Evaluation of Treatment Outcomes in Stress Incontinence in Women Using TVT-O Method

Yu.P. Sernyak, O.I. Lytvinov, O.S. Fukszon, P.Yu. Sernyak

Abstract


According to the European and American statistics, from 10 to 70 % of the female population aged 40–60 years reported symptoms of involuntary urination. Diagnosis and treatment of various forms of urinary incontinence is a major problem of urogynecology. Particular difficulties arise in case of urinary incontinence conjunction with genital prolapse, which according to some authors is reached 47.3 %.
The aim of the study was to find out how untreated genital prolapse worsens outcomes of operative treatment of stress incontinence.
We analyzed treatment outcomes of 112 women with stress incontinence in combination with and without genital prolapse using TVT-O. Criteria for a positive result of operation were: no evidence of recurrence of the underlying disease (urinary incontinence) and restoration of adequate urination. All surveyed patients were divided into 2 groups: 76 women without genital prolapse and 36 women with it.
Statistical analysis of the data was performed on a personal computer using the software package Word and Excel. Data are presented as proportions and averages. We used Student’s test and χ2. Differences were considered reliable when p < 0.05.
The frequency of complications in group 2 was higher than in group 1. In group one, which included 76 patients, various complications occurred in 13 cases (17.11 %). In group 2 complication rate reached 66.67 % (24 cases in 36 patients) (p < 0.05), but in terms of 1 patient in 55.56 % (20 women out of 36) (p < 0.05).
Bladder perforations encountered in 8.33 % of women with prolapse, and absent in women without one (p = 0.05). Hematoma of different locations in the postoperative period were observed more frequently in group 2 (5.5 % compared to 2.63 %) (p > 0.05). Bleeding more than 200 ml from venous plexus were registered in 1 (1.3 %) patient of the first group, and in 1(2.7 %) of the second group (p > 0.05). Groups also did not differ in frequency of occurrence of wound infection (2.63 and 2.77 %, respectively) (p > 0.05). Loop erosion with protrusion into the vagina or bladder occurred in 4 (11.11 %) patients in group 2 and were not observed in group 1 (p = 0.016). Hyperactive bladder de novo after surgery occurred in 6 women with genital prolapse (16.67 %), whereas in the group without prolapse there were only 2 (2.63 %) (p < 0.05). In 6 of 8 patients with intravesical obstruction in the postoperative period detrusor hyperactivity developed, which was absent before surgery.
Obstructive voiding was observed in the 2 groups in 4.22 times more frequently than in the 1st (5.26 and 22.22 %, respectively) (p < 0.05). Relapse of stress incontinence though recorded in 2.11 times more likely in women with prolapse, but this difference was not significant (2.63 and 5.55 %) (p > 0.05).
The study showed that the presence of genital prolapse worsens the results of surgical treatment of stress incontinence: reduced efficiency of correction almost 15 % (from 94.73 to 80.56 %) and 38.45 % increase of the number of complications (from 17.11 to 55.56 %).


Keywords


urinary incontinence; genital prolapse; sling surgery

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DOI: https://doi.org/10.22141/1997-2938.2.25.2014.83095

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