M. Dambros

Impacto da reeducação postural global no tratamento da incontinência urinária de esforço feminina

OBJECTIVE: To evaluate the effect of global postural reeducation (GPR) on stress urinary incontinence (SUI) and quality of life in SUI female patients METHODS: The study design was a prospective non-randomized clinical trial. Twenty-six patients with symptoms of SUI were selected from the Urogynecology Outpatient Clinics of the State University of Campinas (Unicamp), state of Sao Paulo, Brazil. Age ranged from 23 to 72 years old (mean 50.8). All women were submitted to anamnesis, physical exam, postural evaluation and urodynamic testing. Patients were treated by the GPR in individual 50 minute sessions weekly for three months and twice a month for the next three months. All patients were re-evaluated at the end of treatment and six months later by means of General Impression of Improvement, Incontinence Impact, General Perception of Health, Functional Evaluation of the Pelvic Floor, Number of Leaking Episodes and Pad Use. RESULTS: At the end of treatment 4 (16%) of the patients were cured, 18 (72%) had improved significantly and 3 (12%) failed. At 6 months, 6 (24%) were cured, 16 (64%) improved and 3 (12%) failed (p<0.001). Quality of Life questionnaires presented significant improvement (p<0.05) in all domains, with emphasis on General Perception of Health, Incontinence Impact and number of leaking episodes. The Functional Evaluation of the Pelvic Floor and Pad Use also presented significant (p<0.001) improvement. CONCLUSION: These results may demonstrate that GPR is an efficient alternative for treatment of stress urinary incontinence.

A stereological analysis of fibrosis and inflammatory reaction induced by four different synthetic slings

To analyse quantitatively, using stereological methods, the density of the collagen fibres induced by four types of sling materials, and verify by a histopathological analysis the corresponding inflammatory reaction, as fibrosis secondary to sling implantation is considered responsible for restoring urethral support and re‐establishing continence in women with stress urinary incontinence, and new synthetic materials that promote adequate fibrosis with the least intensity and duration have been proposed to substitute the aponeurotic sling.

Corrección transobturatoria de los cistoceles

Resumen Objetivo Presentar nuestra experiencia inicial con el sistema Perigee para la correccion de prolapsos de pared anterior vaginal. Material Y metodo 15 pacientes con prolapso de la pared anterior de la vagina (edad media: 62 anos) fueron intervenidas con el sistema Perigee compuesto de una tela para la correccion del defecto central y cuatro astas autofijables para la correccion del defecto lateral. La tecnica de implante consta de cuatro pasos: 1) diseccion lateral vaginal hasta rama isquiopubica; 2) realizacion de dos marcas superiores en el pliegue genito-femoral y dos inferiores a 2 cm lateralmente y 3 cm inferiormente en relacion a las primeras; 3) introduccion agujas superiores paralelas a la rama isquiopubica y conexion con los “brazos” del injerto e introduccion de agujas inferiores verticalmente con conexion a las “piernas” del injerto; 4) ajuste sin tension de la malla. La tasa de curacion fue medida objetivamente utilizando el sistema POP-Q. Resultados El punto Aa preoperatorio paso de 0.09 a -3.00 a las 6 semanas del postoperatorio y se mantuvo en -2.73 a los tres meses. El punto Ba preoperatorio era de 1.73 y paso a -2.82 a las 6 semanas y se mantuvo en -2.82 a los 3 meses. Las complicaciones no fueron significativas. No se produjeron danos vasculares ni sangrados significativos. Conclusiones La correccion transobturadora de los cistoceles es una opcion atrayente. Los buenos resultados iniciales prometen ser duraderos.

Safyreä: a readjustable minimally invasive sling for female urinary stress incontinence

Introduction: SAFYRE TM is a readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). It is as a pubovaginal sling placed in the medial third of the urethra. The initial experience is described. Materials and Methods: Forty-five patients (mean age = 59 years) underwent a SAFYRE TM implant to treat SUI. Physical examination and urodynamic study were performed before surgery. All patients presented symptoms of SUI and 20% also reported mild urgency. Approximately 60% of this group had a previously failed anti-incontinence procedure. Urethral hypermobility was diagnosed in 40% of the patients and intrinsic sphincter deficiency (ISD) in 60% of the cases. Results: The average follow up period was 10 months. The mean operative time was 20 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 11% of the implants, bladder perforation occurred. During the postoperative period, 9 patients (20%) developed transient urgency symptoms. During the initial follow up period, 90% were found to be continent, 3% reported an improvement and 7% were unchanged. Conclusion: SAFYRE TM is a safe and quick procedure that allows postoperative readjustment. This technique may be an attractive alternative in the management of SUI, should the good result obtained so far prove to be long lasting.

