CC BY 4.0 · Rev Bras Ginecol Obstet 2018; 40(10): 614-619
DOI: 10.1055/s-0038-1670712
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Five-year Follow-up of Transobturator Sling: 152 Cases with the Same Surgeon

Cinco anos de seguimento do sling transobturatório: 152 casos com o mesmo cirurgião
Mucio Barata Diniz
1   Departament of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
,
Luisa Campos Barata Diniz
2   Hospital Vila da Serra, Belo Horizonte, MG, Brazil
,
Gustavo Francisco Lopes da Silva
2   Hospital Vila da Serra, Belo Horizonte, MG, Brazil
,
Agnaldo Lopes da Silva Filho
1   Departament of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
,
Zilma Silveira Nogueira Reis
1   Departament of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
,
Marilene Vale de Castro Monteiro
1   Departament of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
› Author Affiliations
Further Information

Publication History

20 April 2018

03 July 2018

Publication Date:
23 October 2018 (online)

Abstract

Objective To evaluate the long-term subjective cure rate of the transobturator sling, including an analysis of the risk factors and of the impact of increased surgical experience on the results.

Methods A retrospective cohort study of women who underwent transobturator sling surgery from 2005 to 2011 was conducted. Patients were evaluated by a telephone survey using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and by subjective questions regarding satisfaction. An ICIQ-SF score of 0 was considered a cure. The crude and adjusted odds ratios and 95% confidence intervals were estimated in univariate and multivariate logistic regression models to identify risk factors for surgical failure. Differences with p < 0.05 were considered significant.

Results In total, 152 (70.6%) patients answered the questionnaire. The median follow-up period was 87 months. The urodynamic diagnosis was stress urinary incontinence in 144 patients (94.7%), and mixed urinary incontinence in 8 (5.3%) patients. Complications occurred in 25 (16%) patients. The ICQ-SF results indicated that 99 (65.10%) patients could be considered cured (ICIQ-SF score = 0). Regarding the degree of satisfaction, 101 (66%) considered themselves cured, 43 (28%) considered themselves improved, 7 (4.6%) considered themselves unchanged, and one reported worsening of the incontinence. After the univariate and multivariate analyses, the primary risk factor for surgical failure was the presence of urgency (p < 0.001).

Conclusion The transobturator sling is effective, with a low rate of complications and a high long-term satisfaction rate. The risk factors for failure were the presence of urgency and patient age. The increased experience of the surgeon was not a factor that influenced the rate of complications.

Resumo

Objetivo Avaliar a taxa de cura subjetiva do sling transobturatório no longo prazo, incluindo a análise dos fatores de risco e o impacto da experiência do cirurgião nos resultados.

Métodos Foi realizado um estudo de coorte retrospectivo em mulheres submetidas à cirurgia do sling transobturatório entre 2005 e 2011. As pacientes foram avaliadas por meio de uma entrevista aplicada por telefone utilizando o International Consultation on Incontinence Questionnaire-Short Form (“Questionário Internacional de Consulta sobre Incontinência – Forma Abreviada”, ICIQ-SF, na sigla em inglês) acrescido de questões sobre a satisfação das pacientes com a cirurgia. O critério de cura utilizado foi o ICIQ-SF = 0. A razão de chances bruta e ajustada e intervalos de confiança de 95% foram estimados por meio de modelos de regressão logística univariada e multivariada para identificar fatores de risco para falha cirúrgica. Diferenças com p < 0,05 foram consideradas significativas.

Resultados No total, 152 (70,6%) pacientes responderam. A média do período de acompanhamento foi de 87 meses. O diagnóstico urodinâmico foi incontinência urinária de esforço em 144 pacientes (94,7%) e incontinência urinária mista em 8 (5,3%). Complicações ocorreram em 25 (16%) pacientes. Os resultados do ICQ-SF indicaram que 99 (65,10%) pacientes estavam curadas (pontuação no ICIQ-SF = 0). Quanto ao grau de satisfação, 101 (66%) consideraram-se curadas, 43 (28%) melhoraram, em 7 (4,6%) não houve melhora, e uma relatou piora da incontinência. Após análise univariada e multivariada, o principal fator de risco para falha cirúrgica foi a presença de urgência (p < 0,001).

Conclusão O sling transobturatório é eficaz, tem baixo índice de complicações, e alto índice de satisfação no longo prazo. Os fatores de risco para falha foram a presença de urgência e a idade da paciente. O aumento da experiência do cirurgião não foi um fator que influenciou na taxa de complicações.

Contributions

Diniz MC: Project development, manuscript writing. Diniz LCB: Data collection. da Silva, GF: Data collection. Lopes Filho, ASL: Project development and manuscript editing. Reis, ZSN: Project development and review. Monteiro, MVC: Project development, manuscript writing, and manuscript editing. We confirm that the manuscript has been written and approved by all authors.


 
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