Hematoma retropúbico masivo posterior a TVT: enfrentamientos diferentes para una complicación infrecuente / Massive retropubic hematoma after TVT: different approaches for an uncommon complication

INTRODUCCIÓN: La TVT (tension-free vaginal tape) es una cirugía efectiva, pero no exenta de riesgos. Las complicaciones vasculares ocurren en un 0,9-1,7%; solo el 0,33% se presentan como hematoma masivo, en general asociado a la lesión de variante anatómica corona mortis (CM). OBJETIVO: Reportar tres tipos de manejo en pacientes con hematomas masivos después de cirugía para la incontinencia. MÉTODO: Revisión de casos de hematomas masivos tras TVT. Análisis de tres casos con diferente manejo. RESULTADOS: 1086 pacientes operadas en 10 años, 1% hematomas sintomáticos, 0,36% hematomas masivos. Se presentan tres casos. Caso 1: presenta inestabilidad hemodinámica sin respuesta a volumen ni vasoactivos, requirió laparotomía exploradora y se encontró un vaso sangrante retropúbico, compatible con CM, y un hematoma de 1000 cc. Caso 2: hipotensión que responde a volumen, asintomática al día siguiente de alta, reingresó 12 días después con caída de 6 puntos en la hemoglobina y la tomografía computarizada (TC) mostró un hematoma de 550 cc; recibió drenaje percutáneo. Caso 3: asintomática, alta el primer día posoperatorio, reingresa al quinto día con descenso de 4 puntos en la hemoglobina y la TC informa hematoma de 420 cc, que drena espontáneamente por vía vaginal. Todas las pacientes recibieron 14 días de antibióticos, y permanecieron continentes. CONCLUSIONES: Los hematomas retropúbicos masivos son una complicación poco frecuente. Su manejo considera la estabilización hemodinámica, el control del sangrado y el drenaje.

INTRODUCTION: TVT (tension-free vaginal tape) is an effective surgery, not without risks. Vascular complications occur in 0.9 to 1.7%, of which 0.33% present as massive hematoma, generally associated with injury of an anatomical variant, Corona Mortis (CM). OBJECTIVE: To report three types of management in patients with massive hematomas after anti-incontinence surgery. METHOD: Review of cases of massive hematomas after TVT surgery. Analysis of three cases with different management. RESULTS: 1086 patients operated in 10 years, 1% symptomatic hematomas, 0.36% massive. Three cases are presented. Case 1: hemodynamic instability without response to volume or vasoactive agents, required reoperation with exploratory laparotomy, a retropubic bleeding vessel, compatible with CM, and hematoma 1000 cc was found. Case 2: hypotension responds to volume, asymptomatic at next day in discharge conditions, she was readmitted 12 days later with falled 6-point in Hb, and CT showed hematoma 550 cc; she received percutaneous drainage. Case 3: asymptomatic, discharge on the first day after TVT, readmitted on the 5th day with falled 4-point in Hb, CT informed hematoma 420 cc, spontaneously drains vaginally. Patients received 14 days of antibiotics, remained continent. CONCLUSIONS: Massive retropubic hematomas are an infrequent complication, and management considers hemodynamic stabilization, bleeding control and drainage.

Embolization in patient with hypovolemic shock after transobturator sling procedure / Embolização após sling transobturatório em paciente com choque hipovolêmico

Abstract The placement of a suburethral sling is standard treatment for stress urinary incontinence. The transobturator technique (TOT) emerged as an alternative to minimize the risks of the blind insertion of needles, leading to a lower rate of perforation complications compared with the retropubic approach. We present a case of injury to a branch of the left obturator artery following the placement of a urethral sling using TOT, followed by intense bleeding and hemodynamic instability, which was treated with embolization.

Resumo Sling de uretra média é o tratamento padrão para a incontinência urinária de esforço. A abordagem transobturatória (TOT) surgiu como alternativa para minimizar os riscos da inserção às cegas das agulhas com taxa de complicações perfurativas menores quando comparadas à abordagem retropúbica. Apresentamos um caso de lesão em ramo da artéria obturatória esquerda após sling TOT que evoluiu com sangramento intenso e instabilidade hemodinâmica, sendo tratado com embolização.

