Lone-Star retractor perineal exposure method for laparoscopic abdominal perineal resection of rectal cancer

BACKGROUND The abdominal perineal resection(APR),historically referred to as Mile’s proce-dure,stands as a time-honored surgical intervention for rectal cancer manage-ment.Advancements in surgical techniques and the advent of neoadjuvant therapies have significantly improved the rate of sphincter preservation among patients afflicted with rectal cancer,including those with ultralow rectal cancer.Despite these improvements,APR maintains its irreplaceable role in the clinical landscape,particularly for cases involving low rectal cancer with encroachment on the external anal sphincter or levator ani muscles.Optimal perineal exposure stands as a pivotal phase in APR,given that the precision of this maneuver is directly correlated with both the safety of the surgery and the patient’s subse-quent long-term prognosis.AIM To evaluate the value of Lone-Star retractor(LSR)perineal exposure method in the treatment for laparoscopic APR of rectal cancer.METHODS We reviewed the records of 38 patients with rectal cancer at Anqing Municipal Hospital from January 2020 to December 2023,including 20 patients who underwent the APR procedure with a LSR perineal exposure method(LSR group)and 18 patients who underwent the APR procedure with a conventional perineal exposure method(control group).In the LSR group,following incision of the skin and subcutaneous tissue,the LSR was placed and dynamically adjusted according to the surgical plane to fully expose the perineal operative field.RESULTS A total of 38 patients underwent laparoscopic APR,none of whom were found to have distant metastasis upon intraoperative exploration.Perineal blood loss,the postoperative hospital stays and the wound pain scores in the LSR group were significantly lower than those in the control group.A single surgeon completed the perineal operation significantly more often in the LSR group than in the control group(P<0.05).The incidence of infection via the perineal incision in the LSR group was significantly lower than that in the control group(P<0.05).No cases of distant metastasis or local recurrence were found among the patients at the postoperative follow-up.CONCLUSION The application of the LSR technique might be helpful for performing perineal exposure during APR for rectal cancer and could reduce the incidence of perineal complications,shorten the postoperative hospital stay,improve postoperative pain,and allow one surgeon to perform the perineal operation.

The Impact of Perineal Trauma on Postpartum Women at Ndola Teaching Hospital, Zambia: A Phenomenological Study

Perineal trauma following childbirth affects over two-thirds of women in low and medium-income countries (LMICs) birthing in health facilities. Although it is an unfavourable outcome with the potential to affect many aspects of a woman’s well-being in both the immediate and long-term, it is still a neglected phenomenon of women’s health, particularly in sub-Saharan African countries like Zambia. This study sought to understand the impact of birth perineal trauma on postnatal women at Ndola Teaching Hospital (NTH). This study employed a cross-sectional qualitative design using a descriptive phenomenological approach. Fifteen women who had birthed at NTH and sustained birth perineal trauma were purposively sampled as study participants. Data were collected through face-to-face interviews aided by an interview guide. Four themes, namely, perineal pain, substandard perineal wound management, fear of future reproductive health outcomes and diversion from reality, emerged from the study. Most women experiencing childbirth perineal trauma do not receive adequate care to manage their condition effectively. Therefore, midwives should utilise their professional knowledge and skills when providing postnatal care because morbidity affects women. Thus, it has the potential to negatively affect mother-infant bonding. The study concluded that birth perineal trauma is a distressing phenomenon of childbirth;hence, skillful repair, pain management and sexual counselling can greatly reduce its negative impacts.

The Incidence and Risk Factors of Third- and Fourth-Degree Perineal Tears in Ministry of Health in Bahrain over 5 Years

