Post on 14-Apr-2017
SLING AD INCISIONE SINGOLA
PRO & contro
SOC Ostetricia – Ginecologia Montecchio Emilia
Direttore : Dott Roberto Baccichet
Anterior repairs
Retropubic operations
Tension-free synthetic slingse.g. SPARC® , TVT®
Needle Suspensions
Autologous/Graft PV slings
Bone-anchored graft slingse.g. In-Fast Ultra™
Tension-free biologic slings
TO Subfascial HammockTVT-O
Chirurgia della IUS: Percorso Storico
Single incision Single incision slingsling
Minisling:Vantaggi
Ridotto rischio sanguinamento
Possibilità di riposizionamento
Ridotto dolore post-operatorio
Possibilità anestesia locale
Ridotto decorso post-operatorio
Sistema rilascio performante
Sicurezza nel tensionamento
Ridotta Incisione
Autor/Pub n F/U Risultati/Cura
Oliviera et alEAU 2010
90 (30
MiniArc, 30 TVT-
O, 30 TVT-S)
12 mesi Multicentrico
93% CuraMiniArc 87% guarite, 6% migliorateTVT-O 83% guarite, 10% migliorateTVT-S 67% guarite, 13% migliorate
Moore et alGynecology
Surgical Tech Int’l XVIII
61 12 mesiRetrospettivoMulticentrico
91.4%Oggiettivo e soggettivo(Stress test – questionario pazienti)
Minarc
Autor/Pub n F/U Resultati/CuraPickens et al
AUA 2009120 13 mesi
MulticentricoProspettivo
94% guarite (definito come 0 pad))
De Ridder et alInt Urogynecol J
Mar 2010
131 (75 MiniArc
, 56 Monarc
)
12 mesi MulticentricoRetrospettivo
85% MiniArc stress test negativo89% Monarc stress test negativo
Minarc
n F/U Resultati/Cura143 2 anni
MulticentricoProspettico
84,5% cough stress test negativo80,1% 1-hr Pad Test (gm) ≤ 1 gram 92,9 soggettivo
Risultati a 4 anni e anestesia locale
n F/U Resultati/Cura135 4 anni
In anestesia locale
86,7% stress test negativo85,7 soggettivo
Tutti i casi effettuati in anestesia locale
J Urol. 2014 Jun 5
The Safety and Efficacy of a New Adjustable Single Incision Sling for Treatment of Female Stress Urinary Incontinence Through 12 Months of Followup.
Kocjancic E1, Tu LM2, Erickson T3, Gheiler E4, Van Drie D5.
Of 116 surgical attempts 113 subjects were implanted with the Altis sling. Of these patients 103 had primary efficacy data at baseline and 6 months, and 101 had efficacy data at baseline and 12 months. Consequently 88 (85.4%) subjects at 6 months and 91 (90.1%) at 12 months achieved a 50% or greater reduction in pad weight. The cough stress test was negative for 95 (92.2%) subjects at 6 months and 91 (90.1%) at 12 months. A decrease in median leaks per day was observed at 6 months and improvements in all patient reported measures were observed through 12 months. A majority of subjects reported feeling much better or very much better at 6 and 12 months, respectively. There were no reports of mesh erosion or migration and no unanticipated adverse events through 12 months.
Altis
METHODS:In this prospective observational study, a total of 52 women with SUI were implanted with an Altis sling in an ambulatory setting. Before and after intervention (3, 6, and 12 months), women completed the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). In addition, patients underwent a cough stress test at each evaluation and a post-voiding residual urine volume estimation at 3 monthsPatients were excluded if they had POP of stage >2 previous failed sling surgery and OAB symptoms
RESULTS:The subjective cure rate at 12 months was 84.0%, with an additional improvement rate of 8.0%. The objective cure rate was 90.2%. Later postoperative complications included 1 case of vaginal extrusion (requiring surgical removal of the eroded mesh segment), 3 cases of vaginal exposure of the adjustment thread (managed conservatively), de novo urgency in 3 patients, and mild dyspareunia in 2 patients.
Authors No patients Mean F-up (Months)
Efficacy objective %
Efficacy subjective %(1 ou 2 PGII)
F. Haab et al. 97 16 ± 5 86% NA
M. Abdel Fattah et al. 85 12 82% 80%
G. Naumann et al. 52 12 86% NA
M. Meschia,R Baccichet et al. 102 6 91% 86%
R. Assassa et al. 113 12 97% NA
AJUST® Sling – Consistent outcomes
AJUST® Sling – Shorter Return to the normal activity / work
The AJUSTThe AJUSTTM TM system: system: an innovative treatment for incontinencean innovative treatment for incontinence
The Italian experienceThe Italian experience
On behalf of the Italian study group: On behalf of the Italian study group: Magenta ( M.Meschia ), Montecchio Emilia ( L Spreafico ) , Treviso (R Baccichet )Magenta ( M.Meschia ), Montecchio Emilia ( L Spreafico ) , Treviso (R Baccichet )Pieve di Coirano ( M. Mafiolini ) , Milano ( P. Piffarotti )Pieve di Coirano ( M. Mafiolini ) , Milano ( P. Piffarotti )
Interim analysis of 105 women at 3 and 6 months follow-Interim analysis of 105 women at 3 and 6 months follow-upup
Cure ratesCure rates Women without SUI symptoms Negative stress test Subject. and object.
90/105 (85.7%)96/105 (91.4%)87/105 (82.9%)
ICIQ-SF (mean + SD) 3.2 + 4.6*
W-IPSS (mean + SD) 4.5 + 5.2*
PGI-I (mean + SD)
ComplicationsComplications Voiding difficulty Urinary tract infection “De novo” OAB symptoms [dry / wet] Anchor detach./dyspareunia New surgery
1.5 + 0.9
4 (3.8%)8 (7.6%)
9 (8.6%) [5(4.8%) / 4(3.8%)]15
(3 for SUI;1 for POP;1 for anchor removal )
* p < .001 when compared with pre-operative data
TASSO DI COMPLICANZE SOVRAPPONBILE…..SE NON INFERIORE
NESSUNA COMPLICANZA MAGGIORE
POSSIBILITA’ DI REGOLARE IL TENSIONAMENTO ….. E DI RIPOSIZIONARE LA SLING
CURVA DI APPRENDIMENTO SUFFICIENTEMENTE RAPIDA
TASSO DI SUCCESSO SOVRAPPONIBILE
SIGNIFICATIVA RIDUZIONE DELL’INVASIVITA’ CHIRURGICA
Quali i PRO
Grazie.
SLING AD INCISIONE SINGOLA