Update on complications of synthetic suburethral slings

ABSTRACT Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.

The short-term effect of surgical treatment for stress urinary incontinence using sub urethral support techniques on sexual function

OBJECTIVES: To evaluate the impact of surgical treatment of stress urinary incontinence on the sexual function of women and to identify whether such treatment can improve their sexual function and overall quality of life. MATERIALS AND METHODS: 64 heterosexual women with such indication were studied using the Female Sexual Function Index (FSFI) questionnaire, modified by introducing one question to evaluate the impact of urine loss. This was applied preoperatively and six months after surgery. RESULT: Among these 64 patients, 60.94 percent had regular sexual activity, while 39.06 percent did not. Among sexually active patients, 59 percent had urine loss during sexual intercourse and, of these, 87 percent had urine losses in half or more of sexual relations. There were no statistically significant differences in assessments of desire, arousal, lubrication, orgasm, satisfaction and pain, or in totaling the scores, between the preoperative period and six months after surgical treatment. However, the scores for urine losses during sexual intercourse were significantly better after the operation. CONCLUSIONS: Analysis of the results allowed the following conclusions to be reached: Urine lost during sexual activity was frequent among patients with stress urinary incontinence. Suburethral support surgery did not jeopardize sexual activity. Patients cured of stress urinary incontinence did not present improvement in sexual function.

Endoscopic treatment of vesical and urethral perforations after tension-free vaginal tape (TVT®) procedure for female stress urinary incontinence / x

A incontinência urinária de esforço é um problema prevalente em mulheres. As opções para seu tratamento vêm aumentando nos últimos tempos, havendo um direcionamento para as técnicas minimamente invasivas, com auxílio de material sintético. Com a utilização desses procedimentos, surgiram complicações incomuns, como perfuração vesical e uretral. As complicações estudadas foram devido à utilização de material sintético no tratamento de incontinência urinária de esforço e o tratamento endoscópico empregado. MATERIAL E MÉTODO: Onze pacientes foram tratadas com complicações decorrentes do tension-free vaginal tape, seis com faixa de polipropileno dentro da bexiga e cinco com erosão para uretra. Foi realizada ressecção endoscópica em todas as pacientes. RESULTADOS: Uma paciente persistiu com a faixa de polipropileno e foi submetida à nova ressecção endoscópica e cistoscopia controle após três meses era normal. CONCLUSÃO: Realização de ressecção endoscópica de faixas sintéticas intravesicais e intra-uretrais deve ser considerada uma boa alternativa no tratamento dessas complicações.

Aspectos anatômicos da sexualidade feminina / Anatomical aspects of feminine sexuality

A sexualidade feminina possui características próprias, que a diferenciam da masculina. Sua função, na cultura ocidental, durante séculos, esteve voltada para a procriação. Os autores apresentam uma revisão dos aspectos anatômicos relacionados à função sexual feminina, procurando correlacionar essa função com a anatomia. Esta revisão contribui para o entencimento da resposta sexual feminina, bem como para identificar possíveis disfunções associadas com anormalidades ou lesões anatômicas

Concurrent validity, internal consistency and responsiveness of the portuguese version of the king's health questionnaire (KHQ) in women after stress urinary incontinence surgery

OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73 percent) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.

Experiencia inicial do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo com uso de fascia lata homologa para correcao de incontinencia urinaria esfincteriana / Initial experience of the Hospital of the Clinics of the College of Medicine of the University of Sao Paulo with use of homologous fascia lata for correction of sphincteric urinary incontinence

Incontinencia urinaria de esforco causada por deficiencia esfincteriana intrinseca, e o desafio no tratamento da incontinencia de esforco feminina. Nosso objetivo e descrever a tecnica pubovaginal Sling...

Feocromocitoma vesical / Vesical pheochromocytoma

Feocromocitoma vesical é um tumor raro, representando 1 por cento dos feocromocitomas extra-adrenais. Foram descritos 117 casos na literatura. É apresentado o caso de uma jovem com hipertensäo arterial sem causa aparente controlada com enalapril. Três anos depois, realizou-se ultrasonografia para avaliaçäo de queixa abdominal de origem näo-urinária, quando diagnosticou-se tumor vesical. Por näo se tratar de tumor urotelial, optou-se por cistectomia parcial cujo exame anatomopatológico revelou feocromocitoma. Um ano após a cirurgia, a paciente apresentava níveis pressóricos de 140 x 100 mmHg, sendo controlados com 1 mg de prazosim

Carcinoma inflamatório da mama: experiência de 43 casos do Instituto do Câncer Arnaldo Vieira de Carvalho / Inflammatory carcinoma of the breast: experience with 43 cases of the Cancer Institute Arnandlo Vieira de Carvalho

Os autores analisaram 43 casos de câncer inflamatório, estabelecem sua freqüência e faixa etária, sua classificaçäo clínico-patológica e enfatizam a necessidade de biópsia incisional, com retirada de fragmento de pele. Justificam plenamente a terapêutica inicial pela quimioterapia, para controle local e sistêmico, bem como potencializaçäo da RT, que deve ter fracionamento diário. Caracterizam o uso de medidas cirúrgicas nos casos em que somente há comprometimento clínico, sem invasäo linfática dérmica, ou como caráter higiênico nas mamas ulceradas ou em vias de ulceraçäo. Mostram a evoluçäo desfavorável destes casos, malgrado qualquer terapêutica, e a sobrevida de menos de 5% em cinco anos