Background: Perineal trauma and vaginal laceration are considered a common complication associated with vaginal delivery. Well established risk factors, recognized by the Royal College of Obstetricians and Gynecologists, are ethnicity, birth weight over 4 kg persistent occipital posterior position, null parity, induction of labor, shoulder dystocia, instrumental delivery. There are other risk factors that were suggested in the literature, but data are conflicting, such as prolonged second stage of labor, episiotomy and obesity. Objective: To evaluate third- and fourth-degree perineal rears rates and the impact of related risk factors on perineal tears in Ministry of health in Bahrain over 5 years (which includes Salmanyia Medical complex (SMC) and Jidhafs maternity hospital (JMH)). Methods: This retrospective descriptive cross-sectional study analyzed all vaginal deliveries from January 2015 to December 2019 in Obstetrics and Gynecology department in Salmanyia Medical Complex (the main hospital in Kingdom of Bahrain which received all kinds of cases including low and high risks) and Jidhafs Maternity Hospital (tertiary hospital which received only low risk cases), Kingdom of Bahrain. During the period of interest 33,694 records were identified. Data were extracted from observational recording from SMC and JMH labour registry books. Results: There was no statistically significant difference between groups according to age (p = 0.199). On the other hand, there was statistically significant higher cases of >40 weeks at gestational age, obesity > 35 kg/mr, vacuum delivery, pushing stage > 90 min, birth weight > 4 kg, head circumference > 34 cm, fetal length at birth > 50 cm, episiotomy and lower cases of nulliparity in study group compared to control group 16 (66.7%) vs. 13,805 (41.0%), 3 (12.5%) vs. 1448 (4.3%), 3 (12.5%) vs. 1414 (4.2%), 4 (16.7%) vs. 1751 (5.2%), 3 (12.5%) vs. 1751 (5.2%), 12 (50.0%) vs. 15,926 (47.3%), 15 (62.5%) vs. 20,135 (59.8%) and 17 (70.8%) vs. 29,024 (86.2%);(p = 0.027, 0.009, Conclusion: Gestational age > 40 weeks, obesity > 35 kg/mr, pushing stage > 90 min, birth weight > 4 kg, head circumference > 34 cm, fetal length at birth > 50 cm and using of vacuum increase incidence of 3rd and 4th degree perineal tears with vaginal delivery however maternal age and nulliparity have no significant role. Finally, episiotomy did not represent as protective factor for perineal damage. .

Risk Factors Associated with Obstetric Perineal Tear in a Maternity Ward of the Communal Medical Center of Ratoma-Conakry-Guinea

Introduction: Obstetric perineal tears are a common complication during childbirth. The objectives of this study were to describe the sociodemographic characteristics, the different types of perineal tears and to identify the associated risk factors. Patients and Method: The maternity of the CMC of Ratoma served as a setting for carrying out this study. This was a prospective study of a descriptive and analytical type, which took place over a period of 6 months from July 1, 2021 to January 1, 2022. Results: The frequency of perineal tear was 9%. The average age of the patients concerned was 23.99 years ± 5.18 years, with extremes of 15 and 38 years. Housewives were the most numerous (30.88%). Most of our parturient had undergone excision (99.6%) and they were more frequently primiparous (40.44%) and pauciparous (47.79%). The multiplicity of risk factors was a remarkable fact (scarred perineum, edematous, short, and infected). The presentation was cephalic in 96.33%, posterior variety in 3.81% and the variety of positions could not be specified by the health worker who provided care to the parturient in 46.56%. The expulsion took place in OP (92.37%) and in OS (2.30%). In most cases, midwives carried out deliveries (93%). Perineal tears were 1st degree (54.41%), 2nd degree (39.70%), 3rd degree (5.15%) and 4th degree (0.74%). Conclusion: Prevention of perineal obstetric injuries is based on better knowledge of risk factors and delivery by qualified personnel. The main limitation of this study is the impossibility of highlighting occult perineal lesions due to the weakness of the technical platform.

Biological mesh reconstruction of the pelvic floor following abdominoperineal excision for cancer:A review

Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal wounds.Such large wounds are prone to infection and perineal herniation,and their closure is a major concern to most surgeons.Different approaches to the perineal repair exist,varying from primary or mesh closure to myocutaneous flaps.Each technique has its own associated advantages and potential complications and the ideal approach is still debated.In the present study,we reviewed the current literature and our own local data regarding the use of biological mesh for perineal wound closure.Current evidence suggests that the use of biological mesh carries an acceptable risk of wound complications compared to primary closure and is similar to flap reconstruction.In addition,the rate of perineal hernia is lower in early follow-up,while long-term hernia occurrence appears to be similar between the different techniques.Finally,it is an easy and quick reconstruction method.Although more expensive than primary closure,the cost associated with the use of a biological mesh is at least equal,if not less,than flap reconstruction.

Perineal Hernia after Laparoscopic Abdominoperineal Resection for Rectal Cancer: A Case Report and Review of the Literature

Perineal hernias are uncommon complications following laparoscopic abdominoperineal operations. There is still very little known about perineal hernia. There are only few case reports to describe the repair of postoperative hernias after laparoscopic abdominoperineal resection (APR) in the literature. Here we present one patient with a perineal hernia after laparoscopic abdominoperineal resection for rectal cancer. The surgical management with manual purse-string suture is described and discussed in this case report.

