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.

Gestaçäo ectópica molar: apresentaçäo de um caso / Molar ectopic pregnancy: report of a case

A fecundaçäo do ovo ocorre no terço distal da trompa, podendo evoluir para: (1) nidaçäo intra-uterina e desenvolvimento normal de uma gestaçäo; (2) nidaçäo em outro local que näo a cavidade uterina e desenvolvimento de gestaçäo ectópica; (3) nidaçäo intra-uterina e transformaçäo em gestaçäo molar; (4) nidaçäo em outro local que näo a cavidade uterina e desenvolvimento anômalo do trofoblasto, propiciando a gestaçäo ectópica molar. O estudo anatompatológico da gestaçäo ectópica confere diagnóstico e tratamento apropriados. Aconselha-se a ressecçäo intramural da trompa em todos os casos de salpingectomia