1 / 8

Retropubiskt eller transobturatoriskt? Vad styr valet av operationsmetod?

Retropubiskt eller transobturatoriskt? Vad styr valet av operationsmetod?. Transvaginala metoders fördelning på landets kliniker (Anders Kjaeldgaard) TVT håller fortfarande måttet! Jämförelse av registerdata på TVT, TVT-O och TOT (Maud Ankardal) TOT eller TVT eller båda (Tomas Winberg)

maxine
Download Presentation

Retropubiskt eller transobturatoriskt? Vad styr valet av operationsmetod?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Retropubiskt eller transobturatoriskt? Vad styr valet av operationsmetod? • Transvaginala metoders fördelning på landets kliniker (Anders Kjaeldgaard) • TVT håller fortfarande måttet! Jämförelse av registerdata på TVT, TVT-O och TOT (Maud Ankardal) • TOT eller TVT eller båda (Tomas Winberg) • TVT, ofta med ett O (Fatimeh Taheri-Johansson)

  2. Transvaginala metoder:Fördelning på olika sjukhus 2009

  3. Behandlingsresultat 2009

  4. Risk factors for suboptimal outcome Am J Obstet Gynecol. 2008 Dec;199(6):666.e1-7. Risk factors associated with failure 1 year after retropubic or transobturator midurethral slings. Barber MD, Kleeman S, Karram MM, Paraiso MF, Ellerkmann M, Vasavada S, Walters MD. Department of Obstetrics and Gynecology and Glickman Urological Institute, Cleveland Clinic, Cincinnati, OH, USA. Study design • Clinical studies on TVT and TOT. UI and uterovaginal prolapse included • Follow-up: 1 year • Outcome: any recurrent UI or SUI Results • concomittant prolapse surgery • anticholinergics • age

  5. Retrospective study ITOT vs. TVT Acta Obstet Gynecol Scand. 2009;88(8):920-6. Which type of mid-urethral sling procedure should be chosen for treatment of stress urinary incontinance with intrinsic sphincter deficiency? Tension-free vaginal tape or transobturator tape. Gungorduk K, Celebi I, Ark C, Celikkol O, Yildirim G. Department of Obstetrics and Gynecology, Istanbul Bakirkoy Women and Childrens' Hospital, Istanbul, Turkey. maidenkemal@yahoo.com Study design • retrospective • follow-up: mean 2½ years Material • n=300 primary slingoperations as sole procedure, only SUI • TVT=180, TOT=120 Results • Cure rates: TVT 78%, TOT 52,5% p<0.00001

  6. Retrospective study IITOT vs. TVT Am J Obstet Gynecol. 2008 Jul;199(1):76.e1-4. Epub 2008 Jan 25. Comparison of the treatment outcome of pubovaginal sling, tension-free vaginal tape, and transobturator tape for stress urinary incontinence with intrinsic sphincter deficiency. Jeon MJ, Jung HJ, Chung SM, Kim SK, Bai SW. Department of Obstetrics and Gynecology, Yonsei University Health System, Seoul, Korea. Study design • retrospective • follow-up: 2 years & 7years Material • n=253 (PVS=87, TVT=94, TOT=72) Results • cure rates 2yy: PVS=87%, TVT=87%, TOT=35% p<0.0001 • cure rates 7yy: PVS=59%, TVT=55%, TOT= ? ns

  7. Evidence-based medicine BJOG. 2007 May;114(5):522-31. Epub 2007 Mar 16. Review. Erratum in: BJOG. 2007 Oct;114(10):1311. Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. Latthe PM, Foon R, Toozs-Hobson P. Department of Obstetrics & Gynaecology, Birmingham Women's Health Care NHS Trust, Birmingham, UK. pallavi.latthe@bwhct.nhs.uk Material • :TOT vs. TVT: Only 5 RCTs included • TVTO vs. TVT: Only 6 RCTs included Results • Cure rates: No difference between retropubic and transobtorator methods Complications • TVT has more bladderperforations • TOs have more erosions and groin pain

  8. Risk factors for suboptimal outcome of transvaginal slingSummary of literature • concomittant prolapse surgery • anticholinergics (urge incontinence) • age • intrinsic sphincter deficiency (transobturator methods less suitable?)

More Related