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1.
Zhonghua Wai Ke Za Zhi ; 58(5): 388-392, 2020 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-32393007

RESUMO

Objective: To compare the clinical efficacy and safety of single incision mini slings (contasure needless, C-NDL) and tension-free vaginal tape obturator (TVT-O) in the treatment of pure female stress urinary incontinence(SUI). Methods: Clinical data of 107 female SUI patients who underwent C-NDL (n=51) or TVT-O (n=56) procedure during October 2013 and October 2017 in Department of Urology, Beijing Chaoyang Hosptial, Capital Medical University were enrolled.The age of the patients in the C-NDL and TVT-O group was (58.8±9.3) years (range: 43 to 81 years) vs.(56.9±11.4) years (range: 32 to 87 years), the cough leak point pressure was 70(20) cmH(2)O (M(Q(R)), 1 cmH(2)O=0.098 kPa) vs. 80(25) cmH(2)O. The pre- and peri-operative data, subjective cure rate, objective cure rate, quality of life, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Incontinence Impact Questionnaire-Short Form (IIQ-7) and other complications were compared. The t test, Wilcoxon rank sum test, analysis of variance, χ(2) test andFisher exact test were applied to compare the indexes. Results: In the C-NDL and TVT-O group, the median operation time was 30(10) minutes vs. 40(30) minutes (Z=-3.73, P<0.01). The postoperative follow-up period was 32.0(17.4) months vs.41.0(23.2)months. At the latest follow-up, the objective cure rate was 48/51 vs. 54/56 (χ(2)=0.01, P=0.94), the subjective cure rate was 43/51 vs. 50/56 (χ(2)=0.03, P=0.86), ICIQ-SF was 2.29±4.02 (range:0 to 13) vs. 1.71±3.67 (range:0 to 18), and IIQ-7 was 1.12±1.85 (range: 0 to 7) vs.0.70±1.70 (range: 0 to 6). The statistically significant difference in the postoperative visual pain analogue scale (VAS) were found between the two groups (0(1.5) vs.1.0(1.0), Z=3.41, P<0.01). Dysuria occurred in 2 patients in each group, vaginal pain occurred in 1 patient in the C-NDL group, groin pain occurred in 2 patients and urinary urgency occurred in 3 patients in the TVT-O group too. There were no significant difference between the complication rates of the 2 group (3/51 vs.7/51, P=0.325). Conclusion: Both C-NDL and TVT-O may be effective and reliable in the treatment of female SUI.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
2.
Int. j. morphol ; 38(2): 292-298, abr. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056437

RESUMO

Trans-obturator tape (TOT) and tension free vaginal tape (TVT) procedures are efficient treatment options, which reduce the surgical complications and provide adequate support to urethra in case of increased abdominal pressure to prevent stress urinary incontinence (SUI). The aim of this study is to evaluate the effect and efficacy of 3D printed female anatomical model on the training of TOT and TVT procedures. A 3D printed female anatomical model was produced for MedTRain3DModSim, Erasmus+ European Union project led by Turkey with the participation of Greece, Italy, Czech Republic and South Korea. Face and content validities of the model evaluated by the participants and the experts respectively. During two learning & teaching & training activities and a multiplier event of the project between 2016 and 2018; 41 medical students, 30 residents and 19 specialists of urology and gynecology were educated and performed TOT and TVT procedures with this model under the mentorship of 3 experts. All participants were assessed and scored for their achievement on both procedures with model according to 7 parameters by the experts. There was no statistical difference between the students and residents for each parameter. All the parameters of the students and specialists were statistically different. 3D anatomical models produced from real data and mimicking different types of tissues are suitable for basic anatomy education of students and residents, hands on training for junior surgeons before cadaveric courses in hybrid education system, surgical planning of the surgeons and informing the patients before the operation.