Proposal of a new way to evaluate the external sphincter function prior male sling surgey

ABSTRACT Objective: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery. Materials and Methods: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to pre-operative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent. Results: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm. Conclusions: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.

Functional outcomes and quality of life after transobturatory slings: hand - made vs. commercial slings

ABSTRACT Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings. Data from 57 women who underwent consecutive TO sling surgery to treat SUI were pros- pectively collected between 2012 and 2014, and divided in two groups for further compa- rison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test. Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All de- mographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.

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.

Banda suburetral libre de tensión transobturadora versus single-incision sling para el tratamiento de la incontinencia urinaria de esfuerzo: seguimiento a 2 años / Transobturator tape versus single-incision sling for the treatment of stress urinary incontinence

Objetivos: Determinar la tasa de curación objetiva/subjetiva y complicaciones del tratamiento de incontinencia urinaria de esfuerzo con banda suburetral transobutadora y single-incision sling. Métodos: Estudio retrospectivo de pacientes operadas de incontinencia urinaria de esfuerzo (hipermovilidad uretral) con banda suburetral transobturadora (n: 37) y single-incision sling (n: 44) entre enero-2012 y enero-2015. Si se asociaba corrección de prolapso de órganos pélvicos, se colocaba banda transobturadora (TVT-O/ TOT) con internación. Si no precisaba corregir prolapso, se insertaba single-incision sling ambulatoriamente. Las evaluaciones fueron al mes, 6 meses y 1 año. El contacto a 2 años fue telefónico. De 37 bandas transobturadoras completaron seguimiento 35 a 1 año y 26 a 2 años. De 44 single-incision sling, completaron seguimiento 42 a 1 año y 19 a 2 años. Resultados: La edad media para transobturadoras fue superior: 65±9,7 vs 58,2±11,3 (p=0,005). Transobturadoras demostraron más prolapso asociado: 87,8% vs 63,3% (p=0,042) y mayor tiempo quirúrgico (minutos): 81,07±31,27 vs 36,79±11,09 (p=0,000). Hubo mayor morbilidad en transobturadoras, sin diferencias significativas. La continencia al año fue: 80% transobturadoras vs 83% single-incision sling (p=0,706) y a 2 años: 84% vs 79% (p=0,623). Se encontraban satisfechas al año: 80% transobutradoras vs 85,7% single-incision sling (p=0,586) y a 2 años: 88,5% vs 78,9% (p=0,512). Conclusiones: Single-incision sling presentan tasas de éxito y satisfacción similares a bandas transobturadoras, con menor morbilidad, coste y tiempo operatorio, pudiendo ser de primera elección cuando no exista prolapso sintomático asociado.

Objectives: To determine objective and subjective cure rate and complications of stress urinary incontinence treatment with transobturator tape and single-incision sling. Methods: We performed a retrospective study including patients diagnosed of stress urinary incontinence, treated surgically either with transobturator tape (n: 37) or with single-incision sling (n: 44), between January 2012 and January 2015. If pelvic organ prolapse was associated, transobturator route was preferred requiring patient hospitalization. If this correction was not needed, we performed single-incision sling, as an ambulatory procedure. Follow up visits were scheduled at 1, 6, 12 months after surgery and a telephone interview at 24 months. Results: Mean age was higher in transobturator group: 65±9.7 vs 58.2±11.3 (p=0.005). A statistically significant difference between the two groups was found in operating time (minutes): 81.07±31.27 vs 36.79±1.09 (p=0.000) and pelvic prolapse associated: 87.8% vs 63.3% (p=0.042). Morbidity rate was higher in the transobturator group, but without significance. After 1 year follow-up, there were no significant differences between the transobturator and the single-incision groups regarding continence (80% vs 83%; p=0.706) and satisfaction (80% vs 85.7%; p=0.586). We found similar results at 24 months telephonic interview. Conclusions: Single-incision slings are comparable to transobturator tapes in 12 and 24 months success rates and satisfaction, with significantly less morbidity, costs and operating time, becoming first line option when no pelvic prolapse is associated.

