[Complications of female urinary incontinence surgery with mini-sling system]. / Complicaciones de la cirugía de incontinencia urinaria femenina con minicintas.

OBJECTIVE: To evaluate the complications of urinary incontinence (UI) surgery with mini-sling system. Describe its diagnosis and management. MATERIAL AND METHOD: We make a descriptive analysis of the complications of the surgery in a group of 155 women with UI surgically treated with mini-sling system (50 TVT-Secur and 105 MiniArc) from October 2006 to November 2008. All patients were evaluated with clinical history, physical examination and two questionnaires of QoL (ICIQ-SF and EQ-5D). When urethral obstruction was suspected, we included urineculture, post-void residual urine measurement and urodynamics. The complications were grouped into three categories: intraoperatory, early (within de first month after surgery) and late complications (after a month). We use the SPSS program (V 14.0) for statistical analysis of the results. RESULTS: The average age was 56 years (range 33-82) and 180 days for the following-up (range 26-817). We had a complication rate of 20% (22% TVT-Secur, 17% MiniArc). We reported one intraoperatory complication corresponding to a bladder perforation (0.64%), managed conservatively with catheterization. All early complications were reported in the MiniArc group: one obturator fossa hematoma (0.64%) spontaneously resolved, groin pain in 4 patients (2.5%) successfully treated with NSAIDs and one urethral obstruction (0.64%) that required mesh cutting. Late complications included: 8 vaginal erosions (5%), 4 required tape excision and vaginal wall closure; 2 were treated with vaginal estrogens, and the other 2 were asymptomatic so we did nothing. 6 patients (3.8%) showed urethral obstruction: we performed mesh cutting in 5, whereas one patient improved with intermittent catheterization. Urge symptoms were reported in 10 patients (6.45%) and successfully managed with anticholinergic agents. 2 patients suffered from recurrent infections (1.3%) confirmed by antibiogram, treating isolated episodes. CONCLUSIONS: Urinary incontinence surgery with mini-sling system is not free of complications (20%). Most of them are mild and can be successfully treated conservatively.

[REMEEX® system for the treatment of male urinary stress incontinence: our experience]. / Sistema REMEEX® para el tratamiento de la incontinencia de esfuerzo masculina: nuestra experiencia.

INTRODUCTION: We evaluate the effectiveness of REMEEX® (readjustable sling) for the treatment of male urinary stress incontinence (SUI). MATERIALS AND METHOD: Between February 2007 and December 2009, 14 male patients with mild to severe SUI were operated with the use of REMEEX® system. The origin of incontinence was radical open prostatectomy (n=9), laparoscopic prostatectomy (n=4) and TUR (n=1). We evaluate postoperatively complications in three groups: intraoperatively, early complications (before 1 month) and late complications (after 1 month). Follow up was done at 1, 3, 6 and 12 months after intervention. RESULTS: The mean age was 68,5 years (range: 62-71). The average follow-up time was 18,6 months (range: 10,1-35,2). The mean of readjustment was 3,7 (range: 1-6). Twelve patients were readjusted during the early period (24-72h after intervention). The mesh was removed in 3 cases (21,4%) owing to infection in one and the others because patients didn't want more system readjustment. There were four (28,5%) intraoperative bladder perforations. The early complication more frequent was acute urinary retention with five cases (35,7%). To the year of follow-up 41,7% of the patients are totally continent (5/12) and 33,3% presents light urinary incontinence (4/12). CONCLUSIONS: The REMEEX® system for the treatment of male SUI presents (in our experience) a 75% of good results (continent patients or patients with light urinary incontinence) at the year of follow-up with a high rate of light complications. Readjustment are frequent at the first six months after intervention and it's necessary an intense follow-up. We need more studies that evaluate the long-term efficiency of this system.