Los procedimientos de cinta transobturadora (TOT) y cinta vaginal sin tensión (TVT) son opciones de tratamiento eficientes, que reducen las complicaciones quirúrgicas y proporcionan un soporte adecuado a la uretra en caso de aumento de la presión abdominal para prevenir la incontinencia urinaria de esfuerzo (IUE). El objetivo de este estudio fue evaluar el efecto y la eficacia del modelo anatómico femenino impreso en 3D en el entrenamiento de los procedimientos TOT y TVT. Se produjo un modelo anatómico femenino impreso en 3D para MedTRain3DModSim, proyecto Erasmus + de la Unión Europea dirigido por Turquía con la participación de Grecia, Italia, la República Checa y Corea del Sur. Validez facial y de contenido del modelo fueron evaluados por los participantes y los expertos respectivamente. Durante dos actividades de aprendizaje, enseñanza y capacitación y un evento multiplicador del proyecto entre 2016 y 2018; 41 estudiantes de medicina, 30 residentes y 19 especialistas en urología y ginecología fueron capacitados y realizaron procedimientos TOT y TVT de este modelo bajo la tutoría de 3 expertos. Todos los participantes fueron evaluados y calificados por los expertos, por su logro en ambos procedimientos con el modelo de acuerdo con 7 parámetros. No hubo diferencia estadística entre los estudiantes y los residentes para cada parámetro. Todos los parámetros de los estudiantes y especialistas fueron estadísticamente diferentes. Los modelos anatómicos en 3D producidos a partir de datos reales e imitando diferentes tipos de tejidos son adecuados para la educación básica de anatomía de estudiantes y residentes. Además de ofrecer una capacitación práctica para los cirujanos antes de los cursos cadavéricos en el sistema educativo, y una planificación quirúrgica de los cirujanos e información para los pacientes antes de la cirugía.


Assuntos
Humanos , Feminino , Incontinência Urinária por Estresse , Sistema Urinário/anatomia & histologia , Slings Suburetrais , Modelos Anatômicos , Impressão Tridimensional
4.
Cochrane Database Syst Rev ; 1: CD001754, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31990055

