ABSTRACT
ABSTRACT Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings. Data from 57 women who underwent consecutive TO sling surgery to treat SUI were pros- pectively collected between 2012 and 2014, and divided in two groups for further compa- rison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test. Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All de- mographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.
Subject(s)
Humans , Female , Aged , Prosthesis Design , Quality of Life , Urinary Incontinence, Stress/surgery , Suburethral Slings/standards , Polypropylenes , Postoperative Complications , Brazil , Surveys and Questionnaires , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Prosthesis Implantation/methods , Suburethral Slings/adverse effects , Operative Time , Middle AgedABSTRACT
OBJETIVO: Comparar o uso de tela de polipropileno e correção sitio-específica no tratamento cirúrgico do prolapso vaginal anterior. MÉTODOS: Estudo prospectivo randômico comparativo em que foram operadas 32 pacientes com idades entre 50 e 75 anos, que apresentavam prolapso vaginal anterior estádio III ou IV, ou recidivado. A estática pélvica foi avaliada segundo as recomendações da International Continence Society (ICS), o sistema POP-Q e pelo Índice de Quantificação de Prolapso (POP-Q-I) Absoluto e Relativo. Para o rastreamento da incontinência urinária de esforço oculta todas as pacientes, sintomáticas ou não, foram submetidas a estudo urodinâmico em posição semi-ginecológica e semi-sentada, com redução do prolapso com pinça de Cheron. Registrou-se o tempo cirúrgico, o volume de sangramento intra-operatório e as complicações intra e pós-operatórias. O tempo de seguimento médio do estudo foi de 8,5 meses. RESULTADOS: Em relação aos resultados anatômicos ocorreu melhores resultados com a utilização de tela de polipropileno sobre o reparo sitio-específico. Em relação à morbidade cirúrgica, observou-se menor tempo cirúrgico no grupo em que utilizou-se tela. CONCLUSÃO: Houve superioridade dos resultados anatômicos obtidos com a utilização de tela de polipropileno sobre o reparo sitio-específico.
OBJECTIVE: Pelvic organ prolapse is a disorder caused by the imbalance between the forces responsible for supporting the pelvic organs in their normal position and those that tend to expel them from the pelvis. Anterior vaginal wall prolapse, known as cystocele, is the most common form of prolapse and can result from lesions in different topographies of the endopelvic fascia. Currently, a woman has an 11 percent risk of being submitted to a surgical procedure to correct pelvic floor disorder, and a 29 percent chance of being reoperated due to failure in the first surgery. METHODS: A prospective randomized study was conducted to compare the use of polypropylene mesh with site-specific repair in the surgical treatment of anterior vaginal prolapse. Thirty-two patients aged between 50 and 75 years, who had previous vaginal prolapse at stage III or IV, or prolapse recurrence, were operated. Mean follow-up was 8.5 months. RESULTS: The results demonstrate the superiority of the anatomical outcomes with the use of polypropylene mesh over site-specific repair. Regarding surgical morbidity, shorter operative time was observed for the mesh group. CONCLUSION: The results observed in this study indicate the superiority of anatomical results obtained with the use of polypropylene mesh over site-specific repair.
Subject(s)
Aged , Female , Humans , Middle Aged , Polypropylenes , Surgical Mesh , Uterine Prolapse/surgery , Gynecologic Surgical Procedures/methods , Prospective StudiesABSTRACT
A histerectomia radical de Werthelm-Meigs foi o tratamento de escolha para o carcinoma invasivo do colo do útero estadio clínico lb e lla no Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo no período de 1974 a 1993, quando 166 pacientes foram submetidas a esta forma de tratamento. Metástases linfonodal estava presente em 19 pacientes (11,3 por cento). A taxa de recidiva foi de 21 por cento nas pacientes com linfonodos positivo e 6 por cento nas linfonodo negativas. Complicaçöes ocorreram em 35 pacientes (20,83 por cento) e foram as seguintes: atonia vesical 9,52 por cento; fistulas 5,95 por cento; incontinencia urinária 4,76 por cento; estenose reteral 2,97 por cento; deiscência 2,38 por cento de linfedema de membros inferiores 1,19 por cento. Complicaçöes intra-operatórias ocorreram em 4,76 por cento e envolveram lesöes em bexiga ureter e grandes vasos