ABSTRACT
Trans-obturator tape (TOT) and tension free vaginal tape (TVT) procedures are efficient treatment options, which reduce the surgical complications and provide adequate support to urethra in case of increased abdominal pressure to prevent stress urinary incontinence (SUI). The aim of this study is to evaluate the effect and efficacy of 3D printed female anatomical model on the training of TOT and TVT procedures. A 3D printed female anatomical model was produced for MedTRain3DModSim, Erasmus+ European Union project led by Turkey with the participation of Greece, Italy, Czech Republic and South Korea. Face and content validities of the model evaluated by the participants and the experts respectively. During two learning & teaching & training activities and a multiplier event of the project between 2016 and 2018; 41 medical students, 30 residents and 19 specialists of urology and gynecology were educated and performed TOT and TVT procedures with this model under the mentorship of 3 experts. All participants were assessed and scored for their achievement on both procedures with model according to 7 parameters by the experts. There was no statistical difference between the students and residents for each parameter. All the parameters of the students and specialists were statistically different. 3D anatomical models produced from real data and mimicking different types of tissues are suitable for basic anatomy education of students and residents, hands on training for junior surgeons before cadaveric courses in hybrid education system, surgical planning of the surgeons and informing the patients before the operation.
Los procedimientos de cinta transobturadora (TOT) y cinta vaginal sin tensión (TVT) son opciones de tratamiento eficientes, que reducen las complicaciones quirúrgicas y proporcionan un soporte adecuado a la uretra en caso de aumento de la presión abdominal para prevenir la incontinencia urinaria de esfuerzo (IUE). El objetivo de este estudio fue evaluar el efecto y la eficacia del modelo anatómico femenino impreso en 3D en el entrenamiento de los procedimientos TOT y TVT. Se produjo un modelo anatómico femenino impreso en 3D para MedTRain3DModSim, proyecto Erasmus + de la Unión Europea dirigido por Turquía con la participación de Grecia, Italia, la República Checa y Corea del Sur. Validez facial y de contenido del modelo fueron evaluados por los participantes y los expertos respectivamente. Durante dos actividades de aprendizaje, enseñanza y capacitación y un evento multiplicador del proyecto entre 2016 y 2018; 41 estudiantes de medicina, 30 residentes y 19 especialistas en urología y ginecología fueron capacitados y realizaron procedimientos TOT y TVT de este modelo bajo la tutoría de 3 expertos. Todos los participantes fueron evaluados y calificados por los expertos, por su logro en ambos procedimientos con el modelo de acuerdo con 7 parámetros. No hubo diferencia estadística entre los estudiantes y los residentes para cada parámetro. Todos los parámetros de los estudiantes y especialistas fueron estadísticamente diferentes. Los modelos anatómicos en 3D producidos a partir de datos reales e imitando diferentes tipos de tejidos son adecuados para la educación básica de anatomía de estudiantes y residentes. Además de ofrecer una capacitación práctica para los cirujanos antes de los cursos cadavéricos en el sistema educativo, y una planificación quirúrgica de los cirujanos e información para los pacientes antes de la cirugía.
Subject(s)
Humans , Female , Urinary Incontinence, Stress , Urinary Tract/anatomy & histology , Suburethral Slings , Models, Anatomic , Printing, Three-DimensionalABSTRACT
Background: Stress incontinence is one of the most common but debilitating health issue among women. It has a detrimental effect on overall health and quality of life of women. Trans obturator tape (TOT) has emerged as a promising treatment modality. The aim of present study was to assess the usefulness of TOT in terms of change in quality of life of stress incontinence patients.Methods: The study was performed at Department of Obstetrics and Gynecology, Acharya Shri Chandler of Medical Sciences (ASCOMS), Jammu. A total of 50 symptomatic women were enrolled in the study and underwent TOT procedure using outside-in technique. The quality of life of women was assessed at enrolment and 12 months after the procedure using King’s Health Questionnaire (KHQ). Change in QOL was assessed using paired ‘t’-test.Results: After 12 months follow-up, a total of 27 (54%) patients were entirely symptom free. As compared to pre-treatment QOL assessment on KHQ for general health/incontinence impact, quality of life and symptom scores a % decline of 73.2%, 79.8% and 78.4% was observed. For all the three parts, the change in scores was significant statistically. No other complications and side effects were reported.Conclusions: TOT is a useful procedure which provided symptomatic relief as well as QOL enhancement.
ABSTRACT
Based on the integral theory, tension-free placement of a mid-urethral sling (MUS) for female stress urinary incontinence (SUI) has gained substantial popularity owing to the ease of the procedure and its effectiveness. Published series with long-term follow-up show continence rates after the MUS procedure ranging from 70% to 80%. Complication rates after MUS procedures are usually low. This review aimed to describe the historical change and the current use of the MUS. We discuss the efficacy and complications of various MUS procedures and the current strategies for managing failed slings.
Subject(s)
Animals , Female , Humans , Mice , Follow-Up Studies , Suburethral Slings , Urinary IncontinenceABSTRACT
PUROPOSE: Transobturator sling is a new minimally invasive treatment for female stress urinary incontinence. We compared the efficacy and safety of the two procedures, Monarc and TVT-O. MATERIAL AND METHODS: We included 110 patients with stress urinary incontinence who underwent the Monarc (n=52) or TVT-O (n=58) procedure and followed up at least for 1 year. Preoperative evaluations, the indices of voiding and postoperative complication were investigated. They were analyzed by Student's t-test, Paired t-test and chi-square test. RESULTS: There were no significant difference in the preoperative patients' characteristics, postoperative complication and success rate between the two groups. The preoperative and postoperative storage symptoms between two groups had no significant difference but the patients of both groups had significant improvement in storage symptoms such as frequency and urgency after surgery. CONCLUSIONS: The Monarc and TVT-O is equally effective and safe procedures as a treatment method of female stress urinary incontinence.
Subject(s)
Female , Humans , Postoperative Complications , Suburethral Slings , Surgical Mesh , Urinary Incontinence , Urinary Incontinence, StressABSTRACT
OBJECTIVE: This study was performed to evaluate the efficacy and safety of Trans-obturator tape (TOT) in the surgical treatment of stress incontinence and analyze the postoperative clinical outcome. METHODS: Between August 2004 and September 2005, females diagnosed as having stress incontinence (pure or mixed) were operated on using TOT. Eighty cases with more than three-month follow-up period were included for this study. RESULTS: Patient age ranged from 28 to 74 years (mean, 58). After surgical treatment using TOT, 74 cases (92.5%) of stress incontinence showed complete recovery, 4 cases (5%) showed partial recovery, and 2 cases (2.5%) were unchanged without further functional deterioration. Urgency in the mixed incontinence was improved in 30 in 36 cases (83.3%) and frequency was changed for the better in 20 of 27 cases (62.9%). The mean operation time was 14.3 minutes and the mean hospital stay was six hours. Postoperative evaluation with cystoscope was unnecessary. The postoperative complication rate was 10% (8/80). Postoperative wound bleeding occurred in one case and intraoperative bladder perforation happened in one case. Postoperative transient urgency was developed in one case and postoperative transient frequency developed in three cases. Two patients complained of weak urinary stream. CONCLUSION: The surgical treatment using TOT is thought to be a safe and efficient means for the outpatient management of stress incontinence. And also, this method appears to have an effect on urgency and frequency.