Balloon dilation for failed pyeloplasty in children?

ABSTRACT Objective: Pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). However, the failure rate of pyeloplasty is as high as 10% and repeat pyeloplasty is more difficult. This study aimed to evaluate the efficacy of balloon dilatation for failed pyeloplasty in children. Materials and Methods: Between 2011 and 2017, 15 patients, aged 6 months to 14 years, were treated with balloon dilation for restenosis of UPJO after a failed pyeloplasty. Ultrasound and intravenous urography were used to evaluate the primary outcome. Success was defined as the relief of symptoms and improvement of hydronephrosis, which was identified by ultrasound at the last follow-up. Results: All patients successfully completed the operation, 13 patients by retrograde approach and 2 patients by antegrade approach. Thirteen patients were followed for a median of 15 (4 to 57) months and 2 patients were lost to follow-up. Resolution of the hydronephrosis was observed in 5 cases. The anteroposterior diameter (APD) of the pelvis decreased by an average of 12.4 ± 14.4mm. Eight patients needed another surgery. The average postoperative hospital stay was 1.78 ± 1.4 days. Two patients experienced fever after balloon dilation. No other complications were found. Conclusions: Balloon dilatation surgery is safe for children, but it is not recommended for failed pyeloplasty in that group of patients, owing to the low success rate.

A very easy technique of stenting for laparoscopic pyeloplasty: penbegul intravenous cannula (PICA) technique

ABSTRACT Introduction: Double-J stent insertion during laparoscopic pyeloplasty is a difficult and time-consuming process and several techniques were defined to perform a double-J stent with an antegrade approach. In this study we present the technique (PICA) of antegrade double-J placement during laparoscopic pyeloplasty by using 14 gauge intravenous cannula. Surgıcal technıque: After we complete the suturing of the posterior wall of the anastomosis during laparoscopic pyeloplasty, we first puncture the abdominal wall with a 14-gauge "intravenous cannula" from a location that provides most suitable angle for inserting the double-J stent into the ureter. We remove the metal needle of the cannula, and the sheath which has an inner diameter of 5.2F remains over the abdominal wall. The double J stent is then advanced from inside the cannula sheath to the intraperitoneal area; under laparoscopic imaging the stent is gently grasped at its distal end using an atraumatic laparoscopic forceps to insert it into the ureter. The stent is then pulled down to its proximal end, and after the guidewire is removed, the proximal end of the double-J stent is placed inside the renal pelvis with an atraumatic forceps. With this technique we can apply the double-J stent in just one step. Additionaly we can use a 14-gauge IV cannula sheath as a trocar when needed during laparoscopic pyeloplasty to retract an organ or reveal an anastomosis line. Comments: Our new technique of antegrade double-J placement during laparoscopic pyeloplasty by 14 gauge intravenous cannula sheath, is very easy and quick to perform.

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.

Which intraperitoneal insufflation pressure should be used for less postoperative pain in transperitoneal laparoscopic urologic surgeries?

ABSTRACT Purpose To determine whether using different intraperitoneal insufflation pressures for transperitoneal laparoscopic urologic surgeries decreases postoperative pain. Materials and Methods 76 patients who underwent transperitoneal laparoscopic upper urinary tract surgery at different insufflation pressures were allocated into the following groups: 10mmHg (group I, n=24), 12mmHg (group II, n=25) and 14mmHg (group III, n=27). These patients were compared according to age, gender, body mass index (BMI), type and duration of surgery, intraoperative bleeding volume, postoperative pain score and length of hospital stay. A visual analog scale (VAS) was used for postoperative pain. Results Demographic characteristics, mean age, gender, BMI and type of surgeries were statistically similar among the groups. The mean operation time was higher in group I than group II and group III but this was not statistically significant (P=0.810). The mean intraoperative bleeding volume was significantly higher in group I compared with group II and group III (P=0.030 and P=0.006). The mean length of postoperative hospital stays was statistically similar among the groups (P=0.849). The mean VAS score at 6h was significantly reduced in group I compared with group III (P=0.011). At 12h, the mean VAS score was significantly reduced in group I compared with group II and group III (P=0.009 and P<0.001). There was no significant difference in the mean VAS scores at 24h among three groups (P=0.920). Conclusion Lower insufflation pressures are associated with lower postoperative pain scores in the early postoperative period.

