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1.
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
2.
Rev Bras Ginecol Obstet ; 41(2): 116-123, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30786309

RESUMO

OBJECTIVE: To evaluate if performing anti-incontinence procedures during surgical anterior and/or apical prolapse correction in women with asymptomatic urinary incontinence (UI) may prevent stress urinary incontinence (SUI) postoperatively. METHODS: We have performed a systematic review of articles published in the PubMed, Cochrane Library, and Lilacs databases until March 31, 2016. Two reviewers performed the data collection and analysis, independently. All of the selected studies were methodologically analyzed. The results are presented as relative risk (RR), with a 95% confidence interval (CI). RESULTS: After performing the selection of the studies, only nine trials fulfilled the necessary prerequisites. In the present review, 1,146 patients were included. Altogether, the review included trials of three different types of anti-incontinence procedures. We found that performing any anti-incontinence procedure at the same time of prolapse repair reduced the incidence of SUI postoperatively (RR = 0.50; 95% CI: 0.28-0.91). However, when we performed the analysis separately by the type of anti-incontinence procedure, we found different results. In the subgroup analysis with midurethral slings, it is beneficial to perform it to reduce the incidence of SUI (RR = 0.08; 95% CI: 0.02-0.28). On the other hand, in the subgroup analysis with Burch colposuspension, there was no significant difference with the control group (RR = 1.47; 95% CI: 0.28-7.79]). CONCLUSION: Performing any prophylactic anti-incontinence procedure at the same time as prolapse repair reduced the incidence of SUI postoperatively. The Burch colposuspension did not show any decrease in the incidence of SUI postoperatively.


Assuntos
Incontinência Urinária/cirurgia , Adulto , Brasil , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária por Estresse/prevenção & controle , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos
3.
Female Pelvic Med Reconstr Surg ; 25(2): 99-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807408

RESUMO

OBJECTIVE: The aim of the study was to examine current patterns and factors associated with preoperative testing in patients undergoing midurethral sling and to compare 30-day outcomes in subjects. METHODS: This retrospective cohort study was performed using the National Surgery Quality Improvement Program database from 2005 to 2014. All women undergoing midurethral slings were identified by Current Procedural Terminology code. Clinical variables were abstracted and the incidence of preoperative serum labs was determined. Multivariable logistic regression was used to estimate associations between clinical factors and collection of preoperative serum labs and between 30-day outcomes and collection of labs. RESULTS: A total of 12,368 women underwent midurethral sling in the National Surgery Quality Improvement Program database during the study period. Preoperative serum testing within 30 days before surgery was observed in 9172 (74.2%) women. Age, American Society of Anesthesiologists class, diabetes, and hypertension were strongly associated with preoperative testing when modeling together in multivariable regression. Of the 543 women who had any complication, 410 (75.5%) received preoperative testing. Urinary tract infection was the most frequent complication (66.1%). Age, American Society of Anesthesiologists class, body mass index, and presence of any comorbidity were associated with the presence of any complication at 30 days. Adjusting for these factors, the odds of complications were not significantly different between those who did and did not have preoperative testing (adjusted odds ratio = 0.98, 95% confidence interval = 0.78-1.24). CONCLUSIONS: Most women who underwent midurethral sling procedures had preoperative testing. Major postoperative complications were uncommon, and there was no substantial difference in outcomes between women who underwent preoperative testing and those who did not. In the future, surgeons may consider eliminating preoperative testing in low-risk patients.


Assuntos
Análise Química do Sangue/estatística & dados numéricos , Testes Hematológicos/estatística & dados numéricos , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/estatística & dados numéricos , Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária por Estresse/cirurgia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Bases de Dados Factuais , Diabetes Mellitus/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Nível de Saúde , Humanos , Hipertensão/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/sangue , Incontinência Urinária por Estresse/epidemiologia , Adulto Jovem
4.
Eur J Obstet Gynecol Reprod Biol ; 234: 120-125, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30684877

