1. Hypothesis / aims of study
STRESS URINARY INCONTINENCE SURGICAL TREATMENT: AMBULATORY TRANSOBTURATOR TAPE PROGRAM. 6 MONTHS FOLLOW-UP
Medel S., Marques X., Millán R., Vergara P. Division of Urogynecology and Pelvic Floor Surgery, Department of Obstetrics & Gynecology.
Hospital San Borja Arriarán. Universidad de Chile. CHILE.
The estimated prevalence of urinary incontinence in the middle-aged and elderly population is estimated between 30–60 % and increases with age.
Stress urinary incontinence (SUI) affects 10% to 39% of women during life, with significant financial and psychological consequences for the patients.
Surgical treatment is a mainstay of treatment offering demonstrable improvement in symptoms and quality of life.
Surgery for SUI has become less invasive and more simplified with the development of new technologies as the sub-urethral slings and has develop the ambulatory activity as a potential source of savings for the health system and patient benefit.
Background
Hypothesis / aims of study
To prove that Transobturator tape, performed ambulatory, as a treatment for female SUI, is an effective, well tolerared, high rate patient satisfaction surgery among a selected group of patients in a unit where inpatient regimen is the rule.
Prospective, descriptive study. Informed consent was obtained.
Evaluation of objective and subjective results of the surgical treatment of SUI with a free-tension transobturator tape (TOT) , within a pilot program of major ambulatory surgery that took place from November to December 2014 in a Gynaecology Service, Urogynecology and Reconstructive Pelvic Surgery Unit.
50 women with SUI or stress-predominant mixed urinary incontinence were evaluated clinical and with simple cystometry at the beginning of the program and 6 months after surgery.
50 TOT were performed. Monofilament macropore polypropylene mesh of 30x12 mm size was used in all procedures. 6 of these were realized with general anesthesia, the rest was spinal.
After surgery, the bladder was filled with 200 cc of saline solution. Post void residue was measured postoperatively, and the patients were discharged the same day of the surgery if this was less than 50 cc. 47 patients completed 6 months follow up.
Materials and Methods
Results
Population: Average age was 51 years-old, BMI 27.8 kg/m2, and parity 2 vaginal deliveries. There were 4 hysterectomized patients, and 2 had pelvic organ prolapse, asymptomatic, no further than stage 2.
Incontinence characteristics: 85% patients had stress-predominant mixed urinary incontinence and 15% pure stress urinary incontinence. 100% had positive cough test with maximum cystometric capacity during simple cystometry.
Surgery: all procedures were performed by a trained surgeon. Average length of surgery was 32,4 minutes. 100% patients were discharged the same day of surgery. 1 patient presented with urinary retention after procedure, treated with Foley catheter for 48 hours.
6 months follow up, there was 75% symptomatic cure of SUI, 76,6% negative stress test and 57,5% negative cough test with maximum cystometric capacity during simple cystometry. In a subjective evaluation, 95,7% patients felt better after surgery. There was 4,2% mesh extrusion (2 patients) that was solved ambulatory, with local anaesthesia. 8.5% presented with inguinal pain 6 months after procedure. There were no cases of “de novo” urge urinary incontinence.
The ambulatory performance of TOT is feasible, effective, with a low rate of complications, and high rate of patient satisfaction.
 This is a very useful technique in a less developed country like Chile, where the bed-day cost is very high, and the waiting lists in the public hospitals are extensive. Besides, it is a proven fact that same-day discharge improves patient satisfaction, without generating any complications different to the ones when the discharge is two or three days after surgery.
Conclusions
Disclosures Statement
NONE
Bibliography.
1 Female urinary stress incontinence. Cervigni M. Climateric 2015.
2 Outpatient suburethral sling in women: Review of the literature. Serey-Eiffel S. Prog Urol. 2015
3Outcomes associated with the use of midurethral slings for stress incontinence surgery according to the type of hospitalization. Thubert T. Int J Gynaecol Obstet. 2015