RESUMO

BACKGROUND: Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional suburethral slings are surgical operations used to treat women with symptoms of stress urinary incontinence. OBJECTIVES: To assess the effectiveness of traditional suburethral sling procedures for treating stress urinary incontinence in women; and summarise the principal findings of relevant economic evaluations. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), as well as MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP); we handsearched journals and conference proceedings (searched 27 February 2017) and the reference lists of relevant articles. On 23 January 2019, we updated this search; as a result, several additional reports of studies are awaiting classification. SELECTION CRITERIA: Randomised or quasi-randomised trials that assessed traditional suburethral slings for treating stress or mixed urinary incontinence. DATA COLLECTION AND ANALYSIS: At least two review authors independently extracted data from included trials and assessed risk of bias. When appropriate, a summary statistic was calculated: risk ratio (RR) for dichotomous data, odds ratio (OR) for continence and cure rates that were expected to be high, and mean difference (MD) for continuous data. We adopted the GRADE approach to assess the quality of evidence. MAIN RESULTS: A total of 34 trials involving 3244 women were included. Traditional slings were compared with 10 other treatments and with each other. We did not identify any trials comparing suburethral slings with no treatment or sham treatment, conservative management, anterior repair, or laparoscopic retropubic colposuspension. Most trials did not distinguish between women having surgery for primary or recurrent incontinence. One trial compared traditional slings with bladder neck needle suspension, and another trial compared traditional slings with single-incision slings. Both trials were too small to be informative. Traditional suburethral sling operation versus drugs One small trial compared traditional suburethral sling operations with oxybutynin to treat women with mixed urinary incontinence. This trial did not report any of our GRADE-specific outcomes. It is uncertain whether surgery compared with oxybutynin leads to more women being dry (83% vs 0%; OR 195.89, 95% confidence interval (CI) 9.91 to 3871.03) or having less urgency urinary incontinence (13% vs 43%; RR 0.29, 95% CI 0.09 to 0.94) because the quality of this evidence is very low. Traditional suburethral sling versus injectables One small trial compared traditional slings with suburethral injectable treatment. The impact of surgery versus injectables is uncertain in terms of the number of continent women (100% were dry with a traditional sling versus 71% with the injectable after the first year; OR 11.57, 95% CI 0.56 to 239.74), the need for repeat surgery for urinary incontinence (RR 0.52, 95% CI 0.05 to 5.36) or the occurrence of perioperative complications (RR 1.57, 95% CI 0.29 to 8.49), as the quality of evidence is very low. Traditional suburethral sling versus open abdominal retropubic colposuspension Eight trials compared slings with open abdominal retropubic colposuspension. Moderate-quality evidence shows that the traditional suburethral sling probably leads to more continent women in the medium term (one to five years) (69% vs 59% after colposuspension: OR 1.70, 95% CI 1.22 to 2.37). High-quality evidence shows that women were less likely to need repeat continence surgery after a traditional sling operation than after colposuspension (RR 0.15, 95% CI 0.05 to 0.42). We found no evidence of a difference in perioperative complications between the two groups, but the CI was very wide and the quality of evidence was very low (RR 1.24, 95% CI 0.83 to 1.86). Traditional suburethral sling operation versus mid-urethral slings Fourteen trials compared traditional sling operations and mid-urethral sling operations. Depending on judgements about what constitutes a clinically important difference between interventions with regard to continence, traditional suburethral slings are probably no better, and may be less effective, than mid-urethral slings in terms of number of women continent in the medium term (one to five years) (67% vs 74%; OR 0.67, 95% CI 0.44 to 1.02; n = 458; moderate-quality evidence). One trial reported more continent women with the traditional sling after 10 years (51% vs 32%: OR 2.22, 95% CI 1.07 to 4.61). Mid-urethral slings may be associated with fewer perioperative complications (RR 1.74, 95% CI 1.16 to 2.60; low-quality evidence). One type of traditional sling operation versus another type of traditional sling operation Nine trials compared one type of traditional sling operation with another. The different types of traditional slings, along with the number of different materials used, mean that trial results could not be pooled due to clinical heterogeneity. Complications were reported by two trials - one comparing non-absorbable Goretex with a rectus fascia sling, and the second comparing Pelvicol with a rectus fascial sling. The impact was uncertain due to the very low quality of evidence. AUTHORS' CONCLUSIONS: Low-quality evidence suggests that women may be more likely to be continent in the medium term (one to five years) after a traditional suburethral sling operation than after colposuspension. It is very uncertain whether there is a difference in urinary incontinence after a traditional suburethral sling compared with a mid-urethral sling in the medium term. However, these findings should be interpreted with caution, as long-term follow-up data were not available from most trials. Long-term follow-up of randomised controlled trials (RCTs) comparing traditional slings with colposuspension and mid-urethral slings is essential. Evidence is insufficient to suggest whether traditional suburethral slings may be better or worse than other management techniques. This review is confined to RCTs and therefore may not identify all of the adverse effects that may be associated with these procedures. A brief economic commentary (BEC) identified three eligible economic evaluations, which are not directly comparable due to differences in methods, time horizons, and settings. End users of this review will need to assess the extent to which methods and results of identified economic evaluations may be applicable (or transferable) to their own setting.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Urológicos/economia
5.
J Urol ; 203(2): 378, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31661382
6.
Urology ; 136: 257-262, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31669134

RESUMO

OBJECTIVE: To compare ultrasonographic patterns of 2-dimensional perineal ultrasonography in men in the preoperative and postoperative periods after transobturator sling deployment for the treatment of urinary incontinence after radical prostatectomy. Radiotherapy and radical prostatectomy are the primary treatments for localized prostate cancer. Studies comparing anatomic changes in men before and after radical prostatectomy based on perineal ultrasonography are scarce in the literature. METHODS: Thirty-one patients from 2 centers were selected for examination and surgery. They were allocated into mild and/or moderate and severe incontinence groups who underwent the transobturator sling procedure between August 2014 and August 2018. Perineal ultrasonography was performed in the preoperative period for 21 of these patients and 3-6 months postoperatively after the transobturator sling procedure for 30 patients. Hypermobility of the proximal urethra and voluntary contraction of the pelvic floor were evaluated during the Valsalva maneuver, perineal contraction and at rest. RESULTS: Clinical improvements of >50% were significantly more frequent in the mild and/or moderate vs severe incontinence group after male sling surgery (P = .035). Patients who demonstrated clinical improvement >50% showed a significantly greater displacement of the posterior portion of the bladder neck during contraction than those with clinical improvement <50% (P = .024). CONCLUSION: The most important finding of this study was the significant difference in the posterior displacement of the bladder neck during contraction in patients who showed an improvement >50% compared with those with an improvement <50%. These data support the use of perineal ultrasonography in evaluating and selecting patients for the male sling procedure.