Comparison between the retropubic and transobturator approaches in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications

Objective This study aimed to compare the effectiveness and complications between the retropubic and transobturator approaches for the treatment of female stress urinary incontinence (SUI) by conducting a systematic review. Materials and Methods We selected all randomized controlled trials (RCTs) that compared retropubic and transobturator sling placements for treatment of SUI. We estimated pooled odds ratios and 95% confidence intervals for intraoperative and postoperative outcomes and complications. Results Six hundred twelve studies that compared retropubic and transobturator approaches to midurethral sling placement were identified, of which 16 were included in our research. Our study was based on results from 2646 women. We performed a subgroup analysis to compare outcomes and complications between the two approaches. The evidence to support the superior approach that leads to better objective/subjective cure rate was insufficient. The transobturator approach was associated with lower risks of bladder perforation (odds ratio (OR) 0.17, 95% confidence interval (CI) 0.09-0.32), retropubic/vaginal hematoma (OR 0.32, 95% CI 0.16-0.63), and long-term voiding dysfunction (OR 0.32, 95% CI 0.17-0.61). However, the risk of thigh/groin pain seemed higher in the transobturator group (OR 2.53, 95% CI 1.72-3.72). We found no statistically significant differences in the risks of other complications between the two approaches. Conclusions This meta-analysis shows analogical objective and subjective cure rates between the retropubic and transobturator approaches to midurethral sling placement. The transobturator approach was associated with lower risks of several complications. However, good-quality studies with long-term follow-ups are warranted for further research. .

Analysis of voiding dysfunction after transobturator tape procedure for stress urinary incontinence

PURPOSE: The definition of posttransobturator tape procedure (post-TOT) voiding dysfunction (VD) is inconsistent in the literature. In this study, we retrospectively investigated the risk factors for post-TOT VD by applying various definitions in one cohort. MATERIALS AND METHODS: The medical records of 449 patients were evaluated postoperatively. Acute urinary retention requiring catheterization, subjective feeling of voiding difficulty during follow-up, and postoperative postvoid residual (PVR) greater than 100 mL or PVR greater than 50% of voided volume (significant PVR) were adopted for the definition of VD. With these categories, multivariate analysis was performed for risk factors of postoperative VD. RESULTS: Ten patients (2.2%) required catheterization, 47 (10.5%) experienced postoperative voiding difficulty, and 63 (14.7%) showed significant PVR. In the multivariate logistic analysis, independent risk factors for postoperative retention requiring catheterization were previous retention history (p=0.06) and preoperative history of hysterectomy. Risk factors for subjective postoperative voiding difficulty were underactive detrusor (p=0.04) and preoperative obstructive voiding symptoms (p<0.01). Previous urinary retention history (p<0.01)) was an independent risk factor for concomitant postoperative voiding difficulty and significant PVR. Spinal anesthesia (p=0.02) and previous urinary retention history (p=0.02) were independent risk factors for significant postoperative PVR. CONCLUSIONS: With the use of several definitions of VD after the midurethral sling procedure, postoperative peak flow rate and PVR were significantly different between groups. Although there were no independent risk factors consistent with various definitions of VD, preoperative obstructive voiding symptoms and objective parameters suggesting impaired detrusor tend to have predictive power for post-TOT VD.

Predictive factors for voiding dysfunction after transobturator slings / Fatores preditivos para disfunção miccional após cirurgia de sling transobturador

