LrsquoINCONTINENZA URINARIA ELrsquoATROFIA VAGINALE

TRATTAMENTO FARMACOLOGICOE TRATTAMENTO LASER

Bologna Sabato 30 Gennaio 2016

Strategie terapeutiche delle alterazioni della statica pelvica ed impatto sul costo sanitario

Valerio M Jasonni

0

5

10

15

20

25

30

35

40

45

2000 2030

Italia donne con incontinenza proiezioni15-3 milioni donne con IU (ISTAT)

ISTAT 2006

bull Il 39 della popolazione femminile italiana ha piugrave di 50 anni

bull La spesa sanitaria per incontinenza urinaria egrave di 160 milioni di euro

bull 3 milioni di euro per traverse

bull 23 milioni per cateteri vescicali

Costi sanitari per anno

per incontinenza nelle donne

In Italia per donne gt 40 a3518 bilioni lire x anno

Considerando solo i farmaci e assorbenti

Pharmacoeconimics 2002

In USA $76 bilionianno se gt 65 a$36 bilionianno se lt 65 a

Brown et al Obstet Gynec 2001

USA ndash spesa annuale per IU donne 16 bilioni $ superiore alla spesa annuale

per Ca Mammella-Ovaio-Cervice uterina-Endmetrio complessivi

Leslee L et al 2006 Obstet Gynecol

USA Spesa annuale per incontinenza urinaria

=

Spesa per protesi cardiache + emodialisi

Classificazione clinica dellrsquoincontinenza urinaria

bullIncontinenza da sforzo (stress incontinence - IUS)

bullIncontinenza da urgenza (urge incontinence)

bullIncontinenza mista (stress - urge incontinence)

bullIncontinenza da rigurgito (overflow incontinence)

bullIncontinenza continua goccia a goccia (dribbling incontinence)

bullEnuresi notturna

bullIncontinenza funzionale

PREVENZIONE PRIMARIARIVOLTA A TUTTE LE DONNE

INFORMAZIONI COMPORTAMENTALI

CONTROLLO CONSAPEVOLE DEI MUSCOLI PERINEALI

5 milioni di donne sono portatrici di prolasso genitale con o senza

incontinenza urinaria

68 20-29dega18 30-50dega30 50-70dega

20-25 si rivolge allo specialista

Cost-Effectiveness of including a Nurse Specialist in the treatment

of Urinary Incontinence in Primary Care in the Netherlands

Holtzer-Goor et al PLoS One 2015

laquohellipsaving 402 euro x patientyear over 3 year period from a societal perspective

and reducing incontinencehellipraquo

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

0

5

10

15

20

25

30

35

40

45

2000 2030

Italia donne con incontinenza proiezioni15-3 milioni donne con IU (ISTAT)

ISTAT 2006

bull Il 39 della popolazione femminile italiana ha piugrave di 50 anni

bull La spesa sanitaria per incontinenza urinaria egrave di 160 milioni di euro

bull 3 milioni di euro per traverse

bull 23 milioni per cateteri vescicali

Costi sanitari per anno

per incontinenza nelle donne

In Italia per donne gt 40 a3518 bilioni lire x anno

Considerando solo i farmaci e assorbenti

Pharmacoeconimics 2002

In USA $76 bilionianno se gt 65 a$36 bilionianno se lt 65 a

Brown et al Obstet Gynec 2001

USA ndash spesa annuale per IU donne 16 bilioni $ superiore alla spesa annuale

per Ca Mammella-Ovaio-Cervice uterina-Endmetrio complessivi

Leslee L et al 2006 Obstet Gynecol

USA Spesa annuale per incontinenza urinaria

=

Spesa per protesi cardiache + emodialisi

Classificazione clinica dellrsquoincontinenza urinaria

bullIncontinenza da sforzo (stress incontinence - IUS)

bullIncontinenza da urgenza (urge incontinence)

bullIncontinenza mista (stress - urge incontinence)

bullIncontinenza da rigurgito (overflow incontinence)