Assuntos
Períneo/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Prostatectomia , Slings Suburetrais , Incontinência Urinária/diagnóstico por imagem , Incontinência Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Prostatectomia/métodos , Ultrassonografia/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
7.
Urology ; 136: 82-87, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31726182

RESUMO

OBJECTIVE: To determinate the feasibility, reliability, and patient satisfaction of telephonic follow-up in women treated for stress urinary incontinence (SUI) or pelvic organ prolapse (POP): Patient-Home-Office-Novel-Evaluation (PHONE) study. METHODS: This is a prospective comparative study in women following surgery for SUI underwent middle urethral sling (MUS) (Group A), or symptomatic anterior vaginal wall (AVW) defect underwent AVW repair (fascial/mesh/biomesh) (Group B). The 1-year follow-up included a telephonic interview using a checklist and validated questionnaires followed by a standard outpatient clinic visit 7-12 days later including: an interview, validated questionnaires, objective examination, and score satisfaction with the telephone follow-up. RESULTS: We enrolled 420 pts: 215 for SUI in Group A, and 205 for POP in Group B. SUI recurrence was 19.1% and 11.6% at the telephone and office follow-up, respectively. De-novo urgency urinary incontinence rate was 7.5%. Telephone follow-up was able to detect POP recurrence and related symptoms. Tape and mesh extrusions were detected only at the objective evaluation: 1.9% and 4.4% respectively. No difference was found at the questionnaires. Satisfaction with the telephone follow-up was high. CONCLUSION: Due to the wrongly interpretation of de-novo urge urinary incontinence as a recurrence of SUI, a telephone interview may lose reliability in case of reported incontinence. Thus, telephone follow-up was feasible and reliable in women not reporting incontinence. In patients treated for POP the phone interview was a valid tool only in case of no-prosthetic surgery due to the absence of extrusion in these cases.


Assuntos
Autoavaliação Diagnóstica , Satisfação do Paciente , Prolapso de Órgão Pélvico/cirurgia , Autorrelato , Slings Suburetrais , Telefone , Incontinência Urinária por Estresse/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
8.
Urologe A ; 59(1): 65-71, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31741004

RESUMO

Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Feminino , Alemanha , Humanos
10.
J Urol ; 203(2): 372-378, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31479396

RESUMO

PURPOSE: We evaluated whether polyacrylamide hydrogel is noninferior to tension-free vaginal tape to treat women with primary stress urinary incontinence. MATERIALS AND METHODS: In this controlled noninferiority clinical trial patients with primary stress urinary incontinence were randomized to tension-free vaginal tape or polyacrylamide hydrogel treatment. The primary outcome was patient satisfaction and secondary outcomes were effectiveness in reducing urinary leakage and complications at 1-year followup. For statistical power significance was considered at 5%, power was set at 80% and the noninferiority limit was 20% with a 10% expected dropout rate. RESULTS: A total of 224 women with primary stress urinary incontinence entered the study between September 28, 2015 and March 1, 2017. Of the women 111 were randomized to tension-free vaginal tape and 113 were randomized to polyacrylamide hydrogel. At 1 year a satisfaction score of 80 or greater on a visual analogue scale of 0 to 100 was reached in 95.0% and 59.8% of patients treated with tension-free vaginal tape and polyacrylamide hydrogel, respectively. Thus, polyacrylamide hydrogel did not meet the noninferiority criteria set in our study. As secondary outcomes, the cough stress test was negative in 95.0% of tension-free vaginal tape cases vs 66.4% of polyacrylamide hydrogel cases (difference 28.6%, 95% CI 18.4-38.5). However, most perioperative complications, including those in 19 tension-free vaginal tape cases vs 3 polyacrylamide hydrogel cases (difference 16.0%, 95% CI 7.8-24.9), and all 6 reoperations due to complications (difference 5.9%, 95% CI 1.2-12.4) were associated with tension-free vaginal tape. CONCLUSIONS: Mid urethral tension-free vaginal tape slings were associated with better satisfaction and cure rates than polyacrylamide hydrogel in women with primary stress urinary incontinence. However, complications were mainly associated with tension-free vaginal tape. Thus, tension-free vaginal tape should be offered as first line treatment in women who expect to be completely cured by the initial treatment and are willing to accept the complication risks. Since polyacrylamide hydrogel treatment also provides high satisfaction and cure rates, women with primary stress urinary incontinence can be offered polyacrylamide hydrogel as an alternative treatment.


