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2009, Number 3

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Cir Cir 2009; 77 (3)

Subtrigonal sling with abdominal fascia for treatment of complex stress urinary incontinence

Serrano-Brambila EA, Maldonado-Alcaraz E, Espinoza-Guerrero XA, Moreno-Palacios J, Ixquiac-Pineda GA, Cárdenas-Rodríguez E

Language: Spanish
References: 24
Page: 193-200
PDF size: 168.59 Kb.


ABSTRACT

Background: The aim of this study was to describe the technique of subtrigonal sling with abdominal fascia and demonstrate its usefulness in resolving complex stress urinary incontinence (SUI). Methods: We performed a cohort, longitudinal, observational study in adult females who attended the Urodynamics Department of the Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexico City, with recurrent SUI or with risk factors for recurrence, whether or not associated with urge urinary incontinence (UUI). Results: Between 1995 and 2006, 40 patients were included. Mean follow-up was 41.95 months (9-106), and the average patient age was 55 years. In 35 patients (87.5%) SUI was resolved, in two patients (5%) it improved, and in three patients (7.5%) it persisted. Of the 40 study patients, 18 had UUI and in only 7/18 patients (39%) was it resolved postoperatively. UUI de novo was noted in 12/40 patients (30%). One patient presented crural hernia, two patients presented postincisional hernia and two patients required blood transfusion. No patient presented acute urinary retention or urinary voiding problems postoperatively. Conclusions: Results obtained by this surgical technique are effective and long-lasting in patients with complex SUI. We did not observe bladder emptying dysfunction but there were formations of abdominal wall hernias. The minimally invasive approach consisting of the subtrigonal placement of synthetic tapes may maintain efficacy with minimal morbidity.

REFERENCES

  1. Fillol-Crespo M. Incontinencia urinaria de esfuerzo. En: Espuña-Pons M, Salinas-Casado J, eds. Tratado de Uroginecología. España: Ars Medica España; 2005. pp. 145-155.

  2. Nygaard I, Heit M. Stress urinary incontinence. Obstet Gynecol 2004;104:607-620.

  3. Kreder KJ. Managing incontinence: one size does not fit all. Contemp Urol 2002;14:54-58.

  4. Sutherland SE. Treatment options for female urinary incontinence. Med Clin North Am 2004;88:140-167.

  5. Burgio KL, Matthews KA, Engel BT. Prevalence, incidence and correlates of urinary incontinence in healthy middle aged women. J Urol 1991; 146:1225.

  6. American Heart Association. Heart Disease and Stroke Statistics-2008 Update (on line). Disponible en http://www.americanheart.org/downloadable/heart/1200078608862HS_Stats%202008.final.pdf

  7. DuBeau CE, Kiely KD, Resnick NM. Quality of life impact of urge incontinence in older persons: new measure and conceptual structure. J Am Geriatric Soc 1999;47:989-994.

  8. Wagner TH. Economic cost of urinary incontinence in 1995. Urology 1998;51:335-361.

  9. Lobel B, Manunta A, Rodríguez A. The management of female stress urinary incontinence using the sling procedure. BJU Int 2001;81:832-839.

  10. Marshall VF, Marchetti AA, Krantz KE. The correction of stress incontinence by simple vesico-urethral suspension. Surg Gynecol Obstet 1949;88:509-518.

  11. Burch JC. Urethrovaginal fixation to Cooper’s ligament for the correction of stress incontinence, cystocele and prolapse. Am J Obstet Gynecol 1961;81:281-290.

  12. Fantl JA, Newman DK, Colling J DeLancey JO, Keeys C, Loughery R, et al. Urinary incontinence in adults. Clinical practice guideline No. 2, 1996. Update (AHCPR Publication No. 96-06-0682).

  13. Palma P, Dambros M, Cássio ZR, Marcelo T. The Ibero-American experience with a re-adjustable minimally invasive sling. BJU Int 2005;95:341-345.

  14. Kassardjian ZG. Sling procedures for urinary incontinence in women. BJU Int 2004;93:665-670.

  15. Flynn B, Yap W. Pubovaginal sling using allograft fascia lata versus autograft fascia for all types of stress urinary incontinence: 2-year minimum follow-up. J Urol 2002;167:608-612.

  16. Aldridge AH. Transplantation of fascia for relief of urinary stress incontinence. Am J Obstet Gynecol 1942;44:398-401.

  17. Rodríguez L, Raz S. Prospective analysis of patients treated with a distal urethral polypropylene sling for symptoms of stress urinary incontinence: surgical outcome and satisfaction determined by patient driven questionnaires. J Urol 2003;170:857-863.

  18. Ja-Hyeon K, Jae-Seung P, Soo P. Tension-free vaginal tape procedure for urinary incontinence with low valsalva leak point pressure. J Urol 2004;172:1370-1373.

  19. Murphy M, Culligan P, Arce CM, Graham CA, Blackwell L, Heit MH. Is the cough-stress test necessary when placing the tension-free vaginal tape? Am J Obstet Gynecol 2005;105:319-324.

  20. Walters M, Daneshgari F. Surgical management of stress urinary incontinence. Clin Obstet Gynecol 2005;47:93-103.

  21. DeLancey J. The pathophysiology of stress urinary incontinence in women and its implications for surgical treatment. World J Urol 1997;15:268-274.

  22. Petros PE, Ulmsten U. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol Suppl 1993;153:91-93.

  23. Albo M, Richter H, Brubaker L, Norton P, Kraus P. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 2007;356:2143-2155.

  24. Sander P, Sorensen F, Lose G. Does the tension-free vaginal tape (TVT) affect the void function overtime? Pressure-flow studies 1 year and 3½ years after TVT. Neurourol Urodyn 2007;26:995-997.




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