RESUMO
Resumen Objetivo: En busca de mejorar el tratamiento de la incontinencia urinaria de esfuerzo (IUE), se dan a conocer ventajas y beneficios con la técnica cinta libre tensión obturador (tension-free vaginal tape obturador, TVTO, por sus siglas en inglés). Material y métodos: Estudio prospectivo observacional y descriptivo. Se revisaron expedientes clínicos de pacientes con UIE tratadas con TVTO de diciembre de 2004 a diciembre de 2008 (N = 108) en quienes se usó una cinta de polipropileno no absorbible TVTO, Gynecare Jhonson & Jhonson. Datos a investigar: edad, gestaciones, diagnóstico, índice de masa corporal, anestesia, sangrado operatorio, tiempo quirúrgico, complicaciones, estancia hospitalaria, valoración de continencia. Se utilizaron porcentajes, promedios y medidas de tendencia central. Resultados: Se estudiaron 108 pacientes de 39 a 74 años (edad promedio: 48 años). Gestaciones promedio, 3. Se diagnosticaron 52 (48.1%) con IUE, 33 (30.5%) con IUE y cistocele, 23 (21.2%) con IUE recidivante, 46 (42.5%) con peso normal, 39 (36.1%) con sobrepeso, 23 (21.2%) con obesidad. En el 100% se aplicó bloqueo peridural. Tiempo quirúrgico promedio de 24 min. Sangrado operatorio promedio de 30 ml. Complicaciones: retención urinaria, 1 (0.9%); equimosis en muslo, 1 (0.9%); perforación de uretra, 1 (0.9%); estancia hospitalaria, 1 día. Seguimiento a 7 y 30 días, continencia urinaria, 100%; 3 meses, continencia del 100%; a los 6 y 12 meses, 99.07% de continencia urinaria. Actualmente la continencia es de 99.07%. Conclusión. La técnica TVTO reduce morbilidad, tiempo quirúrgico, estancia hospitalaria, incapacidad, y permite que la paciente se reicorpore más rápido a sus actividades y mejore su calidad de vida, en comparación con el estándar de oro para tratamiento de IUE. En manos expertas el tiempo quirúrgico es de 12 min.
Abstract Objective: Seeking a better treatment for Effort Urinary Incontinence (EUI). Announce the advantages and disadvantages of this technique. Material and methods: descriptive, observational prospective study. The clinical records of patients treated with TVTO for EUI with were reviewed. From December 2004 to December 2008 (N=108). Nonabsorbable polypropylene TVTO, Gynecare Jhonson & Jhonson, was used. The following data were assessed: age, number of pregnancies, diagnosis, body mass index, anesthesia, surgical bleeding, surgical time, complications, hospital stay, assessing continence; using percentages, averages, and measures of central tendency. Results: We studied 108 patients from 39 to 74 years of age, average 48 years-old. Average number of pregnancies: 3. 52 diagnosed with EUI (48.1%), EUI and cystoce-le 33 (30.5%), recurrent EUI 23 (21.2%), 46 with normal body weight (42.5%), overweight 39 (36.1%), obesity 23 (21.2%). Epidural anesthesia was applied to the 100% of patients. Average surgical time 24 minutes; average surgical bleeding 30 ml. Complications: urinary retention 1 (0.9%), thigh ecchymosis 1 (0.9%), urethral perforation 1 (0.9%); hospital stay 1 day. Follow-up at 7 and 30 days, urinary continence 100%, 3-month continence 100%; 6-and 12-month continence 99.07%. Currently, continence is 99.07%. Conclusion: TVTO technique reduces morbidity, surgical time, hospital stay, disability, promoting a faster return of the patient to normal activities, improving quality of life, compared with the gold standard treatment for EUI. In expert's hands, the surgical time is 12 minutes.
RESUMO
OBJECTIVE: to know the morbidity and mortality in vaginal hysterectomy (VH) carried out with bipolar electrosurgery (BiClamp). METHODS: a multicentric study with 380 patients who underwent to VH for benign illness, with and without prolapse, with and without abdominal previous surgeries using Biclamp was carried out. RESULTS: twenty five patients (6.57 %) presented complications. The most frequent were related to the urinal system and infection, when VH was carried out. Bladder injury in five cases (1.31 %), vesicular-vagina fistula in two cases (0.52 %). Vaginal vault abscesses in seven cases (1.84 %). A second surgery due to intra abdominal bleeding in four cases (1.05 %) was carried out. Vaginal vault bleeding was present in two cases (0.52 %); other complications were: hematoma in vaginal vault, thrombophlebitis, sepsis and death with one case (0.26 %) for each one. The injuries were repaired by a gynecologist and the fistulae by an urologist. The bleeding was inmediately remedied and the infection was treated with cephalosporin. CONCLUSIONS: the morbidity and the operative mortality were in the range reported in the literature. This technique is quicker, less invasive, with a prompt patient recovery.