Assuntos
Resinas Acrílicas/administração & dosagem , Slings Suburetrais , Incontinência Urinária por Estresse/terapia , Adulto , Feminino , Humanos , Injeções , Pessoa de Meia-Idade , Satisfação do Paciente , Resultado do Tratamento
11.
J Urol ; 203(1): 36, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31625786
12.
BJOG ; 127(1): 88-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31544327

RESUMO

OBJECTIVE: To assess the short-term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse. DESIGN: Prospective longitudinal cohort study using a surgical registry. SETTING: Thirteen public hospitals in France. POPULATION: A cohort of 1873 women undergoing surgery between February 2017 and August 2018. METHODS: Preliminary analysis of serious complications after a mean follow-up of 7 months (0-18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals' information systems. MAIN OUTCOME MEASURES: Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life-threatening complication requiring resuscitation, or death. RESULTS: Fifty-two women (2.8%, 95% CI 2.1-3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow-up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7-2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1-1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2-1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0-5.0%) after MUS alone, 7.0% (2.8-11.3%) after MUS with prolapse surgery, 1.7% (0.0-3.8%) after vaginal native tissue repair, 2.8% (0.9-4.6%) after transvaginal mesh, and 1.0% (0.1-1.9%) after laparoscopy with mesh. CONCLUSIONS: Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long-term risk associated with mesh use and to identify its risk factors. TWEETABLE ABSTRACT: Short-term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.


Assuntos
Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Colposcopia/efeitos adversos , Colposcopia/mortalidade , Colposcopia/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Incidência , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Sistema de Registros , Slings Suburetrais/efeitos adversos , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Centros Cirúrgicos/estatística & dados numéricos , Adulto Jovem
13.
Urology ; 137: 178-182, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31866523

RESUMO

OBJECTIVE: To investigate the incidence and risk factors associated with artificial urinary sphincter (AUS) and male urethral sling placement (MUS), revision, and removal. METHODS: We identified CPT codes of patients undergoing AUS and sling placement, revision, and removal in the American College of Surgeons National Surgery Quality Improvement Program database. Bivariate analysis was used to compare preoperative parameters against adverse events of interest (Length of stay (LOS) >1, readmission, reoperation, other postoperative complications, and death). Variables that were significant or neared significance (P <.1) in the univariate analysis were entered into multivariable logistic regression models. Multivariable models were used to estimate the probability of adverse events. RESULTS: About 2792 patients underwent surgical treatment for stress urinary incontinence in the American College of Surgeons National Surgery Quality Improvement Program database from 2008 to 2016. Increased length of stay was the most common adverse event (12.7%), followed by other postoperative complications (4.9%), readmission (4%), reoperation (2.3%), and death (0.3%). We noted an association between perioperative adverse events and preoperative hypoalbuminemia. Patients with preoperative hypoalbuminemia compared with patients with normal preoperative serum albumin had an increase predicted probability of LOS >1 day (42% vs 10%), readmission (10% vs 4%), reoperation (6% vs 2%), other postoperative complications (18% vs 4%) after adjusting for other factors. CONCLUSION: Surgical treatment for stress urinary incontinence is well tolerated with acceptable levels of perioperative adverse events. Low serum albumin (<3.5 ng/dL) was associated with perioperative adverse events. These data may affect preoperative decision making and direct future quality improve efforts at the highest risk patients to help minimize perioperative morbidity and mortality.