PURPOSE: To identify the predictive factors for voiding dysfunction after transobturator slings. METHODS: We retrospectively reviewed the records of all patients who underwent a transobturator sling between March 2003 and December 2008. A total of 514 women had available data with at least a six-week follow-up. Patients' demographics, preoperative symptoms, urodynamic testing including multichannel voiding studies and surgical variables were tabulated. Voiding dysfunction was defined by a catheterized or ultrasonographic postvoid residual greater than 100 cc (≥six weeks after the procedure) associated with any complaints of abnormal voiding. Univariate logistic regression analysis was performed with respect to postoperative voiding dysfunction. RESULTS: The patient population had a mean age of 58.5±12.9 years. Thirty-three out of 514 patients (6.4%) had postoperative voiding dysfunction according to our definition, and 4 (0.78%) required sling transection. No differences were observed between normal and dysfunctional voiders in age, associated prolapse surgery, preoperative postvoid residual, preoperative urinary flow rate, prior pelvic surgery, and menopausal status. Valsalva efforts during the preoperative pressure flow study was the only predictive factor for postoperative voiding dysfunction, 72.4% dysfunctional versus 27.6% normal (p<0.001). CONCLUSION: Preoperative Valsalva maneuver during the micturition could identify those at risk for voiding dysfunction after transobturator sling, and it should be noted during preoperative counseling.

OBJETIVO: Identificar fatores preditivos para disfunção miccional após a cirurgia de sling transobturador. MÉTODOS: Foram revisados, retrospectivamente, os protocolos de todas as pacientes que foram submetidas à cirurgia de sling transobturador. Entre março de 2003 e dezembro de 2008, 514 mulheres apresentavam dados disponíveis com ao menos seis semanas de seguimento. Foram avaliados os dados demográficos, os sintomas pré-operatórios, o estudo urodinâmico e as variáveis cirúrgicas. A disfunção miccional foi definida como o resíduo pós-miccional (verificado por sondagem vesical ou ecografia) superior a 100 mL (≥seis semanas após procedimento cirúrgico), que foi associado à queixa de micção anormal. Realizou-se análise por regressão logística univariada com relação à disfunção miccional pós-operatória. RESULTADOS: A população de pacientes tinha uma média de idade de 58,5±12,9 anos. Trinta e três das 514 (6,4%) participantes apresentavam disfunção miccional pós-operatória de acordo com a nossa definição e 4 (0,78%) necessitaram secção do sling. Não houve diferenças com relação à cirurgia para prolapso associada, ao resíduo pós-miccional pré-operatório, à urofluxometria pré-operatória, à cirurgia pélvica prévia e ao estado menopausal entre aquelas que apresentaram disfunção miccional quando comparadas às outras. A identificação da manobra de Valsalva durante o estudo miccional pré-operatório foi o único fator preditivo para disfunção miccional pós-operatória, 72,4% no grupo com disfunção versus 27,6% nas normais (p<0,001). CONCLUSÃO: A manobra de Valsalva pré-operatória durante a micção pôde identificar as mulheres que apresentavam maior risco para disfunção miccional após cirurgia de sling transobturador, e deve ser levada em consideração no aconselhamento pré-operatório das mesmas.

Urodinamia en pacientes con IO recidivada / Urodynamics in patients with relapsed recurrent urinary incontinence

El tratamiento quirúrgico de la incontinencia de orina consta de diversas técnicas. siendo las técnicas de Burch, TVT y TOT, las que tienen mejores resultados. La correcta evaluación de estás pacientes, una vez que fracasa la cirugía para incontinencia es tanto clínica como de laboratorio, y requiere de la realización de estudios funcionales, de los cuales el principal es la urodinamia. Nuestro objetivo es describir la indicación de urodinamia y los hallazgos urodinámicos en pacientes operadas de incontinencia. Análisis retrospectivo, descriptivo de /os estudios urodinámlcos posf-operatorios realizados entre 1990 y 2010 a pacientes con antecedentes de cirugía por incontinencia de orina. En el periodo 1990 - 201 0 hemos realizado 141 estudios urodinámicos a igual número de pacientes con el antecedente de cirugía anti incontinencia. La indicación para urodinamia de estas pacientes fue: IOM en 61 (43,3 por ciento), IOE en 36(25,5 por ciento), IOU en 40(28,4 por ciento), UOB en 2(1,4 por ciento), polaquiuria en 1(0,7po ciento), prolapso en 1(0,7 por ciento). Los resultado muestran ausencia de IOE (lOE tipo 0) en 25(18,1 por ciento ) pacientes, IOE tipo I en 34 (24,5 por ciento) pacientes , IOE tipo ll en 16(11,5por ciento), IOE tipo lll en 10(7,2 por ciento), HD exclusiva en 38(27,5 por ciento), Hipersensibilidad en 69,3 por ciento) y urodinamia normal en 7(5,1po ciento), uropatía obstructiva baja en 2(1 ,4 por ciento). El principal motivo clínico por el cual consultan las pacientes post cirugía de incontinencia es la lOM, lo que contrasta con le hallazgo urodinámico que revela que el principal factor involucrado en la persistencia o reaparición de los síntomas es la lOE, esto nos demuestra la necesidad de una completa evaluación clínica que debe complementarse con el estudio urodinámico, ya que et 95 por ciento de estás pacientes presenta alguna alteración en estos estudios...