RESUMO

OBJECTIVE: The purpose of study is to evaluate the recurrence rate of pelvic organ prolapse after surgical treatment and pre- to postoperative changes in sexual function of patients with different stages of pelvic organ prolapse. METHODS: The presented study was a single-centre observational nonrandomized analysis of an ongoing prospective cohort study evaluating anatomical and clinical outcomes in reproductive aged women scheduled for nature tissue repair of POP staged I-III. Two hundred and ten women were recruited, of whom 120 (57.1%) had the advanced prolapse form (POP-Q III). Women at preoperative POP stage I-II were compared with women at stage III without apical prolapse. RESULTS: The best effectively rate with low recurrence depends on preoperative prolapse stage. The overall objective success rate was about 80% in five years in patients with preoperative stage I-II. Study shows a significant improvement in sexual function in all patients with pelvic organ prolapse in five years after surgery. CONCLUSION: This study showed that women with advanced POP have a higher risk of recurrence after POP native tissue repair compared with early stages and proved the improvement of sexual function especially in women with advanced prolapse forms. Women with early stage of POP should be advised to postpone surgery until progression of complaints because of the high recurrence risk.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Vagina/cirurgia , Adulto , Feminino , Humanos , Prolapso de Órgão Pélvico/fisiopatologia , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Recidiva , Comportamento Sexual , Fatores de Tempo , Resultado do Tratamento
5.
Acta Obstet Gynecol Scand ; 98(6): 722-728, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30659576

RESUMO

INTRODUCTION: The retropubic tension-free vaginal tape has been the preferred method for primary surgical treatment of stress urinary incontinence and stress-dominated mixed urinary incontinence in women for more than 20 years. This study presents long-term safety and efficacy data and assesses risk factors for long-term recurrence. MATERIAL AND METHODS: In a case-series design we assessed a historical cohort of primary surgeries performed with the tension-free vaginal tape procedure in 596 women from 1998 to 2012 with follow up through 2015. Information from the medical records was transferred to a case report form comprising data on early and late complications and recurrence of urinary incontinence defined as bothersome stress urinary incontinence symptoms. All analyses were performed with SPSS using Pearson chi-square, survival and Cox regression analyses. RESULTS: After a 10-year follow up, mixed urinary incontinent women (hazard ratio 2.1, 95% confidence interval [CI] 1.4-3.0) had a significantly increased risk of recurrence of stress urinary incontinence symptoms compared with women with pure stress urinary incontinence as the indication for surgery. Overall cumulative cure rates after 1, 5 and 10 years were 92% (95% CI; 90%-94%), 79% (95% CI; 75%-83%) and 69% (95% CI; 63%-75%), respectively. Recurrent surgery (0.3%) and serious tape complications needing major surgical treatment (0.3%) were rare. Six patients (1.0%) had the tape cut due to urinary retention, and nine patients (1.5%) reported urinary retention more than 3 months after surgery. CONCLUSIONS: The tension-free vaginal tape procedure has a high long-term durability. Mixed urinary incontinence as an indication for surgery predicted long-term recurrence. Long-term complications were rare.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Efeitos Adversos de Longa Duração , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos , Adulto , Idoso , Estudos de Coortes , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Efeitos Adversos de Longa Duração/epidemiologia , Efeitos Adversos de Longa Duração/cirurgia , Registros Médicos Orientados a Problemas/estatística & dados numéricos , Pessoa de Meia-Idade , Noruega/epidemiologia , Falha de Prótese , Recidiva , Fatores de Risco , Slings Suburetrais/efeitos adversos , Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária por Estresse/epidemiologia , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos
6.
Prog Urol ; 29(1): 36-44, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30344105

RESUMO

INTRODUCTION AND OBJECTIVES: The periurethral adjustable balloons (PUAB) Pro-ACT™ are less invasive technique to treat non-severe forms of post-radical prostatectomy urinary incontinence (pRP-UI), like sub-urethral trans-obturator male sling. Few data of efficiency are available for their use in second line treatment after male sling failure. OBJECTIVE: To evaluate the efficiency of PUAB Pro-ACT™ (Uromedica, Inc., MN, USA) in the second line treatment for non-severe pRP-UI after male sling failure. MATERIALS AND METHODS: Single center retrospective study of patients treated with male sling (17 Advance™, 1 TOMS™) between 2009 and 2015. The continence results were evaluated by the number of pad per day and the quality of life assessment by the I-QOL questionnaire. The "cure" was defined as no pad and "improved" as decreased more than 50 % of pads use. RESULTS: Eighteen patients were included with median follow-up of 21.5 [14-44] months. Two patients (11.1 %) had a past history of pelvic radiotherapy. The median pads per day used was 2 [1-3] after male sling insertion and before Pro-ACT™ device insertion. After Pro-ACT™ device insertion, the median pads per day used was 0 [0-1], with 77.7 % of patients cured and 22.2 % improved. The median quality of life score I-QOL, was 52.2 [23.3-62.6] and 83 [31.8-97.7], respectively before and after Pro-ACT™ device insertion (P<0.001). Nine (60 %) patients rated their incontinence severity as mild, four (26.6 %) as middle and two (13.3 %) as severe, after balloon insertion. The median volume of adjustment was 3 [2-6] mL. CONCLUSIONS: The PUAB Pro-ACT™ have a significant efficiency for use after male sling failure and can be used in second line therapy. LEVEL OF EVIDENCE: 3.


