Téma: 

Stress urinary incontinence in women: an evaluation of individual operational techniques

Ľubomír Velk, Dušan Martinčok, Tomáš Kička

The aim of the work is to compare individual operational techniques (Perrin, Gittes, vaginal sling – modification of Raz, Burch, TVT, TOT-O) on the basis of a subjective and objective evaluation of their success in the context of a time horizon, a comparison of the hospitalization period and return to normal micturation, an estimate of chances of success in comparison with the technique most widespread in use – the colposuspension according to Burch. Materials and methods: During the period from 1/1996 to 12/2007, 217 patients were operated on in the Urological department in Louis Pasteur Faculty Hospital in Košice for stress urinary incontinence and from 2003 (with the start of the TVT method at our workplace) even for mixed urinary incontinence. During this period patients were operated on using different operational techniques (Perrin, Raz, Burch, Gittes, TVT, TOT), the success of which was measured independently in terms of time intervals (three months, one year, three years for TVT, TOT; five years for Burch; seven years for Perin, Gittes, Raz). The including criterion was proven urodynamic stress urinary incontinence. Excluding criteria were a neurogenic defect in micturation, hyperactive detrusor, descensus of one of the vaginal compartments greater than the II level. From the total number of operated patients during the recovery period the subjective success of the operation was evaluated by 100 % of the patients, after three months 97.7 % of patients, after three years 87 %, after five years in the group Raz, Gittes, Burch, Perrin by 111 patients, 54 %, and after seven years by 59 patients in the group Raz, Gittes, Perrin, 27.1 %. The average age of the patients was 58.3 years (± 8.9). Previous operations due to incontinence were reported by 54 (24.8 %) patients and 96 (44 %) patients reported substantial associated diseases. Results: In the statistical analysis for the identification of significant prognostic factors logical regress analysis was used, the chances of the success of an operational intervention were estimated, while a different model was created for each success indicator. The reference category was the colposuspension according to Burch – the golden standard for the treatment of stress urinal incontinence. Data were processed with assistance of the statistical software SPSS 14. After the evaluation of the subjective evaluation by patients one year after the operation, the patients who underwent the Perrin operation or vaginal sling had a six times lower chance for a successful intervention in comparison with patients who had undergone a colposuspension (not significant, at p > 0.05) while in the objective evaluation there was a statistically significant difference (Gittes p = 0.001, more than a fifteen times lower chance for success, Perrin p = 0.004, more than a sixteen times lower chance for success). There was a significant difference also in the vaginal sling category, in the objective evaluation p = 0.02, indicating an 8.7-times lower chance for success in the subjective evaluation, p = 0.064. There was no statistically significant difference in the subjective and objective evaluation among patients who underwent the operation type IVS, IVS-O compared with colposuspension (p > 0.005). In the statistical processing of the objective evaluation three years on from their operation, patients after the „Gittes“ had more than eighteen times less (1/0.053) and patients from the group „Perrin“ more than a six times lower success through intervention than patients who underwent colposuspension Burch. The difference is statistically significant, p < 0.01 and p < 0.05 respectively. Thus through subjective evaluation there was a significant difference, the chance of success by the Perrin operation being 7.8-times and by Gittes 7.3-times lower than by colposuspension. The chances for success by subjective or objective evaluation in the group who underwent vaginal sling were approximately three times lower, which is not thrown up as a statistically significant difference. In comparison with kolposuspension methods using a sub-urethral tape (IVS, IVS-O) the difference was not significant. After five years only patients with colposuspension were compared with patients who underwent the operations of Gittes, Perrin, vaginal sling type (in the categories IVS, IVS-O the evaluation was completed before five years from operation had elapsed). By subjective evaluation the Gittes operational technique had a five times lower chance of success (p < 0.005), thus in objective analysis the evaluation of the Gittes operational technique indicated lower chances of success in comparison with colposuspension (a 33-times lower chance of success, p < 0.005). On the basis of objective evaluation patients who underwent the Perrin operation had an eight times lower chance of success than patients who underwent colposuspension – category dry (p < 0.05). The most successful technique after five years in comparison with the „golden standard“ – colposuspension in subjective and objective evaluations was the operational technique vaginal sling (a 1.5 and 2.8-times respectively lower success rate in comparison with colposuspension). Conclusion: The operative therapy for (or mixed) urinary incontinence in women offers a very efficient method of treatment. Hand in hand with a technically qualitative undertaken surgical performance, a complete knowledge of the etiopathogensis, the diagnosed incontinence and stability of the pelvic floor is essential. On the basis of a yearly evaluation of operative techniques undertaken in our workspace in the past the likelihood now of improvement in the quality of life and treatment is higher for patients (at least in a short and middle term perspective) who have undergone the implantation of sub-urethral tapes and in the long term even for patients who have undergone a Burch colposuspension. From our own experience (and on the basis of the literature) at present we do not recommend the operational techniques of needle suspensions (Raz, Gittes …) and we prefer the mini-invasive operational techniques of the type TVT, TVT-O). We assume their efficacy in the long term as they are successful also in ISD. In the future it is possible that the effectiveness of invasive anti-incontinence plastics for patients with ISD will have a declining tendency.

Ročník 2009  Témy časopisu Clinical urology 3 / 2009

CHAIRMAN OF THE EDITORIAL BOARD
prof. MUDr. Ján Kliment, CSc.

