Quality of life following transobturator sling surgery for female stress urinary incontinence.

OBJECTIVE: This descriptive study examines quality of life in women undergoing placement of a midurethral sling for stress urinary incontinence. MATERIALS AND METHODS: This was a retrospective cohort study based on data from 51 women consecutively undergoing this procedure at a tertiary hospital in the years 2014 and 2015. The main outcome variable was quality of life assessed through the Sandvick severity test and International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF) at the time points baseline or presurgery, and 6 months and 5 years postsurgery. Factors associated with treatment failure were determined through binary logistic regression. RESULTS: At 5-year follow up we obtained an absolute reduction of 8.78 points (95% CI 6.43-11.14; p < 0.001) in the ICIQ-IU-SF questionnaire and 4.54 (95% CI 3.25-5.83; p < 0.001) in the Sandvick severity test score, compared to baseline, in the 35 patients that completed follow-up. Out of the 51 patients that were followed, the rate of success in incontinence correction was 86.3% (44/50) with a failure rate of 12% (6/50). Multiparity and previous gynaecological surgery were identified as predisposing factors for treatment failure. Obesity was associated with a worse treatment outcome. CONCLUSION: Sling treatment for incontinence was successful in 86.3% (44/50) of participants and remained effective 5 years after surgery in terms of quality of life.

Intra-obturator bupivacaine injection and post-operative pain following the trans-obturator tension-free vaginal tape procedure: randomized study.

PURPOSE: To assess the effectiveness of a long-acting anesthetic injection into the obturator membrane for pain relief in women undergoing trans-obturator tension-free vaginal tape. METHODS: A total of 22 women were randomized for the intra-operative injection of bupivacaine into one of their obturator membranes: the left or right side. All the participants were asked to define their groin pain on a visual analog scale (scored 0-10 cm) at 1, 6, 12, and 24 h post-operative. For each woman, pain scores were compared between the local anesthetic-injected side and the opposite side. RESULTS: Statistically significant differences were not observed in groin pain scores between the bupivacaine injection side and the no injection side at 1 h (p = 0.76), 6 h (p = 1), 12 h (p = 0.95), and 24 h (p = 0.82) post-operative. CONCLUSION: In women who undergo trans-obturator tension-free vaginal tape procedures, intra-operative intra-obturator injection of local anesthetics is not effective in alleviating the characteristic post-operative groin pain. TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov (NCT03479996).

TREATMENT OF STRESS-INDUCED URINARY INCONTINENCE BY TVT-O METHOD (CLINICAL CASE).

Stress urinary incontinence (SUI) is one of the most common diseases accompanied by loss of control over the activity of the bladder. Women are more susceptible to this pathology than men due to the peculiarities of the structure of the genitourinary system, as well as due to pregnancy, childbirth, gynecological operations, and age. Incontinence occurs when a woman coughs, sneezes, laughs, lifts weights, runs, etc. It leads to social isolation and significantly reduces the quality of life of patients. The article analyzes the case of a patient who was in the gynecological department of the Uzhhorod City Maternity Hospital of the Uzhhorod City Council and complained of urinary incontinence during coughing, sneezing, laughing, and physical exertion. A full clinical and laboratory examination, physical examination, and consultation with narrow specialists were conducted. According to the research data, a diagnosis of stress urinary incontinence was made. Urethropexy with a synthetic loop (TVT-O operation) was performed using the Gynecare TVT Obturator System Tension-free Support for Incontinence. The complex treatment included antibacterial, antithrombotic and infusion therapy. The effectiveness of the result of surgical treatment was evaluated taking into account subjective and objective criteria for the restoration of anatomical parameters and functional parameters, as well as the patient's quality of life during dynamic follow-up for 2 years. We noted the high efficiency of surgical treatment of stress urinary incontinence using synthetic material.

¿Existen diferencias entre la vía transobturadora y retropúbica en la resolución de la incontinencia de orina de esfuerzo? / Are there differences between transobturator and retropubic sling in the resolution of stress urinary incontinence?

