Mid-term results of ReMEEX sling system in female stress urinary incontinence with various indications and feasibility of readjustment.

PURPOSE: To examine efficacy and safety of ReMEEX implantation in patients with female stress urinary incontinence (SUI) associated with detrusor underactivity (DU), recurrence, or intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: Retrospective cohort study included 303 females who underwent ReMEEX system (March 2008 to May 2021). Patients were stratified into three groups by purpose of surgery (SUI with DU, reoperation, and SUI with ISD) and evaluated with following criteria: cure (absence of subjective complaint of leakage and objective leakage in the stress test), improvement (rare leakage subjectively, but satisfaction regardless of stress test), and failure. Primary outcome was success rate of surgery assessed through patient interviews and a stress test. Surgical outcomes and complications were evaluated. RESULTS: Mean follow-up was 34.4 months (range, 6.0-145.0 months). At the final follow-up visit, 42.9% and 49.2% of patients were cured and improved. Twenty-one point five percent required tension readjustment (mean number, 1.2). The total complication rate was 19.5% (none for grade ≥4). Preoperative Qmax was significantly higher in the ISD group (p<0.001) and preoperative total International Prostate Symptom Score (IPSS) score was significantly higher in the DU group (p=0.044). Moreover, at postoperative 1 year, both total IPSS score and IPSS quality of life score were significantly higher in the DU group (both p=0.001). CONCLUSIONS: The success rate of ReMEEX system was 92.1% at mean follow-up of 34.4 months in female SUI with DU, reoperation, or ISD. It also enabled postoperative readjustment of sling tension, as needed, up to 130 months after surgery.

Primary care providers practice patterns regarding female pelvic floor disorders.

INTRODUCTION: Pelvic floor disorders (PFDs) pose substantial physical and psychological burdens for a growing number of women. Given the ubiquity of these conditions and known patient reluctance to seek care, primary care providers (PCPs) have a unique opportunity to increase treatment and provide appropriate referrals for these patients. METHODS: An online survey was administered to PCPs to assess provider practices, knowledge, comfort managing and ease of referral for PFDs. Logistic regression was used to assess the association between demographic/practice characteristics of PCPs and two primary outcomes of interest: discomfort with management and difficulty with referral of PFDs. RESULTS: Of the 153 respondents to the survey, more felt comfortable managing stress urinary incontinence (SUI) and overactive bladder (OAB), compared with pelvic organ prolapse (POP) and faecal incontinence (FI) and were less likely to refer patients with urinary symptoms. Few providers elicited symptoms for POP and FI as compared with SUI and OAB. Provider variables that were significantly associated with discomfort with management varied by PFD, but tended to correlate with less exposure to PFDs (eg, those with fewer years of practice, and internal medicine and family physicians as compared with geriatricians); whereas the factors that were significantly associated with difficulty in referral, again varied by PFD, but were related to practice characteristics (eg, specialist network, type of practice, practice setting and quantity of patients). CONCLUSION: These findings highlight the need to increase PCPs awareness of PFDs and develop effective standardised screening protocols, as well as collaboration with pelvic floor specialists to improve screening, treatment and referral for patients with PFDs.

Urinary incontinence in middle-aged and older women with hip and knee osteoarthritis: An outpatient study of frequency and risk factors.

