Surgical treatment of stress urinary incontinence in women

Abstract

Objective. Comparison of the surgical treatment results in patients with SUI with the use of loop operations with prolen nets.

Full Text

Material and methods. At the period from 2000 to 2003,59 patients with SUI were examined and operated on. Depending on performed antistress operation all the patients were divided into two groups with comparable estimators. The 1 st group included 31 patients after the loop operation TVT. The second group (28 patients) were operated by developed method of pubovaginal loop operation with the net “Prolen”. The 2nd type of SE was the most common in both groups: 57,1% in the 1st group and 51,6% in the 2nd one. Most patients had the average severity of the desease: 18 (58,1%) and 21 (72,4%), respectively. Serious desease was diagnosed in 13 (41,9%) patients in the 1st group and in 8 (27,6%) in the 2nd group. The average age of the women in the 1st group was 47,1 ± 1,64 and 52,7 ± 1,84 years old in the 2nd group. Other surgeries were performed simultaneously with the surgical correction of SUI. 29 operations were carried out in 25 patients (80,6%) from the 1st group and 37 surgeries were carried out in 27 patients (93,1%) from the 2nd group.

Results. 23 month later positive result was recorded in 29 (93,5%) patients after the loop operation TVT and in 25 (89,2%) patients after the suggested pubovaginal loop operation with prolen net. Imperative vesical tenesmi appeared in 2 (6,5%) patients from the 1st group and in 3 (10,8%) patients in the 2nd group 3-6 months after surgeries. Therefore therapy results were considered to be negative. Postoperative complications were recorded after the TVT operations in 5 (16,1%) patients and in 5 (17,2%) after suggested loop operation. Intraoperative complications in the form of urinary bladder injuries were recorded one at a time in both groups. Both cases of urinary bladder injuries and one case of bleeding in the 2nd group were recorded in 3 women with 2 and more operations on the pelvis organs. Early postoperative complications (retrosymphysis haematoma, acute urinary retention) were found in 2 patients from the 1st group and in 1 patient from the 2nd group. Detrusor instability was revealed by combined urodynamic investigation in 2 patients from the 1st group and in 3 patients from the 2nd group with imperative vesical tenesmi 6 months later.

Conclusion. 1. Loop operations with prolen net result in high rate of positive results. SUI was eliminated by TVT operations in 93,5% and by pubovaginal operations with prolen net in 89,2% of patients. 2. Both loop operations can be combined with simultaneous surgical correction of genitals prolapse. They can be carried out independently or as a stage of simultaneous surgical treatment. 3. Most common postoperative complication under both operations was detrusor instability: 6,5% after TVT operations and 10.8% after pubovaginal operations with prolen net. Increase in the complications and decrease in the efficiency of suggested pubovaginal operation with prolen net may be caused by greater quantity of performed simultaneous operations.