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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

Society (ICS) and International Urogynecological Association

(IUGA) 23-27 August, 2010,Toronto,Canada.

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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
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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
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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
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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
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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
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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
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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
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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