Laparoendoscopic single site surgery in pediatric urology: does it require specialized tools?

ABSTRACT Purpose: To describe our experience utilizing Laparoendoscopic single site (LESS) surgery in pediatric urology. Materials and Methods: Retrospective chart review was performed on LESS urologic procedures from November 2009 through March 2013. A total of 44 patients underwent 54 procedures including: nephrectomy (23), orchiopexy (14), varicocelectomy (9), orchiectomy (2), urachal cyst excision (3), and antegrade continence enema (3) (ACE). Results: Median patient age was 6.9 years old. Estimated blood loss (EBL), ranged from less than 5cc to 47cc for a bilateral nephrectomy. Operative time varied from 56 mins for varicocelectomy to a median of 360 minutes for a bilateral nephroureterectomy. Incision length ranged between 2 and 2.5cm. In our initial experience we used a commercial port. However, as we progressed, we were able to perform the majority of our procedures via adjacent fascial punctures for instrumentation at the single incision site. One patient did require conversion to an open procedure as a result of bleeding. Three complications were noted (6.8%), with two Clavien Grade 3b complications. Two patients required additional procedures at 1-year follow-up. Conclusions: The use of LESS applies to many pediatric urologic procedures, ideally for ablative procedures or simple reconstructive efforts. The use of adjacent fascial puncture sites for instrumentation can obviate the need for a commercial port or multiple trocars.

A novel transurethral resection technique for superficial flat bladder tumor: Grasp and bite technique

PURPOSE: Transurethral resection of bladder tumor (TURBT) can be a challenging procedure for an inexperienced surgeon. We suggest an easy technique for TURBT, which we have named the "grasp and bite" technique. We describe this technique and compare its effectiveness and safety with that of conventional TURBT. MATERIALS AND METHODS: Monopolar TURBT (24-Fr Karl Storz) was performed in 35 patients who had superficial bladder tumors. After defining the tumor margin, the tumor and surrounding mucosa were grasped by use of a loop electrode and resectoscope sheath. With tight grasping, linear moving resection was performed. The patients' demographic, intraoperative, and postoperative data were analyzed between the conventional and grasp and bite TURBT groups. RESULTS: Of 35 patients, 16 patients underwent conventional TURBT (group 1), and the other 19 patients underwent grasp and bite TURBT (group 2). Both groups were similar in age, tumor multiplicity, size, anesthesia method, and location. Grasp and bite TURBT could be performed as safely and effectively as conventional TURBT. There were no significant differences in irrigation duration, urethral catheterization, postoperative hemoglobin drop, or length of hospital stay. No significant side effects such as bladder perforation, severe obturator reflex, or persistent bleeding occurred. There were no significant pathological differences between specimens according to the type of resection technique. CONCLUSIONS: The grasp and bite TURBT technique was feasible for superficial bladder tumors. It may be a good tool for inexperienced surgeons owing to its convenient and easy manner.

Avaliação da adesão ao checklist de cirurgia segura da OMS em cirurgias urológicas e ginecológicas, em dois hospitais de ensino de Natal, Rio Grande do Norte, Brasil / Assessment of adherence to the WHO surgical safety checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte State, Brazil / Evaluación de la adherencia al checklist de cirugía segura de la OMS en cirugías urológicas y ginecológicas en dos hospitales universitarios en Natal, Rio Grande do Norte, Brasil

O checklist de cirurgia segura da Organização Mundial da Saúde é uma ferramenta útil para diminuir eventos adversos em hospitais, porém sua implantação efetiva ainda é um desafio. Este estudo objetiva avaliar a adesão ao checklist em cirurgias urológicas e ginecológicas de dois hospitais de ensino em Natal, Rio Grande do Norte, Brasil. O desenho foi observacional transversal; selecionaram-se cirurgias eletivas, e a coleta se deu por meio de revisão de prontuários. Descreveu-se a adesão mediante a existência e qualidade do preenchimento do checklist, e analisou-se a associação de fatores estruturais e socioprofissionais valendo-se de análise de regressão múltipla. Das 375 cirurgias revisadas, 61% tinham checklist, e 4% estavam totalmente preenchidos. A existência do checklist se associou às cirurgias ginecológicas (maternidade) (OR = 130,18) e à maior duração da cirurgia (OR = 2,13), enquanto a qualidade do preenchimento se relacionou com as cirurgias urológicas (hospital geral) (β = 26,36). A adesão ao checklist precisa ser aprimorada, e as diferenças sugerem a influência das distintas estratégias de implantação utilizadas em cada instituição.

