[Complications of female urinary incontinence surgery with mini-sling system]. / Complicaciones de la cirugía de incontinencia urinaria femenina con minicintas.

OBJECTIVE: To evaluate the complications of urinary incontinence (UI) surgery with mini-sling system. Describe its diagnosis and management. MATERIAL AND METHOD: We make a descriptive analysis of the complications of the surgery in a group of 155 women with UI surgically treated with mini-sling system (50 TVT-Secur and 105 MiniArc) from October 2006 to November 2008. All patients were evaluated with clinical history, physical examination and two questionnaires of QoL (ICIQ-SF and EQ-5D). When urethral obstruction was suspected, we included urineculture, post-void residual urine measurement and urodynamics. The complications were grouped into three categories: intraoperatory, early (within de first month after surgery) and late complications (after a month). We use the SPSS program (V 14.0) for statistical analysis of the results. RESULTS: The average age was 56 years (range 33-82) and 180 days for the following-up (range 26-817). We had a complication rate of 20% (22% TVT-Secur, 17% MiniArc). We reported one intraoperatory complication corresponding to a bladder perforation (0.64%), managed conservatively with catheterization. All early complications were reported in the MiniArc group: one obturator fossa hematoma (0.64%) spontaneously resolved, groin pain in 4 patients (2.5%) successfully treated with NSAIDs and one urethral obstruction (0.64%) that required mesh cutting. Late complications included: 8 vaginal erosions (5%), 4 required tape excision and vaginal wall closure; 2 were treated with vaginal estrogens, and the other 2 were asymptomatic so we did nothing. 6 patients (3.8%) showed urethral obstruction: we performed mesh cutting in 5, whereas one patient improved with intermittent catheterization. Urge symptoms were reported in 10 patients (6.45%) and successfully managed with anticholinergic agents. 2 patients suffered from recurrent infections (1.3%) confirmed by antibiogram, treating isolated episodes. CONCLUSIONS: Urinary incontinence surgery with mini-sling system is not free of complications (20%). Most of them are mild and can be successfully treated conservatively.

[REMEEX® system for the treatment of male urinary stress incontinence: our experience]. / Sistema REMEEX® para el tratamiento de la incontinencia de esfuerzo masculina: nuestra experiencia.

INTRODUCTION: We evaluate the effectiveness of REMEEX® (readjustable sling) for the treatment of male urinary stress incontinence (SUI). MATERIALS AND METHOD: Between February 2007 and December 2009, 14 male patients with mild to severe SUI were operated with the use of REMEEX® system. The origin of incontinence was radical open prostatectomy (n=9), laparoscopic prostatectomy (n=4) and TUR (n=1). We evaluate postoperatively complications in three groups: intraoperatively, early complications (before 1 month) and late complications (after 1 month). Follow up was done at 1, 3, 6 and 12 months after intervention. RESULTS: The mean age was 68,5 years (range: 62-71). The average follow-up time was 18,6 months (range: 10,1-35,2). The mean of readjustment was 3,7 (range: 1-6). Twelve patients were readjusted during the early period (24-72h after intervention). The mesh was removed in 3 cases (21,4%) owing to infection in one and the others because patients didn't want more system readjustment. There were four (28,5%) intraoperative bladder perforations. The early complication more frequent was acute urinary retention with five cases (35,7%). To the year of follow-up 41,7% of the patients are totally continent (5/12) and 33,3% presents light urinary incontinence (4/12). CONCLUSIONS: The REMEEX® system for the treatment of male SUI presents (in our experience) a 75% of good results (continent patients or patients with light urinary incontinence) at the year of follow-up with a high rate of light complications. Readjustment are frequent at the first six months after intervention and it's necessary an intense follow-up. We need more studies that evaluate the long-term efficiency of this system.

