The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery

ABSTRACT Introduction: The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It's role in acute urinary retention (AUR) is not totally understood. Objectives: To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery. Subjects and Methods: We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis. Results: There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012). Conclusions: The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR.

Bipolar transurethral enucleation and resection of the prostate versus bipolar resection of the prostate for prostates larger than 60gr: A retrospective study at a single academic tertiary care center

ABSTRACT Objective: To evaluate the efficacy and safety of bipolar transurethral enucleation and resection of the prostate (B-TUERP) versus bipolar transurethral resection of the prostate (B-TURP) in the treatment of prostates larger than 60g. Material and Methods: Clinical data for 270 BPH patients who underwent B-TUERP and 204 patients who underwent B-TURP for BPH from May 2007 to May 2013 at our center were retrospectively analyzed. Outcome measures included operative time, decreased hemoglobin level, total prostate specific antigen (TPSA), International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), quality of life (QoL) score, post void residual urine volume (RUV), bladder irrigation duration, hospital stay, and the weight of resected prostatic tissue. Other measures included perioperative complications including transurethral resection syndrome (TURS), hyponatremia, blood transfusion, bleeding requiring surgery, postoperative acute urinary retention, urine incontinence and urinary sepsis. Patients in both groups were followed for two years. Results: Compared with the B-TURP group, the B-TUERP group had shorter operative time, postoperative bladder irrigation duration and hospital stay, a greater amount of resected prostatic tissue, less postoperative hemoglobin decrease, better postoperative IPSS and Qmax, as well as lower incidences of hyponatremia, urinary sepsis, blood transfusion requirement, urine incontinence and reoperation (P<0.05 for all). Conclusions: B-TUERP is superior to B-TURP in the management of large volume BPH in terms of efficacy and safety, but this finding needs to be validated in further prospective, randomized, controlled studies.

Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia

ABSTRACT Purpose Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia. Materials and Methods A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded. Results There were 60 patients in each Group. Their mean age was 35.95±15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697). Conclusion This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.

Acute urinary retention in a pre-school girl with constipation / Retenção urinária aguda em pré-escolar feminina com constipação intestinal

Objective: To report a case of a preschool girl who developed acute urinary retention associated with constipation. Case description: A girl aged six years old presented a 24 h history of inability to urinate. She was went twice to the emergency room during this period. In the first admission, 12 h after the onset of the symptoms, she presented abdominal pain and acute urinary retention. After the drainage by urinary catheterization of 300 mL of clear urine, she presented relief of the symptoms and, as urinalysis had no change, the patient was discharged home. Twelve hours after the first visit, she returned to the emergency room complaining about the same symptoms. At physical examination, there was only a palpable and distended bladder up to the umbilicus with no other abnormalities. Again, a urinary catheterization was performed, which drained 450 mL of clear urine, with immediate relief of the symptoms. Urinalysis and urine culture had no abnormalities. During the anamnesis, the diagnosis of constipation was considered and a plain abdominal radiography was performed, which identified large amount of feces throughout the colon (fecal retention). An enema with a 12% glycerin solution was prescribed for three days. During follow-up, the child used laxatives and dietary modifications, this contributed to the resolution of the constipation. There were no other episodes of urinary retention after 6 months of follow-up. Comments: Acute urinary retention in children is a rare phenomenon and constipation should be considered as a cause.

