Cost effective treatment of stress urinary incontinence and complete reconstruction of the pelvic floor (SIU 2011)

  • uploaded: Jul 14, 2011
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Jul 14, 2011 / Duration: 07:00 / Views: 107 / 0 comments

Authors:

Ivan M. Ignjatovic, Nina C. Medojevic, Ljubomir A. Dinic, Milan B. Potic

Institution:

Clinic of Urology, Clinical Center Nis, Serbia

Abstract

Introduction and Objectives
There is an increased number of patients who request both treatment of the stress urinary incontinence (SUI) and pelvic organ prolapse (POP). The number of patients who are treated with the synthetic material is growing. In low currency countries only a minor part of the patients could be treated with the best industrially tailored materials due to limited financial resources. The aim of the study was to perform treatment of SUI and POP with the cheaper, non-tailored mesh.
Material and methods
Total of 38 patients with clinically proved SUI, and POP grade 2-4 were operated. Macroporous, polypropylene, 46 gr/m2, 10x15cm, mesh was used, which was enough to perform: midurethral sling, transobturatory cystocele support, sacrospinous fixation, and reinforcement of the rectovaginal fascia as well. Five 15x1.2 cm stripes were created, and two larger parts remained for the posterior vaginal wall support. Polidioxanon pulling suture 2-0 was passed through the each stripe. Mid urethral transobturatory sling was created and passed with helicoidal needles “outside in”. Four corner fixation of the bladder base with two stripes was performed transobturatory. Sacrospinous support was performed with two mesh stripes through the sacrospinous ligament and ischiorectal fossa. Posterior meshes were laid free, after creation of the space. Follow up was one year long.
Results
SUI was cured in 34/38 patients (89.4%). POP was cured (grade 0-1) in 31/38 (81.5%) patients, and improved in 4/38(10.5%) patients. Mean hospital stay was 3.2 after the surgery. The most important complications were: one iatrogenic bladder perforation (which did not delay mesh placement) and exteriorization of the mesh in one case. Urgency was present before the surgery in 12/38 (31.5%) and was reduced after treatment to 4/38 (15.7%), without cases of urgency incontinence. Prolapse symptoms (vaginal buldging, pelvic pressure, voiding symptoms, bowel symptoms), moderate or more intensive, were significantly improved after the surgery. Vaginal bulging was the most significantly improved (p<0.00 ) and improvement of bowel symptoms was borderline (p=0.05).
Conclusion
Non tailored meshes, are useful option for the simultaneous treatment of SUI and POP. Treatment is equally successful like with industrially tailored meshe

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