Autori ed affiliazione:
Giovanni Pisapia Cioffi, Davide De Vita, Vito Clemente, Gennaro Auriemma.
U.O. Ostetricia e Ginecologia P.O. “S.Maria della Speranza” Battipaglia (SA)
Topic: Incontinenza urinaria da stress trattamento chirurgico
Abstract
Objectivies:Medium-term results of transobturator tapes for the treatment of female stress urinary incontinence (SUI) are largely unknown.We analyzed the 3-yr results of a prospective observational study designed to evaluate the safety and efficacy of the TVT-O procedure.
Methods: The design of this prospective, observational trial has been previously detailed.Briefly, since March 2010 all women with urodynamic stress incontinence who were offered a surgical treatment were candidates for inclusion in the trial if the following criteria were met: age between 25 and 80 yr, clinical and urodynamic diagnoses of SUI, positive stress test;patients with urodynamically proven detrusor overactivity or impaired bladder contractility, postvoid residual (PVR) 100 ml or greater, a contraindication to anesthesia, pregnancy, neurogenic bladder; were excluded from study.Preoperative evaluation included detailed history, physical examination with a stress test, urine analysis, cystoscopy and urodynamics. All patients were also asked to self evaluate the severity of incontinence with a visual analogue scale graded from 0 to 10 with 0 corresponding to the absence of the symptom and 10 corresponding to the worst condition.. Quality of life
(QoL) was assessed at baseline with the use of questionnaries.All patients were contacted by mail and /or telephone and invited to present to the follow-up visits according to the follow-up evaluation at 1,6 and 12 months, and yearly thereafter included physical examination with a cough test, uroflowmetry with PVR mesaurement, and scoring of symptoms, QoL and visual analogue scales.Postoperative complications were recorded, including urinary retention, the need for tape release/section, vaginal or urethral erosion, neurological complication, and persistent pain.
Results:Between March 2010 and december 2013, 102 consecutive patients with clinical and urodynamic diagnoses of SUI who fulfilled inclusion and exclusion criteria underwent the TVT-O procedure; the latter was associated with pelvic organ prolapse treatment in 16 patients (15,7%). Three-year minimum follow-up (medium 40 mo) was available for 91 patients (89,2%).No erosion or persistent pain was noted. Four patients required tape release or section.Disappearance and improvement of SUI were observed in 88,4% and 9,3% of the patients, respectively. Frequency and urge symptoms were improvred at 3 yr ( p <0.005). Whereas maximum flow rates were somewhat decreased (p=0.01),the severity of obstructive symptoms and PVR volumes were not statistically different (p=0.11 and p=0.32, respectively).Incontinence severity and QoL scale scores were largely better than preoperative ones (p<0.001) and did not differ from those reported at 1 yr ( p =0.15 and p=0.08 , respectively).
Conclusions:the medium term results of this prospective, observational study suggest that theTVT-O procedure is a safe and efficient treatment of female SUI, with maintenance, after a 3-yr minimum follow-up of high cure rates comparing favorably with those reported for TVT.
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