OBJECTIVES: To evaluate the objective and subjective midterm outcomes of transobturator tape (TOT) in the treatment of female stress urinary incontinence (SUI). MATERIALS AND METHODS: A total of 114 consecutive patients affected by stress urinary incontinence (mean age 59±10 years), who underwent the TOT procedure between July 2004 and May 2008 (46 patients received the Safyre, 30 patients the PelviLace, 20 patients the Monarc, 10 patients the DynaMesh and 8 the Align sling), were assessed in June 2008. An evaluation of the patients, based on history, physical examination, stress test, urodynamic tests, and the compilation of two specific quality of life questionnaires, was performed before and after surgery. RESULTS: The therapeutic midterm failure rate for the TOT procedure was 4.4% (5 of 114 patients). The midterm cure rate was 95.6% (109 of 114 patients), 7 (6.1%) of those patients only improved, still with minimal residual urinary leakage. Clinical signs for bowel, urethral, or bladder injuries were undetectable. Intraoperative bleeding, postoperative field infections, or postoperative pelvic floor relaxations were not noted. Three patients (2.6%) presented a little small area of mesh erosion within 6 months from surgery. We also noticed a few obstructive symptoms and irritative symptoms: 4 of 114 (3.,5%) patients showed urge de novo urge symptoms. A high grade degree of satisfaction was assessed reported by QoL questionnaires ( p

OBJECTIVES To study the effects of mini-invasive surgery using the tension-free vaginal tape (TVT) procedure and the transobturator tape (TOT) procedure in modifying clitoral blood flow in women affected by stress urinary incontinence. METHODS The setting of the prospective open clinical study was the Urogynecologic Service of the Department of Microbiological and Gynecological Science, University of Catania School of Medicine (Catania, Italy). A total of 105 women underwent surgery; 42 (mean age 52.8 years) and 63 (mean age 53.9 years) were treated with TVT and TOT, respectively. Each woman underwent translabial color Doppler ultrasonography to measure the resistance index, pulsatility index, peak systolic velocity, and end-diastolic velocity of the clitoral arteries, before and 6 months postoperatively. RESULTS In the TVT group, the mean pulsatility index and mean peak systolic velocity were significantly lower and the mean resistance index was significantly greater compared with the pretreatment values (P

The aim of our study was to evaluate the diagnostic agreement between quantitative sonography of the calcaneum (QUS) and dual energy X-ray absorptiometry (DEXA) of the spine and femur. 153 women enrolled in our study and were divided in three groups. Group A was composed of women aged between 45 and 55, Group B of women of 56-66 and Group C of women 67-77. Mean height cm 164+/-2.8; mean weight kg 68+/-3.2. The most concordant results were obtained in group B. This suggests that QUS screening for osteoporosis may be suitable for the "younger" perimenopausal patient.

Background / aim: The aim of this study was to compare the role of quantitative ultrasonography (QUS) and dual energy X-ray absorptiometry (DEXA) in the assessment of osteoporosis. Methods: From June 1999 to November 2001, 596 women who have not been diagnosed osteoporosis and without previous history of pathologic fractures were enrolled in this study. They had a mean age of 58.7±8.5 years, a mean height of 166±3.5 cm and a mean weight of 66±4.1 kg. According to the age, women were divided into three groups: group A included women between 45 and 55 years; group B women between 56 and 66 years and group C women between 67 and 77 years. Each patient underwent to both methods to determine the presence of osteoporosis. Results: QUS resulted in a greater number of women of group A at risk of osteoporosis, whereas DEXA indicated that more women of group C were at increased osteoporotic risk. QUS and DEXA gave concordant results only in women of group B. Conclusion: These results suggested that QUS screening for osteoporosis may be more suitable for ‘younger’ postmenopausal women.

From December 1999 to February 2001, the Microbiological and Gynaecological Science Department of the University of Catania has been involved in the collection of umbilical cord blood samples. Eight hundred and sixty-three cord blood units were collected and sent to Sciacca's UCB bank. Among them, 429 were collected from newborns delivered vaginally, while the remaining were collected from Caesarean sections. The aim of this study was to evaluate the difference between umbilical cord blood samples collected during a vaginal delivery and those from a Caesarean section. In particular, the blood volume collected and cord blood CD34+ stem cell count were considered. The method of blood collection consisted of puncturing the umbilical cord vein with an 18-gauge needle and withdrawing the blood into a sterile bag immediately after clamping and newborn assistance. The blood was collected when the placenta was still in utero and the indication to the kind of delivery was, independently of the study, according to obstetrical good practice. The results of the analysis showed that the cord blood volume and the number of CD34+ cells collected were similar for the two groups. The higher median volume of blood collected from infants delivered by Caesarean section seems mainly due to the different clamping time, rather than to the kind of delivery.