Objetivo: Relatar um caso de criança que desenvolveu retenção urinária aguda associada à constipação intestinal. Descrição do caso: Menina, seis anos, havia 24 horas apresentara incapacidade de liberação de esfíncter vesical. Foi atendida por duas vezes em um serviço de emergência nesse período. Na primeira consulta, 12 horas após o início do quadro, apresentava dor abdominal e retenção urinária aguda e foi feita sondagem de alívio com saída de 300mL de urina clara. Houve alívio imediato dos sintomas e, como o exame de urina tipo 1 não apresentou alterações, a paciente recebeu alta. No segundo atendimento, 12 horas após a primeira consulta, apresentava as mesmas queixas. Ao exame físico, observou-se apenas bexiga palpável e distendida até a cicatriz umbilical, sem outras alterações. Nova sondagem vesical foi feita com saída de 450mL de urina clara, com alívio imediato dos sintomas. Nenhuma anormalidade foi observada no exame de urina tipo 1 e na urocultura. Durante a anamnese, foi levantada a hipótese diagnóstica de constipação intestinal. Foi feita radiografia simples de abdome, que identificou grande quantidade de fezes em todo o cólon (retenção fecal). Enema com solução glicerinada a 12% foi prescrito por três dias. Durante o seguimento a criança fez uso de laxativos e modificações na dieta que contribuíram para a resolução da constipação intestinal. Não houve repetição do quadro de retenção urinária aguda após seis meses de acompanhamento. Comentários: A retenção urinária aguda em crianças é um fenômeno raro e a constipação intestinal deve ser considerada como uma das causas.

Comparison of perioperative outcomes between running versus interrupted vesicourethral anastomosis in open radical prostatectomy: A single-surgeon experience

PURPOSE: To compare perioperative outcomes between running and interrupted vesicourethral anastomosis in open radical prostatectomy (RP). MATERIALS AND METHODS: The medical records of 112 patients who underwent open RP for prostate cancer at our institution from 2006 to 2008 by a single surgeon were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were measured. RESULTS: Of 112 consecutive patients, 62 patients underwent vesicourethral anastomosis by use of the running technique, whereas 50 patients underwent anastomosis with the interrupted technique. The groups did not differ significantly in age, body mass index, prostate-specific antigen, prostate volume, or pathologic findings. The intraoperative extravasation rate was significantly lower in the running group (8.1% vs. 24.0%, p=0.01). The mean anastomosis time was 15.1+/-5.3 and 19.3+/-4.6 minutes in the running and interrupted groups, respectively (p=0.04). The rates of postoperative extravasation were similar for both groups (6.4% vs. 10.0%, p=0.12). The duration of catheterization was significantly shorter in the running group (9.0+/-3.0 days vs. 12.9+/-6.4 days, p<0.01). The rate of urinary retention after catheter removal and the rate of bladder neck contracture were not significantly different between the two groups. The rate of urinary continence at 3, 6, 9, and 12 months after RP was also similar in both groups. CONCLUSIONS: Both anastomosis techniques provided similar functional results and a similar rate of postoperative urine extravasation. However, running vesicourethral anastomosis decreased the rate of intraoperative extravasation and time for anastomosis, without increasing the risk of urinary retention or bladder neck contracture.

Noxious electrical stimulation of the pelvic floor and vagina induces transient voiding dysfunction in a rabbit survival model of pelvic floor dystonia

PURPOSE: Existing data supports a relationship between pelvic floor dysfunction and lower urinary tract symptoms. We developed a survival model of pelvic floor dysfunction in the rabbit and evaluated cystometric (CMG), electromyographic (EMG) and ambulatory voiding behavior. MATERIALS AND METHODS: Twelve female adult virgin rabbits were housed in metabolic cages to record voiding and defecation. Anesthetized CMG/EMG was performed before and after treatment animals (n=9) received bilateral tetanizing needle stimulation to the pubococcygeous (PC) muscle and controls (n=3) sham needle placement. After 7 days all animals were subjected to tetanizing transvaginal stimulation and CMG/EMG. After 5 days a final CMG/EMG was performed. RESULTS: Of rabbits that underwent needle stimulation 7 of 9 (78%) demonstrated dysfunctional CMG micturition contractions versus 6 of 12 (50%) after transvaginal stimulation. Needle stimulation of the PC musculature resulted in significant changes in: basal CMG pressure, precontraction pressure change, contraction pressure, interval between contractions and postvoid residual; with time to 3rd contraction increased from 38 to 53 minutes (p=0.008 vs. prestimulation). Vaginal noxious stimulation resulted in significant changes in: basal CMG pressure and interval between contractions; with time to 3rd contraction increased from 37 to 46 minutes (p=0.008 vs. prestimulation). Changes in cage parameters were primarily seen after direct needle stimulation. CONCLUSIONS: In a majority of animals, tetanizing electrical stimulation of the rabbit pelvic floor resulted in voiding changes suggestive of pelvic floor dysfunction as characterized by a larger bladder capacity, longer interval between contractions and prolonged contraction duration.

