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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2004 March;56(1):89-98

language: English, Italian

Tension-free transobturator approach for female stress urinary incontinence

Cindolo L. 1, Salzano L. 1, Rota G. 2, Bellini S. 3, D’Afiero A. 3

1 Urol­o­gy ­Unit, “G. Rum­mo” Hos­pi­tal, Ben­e­ven­to, Ita­ly
2 Divi­sion of Gyne­col­o­gy-Obstet­rics “S. Gio­van­ni di Dio” Hos­pi­tal, Frat­ta­mag­giore ­(Naples), Ita­ly
3 Urol­o­gy Sec­tion, “S. ­Maria del­la ­Pietà” Casor­ia (­Naples), Ita­ly


Aim. Ura­Tape is a new ­sling for ­female ­stress uri­nary incon­ti­nence (SUI) insert­ed via a trans­ob­tu­ra­tor per­cut­ane­ous ­approach. We ­report the safe­ty, fea­sibil­ity and ­short-­term ­results of ­this new sur­gi­cal pro­ce­dure.
Met­hods. Ura­Tape® (­Porgès-Men­tor) is a non-elas­tic poly­pro­py­lene ­tape, ­with a sil­i­cone coat­ed cen­tral ­part. The ­sling is ­placed ten­sion-­free ­under the mid-ure­thra and extend­ed ­through the obtu­ra­tor fora­men bypass­ing the pos­te­ri­or ­face of the ischi­o­pu­bic ­ramus. ­From Sep­tem­ber 2002 to May 2003, 80 ­females affect­ed by SUI asso­ciat­ed ­with ure­thral hyper­mo­bil­ity and with­out ­severe uro-gen­i­tal pro­lapse (­with cys­to­cele 1st ­grade) ­received Ura­Tape. ­Mean age was 56 (39-79) years. Six­ty-two out of 80 had a pos­i­tive Q tip ­test; 16/80 had recur­rent incon­ti­nence ­after ­Burch or col­po­plas­ty accord­ing to Kel­ly; 22/60 had ­mixed incon­ti­nence. Pre­op­er­a­tive eval­u­a­tions includ­ed: com­plete his­to­ry and phys­i­cal exam­ina­tion, uri­nal­y­sis, urod­y­nam­ic inves­ti­ga­tions, abdom­i­nal and pel­vic ultra­sound. Qual­ity of ­life assess­ment was car­ried out pre- and ­postoper­a­tive­ly.
­Results. ­Mean oper­a­tive ­time was 16 (11-36) min­utes. No ­major ­intraoper­a­tive com­pli­ca­tions ­were ­observed. One blad­der ­neck lac­er­a­tion ­occurred and was treat­ed intra­op­er­a­tive­ly. No cys­tos­co­py was per­formed. ­Mean hos­pi­tal postoperative ­stay ­time was 1.1 ­(1-6) days. All ­patients ­were exam­ined peri­od­i­cal­ly at 7, 30 and 90 ­days ­from inter­ven­tion (­mean fol­low-up 4 ­months, 1-8). ­There was no ure­thral ero­sion. One vag­i­nal ero­sion ­with ingui­nal ­abscess was diag­nosed and treat­ed with­out remov­ing the ­sling. Two de ­novo ­urge incon­ti­nence was ­observed. The objec­tive and sub­jec­tive ­cure ­rates ­were 92% and 97%; 96% ­expressed ­good qual­ity of ­life (sat­is­fied/very sat­is­fied).
Con­clu­sion. ­This pro­ce­dure is a ­safe, effec­tive new tech­nique for the treat­ment of ­female SUI. The ­easy tech­nique, the ­short learn­ing ­curve and the ­very ­high ­grade of sat­is­fac­tion of the ­patients ­show ­that ­this ­approach is ­based ­upon effec­tive ana­tom­i­cal and phys­io­log­i­cal cri­te­ria. Fur­ther fol­low-up is nec­es­sary in ­order to eval­u­ate urod­y­nam­ic chang­es and over­all sat­is­fac­tion.

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