Summary: We describe the relation between clamping time and blood volume collected, and two enrichment systems of CD34+ stem cells from umbilical cord blood, in order to determine the criteria for an excellent recovery with high proliferative ability and bone marrow reconstitution. After an obstetrician-based cord blood collection, the purification of stem cells was performed either with a combination of monoclonal antibodies, negative selections, using the Stem Sep method, or with a positive cells selection owing to their surface CD34 antigens, using the Mini Macs system. An excellent recovery of haematopoietic progenitors – burst forming unit erythroid; colony-forming unit granulocyte and macrophage; and colony-forming unit granulocyte, erythroid, monocyte, and macrophage – inversely related to an increase in clamping time, was achieved using the Mini Macs system (54 % of colonies with a 90 % purity), while the recovery of haematopoietic progenitors was 35 % (with a 80 % purity) using the Stem Sep method. By clamping umbilical cord blood at an early stage, we obtained a greater number of CD34+ cells, and their clonogenic activity increased with enrichment. This is particularly useful considering that the number of CD34+ stem cells contained in a unit of placental blood is sufficient for transplanting into a child but not for an adult engraftment. Thus, using these methods, we obtain a larger number of CD34+ stem cells. This increases the possibility of reducing graft versus host disease in adult patients and produces survival rates similar to the ones we observed in transplantation of bone marrow from unrelated donors. Zusammenfassung: Wir beschreiben den Zusammenhang zwischen dem Zeitpunkt des Clampings und dem Volumen des gesammelten Nabelschnurbluts sowie von zwei Systemen zur Anreicherung von CD34+-Stammzellen aus dem Nabelschnurblut, um die Kriterien fur die bestmogliche Recovery mit hoher proliferativer Fahigkeit und Knochenmarkrekonstitution zu erheben. Nach einer Gewinnung des Nabelschnurbluts durch den Geburtshelfer wurde die Reinigung der Stammzellen entweder mit einer Kombination von monoklonalen Antikorpern und negativer Selektion unter Verwendung der Stem-Sep-Methode oder durch eine positive Selektion von Zellen mit CD34+-positivem Oberflachenantigen mit Hilfe des Mini-Macs-System vorgenommen. Eine ausgezeichnete Recovery der Vorlaufer der Hamatopoese, die verkehrt proportional zum Zeitpunkt des Abklemmens der Nabelschnur war, konnte mit dem Mini-Macs-System erreicht werden (Recovery: 54 % der Kolonien mit einer 90 %igen Reinheit!). Mit der Stem-Sep-Methode konnte dahingegen nur eine 35 %ige Recovery mit 80 %iger Rein­heit erreicht werden. Das Clampen des Nabelschnurbluts zu einem fruhen Zeitpunkt fuhrte in unseren Handen zu einer groseren Anzahl CD34+-Zellen. Die klonogene Aktivitat dieser Zellen stieg mit ihrer Anreicherung an. Mit dem Einsatz der von uns getesteten Methoden konnten wir eine hohere Zahl von CD34+-Stammzellen aus dem Nabelschnurblut als bisher ublich gewinnen. Diese Ergebnisse sind fur die Knochenmarktransplantation von Bedeutung, da so die aus einer Plazenta gewonnenen Stammzellen nicht nur fur die Transplantation in ein Kind, sondern auch in einen Erwachsenen ausreichen konnten. Dadurch wurde die ge­furchtete Graft-versus-Host-Erkrankung Erwachsener reduziert werden.

Background/Aims: Umbilical cord blood contains a large number of early hematopoietic cells with high proliferating capacity, that has been used as an alternative to bone marrow transplantation. The aim of this study is to investigate the number of two cell adhesion molecules in cord blood and in bone marrow. Methods: We investigated two integrins, named VLA-2 and VLA-5 (Very Late Appearing Antigen), expressed in the surface of CD34+ cells. The CD34+ cells, isolated with MACS CD34+ isolation kit, were labelled with the appropriate monoclonal antibodies. Results: Cell adhesion molecules showed highly expressed in both cord blood and bone marrow CD34+ cells. Conclusion: There are no significant differences between the two sources of CD34+ populations.

