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M431 TRANSOBTURATOR POLYPROLYLENE HERNIA MESH (TOT) FOR URINARY STRESS INCONTINENCE. URUGUAYAN EXPERIENCE IN A UNIVERSITY HOSPITAL
S670
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
Conclusions: The incidence of minor complications during the post-operative period is up to 65.5% and seems to be substantially higher than the overall incidence of complications as reported in the literature. The most common symptom experienced by patients is offensive vaginal discharge, with vaginal pain being the next most common. M431 TRANSOBTURATOR POLYPROLYLENE HERNIA MESH (TOT) FOR URINARY STRESS INCONTINENCE. URUGUAYAN EXPERIENCE IN A UNIVERSITY HOSPITAL 1,2 N. Debat1,2 , M.F. Nozar1,2 , J. Laufer1,2 , S. Bottaro1,2 , F. Gomez ´ , 1,2 1,2 1 D. Vargas , L. Briozzo . Gynecology, School of Medicine. University of the Republic, Montevideo, Uruguay; 2 Obstetric and Gynecology Department A, Pereira Rossell Hospital, Montevideo, Uruguay Objectives: To evaluate the efficacy, safety and complications of TOT procedures for the treatment of female stress urinary incontinence in a university Hospital. Materials: 559 patients who underwent TOT procedure from January 2003 to January 2012 were enrolled in a retrospective observational study. Methods: The procedures were done by gynecologists and gynecology residents in learning process. The technique used was with recyclable needles and a simple polypropylene hernia mesh instead of using commercials kits. Audit was conducted of medical records. The outcomes analyzed were: surgical complications, postoperative hazards procedure’s efficacy, and subjective satisfaction. Results: There was 2 cases of bladder injury and 1 case of urethral injury with the needle (0.5%). 1 patient presented a thigh hematoma. No nervous, neither digestive injury during surgery was registered. There wasn’t postoperatory urinary retention. 3 patients needed to release the mesh for significant urinary residual in the evolution (0.5%). The principal complication was the mesh extrusion that was reported in 2.14% of cases. 78% of the population was asymptomatic or better about the incontinence, and 80% are very satisfied. Conclusions: TOT, with the technical modifications done, is a safe and effective technique, with an acceptable complications rate, for the female urinary stress incontinence treatment in an educational sphere. M432 SINGLE-INCISION MINISLING (AJUST) VS OBTURATOR TENSIONFREE VAGINAL SHORTENED TAPE (TVT-ABBREVO) IN SURGICAL MANAGEMENT OF FEMALE STRESS URINARY INCONTINENCE S. Dati1 , P. Rombola` 2 , S. Cappello2 , E. Piccione2 . 1 Casilino Policlinic Hospital, Urogynecologic Unit, Roma, Italy; 2 Section of Gynecology and Obstetrics, Department of Surgical Sciences, University Tor Vergata, Roma, Italy Objectives: The purpose of our study was to compare the efficacy, safety and complications of Single Incision Mini-Slings (AJUST) procedure with Transobturator Tension-free vaginal shortened tape (TVT-ABBREVO) in the management of female stress urinary incontinence (SUI). Moreover we studied the technical feasibility and clinical outcome of these distinct procedures in association with the urogenital prolapse surgery. Materials: From 2009 till 2011, we unrolled in a randomized trial a total amount of 115 women with urodynamic stress urinary incontinence (SUI) in our hospitals. The population were divided in two group, the first group was made out of 57 patients affected by pelvic organ prolapse (POP ≥2 <3) and the second group consisted in 58 patients without POP or with POP <2. (1) In 27 patients of the first group we implanted AJUST and in the rest 30 patients we implanted TVT-ABBREVO, both in association with POP surgery. (2) 30 patients of the second group we treated only with AJUST and the rest 28 patients only with TVT-ABBREVO.
