Estudo comparativo entre mini-sling e sling transobturatório no tratamento da incontinência urinária de esforço: três anos de seguimento

• Autor(a) principal: Pascom, Ana Livia Garcia [UNIFESP]
• Data de Publicação: 2018
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6419010; https://repositorio.unifesp.br/handle/11600/52701
• topic: Incontinência urinária; Sling de uretra média; Mini sling; Miduretharl sling

Background: Midurethral slings are the "gold-standard" treatment for female urinary incontinence, however major complications are still described. The mini-slings were developed in an attempt to shorten these risks although the role of these devices in female stress incontinence management is still not elucidated. Objective: To compare efficacy and safety of mini-sling and transobturator sling for female stress urinary incontinence after 36 months follow-up. Study Design: 130 women with diagnosed stress urinary incontinence were randomized and had either mini-sling or transobturator sling for the treatment between August 2008 and December 2011. Follow-up visits were scheduled for 12 and 36 months after the procedures and patients reports, cough stress test, pad test and quality of life questionnaires (Incontinence Quality of Life Questionnaire, IQOL, and the Urogenital Distress Inventory Short Form, UDI-6) were performed. Primary outcomes: objective cure defined as negative cough stress and pad tests, and subjective cure reported as satisfaction and no desire for additional treatment. Secondary outcomes: quality-of-life by IQOL and UDI-6 questionnaires, complications and reoperation rates. Student¿s t, X2, Fisher¿s exact and Mann-Whitney tests, ANOVA and p value < 0.05 as cut-off point were used for statistics. Results: At 36-months follow-up 82 patients (n:41 each arm) were evaluated. The objective cure was higher in transobturator group than in mini-sling group, by both per protocol analysis (90.2% and 68.3%, respectively, p=0.027) and intention-to-treat analysis considering missing data as failures (60.7% and 40.6%, respectively, p=0.035), while similar in both groups (93.4% and 81.2%, respectively, p=0.066) considering missing data as successes. Subjective cure rates were similar for both groups. Better quality-of-life scores were seen in both groups, however transobturator sling group presented better outcome regarding the avoidance and limiting behavior domain of IQOL (p=0.021), and UDI-6 scores (p=0.026). Repeat sling procedure was necessary in 7 of 69 (10.1%) women in the SIMS group compared with 2 of 61 (3.3%) in the transobturator sling group (p= 0.172) after 3-year of follow up. Conclusion: At 36-month follow-up, the transobturator sling was associated to higher objective cure rate than mini-sling for female stress urinary incontinence treatment, although satisfaction rate was similar for both groups.