MEMBERS OF THE EDITORIAL BOARD
prof. Andrzej Borówka, M.D., PhD.
prof. MUDr. Ján Breza, DrSc.
prof. MUDr. Peter Bujdák, PhD.
prof. MUDr. Tomáš Hanuš, DrSc.
doc. MUDr. Ladislav Jarolím, CSc.
doc. MUDr. Ján Ľupták, PhD.
doc. MUDr. Jozef Marenčák, PhD.
doc. MUDr. Ivan Minčík, PhD.
prof. MUDr. Dalibor Ondruš, DrSc.
prof. Imre Romics, M.D., PhD.
doc. MUDr. Vladimír Študent, PhD.
prof. MUDr. Ján Švihra, PhD.
prof. MUDr. Ladislav Valanský, PhD.
doc. MUDr. František Záťura, PhD.
MUDr. Peter Zvara, PhD.

PROFESSIONAL EDITOR
prof. MUDr. Ján Švihra, PhD.

EDITOR-IN-CHIEF
Ing. Danica Paulenová
e-mail: paulenova@amedi.sk

GRAPHIC LAYOUT AND TYPESETTING
Lucia Vecseiová
e-mail: dtp@amedi.sk

MARKETING MANAGER
Ing. Dana Chodasová
mobil: 0903 224 625
e-mail: marketing@amedi.sk

ECONOMY AND SUBSCRIPTIONS
Ing. Mária Štecková
telefón: 02/55 64 72 48
mobil: 0911 117 949
e-mail: ekonom@amedi.sk

LANGUAGE PROOFREADING
Mgr. Eva Doktorová

PROOFREADING OF ENGLISH TEXTS
Mgr. Jana Bábelová

SECTIONS

OVERVIEW PAPERS
The latest knowledge on disease and disease groups aetiology, pathogenesis, diagnoses and therapy. Maximum extent is 7 pages of text (font ARIAL or TIMES, font size 12, line spacing 1.5). In case of more extensive theme elaboration it is possible to divide the paper to several parts after agreement with editorial office.

ORIGINAL PAPERS
Structuring: introduction, clinical group and methods, results, discussion, conclusion, bibliography

DIAGNOSTIC AND THERAPEUTICAL ALGORITHMS
Diagnosis and therapy processed into tables and schemes, with minimum text, with emphasis on conciseness and clarity.

CASE STUDY
Maximum extent is 3 pages. Structuring: summary, case study, conclusion, bibliography.

MISCELLANEOUS
Reaction to overview articles, news in the field of diagnostics, therapy, trial results (maximum 3 pages), reports from professional events, abstracts from scientific work published abroad, not older than 1 year. Maximum extend is 1 page. Title of the paper in Slovak/Czech, authors, workplace, then title of the paper in English with full citation.


MANUSCRIPT ELABORATION

Write the paper on computer in any common text editor.
write full length of lines (do not use ENTER at the end of a line)
- do not arrange text into columns
- do not do page make-up, put tables at the end of the paper
- distinguish precisely numbers 1, 0 and letters l, O
- use always parentheses ( )
- explain abbreviations always when first used


MANUSCRIPT REQUIREMENTS

1. An accurate paper title, names and surnames of all authors including titles, authors` workplace. The first author address including the phone number, fax and e-mail address.
2. Summary - structured abstract: goal of work, material and methods (do not state the name of the workplace), results, conclusion
3. Key words - in the extent of 3-6.
Write in 1st or 3rd person singular or plural (unify according the type of an article).
4. English translation: the title of the paper, summary, key words 5. Text
If you insert pictures into a document, send also their original files in "jpg" format, create graphs in Excel and send also their original files. If you send photo documentation via post office, please, send just high-class originals. Mark each original by a number, under which it is mentioned in the text. Write in 1st or 3rd person singular or plural (unify according the type of an article). In the text do not use highlighting of the text as e.g. underlined text, bold, with exception of titles, references to pictures, tables, graphs.

6. Bibliography
Citations are numbered chronologically in bold, references in the text are stated by the number of citations in parentheses.
Citation means in general: the surname of the author (authors), title of the work, year of issuing, volume, pages.
Do not use "ét al.", but state all authors.

Examples of citations:
1. Shaheen NJ, Crosby NA, Bozymski EM, et al. Is there publication bias in the reporting cancer risk in Barrett´ esophagus? Gastroenterology 2000; 119: 333-338.
2. Stenestrand U, Wallentin L. Swedish Register of Cardiac Intensive Care (RIKS-HIA): Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 2001; 285: 430-436.
3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
4. Jurkovičová O, Spitzerová H, Cagáň S. Komorové arytmie a náhla srdcová smrť pri akútnom infarkte myokardu. Bratisl Lek Listy 1997; 98: 379-389.
5. Osborne BE. The electrocardiogram of the rat. In: Budden R, Detweiler DK, Zbinden G. The rat electrocardiogram in pharmacology and toxicology. Oxford: Pergamon Press 1981:15-27.

Do not use dots after first names in citations. Do not use colon but dot after names of authors. Use semi-colon after the year of publishing, colon is before pages.

The editorial board reserves the right to make small stylistic changes in the paper. If it is necessary to shorten the paper, the consent of the author will be required. All articles are reviewed.

Which of following factors is not related to rosacea?
a. genetic predisposition
b. Scandinavian origin
c. propionibacterium acnes
d. endothelial growth factor

The editorial board reserves the right to make small stylistic changes in the paper. If it is necessary to shorten the paper, the consent of the author will be required. All articles are reviewed.

All published papers are paid.

Send contributions in the e-mail to the address: paulenova@amedi.sk