Methods: The preoperative protocol included: history; urogynaecological examination; POP-Q system; pelvic ultrasound exam; validated questionnaire; cough stress test and a complete urodynamic testing. Exclusion criteria were: recurrence SUI; Q Tip test <1;intrinsic urethral sphincteric deficiency (ISD); stage of POP >3. In the post surgical time, the patients subjective degree of suffering was evaluated by a visual analogue scale (VAS). We made clinical followup at 4 weeks and 6 months later with examination, cough stress test and ICI-Q questionnaire. The statistical analysis of the study was performed using Student’s t-distribution and ANOVA tests. Results: After 6 months, in the first group with concomitant prolapse surgery the cure rate was 88.9% and 90% corresponding to AJUST and TVT-ABBREVO respectively. In the second group we observed a cure rate of 86.7% in the patients treated with AJUST and 89.3% with TVT-ABBREVO. Concerning the post-void residual urine amount, complications and postoperative pain in the both populations, no significant difference in the results was observed. Conclusions: In our experience, the success obtained by single incision minisling (SISM) turned out to be slightly lower than transobturator tape. Moreover there were no significant differences in surgical applicability in the two different populations. M433 OUTCOME OF FIRST LINE VERSUS SECOND LINE MESH SURGERY IN HIGH STAGE PELVIC PROLAPSE M. Giana1 , D. Surico1 , I. Nupieri1 , S. Caccia1 , A. Vigone1 , N. Surico1 . 1 Advanced Gynaecological Oncology Centre, Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy, Azienda Ospedialiero-Universitaria Maggiore Della Carit` a di Novara, Novara, Novara, Italy Objectives: The aim of our study was to assess in first line MESH surgery (de novo POP) and second line MESH surgery (recurrent POP to previous urogynaecological surgery): (1) the efficacy of the Prolift Kit® , in higher stage POP; (2) the rate of recurrency and of new segment prolapse after surgical procedure; (3) late complications at 24 months; (4) surgery outcomes in two groups. Materials: We retrospectively analyzed 118/190 women affected by high degree (de novo or recurrent) pelvic organ prolapse of the anterior and/or middle and/or posterior vaginal wall (stage 3–4 ICS] POP-Q), that are submitted, from August 2005 to May 2011, to TVM procedure (Prolift® ). Methods: We divided the patients in two groups: First line (95/118 patients) and Second line MESH (23/118 patients). All patients were underwent to Gynecare PROLIF® Pelvic Floor Repair Systems (Ethicon, Inc., Somerville, NJ, USA). Follow-up is performed at one, six and twelve months after surgery, then every year. Results: Only 118 patients staged 3 or 4 degree according with POP-Q system were selected for the study, with a minimum followup of 24 months on September 2011. Monocompartmental anterior procedure is more frequent 44/118 than the posterior 12/118. Most of the procedures were total implants with or without concomitant hysteroannessiectomy. Uterine sparing surgery were performed in 31% of the case while 34% of patients underwent to concomitant hysteroannessiectomy. The groups were different in rate of previous hysterectomy and operative time. Except two bladder iniury in group one, we didn’t observe any major intraoperative complications. Early complications consisted in three hematoma. As operative longterm adverse events we observed: mesh exposures in 3% of group I and 4% in group II; mesh shrinkage in 1% of group I, dyspaurenia is reported in 11% of group I and 4% patients of group II, 1 vaginal synechia, 5 prolapse recurrence and 2 persistent perineal pain. Conclusions: The transvaginal use of mesh according to the ProliftTM technique is a safe and efficacy procedure.
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
Conclusions: The incidence of minor complications during the post-operative period is up to 65.5% and seems to be substantially higher than the overall incidence of complications as reported in the literature. The most common symptom experienced by patients is offensive vaginal discharge, with vaginal pain being the next most common. M431 TRANSOBTURATOR POLYPROLYLENE HERNIA MESH (TOT) FOR URINARY STRESS INCONTINENCE. URUGUAYAN EXPERIENCE IN A UNIVERSITY HOSPITAL 1,2 N. Debat1,2 , M.F. Nozar1,2 , J. Laufer1,2 , S. Bottaro1,2 , F. Gomez ´ , 1,2 1,2 1 D. Vargas , L. Briozzo . Gynecology, School of Medicine. University of the Republic, Montevideo, Uruguay; 2 Obstetric and Gynecology Department A, Pereira Rossell Hospital, Montevideo, Uruguay Objectives: To evaluate the efficacy, safety and complications of TOT procedures for the treatment of female stress urinary incontinence in a university Hospital. Materials: 559 patients who underwent TOT procedure from January 2003 to January 2012 were enrolled in a retrospective observational study. Methods: The procedures were done by gynecologists and gynecology residents in learning process. The technique used was with recyclable needles and a simple polypropylene hernia mesh instead of using commercials kits. Audit was conducted of medical records. The outcomes analyzed were: surgical complications, postoperative hazards procedure’s efficacy, and subjective satisfaction. Results: There was 2 cases of bladder injury and 1 case of urethral injury with the needle (0.5%). 1 patient presented a thigh hematoma. No nervous, neither digestive injury during surgery was registered. There wasn’t postoperatory urinary retention. 3 patients needed to release the mesh for significant urinary residual in the evolution (0.5%). The principal complication was the mesh extrusion that was reported in 2.14% of cases. 78% of the population was asymptomatic or better about the incontinence, and 80% are very satisfied. Conclusions: TOT, with the technical modifications done, is a safe and effective technique, with an acceptable complications rate, for the female urinary stress incontinence treatment in an educational sphere. M432 SINGLE-INCISION MINISLING (AJUST) VS OBTURATOR TENSIONFREE VAGINAL SHORTENED TAPE (TVT-ABBREVO) IN SURGICAL MANAGEMENT OF FEMALE STRESS URINARY INCONTINENCE S. Dati1 , P. Rombola` 2 , S. Cappello2 , E. Piccione2 . 1 Casilino Policlinic Hospital, Urogynecologic Unit, Roma, Italy; 2 Section of Gynecology and Obstetrics, Department of Surgical Sciences, University Tor Vergata, Roma, Italy Objectives: The purpose of our study was to compare the efficacy, safety and complications of Single Incision Mini-Slings (AJUST) procedure with Transobturator Tension-free vaginal shortened tape (TVT-ABBREVO) in the management of female stress urinary incontinence (SUI). Moreover we studied the technical feasibility and clinical outcome of these distinct procedures in association with the urogenital prolapse surgery. Materials: From 2009 till 2011, we unrolled in a randomized trial a total amount of 115 women with urodynamic stress urinary incontinence (SUI) in our hospitals. The population were divided in two group, the first group was made out of 57 patients affected by pelvic organ prolapse (POP ≥2 <3) and the second group consisted in 58 patients without POP or with POP <2. (1) In 27 patients of the first group we implanted AJUST and in the rest 30 patients we implanted TVT-ABBREVO, both in association with POP surgery. (2) 30 patients of the second group we treated only with AJUST and the rest 28 patients only with TVT-ABBREVO.