AIMS: To investigate the frequency and the factors associated with urinary incontinence (UI) in a sample of middle-aged and older women with lower limb osteoarthritis (OA). METHODS: Women aged 50 years or older with clinical hip/knee OA diagnoses were recruited for this cross-sectional study. Self-reported UI and type, sociodemographic characteristics, medical conditions, physical activity level, anthropometric and body composition measurements, muscle strength, and physical function were assessed. Uni and multivariable logistic regression were used to investigate the factors associated with UI. RESULTS: Among 100 middle-aged and older women (mean 67.27 ± 8.77 SD years), 67% reported UI. In the UI group, 33% reported stress UI, 36% reported urgency UI, and 31% reported mixed UI. In the univariate analysis, age, level of physical activity, pulmonary disease, number of medications, body mass index (BMI), number of deliveries, and activity limitation were significantly associated with UI. In the multivariable analysis, older age (60-69 years OR: 4.91, 95% CI: 1.25-19.36; ≥70 years OR: 8.06, 95% CI: 1.96-33.22), compared to 50-59 years, morbid obesity (OR: 14.10, 95% CI: 1.36-146.48), compared to BMI < 30 kg/m2 , and activity limitation (OR: 5.31, 95% CI: 1.61-17.54), assessed as short physical performance battery ≤8, remained significantly associated with UI. CONCLUSIONS: UI was highly frequent among middle-aged and older women with hip/knee OA. Older age, activity limitation, and morbid obesity were independently associated with UI. Interventions targeting physical function and weight management must be considered to prevent and treat UI in this population.

Management of mixed urinary incontinence: IUGA committee opinion.

INTRODUCTION AND HYPOTHESIS: Mixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI. Management requires an individualised approach to the symptom components. The aim of this review is to identify the assessment/investigations and management options for MUI. METHODS: A working subcommittee from the IUGA Research & Development (R&D) Committee was created and volunteers invited from the IUGA membership. A literature review was performed to provide guidance focused on the recommended assessment and management of MUI. The document was then evaluated by the entire IUGA R&D Committee and IUGA Board of Directors and revisions made. The final document represents the IUGA R&D Committee Opinion. RESULTS: The R&D Committee MUI opinion paper provides guidance on the assessment and management of women with MUI and summarises the evidence-based recommendations. CONCLUSIONS: Mixed urinary incontinence is a complex problem and successful management requires alleviation of both the stress and urge components. Care should be individualised based on patient preferences. Further research is needed to guide patients in setting goals and to determine which component of MUI to treat first. The evidence for many of the surgical/procedural treatment options for MUI are limited and needs to be explored in more detail.

Urinary Incontinence in Midlife According to Weight Changes Across and After Childbearing Years.

INTRODUCTION AND HYPOTHESIS: The objective was to investigate how weight change across and after the childbearing years was associated with urinary incontinence (UI) in midlife. METHODS: Data were obtained from 35,645 women responding to the Maternal Follow-up questionnaire in the Danish National Birth Cohort in 2013-2014. Outcome was self-reported UI and its subtypes. Exposures were changes in body mass index (BMI) across and after the childbearing years. Adjusted odds ratios were estimated using logistic regression. RESULTS: At follow-up, the mean age was 44 years and 32% experienced UI. Compared with stable weight, weight gain across the childbearing years of > 1 to 3, > 3 to 5 or > 5 BMI units increased the odds of any UI by 15%, 27%, and 41% respectively. For mixed UI, the odds increased by 23%, 41%, and 68% in these groups. Weight gain after childbearing showed the same pattern, but with a higher increase in the odds of mixed UI (25%, 60%, and 95% in the respective groups). Women with any weight loss during this period had 9% lower odds of any UI than women with a stable weight. CONCLUSIONS: Weight gain across and after childbearing increased the risk of UI in midlife, especially the subtype mixed UI. Weight loss after childbearing decreased the risk.

Association of Obesity, Metabolic Syndrome, and Diabetes With Urinary Incontinence and Chronic Kidney Disease: Analysis of the National Health and Nutrition Examination Survey, 2003-2020.

