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which was an interesting study that both investigated the safety and efficacy of the four-arm polypropylene mesh (Nazca-Tc, Promedon, Cordoba, Argentina) in the treatment of high-stage cystocele and evaluated clinical outcomes in a subgroup of patients with simultaneous stress urinary incontinence (SUI) via a double transobturator approach. Although the study had strong limitations due to a relatively small number of patients and a single-arm rather than a double-arm study design, the Nazca-Tc system was deemed by the authors to be effective and safe in the treatment of advanced anterior vaginal wall prolapse with a low rate of complications after medium-term followup. Furthermore, the authors suggested that most of the subgroup with concomitant SUI was cured without a second simultaneous procedure. This was a valid and well-conducted study, despite its limitations, and suggests interesting data and conclusions for consideration by urogynecologists. However, the study had a significant structural limitation: the lack of a correct evaluation of pre- and postoperative sexual function. The authors reported that only 29 of 64 patients (45.3%) were

investigative and clinical urology

Letter to the editor: Comment on "Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh"