TRANSOBTURATOR SURGERY IS A SAFE PROCEDURE REGARDING SEVERE BLEEDING IN PRESENCE OF CORONA MORTIS: A STUDY IN 13 WOMEN.

                                                                                                                                              <><>
Cristian Cicconetti1; Pietro Saldutto1; Daniele Castellani1; Vikiela Galica1; Daniela Biferi1; Giovanni Giovanditti1; Giuseppe Paradiso Galatioto1; Carlo Vicentini1.
1 Department of Health Science, University of L'Aquila, Teramo Hospital, Italy

Topic: Stress urinary incontinence.
Abstract                                                                                                                                 
Objective. Severe and life-threatening bleeding has been reported in the literature after retropubic mid-urethral slings procedure, due to corona mortis (CMOR) damage. The aim of this study is to evaluated safety of transobturator passage of the tape in stress-urinary incontinence (SUI) correction and anchoring the mesh in pelvic.-organ prolapse (POP) repair in the presence of CMOR                                                                                                       
Materials and Methods. Thirteen woman with a pre-operatory contrast-enhanced abdominal multidetector computed tomography were prospectively enrolled in the study between January 2009 and December 2014. Eight woman underwent a Monarc® and one a Spark® Sling System procedures for SUI correction, and three an Elevate® Anterior and Apical prolapse system and one a Perigee procedure to repair anterior/apical POP. All procedures were performed by single experienced pelvic surgeon (C.V.).                                                                                            
Results. Surgery was uneventful in all cases. No mayor bleeding was seen during surgery. No pelvic hematoma was identified 24-hours after the procedure. All woman were discharged one-day after surgery.                                                                                                                              
Conclusion. Our study confirms that transoburator surgery is a safe procedure to correct SUI and repair POP regarding serious and life-threatening bleeding, even in presence of CMOR.
References

  1. Hunskaar S, Burgio K, Clark A, et al. (2005) Epidemiology of urinary and faecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence, 3rd International Consultation on Incontinence. Plymouth, United Kingdom: Health Publications; pp. 255–312.
  2. Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 30;4:CD004014 
  3. Botlero R, Urquhart DM, Davis SR, Bell RJ. (2008) Prevalence and incidence of urinary incontinence in women: review of the literature and investigation of methodological issues. Int J Urol 15:230–4.
  4. Ulmsten U, Henriksson L, Johnson P, Varhos G. (1996) An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J 7:81–6.
  5. Hu TW, Wagner TH, Bentkover JD, et al. (2004) Costs of urinary incontinence and overactive bladder in the United States: a comparative study. Urology 63:461–5.
  6. Subak LL, Waetjen LE, van den Eeden S, et al. (2001) Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 98:646-651.
  7. Serious complications associated with transvaginal placement of surgical mesh in repair of pelvic organ prolapse and stress urinary incontinence. October 20, 2008. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm
  8. Novara G, Galfano A, Boscolo-Berto R, Secco S et al. (2008) Complication Rates of Tension-Free Midurethral Slings in the Treatment of Female Stress Urinary Incontinence: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Comparing Tension-Free Midurethral Tapes to Other Surgical Procedures and Different Devices. Eur Urol 53: 288-309.