Resultados de la cirugía para la incontinencia urinaria de esfuerzo con banda suburetral (técnica TVT-O)

  1. PEIRO GONZALEZ, EUGENIA
Supervised by:
  1. Álvaro Zapico Goñi Director
  2. Ana Pascual Pedreño Co-director

Defence university: Universidad de Alcalá

Fecha de defensa: 18 September 2018

Committee:
  1. Fernando Noguerales Fraguas Chair
  2. Tirso Pérez Medina Secretary
  3. Jesús S. Jiménez López Committee member
Department:
  1. Cirugía, Ciencias Médicas y Sociales

Type: Thesis

Teseo: 148410 DIALNET lock_openTESEO editor

Abstract

Objetives: To describe the TVT-O surgery results as a SUI treatment through objective evidences and subjective test, and its evolution throughout the follow-up. To analyse the clinical characteristics of the patients undergoing surgery and their association with the intervention results over time, and in this way to create a success/failure predictive model of TVT-O surgery. Material and methods: This is a longitudinal observational analytical retrospective cohort study, performed at the Gynaecology and Obstetrics Service of the Mancha Centro General Hospital, belonging to the Integrated Care Management of Alcázar de San Juan (Ciudad Real). The time frame of the study comprises from January 2006 to December 2015. The group of patients is made up by SUI operated women with clinical and/or urodynamic diagnosis of SUI or mixed urinary incontinence (MUI) with predominance of stress, with or without associated pelvic organ prolapse. Any exclusion criteria were followed. The technique used in all cases was TVT-O. The main outcome variables were the cough test as a measure of the SUI objective cure and the Sandvik incontinence severity index together with the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) as a quality of life test to assess the subjective cure. As independent variables, multiple variables belonging to the clinical characteristics of the patients, the preoperative diagnosis, the intervention it self, the postoperative period and the 5-year follow-up, were used. We performed a descriptive analysis of the studied variables and a bivariate analysis for the postoperative evolution of the patients regarding their baseline situation and also regarding the independent variables that could be related to a worse evolution after surgery. A multivariate analysis was also performed for confounding biases control and a predictive model was developed for poor evolution according to ICIQ-UI-SF after TVT-O surgery. Conclusions: TVT-O surgery is a safe surgical technique, with very high objective cure rates, although subjective cure is lesser, but with an important improvement in the patients’s quality of life. The risk prediction models of inferior quality of life after TVT-O surgery that include variables such as age, BMI and the taking of drugs for overactive bladder, present a satisfactory/good predictive capacity. This can be a useful tool in the patient information and the decision making.