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Sling de incisão única ajustável (Ajust®) versus sling transobturador inside-out (TVT-O®) no tratamento da incontinência urinária de esforço feminina: eficácia, efeito na qualidade de vida e complicações
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Resumo(s)
Objetivos: Esta tese tem como objetivo primário comparar a taxa de cura aos 12 meses e o efeito na qualidade de vida entre um sling de incisão única (Ajust®) e um sling transobturador inside-out (TVT-O®) no tratamento cirúrgico da incontinência urinária de esforço (IUE). Os objetivos secundários são comparar a taxa de cura ao longo do tempo (12, 24 e ≥ 36 meses) e o aparecimento de complicações ou sintomas secundários à cirurgia.
Métodos: Análise retrospetiva de dois tipos de cirurgias em doentes com IUE: grupo A – Ajust®, realizadas consecutivamente entre 2009 e 2013, sob anestesia local; grupo B – TVT-O®, realizadas entre 2004 e 2012, sob anestesia locorregional. A cura objetiva foi definida por stress test negativo e a cura subjetiva pelas queixas das doentes, refletidas num inquérito de qualidade de vida (King’s Health Questionnaire - KHQ). O efeito na qualidade de vida foi avaliado através da pontuação global do KHQ.
Resultados: 127 mulheres foram analisadas, com a seguinte distribuição: grupo A (Ajust®) – 63 casos; grupo B (TVT-O®) – 64 casos. As taxas de cura aos 12 meses foram semelhantes entre os dois grupos (taxas de cura objetiva: 94.7% vs 93.1%, p=1.000; taxas de cura subjetiva: 81.4% vs 84.1%, p=0.935, respetivamente para o grupo A e B. Ao longo do seguimento não se verificaram diferenças estatisticamente significativas nas taxas de cura entre os dois grupos. Observou-se em ambos os grupos uma melhoria significativa do impacto das queixas na qualidade de vida, não havendo diferença entre os grupos. Não houve diferenças no que respeita à frequência das complicações entre os grupos.
Conclusões: Nesta população, a aplicação das próteses Ajust® e TVT-O® são técnicas cirúrgicas com taxas de cura semelhantes aos 12, 24 e ≥ 36 meses, apresentando impacto semelhante na melhoria da qualidade de vida, com reduzidas complicações.
Objectives: The primary outcome of this thesis was to compare the cure rate at 12 months and the effect on quality of life between a single incision sling (Ajust®) and an inside-out transobturator sling (TVT-O®) in the management of stress urinary incontinence (SUI). The secondary outcomes were to compare the cure rate over time (12, 24, and ≥ 36 months) and the onset of complications or development of symptoms secondary to surgery. Methods: Retrospective analysis of two types of surgery in patients with SUI: group A – Ajust®, performed consecutively between 2009 and 2013, under local anesthesia; group B – TVT-O®, performed between 2004 and 2012, under regional anesthesia. Objective cure was defined by a negative stress test and the patient-reported cure regarding the symptoms reflected in a survey of quality of life (King's Health Questionnaire – KHQ). The effect on quality of life was assessed by the KHQ global score. Results: 127 women were analyzed, with the following distribution: group A (Ajust®) – 63 cases; group B (TVT-O®) – 64 cases. Cure rates at 12 months were similar between the two groups (objective cure rates: 94.7% vs 93.1%, p = 1.000; patient-reported cure rates: 81.4% vs 84.1%, p = 0.935, respectively for group A and B. During follow-up there were no statistically significant differences in cure rates between the groups. In both groups there was a significant improvement of the impact on quality of life, with no difference between groups. There were no differences regarding the frequency of complications between groups. Conclusions: In this population, the application of Ajust® and TVT-O® prostheses are surgical techniques with similar cure rates at 12, 24 and ≥ 36 months, showing similar improvement of the impact on quality of life, with reduced complications.
Objectives: The primary outcome of this thesis was to compare the cure rate at 12 months and the effect on quality of life between a single incision sling (Ajust®) and an inside-out transobturator sling (TVT-O®) in the management of stress urinary incontinence (SUI). The secondary outcomes were to compare the cure rate over time (12, 24, and ≥ 36 months) and the onset of complications or development of symptoms secondary to surgery. Methods: Retrospective analysis of two types of surgery in patients with SUI: group A – Ajust®, performed consecutively between 2009 and 2013, under local anesthesia; group B – TVT-O®, performed between 2004 and 2012, under regional anesthesia. Objective cure was defined by a negative stress test and the patient-reported cure regarding the symptoms reflected in a survey of quality of life (King's Health Questionnaire – KHQ). The effect on quality of life was assessed by the KHQ global score. Results: 127 women were analyzed, with the following distribution: group A (Ajust®) – 63 cases; group B (TVT-O®) – 64 cases. Cure rates at 12 months were similar between the two groups (objective cure rates: 94.7% vs 93.1%, p = 1.000; patient-reported cure rates: 81.4% vs 84.1%, p = 0.935, respectively for group A and B. During follow-up there were no statistically significant differences in cure rates between the groups. In both groups there was a significant improvement of the impact on quality of life, with no difference between groups. There were no differences regarding the frequency of complications between groups. Conclusions: In this population, the application of Ajust® and TVT-O® prostheses are surgical techniques with similar cure rates at 12, 24 and ≥ 36 months, showing similar improvement of the impact on quality of life, with reduced complications.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Incontinência urinária de esforço Sling Cirugia Saúde da Mulher