Resultados del cabestrillo suburetral transobturatriz con cinta de polipropileno para el tratamiento quirúrgico de la incontinencia de orina de esfuerzo / Results obtained with the trans-obturation subureteral sling procedure with polypropylen3 strip for surgical treatment of stress urinary incontinence

La incontinencia urinaria de esfuerzo constituye un problema frecuente en el sexo femenino, con una prevalencia de un 30 por ciento. Aunque no es letal, provoca un impacto importante en las esferas psíquica, social y económica para las que la padecen. Objetivo: demostrar la posibilidad de realizar la técnica de cabestrillo suburetral transobturatriz con medios propios sin afectar la continencia ni seguridad de la paciente. Métodos: se realizó un estudio descriptivo y prospectivo para evaluar las principales variables demográficas y el impacto en la calidad de vida y continencia mediante la escala Cuestionario de Calidad de Vida para Pacientes con Incontinencia Urinaria, Forma corta. Resultados: fueron intervenidas 36 pacientes con un seguimiento de 12 meses. La edad promedio es de 51,2 años, con predominio de las de edades posmenopáusicas y multíparas. Todas presentaban incontinencia de esfuerzo genuina o mixta. Se comprobó una mejoría significativa del puntaje preoperatorio con el posoperatorio. El porcentaje de éxitos al año fue de un 86,1 por ciento. La principal complicación fue la erosión de prótesis e infecciones urinarias. Conclusiones: la realización del cabestrillo suburetral con prótesis por vía transobturatriz es una opción real y factible de ser realizada en nuestro país en pacientes con incontinencia urinaria de esfuerzo o mixta, pues logra una continencia similar a otras técnicas, con una morbilidad menor y un ahorro económico significativo()AU)

The stress urinary incontinence is a frequent problem in the female sex with a prevalence of 30 percent. Although is not lethal it to provokes a significant impact on the psychic, social and economic spheres for those suffering this disease. Objective: to demonstrate the chance of performing the trans-obturation subureteral sling procedure with own means without involve the continence and the safety of patient. Methods: a prospective and descriptive study was conducted to assess the main demographic variables and the impact on the quality of life and the continence according to the Quality of Life Questionnaire scale for patients presenting with a short urinary incontinence. Results: thirty six patients were operated on with a follow-up of 12 months. The man age is of 51,2 years with predominance of postmenopause and multipara ages. All patients had real or mixed stress incontinence. There was a significant improvement of preoperatory score related to the postoperative one. The yearly success percentage was of 86.1 percent. The major complication was the prosthesis erosion and urinary infections. Conclusions: the carrying out of the subureteral sling with prosthesis via trans-obturation that must to be performed in country in patients con stress or mixed urinary incontinence since it is a real and feasible option achieving continence similar to other techniques, with a minor morbidity and a significant economic saving(AU)

Arc-to-arc mini-sling 1999: a critical analysis of concept and technology

PURPOSE: The aim of this study was to critically review the Arc-to-Arc mini-sling (Palma's technique) a less invasive mid-urethral sling using bovine pericardium as the sling material. MATERIALS AND METHODS: The Arc-to-Arc mini-sling, using bovine pericardium, was the first published report of a mini-sling, in 1999. The technique was identical to the "tension-free tape" operation, midline incision and dissection of the urethra. The ATFP (white line) was identified by blunt dissection, and the mini-sling was sutured to the tendinous arc on both sides with 2 polypropylene 00 sutures. RESULTS: The initial results were encouraging, with 9/10 patients cured at the 6 weeks post-operative visit. However, infection and extrusion of the mini-sling resulted in sling extrusion and removal, with 5 patients remaining cured at 12 months. CONCLUSION: The Arc-to-Arc mini-sling was a good concept, but failed because of the poor technology available at that time. Further research using new materials and better technology has led to new and safer alternatives for the management of stress urinary incontinence.

