Surgical treatment of urinary incontinence in geriatric patients

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Abstract

Introduction. Recently, there has been a steady upward trend in life expectancy, so it is extremely important to remember some of the features of the body associated specifically with aging. Thus, an important topic for discussion is the issue of ensuring the quality of life of an elderly woman. The prevalence of urinary incontinence in patients of the older age group leads to significant restrictions in their social life. Surgical treatment using general and regional anesthesia has significant contraindications due to age and comorbidities. In this regard, in some cases, local anesthesia is the method of choice of anesthesia in this category of patients.

Purpose of the study. Evaluation of the possibility of using local anesthesia in the surgical treatment of stress urinary incontinence in geriatric patients.

Materials and methods. We analyzed the results of surgical treatment of stress urinary incontinence in 42 patients. The mean age of the patients was 78±4 years. All patients were treated for urinary incontinence using mini loops under local anesthesia. Pre- and postoperative examination included vaginal examination in mirrors, cough test, cystoscopy (if indicated), uroflowmetry, ultrasound examination of the pelvic organs and bladder, bacterial culture of urine with determination of sensitivity to antibiotics. Taking into account the advanced age of the patients, the protocol of the preoperative examination included the obligatory performance of ultrasound Doppler examination of the veins of the lower extremities and echocardiography.

Results. The duration of the operation averaged 22±5 minutes. Complications requiring a change in the course of the operation were not registered during the operation. 1 month after the operation, at the control examination, the cough test was negative in 40 (95,2%) patients. 2 (4,8%) had a positive cough test. After 6 months, out of 40 (100%) successfully operated patients, 4 (9,52%) had urine leakage during the cough test. The maximum follow-up period for patients was 12 months. Out of 40 (100%) patients with a negative cough test after surgery, it was possible to track the long-term results of treatment only in 33 (82,5%) patients. After evaluating the results of 33 (100%) operated patients after 12 months, it was found that in 30 (90,9%) patients the symptoms of urinary incontinence were completely absent, in 3 (9,09%) there was a recurrence of urinary incontinence.

Conclusions. Surgical treatment of stress urinary incontinence using a synthetic loop under local anesthesia is effective and safe in geriatric patients.

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About the authors

M. Y. Soluyanov

Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences

Author for correspondence.
Email: msoluyanov@mail.ru
ORCID iD: 0000-0003-2635-9161

PhD in Medical Sciences, Urologist, Researcher Laboratory of Surgical lymphology and lymphodetoxication Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences

Russian Federation, Novosibirsk

F. A. Rakitin

Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences

Email: rakitinfedorr@mail.ru

Head of the Department of Gynecology Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences

Russian Federation, Novosibirsk

O. A. Arefyeva

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Email: oksadoc@yandex.ru

PhD in Medical Sciences, Urologist, Senior Assistant Department of Urology A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Russian Federation, Moscow

M. Y. Gvozdev

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Email: m.gvozdev@mail.ru

PhD MD, Professor, Department of Urology A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Russian Federation, Moscow

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