Síndrome de meningitis y retención urinaria / Meningitis-retention syndrome. Report of one case

The Meningitis-Retention Syndrome associates aseptic meningitis and neurogenic bladder, with a vesical dysfunction that outlasts meningitis widely. Urodynamic assessment shows a detrusor palsy with normal function of the external sphincter. We report a 24-year-old male admitted for headache, fever, myalgias and acute urinary retention, which was diagnosed as a urinary tract infection. Worsening of symptoms and slight meningeal signs prompted for a lumbar puncture that yielded a cerebrospinal fluid with 94 lymphocytes, in which etiological evaluation was inconclusive. Meningeal syndrome and myalgia subsided by the fifth day, while urinary retention persisted. A magnetic resonance imaging of the brain and spinal cord done at the fifth day, showed high intensity signals in basal ganglia and central spinal cord, not altered by contrast. These images disappeared in the imaging control performed two months later. Bladder dysfunction lasted at least until the second month of follow up.

Postoperative Urinary Retention Following Anterior Cervical Spine Surgery for Degenerative Cervical Disc Diseases

BACKGROUND: Postoperative urinary retention (POUR) may cause bladder dysfunction, urinary tract infection, and catheter-related complications. It is important to be aware and to be able to identify patients at risk of developing POUR. However, there has been no study that has investigated the incidence and risk factors for the development of POUR following anterior cervical spine surgery for degenerative cervical disc disease. METHODS: We included 325 patients (164 male and 161 female), who underwent anterior cervical spine surgery for cervical radiculopathy or myelopathy due to primary cervical disc herniation and/or spondylosis, in the study. We did not perform en bloc catheterization in our patients before the operation. RESULTS: There were 36 patients (27 male and 9 female) that developed POUR with an overall incidence of 11.1%. The mean numbers of postoperative in-and-out catheterizations was 1.6 times and mean urine output was 717.7 mL. Thirteen out of 36 POUR patients (36%) underwent indwelling catheterization for a mean 4.3 days after catheterization for in-and-out surgery, because of persisting POUR. Seven out of 36 POUR patients (19%) were treated for voiding difficulty, urinary tract irritation, or infection. Chi-square test showed that patients who were male, had diabetes mellitus, benign prostate hypertrophy or myelopathy, or used Demerol were at higher risk of developing POUR. The mean age of POUR patients was higher than non-POUR patients (68.5 years vs. 50.8 years, p < 0.01). CONCLUSIONS: To avoid POUR and related complications as a result of anterior cervical spine surgery for degenerative cervical disc disease, we recommend that a catheter be placed selectively before the operation in at-risk patients, the elderly in particular, male gender, diabetes mellitus, benign prostate hypertrophy, and myelopathy. We recommend that Demerol not be used for postoperative pain control.

Compromiso vesical en síndrome de Guillain-Barré: a propósito de un caso / Bladder involvement in Guillain-Barre syndrome: a case study

Introducción: El Síndrome de Guillain-Barré (SGB) es una enfermedad autoinmune caracterizada por debilidad muscular, arreflexia y disociación albúmino-citológica en líquido cerebroespinal, cuya incidencia clásica a nivel internacional suele uniformarse alrededor de 0,6 a 4 casos por 100.000 al año. Presentación del caso: Paciente de 45 años, sexo femenino, quien ingresó al Servicio de Urgencia del Hospital de Temuco derivada desde Lonquimay, por debilidad progresiva de las cuatro extremidades. En Lonquimay la paciente requirió sonda vesical por retención urinaria. Es diagnosticada con SGB, hospitalizándose en Unidad de Cuidados Intensivos, requiriendo ventilación asistida y tratada mediante plasmaféresis, presentando neumonía como complicación relacionada a la ventilación mecánica y recuperando íntegramente función vesical. Discusión: El compromiso vesical no es descrito como un factor importante en el diagnóstico, siendo controversial aquella afirmación por varios autores.