PURPOSE: Diabetes and obesity, components of the metabolic syndrome (MetS), are risk factors for urinary incontinence (UI) and chronic kidney disease (CKD). We interrogated US population-based data to explore independent, sex-specific associations between nondiabetic MetS, with and without obesity, and UI and/or CKD. MATERIALS AND METHODS: We analyzed data from 8586 males and 8420 females ≥20 years from the National Health and Nutrition Examination Survey. Multivariable logistic regression models were used to examine associations of UI or CKD with diabetes and 4 nondiabetic obesity/metabolic phenotypes: non-MetS/nonobese, MetS/nonobese, non-MetS/obese, and MetS/obese. Multinominal logistic regression models were used to assess associations of co-occurring UI/CKD with obesity/metabolic phenotypes. RESULTS: Male MetS/obese participants had increased odds of any UI (1.25; 95% CI 1.00-1.57) and urgency UI (1.36; 1.03-1.80), compared with non-MetS/nonobese participants. Female MetS/obese participants had increased odds of any UI (2.16; 95% CI 1.76-2.66), stress UI (1.51; 1.21-1.87), and mixed UI (1.66; 1.31-2.11) compared with non-MetS/nonobese participants. The odds of co-occurring UI/CKD were increased relative to either condition alone in persons with diabetes, and in males with MetS/obese phenotypes and females with MetS phenotypes as compared to same sex participants with neither obesity nor MetS. CONCLUSIONS: We found novel associations between MetS/obese and urgency UI in males without diabetes, and between SUI and both MetS and obesity in females without diabetes. Odds estimates for UI/CKD were increased by existing obesity or MetS as compared to those for UI or CKD alone. Improved understanding of modifiable factors associated with UI will inform prevention and treatment opportunities.

Malla suburetral retropúbica (TVT): experiencia clínica y análisis de datos en el Hospital El Carmen de Maipú / Retropubic suburethral mesh (TVT): clinical experience and data analysis at the Hospital El Carmen de Maipú

La incontinencia urinaria de esfuerzo es la pérdida involuntaria de orina durante una maniobra de esfuerzo físico, ejercicio, estornudo o tos. Afecta aproximadamente al 15% de las mujeres de 30-60 años y su prevalencia es del 30-41%. Aunque existen terapias conservadoras para su manejo, muchas pacientes terminarán necesitando cirugía para su resolución. Las mallas suburetrales son alternativas para el manejo quirúrgico, existiendo dos vías de instalación, la transobturadora (TOT o TVT-O) y la retropúbica (del inglés tension-free vaginal tape o TVT), siendo esta última la que presenta mejores resultados y menos complicaciones posoperatorias. Objetivo: evaluar la tasa de efectividad y las complicaciones de la TVT en la Unidad de Piso Pélvico Femenino del Hospital El Carmen de Maipú entre los años 2015 y 2020. Materiales y Métodos: Se obtuvieron 715 registros de pacientes que fueron sometidas a TVT y se logró contactar telefónicamente con el 60,69% de ellas. Resultados: Los resultados muestran una tasa de efectividad del 94,8% y una tasa de complicaciones del 2,3%. Conclusión: Este estudio aporta evidencia local de los resultados posoperatorios en la IOE en pacientes que requirieron la instalación de una malla suburetal retropúbica, demostrando ser una cirugía altamente efectiva y segura.

Stress urinary incontinence is the involuntary loss of urine during physical exertion, exercise, sneezing, or coughing. It affects approximately 15% of women aged 30-60, with a prevalence of 30-41%. Although there are conservative therapies for its management, many patients will eventually require surgery for resolution. Suburethral sling are considered for surgical management, and there are two installation alternatives, transobturator (TOT or TVT-O) and retropubic (tension-free vaginal tape or TVT), with the latter presenting better results and fewer postoperative complications. Objetive: to evaluate effectiveness rate and complications of the TVT in the Female Pelvic Floor Unit of Hospital El Carmen de Maipú between 2015 and 2020. Materials and Methods: A total of 715 patient records were obtained for those who underwent TVT, and 60.69% of them were successfully contacted by telephone. Results: The results show an effectiveness rate of 94.8% and a complication rate of 2.3%. Conclusion: This study provides local evidence for the results of stress urinary incontinence that required the placement of a retropubic suburethral sling, proving to be a highly effective and safe surgery.