Assuntos
Falha de Equipamento/estatística & dados numéricos , Prostatectomia/efeitos adversos , Implantação de Prótese/estatística & dados numéricos , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/terapia , Idoso , Idoso de 80 Anos ou mais , França/epidemiologia , Humanos , Masculino , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Reoperação/instrumentação , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Slings Suburetrais/estatística & dados numéricos , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Cateterismo Urinário/estatística & dados numéricos
7.
Vet Surg ; 48(1): 29-34, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30376185

RESUMO

OBJECTIVE: To evaluate the long-term efficacy of the transobturator vaginal tape inside out (TVT-O) in female dogs with urethral sphincter mechanism incompetence (USMI). STUDY DESIGN: Retrospective study. ANIMALS: Incontinent spayed female dogs (n = 12). METHODS: TVT-O tape was inserted in 12 incontinent bitches diagnosed with USMI. Follow-up information was evaluated by a telephone questionnaire, and a continence score was attributed. RESULTS: One year after surgery, 7 of 12 (58%) dogs were completely continent. Two dogs were removed from the long-term analysis (1 dead and 1 lost). At a median follow-up time of 85 months (range, 28-95), 4 of 10 dogs were completely continent without medical treatment. Incontinence recurred in 6 dogs at a median time of 2 months after surgery (range 1-20). Among these 6 dogs, 4 regained continence, and 2 had sporadic episodes of incontinence with additional medical treatment. No postoperative complications were encountered. CONCLUSION: TVT-O alone was successful in maintaining long-term continence in 40% of the dogs. Additional postoperative medical treatment was effective in restoring continence in another 40% of the dogs. CLINICAL SIGNIFICANCE: TVT-O provides an alternative treatment of USMI in female dogs that is safe and less invasive than standard surgical techniques.


Assuntos
Doenças do Cão/cirurgia , Complicações Pós-Operatórias/veterinária , Slings Suburetrais/veterinária , Doenças Uretrais/veterinária , Incontinência Urinária/veterinária , Procedimentos Cirúrgicos Urológicos/veterinária , Animais , Doenças do Cão/fisiopatologia , Cães , Feminino , Slings Suburetrais/estatística & dados numéricos , Resultado do Tratamento , Uretra/fisiopatologia , Uretra/cirurgia , Doenças Uretrais/cirurgia , Incontinência Urinária/cirurgia , Urodinâmica , Procedimentos Cirúrgicos Urológicos/instrumentação , Procedimentos Cirúrgicos Urológicos/métodos
8.
Int Urogynecol J ; 30(5): 733-741, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30073484

RESUMO

INTRODUCTION AND HYPOTHESIS: Synthetic midurethral slings (MUSs) have shown similar cure rates in several short- and medium-term follow-up studies. Recently, long-term follow-up studies have indicated that the cure rate is higher following the retropubic midurethral sling (RPMUS) compared with the transobturator midurethral sling (TOMUS) procedure. The aim was to evaluate the efficacy of synthetic MUSs and to examine the influence of department and surgeon volume and patient-related factors on the cure rate of synthetic MUSs. METHODS: A retrospective cohort study based on a national population over a 5-year period (2007-2011) using data from the Danish Urogynaecological Database (DugaBase). RESULTS: A total of 4519 women with first-time MUS were registered in the DugaBase. Cure was achieved in 1242/1639 (75.78%) at a 3-month follow-up. RPMUSs were more frequently in use in high-volume departments compared with the other departments and more often implanted by high- than low-volume surgeons. Women treated by a medium- (adjusted OR 1.82; 95% CI 1.01-3.28, "frequency") or high-volume surgeon (1.98; 1.18-3.32, "frequency") had an increased probability of cure compared with women treated by a low-volume surgeon. The difference was only significant for women who received a TOMUS. CONCLUSIONS: This national population-based cohort study confirmed a high cure rate of synthetic MUSs at short-term follow-up. It is the largest study to indicate a learning curve for TOMUS. Patients were not actively involved in which synthetic MUS was to be performed as the choice of surgical option was made at the departmental level.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas , Incontinência Urinária/cirurgia , Adulto , Dinamarca/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/epidemiologia
9.
Int Urogynecol J ; 30(1): 43-46, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29995162