Complicaciones de la cirugía de incontinencia urinaria femenina con minicintas / Complications of female urinary incontinence surgery with mini-sling system

Objetivo: Evaluar las complicaciones de la cirugía antiincontinencia con minicintas, así como describir su diagnóstico y manejo. Material y métodos: Realizamos un análisis descriptivo de las complicaciones en un grupo de 155 mujeres con incontinencia urinaria intervenidas con minicintas (50 TVT-Secur y 105 MiniArc) entre octubre de 2006 y noviembre de 2008. Durante el seguimiento, los controles incluyeron anamnesis, exploración física y cuestionarios de calidad de vida (ICIQ-SF y EQ-5D), incluyendo uroflujometría con residuo posmiccional, urodinámica y urocultivo ante sospecha de obstrucción. Para analizar las complicaciones, fueron clasificadas en intraoperatorias, precoces (primer mes tras la cirugía) y tardías (pasado un mes). El análisis estadístico de los resultados lo realizamos mediante el programa informático SPSS (V 14.0). Resultados: La mediana de edad de las pacientes estudiadas fue de 56 años (rango 33–82). La mediana de seguimiento fue de 180 días (26–817). La tasa de complicaciones fue del 20% (el 22% para TVT-Secur y el 17% para MiniArc). Como complicaciones intraoperatorias registramos una perforación vesical con TVT-Secur (0,64%), que se trató con sondaje vesical. Las complicaciones precoces, todas registradas en el grupo de MiniArc, fueron un hematoma en la fosa obturatriz (0,64%) que evolucionó a la curación, dolor inguinal en 4 pacientes (2,5%) tratados con AINE y obstrucción uretral en un caso (0,64%) que precisó corte de la malla. Las complicaciones tardías incluyeron 8 erosiones vaginales (5%), 4 requirieron exéresis del material y cierre de la pared vaginal, 2 fueron tratadas con estrógenos vaginales y en 2 pacientes asintomáticas optamos por abstención terapéutica. Cinco pacientes presentaron dificultad miccional (3,22%): 4 precisaron corte de la cinta por obstrucción y una paciente mejoró con autocateterismos. La urgencia de novo en 10 mujeres (6,45%) se trató con éxito con anticolinérgicos. Dos pacientes presentaron ITU de repetición (1,3%), tratando los episodios aisladamente. Conclusiones: La cirugía de incontinencia urinaria con minicintas no está exenta de complicaciones (20%), la mayoría son leves y con posibilidad de manejo con éxito de forma conservadora (AU)

Objective: To evaluate the complications of urinary incontinence (UI) surgery with mini-sling system. Describe its diagnosis and management. Material and method: We make a descriptive analysis of the complications of the surgery in a group of 155 women with UI surgically treated with minisling system (50 TVT-Secur and 105 MiniArc) from October 2006 to November 2008. All patients were evaluated with clinical history, physical examination and two questionnaires of QoL (ICIQ-SF and EQ-5D). When urethral obstruction was suspected, we included urineculture, post-void residual urine measurement and urodinamycs. The complications were grouped into three cathegories: intraoperatory, early (within de first month after surgery) and late complications (after a month). We use the SPSS program (V 14.0) for statistical analysis of the results. Results: The average age was 56 years (range 33–82) and 180 days for the following-up (range 26–817). We had a complication rate of 20% (22% TVT-Secur, 17% MiniArc). We reported one intraoperatory complication corresponding to a bladder perforation (0.64%), managed conservatively with catheterization. All early complications were reported in the MiniArc group: one obturator fossa hematoma (0.64%) spontaneously resolved, groin pain in 4 patients (2.5%) successfully treated with NSAIDs and one urethral obstruction (0.64%) that required mesh cutting. Late complications included: 8 vaginal erosions (5%), 4 required tape excison and vaginal wall closure; 2 were treated with vaginal estrogens, and the other 2 were asymptomatic so we did nothing. 6 patients (3.8%) showed urethral obstruction: we performed mesh cutting in 5, whereas one patient improved with intermittent catheterization. Urge symptoms were reported in 10 patients (6.45%) and successfully managed with anticholinergic agents. 2 patients suffered from recurrent infections (1.3%) confirmed by antibiogram, treating isolated episodes. Conclusions: Urinary incontinence surgery with mini-sling system is not free of complications (20%). Most of them are mild and can be successfully treated conservatively (AU)