Assuntos
Complicações Pós-Operatórias , Implantação de Prótese , Reoperação , Albumina Sérica/análise , Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária por Estresse , Esfíncter Urinário Artificial/estatística & dados numéricos , Idoso , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Melhoria de Qualidade/organização & administração , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Risco Ajustado/métodos , Fatores de Risco , Estados Unidos/epidemiologia , Incontinência Urinária por Estresse/sangue , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/cirurgia
14.
Int Braz J Urol ; 45(6): 1186-1195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808407

RESUMO

INTRODUCTION: This study aimed to evaluate the effects of transobturator tape (TOT) on overactive bladder (OAB) symptoms and quality of life. MATERIALS AND METHODS: Patients with stress-predominant mixed urinary incontinence (MUI) who had undergone TOT procedures were considered candidates for this research. Preoperative assessment included anamnesis, pelvic examination, cough stress test (CST), and validated symptom severity and quality of life (QoL) questionnaires. The primary outcome, improvement and cure rates of OAB symptoms were determined based on the patient's baseline scores in symptom-related questions in OAB-V8. Secondary outcomes included the success rates of SUI, changes in the QoL score and patient satisfaction rates. RESULTS: A total of 104 patients were included in the study. Sixty-two patients underwent TOT placement alone, and 42 patients underwent TOT placement along with prolapse surgery. The mean follow-up period of the patients was 30.47 months range: 13-52 months. At the fi rst-year follow-up, 52 patients (50.0%) and 59 patients (56.7%) reported cure in preoperative urgency and urgency incontinence, respectively. The objective and subjective cure rates were 96.2% and 56.7%, respectively. A total of 80.7% of the cases had a 15-point improvement in QoL scores. CONCLUSIONS: MUS is not only a gold standard treatment in SUI but also presents as a promising treatment modality in stress-dominant MUI. Although the improvement rates of OAB symptoms signifi cantly decrease over time, QoL and patient satisfaction rates remain higher than any other treatment in this patient group at the third-year follow-up.


Assuntos
Qualidade de Vida , Slings Suburetrais , Bexiga Urinária Hiperativa/cirurgia , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária de Urgência/cirurgia , Adulto , Idoso , Análise de Variância , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Adulto Jovem
15.
Georgian Med News ; (295): 25-30, 2019 Oct.
Artigo em Russo | MEDLINE | ID: mdl-31804194

RESUMO

The aim of the study was to evaluate the efficacy and safety of the TOTRP (tension-free vaginal tape-obturator retropublic) methodology, as well as the frequency of de novo urgency symptoms. A retrospective study included 32 women with stressful and mixed urinary incontinence with a predominance of the stress component without concomitant genital prolapse, as well as without surgical intervention for a history of urinary incontinence and pelvic prolapse. Patients underwent surgical intervention according to the TOTRP method using Lintex UroSling® polypropylene tape from February to October 2018. According to the results of the ICIQ-SF and OAB awareness Tool questionnaires, 14 (43.7%) patients were registered prior to surgical treatment. with an average degree of stress urinary incontinence, 18 (56.3%) - severe; 19 (59%) patients with mild bladder hyperactivity, 4 (12.5%) - moderate. Through surgical intervention, stress urinary incontinence was completely stopped in 26 (81.25%) and transferred to mild degree in 2 (6.25%), in 5 (15.6%) - moderate degree. So, the effectiveness of the TOTRP technique was 87.5%. Postoperative urgency was 8 (25%), of which de novo - 5 (15.63%). The treatment was characterized by the complete absence of intraoperative complications.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Feminino , Seguimentos , Humanos , Polipropilenos , Estudos Retrospectivos , Resultado do Tratamento , Incontinência Urinária por Estresse/terapia
16.
Rev Med Suisse ; 15(673): 2186-2189, 2019 Nov 27.
Artigo em Francês | MEDLINE | ID: mdl-31778046

RESUMO

Surgical treatments for female stress urinary incontinence is in perpetual evolution. This article reviews the current surgical treatments for stress urinary incontinence in female. Bulking agents, Burch colposuspension, autologous sling, midurethral slings, single incision slings, artificial urinary sphincter and adjustable continence therapy (ACT) are discussed.