RESUMO

INTRODUCTION AND HYPOTHESIS: The primary aim of this study was to investigate long-term patient-reported goals after a tension-free vaginal tape (TVT) operation for stress urinary incontinence (SUI). METHODS: In this prospective study involving 67 women, patients completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) preoperatively and stated three goals for the operation. Postoperatively, a visual analog scale (VAS) ranging from zero (none) to ten (worst) estimated the extent to which goals were achieved. Goals were divided into five groups: symptoms, quality of life (QoL) (physical), QoL (emotional), sexual function, avoidance, and others. Short-term achievement of goal was estimated after 3 months and long-term achievement of goals after a mean of 28.2 months. RESULTS: A total of 201 goals were stated, most of which (38%) were in the group concerning QoL in physical domains. Mean VAS score for all goals was 9.1 after 3 months and 8.5 at long-term follow-up. ICIQ-UI SF preoperatively was mean 14.9; 3 months' postoperatively mean 1.4; and at long-term 3.8. The small rise in ICIQ-UI SF at long-term follow-up was statistically insignificant and due to urge urinary incontinence (UUI). CONCLUSIONS: Our study showed that patients achieved their goals to a high degree and maintained them at long-term follow-up. Most goals concerned QoL in physical domains. Although a proportion of women experienced episodes of UUI at the long-term follow-up, VAS score was not significantly changed.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/estatística & dados numéricos , Adulto , Idoso , Dinamarca/epidemiologia , Feminino , Seguimentos , Metas , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Incontinência Urinária de Urgência/epidemiologia , Incontinência Urinária de Urgência/etiologia , Escala Visual Analógica
10.
J Obstet Gynaecol Res ; 44(8): 1466-1471, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29956423

RESUMO

AIM: To demonstrate the clinical and urodynamic outcomes of transobturator sling (TOT) with or without concomitant prolapse surgery for the treatment of urodynamic stress incontinence (USI). METHODS: We recruited 143 consecutive patients diagnosed with USI, who received outside-in TOT in a university hospital. Preoperative and postoperative examinations were implemented using structured urogynecological questionnaires, pelvic organ prolapse quantification examination and urodynamic testing. Patient demographics, surgical and urodynamic results were compared between TOT with and without concomitant prolapse surgery. RESULTS: The mean follow-up was 30.1 months (range 12-57). Postoperative stress urinary incontinence (SUI) occurred in 10 (7%) patients at 3 months and 10 (7%) patients at 12 months postoperatively. There was no significant difference in prevalence of postoperative SUI between groups of TOT only and TOT combined with pelvic surgery. Preoperative urodynamic results demonstrated that TOT only (n = 96) had a higher maximal flow rate and a lower residual urine amount when compared to TOT combined with pelvic surgery (n = 47). A significant decrease in maximal urethral closure pressure (MUCP) was found in 119 patients who received postoperative urodynamic examination. In comparison with preoperative urodynamic data, postoperative urodynamic results showed a significant decrease in MUCP in the TOT combined with prolapse surgery group, but no significant urodynamic changes in the group of TOT only. CONCLUSION: Both TOT and TOT combined with prolapse surgery can be effective in correcting SUI in patients with USI 12 months postoperatively, with significant changes in MUCP.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Urodinâmica/fisiologia , Procedimentos Cirúrgicos Urogenitais/métodos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Slings Suburetrais/estatística & dados numéricos , Procedimentos Cirúrgicos Urogenitais/efeitos adversos
11.
BMC Urol ; 18(1): 44, 2018 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-29776405

RESUMO

BACKGROUND: Adjustable single-incision mini-sling (SIMS) is a new category of SIMS for stress urinary incontinence (SUI). The aim of this study was to compare the efficacy and safety of adjustable single-incision mini-sling with other slings. METHODS: Literature search in databases such as Pubmed, and Conchrane Library was performed up to December, 2015. The outcomes including cure rate, operation time, postoperative pain score and complications were reanalyzed. The pooled relative risk (RR) and mean difference (MD) with their 95% confidence interval (95% CI) were calculated by RevMan v5.0. RESULTS: Eight studies with 1093 SUI female patients were included. There was no significant difference between adjustable SIMS and other slings (transobturator slings and MiniArc) in patients subjective cure rate and objective cure rate. In addition, adjustable SIMS was associated with a significantly shorter operative time and lower postoperative pain score when comparing adjustable SIMS with transobturator tape (MD = - 1.35; 95%CI: -2.24 to - 0.46, P = 0.003). For the complications, there was also no significant difference between adjustable SIMS and transobturator slings. CONCLUSIONS: Adjustable SIMS had equally efficacy for SUI compared with transobturator slings and MiniArc. However, the significantly shorter operative time and lower postoperative pain score than transobturator tape supported the clinical application of adjustable SIMS.