Outcomes following mid-urethral sling placement in patients with intrinsic sphincteric deficiency: comparison of Sparc and Monarc slings

Purpose: The treatment of patients with intrinsic sphincteric deficiency (ISD) remains difficult. It is theorized that differing vectors of support provided by retropubic versus transobturator mid-urethral sling routes may affect outcomes. We sought to compare outcomes of patients undergoing SPARC versus MONARC sling types in patients with Valsalva leak point pressures (VLPPs) below 60 cm H2O. Materials and Methods: A retrospective review of female patients with stress urinary incontinence undergoing SPARC™ (n = 97) or MONARC™ (n = 39) placement following urodynamic diagnosis of ISD was performed, with minimum 12-month follow-up required. Outcomes were assessed using a questionnaire comprising validated incontinence questionnaires (UDI-6, IIQ-7) and additional items addressing satisfaction. Results: Success rates of 76 percent and 77 percent were observed in the SPARC (mean follow-up 36 months) and MONARC (mean follow-up 32 months) cohorts, respectively (p > 0.05). Superior UDI scores were demonstrated in the MONARC cohort (3.8 vs. 5.3, p = 0.04)), in contrast to similar IIQ scores across both groups (3.7 vs. 3.1, p > 0.05). A deterioration in success rates was seen in both cohorts with more extended follow-up and with lower VLPPs. However, this finding was limited by low patient numbers in these cohorts. A complication rate of 7 percent and 3 percent was noted in SPARC and MONARC cohorts (p > 0.05). Conclusions: We observed no significant differences in subjective outcomes when comparing patients undergoing SPARC versus MONARC sling placement in the treatment of SUI with VLPP < 60 cm H2O. A deterioration in continence rates was seen with extended follow-up. These data may be affected by low patient numbers and related study power, in particular with more extended follow-up.

Self-reported urinary continence outcomes for repeat midurethral synthetic sling placement

OBJECTIVE: To evaluate our experience with tension-free transvaginal tape (TVT) placement for the management of stress urinary incontinence (SUI) in women who had previously undergone a failed midurethral synthetic sling (MUS) procedure. MATERIALS AND METHODS: Ten women underwent retropubic TVT insertion for continued or recurrent SUI following a prior MUS procedure. No attempt was made to remove the previously placed sling at the time of surgery. A retrospective chart review was performed to obtain perioperative and follow-up patient information. Post-operatively, each patient completed a mailed incontinence questionnaire to assess self-reported urinary continence outcomes. RESULTS: All 10 women were available for follow-up at a mean period of 16 months (range 6 to 33). Four of the 10 patients achieved complete continence, and another three patients reported significantly improved continence and quality of life. Three women stated that their continence did not improve. CONCLUSIONS: TVT placement may be a viable option for the management of women with persistent or recurrent SUI following an initial MUS procedure.

Does vaginal anti-incontinence surgery affect sexual satisfaction? A comparison of TVT and Burch-colposuspension

OBJECTIVE: To evaluate the sexual satisfaction rates of women who underwent tension-free vaginal tape (TVT) procedure for stress urinary incontinence and compare it with the results of Burch-colposuspension. MATERIALS AND METHODS: A self-administered questionnaire was given to 81 patients who had undergone TVT or Burch-colposuspension at our institution to determine sexual satisfaction rates and reasons for dissatisfaction. Forty-seven patients in TVT group and 22 patients in Burch-colposuspension group were considered eligible for the study. The mean follow-up period and age of patients in TVT and Burch-colposuspension groups were 34 months, 51.5 years and 89 months, 52.9 years, respectively. The difference between the ages in the two groups was not statistically significant, while the difference between mean follow-up periods was significant (p = 0.000). RESULTS: When evaluating sexual satisfaction, 73 percent in the TVT group and 86 percent in the Burch-colposuspension group did not report any difference in sexual satisfaction following surgery, while in the TVT group, 23 percent expressed negative and 4 percent positive changes, and in the Burch-colposuspension group 9 percent expressed negative and 5 percent positive post surgical changes. The differences in sexual satisfaction rates between the two groups were not considered significant. The majority (54 percent) of those who expressed a negative change suffered from dyspareunia. CONCLUSIONS: Although sexual satisfaction seems to be more adversely affected by TVT compared to Burch-colposuspension, the difference was not statistically significant. Further studies are required concerning different anti-incontinence techniques in order to arrive at more precise conclusions.

