Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en nuestro medio: análisis de resultados

Abstract

Introduction and objectiveSurgical repair is the most effective option for the treatment of stress urinary incontinence (SUI) between the different therapeutical options availables at present. The main objective of our study is to compair the outcome of the different techniques employed in the treatment of SUI in our setting. MethodWe have performed a retrospective analysis of the patients who underwent surgical intervention for SUI between 1991 to 1999 (213 surgical interventions in 194 patients) clustering the surgical procedures into three groups: abdominal, abdomino-vaginal, and sling procedures. The results of the treatment were defined as follows: total continence, significant improvement and insufficient improvement. Comparison of continence rates was performed with χ2 test and Fisher’s exact test. Association between qualitative variables was also evaluated by means of χ2 test. Multivariate analysis of predictive factors was performed with a Cox model. The outcome was also evaluated by Kaplan-Meier’s curves, and comparisons made with log-rank test. Statistical significance level was established for p< 0.05. ResultsGlobal cure rate at 24 months was 54.5% (116 patients). Significant improvement was observed in 33 patients (15.5%), and insufficient improvement was seen in 64 patients (30%). The most frequent postoperative complications were suprapubic pain (33%), acute urinary retention (26%), significant postvoiding residual urine (24%) and wound seroma or infection (20%). None of the analyzed factors (age, weight, number of births, preoperative pads, postoperative acute urinary retention, and need for postoperative bladder clean intermitent catheterization were independient predictive factors for postoperative continence. The actuarial analysis with Kaplan-Meier curves shows no statistical differences between the studied techniques (log rank p=0.41). Sling techniques presented with a superior rate of most postoperative complications. ConclusionsThe cure rate of our serie was 54.5% at 24 months, with a 70% of clinically satisfactory responses. With regard to continence status, it seems that there is not a better surgical technique in our hands, presenting sling techniques with a higher rate of postoperative complications. We could not find no pre o postoperative independient factors as predictors of postoperative continence.