RESINIFERATOXIN FOR DETRUSOR INSTABILITY REFRACTORY TO ANTICHOLINERGICS

PURPOSE We have evaluated the clinical and urodynamic effects of intravesical instillation of resiniferatoxin in patients with idiopathic detrusor instability refractory to anticholinergics. MATERIALS AND METHODS There were 30 women, median age 56 years old with detrusor instability for over 6 months and a history of anticholinergic use with no response or intolerable collateral effects. A 50 nM solution of resiniferatoxin was prepared for intravesical instillation. All patients were evaluated for urinary symptoms, as well as for urodynamic assessments before and 30 days after instillation. Tolerability was analyzed during the instillation. RESULTS A clinical improvement was observed in 30% of the patients with urinary urgency and in 33% of the patients with urge-incontinence. The mean maximum cystometric capacity before application was 303.9 +/- 78.9 and after application 341 +/- 84.6. No significant difference was observed (p = 0.585). The mean maximum amplitude of the contractions diminished from 47.86 +/- 29.64 to 38.72 +/- 30.77 (p = 0.002). CONCLUSIONS Resiniferatoxin, in this concentration, proved to be useful in a small percentage of patients regarding clinical detrusor instability. Maximum amplitude of the involuntary contractions was significantly reduced and in 33% patients the involuntary contractions disappeared. Further studies with different concentrations are recommended.

Readjustable transobturator sling: a novel sling procedure for male urinary incontinence.

Post-prostatectomy incontinence remains a significant problem for both patients and urologists. We report a case and the surgical technique of successful sling in the treatment of post-prostatectomy urinary incontinence. Sling surgery was performed on a 69-year-old male patient with severe urinary incontinence (6 pads/day) following radical prostatectomy. The procedure was conducted through the transobturator approach using a sling with a silicone foam pad to protect the urethra. At the 7-month follow-up the patient is using only 1 pad/day. We consider this operation an alternative to artificial urinary sphincter in cases of male sphincter incontinence.

The Ibero-American experience with a re-adjustable minimally invasive sling.

To report our experience with the SafyreTM (Promedon, Córdoba, Argentina), a new re‐adjustable and minimally invasive sling for treating stress urinary incontinence (SUI), which combines the efficacy of slings with re‐adjustability.

Safyre. Un nuevo concepto de cabestrillo ajustable mínimamente invasivo para la incontinencia urinaria por estrés femenina

Resumen Introduccion SAFYRE es un nuevo cabestrillo (dispositivo de suspension) reajustable y minimamente invasivo para el tratamiento de la incontinencia urinaria por estres (IUE). En los ultimos anos se ha intentado restaurar el lecho suburetral normal utilizando una tecnica anatomica. Los autores comunican su experiencia con este dispositivo, que ademas de poseer la eficacia de los cabestrillos tiene capacidad de reajustacion. Materiales y metodos Un total de 100 pacientes consecutivas con diagnostico de IUE desde el punto de vista clinico y urodinamico se sometieron al procedimiento de implantacion del cabestrillo SAFYRE. Su rango de edad era de 40 a 71 anos, con una edad media de 63 anos. Previamente, 75 pacientes (75%) se habian sometido a procedimientos para la incontinencia que habian fracasado. Antes de la cirugia se realizaron una exploracion fisica clinica, una prueba de estres, un estudio urodinamico y un estudio sobre el uso de almohadillas. Todas las pacientes presentaban sintomas de IUE y el 30% tambien tenian tenesmo leve. Resultados El periodo de seguimiento medio fue de 14 meses (12 – 30 meses). El tiempo medio de la operacion fue de 25 minutos. Durante el mismo procedimiento se reparo la distopia cuando se considero necesario. La estancia hospitalaria media fue de 24 horas. En el 3% de los implantes se produjo perforacion de la vejiga. Durante el periodo posoperatorio 26 pacientes presentaron sintomas de tenesmo. Durante ese periodo de seguimiento, el 92% presentaron continencia urinaria, el 3% mejoraron y el 5% no estuvieron satisfechas con el procedimiento. Conclusion SAFYRE es un procedimiento seguro y rapido que permite el reajuste posoperatorio. Esta tecnica puede ser una alternativa atractiva si se demuestra que los buenos resultados obtenidos hasta ahora son de larga duracion.

New trends in the transobturator management of cystoceles

Anterior vaginal wall prolapse is a frequent condition that affects 11% of American women. The incidence of cystocele doubles in each decade of life and it is estimated that 2.9 million women are affected by grade III–IV cystocele in the USA [1]. Because of the anterior vaginal prolapse recurrence rate of 30% in the first year, new approaches were developed to repair these hernias. The transobturator approach described by Delorme [2] in 2001, along with the principles of biosurgery, allowed for the development of a simple and minimally invasive approach for severe or recurrent anterior vaginal wall prolapse.

Evaluación de la función sexual femenina antes y después de un procedimiento para la corrección de la incontinencia urinaria de esfuerzo

The prevalence of urinary incontinence is around 20% of healthy middle-aged women. Incontinence causes a negative impact on the quality of life and sexuality. From August 2002 to January 2004, 30 patients (mean age 43 years) with stress urinary incontinence (59%), overactive bladder (15%) and mixed incontinence (26%) answered the ICIQ-SF(International Consultation on Incontinence Questionnarie-Short Form) and FSFI (Female Sexual Function Index) questionnaires before and after treatment for urinary incontinence. The follow - up ranged from 12 to 53 months. Mean ICIQ score was 17 and 7 before and after treatment respectivelly (p<0,001). Overactive bladder showed the worst scores in all domains. The patients who underwent surgery increased their scores of desire (p=0,02), satisfaction (p=0,05) and total score (p=0,02). Thirteen patients which ICIQ was zero increased: desire (p<0,01), satisfaction (p=0,05) and total score (p=0,01). Urinary incontinence significantly affects the quality of life. Therefore sexual evaluation in incontinence patients is recommended.