Fulda-Graue SD, Hernández-Castellanos VA, Santana-Ríos ZA, Urdiales-Ortiz A, Pérez-Becerra R, Camarena-Reynoso HR, Sánchez-Turati G, Merayo-Chalico C, Saavedra-Briones D, Cantellano-Orozco M, Pérez-Ortega R, Morales-Montor JG, Pacheco-Gahbler C

Language: Spanish
References: 12
Page: 263-267
PDF size: 326.18 Kb.

ABSTRACT

Introduction: Stress urinary incontinence continues to be a health problem affecting millions of women each year. An estimated 10-35% of older adults present with urinary incontinence and the figure increases to 50% in geriatric patients. Transobturator vaginal sling technique has become the treatment of choice in stress urinary incontinence, whether due to urethral hypermobility or to intrinsic sphincter deficiency. Complications are not common, but can include acute urine retention caused by excessive pressure of the mesh on the urethra, bleeding due to venous plexus injury at the 2 o’clock and 10 o´clock positions on the bladder neck from mesh passage during puncture, and recurrence or persistence of urinary incontinence reported by 10-30% of patients that have undergone surgery. This latter complication is the result of poor sling placement, mesh degradation, and a lack of tension by the mesh on the urethra. Urethral erosion and mesh infection are the most common complications.
Objective: To evaluate results and intraoperative and postoperative complications with transobturator sling in patients presenting with stress urinary incontinence at the authors’ institution over a five-year period of time.
Methods: Forty-one patients having undergone transobturator sling technique for stress urinary incontinence over a period of five years at the authors’ institution were analyzed. Degree of urinary incontinence was revised with preoperative Sandvik Severity Scale and the type of stress urinary incontinence was revised through urodynamics study with abdominal leak-point pressure. Analyzed variables were: number of vaginal births, intraoperative complications, immediate or late postoperative complications, and degree of postoperative incontinence at six, twelve, and thirty-six months by means of the International Consultation on Incontinence Questionnaire - Short Form.
Results: Mean patient age was 56 years, mean number of vaginal births was 3, and there was no statistical predilection for the type of urinary incontinence. A total of 54% of patients presented with moderate incontinence and 24% with severe incontinence. The type of stress incontinence determined through abdominal leak-point pressure was type I (39%), type II (22%), and type III (39%), without being a determining factor in surgical success. There were no intraoperative complications; only one patient presented with acute urine retention symptoms, and 24% of patients presented with some type of complication, the most common being urethral and vaginal pain that represented 12% of all complications. The success rate for the present study was 90% at six months, 85% at twelve months, and 82% at thirty-six months. There was 100% continence.
Conclusions: Transobturator sling has been substituting other urinary incontinence surgical techniques because it is a safe and effective method for patients presenting with stress urinary incontinence, regardless of the type of incontinence, and it is a procedure with an acceptable morbidity rate.

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