bullIncontinenza continua goccia a goccia (dribbling incontinence)

bullEnuresi notturna

bullIncontinenza funzionale

PREVENZIONE PRIMARIARIVOLTA A TUTTE LE DONNE

INFORMAZIONI COMPORTAMENTALI

CONTROLLO CONSAPEVOLE DEI MUSCOLI PERINEALI

5 milioni di donne sono portatrici di prolasso genitale con o senza

incontinenza urinaria

68 20-29dega18 30-50dega30 50-70dega

20-25 si rivolge allo specialista

Cost-Effectiveness of including a Nurse Specialist in the treatment

of Urinary Incontinence in Primary Care in the Netherlands

Holtzer-Goor et al PLoS One 2015

laquohellipsaving 402 euro x patientyear over 3 year period from a societal perspective

and reducing incontinencehellipraquo

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

ISTAT 2006

bull Il 39 della popolazione femminile italiana ha piugrave di 50 anni

bull La spesa sanitaria per incontinenza urinaria egrave di 160 milioni di euro

bull 3 milioni di euro per traverse

bull 23 milioni per cateteri vescicali

Costi sanitari per anno

per incontinenza nelle donne

In Italia per donne gt 40 a3518 bilioni lire x anno

Considerando solo i farmaci e assorbenti

Pharmacoeconimics 2002

In USA $76 bilionianno se gt 65 a$36 bilionianno se lt 65 a

Brown et al Obstet Gynec 2001

USA ndash spesa annuale per IU donne 16 bilioni $ superiore alla spesa annuale

per Ca Mammella-Ovaio-Cervice uterina-Endmetrio complessivi

Leslee L et al 2006 Obstet Gynecol

USA Spesa annuale per incontinenza urinaria

=

Spesa per protesi cardiache + emodialisi

Classificazione clinica dellrsquoincontinenza urinaria

bullIncontinenza da sforzo (stress incontinence - IUS)

bullIncontinenza da urgenza (urge incontinence)

bullIncontinenza mista (stress - urge incontinence)

bullIncontinenza da rigurgito (overflow incontinence)

bullIncontinenza continua goccia a goccia (dribbling incontinence)

bullEnuresi notturna

bullIncontinenza funzionale

PREVENZIONE PRIMARIARIVOLTA A TUTTE LE DONNE

INFORMAZIONI COMPORTAMENTALI

CONTROLLO CONSAPEVOLE DEI MUSCOLI PERINEALI

5 milioni di donne sono portatrici di prolasso genitale con o senza

incontinenza urinaria

68 20-29dega18 30-50dega30 50-70dega

20-25 si rivolge allo specialista

Cost-Effectiveness of including a Nurse Specialist in the treatment

of Urinary Incontinence in Primary Care in the Netherlands

Holtzer-Goor et al PLoS One 2015

laquohellipsaving 402 euro x patientyear over 3 year period from a societal perspective

and reducing incontinencehellipraquo

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

Costi sanitari per anno

per incontinenza nelle donne

In Italia per donne gt 40 a3518 bilioni lire x anno

Considerando solo i farmaci e assorbenti

Pharmacoeconimics 2002

In USA $76 bilionianno se gt 65 a$36 bilionianno se lt 65 a

Brown et al Obstet Gynec 2001

USA ndash spesa annuale per IU donne 16 bilioni $ superiore alla spesa annuale

per Ca Mammella-Ovaio-Cervice uterina-Endmetrio complessivi

Leslee L et al 2006 Obstet Gynecol

USA Spesa annuale per incontinenza urinaria

=

Spesa per protesi cardiache + emodialisi

Classificazione clinica dellrsquoincontinenza urinaria

bullIncontinenza da sforzo (stress incontinence - IUS)

bullIncontinenza da urgenza (urge incontinence)

bullIncontinenza mista (stress - urge incontinence)

bullIncontinenza da rigurgito (overflow incontinence)

bullIncontinenza continua goccia a goccia (dribbling incontinence)

bullEnuresi notturna

bullIncontinenza funzionale

PREVENZIONE PRIMARIARIVOLTA A TUTTE LE DONNE

INFORMAZIONI COMPORTAMENTALI

CONTROLLO CONSAPEVOLE DEI MUSCOLI PERINEALI

5 milioni di donne sono portatrici di prolasso genitale con o senza

incontinenza urinaria

68 20-29dega18 30-50dega30 50-70dega

20-25 si rivolge allo specialista

Cost-Effectiveness of including a Nurse Specialist in the treatment

of Urinary Incontinence in Primary Care in the Netherlands

Holtzer-Goor et al PLoS One 2015

laquohellipsaving 402 euro x patientyear over 3 year period from a societal perspective

and reducing incontinencehellipraquo

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

USA ndash spesa annuale per IU donne 16 bilioni $ superiore alla spesa annuale

per Ca Mammella-Ovaio-Cervice uterina-Endmetrio complessivi

Leslee L et al 2006 Obstet Gynecol

USA Spesa annuale per incontinenza urinaria

=

Spesa per protesi cardiache + emodialisi

Classificazione clinica dellrsquoincontinenza urinaria

bullIncontinenza da sforzo (stress incontinence - IUS)

bullIncontinenza da urgenza (urge incontinence)

bullIncontinenza mista (stress - urge incontinence)

bullIncontinenza da rigurgito (overflow incontinence)

bullIncontinenza continua goccia a goccia (dribbling incontinence)

bullEnuresi notturna

bullIncontinenza funzionale

PREVENZIONE PRIMARIARIVOLTA A TUTTE LE DONNE

INFORMAZIONI COMPORTAMENTALI

CONTROLLO CONSAPEVOLE DEI MUSCOLI PERINEALI

5 milioni di donne sono portatrici di prolasso genitale con o senza

incontinenza urinaria

68 20-29dega18 30-50dega30 50-70dega

20-25 si rivolge allo specialista

Cost-Effectiveness of including a Nurse Specialist in the treatment

of Urinary Incontinence in Primary Care in the Netherlands

Holtzer-Goor et al PLoS One 2015

laquohellipsaving 402 euro x patientyear over 3 year period from a societal perspective

and reducing incontinencehellipraquo

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

USA Spesa annuale per incontinenza urinaria

=

Spesa per protesi cardiache + emodialisi

Classificazione clinica dellrsquoincontinenza urinaria

bullIncontinenza da sforzo (stress incontinence - IUS)

bullIncontinenza da urgenza (urge incontinence)

bullIncontinenza mista (stress - urge incontinence)

bullIncontinenza da rigurgito (overflow incontinence)

bullIncontinenza continua goccia a goccia (dribbling incontinence)

bullEnuresi notturna

bullIncontinenza funzionale

PREVENZIONE PRIMARIARIVOLTA A TUTTE LE DONNE

INFORMAZIONI COMPORTAMENTALI

CONTROLLO CONSAPEVOLE DEI MUSCOLI PERINEALI

5 milioni di donne sono portatrici di prolasso genitale con o senza

incontinenza urinaria

68 20-29dega18 30-50dega30 50-70dega

20-25 si rivolge allo specialista

Cost-Effectiveness of including a Nurse Specialist in the treatment

of Urinary Incontinence in Primary Care in the Netherlands

Holtzer-Goor et al PLoS One 2015

laquohellipsaving 402 euro x patientyear over 3 year period from a societal perspective

and reducing incontinencehellipraquo

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

Classificazione clinica dellrsquoincontinenza urinaria

bullIncontinenza da sforzo (stress incontinence - IUS)

bullIncontinenza da urgenza (urge incontinence)

bullIncontinenza mista (stress - urge incontinence)

bullIncontinenza da rigurgito (overflow incontinence)

bullIncontinenza continua goccia a goccia (dribbling incontinence)

bullEnuresi notturna

bullIncontinenza funzionale

PREVENZIONE PRIMARIARIVOLTA A TUTTE LE DONNE

INFORMAZIONI COMPORTAMENTALI

CONTROLLO CONSAPEVOLE DEI MUSCOLI PERINEALI

5 milioni di donne sono portatrici di prolasso genitale con o senza

incontinenza urinaria

68 20-29dega18 30-50dega30 50-70dega

20-25 si rivolge allo specialista

Cost-Effectiveness of including a Nurse Specialist in the treatment

of Urinary Incontinence in Primary Care in the Netherlands

Holtzer-Goor et al PLoS One 2015

laquohellipsaving 402 euro x patientyear over 3 year period from a societal perspective

and reducing incontinencehellipraquo

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

PREVENZIONE PRIMARIARIVOLTA A TUTTE LE DONNE

INFORMAZIONI COMPORTAMENTALI

CONTROLLO CONSAPEVOLE DEI MUSCOLI PERINEALI

5 milioni di donne sono portatrici di prolasso genitale con o senza

incontinenza urinaria

68 20-29dega18 30-50dega30 50-70dega

20-25 si rivolge allo specialista

Cost-Effectiveness of including a Nurse Specialist in the treatment

of Urinary Incontinence in Primary Care in the Netherlands

Holtzer-Goor et al PLoS One 2015

laquohellipsaving 402 euro x patientyear over 3 year period from a societal perspective

and reducing incontinencehellipraquo

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

5 milioni di donne sono portatrici di prolasso genitale con o senza

incontinenza urinaria

68 20-29dega18 30-50dega30 50-70dega

20-25 si rivolge allo specialista

Cost-Effectiveness of including a Nurse Specialist in the treatment

of Urinary Incontinence in Primary Care in the Netherlands

Holtzer-Goor et al PLoS One 2015

laquohellipsaving 402 euro x patientyear over 3 year period from a societal perspective

and reducing incontinencehellipraquo

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

Cost-Effectiveness of including a Nurse Specialist in the treatment

of Urinary Incontinence in Primary Care in the Netherlands

Holtzer-Goor et al PLoS One 2015

laquohellipsaving 402 euro x patientyear over 3 year period from a societal perspective

and reducing incontinencehellipraquo

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

Weight loss a novel and effective treatmentfor urinary incontinenceSubak et al J Urol 2005

laquoStress and urge incontinence decreased 60 after8 months weight loss in 40 obese overweight

patientsraquo

Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weightloss to treat urinary incontinenceSubak et al Obeste Gynecol 2012

laquoMean cost decreased by 54 at 6 monthsand 81 at 18 months (77$ per week before)raquo

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

French College of Gynecologists and Obstetricians

Pelvic muscle training is the treatment of first intention

Fauconnier et al Eur J Obst Reprod Bio 2010

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

LrsquoAmerican Urologic Association raccomanda gli

esercizi e le tecniche di riabilitazione prima di ogni

intervento chirurgico che riguardi la sfera genitale

femminile In particolare lrsquoincontinenza urinaria

prima di essere trattata chirurgicamente deve essere

preceduta da tutti i presidi terapeutici non

chirurgici

Pelvic floor muscle training for urinary incontinence in womenHay-Smith EJ Boslash Berghmans LC Hendriks HJ de Bie RA van Waalwijk van Doorn ESDepartment of Womens and Childrens Health Dunedin School of Medicine University of Otago PO Box 913 Dunedin New Zealand

ldquoThe review supports the widespreadRecommendation that

Pelvic Floor Muscle Training be includedas the first line treatment for women

With Stress-Urge or Mixed urinary incontinence

The treatment seemms greater in womenWith SUI alonerdquo

Cochrane database 2010Dumoulin amp Smith

The Cochrane database of Systematic ReviewsSurgical management of pelvic organ prolapse

in womenMaher et al 2005

ldquonot enough evidence about the effects of differenttypes of surgery for pelvic organ prolapserdquo

ldquothe impact of pelvic organ prolapse surgery on bowelbladder and sexual function can be unpredicatablerdquo

2 filosofie strategiche

Chirurgia del prolasso e della SUInello stesso tempo

Chirurgia del prolasso primaChirurgia specifica della SUI

in un secondo tempo(Mesh)

269 operate per prolasso urogenitalefollow up 10 anni

Risultati oggettivi soddisfacenti 56-79

Risultati soggettivi soddisfacenti 46-73

Tegerstedt et al 2004

Difetto paravaginale

Difetto trasversale

Difetto centrale

Difetto del lig pubo-uretrale

Uretro-cistoceleRichardson

u

pubo-urethral ligaments

Elevator Vagina

Arcus tendineus

LATERAL-CONNECTIVE

TISSUE

SLING

Outcomes after anterior vaginal wall repairwith mesh a randomized controlled trial

with 3 years follow upNieminen et al Am J Obstet Gynecol 2010

200 pazienti ricorrenza cistocele

Colporrafia = 40 su 97 (41)

Mesh = 14 su 105 (13)

Mesh erosioni = 19

FDA Recommendations

Obtain specialized training for each mesh placement

Be vigilant for potential adverse eventsesp Erosion infection

Watch for complicationBladder-bowel-vessel perforations

Inform patients that may require additional surgerythat may or may not correct the complication

Inform patients about the potentialfor serious complications

A decision-analytic model to compareThe cost-utility of anterior repair augmentedwith aynthetic mesh compared with non-mesh

repair in women with surgically treated prolapseJacklin P et al BJOG 2013

laquoat 5 years the incrementalcost-effectiveness ratio for mesh anteriorrepair was pound15 million including costs of

mesh and treating mesh erosionuse of mesh seems not cost-effectiveraquo

Anterior colporraphy vs transvaginal meshfor pelvic-organ prolpaseAltman et al N EnglJ Med 2011

STUDY ON 389 WOMENAs compared with anterior colporraphy use of a standardized trocar-guided mesh kit for cystocele repair resulted in highershort-term rates of successul treatment but

also in higher rates of surgicalcomplications and postoperative adverse events

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

The Cochrane database of Systematic ReviewsSurgical management of pelvic organ prolapse

in womenMaher et al 2005

ldquonot enough evidence about the effects of differenttypes of surgery for pelvic organ prolapserdquo

ldquothe impact of pelvic organ prolapse surgery on bowelbladder and sexual function can be unpredicatablerdquo

2 filosofie strategiche

Chirurgia del prolasso e della SUInello stesso tempo

Chirurgia del prolasso primaChirurgia specifica della SUI

in un secondo tempo(Mesh)

269 operate per prolasso urogenitalefollow up 10 anni

Risultati oggettivi soddisfacenti 56-79

Risultati soggettivi soddisfacenti 46-73

Tegerstedt et al 2004

Difetto paravaginale

Difetto trasversale

Difetto centrale

Difetto del lig pubo-uretrale

Uretro-cistoceleRichardson

u

pubo-urethral ligaments

Elevator Vagina

Arcus tendineus

LATERAL-CONNECTIVE

TISSUE

SLING

Outcomes after anterior vaginal wall repairwith mesh a randomized controlled trial

with 3 years follow upNieminen et al Am J Obstet Gynecol 2010

200 pazienti ricorrenza cistocele

Colporrafia = 40 su 97 (41)

Mesh = 14 su 105 (13)

Mesh erosioni = 19

FDA Recommendations

Obtain specialized training for each mesh placement

Be vigilant for potential adverse eventsesp Erosion infection

Watch for complicationBladder-bowel-vessel perforations

Inform patients that may require additional surgerythat may or may not correct the complication

Inform patients about the potentialfor serious complications

A decision-analytic model to compareThe cost-utility of anterior repair augmentedwith aynthetic mesh compared with non-mesh

repair in women with surgically treated prolapseJacklin P et al BJOG 2013

laquoat 5 years the incrementalcost-effectiveness ratio for mesh anteriorrepair was pound15 million including costs of

mesh and treating mesh erosionuse of mesh seems not cost-effectiveraquo

Anterior colporraphy vs transvaginal meshfor pelvic-organ prolpaseAltman et al N EnglJ Med 2011

STUDY ON 389 WOMENAs compared with anterior colporraphy use of a standardized trocar-guided mesh kit for cystocele repair resulted in highershort-term rates of successul treatment but

also in higher rates of surgicalcomplications and postoperative adverse events

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

2 filosofie strategiche

Chirurgia del prolasso e della SUInello stesso tempo

Chirurgia del prolasso primaChirurgia specifica della SUI

in un secondo tempo(Mesh)

269 operate per prolasso urogenitalefollow up 10 anni

Risultati oggettivi soddisfacenti 56-79

Risultati soggettivi soddisfacenti 46-73

Tegerstedt et al 2004

Difetto paravaginale

Difetto trasversale

Difetto centrale

Difetto del lig pubo-uretrale

Uretro-cistoceleRichardson

u

pubo-urethral ligaments

Elevator Vagina

Arcus tendineus

LATERAL-CONNECTIVE

TISSUE

SLING

Outcomes after anterior vaginal wall repairwith mesh a randomized controlled trial

with 3 years follow upNieminen et al Am J Obstet Gynecol 2010

200 pazienti ricorrenza cistocele

Colporrafia = 40 su 97 (41)

Mesh = 14 su 105 (13)

Mesh erosioni = 19

FDA Recommendations

Obtain specialized training for each mesh placement

Be vigilant for potential adverse eventsesp Erosion infection

Watch for complicationBladder-bowel-vessel perforations

Inform patients that may require additional surgerythat may or may not correct the complication

Inform patients about the potentialfor serious complications

A decision-analytic model to compareThe cost-utility of anterior repair augmentedwith aynthetic mesh compared with non-mesh

repair in women with surgically treated prolapseJacklin P et al BJOG 2013

laquoat 5 years the incrementalcost-effectiveness ratio for mesh anteriorrepair was pound15 million including costs of

mesh and treating mesh erosionuse of mesh seems not cost-effectiveraquo

Anterior colporraphy vs transvaginal meshfor pelvic-organ prolpaseAltman et al N EnglJ Med 2011

STUDY ON 389 WOMENAs compared with anterior colporraphy use of a standardized trocar-guided mesh kit for cystocele repair resulted in highershort-term rates of successul treatment but

also in higher rates of surgicalcomplications and postoperative adverse events

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

269 operate per prolasso urogenitalefollow up 10 anni

Risultati oggettivi soddisfacenti 56-79

Risultati soggettivi soddisfacenti 46-73

Tegerstedt et al 2004

Difetto paravaginale

Difetto trasversale

Difetto centrale

Difetto del lig pubo-uretrale

Uretro-cistoceleRichardson

u

pubo-urethral ligaments

Elevator Vagina

Arcus tendineus

LATERAL-CONNECTIVE

TISSUE

SLING

Outcomes after anterior vaginal wall repairwith mesh a randomized controlled trial

with 3 years follow upNieminen et al Am J Obstet Gynecol 2010

200 pazienti ricorrenza cistocele

Colporrafia = 40 su 97 (41)

Mesh = 14 su 105 (13)

Mesh erosioni = 19

FDA Recommendations

Obtain specialized training for each mesh placement

Be vigilant for potential adverse eventsesp Erosion infection

Watch for complicationBladder-bowel-vessel perforations

Inform patients that may require additional surgerythat may or may not correct the complication

Inform patients about the potentialfor serious complications

A decision-analytic model to compareThe cost-utility of anterior repair augmentedwith aynthetic mesh compared with non-mesh

repair in women with surgically treated prolapseJacklin P et al BJOG 2013

laquoat 5 years the incrementalcost-effectiveness ratio for mesh anteriorrepair was pound15 million including costs of

mesh and treating mesh erosionuse of mesh seems not cost-effectiveraquo

Anterior colporraphy vs transvaginal meshfor pelvic-organ prolpaseAltman et al N EnglJ Med 2011

STUDY ON 389 WOMENAs compared with anterior colporraphy use of a standardized trocar-guided mesh kit for cystocele repair resulted in highershort-term rates of successul treatment but

also in higher rates of surgicalcomplications and postoperative adverse events

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

Difetto paravaginale

Difetto trasversale

Difetto centrale

Difetto del lig pubo-uretrale

Uretro-cistoceleRichardson

u

pubo-urethral ligaments

Elevator Vagina

Arcus tendineus

LATERAL-CONNECTIVE

TISSUE

SLING

Outcomes after anterior vaginal wall repairwith mesh a randomized controlled trial

with 3 years follow upNieminen et al Am J Obstet Gynecol 2010

200 pazienti ricorrenza cistocele

Colporrafia = 40 su 97 (41)

Mesh = 14 su 105 (13)

Mesh erosioni = 19

FDA Recommendations

Obtain specialized training for each mesh placement

Be vigilant for potential adverse eventsesp Erosion infection

Watch for complicationBladder-bowel-vessel perforations

Inform patients that may require additional surgerythat may or may not correct the complication

Inform patients about the potentialfor serious complications

A decision-analytic model to compareThe cost-utility of anterior repair augmentedwith aynthetic mesh compared with non-mesh

repair in women with surgically treated prolapseJacklin P et al BJOG 2013

laquoat 5 years the incrementalcost-effectiveness ratio for mesh anteriorrepair was pound15 million including costs of

mesh and treating mesh erosionuse of mesh seems not cost-effectiveraquo

Anterior colporraphy vs transvaginal meshfor pelvic-organ prolpaseAltman et al N EnglJ Med 2011

STUDY ON 389 WOMENAs compared with anterior colporraphy use of a standardized trocar-guided mesh kit for cystocele repair resulted in highershort-term rates of successul treatment but

also in higher rates of surgicalcomplications and postoperative adverse events

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

u

pubo-urethral ligaments

Elevator Vagina

Arcus tendineus

LATERAL-CONNECTIVE

TISSUE

SLING

Outcomes after anterior vaginal wall repairwith mesh a randomized controlled trial

with 3 years follow upNieminen et al Am J Obstet Gynecol 2010

200 pazienti ricorrenza cistocele

Colporrafia = 40 su 97 (41)

Mesh = 14 su 105 (13)

Mesh erosioni = 19

FDA Recommendations

Obtain specialized training for each mesh placement

Be vigilant for potential adverse eventsesp Erosion infection

Watch for complicationBladder-bowel-vessel perforations

Inform patients that may require additional surgerythat may or may not correct the complication

Inform patients about the potentialfor serious complications

A decision-analytic model to compareThe cost-utility of anterior repair augmentedwith aynthetic mesh compared with non-mesh

repair in women with surgically treated prolapseJacklin P et al BJOG 2013

laquoat 5 years the incrementalcost-effectiveness ratio for mesh anteriorrepair was pound15 million including costs of

mesh and treating mesh erosionuse of mesh seems not cost-effectiveraquo

Anterior colporraphy vs transvaginal meshfor pelvic-organ prolpaseAltman et al N EnglJ Med 2011

STUDY ON 389 WOMENAs compared with anterior colporraphy use of a standardized trocar-guided mesh kit for cystocele repair resulted in highershort-term rates of successul treatment but

also in higher rates of surgicalcomplications and postoperative adverse events

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

Outcomes after anterior vaginal wall repairwith mesh a randomized controlled trial

with 3 years follow upNieminen et al Am J Obstet Gynecol 2010

200 pazienti ricorrenza cistocele

Colporrafia = 40 su 97 (41)

Mesh = 14 su 105 (13)

Mesh erosioni = 19

FDA Recommendations

Obtain specialized training for each mesh placement

Be vigilant for potential adverse eventsesp Erosion infection

Watch for complicationBladder-bowel-vessel perforations

Inform patients that may require additional surgerythat may or may not correct the complication