Umbilical cord blood is largely employed as an alternative source of stem cells in the treatment of hemato-oncological diseases. Current results show that the success rate of purified umbilical cord blood engraftment is comparable to that obtained using bone marrow, and it is directly related to the number of pluripotent stem cells transplanted. The technique of fetal blood collection varies among different umbilical cord blood banks. Many authors collect umbilical cord blood during vaginal delivery, after placental detachment, while others collect it while the placenta is still within the uterus. In a previous randomized trial, we showed a greater collection of umbilical cord blood before placental detachment during vaginal delivery. The present study was performed to determine whether umbilical cord blood collection before placental detachment (group A) during cesarean section is superior to that after placental delivery (group B) puncturing the umbilical vein once and using a closed bag system. To accomplish this, 47 pregnant women subjected to cesarean section were enrolled in the study. Twenty-one of them were allocated to group A, while the remaining 26 formed group B. The volume of umbilical cord blood collected from the patients of group A was greater than that collected from patients of group B. The cord blood volume collected was 90.7 ± 6.0 versus 60.9 ± 13.7 ml; the cord blood nucleated cell number was 10.1 ± 1.2 × 108 vs. 7.1 ± 0.8 × 108; and the mean cord blood CD34+ cell number was 20.0 ± 6.0 × 105 vs. 16.4 ± 2.4 × 105, respectively.

Hematopoietic stem cells collected from umbilical cord blood (UCB) are widely considered a potential alternative to bone marrow. Research on UCB has now developed with the establishment of cord blood banks throughout the world. The aim of our study is to improve the efficiency of our bank because of the high cost and the administrative effort involved in its organization, finding a correlation between the terms of UCB units discarding, such as the low volume and for the low cell counts, and the obstetrics causes. This process has been made to cut the cost of the research and to improve the final result of each bank. We obtained, in 15 months, 683 cord blood units by blood withdrawal from the placenta. The units were cryopreserved within 24 h of collection, in a volume of at least 60 ml with a nucleated cells total of more than 800 per 10(6). Specific analyses of the unit blood to exclude bacterial contamination were undertaken. Of the 683 bags collected, 340 (49.75%) were discarded, and 343 were banked. The main reasons for rejecting the UCB units were: low volume; low cell counts; clinical history; bacterial contamination; freezing problems; unit misidentification; and no informed consent. We suggest that regular monitoring of the reasons for the rejection of the UCB units could give a significant effort to the bank organization, and identifying those units that are suitable before the cryopreservation could save precious resources.

A clinical case concerning a normal pregnancy outcome in a transfusion-dependent woman affected by homozygous beta thalassemia, whose partner was negative with regard to the "thalassemic trait", was reported. The patient showed no iron deposit problems, viral diseases that could have made the pregnancy management difficult or any complications during the gestation. Blood transfusion was not necessary during the following caesarean delivery. The outcome was a healthy female child, born at a gestational age of 38 weeks, showing neither malformations nor problems. This was possible due to a detailed preconceptual guidance and a pre-pregnancy assessment. The patient normally would have had a blood transfusion every 20 days and a strict desferrioxamine chelating therapy; however, this treatment was suspended during her pregnancy because of the well-recognised teratogenic effects of the drug. The average values of ferritin were just a little higher than before being pregnant. The foetus, due to her particular chelating activity, probably maintained these ferritin levels. A sample of 95 ml umbilical cord blood was taken during the delivery. It is well known that umbilical cord blood contains a good quantity of CD34+ stem cells, the haematopoietic progenitors. It was therefore collected for transplanting to the mother and for bone marrow reconstitution. Moreover, our experience suggests that desferrioxamine therapy during lactation does not alter iron excretion in breast milk. Therefore, women now affected by Cooley disease may possibly have a normal pregnancy without ovulation induction, intrauterine growth retardation, foetal loss and preterm labour.

Fetal stem cells transplants depend on nucleated cells from fetal blood. This study was a prospective randomized trials to compare the collection of fetal blood by gravity into a bag containing anticoagulant, before and after delivery of the placenta. The obstetric and the newborn characteristics in the two group were not significantly different. The mean volume of fetal blood collected while the placental was still in utero was 74.93+/-7.1 ml as against 35.78+/-3.6 ml for collection of fetal blood after delivery of the placenta.

Objectives To study the effects of the mini-invasive surgery using the tension free vaginal tape (TVT) procedure and the transobturator tape (TOT) procedure in modifying clitoral blood flow in women affected by stress urinary incontinence (SUI). Methods The setting of the prospective open clinical study was the Urogynecologic Service. Forty-two women (mean age 52.8 ys) and 63 women (mean age 53.9 ys) were treated with TVT and TOT, respectively. Each woman underwent translabial color Doppler sonography to measure the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV) and end diastolic velocity (EDV) of clitoral arteries, before and 6 months after surgery treatment. Results In the TVT women the mean PI and the mean PSV were significantly lower, and the mean RI was significantly higher compared with pre treatment values (p Conclusions The different vaginal approach for both of the surgical methods influence the clitoral blood-flow. Our data stimulate to study the sexual aspects after incontinence treatment, particularly, the possible impact of clitoral flow changes on sexual function.