[Minimally invasive surgery in women with recurrent stress urinary incontinence]. / Cirurgia minimamente invasiva na mulher com incontinência urinária de esforço.

OBJECTIVES: Evaluate the efficacy and safety of minimally invasive surgical techniques as second procedure in recurrent stress urinary incontinence (SUI). STUDY DESIGN: We retrospectively analyzed data on patients submitted to this type of surgery after previous surgery failure, since September 2002 to December 2006. Several parameters were evaluated: women's age, symptoms, previous surgery, urodynamics results, procedure technique, complications at short (two months) and medium term (one year) results. RESULTS: Of the 73 analyzed cases, 57 patients had been submitted previously to classic surgery and 16 to minimally invasive surgery. In surgery for recurrent SUI using minimally invasive techniques eight complications were registered (five vaginal perforations, two bladder lacerations and one femoral vein laceration); post-op complications occurred in 13 cases (three urinary retentions, two urinary tract infections, one anaemia and seven vaginal sling erosions). Short-term cure, improvement and failure rates were 69.9%, 28.8% and 1.4%, respectively. At medium term, these rates were of 54.8%, 41.1% and 4.1%, respectively. CONCLUSIONS: Minimally invasive surgery for recurrent SUI is a valid option after previous surgery failure, given the low morbidity and reduced failure rate at short and medium term.

Perineal cellulitis as a late complication of trans-obturator sub-urethral tape, Obtape.

The authors report the case of a perineal cellulitis occurring 10 months after the surgical treatment for stress urinary incontinence with a trans-obturator sub-urethral tape, Obtape (Porgès). This is a very rare complication related to a prolonged intra-vaginal tape exposure and infection that occurs after vaginal erosion, possibly due to tape rejection. This complication has been described with Obtape and with Uratape. The former lacks a sub-urethral silicone coated section that distinguishes it from Uratape. We still do not know much about the constituents of these types of sub-urethral tapes specially about their human tolerance, and we should therefore look at them carefully.