Wooden stick penetration from the perineal region up to the thorax

BACKGROUND: Penetrating injuries of the perineum are rare but very dangerous. Since the genitourinary and colorectal organs may be injured, how to evaluate surgical management of the injury is very important.METHODS: The present report presents a case of penetrating injury of the perineum by a wooden stick when the patient fell on the upright wooden stick from a tree. The three feet long stick entered the perineal region just left lateral to the anal opening. Upon reaching the thoracic cavity, it broke and only a foot stick was left in the subcutaneous plane. These injuries are potentially serious with risk of damage to multiple organs. Exploratory laprotomy was done, and bladder injury was repaired. The entry wound and the track of stick was thoroughly washed and allowed for secondary intention healing.RESULTS: The post operative period was uneventful and the patient recovered fully.CONCLUSION: Meticulous evaluation and surgical management of perineal injuries are the key to prevent devastating complications.

Perineal rectosigmoidectomy for gangrenous rectal prolapse

Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of incarcerated acute rectal prolapse,without a relevant previous history or symptoms of predisposing pathology.The patient underwent emergency perineal proctosigmoidectomy,the Altemeier operation,combined with diverting loop sigmoid colostomy.The postoperative course was quite uneventful with an excellent final result after colostomy closure.The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual case scenario of bowel incarceration.

Observation of the effects of three methods for reducing perineal swelling in children with developmental hip dislocation

BACKGROUND Developmental dysplasia of the hip is a developmental abnormality of the hip joint that results from hypoplasia during birth and continues to deteriorate after birth.AIM To observe the effects of magnesium sulfate wet compress,iodophor wet compress,and ice compress on reducing postoperative perineal swelling in children with developmental hip dislocation to provide effective nursing interventions in the clinic.METHODS A total of 120 children with hip dislocation after surgery in a third-class A hospital from January 2018 to January 2020 were randomly divided into four groups,the magnesium sulfate wet compress group,iodophor wet compress group,ice compress group and the control group.Data such as height,weight,age,duration of surgery,intraoperative blood loss,postoperative body temperature,swelling duration,pain score,and incidence of blisters were collected and analyzed.RESULTS There were no significant differences in height,weight,age,duration of surgery,intraoperative blood loss,and postoperative body temperature among the four groups of children.Statistical differences were observed between the intervention groups and the control group(P<0.05).CONCLUSION All three methods significantly reduced postoperative perineal swelling in children with developmental hip dislocation,reduced the duration of postoperative perineal swelling,reduced pain,and improved the quality of care.

Clinical characteristics of perineal endometriosis:A case series

BACKGROUND The prevalence of perineal endometriosis(PEM)is low among women with endometriosis(EM)treated by surgery.It manifests as hard or cystic nodules with pain in the perineal wounds and surrounding areas.Implantation theory is regarded as the main pathogenesis of PEM.There are few clinical studies on the incidence and clinical characteristics of PEM.This study aims to summarize the clinical data of 14 PEM cases and analyze the factors that may be related to the incubation period and pain.AIM To analyze the medical history,clinical manifestations,diagnosis,treatment and treatment effect of PEM.METHODS The present study is a case series.We collected the clinical data and follow-up data of 14 patients with PEM who visited The International Peace Maternal and Child Health Hospital Affiliated to Shanghai Jiaotong University from January 2009 to December 2019.Paired t test and Pearson correlation analysis were used for statistical analysis.P<0.05 was considered statistically significant.RESULTS The 14 patients included had a history of vaginal delivery.All patients underwent PEM lesion resection.Three patients were treated by levator ani muscle repair at the same time and 1 patient underwent extensive PEM lesion resection and anal sphincter repair.Body mass index(BMI)at delivery and BMI within 1 mo after delivery were negatively correlated with the latent period,respectively(R2=0.53/0.86,P<0.05).The average visual analog scale score in lesions at the third month after surgery was 0.57±1.28 for all patients,which was significantly lower than that prior to surgery(P<0.05).One patient relapsed during the sixth month after surgery,and to date,no recurrence occurred after the second surgery.CONCLUSION The higher the BMI during delivery and within 1 mo after delivery,the shorter the incubation period of PEM.It is very important to evaluate the location of lesions before surgery.Surgical resection of the lesion is the best treatment for PEM and results in significant alleviation of symptoms.Therefore,following the diagnosis of PEM,immediate surgery is recommended.

Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain

BACKGROUND Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain.However,ganglion impar block combined with pulsed radiofrequency(GIB-PRF)for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance.AIM To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIBPRF in treating perineal pain.METHODS Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016.Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure,and visual analogue scale(VAS)scores at 24 h before and after treatment and 1,3,and 6 mo later were analyzed to evaluate clinical efficacy.RESULTS Ultrasound-guided GIB-PRF was performed successfully in all patients,and no complications occurred.Compared with pretreatment scores,the VAS scores were significantly lower(P<0.05)at the four time points after treatment.The VAS scores at 1 and 3 mo were slightly lower than those at 24 h(P>0.05)and were significantly lower at 6 mo after treatment(P<0.05).There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo(P>0.05).CONCLUSION Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain.The 6-mo short-term clinical efficacy was favorable,but the long-term outcomes need future study.

