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THE JOURNAL OF FEMALE
URINARY INCONTINENCE

Commented Abstracts

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  • Vaginal retropubic urethropexy with intraoperative cystometry for treating urinary stress incontinence
    Clark, A.D.; Salloum, M.S.
    Departmento de Uroginecologia, St Mary’;s Hospital, Portsmouth, Hampshire, UK
    BJU International

ABSTRACT

OBJECTIVE: To determine the effectiveness of a vaginal retropubic urethropexy with intraoperative cystometry in treating urinary stress incontinence.: One hundred patients with genuine stress incontinence on urodynamic examination underwent the procedure and were followed up for 1 year; 96 completed the follow-up (four were lost to follow-up).: At 1 year, 91 patients (95%) were cured of their stress incontinence and five (5%) failed, with recurrent stress incontinence developing. The complications were mainly of suture erosion (6%).

CONCLUSION: This method of urethropexy has produced excellent results to date, with low complication and morbidity rates, and continues to be our treatment of choice. A randomized control trial comparing it with standard established procedures would be welcomed.

EDITORIAL COMMENT

The authors use a method that apparently improves, at least in a short term, the chances of success in stress urinary incontinence. After an opening in inverted "T" of the vaginal membrane and the dissection of the urethra, a thin thread of polyester (Ethibond Excel TM, Johnson – Johnson, UK) is sutured in the periosteum , initially in the sub-pubic arch, and later in direction to retro pubic space (lower branch of the pubis) the closest possible to the periosteum or the tendineus arcus. During this procedure a 8 mm Hegar dilatos is maintained intra urethral to avoid obstruction or trauma of the urethra. The idea of bthis procedure is to form a sustentation net of the urethra and the bladder neck. Another aspect that deserves a comment is to use the intra-operative cystometry to define the degree of correction to be instituted. A pressure transducer is placed supra-pubic way and "the loss of pressure under general anesthesia is determined" doing abdomen compression (vesicle filling of 400 ml). After placing the stitches, a new abdominal compression is done and the efficiency of the sutures is evaluated (abdominal compression of at least 70 cm H2O up to 30 cm H2O superior to the initial loss pressure). In case the incontinence persists a second suture plan is done. The use of cystometric techniques for tension evaluation (or a lack of it) to be applied on the urethra or bladder neck has been used by some authors.

The obtained results were very good, with 95% of the patients cured, but it is convenient to emphasize 2 aspects: 1. The selection. All with urinary loss due to, primarily, hyper mobility (absence of patients with intrinsic sphyncterian dysfunction. 2. A medium short follow-up. Most cases of SUI recurrence appear in the first 2 years of the follow-up. One is year is a short period of time for an adequate evaluation of a technique. Suture vaginal erosion was the main complication, appearing in 6% of the patients, with the need of retiring the suture in half of the patients.

Aparecido Donizeti Agostinho

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