The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (β = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.

El checklist de cirugía segura es una herramienta útil para disminuir los eventos adversos en hospitales, pero su implantación efectiva aún es un reto. Este estudo tiene por objetivo evaluar la adherencia al checklist en cirugías urológicas y ginecológicas de dos hospitales universitarios en Natal, Rio Grande do Norte, Brasil. El diseño fue observacional transversal, se seleccionaron cirugías electivas y la recogida de datos fue mediante revisión de historias clínicas. Se describe la adherencia a partir de la existencia y calidad de la cumplimentación del checklist y se analiza la asociación de factores estructurales y socioprofesionales mediante análisis de regresión múltipla. De las 375 cirugías revisadas, el 61% tenía checklist y el 4% estaba totalmente cumplimentado. La existencia del checklist se asoció a las cirugías ginecológicas (maternidad) (OR = 130,18) y a la mayor duración de la cirugía (OR = 2,13), mientras la calidad de la cumplimentación se relacionó con las cirugías urológicas (hospital general) (β = 26,36). La adherencia al checklist es una oportunidad de mejora y las diferencias sugieren la influencia de diferentes estrategias de ejecución utilizados en cada institución.

Initial experience of a novel ergonomic surgical chair for laparoscopic pelvic surgery

INTRODUCTION: We present the initial experience of a novel surgical chair for laparoscopic pelvic surgery, the ETHOS TM (Bridge City Surgical, Portland, OR). MATERIALS AND METHODS: The ETHOS chair has an adjustable saddle height that ranges from 0.89 to 1.22 m high, an overall width of 0.89 m, and a depth of 0.97 m. The open straddle is 0.53 m and fits most OR tables. We performed 7 pelvic laparoscopy cases with the 1st generation ETHOS TM platform including 2 laparoscopic ureteral reimplantations, 5 laparoscopic pelvic lymphadenectomies for staging prostate cancer in which one case involved a laparoscopic radical retropubic prostatectomy, performed by 2 different surgeons. RESULTS: All 7 pelvic laparoscopic procedures were successful with the ETHOS TM chair. No conversion to open surgery was necessary. Survey done by surgeons after the procedures revealed minimal stress on back or upper extremities by the surgeons from these operations even when surgery was longer than 120 minutes. Conversely, the surgical assistants still had issues with their positions since they were on either sides of the patient stressing their positions during the procedure. CONCLUSION:The ETHOS chair system allows the surgeon to operate seated in comfortable position with ergonomic chest, arms, and back supports. These supports minimize surgeon fatigue and discomfort during pelvic laparoscopic procedures even when these procedures are longer than 120 minutes without consequence to the patient safety or detrimental effects to the surgical team.

Pure robotic retrocaval ureter repair

PURPOSE: To demonstrate the feasibility of pure robotic retrocaval ureter repair. MATERIALS AND METHODS: A 33 year old female presented with right loin pain and obstruction on intravenous urography with the classical "fish-hook" appearance. She was counseled on the various methods of repair and elected to have a robot assisted repair. The following steps are performed during a pure robotic retrocaval ureter repair. The patient is placed in a modified flank position, pneumoperitoneum created and ports inserted. The colon is mobilized to expose the retroperitoneal structures: inferior vena cava, right gonadal vein, right ureter, and duodenum. The renal pelvis and ureter are mobilized and the renal pelvis transected. The ureter is transposed anterior to the inferior vena cava and a pyelopyelostomy is performed over a JJ stent. RESULTS: This patient was discharged on postoperative day 3. The catheter and drain tube were removed on day 1. Her JJ stent was removed at 6 weeks postoperatively. The postoperative intravenous urography at 3 months confirmed normal drainage of contrast medium. CONCLUSION: Pure robotic retrocaval ureter is a feasible procedure; however, there does not appear to be any great advantage over pure laparoscopy, apart from the ergonomic ease for the surgeon as well the simpler intracorporeal suturing.