Introduction: Guillain-Barre syndrome (GBS) is an autoimmune disease characterized by muscle weakness, areflexia and albumin-cytological dissociation in cerebrospinal fluid, the incidence has been reported to be relatively uniform between 0.6 to 4 cases per 100.000 per year. Case report: Patient of 45 years old, female, admitted to the emergency department of Hospital de Temuco derived from Lonquimay by progressive weakness of four extremities. In Lonquimay the patient required bladder catheterization for urinary retention. It was diagnosed with GBS, hospitalized in intensive care unit, requiring assisted ventilation and treated with plasmapheresis, developing pneumonia as a complication related to mechanical ventilation and fully recovered bladder function. Discussion: The bladder involvement is not described as an important factor in diagnosis and remains controversial this statement by several authors.

Isolated labial fusion as a cause of acute urinary retention in early adolescent period

Fusion of the labia majora is generally an acquired defect because of local inflamation, trauma and vaginal lacerations. In postmenauposal period, it is associated with lichen sclerosis. It is typically found in young neonates or prepubertal girls when the labia and vagina are not adequately estrogenized. In this study, a 14-year adolescent with labial fusion as a cause of acute urinary retention is presented

Bloodless correction. a case report

This report describes a 74 year old woman with urinary symptoms progressing to complete anuria with dense labial adhesions. This condition is mostly reported in pediatric age group but few reports addressed this condition in postmenopause

Pyocolpos with imperforate hymen during early childhood presented with urine retention and bouts of intestinal obstruction

An imperforate hymen is not a rare condition in female newborns, but is often ignored in a genital examination by doctors. We report an unusual case of a 2 years old Sudanese girl with an imperforate hymen and pyocolpos presented with urine retention and intermittent bouts of intestinal obstruction. To our knowledge, this is a first case of female child with pyocolpos to be documented in Sudan literature

Incontinência urinária oculta: diagnóstico e tratamento / Occult urinary incontinence: diagnosis and treatment

A incontinência urinária oculta (IUO) pode ocorrer em casos avançados de prolapso dos órgãos pélvicos (POP), quando este acarreta compressão externa ou acotovelamento da uretra e, dessa forma, encobre a incontinência urinária de esforço (IUE). Contudo, uma vez corrigido o prolapso, a paciente pode tornar-se incontinente. O diagnóstico de IUO pode ser feito com a redução do POP utilizando pessário, tampão vaginal, espéculo de Sims, pinças diversas com gazes e/ou redução digital durante o estudo urodinâmico. A identificação pré-operatória dessas pacientes pode possibilitar o tratamento concomitante da afecção, evitando um segundo procedimento cirúrgico. Alguns autores recomendam a cirurgia para correção de IUE em pacientes com prolapso estágios III e IV, enquanto outros preconizam avaliar a perda urinária após o tratamento do POP. Todavia, não está bem determinado qual o melhor método para diagnosticar a IUO e se os riscos superam o potencial benefício da cirurgia profilática para IUE nestes casos. Assim, nosso objetivo foi discutir os aspectos controversos relacionados ao diagnóstico e tratamento da IUO.

Occult urinary incontinence (OUI) can occur in advanced cases of pelvic organ prolapse (POP) when it causes external urethral compression or urethral kinking and, therefore, it hides the stress urinary incontinence (SUI). When the POP is surgically corrected, the patient may become incontinent. The diagnosis of OUI is made by the reduction of the POP using pessary, vaginal pack, Sims? speculum, several tweezers with gauze and/or digital reduction during urodynamic investigation. Preoperative identification of these patients allows the treatment of this pathology at the same moment of POP treatment avoiding a second surgery. Some authors recomend a prophylatic anti-incontinence surgery in patients with SUI stage III or IV and others prefer to evaluate urinary incontinence after POP repair. However, it is not determined which is the best method to diagnose OUI, as well as if the risks overtake the potencial benefits of SUI procedure in these cases. The objective of this article was to discuss the controversial aspects of diagnosis and the treatment of OUI.

