Complicaciones del tratamiento de incontinencia urinaria y prolapso de la pelvis

ResumenEste artículo tiene como objetivo proporcionar una visión general de las complicaciones asociadas al tratamiento quirúrgico por incontinencia urinaria y prolapso pélvico relacionado con el uso de mallas quirúrgicas. Asimismo, otro de sus objetivos es revisar la nueva clasificación de complicaciones relacionadas con la inserción de prótesis o injertos en la cirugía de piso pélvico femenino otorgada por la Asociación Uroginecológica Internacional (IUGA, por su sigla en inglés) / Sociedad de Continencia Internacional (ICS, por su sigla en inglés) y por las recientes notificaciones proporcionadas por la Administración de Medicamentos y Alimentación (FDA, por su sigla en inglés)

Complications of treatment of urinary incontinence and pelvic organ prolapse

This review aims to provide an overview of complications associated with surgical treatment for urinary incontinence and pelvic organ prolapse relating to synthetic mesh, as well as review the new International Urogynecologic Association (IUGA)/ International Continence Society (ICS) classification of complications for insertion of prosthesis or grafts in female pelvic floor surgery and the recent Food and Drug Administration (FDA) notifications

Macroplastique outcome in women with stress urinary incontinence secondary to intrinsic sphincteric deficiency

Objectives: To evaluate short-term outcomes of Macroplastique (MPQ) in women with stress urinary incontinence (SUI) using patient reported outcome and three-dimensional vaginal ultrasound (3DUS). Materials and methods: After obtaining institutional review board approval, a chart review of non-neurogenic women that received MPQ for intrinsic sphincter deficiency (ISD) was extracted from a prospective database. Patients were divided into three groups: naïve (Group I), prior incontinence surgery (Group II), and both prior incontinence surgery and bulking agent (Group III). Women with urethral hypermobility were excluded. Baseline evaluation included a history, physical examination to confirm SUI, and questionnaires [Urinary Distress Inventory-6 (UDI-6), 1 quality of life (QOL) global score based on visual analog scale], and in select patients urodynamic studies and/or standing voiding cystogram. Patient follow up included repeat questionnaires scores and 3DUS to objectively assess MPQ volume. Success was defined as sufficient improvement after one injection so that a subsequent reinjection/different SUI operation was not requested at the last follow-up visit. It was hypothesized that Group I would fare best. Results: Fifty-nine women met the inclusion criteria. Success rate was 83% for Group I, 70% for Group II, and 69% for Group III (p = 0.54) at 9 months mean follow up. Fifteen patients underwent a second 3DUS during follow up with a stable volume, compared to the first study (4.5 ± 1.5 vs. 4.4 ± 1.5, p = 0.70), which confirmed stable volumes over time. Among the failures (N = 15), nine patients proceeded with reinjection; four patients had fascial slings, and two patients had artificial sphincters. Conclusion: As confirmed by 3DUS, Macroplastique appears efficacious as a primary treatment and as a salvage treatment for SUI due to ISD in the short-term

Do catheter washouts extend patency time in long-term indwelling urethral catheters? A randomized controlled trial of acidic washout solution, normal saline washout, or standard care.

AB PURPOSE Blockage of long-term indwelling catheters with mineral deposit is an ongoing management issue, but evidence on optimal management is lacking. Our purpose was to examine whether catheter washouts prevent or reduce catheter blockage. DESIGN A multisite randomized controlled trial. SUBJECTS AND SETTING Adults with long-term indwelling catheters that required changing every 3 weeks or less, living in the community, and requiring supportive or continuing care were recruited. Participants were randomly assigned to 1 of 3 groups: control (usual care, no washout), saline washout, or commercially available acidic washout solution (Contisol Maelor Pharmaceuticals Ltd, Wrexham, UK). METHODS At baseline visit, the catheter was changed and participants were followed weekly for 8 weeks, with checks for catheter patency and urine pH. Participants randomized to saline or commercial solution had a weekly washout with the appropriate solution. Endpoints were 8 weeks (completion data), 3 or more catheter changes in the 8-week period, or symptomatic urinary tract infection (UTI) requiring antibiotics. The study hypothesis was that catheter life would be extended by 25% in the commercial solution group. It was not possible to blind participants or research nurses to washout versus no intervention, but participants in the saline and washout solution groups were blinded to solution type. RESULTS One hundred twelve potential participants were screened; 73 were enrolled, randomized, and included in the final analysis. Of these, 53 completed the full 8 weeks of data collection; 16 terminated early because of 3 catheter changes or self-reported 'UTI'. Other reasons for termination were hematuria, latex sensitivity, deceased/severe illness, or personal choice. Analysis of variance was used to analyze mean differences on demographic variables and mean number of weeks in study. Kaplan-Meier survival curve analysis showed no statistical difference between the groups in time to first catheter change. CONCLUSION At this time, the evidence is insufficient to state whether catheter washout with saline or Contisol is more effective than usual care with no washout in preventing blocking. No increased risk of UTI was associated with washout regime