Yonsei Experience in Robotic Urologic Surgery-Application in Various Urological Procedures

PURPOSE: The da Vinci(R) robot system has been used to perform complex reconstructive procedures in a minimally invasive fashion. Robot-assisted laparoscopic radical prostatectomy has recently established as one of the standard cares. Based on experience with the robotic prostatectomy, its use is naturally expanding into other urologic surgeries. We examine our practical pattern and application of da Vinci(R) robot system in urologic field. PATIENTS AND METHODS: Robotic urologic surgery has been performed during a period from July 2005 to August 2008 in a total of 708 cases. Surgery was performed by 7 operators. In our series, radical prostatectomy was performed in 623 cases, partial nephrectomy in 43 cases, radical cystectomy in 11 cases, nephroureterectomy in 18 cases and other surgeries in 15 cases. RESULTS: In the first year, robotic urologic surgery was performed in 43 cases. However, in the second year, it was performed in 164 cases, and it was performed in 407 cases in the third year. In the first year, only prostatectomy was performed. In the second year, partial nephrectomy (2 cases), nephroureterectomy (3 cases) and cystectomy (1 case) were performed. In the third year, other urologic surgeries than prostatectomy were performed in 64 cases. The first robotic surgery was performed with long operative time. For instance, the operative time of prostatectomy, partial nephrectomy, cystectomy and nephroureterectomy was 418, 222, 340 and 320 minutes, respectively. Overall, the mean operative time of prostatectomy, partial nephrectomy, cystectomy and nephrourectectomy was 179, 173, 309, and 206 minutes, respectively. CONCLUSION: Based on our experience at a single-institution, robot system can be used both safely and efficiently in many areas of urologic surgeries including prostatectomy. Once this system is familiar to surgeons, it will be used in a wide range of urologic surgery.

Cinco años de experiencia con malla suburetral retropubiana ubre de tensión en el manejo de la incontinencia urinaria de esfuerzo en el Hospital Regional de Valdivia / Five years experience with retropubic tension-free vaginal tape in patients with stress urinary incontinence treated at the Regional Hospital of Valdivia

Antecedentes: La incontinencia de orina de esfuerzo (IOE) es una patología ginecológica de consulta frecuente, por lo que es importante el enfrentamiento de esta para obtener resultados efectivos a corto y largo plazo. Objetivo: Presentar la experiencia de 5 años en la corrección de la IOE con la técnica quirúrgica de malla de prolene suburetral libre de tensión retropubiana en el servicio de Ginecología del Hospital Regional de Valdivia. Método: Se incluyen pacientes con IOE moderada y severa, primaria o recidivada, estudiadas con hidrodinamia. Se insertó malla suburetral, con revisión posterior de la vejiga por cistoscopia para descartar lesión vesical. La sonda Foley se mantuvo por 24 horas. Resultados: Se intervinieron 58 pacientes con edad promedio de 51 años (rango: 36-76 años), en 48 pacientes se asoció otra cirugía (histerectomía y plastia anterior y/o posterior). No hubo complicaciones en el intraoperatorio. Logramos un seguimiento en 55 pacientes (94,8 por ciento) y 3 (5,2 por ciento) se perdieron de control. Cincuenta pacientes se encuentran sin IOE (90,9 por ciento), con una media de seguimiento de 24 meses (rango: 4-50 meses). Cuarenta y dos pacientes se encuentran actualmente asintomáticas (85,5 por ciento) y 8 (14,5 por ciento) presentan vejiga hiperactiva en el seguimiento. Conclusión: La técnica de malla suburetral libre de tensión retropubiana es una alternativa eficaz a corto y a largo plazo en el enfrentamiento quirúrgico de la IOE, permitiendo realizar otra cirugía vaginal simultáneamente.

Cirugía mínimamente invasiva en el tratamiento de la incontinencia urinaria femenina de esfuerzo: TVT-O / Minimal invasive surgery in the treatment of stress urinary incontinence: TVT-O