Obesidade como fator de risco para a falha da cirurgia de Burch / Obesity as a risk factor to Burch surgery failure

Objetivo: observar o impacto da obesidade e de outros fatores de risco sobre a taxa de falha das pacientes submetidas à cirurgia de Burch para tratamento da incontinência urinária. Métodos: estudo de casos de pacientes submetidas à cirurgia de Burch no período de 1992 a 2003. As pacientes foram avaliadas no momento da segunda consulta pós-operatória (66 dias em média) e com um ano de acompanhamento, e classificadas em dois grupos: Continentes e Não Continentes. As variáveis analisadas foram: idade, paridade, índice de massa corpórea (IMC), tempo de menopausa, tempo de terapia de reposição hormonal, avaliação urodinâmica, história de infecção do trato urinário, cirurgia prévia para incontinência urinária, diabetes, cistocele e prolapso uterino, tempo de internação, necessidade de autossondagem, micção espontânea no pós-operatório e ferida operatória. Os dados foram analisados com o pacote estatístico Statistical Package for Social Sciences 14.0. Foram utilizados o teste t de Student ou Mann-Whitney, para comparação das variáveis contínuas, e os testes exato de Fisher e χ2, para variáveis categóricas (p<0,05). Resultados: no momento da segunda avaliação pós-operatória, não houve diferença significativa entre os dois grupos quanto às variáveis analisadas. Com um ano de seguimento, de um total de 97 pacientes, 81 apresentavam-se continentes e 16, não continentes, sendo o IMC e a altura diferentes entre os grupos. No Grupo Continente, o IMC médio foi 27,1 e a altura de 1,57 m e, no Não Continente, 30,8 (p=0,02) e 1,52 m (p=0,01). A Odds Ratio para IMC>30 foi 3,7 (IC95%=1,2-11,5). ConclusÕES: a obesidade mostrou-se um importante fator de risco para a falha da cirurgia no primeiro ano de acompanhamento. Os resultados demonstram que pacientes com IMC>30 têm chance 3,7 vezes maior de apresentarem-se não continentes após um ano da cirurgia de Burch em relação às não obesas.

Purpose: to observe the impact of obesity and other risk factors on the rate of failure in patients submitted to Burch’s surgery for the treatment of urinary incontinence. Methods: cases study of patients submitted to Burch’s surgery, from 1992 to 2003. Patients were evaluated at the second post- surgery appointment (average 66 days) and after one-year follow-up, and classified in two groups: Continent and Non-continent. Variables analyzed were: age, parity, body mass index (BMI), menopause duration, duration of hormonal therapy, urodynamic evaluation, history of urinary tract infection, previous urinary incontinence surgery, diabetes, cystocele and uterine prolapse, time spent in hospital, necessity of self-probing, post-surgical spontaneous micturition, and surgical wound. Data were analyzed with the Statistical Package for Social Sciences 14.0 statistical package. For the comparison of continuous variables, Student’s t-test or Mann-Whitney test were used, and Fisher exact and χ2 tests, for the categorical variables (p<0.05). Results: at the second post-surgical evaluation, there was no significant difference between the two groups, concerning the variables analyzed. After one-year follow-up, from a total of 97 patients, 81 were continent and 16, non-continent, BMI and height being different between the groups. In the continent group, average BMI was 27.1 and height, 1.57 m, and, among the non-continent, 30.8 (p=0.02) and 1.52 m (p=0.01). The BMI>30 Odds Ratio was 3.7 (CI95%=1.2-11.5). ConclusionS: obesity has shown to be an important risk factor for the surgery failure in the first follow-up year. Results show that patients with BMI>30 have 3.7 times more chance of being non-continent one-year after Burch’s surgery than non-obese patients.

The short-term effect of surgical treatment for stress urinary incontinence using sub urethral support techniques on sexual function