Effect of perineal massage on the incidence of episiotomy and perineal laceration

Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother’s pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10), 44.4% (20), 33.3% (15) respectively in interventional group. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statis- tically significant. Rate of first-degree laceration was 33.3% (15) in massage group, while this percent was 28.3% (28) in control group. This difference was not statistically significant. In massage and control groups, second, third and fourth-degree lacerations did not occur. Conclusion: The results showed that massage with a sterile lubricant provides no apparent and significant advantage or disadvantage in reducing perineal trauma. Therefore, the use of massage as technique for perineal control is safe based on labour criteria and woman’s preference during delivery.

Intermediate-term oncological and functional outcomes in prostate cancer patients treated with perineal robot-assisted radical prostatectomy:A single center analysis

Objective:In the last 10 years,robotic platforms allowed to resume of some alternative surgical approaches,including perineal robot-assisted radical prostatectomy(p-RARP).Herein,we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months.Methods:Patients presenting low-or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected.Baseline,intraoperative,pathological,and postoperative data were collected and then analyzed.Results:Thirty-seven p-RARP cases were included.Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4.Body mass index of≥25 kg/m^(2)was reported by 24(64.9%)patients,as well as 7(18.9%)patients reported a past surgical history.Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL,respectively.The median operative time was 242 min.The positive surgical margin rate was 45.9%.In terms of postoperative complications,10 patients reported complications with any grade;however,a single case(2.7%)of major(Clavien-Dindo grade≥3)complication was observed.No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up.Recovery of continence rates were 67.6%,75.7%,and 92.9%,at 6 months,12 months,and 24 months after surgery,respectively.

Use of a specific questionnaire and perineal electromyography to assess neuropathic pain after radical retropubic prostatectomy

Objective:Prostate cancer is the most frequent cancer in men and radical retropubic prostatectomy(RRP)is one of the first-line treatment.However,RRP has some side effects and can lead to chronic perineal pain.The objective of the study was to determine in patients suffering from perineal pain after RRP the possibility of a neurogenic damage by means of a specific questionnaire dedicated to track down neuropathic pain.Methods:Forty patients were explored by a specific and validated questionnaire,the Neuropathic Pain Symptom Inventory(NPSI).Patients were divided into two groups:Group A with an NSPI score≥4 was considered as suffering from neuropathic pain,and Group B was considered as a control group without neuropathic pain(NSPI score<4).All patients had a perineal electrophysiological testing to confirm the possibility of a neurogenic damage.Results:Group A was composed by 13 men and Group B by 27 men,with mean age 72.45 years and mean duration of pain 2.7 years.In Group A,the most frequent symptoms were burning sensation,electrical shock and numbness.Location of the pain was global perineal area(8/13),anus(10/13),penis(5/13)and glans penis(2/13).Electromyography(EMG)findings confirmed the presence of denervation and neurogenic damages compared with controls(p<0.001).Conclusion:One third of the patients consulting for chronic pain following RRP had probably a neuropathic lesion leading to a chronic perineal pain as suggested by an NSPI score≥4 and EMG alterations.

Mine disaster survivor’s pelvic floor hernia treated with laparoscopic surgery and a perineal approach:A case report

BACKGROUND A pelvic floor hernia is defined as a pelvic floor defect through which the intraabdominal viscera may protrude.It is an infrequent complication following abdominoperineal surgeries.This type of hernia requires surgical repair by conventional or reconstructive techniques.The main treatments could be transabdominal,transperineal or a combination.CASE SUMMARY In this article,we present the case of a recurrent perineal incisional hernia,postresection of the left side of the pelvis,testis and lower limbs resulting from a mine disaster 18 years ago.Combined laparoscopic surgery with a perineal approach was performed.The pelvic floor defect was repaired by a biological mesh and one pedicle skin flap.No signs of recurrence were indicated during the 2 years of follow-up.CONCLUSION The combination of laparoscopic surgery with a perineal approach was effective.The use of the biological mesh and pedicle skin flap to restructure the pelvic floor was effective.

Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse:A case report

BACKGROUND Rectal prolapse in young women is rare.Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate,postoperative infertility is a concern.Perineal rectosigmoidectomy(Altemeier procedure)is useful for these patients.However,the risk of anastomotic leakage should be considered.Recently,the usefulness of fluorescence imaging with indocyanine green(ICG)to prevent anastomotic leakage was reported.We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.CASE SUMMARY A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication.The patient also suffered from rectal prolapse,approximately 3 mo before admission.She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder.Approximately 10 cm of complete rectal prolapse was observed.However,the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry.Because she had the desire to bear children in the future,she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility.We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage.Her postoperative course was uneventful,and the rectal prolapse was completely resolved.She continued to do well 18 mo after surgery,without recurrence of the rectal prolapse.CONCLUSION ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.

Anterior perineal hernia after anterior exenteration

Perineal hernia is a rare complication of anterior exenteration.We reported this complication after an anterior exenteration for bladder cancer with bleeding complication requiring packing and second-look laparotomy.Perineal approach is a simple and effective method for repair of perineal hernia.

Evaluating the Role of Measuring the Perineal Length as a Predictor of Progress of Labor and Obstetrical Trauma

Objective: Evaluating the effect of perineal length on the duration of the second stage of labor, the mode of delivery, the need for episiotomy and the possibility of perineal and vaginal tears needing repair. Participants and Methods: It is a prospective hospital-based observational study done on 483 parturient women in a university hospital. Personal, medical and obstetric data together with the measurement of perineal length were recorded in the first stage of labor. We followed up the progress of labor until delivery. Regression models were used to consider possible risk factors of episiotomy or tears needed repair. Results: The mean duration of the second stage of labor was significantly longer among women with a perineum of ≥4 cm length when compared with those with a perineal length of Conclusion: Longer perineum is associated with increase in the duration of the second stage of labor. Obstetricians should expect the need of episiotomy when confronted with circumcised primigravida with long perineum. However, if the perineum is short they should not be deceived, short perineum is more probably torn.

The Perineal Membrane: Its Composite Fibers and Nerve Content, and Relationship to the Levator Ani and Deep Transverse Perineal Muscles

The perineal membrane (PM) is a thick, elastic fiber-rich, smooth muscle-poor membrane extending along the vestibule and lower vaginal wall and embedding the urethrovaginal sphincter and compressor urethrae muscles. To provide a better understanding of the topographical relationship between the PM and the levator ani muscle, we examined histological sections from 15 female cadavers. The composite fibers of the PM were usually continuous with that of a fascia covering the inferior or lateral surface of the levator ani (fascia diaphragmatis pelvis inferior) rather than the endopelvic fascia covering the superior or medial surface of the latter muscle. However, this fascial connection was sometimes interrupted by a venous plexus. The deep transverse perineal muscle was consistently adjacent to the posterolateral aspect of the PM, but whether it extended superficially or deeply to the PM depended on size of the muscle. In contrast to the endopelvic fascia embedding abundant middle-sized nerves (cavernous and sphincter nerves;0.05 - 0.1 mm in thickness), the PM contained very thin nerves: many in 10 cadavers but few in 5 cadavers. Most of the nerves seemed to be sensory on the basis of immunohistochemistry. The levator ani muscle was considered likely to provide traction force to the PM, but active elevation appeared to be difficult because of the highly elastic nature of the PM and the interrupting venous plexus. Loss of nerves in the PM might be one of a number of factors that can accelerate pelvic organ prolapse.

Can We Predict De Novo Urge Incontinence by Perineal Ultrasound?

Introduction: Urinary incontinence affects over 200 million people worldwide [1]. Tension free vaginal tape is the standard surgical treatment for stress urinary incontinence. De novo urge urinary incontinence is a long-term complication of this treatment with a significant impact in the quality of life of these patients. Objective: The major aim of this study is to assess the correlation between perineal ultrasonography findings and the incidence of de novo urge urinary incontinence. Material and Methods: A prospective observational study was designed. Patients with stress urinary incontinence diagnosed by clinical and urodynamic findings submitted to a tension-free vaginal tape surgery were included. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and introital perineal ultrasound were performed before surgical intervention (I-STOP&copy). Clinical and ultrasound re-evaluation were executed six months after surgery. Stress urinary incontinence was defined according to the ICS-IUGA. Data were recorded using a Microsoft Access database and statistical analysis using SAS&copy. Results: Bladder thickness equal to or below 6 mm has a low positive predictive value (PPV, 0.55), but a negative predictive power (NPP) of 0.72. Following surgery, a slight increase in postvoid residue is observed. Considering demographic data, an increase of 5 points in body mass index (BMI) resulted in an odds ratio (OR) of 1.74 of presenting de novo urge urinary in continence. Conclusions: In patients submitted to a tension-free vaginal tape surgery, high BMI seems to be associated with a higher rate of de novo urge urinary incontinence. Preoperative bladder wall thickness below 6 mm seems predict absence of this complication.