Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing Burch and synthetic sling techniques

ABSTRACT Introduction Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. Objective To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Materials and Methods Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Results Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (p<0.001)). Cost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (p<0.001). Conclusion Burch surgery was more expensive than ambulatory synthetic transobturator sling surgery, even when the cost of the synthetic sling was considered.

Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques.

INTRODUCTION: Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. OBJECTIVE: To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. MATERIALS AND METHODS: Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. RESULTS: Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (p<0.001)). Cost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (p<0.001). CONCLUSION: Burch surgery was more expensive than ambulatory synthetic transobturator sling surgery, even when the cost of the synthetic sling was considered.

Egresos hospitalarios por patología genitourinaria en Chile: segunda parte / Hospital discharges by pathologies of the genitourinary tract in Chile: second part

Utilizando el Boletín de Egresos Hospitalarios del MINSAL para los años 1993, 1996 y 2001 se analizaron aquellos códigos correspondientes a Patologías del Sistema Génitourinario (PGU) según el sistemade Clasificación Internacional de Enfermedades OMS CIE-9 y CIE-10, caracterizándolos según su composición geográfica y demográfica.En 1993, 1996 y 2001 se registraron en Chile: 1.404.478, 1.441.374 y 1.566.187 egresos hospitalarios, respectivamente. Los egresos por PGU en esos años fueron 62.978, 70.207 y 64.648, lo que correspondea 4,48 porciento, 4,87 porciento y 4,13 porciento de los egresos hospitalarios totales para ese año. La ITU, HPB, litiasis y fimosisse mantienen como las patologías más prevalentes que requirieron hospitalización. Durante el año 2001,se observó una disminución entre 6 porciento y 7 porciento de los egresos por infección urinaria. Destaca el comportamientode los egresos por cánceres urológicos, los que fueron 4.129 en 1993, 5.206 en 1996 y 6.715 en 2001. Esto corresponde a 6,6 porciento, 7,5 porciento y 10,4 porciento del total de egresos por PGU para cada año respectivo. La patología génitourinaria continúa siendo una contribución menor al total de egresos hospitalarios en el país. Destaca la disminución en el número de egresos por infección urinaria registrado el año 2001. Además, es posible observar un aumento sostenido de los egresos por cáncer urogenital durante estos 8 años de seguimiento.

Modificación a la técnica de Stamey para corregir la incontinencia urinaria de stress / Modifications to Stamey technique to correct urinary incontinence caused by stress

Se describe detalladamente el método de Stamey para corregir la incontinencia urinaria por esfuerzo a 10 pacientes operadas en el Servicio de Urología del Hospital Provincial General Docente "Carlos Manuel de Céspedes" de Bayamo entre los años 1993 y 1995, la cual consiste en elevar el cuello uretrovesical con guía endoscópica para colocar suturas permanentes; es menos invasora y disminuye las molestias en el postoperatorio que causan otros tipos de intervenciones de uso actual. Se realizaron modificaciones a la técnica original consistentes en uso de guía para la introducción de las agujas con ahorro de tiempo quirúrgico y se evito mayor traumatismo vesical, así como se obvió la cistostomía suprapúbica. Se crearon agujas con recursos propios. Se reportan los beneficios socioeconómicos y humanos que brinda al paciente, a la institución hospitalaria y a la economía del país(AU)