Fibroadenoma of the vulva is a benign fibroepithelial tumor that is extremely rare. We present a rare clinical case of a 49-year-old woman with a large slow-growing paraurethral fibroadenoma of the vulva, confirmed by histological examination. This observation describes a rare pathology that contributed to urination disorders, which required surgical treatment and confirmation of the benign process by immunohistochemical examination.

During the last century various loop operations are used in the treatment of stress urinary incontinence. Methods for treating urinary incontinence are inextricably linked with the development of urology as a science. Dominance concept of sphincter deficiency as the main cause of urinary incontinence led to the use of various muscle loops, which was considered by many authors, could carry the functional load. The last decade was marked by significant developments and achievements in the treatment of urinary incontinence in women. Data received today entitle say that, in general, the use of synthetic loops installed without tension in the middle of the urethra, to get rid of urinary incontinence significant number of patients with this medical and social problem worldwide. We can say that with the advent of SIMS and their use in the treatment of urinary incontinence, a new stage. The concept of using SIMS for implantation which the surgeon requires one incision under the middle third of the urethra, is not innovative. So Smith presented his minisling made of pig skin in 1987. First available for use SIMS became minisling TVT Secur company Gynaecare (Ethicon) in 2005. To date, there are many SIMS: TVT Secur®, MiniArc®, Ophira®, Adjust®, Solyx®, Zipper Sling®, Prosurg®, Tissue Fixation System®, Needleless®, Altis®, Just-swing®, Desara®. Many manufacturers do not stop and continue to develop new minislingi with new locking mechanisms.

The analysis of the data of foreign literature in the treatment of recurrence of urinary incontinence in women. Standards for treatment of recurrent forms of urinary incontinence to date does not exist. Efficiency reoperation slightly lower primary. Efficacy of repeat loop plastics made from retropubic access higher than transobturator. The most commonly used and effective operation TVT. A detailed survey of patients helps to increase the effectiveness of the treatment.

CONCLUSIONS It’s well-know that the risk for woman of being the operated for 80 years about the pelvic organ prolapse (POP) or stress urinary incontinence (SUI) is about 11% [1]. It should be noted that approximately 22-30% of patients who were continent before surgery noted SUI postoperatively [2], [3], which has a strong impact on the quality of life of patients. Objective of our study was to evaluate the incidence of SUI and anti-incontinence surgery for 6 months in patients after surgical correction of pelvic organ prolapse (POP) by the vaginal approach. This study included 82 women suffering from POP (cystocele grade 2-4 by POP-Q) who underwent transvaginal surgical repair. The study was approved by the local ethics committee, and all patients. All patients were submitted to standard protocol of preoperative examination including a history taking and gynecological examination with cough tests with or without prolapse repositioning by speculum, pessary or manually. All patients were operated by vaginal approach. The results of surgical treatment of POP were evaluated for the presence SUI within 1, 3 and 6 months after the operation during office visits and using the UDI-6 questionnaire.

The treatment of recurrent lower urinary tract infections in young female patients remains controversial (Naber, 2000; Stamatiou, 2005; Wagenlehner, 2009). Recurrent lower UTI is often associated with sexual intercourse. The association of UTI with sexual intercourse poses both medical and psychological problems for these patients (Stamatiou, 2005). Usually these patients are young females. Repeated courses of antibiotic therapy and postcoital antibiotics prophylactic help some, but not all patients. Conventional antimicrobial therapy has limited success and often has to be repeated (Naber, 2000). A remarkable increase of antibiotic resistance is also noted in uncomplicated UTI (Wagenlehner, 2009). “Intravaginal urethral displacement” during sexual intercourse appears to play a role in both the development of these symptoms and the recurrence of UTI symptoms by contamination of microbial agents in the distal urethra (Stamatiou, 2005), which may often lead to cystitis. The repositioning of the distal part of the urethra may potentially minimize microbial contamination in this area. The operation makes it possible to withdraw the meatus from the area concerned. Careful mobilization of the distal part of the urethra with modern technology and fine absorbable suture materials provides minimal invasion and may be considered an option for patients with recurrent UTI associated with sexual intercourse. In this chapter we shall present detailed surgical techniques and long-term results of distal urethral transposition in female patients with recurrent UTI associated with sexual intercourse.

Aims Objectives: recurrent urinary tract infection deals with anatomical variations of meatus position in more than 10% of patients. lt can lead to retrograde permeation of bacteria during sexual intercourse. Transposition of distal urethra can significantly improve the symptoms of urinary tract infection in such group of patients.

Background: Recurrent lower urinary tract infection (UTI) is often associated with sexual intercourse. Usually these patients are young females. Repeated courses of antibiotic therapy help some, but not helpful to all patients. Distal urethra vaginal ectopy seems to play an important role in accumulating microorganisms, resulting in recurrent UTI. The repositioning of the distal part of the urethra may potentially minimize microbial contamination in this area. Objective: The purpose of this study is to share the results of minimal invasive procedures, such as distal urethral transposition, in the treatment of female patients with symptomatic UTI associated with sexual intercourse. Patients: A total of 328 woman (mean age 25.9 years) with recurrent symptomatic lower UTI associated with sexual intercourse and repeated unsuccessful conventional treatment were found to have intravaginal urethral displacements during vaginal examinations. Two hundred and seventy-one patients underwent distal urethral transposition (group I) - a procedure depicted on a DVD provided with this article. Fifty-seven patients (mean age 25.9 years) with the same histories, anatomical findings, and symptoms and signs of lower UTI, receiving conventional treatment, served as controls (group II). The mean follow-up time of the 271 patients from group I was 52.5 months (48 - 57 months). Surgical Procedure: The operation makes it possible to withdraw the meatus from the area concerned. Measurements: All patients were initially diagnosed and treated for chronic cystitis and urethritis for at least 6 months without success. During vaginal examinations, special emphasis was given to the position of the distal urethra. A plastic penile imitator was introduced vaginally to evaluate urethral movements simulating intercourse. All patients were required to avoid sexual intercourse postoperatively for 1 month and were treated with standard antibiotic therapy for a mean time of 3 weeks. Results and Limitations: Patients from group I were evaluated after 3 months, showing no postoperative complications. Examinations of 204 (75.3%) patients from group I 1 year later showed no symptoms or signs of UTI. Sixty-seven (24.7%) patients required further antimicrobial prophylaxis after the procedure because of the longer preoperative duration of their symptoms. Nineteen patients (7.0%) showed poor results. One hundred and eighty-three patients were available for additional examinations after 3 and 5 years, (mean 4.4 years) revealing stable results with no lower UTI for these patients. Group II patients were followed-up for 1 year. Fortysix (80.7%) of them were found to have recurrent symptoms with poor response to the therapy, and had to undergo repeated treatment. Conclusions: Young female patient suffering from recurrent lower UTI should be evaluated with a specific emphasis on possible intravaginal urethral displacement during sexual intercourse. Conventional treatment can be long and often unsuccessful for the majority of patients. Distal urethral transposition is feasible, replicable, and can be used for these patients, leading to good and stable results in 93% of cases.