OBJECTIVES: To evaluate the impact of surgical treatment of stress urinary incontinence on the sexual function of women and to identify whether such treatment can improve their sexual function and overall quality of life. MATERIALS AND METHODS: 64 heterosexual women with such indication were studied using the Female Sexual Function Index (FSFI) questionnaire, modified by introducing one question to evaluate the impact of urine loss. This was applied preoperatively and six months after surgery. RESULT: Among these 64 patients, 60.94 percent had regular sexual activity, while 39.06 percent did not. Among sexually active patients, 59 percent had urine loss during sexual intercourse and, of these, 87 percent had urine losses in half or more of sexual relations. There were no statistically significant differences in assessments of desire, arousal, lubrication, orgasm, satisfaction and pain, or in totaling the scores, between the preoperative period and six months after surgical treatment. However, the scores for urine losses during sexual intercourse were significantly better after the operation. CONCLUSIONS: Analysis of the results allowed the following conclusions to be reached: Urine lost during sexual activity was frequent among patients with stress urinary incontinence. Suburethral support surgery did not jeopardize sexual activity. Patients cured of stress urinary incontinence did not present improvement in sexual function.

Uretrocervicopexia laparoscópica: seguimiento a largo plazo / Laparoscopic urethrocervicopexy: the long term follow-up

La Incontinencia Urinaria de Esfuerzo (IUE) es una condición en la mujer que causa un fuerte impactosocial, psicológico y familiar. Existía consenso entre los urólogos que las técnicas abdominales con materialno absorbible eran las de mayor éxito. Hacia 1993, la uretrocervicopexia laparoscópica (UL) se hizopopular en centros dedicados a la introducción de la laparoscopía en urología.Se realiza estudio prospectivo entre agosto de 1995 y agosto del 2003. Se realizaron 61 UL, en dos centroshospitalarios, por el mismo equipo quirúrgico. Se incluyeron en esta revisión solamente las 52 pacientesbeneficiarias de FUSAT, de las cuales todas permanecen en control, según protocolo. Todas las pacientescompletaron, al menos, 24 meses de control. A todas las pacientes se les realizó historia clínica, examenfísico, cistoscopía, QT Test, Prueba de Marshall y urodinamia cuando se sospechó incontinencia tipo 1 ó2. La técnica era transperitoneal y la suspensión se efectuaba con malla prolene, fijada a la fasciaperivaginal y ligamento iliopectíneo, con clips de titanio. Las pacientes se evaluaban al mes, 6 meses, alaño y luego cada año, efectuándose uroflujometría, medición de residuo post miccional y encuesta desatisfacción.La tasa de éxito fue de 88,9 porciento al primer año, pero cae drásticamente, hasta llegar a 28,9 porciento a los 9 años. El seguimiento promedio fue de 60,7 meses (26-101). Tiempo operatorio promedio 40 minutos (30-65). Lascomplicaciones perioperatorias fueron 2 perforaciones vesicales mínimas, 2 infecciones urinarias simples,una retención urinaria. Las complicaciones tardías fueron una paciente con un clip de titaniointravesical y 4 pacientes con migración de la malla de prolene dentro de la vejiga.La laparoscopía en urología presenta una serie de ventajas, pero su aplicación exacta debe ser revisadaa largo plazo. Nuestro servicio ha abandonado su aplicación en incontinencia, reservándola para otrasindicaciones.

Cinta vaginal libre de tension en el tratamiento de la incontinencia de orina femenina. Una nueva forma de inserción: a través del agujero obturador (CLT-AO)

Las cintas vaginales libres de tensión en sus distintas modalidades se han hecho populares en el mundo entero desde la década de los 90 para el tratamiento de la incontinencia urinaria femenina. En la literatura destaca la lesión vesical como la principal complicación. Inspirados en Delorme, hemos desarrollado una técnica con paso de la cinta con aguja a través del agujero obturador, con el objeto de evitar el contacto con la vejiga. Entre noviembre de 2002 y abril de 2003 operamos 18 pacientes con esta técnica. No observamos ninguna lesión vesical y luego de un seguimiento promedio de 6 meses, el 100% de las pacientes está continente. Se muestra la técnica quirúrgica y se discuten sus indicaciones.

