Minimally invasive suburethral endoprosthesis for stress urinary

Minimally invasive suburethral endoprosthesis for stress urinary

CLINICAL CASE
Minimally invasive suburethral
endoprosthesis for stress urinary
incontinence treatment: a new method
De León-Jaén SC, Sierra-Mendoza JM, Vásquez-Delgado L, Martínez-Castro MA, Cortés-Gudiño FJ, OrozcoBravo A.
•ABSTRACT
•RESUMEN
Objective: The objective of the present study was
to make a short-term evaluation of a new treatment
method for stress urinary incontinence (SUI) caused by
intrinsic sphincter deficiency.
Objetivo: Valorar a corto plazo un nuevo método para
tratar la incontinencia urinaria de esfuerzo debida a deficiencia intrínseca del esfínter.
Materials and methods: A 2 x 8 cm polypropylene
monofilament suburethral endoprosthesis was placed in
three female patients. Mean patient age was 59.7 years
(41-87 year range) and mean BMI was 30.2 Kg/m2
(19-40Kg/m2 range). All women had been diagnosed
with SUI by means of urodynamic study. None had
undergone previous surgery and they all completed a
symptoms questionnaire. At 12-weeks patient follow-up
included urodynamics, physical examination and repeat
questionnaire application.
Material y métodos: Se estudió a tres pacientes de 59.7
años en promedio (41 a 87) con un IMC de 30.2 kg/m2
(19 a 40) con diagnóstico de incontinencia urinaria de
esfuerzo valorada con estudio urodinámico, sin operación previa, y que llenaron un cuestionario de síntomas;
a éstas se les colocó una endoprótesis de polipropileno
de monofilamento de 2 x 8 cm en un plano suburetral.
Se obtuvo una media de seguimiento de 12 semanas (tres
meses), con urodinamia, nuevo cuestionario y examen
físico.
Results: There were good postoperative results in the
three patients. Surgery duration was 7-17 minutes. Two
of the patients are now continent and one has improved
symptomatology. None of the three presented with urine
retention, hematoma or bladder injury.
Resultados: Las tres pacientes tuvieron buenos resultados posoperatorios con un tiempo operatorio de
siete a 17 minutos; dos de las pacientes se encuentran
continentes y una muestra mejoría sintomática; ninguna presentó retención de orina ni hematomas o lesión
vesical.
Conclusions: Suburethral endoprosthesis is a safe
method that modifies the transobturator system. The
present study is a preliminary one that showed initial
effectiveness but the authors are aware that further
studies, a greater number of patients and a longer
Conclusión: La endoprótesis suburetral media es un
método seguro que modifica al sistema transobturador.
Este estudio preliminar demuestra su efectividad inicial,
pero se requieren más tiempo y estudios y mayor número
de pacientes para corroborar su beneficio clínico.
Faculty of Medicine, Universidad Autónoma de Guadalajara, Mexico.
Corresponding author: Dr. Silvardo C de León Jaén. Hospital Universitario Dr. Ángel Leaño. Universidad Autónoma de Guadalajara.
Guadalajara, Jal. México. Av. Dr. Ángel Leaño No. 500. Los Pobles,
45200 Zapopan Jalisco, México. Telephone: (01) 33 3834 3464 /
3648 8484 Ext. 31687. E mal: [email protected]
Rev Mex Urol 2009;69(6):289-291
289
De León-Jaén SC, et al Minimally invasive suburethral endoprosthesis for stress urinary incontinence treatment: a new method
follow-up period are necessary in order to corroborate
clinical benefit.
Palabras clave: incontinencia urinaria, endoprótesis,
México.
Key words: urinary incontinence, endoprosthesis.
•INTRODUCTION
Today surgical treatment of stress urinary incontinence
(SUI) is a challenge for the surgeon since there
are many procedures for its management.1 More and
more, minimally invasive procedures are acquiring
greater importance due to reduced morbidity which
makes them more attractive to patients.2 The objective of
the present article is to give a short-term evaluation and
description of a new treatment method for stress urinary
incontinence due to intrinsic sphincter deficiency (ISD)
using a monofilament polypropylene endoprosthesis
modified at the authors’ service and put in place with
local anesthesia.
Image 1. Application of local anesthesia: 5 mL of lidocaine at 2%
•MATERIALS AND METHODS
A descriptive study was carried out on three female
patients with clinical and urodynamic SUI diagnoses who
underwent placement of suburethral endoprosthesis
with modified vaginal approach.
Mean age of the patients was 59.7 years (41-87 year
range). All patients were diagnosed with ISD and none
had undergone previous anti-incontinence surgery.
Procedure description: Patient was placed in
the modified dorsal lithotomy position and received
application of 5 mL periurethral simple lidocaine
(Image 1). A 2 cm vertical incision 1.5 cm from
the urethral meatus was made and continued bilaterally
to the endopelvic fascia taking care not to injure it
(Image 2). A 2.5 cm wide and 10 cm long macropore
monofilament polypropylene mesh (Images 3 and 4)
was applied with a curved Kelly tweezer (Image 5).
The U-shaped mesh was introduced around the urethra
toward both sides of the obturator hole (Images 6A
and B). It was vaginally sutured with 2-0 absorbable
chromic catgut (Image 7) leaving a free-draining Foley
catheter in place for 12 hours.
Image 2. 2 cm long incision located 1.5 cm from the urethral meatus
•RESULTS
Procedure results were good and intraoperative time
was from 7-17 minutes. At present two of the patients
are continent and one has had noticeable improvement.
None of the patients presented with urinary retention,
urethral injury or hematoma.
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Rev Mex Urol 2009;69(6):289-291
Image 3. Monofilament polypropylene mesh
De León-Jaén SC, et al Minimally invasive suburethral endoprosthesis for stress urinary incontinence treatment: a new method
•DISCUSSION
Ulmsten and Petros’ integral theory that pubourethral
ligaments are the most important support for urinary
continence gave rise to the development of suburethral
slings using meshes of polypropylene and other materials
used to reinforce periurethral ligaments. 3,4-6
Tension-free vaginal tape has been placed since
1996 with suprapubic approaches such as TVT (6),
SPARC and then ObTAPE.6-9 Transobturator techniques
have undergone modifications with the introduction of
MiniArc® and recently with TVT® Secur.
Image 4. 2.5cm x 10 cm cut polypropylene mesh
The authors performed out-patient surgery using a
modified technique. Mesh sheets were cut and applied
easily with ambulatory local anesthesia resulting in low
cost for the patient.
•CONCLUSIONS
Mid suburethral endoprosthesis is a safe method
that modifies the transobturator system. The present
preliminary trial demonstrates the procedure’s initial
effectiveness but more studies with a larger number of
patients and longer follow-up are required to confirm its
clinical benefit.
Image 5. Bilateral dissection up to the endopelvic fascia
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A
B
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6.
Imáges 6A y B. Bilateral placement of the 2 cm x 10cm polypropylene
endoprosthesis in the mid-urethra
7.
8.
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Image 7. 2-0 absorbable suture application
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