Sistema REMEEX® para el tratamiento de la incontinencia de esfuerzo masculina: nuestra experiencia / REMEEX® system for the treatment of male urinary stress incontinence: Our experience

Introducción: Presentamos un estudio retrospectivo sobre los resultados obtenidos por nuestro servicio en el tratamiento de la incontinencia urinaria de esfuerzo masculina con el sistema REMEEX®. Material y métodos: Entre febrero de 2007 y diciembre de 2009 se intervinieron con el sistema REMEEX® 14 pacientes varones diagnosticados de incontinencia urinaria de esfuerzo moderada-severa. El origen de la incontinencia fue secundario a prostatectomía radical abierta (n=9), laparoscópica (n=4) y RTU prostática (n=1). Evaluamos las complicaciones obtenidas en tres grupos: intraoperatorias, precoces (menos de 1 mes) y tardías (más de 1 mes). Evaluamos el estado de los pacientes tras 1, 3, 6 y 12 meses de seguimiento. Resultados: La mediana de edad fue de 68,5 años (rango: 62–71). El tiempo mediano de seguimiento fue de 18,6 meses (rango: 10,1–35,2). La media de reajustes fue de 3,7 (rango: 1–6). Un total de 12 pacientes fue reajustado en el postoperatorio inmediato (24–72h tras la intervención). En tres ocasiones (21,4%) fue necesario retirar todo el sistema, uno por infección precoz y dos porque no deseaban más reajustes. La complicación intraoperatoria más frecuente fue la perforación vesical con 4 casos (28,5%). La complicación precoz más encontrada fueron 5 episodios de retención aguda de orina (35,7%). Al año, un 41,7% de los pacientes está totalmente continente (5/12) y un 33,3% presenta leves escapes (4/12). Conclusiones: El sistema REMEEX® para la incontinencia urinaria masculina, según nuestra experiencia, presenta un porcentaje de éxito al año (pacientes continentes o con mínimos escapes) del 75%, con una alta incidencia de complicaciones menores.Los reajustes, sobre todo durante los primeros seis meses, son frecuentes y es necesario un estrecho seguimiento. Necesitamos trabajos que evalúen la efectividad de este sistema a más largo plazo (AU)

Introduction: We evaluate the effectiveness of REMEEX® (readjustable sling) for the treatment of male urinary stress incontinence (SUI). Materials and method: Between February 2007 and December 2009, 14 male patients with mild to severe SUI were operated with the use of REMEEX® system. The origin of incontinence was radical open prostatectomy (n=9), laparoscopic prostatectomy (n=4) and TUR (n=1). We evaluate postoperatively complications in three groups: intraoperatively, early complications (before 1 month) and late complications (after 1 month). Follow up was done at 1, 3, 6 and 12 months after intervention. Results: The mean age was 68,5 years (range: 62–71). The average follow-up time was 18,6 months (range: 10,1–35,2). The mean of readjustment was 3,7 (range: 1–6). Twelve patients were readjusted during the early period (24–72h after intervention). The mesh was removed in 3 cases (21,4%) owing to infection in one and the others because patients didn't want more system readjustment. There were four (28,5%) intraoperative bladder perforations. The early complication more frequent was acute urinary retention with five cases (35,7%). To the year of follow-up 41,7% of the patients are totally continent (5/12) and 33,3% presents light urinary incontinence (4/12). Conclusions: The REMEEX® system for the treatment of male SUI presents (in our experience) a 75% of good results (continent patients or patients with light urinary incontinence) at the year of follow-up with a high rate of light complications. Readjustment are frequent at the first six months after intervention and it′s necessary an intense follow-up. We need more studies that evaluate the long-term efficiency of this system (AU)