Inform patients about the potentialfor serious complications

A decision-analytic model to compareThe cost-utility of anterior repair augmentedwith aynthetic mesh compared with non-mesh

repair in women with surgically treated prolapseJacklin P et al BJOG 2013

laquoat 5 years the incrementalcost-effectiveness ratio for mesh anteriorrepair was pound15 million including costs of

mesh and treating mesh erosionuse of mesh seems not cost-effectiveraquo

Anterior colporraphy vs transvaginal meshfor pelvic-organ prolpaseAltman et al N EnglJ Med 2011

STUDY ON 389 WOMENAs compared with anterior colporraphy use of a standardized trocar-guided mesh kit for cystocele repair resulted in highershort-term rates of successul treatment but

also in higher rates of surgicalcomplications and postoperative adverse events

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

FDA Recommendations

Obtain specialized training for each mesh placement

Be vigilant for potential adverse eventsesp Erosion infection

Watch for complicationBladder-bowel-vessel perforations

Inform patients that may require additional surgerythat may or may not correct the complication

Inform patients about the potentialfor serious complications

A decision-analytic model to compareThe cost-utility of anterior repair augmentedwith aynthetic mesh compared with non-mesh

repair in women with surgically treated prolapseJacklin P et al BJOG 2013

laquoat 5 years the incrementalcost-effectiveness ratio for mesh anteriorrepair was pound15 million including costs of

mesh and treating mesh erosionuse of mesh seems not cost-effectiveraquo

Anterior colporraphy vs transvaginal meshfor pelvic-organ prolpaseAltman et al N EnglJ Med 2011

STUDY ON 389 WOMENAs compared with anterior colporraphy use of a standardized trocar-guided mesh kit for cystocele repair resulted in highershort-term rates of successul treatment but

also in higher rates of surgicalcomplications and postoperative adverse events

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

A decision-analytic model to compareThe cost-utility of anterior repair augmentedwith aynthetic mesh compared with non-mesh

repair in women with surgically treated prolapseJacklin P et al BJOG 2013

laquoat 5 years the incrementalcost-effectiveness ratio for mesh anteriorrepair was pound15 million including costs of

mesh and treating mesh erosionuse of mesh seems not cost-effectiveraquo

Anterior colporraphy vs transvaginal meshfor pelvic-organ prolpaseAltman et al N EnglJ Med 2011

STUDY ON 389 WOMENAs compared with anterior colporraphy use of a standardized trocar-guided mesh kit for cystocele repair resulted in highershort-term rates of successul treatment but

also in higher rates of surgicalcomplications and postoperative adverse events

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

Anterior colporraphy vs transvaginal meshfor pelvic-organ prolpaseAltman et al N EnglJ Med 2011

STUDY ON 389 WOMENAs compared with anterior colporraphy use of a standardized trocar-guided mesh kit for cystocele repair resulted in highershort-term rates of successul treatment but

also in higher rates of surgicalcomplications and postoperative adverse events

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

Radiofrequency collagen denaturationin SUI attributable to hypermobility

as first approach or in case of suboptimalsurgical results

Apple amp Davila Curr MedRes Opin 2007

Transurethral radiofrequency energy collagenmicro-remodelling for female SUI

110 cases SUI moderate to severe74 well resolved

Appell et al Neurol Urodyn 2006

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

Cost utility analysis of urethral bulking agents vs Midurethral sling in stress urinary incontinence

Kunkle CM et al Female pelvic Med Reconstr Surg 2015

SUI without urethral hypermobiltyBulking agents more cost effective

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi

CONCLUSIONI

Lrsquoincontinenza urinaria egrave un problema negletto nonostante lrsquoenorme spesa sanitaria

La prevenzione parte da lontano

Adeguata ginnastica perineale in gravidanza e dopo Mantenere il peso corporeo nei limiti

Prevenire lrsquoatrofia vaginale Ricordare che molte pazienti non la riferiscono e quindi

accurata anamnesi