Variables predictive of voiding disfunction following aponeurotic sling surgery: multivariate analysis

INTRODUCTION: Aponeurotic sling surgeries can evolve with obstruction or voiding dysfunction in 5 to 20 percent of patients. There are few studies on factors that could possibly predispose to voiding difficulties or urinary retention. The objective of this work is to identify these potential clinical or urodynamic factors. MATERIALS AND METHODS: Records from 130 patients who underwent aponeurotic sling surgeries were reviewed. All patients underwent a throughout urodynamic study during pre-operative investigation. The variables studied were age above 65 years, previous pelvic surgeries, concomitant surgeries, post-voiding residue higher than 100 mL, vesical obstruction (according to Blaivas-Groutz nomogram) and urinary flow under 12 mL/s. Post-voiding residue was assessed on the seventh post-operative day through vesical catheterization. Recovering of spontaneous voiding after 7 post-operative days or with a residue higher than 100 mL, was regarded as voiding dysfunction. Univariate analysis was performed with qui-square test and Fisher's exact test, and multivariate analysis was performed by logistic regression with alpha = 5 percent. RESULTS: Age in the studied group ranged from 41 to 83 years (mean 56.7 years), with 69 (53 percent) patients having urethral hypermobility and 61 (47 percent) having intrinsic urethral lesion. Normal voiding occurred in 97 (75.6 percent) women with 7 post-operative days. The only significant variable in the univariate (p = 0.014) and multivariate (p = 0.017) analysis was post-voiding residue higher than 100 mL. CONCLUSION: Pre-operative presence of a post-voiding residual urine higher than 100 mL was the only variable predictive of voiding dysfunction.

Use of cadaveric fascia lata to correct grade IV cystocele

We describe a modification of the cadaveric prolapse repair and sling - CaPS technique that uses the sling surgery principles to correct grade IV cystocele. In this modification, the central and paravaginal defects reconstitution are performed using cadaveric fascia lata fixed over rectus abdominis muscle, eliminating the need of pubic fixation by screws, as proposed by the original technique. The modification described, besides presenting the benefits of CaPS, i.e., not using impaired tissues to reconstruct vesical support, and lower risks of perineal hypercorrection, also reduces the probability of complications of bone fixation

Derivaçäo biliodigestiva: estudo de 27 casos / Biliodigestive derivation: study of 27 cases

Os autores apresentam um estudo retrospectivo de 27 pacientes submetidos à derivaçäo biliodigestiva devido a patologias da árvore biliar, no período de janeiro de 1985 a outubro de 1990, no Hospital Universitário Regional do Norte do Paraná. A coleta de dados foi realizada através de protocolo padronizado. A média de idade dos pacientes foi de 58,8 anos, sendo 14 pacientes do sexo masculino e 13 do sexo feminino. A dor abdominal foi o achado mais frequente no momento da admissäo. A litíase biliar foi a principal indicaçäo biliodigestiva, sendo a coledocoduodenoanastomose látero-lateral a técnica mais utilizada. Sete pacientes haviam sido submetidos à cirurgias anteriores do trato biliar. Näo houve complicaçöes ou óbitos no ato cirúrgico ou no seguimento dos pacientes