Macroplastique Implantation System (MIS) para o tratamento da incontinencia urinaria de esforço feminina : analise de dados objetivos, subjetivos e do impacto na qualidade de vida

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

Urinary incontinence is defined by the International Continence Society as the complaint of any involuntary leakage of urine. It is considered a distressing and disabling condition, causing impairment in several aspects of patients quality of life. Nowadays, there are many treatment options available, ranging from the least invasive, such as physiotherapy of the pelvic floor, to external devices, pharmacotherapy, periurethral injections and surgery.Periurethral injection techniques have been developed with the aim of further simplifying the treatment of this symptom. The aims of this study were to evaluate the outcome treatment after :MIS objectively (number of pads utilized per day, pad test and urodynamic assessment by means of the Valsalva leak point pressure), subjectively (Stamey incontinence grade - for the patient and surgeon) and in relation to the impact on quality of life, assessed by means of the Portuguese-language version of King s Health Questionnaire. Between August and December/ 2000, 21 consecutively women urodynamically diagnosed stress urinary incontinence (SUI) caused by intrinsic sphincter deficiency (ISD) were selected. The median age was 48 years (range 33 to 54), mean Body Mass Index was 25.75 kg./m.2 (SD ± 2.9). Patients were treated with MIS (Macroplastique Implantation System), a minimally invasive method for the treatment of female stress urinary incontinence caused by intrinsic sphincter insufficiency. This method utilizes a special device for implanting silicone elastomers (Macroplastique Implantation Device - MID) that do away with the need for endoscopic control, which differentiates it from other methods for implanting periurethral substances. Five mL of silicone elastomers were injected, split into 3 different sites around the urethra (2,6 and 10 o clock). The procedure was performed under local anaesthesia in an outpatient basis. The objective, subjective and quality of life assessments were done in a cohort study, with examination 6, 12 and 24 months after the last application of the silicone elastomers. The subjective gauging of the patient s satisfaction and the surgeon s point of view were done using Stamey s classification. This showed that, at 24 months, the perceptions were the same: 10 patients were considered cured (47.6%), three improved (14.3%) and eight unchanged (38.1%). Over the same period of evaluation (24 months) we observed a significant decrease in the number of pads used per day, and also a reduction in urine losses, measured in grams, by means of the pad test The urodynamic assessment, utilizing the Valsalva leak point pressure as the principal objective parameter, showed that ten (50%) of the 20 patients evaluated were continent and another two (10%) were considered improved. The quality of life study showed a significant improvement in all the domains in the Portuguese-language version of King s Health Questionnaire, and in some items of the symptoms scale. The results from this work have shown that the transurethral injection technique using silicone elastomers, without cystoscopic control, was successful in about 60% of the patients treated, and that these results remained stable for, at least, two years of postoperative follow-up. The improvement in the patients quality of life remained stable from the first evaluation (six months after treatment) until two years after treatment, in tine with the general results

ASSUNTO(S)

uretra - cirurgia urina - incontinencia doenças uretrais silicones

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