Objetivo: Analizar nuestra experiencia en la aplicación de TVT-O, en la corrección quirúrgica de la incontinencia de orina de esfuerzo (IOE). Pacientes y Método: Seguimiento prospectivo de 135 pacientes sometidos a TVT-O en Clínica Las Condes. Resultados: La mediana de edad fue de 55 años (R: 38 a 74 años), IMC 27,5 (R: 23 a 34) y paridad vaginal 2 (R: 0 a 5). Mediana de tiempo operatorio 7 minutos (R: 4 a 15 minutos). Se presentó una complicación intraoperatoria, correspondiendo al paso de la cinta a través de la uretra. Durante el postoperatorio inmediato se presentaron 7 complicaciones (5 por ciento); cinco de ellas fueron sobrecorrección expresada por retención urinaria. En todas se reajustó la cinta por medio de procedimiento ambulatorio a las 48 horas. No hubo hematomas ni infección de la zona operatoria. El alta se dio a las 12 horas en los casos de TVT-O sin asociación a otra cirugía. En el postoperatorio tardío se registró una exposición de la cinta en la pared vaginal anterior. Seguimiento promedio para la serie fue de 10 meses, con un máximo de 16 meses. Se obtuvo la cura de la IOE en 128 pacientes (95 por ciento), mejoría en 5 (4 por ciento) y falla en 2 (1 por ciento). Conclusión: TVT-O es una técnica quirúrgica para el tratamiento de la IOE, con resultados muy promisorios. Sin embargo, de la misma forma que los otros tipos de TOT, requiere una evaluación a largo plazo respecto a su eficacia.

Corrección de incontinencia de orina con cinta vaginal libre de tensión, asociado a la corrección de otras patologías del piso pelviano / Correction of female urinary incontinence using tension-free vaginal tape procedure associated to correction ofassociated to correction of other pathologies of the pelvic floor

Trabajo prospectivo que evalúa los resultados de la corrección de la incontinencia de orina de esfuerzo con la técnica de la cinta suburetral libre de tensión realizada en el Servicio de Obstetricia y Ginecología del Hospital de Talca. Fueron tratadas 44 pacientes con incontinencia de orina de esfuerzo severa de al menos dos años de evolución, asociada a otra patología ginecológica susceptible de ser corregida por vía vaginal. La técnica de corrección se basa en la colocación de una cinta de polipropileno, en forma de hamaca en el tercio medio de la uretra. La cinta se coloca por medio de agujas, que se introducen desde abdomen y salen parauretral psilateral al sitio de punción. El tiempo promedio de seguimiento fue 12 meses con 93 por ciento de curación al fin del periodo. No hubo lesiones de vejiga ni de otro órgano durante el procedimiento. La complicación más frecuente fue la infección urinaria y la retención de orina. Conclusión: la técnica presentada es una excelente alternativa para la corrección de la incontinencia de orina de esfuerzo y junto con la corrección de otros defectos asociados del piso pelviano.

Cirugía urológica laparoscópica realizada por residentes de urología en formación / Laparoscopic urologic surgery, carried out by an ½in training¼ urology resident

La cirugía laparoscópica es parte de la urología actual. Hoy en día se desarrolla una amplia variedad de procedimientos por este medio. Considerando la curva de aprendizaje, existe una dificultad esperable en lograr un buen entrenamiento de residentes en formación. El objetivo del presente trabajo es comunicar la experiencia en el entrenamiento laparoscópico de los residentes de urología en un centro universitario. Se revisaron los registros clínicos de los pacientes con cirugía urológica laparoscópica en el período comprendido entre julio 1999 y agosto 2003. Se registraron: datos demográficos, antecedentes, indicación quirúrgica, cirujano, información de la cirugía, evolución postoperatoria. En el período de estudio se realizaron 128 cirugías urológicas laparoscópicas, de las cuales 20 (16 porciento)fueron realizadas por residentes de urología en formación con experiencia laparoscópica en cirugía generaly/o en cirugía experimental y con ayuda directa de urólogos laparoscopistas. Diez pacientes de sexomasculino (50 porciento). La edad promedio fue de 49 años (r: 19-74). Se realizaron 7 nefrectomías (4 radicalespor tumor y 3 por atrofia renal hidronefrótica), 4 quistectomías renales, 3 linfadenectomías lumboaórticas, 3 biopsias renales, 1 nefroureterectomía, 1 suprarrenalectomía, 1 instalación de catéter de peritoneodiálisismás adherenciolisis. El tamaño promedio de los tumores renales fue de 6,3 cm. El tiempo operatorio promedio fue de 108 minutos (r: 30-240) y el sangrado de 74 cc (r: 0-800 cc). Se presentó una complicación grave (paciente con hígado cirrótico como hallazgo intraoperatorio que presentó hemorragia y coagulopatía). El alta fue a los 2,7 días promedio (r: 1-14). No se registraron conversiones. La docencia directa en cirugía laparoscópica permite obtener resultados que se comparan favorablemente a los comunicados en la literatura.

