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Annual meeting of the International Continence

Annual meeting of the International Continence Society (ICS) and International Urogynecological Association (IUGA) 23-27 August, 2010,Toronto,Canada. Schierlitz L, Dwyer P, Rosamilia A, Murray C, Thomas E, Fitzgerald E, Hiscock R, De Souza A

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Annual meeting of the International Continence

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  1. Annual meeting of the International Continence Society (ICS) and International Urogynecological Association (IUGA) 23-27 August, 2010,Toronto,Canada.

  2. Schierlitz L, Dwyer P, Rosamilia A, Murray C, Thomas E, Fitzgerald E, Hiscock R, De Souza A Mercy Hospital for Women, Australia, Monash Medical Centre, Australia A RANDOMIZED CONTROLLED STUDY TO COMPARE TENSION FREE VAGINAL TAPE (TVT) AND MONARC TRANS-OBTURATOR TAPE IN THE TREATMENT OF WOMEN WITH URODYNAMIC STRESS INCONTINENCE (USI) AND INTRINSIC SPHINCTER DEFICIENCY (ISD): THE THREE YEAR FOLLOW UP. • Prospectivo, Randomizado • IOE + ISD ( LPP < 60 / UCP < 20 cm H2O ) • Outcome primario: Necesidad de reoperación

  3. A RANDOMIZED CONTROLLED STUDY TO COMPARE TENSION FREE VAGINAL TAPE (TVT) AND MONARC TRANS-OBTURATOR TAPE IN THE TREATMENT OF WOMEN WITH URODYNAMIC STRESS INCONTINENCE (USI) AND INTRINSIC SPHINCTER DEFICIENCY (ISD): THE THREE YEAR FOLLOW UP. • 162 Pacientes , 82 por rama • Seguimiento promedio 37 meses (23,3 - 47,9) • Outcome primario: TVT 1,2% (1/82) vs Monarc 18,3% (15/82) • R.R. de falla 1,2 para Monarc • Tiempo medio a reoperación 15,6 vs 43,7 meses • Sin diferencias significativas en encuestas

  4. CONCLUSIONES A RANDOMIZED CONTROLLED STUDY TO COMPARE TENSION FREE VAGINAL TAPE (TVT) AND MONARC TRANS-OBTURATOR TAPE IN THE TREATMENT OF WOMEN WITH URODYNAMIC STRESS INCONTINENCE (USI) AND INTRINSIC SPHINCTER DEFICIENCY (ISD): THE THREE YEAR FOLLOW UP. • NNT 6 • Las pacientes con IOE + ISD tienen menor riesgo de requerir una nueva cirugía anti incontinencia de esfuerzo si se les realiza un TVT vs. Monarc • TVT es la técnica de elección en IOE + ISD

  5. RE-ANALYSIS OF A RANDOMIZED TRIAL OF THREE METHODS OF ANTERIOR COLPORRHAPHY USING MORE CLINICALLY RELEVANT DEFINITIONS OF SUCCESS Chmielewski L, Walters M, Weber A, Barber M Cleveland Clinic • Weber , et al 2001 reportan tasas de éxito de un 30% al 47% plastías anteriores • Éxito definido como Ba < -2 • Población general 35% estadio 2 • 98% de las pacientes con prolapso hasta el introito es asintomática

  6. NUEVOS CRITERIOS DE ÉXITO RE-ANALYSIS OF A RANDOMIZED TRIAL OF THREE METHODS OF ANTERIOR COLPORRHAPHY USING MORE CLINICALLY RELEVANT DEFINITIONS OF SUCCESS • Ausencia de síntomas de tumor genital • Prolapso no sobrepase el introito • No reoperación

  7. RE-ANALYSIS OF A RANDOMIZED TRIAL OF THREE METHODS OF ANTERIOR COLPORRHAPHY USING MORE CLINICALLY RELEVANT DEFINITIONS OF SUCCESS • 114 pacientes operadas entre Junio 1996 y Mayo 1999 • Randomizadas: 38 PA / 38 Paravaginal / 38 PA + Vycril • POP-Q y Encuestas 0, 6, 12 y 24 meses

  8. RE-ANALYSIS OF A RANDOMIZED TRIAL OF THREE METHODS OF ANTERIOR COLPORRHAPHY USING MORE CLINICALLY RELEVANT DEFINITIONS OF SUCCESS • No hay Diferencia en los score promedio del POP-Q • Ba promedio en -1 • 90% no tiene prolapso >0 • 95 % asintomaticas • 1% reoperaciones a los 29 meses

  9. RE-ANALYSIS OF A RANDOMIZED TRIAL OF THREE METHODS OF ANTERIOR COLPORRHAPHY USING MORE CLINICALLY RELEVANT DEFINITIONS OF SUCCESS • La tasa de éxito de la plastía anterior depende del criterio utilizado; utilizando un criterio anatómico estricto es mala. • Usando criterios contemporáneos y clínicamente relevantes, el éxito de la plastía anterior es considerablemente mejor con sólo un 10% de recidiva más allá del introito, 5% de recurrencia sintomática y sin pacientes que requieran reintervenciones al año de seguimiento

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