Assuntos
Gerenciamento Clínico , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese/métodos , Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/cirurgia , Feminino , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento , Incontinência Urinária por Estresse/diagnóstico
12.
Can J Urol ; 25(2): 9268-9272, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29680005

RESUMO

INTRODUCTION: Male stress urinary incontinence (SUI) after radical prostatectomy (RP) is common. The surgical standard of care traditionally has been placement of an artificial urinary sphincter (AUS) but since its introduction the transobturator male sling has been shown to have particular unique advantages. Our aim was to assess outcomes of a consecutive series of suburethral sling insertions in men presenting with all degrees of post RP SUI. MATERIALS AND METHODS: A consecutive cohort of men undergoing AdVance sling insertion following RP were studied. Parameters assessed included pre and postoperative urinary function, 24 hour pad use, quality of life (QoL) outcomes, complications and further treatments. Degree of incontinence was categorized as mild (1-2), moderate (3-5) or severe (≥ 6) depending on daily pad use. Patients were reviewed at 1, 4 and 6 months. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess symptom severity and QoL outcomes. RESULTS: Seventy-seven patients were included, mean age 68 and mean time to sling post RP 34 (8-113) months. Preoperative degree of incontinence: mild 22%, moderate 58%, severe 20%. Fourteen percent had undergone post RP radiation therapy (RT). In total 73% experienced complete resolution of symptoms post sling, 12% significant improvement, 15% no reduction in pad use. Sixty percent with severe incontinence were classified as cured (no pad or 1 dry pad for security reasons). When patients with preoperative RT were excluded, cure rate rose to 82%. On follow up survey at 30 months (mean), the ICIQ-SF score decreased from baseline 17.7 (9-21.0) to 8.0 (0-20) (p < 0.0001), CI 95% (8-12). CONCLUSIONS: Suburethral slings are effective and safe for all degrees of post RP incontinence, are associated with improved QoL parameters and with appropriate selection and counseling are a viable option for more severe degrees of post RP SUI.


Assuntos
Prostatectomia/efeitos adversos , Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Prostatectomia/métodos , Qualidade de Vida , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Urodinâmica
13.
Int Urogynecol J ; 29(4): 585-591, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29435604

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery. METHODS: Data were retrieved from the national Danish Urogynaecological Database, including women with first-time surgery with mid-urethral polypropylene slings from 2011 to 2016. The subjective improvement was assessed by the difference in symptoms based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) completed pre- and 3 months postoperatively. A reoperation was defined as any new surgical procedure for stress urinary incontinence performed within the study period. RESULTS: During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence Questionnaire (ICI-Q) forms. 42.4% had a BMI < 25, 34.6% had BMI 25-30, 16.9% had BMI 30-35, and 6.0% BMI >35. The subjective improvement after surgery was high in all BMI categories and there were no differences between the categories. The overall cumulative hazard proportion at 2 years of follow-up was 1.9% (CI 95%: 1.6-2.3) and after 5 years 2.4% (CI 95%: 2.0-2.9). Adjusted for age, smoking, and use of alcohol, the cumulative hazard proportion after 2 years of follow-up was 3.2% (CI 95%: 1.6-6.2) for women with BMI >35 and after 5 years 4.0% (CI 95%: 2.0-7.7), which was the highest proportion of reoperation in the study. The crude hazard ratio was 1.84 (CI 95%: 0.89-3.83) women with BMI >35 and the adjusted hazard ratio was 1.94 (CI 95%: 0.92-4.09). CONCLUSIONS: We found high subjective improvement after the first-time surgery unrelated to BMI. Women with a BMI over 35 had the highest proportion of reoperations, although this was not statistically significant.


