[Show abstract][Hide abstract] ABSTRACT: Introduction. This study is a comparative evaluation of the TVT, TOT, and our own modification of TOT (mTOT) in the treatment of female stress urinary incontinence from a single center experience. Material and Methods. The study was conducted on 527 patients with SUI diagnosed on the basis of urodynamic studies. They were divided into three groups-TVT: n = 142, (TOT): n = 129, and mTOT: n = 256. All of the patients underwent evaluation at 1, 3, and 6 months after surgery. Results were statistically analysed and compared. Results. Objective and subjective effectiveness after the surgery were not significantly different in the study groups and ranged from 90.1% to 96.4%. Mean surgery time was 32.3, 28.2, and 26.4 in the TVT, TOT, and mTOT, respectively. Mean hospitalization time was 2.51 days. Mean catheter maintenance time was significantly higher in the TVT than in other groups. In the TVT group total incidence of complications was 13.4%, and it was significantly higher than that in TOT and mTOT (9.3% and 8.6%, resp.). Conclusions. TVT, TOT, and mTOT are highly effective and safe methods in the treatment of SUI. There are no differences in the efficacy between the methods with a little higher percentage of complications in the TVT group.
BioMed research international. 01/2014; 2014:347856.
[Show abstract][Hide abstract] ABSTRACT: : To estimate whether levator ani deficiency severity is a predictor of clinically significant pelvic organ prolapse (POP) and to determine whether there is a levator ani deficiency threshold above which POP occurs.
: Two-hundred twenty three-dimensional ultrasound scans performed on urogynecologic clinic patients were reviewed, and each levator ani muscle subdivision was individually scored (0=no defect, 1=50% or less defect, 2=more than 50% defect, 3=total absence of the muscle) on each side. A levator ani deficiency score was calculated and categorized as mild (score 0-6), moderate (score 7-12), and severe (score more than 13). Clinically significant prolapse was defined as stage 2 or higher.
: The mean age was 56.50 (standard deviation ±15.58) and median parity was 2 (range 0-6). A mild positive correlation was demonstrated between levator ani deficiency category and prolapse stage (rs=0.44; P<.001). Score distribution significantly differed by prolapse stage (P<.001). No patients with stage 3 prolapse had a levator ani score less than 6, and no patients with stage 4 prolapse had a levator ani score less than 9. In patients with prolapse, those with moderate levator ani deficiency had 3.2 times the odds of POP compared with patients with a minimal defect; those with severe levator ani deficiency had 6.4 times the odds of prolapse than those with minimal deficiency.
: Levator ani deficiency severity is associated with clinically significant prolapse.
Obstetrics and Gynecology 05/2013; 121(5):1017-24. · 4.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Este artículo tiene como objetivo primordial analizar y recomendar diez factores fundamentales en la obtención de mejores resultados a corto, mediano y largo plazo en el enfoque terapéutico médico-quirúrgico de mujeres con incontinencia urinaria de esfuerzo (IOE). Nos basamos en la casuística de mujeres con incontinencia urinaria en un rango de 18 a 70 años de edad que en total fueron aproximadamente 1.200 mujeres, recolectadas en 19 años de ejercicio médico hospitalario y privado. Desde ese entonces hemos hecho un enfoque terapéutico que nunca estuvo sujeto a una sola modalidad de tratamiento sino enfocando todos los posibles factores que mejoraran los resultados finales (estar "secas" o "bastante menos mojadas" que antes del tratamiento), por supuesto al principio éramos más quirúrgicos y en la medida que íbamos adentrándonos en el seguimiento de las pacientes y profundizando en la fisiopatología de la incontinencia urinaria en la mujer y en el conocimento del piso pélvico muscular, fuimos obteniendo el enfoque que estaremos recomendando en ésta comunicación.
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