Assuntos
Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos , Feminino , Humanos , Slings Suburetrais , Uretra/cirurgia
17.
Arch Esp Urol ; 72(9): 891-903, 2019 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-31697249

RESUMO

OBJECTIVE: Female urinary incontinence has a prevalence of up to 40%. Stress urinary incontinence is the most frequent type, about 50%. When primary management fails, it is unclear what the behavior should be. This study aims to show the cure rate of the second-line management options described in the literature. MATERIAL AND METHOD: Systematic review of the literature with meta-analysis of proportions. Observational and interventional studies were included in which the different types of management of recurrent/persistent urinary incontinence were evaluated in women who had a mid-urethral tape as primary management. RESULTS: 161 studies were identified and screened, including 29 in the qualitative synthesis and 27 in the quantitative synthesis. Given the high clinical and methodological heterogeneity, an estimation of the cure rate for each type of management was performed, with the following results regarding the total combined cure rate: in the implantation of adjustable tapes of 86% ( IC95%: 76.4% -92.1%), the implantation of a second mid urethral tape was 75.1% (95% CI: 68% -81.1%), in the shortening of the previous mid urethral tape was 62.3% (95% CI: 49.1% -73.9%) and finally the implantation of bulking agents was 55.4% (95% CI: 43.2% -67%). We did not find enough studies to perform a quantitative synthesis with respect to: pubovaginal sling, colposuspension and pelvic floor therapy, as well as secondary outcomes. CONCLUSION: The evidence found shows that there may be superiority of the adjustable tapes versus the mid urethral tapes and other included treatments. However, a comparison to statistically corroborate this difference could not be made. These results should be confirmed with multicenter collaborative randomized clinical trials.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Feminino , Humanos , Resultado do Tratamento , Uretra , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos
18.
Arch. esp. urol. (Ed. impr.) ; 72(9): 891-903, nov. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188467

RESUMO

Objetivo: La incontinencia urinaria femenina tiene una prevalencia hasta del 40%, su tipo más frecuente, con cerca del 50%, es la incontinencia urinaria con esfuerzo. Cuando el manejo primario falla, no se tiene claridad sobre cuál debe ser la conducta. Este estudio pretende mostrar la proporción de curación de las opciones de manejo de segunda línea descritos en la literatura. Material y método: Revisión sistemática de la literatura con meta-análisis de proporciones. Se incluyeron estudios observacionales y de intervención, en los que se evaluaron los diferentes tipos de manejos de la incontinencia urinaria recurrente/persistente en mujeres que tuvieran una cinta de uretra media como manejo primario. Resultados: Se identificaron y tamizaron 161 estudios, incluyendo 29 en la síntesis cualitativa y 27 en la síntesis cuantitativa. Dada la alta heterogeneidad clínica y metodológica, se realizó una estimación de la proporción de curación para cada uno de los tipos de manejo, con los siguientes resultados con respecto a la proporción de curación total combinada: en la implantación de cintas ajustables de 86% (IC95%: 76,4%-92,1%), en la implantación de una segunda cinta de uretra media fue de 75,1% (IC95%: 68%-81,1%), en el acortamiento de la cinta de uretra media previa fue de 62,3% (IC95%: 49,1%-73,9%) y por último en la implantación de agentes abultantes fue de 55,4% (IC95%: 43,2%-67%). No se encontraron estudios suficientes para poder realizar una síntesis cuantitativa con respecto a: sling pubovaginal, colposuspensión y terapia de piso pélvico, al igual que para los desenlaces secundarios. Conclusión: La evidencia encontrada muestra que podría haber superioridad de las cintas ajustables frente a las cintas de uretra media y los otros tratamientos incluidos. Sin embargo, no se pudo realizar una comparación para corroborar estadísticamente dicha diferencia. Estos resultados deben ser corroborados con ensayos clínicos aleatorizados colaborativos multicéntricos


Objective: Female urinary incontinence has a prevalence of up to 40%. Stress urinary incontinence is the most frequent type, about 50%. When primary management fails, it is unclear what the behavior should be. This study aims to show the cure rate of the second-line management options described in the literature. Material and method: Systematic review of the literature with meta-analysis of proportions. Observational and interventional studies were included in which the different types of management of recurrent/persistent urinary incontinence were evaluated in women who had a mid-urethral tape as primary management. Results: 161 studies were identified and screened, including 29 in the qualitative synthesis and 27 in the quantitative synthesis. Given the high clinical and methodological heterogeneity, an estimation of the cure rate for each type of management was performed, with the following results regarding the total combined cure rate: in the implantation of adjustable tapes of 86% ( IC95%: 76.4% -92.1%), the implantation of a second mid urethral tape was 75.1% (95% CI: 68% -81.1%), in the shortening of the previous mid urethral tape was 62.3% (95% CI: 49.1% -73.9%) and finally the implantation of bulking agents was 55.4% (95% CI: 43.2% -67%). We did not find enough studies to perform a quantitative synthesis with respect to: pubovaginal sling, colposuspension and pelvic floor therapy, as well as secondary outcomes. Conclusion: The evidence found shows that there may be superiority of the adjustable tapes versus the mid urethral tapes and other included treatments. However, a comparison to statistically corroborate this difference could not be made. These results should be confirmed with multicenter collaborative randomized clinical trials


