جستجوی مقالات مرتبط با کلیدواژه « anti-incontinence surgery » در نشریات گروه « پزشکی »

Urinary incontinence (UI) may be associated with symptoms of overactive bladder (OAB) that may persist after anti-incontinence surgery.

The present study was performed to evaluate the effect of prolapse and anti-incontinence reconstructive surgery in women who had the symptoms of OAB and UI at the same time.

This descriptive cross-sectional study was performed on 56 women with OAB symptoms and stress UI (SUI)/urgency UI (UUI) with or without prolapse who were candidates for restorative and anti-incontinence surgery. At baseline, urinary symptoms, including urinary frequency, nocturia, SUI, and UUI, were recorded. Patients who finally underwent vaginal reconstructive surgery with anti-incontinence surgery were assessed for urinary symptoms six months after the operation.

A total of 28 patients underwent transobturator tape (TOT) surgery, of whom 23 patients were subjected to other anti-incontinence surgeries and 5 patients underwent restorative surgeries. There was no significant difference between the two groups (TOT and others) in terms of age, body mass index, number of deliveries, history of medical problems, and history of surgery or cesarean section. The urinary frequency and nocturia before surgery were observed in 46 (82%) and 20 (36%) patients, respectively, which were not significantly different between the two groups. Before the study, occult UI was observed in 2 patients (4%), UUI in 3 patients (5%), SUI in 18 patients (32%), and mixed UI in 33 patients (59%). Nocturia was completely improved in all 20 patients. Urinary frequency was partially or completely improved in 41 patients (89%), which was not significantly different between the two groups (P=0.051). Overall, 53 patients (95%) had partial or complete improvement in UI, which was not significantly different between the two groups (P=0.058). Both patients with occult UI and all three patients with UUI were completely improved. Sixteen out of 18 patients (89%) with SUI were completely improved and the other 2 patients were partially improved. Thirty patients (91%) with mixed UI had a complete or partial recovery that was not significantly different between the two groups (P=0.137).

The findings of the present study showed that six months after anti-incontinence or reconstructive surgery, nocturia in all patients and urinary frequency in 89% of patients improved partially or completely. Various forms of UI partially or completely improved in 95% of patients, as well.

Significant post-prostatectomy incontinence (PPI) is a crippling condition and managed best through sling or artificial urinary sphincter (AUS) implantation. These procedures are often associated with complications requiring surgical intervention. The aim of our retrospective study was to evaluate the occurrence of major compli-cations and identify risk factors.

Between 2010 and 2018 ninety-one patients have been implanted with sling (22; 24.2%) or AUS (69; 75.8%) in our department. The cases where surgical revision was needed were examined regarding the etiology (mechanical failure (MF), urethral erosion (UE), urethral atrophy (UA), surgical site infection (SSI), combined reasons (COMB) and analyzed, using 16 possible perioperative risk factors.

Surgical intervention was carried out by 19 / 91 (20.9%) patients. (In 16 / 69 cases after AUS (23.1%), 3 / 13 after slings (23%)). The indication was in 6 (31.6%) cases MF, in 3 (15.8 %) COMB, in 4 (21.1%) UE, in 5 (26.3 %) SSI, in 1 (5.2%) UA. The type of reoperation was either explantation (12 / 19), system replacement (6 / 19), or cuff replacement (1 /19). Regarding the surgical intervention requiring complications only preoperative bacteriuria (P = .006) and postoperative surgical site oedema (P = .002) proved to be independent predictive factors.

Preoperative bacteriuria and surgical site oedema seemed to be good predictors for obligate surgical revision. Patients with AUS were more prone to have major complications. In most cases it was mechanical failure, infection or erosion. By reducing the frequency of these risk factors we might be able to decrease the amount of complications.

To evaluate long term outcomes of autologous pubovaginal fascial sling (AFPVS) as a salvage procedure following different types of failed anti-incontinence surgeries. We retrospectively reviewed medical records of patients who had undergone salvage AFPVS after any kind of anti-incontinence surgery from 2005-2015 at our medical center. Patients were contacted by telephone. Revised Urinary Incontinence Scale (RUIS) was used to determine the success rate. A total of 40 patients out of 51 were successfully contacted. Mean patient age was 50.8 ± 9.8 years (range30-75) and mean follow up was 62.6 ± 32.4 months (range12-120). Of 40 patients, 14(35%) had pure SUI and 26(65%) complained of mixed urinary incontinence. A total of 15(37.5%) patients had a failed Burch colposuspention, 5(12.5%) TVT, 8(20%) TOT, 3 (7.5%) AFPVS and five (12.5%) patients had history of failed mini-sling procedure. Four (10%) patients had undergone more than one anti incontinence surgeries. Overall success rate was 65% in our study. New onset urge urinary incontinence was detected in 25% of patient which was negatively associated with satisfaction and recommendation. There was no statistically significant correlation between mixed urinary incontinence, type or number of previous failed surgeries with success however presence of pure SUI had a strong Autologous pubovaginal fascial sling might be considered as a safe and efficacious salvage surgical option following failed midurethral slings, Burch colposuspention and even AFPVS itself. It will provide reasonable long term results with no major complications.