Assuntos
Índice de Massa Corporal , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Sistema de Registros , Reoperação/estatística & dados numéricos , Slings Suburetrais/estatística & dados numéricos , Idoso , Feminino , Humanos , Pessoa de Meia-Idade
14.
Eur Urol Focus ; 4(5): 754-759, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-28753896

RESUMO

BACKGROUND: Subjective and objective cure rates after primary surgery for female stress urinary incontinence are good. Still, some women will undergo repeated operations for incontinence. OBJECTIVE: To study the reoperation rate after incontinence surgery and to compare the reoperation rates between different surgery types. DESIGN, SETTING, AND PARTICIPANTS: This national register-based study included all Finnish women who had surgery for stress urinary incontinence during a 23-yr study period (1987-2009), both in inpatient and outpatient hospital settings. Subcohorts for follow-up times of 5-yr and 10-yr were evaluated separately. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary operations, reoperation rate, patient age, time until reoperation. RESULTS AND LIMITATIONS: A total of 38 500 women had surgery for stress urinary incontinence from 1987 to 2009. Two thousand and seventy-six women (7.2%) had a reoperation with a rate of 7.8/1000 woman-yr. The reoperation rate was 8.3/1000 women-yr after a Burch colposuspension and 4.8/1000 after a retropubic midurethral sling. In the 10-yr follow-up, reoperation was more common after a Burch compared with a retropubic midurethral sling (odds ratio: 1.6, 95% confidence interval: 1.3-1.9). There was no difference in the reoperation rate between retropubic and transobturator midurethral slings in the 5-yr follow-up. CONCLUSIONS: Reoperation rate is lower after midurethral slings compared with Burch colposuspension. PATIENT SUMMARY: Mesh slings are surgically effective treatments for stress urinary incontinence. There are fewer reoperations after implanting these slings compared with older methods that do not use synthetic material. Different mesh slings have equally good results.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Adulto , Idoso , Feminino , Finlândia/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Pessoa de Meia-Idade , Slings Suburetrais/normas , Procedimentos Cirúrgicos Urológicos/tendências
15.
Female Pelvic Med Reconstr Surg ; 24(5): 341-346, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28696948

RESUMO

OBJECTIVES: We describe the rationale, design, and methods and 6-year experience with a real-world surgical registry for female pelvic reconstructive and incontinence procedures and postoperative outcomes. METHODS: The primary goal of creating this registry was to establish the feasibility of prospective data capture for all urogynecologic procedures. Data captured included baseline demographics, surgical procedures, perioperative complications, and subjective and objective findings up to 36 months after surgery. RESULTS: The Pelvic Reconstruction and Incontinence Surgery ± Mesh Registry was developed over 3 years to include 194 unique variables for prospective data capture. The registry was implemented in December 2010, and data from 924 separate case events from a single surgeon were recorded, comprising 100% surgical case capture. Cases included a variety of procedures representing a comprehensive urogynecology practice on 804 unique patients. Patients who were asked to participate in long-term follow-up (n = 299) returned with attendance of 96% at 6 weeks, 64% at 6 months, 51% at 12 months, 39% at 24 months, and 22% at 36 months. CONCLUSIONS: The Pelvic Reconstruction and Incontinence Surgery ± Mesh Registry effectively captured all urogynecologic procedures for the purpose of quality improvement. This real-world tool demonstrates that 100% case capture is feasible and provides valuable information for the highly motivated surgeon, although adequate long-term follow-up is limited. Additional research is needed to better understand the role of surgical registries for quality improvement and development of patient-centered strategies to increase long-term follow-up.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Sistema de Registros , Slings Suburetrais/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Prolapso de Órgão Pélvico/classificação , Prolapso de Órgão Pélvico/epidemiologia , Prolapso de Órgão Pélvico/cirurgia , Estudos Prospectivos , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária/epidemiologia , Incontinência Urinária/cirurgia
16.
Female Pelvic Med Reconstr Surg ; 24(1): 21-25, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28657986

RESUMO

OBJECTIVES: Following Food and Drug Administration communications about the safety of transvaginal prolapse, more than 73,000 patients with complications from treatment of pelvic organ prolapse (POP) or stress urinary incontinence (SUI) have filed product liability claims. This research analyzes the transvaginal mesh claims filed in the United States to identify key characteristics that may inform clinical decision-making. METHODS: We evaluated a 1% random sample from the Bloomberg Law Database: 2000 to 2014 and associated legal documents. Outcomes and measures used included annual rate of claim, mesh type, time interval between surgery and claim, defendants, and surgeon training. RESULTS: The search returned 76,865 results, and 2979 were excluded, leaving 73,915 claims. Of 739 claims (1%), 63.3% involved slings for SUI, 13.3% mesh for POP, and 165 (23.2%) involved both. The mesh named most often in claims was retropubic slings at 30.3% and transobturator slings at 27.1%. The number of cases filed increased significantly from 730 in 2011 to 11,798 in 2012, which then almost tripled in 2013 to 34,017. The interval from surgery to claim filing ranged from 4.8 to 5.3 years. Only 12% of implanting surgeons were or became board certified in Female Pelvic Medicine and Reconstructive Surgery. Only 4 cases named providers as codefendants. CONCLUSIONS: Most legal claims involved slings for SUI and began after the 2011 Food and Drug Administration communication about mesh for POP. The rise in lawsuits does not reflect the acceptably low complication rates for slings for SUI reported in the literature.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/legislação & jurisprudência , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Tomada de Decisão Clínica , Feminino , Humanos , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Fatores de Tempo , Estados Unidos , Incontinência Urinária por Estresse/cirurgia
17.
Female Pelvic Med Reconstr Surg ; 24(1): 32-38, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28657993