Quiste de retención prostético: una causa rara de retención aguda de orina / Prostatic cyst causing urinary obstruction: report of one case

Las lesiones quísticas localizadas en la línea media de la glándula prostética presentan una incidencia difícil de estimar, debido a que la mayoría son asintomáticas y suelen ser un hallazgo casual durante el estudio de otra patología urológica. Presentamos el caso de un varón de 85 años que en el transcurso de un episodio de retención aguda de orina es diagnosticado de un quiste de retención prostético, y realizamos una revisión de la literatura.

The incidence of medial prostatic cysts is unknown, since most of them are asymptomatic, and usually appear as an incidental finding during the study of other urological disease. We report an 85 years oíd man with a urinary obstruction. Rectal palpation disclosed a mass that was adjacent to the prostate. Magnetic resonance showed a cystic lesión of the right seminal vesicle. The cyst was drained, obtaining 250 mi of fluid and urinary obstruction subsided. After three months of follow up, the patient remains asymptomatic.

Liposarcoma metastásico en mama de origen testicular: a propósito de un caso / Liposarcoma metastatic breast of testicular origin: a purpose of a case

El liposarcoma es un tumor de la vida adulta, diagnosticado con mayor frecuencia en individuos entre los 50 y 65 años de edad. Los sitios más frecuentes de presentación son los muslos y el retroperitoneo, siendo infrecuente la localización testicular y en mamas y la asociación con otros tumores es aún más excepcional. Aquellos liposarcomas que el patólogo identifica como "bien diferenciados" no suelen dar metástasis, a su vez el cáncer de mama en el hombre es una enfermedad rara y poco frecuente que se presenta en una proporción muy baja con respecto a los diferentes tipos de cánceres, dicha entidad constituye el 0,2 1,5 por ciento de todos los tumores malignos en los hombres y aproximadamente el 1 por ciento de los cánceres mamarios en ambos sexos. El objetivo principal es reportar un caso de un paciente masculino de 55 años de edad quién refiere inicio de enfermedades de 23 años de evolución caracterizada por pequeño aumento de tamaño en mama izquierda y la cual hace 4 años ha aumentado rápida y progresivamente de tamaño; concomitantemente presenta aumento de tamaño en región testicular y tumoración en mama derecha realizándosele biopsias en dichas zonas resultando compatible con liposarcoma bien diferenciado.

Factores de riesgo de retención urinaria aguda en cirugía mayor ambulatoria bajo anestesia espinal / Risk factors for acute urinary retention after spinal surgery

Introducción: Estimar la prevalencia de retención urinaria aguda en el Programa de Cirugía mayor ambulatoria con anestesia espinal, e identificar los principales factores de riesgo para su desarrollo. Material y método: Estudio descriptivo de casos y controles. De 859 pacientes operados en programa de cirugía mayor ambulatoria entre abril 2003 y julio 2006, se seleccionaron 652 pacientes sometidos a cirugía con anestesia espinal. Los casos fueron 18 pacientes que desarrollaron retención urinaria aguda y 45 controles seleccionados al azar de los pacientes sin complicaciones en el postoperatorio. Se analizó estadística por pruebas estándares. Resultados: La prevalencia de retención urinaria aguda fue 2,76 por ciento. Se asociaron significativamente al desarrollo de retención urinaria aguda en postoperatorio las variables sexo masculino, p =0.026 OR =5.76 (IC 95 por ciento 1.17-28.24), edad sobre 50 años p =0.046 OR =3.14 (IC 95 por ciento 1.01-9.86) y cirugía hemiaria p =0.001 OR =7.59 (IC 95 por ciento 1.71-33.61). En todos los casos se manejó con cateterismo intermitente y la prolongación de estadía hospitalaria fue de un día en el 91 por ciento de los casos, y dos en el resto.

