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      Evaluación de parámetros urodinámicos tras colocación de cintas libres de tensión Translated title: Evaluation of urodynamic parameters following the placement of tension-free tape

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          Abstract

          Objetivo: Analizar los cambios urodinámicos posteriores a la colocación de cintas libres de tensión TVT (cabestrillo vaginal libre de tensión retropúbico) o TVT-O (cabestrillo vaginal libre de tensión obturador). Material y métodos: Se realizó una cohorte retrospectiva en la que se incluyeron mujeres con diagnóstico urodinámico de incontinencia de esfuerzo, a las que se les colocó cinta libre de tensión tipo TVT o TVT-O, y que se les realizó estudio urodinámico pasado un año. El tamaño de la muestra se calculó en función del área de continencia y fue de 15 mujeres por cada grupo. Se incluyeron 40 mujeres, a 22 se les realizó TVT y a 18 TVT-O. El estudio se llevó a cabo entre febrero de 1999 y marzo de 2009. Se analizaron las medias de los parámetros urodinámicos pre y posoperatorios con prueba «t» para variables dependientes. Resultados: Se encontró una disminución media del flujo máximo de 9ml/s posterior a la colocación de TVT-O (p=0,05). Para el grupo de TVT se encontró un aumento en los tiempos de flujo y de micción de 5,3 y 6 segundos, así como de la presión del detrusor al flujo máximo en 6,2cm H2O y de la presión máxima del detrusor al vaciamiento en 8cm H2O (p=0,37, 0,47, 0,21 y 0,12, respectivamente). Conclusiones: En mujeres con incontinencia urodinámica de esfuerzo existe disminución del flujo máximo al año de la colocación de TVT-O.

          Translated abstract

          Objective: To analyse the urodynamic changes subsequent to the placement of TVT tension-free tape (retropubic tension-free vaginal tape) or TVT-O (obturator tension-free vaginal tape). Materials and methods: We carried out a retrospective cohort study that included women with urodynamic diagnosis of stress incontinence, in whom we placed type TVT or TVT-O tension-free tape, and on whom we performed a urodynamic study one year later. We calculated the size of the sample based on the area of continence and it consisted of 15 women per group. We included 40 women. 22 had TVT placed and 18 had TVT-O. We carried out the trial between February 1999 and March 2009. We analysed the means of the pre and postoperative urodynamic parameters using the Student's t-test for dependent variables. Results: We noted an average decrease in the maximum flow of 9ml/ s following the placement of the TVT-O (p=0.05). For the TVT group, we noted an increase in the flow and micturition times of 5.3 and 6seconds, as well as in the detrusor pressure at the maximum flow of 6.2cm H2O and of the maximum detrusor pressure when voiding, of 8cm H2O (p=0.37, 0.47, 0.21 and 0.12, respectively). Conclusions: In women with urodynamic stress incontinence, the maximum flow decreased a year after the TVT-O was placed.

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          Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence.

          A new ambulatory procedure for treatment of female urinary incontinence (intravaginal slingplasty, IVS) was performed on 50 patients. In all patients the surgical procedure was carried out under local anaesthesia and without postoperative urinary catheterization. The technique has been elaborated from previous experimental and clinical studies and aims at restoration of the pubourethral ligament and the suburethral vaginal hammock. Thirty-eight patients suffered from genuine stress incontinence as objectively verified and 12 patients had symptoms and signs of both urge and stress incontinence. Thirty-nine (78%) patients were completely cured from their stress incontinence symptoms. Another six patients (12%) reported a considerable improvement of their urinary incontinence leaking only occasionally. Concerning urge incontinence symptoms a significant relief of the symptoms was obtained in 6 of 12 patients. No intra- or post-operative complications occurred.
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            Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence.

            The aim of this study was to evaluate the long-term effectiveness and safety of the tension-free vaginal tape (TVT) procedure. In a Nordic three-center prospective observational cohort study, 90 women with primary stress incontinence had a TVT operation performed in local anesthesia. Assessment included a 24-h pad test, a stress test, physical examination, and a visual analog scale for assessing the degree of bother. Patient's global impression of cure was obtained, and condition specific quality of life questionnaires were used. Seventy-seven percent of the initial cohort of 90 women and 89% of those alive and capable of cooperating were assessed 11.5 years after the TVT operation. Ninety percent of the women had both a negative stress test and a negative pad test being objectively cured. Subjective cure by patients global impression was found in 77%, 20% being improved and only 3% regarded the operation as a failure. No late-onset adverse effects of the operation were found, and no case of tape erosion was seen. The TVT procedure is safe and effective for more than 10 years.
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              Effectiveness of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency: a randomized controlled trial.

              To compare efficacy of transobturator tape with tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence in women with intrinsic sphincter deficiency. One hundred sixty-four women diagnosed with urodynamic stress incontinence and intrinsic sphincter deficiency with or without concomitant pelvic organ prolapse repair were randomized to receive TVT or transobturator tape. The primary outcome was the presence or absence of urodynamic stress incontinence at 6 months postoperatively. Secondary outcomes were the rate of operative complications, symptomatic stress incontinence requiring further surgery, and quality-of-life questionnaires. Of 180 women eligible to participate, 164 were enrolled and underwent surgery. Of the 138 patients assessed at 6 months with urodynamic studies, 14 of 67 (21%) had urodynamic stress incontinence in the TVT group compared with 32 of 71 (45%) in the transobturator tape group (P=.004), with nine women in the transobturator tape group having repeat sling surgery compared with none in the TVT group. In the intention-to-treat analysis, the incident rate difference for request of repeat surgery was 9.7% (95% confidence interval [CI] 0-19.9); repeat surgery would be requested in one of every six transobturator tape procedures compared with 1 of every 16 TVT procedures. The risk ratio of repeat surgery was 2.6 (95% CI 0.9-9.3) times higher in the transobturator tape group. Retropubic TVT is a more effective operation than the transobturator tape sling in women with urodynamic stress incontinence and intrinsic sphincter deficiency. www.actr.org.au, Australian New Zealand Clinical Trials Registry, ACTRN12608000093381 I.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                aue
                Actas Urológicas Españolas
                Actas Urol Esp
                Asociación Española de Urología (, , Spain )
                0210-4806
                April 2011
                : 35
                : 4
                : 208-212
                Affiliations
                [01] México Distrito Federal orgnameInstituto Nacional de Perinatología Isidro Espinosa de los Reyes orgdiv1Urología Ginecológica México
                Article
                S0210-48062011000400005
                10.4321/s0210-48062011000400005
                63b4c2e6-e6fa-4f83-8435-21b155a821c4

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 04 November 2010
                : 15 September 2010
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 5
                Product

                SciELO Spain


                Incontinencia urinaria de esfuerzo,Urodinámica,Cabestrillo suburetral,Stress urinary incontinence,Urodynamic,Suburethral tape

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