RESUMO

OBJECTIVE: The aims of this study were to describe the characteristics of women presenting with mesh-related complications and evaluate postoperative quality of life, sexual functioning, and patient-perceived outcomes. METHODS: This institutional review board-approved study included a retrospective chart review and a cross-sectional follow-up with validated questionnaires. Demographics and medical histories were collected from charts of women treated for mesh-related complaints between 2010 and 2014. Subjects completed follow-up validated questionnaires regarding health, sexual functioning, postoperative symptom improvement/severity, satisfaction, and regret with the decision to pursue treatment. RESULTS: Ninety-three charts were analyzed. Mean subject age was 55 years, median body mass index was 28.7 kg/m, and median time from mesh placement to presentation was 2.7 years. Forty-nine had midurethral sling mesh only, 30 had prolapse-related mesh, and 14 had both. Forty-two subjects (48.9%) had mesh exposures, 19 involving prolapse-related mesh (52.4% transvaginal and 47.4% sacrocolpopexy). Surgical revisions were most often for exposure and pain. Seventy-five women were reached for follow-up; 71 agreed to participate, 53 (75%) returned the questionnaires. Thirty had sling revision, 22 had prolapse mesh revision, and 1 had both. Questionnaire results revealed no changes in health or sexual function after treatment. Postoperatively, subjects reported symptom improvement, low symptom severity, as well as high satisfaction and low regret with the decision to pursue surgical intervention. CONCLUSIONS: Women with mesh complications presented 2 years after initial placement, most often complaining of exposure or pain/dyspareunia. Although no changes in health or sexual functioning were noted postoperatively, participants reported symptom improvement after revision and satisfaction with the decision to pursue treatment.


Assuntos
Complicações Pós-Operatórias/cirurgia , Qualidade de Vida , Reoperação/psicologia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Inquéritos e Questionários , Incontinência Urinária/cirurgia
18.
Can J Urol ; 24(6): 9121-9125, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29260638

RESUMO

INTRODUCTION: To evaluate the percent of AdVance male sling usage relative to artificial urinary sphincters (AUS) over a 9 year period since its introduction in order to assess trends across the United States. MATERIALS AND METHODS: As a surrogate for procedures performed, we reviewed device utilization trends of the AdVance sling and AUS broken down by American Urological Association (AUA) section. ANOVA testing between years was used to determine purchasing trends with p values of < 0.05 considered statistically significant. RESULTS: Relative to AUS, AdVance sling percentage significantly increased from 36% in 2007 to 48% in 2008 (p = 0.032). Sling percentage then remained stable over the next 3 years from 2008-2011 with no significant percent change between years (p = NS). Compared with 2008-2011, AdVance usage decreased in 2012 to 29% (p = 0.002) and remained stable at this decreased relative level through 2015 (p = NS, difference between years 2012-2015). Comparing incontinence procedures across AUA sections, the Southeast section performed the highest percentage of male stress urinary incontinence procedures, including 27% of all AdVance slings and 25% of all artificial sphincters. CONCLUSION: Proportion of AdVance sling usage relative to AUS increased after its introduction through 2008. Usage remained stable at an increased level for the next3 years. More recent years have found decreased AdVance usage and a resurgence of the artificial urinary sphincter. Reasons for these trends remain speculative.


