RESUMO
INTRODUCTION AND HYPOTHESIS: We present our 10-year experience in treating stress urinary incontinence (SUI) using a new minisling technique based on a tension-free vaginal tape band designed by our group. The major advantage of this tape is the use of minibelt polypropylene inserted through a single retropubic incision without the use of needles-the Endopelvic Free Anchor (EFA)-based on its location at the midurethra with a U shape. For insertion, each branch is placed using a simple Pean clamp from the vagina with perforation of the endopelvic fascia to achieve a retropubic insertion. METHODS: From May 2001 to May 2011, we surgically treated 166 women with primary first- or second-degree SUI due to urethral hypermobility without genital prolapse. All were evaluated according to our study protocol, which included clinical and urodynamic evaluation before and 12 months after surgery. RESULTS: With a median follow-up of 5 (1-11) years, 152 patients (91.6 %) were fully cured both from urodynamic and subjective points of view. Six patients (3.6 %) had significant improvement, and eight (4.8 %) were identified as technique failure. Complications included one bladder perforation (0.6 %), two cases of postoperative urinary retention (1.24 %), two of retropubic hematoma (1.24 %), and one of de novo urgency (0.6 %). No reinterventions were necessary, and there were no major bleeding complications, no chronic pain or de novo dyspareunia, and no voiding difficulty. CONCLUSIONS: EFA is a viable, safe, and effective technique for treating UI due to urethral hypermobility.
Assuntos
Cistoscopia/métodos , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Cistoscopia/instrumentação , Fáscia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Pelve/cirurgia , Polipropilenos , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento , Doenças Uretrais/complicações , Doenças Uretrais/fisiopatologia , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/fisiopatologia , Urodinâmica , Vagina/cirurgiaRESUMO
OBJECTIVES: Due to the absence of randomized studies, the Spanish Reemex Working Group started a registry to analyze and review the results of a large group of patients with mid-term and long-term follow-up to obtain conclusions based on clinical experience. METHODS: A registry of 715 patients who underwent surgical intervention for insertion of the SUI readjustable prosthesis Reemex TRT (tension free readjustable tape) in 15 Spanish hospitals (40% urology departments, 60% gynecology departments). The registry was established to evaluate the safety and efficacy of the sling adjustability concept in the surgical treatment of female SUI. The Spanish Working Group was able to evaluate results of the Reemex system in 683 patients of a total of 715. Mean age was 59.9 yr (range 21-87) with a mean follow-up of 23 months (6-93). The group includes: 30.2% patients with mixed incontinence, 73.1% patients with urodynamic intrinsic sphincteric deficit, 35.7% patients with previous history of failed surgical interventions for urinary incontinence, and 54.3% previous pelvic floor associated operations. All patients were evaluated preoperatively with history, physical examination and urinary incontinence questionnaire. Each follow-up visit included incontinence questionnaire, physical examination and stress test. RESULTS: Cure rate was 92.2%, with 6.9% improvement and 0.9% failures. Readjustment was performed in 416 patients (60.9%) as a second phase of surgery over the following 24-48 hours, before hospital discharge. 80 patients (11.7%) were readjusted in the mid- or long-term (between 6 and 8 months after surgery). The level of support of the sling was successfully reduced in three patients between 6 and 14 months after surgery. No other patient suffered voiding difficulties in the long-term. 1.7% of the patients needed extraction of the tensor due to persistent abdominal wall seroma. 0.8% presented vaginal extrusion of the sling. CONCLUSIONS: The Reemex system is a minimally invasive technique with consistent results and even improved in heterogeneous groups of patients including intrinsic sphincter defficiency, reoperations, mixed incontinence and associated pathologies.