Assuntos
Humanos , Feminino , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Uretra , Procedimentos Cirúrgicos Urológicos , Resultado do Tratamento
19.
Med Educ Online ; 24(1): 1685635, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31662061

RESUMO

Background: Stress urinary incontinence (SUI) is an embarrassing condition, which is one of the last taboos in modern medicine. The study aim was an attempt to assess medical students' knowledge of female stress urinary incontinence.Methods: The study involved 432 students of the Medical Department at the Medical University of Silesia in Katowice. Participants answered open-ended questions about: risk factors, prevention, diagnostic tests, conservative and surgical treatment in stress urinary incontinence.Results: The obtained results indicated that female students know more about SUI than male students. Women - more often than men - could provide the definition of SUI (p < 0.01); additionally, they more frequently indicated prevention methods (p < 0.01), diagnostic testing (p < 0.001) and conservative methods of treatment (p < 0.001). Not all the respondents were able to properly define stress urinary incontinence. Risk factors were known to most of the respondents but only half of them were aware of surgical treatment and prevention methods. Even fewer answered questions about conservative treatment and diagnostic tests correctly.Conclusions: We conclude that the knowledge of medical undergraduates who took part in the survey was not satisfactory. Most of the students were able to define properly the disease and point out risk factors. However, several steps should be taken to make stress urinary incontinence a disease much more known to medical students.Abbreviations: SUI: Stress urinary incontinence; Group F: Females Group; Group M: Males Group; TVT: Tension Free Vaginal Tape; TOT: Transobturator Tape.


Assuntos
Educação de Graduação em Medicina/organização & administração , Estudantes de Medicina/psicologia , Incontinência Urinária por Estresse/prevenção & controle , Incontinência Urinária por Estresse/terapia , Adulto , Competência Clínica , Feminino , Humanos , Conhecimento , Masculino , Fatores de Risco , Slings Suburetrais , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária por Estresse/fisiopatologia , Adulto Jovem
20.
Einstein (Sao Paulo) ; 17(4): eRW4508, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553360

RESUMO

Urinary incontinence after prostatectomy has a significant negative impact on the quality of life of the patient. The surgical treatment includes several models of male slings, such as adjustable slings. The objective of this study was to evaluate the effectiveness and safety of adjustable sling in the treatment of post-prostatectomy urinary incontinence. This is a systematic review of literature. The following electronic databases were searched until January 2018: PubMed®, Embase, CENTRAL and LILACS. The keywords used in the search strategies were: "prostatectomy" [Mesh], "urinary incontinence" [Mesh] and "suburethral slings" [Mesh]. Randomized clinical trials and observational studies, with or without Control Group, and follow-up of more than 12 months were included. Only one randomized study with high risk of bias was included and it concluded the effectiveness equivalence between adjustable and non-adjustable slings. All other studies were cases series with patients of varying levels of incontinence intensity and history of pelvic radiation therapy and previous surgeries. The meta-analysis for 0 pad in 24 hours demonstrated an effectiveness of 53%. For the 0 to 1 pad test in 24 hours, the meta-analysis resulted in an effectiveness of 69%. Risk factors for surgery failure include prior radiation, severity of post-prostatectomy urinary incontinence, and previous surgeries. The meta-analysis of the extrusion rate was 9.8% and the most commonly reported adverse effects were pain and local infection. Evidence of low quality indicates that adjustable slings are effective for treating post-prostatectomy urinary incontinence, with frequency of adverse events similar to the surgical option considered gold standard (the artificial urinary sphincter implant).


Assuntos
Prostatectomia/efeitos adversos , Slings Suburetrais/normas , Incontinência Urinária/etiologia , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Fatores de Risco , Resultado do Tratamento
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