Efetividade da cirurgia de alça transobturatória para incontinência urinária por hipermobilidade uretral: dados clínicos e qualidade de vida

Abstract

Introduction: Stress urinary incontinence is defined by the International Continence Society as involuntary urinary loss. There are several options of surgical procedures described in the literature for its treatment and, currently, minimally invasive surgeries known as suburethral slings are the “gold standard”. Randomized clinical trials, multicenter studies and systematic reviews with meta-analysis carried out with the theme of stress urinary incontinence, demonstrated the efficacy of the suburethral sling in the treatment of urinary incontinence of intrinsic cause or with urethral sphincter defect, but none of them mentioned the extrinsic cause or hypermobility urethral. Objective: The general objective of this study was to evaluate the effectiveness of suburethral sling with synthetic polypropylene mesh via transobturator in extrinsic stress urinary incontinence, through clinical data and the quality of life of patients in the postoperative period. Methods: This is a quantitative, cross-sectional, retrospective, descriptive and analytical study, carried out at the gynecological surgery and urogynecology outpatient clinic of a public hospital in the Federal District (Brazil), with 47 women with a mean age of 53.34 ± 19.52 years (36 to 82 years old). To perform the data analysis (tabulation, descriptive and inferential data) Microsoft Office Excel 2003 and the Statistical Package for Social Sciences - SPSS-IBM 22.0 for Windows, duly registered, were used. Results: surgical time, hospital stay and the beginning of continence presented values below, being lower than in other procedures. The cure rate, assessed until the beginning of self-reported continence (number of days), was high in one or two days (80.4%), totaling 88.4% (45 patients) in up to 29 days, with the other two women showing continence at 60 and 180 days, respectively. Regarding the frequency of complications expected in surgeries of this size, the Sling showed better results. As for the perception of quality of life after surgery, all patients perceive their quality of life as excellent in the 8 dimensions of the instrument applied. Another important result regarding the cure rate is that, regardless of the pathophysiological mechanism of stress urinary incontinence, it was possible to observe that the surgery was effective. Products developed: A systematic review entitled “Effectiveness of the transobturator sling compared to the retropubic sling” was developed, REAS | Vol.13(4) | DOI: https://doi.org/10.25248/REAS.e6866.2021 and an educational leaflet entitled “Pee without feeling?” Conclusion: Was demonstrated that the transobturator sling can and should be used as a resource for the treatment of urinary incontinence, as it offers a shorter hospital stay, high efficiency in the resolution of urinary losses, lower frequency of complications, and quality of life for patients after surgery, he is discharged in all dimensions evaluated.