Complicaciones en la evacuación vesical de la cirugía correctiva de la incontinencia de orina al esfuerzo / Complications in the bladder emptying caused by corrective surgey of the stress incontinence

Se estudian 52 pacientes operadas de incontinencia de orina con complicaciones obstructivas. La edad va de los 38 a los 65 años, con una media de 52. Fueron operadas con la técnica de Burch o similares 32-61, 53 porciento, Schlomo Raz 15-28, 84 porciento, Sling 4-7, 69 porciento y videolaparoscopía 1-1, 92 porciento. Todas las pacientes consultan por alteración de la evacuación vesical y el 76,92 porciento presentan infección urinaria a repetición. El tiempo desde la operación a la consulta fue de 3 meses a 2 años. Se realizaron, previo descarte de infección urinaria, estudios ecográficos, uretrocistografía, cistofibroscopía y urodinamia. Todos tenían residuo postmiccional elevado, con un mínimo de 40 ml y un máximo de 220 ml, con una media de 75 ml. Podemos dividir en 2 grupos. Uno con 32 pacientes, el 61,53 porciento, con contracciones no inhibidas de alta presión, vejigas hiperactivas, con flujo bajo y curva obstructiva, el 60 porciento de ellas tenían escape de orina en el curso de una contracción involuntaria. Otro, con 20 pacientes, el 38, 46 porciento, con vejigas hipoactivas e hipocontráctiles, con marcada dificultad para orinar. Treinta y siete pacientes fueron tratadas y controladas. A 11 se les realizó tratamiento médico, 6 con vejiga hiperactiva y 5 con vejiga hipotónica, con resultados aceptables en el 50 y 60 porciento, respectivamente. A los 26 restantes, 15 con vejigas hiperactivas y 11 hipocontráctiles, se las operó, realizando una uretrolisis y reimplantación de los tejidos periuretrales en situación más distal, con excepción del sling, que se abordaron por vía vaginal, seccionando simplemente el sling. Se obtuvieron buenos resultados en el 53, 33 y 63, 63 porciento, respectivamente. En los 4 sling reapareció la incontinencia. Es importante realizar una buena valoración preoperatoria antes de indicar la terapéutica en la IOE para evitar complicaciones obstructivas, teniendo en cuenta correlacionar en forma adecuada la alteración anatómica con la funcional. Hay técnicas, como las retropúbicas y el sling, que tienden a producir más obstrucción y su indicación debe ser cuidadosa. En las vejigas hipoactivas, tener en cuenta también, la posibilidad de ejercicios y electro estimulación, previo a la indicación de cirugía.

Hernias de la pared abdominal y prolapso genital con incontinencia de orina: manejo quirúrgico / Abdominal wall hernias and genital prolapse with urinary incontinence: surgical management

Las hernias abdominales pueden ser umbilicales, inguinales, crurales o incisionales. El 75 por ciento de las hernias de la pared abdominal se ubican en la región inguinal. El prolapso genital es un motivo frecuente de consulta ginecológica en pacientes de edad avanzada y es posible su asociación a hernias de la pares abdominal. La vía de abordaje quirúrgica para solucionar la patología ginecológica puede permitir, en algunos casos, solucionar el problema herniario. Se presentan ocho casos de pacientes con edades entre 60 y 72 años, portadoras de prolapso genital e incontinencia urinaria de esfuerzo asociado a hernias de la pared abdominal. Se describen los tipos de hernia, la vía de abordaje y las técnicas utilizadas en estos casos, en que fue posible la reparación quirúrgica de la hernia y del prolapso genital. Creemos que esta experiencia puede ser de utilidad para el médico ginecólogo que puede resolver quirúrgicamente ambas patologías en un sólo acto quirúrgico

Corrección de la incontinencia de orina al esfuerzo mediante técnica de Burch modificada / Correction of the urinary stress incontinence with the modified Burch technique

Hemos operado con esta técnica 57 pacientes, controlando a un año más a 55. Se logró perfecta continencia en el 96,36 por ciento de los casos con dos fracasos. No hay disuria significativa y sólo 5 pacientes tuvieron retención post operatoria, manejándose en ese caso con sondeo intennitente, recuperando la micción espontánea entre el 1 y el quinto día después de haber retirado la sonda. La mayoría de los pacientes lograron rápidamente una micción confortable no habiendo dolor significativo en el postoperatorio

