A retrospective comparison of various stress urinary incontinence surgery with there outcome in a tertiary care teaching institute

Abstract

Stress urinary incontinence is defined as the involuntary loss of urine through the intact urethra caused by a sudden increase in intraabdominal pressure on coughing, walking and in some cases during turning in bed. It is the most common type of urinary incontinence in woman and when it is of sufficient quantity causes a great embarrassment which was frequently underreported UI impairs quality of life, affecting the older person's emotional well-being, social function, and general health. Incontinent persons often manage to maintain their activities, but with an increased burden of coping, embarrassment, and poor self-perception. Caregiver burden is higher with incontinent older persons. This was a hospital based retrospective study in the department of Gynecolog at kem hospital mumbai India. Total duration of study from enrollment to completion was 2 years. Each patient was followed for 6 month In the present study the patient presenting to gynecology OPD of k. e. m. hospital with complaint of urinary incontinence were studied. A total 50. patient were included in following study. Working definition was used for classification. History was documented including Age, occupation, severity, duration and frequency of SUI, other menstrual history, urinary symptoms, detail obstetric history, parity, gynecological procedure, pelvic floor trauma, previous urinary tract infection, previous surgeries. trauma in childhood, any spinal surgery, or drugs. A focused physical examination was performed. Lastly stress incontinence was clinically confirmed by “ Bonneys test “. Anal sphincter tone ad sensation at S dermatomes are checked to rule out any neurological lesion. The data were analyzed using appropriate statistical tool. A total no patient enrolled was 50 during the study period. Majority of the patients fall in the range of 30-50 year of age. Most of the patient having duration of symptoms less than 2 year with more common SUI in multiparty patient, about 60% of patient were having SUI without any previous surgery, 62% of SUI was associated with prolapsed with cystorectocele. In I ntraoperative complication only one patient having bladder perforation in TVT procedure. In post operative complication urinary retention was found 30% in kellys placation, 20% in stameys, 20% in TVT, 00% in TOT. However only kellys plication has more recurrence of SUI in about 33%, 12.5% of recurrence in TVT and 8.3% in TOT of patient. As in stameys the number of follow up patient was only two and none of them had recurrence of sui. This study is concluded that, since the symptoms of SUI are not life threatening and most of the female are less health conscious the medical help is not sought for longer duration. In the study TOT procedure was found superior with respect long term failure rate and also intra and post operative complication