Assuntos
Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial/estatística & dados numéricos , Humanos , Masculino , Estudos Retrospectivos , Slings Suburetrais/tendências , Estados Unidos , Esfíncter Urinário Artificial/tendências
19.
Eur J Obstet Gynecol Reprod Biol ; 214: 6-10, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28453959

RESUMO

OBJECTIVE: The goal of this study was to evaluate the outcome of Tension-free Vaginal Tape Obturator (TVT-O) operation in the treatment of urodynamic stress incontinence (USI) in obese females, with respect to uroflowmetric changes, success rate and postoperative complications. METHODS: This prospective observational study included 26 patients with USI at the Obstetrics & Gynecology department-Cairo University hospital during the year 2015. The participants had body mass index (BMI)≥30. Patients underwent TVT-O operation. Follow up of the patients was performed by cough test and uroflowmetry after one week, one month, three months and six months. Postoperative complications such as groin pain, sense of incomplete emptying, need to strain to complete micturition and urinary tract infection were recorded. Comparisons between groups were done using Chi square, Phi-Cramer test for categorical variables. RESULTS: The mean age for the subjects was 43.58±9.01years. The mean BMI was 33.4±2.1. The success rate of TVT-O operation was 21 out of 26 patients (≈81%). Normal maximum flow rate was in 88% of patients at week one and was normal in 100% of patients at months three and six (p=0.101 & 0.101). Postoperative groin pain was the main complaint during the first week after operation and decreased significantly from week one to the 1st month postoperative (84.62% & 65.38%, P=0.041). CONCLUSION: TVT-O operation showed a high success rate in treatment of USI in obese patients without affecting the voiding function of the bladder as proven by the uroflowmetry. The main postoperative complaint was the groin pain which significantly improved after one month.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Obesidade/complicações , Complicações Pós-Operatórias/epidemiologia , Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária por Estresse/cirurgia , Adulto , Egito/epidemiologia , Feminino , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Reologia , Incontinência Urinária por Estresse/complicações , Urodinâmica
20.
Int Urogynecol J ; 28(8): 1119-1130, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28213797

RESUMO

INTRODUCTION AND HYPOTHESES: One of the most relevant topics in the field of pelvic floor dysfunction treatment is the long-term efficacy of surgical procedures, in particular, the use of prosthesis. Hence, a systematic review and meta-analysis was conducted to evaluate the long-term effectiveness and safety of midurethral sling (MUS) procedures for stress urinary incontinence (SUI), as reported in randomised controlled trials (RCTs) and non-randomised studies. METHODS: This systematic review is based on material searched and obtained via PubMed/Medline, Scopus, and the Cochrane Library between January 2000 and October 2016. Peer-reviewed, English-language journal articles evaluating the long-term (≥5 years) efficacy and safety of MUS in women affected by SUI were included. RESULTS: A total of 5,592 articles were found after the search, and excluding duplicate publications, 1,998 articles were available for the review process. Among these studies, 11 RCTs (0.6%) and 5 non-RCTs (0.3%) could be included in the qualitative and quantitative synthesis. Objective and subjective cumulative cure rates for retropubic technique (TVT) and transobturator tape (TOT; both out-in and in-out) were 61.6% (95% CI: 58.5-64.8%) and 76.5% (95% CI: 73.8-79.2%), and 64.4% (95% CI: 61.4-67.4%) and 81.3% (95% CI: 78.9-83.7%) respectively. When considering TOT using the out-in technique (TOT-OI) and TOT using the in-out technique (TVT-O) the objective and subjective cumulative cure rates were 57.2% (95% CI: 53.7-60.7%) and 81.6% (95% CI: 78.8-84.4%), and 68.8% (95% CI: 64.9-72.7%) and 81.3% (95% CI: 77.9-84.7%) respectively. Furthermore, this article demonstrates that both TVT and TOT are associated with similar long-term objectives (OR: 0.87 [95% CI: 0.49-1.53], I 2 = 67%, p = 0.62) and subjective (OR: 0.84 [95% CI: 0.46-1.55], I 2 = 68%, p = 0.58) cure rates. Similarly, no significant difference has been observed between TTOT-OI and TVT-O) in objective (OR: 3.03 [95% CI: 0.97-9.51], I 2 = 76%, p = 0.06) and subjective (OR: 1.85 [95% CI: 0.40-8.48], I 2 = 88%, p = 0.43) cure rates. In addition, this study also shows that there was no significant difference in the complication rates for all comparisons: TVT versus TOT (OR: 0.83 [95% CI: 0.54-1.28], I 2 = 0%, p = 0.40), TOT-OI versus TVT-O (OR: 0.77 [95% CI: 0.17-3.46], I 2 = 86%, p = 0.73). CONCLUSIONS: Independent of the technique adopted, findings from this systematic review and meta-analysis suggest that the treatment of SUI with MUS might be similarly effective and safe at long-term follow-up.


Assuntos
Implantação de Prótese/instrumentação , Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária por Estresse/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Implantação de Prótese/estatística & dados numéricos , Tempo , Resultado do Tratamento
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