Incontinencia de orina en la mujer: etiologías y tratamientos / Urinary incontinence in the women: etiology and treatments

Se propone un protocolo de estudio, en donde tiene relevancia la anamnesis y el examen físico acucioso del aparato genito-urinario. El laboratorio, haciendo hincapié en el urocultivo. Cobra especial importancia importancia, dentro de nuestra metodología, el estudio urodinámico. En muchos de ellos, sobre todo en donde hay marcada alteración del piso perineal o cuando son incontinencias recidivadas, recurrimos a la uretrocistografía dinámica. La cistofibroscopía, tiene indicación, de acuerdo a nuestro protocolo, ante una marcada irritabilidad vesical, infección urinaria a repetición o antecedentes de bematuria. Se estudiaron y controlaron 187 pacientes entre 26 y 79 años. Logrando los siguientes diagnósticos: I.O.E. mecánica: 55,08 por ciento; detrusor inestable: 17,64 por ciento; I.O.E. + prolapso: 14,97 por ciento; I.O.E. + detrusor inestable: 4,81 por ciento; I.O.E. recidivada: 2,67 por ciento; complicaciones de la cirugía: 4,81 por ciento. Se aplicaron distintas medidas terapéuticas según los diagnósticos, obteniendo un resultado favorable entre el 59 y 90 por ciento según las distintas etiologías

Incontinencia urinaria de esfuerzo: Manejo quirúrgico / Urinary stress incontinence: Surgical management

Se estudiaron 98 pacientes operadas por incontinencia urinaria de esfuerzo y se analizaron los factores de riesgo: edad, peso, talla, paridad, edad de menopausia y antecedentes médico quirúrgicos. Se dividieron en dos grupos; el grupo I, formado por pacientes operadas con la técnica de Kelly-Kennedy, (35), y el grupo II, pacientes operadas con la técnica de Burch (63). No se encontraron diferencias entre las características de las pacientes en ambos grupos; la patología agregada más frecuente fueron las distopias; las complicaciones se presentaron en 17.1 y 33.3%, respectivamente. Se corroboró la eficacia de la operación de Burch para manejar este padecimiento, siendo superior a la operación vaginal (p< - 0.05).(au)

La colposuspensión en el tratamiento de la incontinencia urinaria de esfuerzo: rendimiento en el largo plazo / Colposuspension in treatment of stress urinary incontinence: a long-term achievement

Se comunican los resultados del tratamiento en 227 pacientes con incontinencia urinaria de esfuerzo, asociada a otra patología abdominal y/o vaginal, mediante la colposuspensión de Burch, con un 90,3% de curación de la incontinencia urinaria de esfuerzo; 6,6% de mejoría del grado de la incontinencia urinaria y un 98,3% del prolapso genital concomitante, con un período de seguimiento de 42 meses. Se analizan las complicaciones del procedimiento quirúrgico

Incontinência urinária de urgência no contexto da incontinência urinária de esforço / Urgency urinary incontinence and stress urinary incontinence

O artigo trata da relaçäo de incontinência urinária de esforço (IUE) e incontinência urinária de urgência (IUU). Os autores mostram a alta incidência da associaçäo IUE-IUU na Clínica Ginecológica do Hospital Baräo de Lucena, em Pernambuco, e defendem a tese de que a IUU é um componente da IUE quando a esta está associada

Sencillo proceder quirúrgico para la incontinencia de orina por esfuerzo: técnica de Perrin y Marshall-Marchetti reducida / Simple surgical procedure for strees incontinence: reduced Perrin and Marshall-Marchetti technique

Se presenta una nueva técnica para corregir la incontinencia de orina por esfuerzo, basada en la suspensión del cuello vesical y la vejiga de la aponeurosis de los rectos utilizando como sutura el cromado No. 1. Esta técnica es más fácil y rápida de realizar que otras analizadas, y se presentan pocas complicaciones. Se realizó en 32 pacientes, quienes evolucionaron satisfactoriamente en el 90