PROPÓSITO: Comparar la eficacia y complicaciones de la vía retropúbica (TVT o RP) y la vía transobturadora (TVT-O) en el tratamiento quirúrgico de la incontinencia de orina de esfuerzo (IOE). MÉTODOS: Estudio retrospectivo de pacientes con diagnóstico de IOE operadas entre Julio 2004 y Julio 2014 en el Hospital Clínico de la Universidad de Chile. Se evaluaron los datos demográficos, antecedentes médicos, síntomas y examen físico tanto preoperatorio como post operatorio y seguimiento post quirúrgico. RESULTADOS: De un total de 715, se analizaron los datos de 383 pacientes operada durante la fecha. 59,7% (n= 229) fueron sometidas a TVT-O y 40,3% (n=154) a TVT. Un 4,8% (n=11) de las pacientes en que se realizó cinta transobturadora tenían antecedente de cirugía previa de incontinencia versus un 14,29% (n=22) de las pacientes en que se realizó cinta retropúbica (P 0,006). Los datos post operatorios fueron ajustados según el dato anterior. En el seguimiento post operatorio se presentaron diferencias significativas en la disfunción del vaciamiento vesical [OR 0,28, (95%IC 0,10-0,74), p = 0,011]; y en el dolor inguinal post operatorio [OR 0,19 (95%IC 0,06-0,56), p = 0,003); siendo ambos más frecuentes en el grupo transobturador. No hubo diferencias significativas en el éxito subjetivo de la resolución de la IOE así como en otro tipo de complicaciones postoperatorias. CONCLUSIONES: Si bien ambas técnicas presentan tasas similares de éxito subjetivo en la resolución de la IOE, en nuestra experiencia, la vía transobturadora presenta mayor riesgo de disfunción del vaciamiento vesical y dolor inguinal postoperatorio.

PURPOSE: To compare the efficacy and complications of the retropubic sling (TVT or RP) and the transobturator sling (TVT-O or TOT) for the surgical treatment of stress urinary incontinence (SUI). METHODS: Retrospective study including patients diagnosed with SUI who had surgery between July 2004 and July 2014 at the Clinical Hospital of the University of Chile. Demographics, medical history, symptoms and physical examination (preoperative, postoperative and post-surgical follow-up) were evaluated. RESULTS: From a total of 715 operated during this period, the data from 383 patients was analyzed. 59.7% (n = 229) were submitted to TVT-O and 40.3% (n = 154) to TVT. 4.8% (n = 11) of patients in the transobturator sling group had previously had an incontinence surgery versus 14.29% (n = 22) of patients that had a retropubic sling (P 0.006). The postoperative data was adjusted according to this data. At the postoperative follow-up there were significant differences in bladder emptying dysfunction [OR 0.28 (95% CI 0.10 to 0.74), p = 0.011]; and postoperative groin pain [OR 0.19 (95% CI 0.06 to 0.56), p = 0.003); both being more frequent in the transobturator group. There were no significant differences in subjective success of the resolution of the SUI as well as other postoperative complications. CONCLUSIONS: Although both techniques have similar rates of subjective success in solving the SUI, in our experience, the transobturator approach has increased risk of bladder emptying dysfunction and postoperative groin pain.

TVT versus TVTO: revisão bibliográfica para escolha e implantação da melhor técnica cirúrgica para correção de incontinência urinária de esforço em mulheres no Hospital do Campo Limpo

Objetivo: o presente estudo tem por objetivo comparar o melhor resultado terapêutico das cirúrgias TVT e TVTO para correção da incontinência urinária de esforço, levando em consideração a eficácia terapêutica, tempo cirúrgico e complicações no intra e pós operatórias. (...)

TVT versus TVTO: revisão bibliográfica para escolha e implantação da melhor técnica cirúrgica para correção de incontinência urinária de esforço em mulheres no Hospital do Campo Limpo / TVT versus TVTO: literature review the choice and implementation of best surgical technique for correction of stress urinary incontinence in women in the Hospital do Campo Limpo

Objetivo: o presente estudo tem por objetivo comparar o melhor resultado terapêutico das cirúrgias TVT e TVTO para correção da incontinência urinária de esforço, levando em consideração a eficácia terapêutica, tempo cirúrgico e complicações no intra e pós operatórias...