Cost-effectiveness analysis of the surgical treatment of female urinary incontinence using slings and meshes.

OBJECTIVE: To determine the cost-utility and cost-effectiveness of the surgical treatment of female urinary incontinence using suburethral slings and prolapse meshes compared with therapeutic abstention. STUDY DESIGN: An economic analysis was performed on 69 women receiving surgical treatment for urinary incontinence using suburethral slings and prolapse meshes. To calculate the procedure's cost-effectiveness, an incremental analysis up to one year was performed using the incremental cost-effectiveness ratio (ICER). The costs were calculated using a cost-by-process model. Answers to the health-related quality of life questionnaires EQ-5D (generic) and International Consultation Incontinence Questionnaire Short-form (specific) were collected before the operation and as well as one month and one year post-operation to calculate the utility, using quality-adjusted life years (QALY), and the effectiveness, respectively. To complete the economic evaluation, we derived confidence ellipses and acceptability curves. The analysis was conducted for the entire sample and also for each type of urinary incontinence. RESULTS: In total, 45 women presented with stress incontinence, 15 with mixed incontinence and 9 with incontinence associated with prolapse. The average cost per patient at one year post-operation was 1220 €. The QALY achieved at one year was 0.046. The results reveal an ICER at one year of 26,288 €/QALY, which is below the cost-effectiveness threshold considered acceptable, and this value was lower for stress incontinence (21,191 €/QALY). The cost-effectiveness was 106.5 €/International Consultation Incontinence Questionnaire Short-form unit. CONCLUSION: Surgery for female urinary incontinence using slings is cost-effective compared with abstention in our public health environment.

[Correlation between Gleason score on prostate biopsies diagnostic of adenocarcinoma and radical prostatectomy specimens]. / Estudio de correlación entre las sumas de Gleason de las biopsias de próstatas con adenocarcinoma y de las piezas de prostatectomía radical.

OBJECTIVES: We analyse the concordance between Gleason scores on prostate biopsies diagnostic of adenocarcinoma and radical prostatectomy specimens. METHODS: We reviewed the charts of 214 patients who underwent radical prostatectomy between January 1992 and November 2002. We calculated the percentage of correct diagnosis, understaging and overstaging for individual Gleason and for groups with scores between 2-4, 5-6, 7 and 8-10. We performed the statistical analyses of concordance for the groups using the kappa weighted index (< 0.4 low reliability, 0.4-0.75 good reliability; > 0.75 excellent reliability). RESULTS: 41 patients were excluded. The percentages of right diagnosis, understaging and overstaging for the remainder 173 were 32.3%, 44% and 23.7% respectively for individual Gleason scores, and 52.6%, 32.4% and 15% respectively for grouped Gleason scores. Statistical analysis resulted in a kappa weighted index of 0.52, a result which did not vary after excluding patients treated with neoadjuvant hormonal therapy CONCLUSIONS: In our series, the statistical correlation obtained for grouped Gleason scores is good. However, understaging is the biggest problem for prostate biopsies diagnostic of adenocarcinoma when compared with definitive pathologic results on the specimen. Besides, and in opposition, more than 50% of our patients deemed as less differentiated (Gleason score 7 and 8-10) presented lower grades in the specimen. Both limitations should be taken into consideration when therapeutic options are exposed to our patients.

T.V.T. (cinta libre de tensión) nueva técnica quirúrgica para el tratamiento de la incontinencia urinaria de esfuerzo / Tension-free vaginal tape (TVT) for surgical treatment of female stress urinary incontinence

OBJETIVOS: Descripción de la técnica quirúrgica y análisis de los resultados a corto plazo de la uretrosuspensión con cinta de prolene en la incontinencia urinaria de esfuerzo. MÉTODOS: Realizamos la novedosa técnica quirúrgica a 20 pacientes con incontinencia urinaria de esfuerzo pura entre noviembre de 1998 y mayo de 1999. RESULTADOS: Las pacientes fueron portadoras de sonda vesical 24 horas y sólo 1 de ellas requirió sondajes intermitentes durante 1 mes por residuos post-miccionales altos. No hubo complicaciones intraoperatorias y una paciente, en el postoperatorio inmediato, presentó hematoma en cara posterior de recto que se solucionó con tratamiento conservador. Con un seguimiento de 4,5 meses,... el 95 por ciento de las pacientes están continentes y una es incontinente por una incorrecta colocación de la cinta. CONCLUSIONES: Si bien los primeros resultados son alentadores debemos ser cautos en su valoración y esperar un seguimiento objetivo y continuo para precisar la eficacia a largo plazo (AU)