Background: The identified risk factors for acute urinary retention after spinal anesthesia are the dose and duration of anesthesia, old age and ano rectal surgical procedures. Aim: To assess the prevalence and risk factors of acute urinary retention in the program of ambulatory surgery with spinal anesthesia. Material and methods: Descriptive case control study. The medical records of 859 patients operated with spinal anesthesia between 2003 and 2006 were reviewed, and 18 patients aged 52 + 16 years, that had an acute urinary retention, were identified. Forty vive randomly chosen patients aged 46 + 14 years, without urinary retention were analyzed as controls. Results: The calculated prevalence of acute urinary retention was 2.8 percent. Male sex, an age over 50 years and hernia surgery were identified as risk factors for urinary retention with odds ratios of 5.8 (95 percent confidence interval (Cl) 17-28), 3.1 (95 percentCI 1.-9.9) and 7.6 (95 percentCI 1.7-33.6), respectively. All cases were managed with intermittent catheterization. Hospital stay was one day in 91 percent and two days in the rest. Conclusions: in this series, acute urinary retention occurred in 2.8 percent of patients after spinal surgery. Male sex, age over 50 years and hernia repair procedures were identified ads risk factors for the complication.

[ case report of urethra leiomyoma in a young woman]

Leiomyoma of the female urethra is a rare condition and there have been only 35-40 reported cases in literature. We report a 20-year-old woman who had referred with a painless mass in her vaginal vestibule, dysparonia, dysuria and previouse history of urine retention for two times. After clinical examination, imaging studies [US, MRI] and cystoscopy a mass in urethra protruding to vagina and bladder was diagnosed. She underwent biopsy and complete surgical resection. Histopathological study revealed urethral leiomyoma and after operation all symptoms disappeared

Cincha suburetral transobturatriz versus transabdominal: comparación de las complicaciones obstructivas / Obstructive complications of suburethral slings: comparison between transobturator and retropubic procedures

Últimamente las cinchas suburetrales transobturatrices (TO) se han hecho una alternativa popular a la cincha transabdominal (TA) en el tratamiento de la Incontinencia de Orina de Esfuerzo(IOE). Las ventajas de la vía transobturatriz incluyen una mejoría en la velocidad, calidad y en el riesgo de complicaciones obstructivas. Nosotros evaluamos los resultados de las cinchas TO y TA para compararla tasa de complicaciones obstructivas de estos procedimientos. Materiales y métodos: Se revisaron las características de 153 pacientes consecutivas a las cuales se les realizaron cinchas sub uretrales (TO 53 y TA 100) realizadas por 13 diferentes urólogos por IOE en la Unidad de Urología del Hospital del Salvador. Resultados: Las cinchas suburetrales TO y TA presentaron eficacia similar en eliminar la necesidad depaños (TO 85 por ciento, TA 84 por ciento, p=0.30). La técnica TO se asoció con una menor cantidad de complicacionesobstructivas (TO 9 por ciento, TA 15,2 por ciento, p < 0.05). Uretrolisis fue requerida en dos de las pacientes operadas por la vía TO y en 5 pacientes por la vía A. Conclusiones: A pesar de que las cinchas suburetrales TO y TA han demostrado resultados a corto plazo similares en cuanto a continencia de esfuerzo, la aproximación TO esta asociada con una tasa menor de complicaciones obstructivas.

In the last year TO slings has become an increasingly popular alternative to TA slings for the surgical treatment of SUL. Proposed advantages of the transobturator approach include improved speed, safety and the reduction of obstructive complications. We assessed outcomes of TO and TA slings in a large series of women treated at several institutions to compare the rate of obstructive complications from these procedures. Materials and Methods: We reviewed the charts of 153 consecutive women who had synthetic mid urethral sling procedures (53 TO or 100 TA) performed by 13 different urologists for SUI at the Hospital del Salvador. Results: While TO and TA sling procedures appeared to be similarly efficacious in eliminating the need for incontinence pad use (TO 85 percent, TA 84 percent, p = 0.30), the transobturator approach was associated with fewer obstructive complications (TO 9 percent, TA 15.2 percent, p <0.05). Urethrolysis was required in two of the TO cases. Conclusions: Although TO and TA sling procedures had similar short-term results for decreasing pad use in patients with stress urinary incontinence, the transobturator approach is associated with fewer obstructive voiding complications.