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Technical details of surgical procedure and slings for improved results in urinary incontinence surgery

TECHNICAL DETAILS OF SURGICAL PROCEDURE AND SLINGS FOR IMPROVED RESULTS IN URINARY INCONTINENCE SURGERY

LORENZO-GÓMEZ MF; PADILLA-FERNÁNDEZ B; GIL-VICENTE A; SILVA-ABUÍN JM.

Urology Department. Universitary Hospital of Salamanca. University of Salamanca. Spain.

OBJECTIVES

To analyze the surgical approach for stress urinary incontinence (SUI) with transobturator tape (TOT) in order to understand the technical details of the surgical procedure and which slings can improve the results obtained with this treatment.

MATERIAL AND METHODS

425 patients underwent TOT surgery between mar-2003/oct2011.

Two protocols were used: Protocol 1: No hydrodissection, no vaginal plugging, average stay 3.5 days, commercial needle kits; Protocol 2: Extensive hydrodissection, thin atraumatic specific needles, vaginal plugging, sling cut deferred 48-72 hours.

9 types of slings were used. Complications and effectiveness were registered. Descriptive analysis, Student t test, Chi square test, Fisher exact test were used. P<0.05 was accepted as significant.

RESULTS

Per/postoperative complications:

Protocol 1 (n=75): 25% post-operative urinary retention. 6.35% severe inguinal-transobturator pain. 20.63% de novo urgency, 4.76% significant bleeding. Late complications: Recurrent urinary infections in 15.87%, new cysto-colpo-rectocele in 6.35%. Sling extrusion in 4.76%. 68% of patients were continent and 32% were incontinent.

Protocol 2 (n=350): 2 vaginal perforations; 1 sling loss during the dressing. Postoperative: 3 urge UI; 2 urinary retentions that didn’t respond to catheterization. 10% suffered de novo urge. 87% of patients recovered continence, 13% continued with SUI. No haemorrhage, vesical perforation, vascular damage or urethral erosion were found in either protocol.

Slings: The one with whipstitch edges was associated with less post operative urinary retention (p=0.0013), less pain (p=0.0023) and per and postoperative bleeding (p=0.00013), allowed postoperative readjustment and less urinary tract infections (p=0.0045).

CONCLUSIONS

TOT surgery can be properly managed in short stay regime. Extensive hydrodissection, forced lithotomy position, the choice of the most adequate sling (better with whipstitch edges), the use of atraumatic fine needles and the consideration of a possible postoperative readjustment leads to a significant improvement of TOT results.

GRATITUDE: To all healthcare workers of 3th floor of Hospital Virgen de la Vega of Salamanca. Department of Surgery of University of Salamanca, Spain.

 


Lorenzo-Gomez MF; Padilla-Fdez B; Gil-Vicente A; Silva-Abuin JM

University of Salamanca

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