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.

Assessment of the tension-free vaginal tape as a minimally invasive surgical treatment of genuine stress incontinence in women

The purpose of this prospective study was to follow-up and evaluates the results of tension-free vaginal tape as a minimal invasive surgical procedure in treating female genuine stress incontinence. A prospective study was performed for 25 women suffering from genuine stress incontinence. The mean age was 59 years [SD 9]. 23 women [92%] were multiparous while 2 were nulliparous. All of them were postmenopausal and were prepared by local conjugated estrogen for 3 months. Ten women were operated upon by local anesthesia and sedatives while the other 15 had pudendal nerve block. Mean operation time was 31 minutes [range 20-59]. Twenty-two women [88%] had the ability to micturate spontaneously after the operation. Three patients required catheterization for 3-7 days after the operation. The objective overall continence rates at 1-year were 80% [20/25]. Three women [12%] showed improvement. Recurrent incontinence developed in a total 2 patients. There was no tape rejection or healing complications. Tension-free vaginal tape is considered a minimal invasive procedure, safe and effective in treating female genuine stress incontinence. The technique is easy and can be performed under local anesthesia with the ability to discharge the patient within few hours

Efficacy of tension free vaginal tape [TVT] and burch colposuspension in patients with genuine stress urinary incontinence

Aim of the work is to compare the new urethropexy technique, the T.V.T and the gold standard Burch colposuspension, both clinically and urodynamically in patients with genuine urinary stress incontinence. Prospective randomized study. The study was held in Ain Shams University Maternity Hospital between June, 2002, and March, 2003. A randomized study involving 20 patients of combarable age and parity. Randomization were done using a table of random numbers then each patient were given a serial number and received the corresponding therapy. They were divided into two groups. The first group underwent T.V.T for treatment of genuine S.U.I. The second group underwent Burch colposuspention for treatment of genuine S.U.I. The tension free vaginal tape fulfill the criteria of minimal invasive incontinence surgery which are short hospital stay, early postoperative mobilization, no need for urinary catheter or drains, normal everyday physical activity, the use of regional anaethesia, minimal tissue destruction, short duration of operative technique and less need for postoperative analgesia. Results showed that TVT procedure is highly effective in treating female genuine stress incontinence. The results TVT was comparable to the results of the gold standard Burch colposuspension. The study also showed the effect of TVT on the bladder neck mobility and rotational angle which differs from the effect of colposuspension. In the T.V.T. group, the subjective success rate was 90% three month postoperatively. In the Burch group, the subjective success rate was 90% three month postoperatively. In the T.V.T. group, the objective success rate was [90%] three month postoperatively. In the Burch group, the objective success rate was [90%] three month postoperatively. Duration of the operation descriptive statistics and analytical difference between the two studied groups [in minutes] showed that there is very highly significant difference between the two groups, as regards operative time in favour of TVT group. As regard postoperative hospital stay descriptive statistics and analytical difference between the two studied groups [in days], There was very highly significant difference between the two groups, as regards the postoperative hospital stay, in favour of TVT group. From the present study, it is concluded that the tension free vaginal tape is a safe and effective minimally invasive surgical procedure for the treatment of female genuine stress incontinence. The TVT procedure appears to be technically feasible and effective as a treatment for stress urinary incontinence when combined with other pelvic floor reconstructive surgery. Care must be taken to make sure that the sling does not migrate to the bladder neck and that it is not at all obstructive