Assuntos
Próteses e Implantes , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Sistema de Registros , EspanhaRESUMO
OBJETIVO: En ausencia de estudios randomizados,el Grupo de Trabajo Español Remeex inició un registro para analizar y revisar resultados en un gran grupo de pacientes con seguimiento a medio y largo plazo, para obtener conclusiones basadas en experienciasclínicas.MÉTODOS: Se analizan prospectivamente los datos procedentes del registro de 715 pacientes que fueron operadas con una prótesis de incontinencia reajustable Remeex TRT (Tensión free Readjustable Tape) en 15 hospitalesespañoles, servicios de Urología 40% y Ginecología60%. El registro se realizó para evaluar la seguridady eficacia del concepto de ajustabilidad del sling para el tratamiento quirúrgico de la Incontinencia Urinariade Esfuerzo Femenina. El grupo de trabajo español pudo evaluar los resultados del Sistema Remeex en 683 pacientes de un grupo total de 715. La edad media fue de 59.9 (rango 21-87) con un periodo de seguimiento medio de 23 meses (6-93). El grupo incluye: 30.2% de pacientes con Incontinencia Mixta, 33.1% de pacientes con Déficit Esfinteriano Intrínseco urodinámico, 35.7% de pacientes sometidas a intervenciones previas de Incontinencia,y el 54.3% a cirugías asociadas del suelo pélvico. Todas las pacientes fueron analizadas pre-operatoriamentemediante historia clínica, examen físico y cuestionario de incontiencia. En cada seguimiento, las pacientes rellenaron un cuestionario de incontinencia, se sometieron a examen físico y test de esfuerzo.RESULTADOS: El índice de curación valorado en la últimarevisión fue del 92.2%, 6.9% de los pacientes mejorarony el 0.9% de las pacientes fueron consideradas fracasos. La capacidad de reajuste fue utilizada en 416 casos (60.9%) de las pacientes como una segunda fase de la cirugía durante las siguientes 24-48 horas, antesdel alta hospitalaria. 80 pacientes (11.7%) fueron reajustadas a medio o largo plazo (entre 6 y 8 meses después de la cirugía). En tres pacientes el nivel de soporte del cabestrillo fue reducido con éxito entre 6 y 14 meses después de la cirugía. Ninguna otra pacientesufrió dificultades de vaciado a largo plazo. Como complicaciones, al 1.7% de las pacientes se les extrajo el varitensor, debido a la persistencia de seroma abdominal.Un 0.8% presentaron exposición del cabestrillo en la pared vaginal.CONCLUSIONES: El sistema Remeex es una técnica mínimamenteinvasiva con resultados consistentes y mejoradosincluso en grupos de pacientes no homogéneos, en los que se incluyen pacientes con déficit esfinteriano intrínseco, pacientes reintervenidas, incontinencia mixta y patología asociada
OBJECTIVES: Due to the absence ofrandomized studies, the Spanish Reemex Working Group started a registry to analyze and review the results of a large group of patients with mid-term and long-term follow-up to obtain conclusions based on clinicalexperience.METHODS: A registry of 715 patients who underwent surgical intervention for insertion of the SUI readjustable prosthesis Reemex TRT (tension free readjustable tape) in 15 Spanish hospitals (40% urology departments,60% gynecology departments). The registry was established to evaluate the safety and efficacy of the sling adjustability concept in the surgical treatment of female SUI. The Spanish Working Group was able to evaluate results of theReemex system in 683 patients of a total of 715. Mean age was 59.9 yr. (range 21-87) with a mean follow-up of 23 months (6-93). The group includes: 30.2% patients with mixed incontinence, 73.1% patients with urodynamic intrinsic sphincteric deficit, 35.7% patients with previous history of failed surgical interventions for urinaryincontinence, and 54.3% previous pelvic floor associated operations. All patients were evaluated preoperatively with history, physical examination and urinaryincontinence questionnaire. Each follow-up visit included incontinence questionnaire, physical examination and stress test.RESULTS: Cure rate was 92.2%, with 6.9% improvement and 0.9% failures. Readjustment was performed in 416 patients (60.9%) as a second phase of surgery over the following 24-48 hours, before hospital discharge. 80 patients (11.7%) were readjusted in the mid- or long-term (between 6 and 8 months after surgery). The level of support of the sling was successfully reduced in three patients between 6 and 14 months after surgery. No other patient suffered voiding difficulties in the long-term. 1.7% of the patients needed extraction of the tensor due to persistent abdominal wall seroma. 0.8% presented vaginal extrusion of the sling.CONCLUSIONS: The Reemex system is a minimallyinvasive technique with consistent results and evenimproved in heterogeneous groups of patients including intrinsic sphincter defficiency, reoperations, mixedincontinence and associated pathologies