Cirugía en la incontinencia de orina de esfuerzo: cinta suburetral media de prolene(r): experiencia prospectiva del Hospital Dr. Sótero del Río / Surgery in the female urinary stress incontinence: tension-free prolene(r) suburethral slings: prospective experience of Hospital Dr. Sótero del Río

La Incontinencia de Orina de Esfuerzo (IOE) femenina es una patología de alta prevalencia, que deteriora la calidad de vida. Ninguna técnica quirúrgica ha obtenido resultados óptimos al largo plazo en su tratamiento. Por ello han habido muchas modificaciones en la técnica quirúrgica. Desde hace ya 8 años se comenzaron a publicar los primeros reportes sobre las cintas suburetrales (TVT®) sin tensión con resultados muy promisorios. En el último tiempo hemos podido conocer los primeros resultados de seguimiento a 5 años de esta técnica mínimamente invasiva. El propósito de este trabajo es evaluar nuestros resultados de las pacientes operadas de IOE con la cinta suburetral sin tensión con malla de Prolene® construida en nuestro hospital. La técnica consiste en la colocación de una cinta de Prolene® suburetral de 30 x 1,1 cm por vía vaginal anterior, sin tensión, fijándose a los tejidos paravaginales y retropúbicos por fibrosis sin suturas, creando un uroligamento artificial reforzando el piso pélvico, entregando soporte posterior a la uretra. Requiere sólo una incisión vaginal de 1,5 cm y dos incisiones de 5 mm a nivel suprapúbico, bajo anestesia regional. Pacientes: El grupo está formado por 124 mujeres, portadoras de incontinencia de orina de esfuerzo tipo I, II y III, incluyendo pacientes con incontinencia de esfuerzo pura, mixta y/o recidivada. Su edad promedio es de 55,3 (18-78) años, utilizando 5,84 (1-20) paños /día. 21 pacientes tenían IOE recidivada y 23 utilizaban anticolinérgicos preoperatoriamente. En 34 casos se realizó cirugía combinada de IOE más patología ginecológica por vía vaginal o laparoscópica.

Cinta vaginal libre de tensión modificado, asociado a cirugía vaginal en el tratamiento de la incontinencia de orina de esfuerzo / Modified tension free vaginal tape, associated to vaginal surgery in the treatment of the stress urinary incontinence

El objetivo principal de este trabajo es introducir una nueva técnica quirúrgica para la corrección de la incontinencia urinaria de la pacientes ginecológica. Se describe la técnica del TVT (tensión-free vaginal tape) y sus modificaciones. El estudio, incluyó 23 pacientes portadoras de Incontinencia de Orina de Esfuerzo (IOE), la mayoría de ellas asociadas a prolapso genital, que fueron operadas en Clínica Dávila entre Septiembre de 1999 y Julio de 2001. En todas las pacientes se realizó sling suburetral con malla de polypropyleno (TVT modificado), asociado a plastia vaginal anterior y posterior en 16 y a histerectomía vaginal en 9. La anestesia empleada fue espinal o epidural. El porcentaje de curación es de 95,7 por ciento, con un período de seguimiento promedio de 10 meses con un rango de 1 a 22 meses. La sonda Foley se usó por 12 horas en 19 pacientes (95 por ciento), fue necesaria por 72 horas en un caso (5 por ciento) y en 3 no se usó (13 por ciento). Una paciente necesitó cateterización vesical en la segunda semana. Una paciente presentó hematoma en el espacio de Retzius, no hubo perforaciones vesicales. Basados en estos resultados, concluimos que el TVT simultáneo a otras cirugías vaginales, es una alternativa eficaz y segura en el tratamiento de la IOE, asociado a la relajación del piso pélvico

Cinta vaginal libre de tensión: una solución mínimamente invasiva para el tratamiento de la incontinencia de orina / Tension free vaginal tape: a minimally invasive procedure for the treatment of urinary incontinence

Se presenta el caso clínico de una paciente con incontinencia de orina de esfuerzo por deficiencia intríseca del esfínter y patología ginecológica benigna asociada, la que es resuelta a travéz de cirugía vaginal y una técnica para incontinencia mínimamente invasiva de soporte subretral libre de tensión (TVT), Tensión-free Vaginal Tape, (Johnson y Johnson)