Methods: The preoperative protocol included: history; urogynaecological examination; POP-Q system; pelvic ultrasound exam; validated questionnaire; cough stress test and a complete urodynamic testing. Exclusion criteria were: recurrence SUI; Q Tip test <1;intrinsic urethral sphincteric deficiency (ISD); stage of POP >3. In the post surgical time, the patients subjective degree of suffering was evaluated by a visual analogue scale (VAS). We made clinical followup at 4 weeks and 6 months later with examination, cough stress test and ICI-Q questionnaire. The statistical analysis of the study was performed using Student’s t-distribution and ANOVA tests. Results: After 6 months, in the first group with concomitant prolapse surgery the cure rate was 88.9% and 90% corresponding to AJUST and TVT-ABBREVO respectively. In the second group we observed a cure rate of 86.7% in the patients treated with AJUST and 89.3% with TVT-ABBREVO. Concerning the post-void residual urine amount, complications and postoperative pain in the both populations, no significant difference in the results was observed. Conclusions: In our experience, the success obtained by single incision minisling (SISM) turned out to be slightly lower than transobturator tape. Moreover there were no significant differences in surgical applicability in the two different populations. M433 OUTCOME OF FIRST LINE VERSUS SECOND LINE MESH SURGERY IN HIGH STAGE PELVIC PROLAPSE M. Giana1 , D. Surico1 , I. Nupieri1 , S. Caccia1 , A. Vigone1 , N. Surico1 . 1 Advanced Gynaecological Oncology Centre, Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy, Azienda Ospedialiero-Universitaria Maggiore Della Carit` a di Novara, Novara, Novara, Italy Objectives: The aim of our study was to assess in first line MESH surgery (de novo POP) and second line MESH surgery (recurrent POP to previous urogynaecological surgery): (1) the efficacy of the Prolift Kit® , in higher stage POP; (2) the rate of recurrency and of new segment prolapse after surgical procedure; (3) late complications at 24 months; (4) surgery outcomes in two groups. Materials: We retrospectively analyzed 118/190 women affected by high degree (de novo or recurrent) pelvic organ prolapse of the anterior and/or middle and/or posterior vaginal wall (stage 3–4 ICS] POP-Q), that are submitted, from August 2005 to May 2011, to TVM procedure (Prolift® ). Methods: We divided the patients in two groups: First line (95/118 patients) and Second line MESH (23/118 patients). All patients were underwent to Gynecare PROLIF® Pelvic Floor Repair Systems (Ethicon, Inc., Somerville, NJ, USA). Follow-up is performed at one, six and twelve months after surgery, then every year. Results: Only 118 patients staged 3 or 4 degree according with POP-Q system were selected for the study, with a minimum followup of 24 months on September 2011. Monocompartmental anterior procedure is more frequent 44/118 than the posterior 12/118. Most of the procedures were total implants with or without concomitant hysteroannessiectomy. Uterine sparing surgery were performed in 31% of the case while 34% of patients underwent to concomitant hysteroannessiectomy. The groups were different in rate of previous hysterectomy and operative time. Except two bladder iniury in group one, we didn’t observe any major intraoperative complications. Early complications consisted in three hematoma. As operative longterm adverse events we observed: mesh exposures in 3% of group I and 4% in group II; mesh shrinkage in 1% of group I, dyspaurenia is reported in 11% of group I and 4% patients of group II, 1 vaginal synechia, 5 prolapse recurrence and 2 persistent perineal pain. Conclusions: The transvaginal use of mesh according to the ProliftTM technique is a safe and efficacy procedure.